Category: Specialty Care

Coronary artery disease (CAD) is a condition where plaque filled with cholesterol deposits in the blood vessels of the heart. As a result, your heart does not get enough blood flow and oxygen, which leads to a variety of conditions ranging from angina to heart attacks. The biggest risk factors for developing CAD are smoking, diabetes and family history. Hypertension, high cholesterol levels and poor lifestyle habits, like lack of exercise and an unhealthy diet, are also risk factors.

The best treatment of CAD is prevention. Quit smoking, control your diabetes, blood pressure and cholesterol levels. You want your LDL (bad cholesterol) to be low, and you want your HDL (good cholesterol) to be high. This can be achieved with diet, exercise and medications.

 

Symptoms of CAD can be vague. Chest pain is the most common symptom, but it can also present as jaw pain, neck pain, arm pain, back pain, shortness of breath or fatigue. Early recognition is key. Contrary to popular belief, women over 55-years-old carry a higher risk than men of the same age. The risk in younger men is higher than in older men.

There are various ways to treat CAD. Medications, lifestyle changes like quitting smoking, controlling your diabetes, blood pressure and cholesterol levels, as well as stents or bypass surgery. A stent is a device that looks like the spring of a ballpoint pen, which keeps arteries open. These are life-saving in situations of a heart attack. Nowadays, open heart bypass surgeries are reserved for extensive blockages in multiple areas of the heart, and/or when the blockage is in a critical part of the heart, which is not suitable for a stent.

The latest in stent technology is bioabsorbable stents, which disappear after their job of keeping the arteries open is done. These are currently being used by myself and other Michigan Heart physicians. If you have questions about CAD, please talk to your primary care physician or cardiologist.

 

 

Peripheral artery disease (PAD) is a blood disease of the legs, where plaque builds up in the arteries.

Plaque is made up of fat, cholesterol, calcium and other substances in the blood. When you develop PAD your extremities, usually your legs, don’t receive enough blood flow, which causes symptoms such as leg pain or calf cramping when walking. You have a higher chance of contracting PAD if you have diabetes and/or smoke.

 

Most cases of PAD are treatable, although in very serious cases, PAD can lead to leg amputation. At IHA Vascular & Endovascular Specialists, we have an outpatient center equipped to perform the most up-to-date procedures for PAD, if it’s necessary. We try non-surgical options first, such as a medication and lifestyle changes, and work our way toward surgery if it’s needed.

In our outpatient endovascular center, we can perform many minimally-invasive procedures, which will allow the patient to avoid the hospital. We also strive to perform minimally-invasive procedures, which allows the patient less downtime and a faster recovery.

If you have leg pain when you walk or climb stairs, talk to your doctor. Some older adults associate leg pain with the aging process; however the cause of pain could be PAD.

This article was originally published on April 7, 2016, and was updated on September 19, 2016.

Thanks to continuous advances and breakthrough in cancer research, the medical community has been witnessing an unprecedented flow of success

stories through innovative immunotherapy and targeted therapies. Cancer specialists are now able to work successfully with their patients toward less toxic and more effective cancer treatments. Immunotherapy and targeted therapies are ushering in a new era in the fight against cancer.

 

It all starts at the cell level. Under certain series of unfortunate circumstances, some cells in our bodies become corrupted and start to grow to form cancerous cells. Normally, the immune system is supposed to patrol and detect those abnormal cells and destroy them. However, cancerous cells often find a way of evading the immune system through certain mechanisms including receptors.

What are cell receptors and what do they do? Well, certain receptors on the cell surface resemble the function of passcode or Identification Cards (ID cards). Normal cells have “good” passcodes on their surface and when those normal cells are scanned by the cells of the immune system, they are allowed to survive. However, cancer cells are often able to fool the immune system by acquiring (stealing or forging) those same “good” receptors (ID cards). As such, “impostor” cancer cells pass the scanning test of the immune system and they survive and keep growing in number.

Immunotherapy and targeted therapies specifically address this flawed issue of “fake IDs” by training and waking up the immune system to appropriately fight cancerous cells. For example, medications called “check-point inhibitors” block the interaction between particular cancer cell receptors (or fake IDs) and the immune cells “scanners” in order to uncover the true identity of cancer cells and allow the immune system to destroy them.

