Posted by Stony Brook Surgery on February 25, 2015
Our Surgeons Employ the Latest Technology & Procedures to Benefit Our Patients
February is American Heart Month when we address matters of the heart. The mechanics of the heart are the specialty of our Cardiothoracic Surgery Division. We fix hearts every day, on both an elective and emergency basis.
More than half a million coronary bypass procedures are done each year in the United States to fix clogged arteries and improve blood flow to the heart.
At Stony Brook University Heart Institute, we use the treatment approach that's best for each individual patient, and many of our cardiac patients are benefiting from our use of the da Vinci surgical robot to perform leading-edge minimally invasive bypass surgery.
Traditional "open heart" coronary bypass surgery involves stopping the heart to perform the procedure and using cardiopulmonary bypass (CPB); that is, routing the blood through the heart-lung machine to maintain the patient while the heart is stopped.
CPB also requires a large incision and splitting the sternum (breastbone), resulting in a large scar and a lengthy recovery time.
The mid-1990s saw the advent of the minimally invasive approach to coronary revascularization called "beating heart" surgery, also known as "off pump" surgery. This new approach avoids the use of the heart-lung machine. Consequently, patients do not experience the inflammatory response caused by CPB, which disrupts the body's physiologic balance.
The minimally invasive direct coronary artery bypass (MIDCAB) beating heart procedure was developed at that time, in addition to other off pump procedures.
The surgeon performs the operation using the robot — not the other way around.
Patients needing bypass procedures involving one or two vessel grafts could undergo MIDCAB instead of traditional bypass surgery. Using smaller incisions and not requiring the sternum to be split open, MIDCAB produces less trauma, less pain, and faster recovery.
Our cardiac surgery service is a national leader in performing robotically-assisted MIDCAB, which constitutes an improvement over the original MIDCAB that requires a five-inch incision and spreading the ribs for access to the heart.
The robotically-assisted procedure enables the surgeon to optimize the preparation of the internal mammary arteries, the best vessels for bypass grafts, which produce the most reliable, most protective, and longest-lasting (>20 years) grafts.
Robotically-assisted MIDCAB offers eligible patients a number of potential benefits over traditional "open heart" bypass surgery:
Stony Brook's robot is a highly sophisticated tool that enables surgeons to perform a variety of complex operations, such as coronary bypass surgery (also for colorectal surgery in the Department of Surgery; read more). The robotic system makes it possible for them to perform surgery without large incisions by way of superior visualization, enhanced dexterity, and greater precision, which ultimately raises the quality of surgical care.
At Stony Brook, Frank C. Seifert, MD, associate professor of surgery and director of minimally invasive bypass surgery, is leading our use of the da Vinci robot to perform MIDCAB surgery. He was specially trained and certified to operate with the robot.
A nationally recognized expert in MIDCAB and other off pump techniques that avoid the heart-lung machine, Dr. Seifert has performed hundreds of MIDCAB operations at Stony Brook, in addition to more than 2,000 other kinds of beating heart bypass operations. He is among the few surgeons in the country who mastered the technical challenges of the MIDCAB procedure that have limited its use in the hands of other surgeons.
Commenting on the significance of the da Vinci surgical robot, Dr. Seifert says: "The robot represents a major advance in coronary bypass surgery that offers patients more benefits of the minimally invasive approach. My operating vision is two to three times greater with it, and there is no loss of depth perception. As visual clues replace touch, the dexterity of the robot's hands is certainly greater than that of the human hand, and should contribute to improved outcomes."
"Ultimately, with anticipated further advances," adds Dr. Seifert, "robotically-assisted surgery represents the future of all coronary bypass surgery — single- or multi-vessel off pump surgery that doesn't require use of the heart-lung machine or the sternotomy incision.
Click here to learn more about robotically-assisted bypass surgery at Stony Brook University Heart Institute. For consultations/appointments with our heart surgeons, please call 631-444-1820.
Posted by Stony Brook Surgery on February 18, 2015
New Screening Policy Is Expected to Result in Dramatic Increase in Lung Cancer Survival
The Centers for Medicare & Medicaid Services (CMS) just announced earlier this month that Medicare will now pay for lung cancer screening with low-dose CT scanning for eligible patients. This action is welcomed by the team of Stony Brook's Lung Cancer Evaluation Center (LCEC), together with the Lung Cancer Alliance and other patient advocacy groups nationwide.
The final national coverage determination had been anticipated since the agency made a preliminary decision to cover the screening last November.
"This is the first time that Medicare has covered lung cancer screening. This is an important new Medicare preventive benefit, since lung cancer is the third most common cancer and the leading cause of cancer death in the United States," says Patrick Conway, MD, chief medical officer and deputy administrator for innovation and quality at the CMS, in a press statement.
Medicare's action "will save lives and increase the low survival rates associated with lung cancer, our nation's leading cancer killer," according to Harold P. Wimmer, national president and CEO of the American Lung Association, in a press statement.
The new Medicare policy covering lung cancer screening will save tens of thousands of lives
Medicare will pay for an annual lung cancer screening with a low-dose radiation chest CT scan, also called CAT scan, for beneficiaries who are 55 to 77 years of age and who are either current smokers or quit smoking in the previous 15 years, who have a 30 pack-year history of tobacco smoking (an average of one pack a day for 30 years), and who have a written order from a physician or qualified nonphysician practitioner that meets certain requirements.
Notably, the coverage includes a visit for counseling and shared decision-making on the benefits and risks of lung cancer screening.
Thomas V. Bilfinger, MD, ScD, professor of surgery and director of thoracic surgery, who serves as team leader and co-director of the LCEC, responds to the new CMS policy:
"The CMS ruling certainly is a recognition that screening for lung cancer is effective. As a matter of fact, it is more efficacious in finding and preventing cancer than breast screening, colon cancer screening, and prostate screening programs combined.
"The current ruling is a compromise, particularly as far as age is concerned. Lung cancer is a cancer of the elderly. The cutoff at 77 has to do with the fact that we are paying 18% of the nation's gross domestic product for healthcare, and CMS is currently under a mandate to save money. In that light it is a victory, as the data was compelling enough to be funded even under today's circumstances.
"The ruling also makes it clear under what circumstances payment for screening will be available: a 'program' requires more than just a CT scan: a program requires an initial assessment, a low-dose CT scan, and a follow-up visit, plus maintenance of a database. It further requires trained personnel to assess, counsel, and read the CT scans.
"We are proud to say we fulfilled the now prescribed requirements long before this ruling
"We are particularly happy at Stony Brook about that aspect, since we have believed from the onset that these patients need to be followed appropriately. We are proud to say we fulfilled the now prescribed requirements long before this ruling. Lung cancer screening is not a money maker for an organization; rather, it is a community service that when run efficiently just breaks even. So it is unlikely that we will see a fast sprouting of programs.
"Again, Stony Brook as a leading provider in Suffolk County is uniquely positioned to provide that service and keep track of the enrollees, and has done so from the onset. Our program was recognized early by the Lung Cancer Alliance as a model program."
The LCEC established its screening program in 2013 (read more).
The Lung Cancer Alliance, the nation's oldest and leading non-profit organization dedicated to saving lives and advancing research by empowering those living with and at risk for lung cancer, applauds the game-changing move by the CMS.
"Lung cancer screening can now stand shoulder to shoulder with mammography, colonoscopy, pap smears, and other proven cancer screenings that have saved countless lives," says Lung Cancer Alliance president and CEO, Laurie Fenton Ambrose. "This signals a new day where lung cancer transitions from the number one cancer killer to a treatable, even curable disease."
Those who qualify for lung cancer screening can make an appointment by calling 631-444-2981. Watch this video (2:11 min) released with the 2013 launch of our screening program to learn more about it:
Posted by Stony Brook Surgery on February 11, 2015
Long Island's Only Joint Commission–Certified VAD Program Is Recognized as Top Level
Stony Brook University Heart Institute's ventricular assist device (VAD) program has earned two-year recertification from The Joint Commission after an intensive two-day review in mid-January that concluded with the surveyor stating that Stony Brook's VAD program is "the best destination therapy program" ever seen by her.
"Certification — The Joint Commission's 'Seal of Approval' — lets patients in need of a VAD know that they are in capable hands when they come to Stony Brook Heart Institute," says Allison J. McLarty, MD, associate professor of surgery and co-director of the VAD program. "The Joint Commission singled out Stony Brook for its care and commitment to patients with advanced cardiac heart failure and for maintaining the highest standards of care."
Hal A. Skopicki, MD, PhD, assistant professor of medicine, director of the Heart Failure and Cardiomyopathy Center, and co-director of the VAD program, says the success of the VAD program is the result of a collaborative effort by a large network of cardiologists on Long Island, working closely with Stony Brook's multidisciplinary treatment team, including gastroenterologists, pulmonologists, nephrologists, infectious disease specialists, psychiatrists, and hematology/oncologists.
