June 2013

Superior knowledge and skills, commitment, immediate availability and reliability – those are the hallmarks and philosophy of an
Acute Care Surgeon.

July 1, 2013

Q:

When gang members who get shot come to the ER, do you work with police?

A:

We treat victims and perpetrators of gang violence no differently than other patients, with the exception of some increased security concerns. We strive to render the best of care and achieve optimal outcomes without judgment or bias. We cooperate with law enforcement and the courts at all times but also are obligated to protect patient privacy and certain medical information about them. Our pastoral care and social work departments are usually heavily involved in these cases. On occasion, we work with community members and the Cease-Fire organization to mitigate retaliation and further violence.

July 1, 2013

Q:

I am looking for a good psychologist at Loyola that deals with PTSD do you know of one?

A:

We are not sure if you a veteran, but if you are we suggest you contact Dr. Kelly Maiertich, who heads up the Edward Hines, Jr., VA Hospital Trauma program. Loyola has a close association with Hines.

June 26, 2013

Q:

What are the telltale signs of shingles?

A:

Shingles is caused by the varicella zoster virus and is associated with a painful skin rash that starts with the nerves under the skin. Shingles often appears in a band, a strip or a small area on one side of the face or body. It is also called herpes zoster. Shingles is most common in older adults and people who have weak immune systems due to stress, injury, certain medicines or other reasons. Most people who get shingles recover and are rarely ever troubled with the condition.

Symptoms of shingles occur in stages. At first you may have a headache or be sensitive to light. You may also feel like you have the flu but not have a fever. Later, you may experience itching, tingling or pain in a certain area. That’s where a rash or clusters of small blisters may occur a few days later. The blisters fill with fluid and then crust over. It takes two to four weeks for the blisters to heal and they may leave scars. Some people only get a mild rash and others do not get a rash at all. It’s possible that you may also feel dizzy or weak, or you could have long-term pain or a rash on your face, changes in your vision or changes in how well you can think. If you suspect you may have shingles, see a doctor promptly.

Starting antiviral medicine quickly can help your rash heal faster and be less painful. Take care of any skin sores and keep them clean. Pain medicine may also help relieve the common symptoms of severe pain and burning. A vaccine is now available to help prevent shingles. Loyola has a large number of Primary Care and Emergency Medicine physicians at our many Primary Care sites who can help diagnose and treat this painful condition or determine whether you are a candidate for the vaccine to prevent it.

June 26, 2013

Q:

How do you repair hernias?

A:

A hernia is a protrusion of an organ through an abnormal opening or weakness in a surrounding body structure.  There are many types of hernias. Some can be in the abdominal wall, the groin or internal.  Sometimes hernias can occur through an old surgical incision. How, or if, a hernia is repaired depends on the type and size of hernia, its location, how long it has been there and how well the patient is thought to be able to tolerate surgery. Not all hernias need to be repaired.  With regard to abdominal wall and groin hernias in particular, there is sometimes a risk that the intestines may become stuck in the hernia defect cutting off some of the blood supply, which can lead to gangrene.  This is a serious condition called an incarcerated or strangulated hernia.

There are two methods of repairing hernias. The conventional method involves an incision in the skin and an external repair. The newer method uses minimally invasive surgery, which involves laparoscopic techniques to repair the hernia defect from the inside. Not all hernias are amenable to repair with these two techniques. In some cases the conventional method might be the safest approach while in other cases the minimally invasive procedure is better. However, not all surgeons are trained in the minimally invasive method.  In either case, only a surgeon can decide which method would be best for any individual patient. Some feel there may be less pain and an earlier return to normal activity using the minimally invasive technique, but this is not necessarily true in all cases. There also are some questions as to whether the recurrence rate between the two methods is similar. In most cases a mesh patch and/or plug is used to cover the hernia defect so that there is no tension in the repair, which can frequently lead to a recurrence. There are many Acute Care surgeons and minimally invasive surgeons here at Loyola who can help diagnose and treat hernias.

June 26, 2013

Q:

Is it possible to have surgery without getting a blood transfusion?

A:

Loyola is one of the few hospitals in the country that allows patients to opt out of blood transfusions for surgery or other conditions. Loyola physicians can honor the request of patients who want to avert a blood transfusion, which starts with signing a directive. Patients can authorize limitation or refusal of blood transfusions by completing a special form in consultation with their physician or surgeon.

Dr. Hieu Ton-That, one of our Acute Care surgeons, helped establish the Transfusion Free Medicine and Surgery Program at Loyola. He is currently listed with the Jehovah’s Witness Hospital Liaison Committee as a contact provider for patients who require this service. However, religion is only one of many reasons patients have for preferring to not receive blood. Dr. Ton-That feels that more physicians should be having these conversations with their patients. He is equally concerned that many patients and their doctors are not even aware that techniques do exist to eliminate the need for transfusion in numerous cases. If we know early enough, Loyola has many ways to respect a patient’s directives to avert transfusions without this interfering in their care. For more information, call the Loyola Transfusion-Free Medicine & Surgery Program at (708) 327-0RBC (0722).

June 25, 2013

Q:

My cholesterol is high. I’ve heard about that machine that filters out the cholesterol. Can you please give me the address.

