November 2010

Transcription

November 2010

NOVEMBER 2010 • CENTRAL FLORIDA EDITION
Clevens Center for
Facial Cosmetic Surgery
Presents The New Face of
Facial Plastic Surgery
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30
contents
NOVEMBER 2010
CENTRAL FLORIDA EDITION
Photographer: Christopher Prouty, Studio99Creative
4
COVER STORY
Ross A. Clevens, MD, FACS of the Clevens Center for Facial Cosmetic Surgery in
Melbourne is a double board certified facial plastic surgery specialist whose practice has
been dedicated solely to facial plastic and reconstructive surgery for nearly 15 years. The
Clevens Center is a comprehensive aesthetic and reconstructive care center committed
to quality patient care. Ross A. Clevens, MD, FACS is internationally recognized for his
expertise in surgical and non-surgical management of the aging face and balancing facial
features with rhinoplasty and facial implant and contouring procedures.
Ross A. Clevens, M.D., F.A.C.S., a double
board certified facial plastic surgery specialist
26 Aging Does Not Have
To Go Hand In Hand
With Pain
27 What limits of
liability for
malpractice do you
recommend for
doctors in Florida?
28 Healthcare Reform
and Baby Boomers
- More Pressure for
Physicians?
30 CURRENT TOPICS
DEPARTMENTS
2 FROM THE PUBLISHER
3 FOR YOUR ENTERTAINMENT
10 WEALTH MANAGEMENT
12 MARKETING YOUR PRACTICE
14 ORTHOPAEDIC UPDATE
16 FACIAL COSMETIC SURGERY
18 HOT TOPICS IN DERMATOLOGY
20 Social media marketing
22 USING NUTRACEUTICALS
25 PHARMACY UPDATE
FLORIDA MD - NOVEMBER 2010
1
FROM THE
THE PUBLISHER
PUBLISHER
FROM
I
Iam
pleased
to to
bring
you
MD The
Magazine.
It’s hard
to imag-holiday
t is my
pleasure
bring
youanother
anotherissue
issueofofFlorida
FloridaMD.
upcoming
Thanksgiving
is supposed
to beisone
happy times
with family.
Unfortunately,
forthey
somedowomen
and
ine
anyone who
notoffamiliar
with spent
the March
of Dimes
and the work
to
children in central Florida, home life is anything but happy. They suffer an existence fraught
with domestic violence and mental and/or sexual abuse. Accordingly, I have asked the Women’s
always
new programs
and and
services.
up nextthey offer
Center reinventing
to inform usthemselves
about sometoofcreate
the programs
they have
someComing
of the services
month
is
the
annual
March
for
Babies.
It’s
a
wonderful
team-building
opportunity
for
that bring healing and hope, to women and children who are trapped in abusive relationships
or
have suffered physical trauma. If you suspect that one of your patients may be a victim, -please
pass along
the you
information
below.
hope
you will
join to
meform
in supporting
Women’s
tions
on how
and yourdiscussed
family can
joinIthe
march
or how
a team forthe
your
Center and the good work that they do to save women’s lives.
whole practice. I hope to see some of you there.
All the best,
Warm regards,
Donald B. Rauhofer
Publisher
Donald
B. women
Rauhofer
Many
face a number of problems throughout their lives and sometimes need help. The Women’s Center strives to address the
Publisher/Seminar
Coordinator
needs of women by
giving them a step up towards safe, healthy, and self-sufficient lives. For 35 years the agency has been providing quality services and education to clients and community. From local support and government funding sources, we are able to deliver quality,
cutting edge services and fulfill the community’s need for a central location that provides educational information on women’s issues.
When support, education, informaJoin The
more
than aofmillion
people
walking
March women
of Dimes,
for Babies
and
mission
the Women’s
Center
is toin
empower
andMarch
their families
by providing
counseling,
Saturday,
April 24th
raising
to helpCareer
give every
baby job
a healthy
start!
Invite your
family
friends
tion, money
and services.
guidance,
training,
counseling
services,
caseand
management,
transitional
housing,
and victim services are
7am and
Registration
8am
Walk Center
vital
components
in
our
committed
effort
to
carry
out
the
mission.
As
Brevard
County
has
grown
changed,
the Women’s
to join you in March for Babies, or even form a Family Team. You can also join with
has been proactive in assessing the varying needs of our diverse community and clients. Through this progressive approach and with
your practice and become a team captain. Together you’ll raise more money and share
Where
the assistance of our supporters, the Women’s Center has significantly expanded in size and service
and has become known as a leading
a meaningful
experience.
Lake Lily Park, Maitland
source of education
and help for victims of domestic violence.
A recent study indicates that victims of domestic violence endure much higher health care costs than other women for three years
keys tomay
success:
Ask to
your
friends, physicalFor
information
on March
Steps
afterfor
theNew
abuseUsers:
ends. This research indicates Some
that women
continue
experience
andmore
emotional
consequences
long after
family
and
colleagues
to
support
you
by
for
Babies
please
call:
extricating
themselves
from
their
abusive
situation.
It
is
suggested
that
prevention
efforts
can
save
health
care
organizations
considerable
1. Go to marchforbabies.org
Phone: (407) 599-5077
of money while also preventing future occurrences of abuse.
2. amounts
Click JOIN
A TEAM
Fax: (407)
599-5870
The Women’s Center is proud to be able to help over 10,000 women and their children annually
who seek
out our assistance. Help3. ingSearch
fortoyour
name means
in the makingreason
why for
people
do not donate
that to not Central
women
help team
themselves
it possible
the Women’s
Centerisclients
only support
themselves,
Florida
Divisionbut to become
no one
themtotochange
give (don’t
be the
shy)!better, forever.
search
active
andbox.
proud participants in the community.
It isasked
our goal
lives for
341 N. Maitland Avenue, Suite 115
Emailing
is an easy
way to e-mail
ask. [email protected],
For more
information
about the Women’s
Center,them
call (321)
242-3110,
or visit our
Maitland, FL 32751
4. Click
on your
team name
website at www.WomensCenterInBrevard.org.
5.
You’re done! Your personal page has been
created for you and you are ready to begin
Be sure
NEW and IMPROVED
password
forand
futurecheck
reference.out ourfundraising!
website at www.floridamd.com!
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Photographer:
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George
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FOR YOUR ENTERTAINMENT
Orlando Philharmonic Presents Classical Favorites
The Orlando Philharmonic Orchestra features two crowdTickets
to Young Romantics are $14.75, $29, $39, $52 and
pleasers as the lineup for the 2010-11 Season continues. Both are
$70.
This
concert is presented at the Bob Carr Performing
classical favorites.
Arts
Centre,
located at 401 W. Livingston Street, Orlando.
In the spirit of the season, the Orlando Philharmonic presents
a holiday favorite – Handel’s Messiah. The concert takes place on
For more information on both concerts or to order tickets
Monday, December 13, 7:00 p.m., at the Margeson Theater, locall the Philharmonic Box Office at (407) 770-0071 or visit
cated in the Lowndes Shakespeare Center, 812 E. Rollins Street, in
www.OrlandoPhil.org. 
Orlando’s Loch Haven Park. The concert features Maestro Christopher Wilkins as conductor and a host of
talented vocalists: Kimberly Randall, soprano; Tai Oney, countertenor; Curtis Rayam,
tenor; and Thomas Potter, baritone. The
First United Methodist Church of Orlando
Choir, William Shortal, artistic director, enhances the performance. Space is limited so
order your tickets early. Ticket prices are:
$15, $28 & $39.
On Saturday, January 8, at 8:00 p.m., the
Orlando Philharmonic presents Young Romantics - the fifth concert in the Super Series.
Maestro Christopher Wilkins conducts the
program and Yekwon Sunwoo, pianist, and
2008 Winner of the Florida International
Piano Competition, is featured on Chopin’s
Piano Concerto No. 2. Also on the program
are Rossini’s The Barber of Seville: Overture
and Schumann’s Symphony No. 2.
Yekwon Sunwoo, 21, from An Yang,
Central Florida’s ONLY PCAB-Accredited™ Compounding Pharmacy
Korea, entered the Curtis Institute of
Music in 2005 and studies with renowned
pianist Seymour Lipkin. Yekwon made his
Accreditation means that Pharmacy Specialists:
New York City debut in 2009 performing
at the Weill Recital Hall at Carnegie Hall
• Is endorsed by national organizations such as USP, NABP, IACP and APhA.
as First Prize winner of the inaugural 2008
• Uses only pure chemicals from highly reliable suppliers.
Florida International Piano Competition,
where he was the youngest competitor.
• Has an extensive Quality Assurance program and Policies and
His other awards include First Prize in the
Procedures in place.
Concours International de Piano “Interlaken
Classics,” Switzerland; First Prize in the
• Has recieved specialized training and utilizes the finest equipment.
California International Young Artists Piano
Pharmacy Specialists meets or exceeds ALL standards for STERILE as well as non-sterile
Competition; First Prize in the Daegu
compounding and is the only USP <797> and USP <795> validated compliant pharmacy in
Broadcasting Competition; First Prize in
Central Florida.
the Ewha-Kyung Hyang Competition; and
Grand Prize in the Kukmin-Ilbo/Hansei
University Competition.
Pharmacy Specialists • www.makerx.com • 393 Maitland Avenue
In October 2010 Mr. Sunwoo’s perforAltamonte Springs, FL 32701 • 407-260-7002 • 800-224-7711
mance tour in Germany, the Czech Republic
and Russia concluded with the recording of
Owner Sam Pratt, RPh, FIACP, is the only pharmacist in
his solo CD with Classical Records in MosCentral Florida recognized as a Full Fellow by the
cow as part of his First Prize at the 2008 FlorInternational Academy of Compounding Pharmacists.
ida International Piano Competition.
You would not consider using a
non-accredited hospital...
Then why use a non-accredited
compounding pharmacy?
3
COVER STORY
Clevens Center for
Presents The New Face of Facial Plastic Surgery
By Jennifer Roth Miller, Staff Writer
Imagine a triangle on a map of Florida from Jacksonville to
Vero Beach to Orlando… within it you will find Ross A. Clevens, M.D., F.A.C.S., a double board certified facial plastic surgery
specialist, a rare breed in Central Florida.This surgeon’s practice,
The Clevens Center for Facial Cosmetic Surgery, located in Melbourne and Merritt Island, is uniquely qualified, offering expertise in facial cosmetic services for patients of all ages and needs.
Whether a patient is battling skin cancer or trying to reverse the
signs of aging that our Florida sunshine accelerates, The Clevens
Center is the reputable source patients can trust with their face,
nose, neck and eyelids.
The Clevens Center is a comprehensive aesthetic and reconstructive care center dedicated to quality patient care. Ross A.
