Jewett Orthopaedic Clinic Celebrates Seventy

Transcription

MARCH 2011 • CENTRAL FLORIDA EDITION
Jewett Orthopaedic Clinic
Celebrates Seventy-Five Years
of Innovation
2011
EDITORIAL
CALENDAR
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contents
MARCH 2011
CENTRAL FLORIDA EDITION
4
COVER STORY
Photo by Nathan Dobbins
With roots firmly planted in the Central Florida community, Jewett Orthopaedic Clinic
celebrates 75 years of innovation and pioneering orthopaedic care. From its trailblazing,
mission-driven founder, Eugene L. Jewett, M.D., to the sub-specialized, multi-disciplinary
team who serves today, Jewett continues to pave new pathways and lead the charge to
improve patient outcomes and experiences.
Photo provided by JEWETT ORTHOPAEDIC CLINIC
From left to right: Bottom (front row) Jeffrey Deren,
MD, Kenneth Krumins, MD, Craig Mintzer, MD, Colleen
Zittel, MD, Kurt Gasner, MD, Janet Robison, MD,
Brian Barnard, MD. Second row: Sean McFadden,
DO, John McCutchen, MD, John Papa, MD, Gregory
Munson, MD, Richard Konsens, MD. Third row: Adam
Fenichel, MD, Reginald Tall, MD, Wadih Macksoud,
MD, Richard Shure, MD, Joseph Billings, DO, John
Chase, MD. Fourth row: Steven Choung, MD, Hugh
Morris, MD, Michael Jablonski, MD, William Felix, MD,
Philip Meinhardt, MD. Missing from the photo are Mark
Beckner, MD and Mary Lynn Brown, MD
9 Orthopaedic Community
Launches Aggressive
Risk Mitigation Program
26 MAITLAND’S MEDICAL CITY
DEPARTMENTS
27 SBA 504 Refinancing:
A Groundbreaking
Opportunity
2
FROM THE PUBLISHER
3
FOR YOUR ENTERTAINMENT
29 Inflation: How and When
to Hedge Against Rising
Prices
31 CURRENT TOPICS
10 PHARMACY UPDATE
12 WEALTH MANAGEMENT
15 Radiologist’s Corner
17 HOT TOPICS IN DERMATOLOGY
18 FACIAL COSMETIC SURGERY
20 Using Nutraceuticals
22 ORTHOPAEDIC UPDATE
23 Medical Malpractice Expert Advice
24 MARKETING YOUR PRACTICE
FLORIDA MD - MARCH 2011
1
FROM THE
THE PUBLISHER
PUBLISHER
FROM
I
am
It’s hard toIt’simagine
Iampleased
pleasedtotobring
bringyou
you another
another issue
issue of
of Florida
Florida MD.
MD Magazine.
hard toanyone
imag- who is not
familiar
with
the
March
of
Dimes
and
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work
they
do
to
address
the
problems
ine anyone who is not familiar with the March of Dimes and the work they do toof premature
births and babies born with birth defects. They are always reinventing themselves to create new
programs and services. Coming up next month is the annual March for Babies. It’s a wonderful
always
reinventing
themselves
create
newand
programs
and services.
up for
nexta great cause.
team-building
opportunity
fortoyour
staff
their families
and a Coming
great time
month
is
the
annual
March
for
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It’s
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team-building
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for to form a
Listed below are instructions on how you and your family can join the march or how
- manager
team for your whole practice. For your convenience, there is a form for you or your office
to fill on
outhow
on the
backfamily
cover.can
I hope
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you there.
tions
youinside
and your
jointothe
to form a team for your
whole
practice. I hope to see some of you there.
Best regards,
Warm
Donaldregards,
B. Rauhofer
Publisher
Join more than a million people walking in March of Dimes, March for Babies and raising money to help give every baby a healthy
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Where
Phone:
Lake Lily(407)
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3
COVER STORY
Jewett Orthopaedic Clinic Celebrates
Seventy-Five Years of Innovation
By Jennifer Roth Miller, Staff Writer
Eugene L. Jewett, M.D., Started the
Tradition of Innovation in the Field
of Orthopaedics in 1936
After studying at both Cornell and Harvard universities, Dr.
Jewett came to Central Florida to practice medicine along with
his beloved wife, Ruth Jewett, M.D., who became one of the few
primary care physicians to remain in Winter Park, Florida during
World War II. From the beginning, Dr. Eugene Jewett pioneered
advances in orthopaedic care. In the early days, he developed the
Jewett Hip Nail and the Jewett Back Brace, both of which eliminated the need for
Pictured here in 1944, Captain Eugene
body casts and shortJewett, M.D., served as Chief of Surgery
ened recovery time
on the USS Good Samaritan Naval
Hospital Ship during World War II.
for patients.
Dr. Jewett also
traveled all over
the state of Florida,
bringing his innovation to patients who
otherwise wouldn’t
have access to the
technology. He would
put his x-ray machine
and instruments in
the trunk of his car
and drive to Central
Florida hospitals that
would gather groups
of patients who could
benefit from his
medical advances and
expertise.
4 FLORIDA MD - MARCH 2011
This year, Jewett Orthopaedic Clinic is celebrating 75
years of innovation and pioneering orthopaedic care in
Central Florida and the Southeast. In 1936, Eugene L.
Jewett, M.D., arrived in Central Florida and initiated a
unique approach to patient care that has continued to expand and evolve for three-quarters of a century now. Today,
Jewett Orthopaedic Clinic is home to several of Central
Florida’s leading orthopaedic professionals who continue
Dr. Jewett’s legacy of paving new pathways to improve
patient outcomes and maximize mobility. From a solo
physician, Jewett Orthopaedic Clinic has grown and now
hosts 25 board-certified/board-eligible, fellowship-trained
physicians, 11 physician assistants, three accredited nurse
practitioners and a multi-disciplinary team of professionals
ready to provide a full range of orthopaedic care.
Ruth Jewett, M.D., and Eugene L. Jewett, M.D., came to Winter Park,
Florida in 1936.
Craig Mintzer, M.D., one of Jewett Orthopaedic Clinic’s partners and team physician for the Orlando Magic says, “From day
one, when Dr. Jewett drove around Central Florida in his truck
with an x-ray machine, the clinic has taken care of Central Florida
folks like they were family. We have treated children, the elderly,
and professional and recreational athletes alike, from sprains to
major injuries – all one patient at a time, one friend at a time, one
family member at a time. We are honored to have been allowed
the privilege of serving the generations in this community that
we all call home.”
The Jewett Hip Nail
In the 1940’s, after serving as a doctor in the United States
Navy and receiving four battle stars for his service, Dr. Jewett returned home and perfected the Jewett Hip Nail. His revolutionary invention dramatically changed hip fracture patients’ recovery
experiences. In that day and age, being told you had a hip fracture
was often seen as a death sentence. Prior to the development of
the Jewett Hip Nail, hip fracture patients were typically treated
with a cast and had an 80 percent mortality rate.
The Jewett Hip Nail was a monolithic device with a tri-flanged
nail that was inserted into the femur. It allowed doctors to attach plates and fixate or stabilize the hip so it could heal more
quickly and easily. Studies showed success rates of this new device
to be around 95 percent. The only instances in which the hip nail
wasn’t successful were cases where the device was placed poorly
and caused inappropriate healing.
COVER STORY
John McCutchen, M.D., Jewett Orthopaedic Clinic hip surgeon and president, personally knew and worked with Dr. Jewett.
He shares, “Dr. Jewett was an extremely compassionate man whose
intent was always to help patients. He was very kind, humble and
generous. He was concerned with better patient outcomes, not
making money.” In fact, Dr. Jewett sold the patent for the Jewett
Hip Nail, which is still widely used today, for only $150.
The Jewett Back Brace
Dr. Jewett also pioneered the Jewett Back Brace, a device that
is still utilized today. The brace significantly helps patients with
scoliosis or spinal fractures who have undergone back surgeries
such as spinal fusion. The brace, now produced by Florida Brace
Corporation and called the Jewett™ J-35 hyperextension Orthosis,
keeps the spine in a hyper-extended position but can also be removed for showering and resting. Jewett did make money from
the Jewett Back Brace; however, Jewett was always donating his
profits to help others. He valued education and started a foundation to help fund education.
Jewett foot and ankle surgeon Steven C. Choung, M.D., performs a
surgical procedure.
Mission Driven
Doctors Eugene and Ruth
Jewett traveled often and
fell in love with the people
and culture of Colombia.
They saw a need to share
American
advancements
and expertise in the field of
orthopaedics with Colombian doctors. It was this passion that led them to fund
a program that would help
educate Colombian docJewett hip surgeon and current
tors. Dr. Jewett’s foundation President John McCutchen, M.D.
brought men and women
physicians to Florida to complete their residencies and study with
American physicians. The only stipulation was that they return to
Colombia and bring what they had learned to the people of their
country. In recognition of his work, Dr. Jewett received the highest award from the country of Colombia.
Dr. Jewett was also involved in philanthropic efforts with the
University of Florida. He specifically supported programs in orthopaedic medicine and rehabilitation. Dr. McCutchen says, “He
was always giving his money to good causes.”
Decades later, another Jewett physician, John Chase, MD,
followed in Dr. Jewett’s footsteps when on a mission trip to the
Dominican Republic, he encountered a 17-year-old young man
named Roberto who had been nicknamed “horse boy” because he
walked on his hands due to an orthopaedic deformity. Dr. Chase
helped arrange to bring Roberto to Orlando for surgery at no
cost to his family. The procedure involved amputating both legs
and fitting him with prosthetic legs along with intense physical
therapy to teach him how to walk. In the end, Roberto was able
to return to his country, stand upright and walk the streets of his
hometown for the first time in his life.
Today, Jewett Orthopaedic Clinic spine surgeon Philip Meinhardt, M.D., travels to Ethiopia to complete similar mission work
for the people of that country. “I just feel like it’s the right thing
to do,” says Dr. Meinhardt.
Jewett Orthopaedic Clinic through the
Years
Jewett Orthopaedic Clinic, one of the oldest orthopaedic clinics in the country, was originally simply called The Orthopaedic
Clinic. There was no need to distinguish which orthopaedic clinic
it was because there were no other orthopaedic clinics in Central
Florida at the time.
Dr. Jewett died at the age of 87, but the legacy he started is still
well alive at the Jewett Orthopaedic Clinic today. Throughout the
years, many additional talented physicians have joined the team.
Each has carved out an orthopaedic niche by specializing in an
area, allowing for a continued tradition of innovation.
In the 1950’s, Louis Brady, M.D., joined Dr. Jewett, transforming the clinic into a group practice, which was rare at that time.
From that point, the practice began to grow. Dr. Bight McConnell
5
The Jewett Hip Nail revolutionized treatment for hip fracture
patients, and the device was used for decades until technology
surpassed it. As late as in the 1970’s, hip fracture patients were
still being treated with the Jewett Hip Nail because it worked so
effectively.
COVER STORY
With the addition of these doctors, the team continued to refine
and redefine orthopaedic care. In the early seventies, Dr. Brady
performed Florida’s first total hip replacement, the Charnley LowFriction Arthroplasty. Then, in the eighties, Jewett became the official team physicians for the NBA Orlando Magic, the University
of Central Florida Knights and Rollins College. Also around this
time, the Lacey Total Knee and the McCutchen Total Hip replacements were developed. And in the nineties, Jewett physicians began performing some of Central Florida’s first minimally invasive
orthopaedic procedures. All of these innovations significantly improved patient experiences, outcomes and recovery times. Jewett
also continued to grow its sports medicine role in the nineties,
becoming the team physicians for the Orlando Predators and the
Orlando Ballet.
In addition, Jewett led the way in the area of sub-specialization in orthopaedics. As early as the seventies, doctors at Jewett
were already specializing in hip, knee, foot, hand, spine and even
sports medicine.
“Jewett Orthopaedic Clinic has prospered by always focusing on
providing the absolute best orthopaedic care possible, “ said Jewett
Foot and Ankle Surgeon John Papa, M.D. “Early sub-specialization -- before it was popular -- has allowed the quality of care provided to continue to advance. It is this commitment to provide
the highest level of care that has attracted patients from all over the
state of Florida and beyond. Jewett has been an integral contributor to the growth of Central Florida over the past 75 years.”
Jewett Orthopaedic Clinic also paved new paths in outpatient
surgery. The clinic has literally changed the recovery process for
patients receiving orthopaedic services by using technology to perform more patient procedures on an outpatient basis, meaning patients can go home the same day. Back in the days when Dr. Jewett
began practicing, this was not the case. Recovery times were significantly longer, more painful, and required long hospital stays. This
transition to outpatient care has also reduced treatment costs.
In addition to their inventions and innovations, the Jewett physicians have always valued education and promoted the education
of new doctors in the field through developing preceptorships
and residencies to share their expertise with new generations. Dr.
Meinhardt recalls, “I had to leave Orlando to complete my spine
fellowship training but am now so happy to be back home and
humbled to be a new part of the Jewett spine team. Dr. Jewett’s
legacy influences and energizes me daily along with the current
thought leaders within the clinic who challenge all of us to think
of each case as an opportunity to improve a life.” The doctors
at Jewett are committed to providing a place in Central Florida
where new physicians interested in the field of orthopaedics can
train, eliminating the need to leave this community for residencies
like they once did.
also joined the team in the fifties. In the sixties, four more orthopaedic surgeons joined the team: Dr. Thomas Stanford, Dr.
