Regardless of the source, the advice is sound. Like many in my generation, sunscreen was not part of our childhood. I joke with my daughters that I didn’t know what sunscreen was until I left home for college. As a result, in spite of my skin’s Neapolitan origin, I had too many childhood sunburns to count. (Note to self, when I write a future blog post about the importance of skin screening, I will link that post to this spot). That was then. Now we know the dangers of sun exposure. Sun exposure definitively increases your risk of skin cancer. Skin cancer is the most frequent cancer in the US with over one million cases per year. Some forms of skin cancer are very treatable. But one form, known as Melanoma, can be very deadly.

In spite of this knowledge, there is a huge amount of variability in how diligent people are in protecting themselves from the Florida sun. I live on a street that is very popular with joggers and cyclists. This past weekend I saw this family cycling with well protected baby in tow. I think this is GREAT. Unfortunately I also saw someone, who I happen to know has battled Melanoma in past, jogging shirtless. I guess he could have been wearing sunscreen, but I think if I were him, I’d be looking more like Lawrence of Arabia.

Want to learn more about skin cancer?

This Saturday, May 19th, 2012, there will be a Skin Cancer Expo. This wil be held between 8:30 and 10:30 at the mima cancer center. The cancer center is located at 1130 S. Hickory St. in Melbourne Florida. The speakers will be Dr. Larry Bishop (Dermatologist) and Dr. Nanialei Golden (Radiation Oncologist).

Complimentary breakfast will be served. Visit www.mimadermatology.com or call 409-1956 for details

Thanks to Dr. Ian Steele and Kristine Van Workum for very interesting talks. Also thanks to Pam Evans, Kerry Owens, and Ashley Liparini from my office. Also much appreciated is the staff from Melbourne GI Center for participating.

The following links were recommended from the presentation:

http://www.markfuscomd.com/gerd.htm

http://www.markfuscomd.com/peh.htm

http://www.markfuscomd.com/barretts.htm

http://www.markfuscomd.com/lap_nissen.htm

http://www.markfuscomd.com/barrx.htm

http://www.markfuscomd.com/barrx.htm

http://www.brevardnutrition.com

http://www.eatright.org

http://www.tobaccofreeflorida.com

Portion size me promotional video

NIDDK

AICR

ACS

Follow this link to see the books recommended by Kristine:

Slides used in the presentation.

Remember to follow me on Facebook for information about additional events.

Mark Fusco MD

1. Work on my Prezi presentation. Prezi is a very cool on-line presentation tool that allows you to give presentation in the style of writing on a white board. It is more visually interesting than powerpoint that harkens back to the days of the circular slides carrousel. Solution: If you upgrade to the pro version of Prezi you can get a desktop version that allows you to view and edit presentations offline then sync them with your online account. Its $159 per year, but for as many presentations as I give, I think it will be worth it. (www.Prezi.com)
2. Update ideas for future blogs. Presently when I have an idea for a blog post that, I put it into an Evernote notebook (www.Evernote.com). In the past I have mostly pasted in the links using the Chrome extension provided by evernote. As you might imagine, opening the Evernote desktop client to see a note with a URL I have no ablility to access is less than helpful. Solution: Use the evernote clipping tool to save the section of the page you need to access later. This will place the data itself in your Evernote notebook. One last detail, just prior to leaving you need to open Evernote and sync the desktop client with the most up to date data from your online Evernote account.
3. Edit blog posts. Presently I have a list of blog posts that are in various states of research/revision. They reside in the draft section of my wordpress client. This has the advantage letting me scan through the list and when one is ready to go I can add tags and post. Unfortunately this is only available online. Solution: I have created a dropbox folder entitled Future Blog posts. I am going to start each blog post in this folder and only transfer it when it is at the stage to add tags and post. Dropbox synchronizes all your files across multiple machines. It does this in the background any time there is connectivity. So any updates to the file you made off-line will automatically get changed on your online account and to any other machines you have linked to your dropbox. If you haven’t heard about dropbox, it is absolutely the best thing since sliced bread. www.Dropbox.com
4. Google Maps. Solution: I always carry my little Garman Nuvi hand held GPS. It has been a God send and has gotten me all over Europe with minimal fuss. On-line maps via a smart phone or car GPS has the advantage of more frequent map updates, but use a lot of data. This is not usually an issue in the States but even in Europe where you have complete cell coverage, using your phone as a map can be VERY costly.
5. E-mail, Facebook, Twitter. Solutions: wait till you get home. A little time off-line might do you good. Or you can hang off the edge of the balcony trying to get just a little bit of Wi-Fi.

Heartburn, Acid Reflux, and Esophageal Cancer prevention.

April is Esophageal Cancer awareness month!

Come learn about the link between acid reflux and Cancer of the Esophagus and learn about new treatment options for reflux and cancer prevention.

Saturday, April 14^th 2012
9:30 AM to 12 noon

MIMA Cancer Center
1130 Hickory Street
Melbourne, Florida 32901

Esophageal cancer, or cancer of the muscular tube that brings food to the stomach, is increasing in frequency. The risk of esophageal cancer is increased in people who have chronic acid reflux. Chronic reflux can lead to a precancerous condition known as Barrett’s esophagus. Come learn about the link between reflux and cancer and the last dietary, medical and minimally invasive procedural treatments to prevent this devastating cancer.

