Conditions & Treatments

Remote Medical Care at a Distance Through MDC-Atlanta

Combined with detailed Medical History and Laboratory Tests, an accurate diagnosis can be determined nearly 90%

Reference: Western Journal of Medicine, February 1992 (156)

We are excited to announce the newest component of our medical practice, TELEMEDICINE AND TELEPATHOLOGY.  We are accepting patients throughout the State of Georgia, including the Atlanta metropolis, Gainesville, Athens, Rome, Augusta, Columbus, Savannah, West Georgia, Macon, Brunswick, Albany, and Valdosta!

Modern Telemedicine allows patients to talk to a health care provider via Face-Time, for example, which is private, safe, convenient, and effective! Now just a phone call away, you can get an idea about your health status!!! TRY IT TODAY!! No transportation, no traveling to a doctor’s office, JUST SIMPLY CALL, and you will have direct access to an ONLINE DOCTOR at your fingertip!!

GET A BASIC HEALTH ASSESSMENT TODAY, without physically going to the doctor’s office.

 

Here are the steps you would need to take:

1) Complete our ONLINE Medical Survey-MDC-Atlanta, prior to contacting our office

     COMPLETE ONLINE MEDICAL SURVEY

2) For patients who are older than 40 years of age for general health, preventative care evaluation, we suggest that you make an appointment  with Dr. Gates to get basic labs done to assess RISK FACTORS::

a) Complete Metabolic Panel (CMP).  This will give the patient an idea about electrolytes, glucose level, kidney function, liver function, etc

b) Complete Blood Count Report (CBC) with differential.This will give the patient an idea about red blood cells, white blood cells (including the five different types), and platelets, including the specific numbers, and basic morphology with regards to anemia (low red blood cells), leukopenia (low white blood cells), and thrombocytopenia (low numbers of platelets), or other possibly acute and/or chronic hematological abnormalities.

c) Lipid Profile. This will give information about the patient’s total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides, to assess patient’s risk for coronary arterial heart disease, and/or other vascular diseases.

d) Men, Prostate Specific Antigen (PSA). This is typically indicated to assist with evaluating risk of prostate cancer, and/or inflamed prostate glands in men.

3) An automated home blood pressure monitor with pulse rate may be helpful, as well as a weight scale.

4) Contact Dr. Gates directly to discuss Patient-Consent and other related medical policy and procedures at MDC-Atlanta regarding Online Medical Care; Further instructions will be given to potential patient prior to initiating the ONLINE MEDICAL CARE.

5)  Schedule a time for Dr. Gates’ to contact you, the patient, directly to began the ONLINE medical interview and medical care.

We at MDC-Atlanta, believe that proactive preventative care and health maintenance are  the best steps to take to reduce inefficient and expensive SICK-Care. 

MDC-Atlanta remains committed to keeping our patients informed for Better Quality and Safe Medical Care!!


How is My Disease/Illness Diagnosed?

Often times, patients are confused as to how a health care provider may derive at an accurate diagnosis in order to render effective treatment, management, and give patients an idea regarding whether or not the patient will get better or not (prognosis).

Patients should remember this simple equation:

symptoms+/- risks +/- signs + evidential support (lab tests, imaging studies, etc)

= Wellness or Diagnosis of illness/disease

The principle goal of medical evaluation is to derive at an accurate diagnosis of disease and/or illness.
So, when a patient sits down to chat with the health care provider, an interview regarding the patient’s health ensues.

The History of Present Illness (Symptoms):

-The health care provider asks a series of questions pertaining to the present illness, often initiated by “Chief of Complaint,” ie. “what caused you to want to see the health care provider?”

-Time or sequence of events pertaining to the “chief complaint.” When did this problem start? Was there an initiating event that caused it? Do you think the problem is getting better or worse? What makes it better, or what makes it worse? Are there any other symptoms that you can associate with this problem, and if so, what makes those symptoms better or worse? Are you having any other conditions that may be associated with the symptoms? Are there other concerns regarding your health and your current condition that you would like to address?

