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At just 32 years old, Ashley Rochester is in the prime of her life. She and her husband, Nathan, who she started dating in high school, have been married for 10 years. Together they have an 8-year-old son, Easton. As a busy mom who also works full-time as a Certified Medical Dosimetrist at Erlanger’s Cancer Center, Ashley stays on the move while keeping up with her son’s activities. In 20 15, Ashley started to experience pelvic pain and other issues that started with a 9 cm ovarian cyst.

“When my doctor surgically removed the cyst, she commented that I had some large varicosities in my pelvis, but it never registered in my mind that those enlarged veins might be contributing to the terrible pelvic pain I was experiencing,” remembers Ashley. “After the cyst was removed, my pain continued, and I had so much pressure and swelling, especially the week before and during my menstrual cycle. So I felt like I only had two weeks out of the month that I felt somewhat okay, the other two were miserable.” 

For several years, Ashley did her best to ignore the dull pain, pressure, and occasional constipation as well as the intense pain she felt after having any type of intimate moments with her husband.

 “I felt too young to be going through this, but I didn’t know what to do,” says Ashley. In January 2019 Ashley ended up in the emergency room, where a pelvic ultrasound picked up the presence of these enlarged veins. A CT scan was quickly ordered to provide more information and ultimately confirmed that she in fact had extremely large pelvic varicosities. 

Ashley met with Dr. Michael Greer, vascular surgeon with University Surgical Associates. He diagnosed her with pelvic vein congestion, a condition that occurs when pelvic veins become swollen and painful due to low blood flow – like the varicose veins that can develop in your legs. Pelvic vein congestion is often the result of pregnancy and the pressure put on the pelvis from carrying a baby. 

Women with multiple pregnancies are at even higher risk. Dr. Greer recommended a procedure called pelvic vein embolization, a non-surgical, minimally invasive approach that relieves the heaviness, pressure and chronic pelvic pain.  

A Non-Surgical Procedure

During pelvic vein embolization, a venogram is performed where a small catheter is inserted to inject a dye into the dilated vein, providing a road map of what’s happening inside. A synthetic material or medication called an embolic agent is used to seal off the abnormal blood vessels. Sometimes coils are used to block larger vessels, causing blood to be rerouted to other smaller veins and relieve pressure caused by stagnant blood flow. Pelvic vein embolization is a highly effective way of blocking the blood vessel, without the need for open surgery – resulting in less pain and a quicker recovery than an open procedure.

“During the procedure, I discovered that in addition to a problem with her left ovarian vein, Ashely’s left iliac vein was almost completely compressed, which required a stent to be placed to restore proper blood flow,” says Dr. Greer. “When a stent is needed during this procedure, it takes a little longer to recover from any cramping and discomfort, usually lasting less than a week.” 

“Because of the stent, I stayed in the hospital overnight so that they could appropriately observe and monitor the post-operative pain and discomfort. Otherwise I would have more than likely gone home the same day,” says Ashley. “I was uncomfortable due to some muscle spasms, probably from the stent, and had little twinges of pain in my back and pelvis for three or four days. After a week, I was feeling pretty good and already noticing a drastic improvement in my pre-operative symptoms.  After three or four months, all of these symptoms were completely gone and I felt 110% better! 

Comforting and Compassionate Care 

While under the care of Dr. Greer and his team, Ashley felt comforted, accommodated and cared for completely. From the front desk all the way to the surgical team, the experience was top-notch. “Dr. Greer and his nurse practitioner Mary Ann took so much time talking with me, explaining the procedure, answering my questions and helping me feel comfortable throughout the entire process,” says Ashley. “If you are experiencing these symptoms of pelvic pain, bloating and discomfort and you can’t find a cause, you definitely need to see a vascular surgeon like Dr. Greer. I wouldn’t hesitate to have this surgery again.” 

Since her surgery and recovery, Ashley notes that several aspects of her life have dramatically improved. In addition to the restored intimate relationship she has with her husband, Ashley most enjoys the fact that she can live an active life without reservation. 

