New patient forms, FAQ and more
from Piedmont Surgical Clinic. |
Here you'll find information about our practice, new patient forms and other useful resources. If we can be of assistance to you, please call: 704.786.1104. Our team is here to help.
New Patient Forms
Print, complete and bring with you to your first appointment.
Insurance & Payment Info
About Health Insurance & Our Payment Policy
Charges for care vary according to the extent of the services rendered. Upon request, we will prepare an estimate for you, although cost may vary if additional services are needed.
Payment for office visits occur at the time of services. We accept cash, personal checks, money orders, travelers checks, Visa and Mastercard.
Please furnish your insurance information to our office staff. As a courtesy to you, we will file your insurance claim. However, the responsibility for payment remains solely with you, the patient.
The Piedmont Surgical Clinic doctors are Medicare participating physicians and the clinic cooperates with most local "managed care" HMOs, PPOs and other payor systems. All co-payments must be paid in full at the time of service. We will gladly file your claim with the managed care company on your behalf.
If you do not have insurance, a down payment for elective services will be required.
There may be a fee for telephone calls depending on their complexity and frequency. If you have any questions about payment or insurance matters, please talk with us right away.
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Frequently Asked Questions
What is a General Surgeon?
A general surgeon is a physician who has completed an internship and residency training program beyond medical school. A general surgeon is highly trained in the diagnosis and surgical treatment of a wide variety of diseases and health problems. General surgeons are also trained in postoperative management and critical care.
What is a “Board-Certified General Surgeon”?
A board-certified general surgeon has been certified by the American Board of Surgery, an independent, nonprofit organization that certifies physicians who have met standards of education, training and knowledge in the field of surgery.
To be certified by the ABS, surgeons must meet a number of criteria. They must have completed a minimum of five years of surgical training following medical school, carried out a minimum number of operative procedures in multiple categories, and successfully completed written and oral examinations.
Dr. Giltz Croley, Dr. Joseph Simpson and Dr. Michael Houston are each board-certified in General Surgery.
What is your payment policy? Do you accept insurance?
Payment for office visits occur at the time of services. We accept cash, personal checks, money orders, travelers checks, Visa and Mastercard.
If you have health insurance, we will file your insurance claim for you. However, the responsibility for payment remains solely with you, the patient.
Our surgeons are Medicare participating physicians and the clinic also cooperates with most local "managed care" HMO's, PPO's and other payor systems. All co-payments must be paid in full at the time of service. If you do not have insurance, a down payment for elective services will be required.
There may be a fee for telephone calls depending on their complexity and frequency. Feel free to talk with us about any concerns you have regarding our payment policies.
Where do the doctors perform surgery?
Our surgeons are on staff at Carolinas Medical Center-NorthEast in Concord. They also perform outpatient surgeries at Gateway Ambulatory Surgery Center in Concord.
How do I prepare for my surgery? What can I expect after surgery?
You will have many questions about your surgery and every case is different. Rest assured, we will give you detailed instructions about preparing for your surgery, what to expect afterward and about your recuperation. We want you to be fully informed and confident in the care you receive. If you should ever have any concerns or questions we have not answered, please ask your surgeon or nurse.
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Patient Education
Abdominal Hernias
Hernias can occur in multiple locations of the abdomen as sites of significant muscular weakness/thinning out or from a true “hole” in the muscular wall. They usually cause symptoms of pressure, pain, or nausea in association with a visible bulge. The bulge usually is the result of a piece of insulating abdominal fat or a piece of the intestine which protrudes through the muscular defect. Rarely does this protrusion become stuck/locked into position. If so, this “incarcerated” hernia becomes a surgical emergency.
Hernias should be repaired when they cause symptoms, are enlarging, or limit your activity at home or at work. Most abdominal hernias can be repaired as an outpatient, allowing the patient to recuperate in the comfort of their home. This surgical procedure closes or patches the muscular defect with or without a prosthetic (plastic) mesh.
A period of restricted activity is requires after surgery and will be discussed with you by your surgeon before and after the day of surgery. Walking is strongly encouraged post-operatively to speed your recovery and reduce your risks of complications.