Joseph Nixon, Dr. James Spivey and Dr. Carl Croft. In the seventies, Drs. Max Riddick and Allen Lacey came on board. And
in the eighties, Drs. James Barnett, John McCutchen, Gregory
Munson and John Chase also began practicing with Jewett.
Jewett foot and ankle surgeon John A. Papa, M.D., with Florida
Senator Marco Rubio who made a campaign stop at Jewett after his
endorsement by the Florida Medical Association.
Because of its history, leadership and reputation, Jewett Orthopaedic Clinic continues to attract and retain capable and respected orthopaedic specialists in Central Florida.
Innovation in Joint Replacement
The baby boomer generation, a large population that is growing older and staying active longer, has led to a significant increase
in the need for joint replacement surgeries. Jewett physicians performed some of Central Florida’s first joint replacement procedures back in the 1970s, including the first total knee implant
in Central Florida and the first total hip replacement in Florida.
Throughout the years, they have led the way in developing new
and better techniques. Jewett’s skilled physicians now regularly
perform total joint replacement of all appropriate joints, most
commonly hips, knees and shoulders.
Hugh Morris, M.D., a Jewett physician who specializes in hip
and knee surgery, sports medicine and arthroscopy of the knee
and shoulder, follows in Dr. Jewett’s footsteps, continually creating new procedures and enhancing current treatments for joint
procedures. Dr. Morris has been recognized with countless local,
national and international awards, and is known for joint replacements that surpass the typical life span of 10 years. At 15 and 20
years, imaging shows that his replacements are just as solid as the
day they were completed. For many patients, this means they
only need the one replacement in their lifetime. Dr. Morris has
performed thousands of joint procedures, including more than
2,000 total knee replacements and another 2,000+ cases that have
been of a minimally invasive nature.
Dr. Morris is active in researching, testing and employing new
and underutilized technologies to enhance patient outcomes. In
these long-lasting joint replacements, the doctor is utilizing a medium viscosity cement, a technology he believes has been underutilized and he is now advancing and perfecting. “The science
behind this cement technique was first reported 30 years ago, and
I read about it during my fellowship in Boston,” shares Dr. Morris. “Yet, somehow, during all of these years, it has not really been
taught. Newer techniques continue to emerge, but in medicine,
new isn’t always better.”
Dr. Morris’ cement technique has received international recognition. His presentation “Radiographic Results of Total Knee Replacement Cement Technique with Medium Viscosity Cement”
was selected to be one of the few included on the Orthopaedics
Hyperguide site. The site offers continuing medical education
(CME) credits to doctors around the world, allowing them to
learn new techniques such as Dr. Morris’. The presentation shares
Dr. Morris’ cement technique for achieving superior long-term
results in total knee replacement patients.
Dr. Morris has also made significant advancements throughout
his career in the proper fitting and placement of implants. In fact,
he has been involved in designing instruments to help properly
place and fit implants. For a patient, it can be the difference between an implant lasting the rest of their life or having to return
for a repeat procedure years later.
Minimally Invasive Treatments Initially
Performed Twenty Years Ago at Jewett
There is a lot of discussion today about minimally invasive procedures. “Laparoscopic” and “arthroscopic” are hot words. The
truth is that, yes, minimally invasive procedures are changing the
face of medicine, but it’s not as new as you might think. Physicians affiliated with Jewett Orthopaedic Clinic were pioneering
minimally invasive procedures in the field of orthopaedics as early
as 20 years ago.
Today, Jewett doctors are highly experienced in treating cases
in the most minimally invasive manner. Clinic facilities employ
the highest technology in diagnostics so doctors can collect as
much information as possible before surgery. With the information provided by magnetic resonance imaging (MRI) and electrodiagnostic studies such as electromyography (EMG) and nerve
conduction velocity (NCV), physicians can fully understand the
patient’s situation before any incisions are made.
Jewett Orthopaedic Clinic also houses comprehensive physical
therapy facilities. Physical therapists partnered with orthopaedic
doctors can often minimize and sometimes cure orthopaedic issues with therapy to strengthen and rehabilitate muscles. This
usually involves the stretching and exercising of muscles while
increasing flexibility and performance of the affected anatomy.
When surgery is imminent, Jewett’s orthopaedic surgeons will
evaluate whether a case can be solved with a minimally invasive,
meaning arthroscopic or laparoscopic, procedure. Physicians utilize computer navigation and high-tech video equipment connected to an endoscope during these surgeries. Jewett employs
this technology in many joint procedures. Sometimes, the more
traditional type of surgery is still required, but doctors at Jewett utilize the least invasive treatments available to aid in quicker
recovery times, higher surgery success rates and less scarring. Patients also benefit from Jewett’s highly effective and minimally
invasive or disruptive pain management protocols.
Pioneers in Pain Management
Most signficiantly, recent pain management protocols have
changed orthopaedic surgery, and physicians at Jewett Orthopae-
dic Clinic have led in this area. Hugh Morris, M.D., was instrumental in creating a protocol to use a femoral nerve block to
hinder the patient’s pain receptors’ ability to perceive pain. The
nerve block is combined with nonnarcotic
supplements to numb the
knee, allowing for
a quicker recovery
time for patients
undergoing knee
replacement. This
technique has been
proven to eliminate
nearly 95 percent
of the post-operative pain.
“This stage of
pain management
is the most signifiJewett surgeon Hugh Morris, M.D.,
cant advancement
has
followed in Dr. Jewett’s footsteps,
I’ve seen in over 20
pioneering new joint procedures,
years of knee retreatments and protocols.
placement surgery,”
says Dr. Morris. “Traditionally, pain after knee replacement surgery is extremely high, making patients so afraid of the procedure.
This is an important technique that is making the post-operative
experience bearable for patients.”
Connected to the Community
Outside of the clinical setting, many Jewett physicians have
deciated time to be available to the community by way of lectures,
screenings and volunteering in local schools. “I love to spend
casual time with people to help them understand the elements
behind having a knee surgery,” says Richard Konsens, M.D. “It
gives them a sense of what will happen and when it is the right
time to visit Jewett Orthopaedic Clinic as a patient.”
In addition, Jewett knee surgeon Janet Robison, M.D., volunteers by performing screenings at many of the local Track Shack
races. “It gives runners a chance to talk to a specialist and figure
out a plan for their knee status,” she explains.
Sports Medicine Center
Building upon their leadership in the field of sports medicine,
doctors at Jewett Orthopaedic Clinic serve as team physicians for
the Orlando Magic, Orlando Predators, Orlando Miracle, Orlando Titans, University of Central Florida, Rollins College, Orlando Ballet, Cirque Du Soleil and many area high schools. Jewett Orthopaedic Clinic is equipped to help amateur, student and
professional athletes alike. Whether it is an injury or just normal
wear and tear, sports medicine physicians at Jewett work closely
with athletes to develop individualized treatment plans to help
them get back in the game. Sports medicine services include arthroscopic surgery (meniscal repair, ligament reconstruction and
arthritis debridement), knee, elbow, ankle and shoulder surgery,
7
COVER STORY
COVER STORY
Jewett Orthopaedic Clinic Medical Providers
Eugene L. Jewett, M.D.
(1900–1987)
Founder
Craig M. Mintzer, M.D.
Sports Medicine/Arthroscopic Surgery of the Shoulder & Knee
John W. McCutchen, M.D.
President & Chairman
Hip Surgery
Kenneth A. Krumins, M.D.
Arthroscopic & Reconstructive Surgery of the Knee
Sports Medicine General Orthopaedics
Gregory O. Munson, M.D.
Surgery of the Spine
Michael V. Jablonski, M.D.
Arthroscopic & Reconstructive Surgery of the Knee & Shoulder
Sports Medicine
Richard L. Shure, M.D.
Hand Surgery
Jewett sports medicine specialist Craig Mintzer, M.D., serves as
team physician for the Orlando Magic, a role Jewett has played
since the team was established.
realignment of knee injuries (cartilage and ligament) as well as
treatment of acute traumas such as fractures, sprains and strains.
Janet M. Robison, M.D.
Arthroscopic & Reconstructive Surgery of the Knee
General Orthopaedics
With its roots firmly planted in Central Florida, the Jewett Orthopaedic Clinic plans to continue to build upon the foundation
Dr. Jewett laid 75 years ago: a pledge to innovation and leadership
in orthopaedic care guided by a mission of providing their patients
with the highest level of care and the best possible outcomes. 
www.jewettortho.com
Philip A. Meinhardt, M.D.
Spine Surgery
William Felix-Rodriguez, M.D.
Primary Care Sports Medicine
John A. Papa, M.D.
Foot & Ankle Surgery
In addition to its seven office locations, Jewett is home to one of
the country’s first and Central Florida’s only walk-in orthopaedic
convenient care center dedicated solely to treating new injuries
such as broken bones, sprains, strains and lacerations. The Jewett Orthopaedic Convenient Care Center in Winter Park offers
patients an alternative way to see an expert immediately and receive urgent care without the need to go to the hospital emergency
room. In many cases, this service offers patients a quicker and less
expensive alternative to the hospital emergency room. No appointment is necessary, and the co-payment is the same as a physician
office visit, making the center very popular with patients. In fact,
it’s been in such high demand that Jewett will be opening a second
convenient care center this spring in Lake Mary.
Steven C. Choung, M.D.
Foot & Ankle Surgery
Kurt A. Gasner, M.D.
Hand Surgery
Shoulder & Elbow Surgery
Reginald L. Tall, M.D.
Jewett Orthopaedic Convenient Care
Center
Serving Central Florida for
Generations
Richard M. Konsens, M.D.
Reconstructive Surgery of the Knee
Sports Medicine
Brian K. Barnard, M.D.
Hand Surgery
Arthroscopic & Reconstructive Surgery of the Elbow & Shoulder
Sean M. McFadden, D.O.
Surgery of the Knee & Shoulder
Sports Medicine
Adam S. Fenichel, M.D.
Hand Surgery
Pediatric Orthopaedic Surgery
CLINICAL ASSISTANTS
Jared P. Reiss, PA-C
Robert S. Buckley, PA-C
Kit Kwan, PA-C
Skip Repass, PA-C
Joseph B. Billings, D.O.
Arthroscopic & Reconstructive Surgery of the Knee, Hip & Shoulder
Sports Medicine
Karen E. Glavin, PA-C
Collen M. Zittel, M.D.
Rehabilitation Medicine &
Electrodiagnosis (EMG)
Sarah M. Richardson, PA-C
Wadih S. Macksoud, M.D.
Hand Surgery
Shoulder & Elbow Surgery
Mary Lynn Brown, M.D.
Hand Surgery
Jeffrey A. Deren, M.D.
Hand Surgery
Mark A. Beckner, M.D.
John R. Chase, M.D.
Knee & Ankle Surgery
Hugh B. Morris, M.D.
Hip & Knee Arthritis Surgery
Sports Medicine & Arthroscopy of the Knee & Shoulder
David M. Costello, PA-C
Robert W. White, PA-C
Jeffrey A. Wright, PA-C
Bucky Boaz, ARNP
Kara Kobylka, PA-C
Jennifer Britt, PA-C
Neil Whitwam, ARNP
Kathryn Nantz, ARNP
Orthopaedic Community Launches Aggressive
Risk Mitigation Program By Fraser Cobbe
FORPG membership benefits may begin with stable, lower
premiums, but that is just one part of the picture. The organization created an active Claims Review Committee made up of
member orthopods across the state, representing the best and
brightest in almost every subspecialty. When a claim is filed
against an FORPG member, an anonymous summary of the case
file is brought to this committee for review. The entire group of
doctors, not just one reviewer, discusses the issues involved and
offers recommendations on the defensibility of the suit. No other
insurance carrier offers such a depth of orthopaedic specific experience and knowledge when it comes to defending claims.
A third area where the FORPG has made a difference is in
the crucially important area of political advocacy. Keenly aware
that it is the politicians who must eventually reform our broken medical liability system the FORPG has endorsed an aggressive education and awareness campaign for our elected leaders.
Armed with the knowledge provided by the development of the
purchasing group, the leadership of the FORPG is engaged in
efforts to seek targeted reforms to the tort system in Florida that
may deliver more reasonable and effective protections for physicians and patients.
While the FORPG has made great strides in the initial years
of existence there is great promise for the future.
Fraser Cobbe is the Executive Director of the Florida
Orthopaedic Society and the Bones Society of Florida,
813-948-8660 or [email protected]. 
The M o s t P o w e r f u l A n t iox id a n ts
™
PREMIUM RESERVE
As of February 2011, of the 900 or so active members of the
Florida Orthopaedic Society, nearly 1/3 are members of the Florida Orthopaedic Risk Purchasing Group. The buying power of
our group has not only driven down premiums for our members,
but has forced the competition to lower their rates too, benefitting even non member surgeons. Given the cyclical nature of the
insurance industry, the organization is aware that difficult times
are certain to appear again. When that next tight malpractice
cycle rolls around, standing together in unity will prove the far
wiser, and more profitable, course of action.
The final component of the organization is the Risk Management Committee. Charged with distribution of risk mitigation strategies to the members of the FORPG, the Committee
recently unveiled its first publication. Information is power, and
by understanding the types of issues that are giving rise to claims
against our members, we can further reduce our group’s risk profile, thus allowing us to deliver better quality care and hopefully
steer clear of the courtroom.
