Providing New Hope to Patients with Colon Cancer that Has Spread to the Liver

If you or a loved one has colorectal cancer that has spread (metastasized) to the liver, it is important to learn the facts and evaluate treatment options.  A diagnosis of colorectal liver metastases can be overwhelming, but there is hope.

At South Florida Vascular Associates we offer a minimally invasive cancer treatment radioembolization using yttrium 90 (Y90) beads. This non-surgical treatment is most commonly used for advanced stage liver cancer (primary or metastatic). Y-90 beads are used in targeted radiation therapy, also known as selective internal radiation therapy (SIRT) that selectively delivers a dose of internal radiation to liver tumors.

 Due to the liver tumor's unique blood supply, millions of tiny spheres are delivered directly to the tumors while sparing healthy liver tissue. The treatment requires a small incision in the groin and is administered via a very small flexible tube (microcatheter) into the liver.

Treatment Goals & Patient Benefits:
• Extend life
• Increase the time until other treatments are needed
• Shrink tumor size and in some cases allow for removal of tumor
• Improve quality of life
• Give fewer side effects
• Provide symptom relief by surgery
• Slow tumor growth

Published on SIRTEX.com  Heather’s Story: Colon Cancer that Spread to the Liver 

As a mother of five, Heather Bishop knows how to take on anything that life throws her way. However, on August 7, 2014, Heather learned of a new challenge she would have to face: stage IV colon cancer.

Earlier in 2014 Heather noticed that many of the symptoms she was experiencing were closely associated to Irritable Bowel Syndrome, so she decided to schedule a doctor’s appointment. She explained to the doctor how she was feeling and what symptoms she noticed. While the doctor took note of these symptoms, he noticed a hard area under Heather’s rib cage. This area made it difficult for Heather to sit up straight, but she didn’t feel any pain. A CT scan was scheduled immediately and shortly thereafter a colonoscopy.

Heather soon learned that she had a tumor in her colon. Her liver was covered and the tumors had metastasized to her spine, skull, and hip. The doctor acknowledged that it was possible she could also have tumors in her lungs, but unfortunately the tumors were too small to conduct a biopsy.
At the end of August, Heather started chemotherapy. Although she was going through chemotherapy, the amount of cancer discovered in Heather’s liver concerned her doctor. He recommended she look into Selective Internal Radiation Therapy (SIRT). After consulting another doctor that had experience using SIR-Spheres® Y-90 resin microspheres, the doctors agreed that Heather was a great candidate. During off weeks of chemotherapy, Heather went in for her SIRT treatment. If she was more fatigued than normal, she didn’t notice. Out of all of the procedures and treatments, Heather believed that the SIR-Spheres Y-90 resin microspheres interrupted her life the least. She didn’t notice pain or discomfort. Instead, she felt remarkably better. Side effects of SIRT are generally mild, including tiredness, loss of appetite, mild fever, stomach pain, sickness, injection site soreness and diarrhea. There is no hair loss with this treatment. Most side effects following a SIRT procedure are minor, but a small number can be serious. Every patient is different in how he or she reacts to a treatment.
In late November Heather had her last procedure. Her father came to help with her five children as she recovered. By mid-December, Heather felt well enough to take care of her family. She still had help with meals and household responsibilities, but for the most part Heather could take care of herself and her children and even went on vacation. At her final follow up appointment, Heather’s doctor was so surprised by the massive change to her liver that he called in his nurse practitioner to see her, too. The doctor said he hadn’t seen results like that in five years.

When Heather found out about her stage IV colon cancer she was told that her colon wouldn’t kill her, but her liver probably would. Today, Heather believes that without SIR-Spheres Y-90 resin microspheres, her life would be dramatically different. Now, Heather shares her inspiring story with others in the hopes that they, too, can benefit from SIRT and have a greater chance of living a longer, healthier, and more productive life.

Are You at Risk for Peripheral Artery Disease? Is It Preventable?

