#Dr. Audrey Arona

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Signs and Diagnoses of Breast Cancer During Pregnancy

Breast cancer occurs when malignant cells form within the breast. Although most common in women over 50 years old, medical professionals have diagnosed it among women aged 32 to 28. As some women now more commonly delay having children, medical professionals have increasingly diagnosed it in pregnant patients.

Breast cancer occurs in one out of 3,000 pregnancies, including pregnancy-associated breast cancer (PABC) which potentially develops during the pregnancy, the one-year postpartum phase, or during lactation. Incidence increases in the first six months of the postpartum period.

Despite its rareness, PABC has become one of the more common types of cancer that mothers experience during pregnancy and identifying breast cancer is more challenging during that time. As lactogenesis occurs with pregnancy, birth, and nursing, normal functional and anatomical changes occur in the breast tissue. These hormonal changes mean the breasts become tender, larger, and lumpier. These changes make small abnormal lumps more challenging to identify. The breasts may also become denser, making mammograms more difficult to interpret.

These factors, plus denial of potential symptoms and signs among mothers, combine to make delayed diagnosis more common during pregnancy. PABC tends to be more aggressive, estrogen/progesterone receptors tend to be negative in line with more aggressive tumors, and the Human Epidermal Growth Factor Receptor 2 (HER2) tends to be positive.

In addition, the lymph nodes become active and more susceptible to lymph vascular invasion. Therefore, breast tumors can become larger among pregnant women, and the likelihood of it spreading to the lymph nodes increases.

Triple-negative breast cancer and HER2-positive breast cancer have become the most prevalent types of PABC. They grow and divide rapidly, with a greater likelihood of metastasis. Postponing testing and treatment until delivery or after lactation often leads to a poorer outcome.

The presence of cancer during or around the time of pregnancy has several signs, such as breast size or shape changes and thickening or the presence of lumps in or near the breast or underarm region. Other signs include a dimple or puckering of the breast skin or a nipple that turns inward. Bleeding or a dark discharge from the nipple can also be a sign. During pregnancy, a persistent breast mass remains the most common sign of PABC, and most women discover it themselves.

Because of hormonal and breast changes associated with pregnancy, palpable breast lumps, abnormal discolored nipple discharge or nipple bleeding, and skin changes do not always indicate the presence of cancer. Therefore, women should undergo testing in a clinical setting which includes a breast exam by a health care professional, ultrasound, mammogram, and possible biopsy.

The first-line imaging method remains a breast ultrasound, which can capture signs of PABC. Typically, a fluid-filled hypoechoic mass with irregular margins and shadowing is seen. However, normal pregnancy-related physiological changes can overlap, making a tissue sampling known as a biopsy essential in reaching a correct diagnosis.

During pregnancy and lactation, medical professionals rarely use mammography to diagnose patients due to pregnancy-related increased breast density and concerns about fetal radiation exposure. That said, the American College of Radiology (ACR) considers mammography an appropriate route in most cases when utilized alongside ultrasound. It does not recommend breast MRIs due to the risks of fetal exposure to contrast agents containing gadolinium. There is also a relatively new “liquid biopsy” procedure which involves a minimally invasive blood test that can detect cancer cells or tumor-related molecules and provides benefits such as early detection and prognosis with real-time drug-response monitoring.

[orbemnews]

