Friday, May 3, 2013

Doctors to take questions on leg pain, varicose veins

SALT LAKE CITY — Tired and achy legs may not be the result of a busy lifestyle or just getting older, but could be a sign of something more serious and treatable.
Venous insufficiency also doesn't just happen to women or the elderly. It is no respecter of age or gender and can cause intense leg pain and discomfort, as well as unsightly varicose veins, said Dr. Shane Lewis, a surgeon at Intermountain Healthcare's Alta View Hospital.
Treatment for such problems, which now involves less invasive measures, is becoming more common as "people are starting to learn they don't have to live with these ugly legs that also cause a lot of discomfort," Lewis said.
Insurance companies also tend to cover treatment more often than not because maintaining good blood flow in the legs is important to overall health.
If certain vein issues go untreated, people can end up with ulcers and non-healing leg wounds, which can become infected or cause other problems, Lewis said.
"It's a medical problem if your legs are tired and achy and you can't enjoy the things you normally enjoy doing," he said.
Lewis and Dr. Joseph Fyans, a specialist in physical medicine, will be featured on Saturday's Deseret News/Intermountain Healthcare Hotline. They will take questions about leg pain and the symptoms and treatment for varicose veins. From 10 a.m. until noon, those interested are welcome to call 800-925-8177 or post questions on the Deseret News Facebook page,
The most common procedure to remove varicose veins, Lewis said, isn't as "barbaric" as vein stripping can be, but involves placement of a tiny catheter that heats the vein to shut it down.
The results are identical to that of vein stripping, relieving the vein of pressure, but provide fewer side effects and allow the patient to be up and running in less time. Blood flow is left to a deeper venous system in the legs.
Spider veins, Lewis said, can also be treated, but are more of a superficial or cosmetic issue.
A physical examination and simple ultrasound can identify where blood is pooling and which veins are not working correctly. Symptoms of venous insufficiency, he said, include tired, achy legs, some swelling and sometimes a persistent itch in a particular spot.
In his practice, Lewis said he has treated women and men of many ages, but also young patients who are athletes and are in good shape.
Varicose veins, he said, are partly caused by poor genes, but can also be brought on by aging and a sedentary lifestyle. Pregnancy and obesity are also contributors, as weight gain and improper weight can restrict blood flow throughout the body.
"Over time, the veins widen and branch out, not returning blood to the heart," Lewis said, adding that he recommends compression stockings to any age group as a prevention measure.
The socks, often worn by professional athletes, can help with symptoms and sometimes prevent problems, but can't treat the disease once it is present.
Exercise and staying active is likely the best medicine for the prevention of leg pain. Lewis said individuals who sit at a desk all day for work might benefit from standing and walking as much as possible, but also pumping the legs and stretching to keep blood flowing properly.
"People think of varicose veins and they think of their grandmothers," he said. "That's not necessarily who suffers from it. It's women in their 30s and 40s, those who've had multiple pregnancies, and anyone with the genes or certain occupations can develop varicose veins. Fortunately, we can get most anyone back to activity."
Friday, April 27, 2012

Mother's Day Gift

Don't miss out of this great Mother's Day gift:

Be sure to call for your appointment.
Thursday, March 22, 2012

New Colorectal Cancer Screening Guidelines Issued by ACP

Laurie Barclay, MD
March 5, 2012 — A new American College of Physicians (ACP) guidance statement recommends individualized assessment of risk for colorectal cancer (CRC) in all adults. The new recommendations and an accompanying patient summary appear in the March 6 issue of the Annals of Internal Medicine.

"The [ACP] encourages adults to get screened for [CRC] starting at the age of 50," ACP President Virginia L. Hood, MBBS, MPH, FACP, said in a news release. "Only about 60 percent of American adults aged 50 and older get screened, even though the effectiveness of [CRC] screening in reducing deaths is supported by the available evidence."
In the United States, CRC is the second leading cause of cancer-related deaths for both men and women. The new ACP guidelines aim to educate physicians and patients regarding the benefits and harms of CRC screening, based on a review of current guidelines from other professional organizations.

A search of the National Guideline Clearinghouse revealed 4 guidelines meeting selection criteria: a joint guideline developed by the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology, and individual guidelines from the Institute for Clinical Systems Improvement, the US Preventive Services Task Force, and the American College of Radiology.
Specific ACP recommendations include the following:
1. Clinicians should perform individualized CRC risk evaluation in all adults. Risk factors for CRC incidence and mortality include older age; black race; personal history of polyps, inflammatory bowel disease, or CRC; and family history of CRC.

2. Clinicians should screen for CRC in adults at average risk beginning at 50 years of age, and in adults at high risk beginning at 40 years of age or at 10 years younger than the age at which the youngest affected relative was diagnosed with CRC. In these populations, the potential benefits of reduced mortality from earlier detection of CRC outweigh the potential harms of screening.

