“We Care For Your Family”

From Our Family to Yours

This Newsletter Brought to You by the Physicians and Staff of The Center for Primary Care

Winter 2000
Volume 2, Issue 1 In this issue:                                                                                                                                                                                           

Seasonal SADness

Do you feel sad and tired in the fall and winter? You may be experiencing symptoms of Seasonal Affective Disorder.

Tomeo Elected

Congratulations to Jay Tomeo of CPC Central on being named head of Family Practice at Doctors Hospital.

Hidden HBP

If you had hypertension, would you know it? Because high blood pressure lacks obvious warning signs, it may go unnoticed and untreated.

Fighting the Flu

The FDA recently approved two medications to ease flu symptoms, but prevention is still your best course of action.

Winter Can Be ‘SAD’ Time of Year

For Those with Seasonal Affective Disorder

By Edwin Scott, MD

For most people, the fall of the year and the impending holidays are a time of great joy.
It is fun to be outdoors, and there is a sense of anticipation of fun and family time from
Halloween to the New Year. Unfortunately, not everyone shares in the excitement. To
some people, the shortening days and cooler weather mean Christmas is coming, but for
others, it is the beginning of a long winter night and a battle with Seasonal Affective
Disorder (SAD).

Seasonal Affective Disorder is characterized by depression related to the season of the
year. People with SAD have symptoms of depression that begin to worsen around late
fall and early winter and usually go away by the beginning of summer.

SAD is fairly common. Based on various studies of this seasonal illness, it is estimated
that 4% to 6% of the population have severe SAD and as many as 10% to 20%
suffer a milder form of the disorder. It is approximately four times more common
in women than in men. Although children and teenagers sometimes develop SAD, the
disease affects mostly people in their twenties or thirties. It is more common in the
north than in the south. The state of Washington, for example, has seven times more
cases of SAD than Florida does.

Although the cause of SAD is not well understood, it seems to be related to the amount of sunlight to which
a person is exposed. It is thought that some neurotransmitter
levels in the brain are influenced by sunlight.
While this theory is being studied, no exact mechanism
of disease has yet been found. SAD overlaps to some
degree with other mood disorders, such as bipolar disorder
and major depression. As with other mood
disorders, there is evidence that SAD runs in families; however,
SAD families are more likely to have a
history of alcoholism than other mood disorders. Patients with SAD
are also more likely to have
“atypical symptoms” of depression.

The symptoms of SAD are generally similar to those of major depression.
A person with SAD tends to experience
symptoms of fatigue, irritability, and difficulty concentrating,
but in some ways, SAD is not typical of major
depression. Depression tends to cause poor appetite
and weight loss, while SAD usually has the opposite
effect. SAD patients may crave sweet and starchy foods as well.
Depression tends to cause insomnia, while
individuals with SAD may sleep too much (perhaps like hibernation).

Since the symptoms of SAD are related to the time of year, they usually come and go about the same
time every year. As spring approaches, the symptoms of SAD spontaneously get better. Generally, there is
no relation between SAD and obvious seasonal sources of stress, such as losing your job at the same time
every year because you work on a farm.

Along those same lines, there is a difference between Seasonal Affective Disorder and having a depressed
mood around the holidays. There are many potential sources of stress during the holidays. For example,
the first Christmas after the loss of a loved one is very hard because the absence of this person is so noticeable
during family gatherings. Christmas also tends to emphasize the financial difficulties families may be going through.
Many people have problems around the holidays for these sorts of reasons. Some become so distraught that they
may contemplate or attempt suicide. This is a different sort of disorder from Seasonal Affective Disorder and
would be treated differently.

The treatment for SAD consists of increasing the patient’s exposure to sunlight. Natural sunlight seems
to correct the biochemical

problem in the brain that causes this disorder. In addition to natural sunlight, there are commercially
available lamps that emit the kind of light that is helpful in treating SAD. Of note, the kind of light given
off by tanning beds is not effective for treating SAD. In addition to light therapy, some patients find that
antidepressants are also helpful for SAD.

If you or someone you love shows signs of depression, irritability, fatigue (with excessive sleeping), or an
increase in weight as fall and winter approach, please feel free to consult with a CPC physician about the
possibility of Seasonal Affective Disorder.
Source: Current Opinion in Psychiatry (handout), American Academy of Family Physicians, January 1994

CPC Physician Profile: Riaz Rassekh of CPC

 South

Riaz Rassekh’s choice of family practice as a medical specialty is no surprise when you take into account
his love of people and his tendency to look at the big picture.

“I chose family practice mostly to feel closer to people and to be able
to deal with as many aspects of their care as possible,” he explains.
“I would rather look at people as a whole.” Dr. Rassekh believes his
big-picture approach to patient care enables him to serve patients’
needs better than focusing on only one area.

