Skin Screening and Skin Cancer Prevention

Living in the Sun Belt of the United States provides us with ample opportunity to enjoy the warm weather. It also gives us the exposure to the damaging UV radiation that prolonged sun exposure causes. Over years this cumulative exposure causes DNA damage in the skin cells making them change and sometimes turning to skin cancer. The National Cancer Institute estimates there will be more than 1,000,000 cases of skin cancer in the U.S. in 2008.

Changes to the texture of the skin as well as new formed lesions and brown spots should always be watched closely for potential malignancy. Lesions that are growing, discolored, raised or bleed are often skin cancer until otherwise proven.

Visit our clinic for a free skin screening exam and consultation if you have skin lesions that you are concerned about.

Vascular Screening and Stroke Prevention

Stroke is one of the most common causes of cardiovascular mortality in the United States. Strokes are debilitating if not deadly and leave the victim often with a very poor quality of life after the event. Medical illnesses known to cause strokes are hypertension, irregular heart rhythms and cardiovascular disease within the arteries leading to the brain. Each year in the U.S. nearly 700,000 people suffer a stroke.

We want to help you prevent this type of event and live a long and healthy life. We offer painless ultrasound screening at our facility to assess for the presence of disease. It is usually covered by your insurance and the time commitment is less than hour.

Call or visit our clinic for a free consultation if you have any questions regarding the exam.

Reflux Surgery and Heartburn Control

Laparoscopic Nissen fundoplication is the reconstruction and repair of the normal functionality at the gastroesophageal junction that separates your esophagus from the stomach.

The gastroesophageal valve prevents caustic stomach acid from entering the esophagus causing burning and pain. When this valve becomes dysfunctional, acid reflux disease (GERD) which is often mistaken for heartburn occurs. Unlike occasional heartburn, the symptoms of acid reflux disease usually occur several times a week and can damage your esophagus when left untreated.

Five minimal incisions are made (four are 5 mm and one is 11 mm). The length of stay after surgery is generally overnight in the hospital.

You will receive post-procedure diet instruction for the adult soft mechanical diet. In the morning, if you are not having nausea and are tolerating the diet, you will be discharged with the post procedure instructions including your diet, your prescription and a 10-day follow-up in our clinic.

Picture below demonstrate the weakened gastroesophageal valve and reflux up into the esophagus

Picture below demonstrate repair of the weakened gastroesophageal valve with fundoplication wrap completely resolving all reflux into the esophagus

Photos Compliments of Medical Center Enterprise

Candidates for evaluation and work-up display the following symptoms :

• Failure to control reflux symptomatology with proton pump inhibitors

• Inability to afford proton pump inhibitors

• Between the ages of 18 and 60

• History of Barrett’s esophagus

• History of esophageal stricture / Schazki’s ring

• History of esophageal erosions

Health benefits of the anti reflux procedure include :

• Complete resolution of reflux backwash into the lower esophagus and lower pharynx

• Repair allows for patient eructation (burping) without reflux or excessive gas and flatus

• Mechanical anatomic repair restores the natural flap valve functionality of the gastro esophageal junction and the normal esophageal hiatus

• Reduced risk of esophageal dysplasia (pre cancerous state), Barrett’s esophagus and esophageal strictures

• Allows patients to stop all antacid control excluding those with peptic ulcers.

Financial benefits of complete anatomic repair :

• The monthly cost of Nexium without insurance coverage is $194.00 each month, generic Prilosec 20 mg OTC is $30 per month which is ½ the prescription dosage

• Inconvenience of obtaining the drug prescription, taking it once or twice daily and possible drug-drug interactions with other medications that you take

Work-up for qualifications for this procedure includes the following :

• Barium upper GI for esophageal road mapping

• Esophagogastroduodenoscopy to assess for dysplasia / Barrett’s

• pH probe 24-hour monitor to assess for severity of acid reflux

• Esophageal manometry to assess motor function and coordination of the esophageal contractions

It is important that all work-up measures support the anti reflux procedure. Patients that fall within these criteria have excellent results with alleviation of all reflux symptoms.