Gwinnett health officials won't require documentation, will use honor system for newly expanded vaccine categories Gwinnett residents who have chronic health conditions won’t need a doctor’s note to prove they are eligible for the COVID-19 vaccine if they get the shot from the county’s health department, a spokesman for the Gwinnett, Newton and Rockdale Health Departments has confirmed. Georgia is expanding the eligibility to get vaccinated, starting on Monday, to include people with a wide range of chronic health conditions, such as diabetes, cancer, heart conditions, sickle cell disease, cystic fibrosis or kidney or liver disease. The minimum age to get the vaccine will also drop from 65 to 55 on Monday, and adults with disabilities will be eligible as well. Some residents had raised questions when the vaccine was first introduced in December about whether they would need to provide documentation of their conditions when they get the vaccine. Sunday Citizen conducted an eight-question survey from Feb. 4–8, 2021 that asked 1,000 respondents about their sleep and how stress affects it. Click for more. The answer is “no” because they already certified that they met the criteria when they scheduled their vaccination appointment, according to Gwinnett health department spokesman Chad Wasdin. “Verifying proof has been easier in Phase 1a for proof of age (like with an ID) or employment in the approved groups (like with a badge),” Wasdin said. “As we get further into expanded phases, it will become more difficult to verify eligibility, and we’ll have to rely on the honor system and accurate self-reporting. Requiring doctor’s notes or documentation could put a strain on the medical system to provide verification.” While Gwinnett health officials will not require documentation, one key caveat in that statement is that Wasdin said he could not speak to what other sites distributing the vaccine, such as hospitals, clinics, pharmacies or grocery stores, will require. While public health officials are having to rely on people signing up for the vaccine being honest when they say they have a chronic health condition that qualifies them to receive the vaccine, starting Monday, they are stressing the importance of people only getting the vaccine if they truly qualify for it. People with chronic health conditions are becoming eligible for the vaccine a week after teachers could begin getting it. Although the Gwinnett health department’s mass vaccination site in the former Sears at Gwinnett Place Mall is designed to eventually handle 3,000 vaccinations a day — once enough vaccine doses are available to do so — District Health Director Dr. Audrey Arona said it was handling about 1,800 vaccinations a day as of this past Monday. “It is our intention to only vaccinate those in the current approved groups,” Wasdin said. “We ask for those currently ineligible to continue to be patient for eligibility to broaden so that we can vaccinate the most vulnerable first.” The full list of chronic health conditions that now qualify for a vaccine include: ♦ Cerebrovascular Disease Success! An email has been sent to with a link to confirm list signup. Error! There was an error processing your request. ♦ Chronic Kidney Disease ♦ Immunocompromised State ♦ Neurologic Conditions ♦ Overweight and Obesity Source link Orbem News #audreyarona #categories #chadwasdin #condition #covid-19 #documentation #Expanded #Gwinnett #gwinnetthealthdepartment #gwinnettplacemall #Health #honor #immunology #liverdisease #Medicine #Newly #Officials #require #system #Vaccination #Vaccine #Wont

[doctoraudreyarona]

A Look at Inequalities in Public Health

Health inequalities are a persistent issue in public health, creating systemic and avoidable disparities in health outcomes across different populations. These inequalities are rooted in the social, economic, and environmental factors popularly known as the social determinants of health (SDOH). They are visible in the quality and accessibility of care enjoyed by different population groups, and the health, well-being, and life expectancy of these individuals. Addressing health disparities through the SDOH lens is crucial in improving public health and achieving health equity because this approach highlights the sources of disparity, allowing public health experts and other stakeholders to devise proactive interventions.

SDOH are interrelated and encompass various individual and community factors, including economic stability, education, social and community life, and neighborhood. People’s income and employment status are central to health outcomes, since they determine a population’s ability to access nutritious food, safe housing, and primary care services. Low-income earners often experience chronic stress, limited access to primary care, and live in environments that expose them to health risks, including a polluted environment.

Access to quality education also affects health outcomes. Those with high levels of education can make informed health decisions and are often safe from common obstacles in service delivery, including language barriers and literacy issues. Moreover, access to education empowers individuals and communities to secure employment, contributing to economic stability. Marginalized and underserved communities, on the other hand, are susceptible to cycles of poverty that jeopardize access to quality and safe care.

Social relationships and community connections are significant health determiners. Strong social support networks are important in providing emotional and practical assistance, promoting mental and physical well-being. Civic engagement is also important, since it obligates the adoption of policies that advocate for access to safe and quality care by every population group. Conversely, social isolation, incarceration, and discrimination based on gender, race, and ethnicity negatively affect the health of some individuals and groups, resulting in unfavorable health outcomes.

Neighborhoods and built environments are another determiner of health. Easy access to safe housing, clean water, and healthy food significantly improves one’s chances of staying healthy. Violence, crime, and poor air quality can pose a risk to one’s mental and physical health, jeopardize the delivery of prompt healthcare services, and contribute to the prevalence of chronic illnesses, such as asthma and cardiovascular disease.

