Same-Day Crowns Same-Day Crowns
Transcription
Same-Day Crowns Same-Day Crowns
South Sarasota County Edition For additional health care information, visit us on the web at TAKE ME HOME! www.ifoundMYdoctor.com Winter 2015 Featured ARTICLES COMPREHENSIVE DENTISTRY Same-Day Crowns 3 B Health Care Patron Carrier-Route Pre Sort PRSRT.STD. U.S. POSTAGE PAID Tampa, FL Permit No.2397 ob Schaefer had his fair share of teeth filled over the years. Amalgam, or silver, fillings were standard back in his day. He had a total of eight upper teeth filled as a child. Over the years, however, those fillings began to expand and the danger of Bob’s teeth cracking increased. “I went into the Navy when I was young, and I had all of the amalgam fillings replaced with white composite because I was advised it is a stronger, safer material,” Bob recalls. “Also, I was put on a nuclear submarine and they did not want the metal in my mouth, so I had them all replaced.” Things seemed fine with those fillings for a number of years until recently, when it was determined that Bob needed to replace the fillings yet again because his teeth were cracking. So, when Bob went looking for a dentist, he found Joseph H. Farag, DMD, of Port Charlotte Dental Care. “Dr. Farag’s office was just down the street from the house and was very convenient,” Bob shares. “I went in for a consultation and he recommended a four-unit crown bridge on both sides of my mouth. He explained the entire procedure to me and added that he could do most of the work right in his office, which I found to be really amazing.” JOSEPH H. FARAG, DMD CEREC® Omnicam technology Traditionally, those in need of a crown could expect to visit the dentist twice: once to have impressions made and a temporary crown created and again to have the newly fabricated, permanent crown placed. “CEREC Omnicam brings a number of advancements to the table specifically with the image capture,” Dr. Farag advises. “It’s now in full color, so that 3-D model that you work with on the computer is actually in tissue color and tooth color, which gives a lot more definition for our design. The image capture process is now a lot easier and can capture a full arch very quickly and in a higher resolution.” With CEREC Omnicam, dentists can deliver ceramic restorations to their 6 PHOTO FROM ISTOCKPHOTO.COM Advancements in 3D technology allow a Port Charlotte dentist to provide patients with crowns and bridges the same day. patients in a single visit. “In Bob’s case, he had some extractions that needed to be done and he needed a large bridge,” Dr. Farag continues. “So, I was able to design a four-unit bridge on the Omnicam and make it for him in a temporary material so that his tissues could heal around it, and then basically make a copy of that in porcelain with the unit when we were done. In the final stage, he returned for a cementation. I think he spent a total of forty-five minutes in the chair.” CEREC 3D’s CAD/CAM dentistry eliminates many of the steps involved in making crowns, limiting the time needed to a single appointment for the patient. One of the most notable features of the CEREC is that it is a very conservative restoration. Traditional restorations have to be cemented into place, which requires preparing the tooth to provide enough mechanical retention to hold it. Using the older method, dentists would have to grind away much of their patients’ healthy tooth structures. However, with CEREC, they are able to save a good portion of each tooth, and using high-tech adhesive dentistry, they can bond the all-porcelain crowns onto them, which saves a significant portion of good tooth structure. The process of creating a toothconserving crown is relatively simple. “Using a special camera, I make an image of the tooth,” educates Dr. Farag. “This optical impression is then used by the computer to design the necessary crown.” With the CEREC Omnicam, Dr. Farag can see every integral part of the tooth in three dimensions and in color. “Using a computer, I can shape and form (see Same-Day Crowns, page 4) 12 David A. Napoliello, MD, FACS Beware of Hernias Johnson Medical Center Nonsurgical, Effective Pain Relief Domingo E. Galliano, Jr., MD, FACS, FASCRS Treatment for Fecal Incontinence Also In This EDITION 2 5 8 9 10 10 11 Natural Healing Arts Medical Center, Inc. Heal Knee Pain with HYALGAN® Alejandro J. Gruneiro, MD, P.A. Shedding Excess Pounds Kate Ross, MD Eliminate Skin Cancer Center for Artificial Disc Replacement No More Limitations South Florida Eye Clinic Eye Floaters? Sarasota Foot and Ankle Center Eliminate Toenail Fight Nail Fungus Gecko Joint & Spine Stem Cells Instead of Surgery For more information, scan