Summer 2011

Office News

• Melissa Martinez
• Fitness Class
• WellBalance Camp
• Office Hours
• Office Reminders

Medical News

• Summer Fun
• Sun Safety
• Skin Cancer
• Health Links

Contact Us

Pisgah Family Health
220 Ridgefield Court
Asheville, NC 28806
828-670-7077
Fax: 670-7035

www.PisgahFamilyHealth.com/

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About the Newsletter

Office News

Welcome Melissa Martinez

We are pleased to announce that Melissa Martinez is joining the staff of Pisgah Family Health.

Melissa Martinez, PA-C has been a Physician Assistant since 1999. She worked for 5 years in Florida, practicing in Internal Medicine and Geriatrics before moving to Asheville in 2006. She has been training at our office since September, and now will join our medical team.

Melissa will be seeing patients will all types of problems, from colds to physical exams. She is bilingual, which will be a great bonus to our Spanish speaking patients. We also hope any of our female patients who prefer a woman provider will choose to see Melissa.

Fitness Class

The staff of PFH recently enjoyed a fitness class led by one of our most active patients. If you are serious about getting in shape and leaving your old body behind, this is the exercise class for you. Meet each Saturday morning at Sandhill Venable Elementary school at 8:30am for a 1 hour outdoor "boot camp" style workout. Most exercises consist of body weight and cardiovascular training to take your fitness to the top.

All fitness levels are invited. Children can entertain themselves on the adjacent playground during the workout. Bring cold water and a towel or fitness mat. For more information please contact Leslie Norejko at (828)775-4886.

Do you know a teenager who needs to lose weight or improve fitness? There is no better way to improve your potential than immersion in a fitness-oriented camp. Most camps will give you new experiences and a fresh outlook on life. However, if your teen needs a life-changing experience, consider WellBalance Fitness Camp.

WellBalance Camp is specially designed to improve kids' exercise, diet, and motivation for weight loss. Dr. Curran can help you get discounted tuition to this excellent camp in Virginia. Call immediately, as summer sessions have already started.

Call (800) 975-0435 or visit http://wellbalance.com/

Office Hours

Our normal office hours are 9-5 Monday through Thursday, and 9-2 on Friday.   When the office is closed, emergency care is available at the Urgent Care Centers and Mission Hospital ER.  Our answering service can be reached after hours at 251-4873.   Telephone calls are handled by Dr. Curran’s call partners.

• We will be closed June 27 - July 4 for vacation
• We will be closed August 11-12 for a staff outing

Office Reminders

Now is the time to schedule your annual physical. During the summer months we are less busy, and more able to make time for routine care and physical exams. Please remember to schedule these extensive visits well in advance. You will avoid waiting, and avoid contact with sick patients by having your physical during these months.

If you are scheduling a DOT, sport, camp, school or work physical, there is always paperwork to complete. Prior to your exam, be sure your paperwork is entirely completed, leaving only the physician portion blank.

We will also use this opportunity to update your health history record. Please download these forms from our website and complete them before your visit, or arrive 30 minutes early to make time for this paperwork.

Vaccinations are generally required to begin Kindergarten and College. If vaccinations are required, be sure to bring your vaccination records with you.

Medical News - Summer Fun

Summer Fun in Asheville

Summer is the time to get outdoors and enjoy our beautiful environment. We are very fortunate to live in a town that offers great weather, beautiful natural resources, and a vibrant social life. Here are a potpourri of inexpensive and healthy ways to enjoy your summer.

