at 1607 Doctors Drive, Madison, 39110 United States
DERMATOLOGY: Dr. Miriam Shatley Dr. Anna Asher Leah Calder, PA-C Kristen Richardson, PA-C RHEUMATOLOGY: Dr. Robert McMurray Miranda Sudduth, PA-C
Madison Medical Group is committed to providing outstanding Dermatology and Rheumatology care to the tri-county area. Staffed by Dr. Miriam Shatley, Dr. Anna Asher, Dr. Rob McMurray, Kristen Richardson PA-C, and Miranda Sudduth PA-C, we treat a wide variety of skin disease, provide cosmetic procedures, address all types of arthritic conditions (including osteoarthritis, osteoporosis, RA, SLE and other connective tissue disease, and gout) as well as provide acupuncture treatment and injections for painful musculockeletal conditions. We opened in August 2014 and we are currently accepting new patients. We would love to help you with your dermatologic or rheumatologic needs! Please call 769-300-2100 for more information or to schedule an appointment. We also have a sister clinic, Belle Meade Medical Dermatology, which is located in Flowood. To schedule a dermatology appointment at this location call 601-992-7002. Madison Medical Group is located on the north end of Highland Colony Parkway. We are directly across the street from the new Walgreens at 1606 Highland Colony Parkway. Enter the Fountains of Madison development on Fountain Blvd and take the first right onto Doctors Drive. We look forward to seeing you!
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Attention "Dr. Oz" and "The Doctors" fans. Buyer Beware the advice given on these TV shows, a scientific study has shown that approximatley half the advice given on these shows is not supported by medical evidence (see below). Its like gambling, it should be for entertainment purposes only! THE study (skip to bottom if you are easily bored) : Televised medical talk shows—what they recommend and the evidence to support their recommendations: a prospective observational study BMJ 2014;349:g7346 ; Christina Korownyk M.D. Et al. Objective: To determine the quality of health recommendations and claims made on popular medical talk shows. Sources: Internationally syndicated medical television talk shows that air daily (The Dr Oz Show and The Doctors). Interventions: Investigators randomly selected 40 episodes of each of The Dr Oz Show and The Doctors from early 2013 and identified and evaluated all recommendations made on each program. A group of experienced evidence reviewers independently searched for, and evaluated as a team, evidence to support 80 randomly selected recommendations from each show. Main outcomes: measures Percentage of recommendations that are supported by evidence as determined by a team of experienced evidence reviewers. Secondary outcomes included topics discussed, the number of recommendations made on the shows, and the types and details of recommendations that were made. Results: We could find at least a case study or better evidence to support 54% (95% confidence interval 47% to 62%) of the 160 recommendations (80 from each show). For recommendations in The Dr Oz Show, evidence supported 46%, contradicted 15%, and was not found for 39%. For recommendations in The Doctors, evidence supported 63%, contradicted 14%, and was not found for 24%. Believable or somewhat believable evidence supported 33% of the recommendations on The Dr Oz Show and 53% on The Doctors. On average, The Dr Oz Show had 12 recommendations per episode and The Doctors 11. The most common recommendation category on The Dr Oz Show was dietary advice (39%) and on The Doctors was to consult a healthcare provider (18%). A specific benefit was described for 43% and 41% of the recommendations made on the shows respectively. The magnitude of benefit was described for 17% of the recommendations on The Dr Oz Show and 11% on The Doctors. Disclosure of potential conflicts of interest accompanied 0.4% of recommendations. Conclusions: Recommendations made on medical talk shows often lack adequate information on specific benefits or the magnitude of the effects of these benefits. Approximately half of the recommendations have either no evidence or are contradicted by the best available evidence. Potential conflicts of interest are rarely addressed. The public should be skeptical about recommendations made on medical talk shows.
HOW IS PSORIASIS DIAGNOSED? Diagnosis begins with a thorough history in which the physician may ask about family members with psoriasis, recent stressful events or illnesses, and initiation of new medications. Next, he/she will perform a physical examination of the skin, hair, and nails to look for red, white, or silvery raised areas of thick, dry, flaky skin on the elbows, knees, trunk, scalp and other areas as well as characteristic nail abnormalities such as thickening, indentations, discoloration, loosening of the nail beds. Finally, to confirm the diagnosis, a biopsy may be performed to look at a small sample of skin under the microscope.
