So, I have to have a breast biopsy. Now what?

by Dr. Gage Hicks


As seen in Odessa American Medical Matters:

Maybe an abnormality was detected on your screening mammogram or you were feeling a lump, imaging of your breast most likely showed an abnormality that needs further evaluation with biopsy. This means that additional evaluation of the abnormality is needed in order to determine if cancer cells are present. A biopsy obtains pieces of tissue from the area of concern so that a pathologist can look at it under the microscope and determine if it is (or isn’t) a breast cancer.

A biopsy can be performed in several different ways, and the type of biopsy recommended is often determined by the appearance of the abnormality in question. Most breast biopsies can be performed without surgery, through a tiny incision in the skin (percutaneous biopsy). A small amount of numbing medicine is injected into the skin and below the skin (local anesthesia) so that you don’t feel pain during the biopsy. Some breast biopsies are best performed surgically, and more advanced anesthesia is required in those cases.

The types of biopsies that are performed without surgery (through tiny incisions in the skin and with local anesthesia) are ultrasound-guided biopsies and stereotactic biopsies:

  • An ultrasound-guided biopsy uses ultrasound imaging to visualize the needle as it passes through the area of concern. The doctor is able to watch what is going on inside the breast as the needle takes the small pieces of tissue. In my opinion, these are the easiest biopsies to perform – both for the patient and for the doctor. Most masses can be biopsied in this way.
  • A stereotactic biopsy uses mammogram pictures to guide the biopsy needle to the correct location in the breast. These biopsies tend to be a little bit more difficult for the patient … not because of pain (the numbing medicine takes care of that), but because the breast has to be compressed (like in a mammogram) and because the patient has to be very still during the procedure (just like you have to be still during a mammogram). Stereotactic biopsies are most often used to biopsy calcifications in the breast (these cannot be seen with ultrasound). However, occasionally masses in the breast are not seen with ultrasound and can be biopsied in this manner as well.

Just because a biopsy was recommended, it doesn’t necessarily mean that you have cancer. But the radiologist is concerned enough that a biopsy was recommended for further evaluation. There are several criteria that the radiologist takes into account when recommending biopsy of an abnormality in the breast. Certain abnormalities are highly suggestive for cancer based on their appearance, and a biopsy is needed to determine what type of breast cancer we are dealing with so that the appropriate treatment plan can be put in place prior to surgery. However, this is actually not the most common scenario. More often, a biopsy is recommended for an abnormality that is suspicious for cancer but not necessarily highly suggestive for cancer. This is because there is a lot of overlap between the appearance of abnormalities that are not cancer (called benign) and abnormalities that turn out to be cancer.



Mammography: Frequently Asked Questions

by Dr. Mason “Gage” Hicks, Radiologist
As seen in the Odessa American Medical Matters at:

Why do women need to have yearly screening mammograms?

It reduces a woman’s risk of dying from breast cancer. Studies have shown that mammography screening cuts the risk of dying from breast cancer nearly in half.

When should a woman start having mammograms?

There are conflicting recommendations from different societies. We follow the American College of Radiology and Society of Breast Imaging guidelines which recommend yearly screening mammograms beginning at age 40 for women at average risk for breast cancer (most women). Studies have shown that this is how we will save the most lives.

Why yearly and not every other year?

It’s simple … yearly screening results in more lives saved than screening every other year.

Should a woman ever start having screening mammograms before age 40?

There are certain situations where a woman should start mammography screening before age 40 … women who are considered high risk. If you are unsure, then talk to your doctor. The American College of Radiology and Society of Breast Imaging never recommend screening mammograms before age 25.

What are some reasons a woman would be considered high risk for breast cancer?

Women with certain genetic mutations (BRCA1 or BRCA2), family history, women who received radiation to the chest at a young age (usually for treatment of Hodgkin’s disease) and women with a personal history of breast or ovarian cancer.

What is 3D mammography?

3D mammography, or breast tomosynthesis, is a breakthrough technology in breast imaging that allows a clearer, more accurate view of the breast (as opposed to the traditional 2D mammogram). It allows the breast radiologist to see through the different layers of tissue in the breast. This improves breast cancer detection.

What are the benefits of 3D mammography?