A Unique, All Natural Anti-Aging Serum
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Some two years ago Orthopaedic Surgeons across Florida decided to stand together and assume more responsibility in the
medical liability insurance arena. The concept was simple – the
Florida Orthopaedic Society and Bones Society of Florida would
develop a Risk Purchasing Group that would provide its members with buying power in the marketplace. Once purchasing insurance together, the organization could actively engage industry
partners to develop a better understanding of the risk inherent
in the practice of orthopaedics and apply risk analysis and risk
mitigation techniques that will make our individual members
more efficient professionals. Today, the Florida Orthopaedic Risk
Purchasing Group (FORPG) has fundamentally changed the
game of medical liability insurance for orthopaedic surgeons in
the state.
Dr. Michael Steppie
™
Produced by An Award Winning Dermatologist
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9
PHARMACY UPDATE
MTM: Medication Therapy Management
By Sam Pratt, B Pharm FIACP and Jill Weinstein B Pharm,
Robert Bennett and Aissa Roflo, UF PharmD Candidate
Pharmacology is the study of the various drug reactions that
take place within the human body. Although when we think of
the pharmacology of a specific drug we usually think of its primary mechanism of action, it actually extends much further than
that. Most drugs have numerous reactions that take place within
the human system, many of which may lead to unwanted side effects. In addition, many drugs react with other drugs when taken
together. They may potentiate, offset, reduce or nullify the actions of each other. All of these reactions are studied within the
science of pharmacology.
Pharmacotherapy is the study of how to treat various health
conditions through the use of “drugs”. A drug being any substance that when taken into the body, alters its normal function
or physiology. Under this definition the term drug includes
vitamins, minerals, hormones, as well as many other natural,
synthetic, or herbal products.
These two sciences are the backbone of the educational program of all students enrolled in any accredited college of pharmacy throughout the nation. Medical schools, on the other hand,
focus more on diagnoses. Therefore, it is crucial for both professionals to be part of a collaborative healthcare team to deliver
optimal patient care.
Medication therapy management (MTM) incorporates the
collaborative efforts of pharmacists along with doctors and other
health care professionals in providing patient specific care regarding the safe and effective use of medications. Recently, there
has been an increase in the use of MTM services within various healthcare organizations. This should come as no surprise as
many studies investigating the effectiveness of such programs
have shown startling results.
Impact of MTM
The Asheville Project
• Improved patient A1C levels. Number of patients with
optimal A1c values (of <7%) increased at each follow-up
visit at 24.3%, 27.2%, and 18.2%, respectively.
• Lower total health care costs—total mean direct medical
cost decrease of $1,200 to $1,872 per patient per year as
compared with baseline.
• Reduction in patient sick days with one employer group
experiencing an increase in productivity estimated at
$18,000 annually.
Diabetes Ten City Challenge
(DTCC)
• Patients improved in all of the recognized standards for
diabetes care, including decreases in A1c, LDL cholesterol
and blood pressure; and increases in current flu vaccinations and foot and eye exams.
• Employers realized an average annual savings of almost
$1,100 in total health care costs per patient when compared to projected costs if the DTCC had not been implemented and participants saved an average of almost $600
per year
At the crux of the pharmacist’s arsenal in administering MTM
services is Medication Therapy Review (MTR). With a comprehensive review of patients’ medication regimens, a pharmacist can
identify any drug related problems or concerns, devise a solution
to these problems, and provide patient education on their medications. Once these solutions are in place, it does not mark the
end of patient care. Following up with these patients is an integral
part of ensuring a positive response and maintaining a successful
treatment program. Pharmacists are able to conduct follow-up
interviews with patients, to obtain information on their response
to a given intervention. They can then relay this information to
their other healthcare providers as necessary in order to maintain
a continuance of care.
Another aspect that pharmacists play a crucial role in is the use
of functional medicine in the prevention of disease states that
require these medications in the first place. Functional medicine
is based on the following principles. The first is we are all unique
bio-individuals and should be treated as such rather than from
data compiled by a bell curve that shows norms. Second, health
equals positive vitality, not the absence of disease. Being well in
mind and body extend to every aspect of life. Third, functional
health is not throwing medication at a symptom, but instead a
balance in a system of emotional, cognitive and physical processes. The body is a symphony, not separate organ systems. Lastly, is
homeodynamics, the interaction between genes and environment
establishing a balanced system. Functional medicine is assuring
that the body has the building blocks it needs.
Pharmacists will play an important role in the physician-patient-pharmacist triad. We can use the MTM services to look at
the disease states a patient may have and determine from this
other possibilities for the physician, such as recommended lifestyle strategies that remove or reduce risks. The pharmacist will
look at prevention instead of “plugging the hole” with medica-
PHARMACY UPDATE
tions for symptoms. This is an opportunity to show the patient how they can
achieve a healthy lifestyle that will make
them feel good about themselves and save
money and teach the pharmacist to be an
entrepreneur.
A pharmacist is one of the most available healthcare professionals to the patient. They can provide functional therapy
management, which includes nutrition,
vitamins, mineral, amino acids, hormones
and weight loss management instead of
only medication therapy reviews. It is impossible to use an acute method of medicine and apply it as a chronic method of
medicine; then no one will be healed.
The definition of a physician is a healer
that is why we must be practice functional
medicine.
Costs of over $177 billion are associated
in terms of medication-related morbidity
and mortality in the United States. Incidence estimates currently show greater
than 1.5 million preventable medications
associated adverse events occurring annually. It is now, more than ever, imperative
that MTM programs be implemented
throughout the community in order to
combat this issue. With pharmacists being one of the most accessible health care
providers as well as being one of the most
knowledgeable on drug-related topics,
their active collaboration as part of the
healthcare team is essential in optimizing
patient care by identifying and resolving medication related problems, thus
preventing medication related adverse
events. By expanding the role of pharmacists within the healthcare arena the result
is better patient specific care and lower
overall healthcare costs.
References
American Pharmacist Association. Medication Therapy Management Digest: Perspectives on 2009: A Year of Changing Opportunities. March
2010. Available at http://www.pharmacist.com/AM/Template.cfm?Se
ction=MTM&CONTENTID=22674&TEMPLATE=/CM/ContentDisplay.cfm. Accessed January 28, 2011.
Robert Bennett and Aissa Roflo, Pharm. D Candidates at University of Florida
are currently on rotation at Pharmacy Specialists located at 393 Maitland Avenue in Altamonte Springs, FL 32701. Currently, Sam Pratt at Pharmacy Specialists is the only Full Fellow of the International Academy of Compounding
Pharmacists in the Central Florida area. Put a Clinical Pharmacist on Your
Staff-Not Your Payroll! Call Pharmacy Specialists to explore the possibilities of
a clinical pharmacist. For additional information please call (407)260-7002,
FAX (407) 260-7044, Phone (800) 224-7711, FAX (800) 224-0665. 
MartinHIPad.qxd:Layout 2
2/7/11
9:12 AM
“As a surgeon for
over 30 years,
I trust Jewett,
personally and
professionally.”
Sam Martin, M.D.
• Celebrating 75 years
• Eight locations to serve your patients
• Two walk-in clinics in Lake Mary & Winter Park
• Recognized internationally
407.647.2287
Bazaldua O, et al. Suggested Guidelines for Pharmacotherapy Curricula
in Family Medicine Residency Training: Recommendations from the
Society of Teachers of Family Medicine Group on Pharmacotherapy.
Fam Med 2005; 37(2):99-104.
Cranor C, Bunting B, and Christensen D. The Asheville Project: LongTerm Clinical and Economic Outcomes of a Community Pharmacy
Diabetes Care Program. J Am Pharm Assoc. 2003; 43:173–84.
Go to www.jewettortho.com
A tradition of care powered by innovation
The Asheville Project® Website. Available at http://www.theashevilleproject.net/home. Accessed January 28, 2011.
to see Dr. Martin’s full story
Winter Park • Lake Mary • Sandlake • University
Downtown Orlando • RDV Sportsplex • East Orlando
Jewett Orthopaedic Convenient Care Center in Winter Park
•
Fera T, Bluml B, and Ellis W. Diabetes Ten City Challenge: Final economic and clinical results.
J Am Pharm Assoc. 2009; 49:e52–e60.
Page 1
•
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FLORIDA MD - MARCH 2011 11
WEALTH MANAGEMENT
The Medical Professionals Protected Pension Plan;
Best-Selling Author’s Clients Share Their Perspective on a
Proven, Safe Money Solution!
By Chuck Oliver
Last month, I introduced The Medical Professionals Protected
Pension Plan, our proven, safe money retirement solution. This
month, I’ll share insights from the principles of a medical practice that has implemented our programs; what these plans mean
to them and why they decided to do something different about
retirement planning.
Dr. Cassia Portugal and her husband, Al, are my clients and
the principles at First Choice Pediatrics, a Central Florida practice with offices in Orlando and Sanford. Dr. Portugal has nearly
20 years of pediatric experience and Al is the business manager
for their successful practice. I recently asked them to reflect on
their experience with our Medical Professionals Protected Pension Plan.
Chuck – Why did you decide to change your retirement strategy?
Al – (Laughing) Well, Chuck Oliver had a lot to do with that.
Dr. Portugal – From the start, hospitals always offered the option
of several financial advisors. I always declined, thinking, why do
we need a financial advisor when we have no money? We had a
lot of work volume, but we didn’t make enough money so I said, “I
don’t need a financial advisor.” Every time we’d get something from
those (medical) conferences about financial advisors, I would think,
that’s one more person that we’re going to be paying without making
anything back. So, refused, until we knew we had to do something
about our retirement. We wanted to expand our medical practice
and we knew that if we continued the way we were going, we would
wind-up broke in retirement.
Chuck – So you said, “If we keep saying, ‘eventually we’ll do it,’ that
it would end up being too late for you?
Dr. Portugal – Yes! I said, “Time is moving, and we’re not moving
with time!” Then he (Al) went over several options; he’d heard about
you, met with you and he came to me and we discussed what to do.
It was not easy to change. We were reluctant; we had more losses than
gains from our traditional financial planning.
Chuck – Right, your planning was more traditional. Al and I had
several discussions regarding traditional IRA’s and 401k’s.
Al – I was maxing out my contributions on my job to have more
money for retirement. Then we realized that we just kept on losing
our retirement savings.
Dr. Portugal – We came to the conclusion that something wasn’t working
right; we were missing a major retirement piece. So, we decided to go in a
completely different direction.
Chuck – Knowing what you know now, what would you say to
other medical practitioners regarding their planning for retirement?
Dr. Portugal – I almost don’t like to think about this question. If I
knew what I know now 10 years ago, I would have started this sooner; but, I cannot move time back. Your plan takes stress away from
me. We now have a plan that protects in case of death or disability
plus, it has cash value that we can use the way we want. We’ll never
worry about losing money to the market and our gains are protected.
Our account can’t go down with your program. We’re relieved that
we can’t lose money to taxes or the market again.
Chuck – Realistically, if you had started on a traditional retirement
plan 10 years ago, you would have lost a good deal of it in 2001 and
2008. Now, you have a program where you can’t lose your gains.
Ironically, you started slower but, because you chose wiser, our program will help you make up for lost time and dollars. A doctor said
to me recently, “Doctors should be less concerned about their savings
rate and more concerned about their rate of savings.” A rate of return
doesn’t matter if you’re not saving anything to earn a rate.
Al – Examine conventional wisdom. When you see everyone going in
one direction, ask yourself, “Is this the right way to go?” You have to
take responsibility for your own plan and not rely on the traditional,
government endorsed plans (401Ks, IRAs) because taxes are higher
during retirement. You taught us that taxes cause people to withdraw
more money in retirement in order to have enough income to support
their future lifestyle.
Chuck – What action steps should other medical professionals take
to get their retirement plans secured and on-track?
Al – Medical professionals must learn about the alternatives that are
better suited to their needs: 1) invest the time to review your short,
educational webinar, 2) read your best-selling book chapter on The
Medical Professionals Pension Solution (a must) and 3) schedule
a consult to diagnose their wealth, just as our patients do for their
health. Once you look through a different lens and realize there is a
better way to properly plan your retirement, you can begin getting
that plan in place.
WEALTH MANAGEMENT
Your Simple Action Steps:
1.Review the short educational webinar: www.TheHiddenWealthSystem.com/MedicalProsWebinar,
2.Read the best-selling e-book chapter to learn from case studies:
http://www.thehiddenwealthsystem.com/pdf/TaxFreeBusinessOwner.pdf and
3.Set a free consult to diagnose your wealth - email: [email protected].
Charles “Chuck” Oliver is an industry recognized wealth strategist and two-time best-selling author who works with retirees,
those who are about to be retired and their families. These are people whose concerns center on taxes, market risk, and the
possibility of outliving their income.
Chuck Oliver’s Hidden Wealth System specializes in creating and preserving wealth. This helps clients to achieve financial
independence and become immune from economic down turns. Chuck and his Team educate clients on how to increase their
retirement income by 50% or more with little or no tax and with no market risk. Chuck shows his clients how to establish a tax
free income for the rest of their lives; an income that will transfer tax free to future generations.
Chuck is husband to Leanna and the father of two boys. He holds his family as one of his top priorities. Chuck is an avid golfer
and runner. Chuck runs marathons to raise money for special causes.
Chuck’s Unique Ability:“Investing in the well-being of others through strategic planning and innovative solutions to help serve
and transform financial and personal lives.”