If you believe that you have an abdominal hernia and have questions, please feel free to call our office to speak with a nurse or to make an appointment with one of our surgeons.
Learn more about hernia surgery, abdominal hernia and outpatient hernia repair.
Gallbladder Disease
Gallbladder disease is a common problem in North America. Although not required, gallstones are frequently present. Gallstones from when an imbalance occurs in the three components of bile (bile salts, cholesterol, and lecithin.)
In the western world, the prevalence of gallstones in women less than 50 years of age is 11-15 % and 3-11 % for men. At 50 years of age and beyond, the prevalence for stones is 25 % and 10-15 %, respectively. Annually, approximately one million Americans have symptoms of gallbladder disease and of these 700,000 will have cholecystectomies, the large majority of which will be performed laparoscopically. This is the most common operation performed in the United States. Gallbladder disease symptoms include upper abdominal pain (usually below the sternum or on the right side), bloating, and/or nausea. Often these symptoms occur after eating fatty or spicy foods and may radiate to the back. Initially, the first bout of symptoms may resolve on their own but frequently will recur. Becoming jaundiced is rare.
Patients with asymptomatic gallstones have a 2-3% per year chance of developing symptoms up to 10 years and then 1-2 % per year chance thereafter. An ultrasound is usually the first imaging test and the most cost-effective test to evaluate the liver and gallbladder subsequent to being evaluated by your physician.
Laparoscopic removal of the gallbladder (cholecystectomy) is the gold standard operation to treat gallbladder disease. In more than 90 percent of cases, it can be performed as same-day surgery, allowing you to recuperate in the comfort of your home. Unlike the old approach to cholecystectomy, one small and three tiny incisions are required to perform laparoscopic cholecystectomy. Minimal restrictions are required after surgery and these will be reviewed with you by your surgeon. Most patients are back to work within 1-2 weeks.
If you have further questions, please call our office to talk with one of our nurses or to schedule an appointment.
Thyroid and parathyroid disorders.
The thyroid is a butterfly-shaped gland at the front of the neck that regulates the body’s metabolism. The parathyroid glands are four small glands located next to the thyroid, which control the amount of calcium and phosphorus in the blood. The adrenal glands are also part of the endocrine system, producing essential hormones.
A general surgeon may be called upon to treat both benign and cancerous masses or tumors of the thyroid, parathyroid or adrenal glands. Sometimes, the thyroid gland may become overactive and need to be partially or totally removed.
Click here to learn more about surgery of the endocrine glands.
Inflammatory Breast Cancer
Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer. It makes up only 1-5% of all breast cancers diagnosed in the United States and presents in younger women, on average, than the more common type of breast cancer. This locally advanced, rapidly growing cancer typically blocks/clogs the lymphatic vessels in the skin of the breast. These lymph vessels usually drain to the armpit lymph nodes.
Symptoms include redness, warmth, heaviness, enlargement, and/or swelling of the breast. The breast may even have a pink or bruised appearance. The nipple may visibly change in color, position, or shape. Only 50% of patients can feel a lump in the same breast. Enlargement of the lymph nodes in the armpit are not uncommon. These various changes can occur within a short period of time, often from weeks to a few months. This reinforces the need for prompt evaluation and avoidance of patient denial. The diagnosis can be difficult as infections may have a similar presentation. If any of these symptoms develop, the patient should be evaluated by their Primary Care Physician or General Surgeon.
On examination, the physician is looking for signs of redness, warmth, tenderness, enlargement, or peau d’orange (the skin changes which give an orange peel appearance). This latter skin change results from the blocking of the skin lymphatic ducts by the cancer cells. However, peau d’orange can also be seen in cases of breast infections. That is why making the diagnosis can be problematic. It is not uncommon for an antibiotic to be prescribed initially for seven to ten days. If there is no significant improvement with the use of the antibiotic(s), a biopsy of the breast skin is mandatory. Even if the biopsy is unrevealing of cancer and the symptoms do not improve rather quickly, a second skin biopsy should be done.
