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November is an important month for University Surgical Associates, as we work to raise awareness of health conditions that can have a significant impact on quality of life. Two of these conditions in the spotlight this month are diabetes (American Diabetes Month) and gastroesophageal reflux disease (GERD Awareness Week from November 21-27). 

To shed light on these conditions and their treatment options, we asked general and endocrine surgeon Dr. Heath Giles to share his expert perspective on how USA surgeons are helping patients prevent and overcome these common health issues.  

Q: How are USA surgeons helping patients who may be at risk for diabetes?  

A: Diabetes is a serious condition that raises your risk for several health issues, including cardiovascular disease, foot and limb injuries and serious COVID-19. This chronic disease can be caused by multiple factors, and one of the lesser-known causes are adrenal tumors. 
The adrenal glands are found above each kidney. They are triangle-shaped, and measure about half an inch in height and 3 inches in length. The adrenal glands are complex organs that keep the body in balance by making cortisol and other hormones that are critical for maintaining good health. 
It is common for benign (non-cancerous) tumors to develop in the adrenal gland. Up to 20% of adrenal tumors make excess hormones, and one such hormone is cortisol. This can lead to a condition known as Cushing’s Syndrome (CS), which can significantly reduce a patient’s overall wellbeing and life expectancy. CS and diabetes are closely linked as it is estimated that up to 50% of patients with CS have varying degrees of altered glucose metabolism
At USA, our endocrine surgeons have significant experience with procedures to address adrenal tumors. When they are discovered on imaging modalities, successful treatment requires a high level of expertise in diagnosis and management of these tumors. 
Our surgeons have completed additional training at Harvard and The Mayo Clinic to address tumors of the adrenal gland and help patients avoid life-threatening issues like diabetes. If you or someone you love has a rare condition like adrenal tumors, you want a surgeon with this level of experience. 

Q: How is GERD diagnosed, and what are USA surgeons doing to help patients find relief?  

A:  It's estimated that 20 percent of Americans have gastroesophageal reflux disease (GERD). While most can manage their discomfort with lifestyle changes and over-the-counter medications, others will need a treatment plan that could include surgery to ease the symptoms.  
To determine the most effective course of treatment requires extensive testing. If reflux can’t be treated medically and it’s determined that surgery is the best option, it’s important to turn to a surgeon who specializes in reflux. There are multiple surgical options to treat GERD, and our surgeons are highly trained to address this condition in a variety of ways -- including minimally invasive options for quicker recovery. This includes hiatal hernia repair, fundoplication and an innovative new procedure that combines hiatal hernia repair and endoscopic fundoplication called cTIF. 
Again, our surgeons have completed specialized training and have years of experience with these procedures. For example, in the last five years alone our Hernia Center surgeons have helped more than 5,000 patients get back to work and the activities they enjoy.  

About Dr. Heath Giles

Dr. Giles specializes in general and endocrinology surgery. He received his medical degree from the University of Tennessee Health Sciences Center, followed by additional training as an intern/resident in general surgery at the University of Tennessee. He also completed a fellowship in endocrine surgery from Brigham and Women’s Hospital, a major teaching hospital of Harvard Medical School. In addition to his surgery practice, Dr. Giles is an associate professor of surgery in the Department of Surgery, and General Surgery Residency Program Director for the University of Tennessee College of Medicine, Chattanooga. He joined University Surgical Associates in August 2012. Learn more about Dr. Giles.

Alan Koffron, MD, fellowship trained hepatobiliary surgeon with University Surgical Associates, explains pancreatic cancer risks, warning signs you shouldn’t ignore, and advanced treatment options. 

Pancreatic cancer is largely a silent disease process and an elusive type of cancer that affects 60,000 Americans each year. A person’s average lifetime risk of developing pancreatic cancer is about 1 in 65. Risks for developing the disease include smoking, obesity, and a family history of the disease or pancreatitis. 
While cancer tends to be more prevalent as we age, people in their 40s, 50s and 60s are more commonly diagnosed with pancreatic cancer. It’s most often found with computed tomography (CT) scans, endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI). Unfortunately, these screening modalities are not 100 percent effective in finding small lesions, pre-cancer or early-stage cancers. For many people diagnosed – approximately 30 percent – the cancer has already spread before symptoms become noticeable.  
“The first signs of pancreatic cancer are typically abdominal or back pain that doesn’t go away, or the skin becomes jaundiced or yellow. Other symptoms include nausea, diarrhea, bloating and stool changes, along with loss of appetite, elevated blood sugar, weight loss and general fatigue,” Dr. Koffron says. “Because pancreatic cancer is much easier to treat when it’s found early, it’s important to pay attention to your body’s signals and talk to your doctor if something’s not right.” 

Why is pancreatic cancer difficult to treat? 

Pancreatic cancer is a complicated condition to treat, specifically because of the pancreas’ location deep within abdomen. Although it’s not a large organ, it’s nestled right next to the blood vessels that feed the other major organs and the lymph nodes that make insulin and digestive enzymes. Its location alone makes it a technically difficult surgery to perform. 
“The hope for any cancer – including pancreatic – is to surgically remove it using safe but aggressive techniques. When the cancer is contained within the pancreas and hasn’t spread to surrounding tissue, surgery is the mainstay of treatment,” Dr. Koffron says. “For tumors that are larger and beginning to grow but haven’t spread to other organs, we often use neoadjuvant chemotherapy, which means chemo that’s administered before surgery. It’s used to shrink or slow the tumor’s growth so it becomes possible to remove. For individuals whose disease has spread outside of the pancreas, chemotherapy and radiation are used to prolong survival.” 