A:

Yes, maybe you saw our video on LDL apheresis. To consult with Dr. Binh An Phan or Dr. Phillip DeChristopher, please call (708) 327-2784. They will first meet with you for an evaluation and then explain the procedure. You will have your doctor’s appointment in the Loyola Outpatient Center on the Maywood campus at 2160 S. First Ave.

June 24, 2013

Q:

Why aren’t motorcyclists required to wear helmets? This seems counterintuitive. I see many motorcyclists driving very dangerously on the highways and streets and most are not wearing a helmet. I have to believe you see many motorcycle injuries at Loyola and can talk about this.

A:

Statistics from 2006 show that nearly 5,000 motorcyclists died and 88,000 more were injured nationally; head injury was the leading cause of death in these incidents. The cost of motorcycle crashes is now estimated in the billions of dollars annually. So it is both a major public health and health-care economics problem we see way too often at our trauma center.

Motorcycle helmet laws have had a checkered history in Illinois. In 1969 Illinois passed a universal mandatory motorcycle helmet law. This law, which required all motorcyclists to wear helmets, was swiftly challenged and found unconstitutional by the Supreme Court of Illinois. In 2010, Senate Bill 2535, which would have required minors riding on the back of motorcycles to wear helmets, made it out of committee but was defeated on the Senate floor.

So currently Illinois is 1 of only 3 states that does not have any kind of motorcycle helmet law in effect; Iowa and New Hampshire are the other states. However, many other states require motorcyclists and passengers under the age of 18 to wear a helmet and others have mandatory helmet use for motorcyclists of all ages. Illinois lawmakers have tried to vote on motorcycle laws for several years, but the bills never make it through the legislative process.

It has been reported that 83 percent of those who died from motorcycle crashes in Illinois were not wearing a helmet, which is among the highest percent nationally. Illinois ranks No. 47 in the nation for lives saved and economic costs savings due to helmet use.

Here’s a national comparison of states with and without helmet laws to highlight the cost in human life and societal finances (average per 100,000 people):

  • Lives saved for states with a universal law:  36
  • Lives saved for states with a partial law:  10
  • Lives saved for states with no law:  4
  • Money saved for states with a universal law:  $73 million
  • Money saved for states with a partial law:  $21 Million
  • Money saved for states with no law:  $9 million

Here are some facts about motorcycle helmets:

  • The single most effective way for states to save lives and money is a universal helmet law.
  • Helmets reduce the risk of death by 37 percent.
  • Helmets reduce the risk of head injury by 69 percent.
  • The U.S. saved $3 billion due to helmet use in 2010.
  • The U.S. could have saved an additional $1.4 billion in 2010 if all motorcyclists had worn helmets.
  • Helmets do not reduce visibility or impair hearing.
  • Most fatal crashes take place during the weekend.

According to the Illinois Department of Transportation, the risk of a motorcyclist operator or passenger being killed in a crash is greater than the risk of a driver or passenger in a car. At this time, because there are no helmet-use laws in our state, the Secretary of State and insurance companies urge that riders wear helmets for increased safety. A motorcyclist could be found at fault in a crash if the rider fails to wear or use required equipment. Riders must wear eye protection unless their motorcycle has a windscreen. Motorcycle riders must also use headlights during the day. Illinois also does not allow motorcyclists to lane split, or ride between the lanes while traveling the same direction as traffic.

Strengthening Illinois law on this issue will save the lives of many residents and state visitors, protect our families and communities from preventable tragedy and free up money for our other priorities.

For more information on this topic I recommend visiting www.nhtsa.gov  or  www.cdc.gov/motorvehiclesafety/mc/states/il.html

June 24, 2013

Q:

I see Loyola is a Level 1 trauma center and your other hospital, Gottlieb Memorial Hospital, is a Level 2 trauma center. What is the difference?

A:

Trauma centers are an essential component of a trauma system. Most systems recognize as many as four levels of trauma centers ranging from Level I, which provides the highest level of care in the system, to Level IV, which is capable only of initial stabilization and rapid transfer to a higher level center.  Levels II, III and IV have intermediate capabilities and fully care for some types of patients but are supposed to quickly identify and transfer patients whose needs exceed that center’s available resources.  The trauma system leadership is usually responsible for which patients are taken by ambulance or helicopter to a center with a higher level of treatment capabilities.  These “triage and transfer” protocols, as they are called, should be re-evaluated at regular intervals taking into consideration changing trauma care resources within the system.

Most systems consist of a network of centers at different levels.  The state of Illinois currently recognizes and designates only Level I and Level II centers, but the state trauma system’s strategic plan calls for three possible designation levels in the future. This designation process involves an onsite review of the facility and the care it provides by a multidisciplinary team of recognized experts in the field of trauma care. While many trauma systems, like Illinois, use their own designation process, others utilize the American College of Surgeons’ verification process, which is considered the “gold” standard for determining the capabilities and competence of trauma centers of any level.