To learn more about Chuck Oliver and The Hidden Wealth System visit: http://www.TheHiddenWealthSystem.com or call:
(407) 478-1599. 
Take a timeout to care about yourself.
For more information about our Men’s Health Program,
visit www.FloridaHospitalEast.com.
For an appointment with one of our Men’s Health
physicians, call (407) 303-DOCS.
Florida Hospital East Orlando Welcomes
Zamip Patel, MD
Urologist and Fellowship Trained Andrologist
EAST-11-854
EAST-11-854-FloridaMD-March Ad.indd 1
3/4/11 12:19 PM
Radiologist’s Corner
Kinematic Cervical Spine
Magnetic Resonance Imaging in
Low-Impact Trauma Assessment
By Vincenzo Giuliano, M.D., D.A.B.R.
Kinematic magnetic resonance imaging can be implemented
as a non-invasive adjunct examination for injuries in the cervical
spine in the clinical assessment of ligamentous, disk, and soft
tissue injuries, as a basis for determining medical versus surgical
management, and also establishing the degree of functional
clinical impairment.
The cervical spine is particularly susceptible to acceleration and
deceleration injuries resulting from impact trauma. Automobile
accidents and sports-related injuries account for a majority of such
injuries. More than 3 million cases of cervical spine injury related
to motor vehicle accidents are reported annually, with varying
degrees of soft tissue and ligamentous injuries. Cervical spinal
injuries are also prevalent in contact sports, including football,
hockey, rugby, and wrestling, in addition to some non-contact
sports, such as skiing, track and field, diving, surfing, power
lifting, and equestrian events. Football players are particularly
susceptible to cervical spine injuries with an incidence of 10
to 15%, most commonly, in linemen and defensive players.
Recreational activities, such as roller coaster rides, can deliver as
much as 5 G of vertical or axial acceleration force to the cervical
spine, resulting in cervical spinal injury.
Low-impact collisions result in acceleration and deceleration of the head and neck, also known as whiplash. Traditional
teaching viewed acceleration as producing extension forces and
deceleration as producing flexion forces in the cervical spine. Experimental biomechanical studies have further refined whiplash
as a biphasic injury mechanism. In the first phase, the cervical
spine forms an S-shaped curve, with hyperflexion in the upper
cervical spinal segments, and simultaneous hyperextension in
the lower cervical spinal segments. During the second phase,
both the upper and lower cervical spinal segments become fully
extended according to a path of least resistance. The biphasic
injury mechanism best explains the clinical findings observed
following whiplash injury. The cervical spine appears most susceptible to injury during the hyperflexion stage, which increases
biomechanical stress to the posterior cervical complex of the C4/
C5, C5/C6, and C6/C7 spinal segments, corresponding anatomically to the posterior longitudinal ligament, joint capsule,
interspinous ligaments, supraspinous ligaments, and ligamenta
flava. Statistically, the C5/C6 disk is the most common source
of cervical, axial, and referred arm pain. Surprisingly, approximately 60% of whiplash injuries are occult to MRI, and include
occult soft tissue, intervertebral disk, and ligamentous injuries,
accounting for approximately 90% of injuries missed by MRI.
The spectrum of injuries seen in low-impact trauma of the
cervical spine has not been well studied by imaging methods.
Hyperflexion injuries can evade radiologic detection. Kinematic
MRI provides the most optimal means of detecting subtle
hyperflexion injuries and annular disk tears, in addition to
evaluating segmental spinal motion and cervical lordosis
patterns. Kinematic MRI, in contradistinction to other imaging
methods, such as lateral flexion/extension radiographs and
videofluoroscopy, provides accurate assessment of spinal canal
stenosis.
Normal, non-injured patients demonstrate normal cervical
lordosis, with a normal segmental motion pattern characterized
by a characteristic stepwise segmental motion initiating at C1C2 and transmitting to the lower cervical spinal segments in a
coordinated and orderly pattern. Hypolordosis with normal segmental motion is generally observed in 4 to 7% of cases, representing a normal variant. Movement of the spinous processes is
fan-like and unrestricted, with most significant motion observed
from C4 to C7. Normal angular range of motion is 45 to 60
degrees in flexion and 50 to 70 degrees in extension. Small asymptomatic bulging disks can be observed in 2% of patients.
Kinematic MRI evaluations in injured subjects generally
support a spectrum of stable injury to the posterior cervical
complex, including the joint capsule, interspinous/supraspinous
ligaments, and ventral annulus fibrosus, with an intact posterior
longitudinal ligament. The posterior longitudinal ligament is
exceptionally durable, as confirmed in both biomechanical and
autopsy studies. A distinct imaging pattern is seen on kinematic
MRI in injured subjects. Hypolordosis is invariably present, with
notable segmental motion restriction characterized by absence of
the normal fan-like movements of the spinous processes of C4
through C7, sometimes fixed in a more horizontal configuration.
Flexion appears disproportionally restricted compared to
extension, with exacerbation of symptoms, including headache,
arm pain, and arm numbness. Quantitative angular motion
Radiologist’s Corner
restriction is highly variable. Another phenomenon observed are morphologic changes
in the injured disk, with flexion accentuating annular disk tears, disk bulges, and
herniations to produce visible extradural impression on the subarachnoid space.Spinal
stenosis is noted to be increased in these subjects, sometimes with cord compression. In
one series, symptomatic disk protrusions were observed in 28% of injured subjects.
Figure 1. Ligamentous injury characterized
by hypolordosis and segmental motion
restriction, in the flexed position (left) and
extended position (right), 12 weeks post
injury.
Kinematic MRI evaluations of the cervical spine can provide a valuable adjunct
method to the standard static cervical spine MR examination. The kinematic MR
examination can be performed in any suitable MRI system, with system parameters
adapted to achieving an in-plane resolution of between 0.75 to 1.0 mm, if possible, but
can be extended to up to 2.0 mm in open MRI systems with adequate imaging results.
The methodology represents a highly cost-effective approach to dealing with soft tissue
injuries of the cervical spine. Kinematic MRI is clinically indicated in patients with
whiplash injuries with one or more
Figure 2. Disk herniation with increased
persistent neurologic deficits or clinical
spinal stenosis following flexion (left, arrow)
signs and symptoms beyond the normal
and extension (right, arrow), without cord
and expected recovery period, generally
impingement, 12 weeks post injury.
within 8 to 12 weeks. Contraindications to the procedure include the presence of a
large disk herniation, cord compression related to disk herniation or spondylotic disk
disease, and severe congenital spinal stenosis. Results vary from patient to patient but
are generally reproducible and patients can be followed prospectively to assess the
therapeutic benefits of medical and manipulative treatment.
Vincenzo Giuliano, M.D., D.A.B.R.,
is Board Certified in Radiology and
serves as Medical Director of Vincon
Diagnostic Center, in Winter Springs,
Florida. He is also a member of the
teaching staff of the Family Medicine and
Neuromuscular Fellowship Programs
at Florida Hospital East Orlando,
where he was named educator of the
year. Dr. Giuliano attended medical
school at Pennsylvania State University,
residency in Diagnostic Radiology at
Hahnemann University Hospital, and
MRI Fellowship at Thomas Jefferson
University, in Philadelphia, PA, with
expertise in orthopedic MRI. He is the
author of multiple scientific and trade
publications, copyrights, U.S. patents,
and one textbook. He is a member of
the American College of Radiology and
Radiologic Society of North America.
Dr. Giuliano can be contacted at 407699-7787. 
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Hot Topics in Dermatology
A Real Pain in the Neck:
Pseudofolliculitis barbae
By Erica Mailler-Savage, MD
Pseudofolliculitis barbae (razor bumps) is a chronic inflammatory disorder characterized by erythematous follicular papules or
pustules, most often in the beard and neck area of men (Figure
1). Most often induced by shaving, pseudofolliculitis barbae is
a chronic foreign body reaction to ingrown hairs. Patients with
coarse hairs with curved follicles and curly shafts are predisposed
to developing this condition. After shaving, plucking, or waxing,
hairs can either grow normally to the skin surface and curve to
repenetrate the epidermis in a retrograde fashion, or can never
make to the skin surface and pierce the follicular wall and enter
the dermis directly. Both types of growth result in an inflammatory reaction that leads to papules and pustules, and over time
may lead to post-inflammatory hyperpigmentation or keloids.
Figure 1: Pseudofolliculitis barbae
another adjunctive treatment that can be used to exfoliate, however, they have also been shown to reduce the sulfhydryl bonds in
the hair shaft, resulting in straighter hairs that have less potential
to reenter the epidermis.
An alternative to shaving facial hair is chemical depilatories.
These products work by weakening the disulfide bonds within
the keratin of the hair to make it easily removable with a blunt instrument or washcloth. The hair left behind has a blunt tip and is
therefore less likely to pierce the follicular wall. However, irritant
or allergic reactions with these products are not uncommon.
Laser hair removal with a diode (800-810nm) or Nd:YAG
(1064nm) can be used for permanent hair removal. Transient
hyperpigmentation or hypopigmentation may result with these
treatments and frequent treatments are needed to keep up with
Whether
you
selling,
the hair
cycle.are
Permanent
hair removal by electrolysis is not recommended
in patients
with pseudofolliculitis as studies have
buying,
seeking
an associate
shown that it may exacerbate the condition.
or practice valuation,
shouldn’t
use a broker
Ericayou
Mailler-Savage,
MD, is a board-certified Dermatologist and fellowship-trained
Mohs surgeon specializthat specializes
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ing in skin cancer removal. Her practice, Comprehensive
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& Dermatologic Surgery, recently opened in
Winter Park, Florida. Prior to moving to Winter Park,
Dr. Mailler-Savage was a practicing physician and clinis'ENERAL0RACTICE
cal instructor at the University of Cincinnati. She may be
s-EDICAL)NTERNAL-EDICINE
contacted at (407) 339-7546 or by visiting www.comprehensivedermorlando.com. 
The best treatment for pseudofolliculitis barbae is prevention.
s-EDICAL3UBSPECIALTY0RACTICE
Allowing the beard to grow for one month to a hair length of 0.5s'ENERAL3URGERY
1mm usually results in spontaneous resolution of this condition.
s3URGERY3UBSPECIALTY0RACTICE
If facial hair is unwanted or if a clean-shaven appearance
is
mandated by occupation, proper shaving habits can prevents$ENTAL0RACTICES
severe
flares. Decreasing the frequency of shaving is the most significant
s0ODIATRY0RACTICES
factor in the frequency of flares. Prior to shaving, cleanse the
skin
with an antibacterial soap or benzoyl peroxide wash using warm
water. Remove any visibly embedded hairs with a needle. Apply
a shaving gel or foam and use a sharp single-blade or newer fiveblade razor to shave in the direction of the hair growth (with the
(407) 252-5276
grain) and the skin should not pulled or stretched while shaving.
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Apply a topical antibiotic-benzoyl peroxide product after shaving. For severely inflamed lesions, a low potency topical steroid
can be applied. At night, a topical retinoid should be applied to
exfoliate the skin. At-home chemical peels with glycolic acid are
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Sell Your Practice
Buy A Practice • Partnerships
(407)252-5276
Facial Cosmetic Surgery
The Growing Trend of Men Seeking
Cosmetic Surgery By Ross A. Clevens, M.D.
Competition in today’s youth-oriented world markets is fueling more men to turn toward cosmetic surgery for lifting their
chances of success. As the need to compete effectively rises, so
does the acceptance of cosmetic improvement among professional men.
More men are fighting the aging process as they find a more
youthful appearance can be a big benefit for business. Many men
seek facial rejuvenative surgery such as face lifts, eyelid surgery,
nose reshaping, and skin resurfacing such as lasers and peels.
That reflection in the mirror has now become as important to
men as it has always been to women. All individuals, male or
female, are appearance-conscious.
Still, many men are reluctant to explore plastic surgery options, thinking it may not be the “masculine” thing to do. Plastic
surgery is more acceptable to men when there are quicker healing times involved, and once the age signs are removed, men
return to work quicker than expected and begin to live a more
active and aggressive lifestyle.
In addition, men are faced with unique considerations when
contemplating a cosmetic procedure. The anatomy of a man
is quite different from a woman. Muscles tend to be thicker,
chemical reactions in the body differ and a greater variance in
exposed skin areas may be a consideration. While these differences do not necessarily pose a greater possibility of complications, gender difference may alter procedure choice or the extent
of the procedure.
Men need to take into account their tolerance for scarring and
Before Weekend Necklift
After Weekend Necklift
how their own body tends to heal. More often than not, men
cannot cover scars in the facial area as well as women. Hairstyle
and makeup work in a women’s favor. Men are also usually much
more concerned about privacy than women, and may need to
be off work longer following facial procedures to prevent others
from recognizing the tell-tale signs of cosmetic surgery.
In my practice one of the most popular procedures chosen by
my male patients is the laser assisted ‘weekend’ necklift. This surgical procedure represents the evolution of sophisticated facial
plastic surgery techniques. By combining surgical and laser techniques, I achieve improvement in the contour of the chin and
neck with minimal incisions and rapid recovery. Cervicofacial
Liposculpture is first employed to contour the unfavorable fatty
changes seen in the face and neck as time passes by, such as the
‘Turkey neck’ and ‘double chin’. Careful attention is then turned
to tightening the neck muscles and eliminating neck bands. Finally, the laser is used to ‘resurface’ the underside of the neck
skin, thereby ‘shrinkwrapping’ the skin of the neck restoring a
youthful contour.