Patients that do not qualify within the work-up criteria, especially those that fail the pH probe, show less of a benefit after the procedure.

If you have any questions regarding the work-up or the technical portions of the procedure please contact us through the contact us portion within the website by submitting your question or calling our main desk (334)347-0991.

I look forward to taking care of your Acid Reflux problem.

Gallbladder Surgery (Laparoscopic Cholecystectomy)

This involves removal of the gallbladder for problems related to:

• Infection
• Gallstones
• Poor emptying capacity
• Nausea, vomiting and bloating

The gallbladder functions in the body to store bile which is an emulsifier that is used to aid in digesting fats.

The procedure is outpatient day surgery and consists of undergoing general anesthesia and four small incisions to remove the gallbladder with the laparoscope.

Using video monitors this is done safely and is considered the standard of care for this procedure if there are not mitigating factors.

You should be able to be home the same day and recovery is usually 4 – 14 days depending on the patient.

Lifting / straining precautions are advised as with all surgery where an incision is made in the abdominal fascia.

Screening Colonoscopy

This procedure is done for screening evaluation of the internal colon mucosa for polyps and other lesions.

Screening guidelines for Colorectal Cancer from the American Cancer Society are as follows:

Beginning at age 50 , both men and women at average risk for developing colorectal cancer should follow one of these five testing schedules:

• Colonoscopy every 10 years
• Yearly fecal occult blood test (FOBT) or fecal immunochemical test (FIT)
• Flexible sigmoidoscopy every 5 years
• Yearly FOBT or FIT plus flexible sigmoidoscopy every 5 years
• Double-contrast barium enema every 5 years

All positive tests should be followed up with colonoscopy .

People should begin colorectal cancer screening earlier and/or undergo screening more often if they have any of the following colorectal cancer risk factors.

• Personal history of colorectal cancer or adenomatous polyps
• Strong family history of colorectal cancer or polyps (cancer or polyps in a first-degree relative younger than 60 or in two first-degree relatives of any age) Note: a first degree relative is defined as a parent, sibling, or child.
• Personal history of chronic inflammatory bowel disease
• Family history of an hereditary colorectal cancer syndrome (familial adenomatous polyposis or hereditary non-polyposis colon cancer)

Colonoscopy is an outpatient procedure that requires a bowel preparation prior to the procedure.

The procedure is done with a mild sedative to aid in your comfort. The diagram below demonstrates how the colonoscope passes into the large bowel.

Screening of the colon allows for removal of the common mucosal polyps that form from becoming early stage cancer and a larger problem to treat and cure.

Hernia Repair

A hernia is a defect in the abdominal wall or inguinal canal. This can be a congenital problem that a person is born with, but most common adult hernias are due to strain or tissue weakness and may occur after a surgical procedure.

Protrusion of some of the intra-abdominal contents is what causes the hernia to be symptomatic as well as dangerous to the patient. Incarceration and strangulation of this tissue may lead to tissue death and becomes dangerous to the patient’s health.

It is recommended that all hernias once identified be repaired to prevent a situation of incarceration. Repair of an elective hernia electively is a very straightforward, safe and common procedure.

Often a sterile mesh is place to improve tissue strength and prevent recurrence of the hernia.

Most standard hernia repairs are considered outpatient surgery with recovery over one to two weeks. All patients undergoing hernia repair will be requested to be on a light duty status with no heavy lifting (greater than 15 lbs) for 6 weeks from the date of surgery.

Breast Surgery and Lesion Evaluation

Breast lesions are very common in the population and although 1 in 8 women will have a type of breast cancer within their lifetime, most commonly found breast lesions are benign.

