May - Southwest Florida`s Health and Wellness Magazine

SOU T H W EST
FLO RID A'S
www.swfhealthandwellness.com
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Health Month
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Toxins
and
~, Women's
Health
es Wide Open
The
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fyou are looking for excellence in FOOT and ANKLE care; if you are
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There are many people with very serious problems of the foot and ankle
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The typical patient coming to see Dr. Samotin has been evaluated by many
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Myles Rubin Samotin, MD
Board Certified Orthopaedic Surgeon
Fellowship Trained, Sub-specialist in Foot and Ankle Surgery
Columbia Uni versity, Hospit al for Joint Dise ases, Ne w York City
870 111th Avenue North, Naples, Florida 34108
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Contents May 2011
20
Rental Rates Are Climbing
As Demands Rises
8 Toxins and Women's Health
9 Eyes Wide Open
21
Endoscopic Ultrasound:
Better diagnosis of digestive
tract problems
10 Home treatment for people
22
23
Spotlight on 401 (k) Plans
7
Sweet Sleep
The ultimate beauty secret?
Youthful-looking eyes
suffering from Lymphedema
11 A Royal Pain in the Back
12 CUTIING EDGE BODY
SCULPTING WITHOUT
CUTIING
13 Tone Those Thighs
16
Protect Your Skin:
Prevent Melanoma
17
What is Allergy & Asthma?
18 Stop Overlooking Signs
SLEEPvsYOU
PILATES in Your Corner
Ensures a TKO
24 Teeth whitening:
Understanding your options
Probate Avoidance
26 Common
Techniques and
may 3,d
Cape Coral
239-443-1500
may 4th
North Naples
239-596-9075
Unfortunate Pitfalls
may 6 th
Downtown Naples
239-216-4337
may 13th
may 13th
Fort Myers
239-437-8810
Marco Island
239-642-3337
28 Facts about Assisted Living
30 Spiritual Wellness
Building Family Life
RIVERCHASE DERMATOLOGY
of Incontinence
19 Traveling Abroad for
Dental Care
AND COSMETIC SURGERY
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©Copyright SOUTHWEST FLORIDA'S HEALTH&WElLNESS Magazine 2011. All rights reserved. Any reproduction of the material in this magazine in whole or in part without written prior consent is prohibited. Articles and other
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material thai is sent. SWFL Health & Well ness Magazine will not knowingly publish any advertisement which is
illegal or misleading to its readers. The information in SOUTHW EST FLORIDA'S Health & Wellness Magazine
; I
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Collier Edition - May 2011 Health & Wellness
Sweet Sleep
By Joy Lynn Post,Dietitian
Cederquist Medical Wellness Center
his time of year can be a bit hectic for
us all. With kids and phone calls, social
events and visitors and travel, it's no
wonder there is not as much time left
for sleeping. We dip into sleep reserves to do other
things. We stay up later to finish projects, clean the
kitchen, or catch up on emails. The restful, restorative sleep tbat our hody requires gets sacrificed all
too quickly.
Or maybe you have plenty of time to sleep, hut you
have trouble falling asleep or staying asleep. If you
have trouble with waking frequently during the
night, there are many reasons this occurs and lots of
ways to help make your sleep longer and sweeter.
It's obvious that we need to do the things we already
know about, like avoiding caffeine-containing beverages after ahout 12 noon, and avoiding napping. If
those kinds of changes have not worked for you, then
try some of these helpful tricks to falling asleep.
Hints for Restful Sleep
• Avoid alcohol (wine, beer and hard liquor) within
3 hours of bedtime. Scientific research that shows
it can cause you to wake periodically through the
night, as it causes hlood sugar fluctuations.
• Avoid Sudafed or other decongestant cold
medicines at night.
Supplements
• Consider taking magnesium before hedtime.
• Try a warm bath with Epsom Salts added, as this
contains magnesium sulfate which can be
absorbed through the skin.
Consider 1-3 mg of melatonin 2 hours before
bedtime, if you frequently go to sleep too late.
Check with you doctor before you start this, as
melatonin can interact with certain medications.
• Avoid spicy foods before bed.
Bedding and Pillows
Consider using a "side sleeper" pillow for under
your neck when sleeping on your side, or try a body
pillow to hug and put between your knees to align
your back and shoulders at night.
• Roll backwards at a slight angle onto a body pillow
if you have hip bursitis.
• Consider replacing your pillows with hypoallergenic pillows. Use Ultrafine allergy pillow and
mattress covers.
Avoid sleeping on a water bed or an electric
mattress.
• Make sure your sleeping area is the correct
temperature range (not too hot or too cold).
Sleep Planning and Bedroom Preparation
MaJQng your environment a sweet place to sleep can
do a lot for your rest and relaxation. Planning ahead
and making a full night's rest a higher priority can
help. Plan your sleep by putting it into your scbedule;
plan for 7 to 9 hours in bed, allowing for appropriate
falling-asleep time. As much as possible, go to sleep
and wake up at the same time each day. Tbis will belp
train your biological clock.
• Complete any aerobic exercise before 6 pm (or at
least 3 hours before bedtime). This allows your
body to process through metaholite and allows for
more restful sleep.
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7
Light, Noise, Temperature, and
Environmental Issues
• Turn down the light in the bathroom and in rooms
you are in 15 minutes before going to bed.
• Use dark window shades or consider a set of eye
shades if you awaken too early because of light.
• Avoid sleeping near electric fields. Try to have your
head at least 5 feet away from electric fields, if
possihle. Possible sources of electrical fields
include: electrical outlets, clock radios, stereos,
computers and monitors. Consider moving these
devices or moving your hed or your position in
the bed.
Bedroom Air Quality
Keep your bedroom air clean, especially if you have
nasal congestion or are prone to snoring. If your nose
is blocked up, consider using a saline spray before
bed. Also consider Breathe-Easy strips on your nose.
Try using HEPA or other types of air purifiers or filters
to clean the air in your bedroom. Set the filter on a low
setting at night if the noise is soothing. Consider
cleaning the vents in your house once a year and make
sure you change your furnace filters every 3 months.
Avoid toxic glues or other items producing an odor
before bed. If you see mold or have a musty smell in
your bedroom, have it checked or cultured for mold
with culture plates. If there is mold, have the house
evaluated for water leaks and air quality issues to be
fixed and see that the mold is cleaned appropriately.
Nighttime Tension and Anxiety
• Avoid reading or watching the news, or reading
stimulating, exciting materials before going to bed.
• Avoid paying bills or checking your fmancial
reports or the stock market before bedtime.
• Avoid arguments before bedtime.
• Schedule difficult conversations well before
bedtime--preferably at least 3 hours before.
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Health & Well ness May 2011 - Collier Edition
By Kevin Caffrey
T
oxins and the body's ability to process
them are key issues in maintaining
optimal health, particularly for women.
Sources of toxins can be found virtually everyPoisonous phthalates are present in
where.
plastics and Styrofoam containers. Tap water,
alcohol, caffeine, medications and supplements,
processed foods, pesticides, insecticides, paints,
tobacco and living close to an industrial plant are
all toxic exposure factors.
For women, toxins can be more complicated.
Many women put additional toxic stress on their
livers by using cosmetics, beauty creams and
lotions that contain phthalates and other toxins.
Toxic exposure is disruptive for women whether
or not they are taking replacement hormones.
Teresa A. Sievers, MD is Board
ill
both
Internal
Certified
Medicine and Anti-Aging, Regenerative and Functional Medicine.
She owns the Restorative Health
& Healing Center in Estero.
"Toxins are endocrine disruptors that effect our
endocrine and hormone systems," said Sievers.
"We're exposed to toxins every day. They playa significant role in maintaining optimal health. Neurological toxicity can impact a person's mood and
mental sharpness. Immunological toxicity contributes to the presence of allergies, asthma and cancer.
Phthalates and other toxins can disrupt insulin levels
and affect our ability to manage weight. For
women, toxins can affect the reproductive system,
including their libido, fertility and periods. We must
reduce our toxin load. Optimal liver fimction and a
healthy GI tract are critical to doing that."
Detoxification is a process that eliminates not only
environmental toxins, but medications, supplements
and cellular waste products as well. Without
optimal detoxification, women may experience
symptoms that can mistakenly be attributed to
hormone imbalances. Environmental toxins called
xenoestrogens closely resemble estrogen. When the
body sees xenoestrogens, it lets them sit on the same
receptors where estrogen would normally reside.
However, once on the receptor, the xenoestrogens
can mimic estrone (E I), an estrogen that stimulates
breast and other tissues in an unfavorable fashion. The body reads insecticides, pesticides and plastics in
particular as estrone and will stimulate
the receptor even if additional
estrogen is not being taken.
"Toxins can disrupt the endocrine
system to the point that women will
present symptoms indicating a
honnone imbalance," said Sievers.
"The issue is determining whether it's
truly an imbalance. It may not be an
imbalance. It may be a thyroid issue or
simply toxin overload.
We can
measure hormone levels, including
estrogen and progesterone levels of the
thyroid. If they're low, we know what
to do. But we can't measure what's
happening at the receptor. If the
hormone levels are good and
symptoms that overlap with an imbalance still present, we start thinking
about how the person is detoxifying. For women
taking hormones such as estrogen, the question
becomes not only how the estrogen was made and how
much is being replaced, but also how the estrogen is
being broken down and excreted."
The body has a two-step process to break down and
eliminate toxins. Phase one occurs in the liver where
toxins are broken down. Optimal liver health is
critical. Nutrients that promote liver health include B
vitamins, copper, zinc, magnesium and vitamin C. It
is also important to have sufficient good bacteria in
the colon. Bad bacteria produces betaglucuronidase
that will undo the phase one detoxification and cause
a reabsorption of estrogen in the blood stream and an
unhealthy accumulation of estrogen. Alcohol,
caffeine and a diet that includes too many trans-fatty
acids are things that can impact liver health.
Once the toxins are broken down, they become more
reactive toxic metabolites that can be reabsorbed. To
prevent that reabsorption, the body shifts into phase
two to void the toxins. In addition to the nutrients
that promote liver health, specific amino acids and
antioxidants, including glutathione, are needed for
phase two. Nutritional testing and genetic testing for
gene single nucleotype polymorphisms (SNP's) can
determine if amino acids and antioxidants need to
be replenished. A challenge test can identify if
any enzymes are missing and how they can be
replenished. MTHFR, an activated folic acid, is
one thing commonly missing. It can be replenished with a supplement.
"Optimal health depends on the success of the detoxification process, particularly for women," said
Sievers. "There are nutritional supplements, probiotics and detoxification shakes that can be taken daily
to support that process. Some environmental toxins,
including phthalates, must be sweated out of the
system. Infrared sauna treatments are effective in
that regard. Chelation therapy can remove harmful
metals from the body. We can also conduct integrative lab testing to evaluate estrogen and hormone
metabolite levels. That said, a person's diet and the
choices they make to minimize their exposure to
environmental toxins are the first steps in maintaining the ability to process and void toxins optimally."
Teresa A. Sievers, MD
Restorative Health & Healing Center
10201 Arcos Av., Suite 201, Estero
239.948.7291
Learn more about Dr. Sievers at
www.rhhcenter.com
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Collier Edition - May 2011 Health & Wellness
Eyes Wide Open
The ultimate beauty secret? Youthful-looking eyes
By Alina K. Stanciu, MD, FMO
T
he eyes - there is nothing more powerful
on your face: They cry, they laugh; they
show disappointment, dreaminess or
deceit; they reveal surprise and shock, happiness and
honesty. Beyond expressing how you feel they can
even defme who you are.
So with all this significance we place on eyes, it seems
like a cruel twist offate that they exhibit signs of aging
so soon- not only in how we see ourselves, but in how
others see us.
The appearance of our eyes affects the ways others
respond to us. People assume that if your eyes look
young, you have more energy, more spunk, and are
more of a go-getter. So when that reflection looking
back at you looks more like your mother than
yourself, it's time to consider wbat steps you can take
to keep your eyes looking younger, longer.
