Vanessa Becker - Lakeview Clinic

Colorectal Cancer Screenings

by Vanessa Becker | Mar 11, 2024 | General, General Surgery

Colorectal cancer continues to be a major problem in the United States. This cancer affects any portion of the large intestine, or the colon in medical terms. The rectum involves the last 15 cm of the colon. In 2023, colorectal cancer was the fourth leading overall cause of cancer and second leading overall cause of cancer deaths. It is estimated that about 1 in 24 people will develop colorectal cancer at some point in their lifetime.

There are several risk factors for development of colorectal cancer:

Being overweight or obese
Not being physically active
Smoking
Diets high in red meats (beef, pork, lamb) and processed meats (such as hot dogs and some luncheon meats) or cooking meats at high temperatures (frying, broiling or grilling)
Moderate to heavy alcohol use
Increasing age
Personal history of polyps or colorectal cancer
Personal history of inflammatory bowel disease
Family history of colorectal cancer or polyps, especially before age 60
Inherited syndromes such as Lynch syndrome or Familial Adenomatous Polyposis

Symptoms of colorectal cancer can be vague, and many patients don’t have any symptoms at all, especially in the early stages of disease. The more common symptoms include:

Blood in your stool or very dark stools
Changes in your bowel habits, both constipation and diarrhea/loose stools
Changes in the shape of your stool, typically to very thin stools
Feeling bloated
Persistent cramps
Fatigue
Unexplained weight loss
Anemia

Colorectal cancer typically begins as a polyp, which is a growth on the wall of the colon. Fortunately, most of these cases develop over the course of several years and there are multiple options for screening to catch these polyps before they turn into cancer. The recommended age to start screening is age 45 (previously it was 50) for people who are not at increased risk for colon cancer. Some people should start screening at an earlier age, typically depending on family history or personal history of certain diseases or syndromes. Talk to your primary care provider to determine when you should start screening for colorectal cancer. Here are the most common screening options:

Colonoscopy: This is the gold standard screening option, and it is typically fully covered by your health insurance. This is the only test that both detects and prevents colorectal cancer. For this study, you do a bowel prep to clean out your colon. A colonoscope is then inserted through the anus and the wall of the entire colon is visually inspected. The major benefit of colonoscopy is any polyps can be removed and anything abnormal can be biopsied. The procedure takes about 20 minutes and is typically done with conscious sedation. This is the most accurate screening test and can find up to 95% of large polyps (>6 mm) as well as almost all cancerous lesions in the colon and rectum. If no polyps are found, the study should be repeated in 10 years. If adenomatous polyps are found, the study will likely need to be repeated in 3-5 years depending on the number and type of polyps found.

Stool DNA test (Cologuard test): This is an at-home test that is relatively new to the market. For the test, you collect a stool sample at home. The test is mailed to a lab for testing which detects blood in your stool and DNA changes in cells that can indicate the presence of colorectal cancer. The test can detect up to 92% of colon cancers but only about 42% of large polyps. There are also both false positive and false negative results to the test. If your Cologuard test is negative, the recommendation is to repeat the test in 3 years. If your Cologuard test is positive, you will need to have a diagnostic colonoscopy for further evaluation. While the Cologuard test is typically fully covered by your health insurance, a follow-up diagnostic colonoscopy is not fully covered and you may be responsible for some or all of the cost, depending on your insurance plan. This study is not for people at increased risk of colorectal cancer. It is not an appropriate study for someone with a previous history of colorectal polyps, colorectal cancer, inflammatory bowel disease, familial cancer syndromes, a family history of colorectal cancer, or anyone with signs or symptoms or colorectal cancer (see above).

Other, less commonly used screening studies:

Fecal occult blood test

Fecal immunochemical test

Virtual colonoscopy (CT colonography)

Sigmoidoscopy

The bottom line is that while colorectal cancer remains a problem, there are options to detect it early and potentially prevent it altogether. All of the general surgeons at Lakeview Clinic perform colonoscopy and are able to treat many of the cases of colorectal cancer discovered during the exam. Talk with your primary care provider about your options and get your screening done!

Dr. Timothy Thormodsgard, MD

Dr. Thormodsgard is a Lakeview Clinic General Surgeon. He has a special interest in laparoscopic surgery and is trained in robotic surgery. His practice includes caring for benign and malignant conditions of the colon and small bowel.