Earlier detection of small breast cancers

Clearer images of the breast tissue

Fewer additional tests or unnecessary biopsies

Greater accuracy

Greater likelihood of detecting multiple cancers

What does it mean if my doctor says I have dense breasts?

It has to do with the way you are made. It doesn’t mean that anything is wrong with you, though it can increase your breast cancer risk. Every breast has different amounts of fatty tissue versus glandular and connective tissue. When you look at a mammogram, the black/darker parts of the breast are the fatty tissues and the white/lighter parts of the breast are the glandular and connective tissues. When you have dense breasts, it means that there is more of the white/lighter tissues relative to the black/darker tissues.

What is the significance of having dense breasts when it comes to mammograms?

Most cancers also look white on the mammogram. So when you have dense breasts (more of the white/lighter tissues), it sometimes makes it harder for the radiologist to detect cancers. The dense breast tissue can sometimes obscure cancers (particularly smaller cancers) and make them difficult, or even impossible, to see.

What should I do if I have dense breasts?

It’s something to talk to your doctor about. DON’T stop having mammograms. Certain types of cancers, particularly those that present as tiny calcifications in the breast, can easily be detected on mammograms … even in dense breasts. Your doctor may recommend additional screening depending on your overall breast cancer risk. Additional screening with breast MRI can be a valuable tool in certain patients.

Do I need a “screening mammogram” or a “diagnostic mammogram”? What’s the difference?

Generally speaking, if you are not having any breast problems and it’s time for your yearly mammogram, a screening mammogram is recommended. Diagnostic mammograms are generally performed on patients that either had an abnormality detected on their screening mammogram, or are having some kind of breast problem (lump, pain, discharge, etc.)

If the patient had a potential abnormality on a screening mammogram, a diagnostic mammogram is performed for further evaluation. This usually involves specialized mammogram views and possible ultrasound of the area to determine the nature of the abnormality and determine if a biopsy is needed.

The diagnostic mammogram is not better pictures or better image quality than the screening mammogram. It is just performed in a way that allows the problem or potential abnormality to be fully evaluated with the necessary imaging while the patient is in the department. Personally, I like to talk to every patient that has a diagnostic mammogram so that they leave our department with peace of mind and understanding of what my recommendations are.

October is Breast Cancer Awareness Month. Please make your mammogram a priority in your life and encourage your loved ones to do the same. Early detection saves lives.


Tips for a Heart-Healthy Lifestyle

Tips for a Heart-Healthy Lifestyle
by Fernando Boccalandro

As seen in the Odessa American Medical Matters:

Taking care of your heart is so important. Here are tips that can help you live a more heart-healthy lifestyle.

  • Check your blood pressure at least once every six months to make sure it is within normal limits and that you do not have hypertension.
  • Know your cholesterol levels. If they are normal, then you should check them at least every three to five years. If not in normal range, check them yearly.
  • Exercise at least 30 minutes daily five days a week. Include moderate exercise such as walking, biking, aerobics, yoga, etc.
  • One can of regular soda has 126 calories of added sugars. Instead of soda, drink water, coffee, unsweetened tea or other calorie-free drinks. When you do drink beverages with sugar, go for milk or all-fruit juices that count toward the daily dairy or fruit intake.
  • It is important for your cardiovascular health to have a good quality of sleep for a minimum of seven to eight hours daily.
  • Be a hero for your heart and stop smoking today. MCH has a FREE Smoking Independence Class every Thursday at 6 p.m. in the MCH Cardiopulmonary Education Room.
  • One in three Americans has prediabetes … and only one in ten knows it. So know your risk for diabetes and get screened for it if you have not done so recently.
  • Eating a healthy diet, exercising regularly and losing weight can prevent diabetes. Diabetes largely is a preventable disease in the majority of patients.
  • Avoid salty processed food such as salty snacks, chips, packaged food and canned soup. Instead opt for fresh, frozen or canned foods without any added sodium, sauces or seasonings.
  • By you becoming your own chef and seasoning your own food at home, you can control how much sodium is used. Try out other herbs and spices to get the kick you want instead of shaking on more salt.
  • If you drink alcohol, do so with moderation. That means up to one drink a day for a woman and two drinks a day for men … as defined by the U.S. Dietary Guidelines for Americans.
  • The majority of the patients that have experienced a heart attack, have had a stent placed in the heart or have had a prior bypass should be taking one low-dose aspirin and a cholesterol medication for the duration of their lifetime. Make sure you discuss this with your doctor.
  • Stress management is very important for a healthy heart. The best ingredients to help manage daily stress levels are following a good diet, having a healthy sleeping pattern and continuing a daily exercise program.
  • Avoid food products with trans fats, which is known to increase your risk of developing heart disease.
  • Good dental hygiene has been associated with a healthy heart as well. Maintain good dental hygiene by brushing your teeth, flossing and visiting your dentist regularly.


