News - Rapid City Medical Center

Irritable Bowel Syndrome Awareness Month

Irritable bowel syndrome is a chronic disease characterized by abdominal pain and either constipation (IBS-C), diarrhea (IBS-D), or a mix of both (IBS-Mixed). The prevalence in the US population is about 5% or 1 in 20 people and affects both men and women. IBS significantly reduces patients’ quality of life and it is estimated that the direct costs of IBS is $1.5-$10 billion per year, not including prescription or over-the-counter medications.

Another common symptom of IBS is bloating. IBS is considered a disorder of the gut-brain interaction and studies have shown that many people with IBS have hyperactivity of the pain cells in the intestines, known as visceral hypersensitivity. According to the American College of Gastroenterology, the symptoms of IBS are so bothersome that a majority of IBS patients surveyed would give up to 10 to 15 years of life expectancy for an instant cure for their condition. Unfortunately, there is no cure.

However, there are a number of treatments available and approaches to dealing with IBS. These range from dietary changes such as the low FODMAP diet, over-the-counter medications, prescription medications, and occasionally cognitive behavioral therapy and hypnotherapy.

Some alarm signs or symptoms that are not typically found in IBS include blood in the stool or in the toilet bowl, which may be attributable to hemorrhoids which often coexist with IBS, however this typically warrants further investigation to be certain a more serious underlying condition such as a cancer is not present. Other concerning findings would include anemia, unintentional weight loss, and nighttime stooling.

If you have symptoms of IBS, speak with your gastroenterologist to discuss what further evaluation may be necessary such as blood tests, stool tests, and endoscopy (e.g. upper endoscopy or colonoscopy) as there are overlapping symptoms with IBS and other GI disorders. Your gastroenterologist can provide a comprehensive evaluation to arrive at your diagnosis and to discuss the various treatment options and which ones may be best for you.

Colorectal Cancer Screening to Start at Age 45

Colorectal cancer (CRC) screening is now recommended for average-risk individuals starting at age 45 years, according to the American College of Gastroenterology’s (ACG’s) updated guidelines. The starting age was previously 50 years except for Blacks, for whom the starting age was lowered to 45 years in 2005.

The new guidance brings the ACG in line with recommendations of the American Cancer Society, which lowered the starting age to 45 years for average-risk individuals in 2018.

The new ACG guidelines were published in March in the American Journal of Gastroenterology. The last time they were updated was in 2009.

The ACG says the move was made in light of reports of an increase in the incidence of CRC in adults younger than 50.

“It has been estimated that [in the United States] persons born around 1990 have twice the risk of colon cancer and 4 times the risk of rectal cancer compared with those born around 1950,” guideline author Aasma Shaukat, MD, MPH, University of Minnesota, Minneapolis, Minnesota, and colleagues point out.

“The fact that other developed countries are reporting similar increases in early-onset CRC and birth-cohort effects suggests that the Western lifestyle (especially exemplified by the obesity epidemic) is a significant contributor,” the authors add.

The Gastroenterologists at Rapid City Medical Center urge you to self-refer for a screening colonoscopy. They will check your insurance benefits and schedule you within 10 days for colonoscopy. Colonoscopy actively prevents cancer because pre-cancerous polyps can be removed during the screening procedure.

https://journals.lww.com/ajg/Fulltext/2021/03000/ACG_Clinical_Guidelines__Colorectal_Cancer.14.aspx

Shaukat, Aasma MD, MPH, FACG1,2; Kahi, Charles J. MD, MSc, FACG3,7; Burke, Carol A. MD, FACG4; Rabeneck, Linda MD, MPH, MACG5; Sauer, Bryan G. MD, MSc, FACG (GRADE Methodologist)6; Rex, Douglas K. MD, MACG3 ACG Clinical Guidelines: Colorectal Cancer Screening 2021, The American Journal of Gastroenterology: March 2021 – Volume 116 – Issue 3 – p 458-479
doi: 10.14309/ajg.0000000000001122

Rapid City Medical Center’s Team of Board-Certified Gastroenterologists Remind Community of Colon Cancer Awareness and the Importance of Preventive Screening

The highest credentialed group of gastroenterologists in the Black Hills, Rapid City Medical Center’s GI providers recommend colonoscopy for colon health and cancer prevention.