"Together, we marshal our efforts to create excellent outcomes for our patients," says Dr. Skopicki.
A ventricular assist device (VAD) is a surgically implanted, electrically (battery) powered pump
Stony Brook University Hospital was the first hospital on Long Island to implant a HeartMate II VAD in 2010, and is the only certified VAD destination therapy program on Long Island. To date, 42 patients have received VADs. Several of these patients have gone on to have successful heart transplants.
Destination therapy uses VAD technology as the final treatment option for selected patients whose hearts require mechanical assistance to pump blood. Once used only as a temporary device for heart failure patients awaiting transplants (bridge-to-transplant therapy), VAD technology in its advanced state now helps more patients extend their lives and also improve their quality of life.
To achieve certification, VAD programs are evaluated on standards in The Joint Commission's Disease-Specific Care Certification Manual. Programs must demonstrate conformity with clinical practice guidelines or evidence-based practices. They are also required to collect and analyze data on specific performance measures related to clinical practice guidelines (read more).
Founded in 1951, The Joint Commission seeks to continuously improve healthcare for the public, in collaboration with other stakeholders, by evaluating healthcare organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. The Joint Commission accredits and certifies more than 20,500 healthcare organizations and programs in the United States. An independent, not-for-profit organization, The Joint Commission is the nation's oldest and largest standards-setting and accrediting body in healthcare.
Learn about heart failure and the treatments for it. More about the ventricular assist device — artificial heart technology — used at Stony Brook Heart Institute for destination therapy to treat heart failure.
Posted by Stony Brook Surgery on February 4, 2015
Preventing Injuries Is as Important to Us as Treating Them at Stony Brook Medicine
Winter not only brings snow, ice, and wind chill, but a number of hazards such as slips and falls on icy steps and sidewalks; frostbite and hypothermia from exposure to extremely cold temperatures; overexertion from shoveling snow; and injury from hazardous driving conditions to snowblowers.
"During winter weather conditions, we can predict that the Trauma Center will see an increase of patients coming in with injuries due to motor vehicle accidents," says James A. Vosswinkel, MD, chief of trauma, emergency surgery, and surgical critical care, and medical director of the Stony Brook Trauma Center.
"Do not drive when the winter weather gets bad if you don't have to go out, but if you do or you are trying to get home, play it safe. Do not drive distracted, slow down, and be aware of hard-to-spot black ice."
Since everyone is at potential risk for slips and falls, Jane E. McCormack, RN, our trauma nurse coordinator, suggests keeping key safety tips in mind to prevent severe injury:
Awareness of winter's hazards and prevention strategies will help you to stay safe and healthy.
Most important, recognize high-risk situations (steps, darkness, entering cars) and use extra caution."During the winter months at Stony Brook University Hospital, we see an increase in patients who slip and fall because of icy conditions and freezing cold,"says Ms. McCormack.
The incoming arctic air can be dangerously cold, with frostbite and hypothermia both being possible if you are outside too long.
"Prevention is the best medicine for the extreme cold," says Steven Sandoval, MD, medical director of the Suffolk County Volunteer Firefighters Burn Center at Stony Brook University Hospital."Cover up as much exposed skin as possible and wear as many layers as you need to stay warm If you start to get cold or lose feeling, especially in your extremities, try to get back indoors where it's warm. Frostbite occurs when your fingers, toes, or nose become so cold they freeze."
If the frostbite is minor, Dr. Sandoval advises to soak hands or feet in warm water (around 99 to 108 ºF) for 15 to 30 minutes to help raise their temperature. When a person's core body temperature drops after an extended period of time in the cold, it is known as hypothermia.
"Use layers of dry blankets or coats to warm a person who's suspected of having hypothermia, covering the person's head, leaving only the face exposed,"says Ms. McCormack."Having a hot drink can also help warm you up on the inside."
When it comes to heavy snowfalls and plunging temperatures, Ms. McCormack reminds, try to avoid overexertion not only from shoveling but from exposure to the cold.
"Extreme cold puts an extra strain on the heart, and overexertion can cause heart attacks or strokes, especially in people prone to cardiovascular problems."
Other safety tips when shoveling or removing snow:
More winter safety tips from the National Safety Council, and more from the Centers for Disease Control and Prevention. Learn about the Stony Brook Trauma Center and what it has to offer in case of an emergency.
Posted by Stony Brook Surgery on January 28, 2015
Williams Demonstrates the Poetic Can Be Found Everywhere around Us
Almost 100 years ago, America's great physician-poet William Carlos Williams (1883–1963) published his famous poem, "January Morning." A masterpiece of modernist verse, this poetic sequence — he subtitled it "Suite" — presents moments in his daily life, including his life as a pediatrician and obstetrican at Passaic General Hospital in Passaic, NJ.
"January Morning" first appeared in Williams's book, Al Que Quiere! (1917; "To Him Who Wants It!"). His voice in it remains vibrant. Indeed, the New York Review of Books recently proclaimed, "It seems clear that Williams is the twentieth-century poet who has done most to influence our very conception of what poetry should do, and how much it does not need to do."
Williams lived his entire life in Rutherford, NJ, the small town where he was born and raised. It is where he maintained his medical office in his home — where most people knew him simply as "Doc" without knowing he was a widely published author and leader of modernism. He often spent time in Manhattan with fellow artists, crossing the Hudson by ferry.
All told, Williams published during his lifetime some 20 books of poetry as well as 17 books of prose, including novels, and he delivered more than 2,000 babies.
January Morning (Suite)
* Nursing students.
† WCW's mother, who rejected his modernist poetry.
‡ Street near WCW's home in Rutherford.
"Remembering William Carlos Williams" on our blog offers more biographical details and links. Listen to the BBC radio play (til Feb. 9) celebrating Williams that includes a memorable house call and home birth.
Posted by Stony Brook Surgery on January 21, 2015
Novel Neuroscience-Based Technology Provides Alternative to Bariatric Surgery
By Aurora D. Pryor, MD, Director, Stony Brook Bariatric and Metabolic Weight Loss Center, and Past Chair, American Society of Metabolic and Bariatric Surgery Emerging Technologies and Procedures Committee
A first-of-its-kind implant that curbs the appetite by electrically stimulating stomach nerves gained approval last Wednesday from the U.S. Food and Drug Administration.
The new device, called the Maestro System, is the first of several devices we anticipate being approved this year for obesity management. The last time the FDA approved a device for obesity management was in 2007, for the Realize adjustable gastric band.
Many patients currently choose not to pursue surgery, though they could benefit from it. Such patients may be interested in these novel technologies.
The FDA approved the Maestro device for use in patients 18 and older who have a body mass index (BMI) of 35 to 45 (calculate your BMI) and at least one other obesity-related condition, such as type 2 diabetes.
Candidates for the device must also have failed at least one supervised weight management program within the past five years.
The therapy provided by the Maestro device is called VBLOC, which stands for vagal nerve blocking. To control both hunger and fullness, the device intermittently blocks the signals from the vagus nerve, which is the primary nerve that regulates the digestive system.
New devices are essential to keep innovation in the United States,
VBLOC represents an innovative, new approach to the treatment of obesity.
By blocking signals along the nerves that connect the brain and stomach, VBLOC aims to reduce feelings of hunger and promote earlier feelings of fullness, which can help people with obesity reduce the number of calories consumed, thus promoting safe, healthy, and durable weight loss.
The Maestro device is like a pacemaker. It is implanted in the abdomen, usually in an outpatient procedure.
VBLOC therapy does not surgically alter or restrict the digestive system, does not create barriers to prevent absorption of nutrients, and is reversible, allowing patients to lose weight by a new mechanism.
Although new technologies for weight loss are promising, insurance typically does not cover novel procedures until more data are available.
Stony Brook Medicine is expecting to participate in upcoming trials of new bariatric devices and welcomes new options in obesity management. We are in discussions currently about bringing the Maestro technology here.
Bariatric clinical trials at Stony Brook enable eligible patients to gain access to therapies that are not available from other physicians. Our trials enable us to use, in addition to established therapies, the newest and most advanced technologies and treatments.
With our current therapies we are not meeting the needs of 95% of the obese population. Existing weight loss procedures may not be right for everyone. New devices will help us meet the needs of more patients with obesity.
Read the FDA announcement about the Maestro device. To learn about clinical trials and other options currently available at the Stony Brook Bariatric and Metabolic Weight Loss Center, please call 631-444-BARI (2274).