Clevens, MD, FACS. is internationally recognized for his expertise in surgical and non-surgical management of the aging face
and balancing facial features with rhinoplasty and facial implant
and contouring procedures.
Ross A. Clevens, M.D., F.A.C.S. is
Central Florida’s Facial Plastic and
Reconstructive Surgeon
The public is bombarded by advertising campaigns and infomercials for miracle products like age defying makeup and fad
procedures such as “drive-thru” facelifts all promising instantaneous youth and beauty. Dr. Clevens stresses, “You should only
trust your face to a board certified facial plastic surgeon.” In a field
where it is difficult to find truthful information on specialists and
with the face being such a delicate part of the body, patients and
referring physicians can be assured that their patients are in the
most capable hands with Dr. Clevens.
Dr. Clevens, an Ivy League educated facial plastic and reconstructive surgeon is considered to be “One of America’s Top Doctors” as rated by Castle-Connolly Guide to America’s Top Doctors.
Ross A. Clevens, MD is also considered the “Best in Brevard” by
Staff. Standing Left to Right: Judy, Ceresia, Marianne, Lorin, Jeanne, Michelle, Cheryl, Kim, Shelly. Seated Left to Right: Heather, Laura,
Dr. Ross Clevens, Sharon, Kim, Tammy, Sarah
COVER STORY
Florida Today. He is double board certified and ensures the safety
and comfort of his patients with his fully accredited ambulatory
surgery center and physician anesthesiologists. Dr. Clevens has
been in practice for 15 years and has dedicated his practice solely
to facial plastic surgery. His peers and patients regard him as a
compassionate and gentle surgeon.
The Clevens Center for Facial Cosmetic Surgery employs a
knowledgeable staff that includes advanced registered nurse
practitioners and registered nurses, laser specialists, medical aestheticians, patient care coordinators, an insurance liaison specialist and administrative staff to ensure that his patients’ experiences are as enjoyable and effortless as possible while giving
them the support and care they need before, during and after
surgery. With his credentials and reputation, patients can relax
and trust their facial plastic surgery concerns to him to achieve
their desired results.
Be Beautiful and Be Yourself
Dr. Clevens encourages everyone to “be beautiful and be yourself.” He helps people from all walks of life achieve this. From
people recovering after skin cancer removal, to those with scarring from burns, and from those desiring to reduce signs of aging
to those just simply wanting to improve their appearance, Dr.
Clevens offers hope through the restored self-esteem facial plastic
surgery can provide. Many doctors and dermatologists also refer
patients with significant reconstructive needs to Dr. Clevens because they know he is the only facial plastic surgeon in the area
with the skills and expertise to handle these complex cases. Dr.
Clevens is often called upon to correct the work of others. Recognized nationally and internationally as an important lecturer,
Marketing and Patient Experience Team (Lorin- Practice
Administrator, Shelly- Marketing, Tammy-Patient Care Coordinator)
IMAGINE Medispa staff. (from left to right standing: HeatherCoordinator, Sarah- Medical Aesthetician, Kim- Cosmetic Laser
Specialist, and sitting: Judy- Cosmetic ARNP)
Dr. Clevens travels to teach his peers the latest techniques in facial
plastic and reconstructive surgery.
The New Face of Facial Cosmetic
Surgery: IMAGINE MediSpa
In the past, facial plastic surgery was reactive rather than
proactive. Older patients would arrive wanting to reverse advanced signs of aging. These days, patients are more informed
about the causes of aging. Younger generations also experience a more intense culture that demands a youthful appearance. Celebrities and models well into senior years appear to
have firm, youthful skin with little to minimal appearance of
wrinkles.
Beauty often affects self-esteem and self-esteem has many
effects on a person’s productivity. For these reasons, Clevens
Center for Facial Cosmetic Surgery is ready to help clients
maintain beauty and self-esteem at any age, starting at the
IMAGINE MediSpa.
The IMAGINE MediSpa is housed within Suntree’s Imperial Salon and Spa, a well known, trusted and established spa
on the Space Coast. The medispa is a natural and synergistic
extension of Dr. Clevens’ practice. Clients can now stop by
on a lunch break or after work for a massage and an injectable treatment such as Botox, Restylane or Juvederm and leave
looking and feeling rejuvenated, younger and better about
themselves.
5
COVER STORY
Blepharoplasty before
Blepharoplasty after
The IMAGINE Medispa offers an array of non-surgical services
such as injectable fillers including Dysport, Restylane and Perlane,
laser services, hair removal, tattoo removal, prescription skin care
products and even weight loss consultation to help clients of all
ages achieve their desired results.
may benefit from non-invasive laser treatments and injectables
such as Botox, Juvederm, Radiesse and Sculptra to lessen the
appearance of wrinkles. Older, more established clients continue
to receive injectables and laser treatments but may develop needs
for plastic surgery as they begin to experience more extreme
wrinkles, sagging and perhaps even skin cancers. Clients of all
ages show interest in cosmetic nasal surgery or rhinoplasty, a specialty of Dr. Clevens. Other areas of expertise include prescription skin care, injectables, laser treatments, full facial reconstruction and facelifts.
The national trend in cosmetic surgery is toward less invasive
procedures that offer real results with less downtime. People are
living longer and enjoying more active lifestyles. They are able to
take advantage of medispa services to look younger and delay the
need for cosmetic facial surgery. Dr. Clevens’ goal with the IMAGINE Medispa is to offer quality services under the supervision of a
board certified facial plastic surgeon to ensure safe, effective results
for clients. There may be no substitute for facial surgery procedures for restoring a youthful look to the face, but these medispa
procedures can delay the inevitable for a few years.
The Rising Incidence of Skin Cancer
The coexistence of the salon and IMAGINE MediSpa allows
for a natural introduction to Dr. Clevens services. Patients of all
ages can benefit from the cosmetic and lifestyle services offered
at the medispa. Clients in their teens and 20’s may start with
prescription skin care products while clients in their 30’s and 40’s
Patients in Florida are prone to the damaging effects to the sun.
The incidence of skin cancer and patients needing advanced Mohs
procedures and reconstructive surgery has risen significantly. In
the past, skin cancer had been associated with people over the
age of 50, but according to the American Cancer Society, from
the mid-1970s to the late 1990s, melanoma, the most deadly of
the skin cancers, has risen 60.5 percent for women ages 15 to 29.
During the same time period, for men of the same age group, it
rose 26.7 percent. Overall, roughly one in five Americans will
Cancer before
Cancer excision
Cancer repair
Cancer after
COVER STORY
develop skin cancer in their lifetime.
Dr. Clevens strives to work closely with dermatologists so he
can assist in removing large facial cancers and repairing the skin
in the increasing number of younger patients who would otherwise be left with large facial defects from the removal of cancerous
cells on the face, head and neck.
Clevens Center For Cosmetic Surgery
is One of the First in the Country and
Only in the State to Acquire Palomar
Artisan Laser Technology
Calling upon the expertise and experience of Dr. Clevens, Palomar Medical Technologies, a researcher and developer of lightbased systems for cosmetic treatments selected The Clevens Center for Facial Cosmetic Surgery to be a national test site for their
new Artisan Aesthetic System. The new Artisan Aesthetic System
offers multiple skin resurfacing and skin rejuvenation technologies. It has a fractional non-ablative laser for treating acne and
surgical scars, melasma -- the mask of pregnancy, and stretch
marks; a fractional ablative laser for resurfacing and wrinkle treatment; and a pulsed light device for treatment of pigmented and
vascular lesions -- in one comprehensive system for skin rejuvenation and anti-aging practices.
and self-sufficient lives. Dr. Clevens has been an active contributor
to the Brevard Women’s Center for over a decade.
Last year Dr. Clevens began participating in Outreach Africa,
an effort that makes several trips each year to provide medical
care to local people in Tanzania, Africa. Many of the people he
helped are African children in need of cleft palate and lip repairs
or burn victims.
Often, African citizens cook with open flames in small quarters
made of flammable material. They are very susceptible to fires and
burns because of their lifestyle. When the burns heal untreated by
a medical professional, the skin contracts as it heals which can
interfere with mobility. Dr. Clevens helped release the scars so
they could regain mobility.
Dr. Clevens says, “It’s overwhelming what I have seen on the
trips to Africa. There is so much poverty and a lack of resources,
yet the people are so warm and appreciative. It is an extremely
humbling and gratifying experience.”
Facelift before
The leading-edge equipment allows Dr. Clevens the ability to
treat each discrete sign of aging and other undesirable skin conditions using the most appropriate technology. With the system,
Dr. Clevens and his staff can tailor unique treatment regimens to
each patient’s specific needs, offering the best aesthetic outcome
with the least amount of downtime or disruption.
Philanthropy and Humanitarian Facial
Plastic Surgery Efforts Around the
World
Facelift after
Dr. Clevens has recognized the need to give back not only to the
local community but also abroad. The Clevens Center for Facial
Cosmetic Surgery donates thousands of dollars in products and
services each month to local charitable events and organizations.
The Center’s entire staff participates in charities of their choice
throughout the Space Coast. Dr. Clevens and his staff understand
that being philanthropic leads to increased goodwill and patronage
in our community. At the same time, it also contributes to teambuilding as staff organize themselves to raise funds and participate
as representatives of Clevens Center for Facial Cosmetic Surgery.
Most significantly, Dr. Clevens sponsors an annual Health,
Wellness and Beauty Luncheon to benefit The Women’s Center
of Brevard. Dr. and Mrs. Clevens host the annual event, inviting
business professionals and members of the community to join
together to raise money for this worthwhile cause. Each year, the
event raises $10,000 or more for the organization’s life changing
work; aiding abused and battered women in leading safe, happy
7
COVER STORY
Rhinoplasty before
Practice Expands in a New Location,
the Center Offers Patients a Highly
Efficient, Convenient and Enjoyable
Experience
The Clevens Center for Facial Cosmetic Surgery expanded into
a new location in the Spectrum Building in Melbourne featuring
advanced practice management software and enhanced phone
systems in an effort to offer a highly efficient, convenient and
enjoyable experience to new and existing patients.
Dr. Clevens has established a practice grounded in patientcentered care. From the time a patient sets an initial appointment,
Dr. Clevens and young African patient
Rhinoplasty after
the staff strives to welcome the patient and make them feel at
home. Then, when the patient meets Dr. Clevens, the experience
continues to be efficient and enjoyable. Dr. Clevens says, “In my
consultations, I consider what that patient does for a living, the
length of downtime associated with the appropriate procedure
options, and of course, their desired results. I then tailor my
surgical recommendations to best serve each patient’s unique
cosmetic goals.”
