The Simplified Pathology Report for Patient at MDC-Atlanta


The Clinical Image:

Clinical Image of Keratoacanthoma, as viewed while on patient's body

The Diagnostic Pathology Image:

Pathology Image of Keratoacanthoma

Additional Information about Keratoacanthoma and Prognosis

Keratoacanthoma (KA) is a special lesion, a pseudocancer, occurring as an isolated nodule, usually on the face, and mimicking squamous cell carcinoma (SCC). Unique features are its rapid growth rate, much faster than that of an SCC, and also its spontaneous remission over a period of several months.

Simple Language Portends Better Communication For Health-Care Delivery

There are various medical specialties that have different types of jargons for communicating.

Patients are left confused regarding the complexity of language used by the medical professionals through various medical specialties.

We, at MDC-Atlanta, believe that patients want to know about their disease or illness in order to make informed decisions regarding

the Patient’s Individualized HEALTH.


1. Direct, one on one communication with patient by our physician, Dr. Gates

2. A complete medical interview between patient and our physician, is provided, as well as appropriate objective medical assessment

3. Simple language, minimizing certain specialized medical jargon and providing direct discussion regarding the medical assessment, is made available to the patient by our physician

4. Pictures and Video-Presentations may be illustrated for sake of clarity to the patient by our physician with direct STEP BY STEP explanation using clip board drawings, you-tube demonstrations, and other tools

5. Diagnostic options are completely explained to patients to confirm or reject certain illness or disease

6. A Plan of further therapeutic and diagnostic care is made available to the patient

7. Patient is allowed to ask questions to make certain and to give assurance to patient, that patient understands final conclusion

8. Additional reading material may be offered to patient, as well as referral to other medical specialists/experts, if patient desires to have additional information and/or second opinion

We, at MDC-Atlanta, remain committed to informing our patients for better quality and safe medical care!


Making Cost for Medical Services Affordable through MDC-Atlanta


THE greatest expense over a person’s life time is Health-care.  And, unfortunately, as we all age, we will eventually suffer illness and/or disease.  The real question becomes, “How do we make Health-care affordable?  I believe the most basic and simple answer to this question is through EFFECTIVE Communication.

COMMUNICATION: When a patient’s primary health-care provider considers the whole patient, and not just a subject or an item to use as profit, the cost for medical services can be greatly reduced. So, we start our communication process at MDC-Atlanta by defining the role of the primary care provider in our WELCOME LETTER CLICK HERE.

The second step is to allow the patient to choose which level of health-care service that may be appropriate for the patient at the time of initiating service with the provider, and this is defined essentially during TRANSITION OF MEDICAL CARE.

Healthy patients do not always need to visit a doctor.  So providing a form of convenience for a patient to communicate with a physician through TELEMEDICINE, CLICK HERE may also reduce cost and improve compliance as well as prevent advanced stages of certain types of debilitating diseases/illnesses.

Duplicate medical services for laboratory studies, imaging studies, or other diagnostic clinical studies may greatly increase a patient’s expense for health care service. Thus, choosing direct services from a diagnostic specialist  like Dr. Gates, could greatly contribute to reducing the cost for certain medical evaluation,CLICK HERE TO LEARN MORE.   By choosing Direct-Care through Dr. Gates, one can essentially eliminate middle-man expense, i.e. administrative/hospital add-on fees; fees for clinical evaluation IN ADDITION TO  diagnostic laboratory evaluation, phlebotomy, transportation, and the list goes on and on.


The Fight Against Breast Cancer-SIMPLE, Breast Self Examination (BSE)




The statistics are widely known that millions of women and men, world-wide, die each year from breast cancer.  And, most of these deaths from breast cancer can be prevented. Unlike many other cancer-prone organs, breast and skin cancers can be detected early before advanced stages of the disease with routine and appropriate screenings.  Why? Because breast or skin lumps (abnormal growth) can be either seen or detected primarily by the patient. CDC-Report: “Black women have the highest breast cancer death rates of all racial and ethnic groups and are 40% more likely to die of breast cancer than white women”;REFERENCE, CLICK HERE

