Friday, June 22, 2018

OCMA Blog

Paul Lubinsky, M.D. - 2018 Orange County Physician of Excellence

OCMA is proud to recognize our incredible members who are leaders in medicine here in Orange County.  This year, we want to spend time honoring our 2018 Physicians of Excellence and sharing more information on what makes them so excellent.  

                                                                        

Name: Paul Lubinsky, M.D.

Specialty: Pediatric Critical Care

What is the most rewarding thing about practicing medicine?

Helping Kids set the course for the rest of their lives. Children are resilient and tend not to dwell on the past, it is a privilege to care for them.

Why did you choose to practice in Orange County?
From the first day I started my American Medical career as a CHOC intern I could not think of any institution I would rather work at. I have been at CHOC for 34 years and we provide care to whomever needs it.

What’s a great experience you had through your OCMA Membership?

The advocacy work that OCMA is involved in provides a voice for the physicians, that helps to direct and ensure their patients care. As a Pediatric provider we have enhanced Pediatric Board representation and established a Pediatric workgroup to specifically focus attention on Children’s needs 

Do you have a word of advice for today’s students and residents?

If I had it to do over I would choose a career in medicine, and once again Pediatric Critical Care. There are tough days but we can make a positive difference in every patients life story and I cannot think of a more fulfilling career.

Social Media:
Facebook: https://www.facebook.com/CHOCChildrens/
Twitter: https://twitter.com/CHOCDocs 
Instagram: https://www.instagram.com/chocchildrens/


Connie Bartlett, D.O. - 2018 Orange County Physician of Excellence

OCMA is proud to recognize our incredible members who are leaders in medicine here in Orange County.  This year, we want to spend time honoring our 2018 Physicians of Excellence and sharing more information on what makes them so excellent.  

Name:  Connie Bartlett, DO

Specialty:  Pediatrics
  
What is the most rewarding thing about practicing medicine?  The relationships I’ve been able to build with my patients and their families is extremely rewarding – it’s the best thing about practicing medicine for me. As a pediatrician, I’m able to take a special part in “raising" the children who have seen me since birth – watching their development and seeing them transition into adulthood is the best gift.
 
Why did you choose to practice in Orange County?
Besides the great weather, I chose Orange County because it’s home for me and my family, which always comes first for me. It’s also a great benefit to be surrounded by reputable academic institutions and hospitals. I feel blessed to be part of a health system and medical group that takes such great care of me and my patients. 
 
What’s a great experience you had through your OCMA Membership?  I really appreciate the various advocacy efforts from OCMA – championing important issues for our medical community. I also really enjoy the various lectures and workshops available to help me keep up with clinical decision-making and practice management. 
 
Do you have a message for the rest of your POE honoree colleagues? I am humbled and honored to be selected. I hope we can spread the word for next year and recruit more of our colleagues to participate in this great tradition. Congratulations to all.  
 
Do you have a word of advice for today’s students and residents?  It is a gift and a privilege for us to be in the healing profession.  I encourage all students and residents to study hard the science of medicine, but not to forget to learn the art of medicine as well.  It's the compassion, empathy and connection to others that will bring joy to our days and comfort to our patients. 

Follow Dr. Bartlett on Social Media!
Facebook: www.facebook.com/sjhmg
Twitter: @stjoehealth



Eric Ball, M.D. – 2018 Orange County Physician of Excellence

OCMA is proud to recognize our incredible members who are leaders in medicine here in Orange County.  This year, we want to spend time honoring our 2018 Physicians of Excellence and sharing more information on what makes them so excellent.  Our staff spent some time interviewing honorees to bring you this series, and we hope you enjoy this series as we kick off the New Year!

Name: Eric Ball, M.D.

Specialty: Pediatrics
            
What is the most rewarding thing about practicing medicine?
I chose to become a pediatrician because I am drawn to preventative medicine.  I enjoy the ability to educate parents and families about healthy lifestyles in an effort to prevent diseases in the future.  It is a true privilege to be able to play a small role in the life of a growing child, and I am grateful every day for this opportunity.

Why did you choose to practice in Orange County?

My wife grew up in Orange County and we always knew that we would come back here to practice and raise a family.  It is an ideal spot for our children and, as a pediatrician, southern Orange County is the perfect place to practice.