3. Patients at average risk may undergo CRC screening with a stool-based test, flexible sigmoidoscopy, or optical colonoscopy. Patients at high risk should undergo screening with optical colonoscopy. The benefits, harms, and availability of the specific screening test, as well as patient preferences, should affect choice of screening test. For adults older than 50 years who are at average risk, the recommended screening interval is 10 years for colonoscopy; 5 years for flexible sigmoidoscopy, virtual colonoscopy, and double contrast barium enema; and annually for fecal occult blood test.

4. Clinicians should stop CRC screening in adults older than 75 years or who have a life expectancy of less than 10 years because the potential harms of screening outweigh the potential benefits. Risks of colonoscopy include bleeding, intestinal perforation, and adverse reactions related to preparation for the procedure.

"We encourage patients to engage in shared decision making with their physician when selecting a [CRC] screening test so that they understand the benefits and harms," said Dr. Hood. "The success of any screening program, especially [CRC] screening, is dependent on the appropriate testing and follow-up of patients with abnormal screening results as well as following up with patients for repeat testing at designated intervals."

The ACP operating budget was the sole source of support for development of this guidance statement. According to the ACP, any financial and nonfinancial conflicts of interest of the group members were declared, discussed, and resolved. Disclosures can be viewed on the journal's Web site.
Ann Intern Med. 2012;156:378-386.

Offering Patients a New Kind of Surgical Experience

SILS™ Cholecystectomy
With a single incision in the belly button, the SILS™ cholecystectomy means that you can breathe a sigh of relief knowing that there is potential for fewer incisions, and no visible scarring. The SILS™ procedure is a effective minimally invasive procedure that can be used to treat conditions of the gallbladder.

Fewer/Smaller Incisions
The single incision in the belly button avoids the large incision made in the lower abdomen involved in typical open cholecystectomy (gallbladder removal) and the multiple small incisions required for standard laparoscopic surgery.

Potential for No Visible Scar
The SILS™ Procedure requires only a single incision that is about 2 cm. By hiding this small incision within the belly button, the SILS™ Procedure may eliminate the visible scars typically associated with gallbladder related surgery.

How the SILS™ Cholecystectomy Works
The latest advancement in laparoscopic surgery, a cholecystectomy performed using the SILS™ Port allows for the removal of the gallbladder through a small incision made in the belly button which measures 20 mm, or slightly smaller than the diameter of a nickel. To perform this procedure, the surgeon will insert into the belly button a SILS™ Port, a soft and flexible instrument equipped with three distinct openings which allows for the use of three surgical devices at the same time. When the surgery is complete, the SILS™ Port is removed from the belly button, leaving one incision which may not be visible upon healing. Recovery from the SILS™ Cholecystectomy may be similar to the 2 week recovery time associated with laparoscopic cholecystectomy.

In addition to cholecystectomy, the SILS™ Procedure is being used for various other surgeries such as uterus removal (hysterectomy), kidney removal (nephrectomy) and gastric banding.

Ask Dr. Lewis if a SILS™ Procedure is right for you.

SILS™ Port (As seen above)-- A soft and flexible instrument that is equipped with three distinct openings used in surgery.

Original artical can be found here published by Covidien
Monday, March 19, 2012

Laparoscopic Hernia Repair is better than (Lichenstein tension free) open repair

March 19, 2012 — When performed by highly experienced surgeons, total extraperitoneal inguinal hernioplasty (TEP) led to less chronic pain, fewer hernia recurrences, and less sensation impairment during a 5-year follow-up period than the more invasive Lichtenstein repair method for hernias, according to study results published in the March issue of the Archives of Surgery.

Hasan H. Eker, MD, a surgeon from the Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues analyzed the experiences of 660 patients (mean age, 55 years) who underwent hernia repair procedures between July 18, 2000, and April 28, 2004, at 6 centers.
Of the 660 patients, 336 were randomly assigned to TEP, a minimally invasive endoscopic procedure, and 324 were randomly assigned to Lichtenstein repair, an open surgery. Surgeons used polypropylene prosthetic meshes for both types of procedure.

After withdrawals, deaths, or other reasons for exclusion, the final number of patients who completed a 5-year follow-up period totaled 228 in the TEP group and 204 patients in the Lichtenstein group. During the follow-up period, 44 patients died (21 in the TEP group and 23 in the Lichtenstein group), but the deaths were not a result of the hernia repair, the researchers write. Postoperative pain was the primary study outcome. Secondary outcome measures included chronic pain at 5 years, recurrence rate, operative costs, operating time, complications, length of hospital stay, and quality of life.

