Hoag Presents "Ask the Doctor" for Spring 2016

In this edition of Ask the Doctor, Dr. John (Jeb) Brown, Dr. Valentina Dalili-Shoaie, Dr. Sandra S. Kwak and Dr. Sandeep Thakkar provide important information on a variety of topics including minimally invasive robotic surgery, genetic testing, underactive and overactive thyriod conditions, and Parkinson's disease.

John (Jeb) Brown, M.D.

Q: What are the benefits of Hoag’s Multidisciplinary Robotic Surgery Program?

A: At Hoag Family Cancer Institute, we have access to the most advanced minimally invasive technologies and highly skilled clinical teams when it comes to robot-assisted surgery. Compared to traditional “open” gynecologic procedures, robotic surgery has fewer complications, less blood loss, a shorter hospital stay and quicker return to normal activities. This is possible due to the sophisticated optics on the robot as well as the “wristed” instruments which rotate like a human wrist, yet are approximately one-third of an inch in width. Hoag has five robots on its two campuses, including two Xi and two Si systems in Newport Beach, as well as one Xi robot in Irvine. The Xi robot is the newest platform and is designed for the most complex surgical procedures.

Hoag has become a regional leader in the field of robotic surgery and performs the highest volume of robotic procedures in the state of California. The Multidisciplinary Robotic Surgery Program consists of physicians from gynecology, gynecologic oncology, urology, general surgery, thoracic surgery, cardiac surgery and colorectal surgery, who have all been specially trained to use this minimally invasive technology to treat their patients. The physicians on this team meet every other month with representatives from the hospital administration to explore ways to optimize the patient’s experience, increase efficiency and decrease cost.

With a fierce commitment to exploring and perfecting innovative treatment options, Hoag has been recognized as a Center of Excellence in Minimally Invasive Gynecology (COEMIG™) by the American Association of Gynecologic Laproscopists (AAGL) and the Surgical Review Corporation for providing exceptional gynecologic surgical care and being dedicated to continuously improving care and patient safety.

Dr. John (Jeb) Brown is a gynecologic oncology surgeon at Hoag.

Valentina Dalili-Shoaie, M.D.

Q: What does a Medical Geneticist do and how does genetic testing play a role in my health?

A: A Medical Geneticist is a physician that undergoes additional training and education to become board certified in genetics. This physician can provide comprehensive diagnostic testing, management, and counseling services for patients with potential or known hereditary conditions. Examples of hereditary conditions include cancer (breast, colon, ovarian, thyroid, pancreatic), cardiovascular disease (hereditary aortic aneurysms, heart conduction abnormalities), and neurologic disorders (early onset Alzheimer’s disease and movement disorders such as Huntington’s and Parkinson’s).

If a potential hereditary condition is identified within the patient, genetic testing is recommended with two main goals in mind:

  • To identify a pathogenic mutation (an abnormal change in the gene leading to abnormal function). Once confirmed, clinical monitoring (serial imaging, blood work, routine follow up with specialists) is established in order to prevent a serious medical event.
  • To test other family members at risk. For those family members who test negative, unwanted and unnecessary monitoring can be avoided.

Ultimately, appropriate genetic testing is not only beneficial for the patient but for their family as well and can improve quality of life.

By reviewing your personal and family history, a primary care physician is often able to identify a potential hereditary condition that may require genetic evaluation. Or, a patient may already know the specific hereditary condition tracking through the family and ask his or her primary care physician to be referred to a Geneticist for further evaluation. Within the Hoag Family Cancer Institute, Hoag offers a comprehensive Richard J. Flamson Hereditary Screening Program, where familial cancers are evaluated by genetic counselors. Hoag is also in the process of developing multi-disciplinary clinics for hereditary cardiac and neurologic conditions.

Valentina Dalili-Shoaie, M.D. is a Medical Geneticist, with a background in Internal Medicine, at Hoag Medical Group and also serves as the Medical Genetics director for Hoag. She practices at the Newport Beach location. For appointments or more information, visit HoagMedicalGroup.com or call 949-791-3002.

Sandra S. Kwak, M.D.

Q: I think I may have an underactive or overactive thyroid condition. What are some of the symptoms?