Because a neck lift removes excess fat and muscle in the jaw
or chin area, in the case of the neck lift, the beard length and
side burns may be factors in deciding the appropriate place for
incisions. Also, the muscles in the neck are thicker in men than
women. This does not necessarily present a surgical problem or
implicate additional complications. Yet, it may change the extent of the procedure. The skin texture of a man’s chin and neck
is more course than a woman, reducing scar appearance, while
beard and side burns can also assist with covering scars.
and Chin Implant
and Chin Implant
Facial Cosmetic Surgery
and Chin Implant
and Chin Implant
and Chin Implant
and Chin Implant
The goal among men in seeking plastic surgery is to project on the outside what they still maintain on the inside-- a youthful, vibrant
contributor to today’s society. Men want the confidence to compete with their younger counterparts, and many patients are amazed at
what just a nip and a tuck can do within a very short time. For most men, the laser assisted weekend necklift procedure offers maximum
cosmetic benefits with minimum downtime.
Ross A. Clevens, MD, FACS, is a Board Certified Facial Plastic and Reconstructive Surgeon having completed his undergraduate education at Yale University, his medical degree at Harvard Medical School and his M.P.H. in Health Policy and
Management also at Harvard University. Dr. Clevens completed his residency in Head and Neck Surgery and an advanced
fellowship in Facial Plastic and Reconstructive Surgery at the University of Michigan where he also served as Chief Resident.
Dr. Clevens is a nationally recognized educator, author,
lecturer; he has served as President of The Florida Society of
Facial Plastic and Reconstructive Surgeons, Chief of Staff
at Wuesthoff Medical Center, President-Elect of the Brevard
County Medical Society, and has held numerous leadership
positions with the American Academy and the American
Board of Facial Plastic and Reconstructive Surgery.
Dr. Clevens has been in private practice in Central Florida since 1996. At the Clevens Center for facial Cosmetic
Surgery he has established a practice grounded in patientcentered care. Clevens states that his staff is his great asset
- -knowledgeable professionals who impart compassionate
care with exceptional customer service.
Dr. Clevens’ leadership and commitment to excellence
transcends to his philanthropic endeavors through participating in numerous charitable organizations in our community. Dr. Clevens recently joined a humanitarian and
medical mission trip to East Africa. Having the opportunity
to affect profoundly the lives of others through the application of his education, training and judgment proved to be a
deeply gratifying and humbling experience.
He can be contacted by calling (321) 727-3223or by visiting www.DrClevens.com or www.FloridaFaceAndBodySpecialists.com. 
Using Nutraceuticals
Functional Approach
to Men’s Health
By David S. Klein, MD, FACA, FACPM, FAAMIMS
Of the many health issues that are important to men, most
result from hormone imbalance. Focus on individual symptoms,
such as hair loss, erectile dysfunction and prostatic enlargement
tend to divert attention to the underlying pathology that directly,
or indirectly results in each of these three, prevalent problems.
hormones that effect the same genetic trigger. In short, it is
the testosterone to estrogen ratio that will indicate the state of
balance. Other hormones, such as pregnenolone, androstendione, thyroxin, and cortisol are important, and attention to these
is important, as well.
Estrogen
Hormone Replacement
As women age past early adulthood, estrogen levels tend to decrease. The symptoms that result are well known to most medical
practitioners. In men, however, estrogen levels tend to increase
with age. Around the age of 40 years, the total estrogen level in
an average male equals or exceeds the female of the same age. After this middle-aged crossing point, male estrogen levels tend to
significantly exceed those in females. It is the increase in estrogen
level that tends to cause many of the age-related medical complaints in men, particularly those related to prostatic enlargement and erectile dysfunction.
Restoration of hormone balance is the goal of therapeutic intervention, and this intervention takes place on several levels.
Replacement of depleted hormones must reflect diurnal and
seasonal cycles. Testosterone, for example, normally peaks in
the very early morning hours, and drops as the day progresses.
Testosterone replacement is best accomplished with daily application, transdermally. When testosterone is used, it should be
administered so that it peaks in the morning and drops, as occurs
in nature. Sustained release patches are not as physiologically satisfactory as an immediate release cream. Consideration must be
given as to where the cream is applied, as well, so as to avoid lipid
tissues that chemically convert testosterone to estradiol. Further,
these testosterone creams can be given in such a way as to diminish this testosterone to estradiol conversion, through the skin.
Testosterone
Testosterone levels peak, in men and women, in early adulthood, and in both men and women, testosterone levels decrease,
linearly, with age. The testosterone level in a man of 50 years of
age will be approximately 50% of what that level was when the
man was 25 years of age.
DHEA
Dihydroepinandosterone (DHEA) is the most prevalent hormone in human physiology. Sometimes referred to as the “fountain of youth hormone,” DHEA is a precursor to progesterone,
testosterone and estradiol. DHEA levels predictably drop with
age, but in a significant number of persons, these levels can fall
to ‘levels of detection,’ and below. That is, DHEA can be observed to drop off the chart, entirely. Low levels of DHEA has
been identified as factor in depressive illness, low levels result in
loss of libido in men and women, and low levels of this hormone are related to the development of dementia.
When given in an unthoughtful way, testosterone will convert
to estradiol, and the patient will see worsened gynecomastia, hair
loss, axial obesity and worsening of the erectile complaints. This
is seen most commonly in athletes, weight lifters, and amateur
athletes that use intramuscular testosterone. The weekly I.M. bolus results in very high estrogen levels and systemic problems
invariably follow.
DHEA is relatively inexpensive and easily administered. Diurnal variations in DHEA are not as pronounced as with testosterone, so timing is not as tricky. DHEA can be administered
orally. The main issue with DHEA is absorption due to lipid
solubility, and liver enzyme induction when given in high doses.
These pitfalls are avoided by administering the DHEA simultaneously with a fish oil capsule.
The Ratio Effect
Non-prescription Intervention
Steroidal hormones act to trigger genetic switches in cell nuclei. The effector sites at the cell nucleus most often involve multiple hormones, some stimulatory, some inhibitory. The ratio of
these hormones, relative to each other, triggers cellular events.
That is, the ratio of testosterone to estrogen, or estrogen to progesterone determines cellular effect. It is for this reason that the
‘level’ of the hormone is only significant in relation to the other
Reduction in serum estrogen levels is possible through the use
of inexpensive, commonly available supplements. Testosterone
levels can be increased with the proper use of Saw Palmetto, indole-3-carbinol, and zinc. Estrogen levels can be decreased with
the proper use of silymarin, fiber, and D-glucaric acid. Pharmaceutical-grade products are available, at reasonable cost to the
patient.
Using Nutraceuticals
Quality is never guaranteed by high
price, but one rarely gets high quality
without some expenditure. It is important for the practitioner to understand
how to guide the patient through the
maze of available OTC products, some
of which are of exceptional quality, and
some are of little use, at all. Further, timing of when to take the medicines and
supplements is essential to successful
treatment.
Improvement in erectile dysfunction,
nocturia and depression can be seen in
as little as 2-3 weeks. Restoration of hair
growth can be seen in 4-6 weeks. Reversal of gynecomastia and axial obesity can
take 6-12 months.
Dr. David Klein has practiced
pain medicine for the past 27 years
and is the author of over 50 published
articles and textbook chapters and
has lectured extensively. He is a
member of the American Board of
Anesthesiology, American Board
of Pain Medicine, American
Academy of Pain Management,
American Board of Minimally
Invasive Medicine & Surgery, and
has Sub-Specialty Certification
in Pain by the American Board
of Anesthesiologists. Dr. Klein is
presently the Medical Director
of the Pain Center of Orlando,
located at 225 W. SR 434, Suite
#205, Longwood, Florida 32750.
Telephone 407-679-3337. FAX:
407-678-7246. www.suffernomore.
com. 
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ORTHOPAEDIC UPDATE
The Value of Proper and Efficient Imaging to
Accurately Diagnose and Avoid Repeat Tests
By Jennifer Roth Miller, Staff Writer
Diagnostic imaging isn’t perfect 100 percent of the time, but
the value of imaging is that it can provide physicians with more
information about what is actually going on inside a patient’s
body through non-invasive means. There are many conditions
and injuries that elicit similar symptoms and pain, so gathering
more information greatly aids doctors in correctly diagnosing a
patient and is certainly a benefit. In cases where a physician is
contemplating surgery, imaging can either confirm or rule out
the need.
It is important to understand, Florida is not a Certificate of
Need (C.O.N.) state when it comes to outpatient diagnostic testing facilities. This means just about anyone can open a diagnostic
center. While the cost of high-quality equipment has decreased
in recent years, the low-quality equipment is even less expensive.
Of course, businesses are always looking for ways to cut costs to
maximize profits and utilizing the less expensive equipment may
seem like a viable way to cut costs to a person trained in business
rather than treating patients.
Patients are knowledgeable enough to ask questions, but unfortunately many think that magnetic resonance imaging (MRI)
from one company’s machine is equivalent to the MRI produced
from another. This is not always the case. Diagnostic equipment
may look the same, but the internal components and the images
they produce can be very different.
Ron Esteban, Director of Ancillary Services at Orlando Orthopaedic Center, shares an analogy to help others understand
the importance of high-quality imaging. He asks, “Would you
rather watch the Super Bowl on a television with rabbit ears or
on a high-definition television?” Just as the high-definition television provides a significantly clearer picture, so does the MRI from
high-quality equipment.
Unfortunately, there are many diagnostic imaging centers that
utilize poor equipment and the images their equipment produces
sometimes necessitate the need for repeat studies. These repeat
studies aren’t always covered by a patient’s insurance.
The good news is The Centers for Medicare and Medicaid Services have mandated an accreditation policy effective in 2012,
meaning any diagnostic center performing studies on Medicare
patients must be accredited by one of three approved accrediting organizations (AO). While this may seem like a good idea,
there are still problems with the accrediting process. The policy
will probably not eliminate all of the poor or sub-standard equipment, but it is a start.
Even better, patients referred to Orlando Orthopaedic Center
already have access to superior technology in diagnostics, the 1.5
Tesla Closed Short Bore MRI. The center is accredited by the
American College of Radiology, the gold standard and most dif22 FLORIDA MD - MARCH 2011
Dr. Bryan L. Reuss
ficult AO to gain accreditation from. Doctors referring their patients to the center can be confident they will receive proper and
efficient diagnoses. Patients can access the center’s two advanced
MRI magnets at their choice of two convenient locations.
In addition, Orlando Orthopaedic Center is leading the way
with imaging techniques. For example, the center uses advanced
imaging to diagnose labrum tears and pathologies in shoulders
and hips. These are cases in which typical imaging is not adequate.
Bryan L. Reuss, M.D., a physician at Orlando Orthopaedic
Center specializing in sports medicine related surgery says, “A
typical non-contrast MRI of the shoulder has only a 50 percent
chance of diagnosing a superior labrum anterior-posterior (SLAP)
tear or lesion, so you may as well flip a coin.” Dr. Reuss was involved in a study that was published in the Journal of Shoulder
and Elbow Surgery. His team’s research demonstrated that the addition of contrast improved the diagnostic accuracy significantly.
When typical MRIs are not adequate, contrast dye is sometimes injected in a joint. This enhances imaging and is referred
to as arthrography. Dr. Reuss’s team’s research summarizes the
outcome of non-contrast MRI versus MRI arthrogram accuracy
for the diagnosis of SLAP lesions. The MRIs with contrast were
much easier for radiologists and doctors to read and therefore
provided more information for proper diagnosis.
Also, performing a hip MRI to evaluate for a labrum tear is
much less accurate than an MR-Arthrogram. Most of the time
Dr. Reuss, the only surgeon performing hip arthroscopy at the
center, will gather more information by requesting an MR-Arthrogram despite the fact that a plain MRI has already been done.
Patients are sometimes frustrated by this, but it is necessary when
making a decision for surgery.
With the increased information provided by arthrograms, physicians can offer the most effective and minimally invasive treatments available for each of their patient’s situations. There are a
variety of minimally invasive hip, shoulder, knee, elbow and ankle
surgeries currently available to patients with a correct diagnosis.
Referring physicians can expect to receive the highest quality
imaging from Orlando Orthopaedic Center along with proper
and efficient diagnosis of referred patients. The center is accredited
by the American College of Radiology and its doctors take extra
measures such as requesting arthrograms to gather as much
information as possible in a non-invasive manner. This ensures
referred patients receive the treatment they need as quickly and
efficiently as possible. The need for repeat testing is avoided saving
patients and insurance companies time, hassle and money. 
Medical Malpractice Expert Advice
As More Doctors Consider Selling Out to
Hospitals, Should They Be Concerned with
Any Malpractice Liability Issues?
By Matt Gracey
Yes, there certainly are some issues that don’t seem to be much
thought about by those who have already joined hospitals. The
main one that I am worried about is that most hospitals are
demanding that they be the ones to decide the many important
factors involved in fighting a malpractice lawsuit against their
employed doctors. The hospitals want to control everything
about a case against one of their doctors — from initial assessment
and early risk management to dampen the effects of a potential
claim, to overall defense strategy, to ultimately the decision of
settling or not and the amount of the settlement offer.