What’s a great experience you had through your OCMA Membership?
This year I had the opportunity to attend the California Medical Association House of Delegates meeting, where physician leaders from all over the state gather to discuss policy and set the priorities for the medical community.  At the HOD, we heard from medical and government leaders and had vigorous discussions about the future of medicine in California.  As Orange County physicians with OCMA, we had the ability to influence these discussions and help shape state policy.

Do you have a message for the rest of your POE honoree colleagues?
 
It is always an honor to be selected a Physician of Excellence.  In these times of upheaval and change in the medical community, it is refreshing to know that an organization like the OCMA is single minded in its efforts to advocate for the success of the physicians of this county.  I know that through the efforts of organizations like the OCMA, the future of the practice of medicine is bright.

Do you have a word of advice for today’s students and residents?

Choose medicine and choose your specialty because you love them.  I would have made more money, or worked fewer hours, in other professions or other specialties.  I chose pediatrics because I am passionate about the health and well-being of children.  When I leave the office every day, I have a sense of pride and purpose; each day, I feel that I made a small difference in the life of a child or a family.  To avoid burnout, you must love what you do, and your profession must be more than a ‘clock-in, clock-out’ job.  The act of making an impact in the lives of others will bring purpose and meaning to your own life.

Follow Dr. Ball on Social Media!
Facebook:  https://www.facebook.com/socpa/

Twitter: @DrEricBall (personal)  @socpa (practice)




Mission Dhulikhel, Nepal

Mission Dhulikhel, Nepal

November 11-22, 2015
This past November, under the umbrella of Arpan Global Charities CHOC and SJO doctors traveled to Nepal to exchange information and share their skills and time at the Kathmandu University Hospital in Dhulikhel, Nepal, an independent, non-profit  teaching hospital. Opened in 1996, the hospital, besides health services, also provides medical, dental and nursing schools, in collaboration with Kathmandu University.

The devastation from the 7.8 earthquake that killed 9,000 people and destroyed the area’s infrastructure in April 2015 was quite visible. The current fuel crisis was also evident causing the hospital to cook meals for patients and staff outdoors with wood.

Before the trip, some of the Dhulikhel surgeons requested needed supplies. SJO Interim Chief Medical Officer and orthopedic surgeon Paul Beck, MD, who made the trip along with his wife, internist Huong Thi  Duong, MD, cited arthroscopy shavers used to trim tissue in the knee as an example. “In the US we use these blades once but in Nepal they were reused and sterilized dozens of times and were quite dull.”  He has contacted a supplier in the US who will be donating new blades, although after the trip.

SJO NICU Medical Director and the founder of  Arpan Global Charities,  Sudeep Kurkreja, MD, and his wife, Song Kukreja, helped organize and participated in the trip. This Mission Dhulikel , Nepal was the 18th volunteer medical mission organized by Arpan Global Charities and was tremendously successful.  During this mission focus was more on teaching and education than service, although our team members examined and treated more than 300 patients and performed 65 surgical and dental procedures.  Every single day each team members gave 2-3 didactic lectures to their respective counterparts from Nepal as well as hands on demonstration of latest surgical procedures and skills. 

He continues, There is great need for exchange of knowledge and skills between the physicians and surgeons from US and Nepal.”  Dr. Ram Shrestha, the Vice Chancellor at Katmandu University Hospital in Dhulikhel, was very supportive of having an ongoing academic affiliation between Dhulikhel Hospital and SJH/CHOC.  We discussed at great length about developing exchange program between Kathmandu University Hospital in Dhulikhel and SJH/CHOC especially in the area of neonatology and pediatric surgery. SJH President and CEO Steve Moreau, who was part of this mission with his wife Anne, will be working with CHOC to facilitate this exchange.   

Also on the Nepal mission trip were anesthesiologist Jeffrey Sycamore, MD; dentist Vazrick Navasartian; pediatric infectious disease subspecialist Jasjit Singh, MD and her husband pediatric ENT Gurpreet Ahuja, MD; ophthalmologist David Yomtoob MD, and his wife Allison; pediatric nephrologist Dorit Ben-Ezer, MD and her daughter Maya; Hillary Nguyen, a SJO volunteer and Cal State Fullerton student; CHOC neonatal nurse Cindy Hecklau. All the volunteers paid for their own flight, meals, and accommodations at a lodge about a kilometer from the hospital.