Eye-Q
As we well know, tbe quality of our skin cbanges as
we lose collagen and volume, both results of the
natural aging process. As we age and skin becomes
thinner, tbe area under the eyes becomes looser. Blood
vessels behind thinning skin create shadows and dark
circles. The movement of facial expressions can also
age the eye area. Crow's feet and forehead wrinkles
pop up, caused by raising and furrowing eyebrows
and squinting. That leads to sagging skin in the upper
eyelid, exacerbated by brow and forehead descent.
These changes give the impression that you are
older, tired, less alert, sad, less enthusiastic, a bit
depressed, sleep-deprived, overstressed and in need
of a vacation.
Beautiful Outside In
Minor cosmetic tweaks can go a long way towards
improving your appearance and boosting self confidence. A little Botox for example, can erase crow's
feet and raise the eyebrows, offering a mini-brow
lift for tbose with minor drooping and fillers can
plump the dark circles caused by shadows. Injectable fillers such as Restylane and luvederm made
from hyaluronic acid are best suitable for under-eye
hollows. They are reversible whicb is important
because that area is not as predictable as other facial
areas. This is why Dr. Stanciu always undercorrects when filling the area, and then has tbe
patient come back for a touchup a few weeks later.
While non-invasive procedures help put off surgery
and others avoid the knife altogether, for many,
non-surgical options are just not quite enough.
Eyelid surgery (technically called Blepharoplasty) is
a procedure to remove excess skin and fat from the
eyelids. It is one of the most common cosmetic
Restorative Health & Healing Center
10201 Arcos Avenue, Suite 201, Estero 33928
239.948.7291
procedures performed in the US, creating a more
youthful look by removing fat, skin, and or muscle
from the eyelids. Eyelid surgery can correct drooping
upper lids that make you look tired, older or angry. In
more extreme cases it may interfere with your vision.
In upper eyelid surgery, an incision is made externally
in the upper eyelid crease to remove excess eyelid
skin and fat. Because the incisions are made in the
eyelids' natural contours, they are barely visible and
fade with time. The surgery takes about one hour to
complete and is done under local anesthesia. The
bruising can last up to three weeks, while swelling
can last a bit longer.
Think eyelid surgery is not affordable?
Medicare Pays!
Eyelid surgery has various functional benefits that
result in the improvement of one's vision. While the
removal of excess skin can have aesthetic benefits, it
can also restore peripheral vision that has been
obscured by droopy, sagging eyelids. Many purely
cosmetic procedures are not covered by insurance providers because they are elective in nature. Since blepharoplasty can be performed to restore vision, many, if
not most, insurance providers including Medicare will
typically cover the surgery. Preoperative testing
includes a visual field and photos to determine to what
degree the excess skin inhibits peripheral vision and to
establish the true range of vision.
EYELID QUIZ
• Can you see your upper eyelids?
• Do you have to raise your eyebrows or tilt your head
to see more clearly?
• Do you have problems seeing beside you without
turning your head left or right?
If you answered Yes, to any of these questions you
are eligible for a FREE eyelid consultation with Dr.
Stanciu. Call 239-949-2020 today!
&rxkwl'l fllli& 0r; (')nef
May 11, 2011
Botox" Cosmetic
Teresa A. Sievers, MD
Board Certified in Both Internal Medicine &
Anti-Aging, Regenerative & Functional Medicine
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Health & Well ness May 2011 - Collier Edition
By Lisa Minic
L
ymphedema refers to swelling that
generally occurs in the arms or legs.
Although lymphedema tends to affect
just one arm or leg, sometimes both arms or both
legs may be swollen.
Lymphedema is caused by a blockage in the lymphatic system, an important part of the immune and
circulatory systems. The blockage prevents lymph
fluid from draining well, and as the fluid and waste
products build up, the swelling continues. This
swelling can result in recurrent infections (Cellulitis),
open wounds, impaired mobility, and decreased
quality of life, among other complications.
There is no cure for Lymphedema, but it can be controlled. People can be born with Lymphedema, called
primary Lymphedema and it can present itself at different times in life such as birth, adolescence, and
rnidlife. Lymphedema can also be considered secondary, which means there was a causative factor
such as cancer, surgical procedures damaging lymph
nodes such as radical cancer surgery or even hysterectomy, cesarean, or surgeries such as hip replacement, Lymphedema symptoms include:
• Swelling of part of your arm or leg or your
entire arm or leg, including your fingers or toes
A feeling of heaviness and/or achiness in your
arm or leg
Decreased range of motion in your arm or leg
• Recurring infections in your affected limb
• Hardening and thickening of the skin on your
arm or leg
• Potential open wounds and weeping of
lymphatic fluid from the tissue
Stockings help maintain the reduction in swelling
achieved by the use of the Lymphedema pump
and/or massage (manual lymphatic drainage"MLD"). The pump and MLD are an active treatment and help actually reduce swelling and develop
alternative pathways called collateral circulation
through which the lymphatic fluid can drain. A
clinical study conducted at tbe Stanford University
Lymphedema Clinic in December 2002 found that
tbe adjunctive use of MLD and tbe Lymphedema
pump proved to provide the greatest reduction in
swelling and longer term maintenance therapy.
Lymphedema pumps are a safe, effective way to
treat people suffering from venous ulcers, Lymphedema, and other disorders resulting in chronic
swelling. The pump is:
• Easy to use
• Non-invasive
• Clinically proven
Relaxing for patients
• Few side effects
• Reimhursed by many insurances
Treatment of choice is compression therapy. Compression therapy comes in many different options.
Compression can include modalities such as:
• Lymphedema pump
Stockings or wraps
• Specialized massage technique by specially
trained Lymphedema therapists (MLD)
• Program of special exercises
The pump is contraindicated in patients with active
Congestive Heart Failure, active blood clot, active
infection untreated by antibiotics, and severe arterial
disease. Lymphedema pumps require an order from a
pbysician and clearance of any conditions which may
be a contraindication. Lymphedema pumps are covered
by many insurances, including Medicare under the right
diagnosis criteria. Deductibles and co-pays may apply.
Compression therapy, such as the lymphedema
pump, provides you with the necessary support to
maintain and enhance your lifestyle. Whether it's
being engaged in daily activities or spending time
doing the things you really love, like traveling, being
out or participating in your favorite hobbies, you can
continue to engage in daily activities while receiving
the therapeutic benefits of compression.
Trisb Mattimoe, RN/CCT with Acute Wound Care
specializes in educating patients about the disease
process and treatment options available for lymphatic
and vascular disease as well as other chronic wounds.
Having cared for a loved one with Lymphedema,
Trish truly understands not only the disease but that
each patient is an individual with unique needs based
on their life style and the stage of the disease. If you or
someone you know is suffering from Lymphedema,
Peripheral Venous Insufficiency, Chronic Edema or
other wounds please call Trish to obtain information
by a clinical nurse who personally understands the
effects of such conditions. Trish always goes above
and beyond the call of duty to ensure that her patients
are educated about their disease and use of equipment. Trish provides patients with all of the information and training they need to fully comply with
treatment plans.
Whether you need short-term recovery assistance
or have a long-term goal of regaining and maintaining a higher quality of life while living with a
chronic disease, please give the caring and knowledgeable team at Acute Wound Care a call .
239-949-4412
I www.acutewoundcare.com
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Collier Edition - May 2011 Health & Wellness
A Royal Pain in the Back
By Lisa Minie
I
f you've ever groaned, "Oh, my aching
back!" you are not alone. Back pain affects
80% of Americans at some point in their
lives. It comes in many forms, from lower back
pain to neck pain to sciatica.
Back pain is not a diagnosis -- it's a symptom of an
underlying condition. Back pain can range from a
dull, constant ache to a sudden, sharp pain. Acute
back pain comes on suddenly and usually lasts from
a few days to a few weeks. Back pain is called
chronic if it lasts for more than three months.
On the bright side, most back pain is preventable
and reversible. Simple home treatment and proper
body mechanics will often heal your back within a
few weeks and keep it functional for the long haul.
Surgery is rarely needed to treat back pain.
Conditions leading to Back Pain
• Stress or injury of the back muscles, such as
back sprain or strain
• Overload of the back muscles caused by obesity
• A spinal tumor or cancer that has spread to the
spine from elsewhere in the body
Infection, which may be in the disk, bone,
abdomen, pelvis or bloodstream
• Kidney stones or a kidney infection
• Short term overload of the back muscles caused
by lifting or pregnancy
• Disease or injury, including injury to the back
bones (vertebrae), such as a fracture (for example, after trauma or as a result of osteoporosis)
Once upon a time, doctors told people with low
back pain to stay in bed for three days -- perhaps
with a board under their mattress. That very bad
advice actually made back pain worse. Most people
with low back pain have an acute pain episode. But
up to a third of patients report persistent pain of at
least moderate intensity -- chronic low back pain.
A panel of experts found evidence that different
patients can get relief from a wide variety of treatments. These treatments include: Exercise tberapy,
Spinal manipulation from a chiropractor, osteopath,
or physical therapist, Acupuncture, Massage
therapy, Yoga, Progressive relaxation, etc.
9idCOtJe/' a
4&
11
It is quite important to get rid of the problem as
soon as possible. The longer it is left untreated, the
greater the inflammation resulting. It is a process
of tissue edema encroaching on the nerve supply.
The primary causes of back pain are postural
changes or injury. In either case, it is most rapidly
reduced with care by a doctor who specializes in
pain management.
Quick tips for relieving and preventing
back pain:
• If you're on your feet for several hours during
the day, wearing a comfortable and supportive
shoe will help minimize and prevent back pain.
I f you're overweight, lose some weight - even
a 10% drop in weight will help decrease the
amount of pressure on your back dramatically.
• Be sure to stretch the muscles of your back
before any strenuous work or exercising is
performed.
Educate yourself on the various types of exercises that target the back to relieve and prevent
back pain.
• If you experience a pain that lasts more than a
few days, or one that is intolerable visit your
doctor to discover the source of the pain. Taking
care of the issue sooner rather than later will
generally help minimize length and intensity of
back pain.
It is important that you not allow back pain to go
untreated. As mentioned above, back pain is a
symptom of an underlying condition. It is best to get
to the cause of the pain as soon as possible to prevent
permanent damage. For more information about
relieving and preventing back pain please feel free to
contact Dr. Prathima Moorthy at 239-593-9594 or
visit www.pmcnaples.com.
~tffVlp
/?UY'e
ACUTE WOUND CARE
Are you suffering from lymphedema and chronic swelling
of upper or lower extremities?
We Can Help!
Whether you need short-term recovery assistance or a long-term treatment plan ,
we deliver the supplies you need to shorten recovery time in your own home!
Call us today!
239-949-4412
www.acutewoundcare.com
Specializing in Pneumatic Compression Systems, specialty dressing
supplies for treatment of chronic and hard to heal wounds.
and is based
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The most thorough and healthiest cleaning... Or it's FREE!
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12
Health & Well ness May 2011 - Collier Edition
CUTTNG EDGE
BODY SCULPTING WITHOUT CUTTING
A New Approach in Non-Invasive Skin Tightening & Body Contouring
By Lisa Minie
ummer is just around the corner and
achieving the beach body you've
always wanted is never far from thought.
The search for a shapelier silhouette continues to
drive patients to seek aesthetic therapies, but not
everyone is willing to go under the knife to lose
inches. Fortunately getting the body and skin you've
wanted for years no longer requires invasive
surgery. Dr. Manuel Pena is thrilled to be the first in
Naples to offer Exilis Therapy, the newest noninvasive method for body-shaping and circumferential reduction of targeted fatty deposits on the body.
Exilis is a non-surgical alternative to invasive liposuction surgery, and is the fastest, most powerful,
non-invasive aesthetic treatment today. Exilis is a
revolutionary device combining simultaneous
effilsslon of radio frequency and
cooling. It provides effective body
contouring by fat volume reduction
and skin tightening. Exilis treatment
results in marked improvement in
skin tone, elasticity and texture. It's
quick and comfortable.