A personal experience: A family member was seen by her doctor because of a palpable breast lump.  A mammogram was done and confirmed an abnormal breast lump.  A surgeon was consulted, and at which time he advised the family member to follow up in six (6) months with a second mammogram.  The family member sought a second opinion sooner, i.e. 3 months after the the mammogram findings, being advised, at that time, to undergo a simple procedure called, “Fine Needle Aspiration, FNA.” An FNA involves taking a tiny needle, smaller than one used to draw blood, connected to a syringe, then pressing the needle attached to the syringe directly into the breast lump or mass to withdraw cells to be analyzed under the microscope.  From start to  finish, this procedure takes about 10-15 minutes, typically performed at the doctor’s office (outside of hospital), and an accurate diagnosis of malignancy or cancer can be made while the patient is being evaluated at the same time. This is possible because cancerous cells of the breast have a different appearance under the microscope than normal breast cells that are NOT cancerous. The FNA demonstrated malignant (cancerous) breast ductal cells.  The family member was advised to undergo surgical removal of the breast cancer cells.  A simple lumpectomy was carried out with complete removal of the lump, confirming the presence of an invasive ductal carcinoma (an aggressive type of breast cancer), Nottingham Histological Grade II, T2N0M0-(Stage I).  The family member is alive and well, breast cancer free after nine (9) years, perhaps because she decided not to delay treatment of a palpable breast lump for six (6) months or more, that turned out to be CANCER.  CLICK HERE TO VIEW THE BREAST CANCER CELLS, and THE FNA PROCEDURE USED TO DIAGNOSE THE TUMOR

J Clin Oncol. 1991 Sep;9(9):1650-61.

Prognosis in T2N0M0 stage I breast carcinoma: a 20-year follow-up study.


Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.

Let’s talk strategy for how ALL women and men can prevent ADVANCED stages of  Breast Cancer:

1) Monthly Breast Self-Examination (BSE) and/or routine visit to a health-care provider

2) Annual mammogram after age 40 or sooner in certain high-risk female/male population

3) Prophylatic Bilateral Mastectomy in Genetically Positive High-Risk Patient (early, before age 40, familial death due to breast cancer)

4) Rapid Diagnostic Technique, such as Nipple-secretion-smear, Fine Needle Aspiration and/or Tru-cut needle Biopsy for any unresolved palpable lump detected during breast exam

5) Ultrasound-Guided, Needle-Localization biopsy of abnormal micro-calcification detected by Mammogram

6) Holding Health-Care Providers ACCOUNTABLE for delayed diagnosis and treatment for those who routinely visit a health-care provider and/or get annual mammograms, through second opinion/second review.


Breast Cancer detected while tumor size is less than ONE (1) cm almost invariably means high-rate (greater than 99%) Cure.


Pain Management-High Risk Patients



Faxed records of the following:

1. Letter from a Licensed Physician who most recently treated you with CLASS II medication for long-term management of pain, specifically stating that he/she will NOT prescribe Class II medication to you as a patient for Chronic Pain Therapy hereafter.

2.  Pharmaceutical Records for the Patient over the Past Year

3. Imaging Studies or other Diagnostic Studies that would support the use of Class II medication for Long Term Therapy

4. Permanent Resident of Georgia within 100 miles of Atlanta Metropolis.

Patients may be misinformed with regards to safe chronic pain management.  We would like to provide helpful guidelines to those patients who may have been treated through  high risk management.  High Risk Pain Management includes those patients who are being treated or have been treated with more than 200 mg of morphine/opiate equivalent-dosage per day, and combination therapy including long-acting opiates, morphine, methadone, oxycontin, dilaudid, benzodiazepines (valium, Xanax, Klonopin), soma, sleep aid (ambien), etc.  High Risk Pain Management also includes patients younger than thirty (30) years of age, as well as those with a history of multiple doctors prescribing pain medications to them, around-the-clock opiate use, and narcotic-abuse.


1. HIGH-RISK Patients may need appropriate detoxification with appropriate withdrawal protocol under the care of an addictionologist or board certified MD-Psychiatrist prior to contacting our office for continuing ongoing chronic opiate therapy (COT).

2. ALL Patients, including those who are younger than thirty (30) years of age, should consider other alternatives for NON-opiate pain management including surgery, or anesthetic- injectables (under the care of a board-certified anesthesiologist); We recommend such NON-opiate therapy as: Topical Analgesics (Brand Names, OVER THE COUNTER: STOP PAIN, ICY HOT, etc); NON-steroidal ANTI-INFLAMMATORY Medications such as Advil/Motrin/Ibuprofen; Naprosyn (ALEVE), etc.; Or Trigger Point Injections which include a combination INTRAMUSCULAR injectable of steroid/lidocaine/marcaine

3. Patients should always demand an open  DIRECT-dialogue between each physician who previously or currently provides short term or long term pain management to them, as well as pharmaceutical records, and keep records of such oral and/or written communications.

4. Patients who relocate residence from one State to another should have their previous physician who provided pain management to them in their former State of residence to directly contact the physician (Dr. Gates) who will accept the transfer for continual care.