As we all know, in many cases the doctors involved have
very different exposures than the hospital and very often those
exposures lead to extremely different strategies, all of which the
doctors working for hospitals will lose control of in most hospital
employment arrangements. Hospital-employed doctors without
a say in their defense in a lawsuit against them could be put in
very awkward positions as they try to assert their innocence and
the hospital staff’s possible guilt. Worse yet could be the now
potentially career-ending situations due to the “three strikes”
law that has been enacted in Florida. In addition, payments
made on the physician’s behalf are reported to the National
Practitioner Data Bank and follow a doctor for the rest of their
practice life. All potential employers, credentialing entities, and
potential insurers will be aware of a settlement made on the
physician’s behalf and that physician will have to go through the
process of explaining each case many times. Florida physicians
have to report to the Department of Health any settlements of
$100,000 or more made on their behalf and their profiles will
reflect the settlement amount for the public records, which many
prospective patients view, and these settlements could become a
catalyst for disciplinary action against a physician.
Of course, lawsuits and the need to contemplate settlements
in a case gone bad are not great situations for any doctor, no
matter their practice arrangement, but for hospital-employed
doctors or those thinking about selling out to hospitals, a
serious concern that not many are yet talking about is that in
most of those arrangements they will be giving up total control
over their defense of a malpractice lawsuit to their new hospital
employers.
As always, I recommend that you consult an experienced
healthcare attorney and a malpractice insurance expert to help
you further analyze these issues.
Matt Gracey, Jr. is a medical malpractice insurance specialist
agent with the firm of Danna-Gracey in downtown Delray
Beach. To contact him call (561) 276-3553 or (800) 9662120, or e-mail [email protected]. 
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Marketing Your Practice
Are You QR-eady?
By Jennifer Thompson
Intro
They’re everywhere; it’s a promotional pandemic of jumbled
white and black pixels set to take over the marketing scene.
You’ve most likely seen them on magazine advertisements,
popping up on billboards, hiding in brochures, saying hello on
event nametags and saying goodbye on point-of-sale receipts.
But what are these little pixilated labyrinths and what are they
to you?
These little square guys are called Quick Response codes (or
QR codes) and they can take your practice to the next level if you
use them correctly. Acting similar to their linear predecessors you
often find in the local grocery store or shopping mall, QR codes
are essentially barcodes. Only instead of a merchant scanning
one on the back of a product, savvy marketers have begun to
drive exclusive content through them, boosting business and
building loyalty with their patients. QR codes are capable of
holding thousands of alphanumeric characters of information
which means you can create a code – for free even – linking
to essentially any video or webpage you want within just a few
minutes.
QR codes offer a pool of untapped possibilities just waiting
to be used. And if you don’t jump in, you’ll be left high and dry.
Corny? Maybe. True? You better believe it.
Why Does it Matter to My Office?
QR codes are a convenient way to connect people with
multimedia digital content in an interactive fashion. Think
about it: how many working adults do you know that don’t have
a smart phone?
All it takes is a quick scan on a QR code reader app, which can
be downloaded for free or may already be integrated into your
phone. A few of the popular ones are i-nigma for the iPhone,
ScanLife Barcode Scanner for Blackberry and Google Goggles
for the Android platform.
With one snap of a camera utilizing the barcode scanner app
of your choice, a person is instantly linked with supplemental
materials like explanations about their health, profile videos
allowing patients to “get to know” your doctors, directions to
your business, hours of operation , and customer feedback forms.
The best part is, that’s just a small sample as to what’s available
to users. The most important aspect is that there’s no paper and
pencil required. Those are caveman tools, anyway.
I Like It. How Can I Make it Work?
QR codes act as a simple way to bring people in for any call
to action because it asks for little energy on the user’s part and it
provides them with information they want immediately.
With that said, the first step is to decide what you’re going
to be promoting via QR codes. Think of some practical things
you can do that patients would be interested in. Here are a few
examples to consider:
• Office staff and doctor profile videos
• Videos to health related ailments and explanations
• Links to a VIP appointment scheduling – short notice, no
wait, etc.
• Links to photo recaps of past community events you were a
part of
• Links explaining to patients what to expect/bring on their first
visit
With everything you do, you want to promote that you are a
real office and are there to help fulfill the patient’s needs.
The next step is creating your code. One of the more popular
sites is http://qrcode.kaywa.com/. Once you’re there, type in the
URL of the page you already have created, choose a size and
click “Generate!” Viola. Your first QR code for your practice.
The trick, again, is to provide relevant, useful content for your
patients and users – meaning you don’t want to just link to your
website.
Finally, you have got to tell your patients about the code.
This can be done through a variety of ways including in-office
signage, on print or television ads, posters, your website, the sign
in forms at the front desk, and exam room signage. How you tell
them is really all about what works best for your office and your
level of creativity. The important part is that you’re telling them.
If you’ve linked to videos or exclusive pages on your website not
available unless a patient scans a QR code, you can then freely
monitor how well they’re working, how often unique users visit
them and more.
What’s Next?
That’s up to you. If you choose to use QR codes, you’ll be
ahead of the curve and you can really offer something unique
to patients and to fellow medical industry professionals. If you
choose not to, that’s ok too, but you might want to break out
that old black and white tube television
and Walkman cassette player while you’re
living in the past.
The Difference is in the Details.
More Than 39 Years Serving Central Florida
17 Physicians Specializing in all Orthopaedic Issues
MRI Services at 2 Locations
State-of-the-art Outpatient Surgery Center
Physical Therapy Available at Every Location
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About the Author: Jennifer Thompson is a Central Florida small
business owner, serving as President of Insight Marketing Group,
a full-service marketing company
focused on medical office marketing, community outreach efforts,
and grassroots public relations. In
this capacity she is responsible for
developing and implementing the
long-term strategic vision for the
organization, which includes publishing Insight Magazine, the company’s community-based monthly
news magazine, and hosting their
weekly small business networking/
mentoring group, Coffee Club. In
November 2010, Jennifer was elected to the Orange County Board of
County Commissioners. 
5 Convenient Locations:
Downtown Orlando • Winter Park • Sand Lake • Lake Mary • Oviedo
Contact Jennifer Thompson today
for a free consultation and marketing
overview at 321.228.9686 or e-mail
her at [email protected].
www.orlandoortho.com – 407.254.2500
Looking for more
information?
Saturday Hours Available
%
Here’s a QR code for access to my
collection of marketing articles written to
help you grow your practice. To view, use
your phone’s barcode scanner.
Maitland’s Medical City
By Douglas Kinson
Editor’s Note: This article originally appeared in City Talk
Central Florida is blessed in that we have become one of the
nation’s leaders in computer modeling, simulation and training.
Based primarily on the military, and mostly located in the UCF
Research Park, it is a $3 billion industry that encompasses over
130 companies and 30,000 jobs. Did you know that nearly every
member of the military sent to defend our country at some point
in their career was trained on technology that was either designed
or developed in Central Florida?
But in addition to our military advancements, Medical City
in Lake Nona represents a confluence of medical and education
giants that could rival our military advancements in the field of
medical training and simulation. Sanford-Burnham Medical Research Institute, the new UCF College of Medicine, and the Orlando VA Medical Center have joined forces with UCF’s College
of Medicine to create a medical powerhouse that will change the
way the world views medical research.
The impacts of Medical City have already been felt locally with
the creation and addition of thousands of medical, professional
and construction jobs that have helped to stimulate our economy.
And the focus Medical City has brought to Central Florida has
reached our local community.
In Maitland, the development of a 43,000 square foot facility
has quietly and successfully surfaced as the potential beginning
of a sister medical campus to the north. A medical consortium of
some of Florida’s most prestigious doctors has chosen Maitland
Concourse South to locate their new offices and surgery center.
The medical center’s principal focus will be on serving the pediatric needs of the community, providing a multitude of pediatric sub-specialties and outpatient surgery services. A pediatric
campus of this size, accompanied by a 12,000 square foot surgery
center on site, will not only be unique to Central Florida, but will
rival pediatric centers in major metropolitan cities across the nation. Although focused on pediatric care, the medical center will
also offer a variety of medical services for adults.
Lamm and Company Partners developed the project. I attended the ribbon-cutting a couple weeks ago and was incredibly
impressed with the doctors that are a part of bringing this project
to Maitland. Anchors to the medical center will include Eye Physicians of Central Florida, Children’s Ear Nose and Throat Associates, Florida Pediatric Associates and Children’s Surgery Center.
OB+ Architecture is the design architect for the project, which is
located on Maitland Boulevard a few blocks east of the I-4 interchange. In addition to their impact on the Maitland community,
their location is what is important to Central Florida’s future.
Maitland Boulevard, east of Interstate 4 recently received approval for widening to six lanes and is expected to be one of first
east/west rail lines connecting to the Sunrail commuter rail system. This corridor also includes significant undeveloped land in
the heart of Central Florida which could represent a major future
medical development opportunity with easy access to and from
Interstate 4.
Although it will never rival Medical City in Lake Nona in size,
the future medical development opportunities could make this
corridor and the City of Maitland a branch of Central Florida’s
medical city that could over time rival any pediatric center in the
country. But of course, the vision of our future leaders, along
with the involvement of our local medical and development partners will determine the course of action we will take.
We can only hope and dream.
Doug Kinson recently completed his second term as Mayor
of the City of Maitland. Since being elected to office in 2006,
Mayor Kinson has accomplished a number of intiatives.
He instituted for the first time in Maitland history a longrange, strategic planning process that uniquely prepared the
City for the downturn in the economy. In addition to balancing budgets in the most challenging of economic times, he was
focused on improving the economy by supporting efforts to
keep projects moving ahead that resulted in the savings and
creation of thousands of jobs in Maitland. He is credited with
making government more accountable, leaving a financially
stable Maitland, and for providing a more safe, family-oriented environment that has resulted in a greater quality of
life for our families.
Doug moved to Central Florida over 25 years ago after receiving his Master’s Degree from the University of Wisconsin. He
has been active with civic organizations over the years and
has recently served as Chairman of the Community Redevelopment Agency (CRA), the CRA Advisory Board, and the
Maitland Police & Fire Pension Board. He has also served as
an active member of the Orange County Tourist Development
Council, MetroPlan’s Metropolitan Advisory Council and
currently has served as the honorary Chairman of the American Cancer Society’s Relay for Life for the past two years.
Over the years, Doug has held many leadership positions in
Central Florida. After being elected the first Chairman of
the Board of the newly merged Seminole County Chamber of
Commerce, he became president of his Rotary Club and also
served as Maitland Little League President during the Maitland All-Stars trip to Williamsport in 2005. He started his
professional career with IBM in Orlando. After ten years, he
pursued his dream of a career in commercial real estate and
is currently President of Professional Real Estate Company
LLC whose focus is in assisting owners, investors, and tenants
in all aspects of real estate.
Doug and his wife, Barbara, recently celebrated their 20th
wedding anniversay and are extremely proud of their three
children, Cole, Cassidy and Kaley. Doug can be reached best
at (407) 628-4045 or by email at [email protected]. 
SBA 504 Refinancing:
A Groundbreaking Opportunity
By Chris Hurn, CEO/Cofounder, Mercantile Capital Corporation
You may or may not know that several changes were made to
U.S. Small Business Administration (SBA) loan programs this
past September with the passage of the Small Business Jobs and
Credit Act. One of the most-significant changes is the two-year
provision that allows small-business owners to use SBA 504 loans
to refinance commercial real estate and other eligible fixed assets, and this has huge ramifications for physicians who own their
commercial property.
By refinancing your commercial mortgage with a 504 loan,
you can tap the embedded equity in your commercial property,
as well as take advantage of historically low interest rates. The
SBA 504 loan program may be the best-kept secret in commercial
property financing because it offers the highest cash-on-cash return financing available, as well as below-market, long-term fixed
interest rates and longer amortizations. The opportunity to use
these loans for refinancing is a great one for doctors and other
medical professionals, and should be acted upon immediately.
A Second Chance
A large number of physicians bought the commercial property
their practices occupy in recent years. If you were one of them,
then you made a great decision. Doing this allowed you to turn a
monthly lease payment into a mortgage payment which actually
builds equity and ultimately creates wealth. The decision made
great business sense, and you probably got a conventional loan
from your commercial bank to finance your project.
Fast-forward to the present: just like so many other doctors,
you’re facing a ballooning note payment. If you could refinance
and take advantage of low interest rates, your situation would become much more manageable. The only problem is that it’s tough
to find a bank that will do a conventional refinance these days,
even for physicians. Today’s tighter underwriting standards have
made it increasingly difficult for borrowers like you and other
doctors to qualify with most banks.
The scenario I’ve just laid out may not describe your situation
exactly, but if you’ve purchased commercial property in the past
10 years, I’m probably not very far off. The good news is that
the SBA is giving you a second chance by allowing refinancing
with 504 loans of up to 90 percent loan-to-value and up to 125percent with additional collateral pledged. This is a major benefit
for medical practices, whether you’re struggling with the tough
economy or not.
2)Has your debt been outstanding for at least two years?
3)Has your practice been in operation for at least two years?
4)Have you been current (no payment deferrals or past dues of
more than 30 days) on your note for the past 12 months?
5)Was the debt to be refinanced substantially (85% or more)
used for eligible 504 purposes originally (owner-occupied
commercial real estate, heavy machinery, equipment, and closing costs related to the project)?
If you can answer “Yes” to all of the above questions, then SBA
504 refinancing is a strong possibility for you and you ought to
contact a 504 specialist lender right away. Also, the SBA is accepting applications as of 2/28/11 (the day I’m composing this
article), so this program ought to be in full swing by the time you
read this.