THE RELATIONSHIP BETWEEN PSORIASIS AND ARTHRITIS: Dry, scaly skin rashes and stiff, achy joints may appear to be two distinct, unrelated conditions, but this combination of symptoms can be a sign of a type of inflammatory arthritis called psoriatic arthritis. Psoriasis occurs when the immune system “misfires” and inappropriately causes skin cells to grow too quickly which leads to thick, red plaques of skin; in some individuals, this immune response is thought to extend to the joints. Fortunately, less than 30% of psoriasis patients develop psoriatic arthritis. Though psoriasis precedes arthritic symptoms in most cases, sometimes the arthritis appears first or both conditions appear simultaneously.. At Madison Medical Group we evaluate and treat both conditions, in one place, and you can have lunch at Colony Crossing and shop at Rennaisance (although the latter is not included in our charges!). Let us know if we can help!
HAIR LOSS IN WOMEN IS VERY STRESSFUL, THIS ARTICLE FROM THE WSJ EXPLAINS COMMON CAUSES, OF COURSE WE ARE HERE TO HELP UNCOMMON CAUSES IS HAIR LOSS IN WOMEN NORMAL? Women, as well as men, may experience thinning hair as they age. WSJ's Heidi Mitchell and Dr. Paradi Mirmirani discuss on Lunch Break with Tanya Rivero. Heidi Mitchell Jan. 26, 2015 2:37 p.m. ET Wall Street Journal Women are often surprised to find they are losing their hair. At drugstores, they will spend untold amounts of money on products that claim to build back volume or reverse the damage of hair loss. One expert, Paradi Mirmirani, a dermatologist and assistant clinical professor at the University of California at San Francisco, explains how hair changes as we age and why we should chow down on protein. Never Say ‘Bald’ In women, just as in men, the most common type of hair loss, or alopecia, is hereditary thinning. It is popularly believed to be inherited from one’s mother’s side, but actually could come from both parents, says Dr. Mirmirani, who specializes in hair disorders. It is as likely to affect women as men. “Fifty percent of everyone will develop some degree of hereditary hair loss by 50, but it can start as early as age 20 or even the teens,” she says. In women, the pattern of hereditary thinning is different than in men; it is referred to as female pattern thinning. “Women don’t go bald or have a receding hair line,” she explains. “Instead you might notice some thinning on top of the head as opposed to at the back, or that your scalp is more visible or your pony tail isn’t as thick.” Everyone experiences a normal five-to-seven-year cycle of growth and shedding of hair. At any given time, 10% of the hair is in the resting phase and not growing; the follicle, or hair root, will push out the old strand with a new, short strand. Around 100 to 200 strands of hair loss a day is normal. “That is the amount that you should be able to replace daily, and that shedding is fine,” says Dr. Mirmirani. Stress, such as a death in the family or having a baby, might trigger a normal “shedding episode,” especially for those predisposed to alopecia, according to Dr. Mirmirani.“But those follicles aren’t dead,” she says. “The hair will recover, but it may take six to nine months.” Blame Hormones Hormonal changes can cause hair loss. In puberty, male hormones, called androgens, kick in for both men and women. If a woman is genetically predisposed to female pattern thinning, that increase in androgens may encourage the follicles to shrink as early as during her teenage years. In and around menopause, women’s estrogen goes down, which is the time most women with hair loss start to notice thinning. Thinning is related to follicle size. “Think of your hair as a plant: That smaller root would cause a smaller plant to grow, so over time you get finer, thinner hair that won’t grow as long,” Dr. Mirmirani says. Because a woman has gone through as many as eight hair cycles by the time she’s 40, Dr. Mirmirani says, her hair is going to be very different than when she was in her teens—just as her eyes and skin will be different. Still, hair loss is often traumatic. “Women usually come to me with what I call a ‘midlife hair crisis,’ ” Dr. Mirmirani says. “It may seem dramatic to you when your long, dark hair is all over the bathroom floor. But for the vast majority of women, hair thinning is slow and gradual.” Later in life, around age 60 or 70, aging can typically cause further thinning. Hair, like nails, is made up of protein, so eating adequate amounts of protein will help keep hair in peak condition. “I have some vegetarians and vegans who have trouble with hair growth,” says Dr. Mirmirani. In Treatment There are over-the-counter treatments for hereditary thinning, such as minoxidil.“Before you try any product, talk to your doctor to make sure nothing else—medications, recent surgery—is contributing to shedding or loss,” says Dr. Mirmirani. For extreme cases, there are cosmetic and surgical solutions, like transplants. There is not a lot of data about the effects of supplements, she says, despite pharmacy shelves crowded with products making claims of hair growth. “We know biotin deficiency, which is a very rare genetic disorder, will cause brittle hair. The question is, will biotin supplements help reverse that? Science just doesn’t know yet,” she says.
