Hoag Presents: "Ask the Doctor" for Fall 2014

Colleen Coleman, M.D.

Q: What is a primary hyperparathyroidism and what should I know about it?

A: ​Primary hyperparathyroidism is a disease that creates elevated levels of calcium and the parathyroid hormone. The parathyroid hormone causes calcium to be removed from the bones which leads to increased calcium levels in a patient’s blood and urine.

Primary hyperparathyroidism is caused by an abnormality in one or more parathyroid glands. These glands are normally around the size of a grain of rice and are located near the thyroid gland in the neck. One to two people per every 100,000 people in the United States will be diagnosed with the disease. Although it can occur at any age, it typically develops after the age of 60 and is most common in postmenopausal women.

Approximately half of patients with the disease will not have symptoms. When patients have symptoms, they are usually mild and include weakness, fatigue, depression, and muscle or bone aches and pains. Some patients may have more severe symptoms, such as loss of appetite, nausea and vomiting, constipation, confusion or impaired thinking and memory, and increased thirst and urination

The disease is usually diagnosed by a routine blood test that shows an elevated calcium level. Since certain medications can cause this, your physician may remove any medications you’re prescribed that could create elevated calcium levels. Your physician will then have you take another blood test to recheck your calcium and parathyroid hormone levels to confirm if you have the disease.

Although primary hyperparathyroidism may be monitored if the disease is mild, it can cause long-term effects like thinning of the bones, an increased risk of fractures, and kidney stones. As surgical therapies have advanced dramatically with improved equipment and technology, surgical treatment is common and often recommended.

The surgery is a low-risk procedure where the abnormal parathyroid gland or glands are removed through very small incisions in the neck. In most cases, the surgery is performed as an outpatient procedure and the majority of patients are able to go home the same day.

If treatment is necessary, your physician will be able to discuss what option is right for you.

Colleen Coleman, M.D., is a Hoag-affiliated physician located at 520 Superior Ave, suite 200G, Newport Beach, CA 92663. To contact Dr. Coleman or to schedule an appointment, please call 949-791-6767.

Nader Nassif, M.D.

Q: What is sarcoma cancer and how do you treat it?

A: ​Sarcoma is a family of cancers that develops from certain tissues. There are over 70 subtypes of sarcoma. The origin of these cancers can be from bone, muscle, cartilage, or other connective tissue. For this reason, sarcoma can occur anywhere in the body; however, it often develops in the extremities. Bone and Soft Tissue sarcoma are rare cancers that can occur in both men and women, and in people of all ages from children to the elderly. According to American Cancer Society, roughly 12,000 individuals will be diagnosed in the U.S. in 2014.

Individuals diagnosed need expert care and a team approach to the treatment of these often complicated problems. Sarcoma may be asymptomatic, with symptoms only presenting themselves after the cancer has progressed. To provide a diagnosis, a specialist will perform a physical examination and some testing, such as an MRI, a bone scan if it involves the bone, and a CT scan of the chest to assess if the disease has spread to the lungs. A biopsy is often recommended to make the diagnosis and determine what subtype of sarcoma it is. Ultimately, surgical removal of the mass is necessary to be able to save the limb. Often, radiation therapy either before or after surgical removal may also be necessary. Chemotherapy is infrequently used, but may be of benefit for a few subtypes of sarcomas.

Hoag offers a multidisciplinary approach to the evaluation and treatment of sarcoma, through a multidisciplinary tumor board. At these regular meetings, experts across the care of sarcoma – such as a medical oncologist, radiation oncologist, sub-specialized surgeon, pathologist, and nurse navigator – review patient history, imaging and tissue slides and make collaborative decisions with regards to the best course of treatment to provide the best outcome for each patient on an individualized basis.

Nader Nassif, M.D. is an orthopedic surgeon who specializes in orthopedic oncology, limb salvage surgery, hip and knee replacements, revision of hip and knee replacements and treatment of complications following hip and knee replacements. He has recently joined the Hoag Family Cancer Center and his practice is located at Newport Orthopedic Institute, 22 Corporate Plaza Drive, Newport Beach CA 92660.