Along with its Level I designation from the Illinois Department of Public Health (the trauma system lead agency for the state), Loyola University Medical Center has the unique and prestigious distinction of being the only American College of Surgeons-verified Level I Trauma Center in the state. Loyola, therefore, maintains specially trained trauma and acute care surgeons, along with a large number of other physicians and support staff, in the hospital at all times 24/7, including holidays. An operating room, CT scanner and other diagnostic and therapeutic services are always ready to evaluate and treat patients at a moment’s notice without waiting or wasting precious minutes. This level of intensity, immediate readiness and commitment, is not consistently matched at trauma centers of other levels.

June 21, 2013

Q:

My kids want to shoot off fireworks for the holiday, and so does my husband and neighbors. I am concerned about the danger for someone to get burned, or lose a finger or an eye. Am I a wet blanket like my family is calling me, or am I right?

A:

On the contrary, you are far from a “wet blanket,” but rather a very smart and caring “cookie,” You are absolutely correct!

According to the Consumer Product Safety Commission, hand and finger damage are the most common injuries caused by fireworks and account for 32 percent of all injuries reported.

Lately it seems people care more about material things and their ability to social network than they do about their own health. So tell your family that staging an awesome pyrotechnical display for their friends on YouTube may result in blowing off their thumbs, ending for good the ability to communicate using a handheld device.

Also prevalent are head and eye injuries, which account for 19 percent and 18 percent of total reported injuries, respectively. Fireworks are basically explosives and all are capable of causing severe injuries, but even minor injuries can cause significant functional disability when it comes to hand and eye function. Fireworks are not toys.

Fireworks that are considered legal are still very dangerous. Fireworks burn at approximately the same temperature as a household match and can cause burn injuries and ignite clothing, if used improperly. Sparklers burn at nearly 2,000 degrees Fahrenheit at their center.

Even fireworks that are classified as ‘safer,’ such as bottle rockets and sparklers, are responsible for some of the most serious wounds treated by Emergency Medicine physicians and Acute Care surgeons.

Especially in dry weather there is the added risk of danger as sparks ignite highly combustible matter, such as grass and roofing. According to the Alliance to Stop Consumer Fireworks, fireworks in 2010 caused an estimated 15,500 reported fires, resulting in 8 deaths, 60 injuries and $36 million in direct property damage.

If you can’t convince people to avoid the dangers by pointing out the consequences of lost body parts and sight, then maybe reverting to letting people know there’s a good chance of not being able to text will promote caution. Or maybe reminding them of the fact that they would have to pay a lot to rebuild the house or garage might do some good! Common sense education just doesn’t seem to work.

Here are some tips to help keep safe while celebrating Independence Day:

  • If you choose to use legal fireworks, carefully read and follow all directions on the packaging.
  • Plan safe activities for children. Give them glow-in-the-dark wands and noisemakers as substitutes for sparklers and firecrackers.
  • Teach children about the dangers of fireworks and other explosives. Discourage children from lighting them and set a good example by never using fireworks yourself.
  • If you find explosive substances around your home, call the local fire department’s non-emergency line for disposal guidelines. Do not dispose of them or explode them yourself. Too many unknown factors like age, moisture levels and amount of explosive material make them dangerous and unpredictable.
  • Never underestimate the inventiveness of children, who sometimes try to concoct homemade devices. Keep potentially hazardous materials like lighter fluid, charcoal lighter and gasoline out of their reach.
  • Never approach a firework device after it has been lighted, even if it appears to have gone out. It is likely to be excessively hot and may explode unexpectedly.
  • Consider safe alternatives for celebrations. Check the newspapers for community fireworks displays handled by professionals or hold a celebration at home where you can supervise your children’s holiday festivities.
  • If an injury occurs, call 911 or the local emergency phone number. Get immediate medical aid from experts who specialize in treating burns and other traumatic injuries.
  • Make sure any area where firework debris may land is not dry and drought-ridden.
  • Keep fire extinguishers and water hoses nearby BUT always call 911 immediately if a fire starts.

June 21, 2013

Q:

What does it mean when a bone is broken at the growth plate?

A:

These are known as Salter fractures and generally occur in children whose growth plates, which are at the end of the bone and generate its growth, are still open and growing.  These types of fractures can have serious implications for proper bone maturation and function of extremities if not diagnosed and treated properly.  They are often difficult to diagnose.  Any child who sustains an injury to an extremity and then complains of pain with a bone or joint should be evaluated to rule out one of these fractures by an Emergency Medicine physician, Pediatrician or an Orthopaedic surgeon who is particularly familiar with fractures in children. A Radiologist who has experience in reading pediatric X-rays also is a valuable consultant. At Loyola, a special section of our Emergency Department is dedicated to caring for only children and is staffed by Pediatric Emergency Medicine specialists, Pediatricians and Radiologists 24 hours a day. We also have a group of Orthopaedic surgeons who are experienced in caring for children and available for consultation in the Emergency Department or the orthopedic outpatient clinic.

June 20, 2013

Q:

Dr. Esposito, as a trauma surgeon who operates on people involved in drunken driving accidents, what is your opinion about the proposal from the National Transportation Safety Board to lower the blood-alcohol threshold for drunken driving from .08 to .05?

