HealthWatch April 2012

HEALTHWATCH North Georgia’s Health & Prevention Magazine

ALTHWA IN THIS ISSUE

Treatment can help congestive heart failure page 10

Be smart in protecting kids from sunburn page 2

Autoimmune disorders responsible for more than 100 diseases page 17

FEATURING

Pages 12-13

Sunday, April 29, 2012

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Be smart in protecting kids from sunburn

By Savannah King

sking@gainesvilletimes.com

Long summer days give kids more time for outdoor fun and more time for sun exposure.

Without proper protection, exposing the skin to sunlight can cause damage and increase the risk of developing skin cancer.

But navigating the sunscreen aisle can be a little tricky. There are sunscreens with an SPF of 15, 30, 100, broad spectrum, and the list goes on and on.

“It’s very confusing for people. They think if they buy the highest one they’re getting the best protection,” Haley Wilson, a physician assistant at The Longstreet Clinic pediatrics said. “You want a broad spectrum because it protects against UVA and UVB rays.”

Wilson advises parents do a patch test on the inside of their child’s arm before using a new sunscreen. Many kids have sensitive skin which could cause them to have an allergic reaction to some sunscreens.

She said children under 6 months should only have sunscreen applied to small areas of their bodies and special precautions should be taken to assure they don’t get a sunburn.

“They shouldn’t be out on the beach or at ball games without being completely covered,” Wilson said.

One of the most common mistakes parents make when applying sunscreen is forgetting about the scalp.

Wilson recommends wearing a hat, sunglasses, shirt and sunscreen when outside for a prolonged period.

Montyce Scott puts sunscreen on her daughter Cara as they prepare for a day on the lake in this Time’s file photo.

A typical sunburn doesn’t blister but leaves the skin hot and red. Wilson said the best course of action for a typical sunburn is to keep the burned skin cool and take an over-the-counter pain reliever.

There are a number of topical sprays that can help cool and numb the area so the burn isn’t as uncomfortable.

Wilson warns that these

sprays can cause a burning sensation on some children so it’s a good idea to do a patch test on a small area and wait half an hour.

“If it doesn’t cause discomfort then go ahead and apply to the entire area,” Wilson said.

Sometimes a sunburn will blister. When this happens it means the burn is a secondary burn and a doctor can help

prevent scarring from the blisters.

“It’s concerning. But it’s not life threatening,” Wilson said.

Wilson said people should remember that it’s important to be outdoors. Outdoor play is a great way to keep children active and healthy.

“Don’t stay inside out of the sun, just use good safety precautions,” Wilson said.

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Sunday, April 29, 2012

Blurry vision could signal problems

By Savannah King

sking@gainesvilletimes.com

Sometimes blurry vision can indicate nothing more serious than eye strain or dryness, but if you’re seeing flashes of light or spots the problem may be more severe.

While eye drops should take care of most cases of dryness, other symptoms like flashes of light or floaters could signal a more pressing situation.

“We see a lot of spots and floaters. That could be anything as simple as a vitreous floater to a retinal tear, which could lead to a retinal detachment,” said Dr. Jack Chapman, an opthalmologist at Gainesville Eye Associates.

The eye is filled with a clear gel called the vitreous humor. As people age, floaters form in the

eye and cast shadows on the retina that cause spots in vision. The vitreous can also start to liquefy as it ages, which can tug at the retina and cause a flash of light and could result in a tear of the retina.

A torn retina can cause permanent blindness so it’s important to see a doctor if you notice a flash of light in vision.

Chapman said losing vision can be a scary situation but doctors can correct a number of problems as long as they are caught in time.

Eye strain is a common complaint, especially among those who work in front of a computer screen.

“Most of the time, when people describe strain it’s usually dryness. When they look at computer screens they tend not to blink as much and their eyes dry out,” said

Dr. Chirag Parikh, director of glaucoma at North Georgia Eye Clinic and Laser Center.

Parikh suggested taking the time to rest the eyes and using over-thecounter artificial tears to help relieve dryness.

“If you take care of it yourself and you use artificial tears three to four times a day then you’re probably good to go,” Parikh said.

But if you’re experiencing changes in vision or pain, it’s time to see a doctor.

“If you read a certain book and you know you’ve been able to read it but now you can’t. That’s a bad sign,” Parikh said.

Many times the problem is as simple as needing a pair of prescription glasses. But Parikh said there is no way to know for sure what’s going on without an eye

exam.

Experts recommend young people get their eyes checked about once every two to three years, older people more often depending on their medical history.

Eye doctors have been known to diagnose diseases through an eye exam.

“They say it’s the windows to a soul but it tells you the health of a person’s body,” Parikh said.

Parikh said he’s diagnosed patients with lupus, brain tumors, multiple sclerosis and diabetes.

Diabetes poses a certain risk to vision because the disease can cause blood vessels in the eye to bleed and cause blindness. Because of the increased risks, the American Diabetic Association requires diabetics to have their eyes checked yearly

Sunday, April 29, 2012

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Breast cancer classifying promises better therapies

By Eryn Brown

Los Angeles Times

Researchers have found a way to classify breast cancer tumors into 10 distinct categories ranging from very treatable to extremely aggressive, a major step on the way to the long-sought goal of precisely targeting therapies for patients.

The new categories, described in a study released Wednesday, should help scientists devise fresh approaches to treat some of the cancers and could spare many women the risks and pain of unnecessarily toxic treatments, oncologists said.

“If you belong to one group you’ll need one therapy, and if you’re in another you’ll need another,” said Dr. Carlos Caldas, a breast cancer geneticist at the University of Cambridge who helped oversee the research.

For some women, he added, tumor typing might indicate that traditional chemotherapy isn’t warranted at all.

“A lot of women are being overtreated,” he said. “Can we spare them that?”

The study, published by the journal Nature, is the first of many expected in the coming months that will use genetic clues in breast cancer tumors to help refine categories of the disease, which strikes one in eight women in the U.S. Doctors like to say that breast cancer is not a single disease, but a range of them. But because they don’t completely understand which therapies will work for a given tumor and why, they tend to err on the side of caution — administering treatments in cases in which they may provide

little added benefit.

This type of research could begin to change that, experts said.