The Perfect Tool
In addition to its beneficial terms for physicans, the SBA 504
program is a zero-subsidy program. In other words, it does not
cost taxpayers anything. Program fees have carried it for years
Five Questions for Eligibility
In January, the SBA announced specific guidelines to determine who qualifies for 504 refinancing. To find out if you’re eligible, answer the following five questions:
1)Does your note to be refinanced have a maturity date on or
before 12/31/2012?
without any federal subsidy, and the program has run such a surplus at times that
the government redirected some of these
funds for entitlement spending a few years
ago. In addition, the loan-loss rate is historically about one-third that of the 7(a)
program — the SBA’s other flagship loan
program, which has allowed refinancing for
some time.
From the taxpayer’s perspective, 504 refinancing is a better deal, and you benefit
as well. The 7(a) is mostly a floating-rate
loan program — which isn’t the best option
for long-term, hard assets like commercial
property — and often requires additional
collateral. This additional collateral often
takes the form of a second lien on your
home or liens against inventory and receivables. This ties up those assets and can
ultimately be problematic if you later need
a line of credit or other short-term financing. By making 504 refinancing possible,
the SBA is doing a world of good for many
small medical practices.
Some critics will argue that this provision
will only cause business-owners to use their
commercial real estate like an ATM, much
like homeowners did in the recent credit
boom. But that analogy doesn’t apply here.
Small businesses historically create the lion’s
share of jobs in the U.S. Many small-business owners have cut expenses and have
leveraged up to stay in business during an
economically difficult period. In addition,
entrepreneurial physicians like you typically
make decisions to maximize profits and grow
your business — not to spend recklessly.
Larger Implications
There’s one other thing you should know,
something that’s an indirect benefit to you.
This refinance provision also helps banks.
It’s no secret that banks are being forced by
their regulators to increase their capital, lower their risks and generally strengthen their
balance sheets. In many cases, that means
reducing their exposure to commercial real
estate. If you approach your bank to refinance your commercial mortgage into a 504
loan, you might just be doing your banker a
huge favor. And working with a lender who
specializes in 504 lending without requiring
any change in your banking relationship will
lessen any perceived threat in this situation.
If you’ve purchased commercial property
for your practice at least two years ago, you
ought to look into refinancing now with an SBA 504 loan. Even if you haven’t purchased
property, you probably know someone who has. Pass this article along to them because
this opportunity just might make their year.
Chris Hurn is Chief Executive Officer/Cofounder of Mercantile Capital Corporation,
based in Altamonte Springs, Florida. His company focuses exclusively on providing
SBA 504 loans (aka “SmartChoice” Commercial Loans) for small business owners
who want to acquire and/or construct their own commercial facilities. He was recently
awarded the SBA’s “Financial Services Champion of the Year Award” for the second
time in just four years. You can contact him at 1-866-622-4504 or email him at
[email protected]. For more information about Mercantile Capital Corporation, be sure to visit www.504Experts.com and www.504blog.com. 
Inflation: How and When to Hedge
Against Rising Prices
By Tyson Smith
The very significant fiscal and monetary US government response to the most recent economic slowdown and market decline
has many investors concerned about inflation: when it will set in,
how significant it might be, how a portfolio can be protected.
Below we attempt to answer some of these questions. However,
every client situation and investment portfolio is unique. Therefore, we recommend discussing this topic with your financial advisor to determine what actions, if any, are needed to help protect
your portfolio against inflation.
Why Inflation Matters
Inflation, the rate of increase in the price of goods and services
over time, has become a hot topic in recent months. Generally,
a low level of inflation, 2-3% annually, is accepted and even preferred to zero or negative inflation (deflation). However, given the
Federal Reserve’s significant monetary stimulus in recent months,
there is now concern about higher levels of inflation.
High levels of inflation erode purchasing power; as prices move
higher, every dollar buys less. This can be harmful to the overall
economy and to individuals. For the economy, wage inflation1
can hurt profitability leading companies to pass increased costs
on to consumers by raising prices further. For individuals, real investment returns2 are negatively impacted by inflation. Additionally, purchasing power erosion is particularly impactful for those
on a fixed income as they can buy fewer goods and services.
Near-Term Inflation Outlook
Given low interest rates and significant monetary stimulus
many believe inflation will undoubtedly occur, the question is
when. For several reasons, many economists and professional investors believe inflation is unlikely to set in until 2012 or beyond.
Baird’s strategists also do not see the threat as imminent.
First, given the high level of unemployment wage inflation is
unlikely in the near term. Wages represent 45-50% of the US
gross domestic product (GDP). For inflation to be sustainable
wages must move higher, which is unlikely with unemployment
hovering around 10%. Put simply, companies do not need to
raise wages to attract or retain labor when available labor is in
large supply.
Second, while monetary stimulus injected large amounts of
capital into the financial system, relatively little of that capital is
in circulation. Instead, many banks have held onto that capital
to improve their balance sheet metrics rather than lend it out.
Even as that money supply does make its way into circulation going forward, the Fed has halted further monetary stimulus so the
growth will come down.
Lastly, debt levels remain high and an increase in interest rates
would lead to significant decrease in
demand for loans. This, coupled with
households showing a desire to reduce
their overall debt, will likely mute inflation.
All that said, while core inflation (excluding food and energy)
is not expected to set in the immediate future, consumers are seeing higher prices on food and gas impacting their discretionary
spending ability near term.
Hedging Against Inflation
There are several methods investors can use to hedge against
inflation. Below we describe a few of the more common hedging
methods.
• Treasury Inflation Protected Securities (TIPS) – Treasury
bonds for which the principal and coupon payments are adjusted to offset inflation. TIPS are issued by the Treasury, backed
by the US government, and adjusted biannually according to
CPI3.
• Gold – The price of gold generally has an inverse relationship
with the value of the US dollar. Therefore, as high inflation
weakens the value of the US dollar, the price of gold moves
higher.
• Currency – As the US dollar weakens during inflationary periods, investing in other currencies such as the euro, yen or
pound can act as a hedge to the overall portfolio.
• Commodities – After an economic downturn, commodity
prices can rise as demand recovers. Thus, price appreciation
from investing in oil, natural gas or precious metals can offset
price erosion from inflation.
• Short Duration on Bond Ladders – The Federal Reserve’s primary method for controlling inflation is raising interest rates.
As interest rates rise, proceeds from maturing bonds can be
reinvested at higher interest rates4; maintaining a shorter-duration bond ladder results in reinvesting at higher rates sooner.
• Non-US Debt Securities – Exposure to non-US fixed income
can provide diversification for portfolios consisting primarily
of US bonds, which can be impacted by rising US interest rates
should inflation occur.
Considerations
While prices are generally expected to rise going forward, there
are two important factors to consider when deciding if and how
to hedge a portfolio against inflation.
• Investor Risk and Return Objectives. Individuals with a fixed
income are most at risk for purchasing power erosion in an
inflationary environment because their income does not adjust
to rising prices as does a typical wage or salary. For these individuals, some type of inflation hedging is likely prudent.
• Current Valuation. For several of the hedging methods discussed above, prices have moved significantly as investors have
anticipated the effects of inflation. For perspective, in calendar
years 2009 and 2010 TIPS appreciated 11.4% and 6.3%, respectively, the price of gold increased 25.0% and 29.2%, and
commodities rose 18.9% and 16.8%5. Therefore, while inflation hedging over the long-run might be prudent for some
investors, it is important to be mindful of the recent strong
investment performance and valuations in each strategy.
As mentioned earlier, every client situation is different. Therefore, we encourage you to discuss inflation with your Financial
Advisor to determine what changes, if any, are needed in your
portfolio. If you have questions or need more information, please
contact your Financial Advisor.
When workers demand higher wages to offset the decreased purchasing power of their current income.
Total investment return minus the inflation rate.
Consumer Price Index, calculated by the Bureau of Labor Statistics.
4
Raising interest rates encourages saving, which slows growth of the money supply.
5
TIPS measured by the Barclays Capital US TIPS Index; Commodities measured by the Dow Jones UBS Commodity Index.
1
2
3
Important Disclosures
Investments in commodities expose investors to potentially
high volatility and are generally only suitable for investors with a
high tolerance for risk.
Investments in international and emerging markets securities
include exposure to risks including currency fluctuations, foreign
taxes and regulations, and the potential for illiquid markets and
political instability.
In a rising rate environment, the value of fixed income securities generally declines and conversely, in a falling interest rate
environment, the value of fixed income securities generally increases.
Indices are unmanaged and are not available for direct investment. Past performance is not a guarantee of future results.
Tyson Smith is Vice President and Senior Investment Consultant at R. W. Baird & Company in the Orlando office
He provides investment services to business owners, professionals, and retirees. Tyson specializes in retirement plans,
personal wealth management, and financial planning
to help his clients prepare for and overcome the many financial hurdles on the path to their long-term goals. He
understands the challenges faced by members of the medical community and can offer unique solutions. His office
is located at 200 South Orange Avenue, Suite 1550, Orlando, FL 32801. He can be contacted at (407) 481-8286,
[email protected] or by going to www.TysonSmithFinancialAdvisor.com. 
Current Topics
Quite a Concept(ion)!
Florida Hospital East Orlando is pleased to announce that
Urologist Zamip Patel, MD is joining their medical staff. Dr.
Patel is a fellowship trained Andrologist who specializes in male
infertility problems, from the management of semen abnormalities
to advanced microsurgeries that can correct problems that have
existed since birth.
“About 15 percent of couples have trouble conceiving and in
about half of these cases, male infertility plays a role. Couples who
have tried for a year without success, should see a specialist, because it’s a common misconception that conceiving is a female
only issue,” says Patel.
A common test for diagnosing an initial infertility problem is
a semen analysis, where a sample of sperm is examined in a laboratory to determine the number and quality of the sperm. Male
infertility can be treated effectively with medications, lifestyle
changes, surgery, or a combination of the three.
Blockages in the male reproductive system can often be cleared
with minor surgery, and procedures exist to correct varicoceles (a
tangle of varicose veins in the scrotum that causes an increase in
temperature within the scrotum and negatively impacts sperm
production).
In other cases, assisted reproductive techniques such as intrauterine insemination and in vitro fertilization (IVF) may help
couples conceive.
Working with in vitro clinics throughout the region, Dr. Patel
provides a vital part to the team approach of care needed to maximize the chances of conceiving, wherever the couple may reside
within the State of Florida.
Dr. Patel’s procedures include:
• Male evaluations: In addition to a semen analysis, other lab tests
are conducted to determine possible causes of infertility. These
causes become important not only for further evaluation of infertility, but to overall current and future health of the male.
• Management of semen abnormalities: If one of the tests comes
back abnormal, then depending on the abnormality, varying
treatments may be recommended.
• Microsurgeries: If intervention is needed, in cases such as blockages that the man may have been born with or acquired throughout life or pre-existing conditions that affect the production of
sperm, a multitude of different types of procedures to improve
sperm parameters or extract sperm can be performed.
• Sex chromosome abnormalities: Male infertility evaluations
may reveal abnormalities in the actual sex chromosome that can
have implications for overall health of the patient and potential
offspring.
• Treatments for low testosterone levels and erectile dysfunction
include medications that preserve fertility potential while helping with the symptoms that accompany low testosterone.
• Reproductive tract obstruction: Obstruction blocking the tube
that connects vas deferens (commonly known as obstructive
azoospermia) to the remaining male reproductive tract. The
problem could be found where the tract meets the rest of the
urethra, or it may be deeper and can be
addressed with either minimally invasive
surgery or a combination of minimally
invasive and robotic surgery.
• Varicocelectomy: Treatment of testicular veins which may result in increased
Zamip Patel, MD
sperm counts and potentially improve
overall health benefits. This procedure
is also performed with the help of a microscope to maximize
benefit while minimizing potential risks and complications.
• Vasoepididymostomy/Vasovasostomy/Vasectomy Reversal: Correction of obstruction in the tube connecting the testes to the
male reproductive tract. Typically urologists do not do vasectomy reversals and seek an andrologist’s expertise.
Dr. Patel conducted his urology residency at the Mount Sinai
School of Medicine, New York, New York, and his Andrology fellowship at the University of Illinois, Chicago, a state known to
establish national in vitro fertilization standards for the specialty.
Andrology is an extremely specialized field of medicine requiring
exceptional and precise microsurgical skills.
For more information, visit www.FloridaHospitalEast.com or
call 407.303.6865 for patient referrals. 
ORMC Uses First and Only Pacemaker System
for Use During MRI
New pacemaker gives patients
access to critical diagnostic tool
Orlando Regional Medical Center is the first hospital in Florida
to implant a new pacemaker designed for safe use during magnetic
resonance imaging (MRI) scans often used to diagnose and treat
conditions. Recently approved by the U.S. Food and Drug Administration, the Revo MRI™ SureScan® pacing system by Medtronic,
is the first and only pacemaker in the U.S. specifically designed for
use in an MRI environment and approved as MR-Conditional.
