The Side of Medicine You Never Knew

Can you identify what a nephrologist, an endocrinologist and an otolaryngologist do? These are just a few of the specialists you might meet when your health demands some extra attention.

Maybe you can pronounce their titles, and maybe you can’t. The medical field is teeming with specialists who spend years studying and keeping up with advancements so they can more effectively treat their patients.

If you’ve never experienced a health problem that necessitated a visit with a particular specialist, you may not even know what he or she does. What is a nephrologist? An endocrinologist? An otolaryngologist? You might find that at some point, one of these specialists could make a significant difference in your life.

Nephrology: Finding the Silent Killer

Syed Ahmed has taken to introducing himself as a nephrologist kidney doctor because, although redundant, without the “kidney” clarification, most people wouldn’t have a clue what he does.
It’s also why the interventional nephrologist at Rockford Nephrology Associates spends nearly half his time educating patients and the community about chronic kidney disease, dialysis and how people can stave off future problems.

Dr. Syed Ahmed

“Your kidney does two things in your body: one, it cleans the toxic waste in your body, and two, it pumps out extra fluids,” Ahmed says. “That’s what dialysis will do when your kidney has failed.”

Most patients see Ahmed because they unknowingly have chronic kidney disease (CKD), often caused by diabetes or hypertension, he says. A failing kidney can lead to additional health problems, such as heart disease, stroke and even early death.

According to the CDC, 15% of U.S. adults have CKD, but as many as 9 out of 10 adults are unaware of their condition.

Often, the only way to tell if a person has CKD is to look at his or her glomerular filtration rate (GFR), which measures how well kidneys are filtering the blood, Ahmed says.

A normal GFR is 90 to 120, Ahmed says. The Kidney Disease Initiative Global Outcomes recommends seeing a nephrologist when there is “an abrupt sustained drop in GFR or if there is protein or blood in urine,” he says.

“If your GFR is 45, it’s fair to say your kidney is only functioning at 45%,” Ahmed says. “And there are no symptoms. That’s the key issue: people need to start seeing kidney doctors once their GFR is less than 60, because that is the window, the period of time we have, when we can prolong kidney function and delay dialysis.”

Once patients start to have symptoms of CKD – swelling, nausea, vomiting and more – their GFR is usually at 15%, Ahmed says. And by then, it’s too late.

“Someone whose kidney function is already low, say 15% – that’s the time we start to prepare for dialysis,” he says.

There are three types of dialysis:

• In-center hemodialysis: In best-case scenarios, blood is pumped out of a patient into a machine by way of a fistula – an abnormal connection of a vein to a nearby artery manifested through minor surgery to create a large blood vessel with a fast flow of blood. The dialysis machine cleans the blood and takes out excess fluids before returning it to the body. This process takes about 4 hours and requires three visits a week.

• Home hemodialysis: This process is the same as in-center hemodialysis but can be done at home with the help of a partner. Though patients are hooked up to the dialysis machine for fewer hours each treatment, home hemodialysis requires more days of treatment.

• Peritoneal dialysis: This type of overnight home dialysis first entails a small surgery to insert a catheter into a patient’s stomach. At night, the patient hooks up to a machine that pushes fluid through the catheter into the stomach, where a special stomach lining called peritoneum filters the blood. The waste products are then drained out.

“The key thing here is your body does the dialysis for you,” Ahmed says. “Fluid is kept in the stomach for an hour or hour and a half, and it happens four or five times overnight – then you’re done.”

GFR is included in normal labs, so regular checkups with your primary doctor can go a long way in preventing CKD.

“This is a silent killer, and it does not give you any symptoms until it’s time for dialysis,” Syed says.

Endocrine Surgery: Thinking about Your Thyroid

Many people don’t know what Ian Behr does for a living.

“Most people don’t know what an endocrine surgeon does until they have something that requires treatment,” says Behr, an endocrine surgeon at OSF HealthCare in Rockford. “I have a website I made, an Instagram page and Facebook page to try to get my name out there.”

Because so many are unfamiliar with the endocrine system – specifically the thyroid – Behr is a big believer in visual aids.

Dr. Ian Behr

“I have a real-life thyroid model in my office that shows how it sits in our neck,” he says. “I always show this to people. But if you feel your Adam’s apple, two finger-breadths below is where your thyroid crosses your trachea. It’s shaped like a butterfly or bowtie; it wraps around your windpipe. It’s pretty easy to feel. You can tell on your own, by feeling your own neck, if you may have a nodule or big, hard lump there.”