Posted by Stony Brook Surgery on January 14, 2015
Fire Is Not the Major Cause of Burn Injuries in the Pediatric Population
By Erin A. Zazzera, RN, MPH, Pediatric Trauma Coordinator
As the only designated burn center in Suffolk County, Stony Brook University Hospital routinely treats children with burns. The vast majority of these children are not getting burned in house fires.
In fact, 87% of all our pediatric burn patients in 2014 were hospitalized because of burns from hot liquids or objects. For children ages 4 and under, 100% of our hospital admissions were for such burns.
A typical story involves accidentally turning on hot water from the faucet during a child's bath or shower. Another common report is that a small child pulled on a tablecloth, sustaining burns from a hot cup of coffee or tea.
We've also had some injuries when the adult was holding the child while cooking and hot liquids splashed onto them.
Some of the children burned by a hot object involved appliances (such as toaster ovens) or fireplace doors. Over the summer, we had some toddlers who mistakenly had walked barefoot over hot charcoal buried in the sand at the beach.
Whatever the mechanism, these young children were burned by accidental contact with hot liquids or objects in their environments, necessitating hospitalization.
Scald burns — injuries caused by hot liquids or steam — are the most common types
Typically, our pediatric burn patients spend several days in the Burn Center depending upon the severity of the injury. Often, these burns are minor with very little long-term scarring. The treatment team works to minimize the pain while cleaning and dressing the burned areas. Post-discharge plans include continued burn care and dressing changes at home.
It's not uncommon for a referral to Child Protective Services to occur while the child is being treated in the hospital to ensure a safe environment upon return to the home.
Scald burns can be prevented. Nearly 75% of all scald burns in children are preventable, according to the latest data. Here are a few good tips that can spare children (and their parents) from the trauma:
First aid for scald burns is the same as for burns caused by fire:
First, remove the source of heat from the injury. If the burn is at least second degree (blistered skin), remove any clothing from the site, unless it is already stuck to the skin. Cool the burn for about 10-15 minutes with cool or lukewarm water, as by running tap water over it.
Ice should never be applied to a burn, as it can do further damage to the area around the injury.
Blisters in second-degree burns should never be popped. This only increases chances of infection. It is best to wrap the injury very loosely to keep it clean, and seek expert medical attention. Do not place butter, toothpaste, or specialized creams on the burn.
Posted by Stony Brook Surgery on January 7, 2015
More than 30 million Americans suffer from a thyroid disorder, and many more go undiagnosed every year. Now is a good time to become aware of your thyroid and its relationship to your health — and how best to take care of it.
Thyroid nodules and enlarged thyroid glands are common problems, and they can harbor cancers within them. They require proper evaluation and treatment.
When detected, patients with these thyroid disorders are usually referred for further work-up to an endocrinologist, or to an experienced head and neck surgeon, like one of the head and neck surgeons at Stony Brook Medicine.
January is national Thyroid Awareness Month that aims to bring to the public's attention the need to take good care of this important tiny gland in the neck.
Following a thorough work-up, the patient may need to undergo thyroidectomy (removal of part or all of the thyroid gland) for several reasons — for removal of thyroid cancer, removal of part of the thyroid gland for definitive diagnosis, treatment of a hyperactive thyroid gland, or an enlarged thyroid gland that is causing breathing or swallowing difficulties.
The thyroid gland is a small, butterfly-shaped gland located in the base of the neck just below the Adam's apple. Although relatively small, the thyroid gland influences the function of many of the body’s most important organs, including the heart, brain, liver, kidneys, and skin. Ensuring that the thyroid gland is healthy and functioning properly is important to the body's overall well-being.
Since thyroid cancers are highly curable, it is extremely important for the patient to undergo proper treatment and close follow-up. The initial treatment for most thyroid cancers is removal of the thyroid gland, and sometimes removal of lymph nodes which may contain metastatic cancer.
In the hands of a highly-skilled, experienced surgeon, the procedure can usually be done on an outpatient basis and with a low risk of complications. Depending on the type of cancer, some patients may require treatment with radioactive iodine after surgery.
Our thyroid specialists, Mark F. Marzouk, MD, Elliot Regenbogen, MD, and Ghassan J. Samara, MD, perform minimally invasive thyroid surgery in selected patients. This leading-edge approach to thyroidectomy offers these patients attractive benefits, including less postoperative pain, faster recovery, and a smaller scar, thus better cosmetic results.
Also essential is close follow-up by the patient's endocrinologist for tumor surveillance and regulation of the thyroid hormone. Our surgeons take a multidisciplinary approach to providing care for patients with thyroid disorders.
The team of physicians consists of the surgeon, endocrinologists, radiation oncologists, radiologists, and pathologists. Management decisions are often made jointly among the team members. Such a team approach has ensured long-term successful outcomes for our patients at Stony Brook University Hospital.
Hyperthyroidism is a sustained overly active thyroid gland, which may result in anxiety, nervousness, rapid heartbeat, weight loss, and high blood pressure. The causes of hyperthyroidism include Grave's disease and toxic nodular goiter. This condition is treated with medications, radioactive iodine, or thyroidectomy.Role of Surgery in Treating Thyroid Disorders
The advantage of surgery is that the condition can be treated quickly and effectively, minimizing the risk of recurrence. In the past, non-surgical treatment has been the primary approach to patient care because of potential complications associated with the surgery. Now, with surgical expertise and advances in technology at Stony Brook Medicine, more patients are undergoing surgery with minimal complications.
In the past, goiter was treated with medication, but that was proved not to be effective. Patients with goiter now have surgery to alleviate the pressure symptoms on the trachea and the esophagus.
Thyroidectomy is performed for nodules and cancer of the thyroid gland. It is also performed in some patients with overactive thyroid glands.
Surgical intervention is the gold standard in thyroid cancer; there are no other options to cure it.
Traditionally, the procedure is performed through an incision that is about 3-3½ inches in the lower neck. Minimally invasive video-assisted thyroidectomy (MIVAT) is a relatively new approach. It was first perfomed in 1998. With this technique, thyroidectomy is performed through a much smaller incision, usually 1-2 inches.
MIVAT is an adaptation of the established minimally invasive laparoscopic procedures in which similar instrumentation, such as a long narrow telescope attached to a videocamera system, is used to enhance visualization, and special long narrow instruments that grab, cauterize, and cut tissues facilitate dissection through a small incision.
Studies have shown that MIVAT can be safely performed with minimal complication rates, no different from those of conventional thyroidectomy. MIVAT is not appropriate for everyone, and careful patient selection is very important for successful outcome. (See recent study findings.)
Posted by Stony Brook Surgery on January 1, 2015
From Undocumented Immigrant to the Top of His Field and Model of the American Dream
Harold A. Fernandez, MD, joined our faculty in 2012 as professor of surgery and deputy chief of the Cardiothoracic Surgery Division. He serves as co-director of Stony Brook University Heart Institute. He and co-director James R. Taylor Jr., MD, came to us together with the goal of transforming our robust cardiothoracic surgical program into a regional center of excellence, incorporating the newest and most innovative cardiac surgical techniques.
Dr. Fernandez's life story is uniquely inspiring. He came to the United States at age 13 as an undocumented immigrant from Colombia, and within ten years received his bachelor's of science degree in molecular biology from Princeton University, graduating magna cum laude.
Dr. Fernandez earned his medical degree from Harvard Medical School (he was a National Merit Scholar there), followed by a residency in general surgery and a fellowship in cardiothoracic surgery at NYU Medical Center. He joined St. Francis Hospital in Roslyn, NY, in 2001, working closely with Dr. Taylor for the next 11 years before they both came to Stony Brook in 2012.
Dr. Fernandez is the author of a memoir entitled Undocumented: My Journey to Princeton and Harvard and Life as a Heart Surgeon, and has received national publicity for his story as an immigrant who has risen to the height of his profession (see article in New York Times).
So far in his career as a surgeon, Dr. Fernandez has performed over 5,000 heart procedures. He also operates to treat thoracic conditions not involving the heart, contributing to our thoracic surgery service.
Q: Why did you select your field?
A: As a child in Colombia, the doctors who made house calls to care for my grandmothers influenced me. Their ability to heal, and the respect they had in the community, made a lasting impression. I also liked working with my hands, fixing bicycles, putting things together, that kind of thing, which is helpful if you want to be a surgeon. One of the appealing things about cardiac surgery is that it's very technical. It is also a very dramatic field in that you can see the results of your work clearly and immediately, and that fascinates me.
"Being able to fix things with my hands — bringing relief to and extending the lives of
Q: Why choose to work at Stony Brook? What is the opportunity here?
A: The opportunity to continue to work with Dr. James Taylor was important to me. Teaching medical students and surgical residents and being part of different research teams added an extra dimension. The opportunities to grow the program and grow professionally at Stony Brook were, and are, tremendous. The administration has been very supportive and on the same page in terms of creating a top-notch program.