Age-Related Macular Degeneration

by Vanessa Becker | Feb 21, 2024 | Eye Care, General

What is Age-Related Macular Degeneration, and could it impact me?

Age-related macular degeneration, or AMD, is a disease in the back of the eye which impacts a person’s central vision. It is the most common cause of severe vision loss in people aged 50 or older. The effects of AMD range from mild blur or distortion of central vision to profound central vision loss. The prevalence of AMD increases significantly as we age. A census done in 2019 revealed that approximately 2% of Americans aged 40-44 were living with AMD, but that number rose to 46.6% for people who were 85 or older. Annual dilated eye exams are important for early diagnosis and management of the disease.

What are the Risk Factors for AMD?

The biggest risk factor for AMD is age, specifically anyone over the age of 50. Other risk factors include smoking, high blood pressure, a diet high in saturated fats and cumulative UV light exposure over the course of a person’s life. The most common symptoms of AMD are blurry vision, distorted or wavy central vision, difficulty recognizing faces or a dark blind spot in the center of vision. If you or anyone you know is over 50 and has developed any of these symptoms, contact your local eye care provider and schedule a dilated eye exam.

Are there different types of AMD?

There are two different forms of AMD: dry (nonexudative) and wet (exudative) macular degeneration. Although both can cause central vision loss, dry AMD is generally more common and less severe. In dry AMD the nerve tissue in the center of the retina slowly breaks down causing gradual central vision loss. Progression of dry AMD can convert to wet AMD. During wet AMD abnormal vessels begin to grow under the retina. Those vessels leak and hemorrhage, causing more damage to the macula. Wet AMD usually causes faster and more severe loss of central vision than dry AMD.

Retinal Images from Fundus Photography Machine.

What can be done for AMD?

Prevention and early diagnosis are key factors in limiting vision loss from AMD. Protecting your eyes from harmful UV light, not smoking, and eating a diet higher in dark leafy green vegetables are ways to take an active approach in trying to prevent the start of AMD. The Eyecare Team at Lakeview Clinic includes Dr. Bradley Ludwig, Dr. Tracy Jackson and Dr. Thomas Bryan. They have many years of experience using retinal cameras and other forms of diagnostic imaging to diagnose and manage patients with age related macular degeneration. Once a patient is diagnosed it cannot be cured, so the goal of treatment is to prevent progression. Lifestyle modifications and vitamin therapy specifically formulated for dry AMD is the standard treatment. If the disease converts to wet AMD, referral to a retinal specialist is required for further treatment.

Dr. Thomas Bryan, optometrist. at Lakeview in Waconia, MN.

Dr. Thomas Bryan, O.D.

Dr. Thomas Bryan is an optometrist practicing eye care at Lakeview Clinic in Waconia, Minnesota. He enjoys all aspects of optometry, but especially medical cases and contact lens patients.

Heart Disease

by Vanessa Becker | Feb 13, 2024 | Healthy Living, Internal Medicine, Uncategorized

Prevention & Early Signs

It’s February and love is in the air. Can you feel that thump, thump in your heart for your special someone? Valentines, Chocolates, candlelit dinners, and sweet poems. February also brings National Heart Awareness month. Let’s first look at steps to prevent heart disease and second discuss early signs of heart disease.

Prevention is Ideal

I encourage patients to focus on modifiable risk factors. What is a modifiable risk factor? Something we can change with effort and work. Items such as diet, weight management, stress levels, physical movement, environment, and optimizing pertinent medical risk factors are a few.

Diet: What is the best diet? Food that delivers high levels of nutrients, tastes good and has lower calories. Aim for colorful, natural, single ingredient foods. Food such as chicken, broccoli, avocado, oatmeal, raspberries, sweet potatoes, spinach. Nutrients, fiber, antioxidants, and omega fatty acids in these foods can help with weight management, cholesterol levels and inflammatory markers.

Weight management: This is a problem in America. Look at your weight as something that could lengthen your life or shorten it.

A balanced approach with goal setting, nutrition guidelines, activity minimums and accountability are key. Ask yourself “Why do I want to lose weight?” This helps formulate a plan. Ask your doctor for some help too!

Stress levels and environment: Stress is a natural part of life. However, stress hormones can be detrimental to the cardiovascular system. Learning how to recognize stress, minimize it and seek help when it’s too high is important. Exercise, prayer, meditation, gratitude, counseling, and medication are tools to help with this. Being aware of our environment is key. If you have control of leaving or taking a break from a stressful environment, then take the opportunity.