The Center for Facial Cosmetic Surgery is an inviting, convenient
medical facility with compassionate trained professionals ready to
guide patients through their facial cosmetic surgery journey from
the initial consultation to insurance filing to surgery and follow
up appointments.
Dr. Ross A. Clevens is More than
Just a Plastic Surgeon; Trust
Your Face to The Specialist
Photo Provided by cleveens center for cosmetic surgery
The Clevens Center for Facial Cosmetic Surgery
presents a new face of facial cosmetic surgery. From
helping patients delay the appearance of aging to aiding
patients in recovering from skin cancer, to raising money
for local charities and participating in humanitarian
efforts abroad, Dr. Ross Clevens is more than just a
plastic surgeon. He is someone you can trust your face
with. With an Ivy League education at Yale, Harvard
and The University of Michigan, recognized expertise,
new facilities and capable staff, an efficient, enjoyable
patient-centered experience and amazing results are
guaranteed.
The Clevens Center for Facial Cosmetic Surgery
is a comprehensive aesthetic and reconstructive
care center committed to quality patient centered
care. For information about Ross A Clevens,
MD, FACS and The Clevens Center for Facial
Cosmetic Surgery please call 321.727.3223 or
visit www.drclevens.com. 
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make First Professionals a well-rounded — and yes, affordable — choice when it
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For more information, call us toll-free at (800) 741-3742 or visit us at
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You save lives.
We save livelihoods.
9
WEALTH MANAGEMENT
Annuities:
Understanding how an annuity can work for you
By Tyson Smith
Will your savings last a lifetime? Many pre-retirees and retirees are uncertain whether the nest egg they have built will let
them live comfortably for the rest of their lives without running
out of money. With the rising cost of living and the fact that
people are living longer, an annuity could be a solution to help
provide a steady stream of income in retirement.
compared to deferred annuities because it requires you to surrender your principal to the insurer, or annuitize the contract.
Annuitization payments consist of interest and a portion of your
principal. You can choose from many payout options including
life only, certain periods or a combination of both. Some payout
options will continue payments to a beneficiary after death.
What is an annuity?
Deferred variable annuities may offer optional living benefits
to provide guaranteed income. These benefits allow you to receive lifetime income without annuitizing your contract.
Annuities are long-term financial vehicles that allow you to
accumulate money tax-deferred for retirement. An annuity is a
contract between you—the investor—and an insurance company. Annuities also allow you to create a steady stream of income
to live on in retirement.
Types of Annuities
There are two main types of annuities—fixed and variable.
Fixed annuities provide a rate of return at a rate determined by
the insurance company. This rate is guaranteed for a certain period of time. A variable annuity offers a wide range of investment
options and entails more risk in exchange for greater growth potential.
Annuities are also categorized based on when you take income, immediate or deferred, and how you make payments,
single premium or flexible premium. An immediate annuity is
purchased with a single payment and starts providing you with
income payments right away.
Deferred annuities can be purchased with a single payment
or flexible payments. The payment of income you receive is deferred while your money has the opportunity to grow without
being taxed (tax-deferred).
Receiving Income
Immediate annuities allow you to convert a payment into
a monthly, quarterly, semi-annual or annual income stream.
Immediate annuities typically provide higher levels of income
Deferred fixed and variable annuities also have various income options, including the following; 1) Lump sum payments
2) Partial withdrawals and 3) Periodic payments through annuitization.
Benefits of an Annuity
Tax Deferred Growth—Earnings from an annuity grow on a taxdeferred basis. It is important to note that earnings will be taxed
at ordinary income-tax rates when you withdraw your money
from an annuity.
Income for Life—Annuities offer several income options for receiving payments. These payments may last a lifetime.
Penalty-Free Withdrawals—Annuities generally permit penalty-free withdrawals, subject to limitations and restrictions. You
might also be able to withdraw a certain percentage of your contract value or interest earnings each year.
Probate Avoidance—By simply naming a beneficiary, the assets
of your annuity are transferred directly to your beneficiaries, and
may bypass probate.
Reallocation—You may reallocate or transfer among the investment options in variable annuities without paying fees or taxes.
WEALTHYour
MANAGEMENT
Marketing
Practice
Optional Benefits—Principal protection,
lifetime income and guaranteed death
benefits may be offered for an additional
cost and are subject to limitations.
Financial Professional
Help
Your financial professional can help
you structure a retirement planning strategy that best suits you. Like most financial products, annuities have associated
fees and charges. Contact your Baird Financial Advisor to determine if an annuity is right for you.
Annuities are investment vehicles
designed for long-term planning. Variable
annuities are subject to risk, including
the loss of principal. All guarantees are
based on the claims-paying ability of
the insurance company. Withdrawals of
taxable amounts are subject to income
tax, and if taken prior to age 59 ½ a 10%
federal tax penalty may apply. Robert
W. Baird & Co., Incorporated nor its
Financial Advisors offer legal or tax
advice.
Investors should carefully consider
the investment objectives, risks, charges,
and expenses of variable annuities and
their underlying funds before investing.
This and other information can be
found in the prospectus for the variable
annuity and the prospectuses for the
underlying funds, which can be obtained
by contacting Robert W. Baird & Co.
please.
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. 
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Baird does not provide tax or legal advice.
Scenarios are for hypothetical use only.
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1950 South Academy Drive
Melbourne, Florida 32901
FLORIDA MD - NOVEMBER 2010 11
Marketing Your Practice
The Customer is Always Right –
Still
By Jennifer Thompson
Let’s just come right out and say it:
customer service is as integral to your
practice as your medical degree is. That’s
right. Before you cry blasphemy, think
about your office’s most vital assets (hint:
you aren’t number one). It’s your patients
– or your clients, customers or whatever
you want to call them – that keep your
office lights on, pay your salary and,
ultimately, make your job possible. So
how can you reach them better and keep
them happy?
A dissatisfied customer will tell
between nine and 15 people about their
experience, with about 13 percent of
dissatisfied customers telling more than
20 people, according to the White House
Office of Consumer Affairs. That means
a few unhappy patients can go a long way
and do a lot of damage to your practice.
Perhaps even more startling of a
statistic: 86 percent of consumers took
their business elsewhere following a bad
customer experience, up from 59 percent
just four years ago according to Harris
Interactive, Customer Experience Impact
Report.
When developing an office culture for
you and your staff, remember that above
all else everyone should be paying the
most attention to your customers – your
patients. They don’t have to choose your
office, but you have to make them glad
they did.
Start at the Top
In this case, that’s you. No matter what’s
going on in your personal or daily life, no
matter how overbooked your schedule is
– find time to interact and connect with
the patients you’re seeing. Spend an extra
minute or two with them to find out why
they’re there and maybe even a personal
fact or two about them to see if you share
a common interest. Write it down in your
notes, I won’t tell.
This is one of the easiest ways to
ensure a positive experience for a patient
– they’ll tell everyone willing to listen
about the great doctor visit they had and
how wonderful of a person you are. Take
the time to identify customer needs and
listen to what they’re saying – not just
about what hurts, but about who they
are.
But it doesn’t stop there. You’re just
the beginning – step one for you is to set
the “patient-first” mentality. Step two is
to make sure your office staff is following
in line. On average, patients deal with at
least two to three people from your staff,
and each interaction should be a pleasant
one. There is a trickle-down effect from
you to your office manager to your front
desk to your nurses and finally to the
patients. It’s your job to set the tone and
promote the energy throughout your
office.
One of the biggest initiatives that
may help is simply letting employees
know that you’re putting an emphasis on
customer satisfaction. Encourage them
to be friendly, listen to patients and go
out of their way to make sure patients
are happy. One of the most successful
strategies here is to lead by example.
But remember, employees are a type of
customer, too, and they need a regular
dose of appreciation as well. Consider
planning special promotions or contests
that will encourage them to create a
friendly atmosphere and reward them for
succeeding. Thank them throughout the
day and the trend will catch on; if they’re
treated with respect, chances are they’ll
have a higher regard for customers.
Putting Customers First
As silly as it may sound, changing just
a few of the things you do can create a
ripple effect that will positively alter the
entire perception of your office. According
to Lee Resource Inc., attracting a new
customer costs five times as much as
keeping an existing one, so wouldn’t you
like to keep every patient and positive
referral you can? I thought so. Here are a
few tips at how to immediately improve
customer service within your office:
Make customers feel appreciated.
The biggest thing here is to treat them as
individuals – use their name, connect with
them and find ways to compliment them
(as long as you’re sincere). Customers
can tell whether or not you really care
about them, so find ways to show that
you do, like not rushing them or trying
to do three different things while they’re
speaking with you. It’s the small things
that matter.
Harness the Power of “Yes.”
You and your staff should always be
Marketing Your Practice
looking for ways to help your customers
– from a glass of water to explaining an
insurance form – if they look like they
need something, ask. When they have a
request, make it happen (as long as it’s
within reason. I don’t want to hear about
any physicians doing dental work on
the side because it’s more convenient for
patients). Make doing business with you
easy – from paperwork to consultations
to payment – it should all be stress-free.
If you need a better website or a complete
office makeover for that to work – make
it happen.
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. 
Give More than Expected. If the
future of your practice lies in keeping
your patients happy and gaining referrals
– think of ways to elevate yourself above
the competition. What makes you
different from your competitor down
the street? Find those elements and own
them. Identify what you offer patients
they cannot get elsewhere. Think about
what you should do to follow up after a
visit – maybe you send out Thank You
Cards or even a quick phone call from the
front desk to show the office is concerned
with their wellbeing? What can you give
them that’s totally unexpected? Find that
answer and you’ll be well on your way to
a unparalleled level of customer service.
No matter what, just remember the old
saying: “The customer is always right.” It’s
about time you start listening to them.
Looking for more
information?
Contact Jennifer Thompson today
for a free consultation and marketing
overview at 321.228.9686 or e-mail
her at [email protected].
ORTHOPAEDIC UPDATE
Shoulder Specialists at Orlando
Orthopaedic Center Help Patients
Regain Mobility and Eliminate Pain
By Jennifer Roth Miller, Staff Writer
Shoulder specialists at Orlando Orthopaedic Center are
available at several convenient locations throughout Central
Florida to facilitate a smooth process of diagnosis, treatment and
rehabilitation for patients with conditions affecting the shoulder.
The fellowship trained and board certified shoulder doctors
affiliated with Orlando Orthopaedic Center utilize the most
current technology available and offer diagnostics and treatments
in modern offices and minimally invasive surgeries at a new
14,000 square-foot surgery center.