Q: What is the most rewarding aspect of your job?
A: Being able to fix things with my hands — bringing relief to and extending the lives of people suffering from heart conditions — is what drew me to cardiac surgery in the first place and still appeals to me today.
Q: What breakthrough would you most like to make?
A: To me, one of the most important developments is the ability to make heart surgery gentler and less invasive, and to be able to offer these techniques to a wider range of patients, including older and sicker patients, so they have better results. I'd also like to combine our clinical work with some of the basic and translational research going on here at the university. The Heart Institute is positioned well to do both.
"To me, one of the most important developments is the ability to make heart surgery gentler
Q: What might your field look like in the year 2020?
A: I see more collaborative, team approaches to many of the procedures we perform, and greater use of technology and research — in particular, some of the robotic technologies. In addition, I believe our growing ability to manipulate tissues at the genetic level will contribute significantly to what we can do for patients.
Q: If you could send one message to the community about your field, what would it be?
A: At the end of the day, medicine is about people and about patients. No matter how much technology we may have, or how innovative our procedures may be, there is no substitute for compassion. That is one of the things we strive for at the Heart Institute: to use the most advanced technology and latest developments but use them in the most compassionate and caring way.
Q: Do you have a trait you are willing to share, as a window into your personality?
A: I like to spend my spare time with my kids. But an important issue to me personally is access to healthcare by economically disadvantaged populations. I devote a lot of time outside of the hospital reaching out to these communities, including Latin American communities, to talk about heart health. I visit churches and other groups, and also offer educational videos in Spanish.
Posted by Stony Brook Surgery on December 17, 2014
Acid Reflux Disease Is a Serious Health Condition That Doesn't Just Cause Heartburn
President Barack Obama made an unscheduled trip to Walter Reed National Military Medical Center earlier this month because of a sore throat he had for a couple of weeks. The president's physician, Ronny L. Jackson, MD, recommended that he go there for diagnostic tests, in particular computed tomographic (CT) imaging, as well as an evaluation by an otolaryngoloist.
The CT scan was normal. "The president's symptoms are consistent with soft tissue inflammation related to acid reflux and will be treated accordingly," Dr. Jackson says in a written statement released by the White House.
Acid reflux, or gastroesophageal reflux disease (GERD), is a digestive disease that affects an estimated 25% to 35% of the U.S. population. Its common symptom is heartburn. This burning sensation in the chest is caused by stomach acid that flows back into the esophagus, the tube connecting the throat to the stomach.
President Obama's sore throat is a dramatic reminder that stomach acid can also be refluxed into the throat, a condition called laryngopharyngeal reflux (LPR).
LPR can occur without heartburn, making it difficult to diagnose. This is why it is sometimes called "silent reflux."
If LPR is left untreated, it can cause serious damage to the tissues of the throat, upper airway, and the lungs. LPR can also lead to serious problems including vocal cord nodules, subglottic stenosis (airway narrowing), granulomas, and even cancer. In addition, LPR can worsen the conditions of asthma and sinusitis. Common symptoms of LPR include:
President Obama's sore throat offers the opportunity to alert Americans that reflux disease
Commenting on the news about the president's sore throat, Elliot Regenbogen, MD, one of our otolaryngologists with special laryngology expertise, says:
"Initial diagnosis of a sore throat lasting more than five to seven days may consist of a visit to a primary care doctor for simple examination of the mouth and throat culture.
"For persistent symptoms beyond three weeks, a more detailed evaluation by an otolaryngologist is recommended.
"In the president's case, this evaluation included direct visualization of his throat and voice box with a fiberoptic nasopharyngoscope, a tool used in office by otolaryngologists to quickly provide a more detailed understanding of the source of the discomfort.
"If findings are consistent with LPR, 24-hour at-home pH monitoring will frequently be considered prior to treating with medication, dietary modification, or consideration of further workup.
"We offer the Restech pH (acidity) testing for laryngopharyngeal reflux as part of our laryngology program here at Stony Brook. It is a very useful diagnostic tool, and it enables us to provide the most proper treatment to patients.
"Placement of the Restech probe takes only a few minutes, and it is extremely well tolerated."
Melissa M. Mortensen, MD, our other otolaryngologist with special laryngology expertise, also treats LPR using the latest technology. Drs. Mortensen and Regenbogen both focus their clinical practices on advanced diagnosis and treatment of voice and swallowing disorders, as well as on general otolaryngology-head and neck surgery.
For consultations/appointments with our laryngology specialists, please call 631-444-4121. Watch this ABC news clip (2:13 min) about Restech pH testing and hear what two patients have to say about it:
Posted by Stony Brook Surgery on December 3, 2014
Lumpectomy, also known as breast-conserving surgery, is the most common form of breast cancer surgery today.
Lumpectomy may be used as a part of a treatment plan for breast cancer in cases of small, localized tumors. During lumpectomy, the cancerous lump and a portion of the breast tissue around the cancerous lump are removed.
With lumpectomy, the breast itself remains intact, and this treatment option appeals to many women. Studies have shown that women who undergo lumpectomy followed by radiation have similar overall survival rates as those who undergo mastectomy.
A new study, titled "Repeat Surgery after Breast Conservation for the Treatment of Stage 0 to II Breast Carcinoma," was just published in JAMA Surgery.
This study analyzed records from over 300,000 breast cancer patients who had lumpectomy as their initial surgical procedure: 76% had successful lumpectomy, whereas 24% of patients required additional surgery because of close or positive microscopic margins (inadequate lumpectomy).
The ideal lumpectomy removes all breast cancer cells with a small healthy rim of tissue around it. That’s called a clear margin. However, cancer cells are not readily visible at the time of surgery, and even the most sophisticated preoperative imaging techniques can only estimate the size and extent of cancer in the breast.
So, the lumpectomy is performed to hopefully get clear microscopic margins, using the best available preoperative information, while trying to save as much breast tissue as possible.
The safety of breast conservation treatment has withstood the test of time. If re-excision rates
Mohs surgery for skin cancer utilizes real-time margin analysis, permitting the surgeon to afford negative margin surgery during the first operation. Unfortunately, because of the fatty nature of breast tissue, the "frozen" technique is not possible, so that Moh’s surgery cannot be applied to breast lumpectomy surgery.
There are many factors that can affect the rates of additional surgery (re-excision rates).
First of all, the definition of a clear margin varies. A surgeon who requires a 3-mm microscopic margin will have a higher re-excision rate than one who accepts a 1-mm margin.
Also, a surgeon who performs a larger lumpectomy initially has a better chance of clear margins, but what if it turns out that a big lumpectomy wasn’t really needed?
Finally, a surgeon who takes on challenging lumpectomy cases will have a higher re-excision rate than one who is quick to recommend mastectomy for difficult cases.
A recent panel of experts, convened at a consensus conference concerning lumpectomy margins, concluded that even a very narrow microscopic margin is acceptable, as long as cancer cells are not touching the inked margin, assuming that post-lumpectomy radiation is utilized:
"The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR [ipsilateral breast tumor recurrence] and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease healthcare costs" [read more]. The authors of the JAMA Surgery study promote these guidelines.
Women with breast cancer interested in breast-conserving lumpectomy as an alternative to
In 1990, the National Institutes of Health Consensus Development Conference on Treatment of Early-Stage Breast Cancer concluded:
"Breast conservation treatment [BCT] is an appropriate method of primary therapy for the majority of women with stage I and II breast cancer and is preferable because it provides survival rates equivalent to total mastectomy while preserving the breast" [read more].
In the 25 years since, nothing about that statement has changed. The safety of BCT has certainly withstood the test of time.
If re-excision rates alone are used as quality indicators, the message will be inaccurate and misleading.
Women who are interested in BCT as an alternative to mastectomy should seek out an experienced, knowledgeable, skillful breast surgeon, who will work hard to save the breast, with the best cosmetic result possible, even if it requires more than one operation.
Posted by Stony Brook Surgery on November 26, 2014
How to Avoid a Gallbladder Attack from All the Delicious Thanksgiving Food
Most surgeons on-call during the Thanksgiving holiday and the subsequent holiday season are not surprised when a patient visits the ER complaining of upper right side, abdominal pain and tenderness radiating through to the back.
There are also no surprises when an ultrasound shows a dilated gallbladder, possibly with a thickened wall, and gallstones ranging from the size of a pebble to the size of a marble or even an egg. At this point, surgery is the next logical step — a cholecystectomy, or gallbladder removal, which is one of the most common surgical procedures in the United States.
In 2013, over the Thanksgiving holiday weekend, surgeons at Stony Brook University Hospital performed 16 cholecystectomies. This number reflects the common spike associated with the holiday.