Exilis is an FDA approved technological marvel that delivers dual
function radiofrequency energy that
reduces volume and tightens skin. It
used to be that the only way to
reduce fat volume from the body
(aside from diet and exercise) was
liposuction, which requires surgery
and downtime from regular daily activities. Not
anymore! Thanks to Exilis ' patented Energy Flow
Control and thermoelectric cooling, Dr. Pena can
move fatty acids from the cells while simultaneously stimulating new collagen.
Fat cells are stored in the body in lobules that are
clustered like a bunch of grapes. These clusters are
wrapped in a fibrous tissue layer like a hairnet that
holds them together. This fibrous tissue layer
makes it virtually impossible to reach the fatty
clusters without a liposuction cannula- until now.
The Exilis uses radiofrequency energy to volumetrically heat the deeper tissues and to ramp up
the metabolic activity of the fat cells, causing them
to shrink. Patient satisfaction rate among those who
have used the Exilis is very high. Measurable circumferential reduction is observed after only four
treatment sessions spaced at one week intervals. All
of this occurs in a safe, painless, and quick 30
minute office procedure with no downtime or limitations on your activities! Recently Kathie Lee
Gifford had four treatments on the Today Show. In
total, she lost an amazing two inches from her waist
just from the treatments alone!
Benefits of Exilis:
• Non-invasive
• Painless
• Effective for all troublesome areas of the body
• Fast and efficient with no downtime
• Incremental, lasting and measurable results
Get started on that lean beach body with tighter
skin by calling Dr. Pena to make an appointment
for your Exilis therapy sessions today!
Manuel M. Pena, M.D., P.A.
6370 Pine Ridge Road Suite 101, Naples, FL 34119
www.dr-pena.com
239.348.7362
Contact us today to
schedule your treatment!
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Collier Edition - May 2011 Health & Well ness
Tone Those Thighs
day and make sure to schedule in days of rest to
recuperate from all the stress you put on your legs
when beginning any exercise routine.
Toning exercises can help increase the rate at which
the thighs lose fat. Exercises like stair-climbing,
walking, running, swimming and kick-boxing can
increase the intensity of your workout. For those
who prefer something not as intense, you can walk
or jog. The intensity of walking or jogging can be
modified to suit anyone's fitness level. If needed,
walking or running in the swimming pool can take
the pressure off your joints. On the other hand, to
increase the difficulty, try jogging through sand to
help you lose fat and tone your thighs.
any people question how to
lose fat in thighs or other areas
of their legs. Toning the thigh
areas is a very common problem many people
trying to lose weight struggle with. We accumulate
fat on the upper legs and as we get older, it's harder
to lose. Here are some helpful tips you can use to
help tone those thigh trouble areas.
Exercise
It doesn't matter how many leg exercises you do,
you will still need to do regular cardio workouts to
slim down and lose fat in your thighs. Cardio exercises increase blood flow which in tum helps boost
metabolism. A faster metabolism means a shorter
amount of time it takes the body to tum calories
into energy. The more calories turned into energy
means less calories stored as that nasty three letter
word - fat. Try to do 20-30 minutes of cardio every
Diet
Another important element to losing fat in thighs is
what you eat. You will retain extra fluid and fat if
you eat too many foods with high saturated fats,
sugar, and salt.
A great eating plan is not your average three meals a
day diet. Eating five to six small meals a day helps
keep your metabolism working. At each meal, eat a
serving oflean protein (the size of your palm) along
with a serving of healthy carbs (the size of your fist).
Between meals, you can eat dairy products like low
fat yogurt or cheese, nuts, and fruits high in fiber. Try
not to go for more than 3 hours without eating.
Water is very important for fat loss. It is the most
important thing you can consume for effective
weight loss and toning. Try to drink 64 ounces of
water every day.
13
Strength Training
Strength training is really important if you want to
lose fat in your thighs. It will help tone your
muscles and give you well-defined thighs.
Increasing muscle tissue increases the amount of
calories you bum while exercising.
Strength training exercises that help lose fat in
thighs include leg curls, lunges and leg presses.
For extra stability and strength, do lunges with
weights at your side. Yoga can also help slim and
tone your thighs as well as your whole body. It
works on your core and increases your flexibility.
Leg lifts and wall sits are also great strengthening
and toning exercises. For best results, only
strength train every other day and let your legs rest
in between sessions.
Don't let those thunder thighs bother you any
longer. Take these simple tips and start toning
those problem areas today. If you would like help
from professional, trained fitness instructors stop
by Anytime Fitness. The staff is always willing to
answer any question you might have and get you
on the path to a more tone and healthy body!
~Qf!.,(Tjr!}E
. . ':r-I I I\lC~~®
239.261.2610
13040 livingston Rd. #18, Naples, Fl34105
www.anytlmefltness.com
"I strive for the best outcomes using the newest technology."
D
r. Alexandra Konowal, a Board Certified Opthalmologist, is Fellowship
trained in advanced eye care and
performs a variety of vision enhancing surgical
techniques. These include no-stitch, no-patch
cataract surgery, corneal transplants and Custom
LASIK surgery.
Dr. Konowal is also skilled in the use of cosmetic
Botox® and luvederm® to eliminate fine lines,
wrinkles and deep folds. Dr. Konowal was recently
selected as the Laser Vision Gold Surgeon by Laser
Vision Centers nationally, and is recognized as a
leading surgeon in Custom LASIK in Southwest
Florida as well as the nation. "While practicing
ophthalmology in Southwest Florida since 1996,
my interest in providing cutting edge technology
for my patients led to the opening of Konowal Vision
Center in 2003." Dr. Konowal explains, "1 feel I
provide individual care with the best technology available to my patients."
At the Konowal Vision Center, Dr. Alexandra Konowal
offers a specialized focus and emphasis on technology,
safety, experience and, of course, your precious eyes.
Since 1996, thousands of residents of Southwest
Florida have been treated by Dr. Konowal for laser
vision correction, cataracts, glaucoma, dry eyes and
cosmetic enhancements. "When visiting our office you
will feel at home in our professional environment."
At the Konowal Vision Center our clinic not only
provides Comprehensive Eye Care, we equip our site
with the latest technology in medical equipment, such as
the Orbscan lIZ Anterior
Segment analysis system,
the Humphrey Matrix
Visual Field for glaucoma
monitoring, the Zywave II
Aberrometer and Zyoptic
Technolas 217Z custom
laser and Stratius OCT for Dr. Alexandra Konowal
optic nerve and macular imaging and the Nidek
YAG laser for various in office procedures. Our
patients know that quality, safety and their eyes are
our mam concern.
We welcome you to our family of patients. Please
contact the Konowal Vision Center, 9500 Corkscrew
Palm Circle, Suite #3, Estero, FL 33928, Call us at
239-948-7555 for an appointment.
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14
Health & Well ness May 2011 - Collier Edition
What's New In The World Of Venous Therapy
By Dr. John P. Landi, MD, FACS, RPVI, RPhS, Diplomate of The American Board of Phlebology
aricose veins, spider veins, leg
swelling, venous ulcerations and
phlebitis or clots in the veins are
common conditions that affect over
30 million Americans and countless other millions
worldwide. Up until recently venous disease was not
recognized as a separate specialty and, in fact, many
aspects of these diseases especially varicose and
spider veins were considered to be strictly cosmetic.
With the advent of Laser and Radio Frequency
Closure techniques approximately ten years ago, not
only the treatment of venous disease, but also its recognition as a separate specialty has been revolutionized. The new aspects of venous disease can be
divided into three categories: Varicose Veins, Spider
Veins and Venous Specialty Recognition.
Varicose veins are the large ropey veins that can
occur almost anywhere in the leg. For many years the
only treatment of varicose veins was a very extensive
procedure involving multiple incisions and multiple
sutures called ligation and stripping. The end result
of this surgery was the replacement of the veins with
multiple scars and there was a high recurrence rate.
Approximately ten years ago it was recognized that
the main cause of varicose veins were valves in the
veins that did not close properly. Think of this like a
dam that is leaking. In order to treat the problem, the
leak in the dam needs to be sealed. The procedure to
seal the leak is called "Closure" which involves
using either a Laser Filament or a Radio Frequency
Catheter. The beauty of this procedure is that it could
be done in the office under local anesthesia with
either none or very light sedation and very little
downtime. The advent of these Closure procedures
was the initiating step in the formation of the new
field of Phlebology.
Beginning in 2008 Phlebology has become a designated separate specialty with a recognized board
called "The American Board of Phlebology". Certification is obtained by passing a comprehensive
written exam and demonstrating knowledge in
Venous Closure techniques and ultrasonic performance and interpretation. Certification by The
American Board of Phlebology gives one the title of
Diplomate of The American Board of Phlebology. At
the time of this writing there are currently less than
2,000 physicians worldwide certified as Diplomates
of The American Board of Phlebology.
For years the only treatment for spider veins was a
saline solution which was not only irritating to the
vein resulting in potential for discoloration of the
skin and ulcerations of the skin, but was also
extremely painful on injecting. Over the last ten
years many new techniques for spider vein injection
called "Sclerotherapy" have evolved. There are
many solutions used for Sclerotherapy, but there are
three that are commonly used - Polidocanol, Tetradecyl Sulfate and Glycerin. In addition to those
three, originally beginning in Europe and now available in the United States, is Foam Sclerotherapy.
Foam is formed by mixing either Tetradecyl Sulfate
or Polidochinol with either an air or C02 combination
In addition to board certification, since the treatment
of venous disease relies on and is intimately involved
with ultrasonic evaluation, ultrasonic proficiency has
become a prerequisite for the treatment of venous
disease. It is currently considered inappropriate to
make an assessment of varicose and spider veins
without an adequate venous ultrasound. Almost all
patients with varicose veins have valvular insufficiency and at least thirty percent of patients with
spider veins alone have significant valvular insufficiency. Unless the valvular insufficiency is treated
primarily then the varicose and spider veins will not
improve. Because of the emphasis on venous ultrasound, mUltiple certifying boards have been established
resulting in a Foamed Solution that sort of looks like
a shaving cream. By injecting this into the spider
veins it is possible to cover a greater area and better
dissolve spider veins.
to grant qualification in both ultrasonic interpretation and performance. Three common ultrasound
credentials recognized by The
American Board of Phlebology
are the RVT, RPVl & RPhS. The
RVT (Registered Vascular Technician) has been in existence for
many years. Passing this exam
certifies either the physician or
non physician in all types of
vascular ultrasound including
arterial, venous, carotid and
abdominal. The RPVl (Registered
Physician Vascular Interpretation)
has been in exisence for about five
years, and again, this requires an
intense certifying exam. Once this
is passed one then has the credentials to interpret any type of
vascular ultrasound be it venous,
arterial, renal or abdominal. This certification is
available only to a physician. The RVT can be
obtained by both physicians and non physicians.
Both of these exams are offered by the ARDMS
which is the American Registery for Diagnostic
Medical Sonography. The third exam is the RPhS
(Registered Phlebology Sonographer). This is
offered by the Cardiovascular Credentialing International Committee and has only recently been made
available to those physicians and non physicians
qualified to take it. This exam give certification to do
venous ultrasounds.
Dr. John P. Landi at the time of this writing is one ofless
than 2,000 physicians worldwide to obtain the designation of Diplomate of the American Board of Phlebology.
In addition to this, he obtained his RPVI (Registered
Physician Vascular Interpretation) and he is a/so one of
less than 75 people both physicians and non physicians
worldwide to obtain the RPhS (Registered Phlebology
Sonographer). He has performed over 10,000 vein
closure procedures in both Laser and VNUS Closure. He
has also treated thousands of patients for spider vein
resolution. He is medical director of Vanish Vein and
Laser Center located in Naples which has been a state of
the art Vein Center designated to vein treatment for over
10 years. In addition to this he is medical director of
LaBella Mia Medical Spa which is attached to The
Vanish Vein and Laser Center.
For information call (239)403-0800 or visit our
Web Site at www.vanishvein.com
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VARICOSE VEIN
Performed by a Vascular Surgeon and
Board Certified in Phlebology.
