Ask the Doc

Thyroid awareness month

With January being Thyroid Awareness Month, I want to focus on the thyroid gland – how it helps and how it can cause trouble.

The thyroid is an endocrine gland that makes, stores and releases thyroid hormones into your blood to help control your body’s functions, including body temperature, weight, energy level and heart rate. It is located at the base of the neck, just below the Adam’s apple, and is shaped like a butterfly with each wing, or lobe, on either side of your windpipe.

Think of the thyroid gland kind of like a moody teenager. When it is functioning properly everything is just fine; you have energy and you feel good. But when it doesn’t work, life slows down to a crawl. It may be hard to be productive and you just might not feel right. When the thyroid works too much on the other hand you might be overactive. A normal thyroid gland regulates your metabolism; a catch all term for the function of all the little systems in your body that make you, you. 

Just like a thermostat on your furnace or an accelerator in your car, your thyroid gland can get set too high or too low. The most common problem associated with the thyroid gland is when it is set too high.  This is called, appropriately, hyperthyroidism, because of how it makes you feel. With hyperthyroidism your heart can beat faster, you can feel anxious, you might lose weight, the house might feel too warm and your hands might start shaking. There are a number of different causes of hyperthyroidism.

Treating an overactive thyroid depends on the specific cause and can include taking medication to reduce the amount of hormone made by the thyroid gland, taking a radioactive iodine pill that actually kills off the thyroid gland cells or surgery to remove part or all of the thyroid gland. 

Hypothyroidism is when the thyroid is set too low. Hypothyroidism can be caused by a mistake in your immune system where your own body attacks your thyroid gland. Usually hypothyroidism can be treated with a thyroid hormone replacement pill that is taken every day.

There are also tumors of the thyroid gland; the vast majority of which are not cancer. The ones that are cancer make up about 5 percent. Make sure you have a good primary care doctor and see him or her once a year.

There is one other thing about the thyroid gland that I find fascinating. Just about every country in the world tests newborns for hypothyroidism within the first week of life. This is because there is about a one in three thousand chance that a baby will be born without the ability to make enough thyroid hormone which can lead to permanent intellectual disability and growth failure if not treated. This one small test and simple treatment can save over forty thousand children and their families from a terrible disease every year. When you think about the societal consequences to the disease, that is a remarkable win for all of us.

Breast cancer awareness

It’s amazing what health concerns we detect when taking a shower. Patients come see me all the time who have found a lump or a bump while taking a shower. Although you aren’t intentionally examining yourself; while washing in the shower you run your hands, a wash cloth or a bar of soap over every surface of your body. When you get out of the shower, you stand in front of a mirror and rub a towel over your body again. Somewhere in there, if you are paying attention, it can become obvious that something is different than it was the last time you took a shower.

It’s October and breast cancer awareness month. When we talk about breast health, mostly we talk about breast cancer and for many, it can do real damage if you ignore the signs and symptoms, and don’t get help early. Learning more about breast cancer will help remind you to pay attention to your body and encourage you to do breast self-exams.

What do I mean by a breast self-exam? I hear often that patients are sure what to look for when doing their own self-exam. Basically, learn what your breasts feel like and then when an abnormality shows up it can be pretty obvious that there is something different: something that doesn’t belong or wasn’t there the last time. When you are doing your own exam you aren’t looking for anything in particular, you are looking for anything that is different. It’s like going for a walk in the beautiful north woods: the more you walk down a particular trail, the more you will recognize what belongs there and what doesn’t.

Most women have some areas of their breasts that are firmer than others, especially before menopause. And, breasts can feel different depending on what day in the menstrual cycle the exam is done. Breasts also feel different during pregnancy, breast feeding and after weaning your baby. The point is, your breasts will occasionally feel different, but you will begin to recognize the cyclic differences and that will make it easier to find anything that feels out of place. 

If you find something that is different, call your primary care provider right away. If an office breast exam is uncomfortable to you, try taking Tylenol or Aleve a couple of hours before your appointment. Your provider has tools to help diagnose any abnormality they might find in your breast: ultrasound, mammograms and MRI are all studies that can be used. Mammograms are so useful that they are recommended as a regular screening tool to help find breast cancers so small that no one can feel them deep in the breast. Your provider can help you decide when to start getting mammograms and how often to get them.

