Robert McLeod, chief financial officer for McDonald Development Company, argues against a proposed ordinance that would institute transportation impact fees on commercial property at a Nov. 7 County Commission meeting.
Business leaders warn against impact fee plan
By JON WILCOX jon@appenmedia.com
FORSYTH COUNTY, Ga. — Developers, residents and business owners warned the County Commission Nov. 7 that a proposed hike in impact fees for commercial
projects could damage the local economy.
“Best case scenario, it’s going to slow commercial development in a very, very meaningful way,” said Tommy Hughes, president of Hughes Commercial Real Estate.
“And worst case, it’s going to kill
commercial development.”
The warning came months into discussions about increasing transportation impact fees, onetime payments made for each square foot of new construction to
See ECONOMY, Page 5
Sports tourism offsets facilities’ costs, officials say
By JON WILCOX jon@appenmedia.com
FORSYTH COUNTY, Ga. — Sports tourism is big business in Forsyth, county officials said.
FORSYTH COUNTY, Ga. — A new director for the Forsyth County Public Library was announced Nov. 6.
The Board of Trustees unanimously approved Adrianne Junius after a four-month search, according to the library. Library services firm Bradbury Miller Associates conducted the nation-wide executive search.
“I am truly honored to step into the role of library director for Forsyth County Public Library,” Junius said. “As a long-time resident of Cumming and having worked within the North Georgia community for many years, it brings me immense pride to serve my hometown.”
Junius has served as deputy director of the Hall County Library System since 2019. The Forsyth County resident holds a master’s degree in library science from the University of Maryland and a bachelor’s degree from the University of Georgia.
Athletes and their families traveling for tournaments reduced the tax burden for each household in the county by $288 in 2023.
“To some people in this county, it’s a nice meal,” Stacey Gross, director of tourism development for the Forsyth County Chamber of Commerce, said.
“To others, it’s a grocery budget for a month or a car payment. That is a
significant amount of money.”
In 2024, 38,008 athletes competed in dozens of tournaments on Forsyth sports fields, attracting 57,012 spectators, according to the county.
Junius has a total of 15 years in library administration, including experience with budget stewardship, operational efficiency, collection development and construction management.
Sports tourism is one of the larger,
See TOURISM, Page 3
Her appointment comes months
See DIRECTOR, Page 4
JUNIUS
JON WILCOX/APPEN MEDIA
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POLICE BLOTTER
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Cumming man reports threatening text messages
FORSYTH COUNTY, Ga. — A 38-yearold Cumming man reported Oct. 23 he was harassed by a man who repeatedly sent him text messages.
The man said a 32-year-old Alpharetta man had sent him more than 100 text messages and contacted his clients to ruin his business, according to a Forsyth County Sheriff’s Office report.
The suspect is an ex-boyfriend of the Cumming man’s business partner, according to the report.
The suspect’s messages threatened the Cumming man with stalking and blackmail. They also included screenshots of pornography and nude images of the suspect’s buttocks.
The report was investigated as a misdemeanor harassing communication by phone call.
Jon Wilcox
Denver man cited for drugs during Ga. 400 traffic stop
FORSYTH COUNTY, Ga. — A 31-yearold Denver, Colorado, man was arrested on drug charges during a traffic stop Oct. 31.
Deputies stopped a blue Subaru SUV that failed to maintain its lane on northbound Ga. 400 at Pendley Road, according to a Forsyth County Sheriff’s Office report. Deputies noticed the driver’s eyes were bloodshot and glassy and a white powder was on his left nostril.
The man said he was staying with family and had drifted into another lane because he was tired. He denied
consuming alcohol or drugs.
Deputies arrested the man after conducting an impaired driving investigation.
A search of the vehicle revealed cocaine, LSD, MDMA and THC cartridges. A glass spoon with white residue also was discovered.
The man was charged with misdemeanor possession of drugrelated objects and driving under the influence of drugs and felony possession of a Schedule I controlled substance.
Jon Wilcox
Man reports extortion over explicit images
FORSYTH COUNTY, Ga. — Deputies investigated a report of extortion Nov. 2 after a suspect allegedly threatened a 20-year-old Alpharetta man.
The man said he had exchanged explicit pictures with a woman on a messaging app, according to a Forsyth County Sheriff’s Office report. She asked him to visit her at a nearby home to cuddle.
When he declined, the woman demanded he pay her $250 or she would share his photos online.
The man did not send her any money.
Deputies visited the nearby home and determined the only residents were an elderly couple and a dog.
Jon Wilcox
Man points his pistol at teen driver, friend
JOHNS CREEK, Ga. — A teenager reported to police Oct. 28 that a man pointed a gun at him and his friend while driving on Jones Bridge Road.
The teen told police he had pulled up next to the suspect to inform him that the trunk of his silver Honda Accord was open. In response, the teen said the suspect pointed a silver pistol at him. His passenger yelled at them
to pull over, according to the incident report.