The Gastroenterology Department at Rapid City Medical Center reminds the public that March is Colon Cancer Awareness Month.

The current recommendations from the American Cancer Society and the United States Preventive Services Task force are for healthy people with no signs or symptoms and no family history of colon cancer is to begin screening at age 45.

When colon cancer is found in its early stages, there is a greater chance of cure and the risk of death from colon cancer is reduced. Colonoscopy is unique in that it can both detect and prevent cancer by finding and removing pre-cancerous polyps.  Indeed, the American Cancer Society distinguishes colonoscopy as a cancer prevention test, while other screening tests are cancer detection tests.  There are several screening options available and it is important for you to discuss your options with your doctor to determine which one is the most appropriate for you.

Stool-based screening tests such as Cologuard and Hemoccult are usually not appropriate for those with a family history of colon cancer; a personal history of polyps or colon cancer; signs or symptoms such as bleeding, abdominal pain, anemia; or a history of inflammatory bowel disease.  Also, if a stool-based test is positive, this requires a follow up examination with a colonoscopy which is then considered diagnostic rather than screening, and may not be covered as well by insurance.

Gastroenterologists are specialists certified by the American Board of Internal Medicine who undergo extensive and rigorous training to gain expertise in endoscopic therapy (EGD, colonoscopy, ERCP, EUS). This requires at least three years of additional specialty fellowship training, which focuses specifically on performing diagnostic and therapeutic endoscopy on a daily basis. By the end of their training, gastroenterologists will have completed several hundred to several thousand endoscopic procedures. There is literature that shows better outcomes when endoscopy is performed by a gastroenterologist compared to a non-gastroenterologist. Colonoscopy is well-known to be associated with a reduced risk of death from colorectal cancer, and that association is strongest if the colonoscopy is performed by a licensed gastroenterologist.

Our gastroenterologists hold themselves to a high standard for patient outcomes, efficiency, and quality of care. National quality metrics are used to gauge these measures, and RCMC Gastroenterology publishes their quality data on their website for all to see. The Endoscopy Center at RCMC has been recognized by the American Society for Gastrointestinal Endoscopy for its commitment to quality through the Endoscopy Unit Recognition Program, the only endoscopy unit in western South Dakota to have this distinction.  Multiple studies have shown that these quality metrics can predict better patient outcomes, lower rates of colon cancer, lower patient costs, decrease morbidity/mortality, and improve patients’ quality of life. This translates into quality patient care.  Do you know your physicians’ polyp detection, colonoscopy completion, and complication rates?

The Gastroenterologists at Rapid City Medical Center are the area’s only specialists focusing specifically on high quality colonoscopy and carry the highest quality standards in the Black Hills. When scheduling your colonoscopy or other endoscopic evaluation, request that your referring provider send you to a board-certified gastroenterologist.

West River ENT joins Rapid City Medical Center

Rapid City Medical Center expands with New ENT Clinic Location and Providers

West River ENT’s Dr. Rob Schleiffarth, MD brings a new building and expert team to join Dr. Troy Howard, MD in the RCMC network.

Rapid City Medical Center’s Ear, Nose, & Throat Department is proud to announce an expansion through a merger with West River Ear, Nose, & Throat.

Dr. Troy Howard, MD, has moved his ENT practice across 5th street to a brand new, just completed building at 241 Minnesota Street in Rapid City. Dr. Howard and Kristi Larson, C-NP are happy to welcome West River ENT and Dr. Rob Schleiffarth, MD as the newest members of the Rapid City Medical Center, LLP, family.

Dr. Schleiffarth’s team includes Dr. Mark Guy, MD, an ENT physician, JaNell Rubelt, C-NP, Audiologist Ashley Huerta, and John Burke, certified speech therapist. This merger marks the first time speech pathology services will be offered by Rapid City Medical Center.

All of the providers at the WRENT Building at Rapid City Medical Center are accepting new patients and look forward to meeting with you in their state of the art facility. Call 605-791-0602 for scheduling.

Rapid City Medical Center’s Dr. Tyler Ptacek, MD Performs Groundbreaking Treatment for Chronic Pain

Nevro’s HF10 Offers Profound Pain Relief Without Opioids or Tingling

Rapid City Medical Center’s Dr. Tyler Ptacek, MD announced the first performance of groundbreaking therapy for the treatment of chronic pain in Western South Dakota. The Senza® SCS system, which delivers Nevro’s proprietary HF10® (Nevro Corp., Redwood City, CA), is an FDA-approved spinal cord stimulator (SCS) that has demonstrated superior results compared to traditional SCS for the treatment of back and leg pain in a large multicenter study in the United States.

