Wednesday, June 19, 2013

NO ONE SHOULD DIE FROM COLON CANCER!!





MARCH IS COLORECTAL CANCER AWARENESS MONTH





Of cancers that affect both men and women, colorectal cancer is the second leading cause of cancer-related deaths in the United States and the third most common cancer in men and in women. More than 140,000 Americans are diagnosed and more than 50,000 die from the disease each year. Colorectal cancer affects all racial and ethnic groups and affects both genders equally. It is most often found in people aged 50 years or older, and the risk for developing this cancer increases with age.



To help combat this disease, Medicare provides coverage for screening and the early detection of colorectal cancer. All Medicare beneficiaries aged 50 and older are covered; however, when a beneficiary is at high risk, there is no minimum age required to receive a screening colonoscopy (or a barium enema rendered as an alternative). Medicare defines high risk of developing colorectal cancer as someone who has one or more of the following risk factors:

 A close relative (sibling, parent, or child) who has had colorectal cancer or an adenomatous polyp

 Family history of familial adenomatous polyposis

 Family history of hereditary nonpolyposis colorectal cancer

 Personal history of adenomatous polyps

 Personal history of colorectal cancer

 Personal history of inflammatory bowel disease, including Crohn’s Disease and ulcerative colitis

 Personal history of breast or uterine cancer



Medicare pays for the following colorectal cancer screening services:

 Flexible Sigmoidoscopy

 Colonoscopy

 Barium Enema (as an alternative to a covered screening colonoscopy)



What Can You Do?

Be proactive in YOUR care!! About nine out of every 10 people whose colorectal cancer is found early and treated are still alive five years later. I encourage you to understand the importance of early detection. Take full advantage of colorectal cancer screenings covered by Medicare, as appropriate. You can help save lives! Colorectal cancer is preventable, treatable, and beatable.



More Information: Please call 813-633-0081 today to find out how you can save your life and your loved ones.

§ www.Absolutesurg.com

§ MLN Cancer Screenings Brochure

§ MLN Quick Reference Information: Medicare Preventive Services

§ National Colorectal Cancer Roundtable

§ National Colorectal Cancer Awareness Month website





Craig Amshel, M.D.

(813) 633-0081

www.absolutesurg.com

http://twitter.com/ColoRectal_Man

Thursday, September 23, 2010

The Role of Laparoscopy and Colorectal Cancer

There is probably no other topic in the field of surgery that has generated so much controversy over the past 15 years than the use of laparoscopy for curative resection of colon and rectal cancer. There have been several prospective randomized studies that have absolutely taken the question mark out of the title of this article. Although I am a fellowship-trained colorectal surgeon, and thus biased toward my extensive training in laparoscopy, I can present both the pros and the cons for its use and let you decide.

Patient selection is critical when determining if someone would benefit from a laparoscopic resection. A cancer or other large mass can be safely removed without sacrificing negative tumor margins nor adequate lymph node yield from anywhere in the colon and proximal rectum as long as the tumor size is a T3 (i.e., no invasion into other organs or structures) or smaller as shown by CAT scan. Other criteria for laparoscopy include no evidence or perforation or obstruction.

Surgeon selection is equally important for the patient with a diagnosis of colon cancer. Laparoscopic colonic resection is considered to be an advanced technique that requires a steep learning curve of at least 25 procedures. Some general surgeons, especially those whose training did not include advanced laparoscopic techniques, have a difficult time adjusting and are thus more prone to surgical complications or tend to steer patients toward an open resection. Younger surgeons with specialized fellowship training such as advanced laparoscopy or colorectal surgery have obtained the skills and knowledge to perform these procedures with equal risk of morbidity and mortality as compared to an open resection.

The major concerns that were prominent when laparoscopic colorectal cancer resection was initiated, such as adequacy of oncologic resection, recurrence rates and patterns, and long-term survival have all been extensively studied and compared to open resection with no significant differences between the two techniques. In fact, a few studies have shown a slight advantage in long-term survival in patients who have undergone laparoscopic resection compared to same patient criteria who underwent open resection.

Besides a steep learning curve, there are two disadvantages to laparoscopic colorectal cancer resections: cost and longer operating room time. All three of these disadvantages overlap, and as a surgeon becomes proficient in the laparoscopic technique, the OR time will decrease to a time that is comparable to an open resection. While cutting OR time is a key money-saving method, the cost of laparoscopic tools will more than likely always keep the total OR cost of laparoscopy higher than that of an open resection.