Drs. Jeffrey P. Rosen, Lawrence S. Halperin, Samuel S. Blick,
Alan W. Christensen, Randy S. Schwartzberg, Bryan L. Reuss and
Eric G. Bonenberger, all board certified by the American Board of
Orthopaedic Surgery and associated with Orlando Orthopaedic
Center, make up the team helping patients over the age of 14
suffering from shoulder conditions. Their services specifically
aid in eliminating pain, immobility and general concerns. The
team of orthopaedic surgeons collectively specializes in sports
medicine, joint replacement, shoulder and upper extremity
surgery and arthroscopy.
Modern Offices and A New State-of-theArt Surgery Center
Patients are treated in modern offices Monday through Friday
in convenient locations featuring electronic medical records,
digital x-ray, on-site magnetic resonance imaging (MRI), as well
as physical and occupational therapy. In cases where surgery is
necessary, minimally invasive shoulder arthroscopy is available
at Orlando Orthopaedic Center’s new state-of-the-art surgery
center.
The new 14,000 square-foot outpatient surgery center offers
state-of-the-art orthopaedic/musculoskeletal outpatient surgical
services with four operating rooms and a multi-functional
operating suite for Interventional Pain Management procedures.
Complete with the latest treatment advances to reduce
discomfort and healing time for patients, the new facility focuses
on outpatient orthopaedic surgery and pain management.
“Having our own orthopaedic focused outpatient surgery
center allows for the surgeon to control the environment they
work in. From the instruments to the staff and space, the attention
to detail and quality allows for even more successful surgeries and
higher levels of patient satisfaction,” says Dr. Schwartzberg.
The surgery center is located just steps away from Orlando
Orthopaedic Center’s newly opened downtown clinic in the upand-coming South of Downtown (SODO) District.
Common Shoulder Conditions,
Treatments and Surgery
Conditions and injuries such as bursitis, impingement, rotator
cuff and labral tears, biceps pathology and tumors are among the
most common shoulder issues treated.
In many cases, patients are athletes, as swimmers and those
engaging in sports using the shoulders to throw a ball or extend
the arms in an upward motion are susceptible to shoulder injuries.
This is due to the anatomy of the shoulder joint.
The shoulder joint is a ball and socket joint and is extremely
shallow and therefore susceptible to injury. A cuff of cartilage
called the labrum compensates and allows the shoulder joint to
be very flexible and move in all directions.
The rotator cuff of the shoulder or the tendon that links
the muscles that work together to lift and rotate the shoulder
commonly causes shoulder patients pain or mobility issues.
Whether an inflammation of the neighboring fluid filled cavities
(bursitis) is causing tenderness or the rotator cuff itself is being
impinged upon by bones causing pain, Orlando Orthopaedic
Center shoulder specialists can properly diagnose the problem in
their state of the art facilities with digital x-rays. In some cases,
the patient has torn the rotator cuff or the labrum. The bicep
muscle may also become impinged. And of course tumors of the
shoulder can interfere with mobility and cause pain.
Initially, in most cases, the doctors will try non-surgical treat-
ORTHOPAEDIC UPDATE
ment such as rest, avoiding certain activities, non-steroid anti-inflammatory medications, stretching, injections of local
anesthetics and/or cortisone and physical
therapy.
When non-surgical treatments fail, the
doctors may suggest surgical options. If
possible, the specialists rely on minimally
invasive arthroscopic surgery. In an arthroscopic procedure, minimal puncture
wounds are made. The joint is examined
through a fiberoptic scope connected to
a camera. The surgeon uses small instruments to repair the condition while monitoring the surgery on a computer screen.
They also utilize biodegradable suture anchors for cuff and labral repairs.
Be sure and check out our
NEW and IMPROVED
Rehabilitation
After surgery, the arm may be placed
in a sling for a short period of time.
This allows for early healing. As soon as
comfort allows, the sling may be removed
to begin exercise and use of the arm.
The surgeons also provide a rehabilitation
program based on the patient’s needs and
the conclusions in surgery. This includes
exercises to regain range of motion of
the shoulder and strength of the arm. It
typically takes several months to a year to
fully recover and heal.
The team also emphasizes doctor-patient guided shoulder strengthening and
rehabilitation techniques as a means of
maintaining shoulder health after a baseline history and exam are performed.
Shoulder Specialists at
Orlando Orthopaedic
Center are Ready to Help
Shoulder specialists at Orlando Orthopaedic Center are ready to serve patients
with shoulder conditions and injuries.
Concerns are resolved through diagnosis,
treatment and rehabilitation. Referrals are
welcomed with assurance patients will receive first-class care. 
Laser Skin Rejuvenation
By Ross A. Clevens, M.D.
Laser skin rejuvenation improves the appearance of skin and reverses many of the signs of
aging that develop over time. Skin resurfacing
achieves a smoother, clearer and more youthful
appearance to your skin.
As skin ages and suffers the ravages of the Florida sun, a variety of changes ensure including the
development of lines and wrinkles, pigmentary
irregularities, spider veins and the loss of skin
tone as well as malignant and pre-malignant abnormalities. Wrinkles around the eyes, lips and
cheeks develop due to deterioration (heliodematitis and elastosis) in the collagen and elastic fibers
that connect the cells of our skin. These changes
are further accelerated by cigarette smoking, stress
and cumulative lifetime sun exposure.
Laser skin rejuvenation — before
Skin rejuvenation can be accomplished with a
panoply of modalities ranging from laser and light-based systems,
to chemical peels and other techniques. Sun avoidance, the application of sun block, sun protective clothing and a physician
designed and supervised skin care regimen are keys to achieving
and maintaining a satisfactory result after skin rejuvenation.
Laser skin rejuvenation — after
different skin types and this diversity demands a host of resurfacing techniques to accommodate patient concerns. A laser is an
amplified beam of light that vaporizes blemishes imperfections,
lines and wrinkles that were once thought to be permanent.
We offer Portrait Skin Resurfacing, Pixellated “Dot” Laser
Skin Resurfacing, Ablative and Non-Ablative Artisan Skin Resurfacing, Erbium and C02 Laser Skin Resurfacing, Q-switched
Nd-YAG Spectra Peel, Diode Laser, numerous IPL
Laser skin rejuvenation — after
(Intense Pulsed Light or PhotoFacial) systems and
chemical peel techniques along with dermabrasion.
Laser resurfacing may also improve the appearance
of acnes scars and remove precancerous growths.
Skin resurfacing create a tightening and firming effect that helps improve the appearance of loose facial
and neck skin.
The Clevens Center for Facial Cosmetic Surgery offers expertise in achieving youthful skin rejuvenation. There are many
Laser skin rejuvenation — before
This varied collection of state-of-the-art resurfacing devices and lasers ensures a high level of specialization and proficiency that ensures that we meet
and exceed the demands and expectations of our
patients. The Clevens Center for Facial Cosmetic
Surgery has performed thousands of resurfacing procedures. At times, surgery and a laser treatment are
performed in combination during the same sitting
to treat simultaneously loose skin and fine wrinkles.
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 patient-centered 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. 
Hot Topics in Dermatology
Psoriasis is More than Skin Deep:
Recommendations for
Screening Affected Patients
By Erica Mailler-Savage, MD
Psoriasis is a chronic, inflammatory, autoimmune disease of the
skin, nails and/or joints. It presents on the skin as erythematous
silvery-scaled papules, patches, or plaques, most classically on the
elbows and knees (Figure 1). Nail changes consist of onycholysis
or pitting (Figure 2). Thirty percent of patients with psoriasis
may have underlying
inflammatory arthritis
of the digits, large
joints, and/or lower
back. Approximately
75 million people in
the U.S. are afflicted
with psoriasis.
While it has been
known for quite some
time that patients with
psoriasis have an increased risk for depression due to quality of
life issues, it is becoming more evident over
the last several years
that patients with severe preFigure 1: Psoriatic plaque on the elbow
sentations
of psoriasis or psoriatic arthritis have an increased
frequency of cardiovascular disease, hypertension,
obesity, and diabetes, and a greater mortality risk
than the general population. Increased risk of cardiovascular disease prior to 3-4 years ago had been
attributed to obesity and smoking, which were
thought to be related to the psychosocial burden of
the disease. However, more recent studies have been
exploring the inflammatory nature of psoriasis and
its relationship to the metabolic syndrome (Table
1), a combination of metabolic risk factors in an individual, including abdominal obesity, atherogenic
dyslipidemia, elevated bood pressure, insulin resistance/glucose intolerance, a prothrombotic state,
and a proinflammatory state.
It has been recently elucidated that TH-1-mediated inflammation is important in the pathogenesis of both psoriasis and the
metabolic syndrome. TH-1 cytokines, including ICAM-1 and
E-selectin, and angiogenic factors such as VEG-F are elevated
in patients with psoriasis, obesity, and coronary artery disease.
These mediators have various effects on angiogenesis, insulin
signaling, adipogenesis, lipid metabolism, immune cell trafficking, and epidermal proliferation. TNF-a, a mediator critical in
attracting inflammatory cells to the skin and joints in psoriasis,
has been found to be released by adipocytes and is also involved
in impairing insulin signaling in insulin-resistant patients.
Therefore, psoriasis may serve as an early external indicator
of underlying immune and metabolic dysregulation, leading to
more efficient detection of cardiovascular disease which has been
long known as the “silent killer.”
The American Heart Association has issued the following
screening guidelines for prevention of cardiovascular disease
beginning at the age of 40, or as young as 20 if risk factors are
present:
Figure 2: Nail pitting in psoriasis
Hot Topics in Dermatology
• Blood pressure screening, at least
every 2 years, with target of < 120/80
mmHg
• BMI, at least every 2 years, with target
< 25 kg/m2
• Waist circumference, at least every 2
years, with target of < 35 inches for
women and < 40 inches for men
• Pulse evaluation every 2 years
Table 1: Criteria for Metabolic Syndrome
Criteria (≥ 3)
Measurement
Elevated waist circumference (men)
Elevated waist circumference (women)
Elevated triglycerides
Reduced HDL (men)
Reduced HDL (women)
Elevated blood pressure
Elevated fasting glucose
≥ 40 in (102cm)
≥ 35 in (88cm)
≥ 150 mg/dL
≤ 40 mg/dL
≤ 50 mg/dL
> 130/85 mmHg
> 100 mg/dL
• Fasting serum lipoprotein or total HDL
and cholesterol every 2 years if risk
factors present with total cholesterol
< 200 mg/dL, HDL > 50 mg/dL, and
LDL < 100mg/dL
• Fasting blood glucose every 2 years if
risk factors present with target < 100
mg/dL
Patients with severe psoriasis should be
referred for evaluation by primary care
physicians to be screened as high-risk
patients. Additionally, behavior modification including smoking cessation, alcohol
moderation, and adding exercise 3 times
per week for 30 minutes should be discussed.
