What Doctors Know - Wasatch

7/27/2019 What Doctors Know - Wasatch

1/36Wasatch Front/Inaugural Edition

The Emotional Roadto Family Life

What's

The Rush?

Repairing JointsWithout Surgery

Colonoscopy:Out of PocketExpensesEliminated

Know the Signsof Skin Cancer

Special thanks to Mike Farr andstaff of Farr's ice cream for thehelp and the use of their nostalIce Cream Shoppe in Ogden,Utah for the cover photography

Special thanks to our "Cover Gipictured left to right, front row,Katie Berry, Andrea Chavez anNelida Navarro. Back row, left right, Jane Porter and Taylor Ne

Photographer.Doug Reinhart, MD


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Jed Naisbitt, MD, RPhSBoard Certified in PhlebologyMemeber of the American

College of Phlebology

Specializing in Vein Care

John Whitehead, MPAS, PA-CMember of the AmericanCollege of Phlebology

15 Years experience in Phlebology

1525 East 6000 South Lower Level Ogden, Utah 84405 801-337-5854

Superifical VenousReflux Disease2 times more prevalent than Coronary HeartDisease/(CHD), 5 times more prevalent thanPeripheral Arterial Disease (PAD)Estimated 25 million people with symptomaticsuperficial venous reflux: only 1.7 million seektreatment, over 2.3 million go untreated.

PracticeHighlights- Full Service Vein Center- Open M-F, 8-5- Accept all Insurances- Up-to-date Ultrasound Technology- Diagnostics by Registered VascularTechnicians (RVT)

Only Comprehensive Vein Centeroffering a full range of services in theMidwest.

ComprehensiveServices Include- Vein Closure with Laser- Vein Closure with RF Technology- Ambulatory Phlebectomy- Wound Care- Full Line of Medical GradeCompression Stockings

- Spider Vein Treatments Sclerotherapy,YAG Laser and IPL

- Coagulopathy Management

YourHealthy Legs

Begin Here!


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On Call with Dr. Porter

I

am forgoing the traditional publishers letter tointroduce some major changes in our magazine changes that will make your reading experience

more enjoyable and more informative.Welcome to What Doctors Know formerly Local HealthcareToday magazine. We are changing our name for the obviousreason we are no longer a local magazine. We are nationaland available on the Nook, the PC, the iPad, or any androidbased tablet. We are officially part of the digital future.

The name changes, but the mission does not. While we continue to provide localhealthcare information along the Wasatch front, we will be expanding to a monthlynational journal. Over the course of the next several months you will see a broader

range of physicians from around the country and even from around the world.Frankly, I dont want to waste the space here with another history lesson orphilosophical rant. Instead, I would rather make you aware of these changesand invite you our valued readers to take advantage of our online versionexclusively available through the Barnes and Noble bookstore website.Download the app, click on What Doctors Know and get ready to read. Thecost is reasonable a dollar a month but the information is invaluable.

Very shortly we will be offering a greatest hits national printversion which will be available in the more than 700 Barnes and Noble

bookstores across the nation. The local issues will compliment ournational efforts and we would encourage you to explore both.

We are growing, but we want you to grow with us and most of all, we want to hearfrom you. We know you have questions, suggestions and more. If you have a healthquestion you want answered, drop us a line or send us an e-mail. We will match yourquestion with the best medical expert so you get the same kind of information youexpect from a leading healthcare magazine. What Doctors Know, and you should, too!

Steve Porter, MD

Publisher and Chairman

Send us your questions or a topic and we will have one of ourknowledgeable doctors give you the answers...simplified.

We want to hear from [email protected] orwrite us at, What Doctors

Know,585 West 500 South, Ste. 200, Bountiful, UT 84010


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contents Wasatch Front/Inaugural EditionPublished by

What Doctors Know, LLC

Publisher and ChairmanSteve Porter, MD

Medical Advisory Board

Vicki J. Lyons, MD, ChairmanTimothy J. Sullivan, MD, Medical Content Director

Editorial and Design DirectorBonnie Jean Myers

Senior DesignerSuki Xiao

Design AssociateCayden Chan

Executive Director, MarketingLarry Myers

Executive Director, ProductionKai Xiao

IT DirectorEric Lu

Director of OperationsAllen Nunn

Copyright 2011 by What DoctorsKnow, LLC. All rights reserved.Reproduction of this magazine,in whole, or in part is prohibited

unless authorized by thepublisher or its advertisers. Theadvertising space provided in

What Doctors Knowis purchasedand paid for by the advertisers.

Products and services arenot necessarily endorsed byWhat Doctors Know, LLC.

For more information on ad placement or contributing an article, pleaseemail [email protected], or call (801) 299 -1122.

For information on subscriptions, please visit www.whatdoctorsknow.com

Corporate OfficeWhat Doctors Know

585 West 500 South, Ste. 200 Bountiful, UT 84010 (801) 299-1122

Contributing Writers:Dann C. Byck, MD

Russell A. Foulk, MDMegan Wolthius Grunander, MD

Darrin F. Hansen, MD, FACSAaron Hofmann, MDPhillip C. Hoopes, MD

Kenneth M. Hurwitz, MDChristopher Y. Kim, MD

Vicki Lyons, MDStephen L. Miller, MD, FACC

Jed P. Naisbitt, MDMark Newey, DDSSteve Porter, MD

Robert P. Rivera, MDJeffrey J. Rocco, MD

Mark F. Rogers, DPM, FACFASThomas G. Rogers, DPM, FACFAS

Scott F. Rogers, DPMTimothy J. Sullivan, MD

Chad W. Tingey, MDScott K. Thompson, MDMichael Van Bibber, MDRobert Wayment, MD

Raul Weston, MDBrent Williams, MD

The American Heart Association

Utah Association of Oral and Maxillofacial Surgeons

On Call With Dr. Porter ..................................................................................................................1

Flu Season is Here ............................................................................................................................3

Colonoscopy: Out of Pocket Expenses Eliminated ...............................................................4

Whats The Rush? A New Approach to Fast Allergy Relief .................................................6

Oral and Maxillofacial Surgeons-Specialized Training...Specialized Care......................8

New Hip Replacements for Active Lifestyles ...........................................................................9

Controlling Your Risk for Vascular Disease ...........................................................................10Ankle Pain Could Be More Than a Minor Sprain ...............................................................11

The Emotional Road To Family Life ........................................................................................12

Implantable Contact Lens............................................................................................................14

Know The Signs of Skin Cancer ................................................................................................15

Get A Leg Up On Varicose Veins ..............................................................................................17

Wrinkles...Now You See Them, Now You Dont ...................................................................18

Exploring Vision Correction Options ......................................................................................19

Prostate Surgery Enters the Robotic Age ................................................................................20

Why Does My Heel Hurt So Much? .........................................................................................21

Colon Cancer: The Silent Killer ................................................................................................22

Pain Management-There Are No Easy Answers or Cures.................................................23

Repairing Joints Without Surgery .............................................................................................24

An Undercover KillerPeripheral Vascular Disease ..........................................................25

Lap Band Surgery ..........................................................................................................................26

Missing Teeth: More Than Aesthetics, Its A Matter Of Health .......................................27

ED (Erectile Dysfunction) Could be Early Warning Sign for Cardiovascular Disease ....................28

The 411 on Shoulder Pain ............................................................................................................30

Sensible Solutions for Obesity ....................................................................................................32


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Flu Season Is Here

S

easonal flu vaccinesprotect against the three

influenza viruses thatresearch indicates will be mostcommon during the upcomingseason including the SwineFlu. The viruses in the vaccinecan change each year basedon international surveillanceand scientists estimationsabout which types and strainsof viruses will circulate in agiven year. About 2 weeksafter vaccination, antibodiesthat provide protection against

the influenza viruses in thevaccine, develop in the body.The CDC makes the followingrecomendations for influenzaimmunization this year.

When to Get Vaccinated

The CDC recommends thatpeople get their seasonal fluvaccine as soon as vaccinebecomes available. The vaccineis available at all SmithsPharmacies from Logan to St.

George. Vaccination beforeDecember is best since thistiming ensures that protective antibodies are in place beforeflu activity is typically at its highest. The CDC continues toencourage people to get vaccinated throughout the flu season,which can begin as early as October and last as late as May.

Vaccine Effectiveness

The ability of a flu vaccine to protect a person dependson the age and health status of the person getting thevaccine, and the similarity or match between theviruses or virus in the vaccine and those in circulation.

Vaccine Side Effects (What to Expect)The viruses in the flu shot are killed (inactivated), so you cannot getthe flu from a flu shot. Some minor side effects that could occur are: Soreness, redness, or swelling where the shot was given

Fever (low grade)

Aches

If these problems occur, they begin soon after the shotand usually last 1 to 2 days. Almost all people whoreceive influenza vaccine have no serious problems fromit. However, on rare occasions, flu vaccination can causeserious problems, such as severe allergic reactions.

