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Diabetes is a major health issue in the United States and particularly in the southeast region of the county, where approximately 15% of the population is living with this disease. What’s more troubling is that the number of people with diabetes is expected to double in the next 20 years! 

Why does it matter whether you have diabetes? It’s simple – diabetes is destructive to your body’s blood vessels, causing unpleasant and even severe complications for your heart and blood vessels, kidneys, nerves, GI tract and eyes. Diabetes can literally affect every part of the body, but one of the most common ways is through diabetic foot ulcers. 

Diabetic foot ulcer is one of the most common complications of diabetes and is responsible for more hospitalizations than any other complication. These ulcers are open sores on the foot, usually circular in nature, occurring on the toes or heels but can be present anywhere on the foot. These may develop secondary to injury or because of a break in the skin, cuts, blisters, or foot deformity (causing callus formations that turn into ulcers). 

Any inflammation or swelling on any part of the foot, any sign of infection (redness or drainage), or any unexplained pain, gangrene, or black areas should require you to see a doctor or provider as soon as possible. If these are left untreated, they can result in infection and which can lead to amputation.  

Early detection and treatment are important because diabetics with a foot ulcer have a 60% likelihood of becoming infected and, if infected, the risk of amputation increases. Foot ulcers are the leading cause of non-traumatic lower extremity amputations in the United States.  More noteworthy, those diabetics with foot ulcers have only a 60% chance of surviving 5 years.  The survival rate of a diabetic with a foot ulcer is worse than that of breast or prostate cancer! But this statistic can be improved with the appropriate medical care.

What You Can Do 

Know the Signs 

Could you have diabetes and not know it? Sometimes the initial symptoms of diabetes or pre-diabetes can be subtle and easily missed. Talk to your doctor if you are experiencing one or more of these symptoms: 

Blurry vision
Excessive thirst
Feeling exhausted, even after a full night’s rest 
Frequent urination 
Increased irritability 
Recurring yeast infections 
Slow or non-healing wounds 

Understanding how you can control your blood sugar levels is the key to preventing the potentially dangerous complications of diabetes. Controlling blood sugars through proper insulin dosing, eating a healthy diet rich in fruits and vegetables, smoking and alcohol cessation, weight loss, regular medical checkups, and reporting any signs or symptoms about your feet are important in prevention of complications. 

How We Can Help 

Evaluating circulation is part of what we do at USA Vascular, and is one of the ways to prevent lower extremity amputation. Every individual with a foot ulcer, who has numbness in their lower extremities, tightness or pain in their calf or thigh should have their circulation evaluated by a vascular surgeon.The certified vascular surgeons at USA Vascular are the professionals best suited to treat these complicated circulation problems. 

Patients will receive a full evaluation including an exam, and frequently blood flow tests, to determine if the circulation is adequate. If there is inadequate circulation to promote healing, then correction of the circulation may be done through small catheters and placement of stents, removal of the plaque, or angioplasty. Sometimes a bypass is necessary to save a leg. Most amputations are preventable with appropriate care – that’s why seeking care early when problems arise is critically important. The longer you wait, the greater risk of amputation and other complications. 

If you have a concerning foot ulcer or any of the problems mentioned above, call us at 423.267.0466 to schedule a consultation with USA Vascular. 

Dynamic Duo Joins USA

November 17th, 2020

Welcome Dr. Alan
and Dr. Julie Koffron

University Surgical Associates (USA) welcomes a husband-wife duo to the team of highly trained surgeons providing advanced multi-specialty surgical care for people in the Chattanooga region. Alan Koffron, MD will focus on kidney transplant and hepatopancreatobiliary (HPB) surgery, and Julie Koffron, MD will focus on HPB and general surgery.  

“I am pleased to announce the addition of two outstanding surgeons to our team who will greatly enhance our capabilities in kidney transplantation as well as provide the highest level of care for benign and malignant conditions of the liver, pancreas and biliary system,” says Michael S, Greer, MD, USA president and vascular surgeon. “The level of skill, expertise in clinical practice and research, as well as the patient-centered approach to HPB conditions and kidney and liver transplantation that both Drs. Koffron bring to the table is unmatched in this area of the country.” 