1. Acute, short-term pain SHOULD NOT be treated with Long-term, high-dose opiate therapy

2. Arm, leg, hand, foot, and shoulder pain, are often related to Inflamed Joint/Soft tissue or Arthritis, and SHOULD NOT be treated with Long-term, high dose-opiate therapy

3. Fibromyalgia, and/or chronic diseases causing nerve-related pain, ie. diabetes, HIV, etc, SHOULD NOT be treated with Long-term, high dose-opiate therapy

4. CERTAIN SLEEP/ANXIETY/MUSCLE RELAXANT medications, i.e. Ambien, Xanax, Klonopin, Valium, Soma, etc,  in combination with Chronic Opiate Use, SHOULD BE AVOIDED ALL-TOGETHER, OR AT LEAST MANAGED JOINTLY  under the medical-care of a board-certified psychiatrist, prior to use.

WE, at Medical Diagnostic Choices, remain committed to keeping our patients informed for better quality

and Safe Medical Care



Changing the Dynamics of Quality Laboratory Medicine?Transparency Through Smartphone Technology Assures Accuracy in DIAGNOSIS

Our modern society is constantly changing through the influx of smartphone technology.  This truly allows patients to take charge of their health care, and partner with a physician or other health care provider.

The Clinical Laboratory Improvement Act was created initially in the early eighties (’80s) to bring some sense of consistency and uniformity to clinical laboratory testing process (We suggest for further information that one reviews the history of CLIA program).  While productive and practical standards, procedures, and protocols were created at the initiation of CLIA, there is still lack of transparency and accountability through medical laboratory testing; and we, believe this is primarily due to lack of appropriate communication between healthcare providers, and even patients. Early on in the CLIA standardization, and In an attempt to improve on this communication, hospitals and health insurance companies, as well as other organizations and third party entities decided to form BIASED, RESTRICTIVE,  AND SHOULD BE UNLAWFUL EXCLUSIVE SERVICE CONTRACT-relationship with a Pathologist and/or a Group of Pathologists to oversee the general operation of Clinical, Medical Laboratory Testing.  This contracted pathologist or group of pathologists led to the creation of the MEDICAL DIRECTOR of the Clinical Laboratory Operation, and  essentially prevented competition with other independent pathologists within the hospital or institutional setting The Medical Director was placed in charge of selecting the personnel  which would staff the medical laboratory, including sub-specialized pathologists.

Patients were left with inability to select specific pathologists to provide direct medical laboratory services to them in this regard.  Often times, this lack of Patient’s ability to choose provider for medical laboratory services placed patients in position of NOT being able to DEMAND QUALITY AND ACCURACY, as well as to control cost for their health care services with respect to the use of the Clinical Laboratory Testing, including diagnostic medical procedures.


With the initiation of smartphone technology and the various safe and secure operations that are currently used through smartphone technology, accountability and transparency can be assured for not only accuracy of test results, but also to share experiences that will enhance accuracy as well as to reduce cost through repetition of testing, for instance. 

The practice of teleradiology, as a parallel,  has gained wide popularity in this regard, and creates a level of competition that ensures lowering cost for these type services, which can be opined by various groups of radiologists simply through an internet connection, bringing world wide quality to patient no matter where he/she might be.  WE WANT AND SHOULD DEMAND THIS OPEN MEDICAL PRACTICE FOR PATHOLOGY and the MEDICAL LABORATORY TESTING OPERATION.  We, at MDC-Atlanta, believe that patients should be given the authority to choose which appropriately licensed healthcare professional provides laboratory medicine and pathology services to them, as they are allowed to choose internal medicine physicians, surgeons, and other health care providers, including medical specialists, to offer a wide range of clinical services directly to them.

Here are some practical examples of benefit for using TELEPATHOLOGY and TELELABORATORY SERVICES:

1. Patients CHOOSE who provides pathology and/or laboratory medical services to them, be it as an inpatient or outpatient.

2. Patients  have a “say so” about affordability for pathology and/or laboratory services

3. Immediate Second Opinion by World Renown Experts are available through Safe and Secured Smartphone Technology or other online services, with transparency and accountability of transmissible opinion/diagnosis/advice

4. Convenience of Diagnosis or Recommendation for treatment and/or further care improves turn around time so that patients get the needed care in a timely fashion.

Delayed Care May Lead to Advanced Diseases, as in a cancerous tumor which metastasizes or spreads to bone, liver, lymph node, and lung.











The Real Truth About Sexually Transmitted Infections

In the Most Simplest Language, Sexually transmitted infections, also known as Sexually Transmitted Diseases, ARE essentially PREVENTABLE.