Risk factors for breast cancer include

• Personal history of breast cancer
• Therapeutic radiation to the chest wall
• BRCA1 / 2 gene mutation in the family
• First degree relative with breast cancer
• Breast biopsy that had tissue that was “atypical hyperplasia”
• Onset of menarche (menstrual cycle) early
• Older age when you had your first child
• Older age in general
• Hormone replacement therapy
• You had a breast biopsy that was lobular carcinoma in situ (LCIS)
• Ethnicity

Although most breast cancers are visualized on mammogram with suspicious calcifications, this is not 100% and ultrasound will often allow visualization of a non-calcified lesion.

National Cancer Institute Risk Assessment Calculator

The work up of a breast lump includes mammogram and often ultrasound in conjunction. Although most breast cancers are visualized on mammogram with suspicious calcifications, this is not 100% and ultrasound will often allow visualization of a non-calcified lesion.

Once the lesion is identified a tissue sample needs to be obtained if the mammogram or ultrasound is thought to be suspicious. This can be done by the following techniques.

Ultrasound guided biopsy

This technique involves undergoing a needle biopsy of the suspicious breast lump with the assistance of ultrasound guidance. This is a very specific and sensitive technique allowing us to obtain the tissue with very minimal distortion to the breast.

Stereotactic biopsy

This technique involves using the stereotactic Xray machine to obtain a tissue sample of the suspicious breast lump. It is very valuable in evaluating lesions that show suspicious calcifications on the mammogram and that do not show up on ultrasound. It is also a very specific and sensitive technique allowing us to obtain the tissue with very minimal distortion to the breast.

Wire guided open breast biopsy

This technique involves the radiologist putting a tiny guide wire into the suspicious breast lump which provides direction in removing this section of tissue. Many suspicious lesions found on mammogram are so small that they are not able to be felt on exam and the guide wire provides the guidance to the correct suspicious tissue. The great benefit of this procedure is that all the suspicious tissue is removed during the initial surgical evaluation. Although a surgical incision is made on the breast, it is kept to a minimal size to provide a good cosmetics repair and proper healing.

Breast Screening Guidelines

• Yearly mammograms starting at age 40 and continuing for as long as a woman is in good health.
• Clinical breast exams should be part of a periodic health exam, about every three years for women in their 20s and 30s and every year for women 40 and over.
• Women should report any breast change promptly to their health care providers. Breast self-exam is an option for women starting in their 20s.
• Women at increased risk (e.g., family history, genetic tendency, past breast cancer ) should talk with their doctors about the benefits and limitations of starting mammography screening earlier, having additional tests (e.g., breast ultrasound or MRI), or having more frequent exams.

Skin lesion evaluation

Being in the sun belt of the United States, skin lesions and sun damage are very common. We provide service for both the evaluation and removal of skin lesions which may appear suspicious or pose a threat of cancer.

Develop a regular routine to inspect your body for any skin changes. If any growth, mole, sore or skin discoloration appears suddenly or begins to change, see your physician. Skin cancers can be treated if detected early.

The most common lesions we find are:

• Seborrheic Keratosis – Benign greasy lesion
• Actinic Keratosis – Precancerous lesion
• Squamous Cell Cancer
• Basal Cell Cancer
• Melanoma

Although skin lesions can pose problems, melanoma poses the greatest danger. It is usually found as a hyperpigmented mole that may have one or more of the following characteristics:

Asymmetry - You should notice the general look of your moles or growths, for example, if one half of the mole or growth does not match the other half.

Border Irregularity - If the edges of the growth are ragged, notched or blurred.

Color - The pigmentation of the growth is not uniform. Shades of tan, brown and black are present. Dashes of red, white and blue add to the mottled appearance.

Diameter - If the width is greater than 6 millimeters (about the size of a pencil eraser), it could be an indicator of an abnormal skin growth. Generally, any new mole growth should be a concern.

Actinic keratoses

These lesions are small scaly spots most commonly found on the face, lower arms and back of the hands. If not treated, some actinic keratoses may become skin cancers, requiring more extensive treatment.