Who Should Get Vaccinated

Everyone 6 months and older

should get a flu vaccine eachyear at the start of the influenzaseason. While everyone shouldget a flu vaccine each flu season,its especially important that thefollowing groups get vaccinatedeither because they are at highrisk of having serious flu-relatedcomplications or because theylive with or care for peopleat high risk for developingflu-related complications:1. Pregnant women

2. Children youngerthan 5, but especiallychildren ages 6 monthsto 2 years old

3. People 50 years ofage and older

4. People of any agewith certain chronicmedical conditions

5. People who live innursing homes and otherlong-term care facilities

6. People who live with orcare for those at highrisk for complicationsfrom flu, including:

Health care workers

Household contacts of persons at highrisk for complications from the flu

Household contacts and out of home caregiversof children less than 6 months of age (thesechildren are too young to be vaccinated).

Who Should Not Be Vaccinated

There are some people who should not get a flu vaccinewithout first consulting a physician. These include: People who have a severe allergy to chicken eggs

People who have had a severe reactionto an influenza vaccination

People who developed Guillain-Barre syndrome (GBS)within 6 weeks of getting an influenza vaccine

Children younger than 6 months of age (influenzavaccine is not approved for this age group)

People who have a moderate-to-severeillness with a fever (they should wait untilthey recover to get vaccinated)

As of July 2011, 920 cases of the SwineFlu had been reported in Utah along with14 deaths and nearly 300 hospitalizationsfrom the virus. The start of the traditionalflu season is fast approaching andUtah Health Officials as well as theCDC (Center for Disease Control) areconcerned about this year. They don'tknow how forceful or violent the virus willbecome. To be safe, both departments arerecommending seasonal flu vaccines.

For more information and store locations go to www.smithsfoodandrug.com and www.cdc.gov//flu/protect/keyfacts.htm


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Most colon cancers are preventable through early detection. Recently I scoped a

patient in his 60s who had a complaint of rectal bleeding. This patient had beenavoiding the test because of his fear of discomfort and the possible diagnosisof cancer. The result was, unfortunately, exactly what he feared. His reluctance to getthe test delayed the diagnosis and made the prognosis worse. He told me that if he hadknown how easy and painless the procedure was, he would have done it years ago.

Cancer screening is much of what I do. Since moving to Utah nine years ago, I haveperformed thousands of colonoscopies. I, myself, have a family history of colon cancer and

About 130,000 Americans will be diagnosed withcolon cancer this year and 50,000 of those willdiethats roughly the same number of peoplekilled in automobile accidents each year.

Colonoscopy: Out ofPocket Expenses Eliminated

Dont let colon cancer cut

short your retirement.

Health Insurance companies have eliminated the out of pocket expensesrelated to colonoscopies. The industry just eliminated one more excuse.


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had my first colonoscopy at the age of 40 with a follow-upexamination every five years. Ironically, most complaintsregarding colonoscopies have little to do with beinguncomfortable. In our practice, the largest single complaintafter the procedure is that we havent even started yet.

The purpose of screening is to find polyps, which are the

precursors of cancer. These are small tissue growths on the wallof the bowel that may over time grow into cancer. With earlydetection and removal, polyps are generally not a problem.Many physicians have their own opinions regarding the timingof exams, but we follow the guidelines of the American Societyfor Gastrointestinal Endoscopy, also known as the ASGE.

The recommended age to start colon cancer screening in anotherwise healthy male or female is 50. If the initial examshows no polyps, the exam is usually repeated in 10 years.If there are polyps present, they are removed and a repeatexam is performed anywhere between one and three yearslater, depending on the type, size and number of polyps.

Patients with a history of colon cancer in the family shouldundergo a colonoscopy at 10 years younger than the age at whichthe relative was diagnosed. For instance, if a relative had coloncancer diagnosed at the age of 35, family members should havetheir first colonoscopies at the age of 25. If the patient was over theage of 50, the national recommendation is to start screening at theage of 40. Patients with a family history of colon cancer should haverepeat examinations every five years, even if the results are normal.

Patients should also undergo more frequent examination ifthey have a personal history of colon, breast or ovarian cancer,or inflammatory bowel disease such as ulcerative colitis or

Crohns disease. They should also have more frequent examsif they had polyps previously. Some individuals may requirean annual examination, depending upon the situation.

Polyp and colon cancer development can also occur in youngindividuals. The youngest person that I have seen with cancerwas just 18 years old. For that reason, we take rectal bleeding,significant lower abdominal pain or weight loss associated withsymptoms seriously. However, most people with bleeding orlower abdominal discomfort do not have colon cancer or evencolon polyps. The problem is distinguishing between minorand potentially serious problems based solely upon the historyand physical exam. If you are in doubt about your symptoms,arrange a consult with a qualified gastroenterologist.

About the Author:Steve Porter, MD, is the MedicalDirector of the Endoscopy Lab at aleading Hospital in Utah. He hasbeen practicing Gastroenterologyfor more than years. For moreinformation, contact Dr. Porter at(801)387-2550.

...Only about half the peoplethat should be screenedare getting it done.

Some things can be done todecrease colon cancer risk.

These include:

A diet high in fiber and low in red meat and fat.

Proper weight maintenance.

A daily dose of calcium and aspirin(as directed by your physician).

The use of antioxidants.

A recent study from Canada shows that only 60% to 70%of colon cancers are picked up on screening. Most of themissed cancers were on the far right side of the six-foot-

long colon. In Canada, much of the screening is doneby primary care doctors, and studies have shown thatthey often dont reach the difficult far right side.

I recently scoped the mother of a friend from Manhattanwho had been scoped in hospitals there several times(including one quite recently). When I scoped her Ifound a long and twisty colon with a cancer at the veryend. It is likely that the other doctors did not reachthat far. When having a colon cancer screening, findsomeone with experience and a good track record.

It is our hope that with adequate preventive care and screeningexaminations, we will eventually make colon cancer a thing

of the past. Unfortunately, only about half the people thatshould be screened are getting it done. Because cases ofcolon cancer equal the number of automobile-related deathsevery year, I would recommend that if you bother to buckleup, you should probably also get a colon cancer screening.


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What's The Rush?A new approach to fast allergy relief.

Rush Immunotherapy is a method for

providing rapid relief from allergies. What

is this new procedure and where does

this fit into the treatments we already have?

Seasonal or persistent nasal itching, sneezing, runny nose,nasal congestion, sinus headaches, postnasal drainage,sleep disturbance because of nasal obstruction, as well asitching and burning of the eyes (allergic conjunctivitis)affects 10-25% of people in Western countries. Pollen and

airborne substances arising from molds, animals, mitesand other insects are common causes of these problems.

Allergic reactions in the lungs result in asthma inapproximately 5% of the worlds population. Tightness inthe chest, shortness of breath, wheezing, and coughing arecommon asthma symptoms. Asthma can limit activities,disrupt sleep, and have a very negative effect on quality oflife. Acute respiratory tract infections or exposure to allergictriggers can cause severe or even fatal worsening of asthma.

The goals of therapy for upper airway allergic reactions(allergic rhinitis, hay fever) include relief from annoying

symptoms, relief from disturbed sleep, and avoidanceof complications such as middle ear infections or sinusinfections. Antihistamines, decongestants, nasal steroidsprays, and other nasal allergy sprays often provide relief.

The goals for asthma are control of the symptoms,prevention of limitations on activities, and protection fromsevere worsening during respiratory tract infections orexposures to allergic triggers. Bronchodilators, inhaledsteroids, oral asthma medications, and other medications

can provide symptomatic relief for some patients.Allergic rhinitis, allergic conjuctivitis, and allergicasthma, often need immunotherapy (allergy shots). Theseinjections provide control of symptoms and then resolutionof the allergies. Currently this is the only therapy thatcan actually reduce or eliminate the body's unwantedallergic reactions to environmental substances.

Rush Immunotherapy is a new injection procedure

that is revolutionizing how we treat allergies.

Traditional immunotherapy typically involves injectionstwice a week with increasing amounts of antigens (the


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substances that cause the allergies). This process usually takes16 weeks to reach full treatment doses (maintenance doses).

The Rush Immunotherapy revolution has centered on therecently acquired knowledge that relief from allergy symptomsrequires lower doses of antigens than are required to makethe allergies go away entirely over time. Research in United

States and Europe has led to Rush Immunotherapy proceduresthat allow us to reach levels of antigens that begin to relievesymptoms in one day rather than over a period of 2-3 months.

Patients are given high doses of allergy suppressingmedication to minimize reactions at the sites of injections, orin the rest of the body. Typically 8 injections are given overa period of 5 hours and the patients are then observed for 2more hours as the materials are absorbed into the body.

Rush immunotherapy can be a great convenience for patientswith demanding work or school schedules. While theprocedure requires a full day in the office, we avoid nearly 3/4of the visits needed to build up to maintenance doses. A day in

the office also affords time for the patient to ask questions aboutallergic disease and treatment. There is time to discuss anddemonstrate how to deal with unexpected late allergic reactions.

