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To Your Health With Dr. Jim Morrow: Episode 15, How Stress Affects You and What You Can Do About It

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North Fulton Studio
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To Your Health With Dr. Jim Morrow: Episode 15, How Stress Affects You and What You Can Do About It
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Dr. Jim Morrow, Host, “To Your Health With Dr. Jim Morrow”

Episode 15, How Stress Affects You and What You Can Do About It

According to an American Psychological Association survey, 75% of adults questioned reported moderate to high levels of stress in the past month and nearly half reported that their stress has increased in the past year. On this edition of “To Your Health,” Dr. Jim Morrow discusses different stress levels, stress triggers, and what you can do to reduce the effect of stress in your life. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Dr. Morrow’s Show Notes on Stress

  • Stress can be good for you.
    • It keeps you alert, motivated and primed to respond to danger.
    • As anyone who has faced a work deadline or competed in a sport knows, stress mobilizes the body to respond, improving performance.
    • Yet too much stress, or chronic stress may lead to major depressionin susceptible people.
  • Everyone knows that bad things in life are stressful
    • But the good things (marriage, new job or new house) are also very stressful.
  • The “good life” doesn’t happen in a vacuum, it takes a lot of mental and physical work.
  • Many of my patients are stressed because they are doing too much for too many people in too short a period of time and with too few resources.

There  Are Basically 3 Types of Stress

  • Acute stress
    • Acute stress is the most common form of stress.
    • It comes from demands and pressures of the recent past and anticipated demands and pressures of the near future.
    • Acute stress is thrilling and exciting in small doses, but too much is exhausting.
      • A fast run down a challenging ski slope, for example, is exhilarating early in the day.
      • That same ski run late in the day is taxing and wearing. Skiing beyond your limits can lead to falls and broken bones.
    • By the same token, overdoing on short-term stress can lead to psychological distress, tension headaches, upset stomach and other symptoms.
  • Examples of Acute Stress
    • the auto accident that crumpled the car fender,
    • the loss of an important contract,
    • a deadline they’re rushing to meet,
    • their child’s occasional problems at school
  • Emotional distress causes
    • Muscular problems including
      • tension headache,
      • back pain,
      • jaw pain and
      • the muscular tensions that lead to pulled muscles and tendon and ligament problems.
    • Stomach, gut and bowel problems such as
      • heartburn,
      • acid stomach,
      • flatulence,
      • diarrhea,
      • constipation and
      • irritable bowel syndrome.
    • Transient over-arousal leads to elevation in blood pressure, rapid heartbeat, sweaty palms, heart palpitations, dizziness, migraine headaches, cold hands or feet, shortness of breath and chest pain.
  • Episodic acute stress
    • There are those who suffer acute stress frequently,
    • whose lives are so disordered that they are studies in chaos and crisis.
      • always in a rush, but always late.
      • If something can go wrong, it does.
      • They take on too much,
        • have too many irons in the fire, and
        • can’t organize the slew of self-inflicted demands and pressures clamoring for their attention.
        • They seem perpetually in the clutches of acute stress.
  • It is common for people with acute stress reactions to be
    • over aroused,
    • short-tempered,
    • irritable,
    • anxious
    • Often, they describe themselves as having “a lot of nervous energy.”
      • Always in a hurry,
      • they tend to be abrupt, and
      • sometimes their irritability comes across as hostility.
      • Interpersonal relationships deteriorate rapidly when others respond with real hostility.
      • The workplace becomes a very stressful place for them.
  • The cardiac prone, “Type A” personality is
    • similar to a constant extreme case of episodic acute stress.
    • Type A’s have an
      • excessive competitive drive,
      • aggressiveness,
      • impatience, and
      • a harrying sense of time urgency.
      • In addition there is a
        • free-floating, but well-rationalized form of hostility, and
        • almost always a deep-seated insecurity.
        • seem to create frequent episodes of acute stress for the Type A individual.
        • Type A’s are found to be much more likely to develop coronary heart disease than Type B’s, who show an opposite pattern of behavior.
  • The symptoms of episodic acute stress are
    • persistent tension headaches,
    • migraines,
    • hypertension,
    • chest pain and
    • heart disease.
    • Treating episodic acute stress requires intervention on a number of levels, generally requiring professional help, which may take many months.
  • Often, lifestyle and personality issues are so ingrained and habitual with these individuals that they see nothing wrong with the way they conduct their lives.
    • They blame their woes on other people and external events.
    • Frequently, they see their lifestyle, their patterns of interacting with others, and their ways of perceiving the world as part and parcel of who and what they are.
  • Sufferers can be fiercely resistant to change.
    • Only the promise of relief from pain and discomfort of their symptoms can keep them in treatment and on track in their recovery program.
  • Chronic stress:
    • While acute stress can be thrilling and exciting, chronic stress is not.
    • This is the grinding stress that wears people away day after day, year after year.
    • Chronic stress destroys bodies, minds and lives. It wreaks havoc through long-term attrition.
    • It’s the stress of poverty,
    • of dysfunctional families,
    • of being trapped in an unhappy marriage
    • or in a despised job or career.
    • It’s the stress that the never-ending “troubles” have brought
      • to the people of Northern Ireland,
      • the tensions of the Middle East
      • the endless rivalries that have been brought to the people of Eastern Europe and the former Soviet Union.
  • Chronic stress comes when a person never sees a way out of a miserable situation.
    • It’s the stress of unrelenting demands and pressures for seemingly interminable periods of time.
    • With no hope, the individual gives up searching for solutions.
  • Some chronic stresses stem from traumatic, early childhood experiences that become internalized and remain forever painful and present.
    • Some experiences profoundly affect personality.
    • A view of the world, or a belief system, is created that causes unending stress for the individual (e.g., the world is a threatening place, people will find out you are a pretender, you must be perfect at all times).
    • When personality or deep-seated convictions and beliefs must be reformulated, recovery requires active self-examination, often with professional help.
  • One of the worst aspects of chronic stress is that people get used to it.
    • They forget it’s there.
    • People are immediately aware of acute stress because it is new; they ignore chronic stress because it is old, familiar, and sometimes, almost comfortable.
  • Chronic stress kills through suicide,
    • violence,
    • heart attack,
    • suicide,
    • stroke and,
    • perhaps, even cancer.
    • People wear down to a final, fatal breakdown.
      • Because physical and mental resources are depleted through long-term attrition, the symptoms of chronic stress are difficult to treat and may require extended medical as well as behavioral treatment and stress management.
  • Why is too much stress bad for you?
  • Too much stress can be detrimental.
    • Emotional stress that stays around for weeks or months can weaken the immune system and
    • cause high blood pressure,
    • fatigue,
    • depression,
    • anxiety and
    • even heart disease.
    • In particular, too much epinephrine can be harmful to your heart.
  • Sustained or chronic stress, in particular, leads to elevated levels of cortisol, the “stress hormone,”
    • As well as reduced levels of serotonin and other neurotransmitters in the brain, like dopamine
    • These hormone changes have been linked to depression.
    • When these chemical systems are working normally, they regulate biological processes like sleep, appetite, energy, and sex drive, and permit expression of normal moods and emotions.
    • When the stress response fails to shut off and reset after a difficult situation has passed, it can lead to depressionin susceptible people.
    • No one in life escapes event-related stress, such as
      • death of a loved one,
      • a job loss,
      • divorce,
      • a natural disaster such as an earthquake, or
      • even a dramatic dip in your 401(k).
    • A layoff — an acute stressor — may lead to chronic stress if a job search is prolonged.
  • Loss of any type is a major risk factor for depression.
    • Loss of a loved one is a huge stressor
      • Grieving is considered a normal, healthy, response to loss, but if it goes on for too long it can trigger a depression.
    • Loss of health –
      • A serious illness, including depression itself, is considered a chronic stressor.
    • Loss of independence –
      • When patients lose their ability to live alone, or to drive they are very stressed
    • Loss of financial stability –
      • Regardless of cause
    • What you can do?
      • Watch out for signs of stress overload.
        • Symptoms of too much stress can be
        • physical,
        • emotional,
        • mental and behavioral.
        • While everyone is different, some common signs are:
        • memory problems,
        • trouble concentrating,
        • racing thoughts,
        • irritability,
        • anger,
        • sadness,
        • headaches,
        • frequent colds and
        • changes in sleep or appetite.
  • Know your stress triggers.
    • Stress and its triggers are different for everyone.
      • Certain people, places or situations might produce high levels of stress for you.
      • Think about what causes you stress, and brainstorm solutions.
        • If public speaking or presentations make you stressed, start researching early and practice several times.
        • If there are friends or social situations that cause extreme stress, you may want to avoid them when you are already feeling tense or overwhelmed.
    • All forms of exercise
      • reduce stress hormones,
      • flood the body with feel-good endorphins,
      • improve mood,
      • boost energy and
      • provide a healthy distraction from your dilemmas.
      • Plus, exercise may make you less susceptible to stress in the long run.
      • Find physical activities that you enjoy and try to devote about 30 minutes to them each day.
    • While it’s impossible to eliminate all negative stress from your life, you can control the way you react to stress.
    • Your body’s natural fight-or-flight response can take its toll.
    • When you’re faced with a stressful situation that your mind perceives as a threat,
      • it sends various chemicals, like adrenaline and cortisol, throughout your body.
      • As a result, heart rate and breathing speeds up and your digestion slows down. This tires out the body.
      • Relaxation techniques are a huge help in calming you down, boosting mood and fighting illness.
        • Try a variety of techniques — like
          • yoga,
          • breathing exercises,
          • meditation and visualization — to see what works for you, and schedule a relaxation break every day.
  • Manage your time well.
    • Time can seem like a luxury, but there are various ways to manage it effectively.
      • First, focus on one task at a time.
        • Multitasking rarely works.
        • Jot down everything you need to do in a calendar or a task management app/program,
          • prioritize your list and break projects into single steps or actions.
  • Be realistic.
    • Pulling yourself in different directions will only stress you out, so try not to over-commit yourself or do extracurricular activities when you’re super busy with school.
    • Learn to say NO
  • Curb your caffeine.
    • Caffeine might help you study in the short term, but it interrupts sleep and makes you
      • more anxious,
      • tense and jittery
      • This obviously ups your stress level.
      • Try and drink no more than one caffeinated beverage a day.
    • Don’t self-medicate.
      • Some people
        • drink,
        • take drugs,
        • smoke and
        • use other unhealthy behaviors to cope with stress.
        • However, these behaviors can exacerbate stress by negatively affecting your mood and health.
  • Reach out.
    • If you’re stressed out,
      • talk to your friends and family.
      • If you feel like you can’t handle the stress on your own, schedule an appointment with a counselor or therapist.

To Your Health With Dr. Jim Morrow: Episode 14, Skin Cancer

by

North Fulton Studio
North Fulton Studio
To Your Health With Dr. Jim Morrow: Episode 14, Skin Cancer
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Dr. Jim Morrow, Host, “To Your Health With Dr. Jim Morrow”

Episode 14, Skin Cancer

One in six Americans develop skin cancer at some point in their life, and skin cancers account for one-third of all cancers in the country. On this edition of “To Your Health With Dr. Jim Morrow,” Dr. Jim Morrow addresses the prevention of and screening for skin cancer, as well as specific skin cancers to be aware of. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Dr. Morrow’s Show Notes on Skin Cancer

  • One in six Americans develops skin cancer at some point.
    • Skin cancer accounts for one third of all cancers in the United States.
    • Most patients with skin cancer develop non-melanoma skin cancer.
      • This group of cancers includes basal cell carcinoma, the most common neoplasm worldwide, and squamous cell carcinoma.
      • Fortunately, mortality associated with non-melanoma skin cancer is unusual.
    • However, malignant melanoma accounts for 75 percent of all deaths associated with skin cancer.
  • Melanoma, the eighth most common malignancy in the United States, is the cancer with the most rapidly increasing incidence.
    • 1 of 1,500 Americans born in 1935 were likely to develop melanoma, compared with 1 of 105 persons born in 1993.
    • Non-melanoma skin cancer typically affects older persons; the frequency of melanoma peaks between 20 and 45 years of age.
    • Mortality rates are higher in men than in women.
    • This higher rate may occur because lesions tend to develop in less easily observed areas, such as the back, in men.
    • Mortality is also increased in blacks for this reason, as is the propensity to develop more aggressive tumors and to be diagnosed at later stages.
    • The rising incidence of skin cancer over the past several decades may be primarily attributed to increased sun exposure associated with societal and lifestyle changes and to depletion of the protective ozone layer.

Prevention of Skin Cancer

  • Avoid the sun during peak hours.
    • Generally, this is between 10 a.m. and 4 p.m.
    • Water, snow, sand and concrete reflect light and increase the risk of sunburn.
  • Wear sun protective clothing.
    • This includes pants, shirts with long sleeves, sunglasses and hats.
  • Use sunscreen.
    • Look for water-resistant, broad-spectrum coverage with an SPF of at least 30, which blocks 97 percent of the sun’s UVB rays.
    • Apply sunscreen generously, and reapply every two hours — or more often if you’re swimming or sweating.
    • Higher-number SPFs block slightly more of the sun’s UVB rays, but no sunscreen can block 100 percent of the sun’s UVB rays.

Screening for Skin Cancer

  • While early detection and treatment of skin cancer can improve patient outcomes, convincing data regarding the benefit of mass screening programs are lacking.
    • In addition, the ability to identify potentially malignant lesions varies with physician training.
    • So, except for very high-risk persons with a history of skin cancer or atypical mole syndrome, for whom periodic screening is universally recommended, there is considerable debate about who should be screened, who should perform the screening and how often screening should be performed.
    • Part of the screening process should include an assessment of patient risk.
  • Basically,
    • Age 20 to 39 years: complete skin examination every three years
    • Age 40 years and older: annual complete skin examination
  • When screening is performed, the examiner must systematically inspect the entire skin surface.
    • The patient should completely disrobe and remove concealing cosmetics.
    • Daylight is the ideal light source
    • Photographs may improve the quality of documentation and detection of lesion changes over time.
  • ABCDE Rule:
    • Asymmetry (one half of the mole doesn’t match the other),
    • Border irregularity,
    • Color that is not uniform,
    • Diameter greater than 6 mm (about the size of a pencil eraser), and
    • Evolving size, shape or color.