Lee Novick, M.D.

Q: I have heard a lot about “special lens” with cataract surgery. Can I really get out of wearing glasses?

A:​ Modern cataract surgery has progressed dramatically in the past 10-15 years. Currently, cataract surgery is one of the safest, most predictable and frequently performed surgeries in the U.S.

A cataract is defined as haziness in the lens of the eye. The eye, much like a camera, has a lens that is able to focus light on the film (or Retina), and over time this natural lens can become cloudy. There are many causes of cataracts including trauma, certain medications such as Prednisone, certain diseases like Diabetes, and of course time or age, which is the most common cause.

The good news – cataract treatment is performed in an outpatient setting where local anesthesia is used. Recovery time is usually less than one day, allowing most patients to resume their normal activities. In most cases, the procedure is performed by using an ultrasound to break up the cataract and gently vacuum it out of the eye.

A new area of cataract surgery is the rapid advancement of intraocular lenses (IOLs). An IOL is placed into the eye once the natural lens (or cataract) has been removed, effectively replacing the natural lens. I am often asked by patients what these new types of implants or IOLs are, and if they can really improve vision and eliminate the need for glasses. A practical way to think about the types of IOLs is to divide them into three classes: Monofocal, toric, and multifocal or accommodating.

The monofocal IOL is designed to fixate a patient’s vision to a single point. The monofocal IOL will correct the near or far sighted portion of a patient’s vision, which will greatly improve vision, but may leave the need for glasses depending on if the patient is near or far sighted, or potentially both if they have astigmatism. Astigmatism is the additional curvature of the cornea, or front surface of the eye. If astigmatism is present, the cornea is shaped more like a football rather than a baseball, which is round and spherical.

The toric IOL has the ability to alter both the near or far sight portions of a patient’s vision as well as their astigmatism. The net effect is that a patient who chooses a toric IOL has an excellent chance of obtaining clear distance vision without the need for glasses.

Multifocal or accommodating IOLs are the most sophisticated optics now available. These IOLs are designed to give the patient a broad range of vision; distance, intermediate and near. The accommodative IOL works by flexing in the eye. It moves slightly forward within the eye to focus on near objects and moves slightly backward to focus on distant objects. The multifocal IOL has multiple concentric rings etched on the surface of the IOL. The particular rings that your eye focuses through, determined automatically by you pupil, will determine the eye’s ability to see near, intermediate and far objects.

The multifocal, accommodative and toric IOLs are a true breakthrough, but you should discuss with your surgeon what your particular needs are to determine which implant is right for you.

Lee Novick, M.D. is a Hoag-affiliated ophthalmologist located at 18837 Brookhurst St., suite 110, Fountain Valley, CA 92708. To contact Dr. Novick or to schedule an appointment, please call 714-378-0333.

Brian Paik, M.D.

Q: When do men need to go see the doctor?

A:​ Aside from when they are sick, men often assume that they do not need to see the doctor. However, it is important for men of all ages to establish care with a primary care physician and conduct the appropriate screenings.

Initial visit: A physician thoroughly reviews your medical and family history, updates immunizations, and screens for cardiovascular risk factors such as high blood pressure, diabetes, and cholesterol abnormalities.

Blood pressure: Recommended screenings begin at age 18, and then every two years for those with normal blood pressure, or annually for those with pre-hypertension.

Diabetes: Recommended for anyone whose blood pressure is over 135/80 or those who are overweight.

Cholesterol: Levels should be checked starting at the age of 20 for increased-risk men, such as smokers or those with high blood pressure, and at age of 35 for average-risk men.

Early detection, prevention, and treatment are of the utmost importance. If results are normal, men can schedule periodic health visits every three years until they turn 50, and then annually from then on.

Brian Paik, M.D. is a Family Practitioner at Hoag Medical Group. He works at 4900 Barranca Parkway, Suite 103, Irvine, CA 92618 and is currently accepting new patients. To schedule an appointment or request additional information, please visit www.HoagMedicalGroup.com or call 949-791-3103.