Monday, November 3, 2014
We Have Moved!
In order to continue to serve you well, we have moved our blog to a new platform! Please visit us at hcavirginiaphysiciansblog.com to read what our providers are saying about all of the health topics relevant today. We look forward to seeing you there!
Monday, October 27, 2014
Early Detection is the Best Medicine
Susan Uhle, CNP Richmond Surgical Henrico Doctors' Hospital |
Early detection is currently the cornerstone of the
arsenal in the war against Breast Cancer.
This is accomplished through annual Mammographic Screening, and, at
times, other imaging methods such as Ultrasound and Breast Magnetic Resonance
Imaging (MRI). Combined with genetic screening, we look to identify signs of
the disease early and improve the chances for a favorable patient outcome.
Screenings and tests tell us many things about a
patient’s overall risk, and findings from Mammography can lead to Needle
Biopsy, where results can range from benign, to benign but abnormal, to
cancer. These results dictate the next
action, which may include surgery or closer surveillance. The results also allow us to better stratify
individual risks, and determine next steps for investigation or treatment.
There are many paths that further tests and detection can
take. As an example, Christina undergoes a Screening Mammogram, leading to a
Needle Biopsy; results show Atypical Ductal Hyperplasia (ADH), which is a
benign lesion of the breast that indicates an increased risk of Breast Cancer. Her risk of developing cancer is now known to
be four times that of a woman her age without those findings. There are certain measures she can take to
decrease that risk, including lifestyle modification, surveillance, and
chemoprevention (the use of natural, synthetic, or biologic substances to
reverse, or prevent the development of cancer).
Family history plays a significant role in incidence of
Breast Cancer, and there are individuals with a personal or family history, who
should be further evaluated at the time of Mammography or during the office
visit. We know that a family history in
a first degree relative (mother, sister, or daughter) confers an increased risk
for development of Breast Cancer.
There are many available options to pursue if unfavorable
results are found after Mammography or other screening activities. If we find
that there is a malignant tumor, and the Breast Cancer was one of several types
(early onset, two separate Breast Cancers, Male Breast Cancer, Ovarian Cancer,
Multi-Generational), we would consider whether there is an inherited mutation
in the family. Although this is present in only 5 to 10% of individuals, the
Breast and Ovarian Cancer risk is as high as 87% and 44%, respectively, in the
patient’s lifetime, depending on many factors.
Fortunately, there are many options for treatment and
future preventive activity. Preventive Mastectomy and removal of ovaries is the
choice of many, but not all, women. This reduces the risk of Breast and Ovarian
Cancer, but not to zero. This prevention, one form of risk management, was
chosen by Angelina Jolie after she discovered she carries a mutated copy of the
BRCA1 gene, with wide media coverage after the announcement. This is a personal
decision, to be made with all facts in place and with information from a health
care provider with extensive knowledge in this area. For those at a lesser
risk, at the opposite end of the continuum, one would start with lifestyle
changes and medication.
Because more data allows us to make informed decisions
regarding the next steps in the path to prevention, early detection is the most
important piece of the puzzle, and options have never been more readily
available for preventive care.
For further inquiries about breast cancer and genetics, or to set up a
consultation for a breast health screening, contact Susan Uhle, CNP, of Richmond Surgical, at 804.285.9416.
Wednesday, October 22, 2014
Tapering for Your Big Race
Jonathan Wilson, DPT HCA Virginia Sports Medicine Chippenham Hospital |
Runners are good at listening and following instructions. We are especially good if these instructions include running more, longer, or harder. If the work-out seems almost impossible, we are
excited to push out bodies to complete it. However, runners are quick to stop
everything and wait, as if they are waiting for a punchline to a joke, when we
are told to taper.
Taper?
Taper, as in running less? That cannot be right. Tapering is
just another word for resting, right?
No. Tapering has been shown in many research studies
to help improve performance on race day. Research has shown tapering has improved
performance from on average 3 to 5 percent, with a high of 16 percent! A 5% increase,
would take a 4:00 hour marathon and improve it by 12 full minutes, to give you
a 3:48 marathon. Just by tapering and resting, you could run faster by 12
minutes. Not too shabby.
The goal of tapering is to find the balance between
maintaining the cardiovascular fitness level you have obtained through hard
work, and resting to reduce fatigued muscle and stressed tissue from training.
If you taper for too long, you could risk losing the cardiovascular fitness level you
gained. However, if you do not taper long enough your body and muscles will be
fatigued and not at optimal performance level come race morning.
So, how do you taper?