As allergy symptoms improve after Rush Immunotherapy,patients are much more likely to return for the final doses tobuild up to maintenance. These higher doses are requirednot to relieve symptoms, but rather to gradually eliminateor markedly decrease the severity of the allergy itself.

Not everyone is a good candidate for Rush

Immunotherapy. If asthma control is not

stable, if lung functions are not near normal,

Rush Immunotherapy may not be safe.

Preschool children may be good candidates from the point ofview of clinical improvement, but being kept in a relatively

Advantages of Rush Immunotherapy

Convenience for patients with limited time.

Doses of immunotherapy that begin givingrelief of symptoms can be reached in oneday, rather than over 2-3 months.

The time required to reach full treatment

maintenance doses is markedly reduced. Both the patient and the doctor can

quickly determine whether or not thisform of therapy will be successful.

small space can be very difficult for them. For many patients,Rush Immunotherapy is an alternative with several advantagesover medications alone, or traditional immunotherapy.

Any form of immunotherapy carries a risk that the patientmay have a troublesome reaction at the injection site, or thata more severe reaction involving the whole body may occur.This could include hives (urticaria), swelling of the eyes, lips,or other structures (angioedema), even anaphylaxis (reactionsthat cause trouble breathing or decreases in blood pressure).

The possibility of an allergic reaction is why allergistsrely upon patient education, observation in the office afterinjections, and having an emergency plan for dealingwith rare severe reactions. Rush Immunotherapy patientsare taught about the characteristics of the late allergicreactions, are given medications to use in case of a reaction,

and are taught the use of self-injectable epinephrine.Rush Immunotherapy provides a method for achieving clinicalimprovement very rapidly and greatly reduces the number ofvisits required to achieve long lasting freedom from allergy.

About the Author:Vicki Lyons, MD, is a board-certified and fellowship-trainedAllergist and Immunologist.She has been practicing for 0years. For more information,contact Dr. Lyons at(801)387-4850

About the Author:Timothy J. Sullivan, MD, completedtraining in Internal Medicine andAllergy & Immunology at WashingtonUniversity in Saint Louis, Missouri. After years in full-time academic medicineat Washington University, University ofTexas Southwestern Medical School,and Emory Univeristy, he enteredfull-time patient care. Dr. Sullivan

practices Allergy and Immunology in Atalnta, Georgia and is aClinical Professor at the Medical College of Georgia. For moreinformation, contact Dr. Sullivan at (404) 255-2918

Optimize your time to allergy relief,schedule a Rush Immunotherapyevaluation with Dr. Lyons today!Visit www.vicki-lyonsmd.comfor more information.


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ORAL AND MAXILLOFACIAL SURGEONS Specialized trainingspecialized care

Science, experience, and the

ingenuity of humankind haveadvanced the fields of medicine

and dentistry. Doctors interestedin a specific niche choose to spendextra years, between 4-7 beyondmedical/dental school, fine-tuningtheir expertise and knowledge. Theculmination of this additional trainingdefines specialties and specialists.

Most Utahns know that cleanings,fillings, gum problems and simpletooth extraction fall under the

category of basic dental care.However, many are not awarethat procedures such as complexor impacted tooth removal, IVanesthesia and sedation, grafting, ordental implant procedures comprisea large portion of an oral surgeons4-6 years of specialty training.These hospital-based programsexpose the oral surgeon to ill andcomplex patient populations,

About the Author:The Utah Association of Oral and Maxillofacial Surgeons(UAOMS) is the professional organization representingall oral and maxillofacial surgeons in Utah. UAOMSsupports its members ability to practice their specialty

through education, research and advocacy. UAOMSmembers comply with rigorous continuing educationrequirements and submit to periodic office examinations,ensuring the public that all office procedures andpersonnel are prepared to meet a patients needs.For more information about the Utah Association of Oraland Maxillofacial Surgeons, please visit www.uaoms.orgto find an Oral Surgeon near you.

providing invaluable experience

with diagnosis and treatment.

Patients often receive this type ofspecialty care from their family dentist.However, any unexpected outcomesor complications have to be managedby a specialist. While an educationfrom dental school exposes a dentistto certain specialized procedures, newgraduates may have different levelsof exposure or hands-on experience.Oral surgeons,receiving advanced

training beyonddental school,have maximizedexposure tospecializedprocedures suchas wisdom toothremoval, anesthesia,grafting, jawsurgery, trauma, anddental implants.

When contemplating oralsurgery, consider the following:

Removal of impacted wisdomteeth will take an average of 15-20minutes in an oral surgery office.

Oral surgeons place hundredsof implants in residency, oftenin conjunction with advancedbone and soft tissue grafting.

The American Association ofOral and Maxillofacial Surgeonscertifies all oral surgery offices inUtah as safe to administer generaland IV anesthesia. Peer reviewsare conducted every 3 years.

Every oral surgery office isrequired to have emergencyairway kits, defibrillators, oxygen,and emergency drugs to handlesevere medical emergencies.

Every oral surgeon in Utah hasAdvanced Cardiac Life Supportcertification, in addition to BasicLife Support (BLS). All staffmembers are BLS certified.

Oral surgery residency trainingexposes every oral surgeon tomedically compromised patients,enhancing an oral surgeon'sskill and training with both

dental and medical knowledge.Oral surgeons spend nearly 18months learning to managepulmonary, cardiac, ICU, trauma,and general medicine patients.

In an effort to help educate those seekingoral surgery care and treatment, theUtah Association of Oral Surgeons haslaunched a public education programto help patients make an informeddecision about their dental care. Moreinformation can be found at: UAOMS.ORG


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New Hip Replacementsfor Active Lifestyles

In todays world where 50 is thenew 30, people are pursuingtheir recreational passions even

later in life. And as generations age,that increased activity coupled withthe nations overweight population leads to more and more peopleexperiencing increased wear and tear

on their joints and grappling with thefear of losing the activities they love.

But thanks to advances in materialand surgical technologies in recentyears, hip replacement is now anoption for patients of various ages,opening the door for continuedrecreation from leisurely walks tocycling, tennis, even downhill skiing.

Simple design,advanced solutions

The hip joint is a ball and socket joint.

A protrusion at the top of the femurfits neatly inside the pelvic bone, wherea wide range of smooth motion isprovided by the surrounding cartilage,which acts as a lubricant for the joint.

As people age and tens of millions ofrotations accumulate on the joint over alifetime, problems can set in and haveprofound effects on an individuals rangeof motion and comfort. This breakdown,which to some extent is a natural part ofaging, can reach a point where a patients

quality of life is severely impactedand a hip replacement procedure isidentified as the best course of action.

A lifelong solution for any age

As recently as a decade ago, patientsundergoing a hip replacement weretold they would have to come back

approximately 10 years after the surgeryto have a new liner installed in theartificial joint as the man-made materialswould succumb to the same wear cyclesthat impacted the original joint.

But today, advances in materialstechnology are making it easy forpatients as young as 50 to reasonablyexpect the high-tech artificialcartilage polymer to last a lifetime.

The advanced materials also permitthe rigors of most athletic activities,allowing for a high quality of life so

patients can pursue the things they love.

For many people,having a hipreplacement is not anend, but a beginning.

Using Pre-Habto minimizerecovery time

With any surgicalprocedure, theresplenty of focus on

About the Author:Aaron Hofmann, MD, is a board-certified orthopedic surgeon and implantdesigner of hip and knees at The Centerfor Precision Joint Replacement on thecampus of Salt Lake Regional MedicalCenter. He is also the founder of theHofmann Arthritis Institute. For moreinformation, contact Dr. Hofmann at866-431-WELL (9355).

rehabilitation during the weeks andmonths after going home from thehospital. But to maximize the bodysability to recover, patients shouldalso engage in pre-habilitation toget ready for a hip replacement.

Depending on the length of time beforethe procedure is scheduled, pre-hab caninclude everything from weight loss toconditioning of the upper extremities (forhandling crutches afterward). Patientsmay even spend time learning to usea walker or crutches in a comfortableenvironment prior to surgery.

In addition to preparing themselvesphysically, pre-operative educationgives patients and their family membersaccess to valuable information aboutwhat to expect and how to best

accommodate the recovery period.Walk in, Walk out

When the big day finally arrives,patients can expect a procedure thatis very different from the original hipreplacements of 50 years ago. Advanced even robotic surgical proceduresallow for quick and precise installationof the artificial joint, making it easy tofor patients to get back on their feet.

After arriving at the hospital for ahip replacement, most patients leavewithin 48-72 hours, having walked

with assistance and navigated stairsbefore being discharged. Just six weeksafter the procedure, patients can expectto have 80 percent of their recoverybehind them. Within six monthsthey can be back to enjoying theirhobbies and activities at 100 percent.

Insurance

Though each insurance provider varies,insurers, including Medicare, covermost joint replacement procedures.Scheduling a consultation with ajoint replacement specialist can help

determine a patients eligibility.


