The Multi-Layered Benefits of Tomosynthesis

by Agnes Cartner, MD

 

Tomosynthesis, or 3D mammography, is one of the newest tests for early breast cancer detection available at Brookwood Medical Center. Tomography is used in combination with the standard mammogram (2D) to help radiologists detect even more cancers at the earliest possible stage.  

 

Fifteen images are obtained over four seconds and used to reconstruct 1 millimeter thin images for the radiologist to evaluate. The process helps radiologists to better determine which areas of density we see on 2D mammography are merely overlapping fibro glandular tissue versus those caused by the presence of a small cancer. The benefit of tomosynthesis increases as the density of the breast tissue increases. Therefore 3D mammography not only helps us to better detect small cancers, it decreases our need to call a patient back for additional imaging (decrease in callback rate). Both benefits result in a decrease in anxiety patients experience when they have to return for additional imaging!

 

There is an additional radiation dose for the new 3D images since it is added to a standard 2D mammogram for interpretation. However, the total radiation dose is still below the safe levels that have been established by the FDA.

 

We are excited to provide this new technology at Brookwood Women's Diagnostic Center. The stage at which breast cancer is detected influences a woman’s chance of survival. If detected early, the five-year survival rate is 98 percent. Therapies for treating and curing breast cancer are improving every day!  

 

Dr. Agnes Cartner is a diagnostic radiologist at Brookwood Medical Center.

 

Diabetes and your feet_ Disease management must focus on head-to-toe health

 

 

 

 

By Rodrigo Valderrama, MD
Endocrinologist @Trinity Medical Endocrinology & Diabetes Center.

 

 

 

 

 

Diabetes affects 25.8 million people, or 8.3% of the U.S. population. It is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.

About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage that may result in impaired sensation or pain in the feet or hands. In 2008 alone, more than 70,000 people with diabetes had a leg or foot amputated. While diabetes can lead to serious complications and premature death, by taking steps to control the disease, including being extra aware of foot health, people with diabetes can manage the disease and lower their risk for complications, including lower-extremity amputations.

Why diabetes affects the feet

Diabetes has the potential to harm your feet because blood flow is reduced to certain areas of the body, especially limbs such as the legs. This makes it harder injuries to heal. Also, diabetes-related nerve damage may cause you to no longer feel pain in your feet, and you may not realize you have a wound or injury that needs treatment.

Typical warning signs of nerve damage in the feet include:

• pain in your legs or cramping in your buttocks, thighs, or calves during physical activity
• tingling, burning, or aching in the feet
• lost sense of touch or unable to feel heat or cold well
• a change in the shape of your feet over time
• loss of hair on your toes, feet, and lower legs
• dry and cracked skin on the feet
• thick and yellow toenails
• fungal infection between your toes
• blisters, sores, ulcers, infected corns, and ingrown toenails

Protecting Your Feet

Over half of diabetes-related amputations can be prevented with regular exams and patient education which includes the following simple tips from the Centers for Disease Control and Prevention.

·         Check your feet each day. Because you may not feel foot pain, look at the tops and bottoms of your feet and toes every day to check for scratches, cracks, cuts or blisters. If you can’t see well, ask a family member or friend to help. Call your doctor if you have any sores.

·         Wash your feet daily. Don’t soak your feet, as it can dry out your skin, which can lead to infections. Be sure to dry your feet carefully, especially between the toes. Rub a doctor-recommended lotion on the tops and bottoms of your feet—but not between your toes; moisture between the toes will allow germs to grow that could cause infection.

·         Trim your toenails carefully. After washing and drying your feet, trim your toenails. Trim the nails to follow the natural curve, but don’t cut into the corners. If you can’t see well, or if your nails are thick or yellowed, get them trimmed by a foot doctor or another healthcare provider. If you see redness around the nails, see your doctor immediately.

·         Never cut or use a razor on corns or calluses. Ask your doctor how to use a pumice stone to rub them.

·         Protect your feet from heat and cold. Hot water or surfaces are dangerous to your feet. Test your bath water with your elbow and wear shoes and socks when you walk on hot surfaces. In summer, use sunscreen on the tops of your feet, and in the winter, wear socks and warm footwear to protect your feet.

·         Always wear shoes and socks. Never walk barefoot—even indoors.