Dr. Alan Koffron will serve as Surgical Director of Kidney Transplant Services and the HPB Program at Erlanger Medical Center, and on faculty with the Department of Surgery at UT College of Medicine Chattanooga (UTCOMC), where he is tasked with further establishing and expanding the kidney and liver transplantation program. Dr. Julie Koffron’s expertise is in hepatopancreatobiliary (HPB) surgery, or surgery of the liver, pancreas and biliary system. She will also join the faculty at UTCOMC in HPB and General Surgery programs. 

The Koffrons bring a unique set of skills and collaboration to surgery in Chattanooga. Their combination of education and expertise is a game-changer for people who need advanced cancer-fighting surgeries and treatments for the liver, pancreas and biliary system.  
“We work together like two sides of the same coin, each focusing on different aspects of HPB surgery,” says Dr. Alan Koffron. “We provide highly individualized treatment and often offer surgical options to patients who have previously been told there’s nothing more that can be done. Knowing our respective areas of expertise, we defer to each other’s medical judgment and work together in both treatment planning as well as in surgery to provide a nuanced and researched approach to complex cases.” 
“This is exciting progress for Chattanooga – there are no liver or kidney transplant or pancreatic cancer procedures that require a drive to another major medical center. The most advanced treatments and capabilities are here now. I’m confident that Dr. Alan Koffron and Dr. Julie Koffron will continue to provide the safe, high quality care our patients have come to expect from USA,” says Dr. Greer.  

To learn more about USA’s multi-specialty surgical capabilities, visit and click on Our Services. To schedule an appointment, call 423-267-0466.

“Our focus has always been to provide the highest level of care for our patients, taking the whole person into account, and offering minimally invasive options when possible to help people recover from surgery faster and have the best possible outcomes,” says Dr. Julie Koffron. “There is a sense of collegiality and professionalism that’s evident in the culture at USA, and we’re all working toward a common goal. I believe the very strong foundation of quality will ease our transition into practice in Chattanooga and allow us to quickly fill a need in this community.” 

About Dr. Alan Koffron

Alan Koffron, MD earned his medical degree from the University of Iowa College of Medicine. He completed an internship and residency in general surgery from University of Health Sciences/Chicago Medical School where he also served as a senior resident in general and thoracic surgery, a surgical critical care residency at Chicago Institute of Neurosurgery and Neuroscience, and as a resident in pediatric general surgery at Toronto Hospital for Sick Children. 

He continued postgraduate education as chief resident of trauma surgery and general and vascular surgery at University of Health Sciences/Chicago Medical school before completing the American Society of Transplant Surgeons Clinical Fellowship at Northwestern University Medical School, which included pediatric liver transplantation and hepatobiliary surgery at Children’s Memorial Hospital in Chicago. 

Dr. Koffron has been named one of America’s Top Surgeons and in the Best Doctors in America listing since 2005, and has won many awards and honors for excellence in teaching, outstanding academics and surgical advancements. Before joining USA, he served as chief of transplant and hepatobiliary surgery and director of multi-organ transplantation at Oakland University William Beaumont School of Medicine in Rochester, Michigan. 

About Dr. Julie Koffron

Julie Koffron, MD earned her medical degree from the University of Michigan Medical School in Ann Arbor, Michigan. She completed residencies in emergency medicine and general surgery at William Beaumont Hospital in Royal Oak, Michigan where she also served as chief resident. Dr. Koffron then completed a clinical fellowship in pancreatic and hepatobiliary surgery from the University of Pisa in Pisa, Italy. 

From 2005, Dr. Koffron served as an attending physician at William Beaumont Hospital and as an assistant professor of surgery at Oakland University William Beaumont School of Medicine since 2010. Dr. Koffron also served as a surgical resident research mentor since 2007. 