Past Medical/Surgical History (Risks)):

-Previous Medical Evaluation/Diagnosis: Do you have any other medical conditions that have previously been diagnosed by a health care provider? What are they? Have you had any surgeries done before? What are those surgeries that you have had done in the past?

Medication List (Risks):

Are you currently taking medications for treatment of specific diseases? What are they?

Allergy List (Risks):

Are you allergic to certain medications? What are the names of those medications for which you are allergic? What sort of symptoms do you associate with the medication allergy?

Social History (Risks):

Do you smoke or use tobacco or alcohol, or any other illicit drugs? If so, how long have you used tobacco, or how much alcohol do you consume within a week, for example?

Family History (Risks):

Are your parents currently alive and well? Do they have any medical conditions for which they are being treated? If your parents are deceased, what was the cause of death?

Based on the answers to the above questions, the health care provider generally has an idea regarding potential diagnosis, or diagnoses, as this is known as “A differential Diagnosis.”  The next step is The Physical Examination.”

The Physical Examination (efforts to detect signs of disease):

A general physical examination would include an objective analysis of all the organ systems, starting from a general health assessment, i.e. age appearance, physical appearance, gait, presence or absence of acute distress, orientation to time, person, place or situation, etc.  This is followed by assessment of vital signs,i.e. weight, height, temperature, blood pressure, pulse rate, and respiration rate. A detailed physical evaluation of all organ systems is then initiated, starting from Head and Neck, to Chest, then Abdomen; then Pelvis, Extremities, and finally the Neurological Assessment (which is often included during the performance of other parts of the physical examination)

At this point, specific diagnosis or diagnoses can be determined preliminarily.  A plan of action is then discussed with the patient with regards to gathering supportive, confirmatory evidence for disease or illness based on the above clinical assessment.  This would include the following:

Clinical or Pathophysiological Evaluation (ASE) (Evidential Support for Illness/Disease):

collecting blood/body fluid/tissue/cellular samples for laboratory testing

Special Clinical Studies, i.e. cardiac stress, ECHO,  EKG, EMG, Pulmonary function test (PFT), Endoscopy/Colonoscopy, bronchoscopy, colposcopy, cystoscopy, etc

The Anatomic or Structural Evaluation for Disease (Evidential Support for Illness/Disease):

-ordering imaging studies like X-rays, CT scans, MRI, bone scans, Mammogram, Ultrasound, etc

-Procedures, such as skin biopsy, or Fine Needle Aspiration, or Pap smear, Peripheral Blood Smear Review, etc

Based on the findings from the above collective studies, A FINAL DIAGNOSIS AND/OR DIAGNOSES ARE DETERMINED, and the following takes place concluding the medical evaluation:

-Plan of care, i.e. medications or surgeries

-Instructions and recommendations for life-style changes as appropriate for healthy living, recovery from disease or illness, maintaining acceptable functional course with stable chronic disease/illness, or preparing the patient for end of life process.

-Instructions and reading materials for patients to become Informed about their diagnoses and CARE-PLAN (we recommend that our patients get information from websites such as: MayoClinic; WebMD; and Medscape, for example)

-Recommendation for referral regarding specialty medical care and SECOND OPINION.

-Opened Question/Answer Session between Patient and Doctor

Preventative Care and Healthy Care Maintenance:

Now imagine, if the patients come in already prepared to answer the above questions, then the medical interview could be as short as 10-15 minutes, and the patients could be on their way to an accurate diagnosis, treatment, and management.  More importantly, patients without symptoms, should seek medical diagnosis before symptoms develop, as in complications from diabetes, or high blood pressure, or heart disease, or stroke,or HIV, or cancer, etc.  Typically when a patient presents with symptoms, the diagnosis of certain types of diseases is usually  in the advanced stages and effective treatment becomes limited.  Thus, we at MDC stress PREVENTATIVE CARE AND MAINTENANCE HEALTHY CARE, to avoid expensive, typically ineffective/inefficient sick care.