·         Wear shoes that fit well and protect your feet. Don’t wear shoes that have plastic uppers, and don’t wear sandals with thongs between the toes. New shoes should be comfortable when you buy them. Always wear stockings or socks made of cotton or wool to help keep your feet dry.

·         Be physically active. Physical activity helps increase the circulation in your feet. If you are not able to walk, ask your doctor about seated or reclining exercises for your feet and legs.

·         Have your doctor check your feet at least 4 times a year.

 

Primary Types of Diabetes

 

Type 1 Diabetes	Type 2 Diabetes	Gestational Diabetes
Previously called insulin-dependent diabetes mellitus or juvenile-onset diabetes, type 1 diabetes develops when the body’s immune system destroys pancreatic beta cells – the only cells that make the hormone insulin that regulates blood glucose.   To survive, people with type 1 diabetes must have insulin delivered by injection or a pump.	Previously called non–insulin-dependent diabetes mellitus or adult-onset diabetes, type 2 diabetes accounts for 90-95% of all diagnosed cases. It usually begins as insulin resistance, in which the cells don’t use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it.   Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism and physical inactivity. Also, African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or other Pacific Islanders are at particularly high risk.	Gestational diabetes is a form of glucose intolerance diagnosed during pregnancy. It occurs more frequently among African Americans, Hispanic/Latin Americans, and American Indians. It’s more common among obese women and women with a family history of diabetes.   During pregnancy, gestational diabetes requires treatment to optimize maternal blood glucose levels to lessen the risk of complications in the baby.

Previously called non–insulin-dependent diabetes mellitus or adult-onset diabetes, type 2 diabetes accounts for 90-95% of all diagnosed cases. It usually begins as insulin resistance, in which the cells don’t use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it.   Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism and physical inactivity. Also, African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians or other Pacific Islanders are at particularly high risk.

Gestational diabetes is a form of glucose intolerance diagnosed during pregnancy. It occurs more frequently among African Americans, Hispanic/Latin Americans, and American Indians. It’s more common among obese women and women with a family history of diabetes.   During pregnancy, gestational diabetes requires treatment to optimize maternal blood glucose levels to lessen the risk of complications in the baby.

 

Dr. Valderrama is board certified in Endocrinology and Diabetes and practices with Trinity Endocrinology & Diabetes Center.

 

 

Great News to Prevent Aging Skin

By: A. Michele Hill, M.D.
with Total Skin and Beauty Dermatology Center

Recently published evidence suggests that treatment with Intense Pulsed Light (IPL) can restore the gene expression pattern of aged human skin to resemble younger skin.

What this means is improvement in fine wrinkles, coarse wrinkles and pigmentation, giving a more youthful appearance. In a blinded eight-year study from Stanford University, evaluators were asked to estimate the age of each patient before treatment. Patients who were determined to be their actual age were treated every year with broadband light such as IPL and reexamined eight years later.

Evaluators at this visit determined that patients were 9 years younger than their actual age. In other words, they had not aged at all over the eight year study period!

We have known for some time that IPL is a great way to eliminate problems with brown pigmentation and redness. I am now recommending IPL to all my patients who want to delay aging in their skin.


For more information contact:
http://www.totalskinandbeauty.com/

Prostate Cancer

 

By : V. Michael Bivins M.D. Medical West

 

For men, the current leading cancer diagnosis is prostate cancer. 

For the "half-full" folks, one way to look at that is that more men are coming in for prostate exams, so the math indicates that we would find more. Half-empty folks, well, prostate cancer is still not a good thing to have. The National Cancer Institute has an estimated number of new cases of prostate cancer for this year at 238,590 - over a third the population of North Dakota. 

But with the improvements we are making in detection and treatments, prostate cancer has very much become a treatable disease. Simply put, prostate cancer is a cancer that forms in tissues of the prostate (a male gland in the reproductive system) and usually grows slowly and remains confined to the prostate gland. There are some instances when it spreads beyond the prostate, and these can be serious.

Screening for abnormalities in the prostate is primarily centered around two tests, the DRE and the PSA.

The DRE (Digital Rectal Exam) has your doctor inserting a gloved, lubricated finger into the rectum to examine whether there are any abnormalities with your prostate. The prostate is located directly next to the rectum.