Why choose a Pancreatic Cancer Specialist? 

Although we know pancreatic cancer treatment is complex, the diagnosis isn’t an automatic death sentence – particularly when you choose a surgeon with the experience and education needed to offer the very latest and most effective treatment options.
“It’s important for people to know that we have the most advanced cancer-fighting surgeries and treatments right here in Chattanooga. In the last 15 years or so, surgical fellowships that focus on the techniques and procedures of the liver and pancreas allow us to do very technically difficult operations on a routine basis,” Dr. Koffron says. “The outcomes are better when you seek care from a pancreatic cancer specialist at a high-volume center – meaning one that does more than 20 operations a year, which is what we do here at Erlanger. But more than that, you have access to a dedicated surgical and recovery care team and other cancer specialists who are all working together to fight your cancer and help you live a longer and healthier life.” 
If you or a loved one has been diagnosed with pancreatic cancer, you have choices when it comes to your surgeon and your treatment options. For more information or to schedule an appointment, call 423-267-0466.  

About Dr. Alan Koffron

Dr. Koffron is a fellowship trained multiple-organ transplant and hepatobiliary surgeon who specializes in liver and kidney transplant and advanced surgical treatment of conditions of the liver, pancreas and biliary system. He serves as Surgical Director, Erlanger Kidney Transplant Center. 

Dr. Koffron is certified by the American Board of Surgery and fellow of the American College of Surgeons. He sees patients at the USA Surgical Specialties Building. Click here to learn more about Dr. Koffon’s education and experience.  

Every year, 15 million people worldwide suffer a stroke, also known as a brain attack. Nearly 6 million die and another 5 million are left permanently disabled.

A stroke occurs when the blood supply to your brain is interrupted or reduced, which deprives your brain of oxygen and nutrients – causing your brain cells to die. In a third of all strokes, carotid artery disease is to blame. Some individuals can manage carotid artery disease with medications and lifestyle changes. More severe cases, however, may require surgery to repair the blockage in the artery. 

University Surgical Associates was the first in the Chattanooga region to offer a new technology called TransCarotid Artery Revascularization (TCAR), to treat individuals with carotid artery disease who are too high risk for a traditional open procedure. 

“For individuals who require surgery to address their carotid artery disease, we have to consider the impact the surgery itself may have, the patient’s body and most importantly, their brain. Any repair of the carotid artery carries some risk of stroke, but TCAR carries the same low stroke rate as the traditional surgical option with a less invasive approach. That means there’s a reduced risk of heart attack, nerve injury and time needed to perform the procedure,” says Charles Joels, MD, board certified vascular surgeon with USA Vascular. 
TCAR is a clinically proven method for preventing stroke that temporarily diverts blood flow and debris away from the brain – allowing the surgeon to place a carotid stent for long term stroke prevention. 

After the device is turned on and blood flow is reversed, a guidewire is passed across the narrowing plaque inside the artery. In some cases, a balloon is used to open it up, and a stent is inserted int to the artery to hold it open – ensuring adequate blood flow.  

Anyone who is considered high risk for an open carotid artery surgery greatly benefit from TCAR, particularly those over the age of 75 who have heart, lung, or kidney disease or who have an obstructed carotid artery on the other side. 

“The goal of carotid artery surgery is to prevent stroke, and there are two types of people who benefit from this surgery. The first is someone who’s had a stroke or mini stroke that’s caused by a buildup of plaque in the carotid artery. Because they’ve already had symptoms, there’s a pretty high risk of having a more serious stroke in the future,” says Dr. Joels.  “The other type of patient might have a tightening or narrowing of their blood flow in their carotid, but they don’t yet show symptoms. The same procedure is used to prevent them from having a stroke in the first place.” 

TCAR Benefits 

Vascular surgeons are the only specialists who can perform TCAR, and in recent clinical trials, individuals who had the TCAR procedure had lower risk for in-hospital stroke or death and had reduced risk for cranial nerve injuries. 
“TCAR offers exceptional stroke prevention, even in those who are a high surgical risk. There’s less risk of a post-procedure heart attack or nerve injury, and a typically shorter hospital stays,” says Dr. Joels. “No procedure is right for everyone, but TCAR is an important tool that offers distinct advantages for both symptomatic and asymptomatic patients. My highest priority is to do what’s best for my patients, select the treatment option that’s best suited to their specific situation, and help them get back to a full and active life.”  

Expert Vascular Care 
The team of vascular surgeons at USA are highly trained and have extensive experience with minimally invasive options like TCAR, an approach that often leads to early discharge, minimal pain and fast recovery. They also provide advanced and comprehensive care for aneurysms and peripheral arterial disease (PAD), as well as a wide range of venous disorders from varicose veins to chronic venous ulcers.  

To learn more about TCAR and vascular surgery, visit 
Call us at 423.267.0466 to schedule a consultation with USA Vascular


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