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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 possibilities. 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 Dr. Taylor cancer, or a reaction to 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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Longleaf Communities Brought to you by Kathy Rice Atlanta Fine Homes Sotheby’s International Realty Longleaf Communities is the premier luxury homebuilder for active 55+ adults in metro Atlanta. Their spectacular, English Cottage style homes and communities are designed to meet the lifestyle needs and Rice wishes of active seniors while providing low maintenance living. With three convenient locations, Longleaf Communities provides things other Active Adult communities provide: proximity to area attractions and life necessities, low maintenance and ease of living, a lock and go lifestyle and neighborhood amenities. With a Longleaf home, you can have all that plus, the distinguished architecture, attention to detail and superb craftsmanship you’re accustomed to. Our elegant homes feature airy floor
plans with lofty 10-foot ceilings and solid 8-foot doors outfitted with generous millwork throughout. Choose from a variety of custom cabinetry for your designer kitchen and select your preferred finishes for your designer bath. All of our homes feature two main floor bedrooms, each with a full bath
and laundry on the main. The upstairs includes a finished loft, additional full bath and the option to add another bedroom for more livable space to welcome guests. Longleaf currently has 3 communities: Village Green of East Cobb in Marietta (1 opportunity remains), Longleaf Woodstock in Cherokee County (with
Clubhouse and Pool) and Longleaf Battle Park in West Cobb (with Pool & Clubroom). Our thoughtful floor plans and Longleaf’s reputation for superior craftsmanship,are what make Longleaf the luxury builder of active adult communities. www.longleafsouth.com (678) 697-4984
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4 | December 2018 | NorthFulton.com | ForsythHerald.com
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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-threaten-
ing 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
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NorthFulton.com | ForsythHerald.com | December 2018 | 5
Warning signs your aging parents need more help (NAPSI)—Home care agencies often see a surge in calls in late December and early January. Why? Many grown children head home for the holidays and notice their aging parents need some help. “We usually see a surge in demand for care around the holidays as families get together and adult children notice changes in their parents’ well-being and realize they need more support to remain safe and independent in their homes,” said Austin Harkness, head of care for Honor, one of the fastest-growing home care companies in the country. Here are ways to tell: Take The Sniff Test Breathe in that holiday hug. If you notice unclean clothes or an uncharacteristic body odor, that could signal that a parent is having trouble bathing, maintaining personal hygiene or keeping up with household chores such as laundry. Next, follow your nose to the kitchen. Open the fridge. You’ll notice pretty quickly if there’s spoiled food—but your parents may not. The sense of smell diminishes with age, expecially after 70. Many seniors can’t detect unpleasant odors that would normally tell them it’s time to toss last week’s meat loaf. If the sniff test reveals some olfactory oddities, it might not just be “normal aging.” Diminished sense of smell can be an early indicator of Alzheimer’s and Parkinson’s diseases. If you sense something isn’t quite right, help Mom or Dad to set up a doctor’s visit to see if there’s something else going on.
Have A Look Around Your childhood home may look the same as ever— but it may not work as well for older adults. As people age, their environment typically needs simple upgrades to keep them safe. You can significantly reduce fall risks by taping down throw rugs, removing extra furniture, securing electrical cords out of pathways and adding grab bars in the bathroom. Pay attention to clutter as well. Stacks of unopened mail, broken appliances or drooping houseplants may also signal a need for help. Being unable to manage everyday activities can be a symptom of depression or of cognitive impairment, which often presents like depression. If you see any of the above warning signs, you may want to arrange for your parent to see a doctor and for family members or professional caregivers to stop by and help with projects and chores. Just knowing your parents have help and resources can relieve worry, both yours and theirs. Listen Up Is the TV or radio volume blaring? Are conversations repeated? Does Mom keep asking “what?” or just smiling and nodding instead of participating? Don’t brush it off. Difficulty following conversations may be a sign of hearing loss, cognitive impairment or both. Seniors who begin losing their hearing are at greater risk of developing dementia over time since hearing is a brain function. Sometimes, hearing aids stimulate the sounds needed for the brain to restore organization and correctly process sounds.
Making Sense Of Your Senses Talking to parents about warning signs you’ve noticed isn’t fun. But do it anyway. Let them know you want to be involved to help them stay independent for as long as possible. Even if you live far away there’s a lot you can do, such as scheduling appointments and finding help with transportation, chores and projects. Talk to nearby family members about how they can help out or set up a visit with a home care agency that can provide ongoing support. Fear of losing independence keeps a lot of seniors tight lipped. If your parents are open and honest about their changing needs, consider it a generous holiday gift. They trust you’ll know what to do with it.