Specific Skin Neoplasms

ACTINIC KERATOSES

  • Actinic keratoses, sometimes called solar keratoses, often arise on chronically sun-damaged body areas such as the face, ears, arms and hands.
    • They may provide an indication of a person’s cumulative ultraviolet light exposure and, therefore, that person’s risk for all types of skin cancer.
    • Actinic keratoses are often ill-defined and irregular, ranging from 1 mm to several centimeters in size.
    • They may be lesions that can be seen or felt, and generally have a scaly appearance.
    • Patients often have multiple lesions.
  • The lesions are usually pale brown or flesh-colored but may be yellow, reddish-brown or even dark brown or black following trauma.
  • The rate of malignant transformation of individual actinic keratoses to squamous cell carcinoma is less than one per 1,000 per year,
    • but treatment of lesions is indicated to decrease the chance of progression to squamous cell carcinoma.
  • Skin biopsy is occasionally required to rule out squamous cell carcinoma.
  • Cryotherapy with liquid nitrogen is the treatment of choice for most cases of actinic keratosis.
    • Curettage, or scraping away the lesion, may also be used and may be used in conjunction with cryosurgery or electrodessication (burning).
    • Surgical excision is rarely required but may be useful in excluding squamous cell carcinoma as a possible cause in lesions that are larger than 0.5 cm in diameter.
    • Chemical destruction of superficial lesions may be used when there are many lesions, particularly on the face and head.
      • 5-fluorouracil (5-FU), is most commonly used.
      • Areas other than the head and neck require the higher concentrations because of greater skin thickness.
      • In conventional regimens, 5-FU is applied twice daily for two to five weeks.
      • Adverse effects include true hypersensitivity, secondary bacterial and herpetic infection, and post-inflammatory pigmentation changes.
      • This therapy is often associated with significant discomfort related to an intense inflammatory response.
      • Pulsed dosing regimens aimed at reducing skin irritation have met with mixed success.
      • Topical corticosteroids may reduce inflammation but also make the treatment end point difficult to discern.
    • Other therapies used occasionally for treatment of actinic keratoses include laser, topical Retin-A, chemical peeling and facial dermabrasion.

BASAL CELL CARCINOMA

  • Basal cell carcinoma is the most common skin neoplasm.
    • Basal cell carcinomas
      • are usually located on the face or the backs of the hands.
      • They typically grow slowly and generally spread only locally.
      • Metastasis is quite rare.
    • While a preliminary diagnosis of basal cell carcinoma may be made on the basis of appearance, incisional or excisional biopsy is required for definitive diagnosis.
    • Cure rates of 95 to 99 percent can be achieved for low-risk lesions using simple excision with margins of 2 to 5 mm.
    • A lesion is considered low risk if it is less than 1.5 cm in diameter; has not previously been treated; is not in a difficult-to-treat area, like the H zone of the face; and is nodular or cystic.
    • Treatment of basal cell carcinomas with cryotherapy can also be successful, but healing may take weeks, and success depends on the skill of the cryotherapist.
      • Mohs’ micrographic surgery is the treatment of choice for most sclerosing basal cell carcinomas, as well as for large tumors and those located in areas that are difficult to treat.
      • Radiation therapy produces cure rates of 90 to 95 percent but has the same limitations as those outlined for squamous cell carcinoma treatment.
    • Other therapies used occasionally include topical Retin-A.

 SQUAMOUS CELL CARCINOMA

  • Squamous cell carcinoma is the second most common skin cancer, comprising 20 percent of all cases of non-melanoma skin cancer.
    • This is the most common tumor in elderly patients, and it is usually the result of a high lifetime cumulative dose of solar radiation.
      • A new study finds that some types of human papillomaviruses, or HPVs, may increase the risk of squamous cell skin cancers.
    • However, other irritants and exposures may lead to squamous cell carcinoma.
    • Up to 60 percent of squamous cell carcinomas occur at the site of a previous actinic keratosis.
    • Changes in an actinic keratosis that suggest evolution to squamous cell carcinoma include pain, erythema, ulceration, induration, hyperkeratosis and increasing size.
    • As many as 50 to 60 percent of squamous cell carcinomas occur on the head and neck.
    • Other common sites include the hands and forearms, upper trunk and lower legs.
    • Squamous cell carcinomas typically appear as small, palpable tumors that may grow moderately rapidly over a period of months and range from a few millimeters to centimeters in size.
    • They may appear nodular, and may be reddish-brown, pink or flesh-colored.
    • Larger squamous cell carcinomas may appear crusted, erythematous or eroded. In contrast to basal cell carcinoma, a definitive edge is difficult to demonstrate when a squamous cell carcinoma lesion is stretched.
  • Histologic confirmation by a full-thickness skin biopsy (incisional or excisional) is mandatory before definitive treatment.
    • Well-differentiated lesions less than 2 cm in diameter can be treated with surgical excision, with a cure rate approaching 99 percent.
  • Squamous cell carcinomas may grow aggressively and are associated with a 2 to 6 percent risk of metastasis.
    • Risk factors for metastasis include increasing lesion depth and location on the lip or ear.
    • The most common locations for metastatic spread are the regional lymph nodes, lungs and liver.
    • Once metastasis occurs, the five-year cure rate for squamous cell carcinoma is 34 percent.
    • Recurrence and metastasis typically occur within three years of initial treatment.
  • Mohs’ micrographic surgery involves gradual lesion excision using serial frozen section analysis and precise mapping of excised tissue until a tumor-free plane is reached.
    • Mohs’ micrographic surgery is used when tissue removal must be kept to a minimum for cosmetic reasons or to maximize function.
    • It is the treatment of choice for difficult and high-risk squamous cell carcinomas, including lesions that are:
      • larger than 2 cm in diameter;
      • located in areas where deep invasion is more likely or tumor extent is hard to assess, such as the nasolabial folds, eyelids and periauricular areas (facial “H zone”);
      • rapidly growing;
      • recurrent or incompletely excised;
      • ill-defined;
      • located in an area of previous irradiation; or
      • Cure rates of 99 percent have been reported.
    • Cryotherapy and the combination of curettage and desiccation are reserved for treatment of superficial tumors, lesions less than 2 cm in diameter and lesions located on the trunk and extremities.
    • Radiation therapy may be employed when preservation of function and cosmesis are critical, when patients refuse surgery, when metastasis is present or when an adjunct to surgery is required for high-risk tumors.
    • Because of the long-term risk of radiation-induced carcinoma, radiation therapy is used only in patients older than 60 years.

MALIGNANT MELANOMA

  • There are four types of malignant melanoma.
  • The two most common ones are:
    • The superficial spreading type is the most common among whites and accounts for 70 percent of all melanomas.
      • It usually occurs in adults and may develop anywhere on the body but appears with increased frequency on the upper backs of both men and women and on the legs of women
  • Nodular melanoma (accounting for 15 to 30 percent of all melanomas) is a dome-shaped, pedunculated or nodular lesion that may occur anywhere on the body.
    • It is commonly dark brown or reddish brown but may occasionally be uncolored.
    • Nodular melanomas tend to rapidly invade the dermis from the onset with no apparent horizontal growth phase.
    • These tumors are frequently misdiagnosed, because they may resemble blood blisters, hemangiomas, dermal nevi or polyps

Bottom Line on Skin Cancer

  • The incidence of skin cancer is increasing by epidemic proportions.
    • The use of tanning beds the risk of basal cell carcinoma by 1.5 times and squamous cell carcinoma by 2.5 times.
    • Basal cell cancer remains the most common skin neoplasm, and simple excision is generally curative.
    • Squamous cell cancers may be preceded by actinic keratoses – premalignant lesions.
      • While squamous cell carcinoma is usually easily cured with local excision, it may invade deeper structures and metastasize.
  • Aggressive local growth and metastasis are common features of malignant melanoma, which accounts for 75 percent of all deaths associated with skin cancer.
    • Early detection greatly improves the prognosis of patients with malignant melanoma.
    • The differential diagnosis of pigmented lesions is challenging, although the ABCD (Asymmetry, Border, Color, Diameter) checklists are helpful in determining which pigmented lesions require excision.
    • Sun exposure remains the most important risk factor for all skin neoplasms.
    • Thus, patients should be taught basic “safe sun” measures: sun avoidance during peak ultraviolet-B hours; proper use of sunscreen and protective clothing; and avoidance of sun tanning.

[Thanks to the American Academy of Family Physicians for much of the information provided in this episode.]

To Your Health With Dr. Jim Morrow: Episode 13, Medical Marijuana in Georgia, An Interview with Justin Hawkins and Dr. Scott Cooper, Acreage Compass, LLC

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North Fulton Studio
North Fulton Studio
To Your Health With Dr. Jim Morrow: Episode 13, Medical Marijuana in Georgia, An Interview with Justin Hawkins and Dr. Scott Cooper, Acreage Compass, LLC
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Dr. Scott Cooper, Dr. Jim Morrow, and Justin Hawkins

Episode 13, Medical Marijuana in Georgia

How does the new Georgia law (HB 324) allowing prescribed use of medical marijuana work? Is medical marijuana a slippery slope to recreational marijuana use? In a conversation with host Dr. Jim Morrow, Justin Hawkins and Dr. Scott Cooper of Acreage Compass LLC answer these questions and more. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE  back to healthcare.

Justin Hawkins and Dr. Scott Cooper, Acreage Compass, LLC

Dr. Scott Cooper and Justin Hawkins, Acreage Compass, LLC

Justin Hawkins is the General Manager and Dr. Scott Cooper is the Medical Affairs Director of Acreage Compass LLC. Acreage Compass is jointly owned by Compass Neuroceutical, Inc., a Georgia-based team of physicians, advocates, and patients, and Acreage Holdings, the largest vertically integrated, multi-state owner of cannabis licenses and assets in the United States. Through Acreage Compass, Compass Neuroceutical and Acreage Holdings are partnering to bring safe and consistent medical cannabis oil to patients in the state of Georgia.

For more information go to their website or email Justin Hawkins at justin@compassneuro.com.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Show Transcript

Intro: [00:00:06] Broadcasting live from the North Fulton Business RadioX Studio, it’s time for To Your Health with Dr. Jim Morrow. To Your Health is brought to you by Morrow Family Medicine, an award winning primary care practice, which brings the care back to health care.

Dr. Jim Morrow: [00:00:23] Hello! This is Dr. Jim Morrow. I’m with Morrow Family Medicine. We have offices in Cumming and Milton, Georgia. We’re a primary care practice, where we utilize state-of-the-art technology and old-fashioned ideas to bring you the best care we possibly can. We believe that in Morrow Family Medicine, you’ll feel both cared for and appreciated. And we do realize that you have many choices as to where you receive your care, and we hope you’ll find that Morrow Family Medicine is a good place for you.

Dr. Jim Morrow: [00:00:51] I’m here in the studio at Renasant Bank on Windward Parkway in Alpharetta, Georgia with John Ray, my cohort. John’s running the board. How are you doing, John?

John Ray: [00:00:59] I’m great. I hope you’re well today.

Dr. Jim Morrow: [00:01:01] I’m good. It’s not too hot outside today. So, those are pretty good.

John Ray: [00:01:04] Perfect in Alpharetta and Milton

Dr. Jim Morrow: [00:01:07] Always sunny in Alpharetta, right?

John Ray: [00:01:09] Yeah, you got it.

Dr. Jim Morrow: [00:01:11] So, we’re here today for another podcast. We want you to know that you can reach out to us by e-mail at drjim@toyourhealth.md or or you can tweet us, @toyourhealthmd.

Dr. Jim Morrow: [00:01:24] So, we’re here today to talk about cannabis oil and low-THC oil, what some people refer to as medical marijuana in the State of Georgia. And I’m honored to have two guests with me today from Acreage nchorage Compass LLC. We have Justin Hawkins, the General Manager, and Dr. Scott Cooper, who’s the Medical Affairs Director. Hello, gentlemen. How are you today?

Dr. Scott Cooper: [00:01:48] Doing well, thank you.

Justin Hawkins: [00:01:49] I’m good. How are you? I, actually, have both of my doctors here. So, I don’t know if this is an intervention or an interview, but it’s good to be here.

Dr. Jim Morrow: [00:01:55] We’re going to get into that later, Justin. You can count on it. You can count on it. So, this whole thing has started up in Georgia fairly suddenly. If you haven’t been following the news and haven’t followed the path of low-THC oil in Georgia, there is a bill, House Bill 324 that was passed by the state legislature and signed by the governor at the beginning of April of this year. So, Justin, tell us something about House Bill 324.

Justin Hawkins: [00:02:23] Yes. So, House Bill 324 is a piece of legislation that has been tried over the last six years. And we were successful this year in 2019 under the leadership of Brian Kemp. And what House Bill 324 does is it allows the cultivation, and processing, and distribution of low-THC oil, which is 5% THC in cannabis oil, also referred to as medical marijuana.

Justin Hawkins: [00:02:46] The reason that we wanted to push House Bill 324 is because over the last six to seven years, medical cannabis oil was legal for possessions for qualified patients under the Georgia Department of Health, but there was no real legal access for these patients under these 17 indication list to actually acquire the medicine.

Justin Hawkins: [00:03:06] And so, although medical cannabis is actually illegal under federal law, we’ve seen across the entire country that in over 33 — over 43 states across the country that in-state cultivation is a way that provides medicine to patients, also, by abiding by state law. And so, that’s what House Bill 324 does specifically.

Dr. Jim Morrow: [00:03:25] Well, why was it able to be passed this year when it wasn’t able to be passed the other year?

Justin Hawkins: [00:03:30] So, we were fortunate for a couple of different reasons. Georgia Hope is an organization founded by parents. A lot of the times, they’re parents of these kids who suffer from pediatric epilepsy, mitochondrial disease, autism, and they have really led the fight over the last six years. Fortunately, under the leadership, the new leadership, of Governor Brian Kemp and Jeff Duncan, along with public opinion and the way that we’ve seen the research of these in-state cultivation programs being analyzed, all of that came together in a positive way that said, you know, in-state cultivation is a way for kids, and veterans, and all other patients to get medicine. It’s not going to change the culture of Georgia. And I think between that and between organizations like the one Dr. Cooper and I founded, all of us coming together and moving in one step, really, it was everything coming together at once and we were thankful for it.

Dr. Jim Morrow: [00:04:21] Super. And the law allows for specifics about who can grow this, and cultivate it, and produce it, and so forth. Can you talk some about who, and what, and how many companies, and so forth are going to be involved in it?