This mission was not possible without contribution by each and every one of the volunteers and  our host team members at the Kathmandu University Hospital, Dhulikhel.

Anyone interested in upcoming mission trips with Arpan Global Charities can contact Dr. Kukreja at ArpanGlobal@gmail.com.

 


ASCO 2015 Update: Releasing the Potential of the Immune System

This article is brought to you by: John Link, MD of Breastlink

visit www.breastlink.com for more information

- The Annual Meeting of the American Society of Clinical Oncology (ASCO) provides an opportunity for thousands of oncologists and health care professionals to receive research updates and exchange ideas surrounding trends in cancer treatments.

More than 30,000 attend each year, making it one of the largest educational and scientific conferences dedicated to advancing cancer care. I recently joined my colleagues for the ASCO 2015 Annual Meeting, where a focus was on breakthroughs in immunotherapy.

What is Immunotherapy?

Immunotherapy refers to treatments that prompt the human body’s immune system to attack cancer cells. Cancer occurs when a genetic mutations occurs that causes a healthy cell to become cancerous. Can the immune system recognize these cancerous cells as harmful or are they too at home within the body?

Recently, we have determined that the immune system often does recognize cancerous cells. The immune system produces white blood cells called lymphocytes that target harmful substances, called antigens, within the body. In response to the development of some cancers, lymphocytes will gather around cancerous cells. However, they do not always infiltrate cancerous cells and cause them to die.

Some cancers produce certain proteins, such as programmed cell death 1 (PD1). These are similar to other naturally-occurring proteins that prevent the immune system from interrupting certain normal biological functions. For instance, these proteins prevent the body from rejecting a fetus during pregnancy. When a cancer cell produces PD1, it sends a message to lymphocytes to back off.

A relatively new class of drugs called PD1-inhibitors prevents cancer cells from disguising themselves as healthy cells. Several ASCO 2015 Annual Meeting presentations on PD1-inhibitors revealed that they were an effective treatment for several cancers.

  • Pembrolizumab – More than one-half of patients with advanced head and neck cancer experienced noticeable decrease in size of tumors following treatment with pembrolizumab.
  • Nivolumab – Tumors ceased growing in approximately one-half of patients with advanced liver cancer treated with nivolumab. Advanced lung cancer patients treated with nivolumab lived an average of three months longer than patients treated with docetaxel, a chemotherapy.

Immunotherapy in Breast Cancer Patients

Ongoing research is also investigating the use of PD1-inhibitors in breast cancer patients. In an early stage trial, 4 of 21 triple-negative breast cancer patients with the PD1 protein responded to a PD1-inhibitor currently under investigation. These results prompted the FDA to assign the drug, MPDL3280A, Breakthrough Therapy Designation, which is reserved for treatments that appear significantly more effective in clinical trials than existing treatments.

In an upcoming phase III trial sponsored by drug maker Hoffman-La Roche, researchers will investigate the use of MPDL3280A in combination with nab-paclitaxel, a type of chemotherapy, in patients with metastatic breast cancer. The phase III trial is currently recruiting patients. Eligible candidates include women with advanced triple-negative breast cancer with no prior chemotherapy or targeted systemic therapy for inoperable disease.

Breastlink will work with researchers as a clinical partner in ongoing MPDL3280A research. This means patients eligible to participate in the study can receive MPDL3280A at Breastlink locations in Orange County. At this time, Breastlink locations are the only sites in Orange County and Los Angeles County where patients can participate in this study. As part of our commitment to advancing innovative breast cancer therapies, Breastlink is excited to play a role in ongoing research and to offer patients an opportunity to participate.

One drug already approved by the FDA for breast cancer patients combines immunotherapy with conventional chemotherapy. Ado-trastuzumab emtansine ( T-DM1) uses an antibody called trastuzumab to target receptors present on cancerous cells in women with HER2-positive breast cancer. Once T-DM1 has bound to HER2 receptors, a chemotherapy agent called DM1 is delivered to the interior of cancerous cells, destroying them from the inside.