Peripheral artery disease (PAD) is a disease in which plaque, the accumulation of fat and cholesterol, builds up in the arteries that carry blood to your head, organs, and limbs. This build of plaque is a condition called atherosclerosis. Over time, plaque can harden and narrow the arteries limiting the flow of oxygen-rich blood to your organs and other parts of your body. If the plaque build-up is not addressed, you could potentially lose a limb.

The known risk factors for peripheral artery disease are those that predispose to the development of atherosclerosis. Risk factors for peripheral artery disease include:

• High blood levels of the bad LDL cholesterol–the main source of cholesterol buildup and        blockage in the arteries
• High Triglycerides–another form of fat in your blood that can raise your risk for heart disease
• Cigarette smoking
• Types 1 and 2 diabetes
• High blood pressure (hypertension) or a family history of hypertension
• A family history of atherosclerotic disease
• Chronic renal failure
• Overweight or obesity
• Physical inactivity

By taking action to control your risk factors such as being physically active, following a healthy diet rich in fruits and vegetables and quit smoking, you can help prevent or delay PAD and its complications.

Lifestyle changes can also help prevent and control conditions associated with PAD, such as coronary heart disease, diabetes, high blood pressure, high blood cholesterol and stroke. Although PAD can be serious, it's treatable. If you have been diagnosed with PAD, there are medications and minimally invasive, endovascular procedures such as atherectomy that can break up the plague in your arteries and re-establish normal blood flow through your legs. PAD treatment often slows or stops the progression of the disease and reduce the risk of complications.

PAD affects over 10 million Americans, it is slightly more common in men than women and affects 12-20 percent of people 65 and older. By understanding your risks, changing your lifestyle to a healthier one and quit smoking if you smoke, you can hopefully lower and prevent your chances of developing PAD.

Gabriel's Story: Endovenous Laser Treatment for Varicose Veins

39 year old Gabriel Quiroga is an air conditioner contractor. Part of his everyday routine is going house- to -house or business- to -business, where he climbs up ladders get up to roofs, into attics, and other hard to reach areas. Quiroga is totally dependent upon the use of his legs for his livelihood and a good quality of life.

Quiroga was experiencing severe pain in his left leg and swelling at the ankle, especially while standing and climbing up ladders. “I was in constant discomfort and was concerned that I might have to change careers. I could barely stand for any length of time without feeling severe pain”, said Quiroga.

Quiroga was referred to South Florida Vascular Associates and Dr. William Julien to discuss his symptoms and determine a treatment option. Upon testing and examination, Dr. Julien determined that Quiroga had a large varicose vein in his left leg which was causing venous insufficiency, a common condition resulting from decreased blood flow from the leg veins up to the heart. “When valves become weak and don't close properly, they force blood to flow backward, a condition called reflux”, said Dr. Julien. In normal veins, valves in the vein keep blood moving forward toward the heart. With varicose veins, the valves do not function properly, allowing blood to remain or pool, in the vein. Pooling of blood in a vein causes it to enlarge, which creates pain, especially when a person is standing and placing pressure on the leg.

Varicose vein treatment, also known as endovenous laser treatment (EVLT), is a minimally invasive procedure that uses radiofrequency or laser energy to seal off and close varicose veins in the legs. It may be used for cosmetic purposes, but it is most commonly used to help alleviate related symptoms such as aching, swelling, skin irritation, discoloration or inflammation. EVLT is safe, less invasive than conventional surgery known as vein stripping and leaves virtually no scars.

                                         

    Dr. William Julien Explains EVLT

EVLT is an alternative to traditional open surgery and it requires minimal access to the vein.  In the past, if a patient was suffering from painful varicose veins they would need to undergo an open surgical procedure (vein stripping) to seal off the vein. Vein stripping is very painful and a difficult experience for the patient.
                                                   
Vein stripping is done using general anesthesia and the procedure usually takes up to 1 1/2 hours. After surgery patients have bandages and compression stockings on their leg and the leg may need to be wrapped to control swelling and bleeding for 3 - 5 days or longer after surgery.

EVLT on the other hand, is a much easier on the patient. The procedure typically takes less than one hour, provides immediate relief, no general anesthesia, recovery period is minimized and a patient can immediately return to normal activities, without scarring or stitches. There is a lower rate of complication and a higher success rate.

