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Upcoming GERD talk at Swedish Issaquah on 9/26

LINX has arrived at Swedish! After several months of preparation, we will be implanting the first 3 LINX devices on September 21, 2012. For our 3 adventurous patients, we are excited to see them have their GERD controlled with the LINX and also hope that it meets their expectations.

To learn more about this procedure and others options for managing GERD, you may wish to come and hear my partners Dr. Ralph Aye and Dr. Alex Farivar talk at Swedish Issaquah on September 26th, 2012. For more information and to register for the 9/26 GERD class, click here.

Update on 9/23: I am happy to report that our patients who have received the LINX device are all doing well.

Rib Fractures: Essentials of Management and Treatment Options

Rib fractures are the most common chest injury accounting for 10 to 15 percent of all traumatic injuries in the U.S. Nearly 300,000 people are seen each year for rib fractures and 7 percent of this population will require hospitalization for medical, pain, and/ or surgical management.

Rib fractures can cause serious complications including: bleeding in the chest (hemothorax), collapse of the lung (pneumothorax), or result in a fluid accumulation in the chest (pleural effusion), just to name a few. As well, rib fractures may contribute to the development of a lung infection or pneumonia. These problems are important to diagnose following chest trauma and even more importantly, when present, they need to be followed closely in the early post-traumatic period.

The most common symptom that people experience with rib fractures is....

Fixing Chest Wall Deformities: A Minimally Invasive Option

Pectus excavatum often referred to as either "sunken" or "funnel" chest is the most common congenital chest wall deformity affecting up to one in a thousand children. It results from excessive growth of the cartilage between the ribs and the breast bone (sternum) leading to a sunken (concave) appearance of the chest.

(Image source)

Although present at birth, this usually becomes much more obvious after a child undergoes a growth spurt in their early teens. Pectus excavatum can range from mild to quite severe with the moderate to severe cases involving compression of the heart and lungs. It may not cause any symptoms, however, children with pectus excavatum often report exercise intolerance (shortness of breath or tiring before peers in sports), chest pain, heart problems, and body image difficulties. The last issue deserves some attention as children often are reluctant to discuss how the appearance of their chest affects their self-esteem globally. There is a bias even within the medical community to dismiss the appearance component of pectus excavatum as merely "cosmetic", but I view the surgery to fix this congenital defect as corrective and support the idea that the impact of its appearance should be considered. I have seen patients emotionally transformed in ways that they and their families never expected.

Thanks in great part to the pioneering work of Dr. Donald Nuss (a now retired pediatric surgeon in Virginia), we have a well-proven minimally invasive option to correct pectus excavatum: the Nuss bar procedure. This involves ...

Pain after surgery

If you are scheduled to have surgery, it is normal to be concerned about pain you may experience after surgery.

The best time to talk about post-surgical pain is actually before your operation. Make sure you:

  • Talk to your surgeon about your experience with different methods of pain control.
  • Bring a current list of all your medicines and any drug allergies with you to your appointment.
  • Be honest about your alcohol and drug use. If you are abusing alcohol or drugs, you may experience withdrawal from these substances making your postoperative recovery difficult. If you are a recovering from alcohol or drug abuse we can design a pain management plan to reduce the chance for relapse.
  • Ask questions about the post-surgical pain: the severity, how long it will last, how it will be treated, what medications will be used, how they work, and their possible side effects.
  • Discuss any concerns you have about taking pain medications.

Surgical pain is common and should be expected after your procedure. Luckily, modern pain medications and anesthesia can minimize surgical pain. While we cannot eliminate all pain, we want to make you as comfortable as possible. Our pain management goals are simple:

A new treatment for GERD: The LINX - Reflux Management System

Acid reflux, heartburn and indigestion are all forms of gastroesophageal reflux disease or GERD. This common problem afflicts over 20 million people in the United States on a daily basis. As a surgeon who treats patients with some of the most severe symptoms of GERD, I was recently struck by the fact that very little has changed in the treatment of the debilitating problem over the last several decades.

Medications have always been the primary treatment for patients with GERD. TUMS, Rolaids, alka seltzer are easy over the counter remedies that could provide instant but only short-term relief. More potent medications called H2 receptor antagonists (commonly known as Zantac, Pepcid AC) brought about longer lasting relief. These medications were great but many patients experienced a relapse of symptoms.

The newest medications for GERD...

Pectus excavatum – it looks like the chest is sinking inward

Have you ever noticed someone whose chest sinks inward in the front, kind of like a funnel? The first time I ever noticed this bony malformation was when I was in high school, and a friend of mine on the soccer team had one. It was called “pectus excavatum,” he told me.

In my thoracic surgery training, I was often called upon to evaluate patients with this chest wall abnormality. As a result, I began to delve deeper into some of the issues that may affect people with this type of defect.

Pectus excavatum is the most common chest wall deformity and results from abnormal development of the sternum and its attachments. Most patients are self conscious about the defect and usually focus on its appearance but because this is usually present for much of a person’s life, symptoms associated with it may not be totally obvious. Individuals affected generally get used to how they feel and try to overcome any limitations to the best of their abilities without even knowing that’s what they are doing. Most patients describe some chest discomfort, shortness of breath when exerting themselves, lack of endurance, or feeling embarrassed in social situations when their shirt is off. It is not uncommon to hear patients say that they have trouble keeping up with their friends during activities, or that they avoid any activities that would require them to take off their shirt in public-such as going to a pool.

Most physicians aren’t even aware that there is an effective treatment for pectus excavatum...

Palmar hyperhidrosis

Everyone sweats – but what if you had a condition that caused uncontrollable sweating in your hands?

Palmar hyperhidrosis is a benign condition where individuals experience uncontrollable sweating of their hands, way beyond their physiological needs. Hand sweating in such a scenario is often described as being present 24/7, may be worsened in situations of stress but also occurs out of nowhere in times of total rest and serenity. From the constant dampness the hands are exposed to, ulcerations and other skin related changes may develop. Many patients with this condition adopt a line of work and a life style that minimizes public encounters and avoid hand contact such as having to shake hands.

It has been known since the 1920s that by dividing the sympathetic chain (nerve) high up inside the chest, a procedure called thoracic sympathectomy, we can make the hands stop sweating. To achieve this surgically was quite an undertaking back then. The surgical trauma was such that historically very few individuals with hyperhidrosis opted to have corrective surgery. With the development of videoscopic surgery, however, it has become possible to perform the sympathectomy with minimal trauma to the patients. In addition, the magnification provided by the optics of videoscopic surgery has made the surgery safer.

What is involved in an ETS (Endoscopic Thoracic Sympathectomy)?

Nowadays, we offer surgery under general anesthesia as a day surgical procedure (meaning most patients are expected to go home the day of surgery). Two small incisions are needed, and we preferentially place those on your sides. At Swedish, our preferred approach is to clamp the nerve by placing titanium clips on the nerve at appropriate levels. The advantage of clipping the nerve instead of removing a segment of the nerve (as we did prior to 2005) is for possible reversal of the sympathectomy in the rare instance where a patient may be unhappy with the side effects of the surgery (see below).

What results should I expect?

In our hands, ETS will render the hands dry in 99 to100% of cases ...

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