“This is going to have a huge impact on the way we think about breast cancer,” said Raju Kucherlapati, a genetics professor at the Harvard Medical School who was not involved in the study.

“Together with other data coming out in the next few months, I think the whole landscape of research, discovery and treatment is going to change.”

Clinicians already divide tu-

mors into a few different types, and targeted treatments are available for some types of the disease. For instance, women with tumors that test positive for a cancer-promoting protein called HER2 often respond well to the drug Herceptin, which isn’t effective against other types of tumors.

But in a frustratingly high number of cases, scientists can’t explain why one woman will respond to a given treatment and another woman won’t — even

though they both might have tumors that are estrogen-receptorpositive, for example.

“It’s not a very precise art,” Caldas said.

Hoping to hone the process, Caldas and colleagues from Britain and Canada analyzed the genetic signatures of samples from 997 tumors, examining how aberrations in DNA turned various genes on and off. They analyzed 2 million spots on the genome, foPlease see Breast cancer page 5

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Breast Cancer Continued from page 4 cusing on differences in the number of times a string of DNA is repeated and on small gene variations known as single nucleotide polymorphisms, or SNPs. They also looked at RNA, which helps translate DNA instructions into proteins, to gauge gene activity.

Then they correlated that data with long-term health outcomes of the women from whom the tumors were removed, establishing a link between the genetic patterns and how tumors progressed. The analysis involved complicated number-crunching and took more than five years to complete.

In the end, the research team identified 10 distinct subtypes of breast cancer. They reinforced previously known groups and were able to make further distinctions within them.

For example, they found that tumors in two of the categories had very few DNA aberrations compared with those in other groups.

Tumors in one of these categories were particularly vulnerable to immune system cells, and they had one of the best profiles for prognosis.

“These tumors do have something different about them,” Caldas said. And by studying them further, he suggested, researchers may discover that they respond well to novel treatments.

The team confirmed the validity of their categories by testing them in a separate group of 995 tumors.

Experts said the scale of the

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Sunday, April 29, 2012

work was “remarkable,” as Kucherlapati put it.

“The fact that they have 997 samples for discovery and 995 for validation makes it very special,” he said.

Dr. John Glaspy, an oncologist at the University of California, Los Angeles’ Jonsson Comprehensive Cancer Center, added that the genetic analysis also sheds light on a fundamental question: How do cancers emerge?

“It’s an insight into how this whole thing works,” he said. “Insight is the beginning of new treatment.”

But Glaspy and others also cautioned that the discovery would not revolutionize the practice of medicine right away.

“I want to make sure people won’t see this and say, ‘Game over!’” said Stephen Friend, cofounder of Sage Bionetworks in Seattle, a nonprofit organiza-

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tion that promotes collaborative medical research. In truth, he said, the ability to match genetic signatures to long-term cancer outcomes is a sign that “the game starts.”

University of British Columbia breast cancer researcher Samuel Aparicio, another leader of the study, said scientists would need to conduct clinical trials to determine whether the gene aberrations the team identified could be effectively targeted with existing drugs. The findings should also help pharmaceutical companies create new drugs to fight breast cancer, he added.

“This should be a good stimulus” for industry, he said.

Complementary research is expected shortly from the National Cancer Institute’s Cancer Genome Atlas and the Wellcome Trust Sanger Institute in Hinxton, England.

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Sunday, April 29, 2012

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Record pollen count drives increase in eye allergies Eye allergies can occur alone, but often accompany nasal allergy symptoms, such as sneezA mild winter and early ing, sniffling and a stuffy nose. spring have sent pollen counts And, while most people treat off the charts this year. their nasal allergy symptoms, A typical spring allergy sea- they often ignore their itchy, son spans from March to May, red, watery eyes. when the trees begin to pollinate. This year pollen counts What actually began spiking in early Febru- causes the allergy? ary, leading to an especially long spring allergy season An allergy occurs when and a high number of irritants your immune system reacts floating around in the air. to allergens. When an allergen As a result, reports of eye al- comes into contact with the lergies (allergic conjunctivi- eye, some eye cells release tis) are at an all-time high this histamine and other chemiyear. cals to fight the allergen. This Anything more than 90 parti- reaction causes redness of the cles of pollen per cubic foot is eyes, which leads to itching considered a high pollen count, and watery eyes. and counts more than 1,500 Most eye allergies are the are considered extremely body’s response to allergens in high. This spring in the South, the air such as pollen, dust, anwe have had consistent pollen imal dander, mold or smoke. counts of more than 4,000, and In North Georgia, pine trees on March 21, we hit an all-time are the biggest culprit. high of 8,164, five times what is But it is not just pollen that normally “extremely high.” causes eye allergies. AllerAnyone who works or spends gic reactions to perfumes, a lot of time outside can at- cosmetics or medications test. The early spring brought can also cause conjunctivitis. golfers to area courses, and Sometimes the eyes can react many of those golfers have to allergens that are not neccomplained of eye allergies essarily in direct contact with even more this year than in the eye, such as those found in the past. some foods, or those related to insect bites.

What is an eye allergy?

Mold, house dust and animals can also be a source of If your eyes are itchy, red, this pesky condition throughtearing or burning, don’t ig- out the year. Eye allergies also nore them. You may have eye can be inherited from parents, allergies, a condition that af- and are more likely to develop fects millions of Americans. if both parents have suffered Advertorial provided by Gainesville Eye Associates

from them.

What is the right treatment?

First, your ophthalmologist must distinguish whether the symptoms are related to an eye infection or an allergic reaction. The ophthalmologist examines the eyes with a slit lamp microscope to check for signs of eye allergies such as enlargement of blood vessels on the surface of the eye.

If there is a serious allergic reaction, your ophthalmologist can prescribe a test for a specific type of white blood cells (eosinophils) that appear in the eye when there is an allergic reaction.

Coping with allergens Avoidance is still the best advice. If pollen is the cause, avoid the outdoors during the time of the day when pollen counts are at their highest — usually mid-morning to early afternoon. Also, take particular caution on windy days when pollen is easily spread.

Keep windows to your home and car closed to keep the allergens out. Use air conditioners, and avoid window fans.

Change the filter in your air conditioning system regularly to prevent recirculation of the same allergens.