“I can’t believe how simple this procedure was”, said Quiroga. “I postponed having the procedure for so long thinking I would be out of work for several weeks and the day after the procedure, I was able to climb my ladder, something I thought I might never be able to do again”. Aside for wearing a compression stocking for a few weeks, Quiroga did not experience any discomfort and was immediately able to return to his job. “This procedure is amazing, said Quiroga, I can’t believe how easy and painless it was”.

If you suffer from unsightly and painful varicose veins,call our office for a consultation or call 954-725-4141

Today is National Wear Red Day: What women need to know about heart disease and stroke

As Featured On Fox News

February 5 is the day that the American Heart Association asks everyone to wear red in order to raise awareness for heart disease in women.  Created in 2004, Go RED day was designed to promote healthier lives for women of all ages.

Today 1 in 3 women are affected by heart disease in the United States, and nearly 44 million American women are living with heart disease. Even though cardiovascular disease is quite prevalent in women, only 1 in 5 women are aware that heart disease is their greatest health risk.

While we have made great strides in reducing cardiovascular death rates in women over the last 20 years, we still must continue to educate and advocate for women of all ages—this advocacy begins with dispelling the common myths surrounding heart disease in general. It is my hope that through efforts such as the Go Red campaign, we can promote better heart health for millions of American women. Ultimately, we must engage women and their families in order to most effectively eliminate needless cardiac related deaths in the next decade.

Myth 1: Heart Disease is predominantly a disease of men

The truth: More women than men die of heart disease every single year. Heart disease kills more women than all types of cancer combined. While most women believe that their greatest health risk comes from breast or uterine cancer—in actuality, a woman’s greatest health risk is from heart disease and stroke.  Nearly 90 percent of all women have at least one risk factor for heart disease.

Myth 2: Heart Disease affects men and women in the same way

The truth: Heart disease affects men and women differently. Biologic and hormonal differences in men and women contribute to the ways in which heart disease develops and progresses.   Studies have shown that after menopause, women have an even higher risk for heart disease—estrogens seem to promote better cholesterol profiles.

Women tend to present to a healthcare provider far later in the course of the disease and have more diffuse blockages in their heart (coronary) arteries. These blockages in coronary arteries result in heart attacks. Heart attacks have several commonly recognized symptoms. Men tend to have more typical symptoms like crushing chest pain and associated shortness of breath, nausea, radiation of pain to neck or jaw.

Women, in contrast, may have very atypical symptoms and some women have no symptoms at all. According to the Centers for Disease Control and Prevention (CDC), nearly two-thirds of women who have sudden cardiac death due to heart disease have no symptoms. While women may certainly have the same symptoms as men, it is more common for them to present with more vague and non-specific symptoms such as feelings of dread, anxiety, back pain and flu-like symptoms.

Heart attacks appear to be much more severe and carry a higher risk for death and complications in women as compared to men.  For example, in the first year following a heart attack women are 40 percent more likely to die than men. In the six years following a heart attack, women are twice as likely to have a second event as compared to men with similar disease.

Myth 3: Women with heart disease are treated the same as men

The truth: Women with heart disease are under-treated and underserved. Women are not screened for and diagnosed with heart disease as aggressively as men. Many times women are sent home from the hospital with atypical symptoms only to find out later that they had suffered a heart attack. When women are diagnosed with heart disease, they are less likely to be treated with the most advanced and aggressive therapies. Men are more likely to undergo cardiac catheterization or coronary artery bypass operations to restore blood flow to the heart after a blockage occurs. Women are more likely to have both minor and major complications from invasive procedures but, in many cases, women seem to see a greater benefit as compared to men. After suffering a heart attack and being treated in the hospital, women are far less likely to be referred for cardiac rehabilitation and are also less likely to be placed on important medications that have been shown to prevent future events.