Justin Hawkins: [00:04:37] Yeah, we anticipate there’s going to be a lot of interest. Georgia is the eighth most populous state in the nation. It has a huge market, and there’s a lot of patients that are on the registry – 10,000 when we passed the bill, 300 we’re adding per month with no change to the legislation. So, we do believe that in the market of Georgia, it’s a large market. So, from an industry standpoint, there’s going to be a lot of companies and employers interested. What the bill allows specifically, it allows two class 1 organizations with a higher financial stipulation to prove to the state that they have. And it also allows four class 2, which are for smaller entities, small business across the state of Georgia. Those are six private licenses. Now, aside from that, they did allow two university programs to research, and develop, and cultivate. And that’s what the University of Georgia and Fort Valley State University down the south of Atlanta. And so, when you combine, a total of eight enterprises, public and private, that’s who will be the structure of Georgia medical cannabis.

Dr. Jim Morrow: [00:05:38] Interesting. So Georgia’s law, being one of the newer ones, can you tell me how this law is different from the laws in these other states that you mentioned?

Justin Hawkins: [00:05:47] Yeah. So, for instance, I’d like to take the obvious, which is Colorado. So, when you look at Colorado, which passed medical cannabis back in 2000-2001, the way we were different and the largest way that I can contrast between is horizontal versus vertical. And what I mean by that is when you look at Colorado, they allowed a horizontal structure, which means they allowed growers, processors, and distributors, all being separate silos, so to speak. What we did in Georgia is not only do we put a THC cap of no more than 5%, which is very low THC, but what we also did is we allowed vertical integration, which means that the companies vying for these class 1 and class 2 licenses is that they grow, they process, and they distribute their own product.

Justin Hawkins: [00:06:30] And why we feel like that’s very valuable for the State of Georgia is it allows high-quality control. It allows players and companies that know what they’re doing. They have a track record across the country. It allows us to not have price increases with middlemen. So, we’re allowed to go directly to the patient. Obviously, you guys are doctors. You guys know how the pharmaceutical industry works. So, it’s almost like if Johnson & Johnson or Amgen had their own pharmacies, that’s what our company is vying to do.

Dr. Jim Morrow: [00:06:58] Okay. And you called it low-THC oil. And a lot of listeners hearing THC, they’re going to think that this is something that’s going to act and function like marijuana. So, Dr. Cooper, what exactly is low-THC oil?

Dr. Scott Cooper: [00:07:13] It restricts how much THC is in the compound. And let me read you something from the AMA since you bring that up.

Justin Hawkins: [00:07:22] While he’s doing that, I can give you kind of an overview. So, when it comes to low-THC oil, what we have is we have hemp-derived oil, and we have cannabis-derived oil. Hemp-derived oil is what’s often referred to as CBD. And so, you see CBD on the market because hemp CBD oil is now federally legal with the Farm Bill that was passed a couple months ago. With cannabis, you have cannabis oil. And so, when you have natural cannabis, it can be as high as 90%. And so what Dr. Cooper will talk about specifically is that when we form cannabis oil from the actual cannabis plant, then we’re restricting that THC down to 5% per milliliter. And so, that’s what allows us to have different indications. And he’ll speak more to that.

Dr. Scott Cooper: [00:08:05] Sorry for that delay. I didn’t have it prepared for you. So, this is a quote from the FDA stating that it is THC and not CBD that’s the primary psychoactive compound of marijuana. And they approved a medication with low THC for specific seizure disorders, primarily in children. And they approved, and I quote, “They’re committed to this kind of careful scientific research and drug development, continuing to support rigorous scientific research on potential uses of medical marijuana-derived products.” So, we’re not talking about something that is psychoactive. This compounds specifically for specific and, in the case of Georgia, 17 discrete different disease states.

Dr. Jim Morrow: [00:08:51] And these are disease states that have had faulty, not effective medications and treatment methodologies previously pretty much.

Dr. Scott Cooper: [00:09:00] Absolutely. They have done studies with veterans, as well as studies with geriatric patients and chronic pain syndrome. And they found that even in senior citizens, it reduced the opiate use by over one-third. So, we’re looking for a safe medication without the side effects and addictive properties of current therapies that we have for different disease states right now.

Justin Hawkins: [00:09:25] And we say this all the time, it’s not a miracle drug. Dr. Cooper, you’re great at saying this. It’s more of an adjunct. And so, we see a lot of combined with pharmaceutical drugs, it really does make a difference.

Dr. Scott Cooper: [00:09:35] Yeah, this is not going to be replacing every medication that somebody is out there taking right now. This is to help them get over the hump to really control whatever disease state we’re talking about.

Dr. Jim Morrow: [00:09:45] So, in Georgia, the process for acquiring a card, which as I understand is what you have to have to get this, tell me a little bit about the process for going through that.

Dr. Scott Cooper: [00:09:57] Well, the physician, (1), who’s prescribing it has to be registered with the state. So, that’s the first hurdle. Not every physician wants to participate in the program. Then, (2), they have specific paperwork that needs to be filled out and sent in to the Georgia Department of Health. The patient has to be registered, and the patient gets a registration card. And it’s presumed right now it’s not definitely set, but we suppose that this is going to be similar to other states where there will little bit discreet dispensaries specifically for CBD products, and the patient has to present that card to be able to achieve and get the medication.

Dr. Jim Morrow: [00:10:38] And there’s a limit, I’m sure, on how much any particular person can have in their possession at any one time.

Dr. Scott Cooper: [00:10:44] Absolutely. Not just how much they can have at one time in their possession, but how much they can purchase over a 30-day period. And you would have to drink gallons of this stuff to try to get high. So, if you’re going to spend over $100 per bottle, you’re better off doing something illegally if you’re in search of something that’s psychoactive. If high is your goal, you’re not going to get it here.

Dr. Jim Morrow: [00:11:08] So, you take the THC oil, in the case of seizures, let’s say it helps to control the seizures. Do we know how that works in the brain?

Dr. Scott Cooper: [00:11:17] No, we don’t. Yeah, I wish we did. There are a lot of different cannabidiol receptors. We know that what’s available now commercially for these two seizure types, the Epidiolex, does not work for pain disorders or tic disorders. There are two compounds right now in Europe and in Canada that are used for multiple sclerosis-associated pain, as well as cancer-associated pain. And it’s within that realm of cannabis, but it’s a different level of THC. So, there have to be different products specifically developed for different disease states. But yet, we’re at the stage where we know it works, but we don’t know how at this point.

Dr. Jim Morrow: [00:12:01] Well, the results that you see and the stories that you hear about the most heart-wrenching ones are children with disease processes and seizures is a great example are just absolutely mind blowing when you see what this medicine can do for them and what their traditional medicines have not done for them. So, I think it’s a very exciting time.

Dr. Scott Cooper: [00:12:24] That’s absolutely right. I’ll be honest, I was a skeptic when this first came out and was not willing to endorse it, and had patients that were acquiring from other states illegally. And they came in, and their seizures were dramatically reduced. Not controlled, but reduced, such that I could reduce some of the medications that were both expensive, as well as having side effects. And then, saw other patients with autism. Their behavior improved. Parkinson’s disease, tremor improved. Alzheimer’s disease, behavior improved. And that’s when I started looking into it more, and then became an advocate.

Dr. Jim Morrow: [00:13:01] So, the law gets passed. The science says this will work for a variety of different instances. You mentioned 17 different diagnoses that it can be used for. So, along comes Justin and Scott Cooper. And how does this happen that you ended up being in this push to, now, produce and to distribute THC?

Justin Hawkins: [00:13:25] As we were talking earlier, when you look at anybody in this industry, they have a touchpoint. Either they have a family member, or they have a neighbor, or they have a patient that comes to them, and you see them suffering. So, for me, my brother served overseas in Iraq and Afghanistan, and I saw him come back from overseas, and work with the VA. And instead of being on a medication, like a tool like low-THC oil, he was on opiates. And that led to a whole different battle of its own.

Justin Hawkins: [00:13:51] And so, I was very interested from that point. And so, in 2018, Dr. Scott Cooper, and myself, and six other partners around the State of Georgia formed Compass Neuroceutical, which was an advocacy group, all Georgia-based, with a single focus, which was to pass House Bill 324. In doing so, because we were successful with one other company in supporting Georgia Hope, which was the organization with parents, patients, and advocates that have been fighting for this for six years, we all came together. We were successful in passing it.

Justin Hawkins: [00:14:19] Simultaneously, we were talking to national leaders about partnering and having a specific partnership within the State of Georgia to to be a licensed holder and to lead the way in Georgia, so that we could be the standard bearer for the country. And in doing so, we talked to many of the national leaders, and we were fortunate to choose a company known as Acreage Holdings, which is the largest multi-state owner and operator in the United States. They have a great executive leadership team with the board of directors, folks like the former Speaker of the House, John Boeher, former Prime Minister of Canada, Brian Mulroney, governors and former CEOs of international companies.

Justin Hawkins: [00:14:57] And why that matters is you see in this industry, and I tell people all the time, they think I’m joking, but I’m really serious, this industry is either Warren Buffett all the way to-

Dr. Jim Morrow: [00:15:06] Thomas Leary.

Justin Hawkins: [00:15:10] Thomas Leary. All the way to Willie Nelson and in between. And so, the industry is very wide. So, we do a lot of different things. We have good governance and integrity, and we keep stupid away. But on top of that, we have a proven track record of owning more licenses. 20 states, we have 88 licenses across the country. And because we’re the largest, we know how to get safe, reliable product in a quick and efficient manner to patients. And so, with that partnership, we have created what’s now called Acreage Compass LLC, which will be vying for a Class 1 license in the State of Georgia.

Dr. Scott Cooper: [00:15:41] Yeah, if I could add that Georgia Hope was the main thrust behind this. As Justin said, we were able to work with them to finally get it over the finish line. And all of these companies are just drooling over starting business in Georgia. And we were approached by numerous corporations that are in the industry. And we selected the one that we thought had the same vision we do because there are others that are out there that are just interested as this is a bridge to recreational marijuana, and that they really saw medical marijuana as a stepping stone, but they weren’t very interested in the cultivation and in studying which drug combination was going to be best for which disease state. And Acreage has integrity, which is something you don’t see in every partner that was searching out their.

Dr. Jim Morrow: [00:16:31] So, with the passage of the bill, the State is creating this commission, the Cannabis Commission, basically, that will choose these companies. What’s that process like for being chosen? I know you’re doing an awful lot of work, both of you, with Acreage Compass right now in hopes of being selected, but nothing’s written in stone. So, tell me about the process, the timeline, and how you expect all that to happen.

Justin Hawkins: [00:16:56] Yeah. We’re kind of on hold now. I know, Governor Brian Kemp, Lieutenant Governor Jeff Duncan, Speaker David Ralston are doing a whole lot behind the scenes to make sure that a commission is set up in an appropriate way that really has the spear in the integrity of the bill. And so, as of now, the commission is set up – three appointed by the governor, two appointed by the lieutenant governor, and two appointed by the speaker. So, a total of seven appointees to the commission.

Justin Hawkins: [00:17:20] Within the three that the governor has, one of those will be the chair of the commission. In doing so, the commission creates one position under them immediately as the executive director of the commission, which handles the daily functions. This whole commission will be under the Secretary of State’s office as the regulator moving forward in the future.

Justin Hawkins: [00:17:39] So, we’re on hold right now. None of the commission members have been selected. We anticipate from our talks. Of course, this can change between August and September of the appointees being selected. From that process. when they’re selected, they really start from ground up, which means they create the rules and regulations, the application, the criteria. And then, from that point, then private companies are able to do the application, which is a very stringent process. Some are even over 3000 pages from that timeline. Then, three to six months after the applications are submitted, we anticipate the state will then choose which licence holders they feel are competent based on a variety of factors.

Dr. Jim Morrow: [00:18:20] So, you mentioned 10,000 people on the registry now, adding about 300 a month. So, I think, earlier, when we were talking, you said the expectation is a quarter million people on the registry.

Justin Hawkins: [00:18:33] I was talking, when Representative Micah Gravley spoke at our Rotary Club not too long ago, I went out to dinner with him the night before to talk about the different things we could do to work together and other stakeholders. And he had relayed, and we feel very strongly that by the end of next year, we’re almost going to see 50,000 patients in the registry. And it just shows — you saw a lot before House Bill 324 passed that many patients in the 17 indication list were not even registering because there was no real access to acquire this medication. With that, we had 645 doctors as soon as we passed House Bill 324 that were on the registry.

Justin Hawkins: [00:19:11] So, we anticipate both those numbers will dramatically increase. I would argue that about a quarter of a million patients will be registered in Georgia over the next four to five years. And I would even say that’s a conservative estimate. And that’s not to say that this program gets out of control. That’s to say that these, from mitochondrial disease, to autism, to pediatric epilepsy, to PTSD, these are disease states that are large, so to speak. And I know Dr. Cooper can speak to that, but we believe that Georgia is a large market, and it’s been underserved over the last 10 years.

Dr. Scott Cooper: [00:19:47] Yeah, I would have to agree with that. I’d say that, at least, one or two times a day, I have patients that are telling me either they’re already on it, and how do they get a card, or how do they acquire it? People are asking about it. And there were some opponents to the bill who said, “Well, you only have so many people on the registry, so it’s not going to be used.” And I likened that to saying, “Well, the bill hadn’t been passed yet.” So, that’s like saying, “Okay, I see a sign saying Kroger is opening up. When are they opening? And you’re assuming only the people who asked about the sign are going to be future customers.” And the store opens, and, suddenly, you have 100,000 customers. Right. So, I think that once we have the distribution set up and the physicians signed up, that we’re going to see easily well over 100,000 patients within the first year.

Dr. Jim Morrow: [00:20:35] And the patients, those patients will be for these disease processes that are already approved. What does the future of cannabis oil and cannabis, in general, look like medically?

Dr. Scott Cooper: [00:20:46] There are more and more studies that are going on all the time. A lot of them under federal funds. And then, you’ve got the two colleges, universities that will be pursuing some research. Right now, the Georgia Department of Health is the one that regulates which disease states are approved and how many. And they went from seven in one year to 17 the next year. I’m sure, as we gain more experience, we’re going to see future applications beyond what we have right now.

Dr. Jim Morrow: [00:21:15] Okay. So, we’re talking with Justin Hawkins and Dr. Scott Cooper from Acreage Compass, LLC. And Justin, I want to ask you before we go, is  there a way that people can do their own research? Is there a way they can learn something about your company and the business in general?