Panel

• Kristine Van Workum, RD, CSSD, LDN -
  Registered Dietitian, LifeShape Advanced Bariatric Center of Florida.
  President, Brevard Nutrition, Inc
• Ian Steele MD –
  Gastroenterologist, Melbourne Internal Medicine Associates (MIMA)
• Mark Fusco MD –
  Minimally Invasive Surgery, Melbourne Internal Medicine Associates (MIMA)
  Medical Director, LifeShape Advanced Bariatric Center of Florida.

Call 321-728-7553 to reserve your space for this free program or visit www.MarkFuscoMD.com for more information.

When most of us hear the word robot, we conjure up images of Will Robinson’s best friend in the TV show Lost in Space, or gangly arms spitting out sparks, spot welding a long line of Toyota doors, or perhaps the more human-like Cylons from Battlestar Galactica.

Robots

These “robots” all share the characteristic of functioning autonomously. In the case of the welding robots on the assembly line they have been precisely programed to repetitively perform their exact task. Once programed, they preform the task continuously with only casual supervision. Could it be that this type of automation is now occurring with surgery? I’m happy to say that this is not the case. The idea of me watching over a moving line of patients rolling past an arm that removes the gallbladder is totally unappealing. Robotic surgery is really a misnomer. The system used is called the DaVinci surgical platform. It is less a robot and more a very sophisticated “surgical instrument”.  In some ways, the DaVinci system follows the natural progression of surgical technique.

Initially surgery was done mostly with a blade and the surgeon’s hands.

Surgical instruments from the 1500's

The boil or trauma wound would be lanced then probed with the surgeon’s fingers. Over the next hundreds of years progressively more detailed and precise surgical instruments were designed and used as an extension of the surgeon’s hands. A major paradigm shift occurred in the early 1990’s with the adoption of laparoscopic techniques. The idea with laparoscopic surgery was that the operative field is viewed not with direct vision but with a telescope inserted through a small hole in the abdomen. The image viewed via the telescope is then received on a video camera then projected on a monitor placed in front of the surgeon.

Laparoscopic Surgery

The surgeon therefore is viewing the image in real time indirectly. To manipulate the intra-abdominal tissues additional small entry points, called trocars, are placed through the abdominal wall and long shafted instruments are inserted into these trocars. The intra-abdominal ends of these long shafted instruments resemble their traditional surgical instrument counterparts and the surgeon controls the instruments by manipulating the external end of the instrument. Using these techniques, surgeons have been able to routinely laparoscopically perform most of the common open intra-abdominal surgeries. For most surgeries, laparoscopic surgery is associated with less pain, less debility, and shorter hospital stays.

The instruments of the DaVinci system are also inserted via trocars very similar to those used with laparoscopic surgery.

DaVinci Surgical Platform

The striking difference between standard laparoscopic instruments and those used with the DaVinci system is that the DaVinci system has wrist type joints that bend and rotate to add additional motion. The surgeon controls the instruments with computer assistance. For some surgeries, such as prostate removal, laparoscopic surgery is very difficult to accomplish. The addition of the DaVinci system has meant that these patients have been spared open surgery. To date the data suggests that the DaVinci system can be used with safety comparable to laparoscopic surgery. It seems as though it is at least as efficacious as laparoscopic surgery and shares the same advantages over open surgery, as does laparoscopic surgery. As we continue to build experience with the DaVinci system, we will continue to find the types of patients and surgery that hold the most advantage for the use of this technology. There also appears to be several exciting developments on the horizon including the integration of the DaVinci system with advanced imaging techniques and single incision applications.

As we were packing to leave town on the 23rd of December, I couldn’t find my trusty 3G. We called it, texted it, but didn’t hear it anywhere. I fired up my iPad and opened the “Find my iPhone” app. To my surprise it told me that my phone was across town at a house in which I had never been. I was unsure how to handle this situation. I have friends that completely turn their phones off on Sundays or when on vacation. I shutter to think about this, and yet I was cell phone-less. I decided to report the phone stolen to the police. A very nice Sheriff from Brevard county came over, took the report, looked at the location of the phone as reported by the “Find my iPhone” app. The officer decided to set out and knock on the door of that house to see what he would find. Later that evening he called me back and stated the house seemed empty as if the occupants were out or on vacation. I then decided to do a remote wipe on the phone to preserve the integrity of my data. My wife and daughters were watching all this and brought in a wrapped box that was the characteristic size and shape of a iPhone box. They told me to open it. I took the box and sniffed it and took in a long a sniff as if trying to get the scent through the paper and announced “A new iPhone 4s!” My daughter, who thought she had kept the secret so well asked, “How did you know that”?  So for two days I have been enjoying my early Christmas present. My daughter as developed a relationship with Sire. She tells it good night, asks it what her favorite color is and even about the best way to dispose of a body.