We know it is tough, but don’t rub your eyes. Rubbing only irritates them more.

Over-the-counter eye drops and oral medications are com-

monly used for short-term relief of some eye allergy symptoms. However, they may not relieve all symptoms.

Decongestants reduce the redness of the eyes caused by allergies, and oral antihistamines may be of some use to relieve itchy eyes. However, those same antihistamines can cause dry eyes, and thus worsen the symptoms of some eye allergies.

In some cases, prescription eye drops and oral medications also are used to treat eye allergies. Prescription eye drops provide both short-term and long-term targeted relief of eye allergy symptoms, and they can be used to manage eye allergy symptoms in conjunction with an oral antihistamine that might be taken to manage nasal allergy symptoms.

Gainesville Eye Associates has offices in Gainesville, Braselton, Cornelia, Blairsville, Clayton, Hayesville, and Hiawassee, with a consultation office Franklin, N.C. To find out more about Gainesville Eye Associates, or to schedule an appointment, contact their office today at 770-5324444. You can also learn more about the services offered

by Gainesville Eye Associates by visiting their website at www.gainesvilleeye.com and following them on Facebook (www.facebook.com/ gainesvilleeye) and Twitter (@GainesvilleEye).

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Sunday, April 29, 2012

Sunday, April 29, 2012

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Polyps are very common, often benign

By Savannah King

sking@gainesvilletimes.com

One of the easiest and most effective ways to prevent cancer is to get a colonoscopy.

A colonoscopy allows the doctor to visually inspect the inside of the colon and check for abnormal growths, or polyps. If any are found, they can be removed before they become cancerous.

“We don’t mean to scare people, but it’s one of those things that I want people to know that 1 in 4 people will have polyps. Not all of those polyps are going to become cancer, obviously, but I can’t tell you which are and which will not,” said Dr. Chad Copper, a general surgeon with The Longstreet Clinic.

The American Cancer Society recommends people older than 50 get a colonoscopy every 10 years. If the patient has a family history of colon cancer, the society recommends they be tested 10 years earlier than the age of their relative when diagnosed.

“As we age, we’re more likely to develop polyps. If you have a family history, you’re more likely to develop polyps,” said Dr. Namita Pareek, gastroenterologist with Gastroenterology Associates of Gainesville.

According to the Centers for Disease Control, as many as 60 percent of colorectal cancer deaths could be avoided by proper screening.

New guidelines for screening could help prevent even more deaths in the future.

“The other thing that we’re trying to stress is that the new guidelines say that African-Americans

Polyps of the large intestine “Polyp” is a general term for any raised mass of tissue growing on the inside wall of the large intestine. They occur in many shapes and sizes.

Cancer concern: Some polyps may develop into tumors; larger polyps pose a higher risk Magnified view ( right ) through a colonoscope; physician removes any polyps found with electric sparks or a wire snare

Large intestine (colon) About 5 ft. (150 cm) long Absorbs water and dissolved chemicals Most people have a few tiny polyps that cause no symptoms

Small intestine Source: Merck Manual, Human Anatomy and Physiology, KRT News In Motion

should be screened at age 45 because they have an increased risk of developing colon cancer,” Copper said.

Men have a slightly higher rate of occurrence, but Pareek said gender isn’t of much significance when it comes to colon cancer.

Many people don’t get a colonoscopy until they notice symptoms. Some symptoms that could signal a problem include rectal bleeding, changes in bowel habits, abdominal pain, weight loss or blood in the stool.

“The majority of polyps do not cause symptoms. Some that are really big can cause bleeding, pain or diarrhea,” Pareek said.

People often ask doctors how to prevent colon polyps. Based on studies, doctors say that healthy habits like exercise and eating diets high in fiber and low in animal fat can help reduce the risk of developing colon cancer.

“Healthy habits that are good for you in other ways, your heart and your lungs, are good for your colon, too,” Pareek said.

The American Cancer Society estimates that 141,210 people

were diagnosed with colon cancer in 2011, and nearly one-third of them will die from the disease.

Colon cancer is the third most commonly diagnosed cancer, according to the American Cancer

Society.

“Each case is unique, but in general, if the cancer hasn’t spread to the lymph nodes, our cure rates for surgery alone are very high,” Copper said.

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Sunday, April 29, 2012

Vaccine helps avoid risk of painful shingles Shannan Finke

sfinke@gainesvilletimes.com

If you thought the bumps and blisters that came with that case of the chickenpox you had were bad, then you certainly don’t want to experience shingles.

Unfortunately, if you were exposed to or have ever contracted the chickenpox virus, the culprit that causes shingles is already in your body. The varicella virus is responsible for giving 98 percent of American adults chickenpox at some point in their lives, and it remains in the body with the everpresent chance of reappearing as the painful shingles virus.

“Shingles is reactivation of the chickenpox virus, which you typically have as a child. It presents itself as a painful rash on one side

of the body,” explained Dr. Marti Gibbs, a family medicine physician with The Longstreet Clinic.

“Most people know someone who has had shingles, and it’s a very painful rash. I’ve had some patients end up in the hospital just from the pain that is associated with shingles.”

This rash produces blisters that can be found in clusters on the body or sporadically on the skin, but they always appear where nerve endings reach the body’s surface. However, the symptoms of shingles are not felt exclusively through a blistering rash on the skin. Headaches, chills and flulike symptoms could also accompany the virus in the early stages.

“Fatigue and weakness is pretty profound for patients, and they just feel sick,” said Gibbs.

May is Better Sleep Month

Fortunately, there are options for the many who are at risk or already have shingles. Many pharmacies and doctor’s offices offer a vaccine for shingles.

Who’s most at risk? The older you get, the more likely you are to develop shingles. Health care professionals recommend that if you are age 60 or older, you should be vaccinated.

According to Gibbs, “If you’re 60 or up, there’s no reason for you not to have the shot. If your physician hasn’t recommended it, I would say to initiate that conversation with them. That’s a natural question for us to ask them.”

Gibbs noted another group of ideal candidates for the shot would be those with a compromised immune system.

While the vaccine isn’t perfect,

it does cut the chances of getting shingles in half. Additionally, if you do still get shingles after having received the shot, the disease may not last as long and the pain may not be as intense.

