April 2012 - FloridaMD

Transcription

APRIL 2012 • COVERING THE I-4 CORRIDOR
Central Florida Vein
and Vascular Center
is a Vessel for
Patient Satisfaction
An·drol·o·gy (an-dro-’ä-l -jē) n 1. The branch of
medicine concerned with men’s health.
2. It is the male counterpart to gynecology.
3. The solution to your complex
male infertility and sexual
dysfunction issues.
e
See also An·drol·o·gist
(an-dro-’ä-l -jist) n Zamip Patel, MD,
one of the only fellowship-trained
andrologists in Orlando.
e
Zamip Patel, MD
Introducing another new specialty at
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(407) 303-DOCS (3627) or visit FHEastMensHealth.com
to make an appointment.
contents
APRIL 2012
CENTRAL FLORIDA EDITION
4
COVER STORY
Photo: Donald RAUHOFER / FLORIDA MD
After nearly 20 years as a prominent Metro Orlando vascular surgeon, Dr. John Horowitz is offering the community an unprecedented patient care experience at the Central
Florida Vein and Vascular Center. Using office-based techniques that have revolutionized
vein care in the field of Phlebology, Dr. Horowitz has created a patient centered practice
committed to the best possible outcomes. “Our goal is to offer patients the most comprehensive vein care and the best outcomes in a setting that makes them want to return
time and again for their care.” As a committed vein center focusing solely on vein care,
Dr. Horowitz continually commits resources, staffing and patient care plans designed to
best serve the patients of Central Florida. The practice’s mission is to provide the most
advanced care in an office environment not found elsewhere in Central Florida. The only
bottom line for the Central Florida Vein and Vascular Center is patient satisfaction.
20 PROACTIVE POINTERS TO
FIGHT SMALLL BUSINESS
FRAUD
22 BARRETT’S ESOPHAGUS:
A PRE-CANCER CONDITION
29 CURRENT TOPICS
36 FOR YOUR ENTERTAINMENT
36 ADVERTISERS INDEX
DEPARTMENTS
2
FROM THE PUBLISHER
9 MARKETING YOUR PRACTICE
11 ORTHOPAEDIC UPDATE
13 VEIN & VASCULAR
15 DIGESTIVE AND LIVER UPDATE
18 FERTILITY
23 Medical Malpractice Expert Advice
25 PHARMACY UPDATE
26 PULMONARY AND SLEEP DISORDERS
FLORIDA MD - APRIL 2012
1
FROM THE
THE PUBLISHER
PUBLISHER
FROM
II
am pleased to bring you another issue of Florida MD. As physicians, you know that providing a
Iam pleased to bring you another issue of Florida MD Magazine. It’s hard to imagdisability diagnosis can be difficult for a parent to hear; and these parents will rely on your guidance
ine anyone
not for
familiar
thedevelopment.
March of Dimes
the work
they doFlorida
to
to identify
thewho
bestisplan
their with
child’s
I amand
pleased
to remind
physicians
of the support, education and therapy services offered at UCP of Central Florida, a not-for-profit
charter
school and themselves
therapy clinic
helping
children
agesand
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to 21 Coming
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always reinventing
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up next
according to their abilities. UCP offers options for families such as integrated onsite therapy during
month is the annual March for Babies. It’s a wonderful team-building opportunity for
the school day and/or outpatient therapy and rehabilitative services. Please join me in supporting
this truly wonderful organization and the good work they do.
tions on how you and your family can join the march or how to form a team for your
Best regards,
whole practice. I hope to see some of you there.
Donald B. Rauhofer
Warm regards,
Publisher
UCP’s education and therapy programs
UCP’sB.
education
Donald
Rauhoferand therapy programs are geared toward children with all kinds of disabilities and delays including cerebral palsy,
spina bifida, Down’s syndrome, autism, speech and language delays, developmental delays and rehabilitative needs stemming from
Publisher/Seminar Coordinator
injury. UCP’s education and therapy teams collaborate closely with physicians and other professionals to provide each child with a
comprehensive interdisciplinary approach where families are an essential part of the team.
When Therapy focuses on preserving,
Join
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ofinfants
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most common funding sources are Medicaid, commercial insurances and private pay. You can positively impact
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reason why people do not donate is that
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COVER STORY
Central Florida Vein and Vascular Center
is a Vessel for Patient Satisfaction:
Central Florida’s Premier Center for Comprehensive Vein Care
By Nancy DeVault, Staff Writer
“Neglected Medical Specialty Becomes a Local Vascular Surgeon’s Passion”
For decades, Phlebology, the medical specialty devoted to disorders of the venous system,has been eclipsed by the bypasses,
angioplasties, and stents used frequently and often excessively to
treat arterial disease. The “red-headed step child” of medicine,
Phlebology has steadily gained respect as being more complex
and involved than previously appreciated. For 20 years, Dr. John
Horowitz has been practicing vascular surgery in our community and has committed his entire practice to Phlebology. “Phlebology is the Rodney Dangerfield of medical specialties: it ‘Gets
No Respect,’” says Dr. Horowitz. “For all of those years I spent
practicing arterial and venous vascular surgery, patients with venous disease were looked at as the least glamorous and satisfying
patients to care for. No one ever referred to the treatment of
vein patients as ‘cool’. We had little to offer most patients. We
also live in a culture dominated by the complications of lifestyle
choices and atherosclerotic arterial disease. Heart attacks, stroke,
and limb loss have become the intense focus of all vascular specialists.” Fortunately for the patients of Central Florida, that
seems to be changing.
found myself progressively disillusioned with a healthcare
system highly invested in procedures for arterial disease that
were destined for failure and a need for re-treatment because
we had done nothing to effect the root causes. The amount of
resources we spend and the risks to people’s lives we take to stem
the side affects is astounding. People are not engaged in their
own care. We don’t have a healthcare problem, we have a culture
problem! Since I have committed my practice to Phlebology, I
find I can affect patient’s lives in a much more substantial way
and engage them in their own care and the hope of a more
active, fulfilling lifestyle.”
Phlebology is more commonly accepted and embraced as
a bona fide specialty in many countries outside of the United
States, such as the United Kingdom, but is on the rise in the
United States as statistical data illustrates an increase of patients
in the US treated for vein disorders. The Venous Disease Coalition notes that twenty-seven percent of the American adult
One might wonder, why would a
wildly successful and skilled vascular
surgeon that spent his life developing
and refining skills in arterial surgery
and endovascular therapies such as
angioplasty and stenting decide to
commit his practice to vein care?
Phlebology has become an exciting
and challenging discipline compared
to its counterpart of 15 years ago.
“I became one of the pioneers in
minimally invasive vein therapy
and developed an expertise in vein
care really not seen anywhere before
in Central Florida. The exciting
advances in laser technology, the
challenges of ultrasound guided
techniques, and the opportunity to
work with a population of patients
with an interest in participating in
their own care and improving their
overall lifestyle has me completely
engaged,” says Dr. Horowitz. “I
4 FLORIDA MD - APRIL 2012
Dr. Horowitz discusses a patient’s plan of care and what to expect from her treatment.
COVER STORY
Dr. Horowitz and staff perform an in office endovenous laser (gold-tipped laser fiber from AngioDynamics) ablation for saphenous reflux. All
procedures are percutaneous and ultrasound guided (see insert).
population has some form of venous disease in their legs (source:
Framingham study). In fact, it is estimated that at least 20 to 25
million Americans have varicose veins with women being three
times as likely to be affected, most likely a result of physiologic
changes during pregnancy, age, and menopause. To answer the
patient demand surrounding vein care, Central Florida Vein
and Vascular Center opened its doors in 2001 with locations in
Ocoee, within Health Central’s Medical Plaza, and the Sandlake
area, adjacent to Dr. Phillips Hospital.
Why has the treatment of venous disorders changed so much?
To begin with, advances in technology have opened up elegant
and minimally invasive pathways for vein patients to achieve
care. Second, the ability to diagnose and characterize venous
reflux, the root cause of venous insufficiency and symptomatic
venous disease, has become much more sophisticated with high
definition ultrasound. Vascular ultrasound has grown as a discipline itself and has a sub-specialty in venous disease. Lastly, over
the years, providers have developed a greater understanding of
the underlying causes of venous disease and the most appropriate methods of treatment. A greater commitment to developing
ultrasound guided skills has also advanced this field greatly. Virtually all of the minimally invasive vein procedures performed
at the Central Florida Vein and Vascular Center are ultrasound
guided and percutaneous. Intense focus on education and train-
ing and the establishment of an independent Board of Phlebology have revolutionized the delivery of vein care.
Vein Patients are not Vain
When veins become varicose, enlarged and twisted, the results
can be visually unflattering. While most patients admit to this
fact, the truth remains evident in a multitude of Quality of Life
studies that varicose veins and venous insufficiency are a significant source of symptoms and disability. There is a great deal
of pain, fatigue and lower extremity limitations that stem from
venous insufficiency. Many assume that opting for intervention
is simply a cosmetic choice satisfying ones vanity; though some
are seeking visible improvements, others are looking to address
symptoms that may include leg aching, heaviness, fatigue, ankle
swelling, muscle cramping, restlessness, itching or burning, and
skin discoloration. Today’s advanced therapies get to the root of
the venous reflux, which causes the vast array of symptoms and
combats this true clinical issue. In most incidences venous insufficiency is not a dangerous condition, though varicose veins
can lead to complications such as blood clots, bleeding, rashes
and ulceration if not treated. However, the usual implications
of vein disorders are painful, tired, swollen and heavy legs that
impact patients’ quality of life. The modern vein care practiced at
Central Florida Vein and Vascular Center eliminates the venous
5
COVER STORY
Photo BY Fred Gates
explains that these conventional solutions
rarely eliminate the venous insufficiently. In
fact, compression hose are typically uncomfortable for patients, especially in the heat of
Florida and merely offer the temporary results.
Left thigh branch varicosities off of the greater saphenous vein before (left) and after (right)
showing resolution after just 1 week and endovenous laser ablation only.
congestion of failed veins providing more effective venous blood
flow.
Photo BY Fred Gates
According to Dr. Horowitz, recent studies show more than 58
percent of the women between the ages 18 to 49 said that the
one thing they would most like to change about their legs was
better stamina and energy. “Our practice values the opportunity
to help our patients get back to doing what they love without
physical limitations,” said Dr. Horowitz. “We’re able to help a
wide range of patients achieve healthier legs. From the active
mom whose legs became problematic with varicosities following
her pregnancies, to the Baby Boomers that have been told to live
with the leg discomfort they have, all patients show an improvement in symptoms and function once we treat their veins.“
“Proper vein care requires working from
the inside out. We work to find the root of
the problem by identifying the location and
severity of the venous insufficiency, which is
not always visible through the skin,” explains
Dr. Horowitz. “I think this is what separates
a true Phlebology practice like ours from
those that dabble in vein care.”
Vein, Vein Go Away
As a dedicated vein care facility, the Central Florida Vein and
Vascular Center offers a uniquely comfortable patient experience.
The dated high-risk treatments of surgical stripping are now
completely obsolete. Central Florida Vein and Vascular Center
offers convenience with safe, minimally invasive procedures
conducted through an outpatient, office-based setting, followed
by a shortened recovery period. Veins of any size can be treated
non-surgically through minimally invasive outpatient techniques
including Endovenous Laser Treatment (EVLT), Ultrasound
Guided Foam Sclerotherapy, Vein Lite Sclerotherapy, Spider
Vein Sclerotherapy and Aesthetic Laser Services.
Central Florida Vein and Vascular Center’s treatment approach
typically combines two office-based procedures, Endovenous
Laser Ablation and Ultrasound Guided Foam Sclerotherapy, to
Most vein care at Central Florida Vein and Vascular Center
provide management of leg swelling and problematic veins of
is authorized and covered by insurance providers. Approved
any size. These procedures require no incisions to heal, require
treatments often commence with a conservative therapeutic apminimal downtime and are highly successful when performed
proach. This period can range from two weeks to three months
by a trained Phlebologist. The saphenous reflux, the root cause
and include compression hosiery, weight loss, swimming pool
of secondary varicosities is treated with Endovenous Laser Ablatherapy and pneumatic compression; however Dr. Horowitz
tion, the most common catheter-based
Left posterior knee varicosities before (left) and after (right) following endovenous laser therapy and
technique performed at the Central
ultrasound guided foam sclerotherapy.
Florida Vein and Vascular Center. Patients receive local anesthesia, allowing the physician to guide a laser fiber
(see inset) through the skin and into
the insufficient vein, visible through
ultrasound guidance. During the procedure, which spans 15-20 minutes,
Dr. Horowitz and his surgical team
use a laser called VenaCure, medically
designed tool specifically for treatment
of varicose veins by AngioDynamics,
Incorporated. The laser light heats the
vein causing it to seal off from the inside. As a result of delivering laser energy to the targeted insufficient vein,
the vein is sealed and the reflux pressure is reduced, thus eliminating swell6 FLORIDA MD - APRIL 2012
COVER STORY
ing and pain with improved blood circulation. Following the
procedure, patients experience no down time and may be able to
visually see dramatic improvements immediately.
Endovenous laser therapy carries an impressive 98 percent
success rate for this advanced technique. As opposed to surgical stripping, the vein remains in place but is sealed closed and
cannot allow retrograde, refluxing venous blood to leak to the
surface veins. The secondary veins, also known as the superficial
veins which are visible just under the skin, are then treated with
Ultrasound Guided Foam Sclerotherapy. A tiny needle is injected
using high definition ultrasound, to introduce a medicated solution that irritates the lining of the vein. The chemical causes the
veins to collapse or seal shut. Superficial veins handle less than
five percent of blood flow so patients’ general health is not affected. These techniques offer little trauma and pain afterwards,
a quick recovery, and excellent long term results while avoiding
the risks and poor cosmetic outcome of surgical vein care.
Training for a Standard of Care
Dr. Horowitz was among the first physicians practicing in the
Central Florida region to solely commit to the field of Phlebology with specific intention to treat venous disorders including
varicose veins, spider veins, edema and skin changes, and veiBefore and after pictures are an essential component of the patient’s
medical record.
Dr. Horowitz performs sclerotherapy using 2x magnification and a
polarized headlight for better visualization.
nous wounds. Because of his dedication to the evolving techniques and applications of Minimally Invasive Vein Therapy,
physicians throughout the Southeast region of the United States
have sought his direction. Countless doctors have observed and
studied the specialized approaches performed at Central Florida
Vein and Vascular Center and explored the benefits of a dedicated vein care center. Dr. Horowitz, who has authored numerous
journals and book chapters, also presents regularly at medical
conventions and society meetings regarding the latest groundbreaking and cutting-edge treatments in the evolving discipline
of vein care.