There are also several other mechanisms by which immunotherapy can help the immune system to detect and destroy cancer cells. The bottom line is that many patients who suffer from cancer can now be offered less toxic and more effective treatments through FDA approved immunotherapy and targeted therapy. In addition to standard therapies, patients have now more opportunities to enroll on clinical trials that are looking to uncover newer ways to teach the immune system to target effectively cancer cells without affecting the normal bystanders.

National Colorectal Cancer Awareness Month is a great time to talk about one of the most preventable and treatable forms of cancer, if diagnosed early. It may seem intimidating, but a colonoscopy is a very simple test and a big reason why there are more than one million colon cancer survivors in the United States.

A colonoscopy test is a visual examination of the large intestine (colon) using a lighted, flexible video colonoscope. The scope also has a camera to help the physician document findings and notable features.

A colonoscopy is more than just a test. If a polyp is found, it can usually be removed during the exam, thereby eliminating the need for a major operation and potentially preventing the development of cancer. If a bleeding site is identified, treatment can be administered to stop the bleeding. Other treatments can be given through the colonoscope when necessary and further studies or treatments may be recommended.

Colonoscopies also can be used in the diagnosis, treatment or prevention of other issues, such as:

• Abdominal pain, discomfort or change in bowel habits
• Chronic diarrhea or constipation
• Colitis (Ulcerative or Crohn’s)
• Diverticulosis and Diverticulitis

Alternative tests to a colonoscopy include a barium enema or other types of X-ray exams that outline the colon and allow a diagnosis to be made. In addition, study of the stool and blood can provide indirect information about a colon condition. These exams, however, do not allow direct viewing of the colon or removal of polyps or biopsies to be done.

If you’re at risk for colon cancer because of age, medical history or family history, talk to your doctor. They can help you determine which test is right for you.

Protect yourself by knowing the warning signs of skin cancer

Many people are familiar with melanoma, one of the most deadly forms of skin cancer, but are you aware that there are other, more common types of skin cancer that you should be watching for? As we prepare for warmer weather, it is important to know how to prevent and detect skin cancer.

An ounce of prevention

Sun avoidance is key to preventing the development of skin cancer. Ultraviolet (UV) light exposure, such as from the sun or indoor tanning beds, is a known risk factor for the development of melanoma and non-melanoma skin cancers, especially in fair-skinned individuals.

Avoiding tanning beds, staying out of peak sun exposure (during the mid-day), seeking shade, and wearing long sleeves, pants, and a wide-brimmed hat are your best bets to keep your skin looking younger for longer and for the prevention of skin cancer.

If must expose your skin to the sun, using a sunscreen is helpful. Daily use of a broad-spectrum (UVA and UVB blocking) sunscreen is recommended. In the summer months, a minimum SPF (sun protection factor) of 30 is suggested, but the higher the SPF number, the better. If you use moisturizer or make-up, look for products that contain a sunscreen, and you can skip daily application of a second product to your face. Application of an adequate amount of sunscreen is also important to achieve the desired effect. Approximately one ounce (two tablespoons) is the amount of sunscreen required for one full body application. A thin coat of sunscreen can provide one half or less of the labeled SPF. Check to make sure that your sunscreen is not expired. Even if your sunscreen is labeled as water-resistant, be sure to reapply frequently, especially if you are perspiring or swimming.

Get to know your skin

I recommend a full body self skin examination once per month. Pick a day of the month that is easy to remember, such as the first of the month, or another number of personal significance. If you “know your spots,” it is easier to recognize and treat potential skin cancers at an earlier stage.

Know the warning signs of skin cancer

The most common type of skin cancer is basal cell carcinoma. This is a slow growing skin cancer, but can be locally destructive if left untreated. This presents most commonly as a fragile, pimple-like bump that bleeds easily. This cancer fails to heal like a normal pimple would. Scaly, pink or red patches of skin that do not respond to moisturizer may also be a warning sign basal cell carcinoma.

The next most common type is skin cancer is squamous cell carcinoma. This can present as a scaly, sandpapery, rough patch of skin that fails to respond to moisturizer. It may also present as a new or rapidly growing lump on the skin, sometimes with a crusty center.

A less common, but more dangerous form of skin cancer is melanoma. An easy to remember mnemonic device highlights the warning signs of melanoma – look for the “ABCDEs.”

IHA ABCDEs for checking moles

It is also helpful to look for the “ugly duckling” or “black sheep” of your moles or spots. If you have a mole that stands out from the rest of your moles, a professional should examine it.

Other rare forms of non-melanoma skin cancer also occur, such as merkel cell carcinoma or tumors of sweat glands and oil glands.