Wouldn't you rather trust your vein care to
a Vascular Surgeon who has performed over
7,000 Laser Vein Procedures:
LASER • VNUS CLOSURE
SCLEROTHERAPY
John P. Landi, M.D.
Board Certified Surgeon
1/248 Physicians Worldwide Certified by the
American Board of Phlebology (treatment of veins)
La Bella Mia Medical Spa
20 10th Street North, Naples, Florida 34102
(239) 298-8126
www.vanishvein.com
Relief is just a breath away!
-IIergy
Providing expert care to children (
& adultsfor over two decades!
sthma, Si~us &t '
mmunology Center I
_ _ _.,J:,Expert Care For All Ages
•
'
Ask for a location nearest you
239.261.5599
www.allergytoday.com
New Patients, Children & Visitors Welcome
Allergy of the Nose & Sinuses, Hay Fever,
Chronic Bronchitis, Chronic Cough,
Shortness of Breath, Asthma, Skin Rashes,
Hives, Allergy to Foods, ECZEMA
Most Insurances Accepted
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Collier Edition - May 2011 Health & Well ness
17
What is Allergy & Asthma;
what are their symptoms; how do you diagnose and treat them?
--_Expert Care For All Ages---
lIergy is an adverse reaction to certain foods , dust, dust
mites, mildew, pollens, pets, cosmetics, plants, metals,
chemicals, or medications. The immune system tends to
over react in these cases. This can produce inflammation, irritation, and
even life threatening respiratory distress or allergic shock. Over 20% of
Americans suffer from these genetic diseases, which are very disruptive
to the patient and the family. The allergic reaction can affect the nose
and sinuses causing frequent respiratory infections and sinus diseases;
the lungs causing asthma; the skin causing eczema and hives; or the
more serious anaphylaxis (allergic shock).
Allergy and Asthma symptoms include itchy, swollen and watery eyes;
runny, stuffy and itchy nose; coughing, shortness of breath, wheezing, and
tightness in the chest. Many people respond to allergic disease in less
obvious ways and may not realize that allergies is the cause of chronic
cough, frequent respiratory and ear infections, sinus symptoms, sinus
headaches, migraines, dizziness, loss of smell and taste, hearing loss,
hives, eczema, other skin rashes, sores in the mouth and tongue, diarrhea,
nausea and vomiting. Allergy to medications and insects can be serious at
times. Accurate diagnosis is the key for effective treatment.
Allergic children come from allergic parents, if children show symptoms
it is helpful to know the allergy history of parents and grandparents. An
early allergy symptom in children can be eczema and problems with
formulas and table foods and drinks when introduced. Allergic children
have asthma, frequent colds, bronchitis, pneumonia, ear infections,
enlarged tonsils and adenoids, hearing loss and speech problems. Asthma
and hearing loss in children are serious sequels of allergy. Early diagnosis
and treatment of allergies is crucial to prevent complications.
We obtain a complete patient history; evaluate the patient environment
and lifestyle, do a detailed physical examination, order special blood
tests and evaluate lung function . Allergy testing is done by skin tests or
by blood tests. When indicated, we do selected skin tests for possible
environmental, food or chemical allergens. Skin tests are the preferred
method because they yield much more reliable results. This leads to
correct diagnosis, rapid treatment, and fast relief.
Although there is no cure for allergic diseases, almost complete long-term
control of symptoms is achievable by environmental and food control,
special avoidance programs, certain medications and most importantly by
desensitization using allergy shots (immunotherapy). Immunotherapy has
approximately 85% success rate. Visit our website, www.allergytoday.com
where you can find more information about symptoms and treatments of
various allergies. Our best wishes for good health.
Allergy, Asthma, Sinus and Immunology Center
239.261.5599
www.allergytoday.com
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16
Health & Well ness May 2011 - Collier Edition
Protect Your Skin: Prevent Melanoma
Riverchase Dermatology and Cosmetic Surgery
Melanoma doesn't always begin as a mole.
It can also occur on otherwise normal-appearing skin.
Melanoma
Normal moles are generally a uniform color, such as
tan, brown or black, with a distinct border separating
the mole from your surrounding skin. They're oval or
round and usually smaller than 114 inch in diameter
- the size of a pencil eraser.
Most people have between 10 and 40 moles. Many
of these develop by age 40, although moles may
change in appearance over time - some may even
disappear with age.
elanoma, the most serious type
of skin cancer, develops in the
cells that produce melanin the pigment that gives your skin its color. Melanoma
can also form in your eyes and, rarely, in intemal
organs, such as your intestines.
The exact cause of all melanomas isn't clear, but
exposure to ultraviolet (UV) radiation from sunlight
or tanning beds increases your risk of developing
melanoma. Other factors, such as your genetic
makeup, likely also playa role.
Limiting your sun exposure and avoiding tanning
beds can help reduce your risk of melanoma.
Knowing the warning signs of skin cancer can help
ensure that cancerous changes are detected and
treated before the cancer has a chance to spread.
Melanoma can be treated successfully if it is
detected early.
Melanomas can develop anywhere on your body,
but they most often develop in areas that have had
exposure to the sun, such as your back, legs, arms
and face. Melanomas can also occur in areas that
don't receive much sun exposure, such as the soles
of your feet, palms of your hands and on fmgernail
beds. These hidden melanomas are more common in
people with darker skin.
The first melanoma symptoms often are:
• A change in an existing mole
• The development of a new, unusual-looking
growth on your skin
Characteristics of unusual moles that may
indicate melanomas or other skin cancers
follow the A-B-C-O-E guide developed by
the American Academy of Dermatology:
• A is for asymmetrical shape. Look for moles with
irregular shapes, such as two very different-looking
halves.
• B is for irregular border. Look for moles with irregular,
notched or scalloped borders - characteristics of
melanomas.
• C is for changes in color. Look for growths that have
many colors or an uneven distribution of color.
•
D is for diameter. Look for new growth in a mole
larger than about 1/4 inch.
Factors that may increase your risk of
melanoma include:
• Fair skin. Having less pigment (melanin) in
your skin means you have less protection from
damaging UV radiation. If you have blond or red
hair, light-colored eyes, and you freckle or sunburn
easily, you're more likely to develop melanoma
than is someone with a darker complexion. But
melanoma can develop in people with darker complexions as well.
• A history of sunburn. One or more severe, blistering sunburns as a child or teenager can increase
your risk of melanoma as an adult.
• Excessive ultra violent (UV) light exposure.
Exposure to UV radiation, which comes from the
sun and from tanning beds, can increase the risk of
skin cancer, including melanoma.
• Having many moles or unusual moles. Having
more than 50 ordinary moles on your body indicates
an increased risk of melanoma. Also, having an
unusual type of mole increases the risk of
melanoma.
• A family history of melanoma. If a close
relative, such as a parent, child, or sibling
has had melanoma you have a greater chance
of developing it as well.
• Weakened immune system. People with
weak immune systems have an increases risk
of skin cancer. This includes people who
have HIV/AIDS and those who have undergone organ transplants.
If you notice any skin changes that concem you
visit your family doctor or general practitioner
right away. Depending on your situation and the
outcome of any tests, you may be referred to a
doctor who specializes in skin diseases
(dermatologist) or to a doctor who specializes in
cancer treatment (oncologist).
With four convenient locations throughout
Southwest Florida, the skilled providers and
as a mole that grows in size or that changes color or
staff of Riverchase Dermatology and Cosmetic
shape. Moles may also evolve to develop new signs
Surgery
are happy to answer any questions you
and symptoms, such as new itchiness or bleeding.
may have about melanoma or other skin issues.
Contact the office nearest you today if you are
Other suspicious changes in a mole
concerned about any changes you notice on your skin.
•
E is for evolving. Look for changes over time, such
may include:
Scaliness
Itching
Spreading of pigment from the mole into the
surrounding skin
Oozing or bleeding
Cancerous (malignant) moles vary greatly in
appearance. Some may show all of the changes
listed above, while others may have only one or two
unusual characteristics.
RIVERCHASE DERMATOLOGY
AND COSMETIC SURGERY
Downtown Naples
North Naples
Marco Island
261 9th Street 1015 Crosspointe Dr. 950 N. Collier Blvd" #303
Fort Myers
Cape Coral
7331 Gladiolus Dr.
1425 Viscaya Pkwy., #102
1-800-561-0ERM
www.RiverchaseDermatology.com
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18
Health & Well ness May 2011 - Collier Edition
Stop Overlooking Signs of Incontinence
By Rolando Rivera, Board Certified M.D.
Urinary incontinence is a
common medical condition
that affects over 40 million
Americans, yet it often goes
untreated or unrecognized.
Rolando Rivera, MD
The reason for this trend is
multifactorial, spanning from embarrassment to
speak about this topic to dealing with more acute or
morbid conditions that require focused attention.
Nevertheless, it is a treatable condition that frequently affects the quality of life of patients.
Incontinence is classified as stress, urge, mixed
and overflow.
In this article we will address some particular
issues about urge incontinence.
Urinary urge incontinence (UUI) is defined as a
sudden uncontrollable urge to urinate with or
without frequent urination and associated leakage of
urine. With urge incontinence, the bladder contracts
and squeezes out urine involuntarily. Accidental
urination can be triggered by:
• sudden change in position or activity
• hearing or touching running water
• drinking a small amount of liquid
Patients with overactive bladder symptoms, such
as urinary urgency, frequency and nocturia, may
have associated incontinence over 60% of the time.
Though more common in women than men overall ,
after the age of 70 the prevalence in both sexes is
about equal.
There are two bladder abnormalities that are associated to UUI: neurogenic overactivity and detrusor
overactivity (DO).
Neurogenic bladder occurs when there is interruption in the normal nerve conduction from the brain
or spinal cord above the sacrum to the bladder, and
results in loss of bladder sensation and motor
control. Conditions associated with neurogenic
bladder include the following:
• Alzheimer's disease' Multiple sclerosis
• Parkinson's disease' Intervertebral disk disease
• Cerebrovascular events' Diabetes
• Traumatic brain or upper spinal cord injury
• Brain or spinal cord tumors
DO can occur due to multiple conditions,
and many times as a sequelae of others; frequently, it may be idiopathic. Dysfunctions of the
detrusor muscle or nerve pathways are the culprits
for the bladder over-activity. Conditions that can
lead to DO include:
• Bladder polyps and tumors
• Urinary tract infections' Bladder calculi
• Bladder outlet obstruction from BPH or
stricture disease
Medications, such as diuretics, increase the
urgency and frequency of urination in some
people, especially the elderly and bedridden. Dosage modification may ameliorate
the bothersome symptoms. Dietary habits
may lead to significant voiding symptoms. Caffeine
(e.g., in coffee, tea, chocolate), carbonated beverages, spicy foods and tomato-based foods can
irritate the bladder and cause detrusor instability,
resulting in urge incontinence.
The treatment and management of urge incontinence includes nonsurgical and surgical modalities.
An important factor, however, is identifying the
potentially morbid or life-threatening conditions
that may lead to incontinence, such as bladder
cancer, recurrent UTI or neurogenic disorders.
Anticholinergics have been shown to be very effective in the treatment of both neurogenic and idiopathic cause of UUI. As a class, side effects include
confusion, dry mouth, constipation, dizziness, visual
changes and urinary retention to name a few. Beyond
medications there are simple yet effective treatments.
Advanced treatment modalities for refractory patients
to conservative therapy and anticholinergics are
available in the urologic armamentarium. Urological
evaluation of these patients will most likely include a
cystoscopy, urine cultures and urine cytology to rule
out bladder pathology and bladder malignancies. As
well, a detailed, computerized assessment study of
bladder function called urodynamics may help the
clinician in establishing the best treatment option.
Neuromodulation, either via sacral nerve pathways
(Interstim) or peripheral nerve pathways (Urgent
PC), have been shown to be very effective in the
treatment of UUI in patients with refractory disease.