When IBC is diagnosed, a plan of care should be coordinated by your surgeon. IBC is typically treated with intravenous chemotherapy first (under the direction of a Medical Oncologist); followed by complete surgical removal of the breast and the lymph nodes in the same armpit. Sometimes, radiation therapy (under the direction of a Radiation Oncologist) is included to the treatment regimen. Treatment is prompt and judicious. Prognosis is generally not good. The average patient lives only 3 years. Between 25- 50% live 5 years and only 33% live 10 years after diagnosis. Urgent detection and treatment provide the only chance for a cure.
Sentinel Lymph Node Biopsy
What is a Sentinel Lymph Node Biopsy?
Most people hear about Sentinel Lymph Node Biopsy (SLNB) during discussions of treatment options for breast cancer and less often for melanoma of the skin. This advanced technique detects lymph node spread of cancer with increased diagnostic accuracy and with fewer complications than traditionally seen.
Currently, when diagnosed with breast cancer, patients have the option of either Breast Conserving Treatment (lumpectomy, lymph node removal from the armpit, and radiation treatments to the remaining breast) or Modified Radical Mastectomy (removal of the breast and the adjacent armpit lymph nodes). These two surgical options are the “standard of care” treatments for breast cancer. Potential side effects of armpit lymph node removal can include arm swelling (20-25%), cellulitis of the extremity (approximately 10%), and pain. When SLNB is added to either surgical option, arm swelling and cellulitis rarely occur and patients have much less pain. This advanced procedure has been offered by general surgeons at Northeast Medical Center since 2000. SLNB should ultimately become part of the standard of care for breast cancer in the future.
Anatomy
The typical number of lymph nodes in the armpit can vary from 8 to 30 and are connected together as a group. Lymph nodes filter body fluids like an oil filter cleans oil in a car. We are born with hundreds of lymph nodes in many locations of our body. For breast cancer, the armpit (axillary) lymph nodes are most often the first site of cancer spread.
Treatment Factors
The presence of cancer within these armpit lymph nodes is the basis for planning treatment and in predicting a patient’s expected lifespan (prognosis). Following many years of national research, the ability to predict which lymph node (the sentinel lymph node) within a group of lymph nodes is the most likely to harbor cancer spread is highly predictable. The ability to accurately identify whether cancer has spread to a lymph node group is approximately 97% with SLNB. In contrast, approximately 3% of cases where SLNB is utilized, the cancer spread to the lymph nodes is missed.
The SLNB Procedure
A very small dose of a nuclear medicine agent is injected into the skin overlying the breast cancer. Pictures are taken to identify which lymph node within the group has taken up the injected agent. The patient proceeds to the operating room. Under anesthesia, a blue dye is injected around the breast cancer by the surgeon. Both of these injected solutions will drain toward the armpit. The surgeon uses a handheld Geiger counter (radiation detector) to search for a “hot” lymph node that likely will be blue. This is the Sentinel Lymph Node (SLN). This SLN is submitted to the pathologist. If the SLN does not contain cancer by preliminary testing, the remaining lymph nodes are left in the armpit. These patients then avoid the potential complications of complete lymph node removal. However, if the SLN is positive (contains cancer), the remaining lymph nodes in the armpit are removed. The surgeon then proceeds with the definitive breast operation.
Benefits
Increased diagnostic accuracy of the armpit lymph nodes. No upper extremity swelling or cellulitis. Less upper extremity pain.
Expected Side Effects: “Blue or green” urine lasting less than a day.
If you need further information or have questions, please contact us.
Hand-Assisted Laparoscopic Colectomy
Today, many patients needing non-emergent removal of a portion of their large intestine (colon) are candidates for this revolutionary technique. This newer surgical approach to the contents of the abdomen is also being used for other abdominal procedures.
Hand-assisted laparoscopic surgery (HALS) allows a surgeon the ability of combining the use of one hand in the abdomen, through a three and one half to four inch incision, while the other hand manipulates standard laparoscopic instruments from outside of the abdomen. Tiny incisions are made on the abdominal wall to place trocar/port sites so that these various instruments can be interchanged as needed to perform the operation. This dual approach allows the surgeon the ability to not only “feel” various tissues in the abdomen but also the added benefit in assisting with the dissection and/or mobilization of tissues. The patient benefits from smaller surgical cuts on the abdomen, a quicker return to eating regular foods, less pain, and a shorter stay in the hospital. HALS does require a general anesthetic such that the patient is fully asleep and without consciousness.