A baseline visit with a board-certified dermatologist is recommended to screen for any potentially concerning lesions. Your dermatologist can provide further education about how to perform a self-skin examination, will discuss your individual risk factors for skin cancer, and can help you to design a plan for sun protection.

To schedule an appointment with an IHA Dermatologist, please call 734.677.DERM (3376) or make an appointment.

Reposted with permission; originally posted in the 2015 spring edition of Cardiac Advantage

Traditional treatment for severe aortic stenosis – a narrowing of the valve that allows blood to flow from the heart to the body- has been to open the chest, remove the fault valve and replace it with a new one.

Many patients are too sick or too frail to tolerate open-heart surgery. “For a long time, we had little to offer patients with severe aortic stenosis if they were unable to undergo open heart surgery because of their age and/or the severity of their medical condition,” said cardiothoracic surgeon Andrew Pruitt, MD, at St. Joseph Mercy Ann Arbor. “Now there is new hope. In August 2012, we began performing an exciting new procedure, transcatheter aortic valve replacement (TAVR), that is holding great promise for patients who formerly had no options.”

Some people with aortic stenosis have no symptoms at all, but for most patients symptoms include: shortness of breath, fatigue, difficulty exercising or performing other strenuous tasks, chest pain, lightheadedness or fainting.

“In its earlier stages, aortic stenosis can be treated with medication, but in more advanced form traditional surgery, and now, TAVR are the only options.”

How does TAVR work? The surgeon makes an incision in the groin (transfermorally) or through a space in the rib cage (transpically) and threads a catheter into the blood vessel to reach the aortic valve. A balloon on the end of the catheter is inflated forcing open the stiff leaflets of the damaged aortic valve. This leaves room to replace the original catheter with a second one. The second catheter not only has a balloon on the end, but also a compressed replacement valve. The replacement valve is made of cow heart tissue that is sewn onto an expandable stainless steel stent. The new valve is placed on the center of the disease valve and then expanded into proper position with the aid of the balloon. Physicians can choose replacement valves to fit a wide range of patient sizes.

A key advantage is that the procedure is performed on a beating heart and the patient does not have to put on a cardiopulmonary bypass machine, so it is far less stressful for the body. The transfemoral approach usually requires about three hours to complete; the transapical about 30 minutes less.

Developed in 2000 by a French cardiologist, TAVR was approved for use in the United States in 2011, slightly ahead of schedule when clinical trials proved remarkably successful.

However, TAVR is still relatively new and not without risk. “Currently, this approach is limited to patients who must meet very specific criteria,” said Dr. Pruitt. “TAVR brings with it its own set of side effects and has as slightly higher rate of certain complications than traditional, open-heart surgery. The FDA has only approved its use for patients with severe, symptomatic aortic stenosis who are felt to be inoperable, or at very high risk for traditional surgery by two independent cardiac surgeons.”

In addition, potential candidates must undergo a series of test to determine if they meet the physical and medical parameters to accept the device safely. “We very carefully have to weigh risks versus benefits, and for those patients who cannot tolerate open-heart surgery, TAVR can be a life saver,” said Dr. Pruitt. “TAVR not only extends patients’ lives, it can significantly improve their quality of life.”

Cardiologists and cardiac surgeons at St. Joe underwent intensive training to learn this new surgical procedure. Based on the high volume of surgeries conducted here, the expertise of our physicians and staff, and the collaborative multidisciplinary heart team that evaluates all potential cases, patients who qualify for TAVR can feel confident in the skill level and experience of their heart team.

“The message to prospective patients and their referring physicians is this: Don’t give up hope. Even for the frailest patients with extremely advanced conditions, we can offer solutions and relief,” said Dr. Pruitt. “In cases where TAVR is an option, it literally can mean the difference between life and death.”

News Release
December 23, 2014
For Immediate Release
For more information, contact:
IHA
Amy Middleton
734-327-0877
Amy_Middleton@IHAcares.com

IHA Concludes 2014 by Welcoming Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery

ANN ARBOR, MI – (December 23, 2014) – IHA is pleased to announce its planned integration with Community Orthopedic Surgery, P.C & Huron Valley Hand Surgery, effective December 31, 2014. With offices in the Michigan Orthopedic Center on the St. Joseph Mercy Ann Arbor campus and in Brighton, the practice, comprised of Michael S. Fitzsimmons, MD; Fred M. Hankin, MD; John V. Hogikyan, MD; James L. Telfer, MD; and Mark R. Wilson, MD; has provided compassionate, patient focused care to patients across Southeast Michigan and beyond since 1984.