the barcode to the right with your mobile device to visit us online. Page 2 | Florida Health Care News | Winter 2015 | South Sarasota County Edition CHIROPRACTIC Heal Knee Pain with HYALGAN ® Revolutionary treatment provides lasting relief for osteoarthritis of the knee without narcotics, steroids or surgery. W hen Carrie* was preparing for a 21-day trip to Europe last summer with her son and daughter-in-law, she was concerned because she knew the journey would entail a lot of physical activity. Osteoarthritis in Carrie’s knee caused her pain much of the time, and she wasn’t looking forward to wearing a brace or using a cane while on vacation. “I said to them, Listen, this could be a lot of walking. I don’t know,” she remembers. “I said, I’ve got to do something with my knee.” In 2007, Carrie, now 63, tore the meniscus (cartilage) in her left knee during a fall. She had surgery to repair the tear, which was followed by another procedure to remove a cyst in her leg. Afterward, the knee began to develop osteoarthritis, a painful condition in which the cushioning fluid in the joint disintegrates, cartilage in the joint erodes and bone starts to rub against bone. “You can actually feel the knocking in it,” she describes. “You can hear the crrr, crrr, crrr. If you have it, you can hear it.” Carrie’s condition caused pain to the point that she iced her knee once or twice a day. “I’d have an ice pack on the back of it, and then on the side, and that would be routine,” she reports. The pain also caused her to curtail some of her favorite activities, like walking and swimming. “I missed probably a summer and a half because going down to the pool, even walking down the steps, I felt like I was ninety years old,” she laments. She tried physical therapy, a knee brace, anti-inflammatory medications and cortisone shots. Nothing helped for long. Carrie saw David S. Zamikoff, DC, director of Natural Healing Arts Medical Centers in Bradenton and Sarasota, for physical therapy following her 2007 surgical procedures. She continued to visit the office over the years for chiropractic Got knee pain? Dr. David Zamikoff, Dr. Lars Larson and the staff of the Natural Healing Arts Medical Center welcome your questions about osteoarthritis and HYALGAN treatment. Visit them at one of their convenient locations at 2030 Bee Ridge Road in Sarasota or 2215 59th St. West in Bradenton. The telephone number for the Sarasota location is (941) 954-3700 and the number for the Bradenton location is (941) 761-4994. adjustments, massage therapy and other treatments. “Natural Healing is just awesome,” she says. “It really is.” During an appointment last summer, she mentioned her upcoming trip − along with her ongoing knee pain − to the doctor. “I went to Dr. Z, and my left knee was just not getting better,” she recalls. “It started feeling weaker and weaker, and he said, Carrie, I think I’ve got the perfect thing.” FHCN PHOTO BY MICHELLE BROOKS DAVID S. ZAMIKOFF, DC LARS E. LARSON, DC A special diagnostic ultrasound pinpoints the most accurate location on the knee for each HYALGAN injection. HYALGAN eases pain Dr. Zamikoff recommended an FDAapproved treatment for Carrie called HYALGAN. Used exclusively to treat osteoarthritis of the knee, HYALGAN is made of a natural material known as hyaluronic acid, which is extracted from the purified combs of roosters. When injected into the knee, it mimics the body’s natural synovial fluid, a thick, gelatinous substance that lubricates joints, reduces friction and acts as a shock absorber during movement. Osteoarthritis causes synovial fluid in the knee to disintegrate, which in turn leads to cartilage damage followed by pain, inflammation and even joint injury. “What we do is literally put the hyaluronic acid back into the knee,” observes Todd Galuszka, an advanced registered nurse practitioner and registered vascular technologist at Natural Healing Arts in Sarasota. “The body then rebuilds the cartilage.” Todd uses a special diagnostic ultrasound to pinpoint the most accurate location on the knee for each injection, and treatment consists of five injections over a period of weeks. Results can last from six months to two years, depending on the patient’s activity level. Since it’s a natural product and not a medication that enters the bloodstream, HYALGAN has few, if any, side effects. “The only issue would be if you have an allergy to eggs or chicken products,” Todd notes. Several weeks before her trip, Carrie met with a nurse practitioner at Natural Healing Arts to discuss the treatment. “I said, Listen, we’ll give it a shot. If it helps, I’m good to go. If it doesn’t, no harm, no foul. That’s the way I see things. “He