While his is certainly not the most glamorous specialty in medicine, Dr. Howard Keith Berg declares, "I enjoy doing what I'm doing" because his work "can have a tremendous impact on the quality of a person's life."
Dr. Berg knew early in his studies that he might devote his medical career to treating problems of the colon, rectum and anus. "Throughout medical school I enjoyed the field," he said.
This month Dr. Berg was granted full staff privileges as a specialist in colorectal surgery at Carroll County General Hospital. He is not new to Carroll County; one of his three offices is in Westminster -- the others are in Baltimore and Owings Mills -- and he has been a consultant at the hospital for several years.
His appointment reflects a trend among community hospitals to attract subspecialists who overlap the services of general surgeons and physicians and assist on difficult problems.
Linda Harder, the hospital's vice president of planning and marketing, says, "It's like taking your Volvo to a Volvo mechanic. They [specialists] stay up on the latest advances or studies on how we treat those patients best."
"Sometimes we do very long and complicated surgeries," said Dr. Berg. "At CCGH we did a six-hour surgery for someone with Crohn's disease [an inflammatory disease of the intestine]. I'm very impressed with the people at CCGH, especially the operating room and the nurses on the floor."
Diagnosing colorectal illnesses has been aided in recent years by improved technology, better education and physician referrals, Dr. Berg said.
"We not only see patients referred from primary care physicians, but we work with gastroenterologists for inflammatory bowel disease," he said. "There's an overlap. I have been lucky enough to have several general surgeons who have utilized my specialty for more difficult problems."
Colon and rectal illnesses do not respect age. They can affect teen-agers through the elderly, with diverticulosis, fissures, Crohn's disease, ulcerative colitis, hemorrhoids and other problems.
"People make light of hemorrhoidal problems until they have it, then all of a sudden it's not very funny," Dr. Berg said. "This is something we can take care of easily in our office and let them get back to work without pain."
Sometimes a gastroenterologist (specialist for problems with the stomach and intestines) will refer a patient with abdominal discomfort, diarrhea or rectal bleeding to Dr. Berg for evaluation. Some people in their 50s and 60s arrive with symptoms of colon and rectal cancer.
Colorectal cancer, like other forms of cancer, is prevalent in Carroll County, Mrs. Harder said. Citing statistics from the Maryland Department of Health and Mental Hygiene, she said the national average is 17.6 deaths due to cancer per 100,000 population. Maryland averages 20.8; Carroll County averages 23.8. (These figures were adjusted to show no bias toward counties with younger or older populations.)
"Some of [the] things we do for rectal cancer," said Dr. Berg, "are sphincter-saving procedures to prevent permanent colostomy and give curative surgery at same time."
Off-duty, Dr. Berg spends time with his wife, Barbara, and three young daughters at their Greenspring Valley home.
Dr. Berg is the son of a plastic surgeon and spent his childhood on a farm in Baltimore County. Dr. Debra Vachon, an assistant clinical professor at the University of Maryland, will soon team with Dr. Berg at CCGH and his offices. Like Dr. Berg, she is board-certified for general and colorectal surgery. A female surgeon is fairly unusual in this field.
Board certification means that a panel of physicians for the specialty has approved of the doctor and his or her schooling.
To become board certified, a doctor must take a rigorous oral and written exam. After five years in general surgery and as chief resident at the State University of New York at Buffalo, Dr. Berg became board certified in general surgery in 1987.
Subspecialists train for another year or more and take an additional exam for board certification in the subspecialty. Dr. Berg received a one-year fellowship in colon rectal surgery at Buffalo General Hospital. He was certified for colon and rectal surgery in 1988.
"In our practice, we really like to get to know our patients," Dr. Berg said. "We have a good comfort level. The cancer patients we see every three months for first couple years, and for the first five years we follow them very closely.