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6 | December 2018 | NorthFulton.com | ForsythHerald.com
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Soleil Laurel Canyon named ‘Best 50 Master-Planned Communities’ Tucked away in the North Georgia foothills of Canton and just a short drive from exciting Atlanta, Soleil Laurel Canyon is more than a beautiful community of maintenance-free, ranch-style homes and breathtaking views. It’s the lifestyle you’ve worked your whole life to enjoy. If you are 55+, we invite you to come experience Soleil’s incomparable array of recreation, culture, and entertainment for yourself. You’ll have no doubt why it was named among the Best 50 MasterPlanned Communities in the U.S. by Where to Retire Magazine in 2015. “Clubhouses, fitness centers, social clubs and education classes mean residents get much more than a house at a planned community,” said Karen Northridge, publisher of “Where to Retire.” One of the great pleasures of living at Soleil is that a low-maintenance home gives you the free time to take advantage of all that the community offers or take a trip without concern. The landscaped grounds of Soleil Laurel Canyon are always impeccably maintained, while your HOA dues cover complete lawn maintenance and an irrigation system, in-home security monitoring and maintenance, and even Comcast cable TV. Soleil Laurel Canyon offers a selec-
tion of Cottage, Traditional and Craftsman-style single-family homes from the mid $200,000s to $400,000s for adults 55+. Residents live independently in homes that range from 1,500 square feet to almost 3,000 square feet. All of Soleil’s new floor plans include elegant details and are designed for aging-inplace with stepless-entry access and wide doorways. These homes are energy
efficient with HERS ratings above standard. Soleil residents have membership in a 28,000-square-foot clubhouse complete with an arts and crafts room, billiards room, fitness center, gourmet teaching kitchen, indoor heated saline lap pool, and library. Outside the clubhouse, residents have a heated Lagoon-style pool, a community garden and greenhouse, a 3.5-
acre fishing lake and the tennis facility with a full-time USPTA-certified teaching professional. The Fairways of Canton golf course is located just outside Soleil’s gate within Laurel Canyon, and offers challenging golf for a reasonable, daily-fee price. Two Lifestyle Directors maintain a full social calendar of events including wine socials, movie nights, trips to nearby attractions, and Grandkids day.
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Vickery Rose Retirement Resort Imagine coming home to a warm, friendly community that’s luxurious, safe and comfortable. Maintenance and housekeeping included, and every meal of the day is expertly prepared and pleasing to the palette. With all the work done, you have time for family, friends and the important things in life. That can be your life at Vickery Rose Retirement Resort. Designed for your comfort, our community will feature studios, to 3-bedroom apartments with a variety of floor plans and smart details. Each apartment will feature window coverings, climate-controlled thermostat, ceiling fans, and ample closet space. Our kitchens will be fully equipped with a dishwasher, range, microwave, refrigerator and a garbage disposal. Washer/dryer hook-ups are located in a separate laundry closet within the apartment. Our professional staff will provide as-needed maintenance repairs and light housekeeping on a weekly basis. Vickery Rose’s stunning main dining room is the perfect setting to savor meals prepared fresh daily by the chefs in our state-of-the-art commercial kitchen. Experience our signature Freedom Dining program, which includes flexible dining hours throughout the day, plus these dining experience options: • Fine dining • Casual buffet • Chef’s Pantry on-the-go snacks • Room service Residents can access to on-site banking, salon, general store, and pharmacy services. Through our 24/7 concierge services, everything you need will be available at the touch of a button, even scheduled transportation on our shuttle. Relax by the fireplace in our community lounges, or a night of movies or live entertainment in the 150-seat theater. At Vickery Rose, there will be no shortage of social activities. Our community Lifestyle Directors consistently schedule unique activities designed to meet the resident’s requests. Ultimately, companionship and interaction with others are powerful tools to enjoy retirement and with so many entertaining options and the caring community staff on hand, Vickery Rose brings residents together.
NorthFulton.com | ForsythHerald.com | December 2018 | 7
8 | December 2018 | NorthFulton.com | ForsythHerald.com
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Four ideas for health care planning in retirement
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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(NAPSI)—The Employee Benefit Research Institute estimates that a typical 65-year-old couple will spend a total of $265,000 in health care costs over the remainder of their lives. This staggering amount of money has the potential to derail even the best-laid retirement plans. Vanguard and Mercer recently developed a new framework, “Planning for Health Care Costs in Retirement,” that identifies practical tips for forecasting your health care expenses. Here are four top ideas: 1. Personalize health care costs. Start by understanding how your health history and current health status will influence expenses. Even your geographic location, marital status and age at retirement will impact your forecasts. 2. Plan for long-term care. This is a tough one to assess because half of retirees won’t even incur these costs, but on the other end of the spectrum, 15 percent of retirees will spend more than $250,000. Consider potential long-term care options, such as unpaid care from family and lessexpensive available facilities.
3. Create a hedge in your budget for other expenses. Research shows that retirement spending in virtually all categories other than health care tends to decline with age. By forecasting steady spending in other expense areas, you may create a buffer in your budget to deal with rising health care expenses. 4. Forecast costs in annual spending. There are so many variables involved in estimating health care costs in retirement that trying to plan around a total lifetime budget can be overwhelming. Experts recommend that you focus on annual spending plans instead, provided that you understand costs will rise as you age. For seniors who are struggling to find cash in their retirement budgets to offset unexpected health care expenses, it may be a good idea to take stock right now of all your assets. Many seniors are surprised to learn that one potential asset for generating immediate cash is a life insurance policy. You should review your life insurance policy from time to time and determine whether or not it’s still needed. A life insurance policy is considered your personal property, so you have the right to sell it anytime you like. When a consumer sells a policy—something called a “life settlement” transaction—the policy owner receives a cash payment and the purchaser of the policy assumes all future premium payments, then receives the death benefit upon the death of the insured. Candidates for life settlements are typically aged 70 years or older, with a life insurance policy that has a death benefit of at least $100,000. If you own a life insurance policy you no longer need or can afford, you may be able to generate immediate cash to pay your health care expenses by selling that policy for immediate cash.
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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
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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.
10 | December 2018 | NorthFulton.com | ForsythHerald.com
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