MYTH 4:  It can’t happen to me

The truth: Heart disease does not discriminate. The risk factors for heart disease are the same in both men and women:

--Smoking

--Diabetes

--High Cholesterol

--High Blood Pressure

--Family History of Heart Disease

--Obesity

Nearly 80 percent of all women have at least one risk factor for heart disease. More importantly, many of these risk factors are modifiable. While breast cancer affects 1 in 8 women, heart disease affects one in three. Chronic heart disease and suffering a heart attack can result in physical limitation, significant decrease in quality of life, depression and ultimately heart failure.

SO, WHAT CAN WOMEN DO? 

Women must take control of their own health.

Joe's Story: Critical Limb Ischemia

Joe Langer no longer takes walking for granted. “One day I was fine, the next my toes turned purple and I was in horrific pain. I developed open wounds on the bottom of my feet, gangrene set and I could barely walk. It happened very fast and the next thing I knew, I was facing amputation on both legs from the knees down.”

Every 30 seconds some one, some where in the world is undergoing an amputation, according the American Diabetes Association.

Most tragic, the majority can be prevented according to endovascular surgeon, Dr. William Julien founder of South Florida Vascular Associates, “As more people develop diabetes, amputations are becoming more common, yet 96-percent of them can be avoided. Unfortunately the vast majority of patients aren’t aware of that so they end up losing their limbs or worse yet, their lives.”
People at highest risk are diabetics, those with high cholesterol, heart disease and smokers.

The condition is known as critical limb ischemia (CLI). Simply put, plaque builds up in the arteries, seriously decreasing blood flow to extremities including the hands, feet and legs causing extreme pain and at worst, loss of limbs.

Joe, a diabetic and former smoker considers himself lucky. His podiatrist sent him to South Florida Vascular Associates where they specialize in treating CLI. Joe’s brother-in-law, also a diabetic was not so lucky. Joe says, “His podiatrist did not send him to experts like Dr. Julien and unfortunately his toes were cut off. We now know that could have been prevented.”

Endovascular surgeons at South Florida Vascular Associates take a multi-disciplinary approach to saving limbs and lives. Joe is a great example, they opened the blockages in his arteries then worked very closely with his wound care, infectious disease, and primary care doctors to make sure his wounds were properly healed".

Dr. William Julien Explains Atherectomy Procedure in the Video Below

Using state-of-the-art ultrasound and angiogram technology, he first pinpoints blockages inside artery walls. Then an atherectomy procedure is done in which tiny rotating tools can pulverize and remove the plaque. If necessary, stents are used or angioplasty to re-open the arteries and restore blood flow to the limbs. In addition, hyperbaric oxygen therapy is sometimes prescribed to help heal wounds faster.

It’s a crime to amputate when most of the time it can be prevented. The biggest problem is getting the word out and educating the public.

Joe is trying to help do just that, “These docs performed a miracle. I was in such pain, it was killing me and now I’m back to normal and I consider myself a very lucky man.”

Dr. Julien says, “We urge patients who are told that their limbs must be amputated to get a second opinion. By spreading the word we can significantly reduce the number of amputations from wounds that just won’t heal.”

If you are diagnosed with critical limb ischemia and are told you need your limb amputated, please contact one of our 3 convenient offices to schedule a consultation with our board certified endovascular surgeons. We may be able to salvage your limb.

What is Carotid Artery Disease? Are You at Risk?

Carotid artery disease (CAD) occurs when the major arteries in your neck become narrowed or blocked. These arteries, called the carotid arteries, supply your brain with blood. The two carotid arteries, one on each side of the neck, are the main blood supply to the brain. Each carotid artery extends upward from the aorta in the chest and into the base of the skull to enter the brain.

Carotid artery disease can lead to stroke

Approximately 25% of strokes are caused by carotid artery disease from atherosclerosis, a build-up of plaque in the arteries that carry blood to the brain. Eventually, the artery narrows, blood flow is decreased, and the risk of stroke is increased. The patient may experience symptoms such as blurred vision, slurred speech, or weakness, which are all signs of stroke.

By removing the fat and cholesterol build-up inside the artery, adequate blood flow is restored, which can help prevent a stroke. Blockages of carotid arteries in the neck are responsible for more than half of all strokes.

