The Side of Medicine You Didn’t Know

Do you know what a nephrologist does? What about an endocrinologist or an otolaryngologist? These are just a few specialists you might meet when your health requires 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 all of the rapid advancements.

If you’ve never experienced a health problem that necessitated a visit with a specialist, you may not even know what he or she does. You might find one of these specialists could make a huge difference in your life some day.

Nephrology: Finding the Silent Killer

Dr. Syed Ahmed has taken to introducing himself as a nephrologist kidney doctor because, although it’s redundant, without the “kidney” clarification most people wouldn’t have a clue what he does.

Dr. Syed Ahmed

It’s also why the interventional nephrologist at Rockford Nephrology Associates’ Sycamore and Rockford clinics spends nearly half his time educating patients and the community about chronic kidney disease, dialysis and the importance of staving off future kidney problems.

“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 come to 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 is to look at one’s glomerular filtration rate (GFR), which measures how well kidneys are filtering the blood, Ahmed says.

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

“If your GFR is 45, it’s fair to say your kidney is only functioning at 45%,” he adds. “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, to prolong kidney function and delay dialysis.”

Once patients start to show symptoms such as swelling, nausea or vomiting, their GFR is usually at 15%, Ahmed says. And by then, it’s too late to preserve kidney function.

“When someone’s 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 the blood to the body. This process takes about 4 hours and requires three trips a week to a dialysis center.

Home hemodialysis: This process is the same as in-center hemodialysis but can be done at home with the help of a partner. While 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,” Ahmed says.

Dermatology: Lunchtime Procedures

Dr. Suleman Bangash finds most people do have an idea of what he does as a board-certified dermatologist with Ascension Saint Joseph – Elgin. But not everyone knows his practice goes beyond treating acne.

“A lot of what we do is skin exams on people,” Bangash says. “Or, if they’re someone who has a spot on their body, a mole or a growth, and they have an issue with it, they’ll come see us. A lot of times, the reason they came in winds up being just a harmless spot and nothing we have to do anything with. But while they’re here, we find a different spot that is suspicious-looking or is precancerous. That’s a common occurrence: what they think is bad is really not, but there’s something else in our exam that could be a problem.”

Bangash, in particular, focuses most of his time on treating skin cancer. He completed a specialized Mohs micrographic surgery fellowship, which is a surgical treatment of skin cancer located in cosmetically sensitive areas such as the face, head and neck.

But his dermatology group helps patients across the spectrum: skin disease, hair loss, nail problems and some cosmetic problems.

One common skin condition is eczema, which can leave skin with scaly, itchy rashes. It’s common in children, though many outgrow it.

Dr. Suleman Bangash

“We call this the eczema season,” Bangash says. “It seems to get worse or flare up in fall and winter when it gets colder and drier.”

For those experiencing a mild case of eczema, there are very effective topical medicated creams, Bangash says. Those with severe eczema, however, can try new internal medications that have received what he says are “excellent results.”

“There are new classes of medications, oral medications, for eczema that are new in our field in the past couple of years,” he adds. “These are medications that have mechanisms that are unique and have not been used before, and there are some internal oral medications that are proving to be very effective. So, it’s a very exciting and innovative time for the whole specialty of dermatology.”

Many people are surprised to find the role these physicians play in cosmetic procedures, particularly minimally invasive ways to address aging skin.

“There are a lot of laser procedures that require very minimal downtime and are becoming exceedingly popular because you want to get a little skin rejuvenation, but you don’t want to be down for an extended period of time,” Bangash says. “These are procedures that have minimal downtime but also will give you that aesthetic benefit.”

One of the most popular treatments is microneedling with radio frequency.

“The Morpheus device helps with fine lines and acne scarring. It can even give you a little lifting as well,” Bangash says. “This is one of those short downtime procedures, non-ablative, no bandages. We refer to these as our lunchtime procedures: you can come in during your lunch hour and get it done and even go back to work after.”

Many patients are seeking these types of treatments to improve their appearance because of what Bangash and his colleagues call “the Zoom Effect.”

“Because of COVID a lot of people were on Zoom meetings who had never been on video before, and they’re looking closely at what they look like on Zoom, and it hits them, ‘Oh my goodness, is this what I look like? I need to do something about this,’” he says. “We’re seeing a lot of people who are looking at themselves a little differently, and it’s kind of driving people to explore some of these other procedures and treatments.”

Bariatric Surgery: Combating Obesity

Some people recognize the term bariatric surgery, but when Dr. Amir Heydari gives presentations to the general public, he usually calls it weight-loss surgery.

Heydari started what’s now the Northwestern Medicine Huntley Hospital Weight-Loss Surgery program more than 20 years ago, and it’s one of the longest-standing weight-loss surgery programs in the state, he says.

Dr. Amir Heydari

Approximately 70% of Americans are either overweight or obese, which puts almost 25 million Americans as candidates to have weight-loss surgery, Heydari says.

However, even though insurance pays for most procedures and bariatric surgery is a proven treatment, last year there were only 250,000 weight-loss surgeries performed in the U.S., he says.

Some of the most prominent journals of medicine – including the Journal of Internal Medicine and the New England Journal of Medicine – have endorsed weight-loss surgery as being the most successful treatment for morbidly obese patients, Heydari says, adding that they’re also some of the safest surgeries.

There are four common types of weight-loss surgeries, and all are usually covered by insurance. Plus, they’re minimally invasive, meaning the surgical cuts are small and recovery times are quick.