“I wouldn’t feel good day to day and it really interfered with our lives. Our family enjoys being outdoors and we would be at the lake, spending time on the water, and I would have to stay back at the camper while Nathan and Easton went out on the Jet Ski because I did not feel well. That’s not true anymore,” says Ashley. “Instead of always having to sit down and rest, I’m activity participating in my life. Now I can do what I want to do.” 

Don’t let pelvic pain interfere with living your life! If you think you may have pelvic vein issues, click here to take our free online vein assessment. Click here to learn more about pelvic vein congestion, or call (423) 267-0466 to schedule a consultation today. 

Posted by University Surgical  | Category: Vascular

The Colors of Cancer

June 20th, 2019

Bursts of purple and orange in a summer sunset. Smoky gray skies before a thunderstorm. Rippling teal waves in a Caribbean cove. Color can evoke happy emotions and memories. But when these same colors are applied to ribbons and worn in a single loop on a lapel, the emotions are much different. 

Over the years, we’ve adopted colors for representing types of cancer; purple for pancreatic, teal for ovarian, pink for breast. The surgeons of University Surgical Associates (USA) are all too familiar with the many colors of cancer, meeting patients every day in the office and the operating room to fight and manage this disease. They remain dedicated to providing excellent and compassionate care to patients facing a cancer diagnosis. When it comes to cancer, a collaborative approach to diagnosis and treatment often results in the best outcomes. That’s why USA surgeons participate in interdisciplinary tumor boards (also called cancer conferences) to provide the most thorough and advanced care for people with cancer.  

Improving Care - One Discussion at a Time

Since cancer is complex, it often requires multifaceted treatment recommendations. These recommendations are made based on a person’s medical and family history, current health, and treatment options and goals. Their situation presents a specific set of challenges in how they may respond to treatment. That’s why a thorough review and thoughtful discussion among physicians and other professionals mean you benefit from the expertise of not just one physician – but of an entire cancer-fighting team. 

“Treating cancer is not always clear cut, and we come together to review and find a better understanding of each patient’s personal situation –it’s like every patient gets a free second opinion from multiple clinicians on their care plan,” says J. Daniel Stanley, M.D., USA general surgeon who specializes in colon and rectal surgery. “Because there are subtleties in every cancer and every person has a different set of health factors, we can adjust the standard guidelines to tailor a treatment plan for every individual.” 

This round table discussion brings together the expertise of surgeons, medical oncologists, radiation oncologists, pathologists, radiologists, nurse navigators, social workers and other medical professions to discuss every aspect of a person’s cancer diagnosis. All this to determine an optimal treatment plan. The primary physician will give a presentation on each patient and the initial diagnostic tests, and specific circumstances that might impact the way the cancer is treated. Various specialists will discuss the location of the tumor, how aggressive or non-aggressive the tumor may be and any peculiarities that may already be known. 

“The primary doctor ultimately takes responsibility for the recommendation he or she makes to their patient,” Dr. Stanley says. “And sometimes that means objectively presenting the advantages and disadvantages of several treatment plans and determining the best course of treatment together.” 

USA surgeons provide cancer care for breast, thyroid, pancreatic, liver, colon, rectal, and skin cancers, melanoma, pediatric cancers and more. For more information find us at or 423-267-0466. 

Celebrating Survivorship

Nearly all USA surgeons play a role in cancer treatment and are dedicated to providing the most advanced care available. They work in step with other cancer treatment experts, and community resources to support patients every step of the way – from diagnosis to recovery. As part of our commitment to collaborative care, USA hosted a tropical-themed Survivor’s Lounge at the inaugural Colors of Cancer 10k and fun run on Saturday, June 15. 


Women in Surgery

June 11th, 2019

Shauna Lorenzo-Rivero, MD, FACS, FASCRS 

Dr. Shauna Lorenzo-Rivero earned her medical degree from Washington University School of Medicine in St. Louis, Missouri. She then completed a general surgery residency at the University of Iowa Hospitals and Clinics in Iowa City, Iowa before completing a colorectal surgery fellowship from the Ferguson Clinic in Grand Rapids, Michigan. Dr. Lorenzo joined USA in 2008.

Dr. Shauna Lorenzo-Rivero has a unique focus – when you meet her, you immediately know her priorities and see her passion. Read on as Dr. Lorenzo shares the unlikely way she was introduced to surgery, her drive to increase colorectal cancer awareness, and what she finds most rewarding about her career. 