said, Carrie, I’m going to tell you. This is going to help you.” Pain free Carrie received her last HYALGAN injection just two weeks before leaving for Europe. On her vacation, she was very active. “We walked so much,” she remembers. “Eleven days on a cruise, three days walking in London, three days walking in Paris and one day in Amsterdam. I can’t tell you the mileage we put on walking. “It was a success,” Carrie raves. “I came back and I had to go in and say, My knee, not one time did I have to ice it. These shots worked for my knee … I don’t have to ice it; I don’t have to pick it up and elevate it. I don’t have to be afraid of walking up and down my stairs. “I can stand on my left knee and balance myself without it buckling,” Carrie marvels. “I can actually crawl on my knee, which I have not been able to do since the fall.” Carrie will soon begin the HYALGAN treatment on her right knee, which has developed osteoarthritis as well. “If I had known about these shots, I don’t necessarily think it might have prevented the meniscus surgery,” she says, “but I would have certainly done it a lot sooner afterward and saved myself a lot of pain.” FHCN–Melanie Casey *The patient’s name was changed at her request. About HYALGAN David S. Zamikoff, DC, is board certified both nationally and at the state level. He earned his doctorate from Cleveland Chiropractic College in Los Angeles and is currently licensed in Florida. Dr. Zamikoff also holds certification in operating room protocols and Manipulation Under Anesthesia by the American Academy of Manual and Physical Medicine. He holds a diplomate degree from the American Academy of Trauma Professionals and is the current president of the Florida chapter. • HYALGAN is not a drug. It is a naturally derived substance injected directly into the knee that helps lubricate and cushion knee joints and rebuild cartilage. • Since it does not enter the bloodstream, HYALGAN does not interfere with any other medications. • HYALGAN is FDA approved for osteoarthritis of the knee and is indicated for any degree of knee pain, particularly when exercise, physical therapy and pain medication have failed. • HYALGAN has been used safely for almost 25 years, and more than 38 million injections have been administered. • HYALGAN is covered by most insurance carriers, including Medicare. Lars E. Larson, DC, is a licensed chiropractic physician. He holds a degree in political science from the University of Vermont, but became interested in health care in 1987 and attended a yearlong therapeutic massage program at The Humanities Center School of Massage in St. Petersburg. He later graduated with a doctorate in chiropractic from Life University in Marietta, Georgia. Dr. Larson maintained a private practice in Burlington, Vermont for ten years before moving to Sarasota in 2007 with his wife and two children. He has been serving patients at the Sarasota location for seven years. Dr. Larson has co-authored a book on healing, written several articles and has traveled with several mission trips. He is an active member of the Florida Chiropractic Association. Natural Healing Arts Medical Center is a multidisciplinary practice that has been in the community for more than 15 years. Services include acupuncture, massage, physical therapy, chiropractic, nutrition, weight loss and functional medicine. Learn more at www.naturalhealingartsmedical.com. South Sarasota County Edition | Winter 2015 | Florida Health Care News | Page 3 MINIMALLY INVASIVE GENERAL SURGERY Beware of HERNIAS M ore than 600,000 hernia repair surgeries are performed in the United States annually, and everyone is at risk. Adults and children alike can develop hernias as a result of heavy lifting, straining, coughing or any unusual stress that Adults and children alike can causes a sudden increase of intra-abdominal pressure. Some hernias are congenital, or present at birth, whereas develop hernias as a result others develop as a result of a predisposition for hernia, and anyone who has surgery may experience a weakening of tissue at of heavy lifting, straining, coughing or any unusual stress the incision site that could result in a hernia. Because we are all at risk, Florida Health Care News turns to a specialist in minimallyinvasive surgery, David A. Napoliello, that causes a sudden increase MD, to learn more about hernia repair. Dr. Napoliello, practicing in Venice, Sarasota and Lakewood Ranch, is board certified by of intra-abdominal pressure. the American Board of Surgery and is a fellow of the American College of Surgeons. DAVID A. NAPOLIELLO, MD, FACS FAQs itself or improve over time without intervention. The only exception to this