Erica Mailler-Savage, MD, is a
board-certified Dermatologist and
fellowship-trained Mohs surgeon
specializing in skin cancer removal.
Her practice, Comprehensive Dermatology & Dermatologic Surgery,
recently opened in Winter Park,
Florida. Prior to moving to Winter Park, Dr. Mailler-Savage was
a practicing physician and clinical instructor at the University of
Cincinnati. She may be contacted
at (407) 339-7546 or by visiting
www.comprehensivedermorlando.
com. 
Visit Our New Website at
FloridaMD.com
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Practice Management Advice
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Specialists and Professionals
Medical Classifieds
Back Issues with
Informative and
Interesting Stories
For Information Please
Email: [email protected]
or call 407.417.7400
Social Media Marketing
Content Rules for
By Lisa L. Moore
Last month we focused on Content
as one of the top 3 ingredients to social
media marketing. Content in social media marketing is both critical and plays
a very different role from what you may
know from traditional marketing. Missing those differences can be detrimental
to you social media campaign. The world
of social networking demands a disproportionate share of non-selling content.
If your campaign misses this delicate but
uneven balance between selling and providing educational content, your listeners
are likely to tune out. To better understand
content’s role in social media marketing
you need to appreciate the rudiments of
content formats, types, etiquette, SEO,
optimizing tools and strategy.
micro-blog. Micro-blogs can be used to
publish short content, such as an event
or a quick tip, but can also be used as
teaser content to promote and link you
to a larger article from a blog site. This
is a great way to promote the blog on
your company website by promoting it as
a micro-blog on Facebook, Linkedin or
Twitter and directing your social network
of listeners to more information on your
company website blog.
and sometimes where you say it. The uneven balance I refer to is the 95/5 ratio
rule. 95% of the content you post on
your social networks should be an educational type of content with no selling objectives included. The purpose is to build
credibility as a valuable information provider in your field. Once you establish
that content credibility you use the remaining 5% to promote your business in
soft sell content to educate your listeners
content - FORMATS
The two main formats for content
are BLOGGING and MICRO-BLOGGING. Blogging can be used as a general term for posting any content online,
but when differentiating between microblogging, blogging would be considered
a process of posting longer content, such
as an article or even just a few paragraphs,
to an actual blog site. On the other hand,
micro-blogging is typically limited to a
certain number of characters and utilizes
short and sometimes incomplete sentences. Twitter has micro-blogging down to a
science and limits you to 140 characters.
Facebook and Linkedin are also microblogging sites but allow 420 & 600 characters, respectively.
However, unlike Twitter, Facebook and
Linkedin incorporate two other unique
micro-blogging features that include an
area for an article headline and an excerpt
from the URL link you include in the
micro-blog as well as an optional thumbnail photo you want to associate with the
content - TYPES
Content comes in many forms and
from many sources. Basically, you either use ORIGINAL CONTENT, long
or short, that you create or you can use
NON-ORIGINAL CONTENT created by others. Not everyone has time
to write articles every week but there are
plenty of educational resources and news
in every industry that you can repost as
a micro-blog to your social networking
sites. This is a great way to provide valuable content to your online listeners as
well as promote and flatter the author of
the source, in a non-competing but complimentary manner.
content - ETIQUETTE
The delicate role that content plays is
based on what you say, when you say it
on your products or services. (The 95/5
ratio is a good general rule for most businesses, however there are some industries
that are unique in the content they need
to provide, such as a restaurant, and they
can use a ratio closer to 70/30.)
“When you say it” is as important as
what you say. Typically, people use these
social networks during the first 12 waking
hours of their day, but more specifically
it’s safe to narrow that down to general
business hours when people are at work
on their computer. I typically don’t post
on Facebook or Linkedin before 8am or
after 6pm. Depending on your business
and where your customers are, you may
need to adjust that time period if you are
selling to other time zones or even internationally. Special consideration needs to
be spent on how many posts you sched-
ule per day as well as the time between each post. Twitter has a
history of being used as a direct sales initiative so companies like
Starbucks may send out a Tweet at 6:30am to alert their customers of a special on coffee that morning on their way into work.
That’s the beauty of social media and mobile!
content – SEO (search engine
optimization)
When you post your original articles on your blog the search
engines will look for several criteria for them to rank that content for the article to be found in searches on sites like Google,
Yahoo, Bing, etc. Anytime you write an original article for your
blog you should take into account KEYWORDS and HEADLINES. These are two important tactics used in search engine
optimization. Once you identify your keywords, you need to
creatively utilize them throughout the article without saturating
it. Your headline needs to contain your keywords in a concise
manner that describes your article’s valuable message. There are
many other SEO tactics to content, but these are the two basics
for beginners.
content – Optimizing Tools
Lisa L Moore owns a social media marketing company
called clear idea, based in Orlando, Florida. She provides social media marketing training, implementation,
strategy consulting and workshops. As a small business
owner for the last ten years herself, Lisa empathized and
saw the need for affordable social media education for
small businesses and has created her services around limited budgets. Lisa prides herself in not only social media
networking but continues to stay on top of social technologies that are the essence of the social media world.
You can contact Lisa at [email protected], by phone
678-993-3201, or visit www.clear-idea.com. 
Be sure and check out our NEW and IMPROVED
We all know a picture is worth a thousand words. There are
several tools you can use to enhance your blog or micro-blog
and attaching photos or video is the first place to start. Photos
and video can be used as an additional SEO tool if you utilize
those additional options. Adding URL links to other web pages
to your blogging is a great way to direct your reader to more
content on another site, and can be used as a resource to support your comments, such as linking to a site to give examples
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blogging about. Having inbound and outbound links on your
blog also increases your SEO. There are other tools that are
specific to certain networks; like Twitter using Hashtags to reference and track certain subjects or Facebook using other profile
or page name mentions in their updates to link to other people
or businesses so they are recognized in the content. Shorteners
are a necessary tool for micro-blogging and are used to shorten
very long URL links so they do not take up much of your limited
characters. These are a few essential tools to start with.
This list may seem overwhelming, but once you use them
two or three times they are easy to replicate going forward. Your
strategy should start by deciding on your content topics then
create a timing schedule of posting that content when it is appropriate for your customers. There are tools out there to help
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Happy Blogging!
Using Nutraceuticals
Weight Gain and Unsuspected
Gluten Sensitivity, Sub-Clinical
Gluten Enteropathy
The ‘Classical Presentation’ is the Exception, not the Rule
By David S. Klein, MD, FACA, FACPM
Introduction
Clinical Presentation
Obesity is now endemic. More than a national disgrace, the
fattening of America may well be one of our greatest threats to
our national security. In North America, the general public spends
huge sums of money in futile effort to lose weight, when simultaneously, we are wasting huge sums of money ignoring what may
be the treatable cause of weight gain in a large percentage of the
population. Gluten Enteropathy is a common cause of weight issues in populations that consume grain as a diet staple.
Misdiagnosed as ‘irritable bowel disease,’ CD is a life-long complaint. Rare is the patient that presents to the office complaining
of the ‘classical presentation’ of dramatic weight loss, diarrhea and
cramping precipitated by pizza, spaghetti and bread. More typically, patients present with peculiar, episodic cramping, bloating
and weight gain. Self-diagnosed with ‘leaky gut,’ they often go
Celiac Disease (CD) is a digestive disease that damages the
small intestine and interferes with nutritional absorption, and it
can result in unexplained weight gain. Sufferers of CD cannot
tolerate gluten, a binding protein found in wheat, rye, and barley.
Most commonly, gluten is found in food products, but Gluten
may also be found in everyday products such as medicines, vitamins, and cosmetic products.
Sensitivity to Gluten is very common. Affecting as many as
30% of the general population, sensitivity to gluten is a ‘spectrum disorder.’ That is, it varies from Subclinical-mild in severity
to overwhelming-devastating. In its’ severest form, it is known
as Celiac Sprue, Celiac Disease (CD), non-tropical Sprue, and
less commonly as Gee-Herter Disease, Gee-Thaysen Disease or
Heubner-Herter Disease.
Celiac disease is both a disease of malabsorption, and an immunological condition. There may be a familial or genetic predisposition to CD, and it may be triggered after trauma, surgery,
pregnancy, childbirth, infection, or emotional stress.
Autoimmune in nature, CD sufferers will experience periods of
time where symptoms are minimal, stable and flair. Triggers are
usually dietary, as the protein family known generally as ‘Gluten’ will trigger complaints in most patients. Equally confusing
is that hormonal shifts, co-morbid disease states, infection and
stress can trigger symptoms, as well.
through an embarrassing series of self-treatment protocols, GI
detoxifications and fad diets. A minority of patients present with
skin rash known as Dermatitis Herpetiformis, as the principal
symptom.
Other Signs and Symptoms Include:
• unexplained iron-deficiency anemia
• fatigue, depression, anhedonia, anxiety
• arthritic bone or joint pain
• bone loss, osteopenia, or osteoporosis
• tingling numbness in the extremities
• seizures, depression, bipolar disorder
• dysmenorrhea
• canker sores in the mouth
• dermatitis Herpetiformis
The most common complaints are dyspepsia, bloating and abdominal uneasiness.
Associated disorders include:
• Diabetes
• Autoimmune thyroid disease, e.g. Hashimoto’s Thyroiditis,
Grave’s Disease
Nutraceutical Treatment of Celiac
Disease
The mainstay of treatment is as simple and as complicated as
avoiding Gluten in the diet. This means avoidance of most processed foods, and nearly all grains.
Gluten is widely used as a binder in medicines, supplements
and in many cosmetic products.
It takes a good bit of research to identify sources of Gluten in
the ingestible environment, and it takes but a single slip to cause
a patient to go into a gastrointestinal crisis.
1. CLA- Conjugated Linoleic Acid. When taken 1,000 mg two
or three times daily, CLA will act as a topical anti-inflammatory for the GI tract. Taking a week or two, symptomatic
relief can be dramatic
2. Castor Oil- This old standby is useful to settle an inflamed GI
tract. Taken ½ Tsp to ½ Tbs in apple sauce, once daily, the
irritable bowel symptoms often abate within a few days. It
should be taken for several weeks, consistently, then periodically as symptoms dictate.
3. DPP IV (gluten digestive enzyme)- One or two capsules taken
immediately before meals will provide some protection from
modest amounts of Gluten. Taking these digestive enzymes
• Autoimmune liver disease
• Rheumatoid arthritis
• Autoimmune adrenal dysfunction; Addison’s Disease
• Sjögren’s syndrome
• Bipolar Disorder.
• Lupus
Diagnosis
To most medical practitioners, blood work is the preferred approach to diagnosis, elimination diet is often the most practical
way to infer diagnosis. Elimination of gluten from the diet for a 2
week period is often all that is necessary to infer diagnosis.