IN ADDITION TO THE DISCUSSION BELOW DIABETES IS ASSOCIATED WITH SEVERAL TYPES OF ARTHRITIS INCLUDING BUT NOT LIMITED TO CARPAL TUNNEL SYNDROME, GOUT AND PSEUDOGOUT, FROZEN SHOULDER, ETC. IF YOU HAVE DIABETES-ARTHRITIS WE WOULD BE GLAD TO HELP YOU FIGURE IT OUT! The Diabetes-Arthritis Connection What do diabetes and arthritis have in common? Plenty. By Denise Lynn Mann and Donna Rae Siegfried/ARTHRITIS TODAY 2015 People with diagnosed diabetes are nearly twice as likely to have arthritis, indicating a diabetes-arthritis connection. Diabetes occurs when the body does not produce or use the hormone insulin sufficiently. Insulin shuttles glucose from foods into cells so it can be converted into energy. Without insulin, glucose remains in your blood (raising blood glucose levels), your cells create less energy and you feel fatigued. What starts off as a hormonal problem can evolve into joint problems, in addition to the widely known cardiovascular problems. Diabetes causes musculoskeletal changes that lead to symptoms such as joint pain and stiffness; swelling; nodules under the skin, particularly in the fingers; tight, thickened skin; trigger finger; carpal tunnel syndrome; painful shoulders; and severely affected feet. After having had diabetes for several years, joint damage – called diabetic arthropathy – can occur. Though they both share connections with diabetes, rheumatoid arthritis (RA) and osteoarthritis (OA) are related to the disease in different ways. Let's look at a few of the connections: Autoimmunity and type 1 diabetes. Type 1 diabetes is an autoimmune disease, as is rheumatoid arthritis. In people who have type 1 diabetes, the body attacks the pancreas, the organ where insulin is made, just as RA attacks the synovial tissue lining the joints. Inflammation is the common culprit. Levels of inflammatory markers, such as C-reactive protein (CRP) and interleukin-6 (IL-6), which often are high in people with rheumatoid arthritis, also are increased in those with type 1 diabetes. A study of people who had type 1 diabetes for longer than five years shows an increase in tumor necrosis factor-alpha (TNF-a), another inflammatory marker often elevated in people with inflammatory forms of arthritis. Inhibiting TNF-a with drugs such as adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade) is the goal of treating arthritis and related conditions. As scientists learn more about the roots of inflammation, some treatments for inflammatory arthritis may wind up helping to control other inflammation-related conditions. Researchers already are testing the possibilities. Reducing inflammation with Remicade improved insulin sensitivity in people who had inflammatory diseases and were insulin resistant, according to a small study published in the journal Annals of the Rheumatic Diseases. And in a study of 70 people who had type 2 diabetes, the arthritis drug anakinra (Kineret) brought down the glucose level, improved function of the pancreas and decreased levels of CRP and IL-6. Osteoarthritis and type 2 diabetes. Go above your ideal weight, and your lower-body joints feel the burden. As the scale creeps upward, your organs become burdened, too. The pancreas increasingly produces more insulin to deal with excess sugar, eventually becoming exhausted and ineffective. The heart and blood vessels become stressed as they strain to pump blood through a larger body mass and deal with the inflammatory chemicals being churned out by fat cells. “Type 2 diabetes is [largely] a disease of people who are overweight or obese, and overweight and obesity are big risk