Consider preventing diseases through routine healthy check, and not just through dieting and exercising which are helpful but at no means all inclusive in the PREVENTION of major diseases, particularly as it relates to genetic, congenital, infectious, and degenerative diseases, for example.

 

Empowering Patients for Better Health-Care!

The Pathologist, as the common expression among other physicians,  “The doctor that is knowledgeable about many diseases, performs many investigative diagnostic procedures, and a member of the treatment/management team, BUT TOO LATE.” We at MDC-Atlanta, are committed to performing the medical tasks BEFORE IT IS TOO LATE, by partnering and communicating with patients DIRECTLY, as well as providing treatment and management of certain illnesses and/or diseases!

 


Spinal Pain, The Real Truth

Millions of Americans suffer from Chronic Spinal Pain.  Many choose to accept the debilitating function that comes with this type of long lasting and consistent pain, often times interfering with daily functional activity and/or routine activity with family and friends.

The real question becomes what is spinal pain, and what is the accepted course to deal with it.

Our late, and beloved President John F. Kennedy is an example of an elite figure in our history who had to deal with chronic, debilitating spinal pain, choosing medication to do so, in order to carry out daily activity.

Spinal Pain, commonly known as chronic back and/or neck pain, is often caused by a degenerative process of the vertebral (spinal) bone.  The vertebral column, or spine, is comprised of thirty (30) bones located along the central, posterior portion of the neck, back, and tail. Often times due to trauma, as it relates to motor vehicle accident, traumatic fall, and/or injury on job, or simply due to the aging process due to shear weight-bearing stress on the spine, the bones of the spine or vertebrae become brittle and began to break down.  During the life-long, on-going repair of the degenerative bone, extra bone, known as osteophyte, as well as fibrous and obstructive connective tissue may replace the original boney matrix with entrapped nerves along the cortex of the bone causing intense and severe debilitating pain.  Imaging studies, such as CT-scan and MRI, are used to define the anatomy of the abnormal boney structures of the spine.  This allows the patient’s health care provider to define the patient’s illness as it relates to the cause of the chronic pain syndrome, as well as to make recommendation for therapy and/or management.  Although, many of the painful symptoms are caused by irritation of nerves along the cortex of the vertebral bone, as well as nerves encased in reparative connective tissues within the medullary matrix of the bone, there is also bone on bone articulation where the intervening cartilage becomes less functional or absent all-together, as in degenerative knee/hip pain (osteoarthritis).

Three options for medical care currently exist for patients who suffer from chronic debilitating pain syndrome.  Those options are surgery, nerve block (with injecting anesthetic agents), and oral medication.  Often times, patients find themselves limited to medication to treat ongoing chronic pain syndrome due to the expense or inconvenience and other limitations that come with surgery and/or nerve block. Certain types of oral medications used to treat pain are similar in action as to endorphins.

“Endorphins are among the brain chemicals known as neurotransmitters, which function to transmit electrical signals within the nervous system. At least 20 types of endorphins have been demonstrated in humans. Endorphins can be found in the pituitary gland, in other parts of the brain, or distributed throughout the nervous system.Stress and pain are the two most common factors leading to the release of endorphins. Endorphins interact with the opiate receptors in the brain to reduce our perception of pain and act similarly to drugs such as morphine and codeine. “

Most, responsible patients who partner with their physicians to do the right thing in managing their chronic pain syndrome do quite well on oral medication, which tends to be effective in allowing the patient to carry on daily functional activity. Surely oral medication tends to be more readily affordable for most patients as compared to the other two options.