Pioneering efforts at hand-assisted abdominal surgery began in the United States around 1996. Modifications to allow access of the surgeon’s hand during laparoscopic operations took a foothold around 1999. Today, the majority of elective colon procedures are done with HALS. This same technology is being used by many surgeons for operations involving the small intestine, spleen, pancreas, and kidney.
Colon polyps (mushroom-like growths), recurrent bouts of diverticulitis, and colon cancer are typical diseases that patients have when visiting a General Surgeon to discuss considerations for elective (non-emergent) removal of part of their colon. Your surgeon can discuss the amount of colon that is recommended to be removed and the reasonable expectations concerning your planned colon surgery. Though many precautions around the time of surgery are taken by both the surgeon and the anesthesia team to lower risks, all operations have risks. The time to ask questions pertaining to your surgery is before the operation. Following HALS for colon diseases, most patients are out of bed/walking the morning after surgery, drinking liquids by the second day after surgery, and going home around four days post-operatively. The largest scar on the abdomen is usually only three and one half to four inches long. Driving and lifting restrictions are discussed with you by the surgeon prior to your leaving the hospital. Showering can usually begin upon discharge from the hospital. Frequent walking lowers your risk for dangerous blood clots which can develop in the legs or pelvis. A follow up appointment with your surgeon will occur usually within 10 days from the date of surgery.
Learn more about colon surgery and minimally invasive, hand-assisted laparoscopic colectomy.
Abdominal Aortic Aneurysm
What is an Abdominal Aortic Aneurysm?
The abdominal aorta is the largest artery within the abdomen and carries oxygenated blood to the abdominal / pelvic organs and down to the legs. Widening of an artery to more than one and one half times its normal diameter ( >150 percent) is an aneurysm. Most abdominal aortic aneurysms (AAA) exist without symptoms. An AAA is more common beyond 60 years of age and is five times more common in men. Approximately 5 percent of men over age 60 have this type of aneurysm and 10% in men older than 70. Atherosclerosis (hardening of the arteries) causes weakening of the arterial wall leading to aneurysmal formation. Risk factors for an AAA include increased age, smoking, high blood pressure, family history, elevated cholesterol. The most common location for this type of aneurysm is in the segment of the aorta found within the upper abdomen.
Should I worry about having one?
Occlusion or complete blockage of the aortic aneurysm causing sudden loss of blood flow to the pelvis and legs is possible as is dislodgement of plaque or clot from within the aneurysm which will be flushed downstream. The most feared complication of rupture is also the most common. The larger the aneurysm becomes the more likely it is to rupture. A 5 cm AAA has a 16% risk of rupture in 5 years time. At 6 cm diameter, non-operative treatment is prohibitive.
The large majority of people (90%) having rupture of an abdominal aortic aneurysm (AAA) will die before ever getting to a hospital. Of those that do get to the hospital, only 45% overall will survive. Within this latter group, those patients presenting to the Emergency Department in shock (low blood pressure, pale, fast heart rate, etc.), only 10% will survive. Genetic predominance is greatest in the sons of women having an AAA. Also, the rupture risk is greater in women.
The complication rate for repair of an AAA is significantly higher when emergent repair is required.
How do I find out if I have an AAA?
Generally speaking, most abdominal aortic aneurysms can be seen easily by either ultrasound imaging and/or a CT scan. Ultrasound imaging success is more difficult in the obese. Men over 59 years of age should be screened for an AAA. If you have or have had a relative with an AAA, screening should start between 40-45 years of age.
If you have an AAA, contact your Primary Care Physician or your Surgeon for further evaluation.
Treatment Options
Traditional open abdominal surgery that secures an artificial graft in place of the AAA is the “gold standard” procedure. Dr. Rudolph Matas first performed this operation in Louisiana in 1951. This technique is still used today. Overall, this surgical procedure has the best long-term results (10 years or more) in people younger than 70 years old. A mortality rate of 3- 5% is typical for elective repairs and patients are typically in the hospital for a week.