The ‘gold standard’ in confirming diagnosis is the endoscopic
biopsy. When positive, diagnosis is firmly established. Unfortunately, biopsy for CD is fraught with false negatives.
Easiest of all is testing, serum anti-body determinations for
IgG, IgA, IgE and tTG IgA and tTG IgE are useful, but the derived information is sometimes confusing. Best drawn early in
the morning, these anti-body titers may demonstrate patterns
that suggest gluten sensitivity or frank Celiac Disease.
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mitigates but does not eliminate the
damage from dietary gluten, but social
circumstances sometimes dictate the
need for this intervention.
Dietary Supplementation
Celiac Disease results in an unpredictable but inevitable malabsorption of essential vitamins, minerals, amino acids,
oils and essential fatty acids. Many nutritional deficiency syndromes are easily detectable through available nutritional test
panels. Most practitioners are unfamiliar
with these panels making specific intervention impossible. General supplementation should include:
1. Mineral chelate (organic mineral
salts)
2. Essential Fatty Acids & Oils
3. Amino Acid/protein supplementation
erosclerotic plaque stability and thereby decrease the incidence of cardiac ischemia and
ischemic cardiac arrhythmias. An ever-increasing body of evidence supports the role for
omega-3 fatty acids, i.e. fish oil, in through a role as anti-arrhythmic agents, through
anti-thrombotic effect, and through atherosclerotic plaque stabilization, probably as a
result of topical anti-inflammatory action.
Dosage requirement is between 2 and 3 grams per day, in divided doses. Generally,
the preferred cardiac ratio of 3:2 EPA/DHA, but in inflammatory conditions such as
CD, the EPA/DHA ratio does a bit better at 6:1.
Patient should begin with 1 mg per day, increase over a week or two to the desired
daily dosage.
David S. Klein, MD 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. www.stages-of-life.com. 
4. Vitamin B Complex, Vitamin C,
Vitamin E
5. Vitamin D-3 (dosage dictated by age
and condition)
RS
S
ces
Pla
As we age, we become less and less efficient in absorbing nutrients through the
gastrointestinal tract. With CD, this efficiency deteriorates even more dramatically. In short, it takes a great deal more
than the ‘recommended daily allowance
(RDA),’ to ensure adequate levels of these
important and inexpensive nutrients.
NOTE WELL: The commonly available OTC multivitamin/mineral complexes are entirely inadequate.
Individuals with CD tend to have elevations in CRP, suggesting increased risk
of cardio-vascular disease. Omega-3 fatty
acid (fish oil) administration is an interesting, new intervention for the treatment
and prevention of coronary artery disease
(CAD). Certain omega-3 fatty acids have
biochemical properties that promote ath-
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PHARMACY UPDATE
Testosterone Replacement Therapy (TRT):
A Different Venue
By Terry Isler, RPh and Jared Le Fevre, PharmD
Candidate
Testosterone replacement therapy (TRT) has proven
beneficial results in hypogonadism men.¹ I personally and
professional agree entirely with the opening sentence, but as I
rotated through my different health care sites I did not see much
to any TRT prescribed. A perfect opportunity arose for me to
address this important and often controversial topic when my
current pharmacy preceptor, Terry Isler assigned me the task of
writing this article
During my ambulatory care rotation, a family practice
physician and I were finishing up a follow up physical with a
middle aged gentleman; who had one more comment as we
were prepared to exit the room “I’m having trouble….with
performance in the bedroom,” he said. The physician reply
quickly with “Do you want to try some Viagra®?” The patient
agreed. I walked down the hall with the physician to the nurse’s
station, as we were walking I asked the physician if possible
the decreased performance could be due to decreased levels of
testosterone, the physician said “yes.” I thought more on that
patient visit as I prepared to write this article. The questions I
thought were: why did the physician go to Viagra® immediately
as the go to medication for our patient’s troubles, why was there
no investigation to possible causes for erectile dysfunction from
the physician, and lastly is there no other pharmacotherapy
treatment I could recommend to the physician?
Viagra® is one of the leading Phosphodiesterase Inhibitor
(PDE 5) in sales in the United States. This medication also only
has one black box warning contraindication, nitrate therapy in
case you missed it in the television commercials making for a very
safe medication². Speaking of medicine in advertising, that is
how most of the population learns of new medications, including
health care professionals: medical doctors and pharmacists
advertising. A different approach to the television maybe a
Pfizer representative will request a time, around lunch or dinner
to present medication information and leave a few medication
samples and be on their way. The seed is now planted, and very
often that is the medication that will be prescribed before others
even if the other medication is superior.
What are causes of decreased sexual performance in males?
Sleep deprivation, increased stress, depression, and medications
all maybe causes for decreased sexual performance in males. One
other cause may be decreased testosterone, the primary hormone
in the male body and the primary hormone responsible for
erections. Testosterone levels in males decrease as age increases.
Could millions of men, middle aged and elderly men be suffering
from hypogonadism, possibly? To
find the answer to this important
question lab test of testosterone
must be attainted first. To prescribe
Viagra® or any other PGE inhibitor
the only major concern is to ask the
question of current nitrate therapy
Oprah has not yet touched upon TRT yet, but it exists and
it beneficial to men with erectile dysfunction due to hypogonadism. Through out my education at the University Of Florida
College Of Pharmacy TRT was never mainstreamed in the curriculum, I would go on to say that most medical colleges do not
teach much on the subject either. Decreased number of erections
increases with increased age due to decreasing levels of testosterone. Replace the waning testosterone has been proven to improve sexual performance and overall quality of life.³ Replacing
the testosterone will treat the underlying cause of erectile dysfunction also, the previous few sentences are all strong evidence
and background that pharmacists may use in the defense in their
support of a recommendation for TRT. The next patient case
involving “bedroom..trouble” for a male patient: listen, investigate, and then if warranted consider TRT.
1. Reyes-Vallejo L and associates. Subjective sexual response to
testosterone replacement therapy based on initial serum levels of total
testosterone. Journal of Sex Medicine. 2006; 6:1757-62.
2. Arruda-Olson AM, Mahoney DW, Nehra A, et al. Cardiovascular
effects of sildenafil during exercise in men with known or probable
coronary artery disease. JAMA 2002;287:719-725.
3. Coward RM. Prostate-specific antigen changes and prostate cancer
in hypogonadal men treated with testosterone replacement therapy. BJU
International. 2009: 9: 1179-1183.
Terry Isler, RPh, practices with Sam Pratt, RPh, at
Pharmacy Specialists, located at 393 Maitland Avenue
in Altamonte Springs, FL 32701. Currently, Sam is the
only is the only Full Fellow of the International Academy
of Compounding Pharmacists in the central Florida area.
For additional information please call (407)260-7002,
FAX (407) 260-7044, Phone (800) 224-7711, FAX (800)
224-0665 or visit www.makerx.com. 
Aging Does Not Have To Go
Hand In Hand With Pain
In the next 25 years, it is expected that the number of geriatric
patients with arthritis will double to 41 million, and osteoarthritis is expected to be the fourth leading cause of disability by 2020.
But arthritis does not always present as an isolated condition, and
symptoms may overlap with other conditions including carpel
tunnel syndrome.
Brian Leung, MD, Board Certified and fellowship-trained
Orthopaedic Surgeon at Florida Hospital East Orlando, is seeing
an increased number of patients with carpal tunnel syndrome,
a common nerve disorder that effects 4-10 million people
annually.
SYMPTOMS
“Patients may feel tingling, pain, numbness and weakness in
their hands and fingers, which are typical symptoms of carpal
tunnel syndrome,” says Dr. Leung. “Repetitive movements cause
swelling of the carpal tunnel, a small space in the wrist where the
median nerve and nine flexor tendons run from the forearm to
the hand.” The median nerve controls sensation to the palm side
of the thumb, index, middle and half of the ring finger. In some
cases, the pain can radiate all the way up through the arm to the
shoulder. Swelling causes pressure on the median nerve, which
leads to pain and numbness.
TREATMENT
An electromyogram and nerve conduction studies help detect
nerve dysfunction and diagnose carpal tunnel syndrome. Carpal
tunnel syndrome can be treated non-surgically with rest, activity
modification, anti-inflammatory medications, wrist splints and
steroid injections in the carpal tunnel to reduce swelling. Early
diagnosis can prevent permanent damage to the median nerve.
“More severe cases, such as those with persistent pain, numbness, and weakness in the hand and fingers, may need to be treated surgically,” says Dr. Leung, who is the only specially trained
hand and upper extremity orthopaedic surgeon at Florida Hospital East Orlando.
Dr. Leung utilizes the Florida Hospital Surgery Center at Florida
Hospital East Orlando for outpatient surgical cases.
Brian Leung, MD
“Endoscopic surgery involves making
a small incision over the wrist and inserting a tiny camera into the
carpal tunnel. Using another small incision on the carpal tunnel,
median nerve pressure is relieved. This allows for faster recovery and less pain than traditional open surgery, which involves a
larger incision.”
REHAB
After surgery, therapists at Florida Hospital Sports Medicine
and Rehabilitation help patients alleviate their swelling, increase
their range of motion and strength, manage their scars and return them to their previous level of functioning at home and at
work, typically within four to six weeks. Florida Hospital Sports
Medicine and Rehabilitation have eight certified hand therapists
on staff with specialized training in the wrist and hand to help
supervise rehabilitation.
AGING & PAIN
It is estimated that more than 50% of seniors in the United
States reported joint symptoms that were chronic in nature.
With early diagnosis and treatment, as well as surgical options
for the more severe cases, aging does not have to go hand in hand
with carpal tunnel pain and thereby reduced function of one’s
hands and wrists.
Dr. Leung offers a new dimension of Orthopaedic Care to the
residents of East Orlando. As the only specially trained hand and
upper extremity orthopaedic surgeon at Florida Hospital East
Orlando, Dr. Leung treats a variety of injuries related to the hand,
wrist, elbow and shoulder.
Dr. Leung is dedicated to treating his patients and when surgery
is necessary, providing them with the latest in surgical advancements and technology, all of which are geared toward quicker
recovery, smaller incisions, less pain and high success rates. Dr.
Leung says, “Having access to the Florida Hospital Surgery Center, which has the most advanced equipment and a top notch
team of professionals is critical to staying focused on having the
best outcomes.”
After completing his Medical Doctorate from the University
of Nebraska, Dr. Leung completed his Orthopaedic Residency at
Dartmouth Hitchcock Medical Center and his Fellowship Training in Hand and Upper Extremity Disorders from the University
of Florida.
Dr. Leung is currently seeing patients at his practice, Orthopedic Specialists of Central Florida, located at 7975 Lake Underhill
Road Suite 100, Orlando, FL 32822. Appointments can be made
by calling 407-303-6785. 