THE BRAIN AND CHRONIC PAIN, READ

Responsible management becomes the most prominent position to address. Nationally respected panels of pain medicine experts have created guidelines and recommendations for patients and physicians to follow, given the fact, that more than 80% of physicians who manage patients for chronic pain are general practitioners and family medicine practitioners.  And, studies have shown this to be safe and effective when done under appropriate guidelines and recommendations.

(The Journal of Pain Volume 10, Issue 2 , Pages 113-130.e22, February 2009)

It becomes the patient’s responsibility to partner with a physician in choosing which course of management will be most effective for the patient.

Every patient May NOT be a candidate for out-patient based pain management, and licensed physicians who treat patients with certain medications for chronic pain syndrome should be held responsible in making this life-altering decision for patients (in keeping with FIRST DO NO HARM).  Certain high-risk patients for outpatient pain management include those who: 1) require more than 200 mg of morphine-equivalent opiates per day; 2) have been previously discharged from pain management clinics due to overdose, diversion, abuse, and/or addictive behavior; 3) patients who do not have evidential, imaging support of disease indicative of pain management.  The idea is to treat debilitating pain, and NOT pleasurable behavior.  Thus, my recommendation to patients who suffer from chronic debilitating pain syndrome, is to choose your physician and/or health care provider wisely by doing due diligence in reading, asking questions, and making sure the patient understands risk versus benefit in  long-term, oral medicinal/therapeutic management for pain. Moreover, patients who chose to “doctor shop,” visiting multiple doctors simultaneously for certain medications,  or “pharmacy shop,” visiting multiple pharmacies simultaneously for medication fillings, place their own lives at risk for serious complications related to certain type of medications. Physicians or other health care providers who treat patients for chronic pain syndrome with certain medications have ethical and legal obligations to discontinue care of such patients in keeping with the platform, “first do no harm.”  Furthermore, combination therapy, such as xanax, Klonopin, somas, should not be used while taking certain oral medications because of the risk of seizure, coma, and/or death. In our practice, our strategy regarding managing patients with certain types of medication is to follow National Guidelines and Recommendations (refer to above reference article in The Journal of Pain) with respect to: a) retard the development of rapid, high-dose medication tolerance through appropriate dosing of medication; b) monitor for side effects with oral medication(s);c) monitor behavior for abuse, diversion, and/or addiction; and d) appropriately make recommendation for detoxification with withdrawal protocols, and referral to board-certified MD-psychiatrist and/or addictionologist as clinically indicated.  HIGH RISK PAIN MANAGEMENT-A DIRECTION FOR PATIENTS

We, at MDC-Atlanta, have found that the best course of therapy for our patients is to base treatment strategy on the degree of MRI or other imaging findings, i.e. severe degenerative changes with canal and/or foraminal stenosis, nerve/spinal cord impingement, with or without osteophyte formation and/or bone on bone articulation.  The level of pain also helps decide treatment strategy.  Thus, the idea is to “start low and go slow” with chronic opiate therapy for NON-cancer related pain (COT), to maintain low risk potential for addiction, diversion, and abuse.  With this, we suggest oral treatment should only be taken when pain level exceeds level 8 out of 10, and to resist the notion of around the clock COT usage.  Typically, there is a relief of debilitating pain during tolerable therapy for 5-6 hours or more. By  the patient supplementing pain therapy with anti-inflammatory or topical analgesic type medication in between high level pain, this may also delay rapid development of high risk potential. For example, during tolerable oral medication therapy, if a patient takes a pain (analgesic) medication, a tolerable pain level should be achieved for 5-6 hours or longer. As patient begins to experience an incline in intensity of pain, then the patient should take an anti-inflammatory-type medication (i.e. ibuprofen, motrin, advil, aleve, etc) to retard the need for another stronger analgesic medication.  Thus, the time for next dosage could be around 8-10 hours or longer.  Therefore, typically 2-3 tablets of select analgesics (pain medication) (less than 100 mg dosage equivalence/day), each tablet separated in time by at least 6-8 hours,  over an 18 hour day, per day, may be all that is needed.  Keep in mind,  the chronic pain patient should also get appropriate sleep for at least 5-7 hours per day, given a therapeutic cycle of 12-18 hours over a 24 hour period, under appropriate prudence of oral analgesic (pain) medication usage.

