Saturday, December 16, 2017

OCMA Blog

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. 


OCMA Specialty Spotlight: Should Tissue from Mammoplasty be Examined by the Pathologist?

According to The American Society of Plastic Surgeons, 296,203 breast augmentations and 21,714 breast implant   replacements were performed in 2010. In 2011, after 60 cases of breast implant-associated anaplastic large cell lymphoma  (ALCL) became known to FDA, that agency issued a warning to patients who already had or were considering breast implants.1,2 Breast implant-associated ALCL is a rare type of lymphoma of T-cell lineage with clinical signs and symptoms of swelling, pain, pruritis and/or effusion around the implant.3According to a recent study in M.D. Anderson Cancer Center, patients who present with effusion without a distinct mass have an excellent nprognosis if the breast implant and fibrous capsule are removed. In contrast, patients who present with a distinct mass in the vicinity of the implant may have advanced stage or possibly systemic disease and poorer prognosis.4

One of 500,000 women receiving breast implants is estimated to develop implant-associated ALCL.5However, this frequency may be underestimated for the following reasons. Firstly, there are no standardized recommendations for pathologic examination of tissue excised during cosmetic surgery. The routine submission of tissue from that type of procedure is not typically considered the standard of care and is dictated by the individual and/or institutional policies. Secondly, there are no consensus recommendations for examination of the fibrous capsule surrounding the implant, where the lymphoma would be most commonly detected. According to a survey of 413 institutions in 1999, mostly in the United States, 10.7% had policies that exempted the submission of mammary   implants for pathology examination, and 63% had policies that recommended mammary implants for gross examination only, without distinguishing implants from capsulectomy specimens.6 Being more cognizant of the disease, one can surmise that the detection rate of ALCL will increase as more surgeons send the capsule and breast tissue surrounding the implant to pathology, and as pathologists submit more tissue for microscopic  evaluation.

In view of the above discussion, the following questions merit consideration. Should patients with breast implants have them removed for the fear of a malignancy? A negative response to this question would be appropriate; there is no ground for panic unless the patient experiences pain, swelling, retraction, or effusion around the implant. Should the implant, the surrounding capsule and breast tissue be submitted to pathology for both gross and microscopic examination, even though the likelihood of detecting a malignancy in this type of specimen is quite low? An affirmative response would be appropriate in this situation considering that in addition to ALCL, a very small    number of patients could harbor a clinically undetectable mammary carcinoma. 

Newport Coast Pathology (NCP), Inc. is committed to providing high quality care and exceptional anatomic pathology    services for the patient and the referring physician, respectively. Our pathologists treat every specimen as if it were their own or that of their family member. We strongly believe that the pathologist is an integral member of the team of physicians involved in the patient's care, and that communication between the pathologist and the clinician is essential to serving the needs of the patient. Our pathologists are available for consultation with referring physicians and their staff, any time. 

NCP offers a comprehensive menu of diagnostic tests, including: Histopathology, Histochemistry, Immunohistochemistry, Non-GYN Cytology, Cancer prognostic marker tests by various methods  

Newport Coast Pathology, Inc., was founded in 2010 by Mani Ehteshami, MD, a pathologist who recognized a need for a local laboratory that would provide personalized service. Dr. Ehteshami is certified in anatomic and clinical pathology by the American Board of Pathology, and has 17 years of post-fellowship experience and expertise in surgical pathology and cytopathology, specifically in gastrointestinal, liver, genitourinary and breast pathology. He earned a medical degree from Rosalind Franklin University of Medicine and Sciences in Chicago. Following the completion of his residency in anatomic and clinical pathology at the University of New Mexico School of Medicine in Albuquerque, Dr. Ehteshami was a fellow in oncologic surgical pathology at the University of Texas, M.D. Anderson Cancer Center in Houston, where he was trained by many internationally known academic pathologists including Drs. Kathy Foucar, Elvio Silva, Nelson Ordonez, and Ruth Katz. 

http://newportcoastpath.com/  T: (888) 463-3606 


Prior to relocating to Orange County, Dr. Ehteshami was the Medical Director and co-owner of a highly successful private anatomic pathology laboratory in northern California for 13 years. In addition, he held several key leadership positions including Medical Director of Clinical Laboratories, chair of the Pathology Department and chair of the Cancer Care committee at Shasta Regional Medical Center. He was interviewed by and published in Make [Me] Heal publication:"Checking for Breast Cancer when you Have Breast Implants", April 28, 2011 issue. He has affiliation with the following professional organizations: Fellow of the College of American Pathologists, Fellow of the American Society of Clinical Pathology, Member of the California Society of Pathologists, Member of the California Medical Association, Member of the Orange County Medical Association.

