Surgeon takes matters into his own hands - Tepas Healthcare

June 7, 2012
Written by George White for FLORIDA TODAY

In some ways, Dr. Clifford Gelman feels like he was born to become a surgeon.

“I’ve always been good with my hands,” he said. “When I was younger, I used to draw a lot and build models and paint little soldiers, so I’ve always been good at meticulous detail things for a long period of time.” Unlike many other forms of practicing medicine, surgery offers a chance for a doctor to cause dramatic outcomes in a short period of time, he said.  “There’s a lot of immediate gratification with surgery. If they have a hernia, you take them to surgery and an hour later, they don’t have a hernia anymore. I like that aspect as well. If you have a tumor, you can’t cut it out yourself. I like being a person that can do something kind of special that not everybody can do,” he said.

Gelman talked about his career and advances in less-invasive surgical procedures.

QUESTION: Of the innovations during your career, which has had the biggest impact on surgical outcome?

Gelman: The laparoscopy is probably the major one, but born out of that, a lot of the technology and surgical instruments we use have made surgery a lot easier and lot less traumatic for patients as well. The idea is to make it less invasive. As the technology
advances, the bottom line is that it’s less pain and a faster recovery.

Q: What do you think about robotic surgery?

Gelman: I haven’t done any procedures, but I’ve played with the machine and readabout it. It’s one of these things where we’re trying to find where it’s appropriate. A lot of people joke around and say it’s a technology waiting for an indication. Robotic surgery is going to find its place, but it’s yet to be determined where that place is. It does allow better access to certain areas. To get the learning curve for using the devise, you start out with these smaller cases, like gall bladders, things that you don’t need to use it on, but you get the experience. Then, when you start to do the cases where it is appropriate, you’ve had the opportunity to use the technology.

Q: Have improved diagnostics caused cancers and other conditions to be detected earlier, therefore prompting better outcomes?

Gelman: I believe so. Ultrasound has been around a long time, but it has improved. With the thin-slice digital CT scanners and MRIs, those have really exploded the diagnostic capabilities and being able to find small tumors and details. Now with the 3-D scanners, you can almost formulate a 3-D model of the patient’s insides, which is amazing, so that does help a lot.

The caution is not to rely too much on the technology. There’s a potential for higher cost of care if you get CT scans on everyone. And, CT scans have a little bit more radiation than we originally thought, so the judicious use of those technologies needs to be maintained. The digital mammography and the PET scanner is an amazing technology. Once someone is diagnosed with cancer, you know that there is an increased risk that they would have other tumors, so you want to look closer. Once you find it, you would use other modalities like ultrasound to zero in on it. It can get complicated sometimes.

Q: For issues of the colon, there is the colonoscopy, which can discover and assist in the removal of precancerous growths. Are people still reluctant to get that test?

Gelman: To be honest, the most reluctance has to do with the preparation for the procedure, when you have to drink all that stuff, because they don’t feel anything. The last thing you remember is you are going into the room. It’s very important in preventing colon cancer, especially in high-risk cases. It’s one of the most easily detected cancers. If it’s there, you’re going to see it. There’s also a PET scan for the breast now called a PEM.

Q: Are women getting checked earlier for breast cancer?

Gelman: For more women, age 40 is when you start your mammograms. When you listen to the American Cancer Society and other groups, you go every two years, but most say one year apart. They could start earlier if there is family history of it or other high-risk factors.

With all the gene research that has gone on now, we can detect certain patients who are at high risk for breast cancer. If you know that in advance, there are things you can do to reduce that risk. Now there’s also onco-typing to find out what that tumor
will specifically respond to. Now, they can better tailor the therapy by looking at the specifics of the tumor.

Q: What is the biggest post-op concern for breast cancer patients?

Gelman: There are different surgeries for breast cancer. With mastectomies, No. 1 it’s  mobility of the shoulder and the arm, infections, and oftentimes, you’re taking lymph nodes out from under the arm, which can lead to arm swelling.

Q: How do you go about breaking bad news to your patients?

Gelman: I think patients appreciate a direct approach. I think they like to hear exactly what’s going on. I tell them pretty directly, but I try to follow up with the better news that it looks like a treatable lesion and there’s a very good chance of a cure. I spend a lot of time after the diagnosis discussing all the treatment options and the pros and cons of each one. I like my patients to decide, once they have all the information, what they think is going to be right for them.

Q: What is your favorite part of your job?

Gelman: My favorite part is when somebody comes back for a follow-up from getting their gall bladder out. Sometimes they had not felt good for months or years.  They get their gall bladder out and they come back and they are just so happy they can eat whatever they want, and they feel good. Same thing with patients that have chronic heartburn. All the sudden, they don’t have to take medicine and they can eat pizza.

Q: What is most difficult?

Gelman: The most difficult part is when the disease kind of wins. Somebody comes in with breast cancer and everything looks great. It’s a small tumor, you take out it, they do the radiation, and then three months later they get a CT scan and it’s in their lungs and liver. It’s the futility that I hate the most. There are some things that are futile, but that’s the least likely.

Hometown: Born in Los Angeles, raised in Northridge, Calif.
City of residence: Melbourne Beach
Family: Wife, Julie
Hobbies: Gourmet cooking, boating, playing piano
Education: Bachelor of science in biology, UCLA; Rush University College of Medicine in Chicago;general surgery residency at Rush University Medical Center;  three years at Patrick Air Force Base as general surgeon; extra training in thyroid and parathyroid surgery.
Contact: TEPAS Healthcare, 1140 Broadband Drive, Melbourne; 321-733-1901