The teen followed the suspect, described as an Indian male with a light beard, wearing a gray pullover hoodie, snapped a photo of the suspect’s license plate, then drove off, the report says.
The teen told police he didn’t want to press charges.
Police conducted a follow-up at the Johns Creek address associated with the tag number, and a man matching the description of the suspect answered the door, the report says.
The suspect admitted to police he pointed a gun at “some kids” because he believed they were being racist and was protecting his 80-year-old mother who had been in the car, according to the report.
The suspect apologized for the incident, and police did not obtain warrants on him.
— Amber Perry Man taken for $115,000 in
cryptocurrency scam
JOHNS CREEK, Ga. — A Johns Creek man reported to police Oct. 31 that he had been swindled out $115,000 in a cryptocurrency scam.
The man said he had been contacted in September about an opportunity to make money, according to the incident report. A recruiter told the man he would need to invest $1,000 by converting the money into cryptocurrency and to complete a series of tasks that would provide him commission, the report says.
When the man attempted to withdraw money, he was unable to do so without investing more and completing more tasks, leaving him with a balance of more than $120,000 that includes an alleged $8,200 commission.
The man realized he was being scammed after speaking with family and friends, the report says.
— Amber Perry
Tourism:
Continued from Page 1
if not the largest, segment of tourism in the county, Gross said. The games are played and attended by people from outside the county, bringing fees directly to the county and dollars to the local economy.
Their money also contributes to the county’s Special Purpose Local Option Sales Tax (SPLOST) program, which is expected to generate $354 million over six years, funding numerous projects across the county.
When athletes, their coaches and families visit, they stay at hotels, eat at restaurants, visit attractions and do everything vacationers do, Gross said.
The impact to local hotels is especially significant, she said. Often hotels will find large swaths of rooms rented for several days by uniformed and equipment-toting athletes.
“They are all telling me their weekends are really busy,” Gross said. The economic benefit is the result of careful planning and coordination, she said.
Scott Crawford, an event director for Triple Crown Sports, said his company was attracted to the county by the quality of its fields, ease with working with officials and location.
Triple Crown coordinates tournaments throughout the nation, some of which can include up to 1,200 teams.
Crawford said Triple Crown has made a long-term decision to use Forsyth County fields. His organization also may consider bringing larger tournaments to the county.
The area allows families to enjoy their time outside of the games, he
said. Trips into the heart of Atlanta and to neighboring areas are an exciting opportunity for many who have never visited the area.
“Another goal outside supporting demand in an area for tournaments is finding somewhere exciting to visit,” he said. “Our teams will enjoy Atlanta Braves games.”
Barry Brooks, athletic manager for Forsyth County, said the tournaments represent a win-win for county residents. The facilities that host the games also are used for local teams. When there are no games happening, residents are free to use them for Frisbee, pickup games and other forms of recreation.
The visiting tournaments help
offset the facilities’ costs through fees. Each year, Forsyth collects almost $280,000 in tournament fees.
“It’s an extra use we can get out of it,” he said.
Brooks said if the county were to expand its already considerable array of sports facilities, he likely would be able to find visiting tournaments to host.
“We could always use more facilities and fields,” he said. “Ideally, we would love to find a few more national and regional events.”
TRIPLE CROWN SPORTS/PROVIDED
The DC Sox team from Mississippi holds a banner after winning the 16 and up Elite Division title in 2024. A Chamber of Commerce official said sports tourism boosts the local economy and contributes funds directly to the county.
Forsyth County plans holiday drives for local seniors, children in need
FORSYTH COUNTY, Ga. — Forsyth County Senior Services and the county Fire Department are holding separate drives through this holiday season.
Senior Services is inviting residents to participate in the 2024 Holiday Gift Angels, Meal Sponsorship and Home Repair programs.
The Holiday Gift Angels program asks participants to fill gift request for older adult residents by picking up a gift request tag from the “Giving Tree” at Charles Place or Sexton Hall containing the name of an older adult resident and a gift idea; acquiring the gift; and bringing the unwrapped gift in a gift bag with the gift request
Director:
from Page 1
after longtime Library Director Anna Lyle announced she will step down in January.
Lyle was appointed director in 2015. Before that, she spent 16 years in human resources and finance
tag attached to either location during business hours by Dec. 6.
Participants can also request a gift tag by contacting Senior Services at 770-781-2178 or by emailing seniorservices@forsythco.com. Gift Angels will be available at both centers.
The Meal Sponsorship program asks participants to purchase meal certificates.
Donations to the Home Repair program will assist low-income, isolated elders with repairs, safety modifications and property cleanups. Volunteers perform much of the labor, and funds primarily go towards materials.
For additional information on
management for the library.
She oversaw the expansion and renovation of the Sharon Forks Library, design and construction for the Denmark Library, digitization of the Forsyth County News, introduction of a world languages collection and design and launch of one of the first modern mobile libraries in the state.
