Gerald R. Fortuna Jr., M.D., FACS
Q; What’s a new way to help carotid artery disease patients?
A: The carotid arteries are blood vessels in the neck that supply oxygenated blood to the front of the brain. People with carotid artery disease have narrowed carotid arteries, typically caused by a build-up of plaque. When these arteries are obstructed, there’s an increased risk for stroke.
A new procedure, called transcarotid artery revascularization (TCAR), is a minimally invasive procedure that briefly reverses the direction of blood flow in the carotid arteries so that clots cannot travel to the brain and cause a stroke while a physician operates to repair the arteries.
This technique is a game changer for high-risk patients. It gives us another safe and effective tool for stroke risk reduction in patients with symptomatic carotid stenosis and high-grade symptomatic disease.
Q: What’s a pulmonary embolism and how can you treat it?
A: Pulmonary embolism occurs when one or more arteries in the lungs becomes blocked by a blood clot. That blockage can obstruct the lungs, cause stress on the right side of the heart and be life-threatening.
Using an aspiration and mechanical thrombectomy with equipment by Inari Medical®, doctors can go into the lungs with a catheter and remove clots. The procedure takes place in the cardiac catheterization lab and patients can go home the next day. Before this type of procedure, patients needed blood thinners or other medicines to break up the clots or stay in the intensive care unit until after treatment.
Results are seen while patients are still in the catheterization lab, including better oxygen saturations, blood pressure and heart rates.
Q: It’s important to diagnose lung cancer early. In addition to lung cancer screenings, what technology helps doctors do that?
A: Ion®, a new robotic technology, makes it easier to biopsy suspected lung cancer. It can lead to earlier diagnosis, which means starting treatment sooner and improving outcomes. The procedure allows doctors to access lung nodules through bronchoscopy, seeing directly into the airways of the lungs through a lighted camera. There are no external incisions.
Most lung nodules that need to be biopsied are deep in the branches of the lungs. Ion allows clinicians to reach all 18 segments of the lungs and access hard-to-reach nodules. This procedure should allow doctors to biopsy nodules at a smaller size, with more accuracy and less complications.
Q: Can adults develop scoliosis?
A: While people are more familiar with scoliosis in children, most scoliosis cases develop in adulthood as .our spines age and degenerate. Untreated, scoliosis can cause worsening symptoms of back and leg pain, weakness, and difficulty walking. Non-surgical treatments include physical therapy to strengthen the core muscles and pain management to target pain generators in the spine. Select patients may need surgery to correct and stabilize the spine, which can be very effective to treat the pain and disability associated with adult degenerative scoliosis. The decision for surgery is personal. When a patient’s quality of life deteriorates and pain becomes unbearable, he or she should consider surgery. It’s important to have a careful discussion with your surgeon to include the risks and benefits. To prevent wear on the spine that could lead to scoliosis, maintain an active lifestyle and focus on core strength and stability.
Q: What is incisionless brain surgery?
A: Stereotactic radiosurgery is a non-invasive treatment that precisely delivers radiation to brain tumors. It is an alternative to open craniotomy and whole brain irradiation. Unlike a craniotomy, radiosurgery is an outpatient procedure that does not require anesthesia. There is no surgical scar and no risk of infection or bleeding. Multiple tumors can be treated in one setting, which is not feasible via craniotomy.Compared to whole brain irradiation, radiosurgery has fewer cognitive side effects. Most patients have no side effects at all. Radiosurgery is commonly used to treat metastatic brain tumas of brain tumors. It is critical to have a team of neurosurgeons, radiation oncologists, and medical oncologists to coordinate the optimal treatment for each patient. With an experienced team, radiosurgery is safe and highly effective.
Q: How can I eliminate or reduce my need for glasses or contacts?
A: Refractive surgery offers many fantastic options to correct nearsightedness, farsightedness, astigmatism, and presbyopia — age-related inability to focus at near distances requiring the use of reading glasses. LASIK and PRK are procedures using a laser to reshape the cornea — the clear, round dome at the front of the eye — to improve the way the eye focuses light. Refractive Lens Exchange replaces your eye’s natural lens with an artificial intraocular lens (IOL).