These modalities are safe, FDA approved, minimally
Bladder
Pelvic muscle
invasive and provide, through neural pathways,
improvement in bladder function. Urgent PC is an
outpatient, office-based, nonsurgical therapy that
affects the sacral nerve plexus through retrograde
pathways (posterior tibial nerve). Interstim utilizes
the sacral nerve S3 to provide parasympathetic inhibition, thereby decreasing bladder over-activity. It
is based on pacemaker technology, and effective in
about 70% of refractory patients.
Injection of botulinum toxin (Botox) into the
bladder muscle (intravesical injection) is an experimental treatment for refractory urge incontinence.
This treatment has been shown to successfully
reduce the instability that leads to urgency in both
idiopathic and neurogenic patients.
Surgical urinary diversion is an invasive therapy
used mostly for severe patients refractory to all
other therapies.
Urinary incontinence is a common but overlooked
problem. Urologic evaluation is warranted in
refractory patients, or in patients in whom underlying bladder pathology or anatomic abnormalities,
such as prolapsed, need to be addressed as well.
Intervention beyond medications will significantly
improve the quality oflife of these patients.
239-434-6300
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Collier Edition - May 2011 Health & Well ness
19
Traveling Abroad for Dental Care
T
referral services are paid for by the
dentist. There may be no other professional qualification than the number
of dentists the referral service works
with per zip code and whether the
dental office check clears. Convenience is nice, but 1'd bet you'd drive
an hour for great care instead of five
minutes for poor care.
ax day is past, but remains emblazoned in our memories. It seems
everyone wants your money, and after
the bills are paid, there often isn't much left over.
So, what do you do about surprise
expenses ...... like a big unexpected dental bill?
The usual choices are: J) Use savings to pay for it,
2) Borrow money and pay it off over time, 3) Put
it off and tell yourselfyou will do it in the future,
4) Don't do it and hope for the best. Good news,
there is actually another option you may not have
considered: Travel abroad for treatment.
Why consider going abroad for treatment?
First and foremost, to save a lot of money. It is not
unusual to save 50% (and sometimes more) on
extensive, complicated dental treatment in other
countries. If you are looking at proposed treatment
that totals thousands of dollars, the numbers are
enticing. After all, who doesn't want to save money?
But, how good is the treatment? You might be
skeptic about the quality of treatment you can
receive for such deep savings. I have news for you:
You can receive poor quality dental treatment in
the USA. Conversely, you can receive outstanding
quality treatment in other countries.
How did you select your current dentist? Most
people select their dentist with a friend or relative's
suggestion, an advertisement, through a referral
service, or just because they saw the office in a convenient location. Now, ask yourself if any of the
above really involve a quality evaluation of the
dentist and office. Most people base their evaluation
on the way the office looks, how nice the staff is, and
if the treatment hurts or not. These are all important
but not really very much to go on. Likewise, most
1-888-536-2605
www.DentaIDestinationsDDS.com
If it's that difficult to select a local
dentist, how in the world can you
select one in another country? The
truth is, if you try to do it yourself, its
pot luck. A nice web site doesn't
guarantee anything. Neither does accreditation by an agency you 've probably never
heard of. The truth is, it takes a dentist trained in
quality assessments to properly evaluate an office.
That's what we offer. We only work with dentists
that pass our evaluations. Most importantly, we
conduct those evaluations in person, in the dentist
offices. In truth, most offices don't pass our
strenuous evaluation. The ones that do pass are as
good as any you can fmd.
UPCOMING ONLINE EVENT: How to safely
save 50% or more on dental care. Register at
www.DentalDestinations.com or call toll-free
888-536-2605 and find out what we do to insure
your safety and satisfaction when searching for
affordable, high quality dental care.
foe !foa loohltg
a dentist
abroad?
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20
Health & Well ness May 2011 - Collier Edition
Rental Rates Are Climbing As Demands Rises
By Ramia Macdonald, Direct Home Realty, LLC
ood news for landlords, bad news
for renters as the U.S. Census
Department and Rent.com agree
that double digit rent hikes are on the way across
America. "The demand for rental housing has
already started to increase, "said Peggy Alford,
president of Rent.com. By 2012, she predicts the
vacancy rate will hover at a mere 5%. And with
fewer units on the market, prices will explode.
Millions of foreclosures are adding millions of
former homeowners into the competition for rental
properties. At the same time, shifting attitudes also
are adding to the ranks of renters. Many Americans
are concluding that homeownership is not worth it.
"We are learning form our surveys that a huge proportion of people are choosing to rent, "Alford says.
Landlords will take advantage of this situation to
improve cash flow as the housing crisis continues.
As the number of bank and government foreclosed
properties continues to rise in Florida, more and more
people are renting. The housing market's decline is
feeding the growth of the rental housing industry.
People are forced to rent when they lose their homes
to foreclosure. Single family rental homes are scarce
and in great demand in south Florida.
At tbe same time, young people are moving out of
family and friends homes and are looking for their
own places. Couples wbo might once bave bought
a house are continuing to rent because they can 't
qualify for a mortgage under stricter lending standards. An increase in employment could tighten
the rental market.
Who is capitalizing on the rental
market in Florida?
Real estate investors are capitalizing on the today's
rental market by buying single family homes at
fire-sale prices and renting them. An ideal invertors' market bas been created witb rock bottom
home prices and interest rates. The growing
number of homes lost to foreclosure in 2010 and
now in 2011 expanded tbe number of people
seeking to rent, creating a renter surplus.
The ideal situation is to buy properties whose
rental income covers the monthly carrying costs
such as mortgage, insurance payments, property
taxes and maintenance costs. New investors today
find themselves in a positive cash-flow situation
due to low purchase price of bomes and the raising
rental rates.
Achieve Healthy Manageable Hair
H
aving healthy looking hair is certainly one of the most important
tbings voted by women when it
comes to improving their social life. Healthy hair
is always more manageable when it comes to
styling and taking proper care of your hair and
body helps decrease and even eliminate bad hair
days. Having beautiful hair that is easy to manage
definitely increases self confidence witbin a
woman as she carries on throught the day accomplishing multiple tasks.
Maintaining manageable healthy hair may seem
like a simple task to most people, because we all
knew tbat the best way to protect and keep our
hair healthy is to use the right hair care products
that are suitable for our hair type. However,
according to trichologists, this is not entirely
correct. Hair is one ofthe fastest growing tissues in
our body tbat requires a balance source of nutrients
to support the growth. These nutrients consist of
protein, complex carbohydrates and other
vitamins. Using the right nutrients and applying
the proper products will ensure healthy, strong
beautiful hair that is easy to maintain and manage.
Balanced hair nutrition should start with a diet that
consists of protein which is the main building
element for the hair grows process. After having a
good source of protein, you will need some
complex carbohydrates to gather the protein so that
they are ready for hair growtb.
Tenant selection is a skill rental-property agents
know is the key to their success. A good rental agent
does his or her homework before renting a property.
They run a credit check, verify income and employment, call past and present landlords, and check references. Landlords need competent rental agents
who excel at keeping good residents and filling
vacancies. It is worth hiring a good rental agent who
will handle marketing, collecting rent, repair issues
and responding to tenant complaints. A good rental
agent gives Landlords peace of
mind that comes with knowing
their investment is in good hands.
MarcoNaplesVacationRentals.com
Ramia Macdonald
Naples Boardwalk, 1100 6th Avanue S #10
Naples FI, 34102
Office: 239-732-7590 I Cell: 239-404-3521
[email protected]
www.DirectHomeRealty.com
Iron is also one of the important minerals that are
needed for hair growth, but it should only be
consider after having sufficient intake of protein.
Other vitamins and minerals that support healthy
hair growth are the vitamin B complex which is
responsible for producing energy, B 12, folic acid
and zinc. With the availability of healthy hair supplements (dbt blocker) in the market, maintaining a
daily supply of these vitamins is easy. However
neither of these vitamins should be consumed in
excessive amount, as it may causes hair grow
problems in the long term.
For more tips on bow to achieve shiny, healtby, manageable hair please stop in at Sandals Salon to talk to
the hair care professionals. The salon carries top of
the line hair care products whicb can be applied by
the friendly and knowledgeable hair specialists.
~0
SALON ~
239-775-4247
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Collier Edition - May 2011 Health & Well ness
Endoscopic Ultrasound:
Better diagnosis of digestive tract problems
By Shardul A. Nanavati, M.D. - Advanced Gastroenterology
E
ndoscopic ultrasound (EUS) is a
procedure that allows a doctor to
obtain images and information about
the digestive tract and tbe surrounding tissue and
organs. During the procedure, a small ultrasound
transducer is installed on the tip of an endoscope.
An endoscope is a small, lighted, flexible tube with
a camera attacbed. By inserting tbe endoscope and
camera into the upper or the lower digestive tract,
the doctor is able to obtain high-quality ultrasound
images of organs. Because the EUS transducer can
get close to the organ( s) being examined, the
images obtained with EUS are often more accurate
and detailed tban images provided by traditional
ultrasound.
Endoscopic Ultrasound may be used to:
What Happens During an Endoscopic
Ultrasound?
A person undergoing an
endoscopic
ultrasound
will be sedated prior to
the
procedure. After
sedation,
the
doctor
inserts an endoscope into
the person's mouth or
rectum. The doctor will
observe the inside of the
intestinal tract on a TV
Shardul A. Nanavati, M.D.
monitor and the ultra sound
image on another monitor. The entire procedure
usually takes 30 to 90 minutes and the patient
usually can go home the same day of the procedure.
21
Staging of cancer is becoming an important use of
endoscopic ultrasound. The prognosis of a cancer
victim is related to the stage of the cancer at the time
of cancer detection. For example, early stage colon
cancer refers to cancer confined to the inner surface
of the colon before it is spread to adjacent tissues or
distant organs. Therefore early stage colon cancer can
be completely resected with good chances for cure.
However, if cancer is detected at later stages, tbe
cancer tissues have already penetrated the colon wall
and invaded neighboring organs and lymph nodes, or
have spread to distant organs such as liver and lungs.
Complete surgical excision becomes highly unlikely.
An endoscopic ultrasound can provide information
regarding the depth of penetration of the cancer and
spread of cancer to adjacent tissues and lymph nodes,
information useful for staging.
Early detection of abnormalities and cancer is the key
to successful treatment and minimal negative effects.
If you are concerned about any issues within your
body please seek medical advice as soon as possible.
Shardul A. Nanavati, M.D.
239.593.9599
• Evaluate stages of various cancers including:
esophagus, stomach, pancreas, rectum, and lung
• Evaluate chronic pancreatitis or other masses or
cysts of the pancreas.
• Study abnormalities or tumors in organs,
including the gallbladder and liver.
• Study the muscles of the lower rectum and anal
canal to determine reasons for fecal incontinence
• Study nodules (bumps) in the intestinal wall.
• Study bile duct abnormalities including stones in
the bile duct or gallbladder, or bile duct,
gallbladder, or liver tumors
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Health & Well ness May 2011 - Collier Edition
D
id you know that recommended
annual retirement income be 70%
of your annual working income?
If you did, great but are you doing anything to
ensure you reach this target? If you didn't know this
you might be in for an awakening when it comes
time for you to retire. The reduction of pensions
being offered and the possible future decline of
social security payments could leave many people
with a retirement shortfall. The good news is that a
40 I (k) plan can help alleviate the shortfall.
Do you offer a 40 I (k) plan to your employees?
Even if your business is small and still growing
you and your employees could benefit from retirement savings options. A 40 I (k) plan offers a
number of advantages for employees and your
business, including:
• Automated contributions through payroll deductions.
• Pretax contributions that reduce taxable income.
• Tax-deferred growth of investments.
Paychex offers various options customizable to fit
your business needs. With a choice of over 4,SOO
mutual funds, payroll integration, flexibility, and
local support the services provided by Paychex is
convenient and cost effective.
Lucky for you and your employees, Paychex offers
seamless 401(k) and payroll integration which can
save you time and resources. The comprehensive
services offered by Paychex can reduce redundant
activities and potential errors that naturally occur
when each function is handled by different people or
service providers. With everything under one roof,
Paychex is able to provide:
• Automatic enrollment options.
• Broad investment solutions.
• Pre-pay-period payroll reports.