Over 100 million Americans suffer from common chronic pain. It is the primary cause of adult disability in the U.S. and is a costly public health issue. Severe pain can significantly interfere with a person’s quality of life and functionality, yet the condition is largely under-treated and misunderstood.

Spinal cord stimulation represents another option to treat chronic pain. It involves the delivery of electrical signals to the spinal cord in order to alter pain signals to the brain. The electrical pulses are delivered by small electrodes on leads that are placed near the spinal cord and are connected to a compact, battery-powered generator implanted under the skin. SCS is a reversible therapy that has helped hundreds of thousands of people experience relief from chronic pain.

“I am excited to offer HF10 to my Interventional Pain patients with chronic low back and leg pain,” said Dr. Tyler Ptacek, MD. “Patients suffering debilitating pain need alternatives to opioids. In my opinion, this is going to change the way we’re able to help people who have exhausted other options for their pain. In addition to back and leg pain, spinal cord stimulation has been studied for and used successfully on painful conditions such as neck and arm pain, diabetic neuropathy, abdominal pain, and pelvic pain.

HF10® is clinically proven to offer substantial pain relief without the tingling or buzzing used to mask pain in traditional spinal cord stimulation. In a clinical study, HF10® patients demonstrated an average reduction in use of opioid medications of nearly 70%. ”

HF10® represents a significant advance in spinal cord stimulation. FDA approval for HF10® included superiority labeling over traditional SCS therapy, validating that HF10® reduces pain more effectively in more patients. Additionally, HF10® is the only SCS therapy indicated to deliver pain relief without paresthesia (a stimulation-induced sensation, such as tingling, burning, or pricking, which is the basis of traditional SCS) and is the only SCS system approved by the FDA to be used without patient restrictions on driving while receiving therapy.
The CDC has recently determined that the use of chronic opioids is not supported in medical literature as an effective therapy for long-term treatment of persistent pain. HF10® therapy provides an opportunity to reduce or potentially eliminate the need for chronic opioid use.
To schedule with Dr. Ptacek, MD and Rapid City Medical Center’s new Interventional Pain Department, call (605) 342-3280 or visit www.rapidcitypain.com

Preventative and Primary Care Post (& During) Covid-19

Dr. Kay Kelts, DO from the Medical Arts Clinic at Rapid City Medical Center introduces herself and explains a little bit about why preventative care and having a primary care provider is important whether we’re in a pandemic or not. Dr. Kelts and her husband, Dr. Andrew Kelts, DO, came back to Rapid City to practice medicine in Andrew’s hometown. They’re both essential and valuable parts of our team and of the community – with valuable insight and expertise in their areas of practice.

General COVID-19 Vaccine Information:

At this time, all COVID-19 vaccine is being administered by Monument Health as directed by the South Dakota Department of Health. Rapid City Medical Center does not have COVID-19 vaccine available to us.

Beginning January 18th, Monument Health will be scheduling patients that meet the following criteria:

  • 80 years and older, OR
  • Post-transplant (any age over 18 years), OR
  • Actively being treated for cancer (any age over 18 years)

All eligible patients must contact Monument Health at 605-755-1350 to schedule. If you have an electronic medical record with Monument (“My Chart”), they indicate you may request an appointment through that. Or, you can visit https://www.monument.health and choose the “COVID-19 Vaccine Scheduling” quick link.

Staff from Monument Health will be available from 7 am- 7pm each day to schedule patients. Rapid City Medical Center is NOT able to schedule these vaccines at this time.

Please note: If you have issues contacting this number or accessing your “My Chart” account you will need to contact Monument Health. We do not have access to help with any technical issues that you may encounter with their systems.

For more information on the South Dakota Department of Health’s vaccine plan, please visit:  https://doh.sd.gov/COVID/Vaccine/Public.aspx

Dr. Halie Anderson Addresses Covid-19 Vaccine

http://https://youtu.be/tNrF5-TKvTo

Our very own Dr. Halie Anderson, Board Certified Allergist & Immunologist, took some time to address some of the concerns about the COVID-19 vaccine.