A: Simply stated, the thyroid gland releases a hormone into our blood stream that governs the energy production of cells in our body. Hypothyroidism (underactive thyroid) occurs when the thyroid gland doesn’t produce enough thyroid hormone and the body’s processes start slowing down.

Symptoms associated with Hypothyroidism include:

  • Weight gain
  • Fatigue
  • Constipation
  • Cold intolerance
  • Dry skin
  • Hair thinning/hair loss
  • Depression

Hyperthyroidism (overactive thyroid) is exactly the opposite. When the thyroid gland produces too much thyroid hormone, then the functions of the body tend to speed up.

Symptoms associated with Hyperthyroidism include:

  • Weight loss
  • Frequent bowel movements/loose stools
  • Heat intolerance
  • Increased perspiration
  • Rapid heart rate/palpitations
  • Nervousness/anxiety
  • Tremors
  • Insomnia

It has been estimated that more than 20 million people in the United States may have a thyroid condition. The thyroid is a “butterfly” shaped gland located in the neck that, as stated above, regulates our body’s cell metabolism and many routine functions. When the doctor examines your thyroid gland, he/she is evaluating for thyroid growths (nodules) or enlargement (goiter), which may affect thyroid hormone production. In order to evaluate thyroid function and whether or not the patient needs thyroid medication, a blood test is necessary.

There is a higher probability of having an undiagnosed thyroid condition if:

  1. There is a family history of thyroid disease.
  2. Tthere is a personal history of an autoimmune disorder.
  3. There is a history of radiation exposure (especially to the head and neck region).
  4. There are fertility issues including infertility and/or miscarriages.

If you would like to learn more about thyroid disorders, I encourage you to attend my community education class on May 18, where I will discuss symptoms, optimal screening tests and treatment options. Thyroid problems vary with each individual. To receive the best treatment possible, establish care with an Endocrinologist who can create an ongoing care plan tailored to your specific thyroid condition and needs.

Dr. Sandra Kwak is an Endocrinologist specializing in Thyroid Disorders at Hoag Health Center Newport Beach. She is currently serving as the Program Advisor for the development of the Hoag Thyroid Center.

Sandeep Thakkar, D.O.

Q: I’ve been recently diagnosed with Parkinson’s disease (PD). What new treatment options are available in the early stages of the disease and as it progresses?

A. Over the last decade, there have been many advances in the understanding of the disease as well as therapeutic options available to patients with Parkinson’s disease. Parkinson’s disease is a progressive disease that results from the loss of cells in the brain. These cells produce dopamine, a substance that is naturally present in the brain and helps the nerve cells in the brain that control movement to function properly.

As a leader in the management and treatment of movement disorders, the Hoag Parkinson’s and Movement Disorders Program is comprised of a multidisciplinary team who focuses on providing the best individualized care for each patient. We navigate our patients every step of the way to develop a treatment paradigm best suited for each individual. This includes and is not limited to the Parkinson’s disease focused exercise and nutrition guidelines, medical treatment, and the potential for surgical therapy.

There are numerous treatment options available for patients, depending on what stage the disease is at. Treatment usually consists of a combination of oral medications and rehabilitation therapy. There are a variety of oral medications that can be used, including extended release medications that help patients control symptoms throughout the day.

As Parkinson’s disease progresses, the amount of dopamine produced and recycled within the brain decreases. This can lead to motor symptoms such as resting tremors, rigidity, slowness of movement, balance and gait instability. These symptoms are referred to “off – state” when medications are wearing off. Sometimes, patients in advanced stages may begin to experience frequent “off” episodes in a day when their scheduled oral medications are not adequately working, and thus making activities of daily living challenging. In these advanced cases, surgery may be needed. One treatment option is DUOPA, which is administered using a small, portable infusion pump that delivers carbidopa and levodopa – the same active ingredients in oral medications. DUOPA is delivered in a suspension that goes directly into the small intestine via a tube placed by a percutaneous endoscopic gastrostomy procedure with jejunal extension. This type of administration can be more effective than oral medications for the treatment of advanced Parkinson’s because it bypasses the stomach, providing consistent medication to help control motor symptoms.

As always, patients diagnosed with Parkinson’s disease should consult with their physician to determine the most appropriate treatment options.

Sandeep Thakkar, D.O., is the program director of Hoag’s Parkinson’s and Movement Disorders Program.