Dr. Christina Rich of Northeast Georgia Physicians Group described the treatment options that won’t cure the disease but will help with the symptoms.

“There is medicine for shingles that will reduce the pain in the nerves and antibiotics to reduce symptoms. But once you have it, you have it.”

For those who have it, the rash and other symptoms could last anywhere from two to four weeks.

In some cases, the pain from the rash can last several months, but the effects rarely last beyond that.

If you are having trouble: • getting to sleep, • staying asleep, • or if you feel excessively tired during the day, the Northeast Georgia Diagnostic Clinic Department of Sleep Medicine can help.

Under the direction of Wesley Head, MD, Board Certified in Sleep Medicine, the Northeast Georgia Diagnostic Clinic Sleep Center ensures its patients the highest level of care for their sleep disorders.

From the initial diagnosis, through the initiation of CPAP therapy, education, compliance, patient support and follow-up, we do more than just test and prescribe equipment. We make sure it works for you.

Our CPAP Clinic is staffed by registered respiratory therapists who are available at our Sleep Center to see all patients with sleep disorders utilizing CPAP therapy, not just those we diagnose or treat. Our program is accredited by the American Academy of Sleep Medicine.

For more information call the Northeast Georgia Diagnostic Clinic Sleep Center: 678-450-3625.

1240 Jesse Jewell Pkwy., Ste. 500 • Gainesville, Ga. • www.ngdc.com • 770-536-9864

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Treatment can help congestive heart failure

By Megan Gill

mgill@gainesvilletimes.com

Congestive heart failure is a disease people may not exactly understand. What is this disease, and what does it actually mean for you if you’re diagnosed with it?

“Heart failure is when, for some reason, the heart can’t do its job,” said Dr. Brenda Hott, medical director of heart failure programs at Northeast Georgia Medical Center and cardiologist at Northeast Georgia Heart Center.

This can be caused by either the pumping part of the heart not working properly, or the heart not being able to relax property to let blood back in.

Sometimes it’s a combination of both.

“Congestive heart failure is when they have too much fluid,” Hott said about patients with CHF. The heart cannot work properly, and there is an excess of fluid.

Patients with CHF often get swelling in their stomach, lungs and legs from a build-up of fluid, she said. There are several other symptoms involved with the disease.

“They will often have a decrease in exercise tolerance or what they can be able to do,” she said. “They might wake up in the middle of the night and can’t breathe.”

Other symptoms include fatigue, shortness of breath, weight gain and wheezing.

While all the symptoms sound frightening, there are a variety of treatment options for people

Medical poster in Dr. Brenda Hott’s office shows normal and enlarged heart.

with CHF. Medical therapy is the option most commonly used.

“We try to improve the quality of life,” Hott said. “Sometimes we can even get the heart back to normal with medical therapy.”

Medical therapy includes medicine and lifestyle changes such as restrictions of sodium and fluid and checking weight daily. Also, during the first few weeks following the start of treatment, there are check-ups roughly every two weeks.

“We see them quite often initially to see if we can fix the heart,” Hott said. “It’s very frequent until we get them on a steady regimen, and then we back off from there. Once we maximize their medicines, we have to give them time to see if Please see Heart page 11

SCOTT ROGERS | The Times

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SCOTT ROGERS | The Times An ICD (Implantable cardioverter-defibrillator) which is implanted inside the body of patients who are at risk of sudden cardiac death due to ventricular fibrillation and ventricular tachycardia.

Heart

ent,” Hott said.

There are ways people can prevent their risk of having Continued from page 10 CHF. Hott said 50 percent of CHF cases are caused by coronary diseases such as diabetes, the medicine is working.” hypertension and obesity. If Several months after maximi- you control the health risk faczation of the medicine, cardiol- tors, you can help prevent your ogists will check patients to see chances of getting the heart dishow effective the treatments ease. were.

If you’re diagnosed with CHF, In the most severe of cases, the most important thing to reCHF patients may seek other member is that while it is a lifeoptions for treatment if they threatening disease, it is also qualify for it. These options one that can be treated. include mechanical devices “It is something we can treat placed to help the heart func- and improve people’s quality tion better, or sometimes heart and quantity of life,” Hott said. transplants.

“There’s a lot we can do for “Depending on how severe, them. We are getting new things their activities may be differ- every day.”

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GAINESVILLE HEAR S E RV I C E S O F F E R E D

GAINESVILLE HEART AND VA S C U L A R G R O U P At Gainesville Heart & Vascular Group, we believe that the patient is the center of our practice. We are committed to providing the best possible care through diligent clinical evaluation and appropriate use of state-of-the-art technology. Guided by compassion for each individual, we strive to provide convenience and peace of mind to our patients by providing most services under one roof. Our ultimate goal — help our patients achieve a better quality of life.

• Adult Consultative Cardiology • ECG, Holter and Event Monitoring • Exercise Treadmill Testing • Echocardiography • Transesophageal Echocardiography • Stress Echocardiography • Myocardial Perfusion Imaging (Nuclear • Peripheral Vascular (claudication) Testin • Cardiac Catheterization (leg and wrist ac • Coronary Angioplasty and Stenting • Peripheral Vascular Angioplasty and Sten • Renal Angioplasty and Stenting • Pacemaker Implants • Loop Recorder Implants • Pacemaker and ICD Management • Anticoagulation Management • Lipid Management • Pulmonary Hypertension Testing

7 0 5 J e s s e J e w e l l P a r k w a y, S E , S u i t e 2 0 0 , G a i n

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RT AND VASCULAR GROUP Cardiovascular disease af fects over 80 million people in the United States.

• Coronary heart disease or disease in the blood vessels which supply oxygen to the heart affects 17,600,000.

• Myocardial infarction or a heart attack affects 8,500,000 people. There are 785,000 new heart attacks and 470,000 recurrent per year.

• Angina pectoris, chest pain or discomfort caused by reduced blood supply to the heart muscle, affects 10,200,000 people.

• Stroke or disturbance to brain function due to decrease to the brain’s blood supply affects 6,400,000.

• Peripheral vascular disease or disease affecting the blood vessels of the arms and legs affects 10,000,000.