Movement: Strive for 150minutes a week of physical activity outside of your normal nine to five. Long walks, low impact cardio, resistance exercises such as body weight exercises, free weights, and resistance bands. Look for fun activities that allow for social interaction: golfing, skiing, skating, pickle ball, group fitness, frisbee golf are all great options to get moving.

Medical risk factors: Obesity, Diabetes, smoking, high blood pressure, highly processed diet, extreme stress levels, heavy alcohol use, strong genetic risk. Use the above suggestions with the guidance of your doctor to optimize treating these risks. Routine physicals, screening labs for diabetes, cholesterol and organ function, balanced diet, consistent movement, stress relief tactics will help prolong your life.

Now that you know a few preventative strategies let’s look for warning signs for cardiovascular disease. The hearts’ goal is to pump nutrient rich blood all over the body. Simply put, the pump has to squeeze hard enough, fast enough and through pipes (blood vessels) that are not damaged. If there is a problem in this process people need to recognize symptoms.

Warning Signs:

If the heart is not pumping hard enough, fast enough or efficient enough, then patients may experience leg swelling, fatigue, difficulty breathing, cough, dizziness, fainting spells, weakness and erratic blood pressure readings or heart rates.

If the heart is pumping too hard or too fast then the patient can experience headaches, shortness of breath, palpitations, vision problems or fainting spell. If blood vessels are blocked or narrowed, then symptoms vary depending on where the narrowing occurs.

If an issue is in the heart, chest pain or angina could develop as a warning sign of a heart attack, while narrowing in the legs can result in leg pain, cold feet, swelling and/or the development of chronic wound. Narrowing in the neck vessels can result in dizziness, confusion, and stroke like symptoms.

Conclusion:

I encourage you to take aggressive action using the prevention tactics outlined above. Also, if you are experiencing any of the warning signs, don’t hesitate to set up an appointment with your primary care provider or any of our great Lakeview Clinic providers. Happy Heart Month!!!

Peter H. Rogers, DO

Specialty: Internal Medicine, Pediatrics

Dr Rogers joined Lakeview Clinic in 2016. He holds dual board certifications in Internal Medicine and Pediatrics which allow him to provide comprehensive care to all ages.

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The Usefulness of Ultrasounds

by Vanessa Becker | Feb 7, 2024 | Family Medicine, General, Imaging, Internal Medicine, OB/Gyn, Pediatrics

~ Sonography Beyond Obstetrics ~

In medicine, we have a lot of tools to help our patients figure out what is causing their symptoms. An ultrasound is a diagnostic tool most people have heard of, and they are used often. Of course, we all know about ultrasounds being used for pregnant mothers in finding out if they are having a boy or girl, estimating due dates, etc. But it’s so much more than that!

One of the great things about ultrasound is that it’s quite safe. There isn’t the radiation concern that X-rays, or CT scans have, which is why we can use it in pregnancy, and is often a go-to for concerns with kids as we will discuss below. It’s also noninvasive, which means that although you will get some extra moisturizer with the ultrasound gel and pressure from pushing on the skin, there isn’t much risk either.

How it works – to avoid extra nerdy-ness, I’ll keep it brief. The ultrasound machine uses, as the name would suggest, sound waves that get sent through a handheld probe towards the body. The waves bounce off different material, or in our body, different substances and body parts such as bodily fluids, organs, air, soft tissue, bones and such. The sound waves then head back towards the probe. These returning sound waves are different depending on what they bounced off of, and the computer can help separate those different waves on the screen that you see. Most of the time all it can do is show different shades of white/black/grey, but believe it or not, to the trained eye, it shows a lot more than just snow on a screen!

Common Ultrasounds:

ECHO/Echocardiogram – This looks specifically at the heart and how well it is functioning. Healthcare professionals can see if valves are working properly, if you’ve had a prior heart attack or scarring before and can even determine if blood is flowing properly through the heart using Doppler ultrasound.

Obstetrics/pregnancy – Looking at the baby’s position, anatomy, or other issues that could be going on with the mother.

Abdominal – Used to examine gallbladders and find stones, examine kidneys to look for blockages from stones, examine liver to look at liver disease, and is even used to diagnose appendicitis in children.