Tapering is individualized like running programs, shoes,
and styles. However, there are general rules you can follow to find a good
tapering plan for you.
The overall length of your taper is based on the distance
of your race. This is pretty simple. Research supports the below as the optimal
number of days to taper for specific races:
Cut back on mileage, NOT intensity or frequency. Reference the below chart for percent of weekly mileage to decrease:
The overall goal of tapering is to allow your body to rest
and heal from your training, while not losing the cardiovascular gains you have
worked so hard to obtain. It is also important to mentally feel like you are not
getting "out of shape” while cutting back from running before your big race.
By maintaining the amount of times you run
(frequency) and running at your target race pace (intensity), but cutting down
on the overall mileage, you should mentally feel like you have maintained your
current fitness level as your body rests. In other words, you are gaining
speed on your race day from running less. It simply does not get better than
that.
After your race, if you would like a consultation on your results, how to improve performance, or to schedule a comprehensive Biomechanical Gait Video Analysis, contact Jonathan Wilson, DPT, at hcavasportsmed.com, or HCA Virginia Sports Medicine’s Boulders location at 804.560.6500.
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Monday, October 20, 2014
Women’s Health at Every Age
Julie H. Ladocsi, MD Richmond Women's Specialists Johnston-Willis Hospital |
Everyone recognizes Breast Cancer Awareness Month in October, but did you know there are many things you can do throughout the months and years to reduce your risk and stay generally healthy? It's important to stay connected to your overall health as a woman, as preventive care is often the best medicine.
Gynecological care emphasizes women’s health maintenance in ways that
primary care visits do not. We assist in early detection of diseases and develop a customized care plan that facilitates total health
based on family history, lifestyle, nutrition, and current risk factors for
illness.
There is significant overlap of medical care between age ranges for
women, and we try to understand your total health picture so we can develop a
long-term care plan.
In your teens… You should establish
a relationship with an OB/GYN with whom you feel comfortable and can discuss
health issues honestly. We will address concerns regarding menstrual issues,
contraception, and prevention of sexually transmitted diseases. We will discuss
appropriate vaccinations, including prevention options for HPV, the virus that
causes cervical cancer. Internal pelvic exams are unnecessary at this stage
unless needed to address a specific problem. Open and honest dialogue with
parents or guardians is encouraged at this time.
In your 20s… PAP smear screening
for cervical cancer begins. Clinical guidelines recommend PAP smears every 3-5
years; however, gynecologic exams should still be administered annually. We
will also discuss the HPV vaccine with you if you haven’t already been
vaccinated. We will continue to work with you on contraception management and
STD prevention and screening. This is also normally the time when we will begin
pre-conception planning and even reproductive management, if you’re starting to
have children.
In your 30s… We will focus on many
of the items we’ve discussed in prior years, but this is when many women will
be having children and managing the accompanying physical changes.
Contraception and reproductive management are still a priority, as well as
managing routine screenings. Pelvic and menstrual problems can surface during
this decade, and we will develop a care plan for those if necessary.
In your 40s… Screening mammograms
for breast cancer begin with regularity and we will discuss menstrual changes
related to age. HCA Virginia has a robust imaging network and multiple options
for screening locations. We will also continue reproductive planning and
post-partum issues as appropriate.
In your 50s… We continue to focus
on breast health with annual screening mammograms and clinical breast exams.
Colorectal screening begins in earnest in this decade, as well as management of
perimenopausal and menopausal physical changes. For some women, urinary health
can also be an issue and we will address that as necessary.
In your 60s… We will screen for
breast and pelvic abnormalities and begin bone density testing (earlier for
high-risk patients). Menopause management can still be a concern and we will
address those issues accordingly.
In your 70s and
beyond… Our priority will be prevention of osteoporosis and reducing fracture
risks. We will continue to screen for pelvic and breast abnormalities, as well
as manage gynecologic and urinary health.
Women’s health and preventive medicine is a fluid dialogue over many
years between the practitioner and the patient. We hope to develop a
longstanding relationship with you so we can effectively manage the continuum
of your health in a way that promotes great communication and overall
well-being.
For further inquiries about women’s health contact JulieH. Ladocsi, MD, of Richmond Women’s Specialists, at 804.267.6931, or visit
their website at richmondwomens.com.
Wednesday, October 15, 2014
Obesity and Infertility are Linked - Surgery May Relieve Both Conditions
Mohammad Jamal, MD, FACS Surgical Weight Loss Center at Spotsylvania Regional |
Obesity has been linked to infertility and studies show bariatric
surgery may treat one of its most common causes - polycystic ovarian syndrome (PCOS), a hormonal imbalance that affects up to 10% of women of child-bearing
age – 33-50% of whom are overweight or obese.