Reducing disparities in public health requires a multifaceted approach to tackle the SDOH and improve health equity. One such strategy is implementing policy and legislative changes. Governments should expand healthcare coverage, increase funding in education, and improve housing conditions to promote social justice and equal access to healthcare. Expanding Medicaid coverage, for instance, can encourage the uninsured and underinsured to access healthcare services since it cushions the expenses. Empowering education and providing easy access to this resource, especially for marginalized and underserved communities, can help in seeking prompt medical attention, reducing morbidity and mortality rates.

Expanding access to quality and safe care is another important approach to eliminating health disparities. This entails increasing the number of care providers, providing adequate care infrastructure, reducing waiting times, and ensuring care is affordable and culturally sensitive. Addressing implicit bias in service delivery can also optimize care quality and protect vulnerable communities from discrimination within facilities.

In addition, community-based interventions can address health inequities and promote communities’ health and well-being. Important stakeholders, including community leaders, religious leaders, and public health workers, can help bridge the gap between care providers and patients. These stakeholders can address myths and misconceptions against modern care, and encourage community members to take responsibility for their health by interacting and cooperating with care providers.

Finally, collaboration across various sectors is imperative in improving health equity. Public health professionals, policymakers, and educators should work together to devise dynamic solutions to health inequities. Government agencies should also foster partnerships with nonprofit organizations and the private sector to ensure effective resource allocation and the adoption of sustainable interventions.

[doctoraudreyarona]

A History of Ballet

Ballet is a formalized and highly stylized dance in which a dance technique called the “danse d’ecole” combines with artistic components such as music, costumes, and a musical stage. It has fluid and precise movements, classic positions, and techniques that evoke emotions and tell a story.

This dance form has its roots in the Italian Renaissance, when it emerged as a court entertainment. Indeed, the terms “ball” and “ballet” come from the Italian word “ballare,” meaning “to dance.” After King Henry II of France married Catherine de Medici, an Italian noblewoman, ballet spread to France.

During ballet’s early days, dancers wore brocaded costumes, headdresses, masks, ornaments, and pantaloons that were aesthetically appealing but restrictive and difficult to move in for dancers. Dancing shoes were also essentially formal dress shoes. The dances involved elements such as costume, decor, dance, music, poetry, and song, helping popularize “ballet de cour,” a type of ballet performance.

During the 17th century, King Louis XIV of France helped transform ballet. A passionate ballet dancer himself, he supported the establishment of the Academie Royale de Danse in Paris, the Western world’s first dance institution. This transformed ballet from a hobby into an activity requiring professional training. King Louis XIV’s personal trainer Pierre Beauchamp aided in codifying ballet’s five basic foot positions still used by dancers today.

Court ballet dances grew in size, grandeur, and opulence, prompting organizers to host events on elevated platforms for increased audience viewing. In 1681, dances shifted from courts to stages. The Le Triomphe de l’Amour, a French Opera, included ballet in stage performances, introducing an opera-ballet tradition in France.

In the 18th century, Jean Georges Noverre, a French ballet master and dancer, rejected the opera-ballet idea, claiming that ballet could stand independently as an art form. He said that characters should reveal relationships between them through dramatic and expressive movements. This introduced “ballet d’action,” a dramatic storytelling ballet style that was the predecessor of 19th-century narrative ballets.

The 19th century saw ballet become a romantic dance that incorporated theatrical illusions and became fashionable. En pointe dancing, that is, dancing on one’s toe tips, became the standard for ballerinas. Also, a calf-length, full tulle skirt, called the romantic tutu, came into being during this period.

Ballet spread to other European regions, including Denmark and Russia in the late 19th century. Russian composers and choreographers helped elevate ballet to new heights. Marius Petipa, a French-Russian pedagogue and ballet dancer, was a famous ballet choreographer who developed ballet masterpieces that attract audiences to this day.

His work focused on displaying classical techniques, including high extensions, pointe work, and movement precision. “Swan Lake,” “The Nutcracker,” and “The Sleeping Beauty” are some of Petipa’s timeless works.

The classical tutu, shorter and more rigid than the romantic tutu, came about during this period. This new clothing aimed to reveal the ballerina’s legs and show audiences just how complicated some of the footwork and movements were.

Ballet became a mainstream dance in the 20th century. Serge Diaghilev, a Russian theater producer, helped form the “Ballet Russes,” a group comprising some of Russia’s most experienced and talented choreographers, composers, dancers, designers, and singers. The group toured Europe and America, performing various ballet dances.