Find out what your risk of developing breast cancer is. Ask your provider about genetic testing, limit alcohol intake, don’t smoke, control your weight, breast feed, limit your dose and duration of hormone therapy, avoid unnecessary exposure to radiation and environmental pollution.

You know your body better than anyone. If you notice something, yes, it’s scary, but the sooner you get it checked out, the sooner you’ll know what’s going on.

Screening for Colon Cancer

While I’ve never known anyone who wanted colon cancer, I’ve also never known anyone who actually wanted a colonoscopy.
 
I remember when my dad turned 50 and his doctor told him he had to have one. He called his son “the doctor” and read me the riot act about the prep he had to take. That was more than 30 years ago and I still remember laughing that it was the only thing he ever yelled at me for that I hadn’t actually done. Having had a couple of the procedures, I see where he was coming from.
 
The thing about colonoscopy is it isn’t painful; it’s just inconvenient. You have to plan an evening around being close to the bathroom and spend a few hours at the hospital mostly waiting for a 15-45 minute procedure. When I talk to people before their procedure, those who have been through it before are all about just getting it done. People having their first colonoscopy are sometimes anxious and sometimes embarrassed. I understand those concerns: I’ve been on both ends of the scope.  
 
At HSHS St. Clare Memorial Hospital, it’s about low stress and good outcomes. I am always impressed with the sense of family at our hospital. The nurses, techs, assistants and providers are like a family and understand that the people who trust us to care for them are being welcomed into our family. When you walk in the door, you become the most important member of the team – the reason we are here.

The process will go something like this: the procedure is performed in the surgery department. You will be taken to a private room where you change into a hospital gown and are given a warm blanket to keep you comfortable. The only discomfort is the IV that is placed by one of our experienced nurses. Your family is welcome to stay with you until you are wheeled into the procedure room. When you get to the procedure room, you will meet the team that will care for you during your procedure. This entire team is responsible for your safety and the coordination of your care. The lights are turned down a bit, the anesthetist starts running medication and you fall asleep. During the procedure, the anesthetist never leaves your side. They monitor and document your heart rate, blood pressure, respiratory rate and level of comfort.
 
Once the procedure is complete, you are taken to the recovery room. After you wake up, the recovery room nurse will bring you that first cup of morning coffee you missed or a glass of juice and a muffin. Once you are awake and alert, the doctor will talk to you and your family, and then it is time to head home.
 
The procedure really goes so quick, that most people are surprised to find that the procedure is over and they have no recollection other than moving into the room and the lights going down. Speaking from experience, I can tell you it’s nice to wake up and know that you didn’t feel a thing.
 
To learn more about when you should have a colonoscopy, click here.

Contact Richard McNutt, M.D., General Surgeon at (920) 965-7411

Can I live without my gallbladder?

This is a question I get often after recommending someone should have theirs out.
 
The gallbladder is like a little waterproof sack that sits under the liver at the lower edge of the right ribs. It connects to the liver by a system of little tubes, called ducts. The ducts connect to the first part of the small intestine, called the duodenum. The function of the gallbladder is pretty simple. It is a little storage bag for chemicals that drain out of the liver. Those chemicals are stored in the gallbladder until we eat a fatty meal. When we eat fat, the gallbladder squeezes the chemicals into the intestine. The chemicals act sort of like dish soap to help break down fat so that it can be absorbed into the body and used as fuel. In a nutshell, the gallbladder sits around waiting for us to eat fat.
 

So what can go wrong with the gallbladder?

Most people think about gallstones when they think about gallbladder problems. Gallstones remind me of beads you find in a bead shop. Some are the size of sand and some are as big as a chicken egg. Common gallbladder problems boil down to irritation of the gallbladder lining and blockage of the tubes that drain the gallbladder. Both of these problems can be caused by gallstones or can happen without gallstones.

What does a bad gallbladder feel like?

Having a bad gallbladder can cause a little nausea or it can feel like you got run over by a truck. Some people say that they have mild nausea, more burping than usual and maybe a slight discomfort under the right ribs. Other people say it’s the worst pain they ever had in their belly, back and right shoulder. They throw up uncontrollably and feel miserable.

How do you live without it?

