December Special Section
2 | December 2018 | NorthFulton.com | ForsythHerald.com
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How Doctors Think:
Insights into differential diagnosis By Dr. Brent Taylor Premier Dermatology and Mohs Surgery of Atlanta How does a doctor make a diagnosis? How does he or she choose which information is important? On television, it often seems likes the right diagnosis almost magically comes to a doctor. On the tv show House, the main character watches as the less experienced physicians struggle and make missteps. Then, like Sherlock Holmes, the gifted doctor notices a key point or seems to summon up a brilliant insight out of thin air. For me, one of the more interesting topics in medicine is the process by which physicians arrive at a diagnosis. Surprisingly, multiple approaches to making a diagnosis exist, and there is considerable variation across specialties within medicine. Each approach has its pros and cons, and most physicians are likely using a hybrid approach that takes the best from each model. And thank goodness, arriving at the right diagnosis doesn’t require magic. When I was a medical student, I remember being quite impressed at one emergency medicine doctor’s emphatic insistence that all physicians should memorize the emergencies and “can’t miss” diseases that would match up with any complaint that they see. His name is Dr. Corey Slovis. He is a phenomenal teacher, and he shared with his students that there are approximately five “can’t miss” diagnoses for every “chief complaint.” For example, if a patient presents with chest pain, Dr. Slovis said that every doctor should immediately think of heart attacks, cardiac tamponade, aortic dissection, pulmonary embolism, tension pneumothorax and Boerhaave syndrome (sometimes five adds up to six). He had five emergencies or can’t miss diagnoses for almost every complaint a patient could have. He said that you couldn’t rely on consults or reading textbooks to make these diagnoses. Time was of the essence. Dr. Slovis’s approach to differential diagnosis seemed to be to rule out the emergencies, which you had to memorize in advance, then move on to the less time-sensitive diagnoses. On another rotation, a fantastic internal medicine resident shared with me his approach to differential diagnosis, summed up by the mnemonic “VINDICATE,” which stands for vascular disease, infections, neoplasms, drugs, iatrogenic, congenital, autoimmune, trauma and endocrine disease. This resident told me that when making a diagnosis, I should consider all the options and try to run through pos-
sibilities. For example, for the smoker with a cough, could the cough be from a vascular disease such as heart attacks leading to heart failure, or an infection like pneumonia, or a neoplasm such as lung cancer, or a reaction to Dr. Taylor a drug such as an ace inhibitor, etc.,? My resident friend suggested running through the possibilities systematically and thinking of every category of disease first so as to avoid missing something important, such as lung cancer presenting as a cough. Another physician suggested thinking through each organ system (cardiovascular, pulmonary, etc.,) instead of thinking through VINDICATE when creating a list of diagnoses. Finally, a family medicine physician advised me that I should be patient and let my list of possible diseases build with time and experience. He said that the common diseases are almost always the correct ones and that with time the number of diseases that I could think of would grow. I believe that all these approaches have their merit. And each approach seemed to fit the field of the physician who espoused it. In medical school, my synthesis was that I should first try to memorize the emergencies and “can’t miss” diagnoses for as many complaints as possible. In dermatology, a “can’t miss” list for someone with a scaly rash might include cutaneous t-cell lymphoma and syphilis, for example. Second, I should let my list of common diagnoses grow with experience, and if a presentation matches perfectly, there’s rarely reason to go further. However, if someone’s presentation is atypical or doesn’t seem to add up to one of the diseases on the “can’t miss’ list or the common list, then it’s useful to think of VINDICATE or organ systems systematically and generate a list of diseases to work through before turning to textbooks, consultations or medical journals. Obviously, there is a lot more to say on this subject, but I hope that this brief synopsis of methods of differential diagnosis is interesting and thoughprovoking. If you or a loved one has a history of skin cancer, vein disease or any cosmetic or dermatologic complaint, please consider entrusting your skin care to board-certified and fellowship-trained Dr. Brent Taylor of Premier Dermatology and Mohs Surgery of Atlanta.