factors for knee and hip OA,” says David Felson, MD, a professor of medicine and epidemiology at Boston University School of Medicine. The first-line fix for both conditions? Lose weight, which, Dr. Felson says, will improve each one. Modest weight loss will alleviate pressure from the lower extremities, helping to ease pain in the hips, knees and feet. Losing just 15 pounds can cut knee pain in half. And losing just 5 percent to 10 percent of body weight will reduce blood sugar significantly and can enable some people to taper off insulin and other medications. Take Good Care of Yourself Eat regularly and consistently to help your body maintain steady blood glucose levels. Doing so keeps the body from releasing too much insulin, which is known to make weight loss (and fat loss) difficult. Try to eat the same amount of food during meals or snacks at the same times every day, and, of course, choose your foods wisely. Consume some protein and healthy fats, along with whole-grain carbohydrates and nonstarchy vegetables, at each meal, and keep portions small: Eating too much at once causes blood sugar to spike. Then, make sure you engage in about 30 minutes of physical activity on as many days of the week as possible to help keep your weight down, your joints lubed and your blood sugar normal, not to mention to decrease your risk of heart disease – a top health risk associated with both arthritis and diabetes.
THE BACK PAIN PILLS THAT MANY DOCTORS WON'T RECOMMEND ANYMORE By Ali Eaves Men's Health October 2014 Proofed by Robert McMurray MD December 2014 Taking prescription painkillers to ease chronic conditions, like an achy back or headache, is not worth the risk, the American Academy of Neurology recommended in a recent official announcement. These drugs, including Vicodin, OxyContin, and Percocet, are often prescribed for people being treated for cancer or following surgery or an injury. They're very effective in managing pain, but carry substantial risks: They're addictive. Two-thirds of patients who were given a 3-month prescription were still on the drugs 5 years later, according to a recent study from the University of Arkansas Medical Sciences. The drugs require larger doses over time to remain effective, making them particularly susceptible to overdose, and their abuse can increase the risk of non-prescription alternatives, including heroin. They can be deadly. More than 100,000 people have died in the last 15 years from prescription opioids, the AAN reports. If you want relief for chronic conditions--without the risk of developing a dangerous drug habit-- ask your doctor about alternatives to narcotics, suggested Gary M. Franklin, M.P.H., the author of the AAN paper. Your doctor might endorse these alternative options for managing pain: • Taking non-steroidal anti-inflammatory painkillers, such as Advil, as a non-addictive alternative; such as gabapentin, Lyrica, Cymbalta, amitryptiline, cyclobenzaprine, or a number of other alternative medications • Physical therapy or exercise • Cognitive behavioral therapy, which involves talking to a therapist and learning techniques to manage pain mentally; • Using biofeedback to better control your body’s internal processes; or acupuncture If you're already taking a narcotic for a chronic condition, you should consider asking your doc about weaning you off the drug if you meet any of the following criteria, Dr. Franklin says: • You or your family thinks you have become addicted; • Your dose is excessive hasn't substantially improved your pain and daily functioning; • You have overdosed in the past.