It all has to do with fat. Your gallbladder absorbs quite a bit of fat at one meal. Without a gallbladder, you can still absorb fat, just not as much at one time.
 
I have wondered why we are made the way we are. I like to try to think about it in terms of what life was like when we came about. It was difficult for early humans to get fat in their diet. They ate what stood still (plants) and only occasionally could catch an animal with fat on it. That’s where the gallbladder comes in. The gallbladder allowed early humans to absorb much more of the limited amount of fat they ate.
 
Today, the amount of fat in our diet is crazy. That is why we can live without a gallbladder. In fact, the excess fat in our diet plays a role in making our gallbladder go bad in the first place.  

Contact Richard McNutt, M.D., General Surgeon at (920) 965-7411

What kind of surgery do you do?

This is probably the question I get asked most often – by my family, friends and patients.  
 
It’s hard to keep track of all the types of surgeries I’ve done over the course of my career. The greatest variety occurred during my training, when I operated on brains, bones, hearts and every body cavity including the head, chest and belly. The only type of surgery I haven't done is a joint replacement. I was fascinated by every one of these surgeries and I learned something from all of them and continue to be a student of medicine and surgery even at my age of 60.
 
When I started my practice to Oconto Falls, I wanted to focus on the kind of surgeries that belong in a small town hospital, including:  

• Hernias of all types done with minimally-invasive laparoscopic approach or the open approach depending on what is best for the patient
• Thyroid surgery for nodules and cancer
• Skin surgery to remove lumps and bumps
• Skin cancer
• Gallbladder, stomach and intestine surgery for gallstones
• Colon cancer or infections such as appendicitis
• Breast biopsy and lumpectomy
• Varicose vein surgery with the minimally-invasive VNUS technique
• Wounds and ulcers
• Ingrown toenails
• Ganglion cysts
• Colonoscopy to look for polyps and cancer
• Upper endoscopy for severe heartburn, ulcer disease and infections of the stomach

For more complex surgeries where advanced care may be needed, our sister hospitals in Green Bay – HSHS St. Vincent Hospital and HSHS St. Mary’s Hospital Medical Center – are perfect for those instances.
 
We are here to provide high quality care, close to home. Think about having surgery and then having a long car ride home, Ouch! Or a colonoscopy, yikes! We are here so that your family is close by to provide you with the support and care you need.  

Contact Richard McNutt, M.D., General Surgeon at (920) 965-7411

Will surgery hurt?

That is a question that even I have wondered more than once.  Pain is incredibly interesting; there is more to pain perception than we know. The complex nature of pain perception never ceases to amaze me. But, you and I know everything we need to know about pain; we don’t like it and we don’t want it.

However, it’s tough when temporary pain is a part of solving a bigger problem. Not one person I have operated on for colon cancer wanted the surgical pain, but no one wanted to keep the cancer, either. So, how do we make the temporary discomfort associated with surgery as little as possible, while still getting the benefit we expect from surgery?

There are consequences to experiencing pain other than the “ouch” factor. Having pain can result in other things occurring to your body. Pain can cause your heart to beat faster and your blood pressure to go up. It can change the way your blood flows to different organs. Pain can also cause your body to send chemicals, like cortisol and epinephrine, to move around your insides. Pain can even cause different cell types to push into your blood stream. Some of the things that happen to your body when you experience pain can result in problems like poor wound healing, blood clots in the legs and pneumonia when the pain keeps you from moving around enough after an operation. It is in all of our best interest to reduce pain after surgery so that we can avoid trouble.

Different methods of pain control come with different kinds of risks. Even aspirin used to excess can cause stomach ulcers. Acetaminophen, the active ingredient in Tylenol, can cause liver problems if taken incorrectly. And, opiate addiction can come from codeine, oxycodone, hydrocodone and morphine.

At HSHS St. Clare Memorial Hospital, we do some unique things to limit the discomfort. The first is what you experience even before you walk in the door. Surgery can be frightening and that fear can make it easier to feel pain. Our office staff works to make scheduling surgery a clear, orderly and painless process. They will walk you through the process as many times and in as many ways as you need so you are comfortable with where to go and when to get here.

We are conveniently located on Main Street in Oconto Falls. When you get to the hospital there are people just a few steps from every entrance that will help you get to where you need to be.