Scans) ng ccess)

nting

• Heart failure, the heart’s inability to meet the body’s demand, affects 5,800,000.

Risk factors associated with cardiovascular disease include age, diabetes, high blood pressure, high cholesterol, tobacco use and family history of cardiovascular disease. Symptoms associated with cardiovascular disease include chest pain, shortness of breath, arm/leg pain, loss of consciousness and fatigue.

We at the Gainesville Heart and Vascular Group specialize in prevention, diagnosis and treatment of cardiovascular disease. Established in 1994, the Gainesville Heart & Vascular Group, formerly known as the Gainesville Heart Group, is recognized as the first cardiology practice dedicated to the care of heart patients in Gainesville and surrounding areas.

Its founder, Dr. David P. Johnson is a Gainesville native who had a dream of providing full-time and full-service cardiac care to the community. He and his partners played an integral part in bringing the Open Heart Surgery program to Gainesville in 2002.

Our staff has a reputation of applying a personal touch to our care and cherishing the relationship we have with our patients. Our staff, including physicians, enjoys residing and being an active part of the Hall County community.

We would enjoy an opportunity to meet with you to prevent, diagnose and treat cardiovascular disease.

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Our office has a wide variety of services, including general cardiology consultation, electrocardiography, echocardiography/ 2-D Doppler, stress echocardiography, nuclear stress testing and ankle brachial pressure index. Our physicians are staffed round the clock, 365 days a year, at the Northeast Georgia Medical Center.

Cardiac catheterizations, including coronary and peripheral artery stenting, stress testing, transesophageal echocardiography and pacemaker devices are performed at the Northeast Georgia Medical Center.

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Blood test looks promising in diagnosing depression

By Melissa Healy

Los Angeles Times

Even among psychiatric disorders, depression is a difficult disease to diagnose. Its causes remain a mystery, its symptoms can’t be defined with precision, and treatments are spotty at best.

But that may soon change. Scientists are looking for ways to identify patients with depression as reliably as they diagnose cardiovascular disease, diabetes and cancer. A new study takes a significant, though preliminary, step in that direction by demonstrating

that a simple blood test can distinguish between people who are depressed and those who are not.

The test examined a panel of 28 biological markers that circulate in the bloodstream and found that 11 of them could predict the presence of depression at accuracy levels that ranged from medium to large. And if that were not remarkable enough, researchers pulled off this feat in a group of teenagers, whose angst often defies all efforts at classification.

The study, published this month in the journal Translational Psychiatry, offers hope that doctors

can do a better job of helping adolescents whose mood difficulties go beyond those of typical teens, and whose lifelong prospects could be greatly improved by early treatment. What’s more, by using objective data to diagnose mental pain, researchers hope to remove the stigma that often prevents patients from reaching out to doctors.

“Once you have a measurable index of an illness, it’s very difficult to say, ‘Just pull yourself together,’ or ‘Get over it,’” said study leader Eva Redei, a professor of psychiatry and behavioral sciences at Northwestern University’s Feinberg School of Medicine in Chicago. A federal report released last year estimated that as many as two-thirds of the

nation’s 2 million depressed teens are too embarrassed or ashamed to get help.

The study drew responses of praise and caution from other researchers seeking better ways to diagnose and treat major depressive disorder.

“This is definitely an encouraging study,” said Dr. Andrew Leuchter, a University of California, Los Angeles psychiatrist who is researching ways to improve treatment with genetic testing and was not involved in the new work.

Finding a way to intervene with teens would be particularly valuable because a bout of depression early in life makes repeat episodes more likely, and therefore Please see Depression test page 15

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Depression test Continued from page 14 more urgent to treat, he said.

The current study focused on teens and “early onset” depression, but the researchers said they hoped to include adults in future testing.

Redei’s study takes a middle-ofthe-road approach to the search for a “biomarker” of depression.

Her team did not look for genetic variations that might predispose an individual to depression, nor did it use advanced MRI scans to home in on peculiarities in the way the depressed brain works.

Instead, the team focused on the messenger molecules that carry out genetic instructions for producing or inhibiting proteins.

The researchers started out with rats, breeding some for their vulnerability to depression and raising others to serve as healthy control subjects. In an effort to tease out the long-term molecular consequences of childhood stress, some rats from both groups spent hours restrained and alone in their cages. After several generations, the researchers identified 11 distinct molecules that were often found in the blood and brains of depressed rats but were largely absent in the healthy animals.

The tests also turned up 15 molecules that distinguished rats who suffered from a combination of depression and severe anxiety from those whose depression resulted in listless, helpless behavior.

Then the researchers tested the predictive value of the same biomarkers in a group of 14 depressed teens between the ages of

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15 and 19 and a group of 14 healthy control subjects. Sure enough, the teens with depression had significantly higher concentrations of the 11 targeted molecules in their blood. In addition, there were 18 biomarkers that could distinguish between adolescents who suffered from depression alone and those who had depression and anxiety.

Dr. Sidney Kennedy, a psychiatrist at the University of Toronto who is leading a project called the Canadian Depression Biomarker Network, said Redei’s study was the first to use messenger molecules as biological signposts for depression. As other efforts to find biomarkers mature — including costly brain scans and genetic analyses — those could refine and strengthen a blood test to screen large populations, he said.

“There is merit in this work,” Kennedy added.

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In the meantime, he praised the study for making a first attempt at one of the field’s most ambitious goals: to explain, describe and distinguish among depression’s many and varied forms.

Redei said her team hoped to perfect the blood panel by testing it in larger and more varied groups of subjects — including those with other psychiatric illnesses, including bipolar disorder, that are sometimes mistakenly diagnosed as major depression.

But before any such blood test could go into broad use, she cautioned, scientists would have to show that it could reliably detect the presence of illness without generating too many false positives.

“The probability that we will be able to put together a panel that’s usable is rather high,” she said.

“This data at the moment truly proves that it can be done.”

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The Times, Gainesville, Georgia |

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Autoimmune disorders responsible for more than 100 diseases

By Nancy Churnin

The Dallas Morning News

Kathy Krolikowski of Frisco, Texas, suspected something was wrong long before her doctors did.

