Q; What is electrophysiology?
A: Electrophysiologists provide care for patients with arrhythmias, which are irregular heartbeats. Patients with arrhythmias may have hearts that beat too quickly, too slowly, or with an irregular rhythm. Electrophysiologists are experts in treating problems with the heart’s electrical system. They employ treatments such as cardiac ablation and implantable devices such as pacemakers and implantable cardioverter defibrillators.
Electrophysiology accreditation from the American College of Cardiology recognizes hospitals that have the ability to evaluate, diagnose, and treat patients who come to its electrophysiology lab. Hospitals receiving electrophysiology accreditation from the ACC must take part in a multi-faceted clinical process that involves completing a gap analysis, examining variances of care, developing an action plan, completing a rigorous onsite review, and monitoring for sustained success.
Q: A common culprit of shoulder pain is a torn labrum. What is that and how do you treat it?
A: The labrum is a soft rim of tissue attached to the outer edge of the shoulder socket. Injuries occur when moving the shoulder at high speed while the arm reaches away from the body such as in sports like golf, tennis, and baseball. It’s also commonly injured during collision sports injuries such as football and basketball. Working out or playing sports with poor technique can increase the risk of tearing the labrum.
Sometimes, treatment includes a period of rest or activity modification, non-steroidal anti-inflammatory medications, and ice. In addition, physical therapy is often helpful. Not every tear needs surgery, but if it does, it’s usually performed with small incisions. Once you have demonstrated good motion and strength and your pain has improved, your surgeon will allow you to resume the sports and activities you love.
Q: How do you know if you have carpal tunnel syndrome and how do you fix it?
A: Carpal tunnel syndrome occurs when there’s pressure on the median nerve as it moves through a narrow passageway near the wrist called the carpal tunnel. It can cause numbness, tingling, pain, and weakness in the hand and arm.
Cortisone injections may provide pain relief, but they don’t always address mechanical problems. Surgery releases the pressure on the nerve and promotes long-term recovery. The surgery involves a simple, inch-long incision in the palm. Underneath the skin and a layer of muscle is the ligament that pushes on the nerve. Surgeons cut the ligament into two sections, relieving the pressure. Patients without severe carpal tunnel syndrome notice relief almost immediately after surgery. For severe cases, recovery can take up to a year; however, most people are back to normal activity within six weeks.
Q: What is an abdominal aortic aneurysm (AAA)?
A: An aneurysm is an abnormal dilation of a blood vessel and can occur anywhere in the body. The aorta is the main artery that carries blood from the heart to all parts of the body. The portion of the aorta in the abdomen is the abdominal aorta, which is normally about 2cm in diameter. The abdominal aorta can enlarge due to degenerative changes, infection, and trauma. Most AAAs are asymptomatic and are detected by imaging studies such as ultrasound, CT scans, or MRI, often ordered for other reasons.
Risk factors include smoking, being male, family history, advanced age, and atherosclerosis. Repair of AAAs are recommended for progressive enlargement, usually more than 5cm in diameter. Most AAAs are repaired using endovascular stent grafts with minimal incisions and only one or two nights in the hospital.
Q: What is triple-negative breast cancer and how do we treat it?
A: Triple-negative breast cancer (TNBC) lacks the expression of the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). It’s more aggressive than other types of breast cancer and accounts for approximately 15% of breast cancers diagnosed worldwide. It’s more common in women younger than 40 and who are African American. Also, up to 20% of patients with TNBC have a breast cancer susceptibility gene mutation called (BRCA). Surgery, radiation and chemotherapy are common treatments. Patients with tumors greater than ½ centimeter or who have cancer in the lymph nodes receive chemotherapy before or after surgery. Patients with Stage II or III TNBC often receive chemotherapy before surgery combined with immunotherapy. Overall, for patients with TNBC, treatment is individualized based on the genetic profile and stage.
Q: What is chronic lymphocytic leukemia/small lymphocytic lymphoma, and how is it treated?
A: Chronic lymphocytic leukemia is blood cancer with abnormal mature white cells called monoclonal lymphocytes. It accounts for 25 to 35% of all leukemia in the United States and typically occurs in older adults. While most patients have no symptoms, 5 to10 % have unintentional weight loss, fever-drenching sweats, and extreme fatigue. It’s diagnosed through a test called flow cytometry, which assesses the percentage of abnormal white cells.