You can do this. Living a heart healthy lifestyle will make you feel better and you can enjoy the things that are important to you. Take care of yourself … it’s important!

Why Gynecological exams are necessary over the age of 50

Why Gynecological exams are necessary over the age of 50
by Dr. Avelino Garcia

As seen in the Odessa American “Medical Matters”:

Many women feel that there is no longer a need for a gynecologist after childbearing. For women over the age of 50, yearly exams are encouraged and very important. Even if a yearly pap smears are not needed, pelvic and breast exams can give your doctor information to keep you healthy.

Getting a yearly physical exam is so much more than just a pelvic exam and breast exam. A general physical exam begins with a detailed health history, including family history and any health changes that may have occurred. An examination of vital signs, including blood pressure, pulse and oxygen saturation, is also included with a yearly examination. Measurements of your height and weight combine to create your Body Mass Index, or BMI. These numbers can tell a doctor a lot of helpful information regarding your current health.

A pelvic exam can evaluate the condition of your vaginal tissues, cervix, uterus, ovaries and rectum. Even if you no longer have a uterus, a yearly pelvic exam is still encouraged to evaluate vaginal anatomy and pelvic health. If you have a cervix, a pap smear with screening for Human Papilloma Virus (HPV) is collected. A positive HPV test could mean that you are a carrier of the HPV virus and therefore at increased risk of cervical cancer. If your pap smear shows abnormal cells in conjunction with the HPV virus, further testing and treatment may be required. If both pap smear and HPV screenings are negative, it is safe to have a pap smear collected every two to three years. Just as a reminder, even if a pap smear is not required, a yearly pelvic exam still needs to be performed.

Even though it is uncomfortable, a rectal exam is encouraged to check for masses or lesions. A check of your stool for blood can also be done at the same time. Baseline screening colonoscopies are encouraged after the age of 50. However, if there is blood in the stool, a visit to the gastroenterologist is imperative for evaluation of your colon health. Screening colonoscopies are recommended earlier than the age of 50 if there is a history of cancer or colon problems in the family.

A yearly breast examination is performed to evaluate breast health. This examination includes the doctor looking at your breasts and nipples for leakage, lesions, redness, dimpling or other signs that there could be a problem present. The provider then does a manual examination, feeling the breast tissues and the under arms for lumps or masses. A yearly mammogram is recommended after the age of 40, unless a close family history of breast cancer is present. This includes mother and/or sisters with breast cancer.  If there is a close family history, yearly screenings may begin earlier, based on the age of diagnosis.

Bone Density, or DEXA scans, help the provider evaluate your bone health. These tests are generally recommended for those aged 65 or over. These tests are encouraged every two years. It is important to keep bones healthy with Vitamin D and Calcium supplementation as well as regular weight bearing exercise.

Screening blood work can be completed by your primary care provider or your gynecologist. Yearly testing to check iron levels in the blood, cholesterol levels, thyroid levels, and blood sugar levels are some recommended testing. Further blood work can be completed to check for hormone imbalances. The provider may also check your Vitamin D and Calcium levels to help evaluate bone health.

Last, but certainly not least, it is important to discuss required immunizations with your provider. A yearly flu shot is encouraged, especially over the age of 50, unless there is a contraindication. A TDaP (Tetanus/Diptheria/Pertussis) vaccine is required every 10 years. After the age of 65, a one-time pneumonia vaccine is recommended. The CDC recommends that anyone over the age of 60 receive the Shingles vaccine.

It is time to put your health first and get your yearly examination.

Colonoscopy Screening also Serves as Prevention

Colonoscopy Screening also Serves as Prevention
by Ramalinga Kedika

As seen in Odessa American Medical Matters:

“An ounce of prevention is worth a pound of cure” – Benjamin Franklin.