A:

I would endorse lowering the limit. Studies show that the odds of crashing increase exponentially above .05. Some states have passed “zero tolerance” laws for teen drivers that seem to help reduce crashes and the subsequent deaths and injuries. The rationalization that lowering the limit penalizes the person who had one too many or only occasionally drinks “socially” makes no sense. “One too many” is just that – one too many. It’s about impairment, not the number of drinks. Whether it’s one too many or many too many, at .05 your level of impairment is such that it significantly increases the average person’s probability of crashing and injuring or killing themselves or others. Should we now allow commercial pilots to fly with alcohol levels of .05 or less? I think not. And there are far more people driving than pilots flying every day! And planes these days pretty much fly themselves with the advent of sophisticated computer systems. So why the difference in attitude about alcohol-level tolerance in these two activities that demand complete attention and no physical or mental impairments??

June 20, 2013

Q:

My children play football and often get hurt. How do I know if I should have them just shake it off, or if they are in danger of concussion?

A:

It is always best to err on the side of caution and have your children evaluated by a medical professional to rule out serious injury requiring specialized treatment. Sometimes a coach or trainer can serve this purpose, however, these are not medical professionals.  Recently much attention has been focused on concussions. The NFL and the Centers for Disease Control and Prevention (CDC) now have policies and practices on this condition.  You can view a fact sheet on concussions, treatment and more policy information at www.cdc.gov/concussion/sports.

Any suspected injuries to the neck and extremities with symptoms of numbness, tingling or discoloration of the extremities should be evaluated in an Emergency Department immediately.  Pain, extensive bruising and difficulty walking or with mobility of the injured limb that does not improve over a short period of time or worsens should also be evaluated. Injuries to the torso that are likewise associated with unrelenting serious pain, difficulty breathing or lethargy and fainting can be indicators of serious internal injuries to the lungs, ribs or internal organs, such as the spleen, liver or kidney. With particular regard to the kidney, any evidence of blood in the urine warrants immediate attention.

June 20, 2013

Q:

What is a fistula?

A:

A fistula is an abnormal connection between two bodily structures.  This can sometimes be between the intestines, or between the intestines or stomach and the skin.  Other hollow organs such as the bladder and the gallbladder can also sometimes be involved in fistula formation.  An abnormal connection between the internal rectum and the buttocks is known as a “fistula in ano.” In infants, there can sometimes be a fistula between the trachea (breathing tube) and the esophagus (swallowing tube). Fistulas can sometimes form spontaneously or after surgery. Initial diagnosis of a fistula is probably best done by a surgeon, and depending on the type or location of the fistula, by a surgical specialist such as a colorectal surgeon or a pediatric surgeon. Loyola has many acute care surgeons and specialty surgeons who are capable of diagnosing and treating this complex problem.

June 20, 2013

Q:

What is a gallbladder and how can I tell a gallbladder attack from an appendicitis attack? And if your appendix bursts, can you really die?

A:

The gallbladder is a small sac underneath the liver that stores a digestive juice called bile. When you eat a fatty meal, the gallbladder releases bile into the intestines to help digest food.  Gallstones, however, may block the release of bile, causing pain, inflammation and finally infection. This process is commonly referred to as a “gallbladder attack.” The appendix is what we call a vestigial organ, which really has no purpose and is attached to the first part of the large intestine.  Both the gallbladder and the appendix are located on the right side of the body.  Appendicitis and cholecystitis (infection of the gallbladder) show many of the same symptoms, including right-sided abdominal pain and fever. However, gallbladder-related pain and tenderness is usually under the rib cage on the right while appendicitis-related pain is usually lower down on the right side of the abdomen in the pelvis. The only way to determine the cause of the pain is to visit with a medical specialist, who after gathering a medical history, performing a physical exam and running some diagnostic tests, should be able to give you a diagnosis.  If there is any question about whether you have either of these conditions, then you should go to an Emergency Department for a consultation. Unfortunately, appendicitis and cholecystitis can still be fatal conditions unless treated early and appropriately.

June 20, 2013

Q:

My dad burned himself on his new barbecue grill on Father’s Day. His arm has a big red welt and is swollen, but he won’t go to the emergency room because he says it will just go away on its own. Should he still go to the emergency room even though a few days have passed? When is a burn serious enough to go to the emergency room?

A:

Any moderate burn should be evaluated by a medical professional to assure that proper treatment is provided.  Many of these burns do not require specialized care. However,  others do.  Even though it has been several days since the accident, the damaged skin could be infected or need dead tissue removed.  If there is any question at all, he should be evaluated.  Loyola has a nationally renowned Burn Center, which has an outpatient clinic. Our burn surgeons are available for consultation in the Emergency Department here if necessary.  I would suggest he be seen by a medical professional if for no other reason than for your own personal reassurance.

June 20, 2013

Q:

When should I go to an immediate care center vs. the emergency room?

A:

Please see the following video for answers to your question.

June 20, 2013

Q:

My daughter smokes marijuana with her friends and then drives home. I know because I smell the marijuana in the car after she has used it. When I talk to her she says driving after smoking pot is not like drunken driving and is not as dangerous. Is she right?

A:

Unfortunately, she is dead wrong! More than 50 percent of traffic fatalities and injuries are associated with the presence of alcohol, marijuana or both in the blood and/or urine.  Any substance that impairs judgment or reflexes increases the risk of crashing a vehicle while driving. Some states have instituted “drugged driving” laws, which include detection of cannabis (marijuana) in the blood or urine as an offense. For more information on the dangers of impaired driving, go to www.nhtsa.gov.

