Saturday, December 16, 2017

OCMA Blog

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.




OCMA Specialty Spotlight: First-of-its-Kind Room Provides a Special Space Where Parents Can Bond with Their Child After Surrogate Delivery

Laguna Hills, CA - Thanks to the generosity of Dr. Jane Frederick, a co-medical director at HRC Fertility, The Women's Hospital at Saddleback Memorial now has a Bonding Room designated specifically for intended parents (parents utilizing a surrogate). The room allows intended parents to bond with their child after delivery by the surrogate. Saddleback Memorial and Dr. Frederick believe it's the first room of its kind in the U.S. 

 

The room was made possible through philanthropic support from Dr. Frederick, one of the longest practicing female reproductive endocrinologists in the Orange County area who has worked with intended parents for over 20 years.  

 

"In the past, Saddleback Memorial would find a place for intended parents to bond with their newborn, but this is the first time a room has been specifically designated for, and designed with, these parents in mind," says Dr. Frederick. "Surrogacy continues to be a viable option for many families and often these families don't have a place to go in a hospital delivery situation.  Parents really need a special place that is theirs and The Women's Hospital at Saddleback Memorial has come through with a beautiful area that is really unique."

 

The Women's Hospital at Saddleback Memorial remains the only women's hospital in South Orange County and is the birthplace of more than 50,000 babies. The Women's Hospital at Saddleback Memorial offers a team of highly trained obstetricians, pediatricians and other specialists who are sensitive to the needs of new mothers and their babies, and are committed to providing the highest level of service. They deliver nearly 3,000 babies a year, and of these, approximately 10 percent are high-risk births and high-risk multiples referred from throughout Orange County and the surrounding area.

 

"This is a beautiful room for our intended parents to celebrate the birth of their child and is complementary to our facility and specialized programs we currently offer," says Dr. Michael Haydon, medical director of The Women's Hospital at Saddleback Memorial.

About Saddleback Memorial Medical Center  

With campuses in Laguna Hills and San Clemente, Saddleback Memorial provides exceptional medical expertise across a range of treatment areas including cancer, stroke, and cardiac care. Innovations such as robotic surgery, low dose CT, and dedicated breast MRI set us apart. In addition, The Women's Hospital at Saddleback Memorial - Laguna Hills offers special comfort and care to new mothers and their babies. A proud member of the MemorialCare Health System and named Best Regional Hospital by U.S. News & World Report for three consecutive years, Saddleback Memorial continues to provide comprehensive care for patients at every stage of their lives.  For more information, go to memorialcare.org/Saddleback.


About MemorialCare Health System


MemorialCare Health System is a not-for-profit, integrated delivery system that includes six top hospitals - Long Beach Memorial, Miller Children's Hospital Long Beach, Community Hospital Long Beach, Orange Coast Memorial, and Saddleback Memorial's 2 campuses; two medical groups - MemorialCare Medical Group, Memorial Prompt Care; an Independent Practice Association (IPA) - Greater Newport Physicians; MemorialCare HealthExpress retail clinics; and numerous outpatient health centers throughout the southland. For more information, go to memorialcare.org.


Jane Frederick, MD 

Dr. Jane Frederick (Second from right in photo) is a co-medical director of HRC Fertility in Orange County. Practicing in California since 1990, Dr. Frederick is an internationally noted specialist in Reproductive Endocrinology and Infertility. She has developed a diverse clinical practice in reproductive surgery, IVF, and the genetic screening of embryos. Dr. Frederick is board certified in Reproductive Endocrinology/Infertility and Obstetrics/Gynecology from the University of Southern California.  She has recently been honored as the top 10% of specialists in the nation by US News and World Report.

 

Orange County Fertility's Facebook

Dr. Jane Frederick's Facebook

Orange County Fertility's Website


OCMA Specialty Spotlight: Doctor Recognizes a Need for Fewer Loopholes in the Delivery of Healthcare in California

Recently Dr. Johnson took on a complicated case involving a 13 year old male suffering from a symptomatic left mandibular cyst.