• Ongoing recordkeeping with potential integration
for various HR functions.
• Quarterly compliance testing, management
reports and participant statements.
• Preparation of annual Form SSOO and processing
of Forms 1099-R and 94S.
• Employer and employee assistance through a
toll-free support line or the 24-hour convenience
of an intuitive Web site.
Higher limits and greater flexibility than with
other salary deferral retirement plans.
• Improved employee retention and recruitment.
Doctors Talk About VAX-D
By Dan Bartley, D.C. - Physicians Rehab & Spine
"Patients have traveled to our clinic
from all over the United States to be
"Excruciating pain radiated down
my left leg to my toes. MRI scans
treated with VAX-D. My partner and I had a very
successful multidisciplinary medical practice in
Arizona. In 1994, after reading about VAX-D in a
journal, we decided to travel to a clinic in California
to see this "Medical Breakthrough" with our own
eyes. We sat in the reception area for an hour and
listened to the patients rave about this "magical"
table. After a brief visit with the doctor, we flew
home and bought the first VAX-D table in Arizona.
Almost immediately, we too started to see seemingly
miraculous results on the majority of our toughest
cases. That was thirteen years ago, and I am just as
excited about VAX-D now as I was then.
showed deterioration at the L4-LS and LS-Sl
areas. My doctor recommended a IS-day VAX-D
regimen. I was doubtful about the sciatic pain in
my leg, but I continued on with treatment and after
the ISth session I only had a slight twinge occasionally. Since that day on, I am completely free of
the pain in my back and my left leg. I jog the same
as I used to, I cut the lawn, I'm back without any
pain at all, and I've got to say that VAX-D was the
thing that did it for me."
Thomas E. Blankenbaker, D.C. - Phoenix, AZ.
Chiropractic Physician, Spine & Disc Medical Center
Robert Channey, M.D.
Physician, Former Assistant Surgeon General of the
United States
Paychex makes staring a 40 I (k) easy by handling
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Paychex, Inc. is a leading provider of payroll, human
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company has more than 100 offices and serves approximately
561,000 payroll clients nationwide.
"VAX D therapy should be the
initial treatment for chronic back
pain patients suffering from bulging, herniated,
degenerative discs, and facet syndrome. I view back
surgery as a last resort, and VAX-D gives my patients
a more conservative treatment option that can eliminate the need for surgery altogether. VAX-D is also a
treatment option for those patients who have had
surgery and have a relapse or experience a return of
pain following surgery. With VAX-D, I have a key
non-surgical treatment for back pain."
Vik Singh, M.D., a.M.E. - West Hills, CA
Physician, Medical Director, Corespine Program:
California Back and Pain Specialists
Dan Bartley, D.C. • Carlo Penaranda P.T.
Physicians Rehab & Spine Center
The Back and Neck Pain Physical Therapy Center
16517 Vanderbilt Drive (2 Miles North of Wiggins Pass Rd.)
239.947.7844 • www.decompressionofswfl.com
Most insurance companies will pay for the majority of your treatment.
We are in-network providers for Medicare.
We accept all other insurance.
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Collier Edition - May 2011 Health & Well ness
SLEEP vs YOU
PILATES in Your Corner Ensures a TKO
By Traci Schulz-Nussbaum, PMA Certified Pilates Teacher
-.
ust like the age old riddle of the chicken
and the egg, sleep and exercise are in the
same time less struggle for importance.
Saying to yourself over and over "I am just too tired to
exercise" is like saying your too thirsty to drink water.
Knowing you need them both to live and be healthy,
you just don't see the relevance. One ofthe best intentions people have, yet never act on, is exercise. Let's
keep in mind that sleep and exercise are directly
related and equally dependent on each other.
Without sleep, we lack the necessary reserve energy
to draw upon for our daily routines. Joseph H.
Pilates, a former boxer, holistic health connoisseur
and creator of The Pilates Method, stated It is better
to be tired from physical exertion rather than to be
fatigued by the "poisons" generated by nervousness
while lying awake. He also states that the most
important element of better and deeper sleep is
mental calm. Research shows that a troubled nervous
system can be alleviated with exercise. During sleep,
our body performs a diagnostic test on itself, our
health is then restored and our energy is regenerated.
This is also when weight loss occurs. Ultimately
overall functions improve. Exercise is proven to
build bone and muscle structure, combat stress,
fatigue and muscle tension, and improve heart
function and general health.
23
Pelvic Curls- While lying in bed on your back with
knees bent and feet flat, picture a marble resting on
your low belly. You want to begin by pulling the belly
in and curling the pelvis so that the imaginary marble
rolls towards your belly button. Controlling the
marble roll in the other direction, focus your pelvis tilt
backwards so that the marble just might roll forward
off your pelvis. Repeat curling back and forth with
deep breaths emptying the lungs with each curl.
These are some ofthe basic exercises as taught by the
Certified Pilates Instructors at Pilates Plus Studio in
Bonita Springs, FL.
Along with unassisted exercises, or better known as
Mat exercises, Joseph Pilates also created many different apparatus to assist in the strengthening and
lengthening of the muscles.
In Joseph 's book, Return to Life Through Contr%gy, he provides tips on better sleep. Included
in these are environmental elements such as a cool,
quiet, well ventilated and dark room with minimal
covers and the avoidance of bulky pillows. He also
adds some exercises well known to the Pilates
industry as " rolling techniques" . These exercises are
designed to mobilize and lubricate the spine through
various lengthening and strengthening techniques. As
a result, the body is more flexible, oxygen can flow
better and you become more relaxed. Here are some
easy rolling and umolling exercises to try before bed
or if you have trouble sleeping during the night:
Wall Roll Down- stand with feet shoulder width
apart and spine against the wall. Starting from the top
of the head, while pulling the belly against the spine,
curl down slowly rolling through each vertebrae until
you reach the tailbone. Then reverse the rolling back
to standing. Repeat breathing deeply through out
exercise unti l all the air is out of lungs only to be
refilled by fresh air.
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sleep becomes more comfortable and restful.
It is all too often, as teachers we hear the excuses and
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- - - - - - - - - - - - - - - - - - - - - www.sw fH ea lt h a n dWe lln ess.co m - - - - - - - - - - - - - - - - - - - - -
24
Health & Well ness May 2011 - Collier Edition
Teeth whitening: Understanding your options
By Dean J. Mourselas, DDS
Y
our smile is one of the first things
people will notice when you meet
them. Although most of us do not
enjoy our time in the dental chair, there is however
one dental procedure that people seek out and ask for
by name, teeth whitening.
Tooth stains come basically in two types, intrinsic and
extrinsic, in other words, internal and external stains.
External stains are the type most of us already know
about, coffee, tea, tobacco, etc. Tbey are on the outer
layer of the tooth enamel. External stains are sometimes easily removed with simple toothpastes and polishing by your hygienist. As we age, however,
changes in the tooth structure occur, which make
removing them more difficult. Intemal stains are
usually a result of a developmental condition or an
internal issue with the tooth itself. One example of
this is tetracycline staining, which causes a grey
appearance of the teeth. Another example that isn't
developmentally related is the nerve or pulp death in a
tooth, which will cause a darkening of that particular
tooth. Also, an internal stain is that of children with
braces that are not properly brushing. Internal stains
are permanently incorporated into the tooth structure
and difficult to remove. In addition, people with
dental work in the "smile zone" are not typically candidates for whitening procedures simply because porcelain crowns, veneers, etc. cannot whiten.
So the challenge becomes, how do we remove these
stains when they incorporate themselves on our
teeth? Teeth by nature are inherently porous. Our
saliva forms a natural protective coating, called the
acquired pellicle, which protects our teeth from
stains, acids from bacteria, and a variety of other phenomena. Whitening strips the teeth of this acquired
pellicle exposing the true enamel and then removing
any residual stain from that surface. This is why the
teeth become sensitive after most types of whitening
because these little pores, previously blocked,
become open to the environment. Luckily, in a short
amount of time the acquired pellicle reforms and the
sensitivity is resolved.
The basic difference is in how the whitening procedure is performed. One method is take borne trays.
With this method, your dentist will take impressions
of your teetb and then make plastic trays, which snap
over your teeth. At home you will place the whitening
gel in your tray and snap them into place. The
advantage of this is that you are in control. If you
are the type with sensitive teeth this is a preferred
method. The biggest disadvantage is time; it generally takes a diligent person about a month to get
the results they want.
The other type is in-office whitening. Varieties
include ZOOM! , Sapphire, laser, etc. The main
commonality between all of them is a powerful
light source to activate and accelerate the whitening process. In this case a formulation of
hydrogen peroxide is used and in an hour or so the
person's teeth become as white as possible. Due
to the rapid speed of which the procedure is done,
the teeth become very dry and almost act as a
sponge at first. A white diet for the first 24 hours
becomes necessary to avoid rapidly incorporating
stains into the teeth.
So chicken, mashed
potatoes, etc. are good, red sauce, colas, coffee are
bad. And again, after tbe procedure, the sensitivity subsides once that pellicle is reformed.
A third option that has become much more
popular is over the counter treatments like Crest
white strips. These do work, however the potency
ofthe peroxide content in much lower than that of
which your dentist can provide. In cases of slight
staining this may work well. Also, many toothpastes claim to have whitening properties. If you
read the ingredients of your typical whitening
toothpaste, it contains something called silica.
Silica is another word for sand. The concept here
is that by using a more abrasive toothpaste you
will "scratch" away stains from the tooth. This
can be dangerous over time and if you have dental
work such as veneers or crowns, it can actually ruin
the luster of that work by scratching the ceramic.
Other options include whitening spas that you may
find in your local mall. I urge caution here because
unless there is a dentist on the premises, then this
cannot by law be dental whitening. In most cases
they have the customer place the protective materials on themselves to avoid the potentially serious
claim of practicing dentistry without a license. If
the whitening gel is incorrectly placed, permanent
damage and scarring may occur to the lips and
gums. So if you choose this option, be careful and
do your research.
Tooth whitening can be an
exciting and beneficial procedure for those looking to
improve upon the appearance
of their
smile.
However, it is good to keep
realistic expectations with
Dean Mourselas, DDS
respect to whitening.
A sure way to have a white smile is to cover the tooth
structure with crowns or veneers. This is a nice
option to consider if your staining is more of an
intrinsic type, or if you are also unhappy with the
size, shape, and spacing of your teeth. Regardless, it
is nice to have so many options available for those
seeking to improve upon their smiles. After all, a
beautiful smile is one of your more important assets.
Dean J. Mourselas, DDS
Naples Dental Center I 239.261.7291
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Collier Edition - May 2011 Health & Well ness
25
Why Would YOU Want to Become a Hospice Nurse?
By Pippa Steinhart, RN, General Manager, VITAS Innovative Hospice Care® of Collier County
any hospice nurses hear that
question- and similar ones- a
lot. "Isn't it depressing to deal
constantly with the terminally ill?" "How do you feel
going to a patient's home when everyone knows the
patient is dying?"
Those questions bring up legitimate issues. VITAS'
more than 4,000 registered nurses and licensed practical nurses/licensed vocational nurses, who help
hospice patients each day, have provided some interesting answers.
No, it's not depressing to deal constantly with the
terminally ill. In fact, many members of the hospice
interdisciplinary team- from physicians and nurses
to hospice aides, from chaplains to social workersfind it uplifting to work with patients and families at
a time when they truly need our assistance.
"We can comfortably enter each patient's home
because we know it's a time oflife when professional
caregivers can make a real difference for both patients
and their loved ones," says VlTAS Nurse David
Buchheit, RN. "In an age in which medicine seems
increasingly depersonalized, hospice care is one of the
last bastions of hands-on medical treatment."
"The secret of good hospice care is that every
member of the interdisciplinary team gets to know
and understand each patient and his or her loved ones
as unique individuals," adds VITAS Patient Care
Administrator Donna Sessa, RN. "For many clinicians, hospice work brings us back to the
reasons why we chose a career in healthcare: To
make a difference."