There are helpful guidelines that are publically available for the general community, including patients, to review proper steps to prevent contacting a sexually transmitted infection.

Sexually Transmitted Diseases Treatment Guidelines, 2010

Recommendations and Reports

December 17, 2010 / 59(RR12);1-110  (refer to Centers For Disease Control)

The above reference is suggested as a guide with respect to specific types of Sexually Transmitted Infections (STI’s) which can be reviewed.
Often times, patients are confused as to the proper protocol for evaluation as well as treatment and management due to the variations in treatment and management through public and private clinical practices, as well as through resources on the internet.
In our practice at MDC-Atlanta, the following steps are taken to achieve a uniform evaluation and management for patients with potential STI/STD:
1. A complete, relevant recent protected or unprotected sexual history is obtained from the patient to guide with proper evaluation, diagnosis, testing and/or management
2. A thorough pelvic examination is performed using standard medical protocol and procedure
3. A pap smear sample is usually collected for immediate microscopic examination, directly looking for common STI’s such as HPV, HSV, trichomonas, etc.; or a swab smear from male urethra is reviewed under the microscope to examine for evidence of urethritis.
4. A sample is collected in transport media and submitted to appropriately credentialed Reference Clinical Medical Laboratory for appropriate  laboratory studies to confirm and/or reject the clinical impression for STI.
5. Based on the preliminary medical diagnostic impression, the patient is counseled and given appropriate preliminary, impirical treatment and management according to standards of medical care
6. The patient is then given an opportunity for question-answer session regarding further prevention and/or management of sexually transmitted infections, as well as appropriate follow up.
We at MDC-Atlanta remain committed to keeping our patients informed for better quality and safe medical care

The Golden Years and The Challenges that Come

Mothers and Fathers are precious as they, through our Creator, give us life.  When you really think about it, because of our appreciation for their contribution to our existence, there is nothing that we wouldn’t do for our parents or elderly relatives. As mothers and fathers become older, the “Golden Years”, as they are often referred to, set in embarking on the final journey of life.  There are many life altering decisions to be made during this time, and often times, the choices we make can be challenging.  Three conditions have to be addressed during the “Golden Years” which include Biological, Sociological, and Psychological.

The above three aspects of human evaluation are apart of traditional primary care medicine approach, and are most emphasized when evaluating our senior citizens.  The biological evaluation is the most basic and consistent in this approach, and for the most part is standardized. As we age, the eleven systems of the human being, began to decline and/or fail. Due to the sophistication of medical advancement in spite of declining or failing human organ systems due to age, life in many instances can be sustained.

The Quality of Life becomes most important to address through the Sociological and Psychological conditions of the elderly patient and/or love one.  In many instances, the family members of the elderly patient are met with this decision to address in this regard, and it is often a difficult decision to make.  Now, the most important point to emphasize is if the elderly patient is fully capable of appropriately determining which avenue to take in this regard, then there is NO position for the other family members. And, so with that, the topic for this discussion is to consider some form of guidance.

First and foremost, it is NOT appropriate for the health care provider to intervene and make certain choices for family members in most instances, and the health care provider is only positioned to provide information for the informed family member to make the final choice.  I would submit that the choice should be in reference to “what the elderly patient would want for his/her life if he/she were capable of making the decision,” as in a “LEGAL WILL AND TESTAMENT,” which is strongly recommended.  Financial and other social conditions and/or restraints should help in deciding the path for the elderly patient and/or love one.  Sociologically, senior citizens facilities such as assisted living and/or nursing home, may be a source to consider in select instances, or in-home care.

Psychological conditions also should be addressed.  Senile Dementia complicates the psychological issues that may arise in many instances; and, Geriatric specialists as well as mental health experts may be helpful to consult in this regard.  The level of care is often most challenging in this regard.

Family members are often faced with the decision of “End of Life for the elderly parent,” which is extremely complicated, and this too must be guided by: “Legal Will and Testament of the Elderly patient” , AND proper communication with trusted consultants.

We at MDC Atlanta remain committed to keeping our patients informed for better quality and safe medical care!

The Real Truth About Fine Needle Aspiration


As the article in reference has indicated, we have come a long way in accurately assessing and diagnosing cancer at the cellular level.  In fact, most criteria for diagnosing cancer, require astute evaluation of tumor cells to determine it’s neoplastic nature.

Fine Needle Aspiration, either by direct sampling of tumor by a physician or assisted by imaging studies through radiologist, should be the mainstay in diagnosing cancerous tumors as a triage, for instance, before more expensive and debilitating open tissue biopsy or excision.

Fine-Needle Aspiration requires a simple procedure with similarity as with drawing blood through routine phlebotomy.