Every time she said her body ached, she was told she was working too hard or not exercising enough. It took three years before she heard, just as she had suspected, that she had the same autoimmune disorder that had afflicted her mother: rheumatoid arthritis.

Autoimmune disease, which disproportionately strikes women, is easy to miss, says Dr. Neelay Gandhi, a family practitioner on the medical staff at Baylor Regional Medical Center at Plano, Texas who took over Krolikowski’s care six months ago.

That’s because the general symptoms of fatigue and achiness are common, and autoimmune disease can take many forms, including lupus, thyroid disorders and multiple sclerosis, he says.

In autoimmune disorders, an immune system attacks the healthy tissues it was designed to protect.

Getting an early diagnosis can be crucial because the damage the disease causes generally can be stopped or slowed, but not reversed.

Krolikowski, 64, says that’s why she advises women to be persistent when something feels wrong and to find a doctor who will be attentive to their concerns.

“Sometimes it’s hard to keep going in when you think, ‘They don’t believe me. What am I going to do?’” she says.

Dr. Noel Rose, director of the Johns Hopkins Center for Autoimmune Disease Research in Baltimore, has

spent decades advocating for increased recognition of autoimmune diseases, which he says afflict an estimated 20 million Americans. Threefourths of those cases are women; the Office of Research on Women’s Health at the National Institutes of Health describes it as the underlying cause of more than 100 serious, chronic diseases, and it was cited in the American Journal of Public Health in 2000 as being one of the top 10 leading causes of death among women 65 and younger.

The hope for cures lies in finding the common roots for the diseases that continue to be treated in a “scattershot” way by a variety of specialists as separate conditions, says Rose, co-author of the Encyclopedia of Autoimmune Diseases (Facts on File, $75). Rose would like to see autoimmune disease recognized as an umbrella for these various conditions, just as cancer is used to describe a wide array of diseases with an underlying cause.

In fact, the more we understand about autoimmune disease, the better we will understand cancer because they’re opposite ends of the same problem, he says. Cells are too quick to attack healthy tissue in autoimmune disorders and too slow to fight in cancer, allowing harmful tissue to grow out of control.

“Autoimmune diseases are relatively common, and people should be aware that they’re as much a threat to their health as cancer and heart disease,” Rose says.

Dr. Benjamin Greenberg, a neurologist and assistant professor at UT Southwestern Medical Center at Dallas, sees great promise in the Boston-based Accelerated Cure Project.

While it focuses primarily on supporting the latest research on multiple sclerosis, the studies can provide insight into other autoimmune disorders, he says. He also encourages patients to check clinicaltrials.gov, where patients can learn about the latest drugs being studied for various conditions.

Greenberg says research suggests that some important risk factors for autoimmune disorders are vitamin D deficiency, smoking, genetics, toxins in the environment and poor nutrition. Current cures involve killing or suppressing the cells. One exciting

idea on the horizon involves drugs that can retrain cells to not attack healthy tissue, he says.

An intriguing area to explore is why women suffer disproportionately from autoimmune disorders.

Experts speculate that because hormones tend to stimulate immune responses, women’s major hormonal swings may play a significant role in many, though not all forms, of the disease (Type 1 diabetes actually occurs more often in males). Women seem to be at greatest risk during their Please see Autoimmune page 17

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Autoimmune Continued from page 16 childbearing years.

Good communication between doctor and patient can prove the key to navigating this disease, Greenberg says. In neuromyelitis optica, a rare autoimmune disorder that attacks the optic nerves and spinal cord, he learned, many patients reported incidents of vomiting or frequent hiccups before the symptoms manifested themselves. Now when he takes a patient’s history, he asks about hiccups and vomiting.

“If they have this condition and you catch it early, you can prevent them from losing their vision or becoming quadriplegic,” he says.

Elizabeth Brammer, 30, of Burleson, Texas didn’t have anyone around to ask her questions like that when she was 11 and began struggling off and on with her eyesight. Her symptoms were dismissed at first as a plea for attention and were later mistakenly diagnosed as multiple sclerosis.

Due to the lack of proper treatment, she lost vision in one eye while in college. She finally got the correct diagnosis from a neurologist in New York four years ago. Since moving to Texas in 2010, she has been under the care of Greenberg, who prescribes regular, preventive immunosuppressive medications that have prevented a flare-up, attack or relapse during her pregnancy with her twin boys. Gavin and Garrison turned 1 on March 24, and she continues to be in remission.

For Brammer, finding out she had neuromyelitis optica, or NMO, came as a shock, a relief and a vindication that she was right to push her doctors into investigating her case further for so many years.

“I was overwhelmed. I cried because at least I had found a compass as opposed to rolling around in circles

not knowing what to think or what in the world was going on. It’s terrifying that I have NMO, but at least now I am under the proper care.”

COMMON AUTOIMMUNE DISEASES FOR WOMEN Lupus: The immune system creates an antibody that can damage any part of the body, but most commonly the joints, skin, kidneys, heart and lungs.

Symptoms include fever, weight loss, hair loss, mouth sores, fatigue, rashes, painful or swollen joints and muscles, sensitivity to the sun, chest pain, headache, dizziness, seizure, memory problems and behavior changes.

Rheumatoid arthritis: The immune system attacks the lining of the joints, resulting in fatigue, fever, weight loss, eye inflammation, lung disease, lumps of tissue under the elbows and anemia. Can lead to stiff, swollen, deformed joints and reduced movement.

Multiple sclerosis: The immune system attacks the protective coating around the nerves, damaging the brain and spinal cord and causing trouble with coordination, balance, speaking and walking. It can ultimately lead to numbness and tingling in arms, legs, hands and feet and to tremors and paralysis.

Thyroid disease (two common forms): Hashimoto’s disease (underactive thyroid): The immune system damages the thyroid gland, leading to decreased production of thyroid hormone, resulting in fatigue, weakness, weight gain, sensitivity to cold, muscle aches, stiff joints, facial swelling and constipation.

Graves’ disease (overactive thyroid): The immune system binds to receptors in the thyroid gland and activates the gland to make too much thyroid hormone, resulting in insomnia, irritability, weight loss, heat sensitivity, sweating, brittle hair, muscle weakness, light menstrual periods, bulging eyes and shaky hands.