Central Florida Vein and Vascular Center has performed nearly 10,000 procedures. Thanks to a demand for vein care in the
Metro Orlando area, Central Florida Vein and Vascular Center
hopes to offer additional office locations as a convenience to new
and existing patients. Because lifestyle behaviors are contributing factors to the development of insufficient veins, Dr. Horowitz says an expansion could also include a multidisciplinary focus
7
COVER STORY
to incorporate more natural and holistic treatment options for
patients to consider, in addition to maintaining specialized conventional treatments proven to address venous disorders. Statistics show that people who are obese and those leading sedentary
lifestyles tend to be at a greater risk of developing malfunctioning veins and accompanying symptoms; therefore preventive
therapies and weight management is a key factor.
“As physicians, it’s our job to not only treat the acute condition
of the patient in which we specialize. As a medical community,
we need to evaluate the total health of patients and not overlook
any conditions – mild or severe – that impact one’s quality of
life and overall health,” says Dr. Horowitz, who is committed to
debunking the common myths of vein care. “Vein interventions
do hold clinical significance because our patients feel and see the
difference – physically and emotionally.” 
Central Florida Vein and
Vascular Center Locations
10000 W Colonial Drive, Suite 495, Ocoee, FL
34761-3436
7350 Sand Lake Commons Blvd., Suite 3322,
Orlando, FL 32219
Hours: Monday - Thursday 8 a.m. - 4:30 p.m.
Friday 8 a.m. - 4 p.m.
Scheduling: Phone: (407) 293-5944
[email protected] • CFVein.com
Socially Acceptable!
Thanks to reformed treatment options, patients
no longer need to feel embarrassed about their
veins or minimalize the magnitude of their
pain. Hear what patients are saying on
Central Florida Vein and Vascular Center’s
social media channels.
Twitter @ VeinandVascular
Facebook @ Central-Florida-Vein-and-Vascular
YouTube @ CentralVeinVascular
A thorough venous reflux examination by duplex ultrasound is
performed on all patients in our accredited vascular lab and is the
cornerstone of quality vein care.
Central Florida Vein and
Vascular Center
SERVICES OFFERED:
Endovenous Laser Treatment (EVLT)
Radiofrequency Closure Procedure
Ultrasound Guided Foam Sclerotherapy
Vein Lite Sclerotherapy
Spider Vein Sclerotherapy
Aesthetic Laser Services
Laser Hair Removal
Laser Skin Rejuvenation
Laser Removal of Sun Damage
Wound Care
Doppler Testing
Marketing Your Practice
Transitioning Your Business to
the Facebook Timeline
By Jennifer Thompson, President of Insight Marketing Group
If you or your office is already on Facebook, you’ve seen the
trendy new “timeline” layout that has replaced your older format.
But how can you get the most out of your updated Facebook
page?
Remember, the new design doesn’t have to be a source of stress
for your practice. Rather, it will offer your office even more opportunities to interact with patients while creating an interesting,
dynamic means of displaying information.
Direct Communication
Previously, if someone posted on your office’s wall you would
have to publicly respond to them or ignore the comment. With
the new format, businesses are now allowed to communicate directly with fans of their pages. You can now have a one-on-one
conversation with your patients to address their concerns or thank
them. The feature to share messages with patients, referral partners, and potential patients is a great opportunity to answer their
concerns without cluttering your actual page. You will be able to
maintain the look and feel of a fresh page, while at the same time,
handle the concerns of patients (customers). It’s a win-win.
Milestones
Another change is the use of “Milestones.” Basically you can
now add major events that happen to your practice, even before
you had a page. Did you open your doors in 1983? No problem,
you can post that as a milestone and add a photo of that first
building. Fans can then click on the year “1983” in the timeline
and see what happened then. With a little creativity and effort,
this can be a great way to let patients know more about your
practice and build loyalty along the way. You’re practice’s story
will unfold chronologically for readers, which appeals to them
visually and keeps them interested.
Pinning
There is also an interesting “Pinning” application enabling you
to “pin” important updates to the top of your page for 7 days so
it is the first things readers encounter when scrolling through it.
This is a great way of directing reader attention to specific photos,
updates or events you want them to see first. After the 7 days, the
update will no longer be able to be “pinned” so plan accordingly.
To do so, simply post an update like you normally would and
then click the pencil icon. The top option says “Pin to Top” and
you’re done.
Highlights
Another feature of the new pages allows you to highlight a post
and have it span across both columns of your page. Again, doing
so is easy and it will bring added attention to this particular post.
Once you post your update, simply click the star button found in
the upper right of the box and Facebook will take care of the rest.
Note: you cannot pin a highlighted post, so choose carefully. As
of right now, it’s one or the other.
Cover Photo
One of the most obvious changes you’ve most likely noticed is
the giant photo at the top of pages. This is called a “Cover Photo”
and all pages will have them as well as the default thumbnail photo you’re used to. The new cover photo should be an image that
consumers will recognize as representative of your office. It will
need to be at least 399 pixels in width and cannot be promotional
in any way. What does that mean? Essentially, it means nothing
in your cover photo can “sell” viewers. In other words, your cover
photo can’t contain contact information, outline specials, or any
sort of call to action such as “tell your friends” or “visit our website.” All cover photos are public, no matter what, so anyone visiting the page, whether they’re fans already or not, will see it.
Tabs
Now that tabs are displayed across the top of the page versus
along the side, the layout has also changed. Only 3 tabs will be
visible without pressing a button to expand the menu and see
the others so choose your 3 tabs carefully. Be sure to make sure
“Photos” is one of your tabs, since this is often one of the most
viewed aspects of a Fan Page.
Times A-Wastin’
As an admin you’ll want to make sure you begin taking advantages of these changes as soon as possible to utilize all of the new
features. Now that the timeline page has been published, whether
that was your choice or Facebook’s, it’s visible to the world and
all of your fans to see, so make sure your page is everything you
want it to be.
9
Marketing Your Practice
Marketing Your Medical Practice: A Quick Reference Guide
Are you ready to finally start marketing your practice? Visit www.InsightMG.com to learn how you can order your copy of
“Marketing Your Medical Practice: A Quick Reference Guide” by Jennifer Thompson and Corey Gehrold on Amazon. Encapsulating their real world medical marketing knowledge and expertise, this easy-to-read book gives you all the tips and tricks you’ll
need to start marketing your practice today in a fast, fun and friendly format – just like the articles in this series. To learn more,
visit www.InsightMG.com.
Looking for more information?
Contact Jennifer Thompson today for a free consultation and marketing overview at 321.228.9686 or e-mail her at Jennifer@
InsightMG.com.
Jennifer Thompson is president of Insight Marketing Group, a full-service healthcare marketing group focused on digital
and social media administration, referral and partnership development, creative services and graphic design, online reputation management/development and promotional products. She is co-author of Marketing Your Medical Practice: A Quick Reference Guide and an avid Twitter user, regularly posting medical practice marketing tips, articles and more at www.Twitter.
com/DrMarketingTips. You can learn more about her and her company at www.InsightMG.com. 
Coming Next Month: The cover story focuses on the OB Hospitalists and the new OB ED at Halifax Health in
Daytona Beach. There is also a special feature about Olga Ivanov, MD and Florida Breast Health Specialists at
Celebration Health. Editorial focuses on Women’s Health and Advances in Cosmetic Surgery.
Start Weight Sept. 2010: 207 lbS. • end Weight dec. 2010: 166 lbS.
Pathology Lab Results — Patient: SP Age: 63 Sex: Male
Before Diet
Lipid Panel
Result 08/28/2009
Ref Range Result
Cholesterol
H 278
(80-199)mg/dL
Triglycerides
H 199
(30-150)mg/dL
HDL Cholesterol
51
(40-110)mg/dL
LDL Cholesterol
H 187
(30-130)mg/dL
VLDL Cholesterol
40
(10-60)mg/dL
Risk Ratio(CHOL/HDL)
H 5.5
(0.0-5.0)Ratio
8/26/10:
9/24/10:
Tissue Fat %
26.3%
21.1%
Body Scan Results
Tissue (g)
83,019
78,045
Fat (g)
21,864
16,449
After Diet
09/20/2010
180
82
55
109
16
3.3
Lean Muscle (g)
61,155
61,596
Please Note: Gain of 441g of muscle and a fat loss of 5,415g in 30 days! Individual results may vary.
For information call 407-260-7002 or email [email protected].
ORTHOPAEDIC UPDATE
Overuse Injuries in
Youth Athletics
By Jessica Inman
The pressure to excel in athletics mounts from an early age as
children compete in their respective sports. Unfortunately, overuse injuries can occur as a result of the excessive strain children
put on their bones, muscles and joints while competing, says
Bryan L. Reuss, M.D., a board certified physician specializing in
orthopaedic surgery and sports medicine at Orlando Orthopaedic Center (OOC). In his practice he sees these types of injuries
every day; but what exactly is an overuse injury and what should
you do if a patient has one?
often go unnoticed or unmentioned
before causing enough pain to seek
medical attention.”
“Overuse injuries are the most prevalent injuries I see in children and many adults,” Reuss says. “They occur after consistent
strains of the bones, muscles, joints or tendons during physical activity. Unlike the sharp, severe pain that is associated with
acute injuries, the gradual aches associated with overuse injuries
“Some places, such as the shins and knee, hold potential for
overuse injury no matter which sport is played. Other locations,
however, are more closely associated with particular sports,” Reuss says. “Players of particular sports are more prone to certain
injury locations; for instance, I see hip injuries more often in
athletes who run track, and shoulder injuries in baseball and
softball players.”
Dr. Reuss (left) performs a meniscus repair on a local youth athlete.
Bryan L. Reuss, M.D.
Board Certified in
Orthopaedic Surgery
Board Certified in Sports
Medicine; Specializing in
Sports Medicine, Knee
and Shoulder Surgery
According to Reuss, the most
common youth overuse injuries in
the upper body include the shoulder and elbow. In the lower body, the knee, shins, Achilles tendon, and hip are common sites of the injuries.
And Reuss has seen plenty of sports injuries over the years. In
addition to being fellowship trained in sports medicine and an
active member of the American Orthopaedic Society of Sports
Medicine, Reuss also serves as a physician for Cirque du Soleil,
USA Rugby, 13 local area high school athletic programs, and the
Arnold Palmer Invititational.
The STOP Sports Injuries Program (SSI) attributes the stress
placed on youth to become exceptional at one particular sport as
a contributing factor to the parallel between the rise of overuse
injuries and the decrease in the age of those affected by them. In
fact, SSI discourages this “specialization” until the child is a high
school senior.
Reuss echoes the sentiment, and agrees that the more variety
that can be integrated into a child’s physical routine the better.
“It is common for youth to focus on one sport and put all their
time and energy into that from an early age. You’ve got the kids
who’ve been softball players since before they were in school, and
they get to high school and there’s even more pressure. This is a
huge cause for concern regarding overuse injuries,” Reuss says.
“If you’re placing an exceptional amount of tension on the same
muscles every day, and you’re not giving those muscles a break,
there is huge potential for overuse injuries to occur.”
However, this intense concentration on a particular sport is
not the only means to cause an overuse injury.
FLORIDA MD - APRIL 2012 11
ORTHOPAEDIC UPDATE
“Another huge thing to keep in mind is technique. If a child
has the wrong technique, he or she may be straining muscles
without even realizing it,” he says. “Many overuse injuries I see
in youth can be prevented. It’s important for adults to remember
that pushing a child too hard can result in serious injury because
they are not completely physically developed yet.”
Overuse injuries are also caused by jolts in the quantity of
time spent working out, or the intensity of those workouts according to SSI; for instance, if a player had been inactive due to
a previous injury, he or she cannot jump back into their previous
routine with the same vigor.
“I definitely understand the impatience to get back into the
game. There’s a ton of pressure to jump in as soon as possible;
and some athletes worry that their injury will keep them out of
the game altogether if they can’t get back in right away,” says
Reuss. “But it’s more about developing a workout plan that will
ease you back into it.”
don’t hesitate to see a doctor.” He says ignoring it will only make
recovery a longer process in the long run.
If a patient visits your office and is complaining of pain felt
in their muscles, bones and joints and cannot remember how
the injury occurred, this is often a sign of an overuse injury. At
this point, if rest, ice and elevation have not helped the patient
recover, it may be time to refer them to a sports medicine specialist. “These injuries can turn into something major if they aren’t
treated at the right time; so if you’re unsure, it’s always better to
see a physician with a sports medicine background to give their
recommendations.”
Both Reuss and Orlando Orthopaedic Center recognize that
ultimately learning about the cause of overuse injuries is a key
factor in preventing them and through this education they hope
to curb these injuries in youth in the community. 
These injuries, unlike acute injuries, can be prevented. Both
SSI and Reuss place stress on listening to the body as a key factor in this.
“Once pain is detected, it’s crucial to seek medical attention,”
says Reuss. “Whether you are just noticing pain after playing, or
it is affecting both your game and your life outside of your sport,
Looking to reach doctors by direct mail
or email broadcast? Call (407) 417-7400
or email [email protected]
Central Florida
Pulmonary Group, P.A.
Serving Central Florida Since 1982
Specializing in:
x
x
x
x
x
x
x
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Asthma/COPD
Sleep Disorders
Pulmonary Hypertension
Pulmonary Fibrosis
Shortness of Breath
Cough
Lung Cancer
Lung Nodules
Our physicians are Board Certified in Internal Medicine,
Pulmonary Disease, Critical Care Medicine, and Sleep Medicine
Daniel Haim, M.D., F.C.C.P.
Syed Mobin, M.D., F.C.C.P.
Tabarak Qureshi, M.D., F.C.C.P.
Daniel T. Layish, M.D., F.A.C.P., F.C.C.P.
Eugene Go, M.D., F.C.C.P.
Kevin De Boer, D.O., F.C.C.P.
Francisco J. Calimano, M.D., F.C.C.P.
Mahmood Ali, M.D., F.C.C.P.
Andres Pelaez, M.D.
Francisco J. Remy, M.D., F.C.C.P.
Steven Vu, M.D., F.C.C.P.
Pranav Patel, M.D., F.C.C.P.
Ahmed Masood, M.D., F.C.C.P.
Ruel B. Garcia, M.D., F.C.C.P.