The thyroid regulates metabolism, energy levels, even the texture of skin and hair, and when those thyroid levels get out of whack – either too much or too little of the hormone – things can get a little dicey.

There are multiple reasons why a thyroid may not function correctly, and some of those are attributed to overactive thyroid nodules or even autoimmune diseases like Hashimoto’s thyroiditis, Behr says.

Still, many patients can take medication to even out their thyroid levels. But sometimes, nodules (lumps) are found in the thyroid, and that’s where Behr steps in.

About 90% of nodules are benign, but the remaining 10% can be cancerous, Behr says.
Most people get ultrasounds of their nodules to characterize how big they are and what they look like, and there are options to remove them when necessary.

Behr is the only doctor in northern Illinois and southern Wisconsin who performs radiofrequency ablation, a non-surgical option that utilizes a small needle to put heat in the nodule, which shrinks it down until it disappears.

A patient receives a numbing medicine, and the procedure lasts roughly 30 minutes. Behr says patients typically leave 10 minutes after that.

He also performs all standard open surgeries to remove some or all of the thyroid when need be.
“People can have a goiter: a big thyroid,” Behr says. “A goiter can compress people’s windpipe and even go under the chest, to where you have to have your chest opened to have it out.”

Parathyroid glands, meanwhile, are four pea-sized glands behind the thyroid that control calcium levels. When those levels can no longer be stabilized by the body, the parathyroid may need to be removed.

“Calcium is very important,” he says. “If those levels are too high, people can get kidney stones, they’re more prone to developing osteoporosis, it affects kidney functions, and you have joint aches, muscles aches, fatigue and constipation.”

Approximately 100,000 people are diagnosed with hyper parathyroidism every year, so it’s “not super prevalent, but prevalent enough,” Behr says.

One of the newer, “cool” technologies Behr is excited about involves the parathyroid glands.
“If you shine an infrared light on them, they fluoresce,” he says. “They can be very hard to find sometimes in the neck … but with infrared light, they light up like a Christmas bulb. That is a way to make surgery safer because the biggest risk of the thyroid or parathyroid is that behind the thyroid is the nerve to our voice, one nerve on each side. If it gets injured, you can have a hoarse voice. It can be fixed, but never perfect.”

Thyroid cancer, meanwhile, affects about 50,000 people in the U.S. each year.

“Thankfully, it’s the kind of cancer that, if found early enough, we can cure,” Behr says, noting about 95% of patients survive. “Deaths are only about 2,000.”

Otolaryngology: Stuffed-Up Sinuses

Most people understand what Dr. Terry Donat does when he calls himself an ear, nose and throat (ENT) specialist at FHN in Freeport. It’s when he uses the term otolaryngologist that they get a little confused.

Donat treats disorders of the sinuses and breathing through the nose, particularly when patients have excessive drainage issues and sinus infections that haven’t responded to medical therapy like antibiotics and nasal sprays.

Dr. Terry Donat

Severe sinus problems affect about 25% of the population, and many people have dealt with the issues for so long they’ve forgotten what it feels like to breathe clearly, he says.

Several new procedures have become more popular in the past five years, and Donat says they’re meant to “reduce the number of infections; reduce the severity of symptoms; and reduce difficulty breathing through the nose, and drainage and pressure that have not responded to medical therapy.”

“The idea is, with any of these procedures, you have a problem that’s been bothering you – I don’t care if it’s been a month or 10 years – let’s improve your symptoms so the severity is less and you can get off taking chronic medications all the time,” Donat says.

Today, otolaryngologists have “better” methods to help patients. The following three procedures can be performed in the office, under local anesthesia:

• ClariFix: This low-risk treatment reduces nasal symptoms for patients with chronic allergies and other inflammation in the nose.

ClariFix cryotherapy involves freezing a nerve inside the nose so it produces less mucus and reduces the sensation of congestion and excessive drainage, Donat says.

“For 80% of people, nasal symptoms went down for at least two years,” he says, noting the results could last even longer, but studies haven’t confirmed that yet. “There are graphs that show these results. That’s what I show to people: Do you want these symptoms reduced statistically this much?”

• Latera: If you pinch your nose where you would put a clothespin to ward off bad smells, you’ll quickly find that you can’t breathe through your nose.

That’s how some people go through life – not being able to breathe properly through their nose.
“Some people can’t flare their nostrils,” Donat says. “Their nose pinches shut. Either they can’t open it, or their nose has become weak over time so when they breathe in, it collapses and falls in from the side.”

