Welcome to Fall General Surgery, LLC.

Fall General Surgery offers an array of services to patients from the surrounding communities.  Dr. Fall and staff strive to offer a quality choice in surgical and medical care with patient satisfaction our top priority.

 

Chronic Abdomen Pain

Narcotics – The Solution or the Problem?

Fall General Surgery has the privilege of treating, among many things, chronic abdominal pain. By “chronic” we refer to the existence of symptoms over several weeks, months, or even years.

Symptoms may be localized or generalized. Alternation of bowel function, nausea, and/or vomiting may or may not accompany complaints of constant or cramping abdominal pain.

Commonly, this syndrome has a predilection toward young females. Excessive co-existence of stress may add to the clinical picture and challenge diagnostic and therapeutic options.

Often times, previous surgery has been performed raising concerns of symptomatic post-op adhesregions of the abdomenions or other undiagnosed pathology.

Because symptoms can be disabling, many patients are referred for surgical evaluation. Prior to recommending laparoscopy, multiple diagnostic studies are usually performed; i.e., CT scans, MRI, upper/lower endoscopy, etc. Commonly, despite negative studies, many patients will continue to be symptomatic.

For some of these patients, diagnostic laparoscopy may be recommended and, in many of these patients, pathology can be identified and corrected. Since laparoscopy utilizes only three to four tiny incisions, post-op pain is minimal.

An evolving policy of Fall General Surgery is to limit narcotic prescriptions to the first week post-op. After that time, lacking objective data to explain continuing abdominal pain, further treatment with narcotics is felt to be unwise and, therefore, further narcotic prescription requests will be denied.

If continued severe pain persists in the absence of objective signs of cause, the patient will be referred to their primary physician for continued pain management. Referral to a regional pain clinic may also be considered.

We are empathetic to any complaints of pain. Because continued use of narcotics may lead to addiction, however, chronic narcotic prescription writing is not a policy of Fall General Surgery.

Tanning, Sunburn, and Skin Cancer

Deep tans mean damaged skin and could lead to skin cancer

tanningOver 400 years ago Copernicus declared the sun was the center of our universe. For some centuries, a light skin defined the “upper class,” while darker skin defined the outdoor, working class. Women of ancient Greece and Rome used lead paints and chalks and later, arsenic-containing compounds to lighten their skin, often with deadly results. Over time however, with changing fashion, life styles and economies, a tanned skin was increasingly sought after for its cosmetic appeal. A sun tan became a symbol of wealth and leisure.

Indoor tanning first became popular in the 1970’s. Today 20,000-25,000 salons are listed in the yellow pages marketing to 22 million clients per year. The use of tanning devices has now been clearly linked to the development of the two most common forms of skin cancer: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Such devices increase the risk of developing these cancers by 1 1/2 to 2 1/2 times. The incidence of developing malignant melanoma, the most dangerous skin cancer, is also increased.

Skin exposure to outdoor sunshine increased as people continued their tanning quest. Increasing ultra violet light (UV) exposure time combined with a decline in the Earth’s protective Ozone layer, created a scenario of skin tan, sunburn and skin cancer. Today, the tanned look, rather than representing health, instead represents skin injury and an increase in the risk of developing skin cancers with frequent serious consequences and occasionally even death.

There are two major side effects of excess UV light exposure:

  • Premature skin aging
  • Skin cancer

Cosmetic effects include the development of brown age spots, freckled skin, uneven skin tone, sagging skin and wrinkles, wrinkles and more wrinkles.

The immediate effects of UV exposure are increased with skin complexion, color of hair and eyes, skin exposure, environmental reflection (80% by snow, 20% by water), altitude (4% increase for ever 1000 feet increase in elevation) and time of day (65% of UV rays reaches the Earth between the hours of 10 am and 2 pm). Individuals with fair skin, blue eyes and/or red hair are at high risk for UV exposure.

Sunscreens can add a significant element of protection. In 1979, the FDA concluded that sunscreens could help prevent skin cancers and developed the first rating system for sunscreen protection factor (SPF). SPF is equal to the amount of time you can stay in the sun without burning. So if you are sitting in the sun for 10 minutes, apply a sunscreen with an SPF of at least 10. You can sit in the sun for 10×10 minutes without burning.

It is recommended that you use an SPF of at least 15. Use a sunscreen protector that blocks both UVA and UVB rays, i.e. a “broad spectrum” sunscreen. Ensure your sunscreen is water and sweat proof. If you will be in direct sunlight, use a sunscreen with an SPF of 30.

Don’t forget your eyes! UV exposure can damage your vision. Therefore, use sunglasses with UV protection. Use sunscreen to protect your skin. As usual, prevention is the key.

Recommendations to prevent skin damage are:

  • Avoid sun exposure during peak hours of the sun rays (10am to 2pm).
  • Apply sunscreen (SPF 30) especially to exposed areas of skin.
  • Apply sunscreen 30 minutes prior to sun exposure.
  • Use sunglasses with UV protection.
  • Use a lip balm.