Here, Mark A. Talamini, MD, professor and chairman of surgery, who is a renowned gastrointestinal surgeon, shares a few practical tips on how to prevent a visit to the ER, and keep you at home with your family during the Thanksgiving holiday:
Click here for more about gallstones and how to prevent a gallbladder attack. And don't let heartburn be a GI holiday spoiler, either: see our tips blog from last year about GERD Awareness Week, which is Thanksgiving week.
Posted by Stony Brook Surgery on November 19, 2014
Excellence and Innovation Are Focus of Stony Brook University Heart Institute
James R. Taylor Jr., MD, joined our faculty in 2012 as professor of surgery and chief of the Cardiothoracic Surgery Division. He serves as co-director of Stony Brook University Heart Institute. He and co-director Harold A. Fernandez, MD, came to us together with the goal of transforming our robust cardiothoracic surgical program into a regional center of excellence, incorporating the most advanced cardiac surgical techniques.
Since his arrival at Stony Brook, Dr. Taylor has made heart surgery more available here for people who need it. Among his accomplishments, he led the creation of our new cardiothoracic intensive care unit (CTICU) for the care of patients immediately after cardiac surgery.
Dr. Taylor received his medical degree from the Medical University of South Carolina, followed by residencies in general and cardiothoracic surgery at New York Hospital-Cornell Medical Center. He completed a cardiothoracic surgery fellowship at the same institution. He joined St. Francis Hospital in Roslyn, NY, in 1991, and built a reputation during 21 years there as one of the most prolific and top-quality heart surgeons in New York State.
Here, Dr. Taylor answers questions about himself as well as about his vision of the future of heart surgery, including the upcoming use of innovative techniques to advance the care provided patients at Stony Brook.
Q: Why did you select your field?
A: I began my career as a pharmacist and after serving the needs of many patients with heart problems and getting to know them — their concerns, their fears, their hopes — I realized that I wanted to do more than just manage their drug therapy. The challenge of diagnosing and treating cardiac patients appealed to me, and I was interested in cardiovascular physiology. I knew then that cardiovascular surgery was the right choice.
Q: Why choose to work at Stony Brook? What is the opportunity here?
A: At Stony Brook, I saw tremendous potential and an opportunity to grow. Stony Brook is the only true university healthcare system on Long Island, and we offer a full range of advanced treatments: extracorporeal membrane oxygenation (ECMO), left ventricular assist devices (LVADs), complex aortic aneurysm surgery, valve surgery, robotic surgery, coronary bypass surgery, and transcatheter aortic valve replacement (TAVR).
I also was pleased to be able to bring my co-director at the Heart Institute, Dr. Fernandez, with me after 10 years of working together at Saint Francis Hospital. I am not sure I would have come if I had not been able to encourage him to join me.
"I'd like to advance the use of robotic cardiac surgery
We're honing our techniques for
Q: What is the most rewarding aspect of your job?
A: There are two. As a cardiac surgeon, I am with patients and families during pivotal moments in their lives. I learn from them every day about the strength of the human spirit and how much families really rely on each other when faced with these sort of life-altering challenges. I've been doing this for over two decades, and it's always rewarding to hear from patients about how they are enjoying life again.
It's also rewarding to be educating the next generation of surgeons who are so hungry to learn and experience, and have the same drive and passion that I have for our profession.
Q: What breakthrough would you most like to make?
A: I'd like to advance the use of robotic cardiac surgery. Its advantages for patients are that you don't have to open the sternum so there is much less discomfort in the early postoperative period. And the visualization offered by robotic surgery is exceptional. For example, with robotic mitral valve surgery, we can look at the mitral valve without having to distort or retract it as we would if going in through the sternum. Seeing it in situ helps us evaluate the valve better. We're honing our techniques for robotic mitral valve repair, and will be using this innovative technique regularly within a few months.
Q: What might your field look like in the year 2020?
A: If you look at what's been happening in the last five years, it's clear more people will be able to benefit from cardiac interventions done percutaneously, that is, through tiny punctures in the skin. We will be able to do the majority of procedures through small ports, either through the apex of the heart or through the aorta or its branches, using high-tech operating rooms combined with radiology suites. We'll be looking at the heart, great vessels, and valves in real time with both x-ray and echocardiography, while accessing the arteries and veins using guide wires and other techniques to deliver a valve or implant a stent. We're doing these things now, but in a small subset of the population. By 2020, it is expected that this will be the norm.
Q: If you could send one message to the community about your field, what would it be?
A: I'd like people to know that cardiac surgery is well tolerated, life changing, beneficial, and should not be feared. Even though it's serious surgery, it's very low risk for most people, and the outcomes are excellent. I'd also like people to know that postoperative pain is not the issue it used to be. The techniques we are using now make recovery much easier and faster.
Posted by Stony Brook Surgery on November 12, 2014
Measuring Up to the Professional Standards of the American College of Surgeons
Three members of our faculty — plastic surgeon Tara L. Huston, MD, vascular surgeon Shang A. Loh, MD, and general surgeon Dana A. Telem, MD, all assistant professors of surgery — were inducted into the fellowship of the American College of Surgeons at the annual ACS congress held last month in San Francisco. Now, the credentials of Drs. Huston, Loh, and Telem include FACS, and this says a lot about them as surgeons. It means they measure up to the high standards of excellence maintained by the ACS.
FACS means a surgeon's education and training, professional qualifications, surgical competence,
The ACS is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice.
Members of the ACS are referred to as fellows. The letters FACS (Fellow, American College of Surgeons) after a surgeon's name mean that the surgeon's education and training, professional qualifications, surgical competence, and ethical conduct have passed a rigorous evaluation, and have been found to be consistent with the high standards established and demanded by the college.
The ACS currently has about 79,000 fellows, including more than 4,000 fellows in other countries, making it the largest organization of surgeons in the world.
Click here to learn more about what FACS means and the qualifications required to achieve it. Watch this ACS video (4:21 min) celebrating the college's centennial last year and its commitment to quality:
Posted by Stony Brook Surgery on November 5, 2014
Dr. Parikh comes to Stony Brook from Albany Medical Center, where since 2010 she was an attending surgeon and full-time member of the surgical faculty of SUNY's University at Albany.
Board certified in surgery, Dr. Parikh specializes in hepatobiliary and complex foregut general surgery. She performs a wide range of procedures. She has advanced training in hepatobiliary surgery, having completed a two-year fellowship at Indiana University.
Dr. Parikh's clinical interests include pancreatic cancer, liver cancer, and other complex biliary procedures with a specific interest in necrotizing pancreatitis and other benign pancreatic conditions. Additionally, she has an interest in complex gastrointestinal cancers.
Given the range of her surgical expertise, Dr. Parikh will contribute to our general surgery service, as well as to our upper gastrointestinal and general oncologic surgery service.
In addition, Dr. Parikh will contribute to our new exigent general surgery service that streamlines the care of patients presenting in the ER with acute abdominal conditions. Providing minimally invasive treatment in most cases, this new service decreases both the time to surgery and the length of stay in the hospital.
Dr. Parikh's research interests include clinical research that focuses on pancreatic disorders, as well as other gastrointestinal and hepatobiliary diseases. By concentrating on clinical treatment regimens and outcomes research, her research examines quality, delivery, and financing of care in order to have an immediate impact on patient care and systems improvements.
Dr. Parikh received her MD from Drexel University in 2001. She completed her residency training in general surgery at the University of Nebraska Omaha, followed by her fellowship in hepatobiliary surgery at Indiana University.
See Dr. Parikh's profile page for more information. For consultations/appointments with her, please call 631-444-4545 for general surgery and 631-638-1000 for cancer care.
Posted by Stony Brook Surgery on October 29, 2014
Study Finds Increase in Patients, Once Deemed High Risk, Who May Be Eligible for Immediate Reconstruction
Breast reconstruction can be performed at many different time points following care for breast cancer. Immediate breast reconstruction means surgery is done at the same time, while delayed reconstruction is carried out months or years later, once all oncologic care is complete. National rates of breast reconstruction following mastectomy have risen over the past decade.
Here at Stony Brook Medicine, we reconstruct approximately 90% of our patients who have mastectomy. However, surprisingly, this rate is still below 40% across the country.
Both methods of breast reconstruction — implant-based and autologous (using a patient's own tissues) — have seen a significant increase.
This observed increase is due to many factors, including the passage of the Women's Health and Cancer Rights Act; more prophylactic mastectomies; a greater acceptance of breast implants following the FDA's lifting of the silicone implant ban; and state laws that mandate that breast surgeons inform their patients about reconstructive options.
An important study, titled "Diminishing Relative Contraindications for Immediate Breast Reconstruction," was published this month in the Journal of the American College of Surgeons by the team at Memorial Sloan Kettering Cancer Center. It is an exciting multi-center study that supports and underscores what we do here in Stony Brook's state-of-the-art breast reconstruction program.
