Nina Radcliff, MD

Vitamin D – Right Amount is Essential to Your Health

Research is revealing more about the importance of Vitamin D in protecting you against a host of health problems. With that note, Vitamin D deficiency is incredibly common and most people are unaware of it.

Dr. Nina’s What You Need To Know:

About Vitamin D

Actually a hormone, Vitamin D receptors are found in every tissue in our body! While there is still much we do not know, what we do know is that it is so important, our bodies are capable of making it by itself.

Sources include:

• Vitamin Rich D-Foods: It is found naturally in fatty fish such as salmon, mackerel, and sardines. Because there are a limited number of foods that contain sufficient amounts of this fat-soluble vitamin, it makes it difficult to get enough from your diet alone. • Fortified foods: This means that Vitamin D is added to these items--it is not originally found in the food (like milk, cereal, orange juice, and yogurt). • Supplements: Come in either a prescription form or an over-the-counter version. • Safe Sun Exposure: Direct sunlight converts a chemical in our skin into an active form of Vitamin D. A surprising fact is that people get most of their Vitamin D from the sun.

Who’s at risk for a Vitamin D Deficiency?

Because the majority of this vitamin comes from safe sun exposure, those that live north of the equator, live in heavily air polluted areas that block the sun’s rays, remain indoors often, and have darker skin (melatonin pigmentation can block the sun’s rays) are at risk of being deficient. Other common risk factors for Vitamin D deficiency include being elderly, overweight or obese and not consuming Vitamin D-rich or fortified foods.

Additionally, if you have had obesity surgery, you may not be able to properly absorb Vitamin D rich foods and oral supplements.

How to know if you have low levels?

Routine checks of Vitamin D levels are not currently recommended. However, your healthcare provider may want to check your level if you have risk factors or certain medical conditions.

Mild Vitamin D deficiency is not necessarily associated with any symptoms. In fact, most people don’t realize that they are deficient, because the symptoms are generally subtle. You may not notice them easily, even if they are having a significant negative effect on your quality of life.

Signs and symptoms of deficiency include: frequent infections; fatigue/ tiredness; bone loss; bone/back pain; depression; hair loss; and impaired wound healing.

Diseases and Conditions Linked to Vitamin D Deficiencies:

• Obesity. Research has shown that carrying excess weight in your abdominal area is associated with lower levels of Vitamin D, compared to normal waist lines. At this time, it is unclear if having a deficiency causes you to gain weight, or if having the extra weight lowers your body’s Vitamin D levels. • Heart Disease. The ‘sunshine vitamin’ has been shown to preserve heart health. A leading study out of the University of Copenhagen found that those with low levels of Vitamin D (versus the optimal level) were 64% more likely to have a heart attack. • Bone Health. Vitamin D helps to maintain skeletal calcium balance by promoting calcium absorption. Children who lack Vitamin D can develop a condition called rickets, which causes bone weakness, bowed legs, and other skeletal deformities, such as stooped posture. A deficiency can also lead to bone weakening, osteoporosis. And, studies show that calcium and Vitamin D together can build stronger bones in women after menopause. • Depression and Mood. During the winter months when the days are shorter and there is less sunlight, we may experience depressive symptoms. It is believed that drops in Vitamin D levels are the reason.

Getting the right amount?

Many people assume they’re getting enough but, unfortunately, Vitamin D deficiency is still a widespread problem. • Get some safe sun. Experts state that just a few minutes of sunlight each day to the face, neck, hands, and arms is all that is necessary to get your adequate dose of Vitamin D. There are several variables: how much pigment you have in your skin, distance from the equator and the time of day. If your skin is darker in tone, you live further from the equator, or only catch the sun after it rises or right before it sets, you may need a longer period of sun exposure. Additionally, there is good reason to be worried that sun exposure can increase risk for skin cancer. And, sun protection procedures (e.g., sunblock, sun avoidance) decrease sun hitting our skin and Vitamin D conversion. It is important to find a healthy balance, as some sun exposure is important for health. • Increase consumption of fatty fish and foods fortified with Vitamin D.

Nina Radcliff, M.D.,

is a practicing physician and a Board Certified Anesthesiologist. Often called upon by media to speak to medical health topics impacting our lives today, Dr. Nina is passionate about sharing truths for healthy, balanced living as well as wide preventative measures.

3D Mammography Mammogram Recommendations

Breast cancer is the second leading cause of death among women. One in 8 women will develop breast At what age should I start getting screening cancer in her lifetime. Each year it is estimated that over mammograms?