Lyle is the second director in the library’s history, following Jon
the holiday programs, call Forsyth County Senior Services at 770-7812178 or visit www.forsythco.com/ senior-services.
The Forsyth County Fire Department is asking for the community’s help as well as part of its 22nd annual Aerial’s House toy collection. The program is named after an aerial ladder truck, a piece of equipment used by the Fire Department.
The department is accepting toys, gift cards to retailers and new or gently used coats for children and adults.
Items can be dropped off at any Forsyth County fire station, the Fire Department Headquarters at
McDaniel, who served as Director from 1996 to 2015.
In May, the board approved a decision to pay Bradbury Miller $31,000 to find a replacement for Lyle.
Junius said she is grateful for the contributions made by Lyle.
“Forsyth County Public Library is one of the most respected and admired library systems in the state, and I am
3520 Settingdown Road or any of the Forsyth County Public Libraries through Dec. 7.
In December, donations for Aerial’s House may also be dropped off inside the lobby of the Forsyth County Administration Building at 110 E. Main St. underneath the lobby Christmas tree.
For information regarding the distribution of toys collected through Aerial’s House, call The Place of Forsyth County at 770-887-1098. For other questions, such as making a large donation or drop-offs, call Firefighter Jeff Lyons at 678-5135899.
honored to continue this tradition of excellence,” Junius said. “I am deeply grateful to the Forsyth County Public Library Board, to Anna Lyle for her leadership and to the dedicated staff for their warm welcome. Together, we will continue to nurture and enhance this beloved library system, ensuring a bright future for all our patrons.”
Jon Wilcox
— Amber Perry Continued
Economy:
Continued from Page 1
offset wear and tear on local roadways.
Commissioners unanimously approved a hike in residential impact fees in August, more than tripling the required payments for home constructions.
In September, Chamber of Commerce officials countered a county proposal, recommending a fee rate that was a fraction of what the county planned. In July, local business leaders voiced concerns over the fees, which were the result of a 2018 study conducted by economic consulting firm TischlerBise.
A proposed ordinance now under consideration would incur fees at the chamber-recommended rate until December 2025. After that, the fees would increase dramatically, and in some cases, by as much as 22 times the initial amount through 2028. The county currently imposes no transportation-specific impact fees on industrial, commercial, office and institutional projects.
Hughes and six others spoke during a public hearing Nov. 7, pleading with commissioners to consider fees closer to those recommended by the Chamber of Commerce.
County officials expect to hold a second public hearing in December 2024.
Alex Werner, the chamber’s vice president of economic development, implored the commission to allow the chamber to continue its work of building a solid tax foundation by attracting businesses to the community. He said impact fees may provide funding sooner, but they would drive away businesses.
“I don’t understand why we would want to decrease the commercial side of the digest by about 90 percent just so that we can give a one-time fee payment and miss out on all that reoccurring property tax,” he said.
Forsyth County’s explosive population growth has created an imbalance in tax revenue, straining infrastructure and services, Werner said. With about 85% of revenue coming from homes, residents are shouldering too much of the tax burden, he said.
“We are a bedroom community and have been a bedroom community for quite some time,” he said.
About 81,000 residents commute daily for work, and another 51,000 workers come each day, putting enormous demands on roadways, he said.
If more businesses come to the county, they could provide local jobs, reducing the time commuters spend driving, he said.
Justin Abernathy, principal of Abernathy Construction, said the proposed impact fees
Proposed commercial impact fees
A proposed Forsyth County ordinance proposes transportation impact fees for commercial construction, with categories differentiating use and assessments. Fees would increase incrementally through 2028 and potentially later.
The fees expressed in the chart are per 1,000 square feet. The years atop each column in the chart reflect a period running from the first of December of the previous year to the end of November. Private schools would be charged by enrollment.
Source: Forsyth County Government
would kill development deals. He said his firm is “very worried” the plan could prevent the close of a contract for a 16acre project at Castleberry and Bethelview roads.
“Our tenants have already given us their opinion on what they think,” he said. “They will not pay these fees moving forward.”
Residential impact fees passed Aug. 15
Commissioners raised residential impact fees in August to support transportation infrastructure. The chart shows the assessment per dwelling.
Robert McLeod, chief financial officer for McDonald Development Company, said the fees would put county developers at an “enormous disadvantage” with competing counties. He said Cobb County, which has no impact fees, is Forsyth’s primary competitor.
Source: Forsyth County Government
His business is about attracting tenants to developments, and the fees would make that work much more difficult if not impossible, he said.
“The deals we make are made over pennies and nickels,” he said. “They will not pay that.”
Pearl Cai, co owner of water filtration company iSpring Water Systems, said she considered several other counties before deciding to bring her business to Forsyth.