This well-executed retrospective study, encompassing data from 1,040,088 patients over a 14-year period, verified that more women are having reconstruction surgery at the time of surgical treatment for their breast cancer. Even more remarkably, there is a rise in patients who were once considered too high risk for the reconstruction.
Patients, their breast surgeons, and their plastic surgeons are, as a team,
Features considered high risk are: age over 60; stage III or IV breast cancer; and history of, or present need for, radiation therapy to the chest wall.
As little as ten years ago, the need for postoperative radiation was considered by many to be an absolute contraindication to immediate reconstruction. Fortunately, this is no longer the case.
The authors of the study concluded that a leading force behind the change is plastic surgeons' willingness to perform reconstruction in these high-risk patients. The authors believe that increased experience with high-risk patients has given plastic surgeons the knowledge to push the boundaries of what can be achieved.
This forward thinking is important because nearly half of all newly diagnosed patients fall into one of the high-risk categories. The good news is that the overall reconstructive success rate in this population was found to be greater than 88%. Adverse events the authors discussed were tissue expander loss, permanent implant removal, and complications with the autologous flaps.
Not only do the study authors believe that the increased rate is due to plastic surgeons who are willing to attempt breast reconstruction following mastectomy, but even more importantly, they believe that there is an increased acceptance on the part of patients. The risks of failure of immediate reconstruction are often outweighed by the tremendous benefits including an improved body image and higher quality of life.
There are data demonstrating a greater satisfaction with quality of life in the first two years following mastectomy if reconstruction was performed.
What does all this mean for our patients at Stony Brook Medicine? It means progress. Rates of breast reconstruction have gone up in high-risk patients. Reasons that patients should not have immediate reconstruction are shrinking. This is because of patients, their breast surgeons, and their plastic surgeons, who, as a team, are willing to push the envelope in order to improve care.
At Stony Brook Medicine, we strongly believe that all women have the right to learn about and potentially proceed with reconstruction which may improve self-image, self-esteem, and quality of life.
Read the abstract of the MSKCC study provided by the National Library of Medicine. Please call 631-444-4666 for an appointment to discuss reconstruction options with Dr. Huston and our other breast reconstruction specialists.
Posted by Stony Brook Surgery on October 15, 2014
New Study Finds Daytime Better for Minimally Invasive Surgery for Acute Cholecystitis
Laparoscopic gallbladder removal — cholecystectomy — was introduced in the late 1980s, and has largely replaced the open procedure for the majority of the 770,000 cholecystectomies performed annually in the United States. Indeed, laparoscopic cholecystectomy is currently the most commonly performed major abdominal procedure in Western countries.
This procedure generally decreases post-op pain, decreases the need for post-op pain medication, and speeds recovery and the patient's return to full activity, compared with open cholecystectomy. It also provides less scarring, and it is associated with improved patient satisfaction as compared with the open procedure.
However, certain circumstances in the operating room may necessitate converting to an open procedure, thus depriving patients of the benefits of the laparoscopic technique. Last month, the American Journal of Surgery published a news-making study based on a large retrospective analysis comparing daytime versus nighttime laparoscopic cholecystectomy for acute cholecystitis.
Here, Purvi Y. Parikh, MD, assistant professor of surgery, who is a leader on our exigent general surgery service, provides commentary on this study, and explains how the study findings relate to the newly established special protocol and resources for optimum treatment of acute cholecystitis at Stony Brook Medicine.
With the current emphasis on outcomes-based surgery, the cholecystectomy study just published in the American Journal of Surgery is important to help establish guidelines for optimal timing for surgery, as the optimal timing of surgery for acute cholecystitis remains controversial.
One area of uncertainty remains whether patients should undergo early (same hospitalization) versus delayed (six or more weeks after discharge) cholecystectomy. Studies have found that delayed cholecystectomy was associated with higher rates of conversion to open surgery and longer hospital stay.
In a systematic review of randomized controlled trials, 18% of patients randomized to delayed cholecystectomy experienced recurrent symptoms necessitating emergent cholecystectomy, and that subset of patients experienced a 45% conversion rate to open surgery.
A large review of laparoscopic cholecystectomy for acute cholecystitis found incrementally worse outcomes for each day surgery is delayed during the hospitalization. Patients that undergo cholecystectomy within 48-72 hours of admission for acute cholecystitis were associated with reduced conversion rate, operative time, length of stay, and hospital costs.
The so-called Tokyo guidelines, a consensus statement developed by hepato-biliary-pancreatic specialists, recommend early cholecystectomy for acute cholecystitis, and only delayed cholecystectomy in select high-risk patients. Considering these findings, some institutions perform cholecystectomy at night to avoid an excessive delay in time to operation.
At Stony Brook we believe the best treatment for acute cholecystitis is early
In this present study, nighttime (7 pm to 7 am) cholecystectomy was associated with an increased conversion rate to open surgery but had a similar length of stay and complication rate as daytime (7 am to 7 pm) cholecystectomy.
The observed increase in conversion rate during nighttime cholecystectomy was not associated with worse severity of disease or patient condition.
The study presumed that the increased conversion rate was attributable to system-based factors, such as limited operating room availability during daytime hours, limited nighttime resources and personnel, and anticipation of trauma cases at trauma centers that may influence provider decision-making at night that would increase conversion rate to open surgery.
The authors of the study concluded that because of the elevated conversion rate, laparoscopic cholecystectomy for acute cholecystitis should be delayed until regular daytime hours.
We believe that early cholecystectomy for acute cholecystitis is the best treatment for the patient.
With the establishment of the Department of Surgery's new exigent general surgery service, we have developed a protocol for patients with acute cholecystitis.
Patients with acute cholecystitis are streamlined from initial presentation in the emergency room, to exigent general surgery service evaluation, to a dedicated exigent general surgery service operating room during daytime hours, then to the post-anesthesia care unit and discharge home within 24 hours.
For more complicated patients, the exigent general surgery service is able to direct preoperative optimization so that the time-interval to surgery may be decreased. Our goal is to overall decrease patient duration until surgery, length of stay, and hospital costs, while providing the best care for the patient.
See abstract of the article, "Can It Wait until Morning? A Comparison of Nighttime versus Daytime Cholecystectomy." For consultations/appointments with Dr. Parikh concerning general surgery, please call 631-444-4545.
Posted by Stony Brook Surgery on October 8, 2014
October is National Breast Cancer Awareness Month and a special time for us to promote breast cancer awareness and provide information on the disease.
Established in 1985, this awareness month, now an international health observance, has from the start aimed to promote mammography as the most effective weapon in the fight against breast cancer. Since then, breast cancer research has also become an important weapon in this fight.
At Stony Brook Medicine, breast cancer is the focus of a comprehensive, academic program — the only one of its kind on Long Island. At its core is our multidisciplinary breast cancer team.
Here, Brian J. O'Hea, MD, chief of breast surgery and director of Stony Brook's Carol M. Baldwin Breast Care Center, answers some of the frequently asked questions women raise after they have been diagnosed with breast cancer. The bottom line is that every woman's situation is different, and treatment needs to be tailored to the type of cancer, personal and family history, tolerance levels for treatment, and personal preferences.
Dr. O'Hea's perspective, as one of the area's premier breast cancer surgeons, gives women information to serve as discussion points with their doctors.
Breast cancer is the most common cancer among American women, other than skin cancer.
Q: What is a lumpectomy and is it safe?
A: A lumpectomy is the removal of a tumor from the breast along with some of the surrounding normal tissue.
When a lumpectomy is recommended, many women consider whether a mastectomy might be a safer choice in terms of recurrence and survival. Long-term studies have demonstrated that a lumpectomy provides survival rates equivalent to a mastectomy while preserving the breast.
A lumpectomy is often recommended to treat a single tumor that is small to medium in size. Patients with a large tumor or multiple tumors are often treated with a mastectomy. Also, the location, type of tumor, and other factors all must be considered with your doctor when making this important treatment decision.
Q: Why do lumpectomies require follow-up radiation?
A: Even when lumpectomies show totally “clean" (cancer-free) margins after surgery, radiation is required because of the natural distribution pattern that breast cancer takes. Not all the cancer stays together.
Some tiny, isolated cells may migrate to other parts of the breast beyond the scope of the surgery. This has nothing to do with the skill of your surgeon, but everything to do with the nature of breast cancer and how it manifests.
Q: If lymph nodes are “clean" (cancer-free) following surgery, why is chemotherapy needed?
A: Think of chemotherapy as an insurance policy against future cancer. This form of treatment circulates a powerful drug or a combination of drugs through all parts of the body to kill any cells that may have floated away from the cancer site and lodged in other areas.