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Building a support network that works for you Brought to You by Home Helpers of Alpharetta As we head into the holiday season, one of the best gifts to yourself or an older loved one is to assess your care needs and whether you have a solid support system behind you. Here’s what to do to start building a support network that you can rely on in good and difficult times. Look at What You Need and Want When you’re just building or adjusting your support network, it’s vital for you to know what you need and what you want. Do you need someone to run errands? You may want someone to help with personal care or preparing meals. Perhaps there are medical conditions that are posing new challenges. Whatever it is, have a clear picture in mind so that you can look for support from people with the right skills and solutions that meet those needs. Balance What Works and Where You Need Help Chances are there are parts of your
support system that already work well for you. Maybe you’ve got a family member who helps with grocery shopping. That’s something to put in the plus column. Next, figure out where you need more or different types of help. These situations are going to fluctuate depending on what is going on in your and your older loved one’s life. If you are a primary caregiver, remember to provide some time for yourself to recharge. It’s critical to keep your own mental and physical health in shape. With your needs prioritized, you can start to find the right solutions. We’re here to help when life becomes more challenging. A professional heart-centered Home Helpers caregiver has the skills to help with all personal care, help around the house, transportation and specialized care for Alzheimer’s or Parkinson’s, etc. We look for the youthful spirit in our clients and our award-winning care can help live life to the fullest in the comfort of home. For a free in-home consultation and customized plan, please contact Home Helpers of Alpharetta at (678) 430-8511.
NorthFulton.com | ForsythHerald.com | December 2018 | 3
4 | December 2018 | NorthFulton.com | ForsythHerald.com
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Dr. Tamakuwala joins Emory Women’s Center The truth is, very few people like to go to their OB/GYN. Conversations about your reproductive health and annual exams, like a pelvic exam, can be uncomfortable. It is my mission to help all of my patients feel comfortable telling me about any problems that they are experiencing because I know that this is the only way I can help them. My name is Sejal Tamakuwala, DO, and I am excited to be joining the Emory Women’s Center practice at Emory Johns Creek Hospital. As your gynecologist or obstetrician, you can expect your appointments with me to be both comfortable and stressfree. I am committed to explaining every step of your visit as we go along and with an assistant in the room to provide additional support, exams run smoothly for everyone. As an OB/GYN, I often see patients throughout most of their adolescent and adult lives, beginning with the start of menstruation to contraception counseling, pregnancy and delivery, and menopause and beyond. I also specialize in providing OB/GYN care for those who have a history of anxiety or sexual trauma. Whether performing gynecologic surgeries such as hysterectomies and
As your gynecologist or obstetrician, you can expect your appointments with me to be both comfortable and stress-free. I am committed to explaining every step of your visit as we go along and with an assistant in the room to provide additional support, exams run smoothly for everyone.
Sejal Tamakuwala, DO complicated deliveries to your annual well-woman exam, I genuinely enjoy the full spectrum of both obstetrics and gynecology. If you need minimally invasive surgery, which uses special technologies to
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limit the size of surgical incisions and reduce the need for opioid pain medications, please know that I can meet that need for you as well. I am looking forward to bringing my expertise to the Johns Creek community, where I will both take care of patients and finally get to have some real southern comfort food! If you are interested in making an appointment with me, call 404-778-3401 and ask for Dr. Tamakuwala. About Sejal Tamakuwala, DO: Sejal Tamakuwala, DO is an Assistant Professor in Gynecology and Obstetrics at Emory University School of
Medicine. Dr. Tamakuwala attended New York Institute of Technology- College of Osteopathic Medicine and trained in Obstetrics and Gynecology at Hutzel Women’s Hospital and the Detroit Medical Center in Michigan, which boasts the Perinatology Research Branch of the National Institutes of Health, a world-renowned research center in obstetrics, and it was here that she had the opportunity to work with some of the most brilliant minds in high-risk obstetrics. If you are interested in making an appointment with Dr. tamakuwala, call 404-778-3401.
Arbor Terrace of Johns Creek offers exemplary memory care Arbor Terrace of Johns Creek uses Teepa Snow’s trademarked Gem Programming, Positive Personal Approach and other techniques in caring for residents with a dementia challenge. This approach helps families relate to their loved one in a meaningful, engaging way. They offer personal appointments and tours for families to come and learn more about the Arbor Advantage and their 60-day guarantee of satisfaction. This exemplary resort-style community offers beautiful apartments for Seniors at every stage of their care needs. They have several floorplans for Assisted Living and in their Bridges neigh-
borhood. Families love Bridges higher engagement activities designed for early cognitive challenges. Their Evergreen Memory Care Neighborhood is available for when higher care is needed on their dementia journey. They also offer a furnished suite when needed. Families can now focus on the relationship with their loved one in a less stressful manner and begin to feel the peace of mind that comes from knowing their loved ones are exceptionally cared for by a well trained caring team of professionals. Call Arbor Terrace of Johns Creek at 770-676-2410 to schedule a personal tour.