There are many advanced technology intraocular lenses to choose from to meet your vision needs. Patients can also choose from the same IOL options as part of cataract surgery. An intraocular collamer lens is like an implantable contact lens and offers another option for patients with extreme nearsightedness and does not require removal of the eye’s natural lens. Your ophthalmologist will determine which option is best to help you reduce or eliminate your dependence on glasses or contacts.
Q: What is the most common type of heart disease in dogs?
A: Myxomatous mitral valve disease (MMVD) is the most common heart disease in dogs, accounting for up to 75 percent of canine heart disease cases seen by veterinarians. MMVD is also called degenerative mitral valve disease, chronic valve disease, or endocardiosis. Prevalence of MMVD is higher in small breed dogs, and the likelihood of MMVD increases with age. The hallmark problem is the inability of the mitral valve to properly close inside the heart, thereby leading to “leaking” or valve regurgitation.
Dogs with MMVD may be asymptomatic, and the veterinarian suspects the disease by hearing a heart murmur. Others may experience clinical signs of congestive heart failure including coughing, heavy breathing, or exercise intolerance. MMVD is diagnosed by echocardiogram, or ultrasound of the heart. The disease is managed with medications which reduce disease progression and control clinical signs.
Q: What is a cataract?
A: A cataract is simply a cloudy lens inside of the eye. Just like a camera has a lens, your eye is designed with a lens to focus light. With aging, the lens becomes cloudy, which can affect your vision. Everyone eventually develops cataracts, although there is wide variability on how much it affects a patient’s vision and daily life (e.g. driving, reading, and hobbies). Some medical conditions, such as diabetes, steroid use, and history of eye trauma, can accelerate cataract development.
The only treatment to remove cataracts is surgery. Typically, anesthesia is topical and recovery is quick. Your eye surgeon can customize a plan to meet your individual visual goals. Options include laser-assisted cataract surgery, monovision, and premium lens implants to correct astigmatism and presbyopia (near and far vision). Premium options are designed to limit dependence on glasses and contacts after cataract surgery.
Q: How does occupational medicine help at work?
A: Understanding how people work at their jobs and how it affects their health is what occupational medicine doctors do every day. Some types of work can involve exposure to chemical vapors, dust, or mechanical forces that result in on-the-job injuries.
When an injury does occur on the job, it’s important to provide the right type of treatment. Pre-employment physical examinations are one of the ways employers can screen out at-risk job candidates and recruit the right employees for their businesses. Strategies such as rest, medications, and physical therapy help to ensure that workers can return to their jobs when they are ready. Another concern is the maze of paperwork and workers’ compensation procedures, which many people find confusing. For those who work in occupational medicine, it’s rewarding to help workers and businesses navigate through this process, heal from their injuries and get back to full productivity.
Q: Why is it more difficult for women to lose weight?
A: There are several reasons. Women have more body fat and less muscle compared to men, which means they burn calories at a slower rate. Pregnancy is another factor, as a woman’s body stores fat during pregnancy to make breast milk after delivery. As women age, it’s more difficult to lose weight after menopause because of a fluctuation in hormones and changes in body fat distribution. There is also a decrease in muscle mass and overall metabolic rate. After menopause, women need about 200 fewer calories per day.
To help keep weight off, here are some tips: keep a food diary; watch your portion size; limit processed foods, empty calories, and carbohydrates; eat more high fiber foods, healthy proteins, and fats; get 150 minutes per week of moderate physical activity, and sleep!
Q: Is it normal to lose grip strength with age?
A: Declining grip strength is a natural part of aging. People tend to start to lose grip strength after about age 55. Reasons include osteoarthritis, rheumatoid arthritis, nerve compression, tendinitis of the hand, or diminished muscle mass. To keep your grip strength optimal, try using a stress ball or squeezing a ball of clay. This can help maintain the tone of your hand muscles and keep your joints moving.