A patient’s complaint or symptom may on the surface
appear to be related to only one aspect of their
health, he explains, even though the root of the problem may lie
elsewhere. He believes that caring for
the whole person enables him not only to identify the medical cause
of the problem more accurately but also to address the many ways it can impact the patient’s life.
Dr. Rassekh finds this to be especially true in caring for patients with chronic diseases.

Diabetes, for example, can result in health problems such as blindness, stroke, heart attack, kidney failure,
and nerve damage. It can also be emotionally devastating because of its effect on the patient’s quality of life.
“Family practice deals with all of these problems,” he explains, which enables him to provide the best and
most comprehensive care possible for his patients.

Dr. Rassekhs personal philosophy is likewise focused on wholeness and unity rather than fragmentation.
Being of the Bahai faith, he views all people as one. Like other followers of his faith, he is oriented toward
helping people and does not see others as different or in any way less than himself. My beliefs are very
inclusive of others, he says, regardless of race, religion or nationality.

Dr. Rassekh’s philosophy of love and inclusiveness naturally extend to his family. He and his wife,
Bahieh, whom he met at a Baha’i meeting near Charlotte, N.C., have been married for about a
year and a half. They have a young son, Annis Alexander, born earlier this year, and are expecting
a second child in May of 2000. Now that they are a family, Dr. Rassekh finds little time to pursue
other interests – chess, gardening, and nature – but this is a circumstance of choice: he prefers spending
free time with his wife and newborn and in the religious activities they enjoy together. Not surprisingly,
he finds his young son’s emerging personality irresistible. “He has become so sweet . . . he smiles all the time.”
This brings a smile to Dr. Rassekh’s face as well.

Born in Iran, Dr. Rassekh is no newcomer to the United States, as educational opportunities brought
him and his older sister Roza here in the mid-1970s. His first American home was with his uncle, a
long-time resident of New Jersey. When young Riaz finished high school in 1977, he headed west to
attend the University of San Francisco, where he received his undergraduate degree.

He had originally planned to return to his homeland after school, but political turmoil, revolution,
and the certainty of religious persecution were enough to dissuade him. In the late 1970s, his parents
and younger sister, Roya, were visiting Riaz in the United States. Just prior to their return home, a relative
in Iran warned the senior Rassekh that he was being publicly sought for surrender to the Iranian government.
The family decided to stay and make the United States their home.

After finishing undergraduate school at USF, Riaz left California for Santo Domingo, Dominican Republic,
where he attended medical school at the Technology University of Santiago. After completing his medical
training, he ventured back to the United States to complete a family practice residency at the Medical College
of Georgia, where he met and worked with Dr. Paul Fischer.

When Dr. Rassekh completed his residency in 1994, Dr. Fischer was in the process of moving from his teaching
role at MCG into private practice. Mutual respect, a compatible working relationship, and perfect timing put
Dr. Rassekh in the enviable position of becoming the first physician Dr. Fischer invited to join the new private
practice that is now The Center for Primary Care.

Asked about what strengths he brings to CPC, Dr. Rassekh first points out that everyone in the practice
makes a valuable contribution. Among the assets he brings to the practice are his experience and skill in
diagnostic and minor surgical procedures, such as colonoscopy, sigmoidoscopy, cryotherapy, and
mole and skin tumor excision.

For the time being, his personal goals are practical – moving into a larger home to accommodate his growing family.
Professionally, there is growth, too. As part of the CPC practice family, he is looking forward to the completion
of the new Belair Road office. He is as proud of the growth of the other two offices as he is of his own in
South Augusta and firmly believes that this progress has come only through the support of all 11
physicians in the practice.

While continued growth is one of CPC’s goals, it is not the only one. “We are already the largest family
practice group in Augusta but we also want to stay the best,” he explains. “We all want to continue
to professionally exceed ourselves and to serve the areas where we are as well as possible.” Based on the
continued growth of all three offices, Dr. Rassekh believes CPC is doing a good job of medically serving
the community.

Dr. Rassekh derives a great deal of pleasure from the camaraderie shared by the CPC physicians.
“We all get along so well, despite having diverse backgrounds and religious beliefs. Dr. Rassekh
doesn’t hesitate about what makes him most proud. His family takes top honors: his wife, Bahieh;
his beautiful son, Annis Alexander; and his parents for helping him to get where he is today.
He also credits his faith for providing a framework for his life of service to others.

Dr. Rassekh brings more than medical skills to CPC. His warmth, genuine concern, and gentle manner are
surely qualities that further inspire his patients’ affection and confidence in his ability to provide them the
best possible medical care.

.Hypertension Lacks Obvious Symptoms to Warn of Dangers

Do you have high blood pressure? Chances are if you have not been diagnosed with HBP, you probably
assume you don’t have it. The truth is that you might have hypertension even if you feel just fine.

HBP, or hypertension, is often overlooked. Even though it is a serious condition that requires medical
treatment, it doesn’t have obvious symptoms. In fact, one third of the 50 million Americans with
hypertension don’t even know they have it.

The good news is that hypertension is easy to detect and can be controlled with lifestyle and diet changes
and, when necessary, medications. That’s why it is important to have your blood pressure checked at least once a year.