Downtown Orlando: 326 North Mills Avenue
East Orlando: 10916 Dylan Loren Circle Altamonte Springs: 610 Jasmine Road
407.841.1100 phone | www.cfpulmonary.com | Most Insurance Plans Accepted
VEIN & VASCULAR
Post-Partum Venous Insufficiency
and Varicose Veins:
The Perks of Motherhood
By John D. Horowitz, MD
Pregnancy begets varicose veins, like the night follows the day.
Few associations in healthcare are as definitive. Possibly the adage: “if a man lives long enough, he will get prostate cancer.” The
joys of pregnancy and motherhood are tempered by the bodily
changes women experience. Almost all pregnant women develop
venous insufficiency, irrespective of the number of pregnancies
and how healthy they remain throughout their pregnancies The
hormones of pregnancy, the fluid shifts, the weight gain, and the
pressure created by the gravid uterus compressing the abdominal
venous return all serve to destroy the normal function of the vein
system. Although the inciting factors subside as the pregnancy
is completed and a women’s physiology returns to normal, the
damage to her veins is irreversible and lingers, only to become
noticeable years later often with great clinical sequelae.
By way of review, the venous system relies on valves to maintain unidirectional blood flow returning to the heart. There is no
pump to drive the venous system like the heart drives the arterial
system. It is more passive, relying on valves to prevent retrograde
flow. When these valves are incompetent, hydrostatic pressure
gets transmitted to surface veins and subcutaneous tissues giving
rise to the secondary effects of ambulatory venous hypertension
and symptomatic varicose veins.
vein therapy, endovenous laser ablation and ultrasound guided
foam sclerotherapy.
Most women take years after pregnancy to seek treatment for
their post-partum venous reflux. While this may be due to a focus on their babies and toddlers, it more likely reflects the fact
that it takes time for the valvular reflux created during pregnancy
to translate into the ambulatory venous hypertension that causes
symptoms from venous insufficiency. Symptoms are wide ranging
and include prominent palpable varicosities that become painful
and tender, generalized leg pain, tiredness, heaviness, and aching in the legs. A progressive disease, venous insufficiency often
culminates in leg swelling, sclerotic skin changes around the calf
region and the very tender maleolar complex known as corona
phlebectasia if left untreated.
The events of pregnancy create irreversible changes in a woman’s vein valve leaflets and forever destroy normal venous flow.
When these valve leaflets become weakened, or incompetent, venous reflux occurs and creates ambulatory venous hypertension.
There is a great deal of evidence in the Obstetric literature that
even before the hydrostatic pressures of pregnancy take hold,
the hormonal milieu of pregnancy has a degradative effect on the
integrity of the vein valve leaflets. As early as the first trimester
of pregnancy, long before the hydrostatic pressures are ever exerted, vein valve dysfunction begins. The weight gain, fluid shifts
and gravity effects that take place later during the pregnancy only
serve to make the impaired venous return exponentially worse.
A particularly harsh form of pregnancy related venous reflux
comes in the form of vulvar or labial varicosities. The elevated
venous pressure in these cases is multifactorial, stemming from
sapheno-femoral venous reflux, perineal venous reflux, and pelvic
venous reflux through the ovarian veins and the pelvic circulation. Symptoms from these veins can be quite debilitating, especially during the congestion of menstruation, or during sexual
activity. Luckily, these veins are amenable to minimally invasive
VEIN & VASCULAR
Unfortunately, women have difficulty accessing the healthcare system for vein treatment because of inherent biases amongst physicians
and patients alike that these problems are not serious enough to warrant therapy. Frequently, women use their Ob-Gyn as their primary
care and feel uncomfortable or inappropriate speaking to their OB about their legs. As providers, many Ob-Gyn physicians don’t feel
comfortable initiating the venous insufficiency conversation or referral. Consequently, many women with post-partum venous insufficiency never get to treatment.
Venous reflux is a progressive problem that does not correct itself. While conservative measures such as compression therapy and
weight management will control the side effects, they do nothing to address the underlying disease process. Subsequent pregnancies will
only serve to worsen the problem, so it makes no clinical sense to wait until all intentions of subsequent pregnancies are complete. The
recurrence rate of symptomatic venous reflux, even in the face of multiple subsequent pregnancies, is quite low when treated appropriately at the outset.
Minimally invasive vein therapy in the form of endovenous saphenous and perforator vein ablation coupled with ultrasound guided
foam sclerotherapy remains the state of the art method to eliminate the core problem of venous reflux and provide women long term
relief from the deleterious effects of venous hypertension.
John D. Horowitz, M.D. is Board Certified in both Vascular Surgery and Phlebology and is uniquely trained to offer patients
the most advanced vein care possible. He graduated a member of the AOA Honor Medical Society from Temple University
School of Medicine in 1986, from Temple University Hospitals General Surgery Residency in 1991, and from The Ohio State
University Hospitals Vascular Surgery Fellowship in 1993. Dr. Horowitz is an active member in many nationally recognized
societies including the Southern Vascular, Florida Vascular and Society for Vascular Surgery, as well as the American College of
Phlebology. He is nationally renowned for his innovative practice of Minimally Invasive Vein Therapy, has presented his work
at many national society meetings and has authored numerous journal articles and book chapters. The Central Florida Vein
and Vascular Society is routinely used as a training site for physicians seeking to learn Minimally Invasive Vein Therapy. Dr.
Horowitz may be contacted at 407-293-5944 or by visiting www.cfvein.com. 
Celebrating 40 Years
of Orthopaedic Excellence
Orthopaedic
Thank You for Allowing Us to Serve You and Your Family!
Foundation
Visit www.OrlandoOrthoFoundation.org
to see one of the many ways we
are thanking our community for 40 years
of success in Central Florida.
Digestive and Liver Update
Clinical Features and Diagnosis
of Malabsorption (Part 1)
By Harinath Sheela, MD
INTRODUCTION
Malabsorption refers to impaired absorption of nutrients . It
can result from congenital defects in the membrane transport
systems of the small intestinal epithelium or from acquired defects in the epithelial absorptive surface. Another factor that can
interfere with nutrient absorption is maldigestion, which is due
to impaired digestion of nutrients within the intestinal lumen or
at the terminal digestive site of the brush border membrane of
mucosal epithelial cells.
Although malabsorption and maldigestion are pathophysiologically different, the processes underlying digestion and absorption
are interdependent. As a result, in clinical practice the term malabsorption has come to denote derangements in both processes.
Three steps are required for normal nutrient absorption:
• Luminal and brush border processing
• Absorption into the intestinal mucosa
• Transport into the circulation
CLINICAL FEATURES
The clinical features of malabsorption depend upon the cause
and severity of the disease. Malabsorption may either be global or
partial (isolated).
• Global malabsorption results from diseases associated with
either diffuse mucosal involvement or a reduced absorptive
surface. An example is celiac disease in which diffuse mucosal
disease can lead to impaired absorption of almost all nutrients.
The classic manifestations of global malabsorption are diarrhea
with pale, greasy, voluminous, foul-smelling stools and weight
loss despite adequate food intake. However, this spectrum of
findings is relatively uncommon, even with generalized mucosal disease. The majority of patients have relatively mild gastrointestinal symptoms, which often mimic more common disorders such as irritable bowel syndrome. In some cases, anorexia,
flatulence, abdominal distension and borborygmi may be the
only complaints suggesting malabsorption; other patients may
be asymptomatic. Clinical manifestations related to a specific
micronutrient deficiency can predominate in some patients. As
an example, iron deficiency anemia or osteopenia may be the
only clue to the presence of celiac disease in some patients. • Partial or isolated malabsorption results from diseases that interfere with the absorption of specific nutrients. Defective cobalamin absorption, for example, can be seen in patients with
pernicious anemia or those with disease (or resection) of the
terminal ileum such as patients with Crohn’s disease.
Isolated forms of malabsorption may present solely with symptoms that are attributable to the particular nutrient in question.
Thus, the only evidence of malabsorption may be a low serum
concentration of vitamin B12 in patients who have pernicious
anemia.
• DIAGNOSIS — The etiology of malabsorption can often be
obtained from a detailed patient history, which can also exclude
other causes of symptoms. As an example, a history of intestinal
resection or chronic pancreatitis may suggest the diagnosis in
patients with characteristic symptoms.
Because symptoms may be absent or mimic other diseases, a
routine battery of blood tests is often helpful as an initial step
when malabsorption is suspected. Blood tests alone cannot establish a diagnosis of malabsorption but can provide supportive
evidence. Furthermore, deficiencies of specific nutrients and vitamins may point towards the underlying cause and its duration .
Several invasive and noninvasive tests are available to establish
the cause of malabsorption. The malabsorption of fat is the most
commonly used indicator of global malabsorption for two reasons: (1) among the macronutrients (fat, carbohydrates, and protein), the process by which fat is absorbed is the most complex
and, therefore, it tends to be the most sensitive to interference
from disease processes; and (2) it is the most calorically dense
macronutrient and, therefore, its malabsorption is a critical factor in the weight loss that often accompanies malabsorptive disorders. If the history suggests a particular cause, testing can be
directed to confirm the diagnosis. Further testing may not be necessary in patients who have gross steatorrhea (increased fecal fat
excretion) with an obvious cause (such as cystic fibrosis or short
bowel syndrome).
The order of testing and choice of a particular test should be
individualized while considering the availability and expertise
needed for specialized testing. While many tests are established
as gold standards for the diagnosis of particular forms of malabsorption, new tests continue to be developed and their diagnostic
characteristics remain uncertain.
Thus, optimal strategies for diagnosis are still evolving. An approach to patients with suspected malabsorption was proposed in
a guideline issued by the World Organisation of Gastroenterology. Our general approach is as follows:
• We obtain an assessment of stool fat. As a general rule, we begin
with a qualitative assessment of fecal fat on a single specimen
since it is easier to perform. We proceed with a quantitative
assessment of a 72 hour stool collection on a 100 gram fat/day
diet if the qualitative is negative and clinical suspicion remains
high. In those with increased fecal fat, we proceed with serologic testing for celiac disease and fecal elastase determination to exclude
maldigestion due to pancreatic insufficiency.
• Abdominal ultrasonography of the small and large intestine is not used commonly in the United States where a small bowel followthrough, abdominal computed tomography (CT) scan, magnetic resonance enterography, or endoscopy tends to be preferred as the
initial imaging modality.
• We perform a colonoscopy with intubation of the terminal ileum. A sigmoidoscopy may be sufficient in younger patients (<45) since
the yield is similar to colonoscopy (except if Crohn’s disease is suspected).
• We obtain additional testing if a specific cause is obtained on the history or physical examination. By contrast, further testing may not
be needed in patients who have gross steatorrhea with an obvious cause (such as cystic fibrosis or short bowel syndrome). Nevertheless,
when evaluating diarrhea in short bowel syndrome, it is particularly important to perform sufficient diagnostic tests to distinguish
between diarrhea arising from fat malabsorption (steatorrhea) and diarrhea arising from the malabsorption of bile acids, since the
management of these two conditions is diametrically opposite in many respects.
Imaging tests — In many cases, evaluation of malabsorption begins with endoscopy and/or barium studies.
Endoscopy and pancreatic imaging —
The gross morphologic appearance on upper
gastrointestinal endoscopy may suggest the
presence of malabsorption but an intestinal
biopsy provides the essential diagnostic information. A cobblestone appearance of the
duodenal mucosa is seen in Crohn’s disease,
Validated Quality
International Academy of
Compounding Pharmacists
while reduced duodenal folds and scalloping of the mucosa may be evident in celiac
disease. The unusual finding of multiple
jejunal ulcers may indicate the presence of
jejunoileitis or lymphoma. Use of vital dyes
may be helpful in evaluating patients with
celiac disease with partial villous atrophy
since the abnormalities can be patchy and
the duodenum may appear normal during
standard endoscopy. Indigo carmine dye
spraying is more accurate for identifying
patients with partial atrophy than standard
endoscopy (91 versus 9 percent in one series), and is also useful for directing biopsies
in patients with patchy villous atrophy.
Small bowel biopsy is safe and can help
establish the diagnosis. Tissue should be obtained distal to the ampulla of Vater using
biopsy forceps passed through a gastroduodenoscope or enteroscope. Obtaining four
biopsies at different sites optimizes the like• Now accepting your toughest
lihood of obtaining a diagnosis.
patient or medication challenge
Imaging of the pancreas by CT, endo• Personalized Medicine
scopic retrograde cholangiopancreatography
• Community Clinical Pharmacy
(ERCP), magnetic resonance cholangiopancreatography (MRCP), or ultrasonography
• A Drug Shortage Resource
may be helpful in the diagnosis of chronic
pancreatitis and may be critical for distinFor more information please call
guishing benign from malignant causes. Sequential dilation and sacculation of the pancreatic duct are pathognomonic of chronic
or visit us at 393 Maitland Avenue,
pancreatitis of chronic pancreatitis.
However, a normal ERCP does not exAltamonte Springs, FL 32701
clude the presence of pancreatic exocrine
www.makerx.com
insufficiency. Direct pancreatic intubation
tests, such as the secretin stimulation test,
Central Florida’s ONLY
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still constitute the most sensitive means of diagnosing pancreatic
insufficiency in centers in which it is performed accurately (sensitivity and specificity of approximately 80 to 90 percent). The
test involves intubation of the duodenum and the collection of
pancreatic juices after intravenous secretin injection.
Barium studies — An upper gastrointestinal series with small
bowel follow-through or enteroclysis (a double contrast study
performed by passing a tube into the proximal small bowel and
injecting barium and methylcellulose) can provide important information about the gross morphology of the small intestine. As
an example, identification of small bowel diverticula and other
anatomic abnormalities associated with bacterial overgrowth is
best achieved with barium studies. Barium studies can also identify mucosal diseases that are not easily accessible by endoscopy.
Although it is generally accepted that the radiologic findings in
malabsorption are nonspecific, barium studies can be effective
at identifying the disease process responsible for the malabsorption.
Wireless capsule endoscopy — Wireless capsule endoscopy
allows for visualization of the entire small bowel and allows for
much more detailed evaluation of small bowel mucosal disease
than barium studies. Thus, it may have a role in evaluating suspected small bowel disease (such as Crohn’s disease) associated
with malabsorption. Because of the risk of retention, wireless
capsule endoscopy should generally be avoided in patients with
known or suspected small bowel strictures.
SUMMARY AND
RECOMMENDATIONS
•The clinical features of malabsorption depend upon the cause and severity of the
disease .