                                            

       

     Click on the video to hear Dr. William Julien talk about treatment for CAD

Atherosclerosis can lead to carotid artery disease

As people age, arterial plaque made up of cholesterol, other lipids, calcium, and fibrous tissue can build up in the walls of their arteries. As the plaque deposits enlarge, the arteries become narrow and stiffened, causing atherosclerosis (hardening of the arteries), which tends to develop later in life.
Atherosclerosis begins with partial but progressive blockage or narrowing of arteries. When enough plaque has accumulated to interfere with blood flow in the main arteries to the brain, a person is said to have severe carotid artery disease. A complete blockage that stops all blood flow through the carotid artery can follow.

To learn more about carotid artery disease (CAD) visit our educational page to learn about symptoms, risk factors and minimally invasive treatment options performed by our board certified, endovascular surgeons Dr. William Julien and Dr. Curtis Anderson at South Florida Vascular Associates.

Can Diet Improve Your Blood Circulation?

A healthy circulatory system is responsible for the steady flow of blood, oxygen, nutrients, and disease-fighting immune cells throughout your body. Without the circulatory system, the body would not be able to fight disease or maintain a stable internal environment.

In a unhealthy circulatory system, you could have poor blood circulation which can occur from fatty plaques known as atherosclerosis, and blood clots that block the normal flow of blood through the arteries into your limbs. Atherosclerosis raises your risk of vascular and heart disease contributing to peripheral artery disease, heart attack and stroke.

Studies have shown that by adding certain foods to your diet such as garlic, fruits and whole grains, you can help to keep your blood vessels healthy and improve circulation. Below are some of the super foods you might consider incorporating into your weekly diet.

Fiber Helps Reduce Cholesterol

If you have poor blood circulation because of atherosclerosis, your cholesterol levels may be high so reducing these levels can help improve your artery and heart health. The National Institutes of Health recommends eating a diet that contains less than 200 milligrams of cholesterol per day. Foods that contain fiber, such as whole grains, oats, apples, bananas, pears, and legumes such as lentils, kidney beans and chick peas can help to lower your cholesterol which in turn increases healthy blood flow and reduces your risk or cardiovascular disease.

Omega-3 Fatty Acids Thin the Blood

Adding fish such as wild salmon, albacore tuna, trout, oysters and anchovies to your weekly diet gives you essential omega-3 fatty acids. In addition to fish, avocados and nuts are high in omega-3 fatty acids. The healthy fat in omegs-3 helps to lower unhealthy fats called triglycerides in the blood, reduce blood pressure, thin the blood and reduce your risk of blood clots. Recommendations for fish are to eat two to three servings of fatty fish per week.

Garlic -A natural blood thinner that can improve blood flow to your limbs. Researchers gave healthy volunteers a daily dose of 600 milligrams of garlic supplements for seven days. Blood samples from the group showed that blood flow in their calf muscles improved significantly after taking garlic. This is particularly important for individuals with varicose veins or clots in their arteries. Whole garlic has similar benefits if you eat 2 to 4 grams of fresh, minced garlic cloves per day. If you are taking any medication, consult your doctor before using any natural remedy.


Oranges- High in vitamin C and considered to be a natural blood thinner and are said to strengthen capillary walls and prevent plaque build-up which leads to poor circulation.

Dark Chocolate- Cocoa contains flavonoids which is naturally found in plants and fruits and has been well linked to improving blood circulation. A study published in the Circulation Journal showed that dark chocolate rich in natural flavonoids improved blood circulation when compared with white chocolate with no flavonoids.

Cayenne pepper is available as a fresh pepper or dried spice and has been associated with increasing metabolic rate and strengthening arteries and blood vessels. Cayenne pepper is best eaten raw in salads or juiced.

Sunflower seeds- Rich in vitamin E which is shown to help keep blood clots from forming. They are great at helping improve circulation.

Watermelon- Rich in lycopene which is a natural antioxidant linked to improving circulation. Lycopene is a natural pigment which gives certain foods their reddish color. Tomatoes, pink grapefruit and apricots also contain lycopene.

If you suffer from poor circulation and cardiovascular disease and are under the care of a physician consult with your physician before implementing this diet.

Salud!