June 17, 2013

Q:

My teenager texts and drives. How can I make him realize the danger of his actions?

A:

Texting and driving has now been shown to be more dangerous than drinking and driving. Countless numbers of teens, as well as adults, are being treated in emergency departments and trauma centers as a result of this dangerous and irresponsible behavior. Unfortunately, a large number never live to be treated. Children learn from their parents, so the first strategy to utilize is to make sure that you and other adult members of the family do not text and drive.

For more information on the sad and preventable statistics and how to dissuade your son from engaging in this risky and potentially fatal practice go to www.nhtsa.gov. I also recommend:
http://www.youtube.com/watch?v=dht-Vy25jPs&feature=share&list=PL7FEF61DA1F5293A0
and
http://itcanwait.com/

I hope this helps.

June 17, 2013

Q:

I have had a consistent pain under my right rib cage for the past month. It feels like something is lodged there. How do I know if it is a gallbladder problem, or a cracked rib or something else? It isn’t going away.

A:

This rather nonspecific symptom can be caused by a number of different conditions. Certainly, one of these can be related to the gallbladder or liver or even the ribs and lung on the right side of your body.

There are a number of routes that could be taken to help better identify what is causing the pain. You might first seek evaluation by a primary care physician. They may then refer you to a gastroenterologist or a surgeon, more than likely after some preliminary tests are obtained. Depending on your health-care coverage, you may circumvent the primary care physician and make an appointment directly with one of the other specialists I mentioned. All of these doctors are available here at Loyola and at a number of our primary care sites conveniently located in the suburbs.

June 17, 2013

Q:

How important is it to wear a helmet when riding a bike? I have my younger kids wear helmets, but as an adult I feel stupid wearing one and also am sympathetic to my teenager’s protests.

A:

Bicycle helmets have been shown to reduce injuries sustained in riding incidents by 85 percent. Children take cues and learn from parental behavior. Therefore, it is imperative that you wear a helmet when riding to set a good example and increase the chances of your children wearing one as well.

If you think you look “stupid” wearing a bicycle helmet, take a moment to think of how you will look in a wheelchair with a tracheostomy (artificial breathing) tube and a gastrostomy (feeding) tube in a long-term custodial care facility after having sustained a moderate to severe head injury because you weren’t wearing a helmet and crashed your bike? This is exactly the situation that we know can be prevented by wearing a helmet. Admittedly there is more to bicycle safety than just helmet use, but helmets continue to be a big part of it.

For more information on bicycle safety and helmet use go to: www.nhtsa.gov. I hope you will take this advice for your sake, as well as your children’s.

June 14, 2013

Q:

Can you tell me anything about morphea? This is where you get white or brown spots on your skin from the collagen coming to the surface. Is there anything to stop it or treat it? I already have psoriasis and now this!

A:

Morphea is a localized version of scleroderma (where the skin becomes abnormally thickened). When it is active the lesions appear whitish and feel stiff or waxy. Treatment with topical medicines such as steroids (stronger versions of hydrocortisone), vitamin D derivatives or agents to quiet the immune system are helpful in many cases. Some patients may require treatment with oral medicines like methotrexate or prednisone that also affect the body’s immune response. Newer therapies such as laser and light therapy can also be helpful. Once areas improve in texture, some hyperpigmentation may still remain.

June 13, 2013

Q:

I have displacement of a thoracic intervertebral disc – massive rupture at T11-12 with cord compression. I have gone to two doctors so I know I need surgery. Both are neurosurgeons. Is it possible for you to tell me how to choose between them? I also have psoriatic arthritis, lumbar, sacral and cervical spondyloarthritis. Most likely I will need more surgery.

A:

There are no guarantees – no matter which surgeon you decide on, complications can happen. First, you must be comfortable with your surgeon, have confidence and trust this health professional. Do you communicate well with each other and how do you feel about the doctor’s bedside manner? The surgeon’s experience and outcomes are, of course, also important. You should ask how many of these procedures the surgeon has done and what the outcomes have been.

The surgeon should fully and clearly explain all the risks and benefits of the operation. You should not hold back on any questions and the surgeon should not be annoyed or curt if you do. You need to understand everything about the surgery and be fully informed. Communication is key.

Some patients seek recommendations from others who have had this operation to find out about their experience. Don’t forget that the anesthesiologist putting you to sleep and the hospital(s) the surgeon operates at are also factors you may want to check into. This may also influence your decision. Given your other health issues, the availability of experienced specialists, like surgical critical care doctors, and special services to support you and your surgeon should be readily available in case they are needed. if you’re still not comfortable, you might seek a third opinion.

It’s normal to be nervous, but at some point you will need to decide. We wish you all the best in your upcoming operation and recovery.

June 12, 2013

Q:

Is a young man with a prolactinoma and very low testosterone levels likely to be infertile?

A:

Any man with low testosterone levels may have issues that can affect his fertility. He may suffer from problems with libido (low sex drive), erectile problems, or low numbers on a semen analysis. I would recommend evaluation with a semen analysis to help answer his question.