It requires law-enforcement, pharmacist, and health-care practitioner communicating with one the other to keep patients safe.  One missing link in this communication effort may bring harm to patient.

MDC-Atlanta remains committed to keeping patients informed for better quality and safe health care!

 


Classifying Human Diseases

FUNDAMENTAL CLASSIFICATION OF HUMAN DISEASES:

1. Genetic/Inheritable/Congenital: Related to chromosomal abnormality by the transferring of genes from parents to child; or abnormality related to embryonic/fetal development and/ or surrounding birth.

2. Degenerative and/or Metabolic Disease: Related to the aging process or wear and tear

3. Inflammatory, Infectious: Related to pathogens such as Bacteria, Fungi, Viruses, Parasites, etc

4. Inflammatory, Non-infectious: Related to autoimmunity,allergens, environmental pollutants, etc.

5. Neoplastic, Benign or Cancerous: Related to abnormal growth or division of cells.

6. Trauma: Related to chemical and/or physical destruction of cells or tissue

7. Psychiatric: Related to the alteration in mental status and/or perception

Organic Disease Classification could be summarized as Follows:

GENETIC VERSUS ACQUIRED

ACQUIRED DISEASES CAN BE GENERALLY CATERGORIZED AS: CONGENITAL/DEVELOPMENTAL VERSUS REACTIVE VERSUS NEOPLASTIC

REACTIVE DISEASES INCLUDE: INFECTIOUS VERSUS NON-INFECTIOUS (Allergens, Autoimmune, and Degenerative-related to the aging process)

     NEOPLASTIC DISEASES INCLUDE: BENIGN OR CANCEROUS (MALIGNANT) TUMOR-GROWTH 

DIAGNOSTIC CRITERIA FOR SPECIFIC ETIOLOGY OF DISEASE

(Usually established by World Health Organization-WHO, or other International Authority)

This is typically based on:

a) Clinical Presentation and Physical Examination/Evidence

b) Laboratory tests

c) Imaging studies

d) Clinical Studies

e) Research/Investigation by Scientific Methods, Peer-reviewed

TREATMENT AND MANAGEMENT OF SPECIFIC DISEASE

Typically under the auspice of National Standards and Guidelines, as established by Panels of Experts within Selective Fields of Specialty

National Guideliness For Medical Therapy and Management

PREVENTATIVE CARE AND MAINTENANCE CARE

Typically under the auspice of National Standards and Guidelines, as established by Panels of Experts within Selective Fields of Specialty

At the end of our medical evaluation at MDC-Atlanta, we want our patients to understand how we derive at an accurate diagnosis, as well as make recommendation for treatment and/or management; and we welcome the patients to ask the following questions:

1) Which category is my disease classified?

2) What is the specific diagnosis of my disease and/or illness, and what diagnostic criteria were used, as well as which national or world standards were used to derive at the specific diagnosis?

3) What references are available for the patient to access with regards to getting more clarifications regarding specific diagnosis, treatment, management and prognosis?

Thanks for visiting Medical Diagnostic Choices, MDC-Atlanta, as we are committed to empowering our patients to being INFORMED FOR BETTER QUALITY AND SAFE MEDICAL CARE!