After weighing the advantages provided in each county, she preferred Forsyth for its zoning which promotes uniform architectural and landscaping beauty.
Businesses looking to relocate will examine every cost and benefit, and steep impact fees would likely encourage owners to consider moving elsewhere, she said.
“Do you want to hurt the economy with a huge impact fee, or do you want to attract business with a reasonable impact fee that is comparable to other counties?” she said.
After the hearing, commissioners stressed the fees were still under consideration, and hearing from the business community was a part of an ongoing process in selecting the right figures.
Chairman Alfred John said it was important to remember the interests of residents and their contributions to the county’s tax digest. Impact fees would reduce their responsibility in supporting infrastructure.
“At some point our residents are going to demand we have an impact fee,” John said. “We will hear from the residents. You have to balance that. The business community is not incorrect, but that’s what we are here for, to gather information and make a decision.”
Commissioner Todd Levent agreed the discussions should continue, but he also warned deterring businesses would ultimately make residents pay more in taxes.
“What we need to do now is not swing that playbook so hard the other way that we shoot ourselves in the foot,” he said. “Like a lot of people said up here, that will cost our residents a higher tax burden.”
AMSH ASHRITH, manager, StopEatRepeat
6 | Forsyth Herald | November 14, 2024
Young entrepreneurs serve up authentic Indian cuisine, hospitality
By AMBER PERRY amber@appenmedia.com
DUNWOODY, Ga. — At 32, Prudhvi Allam is the eldest of some six family members who own and operate two Indian restaurants and a food truck in Metro Atlanta.
Over a small table in Andhrawala Café in Dunwoody’s North Shallowford Plaza, he and his 25-year-old brother Amsh Ashrith described the authenticity found in not just the food, but the hospitality. Together, those ingredients produce regulars at the cafe which opened just six months ago.
Allam, Andhrawala Cafe’s manager, said a common problem among many Indian restaurants is the service.
“Most of our guests … they would come back to us and say, ‘Yeah, food, we can get it anywhere. The service with the food, this is the only place,” Allam said.
The word “Namaste,” a tradition rooted in “humble love and attention, has proliferated throughout the community, Allam said.
Andhrawala Cafe boasts an eclectic menu of traditional Indian breakfast favorites, like vada, or doughnut-like fritters made from a lentil batter; dosa, or a buttery crisp South Indian crepe; and idly, or soft, steamed rice cake made from a batter of rice and lentils.
It’s advised that these items are dipped, maybe even drenched, in the accompanying tomato- and peanut-based sauces, or with vada, the chutney.
Allam said the cafe quickly became popular because it features cuisines found all over India.
“I think everybody says that for the restaurant business, you need at least
Manager Prudhvi Allam and Head Chef Harish Kumar, center, are primarily responsible for operations at Andhrawala Cafe, an Indian restaurant in North Shallowford Plaza owned by Allam’s family. Allam’s brother Amsh Ashrith, left, manages a food truck called StopEatRepeat, and Pavan Sai helps the family by serving food to customers at the cafe.
six months to one year for the break even,” Allam said. “We never faced these kinds of issues from the last two, three years.”
The family’s food truck StopEatRepeat was launched in 2022, a test of the waters before focusing on scalability.
to return because they say it’s the best they’ve ever had. In some restaurants, the crepe can almost cover the entire table.
“If you bring the authentic food, everybody likes it,” he said.
Tradition is threaded throughout the establishment, including the technique of cooking rice in clay pots. Harish Kumar is the head chef at Andhrawala Cafe.
“There is a history behind the clay pot,” Allam said. “You know, back in the ancient days, most of the culture says that if you cook anything in a pot, that gives a lot of benefits.”
A wall by the door features an outline of a heart filled overflowing with handwritten compliments, from “GOOD FOOD GOOD SERVICE” to “Food is really damn tasty :).”
The family’s second restaurant, a fine dining spot in Suwanee, will soon be rebranded to Dosti Tap and Grill, “dosti” meaning friendship.
The food truck StopEatRepeat was their first entry into the restaurant industry, though, at least in the United States. They had also owned a series of restaurants in Goa, a coastal state in India.
“We are Atlanta's first Indian food truck, and we can proudly flaunt that every time,” said Ashrith, StopEatRepeat’s manager. “That’s our baby.”
All the food operations exist under the home brand TOT, or “Trails of Taste.”
Allam also said they intentionally moved away from Americanizing the food at Andhrawala Cafe.
“Every item, after coming here, they'll fusionize because that way they can attract more customers, like more people,” Allam said.
Allam, who has been in the states for about a decade, said some customers who had been unfamiliar with the more traditional, smaller Dosa have continued
The cafe’s walls are splashed with an inviting yellow as well as hand-illustrated murals, painted by one of Allam and Ashrith’s sisters. On one side, you can see a host of the cafe’s team members, each with a name tag, and on the other side, a painting of farmers using bulls to do their work, layered over a mandala.
