Dr. Woodbury and Dr. Chapman take a look this month
at causes of itching and also an important advocacy topic: ensuring a team-based approach in the Veterans Administration

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Health Enewsletter July 2016

George R. Woodbury Jr. M.D.    Cathy M. Chapman M.D.
Rheumatology and Dermatology Associates PC
8143 Walnut Grove Rd. Cordova TN 38018

"Doc, I'm itching. Can you help me?"

Dr. Chapman's background equips her to tackle arthritis....

Advocacy Corner: Protecting Our Nation's Veterans: AP44

Dr. George Woodbury looks at what we can do about itching:
  Itching, or “pruritus,” is one of the most common problems that bring patients to dermatologists. Our job is to try to sort out whether the itching is coming from the skin itself, or from internal causes, such as low iron (anemia), hormone changes (such as low or hight thyroid), or even internal cancers in the body. Blood tests are often very helpful in sorting out these internal causes. Sometimes the culprit is even a reaction to a medication, but we really discourage patients from stopping drugs until we consult with the other doctor that started the drug.
  Skin conditions that contribute to or cause itching can include psoriasis, eczema (atopic dermatitis), or even a contact reaction to an ingredient in laundry detergent. Sometimes the culprit is a fungus that came from the gymn or even from a cat or dog. Tests that can help include a skin biopsy, fungal cultures, or allergy patch testing. At Rheumatology and Dermatology, we provide an in-house fungal culture laboratory to help people with fungal infections. We also offer allergy patch testing, to help to detect the most culprit chemicals, which include nickel, fragrances, and preservatives that can be in soap, shampoos, and detergents. The moral of the story is: “don’t itch in silence.”
George Woodbury Jr. M.D. (07/17/2016)

This patient’s itching came from psoriasis, which is a genetic condition that affects about 3% of Americans.
Psoriasis can be diagnosed by inspection by the doctor, or sometimes off of a skin biopsy. Psoriasis can often be managed with a topical steroid cream or ointment, a vitamin D ointment, light therapy (phototherapy), skin steroid injections into the lesions, an oral drug called methotrexate, or injections with one of several newer biological medications, including Enbrel®, Stelara®, Humira®, and Cosentyx®.
George Woodbury Jr. M.D. (07/17/2016)

Rheumatology and Dermatology Medical Assistant Shirley works in the lab to help Dr. Woodbury to test a patient’s skin lesions. We maintain a high complexity lab in-house at R&D to help both to speed up both testing turn-around time and to ensure our own  own quality control on test results. We also use several off-site labs for bloodwork and biopsies.
Dr. Chapman actually uses hundred of lab tests to help in diagnosis and management of arthritis.

Dr. Chapman did her rheumatology fellowship at the University of Rochester Strong Memorial Hospital, in Rochester, New York. She manages over 300 types of arthritis, with laboratory testing helping to make a correct diagnosis and to monitor medication. Arthritis treatment has advanced markedly in the last 15 years, now including both new oral medications and injectable medicines and even intravenous medicines.

Drs. Woodbury and Chapman did a joint presentation at the Memphis Dermatologic Society meeting on March 17th, 2016: “Clinical Features of Diagnosis and Management of Gout, Rheumatoid Nodules, Ganglions, Bursitis, and Subacute Lupus.” Here they greet Dr. Courtney Woodmansee, President of the Memphis Dermatologic Society, at the meeting, at 1661 International Drive, Memphis TN.
Advocacy corner: protecting our nation’s veterans:

The Veterans Administration is in the process of receiving final comments from the public on a significant new regulation, called “AP44- Proposed Rule - Advanced Practice Registered Nurses.
AP-44 defines “Advanced Practice Registered Nurses” as 1.) Certified Nurse Practitioners; 2.) Certified Registered Nurse Anesthetists(CRNAs); 3.)Clinical Nurse Specialists, and 4.) Certified Nurse Midwives. AP-44 would remove or supplant state laws that require APRNs to operate under the supervision of a physician. APRNs would be allowed to operate in their capacity of VA employment (in the nation’s 152 Veterans Administration Medical Centers or the 1400 Veterans Outpatient Centers) under a new VA rule by which they would no longer operate under the supervision of a physician or medical doctor in preparing prescriptions, managing airway access, in the diagnosis, management, or treatment of acute and chronic illnesses, and in ordering, performing, supervising, or interpreting laboratory and imaging studies.
Even if a state (such as Tennessee) requires that advanced practice registered nurses be under the supervision of a physician in making a diagnosis or ordering prescriptions, AP-44 would supplant state laws for Veterans Administration facilities, except for prescription of controlled substances (narcotics).
For safety reasons, this proposed change in Veterans Administration rules requiring physician oversight is most concerning. Nurse practitioners should continue to operate under the supervision of physicians, for the safety of veterans. Physicians (medical doctors or osteopathic doctors—MDs or ODs) in Tennessee have spent a minimum of 6 years after college in training before being granted by our state licensure the ability to prescribe drugs, four years of which are in direct patient care. The depth of training and experience of a physician allows for earlier detection of and management of clinical problems. It’s a safety issue.
Comments must be received by VA on or before July 25, 2016. Comments may be submitted either on-line, through, or in writing, to Director, Regulations Management (02REG), Department of Veterans Affairs, 810 Vermont Avenue NW., Room 1068, Washington, DC 20420; by fax to (202) 273-9026. Comments should indicate that they are submitted in response to “RIN 2900-AP44-Advanced Practice Registered Nurses.”

 Comments on AP-44 must be received on-line here
by 07/25/2016. Go to: AP44- Proposed Rule - Advanced Practice Registered Nurses.
Then click on the blue rectangle to the upper right of your screen: Comment Now!
If you prefer mailed comments: Director, Regulations Management (02REG), Department of Veterans Affairs, 810 Vermont Avenue NW., Room 1068, Washington, DC 20420; by fax to (202) 273-9026, re ““RIN 2900-AP44-Advanced Practice Registered Nurses.”

BUT IF YOU WANT TO COMMENT, TIME IS OF THE ESSENCE. The deadline for commentary is Friday 07/25/2016.
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George Woodbury Jr. M.D. (07/19/2016)

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