may be small umbilical hernias in young children. Q: Dr. Napoliello, what is the most common type of hernia? A: The most common type of hernia is called an inguinal hernia. It is a defect or weakness in the abdominal muscle wall through which intestine and fat layers protrude, forming a visible bulge in the groin area. To visualize the dynamics of it, think of an automobile tire. The abdominal wall is like the thick outer wall of the tire. Should the tire get damaged, the inner tube can push through the weakened area or crack and form a small bubble. If the abdominal wall becomes weakened, the thinner, flexible tissue that lines the inside of the abdomen and holds the intestines in place, called the peritoneum, can bulge into the outer wall. In the tire, it is easy to see that the inner tube can become strangled by the pressure of the edges of the crack through which it is protruding. It is the same with a hernia. Q: What treatments are available for hernias? A: Surgeons may choose one of several hernia repair techniques today, depending on the patient and the size of the hernia. In the past, the only hernia repair option available was called a tension repair. In this open surgical procedure, the physician makes an incision at the site, pushes the protruding tissue back into place, and stitches the tissue layers together. The potential disadvantages of this type of surgery are relatively long recovery periods, relatively high recurring rates and discomfort following surgery. Today, we can offer a variety of both minimally invasive open procedures and laparoscopic procedures. Q: What are some of the other common types of hernias? A: An umbilical hernia takes place when abdominal contents protrude through the naturally occurring tiny opening behind the belly button. Incisional hernias can take place when a previous surgery leaves an abdominal wall defect that allows the abdominal contents to protrude through it and bulge out. Q: How does a person know when he or she has a hernia? A: A person may suspect a hernia if he or she notices a bulge under the skin. Additional symptoms may include discomfort or pain during any of the following: lifting heavy objects, sneezing or coughing, straining while using the toilet, standing or sitting for long periods of time. Because delayed treatment can sometimes result in the intestine being trapped inside the hernia sac, resulting in gangrene, any bulge should be brought to a physician’s attention immediately so diagnosis and treatment can begin. If left untreated, some complications from hernias can be fatal. Q: Will a small hernia ever heal itself? A: No, a hernia does not heal Q: Please describe the minimally invasive open procedures. A: Unlike the tension repair, minimally invasive open procedures are tension free because the stitches or sutures used do not put tension on the sides of the defect to keep it closed. Instead, special mesh patches are used that limit the size of the required incision. These procedures offer lower recurring rates, quick recovery and only minor discomfort following the surgery. Additionally, the minimally invasive approach allows the patient to avoid general anesthesia. Q: How do the laparoscopic surgeries differ? A: There are two main options for laparoscopic surgery. In the transabdominal approach, the physician makes a small incision and slides the laparoscope, which is a thin telescope, through the abdominal wall into the abdomen. For the preperitoneal approach, the laparoscope slides in between the tissues of the abdominal wall. With both approaches, the doctor views the hernia and surrounding tissue on a video screen. Q: What are the advantages of laparoscopic surgery? A: Depending on the patient, of course, there are several. Because it requires only small incisions, it will likely mean less pain and a shorter recovery time for patients, and because the physician has the advantage of looking PHOTO FROM ISTOCKPHOTO.COM According to Dr. Napoliello, a hernia is a defect of the abdominal wall that allows a protrusion of an organ or structure through the wall that normally contains it. through the laparoscope, previously undiagnosed hernias may be discovered. Additionally, the laparoscopic approach allows us to manage recurrent hernias and to optimize any repeat surgery because we do not have to go through the same incision site. Q: Is this surgery done on an outpatient basis? A: Yes, and it is usually performed in under an hour as well. Q: Do you have a preference between the minimally invasive open procedure and the laparoscopic procedure? A: It depends on the patient. I specialize in minimally invasive surgery techniques and did my fellowship