Endovascular repair (EVR) has available for several years and is most often chosen for higher risk patients (severe lung and/or heart disease) and those 70 years or older. EVR has very good short-term results (under 10 years). This procedure utilizes catheter-assisted placement of a stented graft in combination with both a surgeon and an interventional radiologist. This stented graft is opened from within the channel that blood flows to exclude the AAA. EVR has a lower complication profile and shorter hospital stay (usually less than 2 days) but with higher total costs. Follow-up imaging over several years is required.
Conservatism might be chosen by your physician is situations of a small AAA, horrendous heart disease, short life expectancy, or in a patient with cancer.
When should I consider AAA repair?
After discussing options with a surgeon by the time the AAA is at least 4.5 cm. New symptoms of back or hip pain in a patient aware that they have an AAA. Consistent enlargement in size over consecutive 6-12 month intervals. Family member having had a ruptured AAA.
If you have questions or desire a screening test, please contact us via e-mail or call our office.
Varicose Vein Treatment
Millions of Americans have varicose veins of the legs. Most do not even know that they have vein reflux. The veins of the leg normally carry blood back to the heart. Within the larger veins of the leg, one way valves are present to prevent blood from falling towards the feet (reflux). A leaky or damaged valve allows pressure to back up into smaller veins causing them to become varicose, similar to the damming of a river. As the varicose vein enlarges, it causes uncomfortable symptoms.
The large majority of varicose veins of the legs are cause by vein reflux. More than 75 million Americans have venous reflux disease. Of these, approximately 25 million have symptoms of pain, burning, itching, tiredness/heaviness, and swelling of the legs, often with enlarging varicose veins. This is more people than are affected by coronary heart disease. Are you bothered by these symptoms throughout the day? Do your progressively feel tired, heavy, or achy? If so, chances are that you suffer from vein reflux.
Left untreated, vein reflux can lead to complications such as the darkening of the skin of the lower leg, skin breakdown/ulcer formation, and bleeding. This reflux even increases your risk of phlebitis (vein irritation or infection) and localized thrombophlebitis (vein clotting). Years ago, either compression stockings or vein strippings were offered as long-term treatment options. Vein strippings often left patients with a painful, bruised leg which prevented them from returning to work and recreational activities for weeks.
Today, catheter-based technology exists to allow radiofrequency energy to be applied directly to the refluxing vein which causes it to shrink and scar down (close). This stops the blood from refluxing down the offending vein. Approved by the FDA in 1999, the Closure procedure (VNUS Medical Technologies, Inc.) is a minimally invasive outpatient procedure that is very effective and widely embraced by vascular surgeons. It offers a much lower post-operative risk profile (pain, bruising, infection, localized numbness) and a quicker return to normal activity than does a vein stripping. More than 100,000 Closure procedures have been done in the United States. Ninety-eight percent of patients treated with the Closure procedure would recommend in to a family member or friend. The first 5 year follow up of Closure patients was reported in 2005 from a multi-center clinical registry showing an 85% success in stopping vein reflux.
The Closure procedure is performed while lying or a procedure table. Ultrasound imaging is used to assist in getting access to the refluxing vein with a small needle. A radiofrequency catheter is advanced under ultrasound guidance to the top of the vein planned to be treated. Local anesthetic is placed around the vein to insulate it and deepen it from the skin surface. Radiofrequency energy heats the vein while the catheter is pulled back. Afterwards, there is usually no more than a single suture placed. The leg is wrapped with mild compression for 24-36 hours. Patients may return to normal activity usually within 24-36 hours. Over-the-counter pain medicines are recommended for short term relief. Post-operative ultrasound evaluations of the treated vein are required during the first year. Most insurance companies provide coverage for this outpatient procedure. Help is just a phone call away.
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Links & Resources
These websites contain helpful information about general surgery, cancer care and the facilities where our surgeons practice.
American College of Surgeons
Susan G. Komen Foundation
American Society of General Surgeons
American Cancer Society
UNC - Chapel Hill Lineberger Cancer Center
Carolinas Medical Center-NorthEast
Gateway Surgery Center - Outpatient Surgery Center
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