June 11, 2013

Q:

This winter my father fell from a ladder while hanging Christmas lights. He sustained a fractured elbow (which was treated with plates and screws) as well as multiple rib fractures on his right side. Months later, he is still experiencing pain from his unhealed rib fractures, but his elbow seems to have healed nicely following surgery. Is there a way to support the ribs to help them heal?

A:

Rib fractures can be very painful for a long time and sometimes the pain never totally resolves. Sometimes non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, which are available over the counter at pharmacies, can be helpful in relieving the pain. If the ribs are truly not healed yet and still unstable, then an operation to “plate” and stabilize them may be advisable. This is similar to what was done with his elbow. The procedure is usually done earlier than in this case and even then does not always work. You may want to have him evaluated by one of our thoracic surgeons or one of our acute care surgery doctors who has experience with this type of operation and patients who may benefit from it. They may also refer you to a pain specialist who may suggest other methods of alleviating the pain.

June 11, 2013

Q:

I’m 33 and on Medicaid and ever since I had my tubes tied I haven’t been able to have a regular bowel movement. Maybe twice a month I can go to the washroom without getting sick or having to use a laxative. Is there something that could be done to help me?

A:

I doubt the two are related, but they may remotely be. I would first seek an evaluation from a gastroenterologist (stomach and intestine specialist) who may also enlist the advice of a colorectal surgeon and/or gynecologist. All of these specialists are available at Loyola.

June 10, 2013

Q:

Why would I have such a problem with blood pressure at 59 when I take a 325 mg of aspirin a day?

A:

Aspirin does not actually treat blood pressure but is thought to prevent or lessen the probability of conditions associated with it, such as stroke or heart attack.  There are many lifestyle changes and medications that actually can treat and control blood pressure. You should consult with a primary care physician or cardiologist to determine which of these treatments are best for you.  We have a number of specialists here at Loyola who would be willing to evaluate not only your blood pressure, but your overall health situation as well.

June 7, 2013

Q:

My husband had quintuple bypass surgery and was told that he was lucky to have survived. How long is life expectancy after a surgery like that?

A:

The information on relief of symptoms and long-term survival after cardiac bypass surgery is constantly changing.  This is not my area of expertise, but I would refer you back to your husband’s cardiac surgeon or his cardiologist.

June 7, 2013

Q:

I’m on Medicaid and my 17-year-old has been suffering with a urinary tract infection that is not responding to antibiotics since December. She has had urinary problems her whole life. I live south of Joliet and cannot find a specialist to take her. What should I do?

A:

It sounds like she should be evaluated by a urologist or a urogynecologist (a specialist trained in both urology and gynecology). Loyola has both types of specialists on staff here in Maywood. If the distance is it not too much of an inconvenience, these specialists would be happy to evaluate her.  Loyola does accept Medicaid patients. Please visit http://loyolamedicine.org/medical-services/urogynecology-reconstructive-pelvic-surgery-center-women

June 7, 2013

Q:

I’m having issues since my first delivery. Somehow I got some of the muscles torn in my colon. Can this be repaired? It’s causing huge problems for me.

A:

Unfortunately this is not an uncommon complication of vaginal childbirth.  There are several potential solutions to the problem depending on its severity.  This is usually best handled by either a urogynecologist (trained in both urology and gynecology, as well as this particular problem) or a colorectal specialist (a surgeon specializing in problems with the large intestine and rectum). On occasion, this may require a team approach from both types of specialists. We have both types of these specialists on staff here at Loyola who have treated a large number of patients with this condition.  They would be happy to evaluate your case. Please visit http://loyolamedicine.org/medical-services/urogynecology-reconstructive-pelvic-surgery-center-women

June 7, 2013

Q:

Every once in a while I get a sharp pain in the center of my chest like someone stabbed me in the back. The pain gets worse when I raise my arms. It happens maybe twice a month. Why is this happening?

A:

There may be many causes for this non-specific symptom. They may range from musculoskeletal pain to problems with the esophagus, the heart or blood vessels in the chest. This is probably best evaluated initially by a thoracic (chest) surgeon. There are a number of thoracic surgeons here at Loyola who would be happy to evaluate you.

June 7, 2013

Q:

I’m under a doctor’s care already, but I have Type 2 diabetes and my weight and my eating habits are bad. Also my blood pressure is up and down. I want to have lipo for a quick fix to some of my issues with my weight. Do you think this could help with my diabetes or can I take some of the weight-loss pills to curb my appetite?

A:

There is increasing evidence that weight-loss surgery is effective in improving, or even eliminating, Type 2 diabetes as well as other health problems associated with being overweight, such as high blood pressure.  Liposuction may not be the right option for you or to control your other health problems.  Loyola has established a very well-respected and effective Metabolic Surgery & Bariatric Care program (treatment of obesity) that offers patients many options for weight loss, including several types of surgery if indicated.  The program evaluates patients from a number of standpoints and selects the best option for each individual patient.  The program, directed by Dr. Chand, would be happy to evaluate you. For more information, visit http://loyolamedicine.org/bariatrics/

June 7, 2013

Q:

I’ve been having constipation, bloating, gas and abdominal pain. I went to the doctor and they’ve done different tests but can’t seem to figure out what the problem is. What do you suggest I do?