This is true across the medical field, but especially pertinent when it comes to colon cancer screening. It is a lot easier to prevent colon cancer than to treat it once it occurs.

Colonoscopy is a very powerful screening technique because you can not only diagnose polyps that are precursors to colon cancer, but also remove them during the procedure. It is this removal of polyps which can eliminate colon cancer risk. Approximately 25 to 30 percent of 50 year old patients will have polyps.

The major hesitation people have about colonoscopies is fear of pain during the procedure. Many gastroenterologists are performing this procedure using anesthesia (deep sedation) that allows the patient to not have any awareness during the procedure. Often patients wake up from sedation and are surprised that the procedure is already completed!

Another hesitation I often hear is “Ugh, I have to drink all that stuff.” It’s true that drinking the prep is the hardest part of the procedure, but the laxative preps have improved over the years. A common laxative used in the past was about four liters of a liquid. While this prep is still used, there are newer preps which are half the volume (or even smaller) and easier to consume. The preps are often split-dosed, which means the patient drinks half the prep the night before the procedure and the other half early morning of the procedure. This fact can be reassuring to patients worried about having to drink a lot of liquid in one session.

The procedure is also very safe. The most common complication is bleeding which occurs in up to 0.6 percent of procedures. Most of the time the bleeding will stop on its own. Perforation, which is the creation of a hole or tear in the colon accidentally, is a serious complication but occurs very rarely in about 0.1% of procedures.

Medical testing can be expensive and this can also deter people from having colonoscopies. However, many insurance carriers cover screening colonoscopies because these are considered preventive tests. Colonoscopies may be a part of your insurance plan, so take advantage of this!



MEDICAL MATTERS: Shoulder pain can be early sign of arthritis or other injury

MEDICAL MATTERS: Shoulder pain can be early sign of arthritis or other injury

As seen in the Odessa American “Medical Matters”:


MEDICAL MATTERS: Shoulder pain can be early sign of arthritis or other injury
by Dr. James Ingram

Dr. James Ingram is a Board Certified Orthopedic Surgeon and specializes in Sports Medicine.

“I saw my Doctor about my shoulder pain. He took an X-ray and told me ‘nothing is wrong’.”

A more appropriate response would have been, “there’s nothing broken”. Most sources of shoulder pain are not obvious on an X-ray. The shoulder is a remarkable joint with more movement than any other joint in our body. Thus, diagnosis of the specific cause of pain in the shoulder can be difficult.

The earliest signs of arthritis in the shoulder typically appear in the joint connecting the collar bone to the shoulder blade (acromio-clavicular or AC joint). In the absence of injury, this joint can show signs of arthritis on x-ray as early as age twenty-five. Pain associated with this joint is increased with lying on the side, using the arm at shoulder height or higher, pulling things toward you or away from your body. The pain does not make motion impossible but the use of the shoulder increases the pain.

Rotator cuff tears may be partial or complete. Risk factors for rotator cuff problems include male gender, high blood pressure and elevated cholesterol. Trauma is also a major cause, fall on shoulder or outstretched hand, shoulder dislocation, lifting or pulling heavy objects. Partial tears are more painful, full thickness tears result in loss of motion and weakness. Many partial tears do not require surgery. Full thickness tears will not heal without surgery. But with therapy, the patient may regain an acceptable motion and use, depending on the patient’s needs.

A cartilage ring surrounds the socket of the shoulder. This cartilage ring, the rotator cuff and the joint capsule provide a stable joint with an extensive range of motion. Tears of this cartilage ring cause pain and mechanical symptoms. They usually result from shoulder dislocation or an unexpected pulling injury to the arm. The bicipital tendon, one of two tendons to the bicep muscle is attached to this cartilage ring. Tears of the bicipital tendon are common. Usually the result of lifting heavy objects. Tears of this tendon usually do not require surgery. The patient will lose ten to fifteen percent of strength bending the elbow. A cosmetic deformity of the bicep contour will occur, but does not contribute to significant weakness.

The shoulder joint contains cartilage and is prone to developing arthritis. The onset is gradual. Primary complaint is pain. As the arthritis becomes more severe the patient will eventually lose motion. The pain is described as constant, increased with use and many times associated with painful catching and grinding.