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Some foods don’t mix with drugs, supplements

By Judy Hevrdejs

Chicago Tribune

Think of your stomach as one big test tube. Maybe you drop in a vitamin or herbal supplement each morning. Maybe a cholesterol-lowering statin or a blood-pressure drug. Perhaps an infection-fighting antibiotic or allergy-relieving antihistamine. And you wash it down with fruit juice or milk or coffee.

That may not always be a good thing because some foods and beverages — from chocolate and caffeine to dairy and alcohol — as well as dietary supplements (vitamins, herbals, etc.) and over-the-counter (OTC) drugs can interact with prescription drugs when they land in your gut. Those interactions may affect the ability of the drug to work as it should. Or that mix may cause unwanted side effects.

With some tetracyclines, for example, you may need to avoid dairy products at the time you take the drug. If you take digoxin for your heart, you may need to steer clear of St. John’s wort and large amounts of black licorice (that contains glycyrrhizin). Take ACE Inhibitors to lower your blood pressure? Go easy on high potassium foods such as bananas, oranges and green leafy vegetables. And depending on the statin you’re taking — there are many different types in this class — you may need to avoid grapefruit.

Such drug, food and supplement interactions become especially important as the num-

ber of drugs taken increases.

Shiew Mei Huang, acting director, office of clinical pharmacology at the Food and Drug Administration’s Center for Drug Evaluation and Research, cites a survey published in the Journal of the American Medical Association that found in the population 57 and older in the U.S., “at least 80 percent use at least one prescription drug. Half of them use OTC drugs. And some use dietary supplements.”

Says Huang, “What is important in that report is that almost 30 percent use more than five drugs. And among those who take a prescription drug, half of them take either OTC or dietary supplements.

“It is the dietary supplements we have to be very careful (about),” she adds, and doctors need to be told about them.

Hartmut Derendorf, a professor who heads the pharmaceutics department in the University of Florida’s College of Pharmacy, might agree about the role dietary supplements play.

“Sometimes they look alike and patients think they are medications like normal medications. But dietary supplements are not required to be investigated and tested with the same rigor,” he says.

Because your age, gender, medical history, etc. can affect how a drug interacts with other substances in your gut, “there are no general rules,” says Derendorf. “The key is for patients to be very open, to work with their pharmacist and physician and tell them about the use of

supplements and also look for the specific food interactions that are known for the medication that they are using.”

That’s crucial because guidelines can change. The FDA regularly releases food-and-drug interaction consumer updates that are prompted by a variety of factors, Huang explains, including the recent grapefruit juice-statin update issued last month. So what should you use to help the medicine go down?

Stick to a plain glass of water, say experts.

Points to remember: Keep a record of all drugs (prescription, over-the-counter), vitamins and herbal supplements that you take. This FDA chart can help www.fda.

gov/drugs/resourcesforyou (type “my medicine record” in the search field).

Tell your doctor or pharmacist about all drugs (prescription, OTC) and supplements you take.

If a doctor prescribes a new drug, ask the doctor or pharmacist if there are food interactions.

Read drug information from the pharmacist; don’t discard.

The following websites offer guidelines, but check with your doctor: www.fda.gov/drugs/ resourcesforyou (type “avoid food and drug interactions” in the search field; nclnet.org/ health/146-food-drug-interactions druginteractioncenter. org and webmd.com/drugs.

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Sunday, April 29, 2012

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Study questions link between gum disease, cardiovascular problems

By Delthia Ricks

Newsday

There is no compelling evidence that poor dental health leads to clogged arteries, heart attack or stroke, and treating diseased gums will not reduce the risk of cardiovascular disorders, a medical panel said earlier this month.

The panel’s findings comprise the American Heart Association’s new stance on the matter, altering a position many experts had accepted as gospel.

For decades, the provocative notion that gum problems — periodontal disease — are linked to clogged arteries has been at the very core of the so-called Germ Theory of cardiovascular disease.

Bacteria and inflammation associated with gum problems lead to dangers elsewhere the theory posits.

Aside from cardiovascular disorders, diseased gums have also been linked to miscarriages, Alzheimer’s and some forms of cancer.

But a team of cardiologists, dentists and infectious disease specialists assembled by the heart association, reanalyzed more than 60 years of research — 500-plus studies — and found none produced a causative link between periodontal and cardiovascular disorders.

“Much of the literature is conflicting,” said Dr. Peter Lockhart, the panel’s co-chair. “If there was a strong causative link, we would likely know that by now.

“The message sent out by some

Some microbes associated with gum disease are also found in arterial plaque. in the health care professions that heart attack and stroke are directly linked to gum disease can distort the facts,” he said.

Doctors have long known that smoking, elevated cholesterol, hypertension and obesity explain a vast number of heart attacks and strokes — but not all. The periodontal link seems to fit, some experts say, because risk factors associated with gum disease are involved in heart disorders.

Also, dental plaque, which must be scraped off teeth, contains a veritable rogues gallery of microbes that colonize the teeth, invade beneath the gumline and are maintained in place by a tough biofilm.

Some microbes associated with gum disease are also found in arterial plaque, but no one knows if they’re causative agents or merely innocent bystanders in heart attacks and strokes.

Dental experts not associated with the heart association say more research needs to be conducted.

“What we have here is a very rigorous analysis,” said Dr. Ronald Burakoff, chairman of dental medicine at Long Island Jewish Medical Center in New Hyde Park. “But it’s possible that further research into periodontal and heart disease could explain

the biological possibility of one causing the other.”

Dr. David Paquette, a professor and associate dean at Stony Brook University’s School of Dental Medicine, said the panel has taken “a cautionary stand.”

Earlier research, Paquette noted, has also shown that C-reactive protein, a biological marker for inflammation, is high in the blood of people with gum disease

and those with cardiovascular problems.

More research could shed more light on the protein’s role in both, he said.

Meanwhile, the Stony Brook team is leading a nationwide analysis of 500 people that is exploring whether periodontal disease is linked to diabetes. That could confirm periodontal problems play a role in heart disease because diabetics are at elevated risk for heart attacks and strokes, he said.

Paquette acknowledged the panel’s analysis seems to prove there is no causal relationship.