If you notice numbness in your fingers or a visible loss of muscle size in your hand muscles, these would be reasons to seek medical attention to rule out a compressed nerve in your arm or hand. Other indications to seek medical attention would be pain from arthritis or tendinitis that accompanies loss of grip strength or an injury that produces diminished grip strength.
Q: Why is sleep important to your heart?
A: Insufficient sleep can greatly impact your heart. In fact, sleep apnea can be a predisposition for heart disease. While this may seem strange, consider what is happening to your body. When you go to sleep and stop breathing, your body is put under great stress. It’s no different than someone putting a pillow over your mouth and choking you. This kind of stress leads to an adrenaline release, which causes your blood pressure and heart rate to increase. The inability to breathe also causes the liver to release high levels of glucose, which may lead to insulin resistance or pre-diabetes.
Sleep is an integral part of a healthy lifestyle. Adults should get about seven to eight hours of uninterrupted sleep a night. If you snore, wake throughout the night, or have excessive fatigue, ask your doctor about sleep apnea.
Q: What symptoms should I be worried about?
A: The symptoms that are typically considered “red flag” symptoms include unintentional weight loss, trouble swallowing, feeling full after eating, bloody or black stools along with night sweats, vomiting, and symptoms that wake you from sleep. In addition to these symptoms, many patients with long-standing heartburn and reflux typically meet the criteria to undergo screening for a pre-cancerous condition in the esophagus called Barrett’s esophagus.
Even if your symptoms occur on a rare basis, it’s important to seek out evaluation to ensure that there is not something ominous developing. In the world of gastroenterology, early intervention is key!
Q: Did the screening colonoscopy guidelines recently change and why?
A: Colorectal cancer remains the second leading cause of cancer related deaths in the United States. To put this in perspective, one in 22 men and one in 24 women will be diagnosed with colorectal cancer during their lifetime, and over 75 percent of people who died from colorectal cancer were not up to date with screening. In 2021, the American Cancer Society and the U.S. Preventive Services Task force, based on new research, now recommend that for those at average risk, colon cancer screening should begin at 45 instead of 50 because of the dramatic increase in colon cancer diagnosis in this younger age group.
If you are 45 years old and have not yet been screened for colorectal cancer please discuss with your primary care physician as screening clearly saves lives.
Q: Why are you being sent to have a colonoscopy?
A: Your primary care physician cares about your health and the prevention of colon cancer. Age 45 is the recommended age for a screening colonoscopy. Colon cancer can be prevented by early detection and removal of colon polyps (growths) in the colon. A colonoscopy is a fiber optic scope with a light source and channels that is inserted into the rectum and visualizes the colon (large intestines) for the detection and removal of pre-cancerous growths (polyps).
During the exam, your physician will diligently identify and remove colon polyps. By removing these polyps, colon cancer may be prevented. Colon polyps are identified in up to 50 percent of colonoscopies.
Q: Why is a colonoscopy important?
A: Colon cancer is one of the leading causes of cancer death in men and women. It is largely preventable if patients undergo appropriate screening colonoscopies. Average risk patients should receive their first colonoscopy at the age of 45. Those with a close family history of colon cancer may need to start even sooner. The procedure requires a bowel prep in order for the gastroenterologist to get adequate views throughout the colon to look for polyps or precancerous lesions.
The number of polyps, their size, and exactly what type of polyp they are will determine the appropriate interval for your next colonoscopy. An average risk patient with a good bowel prep and no polyps should undergo another colonoscopy ten years later.
Q: What is irritable bowel syndrome, and do I have it?
A: Irritable bowel symptom is a functional gastrointestinal disorder in which people typically experience symptoms of chronic abdominal pain and altered bowel function. Symptoms may include abdominal pain, bloating, diarrhea, constipation, gas, flatulence, nausea, and mucous in the stools. IBS is very common, affecting up to 10 to 15 percent of the U.S. population. Up to 40 percent of people who meet the criteria for IBS do not have a formal diagnosis. Given that this condition can greatly diminish a person’s quality of life, seeking evaluation with your gastroenterologist or doctor should be your first step to try to treat this irritable condition. Rapid evaluation is needed in the presence of alarm symptoms (rectal bleeding, diarrhea at night, weight loss, and progressive abdominal pain) and in people who develop IBS after age 50 or have a family history of colon cancer, Crohn’s disease, or Ulcerative Colitis.