At registration, you can find  When you get into the surgery area you will meet our surgery staff: a dedicated group of professionals who could work at any hospital anywhere, yet they choose to drive in from Coleman, Pound, Peshtigo and right here in town to take care of their neighbors and friends. They know how to put you at ease and get you settled in.

When it comes to actual pain control, the anesthesia staff is where the rubber meets the road. As important as it is to be relaxed and comfortable going into the operating room, our anesthesia staff bring it all home. They are remarkable professionals who have years of training and experience from places like the University of Minnesota and the Mayo Clinic. Their work starts when they talk to you about how we are going to manage your pain in the operating room and after surgery. This is the only group of anesthesia providers I have ever known who not only manage pain in the operating room, but also in the recovery room and on the nursing floor after surgery. Anesthesia can do wonderful things with nerve blocks, pain catheters, epidural injections and combinations of medications that are unique to their world of anesthesia. Not only are they well trained and talented, they care.

If you need to stay overnight, the nurses and certified nurse assistants on the nursing floor make sure that you are safe, your pain is controlled and that you are cared for.

I do my best, too, as a surgeon to minimize the pain of surgery. I have spent years learning minimally-invasive techniques and I have a commitment to handling tissue gently to minimize the trauma.

In short, pain is a part of the healing process after surgery. But at HSHS St. Clare Memorial Hospital we do our best – from start to finish – to understand your pain and individualize your treatment so that you feel better faster.

Contact Richard McNutt, M.D., General Surgeon at (920) 965-7411

Skin cancer

Being outside and enjoying the sunshine it is part of what makes being “up-north” so unique – a blessing for all of us who live here. However, that sun carries with it not only light we can see, but light we can’t see called infrared radiation (IR) and ultraviolet (UV) radiation. When you look at a rainbow, you see red, orange, yellow, green, blue, indigo and violet. The light actually starts before the red, as infrared, and continues after the violet, as ultraviolet – we just can’t see those colors.

UV light has the ability to change the cells that make up our skin. The part affected is the DNA deep inside the cell: UV light can break DNA. I always thought DNA was this permanent thing that defined who we are. It turns out, DNA in our cells can be broken and repaired by our body’s natural defenses. Damage to DNA left unrepaired can lead to cancer; melanoma is one of those cancers.

Most health care providers are taught that avoiding sun exposure during high UV months is the most effective way to reduce our risk of developing melanoma. You can still go outside – just take reasonable precautions with sun exposure. The UV index may be useful in deciding how much skin to expose and for how long. This was developed in 1992 in Toronto, Canada.

There are also things that increase our risk of developing melanoma that may help you decide how much sun exposure you personally want:

• fair complexion
• skin that freckles but doesn’t tan
• blue or green eyes
• red or blond hair
• history of many bad sunburns as a child or teenager
• large moles or lots of little ones

All of these factors increase the risk of developing sun-related melanoma.

When I think about melanoma, I am reminded of the patients I have cared for with the disease, as well as friends and family who have dealt with this really nasty cancer. My younger brother was a mountain climber and spent quite a bit of time at high altitudes where the sun shines in a thin atmosphere and the UV index can be very high. He developed a malignant melanoma on his nose that required surgery and a skin graft.

The key to an improved outcome in treating melanoma is an early diagnosis. Prevent what you can, diagnose early, treat completely and follow up. The great part is that with melanoma – prevention, early diagnosis and follow up can be done at home. Look at your skin or have someone who loves you look at your skin on a regular basis. If you find something that wasn’t there before, get it checked out. There is an easy checklist that helps decide what is worrisome. Remember,

• Asymmetrical
• Border irregularity
• Color variation
• Diameter over 6 mm
• Evolution

If there is something on your skin that isn’t round, has multiple colors, is wider than a pea or has grown, changed color or is new, then see your health care provider. I encourage people to take pictures of any areas that they wonder about and compare them over time. As far as treatment goes, surgical removal is the cornerstone. If cancer is the diagnosis, chemotherapy and immunotherapy are making advances that are improving survival rates.

Remember to take care when you enjoy the great outdoors, but do get out there and enjoy it. With care the risk is small and the benefits for both your physical and mental health are incredible

Contact Richard McNutt, M.D., General Surgeon at (920) 965-7411