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Routine Physical Leads to Dual Surgeries

By |2021-10-18T14:31:23-04:00October 11th, 2021|Categories: Health A-Z|Tags: , |

A family medicine physician can often be the first point of contact for preventive issues—and your strongest advocate when there are any health concerns. Although CentraState employee Racquel Diodato, 57, kept up-to-date with her specialty appointments and screenings throughout the years, she was looking to find a primary care provider close to home and get a comprehensive physical.

Seeking peace of mind, she made an appointment with family medicine physician Jaclyn Guliano, MD, at Family Practice of CentraState. During the physical, Dr. Guliano noticed that Racquel’s thyroid gland was enlarged. Bloodwork and an ultrasound proved suspicious—with the ultrasound finding a 1.2 cm nodule on the right side—so Dr. Guliano ordered a biopsy to rule out cancer.

“I was surprised to learn I had a thyroid issue because I didn’t have any symptoms,” says Racquel, a mother of three. “Cancer runs in my family, so I was nervous.”

At the same time, Racquel started experiencing acid reflux and stomach pain after eating. An ultrasound revealed several gallstones, indicating that her gallbladder needed to be removed. Dr. Guliano consulted several physicians about Racquel’s case, including radiologist Kenneth Tomkovich, MD, pathologist Paul Simon, DO, endocrinologist Shilpi Singh, MD, and general surgeon Amit Kharod, MD.

“Test results were still pending, but everyone agreed that Racquel’s thyroid was concerning,” explains Dr. Guliano. “Meanwhile, her abdominal pain was worsening, creating an emergency situation.”

“I was already on board to remove Racquel’s gallbladder, but then the question became which surgery should be done first,” adds Dr. Kharod.

Given the situation, Dr. Guliano worked to find a solution for treating both conditions during one surgical session. Typically, these procedures would require the expertise of two surgeons. But Dr. Kharod, whose broad experience includes thyroid surgeries, considered the challenge and felt confident he was able to take on both tasks at once. He then discussed the risks and benefits of the dual surgery with Dr. Guliano and Racquel.

“In this case, we felt it was safer to perform both surgeries concurrently so that Racquel’s recovery from the first surgery didn’t delay the second one,” adds Dr. Kharod.

“Having two separate surgeries would’ve been too much for me,” Racquel says. “Dr. Kharod made me feel so comfortable that there was no question in my mind this was the right decision.”

One month after her first physical, Racquel underwent the five-hour surgery. First, Dr. Kharod removed a portion of the thyroid nodule, which was sent to CentraState’s Pathology Department for quick analysis. He removed the gallbladder while waiting for the thyroid results. When the biopsy confirmed cancer, he removed the rest of her thyroid.

Two months after surgery, Racquel received a round of radiation and a nuclear body scan to ensure all of the tissue had been removed and that cancer hadn’t spread to other organs. Because the thyroid produces the hormones that regulate metabolism, Dr. Guliano prescribed replacement hormones.

“All of the testing, scheduling, surgery, and treatments were done at CentraState,” says Racquel, who now plans to get regular yearly physicals with Dr. Guliano. “My doctors communicated to ensure that every piece fell into place. Between my clinical team and the support of my family, I couldn’t have had a better outcome.”

For more information about surgical services at CentraState, visit or call 866-CENTRA7 (866-236-8727). For more information about Family Practice of CentraState, visit or call 732-462-9622.

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