In the 1930s, ballet started growing in popularity in America following some of Diaghilev’s dancers leaving his company to settle and work in the US. These dancers helped set up the New York City Ballet and the San Francisco Ballet School, institutions famous for firmly establishing ballet in America.

George Balanchine, a Russian emigrant and New York City Ballet co-founder, expanded classical ballet into a genre called neo-classical ballet, a type of ballet that uses movement to express music and illustrate human emotion and struggles. Contemporary ballet has many different sides. It mixes classic styles, traditional stories, and modern dance concepts to create what we know as ballet today.

[doctoraudreyarona]

Creating a Birth Plan

Couples use family planning to manage the number of children they want and the time between births. Once a couple has decided to have children, they often devise a birth plan. Certain elements of a birth plan may be nonessential, such as playing music for the child during pregnancy or labor, while other elements may be more important to the health and wellness of the mother and child.

First-time parents may lack a clear understanding of what a birth plan looks like. The plan is a list of preferences the mother has for her pregnancy and labor. The plan summarizes the family’s ideal birthing scenario, including the position the mother takes in labor, whether to use pain relief medication, what kind of pain relief medication to use, and who the mother will allow in the birthing room.

Many families write and store their birth plans on a computer. That said, it can be reassuring, and practical, to print out multiple copies. Multiple family members may require a copy of the birth plan so that they can fulfill their roles. Doctors, midwives, and birthing coaches should also have access to the birthing plan. Finally, if possible, both partners should have their own copy of the plan.

The birth plan is a valuable tool providing a concise overview of pregnancy and labor and ensuring that all parties are on the same page. Parents can share the plan with the many care providers that comprise a birth team. Family members can refer to the birth plan for a summary of the upcoming weeks and months during the pregnancy.

To create an effective birth plan, individuals must research different prenatal and natal care subjects and the many unique birthing options available. Women can deliver babies from many positions, including squatting, kneeling, laying on their side, and additional reclining positions. Individuals must understand the advantages and disadvantages of each position before they can make an informed decision about a birth plan. Those starting their birth plans should consider attending an antenatal class that answers many questions about pregnancy and labor.

One of the most effective strategies for developing a birth plan is to speak with other mothers and families with young children, discussing what they liked, did not like, and would do differently. While it may be easier and more comfortable to discuss birth plans with family members and friends, it is also beneficial to discuss matters with women who gave birth at the same hospital.

Lastly, while a birth plan is important, families must understand that various factors can change a plan, and that no birthing strategy is foolproof. If a mother experiences unexpected complications, doctors may opt to perform a cesarean delivery, regardless of preferences in the birth plan. However, couples should not view the plan as set in stone. Instead, they should treat it like a general guide. The purpose of the plan is to reduce stress and optimize communications throughout pregnancy and labor, not create hostilities between families and medical staff.

[doctoraudreyarona]

Types of High Risk Pregnancies

According to the United States Centers for Disease Control and Prevention, about 3.66 million babies are born in the US each year. Studies have shown that 6 percent to 8 percent of births are the result of high-risk pregnancies. Many medical conditions can lead to high-risk pregnancies, such as preexisting medical conditions. The associated risks of each type varies significantly.

In some cases, a preexisting medical condition increases the chance of a high-risk pregnancy. However, these women can speak with medical professionals and make preparations before conception. In other cases, medical conditions arise during pregnancy, increasing the odds of a medical accident or emergency.

Asthma poses little to no threat during pregnancy. However, if the asthma develops or worsens mid-pregnancy and no treatment plan is in place, it can lead to severe consequences. Pregnancy complications associated with uncontrolled asthma range from increased blood pressure to death.

Some conditions that increase the likelihood of a high-risk pregnancy include age. Any person under 20 or over 35 has a greater risk for developing problems during pregnancy, labor, and post-labor.

Epilepsy does not have a direct impact on pregnancy, but several common medications used to treat the condition do. A woman cannot stop taking her epilepsy medication during pregnancy, so she must devise a workable plan with her medical team. Health problems such as high blood pressure and obesity may result from genetics. Lifestyle decisions such as a poor diet and lack of physical activity can also lead to them.