There are several benefits to immunotherapy over conventional chemotherapy and other targeted treatments. Researchers are continuing to produce evidence that immunotherapy improves clinical outcomes compared with conventional chemotherapy. Additionally, patients generally experience fewer side effects when treated. Immunotherapy also allows the immune system to develop a lasting memory of the antigen – in this instance, a type of cancer cell. If this specific type of cancer recurs, the immune system will continue to respond.

Developments such as those presented provide hope for a cure. The scientific and medical communities recognize new immunotherapy agents as huge breakthroughs. With these drugs, we can avoid treating more women with chemotherapy while improving their outcomes. At Breastlink, we are excited by these advancements and will eagerly track updates as they occur.


Breastlink Celebrates 20 Years of Innovation in Breast Health Care

This article is brought to you by: Breastlink

visit www.breastlink.com for more information

This year marks 20 years Breastlink has helped patients with their breast health needs. As I reflect back upon our history I have never felt more strongly that our comprehensive, multidisciplinary approach to treat breast cancer best serves women.

I also believe, thanks to clinical research, we are on the cusp of discovering a real cure for many types of breast cancer in the next decade. Research has begun to reveal the genomic differences in cancer cells. This will lead to new, “targeted” agents that will significantly improve treatment options. Breastlink, through our work with the Cancer Research Collaboration, is involved in many of the promising clinical trials.

However, the reality persists that far too many women succumb to this truly horrible malady. Before we look to the future, I have outlined the history and progress of our practice.

History of Breastlink

In the 1970s, attitudes toward breast cancer treatment began to change for the better. Radical mastectomy had been the preferred method for treating breast cancer since the late 19th century. This procedure called for the complete removal of all breast tissue, the nipple, lymph nodes in the armpit, and muscles lining the chest wall beneath the breast.

During this time, women were rarely consulted about treatment. Some even awoke from sedation to find that the decision to remove their breasts had already been made for them.

The move toward a more individualized treatment approach was welcome. It became increasingly apparent that there were equally effective, more patient-friendly alternatives to radical mastectomy. As this occurred, more women refused the one-size-fits-all breast cancer treatment.

In 1979, the National Institutes of Health issued a statement declaring that surgery to treat breast cancer should preserve as much muscle tissue as possible. They also indicated radiation therapy could be administered as a primary treatment with limited surgery.

More importantly, the consensus statement recognized that a preoperative needle biopsy should be performed “before definitive therapeutic alternatives are discussed with the patient.”Physicians were finally beginning to realize that women should have a say in their treatment.

Inspired by the voices of women calling for a greater role in their treatment, as well as growing enthusiasm for the development of new and better ways to prevent, I helped to found one of the nation’s first comprehensive breast cancer treatment centers in 1985.

Helping to develop the breast cancer treatment center at the Long Beach Medical Center was an invaluable experience that would inform my decision-making when I set out to establish Breastlink.

Founded in 1995 as a single, outpatient facility in Long Beach, Breastlink has grown into a network of three outpatient breast cancer treatment centers. These centers offer women a multidisciplinary medical team and comprehensive services aimed at breast cancer screening, diagnosis, treatment and follow-up.

A Comprehensive Breast Cancer Care Model

Since breast cancer treatment paradigms began to shift in the 1970s, it has become apparent that a multidisciplinary approach to breast cancer offers women the most optimal care available.

A comprehensive breast cancer care model provides access to a coordinated team of multiple physicians practicing across different specialties. Using this model, a woman can have all of her breast cancer screening or treatment needs attended to by a single team working under the same roof.

As medicine has become increasingly specialized and new knowledge revealed how individual cancers behave differently, more and more types of physicians are included in breast cancer treatment. A breast cancer treatment team should include at least four or five different specialists, including:

Most physicians are inclined to practice what they know. For instance, a surgeon will most likely be inclined to believe that surgery is the best available treatment option. This is partly why radical mastectomy remained the standard of care for so long.

However, a multidisciplinary team working together can help physicians to look past professional biases. When we work together with each other and patients, the result is more appropriate treatment.

A comprehensive breast health care treatment model works most effectively when women are placed in a partnership with their physicians. The goal is to provide individualized care that is neither over-nor under-treated. Treatment should offer the best chance for survival with as few side effects as possible. Physicians can optimize treatment outcomes by offering a combination of education, compassion, communication and experience.