Treatment depends on the extent of the disease, including excessive bone marrow failure and worsening red cell count, anemia, and platelet counts, as well as spleen enlargement, enlarged lymph nodes, and the above symptoms. The goal is to alleviate symptoms, reverse abnormal blood counts, and prolong survival. Treatment options have changed significantly over the last several years to benefit patients.
Q: Should my leaky mitral valve be fixed?
A: Mitral valve regurgitation, also known as leakage, can lead to heart rhythm disturbances such as palpitations and cause heart failure if severe and left untreated. Symptoms of heart failure include fatigue, shortness of breath, and extremity swelling. If symptoms occur with a heart murmur, the patient should have an echocardiogram.
Fortunately, symptoms of mitral valve regurgitation can be reliably reduced or prevented altogether with timely recognition and appropriate surgical intervention such as mitral valve repair or replacement. Patients with significant leakage of their mitral valve should be assessed for potential repair in order to improve their quality of life.
Q: What is hip resurfacing?
A: Hip resurfacing is an alternative to traditional hip replacement that is particularly suited to younger, highly active patients. This procedure replaces a thin layer of bone from both sides of the hip joint with metal surfaces, which is biomechanically much more similar to the natural hip than a traditional hip replacement. Resurfacing preserves more of the natural bone — an important consideration for the younger patient who may need additional surgery later in life. Resurfacing facilitates natural movement of the hip joint without fear of dislocation.
As a result, these patients are able to achieve a much higher activity level after surgery to include running and full athletic participation, which is not typically possible after a traditional hip replacement. Less bone loss, increased stability of the hip joint and avoidance of thigh pain are key benefits of hip resurfacing.
Q: How common are thyroid nodules, and should I be concerned if I have one?
A: Thyroid nodules are very common and are more likely to be found in women. The literature agrees that approximately one in every three middle aged women will have a thyroid nodule. Often they are found incidentally on a neck image, as it is rare for thyroid nodules to cause symptoms. Once a thyroid nodule is identified, a dedicated thyroid ultrasound is the next step to further define its size, vascularity, and borders.
Thyroid nodules found to be larger than one centimeter will require a simple fine needle aspiration to study the cells for any thyroid cancer. Approximately 95 percent of thyroid nodules will turn out to be benign following aspiration. Even if the fine needle aspiration is suspicious, thyroid cancer is often slow growing and very treatable with thyroid surgery.
Q: Does skinny equal healthy?
A: Your health can be impacted by your activity level, nutrition, sleep, stress, whether you’re using risky substances such as tobacco, alcohol, or other drugs, and whether you’re connected socially to other people. Being skinny, despite being one of the most common wellness myths, doesn’t necessarily fit.
You can be skinny and be healthy, but you can also be skinny and be unhealthy as well. Why? You can be skinny and have visceral fat, which is fat inside of the body that you cannot see — a risk factor for chronic disease. If you’re eating a poor diet with plenty of processed foods or if you smoke tobacco, your risk for health problems increases even if you’re thin. Weight is just one piece of the puzzle. Talk to your provider about which lifestyle goals you can focus on to achieve a healthier lifestyle.
Q: Should everyone take an aspirin a day for good heart health?
A: The guidelines regarding aspirin have changed over the past few years. Aspirin was recommended because it helps prevent blood clots that can cause heart attack and stroke. It works by inhibiting platelets, which are involved in the body’s mechanism of forming blood clots.
The downside is that you’re also thinning the blood, which puts you at risk for bleeding.
If you’re older than 60, or if you’re between age 40 to 59 without significant cardiac risk, it’s not recommended to take an aspirin every day because it increases the risk of bleeding. If you’re between the ages of 48 to 59 and have an increased risk for cardiovascular disease, you need to talk to your physician about whether taking aspirin is appropriate.
Q: What can affect your fertility?
A: Infertility affects around 15 percent of couples who are having regular, unprotected sex. Age and medical history are the two most known factors that can play a role in getting pregnant, but lifestyle choices can also play a role. These factors include excessive alcohol use (more than five drinks a week for women and more than seven drinks a week for men), tobacco and marijuana use, and being underweight or overweight.