A:

These are very general symptoms, which could be indicative of a number of different underlying causes.  If you have not been seen specifically by a gastroenterologist (stomach and intestine specialist), we suggest that you seek a consultation with one.  If you have seen a gastroenterologist and are not satisfied with the results, then perhaps a second opinion is in order.  Loyola has a large group of gastroenterologists who would be happy to evaluate you.

June 7, 2013

Q:

What causes constant migraines? I wake up to them in the middle of the night and it feels like my head is going to explode. Sometimes they last for months, but these aren’t as strong as the ones that wake me up. My doctor just keeps trying pain pills. I have had them for 8 years now. Any advice?

A:

There are many reasons for headaches that may, or may not, be classified as migraine headaches.  Headaches can be indicative of other more serious problems. There are potentially other medications and treatments besides “pain killers” that may be helpful.  The best type of physician to help sort this out is a neurologist. Sometimes, if a clear cause of the headaches cannot be found, other more effective types of managing the pain, including different pain medications, acupuncture or other strategies can be used. Foods can sometimes cause or aggravate headaches and a dietitian/nutritionist may provide helpful dietary counseling.  These specialists are all available here at Loyola.

June 7, 2013

Q:

I have I.C. I’ve been through DMSO and put on the only pill that’s supposed to help. It didn’t. I then did acupuncture for a year before finally submitting to pain killers. Do you have any suggestions for me? I know this disease is a difficult one.

A:

Unfortunately, I am not familiar with the abbreviation I.C. or the disease for which it stands. Please provide more specific information on the disease, and we will be happy to try to answer your questions.

June 7, 2013

Q:

How is it possible that a person wakes up one day with serious hearing loss? The doctors can’t seem to find nor fix the problem. What do you suggest?

A:

There may be many causes for this problem. The patient should be seen by an otolaryngologist (ear, nose and throat specialist—ENT) with a particular interest and expertise in hearing disorders.  That specialist will more than likely recommend testing by an audiologist. These specialists and testing services are available here at Loyola.

June 7, 2013

Q:

My daughter suffers from seizures. The doctor wants to call them febrile seizures, but she had one yesterday and she didn’t have a fever. How can I help my daughter? What can I do?

A:

Depending on her age, you may want to seek the specific opinion of a pediatric neurologist or, if she is older, a neurologist that treats adults and specializes in the diagnosis and treatment of seizure disorders.  These neurologists are available for consultation here at Loyola.

June 7, 2013

Q:

What can you tell me about Susac’s Syndrome?

A:

Susac’s Syndrome consists of the clinical triad of encephalopathy, branch retinal artery occlusions and hearing loss. It is an autoimmune disease in which the smallest blood vessels in the brain, retina and inner ear become blocked, causing these organs to suffer. More information is available at: http://en.wikipedia.org/wiki/Susac%27s_syndrome. This condition is usually treated by a neurologist or neural surgeon.  These specialists are available at Loyola. However, regionally, the Cleveland Clinic may have particular interest and expertise in treating this rare condition.

June 7, 2013

Q:

Do you know what the rare disorder alternating hemiplegia is? And would you be willing to help find out more and help the families that deal with it daily? My best friend’s daughter was admitted to ICU yesterday from it. Her heart rate is low and she’s unresponsive. Can you tell me more about it?

A:

There is a very informative government website at: www.ninds.nih.gov/disorders/alternatinghemiplegia/alternatinghemiplegia.htm

This has much information on the condition, its treatment and current research into the cause and cure. A neurologist is usually the physician who deals with this, or if the patient is in an intensive care unit, a critical care specialist should be involved.  Both of these services are available here at Loyola.

June 7, 2013

Q:

I have Type 2 diabetes, which is pretty much under control now. I think some of the nerves in my toes are damaged from this. Is there any way to reverse that?

A:

Depending on your actual symptoms, some recently approved drugs may be helpful for you. Please check with the doctor managing your diabetes, or you may want to seek the specific opinion of a general endocrinologist, a diabetologist (an endocrinologist that subspecializes in treating diabetes and its complications) or a neurologist. These specialists and subspecialists are available here at Loyola.

June 7, 2013

Q:

Is it normal to have 4 bowel movements a day or is it a sign of a problem?

A:

Bowel habits are extremely variable, and it is hard to say whether this is normal for you or whether it is a sign of something abnormal that needs to be investigated and treated. If it is of concern to you, then you should seek the opinion of a gastroenterologist (stomach and bowel specialist), or possibly a colorectal surgeon (surgeons specializing in problems with the large and small intestines).  These specialists are available here at Loyola.

June 7, 2013

Q:

I have a retroperitoneal fibrosis tumor wrapped around my abdominal aorta. Where can I find a doctor to remove this? I need help.

A:

I suggest that you be evaluated by a surgical oncologist in conjunction with a vascular surgeon.  Minimally invasive surgery is one possible approach for this condition. Surgeons with expertise in these areas are available here at Loyola.