•The etiology can often be obtained from
a detailed patient history, which can also
exclude other causes of symptoms. As an
example, a history of intestinal resection or
chronic pancreatitis may suggest the diagnosis in patients with characteristic symptoms. Deficiencies of specific nutrients and
vitamins may also identify the underlying
cause and its duration.
•Because symptoms may be absent or mimic other diseases, a routine battery of blood
tests is often helpful as an initial step when
malabsorption is suspected, although
blood tests alone should not be considered
as being sufficient to establish a diagnosis.
•Several invasive and noninvasive tests are
available to establish the cause of malabsorption. If the history suggests a particular cause, testing can be directed to confirm
the diagnosis. Further testing may not be
necessary in patients who have gross steatorrhea (increased fecal fat excretion) with
an obvious cause (such as cystic fibrosis or
short bowel syndrome).
•The order of testing and choice of a particular test should be
individualized while considering the availability and expertise
needed for specialized testing. While many tests are established
as gold standards for the diagnosis of particular forms of malabsorption, new tests continue to be developed and their diagnostic characteristics remain uncertain. Thus, optimal strategies for
diagnosis are still evolving. Our approach is described above.
Harinath Sheela, MD moved to Orlando, Florida after
finishing his fellowship in gastroenterology at Yale University School of Medicine, one of the finest programs in the
country. During his training he spent significant amount
of time in basic and clinical research and has published
articles in gastroenterology literature.
His interests include Inflammatory Bowel Diseases
(IBD), Irritable Bowel Syndrome (IBS), Hepatitis B,
Hepatitis C, Metabolic and other liver disorders. He is a
member of the American Gastroenterological Association
(AGA), the American Society for Gastrointestinal Endoscopy (ASGE) and the American Association for the Study
of Liver Diseases (AASLD) and Crohn’s Colitis foundation
(CCF). Dr. Sheela is a Clinical Assistant Professor at the
University of Central Florida School of Medicine. He is
also a teaching attending physician at Florida Hospital Internal Medcine Residency and Family Practice Residence
(MD and DO) programs. 
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FERTILITY
The Future of Robotic Microsurgical
Training – New Advances at Winter
Haven Hospital
By Sijo J. Parekattil, MD
What is Robotic Assisted Microsurgery?
Robotic assisted surgery has had a tremendous impact in surgical procedures such as the removal of the prostate for prostate
cancer and for kidney cancer surgery. The benefits for the patient
are related to a possible quicker recovery and smaller incisions.
Robotic assistance may aid surgeons in performing these otherwise complex procedures in a minimally invasive manner. Under
the direction of Sijo J. Parekattil, M.D., the only dual fellowship
trained robotic and microsurgery urology specialist in the country, a new robotic microsurgery collaborative program has been
created between Winter Haven Hospital and the University of
Florida. This robotics program has developed new robotic assisted microsurgical procedures to help in treating conditions such
as male infertility and chronic testicular or groin pain. These
new procedures utilize the robotic platform instead of a pure
microsurgical platform to provide enhanced magnification, scaling of motion and elimination of tremor for extremely complex
microsurgical procedures. This center is the leading program in
the world performing such robotic assisted microsurgery – over
700 procedures have been performed so far (the largest experience of this kind in the world).
What kinds of treatment options are
available with this new technology?
Some of the procedures being performed are:
1)Robotic assisted microsurgery for vasectomy reversal and congenital obstruction repair (such as cystic fibrosis vasal obstruction)
2)Robotic assisted microsurgical varicocelectomy for the treatment of varicoceles in men
3)Robotic assisted microsurgical testicular sperm extraction (Robotic Micro TESE) to detect and collect sperm from the testicle in men who have no sperm in the ejaculate
4)Chronic testicular and groin pain – novel robotic assisted microsurgical targeted neurolysis or denervation of the spermatic
cord to treat this condition
How can surgeons be trained to acquire
these new Robotic Microsurgery Skills?
This article is going to focus on some new research work at
Winter Haven Hospital & the University of Florida on the development of two new training models for surgeons who would
like to acquire robotic microsurgical skills.
a) A Novel Synthetic Vas Deferens Model
for Microsurgical Training
Microsurgical vasectomy reversal is a technically challenging
procedure. Our current training models for microsurgical skills
training for this procedure include live rodent and cadaver vas
deferens models – both of which are expensive and require appropriate training lab facilities. The goal of this study was to develop
an inexpensive, easily accessible synthetic vas deferens (SVD)
model for microsurgical skills training.
Methods: A synthetic vas deferens (SVD) model was developed based on an inexpensive hydrocarbon material (SynDaver
Labs, Tampa) as shown in Figure 1. Mechanical tissue shear and
puncture properties where modeled to mimic human vas deferens
tissue. The shape, diameter and lumen size was based on 6 human vas deferens samples. The new model was then tested on 21
trainee microsurgeons during a hands-on microsurgical training
FERTILITY
lab. Measures recorded where ease of use, tactile similarity to human vas and suturing ability.
Results: Mean width and wall thickness for the human vas was
5.08mm and 1mm, respectively. For SVD, 5.08mm and 2mm,
respectively. For shear (break point) testing, the mean break stress
was 12.07psi for SVD and 12.16psi for human vas (statistically
similar). For puncture testing (1mm blunt needle inserted into
tissue at 50mm/min), the mean peak load for 7 SVD samples
was 9.71N, and 14.53N for 6 human vas samples (p = 0.02).
During the 21 microsurgeon trainee lab, all the surgeons reported
ease of use, tactile sensation similar to human vas and ability to
suture an anastomosis similar to human vas. There were 3 minor
complaints: 1) lack of consistency of the vas lumen size along the
length of the SVD in some samples, 2) diffusion of the microdots
placed on the transected SVD surface (used during the microdot
vasovasostomy technique), and 3) difficulty in securing the SVD
to the vasovasostomy holder in some cases where the SVD outer
lining was very smooth and slippery.
Conclusion: The preliminary results in the mechanical and
clinical testing of the synthetic vas deferens model appear promising. Further refinements to the model have been made based
on the above feedback. This model may provide a very cost-effective, portable alternative to our current microsurgical training
models.
b) Robotic Assisted LEGO® construction as
a model for Robotic Microsurgery Skills
Training
The application of robotic assisted microsurgery has been expanding over the last few years. However, there are limited structured training protocols for robotic microsurgical skill development. The existing microsurgical training models (rodent and
cadaver models) are also quite tedious and expensive. Our goal
was to assess the use of robotic assisted Lego construction for
robotic microsurgical skills training and compare it to our current standard.
Methods: 10 trainees (6 medical students and 4 urology residents) were enrolled in the study (all where robotic surgery naïve).
The trainees where randomized into two arms: 1) a test group and
2) a control group. The test group performed 5 sessions: 1 robotic assisted microsurgical vasovasostomy on a biosynthetic vas
deferens model (anastomosis with 4 double armed 10-0 nylon
sutures using microdot technique) – this was the pre-training test
procedure, 3 training sessions where the trainee built a 77 piece
Empire State Building Lego® set to completion with robotic assistance using all 3 instrument arms, and then a final test session
vasovasostomy on the vas deferens model. The control group also
performed 5 sessions: they performed 5 repetitive robotic assisted
vasovasostomy procedures on the vas deferens model – an initial
pre-training test anastomosis, 3 training vasovasostomy sessions
and then a final test anastomosis. The pre-training vasovasostomy
was then compared to the post-training vasovasostomy for all
trainees: duration, number of sutures used, suture breaks, needle
bends, distance between suture placement and microdot where
compared (a scoring methodology was developed).
Results: The mean pre-training vasovasostomy measures did
Figure 1. Synthetic vas deferens during robotic assisted microsurgical
vasovasostomy training.
Figure 2. Robotic Assisted Lego® Construction Training
not differ significantly between the Lego® and control arms.
Mean duration of the anastomosis before and after training was
64.5min and 28.3min (Lego® test group); 88.5min and 34min
(control group), respectively. Mean number of sutures used, needle bends and suture breaks significantly decreased after training in both arms. The mean quantitative scores of the first test
anastomosis were 2 (Lego® group) and 0.5 (control group). These
scores improved after training to 10.25 (Lego® group) and 5.5
(control group). The score improvement after training did not
differ significantly between the Lego group and the control group
(p = 0.25).
Conclusion: Although this is a small sample size, this preliminary study appears to indicate that robotic assisted Lego® construction may provide a comparable training model to develop
robotic assisted microsurgical skills.
Sijo J. Parekattil, MD, is Director of Urology & Robotic
Surgery for Winter Haven Hospital and University of Florida, Winter Haven, FL, and is an Assistant clinical professor of Urology and an Adjunct professor of Bioengineering.
He has dual fellowship training from the Cleveland Clinic
Foundation, Cleveland in Laparoscopy/Robotic Surgery
and Microsurgery and was an Electrical Engineer prior
to his medical training and thus has interests in surgical
techniques incorporating technology, robotics and microsurgery. Dr. Parekattil also runs a dedicated Male Infertility and Groin Pain/Testicular Pain Clinic at Winter Haven
Hospital, Winter Haven (863-292-4652 or www.roboticinfertility.com) As an infertility patient himself at one point,
he is truly dedicated to these patients. He may also be contacted at [email protected]. 
Proactive Pointers to Fight
Small Business Fraud
Preventive safeguards can protect business finances and relieve anxiety
By Joe Rusnic
Attention medical practice owner: What measures are you taking to protect your practice from fraud?
According to a 2010 report from the Association of Certified
Fraud Examiners (ACFE), incidents of occupational fraud are 31
percent more likely to occur at small businesses as opposed to
larger companies. To add insult to injury, as many as 40 percent
of small businesses owners are embezzlement victims, and a staggering one-third of all bankruptcies are the direct result of internal theft.
More alarmingly, a recent TD Bank Small Business survey
found that although nearly three-quarters of American small
business polled are incorporating some steps to protect their business, only one percent of respondents cite falling victim to fraud
as a top business concern, even as cases of criminal fraud are on
the rise.
Here are five proactive steps you can take immediately to help
prevent fraud. Remember, the best defense is a good offense!
While conducting business online, be aware of “phishing” - an
electronic scam that attempts to obtain confidential personal or
financial information from its target. It takes the form of a fake
message, usually an email, which appears to be from a financial
institution or service provider. While some emails are easily
identified as fraudulent, including some containing enticing
headlines, others may appear to come from a legitimate address.
Never reply to any email or pop-up message that requests you to
update or provide personal information.
Manage finances using secure online
banking.
The web isn’t the only place where thieves can steal valuable
information. Some of your own employees and outside parties
can steal important mail, credit card information or checks and
commit fraud.
Printed financial statements, social security numbers and other
sensitive papers should be disposed properly using a shredder or
saved in a securely locked device. To avoid the hassle of handling
several papers, banks such as TD Bank allow customers to opt out
of paper statements and receive online statements instead.
Technological advances have even put photocopiers at risk.
Most photocopiers built since 2002 contain a hard drive that
stores every image scanned, copied or emailed. When a business
sells or upgrades their copier, the machine is usually cleaned up
and reconditioned, but often times the hard drive is left intact
and isn’t scrubbed.
Once resold, it’s possible for anyone to simply pop out the hard
drive, and access and sell confidential information, such as income tax and bank records, social security numbers, and birth
and medical records.
Treat documents in the standard office copier just as they would
any printed document, and guard that information accordingly.
Banks and other financial institutions are at the forefront of
developing and using security measures that help ensure financial
information remains confidential and safe.
Online banking is a secure and essential tool for any small business owner. The benefits of this useful service include 24/7 access
to real-time information, account transfers and payment management. You can easily schedule and manage your payments,
submit remittance information, and have an audit trail of all
transactions.
It’s important to check your account activity regularly. Having
instant access to your history helps you closely monitor your account for any discrepancies. If you see any, contact your financial
institution immediately.
Many banks, including TD Bank, also offer free (and secure)
online bill pay – saving you money on postage costs and mitigating the chance of a paper check being lost or stolen in the mail.
Protect computer systems and
practice online awareness.
Being complacent about cyber protection can lead to the compromise of critical information and detrimental consequences
for your business. Every computer at home and in the office
should have installed and regularly updated firewalls and antivirus software.
Given the influx of new digital technologies and operational
tools available for small business owners, it’s increasingly important to learn about the latest trends and techniques used by cyber
criminals. If an offer received via email or on a website sounds too
good to be true, it probably is!
Safely handle sensitive documents and
financial statements.
Obtain fidelity insurance.
Crime and fraud-related losses generally aren’t covered by
property insurance policies. As a result, it’s important to protect
money losses from workplace fraud.
Fidelity insurance protects your business against criminal acts
such as robbery, embezzlement, forgery and credit card fraud.
Liabilities secured under this type of insurance usually include
money loss coverage (burglary or theft) and employee dishonesty
(embezzlement and forgery).
According to the ACFE, 80 percent of workplace crime and
abuse is performed by employees. Tough economic times often result in increased incidents of fraud and embezzlement. Although
fidelity insurance means an additional cost for your business, it
will save a lot of headaches should your business fall victim to
workplace fraud.
Search for low rates and partner with a broker who can help
you shop for the best deal. For instance, TD Insurance can offer an affordable and comprehensive solution for small business
owners, including protection of property, general liability and
umbrella liability.
If you think you’re a victim of business fraud, immediately
contact the fraud department of any of the three major credit
bureaus to place a fraud alert on your credit file. Also, contact
your banks, credit card issuers and other creditors where your
finances and information are available. TD Bank works hard
with its customers to prevent fraud and takes several measures to
protect your privacy. Visit our Online Security Center for more
tips at www.tdbank.com/security.
Following these five preventive tips will help protect your
finances and allow you to focus on the success of your business!
Joe Rusnic is Regional Vice President of TD Bank. He
may be contacted by email at [email protected] or by
calling 407-622-3536. 
Incorporate appropriate checks and
balances.
Every small business owner should perform an internal review
and assessment of company finances on a monthly basis. Make
sure payment amounts match all invoices and check for any
missing documents. Running random audits or having a third
party audit your books once a year will show your employees
you are serious about fraud and deter them from committing
deceptive acts.
Looking to reach doctors by direct mail
or email broadcast? Call (407) 417-7400
or email [email protected]
Jon Wiese, MD
BRINGING SPECIALIZED
HEALTHCARE TO OVIEDO
Backed by the strength of South Seminole Hospital, the expert team at
Orlando Health Physician Specialists provides Oviedo residents general
surgery and pulmonology services in a location that is convenient and
close to home.