Team members not only provide care, says
David, they also help patients and families experience meaningful events together that families
might have thought were not possible due to
their loved one's illness.
/tJr-
"In this way, our patient care teams help to create
lasting, heartfelt memories for families and
friends," he adds.
Another reason why hospice care isn't depressing is because of the support that underpins the
workings of an effective interdisciplinary
hospice team, says Donna. Each of our hospice
caregivers shares an appreciation of the many
rewards inherent in the hospice experience.
Many hospital-based nurses ask about the
hospice model- specifically the workings of the
interdisciplinary team and the self-directed
nature of hospice care, trying to imagine what
it's like to work outside the rigid structure of the
hospital. But a better question might be this:
Wouldn't you like to work in an environment in
which one-to-one, hands-on care is part of a
typical day? Wouldn't you consider working in
an environment where you need to use all of the
diagnostic and assessment skills you've
acquired throughout your nursing career?
Choices®
"Hospice nurses use all of their skills, including their
clinical, critical-thinking, communication, interpersonal and teaching skills," says VlTAS Nurse Teresa
Jenkins, RN. "Hospice nurses must determine the
cause of a patient's symptoms in order to treat those
symptoms. If a cancer patient has a fever, for example,
the nurse must employ his or her clinical and criticalthinking skills to determine if it's from tumor growth,
dehydration, infection or some other condition."
So what does it mean to be a hospice nurse? It means
that when medical treatments cannot cure a disease,
your work as a hospice nurse has just begun . It's the
time when patients and their families need you the
most. It's a time that can be the most rewarding and fulfilling of your career.
Find out more about hospice nursing. Call VilAS at
866.928.4827 or visit www.vitas.com/ florida .
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VITAS can help.
Juan M. Teodoro, D.M.D
• Diplomate American Board of Periodontology
• Diplomate & Fellow International Congress of Orallmplantologists I.!:~=::~~=-""';~..!::~
VITAS·
Innovative
Hospice Care-
America's hospice leader, founded in 1978
• Clinical Assistant Professor University of Florida
Proudly Serving patients & families in Collier County
• Conscious Intravenous Sedation Certified
1.800.93.VITAS· 1.800.938.4827 www.VITAS.com
• laser Assisted New Attachment Procedure Certified
9510 Bonita Beach Road, Suite 102
Bonita Springs, Florida 34135
Tel: 239.333.4343
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26
Health & Well ness May 2011 - Collier Edition
Probate Avoidance - Common Techniques and Unfortunate Pitfalls
By ROBERT H. EARDLEY, Esq., Florida Bar Board Certified Wills, Trusts & Estates Attorney
Simply put, "probate" is the courtsupervised, statutory process required by law to
transfer ownership of a deceased
person's property
to the heirs.
Although this sounds innocent enough, prudent
advice dictates that probate should be avoided if
possible. This is because probate often proves to be
a slow, expensive and unnecessary burden - particularly at a time of grief and loss.
PROBATE AVOIDANCE
Techniques and Pitfalls
There are several options available to avoid probate.
However, each option has its own particular pros
and cons. Therefore, there is no "one size fits all"
probate avoidance technique.
The main techniques that avoid probate are (I) joint
ownership, (2) asset beneficiary designation to heirs,
and (3) a Revocable Trust.
Technique No. 1
Joint Ownership
Most assets, such as accounts and real estate, may be
individually-owned or jointly-owned. Individuallyowned assets generally are subject to probate.
However, jointly-owned assets (with survivorship
rights) pass upon one owner 's death to the surviving
owner, without probate.
For example, a jointly-owned bank account typically is transferred by the bank, free of charge, to the
surviving co-owner. And jointly-owned real estate
is transferred by filing several abbreviated documents in the county public records.
Pitfalls
One risk of joint ownership - particularly with a
higher value account - is that usually each joint
owner has unrestricted access to the account. Thus,
the use of joint ownership in any situation must be
viewed with great caution.
A second pitfall of joint-ownership is that it may
result in significant and unexpected federal estate
and gift tax consequences.
Finally, a jointly-owned asset "by-passes" one's
estate plan (i.e. Will or Revocable Trust) because it
passes at death directly to the surviving co-owner.
Although probate is avoided, this by-passing of the
estate plan, if not well-advised, may ultimately
result in significant tax liability - largely due to the
under-utilization of the deceased's estate tax andlor
generation-skipping tax reduction planning set forth
in the estate plan.
Also, this by-passing of the estate plan often results
in one heir (the joint owner) receiving a larger share
of the estate.
Technique No.2
Asset Beneficiary Designation to Heirs
Certain types of assets pass at death directly to one's
heirs, without probate, under a "beneficiary designation form" executed by the owner.
The most common examples of such beneficiary
designated assets, or "BDAs," are IRAs, life insurance, annuities and 401(k)'s.
Importantly, to ensure probate is avoided with a
BDA, beneficiaries must be designated, by name,
on the beneficiary form. And at death the bank or
company holding the BDA will simply transfer the
funds directly to the named beneficiaries.
Pitfalls
Although there are several pitfalls to the BDA, the
most common is that the beneficiary designation may
inadvertently transfer the BDA to the "wrong" person.
For example, Mrs. Smith designates her 4 sons, by
name, as heirs of her $1 million IRA using the
standard BDA form for XYZ investment company.
Unfortunately, Mrs. Smith later develops Alzheimer's
disease and then her oldest son, John, predeceases
her. And now Mrs. Smith, due to incompetency, can
no longer legally update her beneficiary designation.
Who inherits John's $250,000 share of the IRA
upon Mrs. Smith's later death? It may be John's
children, or his brothers, or his wife - or even Mrs.
Smith's probate estate.
A second pitfall with the BDA is that, upon death,
the BDA may be subject to increased or accelerated
income tax, the estate tax andlor one's creditors, if
one 's BDA and estate planning documents are not
properly coordinated.
In either situation, it is well-advised to have an
attorney draw the beneficiary designation for the
BDA to properly address contingencies and minimize
tax concerns.
Technique No.3
The Revocable Trust
A Revocable Trust (or "RT") is often the best recommendation to avoid probate. The RT provides many
of the same features as does a Will - but it has the
added benefit of probate avoidance.
The RT avoids probate because, by law, assets which
are legally titled in one's RT at death simply are not
subject to the probate system.
With most RTs, the client typically designates himself or
herself as the initial trustee and the sole beneficiary, and
also retains the right to amend or revoke the RT. And at
death the trustee designated by the client (perhaps the
oldest child) then takes the helm and transfers the RT
assets to the designated heirs, free of probate.
Pitfalls
For one's assets to avoid probate, it is essential that
all property otherwise subject to probate be legally
transferred to the RT before death. Therefore, one
must be diligent to ensure that all "probate-able"
property, whether presently owned or acquired in the
future, is owned by the RT.
However, it is not uncommon that a client either fails
to transfer all assets to the RT at its creation or, years
later, acquires a new asset (i.e. the long-desired North
Carolina cabin) and forgets to transfer it to the RT.
Also, a common misconception about the RT is that it
provides creditor protection. Although other types of
trusts can provide creditor protection, an RT does not.
The comments expressed herein are intended for general
informational purposes only and should not be relied upon
as legal advice. Please consult legal counsel to obtain
specific advice for your situation.
ROBERT H. EARDLEY is a
Florida Bar Board Certified
Wills, Trusts and Estates
attorney, holds his J.D. degree
from the University ofKentucky
College of Law and a Master of
Laws (LL.M.) degree in Estate
Planning from the University of
Miami School of Law. Mr.
Eardley is a partner with the
Naples law firm of Salvatori, Wood & Buckel, and he
or his assistant, Sue Sprouse, can be reached at (239)
552-4124.
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Collier Edition - May 2011 Health & Well ness
27
Health Plans Tighten Provider Networks to
Offer Lower Premiums
By Jennifer L. Wenke, CPIA
tough economy and ever-climbing
health care costs are driving changes
to network-based health plans. Employers, seeking more manageable premiums for their
health plans, have grown more willing to limit
employee provider choice. Insurers have responded
with plan options that feature a more limited number of
in-network providers, or options that segment innetwork providers into tiers, and vary member costsharing based on which providers are used.
Tiered networks assess providers according to cost and
quality benchmarks, then place them in groups with
different member cost-sharing requirements. The
model for this type of plan structure can be found in
health plan prescription drug reimbursement, which
commonly divides covered drugs into tiers based on
whether they are generic, brand, specialty, lifestyle, etc.
"Narrow" or "limited" networks leave certain providers out entirely. The inclusion/exclusion determination may be based on quality, cost,
geography, or "cultural competence," or some
combination of these factors. An insurer may offer
several variations on this concept, with the narrowest networks offering the most limited
provider selection-and the lowest premium.
In a tiered network health plan, each time members
access care, their deductible, copayment or coinsurance
may vary, depending on which tier the selected
provider is in. For example, a plan may segment providers into three tiers that pay benefits at basic, standard
and enhanced levels, with enhanced benefits paid for
providers that have met benchmarks both for quality
and for lowest cost. If a member chooses to have a procedure in a hospital in the basic benefits tier, he or she
may wind up paying an extra $1,000 for a surgery, or an
extra $500 for an imaging service, than if a hospital in
the enhanced benefits tier had been chosen.
The growth in limited and tiered networks is all
about timing. A protracted poor business climate
has spurred employers to buck the status quo of
maintaining almost unlimited provider selection
for employees outside of an HMO plan. Feeling
cost pressures of their own, employees may be
more willing to consider switching providers, if
doing so keeps their premium in check or lowers
their out-of-pocket cost at the point of service.
And, if these plans go over well with employees
now, they're more likely to maintain their market
share, or grow in use, as the economy improves.
Limited and tiered plans also fit nicely with the
consumer-directed health plan approach. Consumer-directed health plans urge members to be more
conscious about their health care "purchases," and
to "shop around" before making a major health
care buying decision, just as they would with any
large purchase. In tiered networks especially,
members can bring cost-conscious consumerism
to every health care decision, by looking at their
choice of providers and deciding whether a particular doctor or hospital is worth a larger copayment or higher coinsurance rate.
As with any change in benefits, employers implementing tiered or narrow networks are likely to see
them go over better with employees if the change
is preceded by effective communications. Though
employees know their payroll deduction for health
insurance, they might not know the employer's
cost. Employees should know how much the
company contributes to their medical insurance;
how this expense is impacting what the business
could do in other areas and the potential premium
savings-to them and to the company-from a tiered
or narrow network. Only then, as better-informed
consumers, are they likely to understand the true
cost of choice.
Jennifer L. Wenke , CPIA
239.418.2106
SALVATORI, WOOD & BUCKEL
....----------Attorneys-at-Law
Robert H. Eardley, Esq.
Florida Bar Board Certified
Wills , Trusts & Estates Lawyer
Master of Laws Degree
in Estate Planning
Practice Concentrating in ...
• Will and Trust Planning
• Florida Residency Planning
• Revocable Living Trusts
• Estate Tax Minimization
• Probate of Estates
• Prenuptial and Postnuptial Agreements
• Powers of Attorney/ Living Wills
The hiring of a lawyer is an important decision that should not
be based solely upon advertisements. Before you decide, ask
us to send you free written information about our qua lifications
and experience.
PLEASE CALL 552-4124 FORA COMPLIMENTARY 30 MINUTE CONSULTATION
9132 Strada Place - Fourth Floor - Naples, Flonda 34108
I
www.swbnaples.com
Email: [email protected]
Visit: www. Lutgertlnsurance.com
Phone: 239.418.2106
•
Jennifer 1. Wenke, CPIA
Individual & Group Medical, Life, Disability, Retirement & Supplemental Plans
Member of the Florida State Chapter of the National Association of Health Underwriters
Lutgert Insurance handles Property & Casualty insurance programs for both your
business and personal insurance needs.