The benefits to the patient, and thus the advantages of laparoscopy have been well documented. There is a significant reduction in post-operative pain and a decrease in the need for postoperative analgesia related to the smaller size of the incision. Postoperative ileus is also less of a problem, and accordingly, with smaller amounts of narcotics, patients are returning to their normal eating habits and activities at a quicker rate, and therefore, are actually discharged from the hospital on average one day earlier. The cost savings of a shorter hospital stay and less narcotic use outweighs the higher cost of the OR instruments. Better cosmesis is also an important factor, especially with younger women. A surgeon with advanced laparoscopic techniques can remove an entire colon and rectum with just a Pfannenstiel incision and three small trocar incisions!

The field of surgery is always evolving, and it is important for both patients and physicians to be aware of newer, studied techniques that will improve the well-being of our patients as a whole.

Craig Amshel, MD is a colorectal fellowship-trained surgeon at South Bay Hospital in Sun City Center and can be reached at 813-633-0081 or www.absolutesurg.com. He also performs general surgery and endoscopy and will be happy to answer any of your questions. References to the above article are available upon request.

Wednesday, February 25, 2009

Hemorrhoids are rarely a matter of life or death, but they can make some peoples lives seem unbearable due to possible symptomatic pain, itching, swelling, bleeding and protrusions. Symptomatic hemorrhoids are one of the most common complaints a physician evaluates. The problem is undiscriminating; it can occur in both men and women of any age. Often, hemorrhoids enlarge and become increasingly bothersome with age. Reports estimate that at least 50% of individuals over the age of 50 have some form of symptomatic hemorrhoids.
Many patients try to doctor their own hemorrhoids; they spend over $100 million a year on nonprescription remedies. Many are able to control their problem by increasing the fiber content of their diets, maintaining normal weight, and avoiding straining during bowel movements. Patients who have hemorrhoids that don’t respond to self-care measures should consult a physician. Not all rectal growths are hemorrhoids. And although rectal bleeding is not necessarily a sign of colon cancer it should be evaluated to rule out the possibility.
“I understand that issues like hemorrhoids and other problems in the rectal area can be quite embarrassing to most people,” assures Craig E. Amshel, MD, of Absolute Surgical Specialists. “Patients shouldn’t be embarrassed, however, because these problems are much more common than people realize. Hemorrhoids, for example, happen frequently to women, especially while they’re pregnant or after they have just given birth. People whose jobs require frequent standing or sitting are also commonly affected.”
Hemorrhoids may be a sensitive subject for most people, but it no longer has to be a painful one. Now new techniques can be performed in the privacy of a physician’s office that can cure the condition quickly and safely.
Non-surgical treatment
“Hemorrhoids, also known as piles, are masses of dilated veins in the anus or in the mucus membrane of the rectum,” explains Dr. Amshel. “Among factors contributing to this condition are heredity, nutrition, occupation, pregnancy, exercise, coughing and constipation. Hemorrhoids are rated in severity by four degrees and are classified as external or internal by their location. The extent of the disorder determines the treatment.”
Dr Amshel notes that the non-surgical treatment of hemorrhoids is best, and he always looks to provide a conservative solution before considering surgery.
“There are many procedures out there, but I like to get a full assessment of each patient’s bowel and dietary habits before considering surgery. How often does the person need to have a bowel movement, what is the consistency of their stool, and especially, how is their diet?”
“I take a conservative approach, avoiding surgery initially and putting the treatment in the patient’s hands. Fiber supplements are an inexpensive way to treat the problem and can make the patient feel so much better. Along with that, we also recommend that they drink an overly sufficient amount of fluids, such as water and unsweetened juice.”
“Dietary fiber supplements come in pill forms, wafers, crackers, and powders. I have the patient try a regimen of fiber and extra fluids for at least a month, and then I perform
a reassessment. Everyone has some improvement: Almost all the patients come in
with less pain, better bowel movements, and less bloating.”
Lesser hemorrhoids may require no treatment, but more extensive ones may need surgery.
In cases which very large internal and external hemorrhoids exist, a hemorrhoidectomy, or procedure for prolapse and hemorrhoids (PPH), may be the best option. A physician experienced in all treatment methods can serve as a knowing guide in making these decisions.
“Some people are just not completely satisfied after a month of the fiber regimen, and then we talk about different surgical options,” educates Dr. Amshel. “There are multiple options, from surgical excision to banding. This just goes to show that there has not been a true gold standard in terms of hemorrhoid removal. There are other procedures that claim to be "painless" by either coagulating or cauterizing the hemorrhoidal tissue or blood vessels. Some claim they use a laser procedure too, however, my opinion is that it’s expensive and doesn’t seem to give much relief and requires multiple visits to the physician who is administering the device. This physician may not even be trained in surgical care of anorectal disease. There is also a stapling technique, which seems to be less painful than a surgical incision.”
“Long-term results of hemorrhoids are generally favorable, but it’s also important to continue the initial regimen of fiber and fluids,” Dr Amshel reminds. “That is a lifetime commitment of at least a one-a-day supplement and fluid. Surgery always involves risks, so for that reason I think it’s important that patients and referring physicians seek out a surgeon with colorectal surgical experience.”
Concierge care
Dr. Amshel offers his patients concierge care – something new to a number of practices but standard for years at Absolute Surgical Specialists (813-633-0081).
“My philosophy is that every patient's time is just as valuable as mine,” he assures. “There is no wait longer than 10 days for an elective consultation. It’s typically a two-month wait just to see a doctor to get a colonoscopy, but in my practice patients are seen within about a week and have a colonoscopy within a week Once a patient arrives, their time is treated as important in the office as well. There is minimal waiting time in our office,” says Dr. Amshel. “If we’re fully booked, and a patient needs to be seen, we will make room for them that day. My staff and I speak Spanish fluently,” he adds, “and I keep my pager with me at all times, so I’m always available to patients. There is no single treatment for all hemorrhoids; the physician must evaluate each patient individually,” concludes Dr Amshel. “The good news is that with the advances in modern medicine we can offer more comfortable, less invasive treatments for a variety of hemorrhoid conditions. An office visit to your physician may produce a simple non surgical answer to a very old and common problem.”