The PSA (Prostate-Specific Antigen test) is a blood sample drawn and analyzed. If too much PSA (an antigen that is produced by your prostate) is found in your bloodstream, more tests may be required.

If an abnormality is found, then it's time to see if we've got cancer. Ultrasounds are performed and samples of prostate tissue may be collected and tested. Your doctor will determine what tests are best for you if cancer is suspected (CT Scans, MRIs, etc.).

Their are four stages of prostate cancer, the first two signify that the cancer is contained within the prostate and with less to more aggressive cancer cells.

Stage III indicates the cancer has spread beyond the prostate to the more immediate area (seminal vesicles as an example).

Stage IV indicates the cancer has spread to nearby organs (bladder, bone, lungs, and more).

Treatment for prostate cancer has improved survival rate and the quality of life for those affected. The treatment factors are different for everyone, of course, as the rate of growth can be different, the stage, and other health factors all mix into the treatment strategy.

Examples of treatment include:

1) Some physicians find that it is best for their patients to be under active surveillance until further treatment is shown to be necessary.

2) Radiation therapy.

3) Hormonal therapy.

4) Surgery to remove the prostate.

5) Freezing prostate tissue (repeatedly freezing and thawing cancer cells to eventually kill them off)

6) Ultrasound - intensely heat the cells, causing the cancer cells to die.

Prostate cancer is found primarily in older men, so if you are either creeping up into your forties or if your family has a history of prostate cancer - ask your doctor what they think about getting you screened.

I work under the policy of "it's better to know than to just wait and see". Getting tested and finding nothing is worth the hassle. Talk to your doctor and decide what is best for you.

Take Care,

Dr. Bivins

 
For more info contact _ http://www.medicalwesthospital.org/doctor.php?cn=531

The O-arm

 

By: Joseph G. Khoury, M.D., Chief of Pediatric Orthopedics at Children’s of Alabama and an Assistant Professor of Pediatric Orthopedics at UAB

 

The orthopedic surgeons here at Children’s of Alabama have taken the next step toward safe and efficient scoliosis care with the incorporation of new technology called the “O-arm” (from Medtronic and Stealth Navigation) for use in all scoliosis surgery. We began using this technology this past summer, and now regard this product as an indispensable tool that we wonder how we ever got along without.

 

The O-arm is a portable, intra-operative CT scanner. The device looks like three-quarters of a circle and moves in over the patient after the spine has been exposed.  A reference frame is secured to a spinous process just below or above where we plan to work. The O-arm closes in to form a complete circle around the patient.  Then, the “spin” occurs. The spin is basically a CT scan taken in the prone position with the spine exposed. The radiation dose is approximately one-third of a regular CT.

 

The data from the spin with respect to the reference frame is then assimilated so we can navigate with special instruments and create pathways for our pedicle screws while watching in three dimensions on a monitor with live feedback in order to avoid injury to the delicate surrounding neurovascular structures.

 

This technology has allowed us to place spinal instrumentation in places where it was previously not possible with standard two dimensional imaging. In addition, the implants are placed more rapidly and we can be confident that they are placed into a completely safe position. While the incidence of neurologic injury from misplaced implants is relatively low, the incidence of misplaced hardware is alarmingly high. We certainly feel much more comfortable knowing exactly where every implant is located.

 

After using the O-arm in several cases, we have found the most efficient way to incorporate the use of the O-arm into our cases and there is no longer any delay or increase in case time. In fact, for more difficult cases and more severe curves, the case time is decreased. This means less blood loss and lower risk of infection for severe degrees of curvature.

 

Scoliosis is only the beginning. Many other centers utilize the O-arm for complicated peri-acetabular osteotomies, to optimize the placement of screws for slipped capital femoral epiphysis or to confirm the complete removal of a subtalar coalition.  The opportunities to use the O-arm to enhance the precision of surgery performed at Children’s are virtually limitless and we feel strongly that our patients will benefit from this new technology.

 

Joseph G. Khoury, M.D., is Chief of Pediatric Orthopedics at Children’s of Alabama and an Assistant Professor of Pediatric Orthopedics at UAB. He earned his medical degree at the University of Iowa College of Medicine, completed his internship and residency at the University of Iowa Hospitals and Clinics and his Fellowship at Children's Orthopedics of Atlanta.

You can reach me at 205-638-9540 for more information.