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Emory Clinic Gynecology and Obstetrics is excited to announce that we are expanding our services to include general gynecologic and obstetrical care with the opening of our second location, Emory Women’s Center at Findley. We want to attend to your pregnancy and delivery needs with care and compassion. Our specialty clinic, offering gynecologic oncology and urogynecological care, continues to provide the specialized reproductive health treatments you seek. And with our new location, Emory Women’s Center at Findley will connect you with general OB-GYN providers and Certified Nurse Midwives to care for you during your pregnancy and deliver your baby. If you are seeking kindness in patient attention and superior quality in patient care, we welcome you. We assure you that we will strive to continuously focus on you as an individual and your personalized health goals. We take the trust you and your family have placed in us seriously, make an appointment today.
NorthFulton.com | ForsythHerald.com | December 2018 | 5
6 | December 2018 | NorthFulton.com | ForsythHerald.com
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The new strong Gaining control over your fitness and your life
For many people, aging equals lower metabolism, weight gain and less energy for activities you enjoy. This is directly related to loss of lean muscle. While you can’t avoid getting older, there are some steps you can take to stop the process of muscle loss and start rebuilding healthy, lean muscle. It doesn’t matter how old you are or whether you haven’t exercised in years. You can still regain lean muscle that improves your shape and increases your metabolism. Our downfall is inactivity. Too much sitting is the new smoking. Our bodies were meant to be active, stay active and be strong. When we stop doing meaningful exercise, we lose ground. What is meaningful exercise? A critical component of stimulating the improvements we seek from exercise is the achievement of momentary muscular failure in each exercise performed. With steady-state activities, like walking on a treadmill or biking, there is no momentary muscular failure involved. Unless activity is demanding, it is practically worthless from an exercise perspective. However, if an activity is sufficiently demanding to take the targeted muscles to momentary failure, then it qualifies as meaningful exercise. Muscle failure should be viewed as a means of signaling the body that it needs to get stronger in order to meet the demands being placed upon it. What is the SuperSlow Zone solution? The SuperSlow Zone protocol is the original and genuine slow-motion, personal strength training workout. The exercise protocol has been proven successful in both building muscle and increasing resting metabolism, thus allowing the body to burn more calories at rest. SuperSlow Zone provides a safe and effective workout in a short amount of time so that you can get in, get out, and get on with your busy life!
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New Year, New You:
Enter 2019 with a brand new smile It’s that time when New Year’s resolutions are being made. The beginning of a new year is exciting in a lot of ways. New ideas are brewing, new adventures are to be had, and you can start over with a fresh new slate. What are you hoping to achieve in 2019? While many join a gym this time of year to get their bodies in shape, how about showing some extra love to your smile? Are there teeth imperfections that you would like to see corrected? If you are dissatisfied with the appearance of your smile, all it takes is a quick phone call to your cosmetic dentist to get you started toward a brand-new smile. Cosmetic dentist Dr. Remaley in Roswell, GA offers a variety of cosmetic dentistry treatments to help patients make their dream smile a reality. He will perform a smile analysis in-office to customize your treatment plan to your unique desires. Below are some common treatments that can help you achieve the new and improved you. Replace those missing teeth Missing teeth are perhaps one of the greatest hindrances. Not only do they mess with the aesthetics of your smile, but they cause self-esteem and functionality issues. To help close the gap – we recommend dental implants for their longevity and realistic results. These small posts are inserted directly into your jawbone and designed to offer superior support for a dental crown, dental bridge, or full arch denture. The number of implants required will depend on the extent of tooth loss. Add sparkle to your smile As you get older, teeth can lose their sparkle and even discolor as a result of the foods you eat. While normal, it’s not something you have to endure for long. Mild to moderate dental stains and discoloration can be corrected with inoffice professional whitening. Although over-the-counter products may help to a certain degree, they are not as effective as the treatments administered by a cosmetic dentist. At our dental office, we provide customized trays and prescription strength whitening agents that can be used together to deliver a brighter smile in a matter of days – up to several shades lighter. Discreetly Straighten Teeth Crooked teeth can affect teenagers and adults alike. If you have avoided correcting your smile out of fear of what
bracket-and-wire braces would do for your appearance and professional life – ask your cosmetic dentist about invisalign. This discreet orthodontic solution uses virtually invisible aligners to correct dental misalignment. Aligners can be removed so you can enjoy all your favorite foods and attend important speaking engagements without worrying what others may think. Treatment times vary, but on average you can straighten your smile in about nine to 12 months. Cover numerous imperfections at once If there are a variety of cosmetic issues – you may want to consider porcelain veneers. This cosmetic dentistry treatment can address: • Crooked teeth • Gapped teeth • Uneven teeth • Severely stained teeth • Chipped teeth • Misshaped teeth Using durable and aesthetically pleasing porcelain, custom-made shells are fashioned to cover individually damaged teeth. With your veneers in place, you will notice a brighter, straighter, and more uniformed smile. Many patients opt for this treatment because it can address numerous issues at once in just two office visits. Ready for a new smile? Contact our Roswell office today to schedule your smile makeover with cosmetic dentist Dr. David Remaley. Roswell Dental Care was recently designated for the 4th year as the ”BEST OF THE BEST” Dental Practice in North Atlanta by Appen Newspaper for 2018. Dr. Remaley has been serving and treating patients in Roswell and the North Atlanta area for over 30 years. As your cosmetic dentist, Dr Remaley will make your comfort and peace of mind a top priority. He offers a comprehensive list of general, restorative and cosmetic dental services designed to meet the needs of the entire family He will thoroughly explain all your options during your private consultation. He will assure that you feel confident in the solution you choose before beginning any treatment. For enhanced comfort during treatment, and we offer FREE nitrous oxide for anxious patients. You can rest assured that your experience will be positive, relaxing, and rewarding on all levels. Give our office a call at (470) 375-9244 to discuss the smile you have always wanted.