Free Music    

Downtown After 5

The city of Asheville hosts FREE music and dancing on the third Friday of the month, May through September. This year's lineup includes on June 17: The Blue Dogs with The New Familiars; on July 15: Aaron Wood with Jon Scales Fourchestra, on August 19: The Lee Boys with Lubriphonic; and September 16: Town Mountain with Bobby Miller and The Virginia Daredevils. The stage is located on Lexington Avenue at I-240. Free live music starts at 5 pm with food and drinks available for purchase.
For more information, visit: http://www.ashevilledowntown.org/

HomeGrown in the Park

Presented by 98.1 the River, enjoy local singer-song writers in Pritchard Park all summer long! Stroll through the park on Thursday evenings from 6-8pm and enjoy our local talent, the beautiful weather and some great fun! This concert series is not to be missed!
For more information, visit: http://www.ashevilledowntown.org/

Shindig On the Green

This mountain tradition features an always-enjoyable variety of mountain dancers, clogging, bluegrass and old time string bands, ballad singers, and storytellers. Saturday evenings from 7-10 p.m. July 2, 9, 16, 23, August 13, 20, 27, and September 3. Located at the newly renovated Roger McGuire Green at Pack Square Park in downtown Asheville .
More details at http://www.folkheritage.org/

Bele Chere

Asheville's biggest street festival offers hours of shopping and snacking, but the best part is the free music. With 4 stages playing music for 3 days, there is guaranteed to be something for everyone.
Find the music lineup and more info at http://www.belecherefestival.com/

Get Wet

Splasheville

Buncombe County Parks and Recreation

• Cane Creek - 590 Lower Brush Creek Rd, Fletcher. 828-628-4494
• Erwin - 58 Lees Creek Road, Asheville. 828-251-4992
• Hominy Valley - 25 Twin lakes Road, Candler. 828-667-9937
• North Buncombe - 892 Clarks Chapel Road, Weaverville. 828-645-1080
• Owen - 117 Stone Drive, Swannanoa. 828-686-1629

Asheville City Parks

• Recreation Park - 55 Gashes Creek Rd. 28806. 828-298-0880
• Malvern Hills - 75 Rumbough Place, 28805. 828-253-1164
• Walton Street - 2 Walton Street, 28802. 828-253-1143

Hendersonville's Patton Park.

• Patton Park - 198 Park Place, Hendersonville, NC 28792 828-697-3084

Hit the Beach (near Asheville)

Lake Powhatan

Located just minutes from our office, in the Bent Creek section of Pisgah National Forest, is lovely Lake Powhatan. With a sandy beach and fishing docks, but seldom a crowd, this hidden gem is great for children and sunworshippers. While there, you can also hike or bike the trails of Bent Creek Forest, or pitch your tent for an overnight camp. Cost is $6 per carload for parking, or you can hike for free from the Hardtimes Trailhead. Learn more at http://www.recreation.gov/

Lake Lure

Just 45 minutes from Asheville, Lake Lure is one of WNC's most scenic waterfronts. Rent boats, slide at the waterpark, or just enjoy the beach, all with a view of Rumbling Bald Mountain and Chimney Rock. Open 10am to 6pm. Cost is $8 for adults, and $6 for kids. Be sure to plan time for hiking at Chimney Rock Park. Learn more at http://www.townoflakelure.com/

Shakespeare in the Park

The Montford Park Players FREE summer season began June 3. Shows are performed at the outdoor theater on weekend nights, starting at 7:30. Each month offers a different production.
Details at www.montfordparkplayers.org

Take a Hike

It's not summer in WNC without hiking in the woods. Asheville is surrounded by Pisgah National Forest, and the closest access - Bent Creek - is just south of our office. Smokey Mountain National Park is less than 1 hour away, as are Dupont State Park, Gorges State Park, and several others. Hiking is a free and healthy way to enjoy summer in our region. Hikes can be chosen for all ages and capabilities - be sure to consult a park ranger or a map before setting out. If you're new to hiking, consider joining a group or organized hike Always know your trails, and hike with a partner, plenty of water, and a map.

For an on-line guidebook, visit http://www.hikewnc.info/besthikes/index.html or http://www.mountaintravelguide.com/North%20Carolina/NorthCarolinaHikingTrails.htm

Visit a Waterfall

WNC is the the land of waterfalls, and our wet summer has made them better than ever. Experiencing our waterfalls is perhaps the most refreshing way to enjoy your summer. You can choose from road-side attractions, to remote and difficult hikes. No matter which you choose, be safe - never climb on waterfalls or walk in the water above them.