Before earning his medical degree, Dr. Ehteshami volunteered his services to educate and counsel patients with multiple sclerosis, and helped to establish housing for those patients. As the Chairman of the Patient Services Committee, a member of the Medical Advisory Committee, and a member of the Board of Trustees of National Multiple Sclerosis Society in Orange County, he was recognized for his outstanding volunteer service. Dr. Ehteshami is an avid runner who has raced in dozens of full and half marathons in the US and abroad. 


References

1. US Food and Drug Administration. Anaplastic large cell lymphoma (ALCL) in women with breast implants: preliminary FDA findings and analyses. 2011. Available at: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm239995.htm. Accessed June 22, 2011.

2. US Food and Drug Administration. FDA medical device communication: reports of anaplastic large cell lymphoma (ALCL) in women with breast implants. 2011. Available at:  http://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm240000.htm. Accessed January 26, 2011.

3. Keech JA Jr, Creech BJ. Anaplastic T-cell lymphoma in proximity to a saline-filled breast implant. Plast Reconstr Surg. 1997;100:554-555.

4. Anaplastic Large Cell Lymphoma Associated With Breast Implants: A Report of 13 Cases.  Aladily, Tariq N.; Medeiros, L. Jeffrey; Amin, Mitual B.; Haideri, Nisreen; Ye, Dongjiu; Azevedo, Sergio J.; Jorgensen, Jeffrey L.; de Peralta-Venturina, Mariza; Mustafa, Eid B.; Young, Ken H.; You, M. James; Fayad, Luis E.;  Blenc, Ann Marie; Miranda, Roberto N. American Journal of Surgical Pathology. 36(7):1000-1008, July 2012.

5. Kenkel JM. Discussion: anaplastic large cell lymphoma and breast implants: a systematic review. Plast Reconstr Surg. 2011;127:2151-2153.

6. Zarbo RJ, Nakhleh RE. Surgical pathology specimens for gross examination only and exempt from submission: a College of American Pathologists Q-Probes study of current policies in 413 institutions. Arch Pathol Lab Med. 1999;123:133-139.


OCMA Specialty Spotlight: The Gavin Herbert Eye Institute

The Gavin Herbert Eye Institute at the University of California, Irvine, refers to both an academic specialty eye care practice and research group already in existence and to a high-technology patient care facility under construction on the UC Irvine main campus on Bison, just off the 73. 

The institute itself comprises 17 full-time clinician faculty, covering all subspecialties, with offices at both UC Irvine Medical Center in Orange and at Gottschalk Medical Plaza on the Irvine campus; 9 basic science faculty researchers located at the UC Irvine School of Medicine in Irvine; 9 residents and 9 post-residency subspecialty fellows; plus volunteer faculty and post-doctoral researchers. The Gavin Herbert Eye Institute provides the only full-service academic specialty care between San Diego and Los Angeles, with a full range of advanced diagnostic imaging and surgical specialty technologies.

The new clinical building on the UC Irvine campus will fulfill a vision that Gavin Herbert has worked for over 30 years to accomplish. The founder of Allergan, Mr. Herbert first recruited the internationally eminent Irving Leopold, MD, from New York to be the first chair of the ophthalmology department in the newly created UC Irvine School of Medicine. Now, Mr. Herbert has led the drive to raise the philanthropy for an outstanding   facility to deliver world-class patient care and simultaneously be the fulcrum for translational research that brings basic research into innovative new therapy. The project is funded 100% through philanthropy, with no state or university dollars. Currently $29.5M has been raised toward the total opening cost of $37M.