~uring Our Clients' Trust Since 1953
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28
Health & Well ness May 2011 - Collier Edition
. about Assisted Living
E.!!~!~
Contracts and Finances
When speaking with someone at a
specific community, ask what are the
policies regarding termination of contracts and refunds? Are there additional services if a resident's needs
change? In addition, inquire about
needs assessments. Is there a process
for assessing and periodically reassessing a resident's needs? Are the
resident, family, community staff and
resident's physician involved in the
needs assessment?
s the population ages, more people
are discovering assisted living and
the benefits and peace of mind it
provides. Assisted living is for those who need some
help in their daily lives, but don't require the medical
care provided by a nursing home or other institutional
setting. It provides housing and services when it is no
longer safe or practical for an older adult to live alone
in his or her home.
Most assisted living communities offer individualized care on a need basis and have a nurse on call 24
hours a day. Services vary, and usually include
bathing, dressing or medication management, nutritious meals, a variety of planned activities, transportation and a comfortable apartment.
"With the help of today's assisted
living communities, older adults
are getting the traditional care they
need, while maintaining much of
their independence and dignity in a
place they can call home, "
said Roger Thiele, vice president of marketing and
product line development for Brookdale Senior
Living" , a leading owner and operator of senior
living communities throughout the United States.
"Assisted living communities alleviate the challenge
of care from the families, and in tum are making a
commitment to enhance the quality oflife for today's
older adults."
Reputable assisted living communities will offer
similar levels of basic services. How these services
are delivered and presented distinguishes one community from another. Beyond the basics, it's up to the
prospective resident to find the particular community
that he or sbe will be bappy to call bome.
Assisted living communities come in a wide variety of
sizes and building styles, ranging from apartment buildings to converted homes. They can be free-standing or
part of a larger campus which includes independent
living andlor skilled nursing. Offerings vary from one
room to a full apartment, and are operated by both forprofit and not-for-profit organizations.
When investigating assisted living communities,
two common questions and concerns are:
Social and Recreational Activities
When researcbing a community, one sbould ask if
activities are available in the community? How
often and what type? Can family members participate in the programs?
At Homewood Residence" Naples, we offer "traditional" activities sucb as outings, etc., but we have a
culture of Optimum Life" where whole person
we1lness is achieved through purposeful, emotional,
physical, social, spiritual, and intellectual dimensions.
Through the six dimensions of wellness, opportunities
are provided for residents to choose a healthy lifestyle
that adds value and fulfillment to their lives.
In addition, Celebrations, a year-long, themed,
award-winning program is offered by Brookdale
Senior Living" , the parent company of Homewood
Residence Naples, to enrich the lives of residents.
Celebrations is distinctive in the fact tbat it is
strongly linked to Brookdale 's" Optimum Life"
culture and dining program. Celebrations encourages a heightened interaction between associates
and residents. This year, Celebrations invites residents on a cross country adventure with the subject
of "Amazing Places of the World." Each month
features experiences, special events, and programs
corresponding with the monthly destination, while
recognizing tbe power of possibilities and fulfilling
all the dimensions of Optimum Life" . There will be
opportunities to visit both natural wonders and
manmade marvels across six continents.
At Homewood Residence" Naples, we use a Personalized Assisted Living approach: Listen. Recognize. Integrate. Based on decades of experience, we
have learned in order to personalize each day, we
must listen to you, recognize who you are, and integrate your preferences in every way possible. Our
associates are committed to listening to all the significant details that represent your life and who you
are. This provides tbem the insight to support your
approach to living while encouraging both independence and a personal sense of wellness.
In addition to the above, look for a community that
offers any other non-tangible needs for a loved
one, including maximizing independence, encouraging individuality, nurturing of the spirit and,
above all, a safe, secure residential environment
for an enhanced peace of mind.
Homewood Residence, facility no. 9584, is located
at 770 Goodlette Road North in Naples and offers
personalized assisted living and specialized
Alzheimer's/dementia care options for seniors.
For more Information, visit www.brookdalellvlng.com
or call 239·430·3535.
® Reg. U.S. Patent and TM Office.
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Collier Edition - May 2011 Health & Well ness
29
Publ ished Government Statistics Show lout of 2 people wi II use
Long-Term Care Insurance ...... why not consider a "Shared" policy?
By Rosemarie Hurley, CSA - Long-Term Care Insurance Specialist
E
very year, the u.s. Congress publishes
interesting statistics on Long-Term Care
utilization. One statistic prompted me
to share an idea with you in this month's article.
issued, it is usually less expensive to do go this
route. Only one caution .. ... make sure you select
enough coverage so that when one person uses a
number of years, it does not leave the other
without ample coverage if you BOTH happen to
use the policy benefits.
Since we know that one of two people will use LTC
insurance in their lifetime, I see it a very prudent and
responsible idea to pursue. When there is a couple,
naturally it is also difficult to know who will need the
coverage, and I can tell you, having been doing this for
over 18 years, it is NOT always the older of the two in
a marriage where there is a big different in age. So
what is the most affordable way to protect yourself?
How about a "Shared" policy?
There are several companies offering a way to share
Long-Term Care benefits. There are some companies
that offer two policies with a "shared" rider, and then
some others that offer a "shared policy". The best way
to determine the way to go is to provide a side by side
comparisons, and see how the numbers turn out.
In the plan where the rider is added to allow sharing of
benefits, there are actually two policies that have
benefits for two people and the rider allows one person
to use the benefits of the other policy if it turns out to
be necessary. It actually doubles the pool of money
allowing more opportunity for one person to access.
For example, each person chooses a 3 year policy, and
the rider allows the flexibility for one person to use 6
years of coverage if necessary.
As I always say, there are many ways to accomplish Long-Term Care protection. Depending on
the circumstances, and given the right guidance, it
is almost always affordable. Being creative and
knowing all the options available, will allow for
taking advantage of the shortcuts that allow for
BIG savings.
In the actual "shared policy", two people have
coverage, but there is only one actual policy. That
is the BIG difference. For example, if you buy a
policy covering 8 years of benefits, then one
person can use 2 years, and then other has 6 years
for themselves. And this can be used in any combination, of course. Since there is only one policy
When working towards finding the right LTC
policy for you, be certain to evaluate things from
every perspective. As a Specialist representing
every company with a LTC product, you can
always be sure you have reviewed every possibility and that ensures you make the very best
decision to protect your future.
Rosemarie Hurley, President ofSenior Insurance Solutions, has worked in the senior healthcare market
for over 20 years. She is a Certified Senior Advisor and has been a Long-Term Care Insurance Specialist
for more than 17 years. She is the Past President of Health Underwriters, a Past President of the Rotary
Club of Estero, Member of the Bonita and Estero Chambers of Commerce, and a graduate of
Toastmaster's International. She represents all ofthefinest insurance companies in the industry. Can be
reached at (239) 274-6678 in Estero, or at her website: www.longtermcareinsurance-online.com
What is Long- Term Carer
I
Imagine watching your loved one rega in an
ent husiasm for li fe with personalized support
in a fri endl y, enco urag ing envi ro nment. A
little hel p can make an enor mous d ifference
with acti vities of daily living such as bath ing
and d ressing.
Ca ll to sc hed u le a get-acquainted visit,
Personalized Assisted living
or to ur our webs ite tod ay and d iscover how
Respecf/or Indi vidual p"ir"""es'"1 we provide o ur residen ts wit h the highest
Alzheimer's &: Dementia Care
standa rds of Personalized Assisted Livi ng.
{E'W()OD Daily MomenfS ojSuccess$.\f
Ca ll t o d ay to sc h edul e yo ur
_~!~.?~~~~~ 770 Goodlette Road North
complimentary lunch or dinner and inquire
BROOKDALE SEN IOR LIVING
Naples, FL 341 02
(239) 430-3535
Assisted Living Facility # AL9584
www.brookdaleliving.com
about our current specials!
Planning for the futu re is so important. Be prepared. Learn
all you can about som eth ing that can jeopardize the financial
fur ure of yo ur entire family. Talk with a broker who represents all the major LTC carriers, and has been a Long-Term
Care Special ist for over 17 years.
Compare before you decide.
Rosemarie Hurley is a Long-Term Care Special ist brokering with many
fine insurance companies. She can find the plan that suits your needs
tI!.
'r,
ROSEMARIE HURLEY
Call SENIOR INSURANCE SOLUTIONS
For a FREE Information Packet at 239.274.6678
Certified Senior Advisor
Visit our Web Site at: www.longtermcareinsurance-online.com
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30
Health & Well ness May 2011 - Collier Edition
--------------- Splrltu~ess
Building Family Life
any people that VISIt my
office are haunted by painful
memories from their childhood.
In the minds of far too many, the family is a place of
hurt and suffering, not a place of peace. There are
numerous homes where fear, anger, and chaos rule
the home. There are few families out there who rise
above the usual problems and drama. Those are the
people who when asked about their families have
many positive stories to share about their growing
up. They remember when dad taught them how to
pray, they think about the way mom and dad got
along, they reminisce on the good times they had
with their siblings, and they conclude to themselves
that family is truly a gift from God. Every family
whether good or bad has one thing in common; they
will both carry on a legacy to the third and fourth
generations. So what makes a good family? Good
families are cultivated, not stumbled upon. There
are basic building blocks that need to be laid to
build the foundation of a healthy family. It is never
too late to start building in a positive direction and
stop tearing your family apart. Each building block
we discuss is found in God's Word.
First Building Block
We need to please and glorify God. God's Word
says, "we make it our goal to please Him (God) ... "
(2 Corinthians. 5:9a, NIV). A healthy family starts
with a desire to please God. A strong foundation
begins with a family that desires to please God. This
starts with an authentic and vibrant relationship with
Jesus Christ our Lord and Savior. Also, it is important to glorify God in our family too. God's Word
says, "whether you eat or drink or whatever you do,
do it all for the glory of God." (I Corinthians 10:31,
NIV) We are here on earth to worship and please
God with every area of our life. Our home reveals
who or what we love and worship, and it is important for us to please and glorify God.
Does your family live to please God?
Would your spouse tell me that you
are seeking to glorify God with your
life? What would your children say
about your relationship with God?
by Terry Hoskins, Director of Oasis
Love
Humility
Second Building Block
We need to put others above ourselves. God's Word
says, "Do nothing out of selfish ambition or vain
conceit, but in humility consider others better than
yourselves." (Philippians 2:3, NIV) It is the practice
of self-denial instead of self-fulfillment. That is the
epitome of Biblical love. John 3:16 says, "for God
so loved the world that He GAVE His Son ... " God
gave everything He had including His beloved Son,
and He asks us to do the same. Love your spouse
and your children above yourself, put their desires
and wants above your own. This may not sound
very appealing to you, but it is exactly what God
calls you to do. God Word says, "husband love your
wives as Christ loved the church and gave Himself
up for her." (Ephesians 5:25, NIV)
How important is it for you to obey
God? Are you trying to love your
spouse above yourself? How often
are you training the children to be
selfless instead of selfish?
be recipients of the grace that is overflowing in us.
Forgiveness and love should consume anger and
resentment. Joy and peace extinguishes depression
and discord.
Is your house a place of grace or
judgement? How often are you
bringing up past sins of others? Are
the children honoring each other?
Do you consider God's grace as you
show patience and love to other
family members?
If you would like to have some help in growing your
family or learning how to live everyday for God's
glory, please contact Oasis for the steps you need to
take. Visit us at www.oasiscounsel.com or call us
239-389-0273.
Oasi
Counseling ~~~----"1
Refresh your life
using God's Word.
Third Building Block
We need to be dispenser's of grace. Grace means
unmerited favor. We love, bless, and forgive one
another freely in our families because God gives us
what we don 't deserve.
God's Word says, "when
you were dead in your sins and in the uncircumcision of your sinful nature, God made you alive with
Christ. He forgave us all our sins." (Colossians 2: 13,
NIV) The Bible tells us that God in His infinite
mercy and grace made us alive in Christ while we
were still living a life of rebellion, Christians should
be the most graceful towards others because God's
grace is poured on them daily. Our families should
/
Call Today! 239.389.2073
Oasis Counseling Center wants to refresh your hope, heart, and life with God's Word. We are located on Marco Island and
our phone #389·2073. We are friends of HOPE Counseling Center located in Fort Myers, and their phone #481·0777.
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