Dr. Walter “Mac” Whitehouse, Jr., IHA Surgery Department Chair commented that “these are not only nationally-recognized surgeons, but also outstanding individuals whom we are thrilled to welcome to the IHA family as IHA Community Orthopedic Surgery.”

“Ready and efficient exchange of clinical services between primary, specialty, and subspecialty providers is vital to delivering the high-quality, cost-effective care that patients need and expect today,” says Michael S. Fitzsimmons, MD, President of Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery. “Joining the IHA team enables us to achieve this by integrating our expansive range of orthopedic services with a high-quality physician group.”

Dr. Whitehouse also adds, “the surgeons provide a broad range of orthopedic capabilities along with sub-specialty expertise which all of us at IHA are now thrilled to have on the same team.”

• Dr. Fitzsimmons has been active in general orthopedic surgery with particular emphasis on hand and microvascular reconstruction. This has included management of carpel tunnel syndrome, wrist pain, and complex replantation of free flap transfers. He has been involved with resident education at a number of programs. Dr. Fitzsimmons will serve as the Site Medical Director.
• Dr. Hankin has interests in a variety of hand problems including congenital deformities, cerebral palsy, acute and late tendon injuries, rheumatologic conditions, infections, and hand problems related to quadriplegia.
• Dr. Hogikyan has been an active provider of care to individuals with a variety of hand afflictions. He has wide ranging experience in management techniques for trauma, compressive neuropathies, nerve and tendon injuries, arthritis and fractures. Common surgeries performed include carpal tunnel release, tendon repair and arthritis surgery.
• Dr. Telfer is active in general orthopedic surgery with an emphasis on sports medicine. His practice includes surgery of the knee and shoulder as well as primary joint replacement.
• Dr. Wilson emphasizes hand and microvascular related conditions in his practice. Various types of non-surgical as well as surgical management are utilized in the care of conditions such as arthritis, trauma, nerve compression and wrist pain. Microvascular reconstruction is used for wound problems such as open fractures and osteomyelitis. He treats avascular necrosis of the hip joint at this center with vascularized fibula grafting.

According to Bill Fileti, IHA’s President & CEO, this integration with Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery represents another major development in a year full of successes and expansion. IHA celebrated its 20th anniversary in February 2014 and opened a new 44,000 square foot medical center at Domino’s Farms Office Park in May 2014. In June, IHA integrated with Michigan Heart and added 47 nationally recognized comprehensive cardiovascular physicians and practitioners. With an active and on-going physician recruitment program, IHA also strengthened its primary care and specialty capabilities with over 50 new physicians and practitioners.

“IHA continues to evolve into one of the largest and best multi-specialty group practices in Michigan,” notes Fileti. “With integrations, such as this upcoming partnership with Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery, IHA continues our commitment to expanding our capabilities in order to give our patients outstanding quality, easy access and cost effective care.”

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About IHA
IHA is one of the best and largest multi-specialty groups in Michigan. IHA employs more than 1,500 staff members, which includes 425 providers consisting of: physicians, nurse practitioners, physician assistants and midwives across 55 practices in Southeast Michigan. IHA provides high quality medical care and excellent service to more than 355,000 active patients. Recognized as one of Michigan’s top performing medical groups, IHA also ranks in the top quartile for patient satisfaction nationally. Offering extended office hours, Urgent Care, and access to clinical research studies, IHA demonstrates that it cares by bringing safe, high quality, comprehensive and affordable care to its patients. For more information about IHA, visit www.ihacares.com.

About Community Orthopedic Surgery, P.C. & Huron Valley Hand Surgery
Community Orthopedics has been providing high quality, nationally-recognized orthopedic care to patients in Southeast Michigan for over 30 years. With five exceptional surgeons – four specializing in hand and microvascular surgery and one in general orthopedics with an emphasis on sports medicine – Community Orthopedics has consistently delivered efficient, compassionate, patient focused care with an emphasis on teamwork. Community Orthopedics has conveniently located clinics in the Michigan Orthopedic Center on the St. Joseph Mercy campus in Ann Arbor and in the St. Joseph Mercy Brighton building on Grand River in Brighton.