Justin Hawkins: [00:21:32] Yeah, absolutely. We have our own website, compassneuro.com. That will have information coming out in the next weeks. And then, also acreageholdings,com, which kind of gives you a layout of who Acreage is. We’re in over 20 states across the entire country. We have a public potential merger with a company called Canopy Growth, which is the largest cannabis company in the entire world. And so, the proprietary information that we have, the assets, and the intellectual property, and knowledge is second to none. And so, those two websites are great resources. Dr. Scott Cooper and I live in the Atlanta area. So, we’re always around to answer questions. We’d like to meet patients. We see all the time these children and parents who have been suffering, don’t know what to do. And so, if there’s any of that case, we’re here to to help any way we can.

Dr. Jim Morrow: [00:22:21] Super. John, you’ve been awfully quiet over there. And we have anybody that sent us any questions or comments during our time here?

John Ray: [00:22:32] You’ve got them all stirred up again.

Dr. Jim Morrow: [00:22:34] I like that.

John Ray: [00:22:36] Yeah,.

Dr. Jim Morrow: [00:22:36] If it’s not disease, this or vaccine.

John Ray: [00:22:37] Vaccines. I thought vaccines hit the high watermark, but I think you got it going again today. So, several questions about the — is this a slippery slope to recreational use?

Dr. Jim Morrow: [00:22:52] That’s a great question. Scott, I’ll send that to you. What do you think? If people start using THC, it will going out behind the Wal-Mart and looking for marijuana to buy?

Dr. Scott Cooper: [00:23:03] Well, not only is this my opinion, but actually a study was just published with over 1.4 million people that were surveyed throughout the entire United States. And in the 33 states, plus the District of Columbia, there was not a single area geographically that there seemed to be a breakthrough for low THC, and then they convert over to recreational. This has been disproven conclusively that this is not a gateway drug to tempt people to, then, go to recreational drugs such as marijuana or other types of substance abuse.

Justin Hawkins: [00:23:40] And if I could add one thing, we did one thing different than a lot of states. And Micah Gravley, who’s the author of House Bill 324, with Senator Matt Brass, really pushed this with Governor Brian Kemp. And it was a great way to contrast ourselves to other states who have gone to recreation. If you look at every state that started as a medical program that goes to recreation, they had one thing in their program that Georgia does not. And that’s the ability to have smokable flower. So, with states like Colorado, or California, or Oregon, or Washington, they had smokable flower in their medical program. Not only does Georgia not allow smoking smokable flower, but we don’t allow vaping as well. So, that’s a main difference that we saw, a common denominator.

Dr. Jim Morrow: [00:24:24] Super. That’s a great question, John.

John Ray: [00:24:27] I only ask great questions.

Dr. Jim Morrow: [00:24:31] We’ll talk about that off the air!

John Ray: [00:24:31] Yeah, okay. I’ve got one more if I can try again.

Dr. Jim Morrow: [00:24:35] Sure.

John Ray: [00:24:35] Let’s see if this is a great one too.

Dr. Jim Morrow: [00:24:37] Yeah.

John Ray: [00:24:37] So, the question relates to side effects. So, all medications have some sort of side effects. Are there any other side effects noted in the use of this THC oil?

Dr. Scott Cooper: [00:24:51] If you read the print out for Tylenol, you’ll see a yard-full of potential side effects. You do not need to monitor any blood tests routinely with this low-THC oil. It can have a little bit of a calming side effect and, sometimes, a little bit of sedation, but that’s about it. So, it’s not the high THC that you see with recreational, so you’re not going to get the munchies.

Dr. Jim Morrow: [00:25:18] That’s good.

Dr. Scott Cooper: [00:25:21] As opposed to other drugs, either a lot of marijuana or methamphetamines that lower the seizure threshold, this actually treat seizures.

Dr. Jim Morrow: [00:25:31] Well, that’s wonderful. If you have a medicine that can treat the things we’re talking about that are difficult to treat, and it doesn’t affect your liver, your kidneys, it’s not mood altering or habit-forming, they don’t drug test for in a workplace, that kind of thing, then I think that’s great. And, of course, there’s a new drug test for it, but with the prescription card, is a negative drug screen.

Dr. Jim Morrow: [00:25:48] So, I think that’s a fantastic thing. And I’m very excited as a practicing physician about seeing where this will go. And I’m very excited as a businessman by seeing where you guys go. So, I really appreciate you all being here very much. I think, John, we’re going to wrap it up for today.

John Ray: [00:26:04] Sounds good.

Dr. Jim Morrow: [00:26:05] All right. This is To Your Health.

To Your Health With Dr. Jim Morrow: Episode 12, The Case to Vaccinate

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North Fulton Studio
North Fulton Studio
To Your Health With Dr. Jim Morrow: Episode 12, The Case to Vaccinate
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Dr. Jim Morrow, Host, “To Your Health With Dr. Jim Morrow”

Episode 12, The Case to Vaccinate

On this edition of “To Your Health With Dr. Jim Morrow,” Dr. Jim Morrow makes the case to vaccinate, arguing that vaccines are safe, necessary, and they work. The fears “non-vaxxers” have on the side effects of vaccines are not based in any proven scientific evidence. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Dr. Morrow’s Show Notes

History of Vaccines

  • Edward Jenner used cowpox material to create a vaccine for smallpox in humans in 1796.
  • Louis Pasteur created a rabies vaccine for humans in 1885
  • And then, at the dawn of bacteriology, developments rapidly followed.
    • Antitoxins and vaccines against diphtheria, tetanus, anthrax, cholera, plague, typhoid, tuberculosis, and more were developed through the 1930s.
  • The middle of the 20thcentury was an active time for vaccine research and development.
    • Methods for growing viruses in the laboratory led to rapid discoveries and innovations, including the creation of vaccines for polio.
    • Researchers targeted other common childhood diseases such as measles, mumps, and rubella, and vaccines for these diseases reduced the disease burden greatly.
  • Innovative techniques now drive vaccine research, with recombinant DNA technology and new delivery techniques leading scientists in new directions.

Measles Has Been All Over The News

  • Measles Cases in 2019
    • From January 1 to June 27, 2019, 1,095** individual cases of measles have been confirmed in 28 states. This is an increase of 18 cases from the previous week. This is the greatest number of cases reported in the U.S. since 1992 and since measles was declared eliminated in 2000.
  • Why The Spread of Measles?
    • The majority of people who got measles were unvaccinated.
    • Measles is still common in many parts of the world.
    • Travelers with measles continue to bring the disease into the U.S.
    • Measles can spread when it reaches a community in the U.S. where groups of people are unvaccinated.

Common Misconceptions About Vaccines

  • “Diseases had already begun to disappear before vaccines were introduced, because of better hygiene and sanitation”.
    • Statements like this are very common with the anti-vaccine crowd, the intent apparently being to suggest that vaccines are not needed.
      • Improved socioeconomic conditions have undoubtedly had an indirect impact on disease.
      • Better nutrition, not to mention the development of antibiotics and other treatments, have increased survival rates among the sick; less crowded living conditions have reduced disease transmission; and lower birth rates have decreased the number of susceptible household contacts.
      • But looking at the actual incidence of disease over the years can leave little doubt of the significant direct impact vaccines have had, even in modern times.
  • For example, there have been periodic peaks and valleys throughout the years, but the real, permanent drop in measles coincided with the licensure and wide use of measles vaccine beginning in 1963.
  • Other vaccine-preventable diseases show a roughly similar pattern in incidence, with all except hepatitis B showing a significant drop in cases corresponding with the advent of vaccine use. (The incidence of hepatitis B has not dropped as much because infants vaccinated in routine programs will not be at high risk of disease until they are at least teenagers. Therefore a 15-year lag can be expected between the start of routine infant vaccination and a significant drop in disease incidence.)
  • Haemophilus influenzae type b (Hib) vaccine is another good example, because Hib disease was prevalent until the early- to mid- 1990s, when conjugate vaccines that can be used for infants were finally developed.
  • Are we expected to believe that better sanitation caused the incidence of each disease to drop just at the time a vaccine for that disease was introduced?
    • Since sanitation is not better now than it was in 1990, it is hard to attribute the virtual disappearance of Hib disease in children in recent years in countries with routine Hib vaccination (from an estimated 20,000 cases a year to 1,419 cases in 1993, and dropping in the United States of America) to anything other than the vaccine.
  • We can look at the experiences of several developed countries after they allowed their immunization levels to drop.
    • Three countries —Great Britain, Sweden and Japan — cut back the use of pertussis (whooping cough) vaccine because of fear about the vaccine.
    • The effect was dramatic and immediate.
      • In Great Britain, a drop in pertussis vaccination in 1974 was followed by an epidemic of more than 100,000 cases of pertussis and 36 deaths by 1978.
      • In Japan, around the same time, a drop in vaccination rates from 70% to 20%-40% led to a jump in pertussis from 393 cases and no deaths in 1974 to 13,000 cases and 41 deaths in 1979.
      • In Sweden, the annual incidence rate of pertussis per 100,000 children of 0-6 years of age increased from 700 cases in 1981 to 3,200 in 1985.
  • It seems clear from these experiences that not only would diseases not be disappearing without vaccines, but if we were to stop vaccinating, they would come back.
    • Of immediate interest is the major epidemics of diphtheria that occurred in the former Soviet Union in the 1990s, where low primary immunization rates for children and the lack of booster vaccinations for adults resulted in an increase from 839 cases in 1989 to nearly 50,000 cases and 1,700 deaths in 1994.
    • There were at least 20 imported cases in Europe and two cases in U.S. citizens who had worked in the former Soviet Union.
  • Here’s another thing you should know about vaccines. Older adults need them too.
    • Here’s why:
      • As we age, our immune system weakens. Older adults are more likely to be infected and develop complications from vaccine-preventable diseases.
      • Immunity from some vaccines can decrease over time, which means booster doses are necessary to maintain protection. Also, some bacteria or viruses change over time; this makes some annual vaccinations necessary.
      • Older adults are more likely to have a chronic condition, which can increase the risk of diseases such as influenza. Skipping a vaccine can have serious health consequences.

 Vaccine Safety: The Facts

  • ​​Many people have expressed concerns about vaccine safety.
    • The fact is vaccines save lives and protect against the spread of disease.
    • If you decide not to immunize, you’re not only putting your child at risk to catch a disease that is dangerous or deadly but also putting others in contact with your child at risk. Getting vaccinated is much better than getting the disease.
    • Indeed, some of the most devastating diseases that affect children have been greatly reduced or eradicated completely thanks to vaccination.
    • Today, we protect children and teens from 16 diseases that can have a terrible effect on their young victims if left unvaccinated.
  • Your healthcare provider knows that you care about your child’s health and safety. That’s why you need to get all the scientific facts from a medical professional you can trust before making any decisions based on stories you may have seen or heard on TV, the Internet, or from other parents.
  • Vaccines work.
    • They have kept children healthy and have saved millions of lives for more than 50 years.
    • Most childhood vaccines are 90% to 99% effective in preventing disease.
    • And if a vaccinated child does get the disease, the symptoms are usually less serious than in a child who hasn’t been vaccinated.
    • There may be mild side effects, like swelling where the shot was given, but they do not last long. And it is rare for side effects to be serious.
  • Vaccines are safe.
    • Before a vaccine is licensed in the United States, the Food and Drug Administration (FDA) reviews all aspects of development, including where and how the vaccine is made and the studies that have been conducted in people who received the vaccine.
    • The FDA will not license a vaccine unless it meets standards for effectiveness (how well the vaccine works) and safety.
    • Results of studies get reviewed again by the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics, and the American Academy of Family Physicians before a licensed vaccine is officially recommended to be given to children.
    • Every lot of vaccine is tested to ensure quality (including safety) before the vaccine reaches the public. In addition, FDA regularly inspects places where vaccines are made.
  • Vaccines are necessary.
    • Your doctor believes that your children should receive all recommended childhood vaccines.
    • In the United States vaccines have protected children and continue to protect children from many diseases.
    • However, in many parts of the world many vaccine-preventable diseases that are rarely seen in the United States are still common.
    • Since some vaccine-preventable diseases still occur in the United States and others may be brought into the United States by Americans who travel abroad or from people visiting areas with current disease outbreaks, it’s important that your children are vaccinated.
  • Vaccines are studied.
    • To monitor the safety of vaccines after licensure, the FDA and the CDC created the Vaccine Adverse Event Reporting System (VAERS).
    • All doctors must report certain side effects of vaccines to VAERS. Parents can also file reports with VAERS.
  • Some parents are requesting that we space out their infant’s vaccinations because they are concerned that receiving multiple vaccinations at a single office visit might overwhelm the infant’s immune system.
    • Vaccine recommendations are determined after extensive studies in large clinical trials. They include studies on how vaccine recipients respond to multiple vaccines given simultaneously.
    • The overall aim is to provide early protection for infants and children against vaccine-preventable diseases that could endanger their health and life.
    • No scientific evidence exists to support that delaying vaccinations or separating them into individual antigens is beneficial for children.
    • Rather, this practice prolongs susceptibility to disease, which could result in a greater likelihood of the child becoming sick with a serious or life-threatening disease.
    • There could also be added expense (e.g., multiple office visits), additional time off from work for parents, and increased likelihood that the child will fail to get all necessary vaccinations.
  • Many patients are reading The Vaccine Book, in which the author, Dr. Bob Sears, cites studies that he interprets as showing that the amount of aluminum found in certain vaccines might be unsafe.
    • He thinks it is better to separate aluminum-containing vaccines, rather than give them according to the recommended U.S. immunization schedule. There is no science behind this.
  • Does the thimerosal in some vaccines pose a risk?
    • Thimerosal, a very effective preservative, has been used to prevent bacterial contamination in vaccine vials for more than 50 years.
    • It contains a type of mercury known as ethylmercury, which is different from the type of mercury found in fish and seafood (methylmercury). At very high levels, methylmercury can be toxic to people, especially to the neurological development of infants.
    • In recent years, several large scientific studies have determined that thimerosal in vaccines does not lead to neurologic problems, such as autism.
    • Nonetheless, because we generally try to reduce people’s exposure to mercury if at all possible, vaccine manufacturers have voluntarily changed their production methods to produce vaccines that are now free of thimerosal or have only trace amounts. They have done this because it is possible to do, not because there was any evidence that the thimerosal was harmful.
  • Some have expressed concern that some vaccines have been produced in fetal tissue.
    • The production of a few vaccines, including those for varicella, rubella, and hepatitis A, involves growing the viruses in human cell culture.
    • Two human cell lines provide the cell cultures needed for producing vaccines; these lines were developed from two legally aborted fetuses in the 1960s.
    • These cell lines are maintained to have an indefinite life span.
    • No fetal tissue has been added since the cell lines were originally created.
    • Some parents are concerned about this issue because of misinformation they have encountered on the Internet. Two such untrue statements are that ongoing abortions are needed to manufacture vaccines and vaccines are contaminated with fetal tissue.
  • The Failed Threat of Autism
    • An article linking autism to the MMR vaccine was retracted for fraud, but this misinformation persists and has caused long-lasting public health consequences.
    • Multiple studies have found no causal link between vaccination and autism, but the falsified report continues to cause parental concern.