Q: What are some indications that my teenager may be suffering with mental illness? And how can I effectively talk to them about it?
A: The most important thing you can do with your children is to normalize talking about mental health and their feelings. If you notice your child is withdrawn, getting in trouble in school, or other changes from their normal routine, it is important to create a supportive environment for them to open up.
Ask open ended questions. Try talking with your children while doing another activity such as making dinner or driving as this shows to be very effective. Use “their language” as opposed to words like “overwhelmed,” “depressed,” etc. For example, ask, “Why do you think you feel sad, mad, confused?” Lastly, it is imperative to prioritize seeking professional help when needed.
Q: Why do doctors of chiropractic recommend wellness care?
A: Wellness or maintenance care of your spine and nervous system is true health care. Most neck and back issues are a result of small, repetitious stress that progressively worsens over time. Waiting until you are sick, hurting, or can’t enjoy activites of daily living prolongs results and costs more time and money.
Chiropractic adjustments restore spinal joint function to promote ease and support nervous system regulation. Your body begins to handle minor stressors more effectively with less discomfort, and likely prevent long-term degenerative changes. Your doctor of chiropractic will assess your spine for misalignments or subluxations and adjust or correct alignment so your body will restore ease to the nervous system and surrounding tissues, helping support your body to naturally self-regulate and heal as it is designed to do. You feel better, move easier, and live well!
Q: Why is high blood pressure a big deal?
A: High blood pressure is considered “the silent killer” because it does not hurt and people may not know they have this condition. A variety of serious medical conditions are seen in emergency departments ranging from heart attack, strokes, acute kidney failure, etc. One major risk factor for these conditions is high blood pressure, also called hypertension. Good news! Hypertension can be prevented or controlled. Purchasing a blood pressure monitor from your local pharmacy is a great investment.
Take your blood pressure morning/night, in a quiet room after five minutes of rest. Generally, blood pressure should be less than 120/80. If consistently elevated or greater than 120/80, please talk to your doctor. Simple lifestyle changes such as adding less salt to your food or more exercise may be sufficient but often times, medication is indicated. If you are on blood pressure medication, please take as prescribed by your doctor.
Q: What is the most common orthopedic knee procedure for dogs?
A: Tibial Plateau Leveling Osteotomy. This procedure is used to treat cranial cruciate ligament injuries in dogs. The canine CrCl is analogous to the human ACL. Even though the canine and human knee joints have similar anatomy, dogs rarely athletically tear their CrCl. More commonly, dogs degenerate their CrCl over a period of months, often having clinical signs of lameness and discomfort that come and go with activity. TPLO surgery eliminates the need for the CrCl by changing the tibial angle. Therefore dogs cannot re-tear the ligament. Dogs typically spend one night in the hospital and walk out the next day; usually already using their leg. It usually takes six to 10 weeks for this procedure to heal. Most dogs are expected to make a full recovery and get back to hunting, fetching, chasing a ball, or lounging on the couch.
Q: Is a natural result from a facelift achievable?
A: A natural result, rejuvenated appearance, fresh face, and an unnoticeable scar are the primary goals for patients undergoing a facelift or necklift surgery. Thankfully surgical techniques have evolved over several decades and have now arrived at a more modern approach to a “lift;” no longer should a patient look “pulled,” “tight,” or distorted around the mouth.
It is critical for the vector of “lift,” or repositioning, not to violate the natural direction of the soft tissue. The incisions are placed where natural folds and creases already exist, making them inconspicuous. A natural result is absolutely achievable and should be the expectation — speak with your surgeon because, at the end of the day, they are just as invested in your natural result as you are.
