Texas Tech El Paso professor/surgeon Dr. Alexandros Flaris talks about common conditions he sees as a general/endocrine surgeon and more in this health news segment.
KC Counts:
First, I'd like for you to tell us about the common conditions that you come across in your work and that you see in this region.
Dr. Alex Flaris:
So 2 parts, for endocrine surgery and general surgery. For endocrine surgery, we do have quite a bit of thyroid nodules, which is to be anticipated, because a lot, half of the population over the age of 50 does have thyroid nodules. We have hyper/hypothyroidism. We also have adrenal nodules that need to be taken out. Then we have some neuroendocrine tumors. So pretty much the entire spectrum, almost the entire spectrum of what I do.
KC Counts:
You just said half of adults over 50 have some. That's a pretty shocking number to hear. And is that something that people are overlooking?
Dr. Alex Flaris:
The best way to describe it is as we grow older, you know, we develop, for example, moles on our skin. And most of them are not a problem. Some of them are, but most of them are not. So it's the same thing for the rest of the body. It is a lot of thyroid nodules, that is true. And that's why you have to be very exact as to what you're going to do and what not you're going to do, because ultimately only 5% to 10% are going to be cancerous. So it's a very low chance. And then some of them also cause compressive symptoms. So if you have a big one right on your throat, you may have issues swallowing or breathing. So that may also need to go one way or another. But even though the numbers are shocking, and I agree with you, that sounds like a lot, most of them ultimately don't require surgery, which is a good thing.
KC Counts:
I think maybe our endocrine systems are a bit of a mystery to many of us. What can you tell us in kind of basic terms about what we should be looking for and how we should be addressing any issues that we may or may not even know about?
Dr. Alex Flaris:
That's a good question. I think there's two big things. For thyroid, the processes are very slow. The only thing that I would have to say is if you feel like you have a growth on your throat, you should go get it checked out. That's the big thing. The two things that I do think are good for screening are if you have high blood pressure, there is, at this point, a new recommendation to get screened for some blood tests. Because between 5 and 20%, depending on where you're at, there could be a secondary cause that leads to your high blood pressure. And either with the correct medication or with the correct surgery, there's a chance you could be on fewer medications or no medications for high blood pressure. And that's related to the adrenals. And I think that's an important thing to screen for because so many people have, a lot more people have high blood pressure than are going to have thyroid nodules. or even adrenal nodules. And even if you can get some, you can probably change the outcome for these people to the better. And then the other thing is your calcium. So whenever we do screening blood work, a lot of times we may end up having high calcium or borderline high calcium. Just for reference, normals between 8 and 10.5. This is something that sometimes may be overlooked. Not always. At this point, we're pretty good about catching it, but sometimes it takes a while until patients and the team realize that there's something going on with that. And the follow up test is a really easy blood test as well to determine if one has hyperparathyroidism. So a nodule in their throat that could be causing that, and that could lead to sonophoresis and kidney stones. And that something can be addressed as well, readily, if you have that disease process. That's much more rare than thyroid nodules.
KC Counts:
I was going to say, I would think, once those kidney stones start moving, then most people really know that right away, right?
Dr. Alex Flaris:
Yeah, they do. It is part of the workup for that. But these will be the two things for me that I think can be changed.
KC Counts:
Interesting. Well, you know, Texas Tech sent out a news release about you, and that's how we learned about you. And the headline says, “expert endocrine surgeon uses minimally invasive techniques to treat hormone disorders”. I think that that's something that interests a lot of people any time we can find more or less invasive ways to deal with health issues. Why don't you describe what that involves?
Dr. Alex Flaris:
Okay, so a few things. The big systems that are addressed: thyroid, parathyroid, adrenal, neuroendocrine, pancreas. For thyroid, The way that we're moving towards, especially for benign nodules or non-cancerous nodules that can be causing problems, is using needles to ablate them if the size is correct and their location is correct. So if it's appropriate to do that. At this point, I'm currently working with Texas Tech. We're almost there and obtaining what we need so we can start doing this. One of my mentors who trained me back at Tulane, I think he's one who has done probably the most in the country, and he is pushing the borders on that, and I think it's very useful to do it, so you avoid having an incision. It's not for everyone that, but it is definitely an option, especially for benign nodules. For adrenals, doing it laparoscopically or robotically or doing it from the back. So the incisions wouldn't show on the front. Again, if you're an appropriate candidate. And then for neuroendocrine pancreas, traditionally, that has been done open. Obviously, more people are doing this laparoscopically at this point. Again, depending on the size and the location of the tumor, you can do this robotically with more cosmetically acceptable incisions. You could still require a bigger incision to take out the tumor, but if you do it robotically, you could do a bikini incision, for example, to pull it out instead of having it in the middle of the abdomen.