“The approval of this device is a major milestone in caring for
Dr. David Bello identifies areas of the heart
patients’ heart conditions and other problems as well,” said Dawhere leads are placed for the MRI compatible
vid Bello, MD, an interventional electrophysiologist and ORMC’s
pacemaker implant.
medical director of diagnostic cardiology. “Previously, an entire
proval of the new MRI compatible pacemaker.
segment of the population with pacemakers was unable to receive
“Being a part of the trial was important in helping determine
the medical imaging used to uncover and treat conditions outside
if patients with permanent pacemakers would be able to undergo
of their heart problems.”
routine MRI testing,” said Dr. Bello who was principal investigator
An estimated 5 million patients worldwide have a pacemaker or
for the study. “MRI scans are an important tool in helping doctors
implantable cardioverter-defibrillator. Up to 75 percent of pacediagnose problems and develop treatment plans. We are honored
maker patients will need an MRI at some point in their lifetime to
to have been a part of helping widen the spectrum of diagnostic
diagnose another health condition. Medical imaging provided by
opportunities for patients today and in the future.” 
MRIs can be used to diagnose cancer, aneurysms, liver abnormalities, arthritis, and many other conditions.
MRI technology uses magnetic fields and
radio frequencies to take pictures of organs,
soft tissues and bone to help doctors diagnose
medical conditions.
The Revo, like traditional pacemakers, uses
electrical pulses to correct slow heart rhythms,
but with a twist — it has an optional “SureScan” mode that can be switched “on” for use
during MRI to eliminate interference.
Before now, patients with pacemakers were
not allowed to have MRIs because of potential
serious side effects. For example, the magnet
can interrupt the pacing and prevent the output of pacemakers, causing improper heart
rhythm. Also, tips of the wires used to connect the pacemaker to the heart could heat up
during the scan and burn heart tissue.
With construction costs at an all-time low, now is the time to expand,
The new MRI compatible pacemaker also
upgrade or invest into the state-of-the-art facility you and your patients deserve!
holds far-reaching future implications.
“The new device is significant to patients
who may one day need a pacemaker and later
an MRI to diagnose and treat another condiwww.lammco.com
tion,” said Dr. Bello. “As the population ages,
the need for pacemakers increases. The use of
968 Lake Baldwin Lane * Orlando, FL 32814 * 407.895.2525 * [email protected]
MRIs as a diagnostic tool also continues to
grow.”
ORMC was also a site in the international
One Vision. One Process. One Solution. One Company.
License #CGC-045526
multicenter study that contributed to the
evaluation of patients leading to FDA ap32 FLORIDA MD - MARCH 2011
meetourkids.org
For over 20 years, Arnold Palmer Hospital for Children has been right here
in Central Florida caring for kids. We’ve watched them grow. Celebrated
birthdays. And holidays. Happy days, sad days—we’ve been here through it
all. That’s why we’re more than just a hospital. We’re a part of the community.
And our kids are more than just patients. They’re part of our family. And we’d
like you to meet them.
Support our kids. Purchase tickets today at
Proceeds benefi t:
ARNOLDPALMERINVITATIONAL.COM
MARCH 21 - 27 s ARNOLD PALMER’S BAY HILL CLUB & LODGE s ORLANDO, FL
Multi-disciplinary Surgical Team Removes Pelvic
Tumor Using Robotic Surgery at Florida Hospital
Patient undergoes robotic-assisted
laparoscopic removal of pelvic tumor
and hysterectomy in one surgery
Sabine Bayona, who suffered from a painful pelvic tumor located
at the tip of her spine, remembers when the same diagnosis nearly
40 years ago left her mother in a body cast for weeks. But today, the
advancements of robotic surgery at Florida Hospital have allowed
Bayona to undergo a combined, minimally invasive hysterectomy
and resection of her tumor and to leave the hospital just 48 hours
later. This case is believed to be the first robotic-assisted resection of
a pelvic tumor ever performed. These tumors are usually removed
through a large front abdominal incision or occasionally through
the back involving surgery of the tailbone.
Florida Hospital surgeons, Dr. Robert Holloway, director of gynecologic oncology at Florida Hospital Cancer Institute, and Dr.
David Rosen, neurosurgeon at the Florida Hospital Neuroscience
Institute, willingly took on Bayona’s complicated and unique case
because there were potentially great benefits for the patient to have
a robotic procedure. Dr. Holloway, who is recognized worldwide
as a pioneer in gynecologic robotic surgery, was able to fully remove the orange-size tumor using the daVinci surgical system with
the assistance of Dr. Rosen who ensured the spinal cord was not
damaged during the resection of the tumor. The hysterectomy was
performed first to allow better visualization of the spinal tumor and
further eliminate pelvic pain for Bayona.
“We both felt our patient would receive the maximum benefit
from the use of robotics,” said Dr. Rosen. “This collaboration saved
her from undergoing multiple potentially invasive procedures. Her
Drs. Robert Holloway and David Rosen perform a robotic-assisted
procedure.
recovery was truly amazing. She was discharged in 48 hours, fully
functional and with minimal discomfort.”
The magnified 3-D field of view of daVinci made resection of
the tumor nearly bloodless and helped to avoid injury to surrounding tissues, including nerves.
“This surgery was a unique collaboration, not just for robotic
surgery, but also for gynecologic surgery and neurosurgery in general,” said Dr. Holloway. “Our expertise in both surgical specialties,
in addition to the use of robotics, allowed our patient to have a
complex surgery with minimally invasive techniques that greatly
reduced her postoperative pain and recovery time.”
“My family and friends cannot believe how well I am feeling,
especially my mother,” said Bayona. “I was able to leave quickly
and since the pain was not too bad, I was able to be up and moving
around. I am ready to get back to work!” 
Florida Hospital Conducts Clinical Trial for
Patients with Advanced Melanoma
Trial drug treats patients with stage three or four melanoma after
conventional treatment options have failed
As the deadliest form of skin cancer, melanoma is diagnosed in
more than 120,000 patients every year and until recently, therapies
offered for patients with advanced melanoma have had little
success rate. Now, the Florida Hospital Cancer Institute (FHCI)
is offering a new experimental treatment called Ipilimumab by
Bristol-Myers-Squibb, a drug that stimulates a patient’s own
immune system to kill the cancer cells.
“The idea is to use the immune system to fight the tumors
instead of using drugs to directly fight the tumors,” said Dr. Lee
Zehngebot, principle investigator for the trial at FHCI. “We hope
this research will lead to an alternative treatment for patients with
advanced melanoma.”
“Advanced melanoma means the cancer has spread to another
part of the body, so these patients often don’t respond well to
traditional cancer treatments,” said Dr. Zehngebot. “This research
is taking us one step closer to finding a reliable treatment option
for this disease.”
For more information on this clinical trial, please contact 407-3032859 or visit www.floridahospitalcancer.com/clinical-trials. 
Central Florida Kids Now Have A Place of Their
Own for Dialysis
Kids Kidney Center at Arnold Palmer Hospital Made Possible by $1.5 Million Donation
Until now, Central Florida lacked a dialysis center exclusively for kids. Children who needed dialysis were treated at
adult centers in the area.
The Hewell Kids Kidney Center at Arnold Palmer Hospital for Children is changing that. The new space is strictly
designed with children in mind to offer comprehensive care
for young patients in need of dialysis and other kidney disease
treatments.
“The Hewell Kids Kidney Center brings together all of
the resources at Arnold Palmer Hospital in a child-friendly,
family-centered environment,” states Jorge Ramirez, MD,
Director of Pediatric Nephrology at Arnold Palmer Hospital.
“Children will receive care more quickly, feel a greater sense of
control, and benefit from the comfort and strength of being
with other children and families with similar experiences.”
The Kids Kidney Center, which cost approximately $3 million to build, was completely funded through philanthropy. A
(From L to R): Arnold Palmer Hospital President, John Bozard, Maricor
large portion of that philanthropy came from the Hewell family
Grio, MD, Jo Hewell, Buddy Hewell, and Jorge Ramirez, MD, cut a ribbon
of Longwood, Florida, who donated $1.5 million to make the symbolizing the opening of Central Florida’s first dialysis center exclusively
for kids. The Hewell family of Longwood, Florida, donated $1.5 million to
center a possibility. The center contains three exam rooms, one
help build the Hewell Kids Kidney Center.
consultation room, four dialysis bays, and family and play areas.
In 2010, Arnold Palmer Hospital saw more
than 7,000 inpatient and outpatient visits from
children seeking treatment for some form of
kidney disease. Additionally, eight percent of
the babies admitted to the neonatal intensive
care unit at Winnie Palmer Hospital for Women & Babies will develop some form of kidney
dysfunction. If left undiagnosed and untreated,
Center for Diagnostic Imaging (CDI) sets the • On-site, fellowshipkidney disease can result in ongoing dialysis or
standard for quality care and convenience: trained radiologists
transplantation, and in some cases, death. 
• Walk-in & same-day
Leading the Way
In Imaging Care
appointments
Florida Hospital Cancer Institute
Offers Clinical Trial Targeting
Aggressive Form of Breast Cancer
• 24-hour online access
to reports and images
at: www.insideCDI.com
• 4 locations: Oviedo,
MetroWest, South
Orlando, Winter Park
Only Florida location to offer trial that uses
a combination of chemotherapy drugs to
suppress a receptor that causes tumors to
grow rapidly prior to surgical removal
Florida Hospital Cancer Institute (FHCI) is
the only site in Florida to offer a clinical trial for
patients with HER2-positive breast cancer that
utilizes a combination of chemotherapy drugs
with two drugs that specifically target the HER2
protein in the body, a growth factor receptor
which promotes the growth of cancer cells. Approximately 40,000 women are diagnosed with
this aggressive form of breast cancer every year.
• Advanced services
including: MRI,
CT, PET, Nuc Med,
X-ray, Ultrasound
and Diagnostic &
Therapeutic Injections
tel 407.741.5400
www.CDIradiology.com
Early results show the use of this therapy prior to surgical removal of the tumor potentially destroys microscopic cancerous tumor cells that might
otherwise spread if chemotherapy is only used after surgery.
Due to a gene mutation, the cancer cells make an excess amount of HER2 protein, causing the cancer to be more aggressive and less receptive
to hormone treatment. Studies have shown the use of drugs that specifically target the HER2 protein, like herceptin or tykerb, are effective. By
combining the two, a sandwich effect may be achieved to interfere the HER2 receptor. However, the FDA has only approved the use of one of
the protein-inhibiting drugs, herceptin, with traditional chemotherapy drugs like docetaxel and carboplatin.
“Nearly 25 percent of breast cancer patients are diagnosed with this form of cancer, so this trial is important in testing the safety, tolerability and
effectivness of a chemotherpy drug combination for HER2 positive breast cancer,” said Dr. Rebecca Moroose, principal investigator for this trial
at FHCI. This clinical trial from the University of California Los Angeles, affliated with Translational Research in Oncology and Translational
Oncology Research International, is currently being conducted in 13 sites nationally.
A preliminary report detailing results of this trial was recently presented at the national breast cancer meetings in San Antonio, Texas in December of 2010. Dr. Lee Zehngebot, one of Florida Hospital’s oncology physicians, was one author of the abstract. Dr. Robert Reynolds, Dr. David
Molthrop and Dr. Linda Lukman are amongst the other Florida Hospital physicians that have enrolled patients in this clinical trial.
For more information on this clinical trial, please contact (407) 303-2859 or visit www.floridahospitalcancer.com/clinical-trials. 
EYE CARE. WE CARE.
ADVERTISERS INDEX
Arnold Palmer Invitational. . . . . . . 33
Associates in Dermatology. . . . . . . 3
Your eyes are your
window to the world.
Center for Diagnostic Imaging. . . . 35
Clevens Center for Facial
Cosmetic Surgery. . . . . . . . . . . . . 13
Comprehensive Dermatology. . . . . 27
Danna-Gracey. . . . . . . . . . . . . . . . 16
Doctors Broker. . . . . . . . . . . . . . . 17
Eye Physicians of Central Florida. . 36
Florida Hospital East Orlando . . . . 14
FloridaMD.com. . . . . . . . . Back Cover
FloridaMD.com 2011
Editorial Calendar. . Inside Front Cover
Florida Orthopaedic Risk
Purchasing Group. . . . . . . . . . . . . 25
The Hidden Wealth System. . . . . . 23
Jewett Orthopaedic . . . . . . . . . . . 11
Dr. David S. Klein. . . . . . . . . . . . . 28
Lamm & Company Partners . . . . . 32
Robert S. Gold, M.D., F.A.A.P.
David B. Auerbach, D.O.
Louis C. Blumenfeld, M.D., F.A.A.P.
Victor B. Thomas, M.D.
Jamie L. Ikeda, M.D.
Lynda Z. Kleiman, M.D.
Larry S. Lewis, O.D.
A Division of Florida Pediatric Associates, LLC
www.eyephy.com
Maitland
407-767-6411
MetroWest
407-398-7730
Michael Lowe PA . . . . . . . . . . . . . 19
March of Dimes
Registration Form. . Inside Back Cover
Orlando Orthopaedic Center. . . . . 25
Pharmacy Specialists. . . . . . . . . . 21
Ravenheart Design. . . . . . . . . . . . 21
Sacred Serum. . . . . . . . . . . . . . . . 9
University Diagnostic Institute. . . . 30
VinCon . . . . . . . . . . . . . . . . . . . . 31
Join the March of Dimes in the fight for healthy
babies & enjoy fun teambuilding at the same
time! Set a group goal, work together to reach
it, then come to the walk & have fun together!
March for Babies 2011
Team Registration Form
Company/Team Name: _____________________________________Store #/Branch/Dept: _______
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Phone: ________________ Fax:_________________ No. of Employees: ____ Years as Team: ____
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WALKSITE:
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Signature_____________________________________________________________
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Jewett Orthopaedic Clinic Celebrates Seventy

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