She did record this before the Moderna vaccine was approved, but the science and information is valuable for community members and healthcare workers who are interested in better understanding the vaccine and dispelling some myths.

Please be aware that Rapid City Medical Center does not currently have COVID vaccine available to us to distribute to our patients. The CDC and the SD Department of Health are currently managing the distribution of the COVID vaccine. As the vaccine becomes more available we hope to receive supply to vaccinate our established primary care patients. If you are not established with primary care we encourage you to do so NOW! Once we receive notice of vaccine being distributed to us we will notify our established primary care patients with information on how to schedule based on guidelines set forth by the CDC and DOH. At this time we will not be taking names to create lists as we will have certain criteria required in vaccinating our patients.

RCMC Providers get Covid-19 Vaccine

RAPID CITY, SD – Providers from the physician owned Rapid City Medical Center began receiving Covid-19 vaccinations the week before Christmas. With nearly full participation from the almost 80 Physicians, Certified Nurse Practitioners, and Physician’s Assistants within the 8 clinic locations of Rapid City Medical Center’s multi-specialty practices, the RCMC providers look to lead the community towards health in 2021.

Dr. Kevin Weiland, MD, a Board Certified internal medicine specialist said, “Ironically, the shot was put in the arm where my small pox vaccine scar is. My son, 10 years ago, asked me why I have a scar there and I told him it was from my smallpox vaccine. He asked why he does not have one. I told him, “Because it worked.” Dr. Oksana Anand, MD, double Board Certified gastroenterologist and internalist expressed how excited her young children were that she was able to be vaccinated before Christmas.

Additional providers, nursing staff, and essential workers on the Rapid City Medical Center team are scheduled for vaccines in waves over the next month. Dr. Halie Anderson, MD, Board Certified Allergist & Immunologist, took some time to address some of the concerns about the COVID-19 vaccine in a video she shared via social media with all staff and with the Black Hills community as a whole. “I’m actually pregnant, and I plan to get this vaccine as soon as it’s available to me,” she said in the video, dispelling myths that the vaccine is unsafe for pregnant mothers. Dr. Anderson received her vaccine on December 30th. Photos are attached.

Rapid City Medical Center does not currently have COVID vaccines available to distribute to their patients. The CDC and the SD Department of Health are currently managing the distribution of the COVID vaccine. As the vaccine becomes more available, RCMC hopes to receive supply to vaccinate their established primary care patients.

Midwest Medical Edition features RCMC Physicians

Thanks to Midwest Medical Edition.    Read the entire article, here.

In 2020, Rapid City Medical Center was proud to welcome four new physicians.

Dr. Kay Kelts is double board certified in Family Medicine with the American Board of Family Medicine and the American Osteopathic Board of Family Physicians. She practices Full-scope Family Medicine including in-office procedures, women’s health, and osteopathic manipulative medicine. Dr. Kelts completed her medical school training at Rocky Vista University where she was part of their inaugural class and a pre-doctoral osteopathic principles and practices fellow. Dr. Kelts believes in treating the whole person, helping each patient achieve his or her personal health goals and live life to the fullest.

Dr. Andrew Kelts was born and raised in Rapid City before completing his undergraduate degree at St. Olaf College in Minnesota. He went to medical school at Rocky Vista University College of Osteopathic Medicine and completed his residency in Internal Medicine at Advocate Lutheran General Hospital in Chicago. Dr. Kelts was awarded a Gastroenterology fellowship at Arnot Ogden Medical Center in Elmira, New York and joins the Gastroenterology department at our Mt. Rushmore Rd. Clinic.

Dr. Luke Hushagen is originally from Bismarck, North Dakota. He began his undergraduate training at Bismarck State College, finishing at the University of North Dakota where he also attended medical school. His medical training was completed with an internal medicine residency at Penn State University practicing at the renowned Hershey Medical Center. As an internist, Dr. Hushagen cares for patients in all stages of their adult lives. His primary focus is on patient education with an emphasis on complex medical care. His goal is to empower his patients to become advocates for their own care. Dr. Hushagen practices out of our newest Tower Road Clinic location.