Dr. Lorenzo served as president of the Chattanooga-Hamilton County Medical Society in 2017, where she focused on building upon the fundamental services of the Medical Society while also making the Society more visible to the public and patients, not just the medical community.


A: “In 3rd grade, my neighbor’s father came to our class to talk about his career. He was an ophthalmologist and let us dissect cows’ eyes during his presentation. I came home that night and told my parents that I wanted to be a surgeon – and I never changed my mind. 

Until medical school, I didn’t realize how many different types of surgeons there were. I did three rotations – trauma, plastic surgery and colorectal – and that helped me decide what was right for me. Colorectal surgery made use of some of the most advanced instruments, and that really intrigued me. The colorectal surgeons I followed during my residency were some of the happiest, and that also really stuck with me. 

My one concern was that I couldn’t stand the smells associated with this specialty, and it nearly made me change my mind. A wise professor told me not to worry and that my sense of smell would be gone within a year, and he was right. It’s not something I even think about anymore." 

Dr. Lorenzo and her husband, Jeremy O'Brien, at the Greater Chattanooga 
Colon Cancer Foundation
's annual Rump Run. 

Q: How did you develop a specific passion for colorectal cancer awareness? 

A: "For me, being a surgeon isn’t a job that I do. It’s something that I am 24 hours a day – I’m always a physician and thinking about my patients and helping them maintain a healthy lifestyle. Ten years ago when I came to Chattanooga, there were awareness events for breast cancer and melanoma and others, but not colorectal cancer. 

It turns out that Tennessee has one of the highest rates of colon cancer in the U.S. In Chattanooga, black women have twice the rate of colon cancer as white women. Black men have four times the rate of colon cancer than white men. I felt compelled to do something about it. I started the Greater Chattanooga Colon Cancer Foundation to educate our community about the importance colon cancer screening and to conquer the disease through awareness, access and advocacy. We began with an annual event called the Rump Run, which was initially about raising awareness, but has grown into helping people who can’t afford it find access to colonoscopy screenings." 

Q: What is a misconception people have about surgeons?

A: “There have been a lot of changes in the last 10 years about the way people view surgeons and medical professionals. When I was in medical school, surgeons were seen as gods and not to be questioned. With the introduction of television shows like Grey's Anatomy and others, it’s brought down the wall and air of mystery around our work. In some ways it’s good to be able to see your surgeon as a human and poke a bit of fun at things. But I also believe it has eroded the physician-patient relationship a bit. Although you should talk openly with your surgeon and ask every question you have, you ultimately must leave some of those major decisions to their professional discretion. That’s why it’s critical to find a physician you trust completely. 


A: “I love when my patients come back after surgery and have found relief for whatever problem we were addressing. It’s wonderful to see patients after the healing period is over get back to their normal lives and live like nothing ever happened. Seeing them out in the community is very rewarding. 

Another area that brings me joy is the Lady Surgeons Club founded my me and my colleague Dr. Laura Witherspoon. We noticed that women in our residency program were leaving in their second or third year, and we found that concerning. We began meeting once a month over dinner, providing an opportunity for younger women surgeons to ask questions, seek advice and talk openly about the unique issues they faced in their work and life. Although we have no formal agenda, we always have plenty to discuss. I’m very proud that we haven’t lost a single female resident since the group was founded."

Dr. Lorenzo is board certified through the American Board of Surgery and American Board of Colorectal Surgery. She specializes in general and colon and rectal surgery. Dr. Lorenzo is an associate professor of surgery, Department of Surgery, for the University of Tennessee College of Medicine, Chattanooga, a fellow of the American College of Surgeons (FACS) and American Society of Colon and Rectal Surgeons (FASCRS)

Dr. Lorenzo has office hours at USA's Surgical Specialties Building on Tuesday (9 a.m. – 3:30 p.m.), Thursday (1 p.m. – 3:30 p.m.) and Friday (8:30 a.m. – noon). Dr. Lorenzo performs surgery at Erlanger Hospital, CHI Memorial Hospital, Parkridge and Parkridge East Hospitals. To schedule an appointment, call (423) 267-0466.