252,710 women in the United States will be diagnosed The American College of Radiology (ACR) and Society with breast cancer and more than 40,500 women will die from the disease. This is why early detection is so of Breast Imaging (SBI) recommend that women start important. With early detection, the five-year survival getting annual mammograms at age 40. The American rate is nearly 100%. The latest weapon in the fight against Cancer Society (ACS), US Preventive Services Task Force breast cancer is 3D mammography (also known as breast (USPSTF), ACR and SBI agree that this approach saves tomosynthesis). This new technology has increased early detection over traditional mammograms, especially in the most lives.

women with dense breasts. Greater accuracy means better breast cancer detection. But the USPSTF recommended starting at age 50 and only getting mammograms every other year?

Q: What is a 3D mammogram? How is it different from Published analysis shows that following these USPSTF regular mammograms?guidelines would miss approximately a third of cancers A: 3D mammogram--also called breast tomosynthesis--is one of the most advanced forms of breast cancer detection. It uses a very low level of radiation to and result in 6,500–10,000 additional breast cancer take multiple pictures of the breast. The x-ray tube moves over the breast in an deaths each year.” arc, capturing multiple images of each breast from different angles. A computer reconstructs these pictures to create a 3-dimensional picture of the breast. A regular mammogram takes a single picture of the breast. What is screening breast ultrasound for? Q: What is the advantage of 3D mammogram? A: One of the challenges of interpreting mammograms is normal dense breast tissue hiding breast cancer. Additionally, overlapping areas of normal dense breast Many women, especially younger women, have dense breast tissue. This normal breast tissue can hide small cancers. There are some cancers that cannot be tissue can look suspicious. This is why detecting breast cancer in women with dense seen on mammograms that can be detected with breast breasts is more difficult. The 3-dimensional images of breast tomosynthesis help decrease the tissue overlap that can obscure cancers. It also helps distinguish normal ultrasound. Women who have been told that they overlapping breast tissue from breast cancer. have dense breasts may benefit from a screening breast

Studies have shown that 3D mammograms significantly improve the ultrasound in addition to their annual mammogram. This detection of breast cancer, especially in women with denser breast tissue. It also picks up breast cancer at an earlier stage, which may be missed by traditional can be discussed with your primary care physician. mammography. 3D mammograms find 20-65% more invasive breast cancers compared to traditional 2D mammograms, with an average increase of 41%.

Would I benefit from getting a 3D-mammogram?

3D-mammography, or tomosynthesis, is a new type of digital mammography that produces 2D and 3D images. Tomosynthesis has been shown to noticeably increase the ability of radiologists to detect cancers and reduce the need for return imaging for findings that turn out to be benign. All mammograms at Toms River X-ray are performed using high- quality 3D tomosynthesis and are interpreted by our radiologists with the assistance of computer-aided detection technology. And to get all the benefits of a 3D-mammogram, the patient doesn’t have to do anything differently at the visit compared with the traditional mammogram!

Q: Is there increased radiation performing a 3D mammogram?

A: Mammograms expose patients to very low levels of radiation. The level of radiation exposure from a 3D mammogram is the same as that from a traditional mammogram. So a patient receives all the benefits without any increased risk.

With traditional mammograms, when a radiologist finds an area that is suspicious, patients need to be called back for additional views. The multiple images created by 3D mammograms have such increased accuracy that there is decreased need for this. On average 3D mammograms reduce callbacks by up to 40% compared to traditional mammograms. This means less radiation exposure, increased convenience for our patients, and more peace of mind.

Dr. Paul Fang

Cancer in this breast is difficult to detect on this standard mammogram.

Q: What can I expect when having a 3D mammogram?

A: The process of having a 3D mammogram is the same as a conventional 2D exam. The technologist will position you, compress your breast, and take images from different angles. There’s no additional compression required, and it only takes a few extra seconds.

Q: Do insurance companies cover 3D mammograms?

A: Medicare, and many private insurers, cover 3D mammograms. In the past, not all private insurance companies covered 3D mammograms. However, in August 2018, New Jersey enacted a mandate requiring nearly all the major health insurers to cover 3D mammograms.

Toms River X-ray has been performing mammograms and serving the community for over 30 years. Our 3D mammogram is the latest on the market and has the most advanced technology. It is our mission to provide the very best for our patients. We thank you for trusting us with your health and the health of your loved ones. We look forward to offering you this significant advance in breast cancer screening.

Using 3D mammogram technology, the cancer was able to be clearly seen. If you have additional questions or would like more information, Cyrus Khorrami, M.D. Medical Director please call our office at 732-244-0777.

PARVIZ KHORRAMI, M.D. Founder

CYRUS KHORRAMI, M.D. Medical Director PARVIN MOTEMADEN

KHORRAMI, M.D.

732-244-0777

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1.5 T and 3 T High Field Open Bore MRIs 3-D Mammography Nuclear Medicine Bone Densitometry Deer Chase Professional Park • 154 Route 37 West • Toms River, NJ 08755 • Fax: 732-244-1428

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