Dr. Tyler A. Ptacek is a double Board Certified pain specialist from O’Neill, Nebraska who completed his residency in Anesthesiology at the University of Nebraska Medical Center in Omaha, NE and his Interventional Pain Fellowship at Wake Forest in Winston-Salem, NC. Dr. Ptacek currently serves in the US Air Force Air National Guard as Flight Surgeon and introduces an Interventional Pain department to our practice. He looks forward to living in and enjoying all the Black Hills have to offer with his wife and small children.

Thanks to Midwest Medical Edition.    Read the entire article, here.

Understanding Life Before & After a Hysterectomy

RAPID CITY, S.D. — In the United States, a hysterectomy is a common surgery for women hoping to relieve long lasting discomfort and serious health conditions. While the benefits of this procedure can be tremendous in some cases, it is important to know that it is not a catch-all solution.

Each patient’s case and needs are different, and every major surgery requires careful thought and consideration. Common circumstances that lead to a hysterectomy include cervical and uterine cancers, abnormal or persistent bleeding, fibroids, and enlarged or prolapsed uterus that causes constant discomfort or pain.

Dr. Heather Moline, gynecologist at Rapid City Medical Center, says that in the right cases the surgery can be transformative. “We have to be conscious that one procedure is not always the best procedure for everyone,” Dr. Moline says, “but when it is the right procedure for the right patient, it is a life changing surgery.”

“The most recent literature is not supportive of hysterectomies for those who have not tried alternative therapies,” she says. Because of the possible complications that come with any surgical procedure, Dr. Moline says that other, less invasive options should be discussed and explored. For those who have not found relief with alternate treatments like hormone therapy, a hysterectomy may be the best option. “Generally speaking,” Dr. Moline says, “a hysterectomy is a great procedure for a vast majority of patients, but it doesn’t solve every problem for everyone.”

Patients who decide to undergo a hysterectomy after experiencing constant pain and discomfort are often surprised by how the procedure can change their life. “Most patients are grateful that they did the procedure and a lot of them wish they would have done it sooner,” Dr. Moline says.

“There are many women who think that a hysterectomy will solve all of their problems, or that it is the best thing for them, but what is most important is that women seek care that is individualized for them, that they are given all of their alternative options, because a hysterectomy is a major surgery, it’s not without risks, and there are usually alternatives that they should consider before moving straight to a hysterectomy.”

What Pregnant Women Need to Know About COVID-19

Heather Moline, MD
Heather Moline, MD

Expecting mothers across the nation want to know what the COVID-19 outbreak will mean for their pregnancy. Heather Moline, MD, who specializes in Obstetrics and Gynecology, has some advice for women who are pregnant or expecting to become pregnant during this time.

There is limited literature available at this time on pregnant women contracting COVID-19, the available information does indicate that due to low immunity in general, pregnant women tend to fall into the a more susceptible category.

“COVID-19 doesn’t appear to target pregnant women compared to other respiratory illnesses such as influenza and SARS, and we don’t believe the outcomes will be necessarily worse when we look at the outcomes from China and so far what has come out of Italy.” said Dr. Moline.

The same type of precautionary measures being recommended to the general public are also being recommended to pregnant women. Dr. Moline advises that mothers-to-be avoid contact with anyone who is currently sick and socially isolate themselves, practice excellent hand hygiene, and avoid any non-essential travel.

The few cases that have been reported on pregnant women have been primarily in the second and third trimester. Mothers who demonstrated positive COVID-19 with symptoms at the time of arriving at the hospital have had an increased risk of pre-term birth or low birth weight, however this data set is small and the majority of patients underwent delivery via cesarean section to expedite delivery of the baby and improve recovery time for the mother.

Currently, there are not enough cases of women contracting COVID-19 in the first trimester to have a firm grasp on the potential long term consequences of the virus on a developing fetus. Regardless of your stage in pregnancy, Dr. Moline suggests the same thing for patients experiencing high fever and significant symptoms of a viral respiratory illness: increase oral fluids and control the fever. “Depleted fluids and high fever can lead to adverse pregnancy outcomes at all stages of pregnancy,” said Dr. Moline.