Here's a list of some of the best waterfall hikes in the area: http://www.romanticasheville.com/waterfalls.htm

More ...

These suggestion and many more are available on the website http://www.romanticasheville.com/outings.html

Sun Safety: A Parents' Guide

Too Much Sun Hurts Did you know that just a few serious sunburns can increase your child's risk of skin cancer later in life? Kids don't have to be at the pool, beach, or on vacation to get too much sun. Their skin needs protection from the sun's harmful ultraviolet (UV) rays whenever they're outdoors.

Turning pink? Unprotected skin can be damaged by the sun's UV rays in as little as 15 minutes. Yet it can take up to 12 hours for skin to show the full effect of sun exposure. So, if your child's skin looks "a little pink" today, it may be burned tomorrow morning. To prevent further burning, get your child out of the sun.

Tan? There's no other way to say it-tanned skin is damaged skin. Any change in the color of your child's skin after time outside-whether sunburn or suntan-indicates damage from UV rays.

Cool and cloudy? Children still need protection. UV rays, not the temperature, do the damage. Clouds do not block UV rays, they filter them-and sometimes only slightly.

Oops! Kids often get sunburned when they are outdoors unprotected for longer than expected. Remember to plan ahead, and keep sun protection handy-in your car, bag, or child's backpack. Parents, help your children play it safe in the sun and protect your own skin as well. You're an important role model.

Hey Moms and Dads! Not all sun protection comes in a bottle. Here are five ways to protect your child's skin all year long.

	1. Hide and Seek. UV rays are strongest and most harmful during midday, so it's best to plan indoor activities then. If this is not possible, seek shade under a tree, an umbrella or a pop-up tent. Use these options to prevent sunburn, not to seek relief once it's happened.
	2. Cover 'em Up. Clothing that covers your child's skin helps protect against UV rays. Although a long-sleeved shirt and long pants with a tight weave are best, they aren't always practical. A T-shirt, long shorts or a beach cover-up are good choices, too-but it's wise to double up on protection by applying sunscreen or keeping your child in the shade when possible.
	3. Get a Hat. Hats that shade the face, scalp, ears, and neck are easy to use and give great protection. Baseball caps are popular among kids but they don't protect their ears and neck. If your child chooses a cap, be sure to protect exposed areas with sunscreen.
	4. Shades Are Cool. And they protect your child's eyes from UV rays, which can lead to cataracts later in life. Look for sunglasses that wrap around and block as close to 100% of both UVA and UVB rays as possible.
	5. Rub on Sunscreen. Use sunscreen with at least SPF 15 and UVA/UVB protection every time your child goes outside. Choose waterproof sunscreen that is made for kids. Avoid alcohol-based sunscreens (Bullfrog) which may burn the skin. Reapply sunscreen every 2-3 hours (or better yet, go inside!) Don't forget to protect ears, noses, lips, and the tops of feet.

Skin Cancer Screening

Summer is an important time to think about preventing and detecting skin cancer. A little caution in the sun can help avoid serious illness later in life. Read on to learn more about how to prevent and detect skin cancer.

Skin cancer is the most common form of cancer in the Unites States. If detected early, skin cancer can usually be treated and cured with minimal consequenses. If left unchecked, some of these cancer cells can spread from the skin into other tissues and organs. Adults should have a skin exam annually by their physician, and should always be attentive to skin changes.

Known risk factors for skin cancer include:

• Complexion: Skin cancers are more common in people with light-colored skin, hair, and eyes.
• Genetics: Having a family history of melanoma increases the risk of developing this cancer.
• Age: Nonmelanoma skin cancers are more common after age 40, though melanoma occurs in all ages.
• Sun exposure: Most skin cancers occur in skin that is regularly exposed to sunlight or other ultraviolet radiation. This is considered the primary cause of all skin cancers.

Prevention

Reduce your sun exposure! Protect your skin from the sun by wearing hats, long-sleeved shirts, long skirts, or pants. Avoid exposure from 10am to 4pm, when sunlight is most intense. Avoid surfaces that reflect light, such as water, sand, concrete, and white-painted areas. Never use tanning beds or sun lamps.

