Determining your Condition: “Level of Need” During the Covid-19 Crisis

A word from Dr. Robert Wright

To patients, their family, neighbors, and friends,

I have provided care to this community for over 25 years and am committed to helping the community through this trying time. Our job at Cascade Hernia & Surgical Solutions at Meridian Surgery Center is to prevent an overburdened ER with a surgical emergency that could be prevented, during the COVID-19 crisis.

Meridian Surgery Center is weathering the storm, following the CDC’s advice, and upholding the state’s COVID-19 medical guidelines to help flatten the curve.

How Meridian Surgery Center can be of help:

  • Do you have a condition that may need surgery soon?
    • Painful and/or worsening hernia, gallbladder, or growth? Lump or mole with concern for cancer?
    • Although elective surgery has been curtailed during the COVID-19 crisis, many conditions need surgical intervention to avoid becoming an emergency.
  • Are you worried your condition may worsen?
    • Let’s get it checked out to prevent unpredictable ER resources.
    • Surgery options are available if Medical deterioration is likely within 3 months
  • Call to schedule a clinic or telemedicine visit; 24/7 scheduling to put your mind at ease.
  • Our doctors and staff continue to see patients in a one on one, waiting room free environment that ensures social distancing practices. Telemedicine options available.

The following are my condition-specific guidelines that may be helpful to you in determining if you should pursue surgery options as soon as possible, if you are safe to wait until a more stable medical time to proceed. Pass this along to family, friends and neighbors if helpful.

Gallbladder Patients—this is a condition that can worsen, consider calling.

If you have gallstones that have continuing episodes of pain, chances of emergent deterioration is high and surgery should be pursued. Additionally, patients with symptomatic gallstones and a history of elevated liver functions, pancreatitis, elevated pancreas enzymes, and/or polyps in the gallbladder should be considered for gallbladder surgery sooner than later.

Gallbladder patients who can safely wait are those with biliary dyskinesia, both with a low functioning gallbladder and a high functioning gallbladder. They generally have symptoms but are not at risk of deterioration into an emergency. In thirty years, I have personally only seen one of these patients go on to develop a fever. Patients with asymptomatic gallstones do not need surgery right away.

If symptoms present fever of 101º or higher, jaundice, and/or severe right upper quadrant pain, the chance of death is high in the first 24-48 hours and the patient needs to be seen in the emergency room urgently. Patients with known gallstones with intractable nausea and vomiting are also best evaluated in the emergency room.

Hernia Patients—this is a condition that can worsen or create long term pain if not treated timely.

Patients with a hernia who have severe and unrelenting pain (unable to sleep and function) should be seen in the emergency room. Additionally, those with bloating and trouble with bowel movements due to the hernia are probably obstructed; if left unattended this will rise to an emergency room evaluation. Call before these things happen. Those with a bulging hernia and with nausea / vomiting are also at risk for obstruction and should be seen in the emergency room, again best to be seen before this level of need.

Patients who have a hernia in the absence of the above extreme symptoms, but pain and worsening levels of a hernias, should give a call, we can be aware of your condition, and available should it worsen. Additionally, patients without the above emergency symptoms who have progressively worsening pain or a history of bloating should be seen with consideration for surgery options should condition be within a 3 month emergency and evaluation for surgery.

Patients who have a painless bulge associated with the hernia in general have a 1-2% chance per year of emergent deterioration and would generally be safe candidates for waiting until after healthcare crisis has passed for elective surgery, but may want to be seen and condition charted in the event of worsening.

Pilonidal Cysts–can be painful and difficult to endure.

Emergency evaluation should be undertaken if the pilonidal cyst is associated with severe pain to the point where the patient cannot sit, if the painful cyst is surrounded by two inches of spreading redness, or if the patient has fever or is immunocompromised.

In the absence of the above symptoms, a patient should be seen soon if they have a painful lump or a lump that has ongoing drainage.

Patients who have a painless lump associated as a pilonidal cyst can generally wait but certainly are at risk for later deterioration, could be seen in the clinic, and charted, should worsening arise in the upcoming months when medical supplies are more available.

Patients with masses below the skin—pain or no pain, worry can get the best of us.

If the patient has previous cancer history, a new mass below the skin is potentially an ominous sign. Those masses should be removed to ensure there is no sign of recurrent cancer.

If there is no history of cancer in the past, masses of less than 5 cm (two inches) in greatest dimeter are safely observed and can wait three months for removal but should be seen now for progression evaluation. Masses that exceed 5 cm (two inches) in diameter have increasing chance of cancer as they grow; these masses should be removed sooner than later to eliminate the possibility of cancer.

When it comes to masses, location matters. Masses present at the creases of joints or in the neck have a higher risk of being cancerous than in the flat areas of the back, abdomen, or legs. An aggressive stance towards removal is appropriate to ensure these are not lymph node-based cancers.

Gastroesophageal Reflux Disease (GERD)—can be silent but deadly.

Believe it or not, gastroesophageal reflux disease can be a fatal condition. Patients should seek emergency room evaluation if they are having severe chest pain to make sure that it is not cardiac in nature. Patients with GERD who cannot swallow can potentially have cancerous degeneration. Patients with GERD who are vomiting blood can also have serious consequences and need to be seen in the emergency room.

Gastroesophageal reflux disease can deteriorate relatively quickly. Patients who have reaction to their acid medications, deteriorating pulmonary condition, vocal cord conditions, multiple recent episodes of chest pain, or patients who are having recurrent aspiration should be considered for antireflux surgery soon.

Patients with GERD who have ongoing symptoms that are poorly responsive to medication, or who are intractable in their need for proton pump inhibitor medications, should consider elective antireflux surgery to prevent long term complications. The testing can take months, so start now.

Melanoma—don’t wait.

Melanoma is an unpredictable and aggressive cancer that may not look like much to start but can have devastating consequences. Melanoma needs to be removed and adequately staged as soon as possible. Most melanoma patients will need to go from diagnosis to excision and biopsy within a month—this is entirely appropriate in an outpatient setting for most patients

The only exception with melanoma is patients who have stage 0 cancer (melanoma in situ) and the chance for cure is 100%. Those patients can wait three months for a wider excision.

There are a lot of grey zones between all of the scenarios discussed and you are encouraged to call our center regarding specific symptoms to choose an appropriate course of action. Our clinic is open for scheduling now both onsite consults and tele medically —; our doctors and staff can help determine your level of surgical need, and be there as needed.

Robert C Wright, M.D., F.A.C.S.

2020-03-30T07:00:54+00:00 March 30th, 2020|0 Comments

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