Providing comprehensive breast cancer treatment means treating the whole woman, not necessarily just the disease. Treatment must be compatible with women’s own beliefs and philosophies. Breastlink helps to accomplish this by providing numerous resources under one roof.

This includes physicians, nurses, researchers, medical assistants, psychotherapists and nutritionists. Each member of this treatment team, those seen and unseen, contribute to healing as defined by the woman being treated.

Looking Toward the Future of Targeted Therapies

Breast cancer is the result of gene mutations. Some mutations cause cells to achieve additional function, allowing them to grow out of control, or to become drug resistant and to spread to other parts of the body. Other mutations can cause cells to lose their function, which creates susceptibility to cancer.

Not all breast cancers are created equal. The underlying gene mutation that allowed cancer to begin growing will also dictate how that cancer behaves as it grows.

Growing knowledge of the relationship between gene mutations and breast cancers has led to the potential for evermore individualized treatments. For instance, in approximately 20 percent of cancers, a protein known as HER2 is present on the surface of cancerous cells. When this protein is present, cancers tend to grow especially quickly and aggressively.

To combat HER2-positive cancers, researchers and pharmaceutical makers have investigated drugs that specifically target this protein. Herceptin, introduced in the late 1980s, was one of the first of these targeted drugs to be developed. Herceptin can attach itself to HER2 proteins to slow cancer growth and promote chemotherapy response. We now have a number of anti-HER2 agents that target this type of breast cancer.

Herceptin is just one example of many targeted therapies, either on the market or being investigated. Targeted therapies are designed to attack a specific genetic mutation of the breast cancer.

It is important for women to learn about their individual cancer, as well as emerging treatment options and targeted therapies, to make an informed decision about treatment. Breastlink has been proud to participate in the research into these targeted therapies and to maintain up-to-date knowledge of ongoing research. This allows us to provide women the information they need to make a decision customized to their priorities and their disease.

Many gains have been made in our understanding of breast cancer over the past twenty years. Women have benefitted from advancements in prevention, screening and treatment. Research exploring new treatments and interventions show potential for continued improvement in breast health care.

A big part of what we do is clinical research. Over the next few years, we will expand our participation in research to help women have access to or receive therapies still under investigation.

Breastlink has worked with researchers for many years to improve access for patients to new drugs or therapies currently under investigation. Through a partnership with Cancer Research Collaboration, a non-profit organization, we are able to continue to offer our patients a robust opportunity to participate in the development of new agents and new tests.

This also provides researchers access to a team of clinical investigators with strong research backgrounds who can help to identify breast cancer patients that are qualified candidates for research projects. We believe partnerships such as these can improve process for delivery and approval of effective cancer therapies, and add to our collective knowledge of cancer. We strive for a future without breast cancer research moves us closer to this future.

I wish to thank my co-workers, colleagues, the community and, most of all, our patients for their support. Without you all Breastlink would not be possible. We look forward to working with you over the next 20 years and beyond to improve breast cancer care.

About Breastlink and Dr. John Link

John Link, MD is the founder of Breastlink and a leading medical oncologist dedicated to the care of women with breast cancer. To learn more about Dr. Link and Breastlink please visit Breastlink.com.


Eric G. Handler, M.D. Named the 2015 OCMA Physician of the Year

During the May 2015 OCMA General Membership Meeting, Eric G. Handler, M.D. was named the 2015 OCMA Physician of the Year.  The Orange County Register Coast Magazine put a spotlight on Dr. Handler’s achievement in their July issue.  Click here or on the link below and scroll through to page 135 to read more about Dr. Handler.

http://www.webpublished.com/gallery/view.asp?seq=280932&path=150624134129




OCMA Member Profile: Theodore Benderev, M.D.

World Vasectomy Day (WVD), which took place on Friday, October 18, 2013, is the largest male-oriented global family planning event. The goal was to perform 1,000 vasectomies by at least 100 doctors across 25 countries in 24 hours. 