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We have all heard it moretimes than we care to admit:preventing vascular disease

is a matter of the right lifestyle choices. Isee patients too often who have ignoredthe potential for heart issues by livinga lifestyle most cardiologists wouldcall dangerous. As a cardiologist, itis my job to try to repair the damage,but so many of these heart problemscould have been prevented.

I am concerned with the number ofpeople who are literally heart attackswaiting to happen. These people dontsee the signs or realize how their lifestyle

is increasing their potential dramaticallyfor vascular disease. I try to educate mypatients about heart care and help thoseat risk make the right lifestyle choices.

But what are those choices? Whatchanges should be made to becomehealthier and live longer?

The choices and changes start bylooking at a number of lifestylehabits including what you eat; yourweight; your physical activity; yourstress level and of course, smoking.

How and what patients eat is a constant

battle we cardiologists fight with our patients.After all, the United States is infamous forour overweight population. Its sad, becausesimple changes can make us healthier,look better, feel better and live longer.

The most recent guidelines for healthyeating from the American Heart Associationincludes at least 4.5 cups of fruits andvegetables per day along with at least twoservings of oily fish a week. The regime alsoincludes three ounces of fiber rich wholegrains, no more than 1,500 mg of sodiumper day and no more than 36 ounces ofsugar sweetened beverages per week.

Also, the AHA recommends fourservings of nuts and seeds per week, nomore than two servings of processedmeats per week and limited saturatedfats for the total energy intake.

Then theres the weight issue. Weight has atremendous effect on the potential for heartdisease. When the belly starts to grow, therisk of high blood pressure, high cholesteroland diabetes goes up remarkably. Therehas been a lot of talk about our BMI (bodymass index) and if you have no clue whatthis is, it certainly is time to learn.

To determine your BMI, you simplymultiply your weight in poundsby 703 and divide the result by thesquare of your height in inches. The

AHA suggests a BMI below 25.If your BMI is below 25, keep up thegood work. If your BMI is above 25,it should be a wake up call for youto change your lifestyle, changethe way you eat and get active.

Along with the potential for added bodyfat, an inactive lifestyle is a risk factor forcoronary heart disease. Regular, moderate-to-vigorous physical activity helps prevent heartand blood vessel disease. The more vigorousthe activity, the greater your benefits. Evenmoderate intensity activities help if doneregularly and long term. Physical activity can

help control blood cholesterol, diabetes andobesity, as well as help lower blood pressurein some people.

Keep in mind thatnot only will physicalactivity help in theweight category, italso reduces bloodpressure, increasesHDL and improvesthe body's sensitivityto insulin, which helpscontrol blood sugar. I

advise 30 minutes of moderate exercise 5x/week. Patients should exercise to a perceivedmoderate level - meaning sweaty andbreathless, not able to speak in a full sentencewithout talking a breath -- but not gasping.

As a general rule, I advise a physicalconditioning program focusing

on 4 targets: endurance (cardio),strength, flexibility, and agility.

Smokers' risk of developing coronary heartdisease is 2-4 times that of nonsmokers.People who smoke a pack of cigarettesa day have more than twice the risk ofheart attack than people whove neversmoked. Cigarette smoking is a powerfulindependent risk factor for sudden cardiacdeath in patients with coronary heartdisease. Cigarette smoking also acts withother risk factors to greatly increase therisk for coronary heart disease. Peoplewho smoke cigars or pipes seem to have ahigher risk of death from coronary heartdisease (and possibly stroke) but their riskisn't as great as cigarette smokers. Exposureto other people's smoke increases the riskof heart disease, even for nonsmokers.

High blood pressure increases the heart'sworkload, causing the heart to thicken andbecome stiffer. This stiffening of the heartmuscle is not normal, and causes the heart towork improperly. It also increases your riskof stroke, heart attack, kidney failure andcongestive heart failure. When high bloodpressure exists with obesity, smoking, highblood cholesterol levels or diabetes, the risk ofheart attack or stroke increases several times.

Finally, diabetes seriously increases yourrisk of developing cardiovascular disease.Even when glucose levels are under control,diabetes increases the risk of heart diseaseand stroke, but the risks are even greater ifblood sugar is not well controlled. At least65% of people with diabetes die of someform of heart or blood vessel disease. Ifyou have diabetes, it's extremely importantto work with your healthcare provider tomanage it and control any other risk factors.

Of course, if there is any doubt aboutyour risk for heart disease, see yourdoctor for a check up. Youll find out

how healthy you heart is and receivelifestyle advice based on your check-up.

Controlling Your Riskfor Vascular Disease

About the Author:Stephen L. Miller, MD, FACC,received his fellowship in cardiologyat the University of Wisconsin. He isthe founder of a leading cardiologycenter in Salt Lake City, UT. Formore information, contact Dr.Miller at (866)885-4278.


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whatdoctorsknow.com

Ankles support five times the body weightwhen you walk. If your ankle ligaments ortendons are stretched, worn or damaged, even

basic joint movement can be extremely painful.

Anyone suffering from chronic ankle sprains and anyonewho avoids certain activities in fear of another sprain, couldbe suffering from such damage but it is easily repaired.

The ankle is a bridge of muscle and tendons connecting theleg and foot. The body asks a great deal of this bridge,demanding it not only provide a sturdy foundation forstanding but that it also offer amazing flexibility. Withall the stretching and pulling on any given day, the

ankle is literally under a great deal of constant stress.The solution for chronic ankle pain formany is a highly successful surgicalprocedure many podiatrists today use.

About the Author:Scott F. Rogers, DPM, graduated fromBrigham Young University and receivedhis doctorate from the Scholl College ofPodiatric Medicine. He then completeda residency at Loyola University MedicalCenter. Dr. Rogers is a member of both theAmerican Podiatric Medical Associationand the Utah Podiatric MedicalAssociation. He is Board Certified in foot

and reconstructive rear foot/ankle surgery.

About the Author:Mark F. Rogers, DPM, FACFAS, graduatedfrom the Illinois College of PodiatricMedicine in Chicago, Illinois and is boardcertified in foot and ankle surgery. Dr.Rogers has lectured on aspects of podiatry.He is a member of both the AmericanPodiatric Medical Association and the

Utah Podiatric Medical Association.

About the Author:Thomas G. Rogers, DPM, FACFAS,graduated from Brigham Young Universityand received his doctor of podiatricmedicine degree from the Illinois Collegeof Podiatric Medicine in Chicago, Illinois.Dr. Rogers is board certified in foot andankle surgery and is a fellow of theAmerican College of Foot and AnkleSurgeons. He is the chief of the podiatry

department at Utah Valley Regional Medical Center. Dr. Rogersis a member of both the American Podiatric Medical Associationand the Utah Podiatric Medical Association.

For more information, contact Dr. Rogers at (801) 763-9049.

Ankle Pain Could BeMore Than aMinor Sprain

Surgical techniques torepair damaged ankles havebeen improved and perfectedwith more than 50 years ofprocedures. The surgery restoresthe ankles form and functionby giving it more strength andstability and helps avoid thosepesky re-occurring ankle injuries.

With ankle surgery, the doctorshortens the problem ligamentsas well as tendons, making itstronger than before. We add

extra support by wrapping anartificial support materialaround the ankle in orderto add extra protectionagainst injury. One of thematerials we use in anklereconstructive surgery is a strip ofmaterial taken from a cadavers pericardialsac. Pericardial means around the heart.

The benefit of using the pericardial material in surgery is itsunique make-up, which provides the ankle more strength andstability. Nature created the pericardial sac with a tough exteriorcoat and an inner double coat. The outer and inner layers

simulate a three-dimensional woven fabric to create a strongerthan original support material for a long-term ankle repair.

The results of this reconstructive method are amazing.We have had patients come back and ask for their otherankles to be worked on since the surgically repaired ankleworked so much better. Of course, the answer is alwaysno. While we are amazed at the success we have enjoyed,no surgery should be undertaken without a need.

Post-operative recovery is fairly standard for what you mightexpect of a surgery of this kind. There is physical therapyprograms but in most cases, a patient can start playingbasketball in eight weeks after surgery. For the first week

after surgery the patient should try to avoid putting anystrain on the foot. The patient should keep an eye out forany complications such as sudden spikes in pain or signs ofinfection (like a high fever or discharge). After ankle surgery,the patient should slowly ease back into normal routines butavoid any intense exercise. Most of those undergoing thesurgery report having slightly more tightness in the anklebut are able to return to a full state of activity in six months.

If you find you are suffering from these chronicsymptoms, this may be an answer for you.As always, consulting with a qualified doctoris an important step to pain free living.


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whatdoctorsknow.com

The Emotional Road

Infertility is a common, yet complex, problem affecting

approximately 15 percent of couples trying to have ababy. Too often, blame for the inability to conceive isplaced on the women when in reality, men and womenshare the burden equally. In up to 50 percent of infertilecouples, the problem is partly related to male reproductiveissues. Fortunately, with today's high-tech procedures andpowerful medications, a diagnosis of infertility means theroad to parenthood will be challenging but not impossible.

Infertility clinics in the United States using

Assisted Reproductive Technology (ART) reported

the success of 61,426 infants in 2008. This is

about 1% of all babies born each year nationally.