Jon Wiese, MD, specializes in general surgery, including laparoscopic
and other minimally invasive procedures, hernia repair, gallbladder and
other surgeries. Antonio Rodriguez, MD, specializes in pulmonology,
including the treatment of asthma, COPD, sleep disorders and other
respiratory conditions.
Accepting
New
Patients
Both physicians are accepting new patients at the Oviedo location, as well
as at their established Longwood practices. For more information, please
call 321.842.3300.
Antonio Rodriguez, MD
Orlando Health Physician Specialists
1000 W. Broadway St., Ste. 105-A
Oviedo, FL 32765
southseminolehospital.com/oviedo
11-ORS-035 FLORIDA MD MAGAZINE JAN.indd 1
12/22/11 5:45 PM
Barrett’s Esophagus:
A Pre-Cancer Condition
By Irteza Inayat, MD
Barrett’s esophagus is caused by chronic gastroesophageal reflux
disease (GERD). Left untreated, Barrett’s esophagus may progress to high-grade dysplasia and, in approximately 1% of cases to,
esophageal adenocarcinoma. Up to 40% of the US population
have symptoms of GERD at least once per month. Up to 20% of
patients sent for EGD for GERD symptoms will have Barrett’s
esophagus. Prevalence estimated to be close to 7% in the general
population of patients >50. Short segment Barrett’s is more common than long segment. 5.2% of patients did not have GERD
symptoms.
SCREENING RECOMMENDATIONS FOR
BARRETT’S ESOPHAGUS
I. History of GERD > 5 years
II. White Race
III. Male Sex
IV. Age >50
V. Family History of Barrett’s / EAC
Gastroesophageal reflux disease (GERD):
“Symptoms or mucosal damage produced by the abnormal reflux of gastric contents into the esophagus.”
Barrett’ Esophagus (BE): A condition in which the stratified
squamous epithelium lining the esophagus is replaced by specialized intestinal-type columnar epithelium.
Esophageal Adenocarcinoma (EAC):
• The incidence of EC has increased by 500% since 1970’s
• Highly lethal with a 5-year survival rate of <15%
• Barrett’s esophagus increases the risk of developing esophageal
cancer 50-fold
Treatment Options
• Medical Rx: All patients should be on PPis
• Surgery: High morbidity (64%) and mortality (6%)
Dr. Irteza Inayat can be reached at Osceola Regional
Medical Center, 700 West Oak Street, Kissimmee, FL 34741, 407-846-6747. For more information please visit
our website at www.OsceolaRegional.com. 
•Endoscopic Therapy (Radiofrequency Ablation- RFA)
BÂRRX® Radiofrequency ablation (RFA) procedure is an
outpatient procedure that entails standard flexible esophagoscopy. With application of RFA energy to ablate the Barrett’s tissue
with precise depth and takes about 30 minutes. There is subsequent re-growth of normal squamous esophageal mucosa, when
coupled with medical or surgical control of acid reflux. RFA has
been shown to obliterate non-dysplastic Barrett’s mucosa and restore a normal squamous mucosa with five year follow up. Goals
of RFA therapy are:
• Elimination of the entire at risk mucosa
• Decrease the need for frequent surveillance
• Minimize complications: Recurrence, strictures, bleeding, etc
BÂRRX® Radiofrequency Ablation Procedure
Medical Malpractice Expert Advice
CLOSING THE MALPRACTICE COVERAGE GAP:
Carrying Separate Entity
Coverage For Your Practice
By Matt Gracey and Dan Reale
Danna-Gracey – The Malpractice Insurance Experts
Many physicians are not aware of the importance and relatively
low cost of purchasing separate-entity coverage for their practice.
A separate-entity layer of coverage can protect the physician from
a recorded loss if the claim can be settled under separate-entity
coverage. This is a real advantage if the physician can avoid having a practice entity claim counted against them. Separate-entity
coverage can save the physician a great deal of time, frustration,
the risk of much higher premiums, and/or even cancellation of
their coverage altogether. The benefits of this low-cost supplemental coverage should not be overlooked if you wish to avoid
the old adage of being caught “penny wise and pound foolish.”
Physicians have a difficult task in determining how much malpractice coverage they need to protect them from a claim. Ideally,
your limits of insurance should be adequate to cover you and
your practice in any “worst case” event. Those who simply look
for the lowest premium amount force more personal risk upon
themselves than they bargained for - or rather, failed to bargain
for. Because each practice is unique, you should discuss whether
you carry adequate insurance, along with all the coverage available to you, with a licensed and professional insurance agent on
a regular basis.
Malpractice insurers typically offer a “shared” limit of coverage
for the entity at little or no extra premium charge. Shared-entity
coverage forces the named insured physician(s) to share their individual coverage limit with the practice entity. Every malpractice
policy should identify the registered practice name along with
each physician regardless of whether you have a shared or separate
limit of coverage for the practice entity.
The premium amount to purchase separate-entity coverage
is roughly 10% – 30% of the physician’s annual premium rate.
Larger physician groups are more likely to be charged near 10%
of each physician’s annual premium rate. Separate-entity coverage
will usually stack onto the physician’s individual coverage, where
the premium rate is often less than if you chose to purchase higher
individual coverage limits. This is why we recommend purchasing separate-entity coverage and benefiting from stacking your
coverage before you consider purchasing higher liability limits.
Consider that an estimated 2/3 of all malpractice cases arise
from “communication” errors rather than from a missed diagnosis or surgical error by the physician. If the claim is not directly attributed to the physician, then this is often referred to as
Matt Gracey
Dan Reale
a “back office” type claim. Carrying separate-entity coverage will
often satisfy a back-office claim without requiring the physicians’
individual coverage assistance. This can also relieve the physician
from having a report filed against them with the National Practitioner Data Bank (NPDB). Moreover, the physician may retain
their loss-free premium discount rather than paying a higher premium surcharge or possibly avoid being cancelled all together.
Many insurance carriers will stack the entity limit onto the physician’s individual coverage limit when both are named in a claim
or lawsuit. For example, a $250,000 individual physician’s limit
may stack onto a separate-entity limit of $250,000 and bring a
combined $500,000 liability limit to settle the claim. There is the
possibility that the physician’s coverage may not be required and
they may be insulated from a back-office-type claim described
above. There is also the possibility that both the physician’s limit
and the entity limit are required to settle the claim. Simply put,
these significant advantages are available only when separate-entity coverage is purchased for the practice.
At the bottom of this article are a few common claim scenarios
in which physicians neglected to carry separate-entity coverage
and experienced serious consequences as a result. Many physicians were led to believe the common falsehood that by limiting
their malpractice coverage they would become less of a target for
lawsuits. First, you cannot insulate your practice from a lawsuit
for any reason (except under sovereign immunity for non-profits). The risk of a lawsuit being made has never changed regardless if there is inadequate coverage or no coverage at all. Plaintiff
attorneys are making a much more proactive stand now by taking
action to make examples of physicians who do not carry adequate
coverage. Some physicians are simply willing to take on more personal risk than others, but it is best to know all the options that
are available to you in any case.
Since malpractice rates have fallen to their lowest level in years,
you can now shop for coverage bargains rather than leaving a gap
in your coverage. You may be surprised how low premium cost
can be to close any coverage gap. Of course, nobody wishes to be
caught “penny wise and pound foolish” and then be forced into
these difficult outcomes described below.
Common Claim Scenario #1 – A patient fails to receive a
Medical Malpractice Expert Advice
problematic test result because it never reached the physician and was not discovered until many months later. If there is only shared entity coverage (not separate), then the claim must be settled by the physician’s individual limit and reported against them with the NPDB.
The physician will likely lose their claim-free discount, pay an additional premium surcharge, or maybe have their coverage cancelled
altogether. This is how a physician may be forced into the non-standard, secondary insurance market where the premium cost is greater
for limited insurance coverage. Had the physician carried separate entity coverage, then the claim might have been resolved without
requiring the physician’s individual coverage, the penalty of higher premium, and/or a report to the NPDB might have been avoided.
Common Claim Scenario #2 – A licensed practice employee is sued along with a supervising physician when the physician carries
only shared entity coverage. Again, there is no separate entity coverage to manage the claim and any liability must be charged against one
or more of the physician’s individual coverage limits. In a recent claim it was necessary to charge a second physician that was not involved
with the patient simply because the first physician’s coverage limit was not sufficient to settle the claim. Although the second physician
never actually saw the patient, their premium was increased along with the first primary physician because both policies were needed to
1 6/30/11 10:57 AM Page 1
settle the claim. The second physician absolutelyfl-md-jewett-july_Layout
would not have been involved
if separate entity coverage had been available.
Danna-Gracey is an independent
malpractice insurance agency with offices located in Delray Beach, Orlando,
Jacksonville & Miami. Our insurance
specialists can be reached anytime by
contacting our toll-free number at 1800-966-2120. 
"Jewett made my family
feel like we were part
of their family."
Looking to
reach doctors
by direct mail or
email broadcast?
Call (407) 417-7400
or email
[email protected]
Coming Next Month:
The cover story focuses on the OB
Hospitalists and the new OB ED at
Halifax Health in Daytona Beach.
There is also a special feature about
Olga Ivanov, MD and Florida Breast
Health Specialists at Celebration Health.
Editorial focuses on Women’s Health
and Advances in Cosmetic Surgery.
Go to www.jewettortho.com
and see the O’Lenick’s full story
Jewett has a WALK-IN to make your summer easy
and stress free!
No appointment necessary!
Monday - Thursday: 7:30am - 8:00pm
Friday: 7:30am - 4:00pm
Saturday: 9:00am - 3:00pm
Stirling Center
701 Platinum Point
On Rinehart Road
Lake Mary, FL 32746
407.206.4500
www.jewettortho.com
A tradition of care powered by innovation
PHARMACY UPDATE
DRUG SHORTAGES
By Sam Pratt, RPh
Voltaren (Diclofenac Gel 1%) -- currently unavailable, manufacturer backorder.
Endo is the sole supplier of Voltaren gel and they cannot provide a reason for the shortage. No product is available and the
company cannot estimate a release date.
Messages and alerts like this are becoming all too common
these days. When a commercially available medication becomes
unavailable it causes an interruption in therapy, compromises or
delays medical procedures, medication errors when trying to find
an alternative. There has been a steady supply decline for about
15 years and building over time. Some of the problems began in
the mid-1990’s when hurricanes hit Puerto Rico and knocked
out several drug manufacturing facilities. There have also been
many drug company mergers recently which results in a smaller quantity of medication available and certain medications are
eliminated altogether. Some point a finger to government policies that drive down reimbursement for old-line generics, which
discourages pharmaceutical industry investment in low-profit
therapeutic categories that are difficult to produce. Whatever the
reason may be, this is not a short term issue. We need to find
alternative sources or solutions for these drug shortages.
In order for hospitals and retail pharmacies to meet their patient’s needs they now have to rely on outside sources or attempt
to compound the items themselves. To do this in their facility
they would have to buy the raw chemical, make it from scratch,
bottle it, and have it tested. That requires having more staff, training them and becoming USP Chapter 797 certified to prepare
sterile products.
Compounding pharmacies do this every day. We are trained,
certified and have the raw ingredients necessary to make many
items that are currently unavailable from the manufacturer.
Voltaren Gel is just one of those products. Compounding pharmacies specialize in personalized, custom medications for each
patient. David G. Miller, RPh, president of the International
Academy of Compounding Pharmacies said, “Compounding
pharmacies play a vital role in filling the gaps that drug shortages
produce and they continue to be a vital resource for our nation’s
health care system.”
ASHP has warned hospitals to beware of compounding pharmacies, stating; “Caution is warranted because preparations from
these pharmacies may not meet applicable state or federal standards (e.g., United States Pharmacopeia chapter 797 or FDA
labeling requirements). The sources of raw materials used by compounding pharmacies have been questioned, and apparent lapses
in quality control have resulted in serious patient injury, including death.”
Pharmacy Specialists is proud to be the only pharmacy in
all of Central Florida and one of only 129 pharmacies in the
country that are accredited by the Pharmacy Compounding Accreditation Board (PCAB). We meet or exceed ALL standards for
sterile as well as non-sterile compounding and we are the only
USP <797> and USP <795> validated compliant pharmacy in
all of central Florida.
Are any of these drug shortages affecting your patients: nystatin 100,000U suppositories, levothyroxine sodium (T4)/liothyronine (T3), ergotamine tartrate 1mg/caffeine 100mg, paregoric (alternate), midazolam injection? Send us your toughest
challenge – medication or patient – and we will help you solve
your problem. Compounding pharmacists at Pharmacy Specialists can be a solution for you.
Currently, Sam Pratt, RPh at Pharmacy Specialists is
the only Full Fellow of the International Academy of Compounding Pharmacists in the Central Florida area. Call
Pharmacy Specialists to check with a clinical pharmacist for suggestions and recommendations. For additional
information please call (407)260-7002, FAX (407) 2607044, Phone (800) 224-7711, FAX (800) 224-0665.

Be sure and check out our
NEW and IMPROVED
website at
www.floridamd.com!
PULMONARY AND SLEEP DISORDERS
IDIOPATHIC PULMONARY FIBROSIS
By Y. Daniel Haim, MD, FCCP
DEFINITION:
IPF is defined as a specific form of chronic, progressive fibrosing interstitial pneumonia of unknown cause, recurring primarily
in older adults, limited to the lungs, and associated with histologic and/or radiographic pattern of UIP defined below. The definition of IPF requires the exclusion of other forms of interstitial
pneumonia, including other idiopathic interstitial pneumonias
and ILV associated with environmental exposure, medication, or
systemic disease.
CLINICAL PRESENTATION:
IPF should be considered in all adult patients with unexplained
chronic exertional dyspnea and commonly presents with cough,
bibasilar inspiratory crackles, and finger clubbing. The incidence
of the disease increases with older age, with presentation typically
occurring in the sixth and seventh decades. Patients with IPF
aged less than 50 years are rare, such patients may subsequently
manifest with overt features of an underlying connective tissue
disease that was subclinical at the time IPF was diagnosed.
More men have been reported with IPF than women, and the
majority of patients have a history of cigarette smoking.
INCIDENTS AND PREVALENCE:
There are no large scale studies of the incidence or prevalence of
IPF on which to base formal estimates. One study in the United
States estimated the incidents of IPF to be between 6.8 and 16.3
per 100,000 persons, using a large data base of health claims in
a health plan.