Use sunscreen whenever you will be in the sun for more than 30 minutes. Choose a sunscreen with sun protection factor (SPF) rating greater than 15, that protect against both UVA and UVB sunlight. Apply the sunscreen before going outside and reapply every 2 hours. Choose a waterproof formula.

Examine your skin regularly for any new growths or changes in an existing skin sores. A new growth that forms an ulcer or is slow to heal is suspicious. Have a skin exam by your physician annually.

Basal Cell Carcinoma

Basal cell carcinoma is the most common form of cancer in the United States. According to the American Cancer Society, 75% of all skin cancers are basal cell carcinomas.

Basal cell carcinoma starts in the top layer of the skin called the epidermis. A new skin growth that bleeds easily or does not heal well may suggest basal cell carcinoma. The majority of these cancers occur on areas of skin that are regularly exposed to sunlight or other ultraviolet radiation.

Basal cell carcinoma grows slowly and painlessly. Basal cell skin cancer almost never spreads to remote areas. However, if left untreated, it may invade and destroy surrounding tissues and bone.

Your risk for basal cell skin cancer is higher if you have:

Symptoms

Basal cell carcinoma may look only slightly different than normal skin. The cancer may appear as skin bump or growth that is:

• Pearly or waxy
• White or light pink
• Flesh-colored or brown
• The skin may be flat, slightly raised, or have a round bump.

You may see

• A skin sore that bleeds easily
• A sore that does not heal
• Oozing or crusting spots in a sore
• Irregular blood vessels in or around the spot
• A sore or nodule with a depressed (sunken) area in the middle

Treatment

Treatment varies depending on the size, depth, and location of the basal cell cancer. Basal Cell cancer can be usually be cured by removing the mass surgically. It will be removed using one of the following procedures:

• Excision cuts the tumor out and uses stitches to place the skin back together.
• Curettage and electrodesiccation scrapes away the cancer and uses electricity to kill any remaining cancer cells.
• Surgery, including Mohs surgery, in which skin is cut out and immediately looked at under a microscope to check for cancer.
• The process is repeated until the skin sample is free of cancer.
• Cryosurgery freezes and kills the cancer cells.

Prognosis

Basal cell carcinoma rarely spreads to other parts of the body. The rate of basal cell skin cancer returning is about 1% with Mohs surgery, and up to 10% for other forms of treatment. Smaller basal cell carcinomas are less likely to come back than larger ones. You should follow-up with your doctor as recommended and regularly examine your skin for any reoccurrence.

Possible Complications

Untreated, basal cell cancer can spread to nearby tissues or structures, causing damage. This is most worrisome around the nose, eyes, and ears.

Prevention

The best way to prevent skin cancer is to reduce your exposure to sunlight. Ultraviolet light is most intense at midday, so try to avoid sun exposure during these hours. Protect the skin by wearing hats, long-sleeved shirts, long skirts, or pants.

Actinic Keratosis

Actinic keratosis is a rough, scaly, raised area found on skin that has been exposed to the sun over a long period of time. If left alone for years, Actinic Keratoses can turn into Squamous Cell skin cancer. Therefore, these are considered "precancerous", and should be removed.

Causes

Symptoms

Actinic keratosis is usually found on the face, scalp, ears, back of the hands, chest, or other sun-exposed areas. They may be gray, pink, red, or the same color as the skin. Often, they have a white or yellow scale on top. They begin as flat and scaly areas. The skin lesion may be easier to feel than to see. Later they develop a hard and wart-like or gritty, rough, and "sandpapery" surface.

Treatment

Because about 5% of actinic keratoses go on to develop into squamous cell skin cancer, they should be examined and removed. Growths may be removed by:

• Freezing with liquid nitrogen
• Burning (electrical cautery)
• Cutting out the affected skin
• When many actinic keratoses are found over a large area, they may be treated with creams such as 5-fluorouracil (5-FU) and imiquimod.

Prognosis

Actinic keratosis itself is harmless ( benign), but about 5% develop into skin cancer. Removal of the growth is usually effective.