If you’re struggling to get pregnant, talking to your OB/GYN provider is a good place to start. Women are encouraged to seek help if they: are under the age of 35, experience regular menstrual cycles and have been trying to conceive for 12 months; are 35 to 40 years old, experience regular menstrual cycles and have been trying to conceive for 6 months; or are over 40 years old.
Q: What is the difference between a breast reduction and a breast lift?
A: A breast reduction decreases the overall size of the breast while a breast lift restores the shape of the breast. Both procedures have similar incisions and allow for repositioning of the nipple-areola complex resulting in a more youthful breast appearance. Breast reduction patients often seek treatment for neck or back pain, grooves from bra straps, or skin irritation. Breast reduction is covered by most insurance carriers while breast lift is a cosmetic procedure to restore a more youthful breast shape. The post-operative care and recovery time are the same. It is generally recommended that you take at least five to seven days for recovery.
Q: What is the Webster Technique?
A: Chiropractic care during and after pregnancy is vital to the comfort and function of mother and baby. The Webster Technique is a specific chiropractic analysis and adjustment to reduce the effects of strain, misalignment, or dysfunction of the lower back and pelvis. This pelvic subluxation (misalignment) affects nervous system regulation, uterine function, pelvic contraction, and baby position in utero.
Chiropractic correction of the subluxation helps restore and coordinate function of the joints, muscles, and nervous system so mom’s body better adapts to the physical changes during pregnancy. With less uterine/pelvic constraint, baby has the improved ability to position head down naturally. Pregnant moms under chiropractic care routinely move easier, feel better, labor more effectively, and recover faster post-partum.
Q: I have frequent sinus infections. Is this normal?
A: Absolutely not. Many people suffer from recurrent bouts of nasal obstruction with associated headaches, a feeling of “congestion,” cough, and associated post-nasal drip. An otolaryngologist with experience in treating nasal problems will be able to diagnose and treat the underlying reasons for these flares. In many cases, there are problems with nasal and sinus anatomy that prevent normal function, and simple treatments can stop the frequent sinusitis bouts (mistakenly referred to as “head colds”). A simple adjustment in medication or quick procedures performed in the office are often enough to permanently solve long-term nasal obstruction symptoms. Life will be improved, and potentially serious complications avoided.
Q: What are the common symptoms of anxiety, and what are treatment options?
A: Anxiety is defined as excessive worry, and worry eventually leads to other psychiatric, emotional, or physical concerns. Initial symptoms can include sleeping issues, sore muscles, a racing heartbeat, and problems going to the bathroom. To diagnose, your provider can start by asking straightforward questions such as: “Are you depressed or anxious?” “Are you carrying any weight on your shoulders from childhood, personal or professional relationships?”
Exercise, relaxation, mindfulness, therapy, and support from family or friends are some of the most common methods of treating anxiety. Be sure to openly and honestly discuss how you are feeling with your provider. This helps with the development of the best treatment options for your needs.
Q: What is a cervical disc arthroplasty?
A: The cervical spine represents the portion of the spine that comprises your neck. The cervical spine has vertebra and discs to allow movement of the neck. The discs that help your neck move can wear out over time. This is referred to as degenerative cervical disc disease. Sometimes the treatment of this condition requires surgical removal of the disc. Cervical disc arthroplasty, which is the same as disc replacement, is a surgical procedure that allows the surgeon to remove the disc and replace it with a man-made disc. The man-made disc functions similarly to the natural disc. Disc replacement has a significant advantage over fusion surgery which is often employed to treat this condition. Fusion surgery permanently limits your neck range of motion and may contribute to wear at the disc above and below the surgery level. Disc replacement allows the patient to have normal range of motion at the surgical segment and reduces the likelihood of wear at the adjacent segments.
Q: Can you share your professional perspective of what the term ‘mental health’ means to you while providing care?
A: Mental health encompasses our physical, psychological, and emotional wellness. Common misconceptions about mental health reduce it to clusters of symptoms found in a diagnostic manual; in reality, mental health is how we cope each day with our increasingly hectic and taxing lifestyles, not to mention individual struggles with trauma, chemical dependence, and/or relationships. Whether experienced directly or through a loved one, these hardships can create emotional scars that must be identified in order to begin healing. Positive changes to our routine can be as small as increasing daily activity, reducing workplace demands, connecting with a mental health professional to determine the right evidence-based treatment, or anti-depressant medication. Mental health is more than a diagnosis. It’s how we manage difficulties occurring in life to enhance our overall well-being.