Prevalence estimates for IPF have varied from 2 to 29 cases per
100,000 in the general population. The wide range in these numbers is likely explained by the previous lack of uniform definition
used in identifying cases of IPF, as well as differences in study
design and populations.
POTENTIAL RISK FACTORS:
Although idiopathic pulmonary fibrosis is, by definition, a disease of unknown etiology a number of potential risk factors have
been described.
1.Cigarette smoking – smoking is strongly associated with IPF,
particularly for individuals with a smoking history of more
than 20 pack years. This applies to familial as well as sporadic
IPF.
2.Environmental exposure – increased risk for IPF has been
found to be associated with a variety of environment exposures.
A significant increased risk has been observed after exposure to
metal dust and wood dust, farming, raising birds, hair dressing, stone cutting and polishing, and exposure to livestock and
to vegetable dust, and animal dust have also been associated
with IPF.
3.Microbial agents - several studies
have investigated the possible role
of chronic viral infection in the etiology of IPF. Most research has been
focused on Epstein –Barr virus and
Hepatitis C.
4.Gastroesophageal reflux – several studies have suggested that
abnormal acid gastroesophageal reflux; through it is presumed
association with microaspiration is a risk factor for IPF.
5.Genetic factors - Familial pulmonary fibrosis – Although accounting for less than 5% of total patients with IPF familial
forms of IPF have been reported. The most likely mode of
genetic transmission of pulmonary fibrosis in familial cases is
autosomal dominance with variable penetration.
DIAGNOSTIC CRITERIA:
The diagnosis of IPF requires the following:
1.Exclusion of other causes of ILD such as domestic and occupational environmental exposures, connective tissue disease, and
drug toxicity.
2.The presence of UIP pattern on high resolution CT (HRCT)
in patients not subjected to surgical lung biopsy.
3.Specific combination of HRCT and surgical lung biopsy pattern in patients subjected to surgical lung biopsy.
Thus the accuracy of diagnosis of IPF increased with clinical,
radiographic, and histologic correlation and can be accomplished
with multiple disciplinary decisions among experience clinical
experts in the field of ILDs.
NATURAL HISTORY OF IPF:
The natural history of IPF has been described as a progressive
decline in subjective and objective pulmonary function until eventual death from respiratory failure, or complicating comorbidity.
Available longitudinal studies do not allow a clear assessment of a
median survival in IPF. Several retrospective longitudinal studies
suggest the median survival time from two to three years from the
time of diagnosis. However, more recent data from clinical trials
of patients with preserved pulmonary function suggests this may
be underestimated.
There appears to be several possible natural histories for patients
with IPF. For a given patient, the natural history is unpredictable
at the time of diagnosis. The majority of patients demonstrate a
slow gradual progressive course over many years. Some patients
remain stable while others have an accelerated decline. Some patient may experience episodes of acute respiratory worsening. It
is unknown if these different natural histories represent distinct
phenotypes of IPF, or if the natural history is influenced by geographic, ethnic, culture, race, or other factors. Other comorbid
conditions such as emphysema and pulmonary hypertension may
impact the disease course.
DEFINITION OF UIP PATTERN:
tion and treatment of comorbid conditions, such as pulmonary
hypertension and emphysema.
Education in various components of supportive care should be
offered to all patients with IPF. Supportive care may be preferred
as the sole treatment option for many patients given the lack of
proven therapy.
Inclusion and exclusion criteria for clinical trials vary so we
provide all patients with information regarding participation in
randomized clinical trials whenever appropriate trials are available. Patients with mild to moderate disease are frequently ideal
candidates for clinical trial as many limit participation to patients
with early disease.
HRCT features:
HRCT is an essential component of the diagnostic pathway in
IPF. UIP is characterized on HRCT by the presence of reticular
opacities, often associated with traction bronchiectasis. Honeycombing in common and it is critical for making a definite diagnosis. Honeycombing is manifested on HRCT as clustered cystic
air spaces, typical of comparable diameters on the order of 3 to 10
mm, but occasionally as large as 2.5 cm. It is usually sub pleural
in location.
Ground glass opacities are common,
T H E M O S T A D VA N C E D
but usually less extensive than the reticulation. The distribution of UIP on HRCT
is characteristically basal and peripheral,
though often patchy. Several studies have
documented that the positive predictive
value of HRCT diagnosis of UIP is 90 to
100%.
H E A LT H C A R E I S R I G H T H E R E .
SELECTED FEATURES ASSOCIATED WITH INCREASED RISK OF
MORTALITY IN IDIOPATHIC PULMONARY FIBROSIS INCLUDE THE
FOLLOWING:
Baseline factors which include the following:
A. Level of dyspnea
B. Diffusing capacity less than 40% of
predicted
C. Desaturation less than 88% during a
six minute walk test
D. Extent of honeycombing on HRCT
E. Pulmonary hypertension.
Robotic Treatments
for Male Infertility”
Sijo Parekattil, M.D., is the Director of Urology and
Robotics at Winter Haven Hospital. He is Board
certified in Urology, and has completed an Advanced
Lapraroscopy / Robotics Fellowship and a Microsurgery
& Male Infertility Fellowship at The Cleveland Clinic
Foundation. Dr. Parekattil is one of the world’s most
renowned robotic micro-surgeons having performed
more robotic microsurgery procedures than any other
surgeon in the world. In addition to a full time Medical
Practice he is also the Assistant Professor of Medicine
and Co-director of Robotic Surgery at the University of
Florida College of Medicine and Shands Healthcare a
Urology Department.
LONGITUDINAL FACTORS
WHICH INCLUDE:
A. Increase in level of dyspnea
B. Decrease in forced vital capacity by
more than 10% absolute value
C. Decrease in diffusing capacity by more
than 15% absolute value
D. Worsening of fibrosis on HRCT
TREATMENT:
As there is no therapy that has been
proven to be efficatious in this disease,
management generally includes some combination of supportive care. This includes
supplemental oxygen, and pulmonary rehabilitation, as well as consideration for
participation in clinical trials, referral for
lung transplant evaluation, and identifica-
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Agents such as Pirfenidone show promise but there is insufficient evidence to recommend their general use at this time. Prevention of gastroesophageal reflux and recurrent microaspiration
may slow disease progression.
Ongoing monitoring is used to evaluate the clinical course and
identify patients with progressive accelerated deterioration. The
response to therapy is usually assessed at 3-6 month intervals. We
monitor symptoms such as dyspnea, exercise tolerance, forced
vital capacity, total lung capacity, diffusing capacity and oxygenation at rest and with exercise.
In patients with advanced or progressive disease, careful evaluation for the development of hypoxemia, pulmonary hypertension, thromboembolic disease, or other comorbid conditions
such as COPD, heart failure, and obstructive sleep apnea may
yield additional treatment options.
The most important components of supportive care for patients with IPF are provision of supplemental oxygen when needed, education, pulmonary rehabilitation, and vaccination against
Streptococcus Pneumonia and influenza.
CLINICAL TRIALS – The best hope for patients with IPF is
that carefully performed clinical trials will confirm the efficacy
and safety of agents that are identified based on animal models of
IPF. We encourage appropriate patients to participate in clinical
trials of emerging therapies for IPF. Specific trials and registries
are available for patients with familial history of IPF.
There are two ongoing IPF clinical trials at Central Florida Pulmonary Group. Please call 407-841-1100
for more information.
TRANSPLANTATION – IPF is the most
common interstitial lung disease among referrals for lung transplantation and the second most frequent disease for which lung
transplantation is performed.
General guidelines for transplantation in
IPF include histologic or radiographic evidence of UIP and any of the following:
I. A diffusing capacity less than 39% of
predicted.
II. A decrement in the forced vital capacity,
more than 10% during the six months
that follow.
III.A decrease in pulse oximetry below 88%
saturation during a six minute walk test.
IV.Honeycombing on high resolution CT
scan, fibrosis score greater than 2.
PROGNOSIS – Prognosis of IPF is poor
with only 20 to 30% of subjects alive five
years after diagnosis. Several factors have
been associated with shortened survival time,
such as older age at presentation, extensive
cigarette smoking, low body mass index,
more severe physiologic impairment, greater
radiographic extent of the disease, and the
development of other complications such as
pulmonary hypertension, emphysema, and bronchogenic cancer. Comorbid diseases and adverse effects of therapy also contribute.
Clinical deterioration is most frequently due to disease progression.
Y. Daniel Haim, MD, graduated from Sackler School
of Medicine in Tel-Aviv, Israel. He completed an Internal Medicine Residency at St. Lukes-Roosevelt Hospital
in New York, New York. He then did a fellowship in pulmonary and critical care medicine at Temple University
Hospital in Philadelphia, Pennsylvania. Then in 1995,
he joined Central Florida Pulmonary Group in Orlando. Dr. Haim is the current President Elect of Florida
Hospital’s Medical staff, a member on the Tumor Board,
and Assistant Professor at UCF’s school of Medicine. Dr.
Haim’s special interests include interventional bronchoscopy, which includes laser ablation, airway stents, and
ultrasounds. Additionally, Dr. Haim is involved with
research involving another area of interest, pulmonary
fibrosis.
Dr. Haim may be contacted at 407-841-1100 or by visiting www.cfpulmonary.com. 
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Translational Research Institute Seeks
Individualized Approaches to Curing Global
Epidemic of Diabetes
Innovative partnership between Florida Hospital and
Sanford-Burnham Medical Research Institute will bridge
research and treatment to accelerate personalized
medicine in diabetes and obesity
Orlando will soon be recognized as a medical destination seeking cures for diabetes, according to Florida Hospital – SanfordBurnham researchers.
“It is my professional goal to cure diabetes,” said Dr. Steven R.
Smith, a diabetes expert and scientific director of the Florida Hospital – Sanford-Burnham Translational Research Institute for Metabolism and Diabetes (TRI). Researchers at the TRI, an innovative partnership between Florida Hospital and Sanford-Burnham
Medical Research Institute, believe that by applying the concept
of personalized medicine to diabetes and obesity, the TRI can help
“crack the code” on these global epidemics and provide a more
individualized, tailored approach to finding cures.
Diabetes and metabolism-related diseases now affect nearly
one out of every three Americans. However, the current model
for treating both diabetes and obesity reflects a one-size-fits-all
model of “eat less and exercise more.” Alexandra Fields-Garrity, a
27-year-old psychology student, is a twin but the few differences
that exist between her and her sister have had big consequences on
Fields-Garrity’s health.
“I have battled with weight issues my entire life and am now
pre-diabetic,” Fields-Garrity said. “My twin sister is the complete
opposite of me in terms of weight and health issues, yet we share
a very close genetic make-up. I enrolled in a research trial at the
TRI so my information can help the researchers understand what
makes my sister and me so different.”
Fields-Garrity’s story is just one example of what the research at the TRI
will help to uncover. The TRI’s new
Steven Smith, MD
state-of-the-art facility is dedicated to
the advancement of a new paradigm of personalized approaches
in researching and treating diabetes and obesity. TRI researchers
will integrate and apply genomics and metabolomics findings in
a clinical research setting. The innovative partnership bridges the
fundamental discovery research conducted in Sanford-Burnham
laboratories with clinical studies at the new TRI facility. The twoway information sharing will accelerate discoveries and yield more
individualized approaches to prevent, diagnose and treat these
global epidemics.
“We are witnessing the rise of personalized medicine, most notably, in cancer. Our goal at the TRI is to accelerate the advancement of personalized medicine in diabetes and obesity,” said Dr.
Steven R. Smith, scientific director of the TRI. “We are working
to rapidly expand knowledge of complex genetic and molecular
causes of diabetes and obesity so that we can better define disease
subpopulations and, working both independently and in partnership with industry, develop therapies and treatment approaches
tailored to those subpopulations. Our ultimate hope is that our
discoveries will someday lead to cures for certain patients.”
Leaders joined together to officially open the Florida Hospital – Sanford-Burnham
Translational Research Institute for Metabolism and Diabetes.
Diabetes and metabolism-related diseases now affect
nearly one out of every three Americans. Every year,
diabetes and metabolic diseases cost Central Floridians
more than $4 billon, and nationally account for approximately $174 billion in direct and indirect costs,
according to the American Diabetes Association.
“In order to successfully tackle diabetes and obesity
and ease the tremendous, growing burden they exert
on our medical and economic systems, we must move
beyond a one-size-fits-all algorithm for diagnosis and
treatment,” said Dr. Smith. “Personalized medicine will
define the next era of patient care, and we look forward
to playing a major role in introducing this necessary
paradigm shift in the metabolic disease space.”
The TRI’s new 54,000 sq. ft. facility in Orlando,
Fla., contains a variety of tools including a research
clinic, advanced imaging technology, a biorepository
Continued on page 30
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for sample collection and storage, as well as several other resources for metabolic studies. One of the facility’s highlights is the Calorimetry
Laboratory, which contains two “dorm” sized rooms and two small calorimeter rooms that will analyze the air in the room to measure
energy expenditure and the type of food a person is burning without the person having the discomfort of being hooked up to machinery.
The two small calorimeter rooms will be the first ever designed for precisely measuring energy expenditure at rest or during exercise.
“While the concept of personalized medicine for diabetes and obesity is still nascent, developments in genomics and other advanced
technologies are having a transformational effect on individualizing therapeutic strategies,”” said Dr. John Reed, CEO of Sanford-Burnham Medical Research Institute. “We now have the opportunity to apply genetic and molecular findings, enabled by Sanford-Burnham’s
research technologies and expertise, to real-world clinical problems at the TRI’s remarkable new facility.”
The first research advancing from Sanford-Burnham to the clinical research stage at the TRI will begin this spring. The research will
focus on orexin, an appetite-inducing hormone produced in the brain, which appears to resolve obesity without changes in food consumption or elevation in physical activity. Other research studies underway at the TRI focus on the discovery and validation of biomarkers of
metabolic diseases and disease responsiveness to treatments, and studies on the fundamental mechanisms of metabolic diseases.
“The TRI is a natural extension of Florida Hospital’s overall focus on holistic, healthy living combined with world-class patient care,”
said Lars Houmann, president and CEO of Florida Hospital. “The new TRI facility represents another step forward in Orlando becoming
a major medical destination and marks a major initiative in patient-oriented research as well as ultimately enabling better outcomes for
patients.” 
Local 92-Year-Old Undergoes New LifeLengthening Heart Procedure
Florida Hospital cardiac team is first to use breakthrough device in the Orlando area
Duyane Hoffman, 92, made the decision to have a newly FDAapproved device placed inside his heart to keep his golden years
active ones.