1. The Skin is prepped by simply using proper protocol for cleaning with an antiseptic solution for deeper organ-aspiration, or sterile alcohol-wipes for superficial aspiration, as with Breast, Soft tissue, or Lymph node for example.

2. A fine-needle, size generally about 22 gauge, attached to a syringe for aspirating cells, is used.

3. The needle with attached syringe is inserted directly into the lump or “mass” by palpation or direct imaging study such as Sonogram, CT scan, etc.  A pinch-like pain is experienced briefly which goes away soon thereafter.  No local or generalized anesthesia is required typically.

4. Cells are aspirated by negative pressure via suction technique with the syringe, with slight, small cutting motion while attempting to remove cells from the lump or mass.

5. Once fluid is visible in the “hub of the needle”, then the procedure is terminated, and pressure is applied for appropriate amount of time to achieve hemostasis or to stop any potential for bleeding, which is typically absent or minimal in person without bleeding abnormality

6.  The aspirated sample is smeared onto a glass slide and stained with a simple blue dye (CLICK HERE) to determine adequacy to derive at an accurate diagnosis.

7. Generally, up to three passes may be necessary to achieve adequate material for evaluation, so the above steps may be repeated.

8. The Final Aspirated Cells are subjected to further study and/or investigational analysis with special stains or additional specialized studies such as molecular studies.

9. An image or video demonstration can be accompanied with the FINAL ANATOMIC DIAGNOSTIC REPORT.

The FNA is an acceptable procedure performed by a broad spectrum of physicians, pathologists, and radiologists, and is affordable through MDC-Atlanta.  Significant Risks, such as infection, bleeding, scarring, etc, for the FNA procedure are minimal as compared to an open tissue biopsy!

WE, at MDC-ATLANTA, remain committed to keeping our patients informed for better quality, safe, and affordable medical care.


The Real Truth About the Human Defense System

The Human Defense System is one of the most challenged systems of all the organ systems. It essentially requires a collaborative surveillance of many types of organs from skin to the organs which make up the overall reticulo-endothelial system (which includes cells formed by bone marrow, spleen, thymus, lymph node, tonsil, Intestine,etc).

In fact, most diseases that are derived from the human defense system are classified as “Reactive Diseases” because they are triggered by “an inflammatory response.”  The “inflammatory response” allows the body to determine self from NON-self through this surveillance of different types of cells.  The response is primarily initiated by invading pathogens, such as bacteria, fungi, parasites, viruses, or foreign matter (such as allergens), or at times, simply self-cells which may be misinterpreted as foreign (autoimmunity) due to an abnormal protein (as with Systemic Lupus Erythematosus, or Psoriasis, etc) or tumor cell, etc.  Depending on the nature of the invading foreign matter, the defense system incorporates the activities of different organ systems to generate an overall “REACTIVE RESPONSE.”  Such response may require  simple bacteria that generate a chemical toxin that attracts certain white blood cells which will phagocytize the bacteria and destroy it. Or, an immune response may require labeling the foreign cell, i.e. fungi, parasite, viral infected cell, or tumor cell, to be destroyed by the immune-mediated defense system.  The immune mediated defense system is the most complex  because it requires a humoral activity and/or a cell-mediated activity, and thus the topic for this discussion.

Often times, the humoral and cell-mediated immune responses overlap or at least work together to destroy foreign matter.  In simple language, the humoral response requires a communication between B-lymphocytes and T-lymphocytes for the production of antibodies which will essentially label foreign substances to be recognized by the defense system to be destroyed.  Foreign matter and/or cells labeled by antibodies may also be further labeled to be attacked by specialized cytotoxic T-cell lymphocytes and/or compliment factors that will eventually cause lysis or destruction of the foreign cell all together, or picked up by the reticulo-endothelial system to be removed from the human body, as with certain viral infected cells, or tumor cells, or organ-transplant cells.



With a normally functioning IMMUNE OR DEFENSE SYSTEM, this process takes place often times and soon resolved in an ACUTE REACTION.  Still at other times, medications, such as antiviral, antibacterial, and antifungal, OR STEROIDS, etc may be used to resolve the inflammatory reaction sooner.  Or still, yet, supportive care, which may include among others,  intravenous-IV injection of recombinant-monoclonal antibodies (antiserum), may be necessary while the Immune Defense System is in the process of completely destroying a foreign matter, or invading pathogen, or tumor cell, etc, as with a CHRONIC REACTION.  The final outcome is recovery, or maintenance, or death.

MDC Atlanta remains committed to keeping our patients informed for better quality and safe medical care.