in minimally invasive and advanced laparoscopic surgery. In fact, I was involved in training surgeons using the laparoscopic approach when it was first developed. When my patients are good candidates for either one, I provide them with information on both the minimally invasive open procedures and the laparoscopic procedures, and we make the decision together as to which one will be more appropriate. Q: Have there been any improvements to these surgical techniques in recent years? A: Definitely. Scientific improvements to help hernia repair include the addition of very lightweight artificial meshes and biologic meshes such as processed skin grafts. Other improvements to decrease chronic pain associated with hernia repairs include the addition of absorbable tacking devices and dissolvable sutures, which help to decrease the risk of nerve entrapments. These improvements are mainly geared toward decreasing pain and improving the repair, thereby shortening recovery time. Q: Once the surgery has healed, will the patient experience any diminished quality of life? A: No, most patients will be able to return to a normal routine. In fact, data show that within a week’s time, most people will feel well. Because I am conservative, I recommend that my patients avoid any physical strain for four weeks. This interview with Dr. Napoliello was conducted by a member of the editorial staff at Florida Health Care News. Learn more Dr. Napoliello and his staff look forward to answering your questions. For additional information or to schedule an appointment, please call (941) 388-9525 for the location at Medical Office Building 1, 8340 Lakewood Ranch Blvd., Suite 101, in Bradenton or 1211 Jacaranda Blvd. and 825 Venetian Pkwy. in Venice. David A. Napoliello, MD, is board certified by the American Board of Surgery and is a fellow of the American College of Surgeons. He earned his undergraduate degree at Bucknell University, Lewisburg, PA, and his medical degree at Georgetown University School of Medicine. Dr. Napoliello completed his residency in general surgery at Penn State-Geisinger Medical Center, Danville, and a fellowship in minimally invasive and advanced laparoscopic surgery at Mayo Clinic Jacksonville. He is past chief of surgery for Venice Hospital and Lakewood Ranch Medical Center. In addition, Dr. Napoliello has been voted one of the top general surgeons in Sarasota and Manatee Counties by his peers and patients for the past six years running in Castle Connolly’s list of America’s Top Doctors. For more information, please visit www.DavidNapolielloMD.com. Page 4 | Florida Health Care News | Winter 2015 | South Sarasota County Edition COMPREHENSIVE DENTISTRY Same-Day Crowns 215 Bullard Parkway Temple Terrace, FL 33617 (813) 989-1330 (continued from page 1) every fraction of each crown and restoration with this 3-D software while the patient is watching. The CEREC computer gives a good representation of the tooth based on several factors: the shape of the other teeth, the size of the jaw, the angulation of the other teeth in the mouth and the anatomy of Advantages of CEREC Omnicam The CEREC Omnicam advantages far exceeded his own expectations, Dr. Farag shares. “Let’s say a patient broke a tooth off and they came to my office,” he explains. “I now have the ability in-office, from start to finish, to put them in a restoration without going anywhere else. With the use of the CEREC and a CT scan, the diagnosis is pretty much spot-on, and the precision of the restoration is calculated from the very beginning.” In addition to fashioning full-porcelain crowns, CEREC has the ability to design and contour all types of porcelain restorations, including onlays, inlays, veneers and even implant crowns. “The CEREC is excellent for inlays and onlays because the material that is used is typically stronger and more wear resistant than that used for a traditional filling,” observes Dr. Farag, “so for large fillings, the porcelain is a better choice, which was the case for Bob.” Dr. Farag also points out that the material used to create CEREC crowns is the closest thing in dentistry to human enamel. The natural-looking, affordable material is antiabrasive and plaque resistant, making the crowns reliable and long-lasting. “Everything is done here and basically, as far as implants Treating gum disease with LANAP Between 50 and 75 percent of Americans have some form of periodontal disease. Fortunately, thanks to dental laser treatment, it can now be comfortably treated, which can help stop the bacteria dead in their tracks without destroying the gum line. Periodontal disease is an inflammatory process that can be both a chronic and an acute