Hoag Presents “Ask the Doctor" for Winter 2017

In this edition of Ask the Doctor, Drs. Leah Nakamura and Jennifer Gruenenfelder, Dr. Gayle Hopper, Dr. William Tseng, Dr. Daniel Su and Dr. Michael Bain provide important information on a variety of topics including urinary incontinence, Hepatitis C, liposarcoma, prostate cancer, and wound care.

Dr. Leah Nakamura and Dr. Jennifer Gruenenfelder

Q. What is urinary incontinence and how do you treat it?

A. Urinary incontinence is an involuntary loss of urine or “wetting your pants.”

This surprisingly common, yet embarrassing condition affects both women and men and can have a large impact on your quality of life.

There are four main types of urinary incontinence:

  • Stress Incontinence: Leakage that occurs with exertion such as when you cough, laugh, sneeze or exercise.
  • Urge Incontinence: Leakage that occurs with urgency often associated with frequency and an overactive bladder.
  • Overflow Incontinence: The bladder never fully empties and leaks like an overflowing cup, common in men with prostate gland problems.
  • Functional Incontinence: Individuals with poor mobility have difficulty reaching the bathroom in time.

Factors that increase your risk of developing urinary incontinence include:

  • Gender: Women are more likely to experience bladder control problems due to childbirth.
  • Age: The muscles in your bladder and urethra lose strength as you get older. In men, the prostate enlarges which leads to increased risk of urge and overflow incontinence. In women, menopause increases incontinence risk.
  • Weight: Being overweight increases risk.
  • Neurological Disorders: Disorders, such as Parkinson’s disease, stroke or Multiple Sclerosis, can interfere with bladder control.

Urinary incontinence can be treated in a variety of different ways, ranging from simple lifestyle changes, such as reducing caffeine intake and other bladder irritants, losing weight, and other conservative medical treatments like pelvic floor physical therapy and Kegel exercises.

If these treatment options aren’t able to help your urinary incontinence, schedule a consultation with a urologist to discuss medications and potential surgical options to treat your condition. The urologist will talk through your history and perform a full physical examination, including a pelvic and/or rectal exam to best assess your condition and develop a treatment plan.

Drs. Leah Nakamura and Jennifer Gruenenfelder are urologists specializing in Female Pelvic Medicine and Reconstructive Surgery at Orange County Urology Associates. Dr. Nakamura works alongside Dr. Gruenenfelder to help develop the Pelvic Floor Program at Hoag Health Center in Irvine.

Dr. Gayle Hopper

Q: Hepatitis C – am I at risk and how do I know if I should be tested?

A: Most people who have Hepatitis C don’t even know they have it. Hepatitis C can damage the liver and lead to liver failure and liver cancer. The good news is, in 90 percent of cases, it is treatable and curable within a few months with some of the new antiviral medications.

One in 30 baby boomers has Hepatitis C and most are asymptomatic and unaware. It is estimated that 3.2 million Americans have Chronic Hepatitis C. Many people were infected in the 1970s and 1980s when Hepatitis C rates were at their highest. Perhaps this is because the blood supply was not screened then. Some contribution to the increase could also be attributed to the increasing popularity of tattooing and piercing. In addition to being transmitted through blood products, Hepatitis C is also transmitted sexually.

Who should be tested? The Center for Disease Control (CDC) recommends that people born between 1945 and 1965 should be tested. If you fall into this age category, ask your doctor to add this test to your next blood work order. If you’ve had sex with more than 10 people in your lifetime, you should be tested. If you’ve ever shared a needle for drugs, snorted drugs, or shared drug paraphernalia, get tested. If you received a transfusion, blood products, or had a transplant before 1992, you should be tested. Finally, if you are HIV positive, received tattoos or body piercings with unsterilized instruments or reused dyes, ever had an accidental needle stick (most common in health care workers), are a Vietnam veteran, or are on long term kidney dialysis, get tested.

Gayle Hopper, M.D. is a family medicine doctor with Hoag Medical Group. She practices at the Fountain Valley location and can be reached at 714-477-8400 or HoagMedicalGroup.com.

Dr. William Tseng

Q. What is liposarcoma and how is it treated?

A. Liposarcoma is a rare form of cancer that arises in fat cells. It is so rare that the majority of physicians are only vaguely aware of the disease.

Liposarcoma affects fat cells, but it has nothing to do with being fat or eating fatty foods. It doesn’t affect one race or ethnicity more than another and it doesn’t target people by gender or age. The people who have liposarcoma represent nearly every demographic.

Liposarcoma can develop in any part of the body, however the most common locations are in the legs, arms and the back of the abdomen. In the back of the abdomen (“retroperitoneum”), these tumors can develop without symptoms and they can often present as massive, watermelon-size tumors that touch almost every organ in the abdomen. High-grade tumors can grow aggressively and even spread to other parts of the body. There are actually three subtypes of liposarcoma and differentiating them is very important for treatment decision-making.

Surgery is the main form of treatment for liposarcoma. Chemotherapy and radiation therapy can be used, however all patients with tumors that have not spread will still need surgery. Surgery can be very painstaking and challenging. Sometimes, removing liposarcoma takes a team of specialists who rotate through the operating room, each lending their specific expertise to the procedure. Although we try to preserve organs and major vessels without causing injury, sometimes we do have to remove them to get the tumor out completely.