 

OCMA member Theodore Benderev, M.D., founder of Vasectomy.com, led the charge for World Vasectomy Day in Southern California. In honor of this international day, Dr. Benderev has submitted an educational piece on the No-Needle No-Scalpel Vasectomy (below).


The No-Needle No-Scalpel Vasectomy

"As Good as it Gets"

About Vasectomy Surgery 
 
The No-Scalpel Vasectomy was brought over from China in 1987. A procedure that was initially thought to be "gimmicky", the minimally invasive technique with minimal manipulation of tissue via special instrumentation was studied and found to indeed reduce the risk of bleeding and infection. In the hands of experienced surgeons, this sometimes challenging surgical procedure can be done through a 1 cm opening usually in less than 15 minutes. Though vasectomy has been the number one procedure performed on men in the U.S. (500,000/yr), there are twice as many tubal ligations done. Not surprising, nightmare stories of inadequate anesthesia have kept more men from taking the lead in permanent sterilization. 
 
That was so until approximately 10 years ago when a high powered anesthetic jet spray was found to provide superior deep local anesthesia without a needle - hence, a virtually pain free experience for the patient. 

As with nearly all surgical procedures, experience of the surgeon correlates with success. The smoothness and confidence of the surgeon is particularly important when men are awake and someone is working on a part of the body that men are hard-wired to protect. Combine the anxiety of the man with a Cremaster muscle that pulls the testicles out of harm's way (think George Castanza in Seinfeld) and within easy reach of the surgeon and one understands that the words "gentle and efficient technique" have a special meaning with vasectomies.
 
What issues must be considered? 
 
Before each vasectomy, there is a consultation session with the patient and, preferably, with their partner to fully discuss the pros and cons of a vasectomy. The great benefit of a vasectomy is that the only better form of contraception is abstinence. Patients are thrilled with the freedom from contraception - fondly called "The Bedroom Bonus". The risks, though uncommon in experienced hands, are bleeding, infection and pain.
 
What is the patient to expect post-operatively?

Post operative pain is so uncommon that patients frequently forget that they have limitations and must remember to restrict their activity for the first few days after the procedure. In general, when patients have the procedure done on a Friday, they usually return to work on Monday. By the beginning of the second week, they can usually return to normal activity, except that sex without contraception must wait until at least one negative semen analysis. 
 
What if there is a change of mind?

While vasectomies can be reversed in most cases during the first few years postoperatively, assurance must be obtained by the surgeon in the pre-operative consultation that the couple is in full agreement for permanent contraception. Despite excellent vasectomy reversal surgical technique and artificial reproductive technologies, in the 5-10% of couples who choose reversal later, there are cases when pregnancy may be difficult to achieve. 

 Dr. Theodore Benderev founded Vasectomy.com 17 years ago and was the first known urologist to perform the No-Needle No-Scalpel Vasectomy in California. Dr. Benderev has performed over 2000 of these procedures. In addition, he has developed numerous surgical techniques and technologies with over 35 patents in various areas of urology. A board-certified urologist, he practices primarily in Mission Viejo and is a Clinical Professor in the Department of Urology at UCI.  Besides his focus on vasectomies, Dr Benderev is Board sub-certified in Female Pelvic Medicine and Reconstructive Surgery and is Medical Director of the Incontinence and Pelvic Support Institute.
 
 Dr. Benderev is a graduate of University of Maryland. He completed his urology residency training at Northwestern University in Chicago to prepare for an academic career. After a period as faculty member at UCI, he established a specialized center in south Orange County that to this day retains that special personal attention from each of his specially trained staff. 
 
A resident of Orange County since 1985, Dr. Benderev raised his family here and enjoys hiking and biking for leisure. When not on call, he looks forward to working about his cabin in Mariposa. 

Please contact Dr. Benderev at 888-VASECTOMY (or 949-364-4400) for any further information

OCMA continues to profile and highlight our valued members. These profiles provide a forum for physicians to share information among their colleagues. It is important for members to be aware of one another. Maintaining a close community of engaged physicians is beneficial for both OCMA and the medical community.  This is open to any current OCMA member. If you are interested in submitting an article and profile, please contact: 
 
Ashley Buchwald, OCMA Marketing/Communications Coordinator at abuchwald@ocma.org or (949) 398-8100 ext. 105. You may also contact Holly Appelbaum, Managing Editor, OCMA Bulletin, at happelbaum@ocma.org or (949) 398-8100 ext 106.