What is high blood pressure?

Blood pressure is a measurement of the force of blood against the artery walls as the heart pumps it through
the body. It is measured in two ways: systolic pressure and diastolic pressure. The systolic measurement is
the peak pressure generated when the heart is in its pumping phase. The second or diastolic measurement
is taken when the heart relaxes and refills with blood. The diastolic pressure is the lowest value measured.
A blood pressure measurement of less than 130 systolic and 85 diastolic (130/85 mm hg) is considered
normal for adults. Higher values indicate varying degrees of hypertension ranging from high-normal
(130/85 mm hg to 139/89 mm hg) to very severe (more than 209/119 mm hg).

Why is it harmful?

Elevated blood pressure means that the heart has to work harder than normal to pump the blood
throughout the body, straining both the heart and the arteries. This strain can result in heart attack,
stroke, kidney failure, hardening of the arteries, and eye damage.

When HBP is untreated, the heart tends to enlarge. A heart that is significantly enlarged is unable to meet
the body’s demands. Hypertension also damages arteries, causing them to become scarred, thicker, and
less elastic. This process occurs naturally with age, but HBP accelerates the damage. Arteries compromised
in this way are unable to supply enough blood to the body’s organs. When the organs do not get enough
oxygen and nutrients, they do not function well. Damaged arteries are also more susceptible to blood clots,
which can deprive a part of the body of its needed blood supply. The heart, brain and kidneys are particularly
vulnerable to damage from blocked arteries.

What causes high blood pressure?

In 90% to 95% of patients with hypertension, the cause is unknown. This type, known as essential hypertension,
cannot be cured but can be kept under control by regular, ongoing treatment. In other cases, hypertension is a
symptom of an underlying medical condition. Known as secondary hypertension, this type of blood pressure
elevation returns to normal once the root cause is corrected.

See the upcoming issue of From Our Family to Yours to read about the risk factors for hypertension, how it is
treated, and what you can do to prevent it.

Source: High Blood Pressure, American Heart Association, 1998; High Blood Pressure: A Common but Controllable Disorder,
National Institute on Aging Age Page, Administration on Aging; High Blood Pressure, American Medical Association Health Insight, 1998.

Two New Medications

Approved for Flu

Did you remember to get your flu shot this fall? The influenza vaccine is definitely your best line of defense
against the aches, pains and inconvenience of this seasonal illness, but if you did forget and you come down
with the flu, there is something available to ease your distress.

Zanamivir, an inhaled medication, and tablet-form oseltamivir recently received FDA approval for the
treatment of all strains of influenza A and B. These medications are designed for use by adults and
adolescents at least 12 years old and are most effective when therapy is begun as soon as possible after
symptoms first appear, or within 2 days. Unfortunately, neither medication has been shown to reduce
the risk of transmission of influenza to others.

Zanamivir and oseltamivir are options for relieving symptoms and reducing the risk of complications
from the flu, but when it comes to avoiding it altogether, nothing compares with the flu vaccine.

Source: “Two Neuraminidase Inhibitors for Treatment of Influenza,” The Medical Letter, Vol. 41
(Issue 1063), 10/8/99; New Relenza, Zanamivir for Inhalation , 9/99, GlaxoWellcome, Inc.

Dr. Tomeo Elected Chairman of Family Practice

Jay Tomeo, MD, of the Center for Primary Care’s Central Office was recently
elected chairman of the Family Practice Department at Doctors Hospital,
formerly known as Columbia-Augusta Medical Center.

In this new role, Dr. Tomeo will serve on the hospital’s executive committee
and chair quarterly meetings of the Family Practice Department, comprised
of approximately 25 family physicians on staff at Doctors Hospital. As the link
between the hospital’s leadership and the Family Practice Department, he will facilitate communication between the two and troubleshoot any problems that might arise.

“I see this as a challenge and an opportunity to grow and become better,” Dr. Tomeo
says. “It is nice to have been elected and to have the confidence of the other
family physicians on staff. I look forward to working with both the physicians and the executive committee.”

Dr. Fischer Elected to IOM

Paul Fischer, MD, of the CPC Evans office has been elected to the Institute of Medicine
(IOM), a non-profit, private group that reports to the government on health issues. As one
of 55 newly elected members, Dr. Fischer is now linked to a national network of prestigious researchers.

The IOM is a unique organization in that it analyzes health issues in an independent and
unbiased way. Congress and federal agencies often call upon the IOM, which is comprised of
588 members, to research and report on health topics or to suggest standards based on existing
research. The group investigates topics ranging from basic health matters to controversial and
major public health issues.

Dr. Fischer considers his election to the IOM a unique opportunity for a family doctor like
himself. “Policy implications from research is something I understand, and I hope to continue
pursuing this area of interest with the IOM.”

The Center for Primary Care offices are staffed by
11 board-certified family physicians who provide
care at three convenient locations:

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