“I used to do 45 minutes of cardiac rehab on the treadmill,” said
Hoffman. “Before this procedure I could barely do 10 minutes.”
But it’s not only the time on the treadmill that motivated him
to replace his calcified heart valve; it was to spend more time with
his wife of 27 years, Nancy, five daughters, four grandchildren
and four great-grandchildren. Both Duyane and Nancy met and
married as widows and developed a love for cultivating orchids in
their backyard greenhouse.
“I have a lot to live for,” said Hoffman. “If you sit around in a
rocker in your old age, you won’t last very long.”
A calcified heart valve blocked Hoffman’s dream of an active
lifestyle. At 92 years of age, he was not a candidate for a traditional heart valve replacement surgery. But Hoffman’s longing for
longevity is part of the reason why the multi-disciplinary team
from Florida Hospital believed Hoffman would be a good candidate for the newly FDA-approved valve replacement procedure
called TAVR. The buzz surrounding the transcatheter aortic valve
replacement (TAVR), manufactured by Edwards Lifesciences, allows a multi-disciplinary cardiac team of doctors to replace a heart
valve by inserting it through a catheter into the heart. Traditionally, in the United States, a heart valve replacement would require
an open incision into the chest to repair or replace the malfunctioning valve. But now, patients who are too ill for surgery may
be able to have their heart valve replaced with this transcatheter
procedure.
“The team is thrilled with how well Mr. Hoffman is doing. This
clearly has the potential to be a major development in how cardiac
valve surgery is performed,” said Dr. Kevin Accola, medical director of valve surgery, Florida Hospital Cardiovascular Institute at
Florida Hospital Orlando. “The TAVR device could help many
patients who are too ill or are at high risk to undergo more traditional heart valve surgery. There are risks to this procedure and for
now the FDA has approved this device only for patients for whom
traditional cardiac surgery is not an option.”
Over the past year, Florida Hospital Orlando has developed
a multi-disciplinary team of four physicians to learn about and
eventually implement the TAVR technology in Central Florida.
The physician members of the TAVR team include Dr. Kevin Accola, Dr. Andrew Taussig, Dr. Jorge Suarez-Cavelier, and Dr. Jose
Arias. In total, it took 20 clinical professionals from the operating
room, anesthesia and the catheterization lab working collaboratively to insert the TAVR device.
“The Florida Hospital Cardiovascular Institute is dedicated to
remaining in the forefront of new technology and bringing TAVR
to the Orlando community is part of that commitment,” said Dr.
Andrew Taussig, medical director, Florida Hospital Cardiovascular Institute. “People like Mr. Hoffman refuse to be limited by
their age and are committed to a high quality of life for their entire
life. I am pleased that we have this technology to help him meet
that goal.” 
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Orlando Health Doctor Earns Specialty Certification
Walter Conlan, MD, was recently designated a Certified Wound Specialist Physician (CWSP), by the American Board of Wound Management (ABWM). Dr. Conlan practices at the Wound Care & Hyperbaric Medicine Center at South Seminole Hospital and is medical
director of the Wound Management Department at Orlando Regional Medical Center.
Established in 1995, the ABWM is dedicated to the multidisciplinary team approach in promoting the science of prevention, care and treatment of acute and chronic wounds. The primary function is to establish and
monitor a national certification process, recognize a high level of wound care knowledge, promote education/
research and elevate the standard of care across the continuum of wound management.
Qualified candidates for certification are required to achieve a passing score on an examination and are a
group of healthcare professionals dedicated to the practice of wound management. Currently, there are only 68
physicians in the United States who have earned the prestigious CWSP certification.
Dr. Conlan, board certified in physical medicine rehabilitation, is a graduate of Jefferson Medical College, a
part of Thomas Jefferson University, in Philadelphia, Pennsylvania. He completed an internship and residency
at the Rehabilitation Institute of Chicago. In 1996, he focused exclusively on wound care and founded Florida
Wound Care Doctors shortly thereafter. He currently serves as president–elect for the ABWM. 
Walter Conlan, MD
Bcenter.com launches Global Stroke Provider Map
Medical and professional stroke services showcased in centralized hub
Bcenter.com, an online global stroke resource center, announced the launch of a medical and professional provider map designed to
connect survivors with stroke specialists. The interactive diagram showcases facilities and organizations allowing users to easily explore
various natural and conventional therapies throughout the world. According to the World Health Organization, 15 million people suffer
stroke worldwide each year; of these, 5 million die and another 5 million are permanently disabled.
“Bcenter.com’s provider map is like a GPS for stroke survivors on a journey to finding recovery options,” said Valerie Greene, CEO and
Founder of Bcenter.com, a survivor of two strokes. “Stroke survivors around the world are crossing boundaries to find the best care and
the medical community can now proactively get on the radar of potential patients to direct them to care.”
Stroke-related providers can now join top companies and associations already impacting Bcenter.com users including Oxygen Care
Centers of America, National Stroke Association and Holistic Options. Bcenter.com stands out from other stroke websites because it pairs
cutting-edge medical options with direction and perspective of an individual who has personally benefitted from an array of therapies,
including nearly twenty preferred treatments such as stem cell therapy, Energy Medicine and Hyperbaric Oxygen.
Users can easily navigate through the Bcenter.com’s all-inclusive online recovery center through three main functions: the interactive
world provider map lives under the Bconnected website section, allowing stroke survivors and patients to identify providers/experts; Bwell
offers insight into diverse conventional and holistic treatments option; and Bempowered presents motivational resources including survivor testimonials, educational videos and uplifting books.
Bcenter.com is headquartered in Orlando, FL under the direction of CEO Valerie Greene who stunned the medical community after
refining her abilities following two debilitating strokes. Her efforts surrounding stroke awareness, advocacy and business advancements
have been internationally recognized. 
Orlando Health to Replace Heart Valves Without Surgery
Heart Institute to offer first FDA approved artificial aortic heart valve without
open-heart surgery
Doctors at the Orlando Health Heart Institute have found a
new pathway to a patient’s heart valve. In May, cardiologists and
cardiovascular surgeons will begin using the first artificial heart
valve approved by the U.S. Food and Drug Administration, to
replace a narrowed heart valve going through a leg artery instead
of a traditional open heart surgery.
The new device and procedure is an option for some patients
with aortic valve stenosis – an age-related heart disease caused
when calcium deposits cause the aortic valve to narrow. The narrowing forces the heart to work harder to pump enough blood
through the smaller opening, leading to heart failure, irregular
heart rhythms, heart attack and other heart problems.
“For most patients, once symptoms from aortic stenosis develop, death occurs within a couple of years,” said Deepak Vivek,
MD, director, Orlando Health Heart Institute Heart Valve Center. “Open heart surgery is too risky for some patients. Having an
CURRENT TOPICS
alternative to save lives and improve the quality of lives is a vital to
caring for patients with heart disease – which remains the leading
cause of death for men and women in our country.”
The artificial valve, called the Sapien THV and manufactured by
Edwards Lifesciences, is made of cow heart tissue and a polyethylene skirt and is supported with a stainless steel mesh frame. To
replace the diseased valve, the artificial valve is delivered through
a catheter, inserted through a small cut in the leg. The new valve
is released from the catheter, expanded with a balloon and is immediately functional.
“Offering patients this innovative new device through a less in-
vasive approach is part of our ongoing efforts to provide effective
treatment options to patients who cannot undergo a traditional
open heart surgery to replace a valve,” said Arnold Einhorn, MD,
Co-Medical Director, Orlando Health Heart Institute. “This artificial valve may also be an answer for those patients.”
The Heart Institute’s Valve Center is part of our new model of
care that puts the patient first by promoting seamless coordination of all aspects of the patient experience, is made up of cardiologists, cardiac surgeons, radiologists, anesthesiologists and other
clinicians who work together to evaluate options to treat high-risk
patients with aortic stenosis. 
Winter Park Memorial Hospital Unveils New Robotic Program
That Allows Surgical Technique Learning Over Distance
Dr. Steven McCarus introduces new robotic program that allows proctors to train physicians
around the world in minimally invasive surgery
Florida Hospital’s Dr. Steven McCarus, the American Institute of Minimally Invasive Surgery (AIMIS) and Karl Storz Endoscopy have
collaborated on an innovative computer robotic program that allows experienced physicians to remotely proctor surgeons learning how to
perform minimally invasive surgeries. Located at the Winter Park Memorial Hospital, the Visitor One robot permits the proctor in a remote
location to view exactly what the surgeon is seeing in his operating room and coach him throughout the surgery process. This is the first
gynecology training on the Visitor One in the Southeast of the United States.
The Visitor One is a compact, moveable robot with a high-definition camera and screen and is able to be used in a variety of surgical
procedures. The proctor sees what the surgeon is viewing on the screen in the operating room. Not only will an experienced proctor like
Dr. McCarus be able to give step-by-step instructions to the surgeon, but he can also draw on the screen, like a football analyst, to point out
specific aspects of the technique and instruct on specific areas and the procedure. This process is called “telestrating.”
“The Visitor One is a very effective teaching modality to train physicians in minimally invasive surgery,” said Dr. McCarus, Medical Director of the Florida Hospital Center for Pelvic Health. “With this technology, no patient will be left behind as we will be able to provide
physicians around the world with the information necessary to perform these life-saving surgeries.”
Winter Park Memorial Hospital, a Florida Hospital, is one of only five nationally acknowledged AIMIS Centers of Excellence. This new
technology is another example of how the hospital is providing cutting-edge medical training for physicians. 
Florida Hospital and USF Health Partner in Key Specialties
to Expand Translational Medicine Across Tampa Bay, Brings
the Latest Medical Advancements to Local Communities
Florida Hospital and USF Health have formed a strategic alliance, combining Adventist Health System’s innovative approach
to patient-centered care with the University of South Florida’s
leading research, to deliver cutting-edge medical therapies in hospital and outpatient settings. Through this unique public/private
partnership, Florida Hospital is making an investment of approximately $14 million in four key specialty areas to bring enhanced
patient care, state-of-the-art technology and expanded services to
Tampa Bay.
“Our partnership with USF Health will bring their leading-edge
research right to the doorsteps of residents in communities where
we have hospitals in Tampa Bay,” said Mike Schultz, President
and CEO of the Florida Region for Adventist Health System, the
parent company of Florida Hospital. “Patients in Hillsborough,
Pinellas and Pasco counties will no longer have to travel for personalized and state-of-the-art medicine in the specialties where we
have affiliations with USF Health.”
In September 2011, the Florida Hospital announced that it was
developing strategic health care partnerships, including one with
USF Health. Today, both organizations announced how the partnership is translating medical research advancements into cuttingedge patient treatment in the following specialty areas: cardiology
at Florida Hospital Pepin Heart Institute, breast health at Florida
Hospital Tampa, neuroscience at Florida Hospital Zephyrhills,
and surgical oncology, melanoma and breast cancer at Helen Ellis
Memorial Hospital in Tarpon Springs.
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“Through these critical specialties, we’re going to transform how
patients experience health care at Florida Hospital in our area,”
said Dr. Stephen K. Klasko, CEO of USF Health and dean of
USF Health Morsani College of Medicine. “Patients will have
greater access to our world-class physicians and the new scientific
discoveries at USF Health. As important, USF Health will also
work with Florida Hospital and its patients to create personalized,
coordinated care in cardiology, breast health and other targeted
specialties.”
Cardiology
Cardiovascular patients at Florida Hospital Pepin Heart Institute will benefit from research collaboration and USF Health’s exploration in genomic screening for personalized health care. Genomic screening uses an individual’s genetic profile to customize
the prevention, diagnosis and treatment of cardiovascular disease
to each patient.
“No other providers in Tampa Bay will be able to replicate the
level of how we begin to tailor procedures to individual patients to
maintain their heart health,” Dr. Klasko said.
“Florida Hospital Pepin Heart Institute will now combine its
personalized health care delivery and clinical research with USF
Health’s leading academic medicine and research,” said John Harding, President and CEO of Florida Hospital Tampa Bay Division. “This innovative partnership will give health care consumers
a broader range of treatment options for cardiovascular disease.”
Breast Health
Women across Tampa Bay have been experiencing the benefit of
a comprehensive diagnostics center exclusively dedicated to breast
care at Florida Hospital Tampa. Recently, USF Health partnered
with an existing breast program composed of Florida Hospital
Tampa, Community Medical Imaging and Tampa Bay Breast Care
Specialists to build an even more comprehensive breast health and
cancer program. This collaboration brings together private practices, academic medicine and a hospital to form a renowned team
of expert radiologists, radiation oncologists and breast surgeons.
Based at Florida Hospital Tampa, this multidisciplinary approach
to breast care provides a comprehensive range of diagnostic services, cancer treatments and research protocols to patients, while
offering a higher level of coordinated care. One of the major patient benefits is reducing the time from screening to diagnosis to
treatment. Providing rapid diagnosis — often within the same day
— increases early detection, which is a critical factor in successful
outcomes for breast cancer patients.
Neuroscience
The new Neuroscience Institute at Florida Hospital Zephyrhills
will have a team of USF Health neurosurgeons on-site who are
trained in the treatment of brain, spine and acute stroke procedures. Time is an important factor with most medical issues,
but especially with stroke and neurological conditions. The new
24/7 dedicated stroke team includes academic neurosurgeons
from USF, neuro-interventional radiologists, board certified neurologists, emergency physicians and certified registered nurses to
coordinate care from triage to diagnosis, treatment and recovery.
Patients will have access to the latest evidence-based treatments
from USF, including brain surgery, spine surgery and minimally
invasive treatment of aneurysms. Having all of these services offered in one location means patients will no longer need to travel
outside Pasco County, saving precious time, which is a critical factor for neurological procedures.
Surgical Oncology, Melanoma and
Breast Cancer
To round off the partnership, patients in Pinellas and west Pasco
counties will benefit from enhanced medical expertise at Helen Ellis Memorial Hospital. USF Health physicians will now be available for patients – a plastics and reconstructive surgeon trained in
the most advanced technologies and treatments for breast cancer
and other oncological disorders, and an internationally known
surgical oncologist specializing in the treatment of malignant melanoma, complicated skin cancers and breast cancer. The partnership creates a comprehensive and coordinated approach to cancer
care that gives patients the option to receive state-of-the-art treatment without leaving their community.
“These four affiliations are the foundation for Florida Hospital
and USF Health’s plans to establish a higher standard of coordinated care throughout the market,” said John Harding. “This
announcement is just the beginning of our vision to elevate health
care in Tampa Bay.” 