Another frequent source of “shoulder pain” is actually referred from the neck. The patient’s neck may not hurt! The pain is typically in the back of the shoulder blade. The majority of time, the pain will go below the elbow sometimes causing numbness and tingling in the fingers. Pain that is solely due to a shoulder problem may go to the elbow but not below. Unfortunately, having an injured shoulder does not mean you don’t also have a neck problem, and vice versa.

The key to minimizing shoulder pain lies in maintaining muscle fitness not only the rotator cuff, but the muscles that stabilize your shoulder blade. The shoulder allows us an incredible ability to perform complex tasks. Shoulder pain consequently can be a source of severe dysfunction.



MEDICAL MATTERS: Good Nutrition is Vital for Pregnancy

MEDICAL MATTERS: Good Nutrition is Vital for Pregnancy
As seen in the Odessa American “Medical Matters”:

by Dr. Avelino Garcia

Good nutrition is vital for a healthy pregnancy. Between fatigue and pregnancy cravings, it can seem difficult to keep healthy eating habits. Planning healthy meals and staying physically active can help.

Eating five or six small meals daily, rather than three large meals, can help with nausea and can also help pregnant women get extra vitamins and minerals needed for growing babies. Each day, eat foods from the major food groups, keeping fats and sugars in moderation. Fresh fruits and vegetables, whole grains and lean proteins are encouraged. Be sure that red meats are fully cooked, not rare, as this can cause illness in a pregnant woman. Fish and seafood are good sources of protein, but stay away from seafood with high mercury content such as shark, swordfish, king mackerel or tilefish. Limit white (albacore) tuna to 6 ounces weekly.

Hydration is also a key part of proper nutrition. Pregnant women are encouraged to drink at least two liters of water daily. Symptoms of dehydration in pregnancy include thirst, headache and uterine cramping. Sugary and caffeinated drinks increase risk for dehydration, so they are to be avoided.

Staying physically active is one of the healthiest things an expectant mom can do for her unborn baby. Thirty minutes of low intensity exercise, like walking, is encouraged.

Unless an expectant mother has a high-risk pregnancy, exercise can help regulate blood sugar levels, keep blood pressure in the normal range, and minimize abnormal weight gain.

The United States Department of Agriculture has made meal planning easier by creating The website assists everyone, including pregnant women, figure out how to make healthy choices with each meal. According to the American College of Obstetricians and Gynecologists (ACOG) Frequently Asked Questions (FAQ) on Nutrition During Pregnancy, the MyPlate website gives “personalized nutrition and physical activity plans by using the ‘Super Tracker’ program. This program is based on five food groups and shows the exact amounts needed each day from each group during each trimester of pregnancy.”


MEDICAL MATTERS: It’s just allergies … or is it?

MEDICAL MATTERS: It’s just allergies … or is it?
As seen in the Odessa American “Medical Matters”:

by Dr. Kevin Benson

Allergies seem to be a big part of our lives here in West Texas. It seems that no matter what the season, or the symptoms, people tend to think it’s their allergies. Or is it? Does it matter?

Environmental allergies are the body’s excessive response to things we need not respond too. For example, pollen is not really a threat to me, but my body responds to it in unhelpful ways. My nose fills with mucous, my eyes get red and itchy, that familiar cough makes its annual return. How do I know it’s my allergies versus a cold I may have been exposed to?

History: Seasonal allergies are just that, they occur at certain seasons. Everyone with allergies is a bit different, but most of us can predict the seasons where we will have trouble. Pollen allergies tend to be in the springtime, fall allergies tend to be more mold and mildew sensitivities, winter allergies are often caused by dust or dust mites blowing around as we turn on our heat. So with experience we know when it’s more likely to be allergies than a viral illness. And also why it’s difficult to know in a baby or young child, since they haven’t had as many seasons of experience to know how they respond to those environments.

Duration: Allergies can linger for weeks, sometimes months. It is very unusual for a cold to last more than a week or two. Sometimes we can be fooled though, as we or our children are recovering from one illness and fall into the trap of another illness; what feels like one illness can be a few separate ones. However, it is common to have one viral infection after another, especially in the wintertime.

Fevers: Allergies do not cause fevers. Fever is the body’s natural response to infection, and allergies are not an infection. However some people will develop secondary infections due to allergies; for instance the congestion caused by seasonal allergies can trigger ear infections or sinus infections. That is why it is always a good idea to treat those allergic symptoms as soon as possible, to prevent them from becoming something more serious.