OCMA Specialty Spotlight: Specialty Care for Hernia Repair

Specialty Care for Hernia Repair

by:


About Hernia Surgery

Hernia surgery today is much more advanced than even five years ago. The use of laparoscopic surgery techniques and the newest, lightweight meshes (if needed), often allow patients to heal faster, in less pain, and have a more cosmetic outcome. Healthcare providers who are deciding on where to refer hernia patients should make sure that their surgeon has all the tools available to offer the most state-of-the-art techniques and mesh to their patients.

 

About Hernia Symptoms

Hernia symptoms vary dramatically from one patient to the next. One of the most common symptoms of a hernia is therapid onset of pain at the hernia site. When internal fat or internal organs press through a hole in the muscle, a hernia develops. These internal organs and fat cause the skin over the hernia to 'bulge' out. In rare cases, a piece of intestine can become trapped inside a hernia causing strangulation (see image). This is a rare, but serious concern. 



Open versus Laparoscopic Hernia Repair 

The two major types of hernia surgery are traditional open surgery, and laparoscopic surgery. No one approach is suitable for every patient. Patients with certain types of hernias may benefit from open hernia surgery while another similar patient may need laparoscopic hernia repair. The size of the hernia, the location, and whether it is unilateral or bilateral influences the best approach (see comparison chart). At California Hernia Specialists, we develop treatment plans for individual patients to suit their medical needs, their overall medical condition, and their preference when possible. 

 

Open Hernia Repair

Laparoscopic Hernia Repair

Most common technique

used for hernia repair.

Techniques vary widely from surgeon to surgeon

Less common approach for hernia repair. Requires advanced training

Can be done under local

anesthesia with sedation

Requires complete general anesthesia

Hernia is fixed on the

outside by opening the

muscles over the weakness

Hernia is fixed from the inside, behind the muscles where the weakness is located

Requires standard surgical equipment.

Requires advanced

laparoscopic equipment

Recurrence rates of 1-2% and infection rates of <1%

Recurrence rates of 1-2% and infection rates of <1%

Basic preoperative workup is required

Occasionally requires more advanced workup because general anesthesia is used

4-5 cm incision in the groin or bikini area

1-2 cm incision next to belly button, and 2 small punctures below the belly button

Mesh is placed behind the muscle and above the muscle. The mesh is sutured in place

Mesh is placed only behind the muscle, and is secured in place with dissolvable sutures



Tension Free Repair 


The term 'tension free' hernia repair is commonly used to describe hernia surgery. Hernias are caused by a weakening of the abdominal muscles. Some surgeons choose to sew the muscles back together, thus causing 'tension' on the muscles around the hernia. However, the muscles around a hernia are already weak, and over time those muscles tend to pull apart and the hernia can recur, or come back. Therefore, most hernia specialists today utilize a mesh to help strengthen the muscles. When using a mesh, the muscles themselves are not sewn together (see image). Instead, a mesh is placed over or under the hole in the muscle to prevent anything from pushing through the abdominal wall. 



For Referring Physicians


Patients and providers can learn more by visiting our website at www.CaliforniaHerniaSpecialists.com. We work with a large number of primary care, internal medicine, and other physician specialties for hernia care. We take your referrals as the highest compliment we can receive. By choosing to have treatment at California Hernia Specialists, patients and their healthcare providers can ensure the most consistent and highest quality hernia care.


 Todd S. Harris, MD

Dr. Todd S. Harris is board certified in general surgery as well as highly experienced in hernia surgery. Dr. Harris is a Fellow of the American College of Surgeons, one of the highest distinctions for a general surgeon. He is the medical director of California Hernia Specialists and coordinates all clinical functions of the office and surgical center for hernia patients.

Dr. Harris was born and raised in South Carolina and is a graduate of The Medical University of South Carolina. He completed his general surgery training at St. Vincent's Hospital and Medical Center in New York City. After completing his surgical residency, Dr. Harris returned for a cardiovascular and interventional radiology (CVIR) fellowship at the University of Minnesota. After completing his fellowship in 2008, he relocated to Orange County to develop his hernia practice.