Monday, February 16, 2009

What does a General Surgeon do?

Dear Reader: By many I am known as the AssMan (I even had the name, "ASS-MAN,MD" as my bib name while completing the 2008 Sarasota half marathon) as I am a colorectal surgeon. I don't mind the name and actually relish it as who else can speak about poop and digital rectal exams to break the ice at a party as well as someone who deals with that anatomical area day in and day out.
I enjoy the lectures I give throughout the community and have an expanding patient base, however, even though I write a few published articles a year, I have steered away from chat rooms, blogs, etc. Why? Because I just didn't know how to join? Because there is so much misinformation out there in cyberspace that I didn't want to be part of it? I think more of the latter. Every week I have patients in my office stating what new pill, surgical technique, mudmask, etc. they have read on the internet that will cure them of the disease with which they are sitting in my office discussing their problem for which they went out of their way to make their appointment in the first place. I would like to do my best to educate these patients and dispell the myths that are around regarding the treatment of these diseases.
There are so many issues to tackle, but I want to first start with some basic information and build on various topics with the hopes of answering your questions that you cannot find or are afraid to ask. So to start...

What does a General Surgeon do and how can he/she help you? What about a Colon and Rectal Surgeon?

Craig Amshel, MD

Before diving into the vast discipline of Surgery and the health benefits of becoming acquainted with your local General Surgeon, I would like to inform you, the reader, of some background requirements of becoming a General Surgeon and a Colon & Rectal Surgeon.
Modern surgery is divided into many subspecialties, including Vascular, Surgical Oncology, Plastic Surgery, Trauma/Critical care, Endocrine, Laparoscopy, Transplantation, Cardiothoracic, and my own subspecialty, Colon & Rectal Surgery. Except for the few surgical specialists that operate from the chin on up, the above specialties derive their training first from a General Surgical residency.
Except for the Neurosurgeon and beside the Urologist, today’s General Surgeon is the most trained single-specialty physician in practice. After earning a Bachelor’s degree and four years obtaining a Medical degree, the next five to eight years of life he (I recognize that there are many female General Surgeons, but for ease of reading, I will now refer to the masculine description) once knew, is now over for the General Surgeon-to-be. As if that was not enough, to specialize in Colon and Rectal surgery, a General Surgeon must spend another year or two in a fellowship-based program learning about all the disease processes that affect the colon, rectum, and anus.
The stories told and seen on TV are somewhat accurate about life as a surgical resident: he must learn to become efficient and establish the mental and physical stamina to interact with patients, focus his attention to details during an operation which could last between 30 minutes to six hours, follow-up on multiple tests that were performed on his patients and immediately decide upon a treatment plan derived from those test results while working 24 hours around the clock every other or every third day. Work is never mundane; at any time an emergency such as a gun shot victim, a person bleeding in his gastrointestinal tract, or a patient with appendicitis can arrive at the ER doorstep, a wound infection has developed, or a tube has been accidentally pulled out of a patient. Meanwhile, time away from the hospital is spent studying for the day’s next rounds, operations, or exams lest he look unprepared in front of his peers and organizing multi-media teaching presentations. Currently the maximum allowable time a resident can work in the hospital is 80 hours/week. However, prior to just a few years ago, a resident such as myself, could spend 132 hours/week living in the hospital.
All of this training does prepare the General Surgeon for the majority of disease processes he will treat in practice, however like residency, he must be prepared for the surprises that can be thrown his way.
I will describe typical clinical diseases seen by the General Surgeon and explain their symptoms of what you, the reader, should look for and ask questions about so you will be treated properly.