Not many patients come to a bariatric surgeon to treat infertility
problems, but women with morbid obesity, who are infertile secondary to PCOS,
may have a surgical option. Many other studies have shown bariatric surgery can
improve or resolve a multitude of diseases and conditions, and now infertility
appears to have joined the list.
Recent clinical research from the University of Iowa Hospitals and
Clinics showed that nearly all morbidly obese women enrolled in the study, who
were diagnosed with PCOS-related infertility and desired children, became
pregnant within three years following gastric bypass surgery. Doctors advise
women not to try to conceive until at least 18 months after bariatric surgery
due to surgery-related changes that could affect fetal development.
Before surgery, the women had an average body mass index (BMI) of 52,
and after surgery had an average excess weight loss of nearly 60%. Menstruation
corrected in 82% of the women and nearly 80% no longer had Type 2 diabetes. In
addition to infertility, PCOS increases the risk of obesity, insulin resistance
and Type 2 diabetes, heart disease, irregular menstrual cycles and miscarriage.
Obese women who become pregnant may suffer from a complication of gestational
diabetes, which passes on an increased risk for early diabetes and obesity to
their children.
Significant weight loss also reduces the risk of pregnancy related
complications, which is another important consideration. Though this is a small
study, it has a big result and should be an area for more investigation and
should be discussed with morbidly obese women who are having difficulty
conceiving – especially those who have failed conventional methods of conception
including hormonal treatments and in-vitro fertilization.
Bariatric surgery has been shown to be the most effective and long
lasting treatment for morbid obesity and many related conditions. People with
morbid obesity have BMI of 40 or more, or BMI of 35 or more with an
obesity-related disease such as Type 2 diabetes, heart disease or sleep apnea.
According to the American Society for Metabolic and Bariatric Surgery (ASMBS),
more than 15 million Americans have morbid obesity. Studies have shown patients
may lose 30-50% of their excess weight 6 months after surgery and 77% of their
excess weight as early as one year after surgery.
The most common methods of bariatric surgery are laparoscopic gastric
bypass and laparoscopic adjustable gastric banding (LAGB). Bariatric surgery
limits the amount of food the stomach can hold, and/or limits the amount of
calories absorbed, by surgically reducing the stomach’s capacity to a few
ounces.
If you have more questions about obesity-related infertility, metabolic
disease, or bariatric surgery, contact Dr. Mohammad Jamal with the Surgical
Weight Loss Center at Spotsylvania Regional at 540.423.6600 or visit their
website at fredericksburgweightloss.com.
Quick Question - Why Is a Patellar Tendon Tear So Bad?
Source: Associated Press |
Last night, during Sunday Night Football, the New York Giants faced a heavy loss to the Philadelphia Eagles.
Their loss, though, involved so much more than a football game. Victor Cruz,
the Giants’ standout wide receiver, suffered a torn patellar tendon in his
right knee, a season-ending injury.
The patellar tendon connects the
patella (kneecap) to the tibia (lower leg “shin” bone). This tendon is what
allows for extension and movement of the lower leg. Surgical reconstruction is
complicated because not only does the tendon need to be properly reconnected,
but the tension must also be accurately reinstated.
In Cruz’s injury, early
reports tell us that it has been a complete tear, which will require surgery,
extensive rehabilitation, and a minimum of 4-6 months before active
participation.
For more questions about sports
injuries, contact Dr. Doug Cutter of HCA Virginia Sports Medicine at
804.560.6500, visit online at hcavasportsmed.com, or like us at
facebook.com/hcavasportsmedicine.
Monday, October 13, 2014
I Feel a Breast Lump - Now What Do I Do?
Eric P. Melzig, MD Richmond Surgical Henrico Doctors' Hospital |
One of the scariest moments for a woman is when she feels
a lump in her breast, with the human nature of fearing the worst taking over. Thoughts
of a cancer diagnosis become the immediate concern; anxiety then enters the
picture, along with the perception of a negative outcome. The good news is the
vast majority of breast lumps are benign and harmless. A similar scenario plays
out when a woman is informed that her mammogram is abnormal and further imaging
is indicated, with the vast majority of mammogram abnormalities being benign.