Assurance in Accuracy of Pap Smear and Diagnostic Laboratory Medicine at MDC

Carcinoma in-situ by Cytology of Cervix/Pap smearModerate to Severe Squamous Dysplasia (HSIL) of Cervical Tissue

Typically, when a patient visits a clinician for laboratory medicine evaluation, i.e. pap smear, cellular or tissue biopsy, blood or body fluid testing, the medical laboratory that receives the sample is relatively dependent on the clinical office staff, non-laboratory staff member at hospital, and/or physician for appropriate collection of test sample, accuracy of labeling  test sample as well as other  documentations regarding the test sample.  This level of dependency, which by the way loses credibility simply by being manipulated by multiple persons before testing, requires appropriate communication and documentation about the patient’s demographic, clinical information, and descriptive characteristics pertaining to the pap smear, cellular/tissue biopsy, or blood/body fluid sample submitted.  Often times this most important first-step in communication and documentation is compromised, leading to error and/or potentially harmful medical outcome for patients. Remember in general, “Quality and Accuracy in Laboratory Medicine Diagnosis” starts with appropriate communication and documentation before the sample reaches the medical laboratory for testing.

In our unique medical practice at MDC-Atlanta, we are able to essentially eliminate this potential compromise in patient care, because there is a direct complete medical evaluation/communication between the patient and the general practitioner/ laboratory medicine specialist at MDC, which assures accountability for appropriate therapy and management as well as  continuity of care.

For example during a pap smear evaluation, our physician directly interviews the patient regarding ALL pertinent clinical information.  This would include collecting information directly from the patient as it would relate to the patient’s gynecological history such as previous  pap smear result(s), previous or current gynecological diagnosis(es) and/or treatment(s), last menstrual period and its regularity or lack thereof, history of pregnancy, presence or absence of previous sexually transmitted diseases, other medical diagnoses,etc. Once a complete history is obtained, our physician provides a thorough clinical pelvic examination using standard medical procedures.  We also perform a bi-manual examination to palpate for abnormally enlarged ovary, uterus, or any other palpable abnormality. A swab sample of the vaginal canal, external and internal cervix is collected and appropriately smeared onto a glass slide, and prepared for immediate microscopic review of the cells collected for accurate diagnosis by our physician the same day while the patient wait. The most important component to this process, is that the physician collecting and reading the sample, can determine if the sample is adequate or representative of any abnormal changes during the clinical examination. We believe that a conventional pap smear is just as effective in detecting pertinent vaginal/cervical and even uterine lesions in some instances as the liquid-based pap examination; and this has been documented in the medical literature (JAMA. 2009;302(16):1757-1764).  Furthermore, a decision can be made along with the patient for further diagnostic testing as it relates to, for example, the necessity for Human Papilloma Virus (HPV) testing, or molecular testing or other diagnostic testing at the time of the initial clinical visit. Keep in mind if a Pap smear is within normal limits, then Human Papilloma Virus testing or any other additional tests may not be necessary.  In general, this process of having a laboratory medicine specialist directly evaluate the pap smear alone saves patients unnecessary expense as it relates to the pap testing and/or diagnosis.

Our physician routinely consults with associated, appropriately credentialed laboratory medicine physician consultant/specialist with respect to second review and/or second opinion to highlight our commitment to accuracy and quality diagnostic testing.

We are essentially able to minimize or eliminate false negative and/or false positive results from ANY CELLULAR OR TISSUE TESTING, through direct-patient care/evaluation by our physician.  This is the assurance that we give to our patients, and we provide immediate medical therapy and/or appropriately refer our patients in the proper direction for continuity of care as deemed necessary.

Saving patients hundreds of dollars as well as anxiety and frustration through direct-patient care by General Practitioner/ Laboratory Medicine Specialist!

Thanks for visiting Medical Diagnostic Choices.

 


Cytology: Doc, Just tell me, “Is This Lump Cancer or Not?”

Cytology in History

Much information can be gathered by observing the cell and/or its surroundings under a light microscope.

More than 170 years ago, scientists/pathologists recognized that accurate diagnosis of cancer could be determined by simply observing the structure of the cell under a light microscope.