An awning made of dried grass hangs over the front counter, which Ashrith said hearkens to the clay homes found in South Indian villages.
With a full-time career in IT, the restaurant business is Allam’s side gig. He and Ashrith, a college student who has helped Allam create food-related phone apps, volunteer their time.
Ashrith said money is less important.
“Every day we do something, we try to make sure that it makes a difference, not more money,” Ashrith said. “To make money, you can do anything, but to make a difference, there are only certain things that you can do.”
AMBER PERRY/APPEN MEDIA
ARTS & ENTERTAINMENT
‘American Pickers’ program seeks local hidden treasures
ATLANTA — The History Channel’s “American Pickers” television series is asking North Metro Atlanta residents to reach out with their hidden treasures.
The show is asking to connect with residents with unique items, stories, according to Cineflix.
The show does not “pick” stores, flea markets, auction businesses, museums or anything open to the public.
Anyone interested may send your name, phone number, location and a description of the collection with photos to americanpickers@cineflix.com, call 646-493-2184 or message on Facebook to @GotAPick.
“American Pickers” is a documentary series that explores the world of antique “picking.” The show follows skilled pickers in the business as they hunt for America’s most valuable antiques.
They are always excited to find historically significant or rare items, in addition to unforgettable characters and their collections.
The pickers are on a mission to recycle and rescue forgotten relics. Along the way, they want to meet characters with amazing stories and fun items. They hope to give historically
CINEFLIX/PROVIDED
The “American Pickers” television show is asking residents to reach out with their hidden treasures for an upcoming production in Georgia.
significant objects a new lease on life while learning a thing or two about America’s past along the way.
The pickers have seen a lot of rusty gold over the years and are always looking to discover something they’ve never seen before. They are ready to find extraordinary items and hear fascinating tales about them.
Jon Wilcox
for
Taking a moment when confronted with change
The holiday season is almost upon us and, as we gather with older loved ones, warm memories of the past can be tempered by the realities of the present. When we get to spend more time together, changes in our lives as we age are more apparent.
Whether it’s the unexpected condition of their home, personal grooming or signs of slowing down physically and mentally, it can be a shock to the system to realize that help is needed. It’s natural to try and attribute changes to “holiday stress” or move quickly and “fix” things. This is when it’s also important to take a moment and try to understand the full scope of the issues your loved one is facing.
ADLs, or activities of daily living, are those activities that you don’t think much about until you or your older loved one has trouble with them. These are activities like walking safely around the house, being able to perform basic grooming, bathing, dressing, toileting and move safely from one space to another.
Perhaps you’re seeing signs that may indicate concerns about more serious emerging health issues. It’s important to work with your loved one and consult their health care professionals to determine what the issues are and what the prognosis is for the short and long term.
Home Helpers knows that in-home
care can give you the time to take a breath, giving you a moment to stop and assess the true degree of assistance needed. Reacting to a potential medical prognosis or the aging process too quickly can add to the stress level of you and your older loved one. We know staying in the safety and comfort of home is the preference of most seniors. A skilled caregiver can help balance their needs with respect for their dignity and honor their desire to maintain as much independence as possible.
There are times when extra help is needed recuperating from an accident or surgery. Should fall risks emerge, your caregiver can add security and peace of mind. A dedicated Home Helpers caregiver can make life and nights easier if your loved one is starting to wander. For couples, this also makes sure a good night’s rest happens for their partner.
A Home Helpers caregiver can assist with all personal care, help around the house, accompany you on doctor’s visits and provide specialized care for Alzheimer’s, Parkinson’s, etc. With a heart centered approach and positive spirit, they can also help pursue a hobby, enjoy outings and community activities, and build relationships that make for a longer and better life in the comfort of home.
We have a team with depth and skill that can provide the care you need from six hours a day, several days a week to 24/7 care. For a free consultation, please call Home Helpers of Alpharetta and North Atlanta Suburbs at (770) 681-0323.
Brought to you by – Home Helpers of Alpharetta and North Atlanta Suburbs
PEXELS
Transplant Medicine and Dermatology
Our immune systems are our defense against the outside world’s infections – viruses, bacteria and all manner of pathogens ready to run amok.
And our immune systems are also our defense against the rebels within our own bodies – cells that have mutated and have turned into cancer.
One only needs to observe the effects of suppressing the immune system to know just how important the immune system is. Transplant doctors are in the unfortunate position of having to intentionally suppress a patient’s immune system. When a patient receives a new kidney, heart, lung or other organ, the patient is placed on medicine that suppresses the immune system. Without those medicines, the immune system would attack the transplanted organ, treat it as foreign, and “reject” it – attacking it until it perished.
Suppressing the immune system comes at a great cost. Organ transplant recipients have an approximately 200-fold increase in squamous cell carcinomas (SCC), which is the most common type of skin cancer in this group of individuals. A 200-fold increase means a 20,000% increase. When a SCC occurs in such a patient, the mortality is nearly ten times higher than that of someone with a normal immune system.