Dr. Koffron’s surgical expertise includes general and minimally invasive surgery, including robotic surgery of the abdomen. In her specialization as an HPB surgeon, she focuses on open and minimally invasive section and vascular reconstruction of the pancreas, liver and biliary system, as well as biliary bypass and liver-directed tumor ablation.  

Could That Pain be a Hernia?

November 12th, 2020

Understand Your Options at the USA Hernia Center 

A hernia happens when a weak spot or hole in the abdominal muscle allows fat, tissue or internal organs to bulge through. A hernia can happen to anyone – some occur at birth and some are caused by previous surgery or injury. And if you’ve experienced a hernia, you know they can be painful and uncomfortable. But if left untreated, hernias can sometimes cause life-threatening complications including internal organs becoming twisted, blocked or infected. 

“Not all hernias are the same, and there are different methods of treatment based on a person’s unique health history, the size of the hernia and the risk of recurrence. That’s why it’s so important to be evaluated by a surgeon if you suspect a hernia or if you’re experiencing pain or discomfort,” says USA hernia surgeon Robert Jean, MD. “Hernias will not get better on their own, and we have no way of knowing when things could get worse very quickly. Knowing the symptoms to watch out for and making a plan for treatment can help prevent a serious medical emergency.”    

While the symptoms for hernia can vary, they are soft to the touch, can be pushed back inside when laying down, and may be uncomfortable but not painful. Seek emergency medical care immediately if you have increased pain or skin discoloration around the hernia, it feels firm or hard to the touch, or you have extreme abdominal bloating or vomiting. 

Help for Hernias 
Many insurance companies allow for self-referrals for hernia consultation.
The USA Hernia Center will work with you to determine what information is required and help obtain a referral from your primary care physician if one is needed. They will also help you select an office location and surgeon.
Call 423.757.0895 to get started. 

Expert Hernia Care 
USA Hernia Center surgeons work with patients to help them understand their hernias and treatment options from the beginning – including hiatal, inguinal, ventral and femoral hernias. USA pediatric surgeons also treat hernias in babies, children and teens. Some hernias are simple to repair, others are complex because of their size, previous surgical incision or because of a person’s genetic predisposition to developing hernias. 

“We have 12 dedicated surgeons who are focused on the most modern standard of care when it comes to hernia repair. When patients see one of us, they can expect the highest quality and that their procedure will be customized based on their personal risk factors and health condition,” says USA hernia surgeon Craig Murray, MD. “For individuals who are not yet candidates for surgery because of their body mass index, smoking or uncontrolled diabetes, we can help them take appropriate steps that lead to effective and lasting hernia repair in the future.”

Do I Need Hernia Surgery?   
While it’s true that some hernias don’t need to be treated immediately, especially if they aren’t causing pain, there is a possibility that the hernia could lead to bowel obstruction. Your hernia may or may not get worse, but it’s important to have your hernia evaluated by a specialist, even if your plan is to hold off on surgery for a while.   

“Seeing a surgeon doesn’t necessarily mean you’re heading straight to the operating room. But it does help you know what symptoms to look out for and the best path forward – and in some cases, that’s watching and waiting,” says USA hernia surgeon Stephen Greer, MD. “The field of hernia repair is rapidly expanding, and our priority is to perform a durable and lasting repair and do that in the least invasive way we can.”  

“As members of the Abdominal Core Health Quality Collaborative (, USA Hernia Center surgeons are continually learning and collaborating with hernia surgeons across the country. By staying on top of the latest education, surgical techniques and quality data, we can offer the procedures that lead to the very best outcomes for our patients,” says USA hernia surgeon Darren Hunt, MD. “When we all subscribe to the appropriate standard of care, we reduce the likelihood of infection and recurrence while helping people get back to life or work faster and with less pain.” 

If you’ve noticed a bulge in your abdomen, groin pain or felt uncomfortable while coughing, bending or lifting objects, you may have a hernia. Call us at 423.757.0895 to schedule an evaluation. To learn more about the USA Hernia Center, visit

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