UF & Shands Florida Recovery Center Opens Location
at Orlando Health’s South Seminole Hospital
Nationally recognized addiction treatment program based at the University of Florida
brings new options to Central Florida.
The UF & Shands Florida Recovery Center (FRC), a nationally recognized academic and clinical research-driven addiction treatment
program, will bring new treatment options to patients in Central Florida with a new location at the Orlando Health Behavioral Specialists
practice at South Seminole Hospital. The FRC, based at the University of Florida (UF), is rated by the Annenberg Foundation as one of the
nation’s top three addition programs and training sites.
Beginning in April, the new center, named UF & Shands Florida Recovery Center at Orlando Health, will serve as a destination for the
evaluation and treatment of people facing alcohol and drug addiction.
The UF&Shands Florida Recovery Center at Orlando Health bridges the gap in outpatient services for people suffering with an addicContinued on page 34
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tion, who are receiving fragmented inpatient and outpatient services or those who are leaving the Central Florida area to seek addiction
treatment elsewhere.
“Addiction is both a national and local public health concern,” said Gilbert T. Tamakloe, medical director, Behavioral Health Services,
Orlando Health. “Additional outpatient services for addiction are a great need in our community. Although there are programs available,
there are few programs that compare to the comprehensive approach the FRC provides to its patients. We are pleased that the Florida Recovery Center will join our health care organization in meeting our community’s growing needs.”
Orlando Health and UF&Shands look forward to offering the community a partnership in alcohol and drug addiction evaluations,
inpatient and outpatient services and addiction intervention and treatment, officials said.
“It is an ideal scenario to bring a new, expert Florida Recovery Center team with special training and skills to Orlando Health, which
is a state leader in so many other areas of medicine and surgery,” said Mark S. Gold, MD, professor and chairman of the department of
psychiatry at UF. “We know from the calls for help that we receive, that Orlando is an underserved area. Dr. Scott Teitelbaum, our division
chief of addition medicine, is the president of the Florida Society of Addiction Medicine and we know from his work, that board-certified,
fellowship-trained addiction physicians are very hard to find in the Orlando area.”
Timothy Huckaby, MD, addiction medicine specialist, has been appointed as the medical director of the UF&Shands Florida Recovery
Center at Orlando Health and will evaluate patients, consult with physicians and healthcare professionals at South Seminole Hospital and
others in the Central Florida community and oversee an intensive outpatient program (IOP), a three- to six-week program that integrates
patients back into their communities, families and work lives.
The IOP also consists of group meetings four nights a week for 12 to 16 weeks. The primary goal of the IOP is to help assist patients in
their recovery from addiction and help integrate them back into living healthy lives.
Dr. Huckaby and his clinical team will examine some of the behaviors that have caused the patient to have difficulty in the past, and
change those behaviors to establish and maintain a sober support system. The FRC team will provide family couples and group counseling
as well. The goal of the program is to help those in recovery effectively manage the social, spiritual, physical and emotional aspects of life to
maintain a lifestyle of recovery.
The FRC team will work with the Orlando Health Behavioral Healthcare at South Seminole Hospital (inpatient) and the Orlando
Health Behavioral Specialists (outpatient) teams of certified and experienced psychiatrists, nurses, social workers and other clinicians to
provide patient care.
Dr. Huckaby is a board-certified anesthesiologist, who has also been trained in an addiction medicine fellowship at UF and an obstetric
anesthesiology fellowship at Harvard. His experience in pain, pain management, women’s health and iatrogenic addictions will add to FRC
at Orlando Health’s suite of treatment options. In addition to addiction services, Dr. Huckaby also will offer pain medicine services through
the UF&Shands Florida Recovery Center.
Because the Florida Recovery Center is affiliated with the University of Florida and with the UF McKnight Brain Institute, patients have
the benefit of a bench-to-bedside approach to addiction science, receiving treatment based on the latest addiction medicine research.
The UF&Shands Florida Recovery Center at Orlando Health is part of an ongoing collaboration of health initiatives between Orlando
Health and UF&Shands making care more accessible to millions of patients over a 20-county region. The alliance was formed in 2010 as a
result of a longstanding history of close working relationships.
In addition to the recent addiction medicine initiative, the organizations have formed or will begin several joint clinical programs in areas
including pediatrics, neuroscience, oncology, women’s health, transplantation and cardiovascular medicine.
For additional information about the UF&Shands Florida Recovery Center at Orlando Health, contact 855.265.4FRC (4372), or visitfloridarecoverycenter.ufandshands.org. 
Florida Hospital Memorial Medical Center Joins Federal
Initiative To Make Hospitals Safer
In an effort to continually improve the quality, safety and affordability of health care for patients, Florida Hospital Memorial Medical
Center has elected to participate in the Partnership for Patients initiative.
Established by the Center for Medicare and Medicaid Innovation Center, the Partnership for Patients program offers support to physicians, nurses and other clinicians. The goal of the initiative is to help patients heal without complications while in the hospital.
Specifically, hospitals participating in the Partnership for Patients campaign focus on reducing preventable hospital readmissions by 20
percent and reducing preventable hospital-acquired conditions by 40 percent by the end of 2013. In doing so, Centers for Medicare &
Medicaid Services estimates that over the next three years, the partnership has the potential to:
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• Save 60,000 lives;
• Reduce millions of preventable injuries and complications in patient care; and
• Save as much as $35 billion, including up to $10 billion in savings to Medicare.
To participate in the Partnership for Patients initiative, Florida Hospital Memorial Medical Center joined with Premier healthcare alliance.
Premier, a health system owned performance improvement alliance of hospitals and other healthcare organizations, is the second largest of 26 Hospital Engagement Networks (HEN) approved by Centers for Medicare & Medicaid Services to participate in the initiative.
As a HEN, Premier is helping identify the solutions already working to reduce healthcare-acquired conditions, and spread them to other
hospitals and healthcare providers.
“We are committed to providing the
highest quality care and our partnership
with Premier is part of that commitment,”
said Kelly Rogers, Florida Hospital Memorial Medical Center’s Executive Director
of Clinical Effectiveness. “One of our top
priorities has always been to continue making strides in improving the quality, safety
and affordability of health care and getting
involved in the national Partnership for Patients initiative will help us continue to do
just that.”
This serves as another example of Florida
Hospital Memorial Medical Center’s mission of hope, health and healing. With five
nonprofit hospitals in Volusia and Flagler
counties, Florida Hospital is the largest
hospital system in the area, with nearly 800
beds and 4,700 employees and caring for
nearly 650,000 patients every year. 
MARKETING
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Email [email protected]
Looking to reach
doctors by direct
mail or email
broadcast? Call
(407) 417-7400
or email
[email protected]
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FOR YOUR ENTERTAINMENT
Certified Financial Group, Inc. presents
ROCKY MOUNTAIN HIGH AT THE SPRINGS
A Musical Tribute to John Denver
Mark your calendar for Saturday, May 5, 8:00 p.m., as the Orlando Philharmonic’s annual outdoor concert tradition at The Springs returns. Excitement is growing
as the Orlando Philharmonic prepares to pay tribute to America’s beloved musical
icon, John Denver. The concert, Rocky Mountain High at The Springs, is presented by
Certified Financial Group, Inc.
The Orlando Philharmonic and vocalist Jim Curry pay tribute to the music of one
of the most beloved singer/songwriters ever to grace the stage. The music of the late
John Denver is like an old friend, outlasting trends and standing the test of time.
Denver’s uplifting music and lyrics continue their appeal to people of all ages.
Tribute artist Jim Curry, whose voice was heard in the CBS-TV movie Take Me
Home: The John Denver Story, has performed Denver’s music in sold out shows
throughout the country and has emerged as today’s top performer of Denver’s vast
legacy of multi-platinum hits.
Even at an early stage in his singing career, Jim’s natural voice resembled Denver’s. Embracing this similarity, he continued to sing and specialize in the songs of
John Denver, sharing John’s positive messages of love, humanity, and environmental
awareness.
The untimely death of John Denver in 1997 was a tragedy that was felt the world
over. Such a void in the musical world left John’s ardent fans demanding that his
music survive. CBS television responded by producing a made for TV movie: “Take
Me Home, the John Denver Story” in which Jim landed an off-camera role singing as
the voice of John Denver. This experience inspired Jim to produce full–length John
Denver tribute concerts.
Jim is not your usual “Vegas style” impersonator. In fact, he is not an impersonator
at all. Jim sings, in his own natural voice, a tribute to the music in a way that needs to
be seen and heard to understand the pure honesty of his amazing performance. His
looks and his voice are simply a pleasant coincidence that captures the true essence of
John Denver’s music. Curry’s heartfelt delivery rolls out into the crowd as multi-platinum hits like “Rocky Mountain High,” “Annie’s Song” and “Calypso” fill the room.
Jim will be performing with the Orlando Philharmonic, using the original orchestrations written for John Denver by Grammy award winning composer Lee Holdridge. Jim’s uncanny ability to mirror John’s voice and clean-cut look takes you back
to the time when “Rocky Mountain High,” “Sunshine,” “Calypso,” and “Annie’s
Song” topped the charts, and his popular music had the heartfelt message of caring
for the earth and caring for each other.
The Orlando Philharmonic celebrates this ninth annual Springs concert on
Saturday, May 5, 8:00 p.m., at the Springs Community, located off SR 434 (1
mile west of I-4), in Longwood. The concert begins at 8:00 p.m. (gates open at
5:00 p.m.). To order tickets, call the Orlando Philharmonic box office at (407)
770-0071 or visit www.OrlandoPhil.org. Tickets are $35 in advance ($40 day of
concert) and $125 VIP.* VIP tickets include catered buffet, beer & wine, and special
VIP seating & parking. (A rain date is set for Sunday, May 6.)
Pack a picnic, grab your blanket and join us for The Springs 2012 as you fill up
your senses with the music and the memories of John Denver in a Rocky Mountain
High celebration at The Springs 2012. 
ADVERTISERS INDEX
Central Florida
Inpatient Medicine. . . . . . . . . . . . 28
Central Florida
Pulmonary Group. . . . . . . . . . . . . 12
Cyeron Corporation Medical
Financial Services . . . . . . . . . . . . . 3
Danna-Gracey. . . . . . . . . . . . . . . 17
Digestive & Liver Center
of Florida. . . . . . . . . . . . . . . . . . . 18
Florida Hospital East Orlando –
Urology. . . . . . . . Inside Front Cover
Florida MD 2012 Editorial
Calendar. . . . . . . Inside Back Cover
Insight Marketing Group. . . . . . . . 35
Jewett Orthopaedic . . . . . . . . . . . 24
Last Diet ad. . . . . . . . . . . . . . . . . 10
Michael Lowe, PA. . . . . . . . . . . . . 24
Orlando Health
Physician Specialists . . . . . . . . . . 21
Orlando Orthopaedic
Center. . . . . . . . . . . . . . . . . . . . . 14
Osceola Regional
Medical Center. . . . . . . . Back Cover
Pharmacy Specialists. . . . . . . . . . 16
Winter Haven Hospital
Robotics Institute. . . . . . . . . . . . . 27
2012
EDITORIAL
CALENDAR
Florida MD is a four-color monthly
medical/business magazine for physicians in
the Central Florida market.
It goes to 4,000 physicians at their offices, in the twelvecounty area of Orange, Seminole, Volusia, Osceola,
Polk, Flagler, Lake, Marion, Sumter, Hardee, Highlands
and Hillsborough counties. Cover stories spotlight
extraordinary physicians affiliated with local clinics
and hospitals. Special feature stories focus on new
hospital programs or facilities, and other professional
and healthcare related business topics. Local physician
specialists and other professionals, affiliated with local
businesses and organizations, write all other columns or
articles about their respective specialty or profession.
This local informative and interesting format is the main
reason physicians take the time to read Florida MD.
It is hard to be aware of everything happening in the
rapidly changing medical profession and doctors want
to know more about new medical developments and
technology, procedures, techniques, case studies,
research, etc. in the different specialties. Especially
when the information comes from a local physician
specialist who they can call and discuss the column with
or refer a patient. They also want to read about wealth
management, financial issues, healthcare law, insurance
issues and real estate opportunities. Again, they prefer
it when that information comes from a local professional
they can call and do business with. All advertisers have
the opportunity to have a column or article related to
their specialty or profession.
JANUARY –
Digestive Disorders
Diabetes
FebRUARY –
Cardiology
Heart Disease & Stroke
MARCH –
Orthopaedics
Men’s Health
ApRil –
Surgery
Scoliosis
MAY –
Women’s Health
Advances in Cosmetic Surgery
JUNe –
Allergies
Sleep Disorders
JUlY –
imaging Technologies
interventional Radiology
AUgUST –
Sports Medicine
Robotic Surgery
SepTeMbeR – pediatrics & Advances in NiCU’s
Autism
OCTObeR –
Cancer
Dermatology
NOveMbeR – Urology
geriatric Medicine / glaucoma
DeCeMbeR – pain Management
Occupational Therapy
Please call 407.417.7400 for additional materials or information.
O
Our COmmitment tO PrOvide YOu with
the Latest surgiCaL OPtiOns
Robotic Surgical Advancements at
Osceola Regional Medical Center
Osceola Regional Medical Center’s
dedicated surgeons specialize in providing
the latest surgical techniques and
treatments for patients.
Our continued advancements in surgical
technology, techniques and minimally
invasive procedures provide patients with
the best possible results and reduced
recovery times.
Osceola Regional Medical Center is proud to be
one of the few in the region to offer multiple
specialties utilizing Robotic Technology:
•
•
•
•
•
Gynecology
Gynecologic Oncology
Urology
Colorectal Surgery
Thoracic Surgery
Matthew Campbell, MD
Thoracic Surgeon
Zaid Fadhli, MD
Urologist
Sara DeNardis, DO
Gynecologic Oncologist
Douglas Winger, MD
OB/GYN
To learn more about the robotic surgery program at
Osceola Regional Medical Center, or to join us for an
upcoming Women’s Health Event, visit our website at
OsceolaRegional.com or call 1-877-762-6801.
Jeffrey Fischer, MD
Urologist
Bhupendrakum Patel, MD Richard Real, MD
OB/GYN
OB/GYN
Lucrecia Sta. Ana, MD
Colorectal Surgeon
700 West Oak Street • Kissimmee, FL 34741

April 2012 - FloridaMD

Transcription

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