June 7, 2013

Q:

I was a victim of a violent crime and I have a scar on the left side on my face under my ear to my chin. My throat was cut and I also have a double ripped earlobe. Is it expensive to get my earlobe repaired? I try to hide it with my hair or clip-on earrings. I feel deformed and don’t want anyone to see my ear. I feel embarrassed. What can you tell me about this?

A:

The best specialist to see for this problem is a plastic surgeon who can evaluate you for scar revision and reconstruction of the earlobe.  As an aside, there is a fund designated in the state of Illinois to assist victims of violent crime with medical costs incurred as a result of injuries sustained in that crime. The plastic surgeons and social work department here at Loyola would be happy to discuss your problem with you. Counseling is also available to help you deal with your very real and troubling concerns.

June 7, 2013

Q:

I have a lot of feet problems. I have been diagnosed with neuropathy, plantar fasciitis and a few other things. I do have a foot doctor and he does try his best with me. When he treats one problem, it’s like one of my other problems acts up. I’m worried that I am always going to be in pain from foot problems. What would you suggest?

A:

There are several new treatments for neuropathy that involve medication.  If neuropathy is truly the cause, it may be beneficial to consult with a neurologist in addition to the foot doctor.  Sometimes when the underlying cause of the pain cannot be identified, it can be helpful to see a pain specialist who may have a number of potential solutions to lessen or eliminate the pain, including potentially acupuncture.  All of these services are available here at Loyola. Please visit Neurology http://www.loyolamedicine.org/medical-services/neurology-services and our Pain Management Center http://www.loyolamedicine.org/medical-services/pain-management-center

June 7, 2013

Q:

What can cause your insides to swell? The pain is so bad that I can’t move. I’m pretty much bedridden and been seeing doctors, but it’s been no help. They either pass me to another doctor or write me a prescription for Irritable Bowel Syndrome and then say ‘Try this and come back in 2 weeks.’ I don’t have IBS and I don’t have Crohn’s disease. I also can’t eat; it makes me sick. I’ve lost 25 pounds in a short period of time. This happened before. Any advice?

A:

This is a rather non-specific complaint, which may stem from many possible causes and can be complex and difficult to diagnose. If you have not been seen by a gastroenterologist (stomach and bowel specialist) you should be.  Consultation with a dietitian/nutritionist may also be helpful in identifying foods that may be causing these symptoms.  Both of these types of medical professionals are available here at Loyola. Please visit http://www.loyolamedicine.org/medical-services/gastroenterology-services

June 7, 2013

Q:

How should you store your finger after it is cut off?

A:

The amputated part should be kept as clean as possible and wrapped in sterile moistened gauze.  That should been be placed in a similarly moistened, but not soaking wet, towel.  The towel containing the gauze-wrapped part should then optimally be placed in an ice-filled container. Care should be taken not to freeze the amputated part.  The patient and the amputated part should then be rapidly brought to an emergency department, preferably by EMS professionals.  In most instances, it is best to retrieve the part, call 911 immediately, and let those medical professionals assume management of this situation.

June 3, 2013

Q:

What is Acute Care Surgery?

A:

Acute Care Surgery is a new discipline emerging in General Surgery that expands upon its roots in Trauma Surgery.  It involves emergency and elective General Surgery, Surgical Critical Care (caring for patients in the ICU),Trauma Surgery, of course, and, in our model, Burn Surgery.  We like to call it “Back to the Future Surgery” because this is nothing different than what general surgeons did as recently as 10 or 20 years ago, before the age of super-specialization and boutique practices.  They did everything that came their way, all the time, every time.

June 3, 2013

Q:

What types of surgery do Acute Care surgeons do?

A:

It’s not really about what we do, but perhaps how we do it.  We function as a team – not only of surgeons, but of an array of support staff including nurse practitioners, a clinical pharmacist, dietitian, social worker and case manager whose time in dedicated solely to our Acute Care surgery patients.  Our cadre of six surgeons do a variety of operations primarily in the abdomen but also occasionally on other parts of the body.  Most commonly we handle problems with the gallbladder, stomach, intestines, appendix, colon, hernias and the like. When it comes to injured patients, we do it all except dealing specifically with the bones or the brain and spinal cord.  We use both conventional  surgical techniques as well as the minimally invasive laparoscopic technique.  No case is too big or too small.  No case is too simple or complex.  We never transfer our patients to another hospital for a higher level of care.

June 3, 2013

Q:

What is different about Acute Care surgery?

A:

First perhaps, our passion for challenges and commitment to superior outcomes.  We maintain a presence in the hospital 24/7, including holidays, and have a very robust performance-monitoring and improvement process.  There is a higher level of intensity in what we do – and again, the team approach.

June 3, 2013

Q:

How can you reach Loyola’s Acute Care surgery team?

A:

We can be reached for an appointment at (888) 584-7888.  All of our group maintains clinics both at Loyola and Burr Ridge where you can arrange to see one of us.  We also maintain a STAT Clinic where your physician can arrange for you to be seen in one of our clinics within 24 hours or on the next business day.  This service focuses on subacute problems like minor abscesses  or skin infections and abdominal pain that may be caused by a surgical condition.  The intent is to provide scheduled prompt care and avoid prolonged waiting in an Emergency Department for relatively minor conditions.