Hernia. An abnormal protrusion due to a weakness of the abdominal wall. These are typically seen in the groin, umbilical region, or thru a previous abdominal incision. Hernias do not go away. They must be surgically repaired in the out-patient setting either laparoscopically (less pain than “open” but general anesthesia is required) or “open.” Most hernias are a nuisance that may be tender and negatively affect a patient’s lifestyle, but they don’t require immediate treatment, however, they can become “incarcerated” (the protrusion can’t be pushed back in), which does require urgent repair and admission into the hospital. If you are absolutely against undergoing an operation, and you do not possess an incarcerated hernia, there are lifestyle changes you can discuss with your General Surgeon to reduce your chances of incarceration.
Gallbladder disease. If you develop pain under your right ribcage, flatulence, or diarrhea after eating, especially with fatty foods, you may have problems with your gallbladder. A simple test or two by your primary care physician (PCP) can determine whether your gallbladder is diseased. If so, it can easily be removed, and after a few weeks of light work, you can enjoy your previous normal lifestyle. If you do not wish to have your gallbladder surgically excised, the easiest and cheapest method to reduce the above symptoms is to maintain a strict non-fat diet. If you do not see improvement in a few weeks, you should consult your PCP for a referral to a General Surgeon.
Acid reflux. Sometimes gallbladder pain can be felt in the upper, middle portion of your abdomen. However, this pain usually represents acid reflux and can be quite bothersome, especially when trying to sleep. This disease can be diagnosed with an upper endoscopy (either by a General Surgeon or Gastroenterologist) and treated with both medication and lifestyle changes, such as limiting alcohol, caffeine, late-night meals and losing bodyweight. If this treatment plan is not effective, other tests should be performed to determine the exact cause of the pain, which may be amendable to an operation called a laparoscopic Nissen fundoplication, whereby a portion of the stomach is tightened to prevent acid from entering the esophagus.
Breast mass. Every female, starting at age 25, should examine her breasts on a regular basis coinciding with her menstrual cycle. Any change or suspicious finding should be presented to her PCP. Ask your PCP about scheduling a mammogram, which unless there is a strong family risk of cancer, should be initiated at age 35 and continued annually at age 40. Suspicious masses or mammograms should be brought to the attention of your PCP and General Surgeon to discuss a surgical biopsy and definitive treatment depending on what the biopsy reveals.
Colon/Rectal cancer, blood per rectum, hemorrhoids, constipation, etc. Colon and rectal cancer is one of the most preventable diseases we live with. These cancers do not just appear out of nowhere but start as a small polyp that continues to grow, and over time mutates into cancer. The only symptom may be some blood in the toilet or stool. Pain is extremely rare in the early stage of this disease. There are several options for diagnosis; however, a colonoscopy under “twilight” anesthesia is both diagnostic and a method of treatment. Unless there is a strong family history of colon cancer, every person should undergo a colonoscopy starting at age 50 by either a Colon & Rectal or General Surgeon, or Gastroenterologist. Think of the colonoscopy as the “mammogram for the colon.” If no polyps are found, the next colonoscopy won’t be due for another 10 years. To maintain a healthy colon and to treat and prevent both hemorrhoids and constipation, it is imperative to increase your fiber and fluid intake and activity level. If an operation is required, options including laparoscopic partial colectomy and hemorrhoidal stapling can be discussed with your Surgeon.
Although the above are just a few of the many diseases seen by the General Surgeon, be sure to question him about all of the treatment options or other ailments that may be bothering you. During your visit, it is also useful to bring a relative or friend to help ask and answer questions, and be sure to bring an updated list of all of your medications.
Dr. Amshel is East Hillsborough’s first fellowship-trained colon and rectal surgeon. He is currently accepting new patients at 1901 Haverford, suite 105, behind Southbay Hospital and at his Seffner office at 2204 S. Parsons Ave. Just about every major and minor insurance accepted and payment plans can be arranged for non-insured patients. Office phone # is 813-633-0081 to schedule appointments and happily answering any and all questions.