Roger F. Steinert, MD, was recruited from Harvard 8 years ago with the allure of the opportunity of helping to achieve this project. For Dr. Steinert, a Massachusetts native, a summa cum laude graduate of Harvard College and an Alpha Omega Alpha graduate of Harvard Medical School, and a faculty member of Harvard Medical School and the Massachusetts Eye and Ear Infirmary, the potential of the eye institute project and the draw of Orange County nevertheless was irresistible.

"I had frequently visited Orange County over several decades as part of my research in lasers and cataract   surgery," commented Dr. Steinert. "The potential for world-class innovation in prevention and treatment of blinding disorders is clear. Orange County has the highest concentration of eye technology industry in the world. When you combine that with a highly supportive community and a world-class university, the ability to make a difference is clear."

"Our vision is to provide leading eye care to Orange County, right here, right now, while also, by collaboration with the Orange County community and the university, be a global leader in developing the new technology of tomorrow. Simultaneously, we will support our profession with accessible continuing medical education and train the leaders of the next generation."

The new building just celebrated the traditional "Topping Out" event, recognizing the completion of the    highest level of the building. Full occupancy and patient care is scheduled for Summer 2013. The new building comprises 70,000 square feet, and includes patient care offices, translational and clinical research spaces,  ambulatory surgery, laser and oculoplastic reconstructive surgery, and conference and teaching spaces. Extensive work has gone into creating innovative architecture, including collaboration with the Braille Institute to minimize architectural barriers to patients with limited vision. High definition video can be transmitted over the internet to teaching sites in the Institute but also throughout the world. Medical records are fully electronic, facilitating communication to referring physicians. 

The location of the clinical facility is just 500 feet away from the 2 laboratories conducting basic research in stem cell therapy for age-related macular degeneration and the inherited blinding disorder known as retinitis pigmentosa; innovative immunological studies on developing the first effective vaccine against herpes simplex virus; laser imaging of microstructures in the eye that will guide understanding of disease processes and therapy; and the pediatric blinding condition of cystinosis.



Roger F. Steinert, MD, graduated from Harvard College and Harvard Medical School, going on to complete his ophthalmology training at the Massachusetts Eye and Ear Infirmary. His career-long clinical interests are corneal surgery, cataract and implant surgery, and refractive surgery. He maintains a consultation practice in these areas. His research has centered on optics, with an emphasis on lasers and related technology. Dr. Steinert's current appointment is the Irving Leopold Professor of Ophthalmology, Chair of the Department of Ophthalmology, Professor of Biomedical Engineering, and Director of the Gavin Herbert Eye Institute, as well as Vice President and President-Elect of the Medical Staff of UC Irvine Medical Center. He has published 5 textbooks, including Cataract Surgery, currently in its 3rd Edition, as well as over 90 book chapters and over 140 peer-reviewed scientific publications. He is past president and current program chair of the American Society of Cataract and Refractive Surgery and Associate Editor of Ophthalmology, the journal of the American Academy of Ophthalmology.


OCMA Specialty Spotlight:The PRECICE Device

Dr. Samuel Rosenfeld, an orthopedic surgeon with the CHOC Children's Orthopaedic Institute, is the first on the West Coast to perform a limb lengthening procedure using the PRECICE™ Remote Control Device. Developed by Irvine-based Ellipse Technologies, in collaboration with Dr. Stuart Green of UC Irvine, and cleared for use in the United States by the FDA in July 2011, the PRECICE represents a new era for limb lengthening.

The device, considered by physicians to be precise and gentle, is implanted with minimal incision   surgery. A magnetic motor assembly in a rod is placed inside the patient's bone and responds to an external remote controller. The surgeon uses the external remote controller to gently and more accurately control the rate of lengthening, including the potential to reverse the lengthening. In addition to providing a less invasive procedure for limb lengthening, PRECICE has been recognized for significantly reducing the potential for complications, such as infections, during the healing process. Presently, the device is used for lengthening the femur and tibia bones.

Leg length discrepancies can be congenital (present at birth) or acquired as a result of an accident, a significant fracture that does not heal or disease, such as cancer. The conventional approach for leg lengthening has been the use of an adjustable external fixation device attached to the bone with pins and adjusted by the surgeon. The leg lengthens as the bone heals. The procedure has been associated with a high rate of complications, most commonly infections at the pin sites.