What Limits of Liability for Malpractice
Do You Recommend for Doctors
in Florida?
By Matt Gracey
This is probably the toughest question any expert in medical malpractice insurance is asked. Unfortunately, no easy answer exists
that are appropriate for every doctor, but after considering all of the
factors you will certainly be in a better position to make an educated
decision on this important issue.
of the passage of Amendment 8 is that maybe doctors would now
rather have the insurance company eager to settle their case to avoid
a “strike” on their claims record.
The first consideration these days usually deal with costs and if
you can afford anything other than the lowest limits, which are
generally $250,000 / $750,000. Next determine if you have any
contractual obligations with your managed care companies, hospitals, or within your group to satisfy that might limit your choices of
liability limits.
Even after considering all of these factors, the answer to which
limits of liability you should carry is very personal as there is no “correct” answer. Much depends upon your fundamental belief in using
insurance to mitigate your practice’s risk, and some depends on how
well you can sleep at night with little or no insurance coverage.
Other considerations include how many “bare” and under-insured doctors do you practice close to or with whom you exchange
patient referrals. In a large, multi defendant lawsuit you certainly do
not want to be the “deep pocket” if you are carrying very high limits
and the others all have low limits or are uninsured.
If you are retiring soon you may want to consider raising your
limits the last year of your practice so that you can obtain a higher
limits tail when you retire since a “tail” policy is just an extension of
your last policy and the limits cannot be “recharged” yearly as normal annual policies. The “tail” of your policy will extend your policy
with one liability limit covering the rest of the exposure window,
which in Florida typically is four years or a child’s eighth birthday.
Conclusion
Matt Gracey is a medical malpractice insurance specialist
with Danna-Gracey, Delray Beach, 800-966-2120; matt@
dannagracey.com. Danna-Gracey offices are located in Delray Beach, Orlando/Tampa, Jacksonville, and Miami. 
Performing MOHS Micrographic Skin Cancer Surgery
How much risk do you want to take?
The average claim in Florida settles for around $300,000. However, the average is weighted sharply downward by the high percentage of nuisance cases settling for very minor sums. A serious
case that goes to trial and is lost has an average exposure of over a
$1,000,000, so practicing with $250,000 limits is certainly risky on
one hand.
On the other hand, many believe that by purchasing higher limits of liability doctors become targets of the plaintiff attorneys and
expose themselves to worse claims than by carrying lower limits. In
Florida the “bad faith” laws often pass any danger of excess limits
judgments to a doctor’s insurer, so some doctors believe that they
can be comfortable by just purchasing the lowest limits.
One serious consideration against carrying low limits is this: if
you practice with low limits of liability the insurance company
claims managers say that they are much more likely to settle a case
quickly because they do not want to expose the doctor or the insurance company to a possible multi-million dollar verdict against
either of them. However, the newest twist to that thinking because
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Healthcare Reform and Baby BoomersMore Pressure for Physicians?
By Robert E. White, Jr
With the passage of universal healthcare legislation, which will provide health
insurance coverage to a significant part of
the 47 million Americans who lack insurance, the need for more doctors will
escalate. A shortage of physicians already
exists and the anticipated addition of
new patients will dramatically increase
demands on providers.
proactively managed.
The American Academy of Family
Physicians predicts a shortfall of roughly
40,000 primary care physicians over the
next decade as medical students are increasingly drawn to the higher pay and
better hours of specialties such as surgery,
cardiology, and radiology. In addition,
the rate of physicians retiring is expected
to rise dramatically in the next decade.
In an effort to reduce the impact and
in recognition of the growing need for
patient access to physicians, legislators
included in the new law bonus payments
for primary care physicians as well as forgiveness of tuition loans as incentives to
medical students to pursue primary care
careers.
Impact of Healthcare
Reform
Healthcare reform will only increase
the physician shortage crisis, and it will
create additional difficulties in the search
for solutions to improve patient access to
care. Some experts predict that by 2020,
the United States could experience a
shortage of between from 200,000 and
700,000 physicians depending upon the
level of utilization.
The anticipated availability of health insurance for the majority of Americans as
a result of the healthcare reform does not
necessarily promise equal access. Without
an adequate infrastructure in place, many
former insureds will be forced back into
costly emergency rooms for routine care.
The changes to America’s healthcare delivery system could affect physicians’ ability to provide patient care. A shift in how
it would be carried out while delivering
the expected level of quality care must be
The U.S. has never faced the level of
physician shortage that currently exists
and which is further threatened by the
new reform legislation. Without a solution for this dilemma, the healthcare system cannot function properly and may
be impacted indefinitely.
Although medical schools are projected
to graduate 4,000 more physicians each
year by 2020, this is fewer than half of the
needed increase. During the overwhelming 25-year U.S. population increase
between 1980 and 2007, there was zero
growth in medical school enrollment for
conventional medicine treatment.
Aging of America
Baby boomers are quickly outpacing all
other age categories of Americans. At the
same time, more and more doctors are
approaching retirement age. The number
of Americans age 65 and older will almost double between 2000 and 2030 (20
percent of the population) – an increase
of 104%. With the rise of an aging population, the medical ailments of senior citizens also escalate, including millions with
diabetes and obesity, sharply increasing
doctor visits for those over 65. Regardless
of the most common medical health risks
inherent with aging, the next generation
of retirees will be the healthiest, longest
lived, best educated, and most affluent in
history.
Aging Physicians
The physician workforce is aging at a
faster pace than can be replaced by medical students entering the healthcare profession. Medical school graduates that
may potentially bridge the gap are electing to reduce the number of hours they
practice. More than 250,000 active physicians are over the age of 55 and thousands more are expected to retire in the
next decade.
Population Growth
Along with the rise in baby boomers,
there has also been growth in the general
U.S. population. Experts estimate that
such sustained population growth will require a minimum of 200,000 additional
physicians by 2020. However, with the
retirement of current physicians and a
shortage of new physician replacements,
it is likely that the United States will be
100,000 short of that goal.
Physician Shortage
•Geriatrics
Although the aging population is
already a significant factor for the
healthcare industry, perhaps one of
the greatest concerns is the deficit of
geriatricians that already exists. The
number of geriatricians is roughly half of what is currently
needed.
•Family Practice
The number of U.S. medical school students entering primary
care has dropped more than 50% since 1997, already causing
an increased demand for the specialty. Obviously, the demand
for these physicians will become critical as the number of baby
boomers continues to escalate.
•Nurses
Although allied healthcare workers are expected to play a
greater role as physicians leave the workforce, a significant decline in the number of licensed nurses will also affect medical
treatment for Americans. In Florida alone, more than 40%
of Florida’s nurses are approaching retirement age within the
next 10 years and there are not enough younger nurses to replace them. The state’s nursing shortage has the potential to
cripple Florida’s healthcare system.
•Projected sector growth
With the decrease in physician specialties, expanded roles
and the use of ancillary personnel will be necessary. To relieve
pressure from doctors, substantial increases are projected for
physician extenders, including physician assistants, medical
assistants, and licensed nurses.
is essential that all efforts are taken to preserve the physicianpatient relationship. Special liability factors impact this era of
healthcare reform and the aging population. The partnership between First Professionals and its policyholders includes proactive
risk management services to help reduce potential claims. The
challenge will be to maintain the high standard of patient safety
in a way that does not impact the standard of care for patients.
“Regardless of the impact of the passage of healthcare reform
legislation, we will continue our dedicated efforts to protect our
policyholders,” said Bob White, President of First Professionals.
“We will maintain our commitment to our insureds and focus
on remedies to further reduce the victimization of physicians
during an already challenging malpractice climate.”
First Professionals is aware that the implications of the healthcare reform and aging population issues will place even more
pressure on physicians. Regardless of the threat to physicians of
these unique challenges, our goal is to help physicians reduce the
potential to incur additional liability expense. We will remain
cognizant of these new emerging trends and exposures and continue to monitor them accordingly.
Robert E. White, Jr. is President of First Professionals Insurance Company. 
However, these healthcare professionals don’t have the level of
diagnostic skill of physicians. In the event of a medical error,
patients may incorrectly assume the lack of an available physician is a reason for the error.
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An Increase in Claims?
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As physicians become understaffed and overworked, the risk
of medical errors rises. The stress and fatigue experienced by doctors may increase the likelihood of clinical accidents. Because
of the patient load and the need to evaluate as many patients as
possible, physicians may rush an examination and fail to make
proper diagnoses.
COMPANY
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“National healthcare reform further diminishes the core of
care: the physician-patient relationship,” said Cliff Rapp, Vice
President of Risk Management at First Professionals. “A significant reduction in the quality of care is arguably a motivating
factor for a claim.”
Looking ahead 10 years when there are fewer doctors treating
a greater number of patients – aging patients who generally have
more medical problems – we could see an increased number of
medical incidents. That does not mean that malpractice will be
the root cause; rather that the projected imbalance of practitioners to patients, who because of their age will require more
medical encounters, will adversely impact patient safety.
As Congress implements the requirements of the new law, it
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Current Topics
Surgeons Develop A New Approach To Alter The Way They
Implant A Cardiac Support Device and Prevent Strokes
Pioneering technique may reduce by more than half the stroke rate in patients requiring
mechanical heart support for end-stage heart disease
A surgical team from the University of Central Florida College
of Medicine and Arnold Palmer Hospital for Children has presented findings from the first study to demonstrate that the way
a ventricular assist device (VAD) is implanted can have an impact
on whether or not a patient may have a stroke while the device is
in use.
will tend to bypass the carotids and travel down the descending
aorta. So instead of embolizing to the brain, the clots embolize
more peripherally where one would hope potential damage would
not be so severe,” Dr. DeCampli said. Furthermore, by using patient specific MRI data, each patient could potentially be prescribed
a unique configuration in which to implant the VAD.
Specifically, the surgeons reported that they can adjust the way
they implant a VAD to align with a patient’s thoracic anatomy and
as a result, modify blood flow patterns so that blood clots don’t
travel to the brain and possibly cause a stroke while the VAD is
in use. This landmark study on stroke prevention in heart failure
patients was reported at the 2010 Annual Clinical Congress of the
American College of Surgeons.
Findings from this study, in fact, suggest other surgical procedures during VAD place-ment that could further reduce stroke
risk. “While we found that clots could be directed away from one
carotid artery, they tended to go up the other carotid artery,” Dr.
DeCampli said.