Postoperative pain, measured as presence vs absence of pain at 1, 2, 3, 7, and 30 days after the procedure, was significantly less after TEP than after Lichtenstein repair (23% vs 32%; P = .01).

For chronic pain, the researchers found the incidence rate at 28% for the Lichtenstein group after 5 years compared with 14.9% for the TEP group (P = .004). For sensation, the authors found that 22% of the Lichtenstein group reported impairments compared with 1% of the patients receiving TEP (P < .001).

The experience level of the surgeon turned out to be a major factor: Of the 457 surgeons who reported their experience level, most (402) were highly experienced surgeons. Even when less-experienced surgeons performed TEP, a surgeon who had performed at least 30 hernia procedures endoscopically was required to supervise.

The researchers found that the cumulative hernia recurrence rates were comparable, at 4.9% for the TEP group and 8.1% for the Lichtenstein group (P = .10), but recurrence rates plummeted for procedures performed by experienced surgeons.

"The overall hernia recurrence rate after 5 years for both procedures performed by experienced residents or surgeons (level 3) was significantly lower than that for inexperienced residents or surgeons (level 1) (2.4% vs 14.3%, P = .001)," the researchers write. When they analyzed only TEP procedures, the gap widened even further between recurrence rates for highly experienced surgeons (0.5%) and inexperienced surgeons (25.0%).

When the researchers compared procedures performed only by experienced surgeons or residents, recurrence rates amounted to 0.5% for TEP and 4.2% for Lichtenstein repair (P = .04).
Patient satisfaction ranked 8.5 for the procedure and 8.8 for the operative scar on a scale of 1 to 10 for the TEP group, and 8.0 and 8.4, respectively, for the Lichtenstein group (P = .004 for comparison of procedure satisfaction between the 2 treatment groups, and P = .02 for comparison of scar satisfaction between the 2 groups).

Patients who received the TEP experienced more operative complications (6% vs 2%; P = .001) and longer operating times than patients who received the Lichtenstein procedure, but the researchers write that the positive outcomes "counterbalance" that, and that complications had no long-term effects. Total costs and length of hospital stay turned out to be comparable for both procedures. Patients who received TEP returned to daily activities sooner (P < .002) and had fewer days off from work (P = .001).

Long-term follow-up patient visits occurred at 1 year and 5 years after surgery, at which 2 independent physicians who were unaware of each other's findings actually performed physical examinations.
Compared with other studies into hernia repair procedures, the researchers write that their follow-up period was longer and their methods more precise. "The accuracy of hernia recurrence rates in our study is ensured because every patient in our study had a clinical follow-up visit with physical examination performed by 2 independent physicians," the researchers write.

They conclude, "Postoperative pain in the short term and chronic pain at 5 years after surgery were significantly greater after Lichtenstein repair vs TEP (32% vs 23% and 28% vs 15%, respectively), as was impairment of inguinal sensibility (22% vs 1%). Patients are more satisfied after TEP with the surgical procedure and with their operative scars. Therefore, TEP should be recommended in experienced hands."

Arch Surg. 2012;147:256-260.
Medscape Medical News © 2012 WebMD, LLC
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Wednesday, January 25, 2012

Surgery with No Visible Scarring

Taking Laparoscopic Surgery
One Step Closer to Incisionless Surgery

What is Single Incision Laparoscopic Surgery?

The SILS (Single Incision Laparoscopic Surgery) procedure is one of the newest surgical developments since the first laparoscopic cholecystectomy, or gallbladder removal, in 1987. In traditional laparoscopic surgery, a telescopic rod connected to a video camera or laparoscope is inserted through a small incision in the abdomen. Three to five additional incisions are made and used as ports, where the other necessary surgical instruments are inserted.

In contrast to traditional laparoscopic surgery, SILS is an advanced, minimally invasive procedure. It allows the surgeon to operate exclusively through a single entry point, typically the patient’s navel (or belly button), using one small incision that is usually less than an inch in length. After healing has taken place, the scar is hidden and may not be seen. This procedure has evolved from the current laparoscopic technique that has been used safely and effectively in people of all ages.

SILS has several benefits: decreased pain, better cosmetic results (scar hidden in belly button), faster recovery, and fewer potential complications from multiple entry sites. The following surgical procedures can be done with SILS:
• Appendix (appendectomy)
• Colon surgery (colectomy)
• Colostomy
• Colostomy reversal
• Diagnostic procedures
• Gallbladder removal
• All hernia repairs (inguinal, femoral, incisional, hiatal, ventral)
• Hysterectomy and other gynecologic procedures
• Splenectomy
• Surgical correction of esophageal reflux (Nissen fudoplication)

The black spots are where the Traditional laparoscopic surgery with four incisions are performed.  The Green spot is where Single-incision laparoscopic surgery (SILS) is performed.
Photo used by permission from Covidien.




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