Many of those who suffer from infertility describe overcomingthe disease is like riding an emotional roller coaster. Casseeand Patrick McClearys story exemplifies this well.

Cassee and Patrick decided to have a baby in 2002, but after ayear of trying and no luck, they began the emotional trek ofexploring infertility options. The first stop was their familyOB/GYN. Under his care, Patrick had surgery and Casseehad a few procedures. After another non-productive year,their OB/GYN referred the couple to an Infertility Specialist.

The McClearys OB/GYN is a very good physician, butrecognized he didnt have the proper training nor equipmentnecessary to help the couple. He knew all about womenshealth and delivering babies, but making babies was an

entirely different discipline. He did the right thing in

referring the couple to someone he thought could help.While their hopes were high, the results were not.Unfortunately, they then spent another 3 years visitingseveral other specialists who could not provide thecare they needed. Insurance hassles and continuedunsuccessful treatments led to much disappointment.

There were so many roadblocks at almost

every turn, Cassee said. But we werent going

to give up. We werent going to back down.

In Patricks mind the worst frustration was the suboptimalquality of care they received. Patrick works for a major

pharmaceutical company and knows the practice ofmedicine well. They were looking for a physician andclinic that would demonstrate the same care and passionthat they have in their quest to become parents.

Patrick said, We often talk about medical care,

but the element of care was noticeably absent

in most practices. We want to feel good about

our doctor. We even visited a major University

and walked away. The lack of individualized

care and concern was a major turnoff.

Cassee and Patrick felt they lost five valuable years. They

were determined to experience the joy of bringing a newlife into the world, but they also realized they had to be


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whatdoctorsknow.com

To Family Life

more cautious and do a little more homework. They didntgive up. After talking to friends, other doctors and anyonewho listen, they somehow found information about myclinics in Boise, Idaho and Pleasant Grove, Utah.

I met the McClearys in 2007 and it was obvious from thestart that they were determined, yet cautious. They were

educated, patient and had gone through a great deal in theirquest for pregnancy. I learned they had been thorough intheir research and had been to a number of treatment centers.Having suffered personally from infertility, I believe thatinfertility puts a couple in an emotional state that, quitefrankly, requires an emotional connection with their doctor.

Patrick was obvious in his frustration when he said: Dr. Foulksoffice was different. It seemed he and the staff were passionateabout what they did and we felt like we were their only patients.

I give a lot of credit to Patrick who recognized, throughtesting, that he was a major part of the problem. Looking

back on the issue, he explains the problem with a smile,most sperm are active little swimmers looking for an eggto impregnate, and my swimmers ended up being thelazy kind who simply laid at the bottom of the pool.

Infertility is treatable--virtually every cause can be overcometo help every couple have a baby of their own. The mostcommon cause of infertility problems are ovulationdefects and male factors. Couples must understand whythey can not get pregnant and have a plan to overcome it.They should begin with the easiest step and understandexactly why any treatment is not successful. It is crucial

to identify the problem, then treat it proactively

each month. Many people become frustrated andquit if they dont get the right kind of help.

We are meant to have children; there is

always a reason why we can not. The key

is to know the reason and overcome it.

Infertility treatment is affordable. Most couples canachieve pregnancy with minimal and affordabletreatments. Too often, unwary couples get pushed intotreatments that are not best for them or do ineffectivetreatments that waste their time and money.

Less than 10% of infertile couples need the

expensive high tech treatments like IVF.

Infertility is an emotional burden. The best wayto cope is to understand the dysfunction, know allthe options and then develop a plan that is realisticand based on the ones history and needs. After five

years of frustration, the McClearys took a pragmaticapproach and the roller coaster eased into a smoother road.

For the McClearys, after we identified the problem, thesolution was easy and effective. They were undaunted in theirquest and the results were beautiful. Cassee gave birth to thecouples first baby in 2008. Recently, the couple came to me

again and we were able to produce a second pregnancy. Thistime, Cassee gave birth to twins at the end of April this year.

Happily, Cassee and Patrick will tell you thatmarriage and kids go together. In spite of all the trialsand tribulations the couple went through, the endresult has been three healthy children. They will tellyou it was a fun, yet often trying, experience.

Evidently the journey with my staff was more enjoyablethan I had realized. Cassee referred her 40-year-oldsister and another cousin to me, both who are nowpregnant and happily expecting their first children.

About the Author:Russell A. Foulk, MD, is boardcertified in ReproductiveEndocrinology, Obstetrics &Gynecology. He has served on thePacific Coast Reproductive SocietyBoard of Directors for years.For more information, contact Dr.Foulk at (801)492-9200


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Contact lensesyou eitherlove them, or hate them.If you are a hater, there is an alternative to contacts called

Implantable Contact Lens, or ICL. ICLs have already beenused to correct the vision of more than 200,000 eyes worldwide.

Implantable contact lenses (ICLs) correct vision in much thesame way as external contact lenses, except ICLs are placedinside the eye where they permanently improve vision. Thesethin, pliable lenses are inserted through a small incisionin the cornea and placed behind the iris and in front of thenatural lenses. The natural lens is kept in the eye and workswith the implanted lens to correct vision. The ICL procedureis virtually pain free and has a 95 percent success rate.

As a pioneering ICL implant surgeon, I have seen the amazingway this procedure corrects vision. The first ICLs wereimplanted in 1993, however, my introduction to ICL surgerydates back to the days of an FDA clinical study in 1998.

Over the years, as study patients returned forfollow-up visits, they would often describe their

vision as spectacular, amazing, and more.

Oddly enough, the majority of these patients were not candidatesfor any other refractive procedure, including LASIK or PRK, dueto a number of reasons including extremely high prescriptions,thin or irregular corneas, or dry eye syndrome. For the mostpart, ICL exceeded expectations in these challenging patients.In 2005, the FDA approved STAAR Surgicals Visian ICL forthe treatment of myopia. We are expecting FDA approval forthe Visian Toric ICL, which in addition to treating myopia,corrects astigmatism with very impressive results.

Patients I have treated with ICL surgery include pilots,sharpshooters, military service men and women, local andfederal law enforcement officers, professional photographers,surgeons, scuba divers, race car drivers, radiologists, andstay-at-home-moms. Patients who want the best out of theirvision are candidates for the ICL as well as those patients whoare not candidates for LASIK or PRK or other techniques.

One of my latest ICL patients was a 30-year-old male whowas functionally blind from nearsightedness. His visionwas so poor that he had to wear -18.00 prescription glasseseverywhere (-18.0 means his eye focuses clearly at just over5 centimeters while everything beyond is out of focus!)Whenever he would set his glasses down on the counter, heliterally could not see them. He couldnt wear contact lenses,and clearly was out of the treatment range for laser visioncorrection. His eyeglasses were so thick that it was difficultto find an optical store capable of making a pair of glassesfor his prescription. Even though he lived in Alaska, hisfamily realized the need to fly him here for ICL surgery.

Today, the young man is on Facebook and his phototells it all. Looking straight at the camera for his picture,his smile is amazing! Affected by Downs syndrome,he will never need to find his glasses again and he willwake up every morning to a bright and clear world.

It has been particularly rewarding to treat so manypatients and see the look of joy on their face after surgery.As a surgeon, there is no better feeling of satisfactionwhen you have dramatically changed someones life.

There is nothing as precious as vision, and

nothing as valuable as the ability to see the

world around us in its clearest form.

About the Author:Robert P. Rivera, MD, is Director of ClinicalResearch at Hoopes Vision. He has lectured,conducted formal physician training courses,and taught eye surgery at numeroushospitals throughout the world. He routinelytravels to developing nations as a volunteereye surgeon for patients who wouldotherwise not have access to vision-restoringmedical care. For more information, contactDr. Rivera at (877) 305-2745

Implantable

Contact LensThe Permanent SolutionTo Every Day Contacts

whatdoctorsknow.com


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whatdoctorsknow.com

Know The Signs ofSkin Cancer

B

y the third quarter of 2011, there were more than70,000 reported cases of melanoma and nearly 9,000deaths in the United States. For that same period,

there were nearly 1 million cases of other non-melanomacancers reported with less than one thousand deaths.

There are many forms of skin cancer and justlike virtually every other cancer, the sooner the

diagnosis, the higher the chance of survival.

Skin cancer mostly develops on the sun-exposed areas ofthe skin, including the scalp, face, lips, ears, neck, chest,arms and hands, and on the legs in women. But it canalso form on areas that rarely see the light of day yourpalms, beneath your fingernails, the spaces between yourtoes or under your toenails, and your genital area.

What could be misunderstood as a pimple that just wont heal ora dark spot on the skin could be a form of skin cancer in its earlystages. If you have any skin changes that worry you, see a doctor.Not all changes in skin are cancer, but considering with earlydiagnosis, the better chance for cure, its best to seen by a doctor.

Skin cancer affects people of all skin tones, includingthose with darker complexions. When melanoma occursin those with dark skin tones, it's more likely to occur inareas not normally considered to be sun-exposed.