KC Counts:
I think many of us find our hormones a mystery, especially for many like me who are, you know, find themselves immediately sweating all of a sudden. You know, that period of life, I think you've addressed it to, you know, over 50 and seeing all these changes happening. But how do you know, what should we be looking for ourselves to identify whether there is something wrong with our hormones that needs a doctor's attention.
Dr. Alex Flaris:
It's a very difficult question to answer because there's so many things that go into this and it's a lot more complex. It's not only the four systems that I'm working with. There's a lot more that go into this. I think the only way really to do this is regular checkups because things will pop up. on the blood work, at least the yearly ones, and following up with your primary care physician, and then having a low threshold to go to the doctor, and then knowing your family history. So if every woman in your family, for example, does have thyroid issues, that's a good thing to know about, or if there's more people having, for example, kidney stones. or adrenal tumors, which we definitely know that has a very high chance, about 40%, that it's genetically related, or pancreatic tumors. So I think, you know, talking with the rest of the family members and... Sharing the stories, I think that's an important thing that we don't really do as much. I know that it's difficult to do up to a point for a lot of people. I come from Greece. Usually the adults, so the generation above you keeps it to themselves until it's too late and like, hey, I got cancer. And you're like, well, thanks. I wish I knew that earlier. So I think that sharing is a good thing.
KC Counts:
All right, very good. What else do you think is important for people to know that I haven't asked you about yet?
Dr. Alex Flaris:
You have a lot of good questions.
KC Counts:
Well, one thing I noticed was how few of you there are in our region. And so you're kind of training the next generation of doctors in your field. And I just noticed that I think it was a 200-mile radius that we'd have to go to find someone who does what you do. So maybe you can address some of those, you know, access disparities that we tend to see in our region.
Dr. Alex Flaris:
That's a good, that's a very good way of putting it. And that's actually one of the reasons why I wanted to come to El Paso, because I knew that there was no other endocrine surgeon. The previous The colleague, he left about a year before it got here. And I think that in the region here, it might be difficult to recruit because ofEl Paso's PR. Actually, El Paso is a great city. I didn't know about El Paso before. I mean, I knew about it, but I never visited beforehand. When I visited, I fell in love with the city. My family did as well, and the population too. But unfortunately, people outside of El Paso and Western Texas, I think, view Western Texas as an area that not necessarily be ideal to go to, which is not true again. I think that does lead to having fewer physicians. And that is always a problem. When you recruit a physician, you're recruiting the entire family. If the family's not happy here, then that's a big problem. For endocrine surgery specifically, there's not that many of us anyway because there's about 20, 25 spots, max, I don't even think we're 30 a year in the country where they do the training. So there's not that many. Usually a lot of the endocrine surgeons cluster in bigger cities. For example, Houston has a lot of endocrine surgeons, but El Paso does not. Dallas has not as many as Houston, but definitely has there. Northeast has a lot of endocrine surgeons. It's a lot easier to cluster in areas where you can do most of your subspecialty. So you could be doing endocrine surgery only, but I think that there is merit to also do your original specialty. So an endocrine surgeon at this point in time is by definition of general surgeon. And usually we spend five years of training in general surgery and then an extra year or two, depending on where you go and how much research you wanna do in endocrine surgery. I think that keeping up with your general surgery skills is a good thing. And that also, it's like bringing in two surgeons at the same time, but bringing only one person. So a person that can do both. It is different lifestyles, different qualities of life, but I think it's still a good service for the people.
KC Counts:
A 2 for one deal. Well, maybe in your spare time, you can act as an ambassador and draw more physicians to our region.
Dr. Alex Flaris:
I'm going actually to our yearly meeting like in a couple of weeks with the interviews. I want to see a bit what's going on, if anybody's interested.
KC Counts:
Well, you know, and of course, the differences between Texas and New Mexico, we're based in Las Cruces, and we've been having a lot of discussions. around attracting and retaining medical professionals. So I know that's a conversation that's going to continue. And we appreciate you taking this time to speak with us, Dr. Flaris. Been nice getting to know you. Thank you for sharing that important information with us.
Dr. Alex Flaris:
I appreciate it.
