What does a General Surgeon do and how can he/she help you? What about a Colon and Rectal Surgeon?

Craig Amshel, MD

Before diving into the vast discipline of Surgery and the health benefits of becoming acquainted with your local General Surgeon, I would like to inform you, the reader, of some background requirements of becoming a General Surgeon and a Colon & Rectal Surgeon.

Modern surgery is divided into many subspecialties, including Vascular, Surgical Oncology, Plastic Surgery, Trauma/Critical care, Endocrine, Laparoscopy, Transplantation, Cardiothoracic, and my own subspecialty, Colon& Rectal Surgery. Except for the few surgical specialists that operate from the chin on up, the above specialties derive their training first from a General Surgical residency.
Except for the Neurosurgeon and beside the Urologist, today’s General Surgeon is the most trained single-specialty physician in practice. After earning a Bachelor’s degree and four years obtaining a Medical degree, the next five to eight years of life he (I recognize that there are many female General Surgeons, but for ease of reading, I will now refer to the masculine description) once knew, is now over for the General Surgeon-to-be. As if that was not enough, to specialize in Colon and Rectal surgery, a General Surgeon must spend another year or two in a fellowship-based program learning about all the disease processes that affect the colon, rectum, and anus.

The stories told and seen on TV are somewhat accurate about life as a surgical resident: he must learn to become efficient and establish the mental and physical stamina to interact with patients, focus his attention to details during an operation which could last between 30 minutes to six hours, follow-up on multiple tests that were performed on his patients and immediately decide upon a treatment plan derived from those test results while working 24 hours around the clock every other or every third day. Work is never mundane; at any time an emergency such as a gun shot victim, a person bleeding in his gastrointestinal tract, or a patient with appendicitis can arrive at the ER doorstep, a wound infection has developed, or a tube has been accidentally pulled out of a patient. Meanwhile, time away from the hospital is spent studying for the day’s next rounds, operations, or exams lest he look unprepared in front of his peers and organizing multi-media teaching presentations. Currently the maximum allowable time a resident can work in the hospital is 80 hours/week. However, prior to just a few years ago, a resident such as myself, could spend 132 hours/week living in the hospital.

All of this training does prepare the General Surgeon for the majority of disease processes he will treat in practice, however like residency, he must be prepared for the surprises that can be thrown his way.
I will describe typical clinical diseases seen by the General Surgeon and explain their symptoms of what you, the reader, should look for and ask questions about so you will be treated properly.
Hernia. An abnormal protrusion due to a weakness of the abdominal wall. These are typically seen in the groin, umbilical region, or thru a previous abdominal incision. Hernias do not go away. They must be surgically repaired in the out-patient setting either laparoscopically (less pain than “open” but general anesthesia is required) or “open.” Most hernias are a nuisance that may be tender and negatively affect a patient’s lifestyle, but they don’t require immediate treatment, however, they can become “incarcerated” (the protrusion can’t be pushed back in), which does require urgent repair and admission into the hospital. If you are absolutely against undergoing an operation, and you do not possess an incarcerated hernia, there are lifestyle changes you can discuss with your General Surgeon to reduce your chances of incarceration.
Gallbladder disease. If you develop pain under your right ribcage, flatulence, or diarrhea after eating, especially with fatty foods, you may have problems with your gallbladder. A simple test or two by your primary care physician (PCP) can determine whether your gallbladder is diseased. If so, it can easily be removed, and after a few weeks of light work, you can enjoy your previous normal lifestyle. If you do not wish to have your gallbladder surgically excised, the easiest and cheapest method to reduce the above symptoms is to maintain a strict non-fat diet. If you do not see improvement in a few weeks, you should consult your PCP for a referral to a General Surgeon.

Acid reflux. Sometimes gallbladder pain can be felt in the upper, middle portion of your abdomen. However, this pain usually represents acid reflux and can be quite bothersome, especially when trying to sleep. This disease can be diagnosed with an upper endoscopy (either by a General Surgeon or Gastroenterologist) and treated with both medication and lifestyle changes, such as limiting alcohol, caffeine, late-night meals and losing bodyweight. If this treatment plan is not effective, other tests should be performed to determine the exact cause of the pain, which may be amendable to an operation called a laparoscopic Nissen fundoplication, whereby a portion of the stomach is tightened to prevent acid from entering the esophagus.

Breast mass. Every female, starting at age 25, should examine her breasts on a regular basis coinciding with her menstrual cycle. Any change or suspicious finding should be presented to her PCP. Ask your PCP about scheduling a mammogram, which unless there is a strong family risk of cancer, should be initiated at age 35 and continued annually at age 40. Suspicious masses or mammograms should be brought to the attention of your PCP and General Surgeon to discuss a surgical biopsy and definitive treatment depending on what the biopsy reveals.

Colon/Rectal cancer, blood per rectum, hemorrhoids, constipation, etc. Colon and rectal cancer is one of the most preventable diseases we live with. These cancers do not just appear out of nowhere but start as a small polyp that continues to grow, and over time mutates into cancer. The only symptom may be some blood in the toilet or stool. Pain is extremely rare in the early stage of this disease. There are several options for diagnosis; however, a colonoscopy under “twilight” anesthesia is both diagnostic and a method of treatment. Unless there is a strong family history of colon cancer, every person should undergo a colonoscopy starting at age 50 by either a Colon & Rectal or General Surgeon, or Gastroenterologist. Think of the colonoscopy as the “mammogram for the colon.” If no polyps are found, the next colonoscopy won’t be due for another 10 years. To maintain a healthy colon and to treat and prevent both hemorrhoids and constipation, it is imperative to increase your fiber and fluid intake and activity level. If an operation is required, options including laparoscopic partial colectomy and hemorrhoidal stapling can be discussed with your Surgeon.

Although the above are just a few of the many diseases seen by the General Surgeon, be sure to question him about all of the treatment options or other ailments that may be bothering you. During your visit, it is also useful to bring a relative or friend to help ask and answer questions, and be sure to bring an updated list of all of your medications.

Dr. Amshel is East Hillsborough ’s first fellowship-trained colon and rectal surgeon. He is currently accepting new patients at 139 S. Pebble Beach Blvd, Suite 200 , next to CVS and at his Brandon office at 514 Eichenfeld. Just about every major and minor insurance accepted and payment plans can be arranged for non-insured patients. Office phone # is 813-633-0081 to schedule appointments and happily answering any and all questions. Se Habla Espanol.

(view before and after Hemorrhoidal Artery Ligation with Rectopexy (HALs/RAR) pictures: graphic)

Craig E. Amshel, MD, received his medical degree from the university of Kansas School of Medicine, Kansas City. Following his general surgical internship at Roanoke Memorial Hospitals Carilion Health Care Systems, VA, he completed a general surgical residency at Maricopa medical Center, AZ, and was awarded a colorectal fellowship from the University of Miami. Dr. Amshel has published numerous articles and has spoken at many national conferences about various surgical topics, in addition to serving as chief of surgery at multiple facilities during his distinguished military career.