“But,” he added, “I would say the discussion is not over yet.”

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How to introduce oral hygiene to kids

By Alison Johnson

Daily Press (Newport News, Va.)

Turning good dental practices into habits very early can prevent cavities and many other problems down the road. “It’s all about making it a routine, which will last a lifetime,” says Dr. Miles Hall, chief dental officer at Cigna. Some tips: Start early. As soon as a child’s first tooth appears, begin cleaning it with a brush and water — no toothpaste yet — and make a dental appointment.

Introduce toothpaste slowly.

Kids usually are ready for toothpaste by age 2 or 3 years old. To keep them from swallowing large amounts, put a pea-sized bead of paste on the brush and squash it

down into the bristles.

Let kids pick out their toothbrushes. Opting for a favorite color or cartoon character helps them feel in control.

Make brushing fun. Put on some great music and do a little dancing as part of the nighttime brush-and-floss routine. Parents can brush at the same time so kids can imitate them.

Help with flossing. Kids don’t need to floss until gaps between their teeth have closed, but they likely won’t be coordinated enough to try it on their own until ages 6 to 8. Before that, it’s a parent’s job.

Expand the tooth fairy’s role.

She doesn’t just need to bring money for lost teeth. She also might leave encouraging notes

and little rewards for good brushing and flossing.

Limit sugary snacks. Emphasize regular meals and healthy snacks, but if kids do eat or drink something sugary, teach them to brush or rinse their mouths with

water soon afterward.

Talk up the dentist. Don’t pass on your hatred of dental appointments or details on your fillings and root canals. Keep it positive: the dentist’s office is a fun place that helps kids stay healthy.

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Large doses of vitamin C may lower blood pressure, research finds

By Andrea K. Walker

The Baltimore Sun

Large doses of vitamin C may moderately reduce blood pressure, Johns Hopkins researchers have found.

But the scientists don’t recommend people start taking large amounts of the vitamin.

Researchers led by Dr. Edgar “Pete” R. Miller, an associate professor in the division of general internal medicine at Hopkins, reviewed and analyzed data from 29 previous clinical trials and found that taking 500 milligrams of Vitamin C daily, or five times the recommended amount, could lower blood pressure by 3.84 millimeters.

“Although our review found only a moderate impact on blood pressure, if the entire U.S. population lowered blood pressure by 3 milliliters of mercury, there would be a lot fewer strokes,” Miller said in a statement.

However, Miller warned that none of the studies showed that

vitamin C directly prevents or reduces rates of cardiovascular disease, including stroke.

Scientists have focused on vitamin C’s potential role in blood pressure reduction because of its biological and physiological effects. It may act as a diuretic, causing the kidneys to remove more sodium and water from the body. This helps to relax the blood vessel walls and in turn lowers blood pressure.

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The Longstreet Clinic again the first in area to achieve quality care recognition Advertorial provided by Longstreet Clinic

Gainesville, April 27, 2012 – Since its formation in 1995, The Longstreet Clinic, P.C., (TLC) has been committed to innovation and driving improvement in health care. By embracing compassionate, evidence-based quality standards of care, the Clinic recently received recognition from two national organizations that measure and certify practices in key areas of performance, making it one of the first to achieve such designations.

Longstreet Cancer Center is now one of only two practices in the state of Georgia and 116 in the United States to be certified

by the Quality Oncology Practice Initiative (QOPI®) Certification Program, an affiliate of the American Society of Clinical Oncology (ASCO). The QOPI® Certification Program is an initiative to certify oncology practices that meet rigorous standards for highquality cancer care.

“We are proud to be among the first to receive this important certification, which underscores our commitment to both safety and the highest quality of care for our patients,” said Dr. Richard LoCicero, an oncologist at Longstreet Cancer Center.

On March 12, the National Committee for Quality Assurance (NCQA) announced that TLC’s Department of Family

Medicine in Oakwood, which includes Marti Gibbs, M.D., John N. Range, M.D., and Andrew B. Reisman, M.D., had been certified as a Level 3 Patient-Centered Medical Home Program, an innovative program for improving primary care. The Longstreet Clinic is the first practice in Northeast Georgia and only the 10th in the state to receive this level of PCMH recognition.

Obtaining this level of recognition means a practice has demonstrat ed that it meets required standards including utilization of evidence-based criteria, patientcentered care and information technology in the delivery of care to patients.

In addition to the PCMH, TLC holds certification by the NCQA’s Diabetes Recognition Program and Heart/Stroke Recognition Program, making it the only practice in the state to carry three different sets of NCQA recognitions.

“As the delivery of medical care continues to evolve, our commitment to providing the highest level of patient care hasn’t wavered,” said Mimi Collins, CEO of The Longstreet Clinic. “We are pleased that we continue to be leaders when it comes to adopting the best practices in the industry that improve the quality of care, patient outcomes and patient satisfaction.”

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What’s all the hype about

P.A.D.?

Do you have pain in your hips, thighs, or calves when walking or climbing stairs? If so, you may have Peripheral Artery Disease (PAD). This life-threatening condition can be managed or even reversed with proper care. Learn more about the risk factors, symptoms, prevention, diagnosis and treatment at a FREE community seminar.

Attend a FREE seminar presented by Thomas A. Abbruzzese, MD, vascular surgeon with Northeast Georgia Physicians Group (NGPG) Surgical Associates Vascular Center.

Dr. Abbruzzese received his medical degree from Stanford University School of Medicine and completed his internship and residency in general surgery at Brigham and Women’s Hospital, a teaching affiliate of Harvard Medical School in Boston, where he served as chief resident. He also completed a fellowship in surgical critical care at Brigham and Women’s Hospital and a fellowship in vascular surgery at Massachusetts General Hospital. Dr. Abbruzzese is certified by the American Board of Surgery in general surgery, vascular surgery and surgical critical care.

There are two opportunities to attend: Tuesday, May 1

6 - 7 p.m.

Spout Springs Library Flowery Branch

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Northeast Georgia Medical Center Walters Auditorium, Gainesville

Check-in and a free sandwich supper begin at 5:30 p.m.

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Register online at www.ngpg.org/vascular-surgery or call 770-219-3840 to register or to learn more about the seminar.