For these reasons, regular skin exams are critical in the transplant population. Oddly, the importance of skin exams has sometimes seemed to be a bit of a blind spot. Many patients with organ transplants have told me that they were counseled about many of the problems that they could face after receiving a transplant but that the risk of skin cancer was either not mentioned or not particularly emphasized.
For organ transplant patients, immunosuppression is only part of the story. Unfortunately, some of the transplant medications are not only immunosuppressive but also mutagenic. There is evidence that some immunosuppressants (such as tacrolimus and mycophenolate) can cause mutations. These immunosuppressants may increase the rate that cancers occur independent of their immunosuppressive effects. To avoid this double whammy, dermatologists managing skin cancers in transplant patients often discuss whether alternatives can be employed.
Compounding the problem, some organ transplant recipients, particularly lung transplant patients, sometimes contract fungal infections that must be treated with voriconazole or its cousins. Voriconazole can directly and indirectly increase skin cancer risk in a population that is already vulnerable.
Science marches forward, and hope abounds as new strategies and treatments continue to be developed for skin cancer in the setting of organ transplantation. Increasingly effective “blue light therapy” regimens, topical chemotherapeutics and prompt skin cancer surgery keep almost all skin cancers in check. Trials are exploring injecting new immunotherapy medicines directly into skin cancers to reverse immunosuppression at the site of the cancer without reversing the immunosuppression at the transplanted organ.
Organ transplants are a miracle of modern science. However, like all gifts in medicine, organ transplants require maintenance, time and attention and come with risks. Dermatologists are instrumental in helping to manage these risks, and timely Mohs surgery is critical to prevent progression of skin cancers from operable lesions into much harder to manage tumors.
What is the lesson for the reader who doesn’t have a transplanted organ? Transplantation shows us the extremes of immunosuppression, but any amount of immunosuppression can be dangerous. If a patient has CLL (chronic lymphocytic leukemia), rheumatoid arthritis or any disease that results in a weakened immune system, then be on the lookout for skin cancer, and consider seeing a dermatologist regularly.
As we get into our 60s and older, “immunosenescence” kicks in, which is to say our immune systems get weaker as we get older, so it becomes increasingly important to treat skin cancers quickly the older we are.
Cherish a healthy immune system and protect it. Even topical steroids prescribed for conditions like eczema can be dangerous if used too long and in the wrong setting. Topical steroids like hydrocortisone and triamcinolone suppress the immune system where they are applied and should usually be avoided in heavily sun-damaged areas.
Make sure to do your part in keeping your immune system healthy. There’s no great secret – it’s exactly what you’ve heard before: Get plenty of rest. Laugh often. Avoid stress. Take wonderful vacations and do lots of what makes you happy. It’s just what the doctor ordered.
Insist
Dr. Brent Taylor is a Board-Certified Dermatologist, a Fellowship-Trained Mohs Surgeon, and is certified by the Board of Venous and Lymphatic Medicine in the field of Vein Care.
He is an expert in skin cancer and melanoma treatment, endovenous laser ablation, minimally invasive vein procedures and cosmetics procedures such as Botox and injectables.
Kathryn is a certified physician assistant with over 22 years experience as a Dermatology PA and cosmetic dermatology.
Her specialties include general dermatology such as acne, eczema, rashes, hair loss, full body skin exams, abnormal growths etc. Kathryn also specializes in cosmetic dermatology including lasers, injectables, micro-needling, PRP, facial peels, sclerotherapy for spider veins and at home skin care.
Kathryn Filipek, PA-C
Brought to you by – Dr. Brent Taylor, Premier Dermatology and Mohs Surgery of Atlanta
What do weight loss drugs mean for your fertility journey?
HIPP
Brought to you byEmory Reproductive Center
In recent years, there has been growing interest in understanding how diabetes, polycystic ovary syndrome (PCOS), and fertility are connected. Recently, medications with the generic names of semaglutide, tirzepatide and dulaglutide, which help lower blood pressure, improve glucose control and promote weight loss, are being explored to understand their risks and benefits for women’s reproductive health. Dr. Heather Hipp, an Associate Professor in the Department of Gynecology & Obstetrics and a physician with the Emory Reproductive Center, shares her thoughts on this topic and how it might affect those beginning their fertility journey.
Why weight loss can help with fertility
Recent studies1 have shown that
weight loss, often achieved through these medications, can have a positive impact on fertility in women with diabetes or PCOS. Obesity can cause women not to ovulate, which results in irregular menstrual cycles, and can also affect egg health. Losing weight can improve overall health, reduce risks of insulin resistance and pre-diabetes, and help women with PCOS regain regular ovulation cycles and increased fertility. Dr. Hipp notes, “Improvement in regular ovulation can often result in a successful pregnancy outcome for women with PCOS.”