Sun spots, called actinic keratosis, are early warning signs ofcancer that are still very close to the top of the skin. These canbe frozen and drop off. In more advanced cases when skincancer is diagnosed, the patient may be faced with the need

to have it surgically removed. In these cases, your doctor mostlikely will be using Mohs Surgery to remove the cancer.

I prefer Mohs because it is one of the most effective andadvanced treatments for most types of skin cancer today.It offers the highest potential for cure - nearly 100 percentin some studies. It is the treatment of choice when the skincancer has been previously treated by another method.

In the days before Mohs, the surgeon would

remove the tumor and even though it wasgiven the all clear by pathology 10-15% would

grow back and need further surgery.

About the Author:Chad W. Tingey, MD, is a Fellowshiptrained skin cancer and reconstructivesurgeon and Dermatologist. Aftergraduating from Dartmouth MedicalSchool with Honors, he recentlycompleted his Dermatology residencyat Loma Linda University MedicalCenter and and ACGME ProceduralDermatology Fellowship in Mohs and

laser surgery at Scripps in San Diego. For more information,contact Dr. Tingey at (801) 475-3000

Preventing Skin Cancer:

When ultra violet light comes down from the sun, it

scrambles your DNA. Your body works hard at fixing thedamage all day long. When it becomes too much andthe body cant fix it anymore, the result is skin cancer.The first step in preventing skin cancer, of course, isto avoid overexposure to the sun including tanningbeds. Always use a good SPF sunscreen and a hat orlong sleeves can help a lot. Recent research, however,has also demonstrated that people avoiding the suncan become low in Vitamin D, therefore getting healthyamounts of Vitamin D from your diet is important too.

Not acceptable if its your nose the tumor is growing on! Theproblem is that most skin cancers have growths like rivertributaries that grow below the surface without any specificpattern so the surgeon had to take a wide area to try andremove everything. Often, to avoid the regrowth problem,more tissue than necessary was removed causing a larger

wound. Mohs makes the entire process more accurate.The main reason Mohs surgery is so effective is becausethe removed tissue is microscopically examined, carefullymapped out and evaluated by the surgeon at the time ofthe surgery. The patient doesnt have to wait days for theslides to be read and face the return of another surgery.Mohs nearly eliminates the chance of the cancer growingback and minimizes the amount of healthy tissue lost.

Surgeons usually perform Mohs surgery as anoutpatient procedure in their office, which will have an

on-site surgical suite and a laboratory for immediatepreparation and microscopic examination of tissue.

Local anesthesia is administered around the area of the tumorand the patient is awake during the entire procedure. The useof local anesthesia in Mohs surgery versus general anesthesiaprovides numerous benefits, including the prevention of lengthyrecovery and possible side effects from general anesthesia.

When the surgery is complete, the physician will assess thewound and discuss options for cosmetic reconstruction andrepair of the affected area. Most often, the surgery starts earlyin the morning and in most cases is completed the same day.

Take care of your skin and if you areunsure, see your dermatologist.


18/36

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19/36

Get A Leg UpOn Varicose Veins

In the United States, it is estimated that 25 percent of womenand 18 percent of men will suffer from varicose veins. Theodds are stacked against you, by 90 percent, if both your

parents have varicose veins. Ironically, if only one parent isaffected, their daughter has a 60 percent chance of being affectedwhile the son only has a 25 percent chance. As we age, thepercentage of women and men with venous disease increases.It is also estimated that 60 percent of all leg ulcers result from

varicose veins. Exercise can help, but 12 percent of varicosevein patients will end up with long-term support stockingsand fewer than 10 percent will require surgical treatments.

Whether the initial cause is genetics, pregnancy,prolonged standing or sitting, excess weight,inadequate exercise or a damaged saphenous vein (thelarger, superficial veins in the leg), the physiology ofvenous insufficiency is nearly always the same.

Your arteries pump oxygen-rich blood from your heartthroughout your body and your veins return oxygen-poor blood back to your heart. Venous insufficiency,commonly known as venous reflux, occurs when your

leg's veins cannot pump enough blood back to your heart.Because your blood doesnt move through your veinsproperly, it begins to pool, causing varicose veins.

There are three types of veins: superficial veins, that lieclose to your skin, deep veins, that lie within your muscles,and perforating veins, that connect your superficial veins toyour deep veins. When these veins function properly, yourblood is pumped efficiently through your system. However,when you stand or sit for prolonged periods of time, theblood in your legs can pool and increase your venous bloodpressure. This can stretch the vein walls and with time it canweaken the walls of the veins and damage the vein valves.

Varicose veins are often an indicator of venousreflux. Smaller varicose veins near the surfacegenerally arent a serious problem and can bemanaged with simple home measures. As thelarger deep veins fall victim to this progressivedisease, significant circulatory complicationscan occur, such as bleeding under the skin, deepvein blood clots, edema, and venous ulcers.

General symptoms of venousreflux can often include:

Varicose veins

Leg pain, restless, aching, tiredor weak legs, especially after longperiods of standing or sitting

Itching or burning of the skin

Edema or swollen legs and/or swollen ankles

Color and texture changes of the skin

Wounds that wont heal (skin ulcers)

Most mild cases of venous insufficiency can be treated

with compression stockings while more seriouscases may be treated with surgical procedures.

One surgical method is a minimally invasive officeprocedure called radiofrequency ablation has been highlysuccessful in treating superficial venous reflux. Thistechnology uses a very small catheter and radiofrequencyenergy to occlude, or seal shut the saphenous vein.

A single small incision is made near the knee where aslender catheter is inserted into the saphenous vein. Thecatheter is positioned near the groin, and in a series ofsteps, energy is applied to heat the vein, which destroys thevein. Because blood no longer flows through this vein, over

time it is absorbed by your body. Radiofrequency ablationmay also be used to seal shut incompetent perforator veinsthat are often associated with venous stasis ulcers.

This short procedure, usually 30 to 45 minutes, requiresonly a local anesthetic used to minimize pain anddiscomfort. There are no stiches, and most patientsreturn to normal activity within a day or two.

While venous insufficiency is not usually considereda serious health risk, it can be a source of serious painand discomfort, and even disability. It is important todiscuss all your medical conditions with your doctor sothey can explore the best treatment options for you.

About the Author:Jed P. Naisbitt, MD, is board certified bythe American Board of Obstetrics andGynecology and is a board eligible memberof the American Board of Phlebology. Heis also a member of the American Instituteof Ultrasound in Medicine. He has treatedvenous disease for the past years andis considered one of the leaders in thetreatment of venous disease.

For more information, contact Dr. Naisbitt at (801)337-5854

whatdoctorsknow.com


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whatdoctorsknow.com

Fine lines, wrinkles, and folds in the skin develop with age butare not necessarily a welcome badge of honor we are readilywilling to display. As our skin loses collagen and elasticity,

the lines and folds develop and our youth begins to slip away.

Thanks to an increasingly popular non-surgical treatment calledinjectables, slowing down the visible aging process can be achieved.

Fillers

The term filler refers to a substance injected into thefaces soft tissues to add volume. These substances literallyrestore lost volume thereby reducing the appearance andvisibility of lines, folds, and wrinkles in the skin.

Wrinkles...Now You See Them, Now You Dont

About the Author:Scott K. Thompson, MD, focusesexclusively on conditions of the face, headand neck. He is board certified in bothfacial plastic and reconstructive surgery, aswell as otolaryngology. He specializes in allreconstructive and cosmetic aspects of theface. He has offices in Layton, Bountiful,and Draper. For more information,contact Dr. Thompson at (801)776-2220or www.utahfacialplastics.com

Treatment of the lines around thenose and mouth with filler significantlydecreases their visibility and diminishesthe aged appearance of the mouth.

Fillers can also be used toeffectively add volume to thelips, giving them a more youthfuland feminine appearance.

Following treatment with Botox Cosmetic,the visibility of the frown lines andcrows feet are dramatically reduced.

How long do fillers last?Although the above fillers are broken down by the body,the metabolism rate varies by product and from patient topatient. Generally, studies have shown fillers to last anywherefrom 6 to 18 months. In some cases fillers can stimulate newcollagen growth resulting in more permanent improvement.

Are fillers safe?The fillers listed above have been extensively studied, are FDAapproved, and have been used to treat millions of patients

worldwide. They are biocompatible with the human body andeventually break down naturally. Most patients can expectsome temporary swelling, bruising, redness, or tendernessfollowing treatment - usually lasting less than seven days.

Neurotoxins

For those unfamiliar with these products, the idea of deliberateinjection of a neurotoxin raises eyebrows. However, the two mostcommonly used and well known of these prescription medications,Botox Cosmetic and Dysport have been extensively studied. BotoxCosmetic, has a longer track record and has been used in close to 12million cosmetic procedures. As with other medications and vaccines,a medication potentially harmful in large quantities can be therapeuticwhen used in smaller concentrations directed at specific targets.