Why Vaccinate?

  • Vaccination’s immediate benefit is individual immunity:
    • It provides long-term, sometimes lifelong protection against a disease.
      • The vaccines recommended in the early childhood immunization schedule protect children from measles, chicken pox, pneumococcal disease, and other illnesses.
      • As children grow older, additional vaccines protect them from diseases that affect adolescents and adults, as well as for diseases they may encounter during travel to other regions.
      • Travelers to certain parts of South America and Africa, for example, are required to receive the yellow fever vaccine, as the disease is still prevalent there.
  • The secondary benefit of vaccination, however, is herd immunity, also known as community immunity.
    • Herd immunity refers to the protection offered to everyone in a community by high vaccination rates.
    • With enough people immunized against a given disease, it’s difficult for the disease to gain a foothold in the community.
    • This offers some protection to those who are unable to receive vaccinations—including newborns and individuals with chronic illnesses—by reducing the likelihood of an outbreak that could expose them to the disease.
    • It also protects vaccinated individuals wh may not have been fully immunized against a disease (no vaccine is 100% effective)
  • When community vaccination rates drop below the threshold of herd immunity, widespread disease outbreaks can occur.
    • The threshold of herd immunity for polio, for example, is estimated to be between 80% and 86%;[1]if the vaccination rate drops significantly below this level, the level of community protection may not be enough to prevent the disease from spreading—primarily to those who have no prior immunity because they haven’t been vaccinated (due to chronic illnesses or vaccine refusal) or because they were vaccinated, but it was not effective.
  • This is precisely what happened in England when MMR (measles, mumps, and rubella) vaccination rates dropped.
    • Measles is extremely infectious; therefore, it has a higher herd immunity threshold than most other diseases.
    • In the late 1990s, MMR vaccination rates began to drop from more than 90% to 80% or lower—well below the level required for herd immunity against measles.
    • In response, the number of cases began to rise: while only 56 cases were confirmed in Wales and England in 1998, 1,348 were confirmed by 2008.
    • A disease whose spread in the country had been halted more than a decade prior was once again endemic.
  • Vaccination does more than just protect an individual; it protects entire communities. Sufficient vaccination levels can provide protection against disease for members of the community who would otherwise be left vulnerable.

            The best reason to vaccinate yourself or your child is, well, SCIENCE!!

To Your Health With Dr. Jim Morrow: Episode 10, Colon Cancer Screening, An Interview with Dr. Simon Confrancesco

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North Fulton Studio
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To Your Health With Dr. Jim Morrow: Episode 10, Colon Cancer Screening, An Interview with Dr. Simon Confrancesco
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Dr. Jim Morrow and Dr. Simon Cofrancesco

Episode 10, Colon Cancer Screening

Statistics show that colon and rectal cancers are the second biggest cancer killer, yet unlike most cancers, this disease is preventable with proper screening. On this episode of “To Your Health with Dr. Jim Morrow,” Dr. Morrow welcomes gastroenterologist Dr. Simon Cofranceso to the show to get the lowdown on colon cancer screening. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.

Dr. Simon Confrancesco, GI North

Dr. Simon Cofrancesco

Dr. Simon Cofrancesco is a board certified gastroenterologist with over 25 years of experience.  Dr. Cofrancesco is originally from Massachusetts. He completed his medical training at Baystate Medical Center of the Tufts University School of Medicine, followed by a Fellowship in Gastroenterology at Long Island College Hospital in Brooklyn.

Dr. Cofrancesco began his career in an underserved area of Mississippi as part of his school loan repayment. He worked at Southwest Mississippi Regional Medical Center in McComb, Mississippi, for over sixteen years and was named Chief of Staff in 2007. While in Mississippi, he met his wife Roxanna Redden, and they started their family of 5 children, ages 10-19.

Dr. Cofrancesco then moved to Georgia and founded GI North in 2011, followed by GI North Endoscopy in 2018.  GI North has steadily grown and currently has 3 additional providers including two additional gastroenterologists and a GI nurse practitioner.  GI North is physician owned and operated, and because of their commitment to patient centered care has been awarded “Best of Forsyth” in 2017 and 2018.   For further information on GI North you can go to their website at gi-north.com, or call 404-446-0600.

 

 

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

 

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Show Transcript

Intro: [00:00:06] Broadcasting live from the North Fulton Business RadioX Studio. It’s time for To Your Help with Dr. Jim Morrow. To Your Health is brought to you by Morrow Family Medicine, an award-winning primary care practice, which brings the care back to health care.

Jim Morrow: [00:00:23] Good afternoon. This is To Your Health with Dr. Jim Morrow, and that’s me. I’m Jim Morrow. I’m with Morrow Family Medicine. We have an office in Milton, Georgia and in Cumming, Georgia, where we like to say we are bringing care back to health care. And we are here every second and fourth Wednesday on North Fulton Business Radio. We’re very excited to be here today. We’re doing something new and different for our show today. Today, for the first time, I have a guest with me who I’m going to be talking with about colon cancer and colon cancer screening. So, I’d like you to welcome Dr. Simon Cofrancesco from GI North in Cumming, Georgia. Hey, Simon.

Simon Cofrancesco: [00:01:01] Thanks, Jim.

Jim Morrow: [00:01:03] Good to have you.

Simon Cofrancesco: [00:01:03] Thank you very much. Glad to be here.

Jim Morrow: [00:01:05] Yeah. So, tell me a little bit about your practice and you before we get started, if you would.

Simon Cofrancesco: [00:01:09] GI North started in 2011 when I got to town, and we’ve steadily grown since then. We started out with just myself. And then, we’ve added three additional providers – two gastroenterologists and one nurse practitioner. And we’ve opened up an endoscopy center that’s just starting to get going. In addition to our clinic, it’s actually just across the hallway in a building, probably a half a mile from where you are.

Jim Morrow: [00:01:41] Well, that’s wonderful. I know you’re glad to have that up and running.

Simon Cofrancesco: [00:01:44] Absolutely.

Jim Morrow: [00:01:45] That’s got to be a good thing. So, I want to talk to you about colon cancer screening and colon cancer itself a little bit. And I know the whole thing of colon cancer screening has changed so much since you and I were in training. We went from what looked like this stand this microphone is on to what’s thankfully a lot more flexible now. But if you would, give us an overview of what a colonoscopy is all about.

Simon Cofrancesco: [00:02:14] Most people today, especially around here, know about it. It’s unusual, like you said, 20 or 30 years ago to run into somebody who’s not familiar with what it is. But it is just a long, flexible tube, very small, about like a finger in diameter, and it has a light on the end. And we just look carefully in the colon for little growths called polyps and remove those because that’s how you develop colon cancer. A slow process of a little growth called a polyp that over years gets bigger, and eventually turns into cancer.

Jim Morrow: [00:02:50] Okay. Now, speaking of colon cancer, can you talk a little bit about how many people get colon cancer and how common it is? Is it something everybody needs to be worried about and so forth?

Simon Cofrancesco: [00:02:59] Well, it really is either the second or third most common cancer in this country. And I think the number has hovered around 5%. That’s a big number, 5% of people in this country are going to get colon cancer. But the good news is, is that you can prevent that. Not catch it early but prevent that by getting a colonoscopy and removing polyps to prevent cancer.

Simon Cofrancesco: [00:03:26] So, it’s really a very different concept than most other cancers. It’s not like a mammogram where you detect breast cancer early. We prevent it. And the numbers are showing that. So, the newest numbers out show that colon cancer in people older than 50 is going down in this country over decades because people are getting screened for it. Unfortunately, the other new news is people under 50, it’s going up. So, the good news, though, is you can prevent it and they’re starting to change some of the age ranges, and it’s very prevalent, and it’s the number two cancer killer in this country.

Jim Morrow: [00:04:10] Wow. Well, that’s a wonder. I know I preach to people about going to get colonoscopies to the point, sometimes, of berating, I suppose you could say, but I certainly browbeat them if nothing else if they’re 56 or 58 and they haven’t been.

Jim Morrow: [00:04:25] So, you had one the other day, 63 years old, never been for colonoscopy. I’ve broken the bad news to him. I said, “You need two colonoscopies. You need one for when you were 50 and one for when you were 60. Lucky for you, you can make that all up in one. You don’t have to worry about it.” Now, people worry about colon cancer, but what are the signs and symptoms of colon cancer?

Simon Cofrancesco: [00:04:45] The bad news is, is that we go based on age because symptoms are not a reliable way to detect it. So, everybody thinks they’re in touch with their body. And I constantly hear, which I’m sure you hear too, “I know my body. I feel fine. There’s nothing wrong.” And it’s hard to explain to people, when you do find cancer, and it’s really a surprise that it’s probably been there for — it’s been cooking or evolving for 5 to 10 years. So, probably, one of the most common symptoms of colon cancer is that there isn’t any symptoms.

Jim Morrow: [00:05:22] Wow.

Simon Cofrancesco: [00:05:22] And that’s the scary part. But when people do get more advanced disease, some things that do show up to the patient are pain, or change in bowels, or blood in the stool. If they’re lucky enough to have those symptoms because of where the cancer is, then they may get detected at a time where they can be treated successfully. But, again, probably the cancers that we’re seeing more and more lately start in the beginning of the colon. And so, those symptoms I just mentioned are not usually as prevalent or common.

Jim Morrow: [00:05:59] Okay, good. Now, I know the thing that patients talk about the most about a colonoscopy, at least, to me, is the prep. They dread the prep because they know that they’ve got to drink, or they think they’ve got to drink this gallon of salt water, and it’s horrible. Last time I had one, I think you told me to put a packet of Crystal Light in my gallon of GoLytely. And, now, I can’t drink Crystal Light because I can’t get that taste out of my mouth, the GoLytely. But talk about the options for a prep for a colonoscopy.

Simon Cofrancesco: [00:06:30] Well, there’s been some improvement. We have smaller preps now that are about half of a soda, six ounces or so. So, it’s improved. It’s not a major improvement, but it’s an improvement. And it does make it a little easier on patients, to be honest with you, because more people can tolerate low volumes even though the taste isn’t that good. So, it’s a lot easier as far as the prep goes. It’s still the part that people don’t like.

Jim Morrow: [00:07:03] Well, if it’s only a few ounces, it must be liquid dynamite. Is that what they call it?

Simon Cofrancesco: [00:07:06] Well, it works. It works for 99% of people.

Jim Morrow: [00:07:10] I bet. I bet it does. I can just imagine. So, if we’re going through the colon, and we’re looking for things, and we found a polyp, what do you do at that point?

Simon Cofrancesco: [00:07:21] The majority of the time, we just take it out. It’s usually not big. And we have devices that can remove them. People don’t feel anything. The risk of injury to the colon is very very small. Especially today, we use devices where we don’t have to use any electricity. And that really has almost completely removed significant risks from performing a colonoscopy, but it’s just a small bump. Now, there are times where it’s big unexpectedly, and we can’t safely remove it endoscopically. And sometimes, people do have to have surgery, but that’s a real vast minority of people.

Jim Morrow: [00:08:02] And am I right in remembering that if you do that, you’ll put a tattoo on the inside of the colon?

Simon Cofrancesco: [00:08:07] Very correct. That is correct. If there’s something that we have to monitor closely or we have to alert the surgeons to, then we do put a tattoo on that. That’s correct.

Jim Morrow: [00:08:17] That’s amazing.

Simon Cofrancesco: [00:08:18] Yeah.

Jim Morrow: [00:08:18] That’s amazing. So, you mentioned a potential problem. And the other thing people talk about is I’ll say, “Well, you need a colonoscopy,” and I’ll hear, “Well, I don’t want a colonoscopy because I knew somebody that had a colonoscopy, and they had a perforation.” And, usually, at that point, I’ll say, “Well, how do you get to the office?” And they’ll say, “Well, what do you mean? I drove.” And I’ll say, “You drove an automobile? Have you not known anyone that got killed in a car wreck? Oh my God. And you drove here.” So, talk about the numbers for perforations.

Simon Cofrancesco: [00:08:51] Well, they’re changing, and they should be changing because, as I mentioned, in the last 5 to 10 years, we’re using devices that make it almost impossible to perforate somebody. Now, if something’s big, and we have to use what’s called electrocautery or electricity, that does increase the risk, but it’s still somewhere in the range of 1 in 2000. And I like your approach with the automobile. What I tell people though is the other side of the coin is that there is a rare risk of perforation, but what is your risk of colon cancer? And it’s going to be, at least, 5%. So 1 in 2000 versus, at least, 5%, which one’s less risky?

Jim Morrow: [00:09:36] I have to get the calculator, Apple, my phone, open to answer that, but I’ll do that later, I promise. So, you’re going through the colon, and you’re looking at polyps, and you pull them out, and you take them off and do a polypectomy. You send them to the lab. This is a little bit more detail than some people will want, but I think we’ve got a fairly intellectual listening audience. So, I want to give them some details about that. Can you talk a little bit about the types of polyps they might find?

Simon Cofrancesco: [00:10:01] Probably the easiest thing for me to say, and this is a big point of confusion, is that there’s two types of polyps. Not really, but I’m going to simplify it. So, there’s the kind of polyp that you have to remove because it has potential in time to turn into cancer. And then, there’s some small percentage of polyps that don’t have any potential to turn into cancer. And we see those in certain locations of the colon.

Simon Cofrancesco: [00:10:29] So, I first divided into that kind of approach. Then. you get into a lot more detail that’s probably, as you’ve mentioned, a little bit above the routine dialogue you’ll have with the patient, but there is two kinds of polyps. And there’s some that we can simply ignore because they’ll never be a problem.