Deep vein thrombosis is the formation of a blood clot, primarily in deep veins of the lower legs or thighs, occurring when the vein is completely or partially blocked slowing or stopping blood flow. Patients can expect signs and symptoms of: pain or tenderness in the leg, swelling of the leg, discoloration, or no symptoms at all.

Blood clots can happen to anyone, at any age, and sometimes go undetected until the clot has dislodged and made its way to the lungs potentially causing a pulmonary embolism, which is the blockage of an artery in the lung. The risk, however, increases with a family history of clotting, or long periods of immobility.

Trellis Peripheral Infusion System is a unique and innovative treatment used to treat deep vein thrombosis (DVT). Before the Trellis procedure, previous techniques such as blood thinning medication were used along with compression stockings as to break up clots. Blood thinners, while effective in decreasing the blood clot and risk of a fatal pulmonary embolism, could lead to post thrombotic syndrome and don’t fully dissolve the clot.

The Trellis procedure, introduced in 2006, has proved to be safer and provided a quicker return to normal blood flow for the patient. Within 24 hours patients can go home and in a period of 1-2 days after the procedure they can return to normal activities.

Known as the clot buster, the Trellis procedure uses an oscillating catheter that is inserted into the problem vein. Two balloons are inflated isolating the clot within the vein. Clot dissolving medicine is infused through the catheter into the space between the balloons and takes 10 minutes of oscillation to dissolve the clot, at the end of the procedure the liquefied clot is aspired out of the catheter.

IHA Vascular & Endovascular Specialists like me, routinely preform this operation. We are all highly trained and board certified in our respective fields. These operations are routinely preformed and if you fit the right criteria the Trellis Procedure is a quick and easy procedure for DVT.

To decrease the risk of DVT, I recommend maintaining an active lifestyle. Also preforming leg exercises and stretching at least two times a day can help lower the risk. Along with exercising, choosing a healthy diet and getting regular check-ups for blood pressure can also help decrease the formation of blood clots.

It is also wise to get up and move around after long periods of immobility. For example, on long plane rides get up from your seat and walk the aisles. Similarly if you sit at a desk all day, get up and take breaks from your desk. The same is true for long car rides as well, pull over and take pit stops to stretch your legs.

If you are experiencing any of the signs or symptoms, or feel that you are at risk for DVT, call your primary care physician to set up an appointment.

PEVAR (Percutaneous Endovascular Aneurysm Repair) is an FDA-approved, minimally invasive procedure for patients with an abdominal aortic aneurysm. An aortic aneurysm is an abnormal enlargement in the wall of the aorta, which is the largest artery in the human body. The aorta supplies oxygen-rich blood from the heart, down through the chest and abdomen area before dividing into the vessels in the legs.

An aneurysm can happen to anyone, at any time, however, your risk increases with age, tobacco use and a family history of heart disease or aneurysms. In general, if you’re an older male, who smokes, has high blood pressure and a family history of hypertension, you’re at a higher risk.

Previously, the only surgical options to fix an abdominal aortic aneurysm were Open Surgical Repair (OPEN) and Endovascular Aneurysm Repair (EVAR). OPEN repair involves an incision in the abdomen directly over the aortic aneurysm, usually from below the breastbone to just below the navel. A long cylinder-like tube called a graft is used to repair the aneurysm. This operation is highly invasive, has a higher short-term and intermediate-term mortality rate, longer hospital stays, longer at-home recovery times, and is not suitable for high-risk patients.

EVAR entails making small incisions in the groin area, above the femoral arteries, uses special endovascular instruments to insert a stent-graft through the femoral artery and into the aneurysm. EVAR is minimally invasive, with lower mortality rates, shorter hospital stays, shorter at-home recovery time, and is safer for high-risk patients.

PEVAR expands upon the minimally invasive concept of EVAR, requiring only small nicks in the skin, meaning there is less blood loss and less pain. It reduces groin complications, hospital time and recovery time, meaning the patient can return to their normal activities much quicker than they could with OPEN or EVAR. It also requires less operating time, making it a more cost effective and less invasive surgical option for patients.

IHA Vascular & Endovascular Specialists are the only certified physicians who can perform the PEVAR procedure at St. Joseph Mercy – Ann Arbor. Personally, I have been performing the surgery for the past year, and it is a routine procedure for me and the other providers here. If you’re a good candidate, PEVAR is a great option that allows the patient very quick recovery time and minimal pain, while still gaining the benefits of a fixed aneurysm.

For more information about PEVAR, please call 734.712.8150.