Neurotoxins at work

Botox Cosmetic and Dysport work by temporarily blockingnerve impulses to specific muscles. This results in decreasedmuscle activity and consequent reduction of lines. The

most commonly treated areas include the lines between thebrows (frown lines), lines at the corners of the eyes (crowsfeet), and the horizontal frown lines (Figures and ).

Fillers at work

Commonly used examples include Restylane, Juvederm, Radiesse, and Sculptra. In general, the areas around the nose and mouth,including the lines extending from the nose to the corners of themouth (nasolabial folds), the folds extending downward from thecorners of the mouth (melolabial folds), and the fine lines that developaround the mouth (lipstick lines) are most effectively treated with fillers

(Figure ). Fillers can also be great volumizers for the lips (Figure )

How long do Neurotoxins last?Injections are made with a fine gauge needle and last between3 and 6 months. With repeated injections, the muscle graduallybecomes weaker and injections can often be spaced further apart.

Are they safe?When used in correct doses, proper location, and whenadministered by a physician trained in facial structure and anatomy,neurotoxins effectively reduce fine lines and wrinkles. The mostcommon side effects include temporary bruising and swelling.More safety information can be found at botoxcosmetic.com.

Are treatments painful?Cosmetic injectables are administered through a very small, fine

gauge needle, not unlike a typical shot or IV. The use of topicalanesthetic creams, can significantly reduce injection discomfort. Iceis also recommended to minimize pain, swelling, and bruising.

Injectables treat these lines at their source andachieve powerful results while allowing patients toimmediately return to normal daily activities.

Creams and other topical agents which promise to reduce lines,are simply moisturizers that plump the skin and mask finelines. Injectables offer a new and exciting non-surgical methodof effectively treating fine lines and wrinkles in the face.

Because these substances are injected beneath the skinnear important nerves, muscles, and blood vessels: seekingtreatment from a physician who is thoroughly trainedin the anatomy and physiology of the face is critical.


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whatdoctorsknow.com

Exploring VisionCorrection Options

The first experimental studies aboutrefractive surgery were publishednearly one hundred fifteen years

ago by an ophthalmologist in Holland.Today, many options are available tosurgically correct ones vision. Thoselooking to rid themselves of glasses or

contact lenses may be confused as towhich option, if any, is best for them.

When investigating vision correctionsurgery, it is important to visit a facilitywith surgeons who are experiencedand comfortable with a wide rangeof surgical vision correction options.When determining which form of visioncorrection surgery is best for an individual,a surgeon must consider the age andhealth of the patient, degree of refractiveprescription to be treated, the patientsindividual vision requirements, and the

physiology of the patients eye. Laservision correction is a popular choice, butsome people will be better off with a lensimplant. In some cases no current form ofvision correction surgery is appropriate.

Current vision correction options

can be classified into three main

groups: first, surgery that changes

the shape of the cornea (the clear

dome that covers the front of the

eye) such as LASIK or PRK; second,

implantable lenses that are inserted

between the cornea and the natural

lens inside the eye (ICLs); and third,

intraocular lenses that replace

the eyes natural crystalline lens

after it has been removed (IOLs).

The first group (changing the shape of thecornea) includes LASIK, IntraLASIK, PRK,CK and many similar variations. This isoften the first type of surgery that patientsconsider when thinking of correctingtheir vision. FDA approved in 1995,PRK was the first laser vision correctionprocedure that removes tissue to correctvision. LASIK and then IntraLASIK wereapproved soon after, and have become

the most popular choice. PRK is still agood choice for patients with thinnercorneas or higher prescriptions. Generallyspeaking, laser vision correction is thefirst choice for patients in their 20s and30s with nearsightedness, farsightednessor astigmatism. People in their 40s, 50sor even 60s may also find laser visioncorrection to be the best choice for theirneeds. These patients may consideroptions such as monovision or blendedvision, where the laser corrects one eye to

distance and the other for near vision, asa solution to presbyopia (difficulty withnear vision that starts around age 40).

Some people find that their cornea is toothin, or their prescription too strong forlaser vision correction. These patients maystill be excellent candidates for implantablecollamer lenses (ICLs). Think of theselike contact lenses that can be implantedeither just in front of or just behind the iris(the colored part of the eye). These lensescan correct higher prescriptions thanlasers are able. They cannot be felt, andgenerally cannot be seen. These lenses arecommonly appropriate for nearsightedpatients that are in their 20s, 30s, and 40s.As with LASIK, patients that can naturallychange focus from near to far should stillbe able to do so after this procedure.

The third common option for visioncorrection is to remove the natural

crystalline lens and replace it with anartificial implantedlens. This is sometimesrecommended topatients in their 50s, 60sand beyond. This typeof vision correctionsurgery includescataract surgery,where the lens mustbe removed becauseit has become cloudy.

About the Author:Phillip C. Hoopes, MD, is a pioneerin Lasik surgery. He has performedmore than ,000 Lasik and refractivesurgeries, and over 0,000 visioncorrection procedures. For moreinformation, contact Dr. Hoopes at(877)305-2745

1 2 3

Procedures include PRK,

LASIK IntraLASIK, CK, and

others. Can correct nearsight-edness, Farsightedness and

astigmatism.

Changing the shape

of the cornea.

Intraocular lens implants

(IOLs)

Implantable lenses

(ICLs)

A thin lens implanted just

in front of or just behind

the iris. Used to correctnearsightedness in patients

with thin corneas or

extremely high prescriptions

Replacing the natural lens

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New lenses provide both nearand distance vision correction.

Cataract surgery is one form,

but many select this option

before cataracts form.

This is the most commonly performedvision surgery in the world. New multifocaland accommodating lenses are now ableto correct both distance and near visionallowing some patients to function withouteither distance or reading glasses. Patientsmay opt to have these lenses implantedeven if they do not have cataracts with a

procedure known as clear lens exchange.The surgeons at Hoopes Vision areexperienced with each of these currentsurgical options and have access tothe newest technology associated witheach form of vision correction. Theyhave an on-site laser surgical suite forLASIK, PRK and IntraLASIK surgery, aswell as an on-site, Medicare-approved,ambulatory surgical center where ICLand IOL surgeries are performed. If youwould like to know which type of visioncorrection is best for your needs, please

schedule a complimentary evaluationwith one of the doctors at Hoopes Vision.


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Minimally Invasive and Robotic surgery havebecome the medical communitys new buzz-words. Robotic surgery is becoming the standard

in some areas and almost every day physicians are findingnew ways to apply minimally invasive and robotic surgery.

The fight against prostate cancer is no exception. The use ofrobotics to perform an operation known as radical prostatectomy

is one of the best applications for this new robotic technology.As a urologist, I am excited about the benefits of using roboticsin the fight against prostate cancer, but realize, as physicianswe must remember patients facing a cancer diagnosis needmore than technology. They also need comfort and education.

What is Robotic and Minimally Invasive Surgery?

Robotic surgery is laparoscopic surgery performed with theassistance of a high tech robot under the control of the surgeon.The surgeon is at a panel with monitors and controllers notunlike a powerful video gaming console performing theprocedure. Imagine major surgery performed through thesmallest of incisions (minimally invasive), with improvedoptics (3-D vision and easy magnification and zoom) and small,precise, wristed instruments that can work in tight places.

Imagine having the benefits of a definitivetreatment but with the potential for significantlyless pain, less blood loss, shorter hospital stayand faster return to normal daily activities.

We are also seeing anecdotal evidence that robotic prostatectomyis resulting in faster return of urinary continence and higherlevel of recovery of sexual function following surgery.

Thanks to this breakthrough surgical technology, the Ogden Clinicis now using the da Vinci Robotic-Assisted Prostatectomy as atool in the fight against prostate cancer in the Weber County area.Three of our staff urologists have been extensively trained in thisamazing robotic surgical system. Always remember, the roboticsurgical system does not replace your surgeon at the controls.

ProstateSurgery

Enters theRobotic Age

Your surgeon is always in control of every aspect of the surgerywith the assistance of the da Vinci robotic surgical system.

In prostate cancer treatment, millimeters matter. Nerve fibers andblood vessels are attached to the prostate gland. To spare these nerves,they must be delicately and precisely separated from the prostatebefore its removal. Surgeons use the precision, vision and controlprovided by the da Vinci to assist them in removal of the cancerousprostate while preserving important nerves and blood vessels.

Prostate Cancer Facts

One in six American men will develop prostate cancer sometimein their lifetime. According to the Center for Disease Control andPrevention prostate cancer is the most common cancer in men.

The American Cancer Society noted that morethan 203,415 men were diagnosed with prostatecancer in 2006 (the most recent data) and28,372 men died from the disease that year.

There are no warning signs or symptoms of early prostatecancer. Screening is based on examination of the prostate witha digital exam and the use of screening blood and urine testsmost commonly the blood test known as a PSA. Your doctorwill examine your prostate gland to determine whether it isenlarged, inflamed with an infection, or may have cancer.