Vascular – We commonly use ultrasound to help rule out blood clots in the veins and also look at the general blood flow of arteries to see if there is any narrowing or aneurysms.

Pelvic – This is more helpful for looking at women’s ovaries and uterus to evaluate for cysts, or other causes of abnormal bleeding.

And so much more!

Some health care providers, myself included, like to use something called a bedside ultrasound (or POCUS, short for Point-of-care Ultrasound) to help with patients in clinic. This can be used to take a quick look at things such as skin infections to see if there is any fluid to drain. It can also identify if there is any fluid around the lungs without needing an X-ray. However, we may often still order a formal ultrasound, as these tend to be a better-quality machine than point of care ultrasound. The benefit of POCUS is its accessibility in the clinic setting.

Some providers also use ultrasound to help with procedures, such as joint injections, ensuring the injection reaches the intended site. Another procedure often aided by ultrasound is biopsy. For example, in an Ultrasound-guided breast biopsy, ultrasound imaging is used to help guide the instruments to the site of abnormal growth.

We are happy to report that Lakeview Clinic is expanding the availability of ultrasound services in our Waconia Clinic. In addition to bedside ultrasound, we are adding sonography/ultrasound to our imaging department. This will mean added convenience for our patients and additional in-house diagnostic resources for our medical providers. As always, ask your provider if you have any questions about the imaging they order!

Lucas P. Labine

Dr. Lucas Labine is a Family Medicine provider at Lakeview Clinic. Dr. Labine sees patients at the Norwood and Waconia locations. During his third year of medical school, he had an extended rotation (with the RPAP program) at Lakeview Clinic and immediately loved the staff and patients alike. His interests include caring for the full family, pediatrics, complex care, procedures, family planning, preventative care, point-of-care ultrasound, and overall teaming with patients and forming long lasting relationships.

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Fatty Liver Disease

by Vanessa Becker | Jan 18, 2024 | Healthy Living, Internal Medicine

What is it and why should I care?

Often heard in the news is the degree to which your diet can impact your overall health. In general, people tend to think of diabetes, high blood pressure, and heart disease as consequences of a less healthy lifestyle, but a rising disease known as fatty liver disease also has significant adverse health outcomes. There are two types of fatty liver disease, known as alcoholic fatty liver and nonalcoholic fatty liver disease (NAFLD). With the rising rates of obesity in the world, NAFLD can be found in 25% of the population worldwide.

What does a “fatty liver” mean?

A fatty liver is often found on imaging of the abdomen such as with an ultrasound or CT scan. This is not something typically found on a physical exam. Fat on imaging looks different than normal liver tissue and is often found on imaging incidentally. Fatty infiltration can disrupt the normal function of the liver which includes filtering toxins from the blood, creating clotting factors for the blood in case of injury as well as helping manage blood sugar levels.

How can I prevent this?

It is recommended to visit a doctor at least once per year even if feeling well to ensure proper screening for more silent diseases like fatty liver disease. At these visits, the doctor will monitor weight and labs to include screening for metabolic disturbances like elevated glucose levels, cholesterol, and liver function. Ways to prevent this disease in everyday life include eating a well-balanced diet to include higher protein, lower carb foods and plenty of fruits and vegetables.The American Liver Foundation has a great 30-day liver healthy meal plan to get you started! Daily exercise is also important, aiming for 150 minutes of activity per week.

I developed fatty liver disease, now what?

If significant fatty infiltration exists, it is possible that lab values may be abnormal that can indicate liver dysfunction. These labs include AST, ALT, alkaline phosphatase, and bilirubin levels. These may be checked by your primary care provider regularly. In severe cases, the injury is so severe that it can develop into liver failure. Because of this, it is best to prevent and treat as early as possible to avoid these complications.

The majority of the time lifestyle modifications are the mainstay of treatment for this disease. This includes weight loss if overweight or obese, abstaining from alcohol, and avoiding any potential medications or herbal supplements that could further injure the liver. Other modifications include optimizing blood sugar control if diabetic and managing high cholesterol or known heart disease aggressively. If these modifications don’t improve the condition, typically patients will need to see a liver specialist for further treatment and guidance.

Jordyn N. Walter

Jordyn Walter, M.D. began practicing Internal Medicine at Lakeview Clinic in 2022. Dr. Walter has special interests in chronic disease management such as diabetes, heart failure and hypertension. She also utilizes point-of-care ultrasound.