However, these benefits are not universal. Research2 has shown that women within a healthy weight range have a higher success rate with in vitro fertilization—commonly called IVF— compared to obese women, highlighting the importance of weight management for better fertility outcomes.
What should you consider before taking weight loss drugs?
While there are benefits to these medications, there are important considerations before becoming
pregnant. There’s limited data on their use during pregnancy, and some researchers are concerned about the possible effects on a fetus’s weight and bone formation. Some studies suggest weight loss drugs may increase the chance of a miscarriage. One recent study did not find a higher risk of major birth defects in women who took these medications in early pregnancy compared to a group of women with diabetes who did not take the medications. However, it is recommended to stop taking them at least two months before pregnancy.
Dr. Hipp’s recommendations:
Dr. Hipp advises women with diabetes or PCOS planning for pregnancy and considering these medications to:
• Consult with your primary care provider, OBGYN or a weight loss specialist to evaluate if weight loss could benefit their treatment plan and explore treatment options.
• Consider how these medications fit into broader pregnancy planning.
• Stop taking these medications
two months before trying to conceive to reduce any potential risks during pregnancy.
We welcome you
At the Emory Reproductive Center, comprehensive support is offered to women managing diabetes or PCOS and fertility concerns. Our team provides personalized treatment plans for a wide range of issues that affect reproductive health.
For more information or to make an appointment, call 404-778-3401 to meet with a fertility specialist at the Emory Reproductive Center at Emory Johns Creek Hospital. We understand that every situation is unique, and we tailor your care to your specific needs and goals.
1Health https://www.health.com/ ozempic-mounjaro-pcos-7510971
2American Society for Reproductive Medicine https://www.asrm.org/practiceguidance/practice-committee-documents/ obesity-and-reproduction-a-committeeopinion-2021/
This “ you’re gonna be a big sister
”
PRENATAL CARE
The di erence? Emory Women’s Center at Johns Creek uses research and innovation in health to provide exceptional care, close to home. From the first prenatal appointment to delivering your precious bundle, our trusted team is here to listen to you and guide you along the way.
Visit emoryhealthcare.org/women to schedule an appointment.
Need help before the holidays?
Dear Reader,
Are any of you cringing when you begin to think about the holidays and the difficult or perhaps challenging family conversations you have to look forward to? Maybe it’s time to talk to your parents about whether they are protected. Do they have an advanced healthcare directive that appoints other people to make medical decisions for them? Do they have a Durable Power of Attorney that appoints other people to make financial decisions for them? Do the “other people” include you? If so, you may need to know where to find
these documents in case your parents need to use them. Have they told you where they are?
Maybe you are the parent who needs these documents and you don’t have them or it’s been five years since you signed them and they need to be updated. When the family is in town for the holidays, maybe you want to make planning a priority. We’re open Monday to Wednesday before Thanksgiving and we’re happy to meet on a Saturday or outside of regular business hours if it would help to have someone other than family help manage those conversations. Let us know if we can help.
Make colon health your habit
Brought to you by - Dr. Ashish Zalawadia, gastroenterologist at Wellstar
Being proactive with your preventative care can help catch colon cancer early—before it becomes a bigger problem. Your Wellstar care team can help you evaluate your colon cancer risk and create a screenings plan.
Here’s an overview of what you can expect when you get a colonoscopy at Wellstar.
What is a colonoscopy?
A colonoscopy is a medical procedure that allows a gastroenterologist to visually examine the inside of the colon (large intestine) using a flexible tube with a camera and light on the end called a colonoscope.
Why is a colonoscopy performed?
Colonoscopies are a screening for colon cancer and polyps. They are considered the gold standard for colon cancer screening because they are the most effective way to identify and diagnose colon cancer. The United States Preventive Services Task Force recommends that patients start getting screened for colon cancer at age 45.
The procedure can also be used to investigate symptoms such as abdominal pain, blood in stool or a change in bowel habits and to monitor inflammatory bowel disease.
How frequently do I need a colonoscopy?
You need a colonoscopy every 10 years starting at age 45. You may need colonoscopies sooner and/or more often depending upon your medical history, family history or results from previous testing.
How do I prepare for a colonoscopy?
Preparing for a colonoscopy involves several steps to ensure a safe and effective procedure.
Tell your gastroenterologist about your medical history, including your previous colonoscopy results, allergies and medications, including over-thecounter medications. You will be asked to stop blood thinning medications before your colonoscopy.
Avoid nuts, seeds and popcorn and stay on a low-fiber diet one week before the procedure.
You will be asked to stay on a clear liquid diet (such as water, clear broth and electrolyte-rich beverages) the entire day before your colonoscopy. Avoid red,
orange or purple liquids, which may interfere with visibility.
What is colonoscopy prep, or bowel prep?