For those concerned about transmission of the virus to the child, “It appears that if a mother is to become sick with COVID-19 during her pregnancy that there is, right now, very limited data to suggest that there is transmission to the fetus,” said Moline, “While there may be positive cases as we move into the future, it seems that the current infants that have been born to mothers who tested positive for COVID-19 have tested negative for the virus. In addition, there currently does not appear to be any transmission of the virus into breast milk.” Dr. Moline added, “As long as the mother is not too sick to breastfeed, there are still many significant benefits to breastfeeding”

Pregnant mothers and other non-pregnant patients may be apprehensive about entering a hospital due to the increased risk of contracting the virus. In this case, Rapid City Medical Center is offering telehealth appointments, where patients can phone-in for their regular appointments. While this does not allow for neonatal assessments, Dr. Moline still urges regular visits via telehealth or in-person for the continued monitoring of mother and baby. Patients should discuss their pregnancy with their OB/GYN so that they can work on a strategy to be seen regularly and limit their visits to hospitals.

Limiting exposure, practicing good hand hygiene and social distancing is vital to keeping everyone healthy. Dr. Moline suggests that pregnant women especially avoid unnecessary visits to the hospital which includes taking family members to regular appointments as well as visiting family or friends who are admitted for extended hospital stays, for any reason.

Amid all the anxiety about the current situation, Dr. Heather Moline wants her pregnant patients to know that they will be taken care of. “The whole medical system in the United States and everywhere in the world right now is trying to keep patients safe and healthy and we’re working together to do everything we can to keep people as healthy as possible. It is a very worrisome time and the best thing patients can do is just to protect themselves from potential sick contacts and practice social distancing.”

 

 

COVID-19 Update

We are protecting our community in the wake of the COVID-19 epidemic by offering virtual visits to patients in their homes.  Just like the seasonal flu, limiting contact with those who are experiencing acute symptoms is key to reducing the spread of this virus. As of Monday, March 16, 2020,

80% of all coronavirus patients indicate the symptoms are mild and most relatively healthy individuals will beat this while staying at home.

for any patient over the age of 60 and who has chronic conditions or for those experiencing acute respiratory symptoms, RCMC physicians are encouraging you to call to see if this tool is right for you. It is easy to use with a smart-phone or computer equipped with a camera.

In addition, Rapid City Medical Center has implemented best practices to focus patients with respiratory illnesses to certain waiting rooms and exam areas in their locations, allowing the majority of each clinic’s physical space for routine physician visits. “Rapid City Medical Center’s physicians continue to be the leaders in providing healthcare to our communities. We have been working diligently over the past several weeks and have fluid plans to meet and beat this virus,” says Heather Bindel, Chief Operations Officer at Rapid City Medical Center. “We will update our patients every Wednesday on our website as our plan evolves. Using telehealth ‘virtual visits’ and directing patients to specific clinic-areas based on their requested treatments are just two of the ways we are managing this concern. However, patients are encouraged to join us in remaining calm and working as a team to continue all types of healthcare. 80% of all coronavirus patients indicate the symptoms are mild and most relatively healthy individuals will beat this while staying at home. We continue to encourage hand-washing and not touching your face.”

If you wish to request a virtual visit, please call our direct line at 342-3280.  All of our board-certified physicians are able to utilize this platform and they will determine with you if it is the best way to serve your needs.

 

Click here for more information about COVID-19

Now Offering Trifocal Replacement Lens for Cataract Patients

Cataracts are cloudy areas in the lens of the eye that can cause changes in vision. Symptoms include cloudy or fuzzy vision and sensitivity to glare. For people with cataracts, seeing is similar to looking through fogged glasses. This obstruction can make it more challenging to read, drive a car, especially at night, or even see facial expressions.

Cataracts form gradually as your eyes get older. According to the American Academy of Ophthalmology by age 75, approximately half of all Americans have cataracts. The good news is that cataract surgery is one of the safest and most effective procedures performed today.

In addition to traditional cataract surgery, Dr. Gail Bernard and Dr. Rebecca Linquist are allowing their patients to enhance their vision with the PanOptix Trifocal Lens at the time of cataract surgery. While monofocial lens can help you see far away, the PanOptix lens gives you a full range of vision, allowing you to rely less on glasses. Clinical studies have reported patients experiencing an exceptional combination of near, intermediate and distance vision while reducing the need for glasses after surgery.

Linquist PanOptix Lens
Dr. Linquist preforming first PanOptix trifocal surgery.
Linquist PanOptix
Dr. Linquist and team post-surgery.
Dr. Bernard and team post-surgery.
Bernard PanOptix
Dr. Bernard performing first PanOptix trifocal surgery.