The surgeons reconfigured the angles along which they would
sew a VAD into the heart based on a magnetic resonance imaging
scan of a patient’s heart, aorta, and aortic arch (the main blood
vessels that come out of the heart). Using computerized simulations of blood flow, the surgeons determined, for each surgical configuration, the size and percentage of blood clots that entered the
two carotid arteries (arteries that carry blood to the brain). At one
extreme, one of the configurations had an 18 percent average rate
of embolization (blood clots travelling to the brain). At the other
extreme, a configuration had an 8 percent rate of embolization.
The computerized technique, which is known as computational
fluid dynamics, produces numerical simulations, not tests on actual patients. However, the surgeons applied the simulations to a
real patient’s aortic anatomy. “We took a patient’s MRI scan and
recreated the flow through it down to a fraction of a millimeter
precision through computational fluid dynamic modeling. So a
very real patient’s anatomy went into very precise simulations as
a starting point. Then, we calculated the pathway of blood clots
forming within the VAD and travelling along the aorta,” said William M. DeCampli, MD, PhD, FACS, a professor of surgery at the
University of Central Florida and chair of surgery at the ArnoldPalmerHospital for Children in Orlando.
The surgeons are theorizing that “we could conceivably lower the
stroke rate following the implantation of a VAD from 20 percent
to 7 percent by making a surgical maneuver which is not that difficult to make,” he explained.
At the ACS Clinical Congress, the surgeons showed videos of
blood flowing through a VAD and the path taken by blood clots
formed on the interior of the device. “We will demonstrate that as
you change the angle of implantation of the VAD, the blood clots
The solution to this problem would simply be to use a graft to
bypass the other carotid artery. “With the simulations, we’re finding that without a whole lot of extra surgical work, surgeons could
place such a graft in a suitable location to ensure blood flow to both
carotids and prevent embolization of blood clots,” he said.
VADs are implantable mechanical pumps that direct blood from
a small conduit connected to the left side (ventricle) of a heart that
is failing to the aorta. VADs take over the work of the ventricle
and pump blood to the body. They are used to manage patients
with end stage congestive heart failure by providing a “bridge” to
receiving a cardiac transplant. The devices also are being applied
as destination therapy or continuous, long-term support of failing
hearts. “We now have evidence that patients can live with an acceptable quality of life with an implanted mechanical VAD in lieu
of a transplanted heart,” Dr. DeCampli reported.
Stroke is the most frequent serious complication following VAD
implantation. The annual risk of stroke varies between 10 percent
and 47 percent. Efforts to reduce the incidence of stroke have
focused on altering the surfaces of the devices so the mechanical
elements are not considered to be foreign bodies by the immune
system and do not cause blood to clot. Alternatively, stroke prevention has focused on the use of blood thinners, or anticoagulants, that prevent clot from forming. Neither approach has been
very successful.
The surgical team from the University of Central Florida is following a different avenue of research. Rather than try to prevent
blood clots from forming, “we just assume the blood clots will
form. We’re trying to modify blood flow patterns so the clots will
not go to the brain,” Dr. DeCampli concluded. Also participating in the study were Ivan Ricardo Argueta-Morales, MD; Reginald Tran, BS; William Clark, BS; Eduardo Divo, PhD; and Alain
Kassab, PhD. 
Orlando Health, the University of Florida and Shands
HealthCare Partner to Confront Health-Care Challenges,
Embrace Opportunities
Orlando Health, the University of Florida and Shands HealthCare announced their intent to collaborate on new health initiatives that will make care more accessible to millions of patients
over a 20-county region and expand training opportunities for
physicians.
Officials signed a memorandum of understanding that provides
a foundation for these and other related efforts, a natural result of
years of close working relationships.
Under the agreement, the organizations will negotiate to form
joint clinical programs in the areas of pediatrics, neuroscience, oncology, women’s health, transplantation and cardiovascular medicine, including a plan to develop a regional comprehensive cardiac
care program. They also will look to increase undergraduate and
graduate medical residency and fellowship training opportunities
at Orlando Health, and open opportunities for conducting clinical trials through UF’s robust clinical research program, while also
launching common approaches to quality care and safety initiatives.
“The formal affiliation of Orlando Health with the University
of Florida and Shands will build on our longstanding and valuable relationship and enhance our collective energies as regional
and statewide clinical leaders,” said David S. Guzick, M.D., Ph.D.,
senior vice president for health affairs at UF and president of the
UF&Shands Health System. “As the health-care needs of patients
throughout Central and North Central Florida continue to grow,
we will seek out ways to collaborate on comprehensive clinical programs for adults and children and fortify our role as educational
leaders in delivering the highest-quality education for future physicians and other health providers.”
This agreement will pave the way for the organizations to meet
new mandates under health-care reform, particularly those addressing quality of care.
“Our focus at Orlando Health has always been to provide patients
with the highest quality of health care. New health-care reform
initiatives add even greater emphasis to improving the quality and
efficiency of health-care services,” said John Hillenmeyer, president
and CEO of Orlando Health. “This alliance will open additional
opportunities for us to work together to implement programs and
modify models and structures that will positively impact the quality of healthcare for patients across multiple Florida counties.”
Physicians with these organizations will play an integral role in
these efforts. Through this collaboration, Orlando Health physicians could receive faculty appointments, teach UF medical students or graduate medical trainees, or participate in UF-sponsored
clinical trials. The agreement also could result in increased use of
Orlando Health as a training site for UF medical residents and fellows. It is also envisioned that clinical faculty from UF’s College of
Medicine could participate with Orlando Health medical staff on
future clinical services.
The alliance also opens up additional opportunities for the physician groups to work together to develop joint clinical protocols
that will enhance quality and safety for patients.
More than 2.5 million Floridians across nearly 20 counties are
served by the three health-care organizations.
In a proactive response to pending health-care reform mandates,
the organizations will develop similar or compatible electronic
medical records capabilities and quality information systems to ensure easy access to relevant patient health information. They also
are seeking to develop a comprehensive system of care that provides
a spectrum of health-care services — from primary care to the most
complex, such as transplantation.
In addition, the organizations, which share a common set of values in education, research and charitable missions, will pursue joint
safety net ventures to better provide care to the traditional “safety
net” patient population. Safety net patients are patients with limited or no access to health care due to their financial circumstances,
insurance status or health condition.
“This collaboration lays the groundwork for advancing discussions to enhance patient care, medical education and research
advances and will look to build upon affiliations each of the organizations already has in place with other health-care entities,”
Hillenmeyer said. 
THE STRENGTH TO HEAL
and stand by those who
stand up for me.
Learn the latest treatments and play an important role in the care of Soldiers
and their Families. As a physician on the U.S. Army Reserve Health Care Team,
you’ll continue to practice in your community and serve when needed. You’ll
work with the most advanced technology
and distinguish yourself while working with dedicated
professionals. You’ll make a difference.
To learn more about the U.S. Army Reserve
Health Care Team, call 800-336-1574 or visit
healthcare.goarmy.com/info/mcar.
©2007. Paid for by the United States Army. All rights reserved.
Palm Bay Hospital Unveils New ‘Micro-Camera Procedure’
Hospital Offers Patients Less-Invasive, High-Tech“SpyGlass” Equipment
Palm Bay Hospital, part of the not-for-profit, Brevard-based Health
First family of healthcare facilities and services, now offers patients a new,
high-tech visualization system that can cut down on procedures, return
trips to the hospital, and eliminate additional testing.
Until now, if a patient had a problem with the liver, gallbladder, or pancreas (among others), a physician would probably need to use a scope that
was inserted in the patient’s mouth and twisted and turned through the
entire digestive system until the trouble spot was reached. That procedure
can be uncomfortable and often does not provide enough information
about a patient’s problem, leading to additional tests, X-rays, and more.
Palm Bay Hospital now offers patients a less-invasive, more powerful
alternative. The revolutionary “SpyGlass System,” now available to any
Palm Bay Hospital patient, involves inserting a tiny 6,000-pixel camera
directly into the troublespot through a small catheter. This tiny camera is
lit, can be steered in any direction. and is designed to allow doctors to access and inspect all four quadrants of the examination and treatment area.
As a result, physicians are able to achieve improved diagnoses.
“When Palm Bay Hospital doubled its size last year, we renewed our promise to provide Palm Bay and our surrounding communities
with the latest, cutting-edge medicine available,” says Palm Bay Hospital President Judy Gizinski. “This new “SpyGlass” procedure offers our
patients improved results, better recovery times, and reduces the possibility of additional tests. This is the latest step in fulfilling our promise
to our patients and the community.” 
)SNTITTIMEYOUCALLED
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Florida MD 2011
Editorial Calendar. . Inside Back Cover
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Delray Beach: 800.966.2120 • Orlando: 888.496.0059 • Miami: 305.775.1960 • Jacksonville: 904.388.8688
[email protected] • www.dannagracey.com
2011
EDITORIAL
CALENDAR
Florida MD is a four-color monthly
medical/business magazine for physicians in
the Central Florida market.
It goes to 4,000 physicians, at their offices, in the
thirteen-county area of Brevard, Flagler, Hardee,
Highlands, Indian River, Lake, Marion, Orange, Osceola,
Polk, Seminole, Sumter and Volusia counties. Cover
stories spotlight extraordinary physicians affiliated
with local clinics and hospitals. Special feature stories
focus on new hospital programs or facilities, and other
professional and healthcare related business topics.
Local physician specialists and other professionals,
affiliated with local businesses and organizations, write
all other columns or articles about their respective
specialty or profession. This local informative and
interesting format is the main reason physicians take
the time to read Florida MD.
It is hard to be aware of everything happening in the
rapidly changing medical profession and doctors want
to know more about new medical developments and
technology, procedures, techniques, case studies,
research, etc. in the different specialties. Especially
when the information comes from a local physician
specialist who they can call and discuss the column with
or refer a patient. They also want to read about wealth
management, financial issues, healthcare law, insurance
issues and real estate opportunities. Again, they prefer
it when that information comes from a local professional
they can call and do business with. All advertisers have
the opportunity to have a column or article related to
their specialty or profession.
JANUARY –
Digestive Disorders
Diabetes
FEBRUARY –
Cardiology
Heart Disease & Stroke
MARCH –
Orthopaedics
Men’s Health
APRIL –
Surgery
Scoliosis
MAY –
Women’s Health
Advances in Cosmetic Surgery
JUNE –
Allergies
Sleep Disorders
JULY –
Imaging Technologies
Interventional Radiology
AUGUST –
Pediatrics & Advances in NICU’s
Autism
SEPTEMBER – Sports Medicine
Robotic Surgery
OCTOBER –
Cancer
Dermatology
NOVEMBER – Urology
Geriatric Medicine / Glaucoma
DECEMBER – Pain Management
Occupational Therapy
Please call 407.417.7400 for additional materials or information.
FLMD 2011 Editorial Calendar.ind1 1
10/11/10 9:25:02 AM

November 2010

Transcription

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