Jim Morrow: [00:10:51] So, I know, until recently, it was fairly clean cut, very simple. If you had a hyperplastic polyp that doesn’t turn to cancer, you can repeat the test in five years. If you had an adenoma, the type that can turn to cancer, you’re going to repeat it in one to three years, depending on size. But you told me not long ago that that has changed. So, what should people expect in that now?

Simon Cofrancesco: [00:11:14] Yeah. The most common thing is that if people are going to have polyps, or there’s a family history of polyps or cancer, they should get a colonoscopy roughly every three to five years. It’s usually five years but depending on what we find, it can vary a little bit.

Simon Cofrancesco: [00:11:30] In people who are average risk, where they don’t have polyps, and/or nobody in their family has polyps or cancer, they can go 10 years. That shows you how slow a process colon cancer is. If we check someone today whose average risk, it would, generally speaking, take 10 years for them to start to develop colon cancer. So, it’s such a slow process, but it’s usually that 5 or 10 years.

Simon Cofrancesco: [00:11:57] And then, we do kind of bring it down under certain circumstances. There’s variables that we look at that can make us do it more frequently – the size of the polyp, how we have to remove the polyp, the specific pathology of the polyp, the number of polyps, how well they were cleaned out, avariety of different things.

Jim Morrow: [00:12:19] And the low-volume prep, as they usually call it, does a good enough job, so you don’t have to go back because you didn’t get cleaned out well in most cases.

Simon Cofrancesco: [00:12:26] The preps work but not all the time. And that’s true. Unfortunately, we disappoint about 1 out of 10 people. They have to come back because the standard prep, for whatever reason, didn’t work. Studies show that. I see that in my experience. So, there are a small group of people that will do what they’re supposed to, and it doesn’t matter whether it’s a large volume prep, Jim, or the new smaller ones.

Simon Cofrancesco: [00:12:52] The change we have in the preps today are split dose. And nobody likes this, but it does allow us to get a better examination where you take half of the prep the day before like usual, and the other half, three hours before your colonoscopy. And what that does is it keeps the colon clean on that beginning part of the colon where the bacteria start to repopulate very quickly from drinking the prep the day before. So, we don’t see as well when they do it all in one day versus plating it up. So, that’s a quality measure that us, GI doctors, are supposed to be doing to get a more thorough examination.

Jim Morrow: [00:13:34] Super. You mentioned the family history. If they do have a family history, what age do you recommend they start it?

Simon Cofrancesco: [00:13:40] A family history is either at 40 years of age, from 50 to 40, or if the person in the family, like a 45-year-old comes in, and I find a polyp on them, it would be 10 years younger than that, whichever is the youngest. So, I’m seeing polyps now, and people in their 30s and 40s, their children have to get checked 10 years before they were diagnosed with a polyp. So, we’re starting to reach downwards with colonoscopy.

Jim Morrow: [00:14:11] Well, as I tell patients too, I think very few people ever died and went to the pearly gates and said to St. Peter, “I wish I had so many colonoscopies.” But I can promise you that the opposite have been said to St. Peter.

Simon Cofrancesco: [00:14:23] Yeah.

Jim Morrow: [00:14:24] So, occasionally, patients will tell me that it was very uncomfortable when they had their colonoscopy or there were unable to finish the colonoscopy because of what’s called a torturous colon, a twisted sort of colon, curvy colon. Can you tell me a little bit about what you do in that situation and what all that means?

Simon Cofrancesco: [00:14:41] Well, first off is that if you have an experienced gastroenterologist, the chances of not completing a colonoscopy should be literally 1%, 2%, or 3%.. I mean it should be exceptional.

Jim Morrow: [00:14:55] Good.

Simon Cofrancesco: [00:14:55] So, first of all, that’s not really something that’s very common. But on occasion, it can happen. And then, if that does, by chance, happen, the testing you would have to do as an alternative would be probably some form of an x-ray or some of those tests that people who don’t want to have colonoscopy get like hemoccult testing, which is testing for microscopic blood in the stool, or there’s that relatively new DNA test cologuard. Those aren’t perfect ways. Those have limitations, but those are some of the things that you can do. It should be exceptional that a colonoscopy cannot be completed, just so you know.

Jim Morrow: [00:15:34] So, you mentioned cologuard. I was going to get to that because I get asked that daily, it seems like. What do you tell patients about why the colonoscopy is a preferred test to cologuard?

Simon Cofrancesco: [00:15:46] Cologuard has a lot of limitations. It’s not meant to pick up polyps, first of all. It picks up cancer. So, you’re already moving away from something that can prevent cancer, and you’re moving into something that diagnoses cancer. Big difference there, right? Number one.

Simon Cofrancesco: [00:16:07] Number two. Although the studies say that it’s supposed to be accurate or specific 85% of the time, I think not, just myself but everybody I’ve spoken to will say that it’s not the case. Probably the last 20 people I’ve scoped with a positive cologuard have not had colon cancer. So, it’s been wrong.

Simon Cofrancesco: [00:16:32] And then, finally, the biggest thing about cologuard is that patients and doctors don’t know what it’s indicated for. It’s very narrow indication. It’s not for everybody. It’s for average-risk individuals. So, if they have had polyps, or cancer, and/or if somebody else in their family has had polyps or cancer – in other words, a high-risk individual – it’s not intended for them because those people have a high rate of polyps, and the cologuard test will not tell you if they have polyps.

Simon Cofrancesco: [00:17:07] So, it’s very narrow, but, in reality, I know that people get it, and I don’t blame you for what you do or anybody else, is that they’re just not going to have a colonoscopy. And this is probably the best you can do. So, that’s real world. People ask me, who’s the cologuard for? I tell them it’s for chickens because it’s just for people who don’t want to have the best test because they’re scared, or frightened, or things like that.

Jim Morrow: [00:17:31] They’ve been reading on the internet about colonoscopies.

Simon Cofrancesco: [00:17:34] Yeah. And like you say, it’s very anecdotal. They’ll hear about — you do hear about that one person who had a tragic complication, but they don’t hear about the thousands of people that they don’t mention it because it was no big deal.

Jim Morrow: [00:17:49] Yeah. And after a colonoscopy, what should patients expect post-op, if you will? I know it’s not an operation. But after the colonoscopy, what’s the rest of their day likely to be like?

Simon Cofrancesco: [00:17:59] I have to say it should be normal. I mean, the biggest thing when they wake up is going to be just the sedation wearing off, and what they’ve just been through the day before by not eating, and maybe some electrolyte disturbances. They may feel tired a little. They’ve been getting up very early to finish the second half of their prep. So, the biggest thing is this, people are going to probably be a little bit fatigued or tired after sedation, and not eating regularly, and maybe some mild electrolyte abnormalities.

Simon Cofrancesco: [00:18:30] But here’s a nice thing, I’ll put a little plug in for our practice. We have scopes now where we are that we don’t use air to put into the colon. We use CO2. So, that bloating, and distention, and air feeling that some people got, or cramping, they won’t have that at our place because we have CO2, for instance, which was probably the most common complaint – feeling bloated, or distended, or cramping. So, barring a rare complication, most people are just pretty normal after the procedure. They can eat normal. They can’t drive but everything else is pretty much the same.

Jim Morrow: [00:19:10] And they can’t drive because they’ve been sedated. In these days, you’re using Propofol. Is that right?

Simon Cofrancesco: [00:19:15] Which is ultra quick, and it wears off quick. And people feel great. They really feel like they can drive, but, still, their motor skills probably aren’t up to snuff, and that’s even though they feel like they are.

Jim Morrow: [00:19:28] Right. And by that, Propofol was what Michael Jackson used to go to sleep at night for years, and years, and years, which is a little bit of a problem, which is why his doctor is in jail right now.

Simon Cofrancesco: [00:19:39] Yeah. And that came up a lot. When that first happened with Michael Jackson, a lot of patients were very scared. And all I can convince people and tell people about is I’ve been using Propofol for my patients for probably 20 to 25 years right before we were using Versed and so forth. And it’s a perfect drug for endoscopy. In fact, when I have my colonoscopy, that’s what I have, Propofol.

Jim Morrow: [00:20:04] Which is incredibly safe, and people just don’t realize the one-off that they’re doing is nothing compared to anything else. So, I think it’s a great choice. I’m glad you’re using it now. I know when I had mine done, it was a nothing event.

Simon Cofrancesco: [00:20:17] Exactly, exactly.

Jim Morrow: [00:20:18] [Crosstalk] is just a nothing event. So, with the colonoscopy, you’re going through there, you’re looking for polyps, but I know there are other things that you might find. It doesn’t relate directly to colon cancer screening, but talk about some of the other things you might find – the inflammation, and bleeding, and so forth, and so on.

Simon Cofrancesco: [00:20:37] Yeah, the most common thing we see is polyps or actually second most common thing because everybody’s got diverticulosis. I’ll mention that. It’s very unusual in this country that I do a colonoscopy on someone 50 or older and don’t see diverticulosis. So, fortunately though, most people won’t be bothered by that. Only a small percentage will get an infection called diverticulitis.

Simon Cofrancesco: [00:20:59] So, that is the most common abnormal finding, and we don’t really do anything about it except, excuse me, encourage people to eat more fiber, and to take a fiber supplement every day. Actually, I encourage everybody to take a fiber supplement every day. It’s an important part of our diet that we are missing in this country. We just don’t get enough fiber. So, with or without diverticulosis, I think it’s a good idea, but especially with diverticulosis.

Simon Cofrancesco: [00:21:26] And then, probably, the next most common thing that we see is inflammatory conditions, which you’ve already kind of alluded to. And they can be infections, or, very commonly, it can be autoimmune conditions like Crohn’s disease or ulcerative colitis. We see a lot of autoimmune conditions. It’s very common. It’s not diminishing. In fact, I think it’s probably becoming more common in my practice to see somebody with Crohn’s or ulcerative colitis. And then, there’s a smattering of less common diseases that cause inflammation.

Jim Morrow: [00:22:00] And with insurance coverage today, most insurance companies that I know of these days cover a screening colonoscopy. Is that right?

Simon Cofrancesco: [00:22:08] Yes, they do. And the problem is it’s very complicated, but you’re correct. If someone has no history of colon cancer, colon polyps, they get screening, but it’s funny how the insurance companies play games. And if your family history was positive, or you have irritable bowel syndrome or symptoms, or you’ve had a polyp in the past, they try to change things, or if I remove something during a screening colonoscopy, it changes. So, my perspective on that is it’s become a very tricky thing. It’s become a game, and you know how insurance companies do that.

Jim Morrow: [00:22:50] True.

Simon Cofrancesco: [00:22:50] And we were constantly struggling to placate the insurance companies on this and help our patients. It’s kind of a little conflictual.

Jim Morrow: [00:23:01] Okay. Yeah. So, while you’ve got patients, so there are a lot of times when the patients will come to me, and they’ll be taking Prilosec or the generic version and take it every single night. If they don’t take it for two days, they have horrible heartburn. So, while we’re staying in the endoscopy suite, sort of, you can look for ulcers by doing an upper endoscopy, not just a colonoscopy. So, how is that procedure done?

Simon Cofrancesco: [00:23:30] Upper endoscopy is a much quicker test. You don’t have to prepare for it. It takes about 10 minutes. All you do is skip your breakfast, put in an IV, and then people take a nap for 5 or 10 minutes. They won’t know anything was done. Just like a colonoscopy, they’ll wake up speaking to the nurse like when are they going to start. So, like you said about your experience, there is no experience.

Simon Cofrancesco: [00:23:51] And we look carefully at the esophagus, stomach, and do a DME, which is basically the upper GI tract. Commonly, we see diseases of the esophagus. It’s very common, probably more so now than stomach disorders, believe it or not. Ulcer disease was the king when I was starting out in the early ’90s. And it’s funny how it’s shifted esophageal diseases have become much more common. Maybe it’s because of the medications we have over the counter. Maybe it’s because of H.pylori being treated so much. But esophageal diseases make up a big part of what gastroenterologists take care of in the upper part.

Jim Morrow: [00:24:29] I think every time I mentioned to a patient that they can do the two tests at the same time, their biggest question is, will they use a different scope? And I assure them that they will. And if they don’t, ask them to do the upper first. That way, it doesn’t really matter.

Simon Cofrancesco: [00:24:44] Yeah. I joke around, and I tell them it depends on their insurance.

Jim Morrow: [00:24:50] I’ll have to remember that. I love that. So, John’s over here acting like he has some question for us. We’re here in the studio at Renasant Bank on Windward Parkway. And we’ve got John Ray here in North Fulton Business Radio. John’s got some questions from listeners.

John Ray: [00:25:05] That’s right.

Jim Morrow: [00:25:05] What you got, John? How are you doing?

John Ray: [00:25:07] I’m good. How are you?

Jim Morrow: [00:25:08] Good. This is my first guest.

John Ray: [00:25:10] I know. You did a great job.

Jim Morrow: [00:25:11] I’m nervous as a cat.

John Ray: [00:25:13] Why?

Jim Morrow: [00:25:13] I don’t know, but I am.

John Ray: [00:25:15] Well, he’s the one that had to have all the answers today. Usually, it’s you.

Jim Morrow: [00:25:20] I count on him too.

John Ray: [00:25:22] Okay. Well, here’s a couple of questions that we’ve got that have come in. So, this question is about blood in the stool. Does that automatically mean I have colorectal cancer?

Simon Cofrancesco: [00:25:37] Absolutely not. If I looked at all comers with that problem, fortunately, it’s a minority, but it’s important for us to make sure that it isn’t colon cancer. But in many instances, it’s something very insignificant or small that we can easily take care of, hemorrhoids, et cetera.

Jim Morrow: [00:25:59] So, along those lines — let me jump in there, John.

John Ray: [00:26:01] Sure.

Jim Morrow: [00:26:02] If someone comes to me, their family doctor, and says ” I have some blood in my stool,” do I send them straight to you?”

Simon Cofrancesco: [00:26:11] I guess, if it’s been a few years since they’ve had a colonoscopy, and if they’re not young like 20 or 25, it does kind of get into that mode where there might be a concern about liability because today, it’s hard to ignore an adult who has blood in the stool, who hasn’t had a recent colonoscopy. I’d say it’s almost a no-brainer, but there are some circumstances where you could probably just say, “Let’s try to treat you for hemorrhoids first because you had a colonoscopy a year or two ago,” or something like that.