You will be given a strong laxative (bowel prep) to clean your colon. A clean colon allows your gastroenterologist to better view the inside of your colon. Your gastroenterologist can then more easily find polyps or early signs of cancer. You will start taking laxatives the day before your procedure. After taking the laxative, you will have diarrhea. Over time, your stool will get more and more watery and turn a yellow or clear color as the medicine cleans out your colon.
What should I expect on the day of my colonoscopy?
The test is often done in the hospital or surgical center on an outpatient basis. Please arrive one hour before the scheduled time. Remove all jewelry, makeup and contact lenses. Wear comfortable clothing and bring someone to drive you home.
What should I expect during the colonoscopy?
During the procedure, you will lie on your left side. You will be sedated with IV medication. The colonoscope is inserted through the rectum. Air is inserted to expand the colon for better visibility. The procedure typically takes 30 minutes. Biopsy, polyp removal or other treatments may be done during the test.
What should I expect after a colonoscopy?
After the procedure, you may experience bloating, gas or mild discomfort. You can go back to normal eating and activities after the test. Drink plenty of water but stay away from alcohol. You may be tired from sedation and need to rest for the day. Don’t work or drive after the procedure. Ask your gastroenterologist when you can resume taking your regular medication, especially blood thinning medication. Your gastroenterologist may talk with you about the results right away or you may need to schedule a follow-up visit to talk about the results.
What are the complications of a colonoscopy?
Colonoscopies are a very safe procedure. Rare complications include bleeding, perforation (hole or tear) or sedation medication (anesthesia) reaction.
To schedule an appointment with Wellstar Gastroenterology in Roswell, call (470) 267-1520.
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ZALAWADIA
The steps to completing the Stress Cycle
Brought to you by - Summit Counseling Center
There is no denying we live in a stressful world. Stressors include external things like work, family, finances, friends, discrimination, and societal expectations, as well as internal factors such as selfcriticism, identity, memories, the future. Stress is a normal human response to these difficult situations. Stress is neurological and physiological sift that happens in our bodies when we experience stressors. Stress in not wholly a negative experience. Low to moderate levels of stress motivate us to take actions and perform tasks. However higher levels of stress or difficulty coping with stress can overwhelm us leaving us paralyzed, unable to act. Stress leads to the activation of the bodies stress response prompting the release of neurotransmitters and hormones that creates a kind of energy in our bodies prompting us to act I order to dispel this energy. Stress is cyclical, and so it is important to learn how to complete the Stress Cycle to move this energy through our bodies to return to a state of rest and relaxation in preparation for the next stressor.
Sisters Drs. Emily and Amelia Nagoski discuss ways to complete the Stress Cycle in their book Burnout: The Secret to Unlocking the Stress Cycle. They say, one of the most effective ways to complete the Stress Cycle is to move our bodies for about 20-60 minutes a day. Movement can include running, swimming, or dancing. Because we experience stressors every day it is important to intentionally move our bodies daily. Here are other ways to complete the Stress Cycle:
• Deep Breathing. Taking slow
deep breaths relaxes the body allowing the release of stress. Deep breathing is most effective with low to moderate levels of stress. It is characterized by inhaling through the nose and exhaling through the mouth where the exhale is longer than the inhale.
• Positive Social Interactions. Casual social interactions with friends and acquaintances help us to see the world as safe. Innocuous chit chat with strangers like telling the grocery store clerk to have a nice day or giving someone a compliment helps us to know that there are sane people in the world.
• Laughter. Laughter releases a flood of feel-good chemicals in our brains. Deep belly laughs with others increases our social bonds. When we laugh like this, we realize there is good in this life.
• Affection. When casual social interaction is not enough, we need deep connection from a loving person help us to feel safe and validated. Affection does not have to be physical although a 20 second hug
or a six second kiss can do wonders to release stress. A deep connective empathic conversation also helps us to feel seen and heard thus reducing our stress. Affection can also be spiritual by connecting with our higher power through prayer or meditation we feel close to a being bigger than ourselves.
• Crying. Crying helps to release pent up emotions leaving us with a sense of relief from the weight of the stressor. Whether you’re on the
verge of tears and need to find a quiet place to let them out or you artificially create a situation that will lead to crying like watching your favorite tearjerker movie or pet adoption commercials, crying helps us to complete the Stress Cycle.
• Creative Expression. Creative outlets encourage big expressions of emotions. From love songs, to dance, to paint and poetry, creative expression is a socially acceptable way to express ourselves without having to adhere to such strict social norms like being “nice” or not creating waves. Creative expression allows us to process emotions we may not have words for.
In our world today we are constantly being bombarded with stressors. If we do not complete the Stress Cycle, we can experience higher rates of mental and physical health problems that lead to burnout. But it doesn’t have to be that way. By listening to our bodies and giving ourselves permission to intentionally use these skills we can move through the Stress Cycle more quickly to experience the joys of life.
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