A cytological diagnosis can be simple to perform, saves patients hundreds of dollars ( essentially pennies on a dollar as compared to tissue diagnosis), and typically is less painful than an open tissue biopsy; surely less scarring and debilitating. More importantly, Cytology creates practicality for mobile pathology and rapid diagnosis.  In fact, the only materials needed for a pathologist to make a definitive cytological diagnosis are a slide (generally less than $1), non-toxic stain/fixative (generally less than $5), and a light microscope.  So this gives you an idea just how inexpensive cytological diagnostic testing can be. For example, when you factor in the above expense and the professional services, the fee for cytological diagnosis could be as little as $50 dollars, depending on the type of cytological evaluation done.  Not bad, eh?

Dr. Gates demonstrates the simplicity and low expense to study cells for an accurate diagnosis

The Immediate Use of Cytology? To determine if a growth is cancerous or not (benign or reactive). And, it should be the mainstay in diagnostic pathology.  This is what I use in my practice to prioritize  further diagnostic study on cytological samples from my patients when assessing cancer diagnosis through Fine Needle Aspiration (FNA), or simple body fluid smears/touch imprints, as with pap smear, or blood smear for example.  And, I am literally able to save them frustration, anxiety, and expense, by giving my patient a cellular diagnosis on the spot.

Here are the criteria that are typically helpful when assessing cellular disease:

1) Reactive versus Neoplastic: Reactive implies benign appearing cells, i.e. having usual preservation of the cell’s normal shape and size, mixed with inflammatory cells, or showing degenerative changes with or without inflammatory cells.  Neoplastic implies loss of cellular maturation, as well as an abnormal growth pattern that is different from normal mature cells of the same origin.

2) Neoplasia: a) Benign Growth; or  b) Cancerous Growth

3) Benign Growth:

a) Low cellularity (low number of cells); tightly cohesive cells.

b) Maintain Cellular Polarity (i.e. usual structure of nuclear size, shape, and position in the cell with cytoplasm)

c) Demonstrate minimal maturation arrest.

4)  Cancerous Growth (May Not Apply to Hematological Cancers):

a) High Cellularity (increased number of cells); loosely cohesive cells,usually in various sized clusters or singly.

b) Loss of cellular polarity (i.e, cell nuclear size, shape, and position vary from one cell to the other with respect to cytoplasm.

c) Pleomorphism/Polymorphism: This means that cells of same origin, i.e. epithelial, or stromal, or neural, etc, have variation in nuclear membrane irregularity, often with the size of the nucleus being enlarged and distorting the cell cytosol/cytoplasm and cell membrane.

d) Proliferative index: Generally, normal cells are in resting phase of growth; so to see many cells, and/or evidence of cellular division is a sign of rapid, abnormal cell proliferation, i.e. mitotic index.

e) Cell growing within cell.  Normal cells (other than placental cells or certain types of hormonal cells and the likes) do not grow within other cells, ie. cup and saucer, cell nuclear fusion, etc.

f) Marked cell-maturation arrest (a cancer cell may not resemble the original cell, having features of embryonic cell, or undifferentiated cell)

5. Hematological Cancerous Growth:

a) Monoclonal, which means a proliferation of one cell type, i.e. myeloblast or lymphoblast, etc, which often times requires special studies as indicated below

b) Lack of appropriate maturation sequence of individual hematological cell when compared to other cells of same origin, often expressing genetic or chromosomal abnormality as in dysplastic changes.

Special cytochemistries, or cytogenetics or other molecular studies can now be performed on cellular samples to objectively and accurately confirm cellular abnormality/diagnosis, as needed.  This also essentially eliminates subjective interpretation of cytological results.

Cellular Images of Diagnostic Features Can be Provided Via DIGITAL DIAGNOSTIC REPORTS (for transparency and Evidence for Diagnosis).

We make every attempt to save our patients time and money by simply doing cellular procedures over open tissue biopsy.  Open tissue biopsy tends to be more painful, debilitating, risky and yes, “expensive.”

Thanks for reading.

Jackson L. Gates, MD, Medical Diagnostic Choices, MDC-Atlanta