Jim Morrow: [00:26:47] Well, it’s good to know I’m doing that, right? Because I do know that one of the worst things I hear is when you hear about a patient, 36 years old, that actually died from colon cancer because it does happen, and you talked about that earlier. And if anybody gets anything from this, I hope they’ll get it, they need to go for colonoscopy. What else you got, John?

Simon Cofrancesco: [00:27:07] So, I want to say something about that because I, actually, last year, had a young man with no family history who came to me with what sounded like hemorrhoidal bleeding, and I wiped the sweat off my brow after I scoped him because he had colon cancer. So, your experience with a 30-year-old, and I’ll just tell you why you got to pay attention, and I didn’t mean to say you don’t pay attention when they’re younger because I’ve clearly had people — fortunately, this young man survived and has done very well, but I see all age groups. And so, it gets tricky, but it’s a no-brainer when they’re mid 40s and 50s, and they have blood, and you just got to get checked.

Jim Morrow: [00:27:49] Right, right.

Simon Cofrancesco: [00:27:49] Yeah.

John Ray: [00:27:50] So, you’re hitting something on that this next question gets at right now, which is you mentioned the earlier incidents of colorectal cancer. So, is every 10 years enough?

Simon Cofrancesco: [00:28:07] I can just tell you about my experiences is that it works well the vast majority of times. The screening procedures are set up not to be perfect. They’re not perfect. And I hate to have to explain common sense to people. We don’t have perfect tests, and we don’t have unlimited resources, so they draw a line somewhere that gets almost everybody. But yeah, 10 years is a long time. And when that first was incorporated, a lot of us were very uncomfortable. As it’s panned out over the years, I don’t see a lot of people getting burned, but it’s not perfect. Some people will.

John Ray: [00:28:51] Now, one other age-related question. This comes from a listener talking about her mom. At what point does a patient’s age make a colonoscopy more of a problem than it’s worth?

Jim Morrow: [00:29:03] Good question.

Simon Cofrancesco: [00:29:03] Yeah, that’s an excellent question, and there’s no simple answer to that. I go through that every day. Everybody’s very focused on the number. The first thing I’d say is the number starts the conversation. So, to give you an example, I have an 85-year-old gentleman, and this is not an isolated situation. I have lots of people like this in their mid-80s, highly functioning. They just finished mowing their lawn, they drove themselves in, and I diagnosed them with colon cancer six years ago, and they want their colonoscopy. So, they’re a high-risk individual, and they’re highly functioning. That person has already broken the curve on the age thing.

Jim Morrow: [00:29:39] Right.

Simon Cofrancesco: [00:29:40] So, I do a colonoscopy. And I have lots of those people, and they do great. And then, I have somebody who comes in who’s 75, who’s not doing well. They’re just not healthy. And they have a limited life expectancy. Maybe three, four, or five more years left. They haven’t had polyps, or there’s no high risk. That person clearly doesn’t need a colonoscopy. The risk of the colonoscopy might be greater because their risk of cancer is low.

Simon Cofrancesco: [00:30:08] So, I mean, age is, to me, something that you start a dialogue with. And then you have to look at both sides. What’s the risk for the patient of the procedure, and what are their risks possibly of having colon cancer? And then, I get with the patient. And then, we come together on a decision because, many times, sometimes, I do a procedure because the patient wants me to because they’re concerned because their dad had colon cancer, and they don’t want to get colon cancer. And that may make us favor doing a colonoscopy. So, it’s not an easy answer, and it’s a case-by-case basis.

John Ray: [00:30:43] Peace of mind is an incredible commodity. I tell people you should get all you can get.

Simon Cofrancesco: [00:30:49] It can be therapeutic for some people. Jim and I see people everyday that suffer from anxiety. I mean, it’s real, especially as people get older. They get more fragile. And you can give them peace of mind. And if you’re smart, and you’ve done this, we’re not hurting older people, but there’s definitely people that are older that safely can have colonoscopy.

John Ray: [00:31:13] Great.

Jim Morrow: [00:31:13] That’s it?

John Ray: [00:31:14] That’s it.

Simon Cofrancesco: [00:31:15] That’s it.

Jim Morrow: [00:31:16] Well, good. Well, this is Dr. Jim Morrow. And, again, I want you to know that I’m with Morrow Family Medicine. At Morrow Family Medicine, we use technology and old-fashioned attitudes to do our very best to make you feel better every day. We’re located in Milton and Cumming, Georgia. Our website for the show is toyourhealth.md. If you want to send us a question or a show topic you might want us to try, the email is drjim@toyourhealth.md, or you can tweet us @toyourhealthmd. And Dr. Simon Cofrancesco, if you would tell us a little bit about how patients can get in touch with you, and come see you, or one of your partners.

Simon Cofrancesco: [00:31:55] Absolutely. Thanks, Jim. GI North. And the phone number is 404-446-0600. They can also look at our website, ginorth.com. And I believe our web site is GI-north — I’m blanking out right there. Help me out here.

Jim Morrow: [00:32:19] His marketing director is right behind him.

Simon Cofrancesco: [00:32:21] Unfortunately, my marketing director doesn’t remember our website. So I apologize.

Jim Morrow: [00:32:27] We’ll have it in the show notes. This is great. I love it. Well, I do appreciate everybody listening. And if you are enjoying the show and the podcast, wherever you’re listening, hit the subscribe button, so you can be sure and be notified when there’s another episode. I really want to thank Dr. Simon Cofrancesco for being my first guest on the show and for coming on with us. It’s great.

Jim Morrow: [00:32:49] In two weeks, we’re going to have a very interesting show, a little bit different also. This is going to be an interview with Derek Bailey from the Right Move. They specialize in helping your seniors find a good location and a good solution to whatever their residential situation might be. So, we’re going to talk with Derek in two weeks. And until then, that is To Your Health.

To Your Health With Dr. Jim Morrow: Episode 9, Lyme Disease

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To Your Health With Dr. Jim Morrow: Episode 9, Lyme Disease
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Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Episode 9, Lyme Disease

What causes Lyme Disease? What about chronic Lyme Disease? What is it about some treatments of chronic Lyme Disease that should be concerning?  On this episode of “To Your Heath,” Dr. Jim Morrow addresses these questions and more. Dr. Morrow also talks about why he maintains ownership of his practice and what that means for his patients.

Dr. Morrow’s Show Notes on Lyme Disease

  • Today, I am going to talk about Lyme Disease, and before I am finished, I suspect that some of you will be shaking your heads and changing the dial, metaphorically at least.
  • Lyme disease, caused by the bacterium Borrelia burgdorferi, is the most common tick-borne illness in the United States.
    • Transmission occurs primarily through the bite of an infected deer tick.
    • Lyme disease cases are concentrated in the Northeast and upper Midwest, with 14 states accounting for over 96% of cases reported to CDC.
    • Georgia has had cases of documented Lyme disease but the numbers are very low.
    • Identification of an erythema migrans rash following a tick bite is the ONLY clinical manifestation sufficient to make the diagnosis of Lyme disease in the absence of laboratory confirmation.
    • The Centers for Disease Control and Prevention recommends a two-tier approach using an enzyme-linked immunosorbent assay initially, followed by the more specific Western blot to confirm the diagnosis when the assay samples are positive or equivocal.
      • This is a tremendous point of conflict among patients. The test reports a series of positive or negative “bands” that correspond to possible infection.
        • In order for the test to be POSITIVE, you MUST have FIVE or more positive bands. This is due to cross-reaction or false positive results on any one band.
        • Very often, when we get these results back, 1-3 bands are positive. I have seen too many times when the patient, or even on occasion, the clinician, made the diagnosis of Lyme disease based on this.
  • This is just wrong and is completely unfair to the patient. And it can make the patient vulnerable to the mountain of information available that would make them believe that they could someday have what has been labeled as “chronic Lyme disease”
  • The treatment of Lyme disease is determined mainly by the clinical manifestations of the disease.
  • Doxycycline is often the preferred agent for oral treatment because of its activity against other tick-borne illnesses.
  • Preventive measures include
    • avoiding areas with high tick burdens,
    • wearing protective clothing,
    • using tick repellants (e.g., DEET),
    • performing frequent body checks and
    • bathing following outdoor activities, and
    • instituting environmental landscape modifications (e.g., grass mowing, deer exclusion fencing) to reduce the tick burden.
  • Although there is controversy regarding treatment of post–Lyme disease syndrome and chronic Lyme disease, there is no biologic or clinical trial evidence indicating that prolonged antibiotic therapy is of benefit.
  • Symptoms of early Lyme disease usually begin one to two weeks after a tick bite (range of three to 30 days)
  • There are three well-recognized clinical stages of Lyme disease, and clinical manifestations are different at each stage.
  • As many as 80 percent of patients develop the characteristic erythema migrans rash, which may be confused with other similar conditions.
  • Erythema migrans is classically reported as a single lesion
    • most commonly appears as a uniform red oval rash with average size of about 7-8 inches. It can be as small as a couple of inches.
  • Approximately 19 percent of Lyme rashes are a “bull’s-eye” rash. So, if you are basing the diagnosis only on a bulls eye rash, you could easily miss this.
  • Multiple similar rashes may occur in up to 10 to 20 percent of patients.
  • Associated symptoms are similar to a nonspecific viral illness and often include fatigue, malaise, fever, chills, myalgia, and headache.
  • Following this initial stage, the bacteria disseminate systemically via the lymphatic system or blood.
  • With untreated disease, the most common sites of extra-cutaneous involvement are the joints, nervous system, and cardiovascular system.

Stages of Lyme Disease

  • Early localized
    • Erythema migrans – (typical rash)
    • Virus-like illness (e.g., fatigue, malaise, fever, chills, myalgia, headache)
  • Early disseminated:
    • Cardiac (e.g., atrioventricular block)
    • Dermatologic (e.g., multiple erythema migrans lesions)
    • Musculoskeletal (e.g., arthralgia, myalgia)
    • Neurologic (e.g., lymphocytic meningitis, facial nerve palsy, encephalitis)
  • Late
    • Arthritis (can be one or multiple joints)
    • Neurologic symptoms (e.g., encephalomyelitis, peripheral neuropathy)
  • These are associated with a positive test for Lyme disease

Chronic Lyme Disease

  • Symptoms attributed to Chronic Lyme Disease are chronic pain, fatigue, neurocognitive, and behavioral symptoms
    • Clinicians who subscribe to the idea that chronic Lyme is a real entity will misread, either intentionally or through ignorance, the lab tests for Lyme disease.
    • Too often, they will explain to the patient that the only treatment for their symptoms is long-term antibiotic treatment with or without some other very involved, complex and almost always wasteful treatment THAT ONLY THEY CAN PROVIDE.
    • Perhaps the most recognized and contentious facet of this debate is whether it is effective, appropriate, or even acceptable to treat patients with protracted antibiotic courses based on a clinical diagnosis of CLD.
    • Patients and their families spend an unbelievable amount of money every year on these treatments. Thousands and thousands of dollars are wasted and just handed over to unscrupulous physicians who prey on the hardship of others.
  • The dialogue over CLD provokes strong feelings, and has been more acrimonious than any other aspect of Lyme disease.
    • Many patients who have been diagnosed with CLD have experienced great personal suffering; this is true regardless of whether Lyme infection is responsible for their experience.
    • On top of this, many patients with a CLD diagnosis share the idea that the medical community has failed to effectively explain or treat their illnesses.
      • In support of this patient base is a community of physicians and alternative treatment providers as well as a politically active advocacy community.
      • This community promotes legislation that has attempted to shield CLD specialists from medical board discipline and medicolegal liability for unorthodox practices, to mandate insurance coverage of extended parenteral antibiotics, and most visibly to challenge legally a Lyme disease practice guideline.
      • The advocacy community commonly argues that Lyme disease is grossly underdiagnosed and is responsible for an enormous breadth of illness; they also argue that the general scientific and public health establishments ignore or even cover up evidence to this effect.
      • A large body of information about CLD has emerged on the Internet and other media, mostly in the forms of patient testimonials and promotional materials by CLD providers.
      • This volume of information can be confusing and difficult to navigate.
    • The concept of CLD has for the most part been rejected. Clinical practice guidelines discourage the diagnosis of CLD and recommend against treating patients with prolonged or repeated antibiotic courses.
      • National and state public health bodies agree with this rejection of CLD.
      • Within the medical community, only a small minority of physicians have accepted this diagnosis: 2.1%
    • Many patients referred for Lyme disease are ultimately found to have a rheumatologic or neurologic diagnosis.
      • Rheumatologic diagnoses commonly misdiagnosed as Lyme disease include osteoarthritis, rheumatoid arthritis, degenerative diseases of the spine.
      • Some patients are found to have neurologic diseases, including multiple sclerosis, demyelinating diseases, amyotrophic lateral sclerosis, neuropathies, and dementia.
      • Some CLD advocates have argued that these various conditions are simply manifestations of Lyme disease, but these hypotheses are unable to be proven.
      • There is no evidence that these conditions are related to Lyme infection at any time.
    • Bottom line on chronic Lyme disease is that there is just no science behind it. No study has ever shown a definitive link between these vague symptoms and Lyme disease.
      • The only information even found with the infamous Google search is found on non-medical sites. Websites of any scientific value (those reporting actual scientific studies) reveal NO DATA supporting chronic Lyme disease.
      • The symptoms of chronic Lyme can sometime be explained by other REAL disease processes, but more often than not, these symptoms are just the symptoms of life. They can happen to anyone and do happen to a huge percentage of people in the everyday living of life.

(Information included in these notes comes, in part, from the American Academy of Family Physicians website at www.aafp.org.)

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

To Your Health With Dr. Jim Morrow: Episode 8, Sleep Apnea, and Two Special Guests from Taylor Road Middle School

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To Your Health With Dr. Jim Morrow: Episode 8, Sleep Apnea, and Two Special Guests from Taylor Road Middle School
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Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Episode 8, Sleep Apnea, and Two Special Guests from Taylor Road Middle School

Sleep apnea affects not only a partner who can’t sleep for the snoring, but it reduces quality of life for the person affected by this condition. So why does sleep apnea occur, and what are the best treatment options? On this episode of “To Your Heath,” Dr. Jim Morrow addresses these questions and more, and talks about his own experience with sleep apnea.

Also in this episode, Dr. Morrow welcomes two 8th grade students from Taylor Road Middle School in Johns Creek, Cion Kim and Ananya Shaeker. To complete a project assignment for their language arts class, Cion and Ananya used a previous episode of “To Your Health” to explore the dangers of vaping for their peers. Impressed by their work, Dr. Morrow was delighted to welcome Cion and Ananya to the show!