Whether this actually happens depends on the characteristics of the tumor; some tumors can put women at a higher risk for scattered cells. This is why chemotherapy is the recommended precautionary measure.
Are you worried about the cost of mammography? CDC offers free or low-cost mammograms.
Q: If a doctor recommends a mastectomy on just one breast, wouldn't it be safer to have a bilateral mastectomy (removal of both breasts)?
A: Long-term studies show that there is a 15% risk of a woman developing cancer in the opposite breast. However, women at higher risk may need to consider the bilateral mastectomy because their odds of developing cancer in the healthy breast are much higher.
These risk factors include a strong family history of breast cancer and the presence of the BRCA gene, which indicates a genetic disposition to breast cancer.
Q: Are there any new options when it comes to reconstruction?
A: Fortunately, because of dramatic improvements in imaging and screening technology, we are more able to find cancer in its earliest stages, which offers some women an opportunity for breast conservation instead of mastectomy.
At Stony Brook, 65% of the women treated for breast cancer have breast preservation surgery. Our surgeons work closely with plastic and reconstructive surgeons to maximize cosmetic outcomes.
Techniques include inserting AlloDerm®, a type of collagen, along with the tissue expander to give a more natural shape to the breast; smaller and more limited incisions that preserve as much of the natural breast skin as possible to facilitate a more natural reconstruction; and a new total skin- and nipple-sparing technique that leaves all of the breast skin in place, which also helps achieve the most natural result available.
However, the nipple-sparing technique is possible in only a small group of highly selected patients requiring a mastectomy [see our FAQs about nipple-sparing mastectomy].
As an academic medical center and accredited breast care center, Stony Brook works to continually refine techniques to make them more widely available for more patients.
Special events for Breast Cancer Awareness Month: Stony Brook University Cancer Center and the Town of Brookhaven are partnering to "Turn the Town Pink." CDC fact sheet, "Breast Cancer: What You Need to Know."
Posted by Stony Brook Surgery on October 1, 2014
Providing Special Guidance and Support to Female Medical Students
The Stony Brook Medicine Student Branch of the American Medical Women's Association (AMWA) sponsors a mentoring program for medical students to provide them with special guidance and support. Faculty in the Department of Surgery are active in the program, and of the 28 school-wide faculty matched this year to provide mentor oversight, five (18%) are from our department.
At the start of each academic year, the AMWA mentoring program pairs female faculty members with female students in Stony Brook's School of Medicine, providing them with opportunities to gain insight into their fields of interest from the perspectives of professional women who have gone through the process.
A common focus is placed on work/life balance, as well as long-term professional career development, scholarly endeavors, and life-long learning skills.
AMWA focuses on effective mentor-mentee interactions balancing three key elements:
The Department of Surgery's faculty that matched as mentors this year are: Paula I. Denoya, MD, assistant professor of surgery; Angela A. Kokkosis, MD, assistant professor of surgery; Melissa M. Mortensen, MD, assistant professor of surgery; Aurora D. Pryor, MD, professor of surgery and chief of general surgery; and A. Laurie W. Shroyer, PhD, MSHA, professor of surgery and vice chair for research.
Dr. Shroyer says, "I strongly support this program, and I am very excited to see the very high participation rate of our Department of Surgery's female faculty members."
Eight students have been assigned to these mentors for the current academic year. Four are first-year students — Chelsea Dahl, Danielle Fassler, Malack Hamade, and Kelli Summers — and the others are second-year students — Sydney Beck, Nicole Golbari, Jessica Johl, and Lydia Liu.
One of Dr. Shroyer's several long-time mentees is Brianne Sullivan, a fourth-year student, who is applying to surgical residency programs this year. She is a former co-president of Stony Brook's AMWA Student Branch.
About her experience in the mentoring program, Ms. Sullivan says: "This program is wonderful, and I think it is very important for those seeking guidance and mentorship, especially when relating to some of the unique challenges faced by females in medicine. The program gave me a glimpse at my potential future, and made me realize that to a degree I needed to be considering future goals and plans. It gave me a rough idea of what to expect in the years to come.
"We have a potluck dinner where the faculty mentors come to meet the students, and they discuss a little bit about their personal and professional life and how they got to where they are today.
Mentees are encouraged to look for opportunities to expand their network of colleagues
"I think this exposure is invaluable. I could look at successful women who at one point were in my shoes, wondering where medicine was going to take them, and hear about their journey. Their stories gave me confidence that I would make it too, and made me excited for the ride.
"Dr. Shroyer lent unconditional support and advice throughout my four years of medical school. Having a person like that to reach out to is very reassuring, and I am very grateful to have been involved in this program and to have met her.
"For me, surgery more fell into place once I did my third-year rotation and realized that I had the same passion for the OR and surgeries as the vascular surgeon I spoke to at the potluck dinner."
Commenting on the importance of the department's contribution to the AMWA mentoring program, Mark A. Talamini, MD, professor and chairman of surgery, says: "The specialty of surgery, unfortunately, is late in its appropriate incorporation of women at all levels into the field. There are reasons for this which are inherent in the specialty itself.
"We have made it difficult for women to both have a successful career in surgery and be effective in their family roles. This has been a deficit and a loss both for our patients and for our profession. We are in the process of correcting this, and the mentorship by our spectacular women surgeons and scientists will go a long way, person to person, to address the profession's shortfall."
About AMWA and Its Presence at Stony Brook
AMWA is a professional organization that functions at the local, national, and international level to advance women in medicine and improve women's health. It fulfills its mission by providing and developing leadership, advocacy, education, expertise, strategic alliances, and mentoring.
Founded in 1915, AMWA began when women physicians were an under-represented minority. As women in medicine increase in numbers, new issues arise that were not anticipated. AMWA has been addressing these issues for nearly a century. Its membership comprises women physicians, medical students, and others dedicated to the advancement of women in medicine.
AMWA's Student Branches provide support and resources for their members, plus valuable leadership and mentoring opportunities. Branches organize local events and facilitate interactions and connection with national AMWA initiatives and leadership. Branch leaders also act as the face of AMWA on their medical school campuses.
At Stony Brook, women physicians on the faculty established AMWA's presence here soon after the School of Medicine was established. Last year, the Student Branch renewed its official affiliation with the national organization. It is run by medical students themselves, with a faculty advisor.
"We will continue to seek venues and ways to attract women to our field, and to our department
The mentoring program sponsored by our Student Branch was started in the 1990s.
Jadry Gruen, one of the branch's current co-presidents, says, "In addition to matching interested students with female physicians at Stony Brook through our mentoring program, we also host events like an annual student-faculty potluck, lectures on women in medicine/the workforce, preview documentaries, and host panel discussions and any number of events that promote insightful conversation about the role of women in leadership and in medicine."
"Several of our members are helping to organize an upcoming regional AMWA event held in New York," adds Ms. Gruen. "AMWA members from Stony Brook have participated in this regional conference in the past, and we have even hosted the event at the SBU campus."
Most of the current female faculty in the Department of Surgery have participated in the Stony Brook AMWA mentoring program. Some not matched in the current academic year continue to mentor students from previous years. New faculty intend to join.
All told, the department is doing its part to provide special guidance and support to female medical students here through AMWA, and to encourage them to pursue careers in surgery.
While the gender gap remained particularly large among surgeons throughout the 20th century, the new century has seen the number of women attending US medical schools reach that of men, and the gap is apparently closing among graduates entering general surgery training programs, according to a recent study published in the Journal of the American College of Surgeons.
"We will continue to seek venues and ways to attract women to our field, and to our department here at Stony Brook," says Dr. Talamini. "Fortunately, we have a nucleus of absolutely outstanding women surgeons and scientists on our faculty who are naturally attractive as role models to our learners here at Stony Brook."
Posted by Stony Brook Surgery on September 24, 2014
Varicose veins affect approximately 40% of the adult population. They are superficial vessels that are abnormally lengthened, twisted, or dilated, and are seen most often on the legs and thighs.
Varicose veins bulge and rise above the skin's surface. They may be uncomfortable and result in swelling of the legs. If left untreated, varicose veins may lead to more serious medical problems, such as phlebitis (swelling and inflammation of a vein) or leg ulcers.
Here, Angela A Kokkosis, MD, assistant professor of surgery (Vascular Surgery Division) who practices at the Stony Brook Vein Center, answers questions about endovenous laser treatment for varicose veins. Dr. Kokkosis and her vascular colleagues also offer free screenings at the Vein Center to discuss these and other related questions; see contact info below.
Q: What is endovenous ablation?
A: Endovenous ablation is a treatment for closing the saphenous vein in the leg, which is typically the main superficial vein associated with varicose veins. This treatment can be performed with either laser or radiofrequency (RF) technology.