Q: Why are my eyes watery if I have dry eyes?
A: In a healthy eye, tears consist of watery, oily, and mucous layers that lubricate and protect the eyes. Dry eye occurs due to an imbalance in tear composition. There are two types: Aqueous Deficient Dry Eye, where tear glands don’t produce enough tears, and Evaporative Dry Eye (which accounts for 85 percent of dry eye cases), where there is a lack of oil in the tears, often caused by meibomian gland dysfunction (MGD). Without the oil layer, tears evaporate quickly, resulting in dryness, redness, and irritation. As a compensatory response, the eyes produce excess watery liquid, leading to watery eyes.
OptiLight by Lumenis is a highly effective treatment for restoring tear balance. It is an FDA-approved IPL treatment that reduces inflammation, improves tear stability, and enhances meibomian (oil) gland function. This safe, gentle, and non-invasive procedure takes only 10 to 15 minutes. Consult your doctor to determine if you’re a good candidate.
Q: What are the most common cognitive and emotional changes that can occur after a concussion?
A: Although concussions are best known for physical symptoms like headaches, dizziness, nausea, light/sound sensitivity, sleep disturbance, and fatigue — changes in the way someone thinks and feels may occur as well. In fact, these neuropsychological changes can outlast the physical ones and can be very upsetting for patients.
Difficulty staying focused, slowed processing speed, and decreased stamina for cognitive tasks are the most common, but individuals sometimes notice difficulty with working memory and short-term recall as well. Together, these changes can make it more difficult to complete tasks and keep track of details at home, work, and school. Children and adults also often report feeling more emotional and reactive to daily stressors. Good concussion management should include assessment and treatment of these symptoms as well.
Q: What is a common complaint in an emergency department?
A: One of the most common complaints we see in the emergency department is chest pain. Let’s talk about chest pain related to coronary artery disease. The blood vessels that run through the heart are called coronary arteries. If the arteries become injured or diseased, it can lead to a heart attack. The good news is in most cases, this is preventable!
Risk factors for coronary artery disease include smoking, drug abuse, hypertension, diabetes, and high cholesterol. Under the guidance of your doctor, do your best to prevent or control these conditions. Keep in mind, although chest pain is a common symptom, a problem with your heart can present as shortness of breath, back pain, abdominal pain, or vomiting. If in doubt, don’t waste time — go to the emergency department immediately!
Q: Do you need a brain scan for a concussion?
A: A concussion is a type of traumatic brain injury (TBI). Concussions occur when a hard hit to the head or body causes the brain to move inside the skull. Increasingly more common, especially in children and teenagers involved in full contact sports, these types of injuries often exhibit no external signs of injury, as the trauma is on a microscopic cell level, but can have serious long term effects if not diagnosed and treated early. While x-rays and CT scans are useful to diagnose many traumatic injuries, an MRI evaluates the brain with greater detail to aid in the detection of the immediate effects of TBI and can help predict possible long term consequences. This is especially important when symptoms persist or even get worse in patients not improving as expected.
It is important to remember that an MRI is only one part in the thorough evaluation of TBI, and that a detailed history, a thorough neurologic exam, as well as memory testing by the treating team of physicians is equally as important for the best patient care and outcomes.
Q: Is therapy for me? I don’t have any serious problems but more everyday issues.
A: Yes! Therapy (also called psychotherapy, talk therapy, or counseling) is a beautiful way to practice routine self care. You are not required to have a serious crisis to enter into therapy. Literally everyone can gain so much from the process of sitting with a professional to talk through whatever is on your mind and whatever is happening in your life. Your therapist will guide you to process your feelings and thoughts, and the behavior patterns that might be unnoticed.
A good therapy session should leave you feeling like you just had a workout: refreshed and reset. You will have pondered, “What if I responded in a new way? How would that feel?” The mind is quieter and more hopeful. You have been reminded of the incredible power you hold yourself to make things feel better in your world.