The treatment for liposarcoma is not good enough. Even with the best care, over the course of the patient’s life, the cancer is likely to come back.

That is why I also work outside the operating room, researching liposarcoma to try to help develop a more effective treatment option. Currently I’m researching immunotherapy as a possible treatment and I am an active part of an international group of collaborators focused on this rare disease.

William Tseng, M.D. is a surgical oncologist who specializes in sarcoma, with special interest in liposarcoma. His office is located in Newport Beach and can be reached at 949-764-5389.

Dr. Daniel Su

Q. I understand that the prostate-specific antigen (PSA) test only indicates that there is a problem with the prostate; it does not determine whether cancer is present. How do I determine whether an elevated PSA test means I have cancer?

A. The current model of using the PSA and the annual digital rectal exam to diagnose prostate cancer is imperfect, and it has led to a lot of men undergoing unnecessary treatment.

In spring 2016, Hoag purchased UroNav, which combines a pre-biopsy MRI and ultrasound-guided biopsy imaging to create a 3D image of the prostate. This helps locate suspicious areas, reduce both false positives and negatives and limits the need to remove the entire prostate for patients with prostate cancer. Furthermore, a MRI/ultrasound-guided prostate biopsy has been shown to find prostate cancer that needs treatment and ignore cancers that can be safely watched, therefore reducing overtreatment.

What we have seen so far are three significant changes to the way we are able to diagnose and treat patients:

  1. In patients with rising PSAs, particularly those who have undergone several standard biopsies that did not find cancer, we are able to use the MRI to identify the biopsy location and offer a more accurate diagnosis as well as find potentially missed cancers.
  2. We are able to more confidently diagnose low-grade cancers in patients while reducing the concern that we are missing a more aggressive cancer. This is especially important for patients who have elected to watch their cancer.
  3. The technology has opened our ability to offer focal therapy – treating only the cancerous areas without having to remove the entire prostate. Prostate removal has a higher chance of side effects.

Before coming to Hoag, I completed a two-year Society of Urologic Oncology fellowship at the National Cancer Institute, where I researched advanced imaging for prostate malignancy, detection and screening. Few if any hospitals in the region offer MRI/ultrasound fusion technology, and very few practitioners have the level of expertise with the tools that I have had the opportunity to develop.

While fusion biopsies is only indicated for select patients and does not fully replace standard prostate biopsies, the new technology allows us to find more cancer and differentiate between dangerous tumors and less aggressive tumors.

The improved precision allows patients to partner with their physicians to make better informed decisions about appropriate treatment. This helps to avoid surgery in patients with less aggressive disease, and ensures that patients with more aggressive cancers are identified earlier.

Prostate cancer is the second most common cancer diagnosed in men, and risk increases with age. According to the National Cancer Institute, about 14 percent of men will be diagnosed with prostate cancer sometime during their lifetime.

Due to the prevalence of the disease and the challenges of diagnosing it properly, fusion-targeted prostate biopsy will eventually become the “gold standard.” Thankfully, Orange County residents don’t have to wait for the technology to become more widespread.

Daniel Su, M.D. is a urologic oncologist who specializes in prostate cancer. His office is located in Laguna Hills and can be reached at 949-855-1101.

Dr. Michael Bain

Q. When should you seek medical treatment for a wound that won’t heal?

A. Typically, if a wound does not respond to conventional treatment within 30 days, it’s time to seek expert care.

At Hoag Wound Healing & Hyperboric Medicine, we offer a comprehensive team approach which brings together physicians, nurses and physical therapists, all trained in advanced wound care, to specifically tailor a treatment plan for each patient’s unique needs.

Risk factors, such as diabetes, blood flow problems, and immobility, can increase the chances of developing chronic or non-healing wounds.

If you are experiencing a diabetic foot ulcer, venous leg ulcer, a chronic wound from radiation therapy, or a skin injury that won’t heal, don’t ignore it. Even seemingly small diabetic foot wounds, if unrecognized or undertreated, can rapidly progress, resulting in infection, amputation and loss of mobility, and sometimes permanent disability. It is easier to heal you if you seek treatment right away.

Seeing a specialist trained in wound care is critical to healing properly. That is why, in partnership with the patient’s primary physician, Hoag’s wound-healing experts provide comprehensive care from start to finish, utilizing the most innovative approaches in the science of wound care.

Hoag Wound Care Center also offers state-of-the-art treatment options, including hyperbaric oxygen therapy. Hyperbaric oxygen therapy is a treatment that delivers a high concentration of oxygen to the bloodstream, which helps reduce swelling, fight infection, and build new blood vessels, and ultimately produce healthy tissue.

With a healing rate of 95 percent and an average healing time that is seven days faster than the national average, Hoag Wound Care Center, with locations in Newport Beach and Irvine, was recently honored with the Center of Distinction Award for clinical excellence by Healogics™ Inc. and was one of only four California hospitals that qualified as a Center of Excellence.

Patients with private insurance, Medicare and most health care plans can utilize the services offered at Hoag Wound Care Center.

Michael Bain, M.D. is a Plastic Surgeon in Newport Beach and second generation Hoag physician. He has presented both nationally and internationally and has extensive experience in both cosmetic and reconstructive surgery. His office is located in Newport Beach and can be reached at 949-720-0270.