Squamous Cell Skin Cancer

Squamous Cell carcinoma grows from the outermost (squamous) layer of the skin. Squamous cell cancer spreads faster than basal cell cancer, but still may be relatively slow-growing. Rarely, it can spread (metastasize) to other locations, including internal organs.

Squamous cell carcinoma in situ (also called Bowen's disease) is the earliest form of squamous cell cancer. The cancer has not yet invaded surrounding tissue. It appears as large reddish patches (often larger than 1 inch) that are scaly and crusted.

Risks for squamous cell skin cancer include:

• Having light-colored skin, blue eyes, and blond or red hair
• Long-term, daily sun exposure (such as outdoor workers)
• Many severe sunburns early in life
• Older age
• A large number of x-rays or radiation exposure
• Arsenic and other Chemical exposures

Symptoms

The main symptom of squamous cell skin cancer is a growing bump that may have a rough, scaly surface and flat reddish patches. The bump is usually located on the face, ears, neck, hands, or arms, but may occur on other areas. A sore that does not heal can be a sign of squamous cell cancer. Any change in an existing wart, mole, or other skin lesion could be a sign of skin cancer.

Treatment

Squamous skin cancer has a high cure rate if it is treated early. Treatment depends on how big the tumor is, its location, and how far it has spread (metastasis).

• Excision refers to cutting out the tumor and using stitches to place the skin back together.
• Curettage and electrodesiccation scrapes away the cancer and uses electricity to kill any remaining cancer cells. It is used to treat cancers that are not very large or deep.
• Mohs surgery involves cutting out a layer of the skin cancer and immediately examining it under a microscope to check if any cancer has been left behind. More layers are removed until the skin sample is free of cancer. Mohs surgery is more likely to be used for skin cancers on the nose, ears, and other areas of the face.
• Cryosurgery freezes and kills the cancer cells.
• Radiation may be used if the cancer has spread to organs or lymph nodes, or for squamous cell cancers that cannot be treated with surgery.
• Photodynamic therapy, a special type of light treatment, may be used to treat Bowen's disease (BD).

Prognosis

Most (95%) of squamous cell tumors can be cured if they are removed promptly. Squamous cell carcinoma only rarely spreads to other parts of the body. However, new tumors may develop with age. If you have had squamous cell cancer, be sure to have your skin examined annually by your physician.

Melanoma

Melanoma is the most dangerous type of skin cancer. It is the leading cause of death from skin disease. It involves cells called melanocytes, which produce a skin pigment called melanin. Melanin is responsible for skin and hair color. Melanoma can also involve the colored part of the eye.

Causes

Melanoma is more common with sun exposure, but can occur even in places that never receive sunlight. Melanoma can appear on normal skin or it may begin with a mole that changed in appearance. Some moles that are present at birth may develop into melanomas.

Melanoma can spread very rapidly. Although it is less common than other types of skin cancer, the rate of melanoma is steadily increasing. It is the leading cause of death from skin disease. Melanoma occurs in young and older individuals.

There are four major types of melanoma:

• Superficial spreading melanoma is the most common type of melanoma. It is usually flat and irregular in shape and color, with different shades of black and brown. It may occur at any age or body site, and is most common in Caucasians.
• Nodular melanoma usually starts as a raised area that is dark blackish-blue or bluish-red. However, some do not have any color.
• Lentigo maligna melanoma usually occurs in the elderly. It is most common in sun-damaged skin on the face, neck, and arms. The abnormal skin areas are usually large, flat, and tan with areas of brown.
• Acral lentiginous melanoma is the least common form of melanoma. It usually occurs on the palms, soles, or under the nails and is more common in African Americans.
• Rarely, melanomas appear in the mouth, iris of the eye, or retina at the back of the eye. They may be found during dental or eye examinations. Although very rare, melanoma can also develop in the vagina, esophagus, anus, urinary tract, and small intestine.