An alternative to external fixation devices, the first implantable device - called the intermedullary skeletal kinetic distractor (ISKD) - was approved by the FDA in 2001. A telescopic rod implanted in the marrow cavity of the bone and activated by movement, the ISKD makes it more challenging to control the rate of lengthening, potentially resulting in nerve damage, poor bone healing and muscle contractions. With the better control of the PRECICE system, some of these issues may be eliminated.

Named a "physician of excellence" from the Orange County Medical Association, Dr. Samuel Rosenfeld is a pediatric orthopedic surgeon with special interests in muscular dystrophy, spina bifida and spasticity.

He received his medical degree from Pennsylvania State University College of Medicine; his internship in general surgery at the University of California Irvine Medical Center, where he also completed his residency in orthopedic surgery; and a fellowship in pediatric orthopedics and rehabilitation at Rancho Los Amigos Hospital in Downey, California. He's part of the multidisciplinary team of experts at the CHOC Children's Orthopaedic Institute.

The CHOC Children's Orthopaedic Institute is the only program of its kind in the region offering a wide range of comprehensive subspecialty programs specializing in the diagnosis and treatment of complex orthopedic injury, illness and disorders in children and adolescents. At the CHOC Orthopaedic Institute, highly experienced pediatric orthopedic surgeons and specialists, along with a multidisciplinary team, provide a complete range of clinical, surgical and ancillary support services for their patients in one convenient setting.


Dr. Samuel Rosenfeld is a pediatric orthopedic surgeon with special interests in muscular dystrophy, spina bifida and spasticity. He received his medical degree from Pennsylvania State University College of Medicine; his internship in general surgery at the University of California Irvine Medical Center, where he also completed his residency in orthopedic surgery; and a fellowship in pediatric orthopedics and rehabilitation at Rancho Los Amigos hospital in Downey, California.

 


OCMA Specialty Spotlight: The Be Aware Foundation

Be Aware Foundation Releases Two New Videos that Empower Women to do Breast Self-Exam with Confidence

The Be Aware Foundation, a non-profit organization dedicated to raising awareness for early breast cancer detection, released two educational videos developed to empower women to perform breast self-exam (BSE) with confidence. The two videos can be viewed on the foundation's website (beawarefoundation.org) or on the foundation's YouTube channel (BeAwareFoundation).


Although mammography has been proven to be the best screening tool to detect breast cancer at an early stage, mammograms have some significant limitations. In women with dense breasts, mammograms miss approximately 30 percent of cancers. Some cancers show up as lumps between mammograms, and women under 40 years are not advised to do annual screening.

"Current guidelines for doing BSE are confusing," said Be Aware Foundation President Peggy Brooker. "The guidelines recommend that women should be aware of their breasts and report any changes to her doctor, but the guidelines also state that doing BSE should be a woman's choice." The next question is "how can a woman detect an early change if she is not doing regular breast self-examination?"

"My 40 years of treating women with breast problems has convinced me that women can be taught to do BSE with confidence," said Be Aware Foundation co-founder Dr. John West. "With the support of the Be Aware Foundation I have created two videos which spell out, step-by-step, what women must do to learn how to do BSE with confidence. These videos have the potential to save lives, save breasts and save money....and it's free for every woman to learn from."

 

Founded in 2004 by Tanja Cebula, a cancer survivor, and Dr. John West, the Be Aware Foundation is dedicated to saving lives by educating and inspiring women to follow early detection guidelines for breast cancer. Our volunteer RN's and breast cancer   survivors deliver a compelling educational program in a "lunch and learn" format to companies, agencies and other groups of women in Orange County. Women who attend our Pearls of Wisdom program are encouraged to fill out a Personal Plan of Action whereby they commit to following the early detection guidelines.

We send email reminders to perform monthly breast self exams and annual clinical exams and mammograms. These email reminders also offer important information about new developments in breast cancer prevention and treatment, as well as general women's health topics, and our Ask the Doctor topics. 


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