 

The young patient complained of swelling, pain and recurrent headaches. Before finding Dr. Johnson the patient had been turned away from treatment due to insurance. After initial consultation with the patient, Dr. Johnson found he was unable to treat the patient's urgent condition due to insurance constraints.  The patient was referred back to his insurance for definitive care. Later, the patient's mother and father called, frustrated with the inability of the insurance company to properly refer to a surgeon for definitive and prompt care.

 

The patient was re-examined and noted to have increasing pain, swelling and was now damaging other dental structures. Dr. Johnson's staff subsequently called the insurance company on behalf of the family, urging them to assign a person responsible to get their son treated. Unfortunately this took several months, and many phone calls from Dr. Johnson's staff to get the required approval to treat the patient in a hospital setting.

 

Once the services were approved, Dr. Johnson was able to perform the initial recommended biopsy and decompression at Mission Hospital in Mission Viejo.  The pathology report showed an inflamed dentigerous cyst with a prominent hyperplastic follicle and segments of dental papilla.  There was no evidence of malignant growth histologically.  

Cyst-pre operative tennis ball sized 

.

Home and office care continued over the next several months from the initial decompression, sometimes referred to as marsupialization, proved successful as the size of the cyst was reduced by approximately half its original size. The tooth and periodontal structures which were initially compromised by the growth of the cyst began to heal.  The boy's headaches and jaw pain improved over the next several months.    


Cyst-now golf ball sized (about 1/2 the initial size)

The recommended treatment was extraction of tooth #17, supernumerary tooth and cyst under general anesthesia.  During surgery, the original tumor and the initial cyst was identified. The cyst components, including soft cystic material as well as osseous material, mass and other hard tissues appearing to look like teeth were all removed.  The area was examined for any residual areas of cyst.  The remaining osseous structure in the jawbone appeared to be intact without any evidence of infiltration or fracture.  The boy, now 14, has continued to heal, although now a consultation with a dental orthopedist is recommended to evaluate for a dento-facial skeletal deformity.

 

The case illustrates the need for fewer loopholes in the delivery of healthcare in California. The difficulties with case assignment, surgeon contact, treatment authorization and follow-up care were all compromised in this situation.  There were several unnecessary dental/doctor consultations, as well as visits to the emergency department in order to finally alert the insurance company of the urgency of the patient's needs.  The insurance company also failed to find a treating surgeon in-network within a 50 mile radius.  It seems unimaginable that a qualified, contracted surgeon could not be secured in a timely manner.  The delay in treatment  likely caused the need for more extensive care, causing missed days at school and work days for the parents.

 

Arthur Johnson, III, DDS, MD  

 Arthur Johnson, III, DDS,MD earned his degree in dentistry at the University of Michigan in 1993.  He continued his studies at the University of Pennsylvania, where he earned a degree in medicine in 1998.  Dr. Johnson completed his residency program at Johns Hopkins Hospital.  He maintains hospital affiliation at Mission Hospital in Mission Viejo. Sustaining a private practice in Southern California for more than ten years, Dr. Johnson has volunteered with Health Care International since 1993, where he provides medical and dental care to the underserved regions of Jamaica. He is a member of the Laguna Niguel Rotary Club whose mission is service, volunteerism and goodwill.  He's an active member of the California Medical Association and Diplomat of the American Board of Oral and Maxillofacial Surgery.

 

Dr. Johnson's concern with a patient's dental health expands beyond tooth removal. Dr. Johnson takes pride in helping to change or improve a patient's smile with bone grafts and implants and correcting facial and jaw abnormalities or traumatic injuries with reconstructive surgery.  His attention to detail and philosophy of providing optimal, quality care with the least amount of invasive surgery has earned him the trust from patients and confidence from referring doctors.  


OCMA Specialty Spotlight: The Pocket Dietitian

Developed by Dr. Eric Wechsler of Newport Beach, The Pocket Dietitian™ offers a personalized dietary prescription for easy use on the iPhone or iPad. Based on the expertise of a registered dietitian, and board-certified nephrologist, The Pocket Dietitian™ targets a variety of ailments: chronic kidney disease (CKD), end-stage renal disease (ESRD), hypertension (high blood pressure), diabetes, and obesity. People with these ailments, or a combination of them, will benefit most from using this product.