About the Author:Michael Van Bibber, MD, is a graduatefrom the University of Utah and receivedhis MD from the University of Utah Schoolof Medicine. He also received extensivetraining in General Surgery and completedhis Urology Residency at Dartmouth-Hitchcock Medical Center in Lebanon, NewHampshire. For more information, contactDr. Van Bibber at (801) 475-3000

Call Your Doctor About Prostate Cancer If:

You have a painful or burning sensation duringurination or ejaculation or have abnormalsymptoms such as blood in the urine or semen.

You have dull, incessant deep pain or stiffnessin your lower back, pelvis, upper thighbones, orother bones in that area. Ongoing pain withoutexplanation always merits medical attention. Painin these areas can have various causes but maybe from the spread of advanced prostate cancer.

You experience unexplained weight loss or loss ofappetite, as well as fatigue, nausea or vomiting.

You have swelling of the lower extremities.

You experience weakness or paralysis inyour legs and/or difficulty walking.

2011 Intuitive Surgical, Inc.


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Almost 100% of the time, plantar fasciitis (fash-eye-tis) iscaused by a tightness in the calf muscle known as thegastrocnemius, or gastroc for short. The gastroc crosses

the ankle through the plantar fascia. Plantar fasciitis is simplyinflammation of the plantar fascia, a dense, fibrous structurealong the sole of the foot and just beneath the skin that starts onthe bottom of the heel bone (or calcaneus) and extends towardthe ball of the foot. The plantar fascia acts as a tension band thathelps to maintain the arch of the foot when your weight is on it.

The pain of plantar fasciitis tends to be at its worst with the firststep out of bed in the morning and also following high-impactactivities. Typically this pain will subside somewhat after that firststep, and then may be more painful again by the end of the day.

Symptoms of plantar fasciitis can be severe enough to interferewith everything from basic daily activities to intense athletictraining. In athletes, heel pain will most often increase duringphases of higher-intensity and higher-volume training.

Some common risk factors for heel pain are overuse, pregnancyand obesity. Patients with a body mass index (BMI) greaterthan 30 are 5.6 times more likely to have plantar fasciitis thanpatients with a BMI less than 25. Overweight women are six timesmore likely to have plantar fasciitis than overweight men. Ofcourse, weight loss is extremely difficult without exercise, andexercise is even harder with heel pain from plantar fasciitis.

What can I do if I have plantar fasciitis?

There are a number of recommendations for non-operative treatment

of plantar fasciitis. Night splints, physical therapy to stretch the calfmuscles and foot, over-the-counter antiinflammatory medicationsand massage can also provide some relief. Modifications to footwearcan also help alleviate plantar fasciitis. Cushioned running shoesare best for support and absorbing shock. Many running shoespecialty stores have an experienced fitter to make sure you getthe best shoe fit and type for your foot. Its important to rememberthat the shock absorption of running shoes decreases dramaticallyafter about six months or 500 miles, so be sure to replace yourrunning shoes in accordance with these guidelines. Custom orprefabricated shoe inserts, called foot orthotics, have also beenused to treat plantar fasciitis. However, recent studies have shownlimited benefits of orthotics used specifically for plantar fasciitis.

* The Gastroc Slide for Chronic Plantar Fasciitis, presented to AmericanOrthopaedic Foot and Ankle Society by M. Chilvers, J. Rocco and A. Manoli inJuly 2007. Read the entire presentation online at www.utahorthopaedics.com.

More aggressive treatments of plantar fasciitis include cortisoneinjections and extracorporeal shockwave therapy, like that usedto break up kidney stones. The results of these treatments have

been mixed. Traditionally, surgical treatment has focused on heelspur surgery or plantar fascia release, which involves cutting aportion of the plantar fascia to relieve pressure and inflammation.Some providers have reported success with these treatments,but plantar fascia release has been implicated in painful arches,increased and new foot pain and even continued heel pain.

Surgical lengthening of the gastroc muscle has been effectivein treating resistant, chronic plantar fasciitis, and in improvingand maintaining ankle flexibility. In fact, a recent study hasshown that 93.6% of patients experienced good or excellentresults, which were relief of pain and return to sports, includingrunning.* This procedure is called the gastroc slide because thegastroc muscle slides apart as it is lengthened. The gastroc slide isperformed as an outpatient procedure through a small incision.The procedure can be performed in about 10 minutes. Followingsurgery, patients are allowed to walk with full weight-bearingin a walking boot. The boot is worn during sleep for one monthfollowing surgery. The boot can be removed for walking as soonas the patient feels comfortable doing so. Most patients are able towalk in a regular shoe three to seven days after the procedure.

Greater than 80% of heel pain gets better with non-operativetreatment. The gastroc slide procedure, however, hasbeen successful where other treatments have failed.

Heel pain is a common problem. There are a number of potential causesof heel pain, but the most common culprit is plantar fasciitis.

Why Does my Heel Hurt So Much?

If you have heel pain:

Stretch regularlyespecially the calf muscles.

Replace your running shoes regularly.

Seek medical treatment if necessary.

About the Author:Jeffrey J. Rocco, MD, is an OrthopedicSurgeon specializing in foot and anklereconstruction and lower extremitytrauma. He is fellowship-trained by theMichigan International Foot and AnkleCenter. Dr. Rocco is also on the researchreview board for First Enduranceand writes sports nutrition articlesfor the company blog at http://blog.

firstendurance.com. For more information, contact Dr. Roccoat (801)917-8000 or visit www.utahorthopaedics.com


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ColonCancer:The

SilentKiller

Colon cancer can grow for yearswithout any symptoms. Thatswhy there is such a push from the

medical community for colonoscopies.Merely being age 50 or older is the numberone risk factor for colon cancer. However,if you have a family history, you shouldbe aware of the ten-year rule. That meansif colon cancer has shown up in one ofyour family members at age 50, youshould get tested at 40 ten years beforethe first family member was diagnosed.

Colon cancer has no bias. It affects

women equally as it does men.Even though we highly recommendpatients at age 50 or more get acolonoscopy, I have seen patientsas early as age 20 and as old asage 80 with colon cancer.

Because colon cancer can silently growwithout any warning signs, there aresome early body indications we allneed to be aware of just in case thereis a presence of cancer growing. Coloncancer symptoms come in two generalvarieties: Local and Systemic.

About the Author:Megan Wolthius Grunander, MD, recieved her Doctor ofMedicine at the University of Utah. After completing herGeneral Surgery internship at the Universtiy of California SanFrancisco and Gerneral Surgery residency at Harbor-UCLAMedical Center, she then completed her fellowship trainingin Trauma/Surgical Critical Care at Cedars-Sinai MedicalCenter in Los Angeles. For more information, contact Dr.Grunander at (801) 475-3000

Local Colon CancerSymptoms

Local colon cancer symptomsaffect your bathroom habits andthe colon itself. Some of the

more common local symptomsof colon cancer include:

Changes in your bowel habits,such as bowel movementsthat are either more or lessfrequent than normal

Constipation (difficulty havinga bowel movement or strainingto have a bowel movement)

Diarrhea (loose or watery stools)

Intermittent (alternating)constipation and diarrhea

Bright red or dark red bloodin your stools or black, darkcolored, "tarry" stools

Stools that are thinner than

normal ("pencil stools") orfeeling as if you cannot emptyyour bowels completely

Abdominal (midsection)discomfort, bloating, frequentgas pains, or cramps

Systemic ColonCancer Symptoms

Systemic colon cancersymptoms are those thataffect your whole body, suchas weight loss, and include:

Unintentional weight loss(losing weight when not dietingor trying to lose weight)

Loss of appetite

Unexplained fatigue(extreme tiredness)

Nausea or vomiting

Anemia (low red blood cell countor low iron in your red blood cells)

Jaundice (yellow color to theskin and whites of the eyes).

If you experience any of thesefor two or more weeks, callyour doctor right away todiscuss your concerns andarrange for tests to get to thebottom of your symptoms.

Living With a ColonCancer Diagnosis

Colon cancer is categorized in four stages.

Stage I is when the tumor has spreadjust beyond the lining of the inside ofthe colon. During this stage, treatmentconsits of removing the colon segmentaffected by the turmor. The fiveyear survival rate is 95 percent.

Stage II is when the tumor cells have spreaddeeper into the colon wall and possiblethrough the outer lining of the colon andinto nearby tissues or organs. Treatmentis surgical removal of all tissues affected.Survival rate for five years is 60 percent.

Stage III is the cancer has spread intothe surrounding lymph nodes. Thefive year survivial rate is 35 percent.

Stage IV is when the cancer hasspread to distant organs such as the

liver, lungs or bone. The five yearsurvival rate is about five percent.

Most patients diagnosed withcolon cancer will require surgery.Surgery may then be followedwith chemotherapy treatment.Rectal cancer, however, may betreated with radiation therapy andchemotherapy followed by surgeryand then more chemotherapy.

Surgery for early colon cancer may be theremoval of the polyp with the aid of a thin,lighted tube called a laparoscope. Three orfour tiny cuts are made into the abdomen

and the tumor and part of the healthycolon are rem

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