Remember to use your judgment. If you’re not sure if you or your child has a cold or allergies and the symptoms are getting worse, changing or not improving, there’s no harm in consulting with your medical practitioner. When in doubt, check it out!


MEDICAL MATTERS: Preserving your hips and knees

As seen in the Odessa American “Medical Matters”:

by Dr. James Ingram

Time takes a toll on our bodies and our weight bearing joints and cartilage are no exception. Watching a youngster spring up from a sitting position at the speed of a slingshot reminds us all of the creaks and squeaks of our aging joints. However, you can take control and slow Father Time with a few key non-operative interventions.

Decreasing weight through exercise has a dramatic effect reducing wear and tear on hips and knees. Just to name a few, it improves circulation and cardiovascular health; helps the management of blood sugar; preserves and maintains joint cartilage. Low impact exercises are key. Stick with cycling, swimming or elliptical and stair stepping machines. The benefit of low impact exercise in addition to weight loss, is a reduction of shear force on weight bearing joints, minimizing cartilage loss and improving flexibility.

Supplements have a huge following but no supplement has FDA approval. Of all the supplements, the only one shown to minimize cartilage loss was Glucosamine. When trying supplements, I suggest avoiding ones with multiple ingredient, ie. Glucosamine, Chondroitin, MSM. If you have an untoward reaction with a multiple ingredient supplement, it’s virtually impossible to determine which ingredient did not agree with you. I recommend starting with Glucosamine because it’s the only one proven to be effective.

Support braces that unload the joint showing signs of wear is another intervention worth consideration. Two options are available; off-loader braces, or lateral wedge orthotics. Off-loader braces are bulky where lateral wedge orthopedics are more discretely worn. Although purely mechanical, both unload the burden to tired joints.

Anti-inflammatory, biologicals and injectable are pharmaceutical approaches to joint health. Non-steroidal anti-inflammatory drugs (NSAIDs) were the corner stone for osteoarthritis and rheumatoid arthritis until biologicals (Embrel, Humira, etc.) were developed. Over-the-counter or prescribed NSAIDs are still extremely effective but create cardiovascular risks, elevate blood pressure, can cause stomach ulcers, and even kidney failure. Injectable intervention falls into two categories; cortisone and injectable viscosupplementation. Cortisone injections have been around for decades and provide rapid but short term relief. They also exhibit side effects therefore should be used in moderation. In my practice, no more than once a quarter. Injectable viscosupplementation (“rooster shots”) are injections of a protein normally found in our joints and make a cushion to replace cartilage while improving the viscosity of joint fluid. These injections are performed in an office environment on a weekly basis for a period of 3-5 weeks.

Utilizing these recommendations will hopefully make your interaction with your orthopedic surgeon a social visit rather than professional.




Baby Teeth and Babies’ Teeth

 Baby Teeth and Babies’ Teeth

by Dr. Robert Stanaland

Baby teeth are so important! This cannot be stressed enough. Yes, they will be “lost” eventually, but they play a vital role in a child’s jaw development in addition to aiding in proper nutrition and socially.  Here are the answers to several questions we hear a lot.

When should I start brushing my baby’s teeth?

As soon as you are aware that any have erupted. Even before teeth come, you can be wiping down your baby’s mouth with a damp cloth after every feeding.

Why are baby teeth so important if they just fall out?

Obviously, children use their teeth to chew food, just like the adults. The baby teeth also act as place holders for the adult teeth, and if they are lost too soon, the adult teeth will have huge problems coming in correctly. Teeth that get decay can cause severe pain and infections. Children miss a lot of school in order to deal with dental problems, and the cost of treating these dental problems far outweighs the cost of preventing them. 

When should I take my child to the dentist?

It is recommended that a child be seen by age one (1) or within six (6) months of their first tooth erupting, but the child should have been in a dental office long before then. Expecting mothers should be seeing their dentist regularly before the child is here, so education begins then.

What else can I do for my kid’s teeth?

Take care of YOUR teeth! See a dentist regularly. If you have established good oral hygiene and diet habits, your children will too. “Bad teeth” are NOT inherited, but bad habits can be passed down to your children.

Dr. Robert Stanaland is a dentist at the Family Health Dental Clinic at
840 West Clements in Odessa, TX. (432) 332-8870