One day into my proud ownership of my new phone, my wife found my old 3Gs. It was hiding in my closet all the time. So first of all, I would like to recommend to you that you should not fully trust the Find my iphone app. And, more importantly, I would like to apologize for sending the Po-Po to that strangers home. “If your neighbors ask about why the police were knocking at your door, its a case of mistaken GeoLocation.”

Mapping the genome of Esophageal Cancer will dramatically improve chances of finding effective treatments for individual patients, identifying pathways to improved prevention and early detection and, ultimately, a day when nobody has to die of Esophageal Cancer.  TCGA already has produced significant findings in brain and ovarian cancer.

TCGA’s research in Esophageal Cancer may begin before year’s end.  But, until researchers can find better ways of detecting and treating this devastating disease, ECAN (Esophageal Cancer Action Network) is attempting to ensure that everyone at risk knows that Heartburn can cause Cancer and that screening can save lives. By identifying this devastating disease at the precancerous stage known as Barrett’s Esophagus, new outpatient procedures now mean it can be cured before it ever becomes cancer.

ECAN initiated the designation of April as Esophageal Cancer Awareness Month.  This year, our Awareness Month Reach-Out Kits, featuring posters, brochures and wristbands with the Heartburn can cause Cancer message, reached thousands in nearly every state – and other nations, as well.

ECAN’s efforts resulted in 26 states declaring April Esophageal Cancer Awareness Month, triggering extensive media coverage about our volunteers who made it happen.  In 2012, we want the U.S. Congress and all 50 states on board!  Be a volunteer in your state.

Our challenge is great. Even though Esophageal Cancer is the western world’s fastest growing cancer diagnosis, few people who are at risk even understand the link between Heartburn and Cancer.

But we are making progress – just think of what the TCGA research could mean for patients in the future!

Dr. Fusco

CHAPEL HILL, NC — Radiofrequency ablation (RFA) is safe and effective for treating dysplastic Barrett’s esophagus, according to a study out of the University of North Carolina at Chapel Hill.

For more information on the Barrett’s esophagus or treatment options using radiofrequency ablation, visit our website or call for a consultations.

Dr. Fusco

About this time, surgeons began removing the gallbladder using the laparoscope. In my residency program we started performing this procedure in my third year of training. By the time I finished my five years of training, an examination of my case log showed that in the first two years all gallbladder removals where done open and the last two years virtually all gallbladder removals were done laparoscopically. A friend who graduated from the same program as I three years later graduated with virtually NO experience with open gallbladder removal. So in the span of a few years there was a complete shift in the way we performed one of the most common general surgery operations.

In 1992 I began performing laparoscopic colon removals. The early experience with colon removal was equally encouraging as it was with gallbladder removal and since that time it has been the predominate technique I use for colon removal. Unlike gallbladder removal where laparoscopic removal very quickly became the standard, the adoption of laparoscopic colon removal has been VERY slow. A recent review estimates that nationwide only 10 to 30 percent of colon removals are done laparoscopically. The following is a list of “reasons” that have been thrown around usually be people resisting this change:

1. “Laparoscopic surgery may not be as good a cancer operations“- FALSE – I’m sad to say that I contributed to this misconception in a small way. I reported the first case in the literature of a patient with recurrent cancer at a trocar site after laparoscopic colon removal. This issues has very vigorously been resolved. There are multiple multi-center randomized controlled trials both in Europe (“c.o.l.o.r. trial”) and in the US (“c.o.s.t. trial”) with thousands of patients that show that laparoscopic surgery is as effective as open for cancer cure.
2. “Laparoscopic colon removal is a lot more difficult to learn” – TRUE – The difficulty lies in needing to operate in multiple different quadrants of the abdomen, having to handle much larger blood vessels than with gallbladder removal, needing to be able to sew inside the body. It is estimated that the “learning curve”, the number of cases it takes before the surgeons facility with the procedure approaches the average, is 50 to 100 cases. For surgeons in low volume colon practices this can take such a prolonged period of time that they never make the needed strides to feel proficient.
3. “Open surgery patients leave the hospital after 4 or 5 days anyway so the trouble of doing this procedure is not worth it” – FALSE – I guess a lot of this depends on which end of the knife you are on. When I first moved to Melbourne I did a study looking at the early recovery results of my laparoscopic colon removals vs the rest in the community which were primarily done open. This study showed that the average length of hospital stay for the open group was 11.3 days. The length of stay for the laparoscopic group was 2.6 days. The open colon removal group was also 6 x more likely to need intravenous narcotic pain medications. Clearly this is a marked improvement in overall short term recovery.
4. “Its more expensive” – PROBABLY NO LONGER TRUE – Have you looked at what a week in the hospital costs lately. As time has gone on this cost gap has decreased and in some cases reversed.
5. Unlike with gallbladder surgery where there is often little urgency to the timing of operations, colon surgery often must be done on a more expedited basis. Patients are therefore referred to a surgeon by a primary of GI doctor and may not be aware that by seeing a different surgeon they could have the surgery laparoscopically.

In most cases colon removal (colectomy) can be done with minimally invasive techniques (laparoscopy). Only in very few situations is open colon surgery required. Make an appointment with a surgeon who specializes in minimally invasive techniques to see if you are a candidate.