NorthFulton.com | ForsythHerald.com | December 2018 | 7
8 | December 2018 | NorthFulton.com | ForsythHerald.com
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The importance of staying warm during winter training With humans being warm weather mammals, it is very important that we keep our warms when we are running in the cold. As the new year is just around the corner, and many runners are preparing to ramp up their outdoor running schedules, it is crucial that we follow safety precautions being out in the cold. Endurance runners, with their lean build, are even more vulnerable to cold and wet environments. Also important, and often overlooked, is doing regular sessions of stretching and strengthening exercises. Warming up prior to heading out as well as maintaining your carbohydrates and fluid intake levels in cold weather will yield a better and often safer performance. During colder temperatures, your muscles don’t contract with the same intensity as they do during warmer temperatures. Your body burns through more carbohydrates and your body becomes less efficient in using oxygen as fuel in the cold weather. As the thermometer drops, your body has to work harder to maintain your core temperature, meaning more energy is being expended. Your body temperature drops and your blood pressure rises as your blood flow is constricted. The body removes excess water to counter this in the form of urine and that’s why
it’s easy to become dehydrated in the winter. Also because you sweat less, your body doesn’t trigger thirst in the same way, so it’s easy to become dehydrated. The hydrating rules are the same in cold Dr. Simmons weather as in warm weather. During warmer temperatures, you’ll have to watch for overheating and heat exhaustion. While when it’s cold, the onset of hypothermia is a real risk that can only be treated by immersing yourself in warmer temperature. If it’s too cold outside, you don’t have to skip your training, just move it indoors. I know a treadmill may not be the ideal place for many runners to train, but maybe you can find an indoor track that will help keep your running routine and regimen fresh, while preventing unnecessary strain and injury. Dr. Matthew T. Simmons is a boardcertified physician with Northside Hospital Cherokee Orthopedics & Sports Medicine and specializes in the diagnosis, evaluation and treatment of sports injuries. Visit northsidecherokeeortho. com or call 770-517-6636 for more information.