When prevention has failed, here are some tips:

  • Apply cool baths/compresses 10-15 minutes, several times per day.
  • Apply a soothing lotion.
  • Tylenol may be used for pain.
  • Don not apply petroleum jelly, ointment, or butter to the injured area.

In northern Wisconsin, summer time is met with anxious anticipation. Enjoy your summer, enjoy the sun, but protect your skin and eyes to enjoy good health in the coming years.

Diverticular Disease, a Common Problem

Diverticulitis of the Colon

Do you have “tics” in your colon?

If you have significant abdominal pain,  seek the advice of Dr. Fall.

Diverticula are sac-like protrusions of the wall of the colon (large bowel). Causes of this condition probably are related to a low fiber diet and altered motility of the colon. There has been a dramatic increase in this disease over the past fifty years and is much more common in industrialized nations. Diverticulosis is rare below age 35 but affects 65% of our  population by age 80.

The natural history of diverticular disease includes no symptoms or may progress from inflammation (diverticulitis) to bleeding (15%), abscess, perforation and obstruction.

When diverticula become inflamed, we use the term diverticulitis. In the general population, 10 patients per 100,000 people will have this condition, leading to 200,000 admissions per year. 95% of diverticulitis involves the lower larger bowel (sigmoid colon). In patients with known diverticulosis, 10-25% will develop diverticulitis. After one attack, half of  patients will have a second attack. Half of second attacks occur within one year and 90% of second attacks occur within five years of the first attack.

Symptoms of diverticulitis include abdominal pain, usually left lower quadrant, and may include fever, elevated white blood count, nausea and vomiting.

Diverticulitis is classified into two main categories: uncomplicated and complicated.

Uncomplicated demonstrates inflammation only. Patients have abdominal pain, abdominal tenderness and may or may not have fever or elevated white blood count. 70% of these patients will respond to medical treatment and have no further problems. However, severe diverticulitis at a young age may lead to a poor outcome. With second attack, surgery is indicated.

Complicated diverticulitis includes patients with perforation, abscess formation, bleeding and smoldering infection. Surgery may be recommended with only attack. In patients who present with abscess, almost one half will require surgery with 65% requiring a second, planned surgical procedure. If the surgeon can delay surgery with medical therapy, over 90% of patients can be treated with a single operative procedure.

When diverticulitis occurs in the younger age group (less than 40 years old), 90% will require surgery during initial hospitalization, compared to 40% in patients in an older age group.

Indications for surgery in an acute setting include free perforation, uncontrolled sepsis (infection), obstruction, uncontrolled bleeding and lack of response to maximal medical therapy. In an elective setting, surgery is indicated after two or more acute episodes, chronic smoldering symptoms, or one attack in patients with a compromised immune system.

Surgery for diverticular disease is common. In some cases, two operations may be required. Many times however, a single procedure can solve the problem. For some time, Fall General Surgery has been doing this surgery partially using a technique called hand-assisted laparoscopy. When this can be done, patients have less post operative pain and can be fed earlier and hospital stay is shortened.

Many other conditions can simulate diverticulitis i.e.) acute appendicitis, bowel obstruction or perforated gastric ulcer.

If you have significant abdominal pain, seek the advice of Dr. Fall.

Breast Cancer

breast cancer screeningBreast cancer is the most common malignancy found in women. One of every 8-10 women will be affected. Though much more rare, men also may develop the disease.

There are various types of breast cancer:

  • Ductal and lobular carcinoma in situ (earliest of cancers)
  • Infiltrating ductal carcinoma (80% of all breast cancer)
  • Infiltrating lobular carcinoma (10-15%)
  • Inflammatory carcinoma (1% but aggressive)

Breast cancer may present in various “stages,” i.e. stage 0, 1, 2, 3 (A-B) and stage 4. Proper treatment of your breast cancer relates to these stages.

Surgical treatment options have been controversial over the years. Common operations in the past included:

  • Radical mastectomy (removal of the breast, underlying two muscles of the chest wall and removal of lymph nodes of the armpit)
  • Simple mastectomy (removal of the breast)

More recently, common procedures are breast conserving, i.e. lumpectomy and quadrectomy.

These procedures commonly involve sampling of one or two auxiliary lymph nodes, “sentinel” nodes, and most often are accompanied by post operative radiation. Other treatment modalities include chemotherapy and treatment with hormones.

Your personal risk of developing breast cancer is increased with:

  • A personal or family history of breast cancer
  • Nulliparity (having no children)
  • Late age with first live birth after age 30
  • Early age with beginning menstruation
  • Late menopause

Detecting breast cancer early, when it is more easily treated can be accomplished by:

  • Being aware of your risk factors
  • Monthly self examination of your breasts
  • Regular mammograms (every 1-2 years between age 40-49; every year age 50 and over
  • Being aware of the signs of breast cancer, including the presence of a lump, dimpling of the skin, newly developed nipple inversion, nipple discharge, and change in color or shape of the breast.

Remember, breast cancer is treatable and often-times, curable. Your best protection is your awareness and understanding of this disease process.