Poor dietary decisions in patients with one or more of these diseases can lead to dire medical outcomes, including increased risk of congestive heart failure, cardiac arrhythmias, accelerated decline in kidney function, early coronary artery disease, and even pre-mature death.

As a nephrologist, Dr. Wechsler has intimate knowledge of the power of healthful eating combined with proper medical care. Many scientific studies indicate that a proper diet can either decrease medication requirements or improve their efficacy. Additionally, following a recommended diet for specific illnesses can improve quality of life and increase longevity.

The Pocket Dietitian™ App was designed with the user in mind. It's pragmatic enough so that planning a   single meal is simple; yet it's comprehensive enough to analyze and integrate a host of complex dietary recommendations for patients with CKD, ESRD, hypertension, diabetes, dyslipidemia, cardiovascular disease, and obesity. It also knows that these diets occasionally contradict one another - so the final recommendation will provide an accurate dietary prescription.

How does it work?


Before using The Pocket Dietitian™ for the first time, the user answers a questionnaire found at the registration of the app. The Pocket Dietitian™ then calculates a dietary recommendation based on a number of dietary guidelines using, but not limited to, the Harris-Benedict Equation and the Body Mass Index calculation, combined with the accepted dietary guidelines recommended by the American Diabetes Association, National Kidney Foundation, American Heart Association and the American Dietetic Association.

From the home page, the user is able to add food to the diary. The Pocket Dietitian™ App then calculates the nutritional information and alerts the user to foods that may expend too much of their daily total. The Pocket Dietitian™ at this point will then suggest a healthier food option. There is even a quick list of super foods that are almost always good to eat in the right proportions.

With a real-time color-coded bar graph the viewer can visualize how the food items affect one's daily nutritional requirements for the day. Our goal is to help individuals maintain a balanced approach to their daily meals and avoid eating foods that lead to a disproportionate consumption of their tracked nutrients. For example, eating a twelve-ounce steak at lunch may consume more than 50% of one's recommended sodium and fat intake for the entire day. The Pocket Dietitian™ App will recommend several options: either decreasing the portion size, or offering an alternative, such as an  eight-ounce chicken breast. This real-time dietary assessment will help educate users on the impact food has on their bodies.

The Pocket Dietitian™ allows one to harness the most information and best available options as quickly as possible, leading to informed decisions. The user will enjoy healthful eating, and, in turn, learn more about the effects of food on overall wellness and longevity.



In 2012, Dr. Wechsler developed a mobile medical application for the iPhone, called The Pocket Dietitian. His motivation stemmed from witnessing the struggles his patients were having adhering to their dietary restrictions while maintaining a healthy, balanced diet. On a daily basis, the patients expressed confusion about what they were supposed to eat while also feeling a significant loss in their quality of life when dietitians would tell them they could never eat their favorite foods again. This mobile application was designed to provide more freedom and understanding of the various medical dietary   prescriptions and offer a simulated experience to a dietitian, on a real-time basis.


 Also, in 2012, Dr. Wechsler was asked to be the medical director of a dialysis company, called First Learn Balance. This will be unlike any dialysis unit ever developed, focusing on complementary medicine including yoga, Tai Chi, acupuncture, as well as nutrition education and lifestyle management. Dr. Wechsler hopes to develop ways to minimize some of the detrimental effects of dialysis and develop new modalities that can help improve the quality of life for dialysis patients.

Dr. Wechsler believes very strongly that kidney disease and the associated conditions of heart disease and diabetes can be prevented or slowed with early detection and treatment. His general philosophy in medicine is to educate his patients so they will be empowered to aid the doctor in treating their disease.

Dr. Wechsler states, "Without the patient's complete involvement in the process of medical management, even the brightest doctor in the world would be of little use."

 Dr. Wechsler is eager to work with new patients and continuously strives to expand his knowledge in different areas of nephrology including nutrition, dialysis, hypertension, weight loss, and disease prevention. 


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