The evaluation of a new breast lump should begin with a
visit to one's primary care physician or gynecologist. Your physician will
perform a dedicated history and physical examination with emphasis on factors
influencing breast health. Key features of the history include the presence or
absence of nipple discharge, pain, or lymph node swelling. Is there redness of
the breast associated with the lump? This may indicate mastitis. If one is
premenopausal, has the breast lump changed in size and texture over time, and
does this correlate to the timing of the menstrual cycle? If nipple discharge
is present, is it clear or bloody, and is it spontaneous? Much information can
be gleaned from a detailed history, which can be segmented into the below
parts:
Risk
Assessment
A detailed personal risk assessment will not necessarily
dictate treatment of the newly discovered lump but can add perspective. Risk
analysis is helpful in planning a long-term approach to breast health and a
screening strategy. The salient risk factors, in order of importance, are: 1) personal history of familial genetic
mutations (Angelina Jolie's BRCA1 and BRCA2 mutation, for example); 2) personal
history of previous breast cancer; 3) personal history of non-malignant
proliferative benign disorders (sclerosing adenosis, ductal hyperplasia or
atypical ductal hyperplasia, for example); 4) breast density on mammography; 5)
family history of breast cancer; and 6) previous radiation therapy to the chest
(for example, Hodgkin's disease treatment). The risk factor generating the
greatest misconception is a positive family history of breast cancer, with
women automatically suspecting doom when they feel a breast lump. Conversely,
women with negative family history tend to feel bullet proof. Both concepts are
incorrect, as the status of the family history is an important factor, but
breast cancer is multifactorial and family history is only one of many risk
components. Ultimately, most breast cancer patients have a negative family
history of breast disease and the majority of patients with breast cancer (60%)
have no identifiable risk factors.
Physical
Examination
The breast exam alone can lead to a benign diagnosis
without imaging or biopsies. Findings such as mastitis, fibrocystic changes
with associated breast thickening, waxing and waning masses associated with
one's menstrual cycle, and lesions that are actually in the skin and not in the
breast can all be readily diagnosed as benign entities. If the palpable lesion
is indeed a true mass on physical exam, then breast ultrasound is the preferred
method of evaluation. Ultrasound will distinguish a benign simple cyst from
complex cysts and solid lesions. This distinction can lead to an
ultrasound-guided cyst aspiration and resolution of this benign lump or it can
point to the need for further investigation with additional imaging.
Diagnostic
Mammogram
After intake of a patient’s history and a physical exam,
a diagnostic mammogram is the next tool for patients aged 35 and older. If less
than 35 years of age, the accuracy of a diagnostic mammogram significantly
decreases due to the natural breast density of a young woman, as breast density
naturally decreases with age. For those under 35, a solid lesion can best be
diagnosed with an ultrasound-guided needle biopsy. At this young age, the high
percentage diagnosis is a benign fibro-adenoma.
For those over 35, the diagnostic mammogram will yield
important information concerning the nature of the mass. Is it smooth or are
the borders irregular? Does it create architectural distortion? Are there any
other lesions present that are too small to be palpated? The recent
introduction of 3D tomosynthesis with mammography adds detection sensitivity. Needle
biopsy using mammogram imaging is called a stereotactic biopsy. Imaging with
breast MRI is very sensitive in detecting breast abnormalities and is
especially helpful in patients with dense breasts. If a lesion is not
visualized on mammography, 3D tomosynthesis or ultrasound, then a needle biopsy
using MRI image guidance is the preferred diagnostic option.
Multiple well-controlled, large, randomized studies
document that annual screening mammography saves lives. As a cancer is
evolving, mammography leads to early detection. If the malignant process is
diagnosed earlier in its natural history, we are lead to higher cure rates and
less severe treatments. Despite some controversy, mammography lowers the risk of
dying from breast cancer and should be a mandatory component of every woman's
healthcare plan.
It is important to note that men are not exempt from
breast cancer. While women account for 99% of breast cancer diagnoses, men are
still at risk and 2,000 men per year in the United States are diagnosed. Therefore,
men must fight their usual reluctance to seek medical attention and have any
breast lumps examined by their physicians.
Do not panic if you find a breast lump on self-exam. Benign
diagnoses far surpass malignant diagnoses. Remain calm and consult with your
treating physicians. Personal history, physical examination, imaging, and, if
required, image-guided needle biopsy will most likely lead to a benign
diagnosis, ruling out malignancy.
For further inquiries about
breast cancer management and advancements, or HCA Virginia’s Breast CareNetwork, contact Eric P. Melzig, MD, of Richmond Surgical, at 804.285.9416, or
visit their website at richmondsurg.com.
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