Latera is a nasal implant that provides support – like the stays in an umbrella – inside the skin of the nostril to support that area, Donat says.

“It’s a 1-minute procedure in the office,” he says. “It creates some scarring on the inside of the skin so the nostril doesn’t cave in.”

Latera has only been around for about three years, but studies have shown patients experience, on average, a 57% reduction in nasal obstruction symptoms after two years.

• Balloon sinuplasty: Balloon sinuplasty, or balloon sinus dilation (BSD), is 94% effective for patients, meaning only about six patients in 100 need an additional procedure, Donat says.

The minimally invasive procedure opens blocked sinus passageways that typically are “the width of a Bic pen filler,” Donat says. “We open them up to the size of a Bic pen.”

“It’s like expanding a heart vessel with stents,” he adds. “They expand it with a balloon; it’s the same thing here.”

Balloon sinuplasty is less invasive and has the same outcomes as more traditional sinus surgery under general anesthesia, Donat says – plus there’s a shorter recovery period.

“We don’t cure sinus problems, but they shouldn’t be as long, as severe or as frequent,” he adds. “Same with allergies: symptoms should be less, you shouldn’t be bothered by them as much, and you should need less therapy.”

Orthopedic Surgery: There’s No Jumping to Conclusions

Many people assume that because “surgeon” is in his title, a trip to visit Dr. Jamie Frantz will result in a surgical procedure, he says.

But Frantz, an orthopedic surgeon with Beloit Health System who is fellowship trained in sports medicine, doesn’t push someone to go under the knife without exhausting other options.

Dr. Jamie Frantz

“A lot of people are hesitant to see an orthopedic surgeon because they start thinking about surgery,” he says. “Realistically, we treat every musculoskeletal complaint: broken bones, tendons, muscles and more. We’re not just the typical ‘broken bone, fix it with plates and screws’ type of surgeon that people hear about. Surgery is part of what we do, but it’s not the majority of where we spend our time.”

While acute injuries – those suffered suddenly, such as from a fall – could require surgery if the injury is severe, there is a host of nonsurgical treatment options to help patients suffering from chronic injuries – the type that develop gradually.

A medical team – orthopedic surgeons, physical therapists, nurses, physician assistants and nurse practitioners – discuss possible remedies, which might include stretching and home exercise programs, anti-inflammatory medications, cortisone-type injections and “all sorts of more conservative or non-surgical interventions before we get to the surgical intervention,” Frantz says.
There are certain things patients should expect when they visit an orthopedic surgeon.

In most cases, the medical staff will start with an imaging test even before the patient sees a doctor, he says.

An X-ray – the most common imaging test – helps orthopedic surgeons rule out broken bones or arthritis as causes of pain, and it’s often done first so a patient doesn’t have to leave the examining room multiple times during the visit, Frantz says. Sometimes an MRI, CT scan, ultrasound or other specialized test will also occur.

“The other thing people should expect is that, typically, if you come in for a new injury, there’s going to be some kind of a specialized examination routine to evaluate that injury or that problem,” Frantz says. “Sometimes people have a sore joint or leg or arm, and they don’t want to move that arm. But that is one of our key ways to make a diagnosis and get an idea of what’s going on. A hands-on examination is very important.”

When should a person visit an orthopedic surgeon? Shoulder pain, for example, is a common ailment and could be a good reason to schedule a visit.

“I don’t think everyone who has shoulder pain for a day or two needs to come see us,” Frantz says. “But when the shoulder pain affects their daily life – they can’t put on their purse, can’t wash their hair – they should start to think about seeing a specialist.”

On the flip side, don’t let a condition fester without seeking treatment, Frantz cautions.

“People who ignore things for too long – ‘I’ve had carpal tunnel for 10 years, my fingers are numb all the time,’ or someone tore a rotator cuff 10 years ago – now that’s not a fixable problem,” he says. “They stay at home and avoid being seen. If people are having problems, they should be seen.”

While some physicians have the “luxury” of giving advice to prevent the medical problems they specialize in – eat right and stay healthy and you won’t have to see me – that’s not the case with orthopedic surgeons, Frantz says.

“Sometimes needing to see an orthopedic surgeon is hard to avoid,” Frantz says. “In the winter, if you’re getting out of your car and you slip on a patch of ice, there’s not really a way to prevent that. But I don’t think people should be scared to see us. We want to get people back to doing activities they no longer can do.”