IN KEEPING TRYING UP TO DATE IN THE MEDICAL LITERATURE, WE FOUND THE MEDICAL STUDY ON BOTOX REFERENCED BELOW VERY INTERESTING. WHILE SHARING IT IS SELF-SERVING, GIVEN THE AMOUNT OF MONEY SPENT ON ANTIDEPRESSANTS AND THE UPCOMING STRESS OF THE HOLIDAY/POST-HOLIDAY SEASON, BOTOX MAY BE A GOOD WAY NOT TO ADD ANOTHER PILL. THEY USED TO SAY ON SATURDAY NIGHT LIVE –“IT IS BETTER TO LOOK GOOD THAN FEEL GOOD” – WE SAY “IT IS BETTER TO LOOK GOOD AND TO FEEL GOOD” In the American Journal of Psychiatry TREATMENT OF MAJOR DEPRESSIVE DISORDER USING BOTULINUM TOXIN A: A 24-WEEK RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY. Magid M, et al. OBJECTIVE: To determine whether a single treatment of botulinum toxin A in the forehead (glabellar) region can improve symptoms of depression in patients with major depressive disorder (MDD), as defined by DSM-IV criteria. METHOD: Thirty participants were randomly assigned to receive either placebo or botulinum toxin A (BTA; onabotulinumtoxinA) injections in the forehead. Female participants received 29 units; male participants received 39 units. At week 12, the groups were crossed over. Participants were evaluated at weeks 0, 3, 6, 12, 15, 18, and 24 for improvement in MDD symptoms using the Patient Health Care Questionnaire-9, Beck Depression Inventory (BDI), and 21-Item Hamilton Depression Rating Scale (HDRS-21) objective measurement scales. The primary outcome was the rate of HDRS-21 response, defined as ≥ 50% score reduction from baseline. The study occurred from July 2011 to November 2012. RESULTS: Patients who received BTA at week 0 (BTA-first group) and at week 12 (BTA-second group) had a statistically significant reduction in MDD symptoms as compared to placebo. Improvement in MDD continued over 24 weeks in the group that received BTA first even though the cosmetic effects of BTA wore off at 12 to 16 weeks. HDRS-21 response rates were 55% (6/11) in the BTA-first group, 24% (4/17) in the BTA-second group, and 0% (0/19) in the placebo group (P < .0001). HDRS-21 remission rates (score ≤ 7) were 18% (2/11), 18% (3/17), and 0% (0/19), respectively (P = .057). HDRS-21 scores dropped -46% and -35% in the BTA-first and -second groups versus -2% in the placebo group (P < .0001). The BDI response rate (≥ 50% reduction from baseline) was 45% (5/11) in the BTA-first group, 33% (6/18) in the BTA-second group, and 5% (1/19) in the placebo group (P = .0067). BDI remission rates (score ≤ 9) were 27% (3/11), 33% (6/18), and 5% (1/19), respectively (P = .09). BDI scores dropped -42% and -35% in the BTA-first and -second groups versus -15% in the placebo group (P < .0001). CONCLUSIONS: Botulinum toxin A injection in the glabellar region was associated with significant improvement in depressive symptoms and may be a safe and sustainable intervention in the treatment of MDD.
More Evidence Botox Works for Depression - WEBmd June 19, 2014 (NEW YORK) -- A single injection of Botox, which is typically used to improve the appearance of facial wrinkles, may be an effective treatment for depression. Investigators at the Hannover Medical School in Germany found that treating the facial muscles involved in emotion with Botox eases symptoms of depression. "Our emotions are expressed by facial muscles, which in turn send feedback signals to the brain to reinforce those emotions. Treating facial muscles with botulinum toxin interrupts this cycle," study investigator Prof. Tillmann Kruger said at a press conference at the American Psychiatric Association's 2014 Annual Meeting. Novel ApproachAccording to the investigators, positive effects on mood have been seen in patients who've had Botox treatment for the frown lines in the area above the nose and between the eyebrows. To confirm these results, Kruger and colleague M. Axel Wollmer, MD, from the Asklepios Clinic North Ochsenzoll in Hamburg, Germany, did research on Botox injection as an additional treatment for major depression. A total of 30 patients with high levels of chronic and treatment-resistant depression were enrolled in the study. Patients were randomly assigned to receive a single injection of Botox or a single injection of saline placebo ("fake treatment"). Six weeks after a single treatment, the Botox group had an average 47.1% reduction in depression symptoms vs. 9.2% in the placebo group. The investigators found that the effect size was even larger at the end of the study. Improvement was also reflected when other tools were used to measure depression symptoms. Kruger said Botox may offer a "novel, effective, well-accepted, and economic therapeutic tool for the treatment of major depression." These findings have since been repeated in two other studies. The researchers are also testing Botox’s therapeutic potential in other psychiatric disorders. Jeffrey Borenstein, MD, president and CEO of the Brain and Behavior Research Foundation in New York City, said at the press conference that pursuing new treatments for depression is "crucial." Borenstein said he'd like to see this line of research pursued in studies that include larger numbers of patients.