Basal Cell Carcinoma

This skin lesion usually appears as a small, fleshy bump or nodule often on the head, neck and hands. Occasionally, these cancers may appear on the trunk of the body as red patches. Basal cell carcinomas are the most common skin cancers found in fair-skinned people. Untreated, the cancer will begin to bleed, crust over, heel, and then the cycle repeats.

Squamous Cell Carcinoma

This skin cancer may appear as a bump, or as a red, scaly patch. Squamous cell carcinoma is the second most common skin cancer found in fair-skinned persons. Typically, it is found on the rim of the ear, the face, the lips and mouth. This cancer can develop into large masses.

Malignant Melanoma

It is projected that this most deadly of all skin cancers will develop on the skin of 44,000 Americans annually. Every year, an estimated 73,000 Americans will die from melanoma. 1 in 70 Caucasians may be at risk of developing melanoma in his or her lifetime. Melanoma begins in melanocytes, the skin cells that produce the dark, protective pigment called melanin.

Melanoma may suddenly appear without warning, but it may also begin in or near a mole, or another dark spot on the skin. It is important to know the location and appearance of the moles on your body. The most important step you can take to identify skin cancer is to have any changing mole examined by a physician.

Excessive sun exposure, particularly sunburn is the major cause of melanoma. Heredity also plays a part since a person has an increased chance of developing melanoma if a family member has had melanoma

Dark brown or black skin is not a guarantee against melanoma. Dark-skinned people can develop melanoma, especially on the palms of the hands, soles of the feel, under nails or in the mouth. Warning signs of melanoma include the following: changes in the surface of a mole, oozing, bleeding or the appearance of a new bump, spread of pigment from the border into surrounding skin and change in sensation including itchiness, tenderness or pain.

Prevention is the best weapon against skin cancer. If a melanoma should develop, it is almost always curable if caught in the early stages. Practice periodic self-examination to aid in early recognition of any new or developing lesion.

Thyroid Evaluations

Hypothyroidism - Thyroid gland is underactive

Hypothyroidism is often found within older individuals ages 55+. It affects nearly 15% of women and 10% of men by the age of 60 years.

Signs and Symptoms of hypothyroidism :

• Skin may feel cold, thick and dry with little or no sweating.
• Puffiness of hands and face is seen especially around the eyelids and under the eyes.
• There is often a feeling of ongoing fatigue and slow mentation. Hypothyroidism can often be diagnosed as depression.

Hyperthyroidism - Thyroid gland is overactive

Most common between the ages of 20-40 but may occur at any age.

Signs and Symptoms of hyperthyroidism :

• Increased anxiety, hand tremor, insomnia, overt drive to get tasks accomplished, increased appetite and weight loss.
• Patients often feel that they have restless energy, however, they are often overly fatigued with the inability to get the proper rest that their body requires.
• Frequent bowel movements and diarrhea may also occur. It is an over stimulation of the entire system due to excessive thyroid hormone.
• Over time this takes its toll on the body causing cardiac stress due to elevated blood pressure, decreased protein deposition and bone loss.

It is best to say that both diseases above may have only a few symptoms. Seniors often will lack the full myriad of symptoms and may present atypically.

Diagnosis of a thyroid disorder is usually very simply done with a blood test and ultrasound of the gland. TSH and T4 levels give information on what is occurring with the hormone production by the gland and the ultrasound provides information if there is an anatomic structural abnormality.

Cancer Surgery

During the screening processes that we provide, cancer is sometimes found allowing for early detection and removal.

This includes:

• Breast cancer
• Colon cancer
• Gastric and gastrointestinal cancer
• Skin and soft tissue malignancy

Once cancer is diagnosed, a team approach is taken to allow for multi-specialty team treatment of the cancer.

Cancers that are a high stage will often be treated with multiple modalities including surgical resection, chemotherapy and radiation treatment. This is where the team approach comes to fruition. Small cancers which include most low stage colon cancers, skin malignancies and some breast cancers often require no further therapy other than surgical removal.

Full coordination is made between the patient and their family, surgical staff, medical oncology and radiation oncology to obtain the most effective and best care available to the cancer patient.