Outside of work Dr. Harris enjoys a variety of recreational activities. He is an avid runner and swimmer. He has competed in several triathlons, including the 2012 Malibu International distance race. He balances cardiovascular activities with core and strength training. His interest in fitness allows him to appreciate getting patients back to what they enjoy as quickly and pain free as possible after their hernia surgery.


OCMA Specialty Spotlight: Humanitarian Healing


Arpan Global Charities (AGC) is a non-profit organization established in 2005 by Dr. Sudeep Kukreja.  The goal of AGC is to bring health and hope to medically underserved populations around the world while providing humanitarian assistance and medical education to those who need it the most.

Arpan Global Charities' 13th international medical volunteer mission took place in the city of Latacunga, Ecuador and a team of 52 dedicated medical and non-medical volunteers participated. Team  members had diverse backgrounds and many years of experience in their respective fields and among them were: 5 nurses, 5 pediatric residents from CHOC Children's Hospital of Orange County, an echo tech, 3 anesthesiologists, 7 pediatricians, 1 cardiologist, 1 dentist, 1 geneticist, 1 gynecologist, 1 CT surgeon, 1 ENT surgeon, 1 ophthalmologist, 1 plastic surgeon, 2 general pediatric surgeons, 1 pediatric orthopedic surgeon, 1 orthopedic surgeon for adults, 1 radiologist, 1 pharmacist, and 10 non-medical volunteers.

Volunteers arrived from the US to Quito in waves and landed in Quito's new airport, located approximately an hour and half away from Latacunga. Although team members faced multiple challenges due to delayed airport pick-ups, lost luggage, and a late arrival to the hotel in Quito at 2:30 AM, the volunteers were eager to start working so they rushed to their rooms to get some rest. The team members were ready at 6 AM for the bus ride to their final destination, the small town of Latacunga.  After a 2-hour trip, the team arrived at a government clinic named Patronato where they immediately examined hundreds of patients and pre-screened them for treatments and/or surgery. Arpan Global Charities rented two facilities with operating rooms in Latacunga for surgeries: Clinica Continental and Instituto de la Mujer. Some surgeries were also performed by the pediatric orthopedic surgeon and the geneticist at Baca Ortiz Children's Hospital in Quito. Furthermore, Arpan's genetics doctor took the initiative to collaborate with local physicians to organize a genetics conference scheduled to take place at the Sheraton Hotel in Quito for the "Rare Diseases Day."  While reaching out and collaborating with local physicians, our medical team established a promising relationship with Quito's medical faculty to discuss the development of a partnership between CHOC Children's Hospital of Orange County and Baca Ortiz Children's Hospital in Quito to promote international collaboration and exchange programs.



Volunteers of Arpan Global Charities also visited 4 different orphanages in Latacunga and Quito where they examined every orphan residing in those centers and facilitated treatment, distributed clothes, and donated toys. Mission volunteers had the opportunity to visit two schools located in very poor areas of their town where they examined every student and discovered some children who had undiagnosed serious medical conditions for which treatment was facilitated. The team of anesthesiologists and nursing staff provided supportive services to patients in the recovery room which allowed skilled surgeons to perform more than one hundred major surgical procedures. With the help of the echo technician, the cardiologist volunteer was able to examine and treat hundreds of patients. Even the dentist surgeon was kept extremely busy from 8 AM to 6 PM everyday with long lines of patients eagerly waiting to see him. 


The help and support of the nursing members, pediatric residents, pharmacist, non-medical volunteers, Ecuadorian volunteers and Ecuadorian medical students was phenomenal. This mission would have not been possible without them.  Besides providing free medical care to the most underserved population in Ecuador, Arpan Global team members were also involved in the education of local nurses, medical students, and doctors in both Latacunga and Quito.

Considering that team members had limited equipment and very scarce medical supplies, it is important to acknowledge their caring attitude and sense of commitment for these qualities enabled them to work long hours on a daily basis to provide humanitarian healing to all their patients.  Indeed, the team's dedication and hard work enabled Arpan Global Charities to touch the lives of more than 1,500 Ecuadorian children and adults. A lot was accomplished during this missionary trip which makes it one of the most exciting and successful medical volunteer missions of Arpan Global Charities.




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