Risks for melanoma include the following:

• Living in sunny climates or at high altitudes
• Long-term exposure to strong sunlight because of a job or other activities
• One or more blistering sunburns during childhood
• Use of tanning devices

Other risk factors include:

• Close relatives with a history of melanoma
• Exposure to chemicals that can cause cancer, such as arsenic, coal tar, and creosote
• Presence of certain types of moles (atypical dysplastic) or multiple birthmarks
• Weakened immune system due to AIDS, leukemias, organ transplant, or immune medications.

Symptoms

The primary symptom of any skin cancer is usually a mole, sore, lump, or growth on the skin. Melanomas are pigmented, so any unusual pigment changes can be a sign of melanoma. Any change in appearance of a pigmented skin sore over time is a warning sign. Also, watch for any skin growth that bleeds.

The ABCD system may help you remember features of melanoma:

• Asymmetry: One half of the abnormal area is different from the other half.
• Borders: The lesion or growth has irregular edges.
• Color: Color changes from one area to another, with shades of tan, brown, or black
• Diameter: The trouble spot is usually (but not always) larger than 6 mm in diameter.

The key to treating melanoma is recognizing symptoms early. You might not notice a small spot of concern if you don't look carefully, so perform thorough self-examinations monthly, and schedule a formal skin exam with a physician yearly. Suspicious moles should be removed by biopsy and evaluated by a pathologist.

Treatment

The cancerous skin cells and some tissue that surrounds the cancer will need to be surgically removed. How much normal tissue is removed depends mostly on how deep the melanoma has grown.

If the cancer has spread to nearby lymph nodes, these lymph nodes may also need to be removed. Treatment with interferon after surgery may be useful for these patients.

For patients with melanoma that has spread beyond the skin and nearby lymph nodes to other organs, treatment is more difficult. At this point, melanoma is usually not curable. Treatment is usually directed at shrinking the tumor and improving symptoms:

• Chemotherapy is often used to treat melanoma that has returned or spread.
• Medications such as interferon or interleukin, which boost the immune system to fight the cancer, may be useful in addition to chemotherapy and surgery. This kind of treatment is called immunotherapy. However, interferon has many side effects and can be difficult to tolerate.
• Radiation treatments may be used to relieve pain or discomfort caused by cancer that has spread.

Prognosis

Treatment success depends on many factors, including the patient's general health and whether the cancer has spread to the lymph nodes or other organs. If caught early, some melanomas can be cured. Deeper tumors are more likely to come back. If the skin cancer is deeper than 4 mm or the lymph nodes have cancer, there is a high risk of the cancer spreading to other tissues and organs. If the cancer has spread to the lymph nodes, there is a greater chance that the melanoma will come back. For patients with melanoma that has spread beyond the skin and nearby lymph nodes to other organs, treatment is more difficult. At this point, melanoma is usually not curable.

Source: http://www.nlm.nih.gov/medlineplus/ency/article/001442.htm

Additional Skin Cancer References:
http://www.webmd.com/melanoma-skin-cancer/slideshow-precancerous-skin-lesions-and-skin-cancer
http://cancer.about.com/od/skincancermelanoma/f/skincancerlook.htm
http://cancer.about.com/od/skincancermelanoma/a/skinsymptoms.htm
http://www.mayoclinic.com/health/melanoma/DS00575
http://www.skincancer.org/

Health Links

For local health events, check out these links:

• Asheville Citizen Times Health listings: Local health news and calendar.
• Mountain Express Health calendar Up to date local listing of health events in many categories.
• WNC Parent Magazine A monthly publication for parents.
• Mission Hospitals Asheville's best hospital system.

A few of the most-trusted health information links:

• WebMD.com A web service with health advice on hundreds of topics.
• FamilyDoctor.org Patient-oriented information from the American Academy of Family Physicians.
• CDC.gov The Center for Disease Control features credible information on almost every health topic.

About our Newsletter

Dr. Curran and the staff at Pisgah Family Health are proud to publish the Pisgah Family Health News to our patients.  Our goal is to provide regularly updated information about the office and current medical topics.  We plan to publish a new issue each quarter with breaking news.  The newsletters will also be archived on our website, http://www.pisgahfamilyhealth.com/. 

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