Q: How does endovenous ablation work? What does it do to a varicose vein?
A: A thin catheter (flexible tube) is inserted into the vein through a tiny skin puncture, and the entire length of the vein is treated with laser or radiofrequency through the catheter, thus "injuring" the vein's wall.
At the Stony Brook Vein Center, we use the latest technology to treat varicose veins with
Sclerotherapy involves the injection of a specially-developed solution (Sotradecol) into the varicose vein. The solution then hardens, causing the vein to close up or collapse.
Microphlebectomies involve the removal of the vein by tiny punctures or incisions along the path of the enlarged vein. Through these tiny holes, we use a surgical hook to remove the varicose vein, which results in minimal scarring.
Q: Does loss of a laser-treated vein create a health problem in any way?
A: The leg has two systems of veins, the deep and the superficial. Between these two systems there are many collateral pathways to enable normal venous blood flow. When the diseased superficial system is treated, the blood gets redirected into the deep system without affecting blood flow in the leg.
Q: What is the recovery time after endovenous laser treatment?
A: Patients are encouraged to start walking immediately after the procedure, but they should avoid any strenuous exercises involving the legs (such as weight training) for two to three weeks, to enable adequate time for healing and for the treated veins to remain closed. There is bruising and mild discomfort in the treated leg for two to four weeks.
Q: How much time does it take to see the results after the laser procedure?
A: Within one week patients may start to notice a difference in the prominence of their varicose veins, but complete results may take weeks to months. Additionally, some patients may require adjunctive procedures depending on the severity of their varicose veins, as mentioned above.
Q: What is the risk of recurrence of varicose veins after endovenous ablation treatment?
A: Varicose veins are the result of a progressive disease, and while we can treat the problematic veins now, it is up to the individual patient, their genetics, and their lifestyle which dictate whether other varicosities will develop over time.
Q: What are the risks and potential complications of the laser/RF procedure?
A: The goal of the endovenous procedure is to thrombose, or clot, the saphenous vein (a superficial vein). Rarely, there are situations where the clot can extend into the deep vein system and cause a DVT (deep venous thrombosis).
Q: How does laser/RF treatment compare with other treatment options, including surgery?
A: Previous generations performed the tradition “vein stripping" in which the entire saphenous vein would be removed through large skin incisions, with less than cosmetic results. With the current endovenous ablation, there is no need for skin incisions to obtain excellent results of varicose vein resolution.
Q: Will insurance cover the laser procedure?
A: Many insurance companies cover the endovenous ablation procedure with or without the adjunctive sclerotherapy or microphlebectomy procedures based on various criteria. In our practice at Stony Brook, an individualized discussion takes place with the patient regarding this process.
Q: Why is the Stony Brook Vein Center the place to go for endovenous ablation treatment? What makes it special there?
A: Our staff and vascular surgeons manage a large population of patients with venous disease, and we manage a variety of both common and complex cases. The unique needs of patients with varicose veins are recognized by everyone at our practice, and we strive for exceeding the expectations of our patients.
We use the latest technology to treat varicose veins with endovenous ablation, and we also are leaders in using minimally invasive treatments, such as the new drug therapy called Varithena, which we are the first on Long Island to offer.
Click here for more information about varicose veins and their treatment. For consultations/appointments with Dr. Kokkosis and our other vein specialists, please call 631-444-VEIN (8346).
Posted by Stony Brook Surgery on September 17, 2014
Boxer Travels from Greece to Be Treated by Our Doctors to Get Back in the Ring
For the past five years, 17-year-old Nikoleta Pita of Piraeus, Greece, has dreamed of making her country's Olympic boxing team. As a two-year national team member with a strong won-lost record, her dream was getting close to becoming a reality.
But almost a year ago, after a period of intense weight training, her right arm and shoulder suddenly swelled up and became very painful. And she developed numbness in her fingers.
Doctors in Greece told her she had clotted her right subclavian and axillary veins, the main veins draining the arm, and to stop everything — making her dream to become an Olympian come to a sudden halt.
Ms. Pita was diagnosed with thoracic outlet syndrome (TOS), a disorder that occurs when the blood vessels or nerves of the arm become compressed in the space between the collarbone and the first rib (thoracic outlet).
She was offered only conservative treatment with blood thinners by her doctors in Greece, who strongly suggested that she should completely abandon boxing or any other sport that involves intense weight training of the arms.
The boxer in Ms. Pita was hit hard by all this, but she wasn't going to give up.
With the support of her family she found out that a surgical treatment could help her keep her boxing career alive, but she would have to travel abroad to get the treatment she needed.
Through a family friend who had visited Stony Brook Medicine as an observing physician, Ms. Pita and her parents — Archilleas and Agapi Pita — learned of a doctor that could take care of her problem in the United States.
Apostolos K. Tassiopoulos, MD, professor of surgery and chief of vascular and endovascular surgery, who was in Athens for a scientific meeting, met with Ms. Pita and her family, and he discussed the surgical treatment that could get their daughter back in the ring.
Ms. Pita arrived in New York on August 31. The next day, Dr. Tassiopoulos and his colleague Thomas V. Bilfinger, MD, ScD, professor of surgery and director of thoracic surgery, performed the surgery together to remove the first rib and free the attached muscles in order to free the compressed vein.
The surgeons made an incision in the armpit, and then removed the rib and the muscle attached to it, which allowed for more space around the vein. Patients usually need physical therapy after surgery to get their strength back.
One day after surgery, Ms. Pita felt great and ready to get back to her dream. "I'm feeling really strong, physically and mentally," she said. "This has definitely changed my life — Stony Brook saved my career, saved my dream."
Just after one week in the United States, Ms. Pita and her parents flew back to Greece.
About Thoracic Outlet Syndrome
Common causes of TOS can include physical trauma from a car accident, repetitive injuries from job- or sports-related activities, certain anatomical defects (such as having an extra rib), and pregnancy. However, often doctors cannot determine the exact cause of this syndrome.
TOS symptoms can vary, depending on which structures are compressed.
When nerves are compressed, signs and symptoms of TOS include wasting in the fleshy base of the thumb (Gilliatt-Sumner hand); numbness or tingling in the arm or fingers; pain or aches in the neck, shoulder, or hand; and weakening grip.
The hallmark of venous compression is painful swelling of the forearm and back of the hand particularly, often accompanied by a bluish discoloration of the skin. Symptoms may include numbness, tingling, aching, swelling of the extremity and fingers, and weakness of the neck or arm.
The purpose of thoracic outlet surgery is to release or remove
When arteries are compressed, the most prominent features are change in color and cold sensitivity in the hands and fingers, swelling, heaviness, paresthesias (tingling, tickling, or burning sensation of the skin), and poor blood circulation in the arms, hands, and fingers.
TOS is more common in women. The onset of symptoms usually occurs between the ages of 20 and 50. Doctors usually recommend nerve conduction studies, electromyography, or imaging studies to confirm or rule out a diagnosis of TOS.
Common treatment for TOS usually involves physical therapy and pain relief measures. Often, when only nerves are compressed but blood vessels are intact, patients will improve with these approaches.
However, when clots develop in the blood vessels or when pain from nerve compression is not improved with conservative measures, doctors usually recommend surgery.
The purpose of thoracic outlet surgery is to release or remove the structures causing compression of the nerve or blood vessels. TOS is known to affect athletes, particularly overhead athletes such as swimmers and baseball players. With appropriate care, these athletes can return to full activity within three to four months from surgery.
Click here for more information about thoracic outlet syndrome. For consultations/appointments with our surgical specialists, please call 631-444-4545.
Posted by Stony Brook Surgery on September 15, 2014
Our Chairman Talks about the Power of Innovation and Excellence at Stony Brook
Mark A. Talamini, MD, professor and chairman of surgery, just appeared as the featured guest on BlogTalkRadio's "Strategies of Success." Host Brian A. Cohen interviews him, focusing on how Dr. Talamini identified his career goals, and how he has pursued them to the max.
Dr. Talamini explains that Stony Brook Medicine and Stony Brook University attracted him as an opportunity to further his career goals by joining a dynamic multidisciplinary team committed to advancing healthcare through technological innovation.
Dr. Talamini also discusses his role in the advances in surgical care that have been made through the development of minimally invasive endoscopic surgery, as well as advances in treating inflammatory bowel disease, specifically, Crohn's and colitis, where he is a specialist.
Mr. Cohen's program, "Strategies of Success," explores actionable ideas leading to success. His guests come from different places, he says, but they all share the goal of developing the right strategies of success for them.
BlogTalkRadio produces audio podcasts as a social radio network with independent experts hosting shows on every kind of topic — from politics and current affairs, entertainment and sports to health and finance.
Click here to listen to the entire interview (31:04 min).