Healthy mothers, fetuses, and newborns may experience any number of common health issues during pregnancy and labor. Nonetheless, many medical teams have the training to deal with these issues. However, in some cases, complications become more complex and dangerous than anticipated. Fetuses grow at different rates to different sizes, but an abnormally small fetus may be diagnosed with fetal growth restriction, a potentially serious condition.

Abnormal placenta and Rhesus sensitization are further pregnancy complications. Many different health conditions can impact the placenta, such as placental insufficiency, placenta previa, and placenta abruption. Preeclampsia and other hypertension-related conditions are particularly common, occurring in up to eight percent of pregnancies, or about 400,000 Americans.

Rhesus sensitization, or Rh sensitization, occurs when the mother has an Rh-negative blood type and the fetus has Rh-positive blood type. In these situations, the mother's body begins to produce antibodies. Rh sensitization is usually a non-issue for first-time mothers but can become a serious issue after multiple pregnancies. Since mothers do not experience any symptoms related to Rh sensitivity, it complicates the issue further. To diagnose it, medical professionals use blood tests.

Multiple-birth pregnancies are inherently high-risk, posing dangers to the mother and the babies, especially if the mother underwent infertility treatments, which may indicate a preexisting health condition that also contributes to risk. Further, assisted reproductive technologies can exacerbate health issues such as high blood pressure and diabetes.

Finally, lifestyle choices can also contribute to high-risk pregnancies. Abstaining from drugs, alcohol, and tobacco products, including vapes, can greatly reduce the chances of medical complications for mother and child.

[doctoraudreyarona]

An Introduction to Medical Weight Loss Clinics

The United States has been experiencing an obesity epidemic for many years. Therefore, several solutions have sprouted to help individuals lose weight, including medical weight loss clinics.

Medically speaking, obesity refers to a person with a body mass index (BMI) of 30 or higher. Medical professionals consider any person with a BMI between 25 and 29 overweight. The impact of obesity on national health has severe ramifications. According to the World Health Organization, unhealthy BMIs led to roughly five million noncommunicable disease deaths. In the US, healthcare expenses associated with obesity and overweight conditions range from $147 to about $210 billion annually, per the STOP Obesity Alliance.

Since 1990, the rate of overweight and obesity has consistently risen. Globally, the percentage of children ages five to 19 living with obesity jumped from two percent to eight percent, while prevalence among adults more than doubled from seven percent to 16 percent. The numbers are far worse in America: more than 100 million adults qualify as obese, in addition to over 22 million adults living with severe obesity. The prevalence of obesity increased from 30.5 percent in 1999 to nearly 42 percent in 2020, according to the Centers for Disease Control and Prevention. About one in six American children live with obesity. When accounting for Americans who qualify as overweight, nearly three-quarters of the population is living with an unhealthy BMI.

Maintaining a healthy weight is not always easy, but several services, programs, and facilities, such as weight loss clinics, can provide support. A medical weight loss clinic is a health and wellness center focusing on helping patients lose weight via doctor-supervised, integrative medicine. Most weight loss clinics do not offer or recommend invasive weight loss strategies, such as surgery. Instead, clinicians and doctors help patients develop individualized nutrition plans and workout regimens. They also provide weight loss supplements, ranging from vitamin injections to natural appetite suppressants.

In some cases, weight loss clinics may resemble a fitness center more closely than a medical facility. However, the two differ. For example, personnel and programs at a weight loss clinic specially help patients lose weight in a safe, controlled environment. For example, while many clinics provide access to workout equipment and physical fitness specialists, clinicians will initiate the process by assessing a person’s medical history and evaluating their BMI. Doctors may request blood samples to determine if obesity may result from an underlying medical problem, such as a hormone imbalance. The weight loss clinic team devises a personalized weight loss plan following initial assessments. Physicians, nutritionists, and personal trainers develop the plan.

Individuals should consider exploring the benefits of a weight loss center to lose weight and maintain a healthy BMI over a long period. Clinics are especially helpful for people who have previously made multiple attempts to lose weight on their own.

Individuals should research potential clinics before beginning a weight loss program. Successful clinics recognize that there is no one-size-fits-all approach to weight loss and related aspects of health and wellness. Therefore, individuals should avoid any clinic that promotes a specific program to all patients.

Furthermore, a reputable clinic understands that a person’s weight stems from various aspects of their body and overall health. Therefore, individuals benefit from a personalized, full-body approach to weight loss.