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It is fall and time for falls prevention Falls can be a leading cause of fatal and nonfatal injuries in persons over the age of 65 years. That is why it is recommend that all adults older than 65 years of age be screened annually for a history of falls or balance impairment. Fall injuries result in millions of emergency department visits annually. Approximately 25% of all falls can cause serious injuries, such as fractures or traumatic brain injury. The risk of falls that can result in serious injury increases with age. Injuries, such as hip fracture, and falls are can be risk factors for placement in a nursing home, where the fall risk is nearly three times that of persons living at home. Assessment: All persons older than 65 years should be assessed by their physician annually about whether they have fallen. Documenting the number of falls they have had and if they caused injury, and whether they have difficulty with walking or balance. Non-injury falls are an indication of potentially life-threatening events and are an opportunity for your
physician to intervene. Potential Risk Factors for Falls: • Balance impairment • Gait impairment • Muscle weakness • Medication use Interventions to Help Eliminate Falls: • Exercise or Physical Therapy • Vitamin D • Medication Review • Home Safety Evaluation • Vision Correction • Foot Care With early intervention listed above you and your doctor can effectively decrease the potential for falls. Fall prevention is reimbursed as part of the Medicare Annual Wellness Visit. You can schedule an appointment at Alpha Family Medicine for your evaluation and assessment. Checklists for home safety and risk factors for falling (Stay Independent brochure) are available at: http://www.cdc. gov/steadi/patient.html
NorthFulton.com | ForsythHerald.com | December 2018 | 9
10 | December 2018 | NorthFulton.com | ForsythHerald.com
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The Memory Center Atlanta The Memory Center Atlanta is the Southeast Region’s most unique, allinclusive, residential memory care community for people living with Alzheimer’s and any other form of dementia. A diagnosis of dementia does not mean that you cannot keep many aspects of your current lifestyle. It simply means you may need assistance maintaining that lifestyle. At The Memory Center Atlanta, we strive to ensure you truly live with us. Daily activities include Music, Dancing, Local Entertainment, Outings, Art Therapy, Pet Therapy, Religious Services and more. Enjoy a drink in the Chattahoochee Tavern, grab a movie in the Fox Theater or enjoy an ice cream cone at the Bull Dog Café. All residents experience socialization and activities and
those who need 24/7 medical care will benefit from the care provided at The Memory Center Atlanta. We are proud to have Dr. Gary Figiel, M.D., a locally and nationally renowned expert in the field of geriatric healthcare, as the Medical Director. Dr. Figiel works with our team of Licensed Practical Nurses and Certified Nursing Assistants to provide 24/7 care within the comfort of your loved one’s new home. Don’t let a crisis determine where your loved one can receive care. Deciding on memory care early enough, will allow your loved one the opportunity to have the best quality of life and that decision is priceless. Schedule a tour of The Memory Center Atlanta and learn more about how our entire team works together to provide a seamless transition
Happy Holidays from The Memory Center
Atlanta!
for your loved one into their new home. Located at 12050 Findley Rd, Johns Creek, GA 30097, less than ½ mile in
from Medlock Bridge Rd. and directly behind Emory Johns Creek Hospital. Call Today – (770) 476-3678.
NORTH ATLANTA’S HOT TOPICS ON PODCAST
If the holidays have you stressed and you are a caregiver providing care for someone with dementia, please consider utilizing our respite care program. Your loved one will enjoy an all-inclusive stay while you are able to take a vacation or a much needed break. Your loved one will enjoy engaging activities, nutritious meals, and personalized care while you have peace of mind and relaxation.
Please call Michelle at 770-476-3678 for more information. 12050 Findley Rd., Johns Creek, GA 30097 (Behind Emory Johns Creek Hospital)
Go to NorthFulton.com, click on Podcasts and select Inside The Box
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NorthFulton.com | ForsythHerald.com | December 2018 | 11
Cancer-fighting drugs in your medicine cabinet By Jonathan Stegall, MD When we think of cancer treatments, we typically think of chemotherapy, surgery, and radiation. But did you know that you might have some great cancer fighting drugs in your medicine cabinet at home? DR. STEGALL It turns out that many drugs which have been approved for non-cancer indications are found in subsequent research to have an anticancer effect. The most well-known of these is the diabetes drug metformin. In addition to its blood sugar lowering effects, metformin has also been shown to kill cancer stem cells, a key in cancer’s spread. The cholesterol-lowering drugs known as statins have also been found to have an anticancer effect, by affecting the way cancer cells use fat and carbohydrates for fuel. Even baby aspirin, taken by millions of Americans each day for its cardiovascular benefits, has anticancer activity by reducing inflammation and also affects the way cancer cells communicate.
Writing off the end of the year Americans are officially abandoning attempts to be healthy until 2019, according to a new study. A new study into the health and diets of Americans saw as many as 45 percent say they’re postponing any resolution to eat clean or lose weight until after the holiday festivities. The research, commissioned by Herbalife Nutrition, delved into the true extent of holiday indulging and found the average person gains six pounds in holiday weight. Just 12 percent will make it through the holidays without any weight gain at all. Where does that weight gain come from? • Forty-four percent have eaten more than one Thanksgiving dinner in the same day. • Four in 10 have devoured so much holiday food they’ve needed to loosen a button on their pants. Nutrition and health expert Dr. John Agwunobi says that holidays don’t have to throw off your healthy lifestyle. “Healthy snacking is a useful tool in combating overindulgence. Consuming protein-rich snacks before heading out to a holiday feast can help make you feel full, so that you don’t overindulge.”
These are just a few of the many drugs which have been shown in studies to have an anticancer effect. However, it is worth noting that these drugs are not FDA approved to
treat cancer, so their use is considered “off-label.” As always, please discuss this with your doctor to see if these medications might be a helpful addition to your treatment regimen.
12 | December 2018 | NorthFulton.com | ForsythHerald.com
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