Gastric sleeve: The most common approach is gastric sleeve, or sleeve gastrectomy, a procedure in which surgeons cut and remove a good portion of the stomach to make it look like a sleeve.

“Even some physicians don’t know that there is no foreign body placed in your stomach,” Heydari says. “People often think we’re going to put a sleeve around your stomach. No. Other countries call it a banana surgery because the stomach will look like a banana.”

Gastric sleeve surgery only restricts how much a person can eat at one sitting; it doesn’t change his or her anatomy, Heydari says. “It just makes the stomach smaller.”

Gastric bypass: This was the most common weight-loss procedure until 2014, when gastric sleeve became more popular, Heydari says. Both are considered restrictive surgeries, meaning they restrict the stomach’s natural capacity. But gastric bypass also changes the digestive system’s anatomy because the intestines are rerouted. With a shortened intestine, fewer nutrients and calories can be absorbed. It helps some patients more than others, Heydari says.

Lap band: This restrictive surgery uses an adjustable ring around the upper portion of the stomach to decrease the organ’s functional size, thus making a person feel full after eating a small amount of food. While many weight-loss programs no longer offer Laparoscopic Adjustable Band, Heydari does.

Lap band was a very common surgery between 2001 and 2011; it made up 40% of all weight-loss surgeries at the time, Heydari says. Ten years later that percentage has reduced drastically to less than 2% of patients.

“That is because it has some long-term problems, and the success rate was not as good,” he says. “But it’s good for 1 in 10 people, I think. That’s why I still offer it.”

Duodenal switch: In this restrictive and malabsorptive treatment, surgeons combine a gastrectomy (removal of part of the stomach) with intestinal bypass, so that food bypasses the lower part of the stomach and a good portion of the intestine.

Leading weight-loss centers around the country report that duodenal switch surgery results in the greatest weight loss and can offer the best control of diabetes and similar metabolic conditions. However, it’s currently the least common of the four major surgeries because it’s more complex.

Many bariatric surgeons are open to revisional surgery – which could involve removing a lap band, trying a different surgery, or other methods – and about 17% of patients who have had bariatric surgeries are now having revisional surgeries, Heydari says.

“This is surgery for people who have had previous weight loss surgery and either they’re having problems, or they did really well and they’re gaining weight,” Heydari says. “My philosophy is, why not help them? With the disease of obesity, why do people get one chance? A person with cardiovascular problems, they often get anywhere from three to 10 procedures in the span of their lifetime. With our patients, we expect them to only get one?”

Cardiology: Get the Blood Flowing

Most of the general population correctly associates cardiologists with heart care, but as an interventional cardiologist at Advocate Good Shepherd in Barrington, Dr. Jeffrey Freihage treats more than just the heart. He treats any disease related to blood vessels.

Sometimes that means treating those with peripheral arterial disease, a circulatory problem in which narrowed or blocked arteries can’t carry enough blood to the legs and arms.

Dr. Jeffrey Freihage

People may not even realize they have PAD until they receive a wound on their legs or feet that just won’t heal. In severe cases, amputation could be a possible treatment.

“It takes a lot more blood to heal a wound than to keep tissue integrity,” says Freihage. “If you wear a pair of new shoes that rub against your foot or you drop a hammer on your foot, and you don’t have enough blood flow to heal the wound, that’s a problem.”

What amazes Freihage is that more than 50% of patients who had a serious leg or foot wound that resulted in an amputation did not first receive a proper evaluation of their arterial system.

“At Good Shepherd, we’ve really worked the past three to four years on identifying those in podiatry offices who should get a vascular evaluation early,” he says. “It doesn’t have to be with a cardiologist, but it lets us know what the blood flow is to the foot. There are quite a few of us who can aggressively treat peripheral arterial disease.”

The technology to treat PAD has developed rapidly over the past decade, he adds.

“Not only the ability to open an artery has improved, but treatment modalities to keep the artery open over time have improved,” he says.

Part of the reason Freihage is adamant about vascular evaluations – and having regularly scheduled appointments with a primary doctor – is that a patient with a blockage in one vascular bed has a 40% chance of having a blockage somewhere else.

“Say they have a blockage in their leg,” he says. “Now that they’re walking, we have to ask, ‘Are you having chest pain? Could you have blockages in your heart as well?”

If you have established routine blood pressure checks with your primary doctor, that’s a great first step toward taking charge of your cardiovascular health, he says. Monitoring risk factors such as smoking or heart disease may also help. It’s also helpful to engage in regular exercise that includes 30 to 45 minutes of increased heart rate several times a week.

“Not every exercise has to be going to the gym,” Freihage says. “Vigorous work around the house, I count that. Get your heart rate up, walk some distance, achieve your step count.”

One of the great things about cardiology is that surgeons can improve the negative effects of most cardiovascular diseases.

“What attracted me to cardiology is the ability to see a problem and fix a problem,” he says. “We have come up with less-invasive methods that historically would require major surgery. Patients don’t always know that.”

A trans aortic valve replacement (TAVR), for example, is a minimally invasive procedure that allows surgeons to replace a narrowed or diseased aortic valve to improve blood flow.

Similarly, those with carotid artery disease, which limits blood flow to the brain, can benefit from carotid stenting, a minimally invasive procedure that utilizes a small mesh tube to hold open passages.

“We enter an artery, usually in the groin, and pass a wire filter through the blockage and implant a stent,” Freihage says. “That’s a very safe, validated method of treatment especially for patients under 65.”