Ananya Shaeker and Cion Kim
Ananya Shaeker and Cion Kim

 

 

Dr. Morrow’s Show Notes on Sleep Apnea

Sleep Apnea

  • There are two kinds of sleep apnea: obstructive apnea and central apnea.
  • Obstructive sleep apnea is the most common type.
    • Nine out of 10 people who have sleep apnea have this type of apnea.
    • something is blocking the airway that brings air into your body (also called the trachea).
    • When you try to breathe, you can’t get enough air because of the blockage. Your airway might be blocked by your tongue, tonsils, or uvula (the little piece of flesh that hangs down in the back of your throat).
    • It might also be blocked by a large amount of fatty tissue in the throat or by relaxed throat muscles.
  • Central sleep apnea is less common. This type of sleep apnea is related to the function of the central nervous system. If you have this type of apnea, the muscles you use to breathe don’t get the “go-ahead” signal from your brain. Either the brain doesn’t send the signal, or the signal gets interrupted.

Obstructive Sleep Apnea

  • Obstructive sleep apnea is a common disorder that causes patients to temporarily stop or decrease their breathing repeatedly during sleep.
  • People who have sleep apnea stop breathing for 10 to 30 seconds at a time while they are sleeping.
    • These short stops in breathing can happen up to 400 times every night.
    • If you have sleep apnea, periods of not breathing can disturb your sleep (even if they don’t fully wake you up).
  • This results in fragmented, non-restful sleep that can lead to symptoms such as morning headache and daytime sleepiness.
  • Obstructive sleep apnea affects persons of all ages, especially:
    • Men,
    • people who are overweight, and
    • people who are older than 40 years of age are more likely to have sleep apnea.
  • However, it can affect anyone at any age.
  • There are many health conditions associated with obstructive sleep apnea, including
    • hypertension,
    • coronary artery disease,
    • cardiac arrhythmias, and
    • depression
  • Predictive clinical features are:
    • Loud snoring,
    • gasping during sleep,
    • obesity, and
    • enlarged neck circumference.
  • Screening questionnaires can be used to assess for sleep apnea, although their accuracy is limited.
  • The diagnostic standard for obstructive sleep apnea is nocturnal polysomnography in a sleep laboratory (a sleep study).
    • Home sleep apnea tests are available and in recent years have become more reliable.
    • Home portable monitoring can be used as a substitute for in-laboratory polysomnography for the diagnosis of OSA in patients with a high likelihood of SA.
    • Most patients prefer home monitoring, and clinical outcomes among patients diagnosed by either method are comparable regarding sleepiness, sleep-related quality of life, and compliance with continuous positive airway pressure (CPAP) therapy

What is the Result of Untreated Obstructive Sleep Apnea?

Relation to Hypertension

  • About one half of patients who have essential hypertension have obstructive sleep apnea, and
  • About one half of patients who have obstructive sleep apnea have essential hypertension.
  • A growing body of evidence suggests that obstructive sleep apnea is a major contributing factor in the development of essential hypertension.

Excessive Daytime Sleepiness

  • Excessive daytime sleepiness is one of the most common sleep-related patient symptoms
    • affects an estimated 20 percent of the population. Persons with excessive daytime sleepiness are at risk of motor vehicle and work-related incidents, and have poorer health than comparable adults.
    • The most common causes of excessive daytime sleepiness are sleep deprivation, obstructive sleep apnea, and sedating medications.
    • Other potential causes of excessive daytime sleepiness include certain medical and psychiatric conditions and sleep disorders, such as narcolepsy.
    • Obstructive sleep apnea is a particularly significant cause of excessive daytime sleepiness.
      • An estimated 26 to 32 percent of adults are at risk of or have obstructive sleep apnea, and the prevalence is expected to increase.
      • The evaluation and management of excessive daytime sleepiness is based on the identification and treatment of underlying conditions (particularly obstructive sleep apnea), and the appropriate use of activating medications.

Connection to Heart Disease

  • The connection between sleep apnea and heart disease is evolving very rapidly.
  • People with cardiovascular problems such as high blood pressure, heart failure, and stroke have a high prevalence of sleep apnea.
  • Whether sleep apnea actually causes heart disease is still unclear, but we do know that if you have sleep apnea today, the chance that you will develop hypertension in the future increases significantly.
  • One of the problems in defining the relationship between sleep apnea and heart disease is that people with sleep apnea often have other co-existing diseases as well.
  • If you treat people with high blood pressure and sleep apnea, or heart failure and sleep apnea, the measures of blood pressure or heart failure are significantly improved. There is good evidence to think there is a cause-and-effect relationship between hypertension and sleep apnea.
  • Why does your blood pressure go up when your sleep is disrupted by sleep apnea?
    • Your blood pressure will go up because when you’re not breathing, the oxygen level in your body falls and excites receptors that alert the brain. In response, the brain sends signals through the nervous system and essentially tells the blood vessels to “tighten up” in order to increase the flow of oxygen to the heart and the brain, because they have priority.
    • The problem is that things that go on at night tend to carry over in the daytime, even when the sleep apnea patient is awake. The low oxygen levels at night seem to trigger multiple mechanisms that persist during the daytime, even when the patient is breathing normally.
  • How can CPAP (continuous positive airway pressure) reduce the cardiovascular consequences of sleep apnea?
    • The available evidence tells us that when you treat people with sleep apnea using CPAP, their blood pressure is not only lower at night—it’s also lower during the day. That’s a very good thing.
    • Moreover, people with atrial fibrillation (a common type of irregular heart beat) with sleep apnea that is appropriately treated have only a 40% chance of coming back for further treatment of their atrial fibrillation.
      • If their sleep apnea is untreated, the chance of a recurrence of atrial fibrillation goes up to 80%. The message to heart patients with sleep apnea is: With treatment of your sleep apnea, your chances of improvement are considerably better.

Can Sleep Apnea Be Prevented or Avoided?

  • There are things you can do to prevent sleep apnea. The following steps help many people:
    • Stop all use of alcohol or sleep medicines. These relax the muscles in the back of your throat, making it harder for you to breathe.
    • If you smoke, quit smoking.
    • If you are overweight, lose weight.
    • Sleep on your side instead of on your back.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

To Your Health With Dr. Jim Morrow: Episode 7, Allergies

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North Fulton Studio
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To Your Health With Dr. Jim Morrow: Episode 7, Allergies
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Dr. Jim Morrow, Host of “To Your Health With Dr. Jim Morrow”

Episode 7, Allergies

Allergies affect almost 50 million people in the United States alone. On this episode of “To Your Heath,” Dr. Jim Morrow, an allergy sufferer himself, takes them all on:  food, plants, drug, environmental, and contact allergies. Dr. Morrow also talks about Forsyth BYOT, a non-profit established by Dr. Jim and Peggie Morrow to support technology initiatives in Forsyth County Schools.

Dr. Morrow’s Show Notes on Allergies

Allergies

  • When you hear someone talk about having allergies, usually they mean rhinitis or upper respiratory symptoms (runny nose, watery eyes, itching eyes and ears and nose, sneezing).
  • Allergies also can be due to food, medications, animal dander or plants.

Allergic Rhinitis

  • The diagnosis of allergic rhinitis (AR) should be made when history and physical findings are consistent with an allergic cause (e.g., clear rhinorrhea, pale discoloration of nasal mucosa, and red and watery eyes) and one or more of the following symptoms: nasal congestion, runny nose, itchy nose, or sneezing.
  • Individuals with allergic rhinitis should be assessed for the presence of associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media.
  • Specific testing (blood or skin) should be performed for patients with a clinical diagnosis of allergic rhinitis who do not respond to empiric treatment, or when diagnosis is uncertain, or when determination of specific target allergen is needed.
  • Sinus imaging should not routinely be performed in patients presenting with symptoms consistent with allergic rhinitis.
  • Intranasal steroids should be prescribed for patients with allergic rhinitis whose symptoms affect quality of life.
  • Oral second-generation/less sedating antihistamines should be prescribed for patients with allergic rhinitis and primary complaints of sneezing and itching.
  • Intranasal antihistamines may be prescribed for patients with seasonal, perennial, or episodic AR.
  • Oral leukotriene receptor antagonists should not be prescribed as primary therapy for patients with AR.
  • Combination pharmacologic therapy may be prescribed for patients with allergic rhinitis who have inadequate response to monotherapy. The most effective combination therapy is an intranasal steroid and an intranasal antihistamine.
  • Immunotherapy should be prescribed for patients with allergic rhinitis who have inadequate response to pharmacologic therapy
  • Avoidance of known allergens or environmental control may be considered in patients with allergic rhinitis who have identified allergens that correlate with their clinical symptoms.
  • Inferior turbinate reduction may be considered for patients with allergic rhinitis with nasal airway obstruction and enlarged inferior turbinates who have failed medical management.

Allergy Testing

  • Many types of allergies: environmental, foods, drug, contact.
  • An estimated 10% to 30% of the global population has an allergic disease.
  • Clinical presentations of allergic diseases, respiratory infections, and autoimmune conditions have similar features.
  • Allergy and immunologic testing can help clarify the diagnosis and guide treatment. Immediate immunoglobulin E (IgE) and delayed T cell–mediated reactions are the main types of allergic responses.
  • The allergens suspected in an immediate IgE-mediated response are identified through serum IgE-specific antibody or skin testing.
  • For patients with an inhalant allergy, skin or IgE-specific antibody testing is preferred.
  • In patients with food allergies, eliminating the suspected allergenic food from the diet is the initial treatment.
  • If this is ineffective, IgE-specific antibody or skin testing can exclude allergens.
  • An oral food challenge should be performed to confirm the diagnosis. Results of laboratory testing for food-specific IgE are generally poor, even less helpful than those for percutaneous skin testing.
  • Patients with an anaphylactic reaction to an insect sting should undergo specific antibody or skin testing.
  • Skin testing for penicillin has a high negative predictive value and can help when penicillin administration is indicated and there are limited alternatives. Testing for other drug allergies has less well-determined sensitivity and specificity, but can guide the diagnosis.
  • Patch testing can help identify the allergen responsible for contact dermatitis.

Food Allergies

  • Patients with suspected food allergies are commonly seen in clinical practice.
  • Although up to 15 percent of parents believe their children have food allergies, these allergies have been confirmed in only 1 to 3 percent of all Americans.
  • Family physicians must be able to separate true food allergies from food intolerance, food dislikes, and other conditions that mimic food allergy.
  • The most common foods that produce allergic symptoms are milk, eggs, seafood, peanuts, and tree nuts.
  • Although skin testing and in vitro serum immunoglobulin E assays may help in the evaluation of suspected food allergies, they should not be performed unless the clinical history suggests a specific food allergen to which testing can be targeted.
  • Furthermore, these tests do not confirm food allergy. Confirmation requires a positive food challenge or a clear history of an allergic reaction to a food and resolution of symptoms after eliminating that food from the diet.
  • More than 70 percent of children will outgrow milk and egg allergies by early adolescence, whereas peanut allergies usually remain throughout life.
  • The most serious allergic response to food allergy is anaphylaxis. It requires emergency care that should be initiated by the patient or family using an epinephrine auto-injector, which should be carried by anyone with a diagnosed food allergy.
  • There are no recommended medications to prevent IgE- or non–IgE-mediated allergic reactions to food. Allergen-specific immunotherapy or immunotherapy with cross-reacting allergens is not recommended to treat food allergy.
  • Some environmental allergens cross-react with foods, such as:
    • Birch pollen:  Carrots, celery, fresh fruit (e.g., apples, cherries, nectarines, peaches, pears), hazelnuts, parsnips, potatoes
    • Grass pollen:  Kiwi, tomatoes
    • Ragweed pollen:  Bananas, melons (e.g., cantaloupe, honeydew, watermelon)

Nonallergic Rhinitis

  • Chronic nonallergic rhinitis encompasses a group of rhinitis subtypes without allergic or infectious etiologies.
  • Although chronic nonallergic rhinitis represents about one-fourth of rhinitis cases and impacts 20 to 30 million patients in the United States, its pathophysiology is unclear and diagnostic testing is not available.
  • Characteristics such as no evidence of allergy or defined triggers help define clinical subtypes.
  • There are several subtypes with overlapping presentations, including:
    • nonallergic rhinopathy,
    • nonallergic rhinitis with nasal eosinophilia syndrome,
    • atrophic rhinitis,
    • senile or geriatric rhinitis,
    • gustatory rhinitis,
    • drug-induced rhinitis,
    • hormonal rhinitis, and
    • occupational rhinitis.
  • Treatment is symptom-driven and similar to that of allergic rhinitis. Patients should avoid known triggers when possible.
  • First-line therapies include intranasal corticosteroids, intranasal antihistamines, and intranasal ipratropium.
  • Combination therapy with decongestants and first-generation antihistamines can be considered if monotherapy does not adequately control symptoms.
  • Nasal irrigation and intranasal capsaicin may be helpful but need further investigation.

Hives (Urticaria)

  • Hives are typically large, raised areas on the skin that can itch and spread and coalesce into huge areas of swelling
  • They can be caused by many things, including:
    • Colds
    • Bladder infections or other types of infection
    • Allergies to food, particles in the air, or things that touch your skin
    • Insect stings or bites
    • Medicines
    • Heat, cold, or pressure
    • Exercise
    • A serious disease, but this is uncommon In many cases, no specific cause is found.

About Morrow Family Medicine and Dr. Jim Morrow

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

Forsyth BYOT

In 2013, Dr. Jim and Peggie Morrow found that hundreds of students in Forsyth County did not have the technology necessary to succeed in the highly technical environment that school is today. The county relies on online work a great deal and so many students were having to go to the library or a Starbucks to access assignments because they did not have internet in their homes.  Additionally, many did not and do not have internet capable devices that make this work possible either.

So, the Morrows made it their mission to bridge this gap and help these students try to break the cycle of generational poverty that so many of them are born to.

In the last five years, over $300,000 has been raised and donated by Forsyth BYOT to the Forsyth County Schools for this purpose. Forsyth BYOT seeks to raise awareness of the problem and find sponsors to donate or raise money outright through two yearly fundraisers, the BYOT Golf Tournament in May and the iRUN for BYOT 5K & FunRun in October.  Donated funds are given to the school district, which has staff in place to first determine which students are in need and then to purchase and distribute internet hotspots or devices to that family.

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