[orbemnews]

Gwinnett celebrates John Lewis Day, highlights late congressman's life and legacy As she reflected on U.S. Rep. John Lewis’ life, the congressman’s longtime aide, Tuere Butler, recalled an occasion where he used his words to diffuse a heated situation involving a man who had called Lewis’ office. The man, who was not from Georgia, was angry about a vote Lewis had taken on an issue in the U.S. House of Representatives. He called the congressman’s office, yelled at Lewis’ staff and they took down his phone number. The staffers were unsure if Lewis would want to talk to the man after he yelled at the staff over the phone. The views and opinions depicted here are those of the artists and do not necessarily reflect the views of this publication. Click for more. “We told the congressman ‘This is what happened,’ and the congressman said, ‘Well, let’s call him back,’ “ Butler said. “And, so he got on the phone with some of the staff members in his office and put the gentleman on speaker phone, and the way that he spoke with this gentleman who was very irate and disappointed and frustrated. “By the end of that conversation, it was like two old friends were talking.” Sunday would have been Lewis’ 81st birthday, and Gwinnett officials commemorated the occasion with a two-and-half hour event at the Gwinnett Justice and Administration Center called “The Impact of John Lewis” on Monday morning. The event was held live, with only abut 43 people in attendance because of COVID-19 restrictions, and was broadcast live on the county’s Facebook page. After Lewis died last year, the county commission took steps last year to declare his birthday as John Lewis Day in Gwinnett. “We wanted to make sure we showed the impact of everything he’s done because it goes past generations,” Gwinnett County Commissioner Marlene Fosque said after the event ended. “It’s multigenerational.” There were video tributes to Lewis, musical and spoken word poetry presentations and the presentation of a proclamation honoring Lewis’ life, which county commission Chairwoman Nicole Love Hendrickson presented to Butler. His participation in the Freedom Rides, the march across the Edmund Pettus Bridge in Selma, Ala., and the March on Washington, D.C., were among the many accomplishments in his life that were recalled by participants. Success! An email has been sent to with a link to confirm list signup. Error! There was an error processing your request. Gwinnett, Newton and Rockdale Health Departments Director Dr. Audrey Arona evoked Lewis’ memory as she talked to attendees about the effects of the COVID-19 pandemic and efforts to encourage people to get people to get vaccinated against the disease. “I know that Congressman John Lewis would have stepped up to be an advocate for this vaccine, and he would have worked to ensure that everyone has equal access to this vaccine,” Arona said. Fosque also led two panel discussions on Lewis’ impact at the event. The first featured Butler, where she recounted the story about Lewis and the phone call, as well as Hendrickson and U.S. Rep. Carolyn Bourdeaux. The second panel featured former state Rep. Brenda Lopez Romero, Berean Christian Church Pastor Kevin Lee and Farooq Mughal. Both panels focused on Lewis’ legacy and the work still left to be done in the area of Civil Rights. Bourdeaux said that, in the 1950s and 1960s, there was uncertainty about what would be the result of the efforts made by the people fighting for equal rights. “When you’re filled with passion to change something, there’s always going to be this uncertainty that is going to dog you throughout the process,” she said. “That is why it’s so impressive what he accomplished — his courage and persistence over time — and that is really what you have to bring to many of our problems. “Every once in while, we have a public problem, and you go out there and it’s solved easily, but so many times you just have to persist over and over again.” Hendrickson said there is still “good trouble,” as Lewis used to call it, to be done in some of the areas that the congressman was trying to address 60 years ago. “It’s about continuing to fight for racial and social justice and (confronting) inequities that we continue to experience,” the chairwoman said. “While it’s not in your face, it manifests in so many different ways in our policies, in behaviors, in zoning laws and restrictive access and undue justice. “You know, we have to speak out about those injustices and I think is what ‘good trouble’ is about. It’s about speaking out against injustices no matter what the cost is, and not being afraid to do so because, at the end of the day, it’s about ensuring freedom.” Source link Orbem News #audreyarona #carolynbourdeaux #Celebrates #Commission #Congressman #Congressmans #Day #Gwinnett #gwinnettcounty #Highlights #institutes #John #Late #Legacy #Lewis #life #marlenefosque #nicolelovehendrickson #Politics