problem, describes Dr. Farag: “At its initial stage, called gingivitis, it affects only the gums. Patients may experience some red, swollen, tender gums that appear puffy and bleed easily, or they may experience no warning signs at all.” In the past, traditional gum treatment involved cutting away the infected gum tissue and placing sutures to hold the reduced tissue in place during the healing process. During conventional gum surgery, the scalpel cannot differentiate between healthy and diseased gum, so the patient loses both tissue types. This approach always results in recession of the gums – a lowering of the level of gum tissue. If the gum tissue recedes too far, it can leave the sensitive tooth roots exposed. “But today,” observes Dr. Farag, “we can offer patients laserassisted new attachment procedure, or LANAP. “LANAP is a therapy that uses regeneration rather than resection. As well as preventing cases from digressing, the laser is helpful in killing the bacteria colonies, something the scalpel does not accomplish, and reducing the amount of bacteria exposure to the body. It can stop gum recession right in its tracks and will regenerate attachment beneath it. “Research studies find that laser-assisted dental gum therapy is superior to the conventional surgery in a number of ways – the most notable to the patient is that they don’t lose their gum line. Additionally, while patients having the traditional surgery usually require sedation, our patients remain wide awake, watching a movie with stereo sound and adjustable headphones.” Barry P. Levine Executive Publisher Gina L. d’Angelo CFO/HR Manager Judy Wade Editorial Manager Michael J. Sahno Senior Writer Patti DiPanfilo Melanie Casey Editorial Staff Michelle Brooks Creative Director Nerissa Johnson Graphic Designer are concerned, what we do is we strive for something called resultsbased planning; we’re planning the implants from the end restoration backward,” Dr. Farag emphasizes. “We place the tooth with the BEFORE AFTER The CEREC Omnicam 3D Smile design feature allows the patient to discuss the length and characteristics of their smile with the dentist in a 3D, simulated environment. GRAPHICS COURTESY OF PORT CHARLOTTE DENTAL CARE the teeth. The opposing teeth are also taken into consideration. Consequently, the bite is incredibly accurate.” Once Dr. Farag has designed the crown, it is milled from a block of porcelain and then finished, characterized and glazed, and cemented onto the tooth. Winter 2015 PHOTO FROM ISTOCKPHOTO.COM CEREC technology and materials advancements allow for in-office, multiple-unit bridgework and implant restorations to be completed in a single visit. Florida Health Care News computer software ideally where the patient wants it, where they need it. Then, we work backward to make sure the implant goes into that spot so that when we place it permanently, we already know what our outcome is going to be before we start.” Bob says he is pleased with his results and can chew foods and smile with confidence. “Dr. Farag and his staff are very caring and compassionate, and they all do fabulous work,” he states. “I am very happy with the crowns and with Dr. Farag. I am really glad I can chew with confidence once again. I think Dr. Farag is excellent.” FHCN–Judy Wade Have a beautiful smile Dr. Farag looks forward to hearing from readers of Florida Health Care News. For more information or to schedule an appointment, please phone (941) 764-9555 for his location at 3441 Conway Blvd. in Port Charlotte. Joseph H. Farag, DMD, earned his Doctor of Dental Medicine degree from the University of Florida College of Dentistry, Gainesville, FL after completing his undergraduate degree at Florida Atlantic University, Boca Raton, FL. Dr. Farag served an implant residency at the Misch Institute and is trained in advanced laser dentistry. He is a member of the American Dental Association, American Association of Dental Practitioners, American Academy of Operative Dentistry, the International Association of Dental Researchers, and is a Diplomate of the International Congress of Oral Implantologists. Marc Edwards Nerissa Johnson Photography Brian Levine Project Coordinator Laura Engel Production Assistant Steve Turk John Gnibus Vincent Ortiz Aaron Ogden Distribution Contributing Editors Port Charlotte Dental Care Comprehensive Dentistry Natural Healing Arts Medical Center, Inc. Chiropractic David A. Napoliello, MD, FACS Minimally Invasive General Surgery Alejandro J. Gruneiro, MD, P.A. Bariatric Surgery Johnson Medical Center Sedative Stretching Kate Ross, MD Dermatology Center for Artificial Disc Replacement Minimally Invasive Spine Surgery South Florida Eye Clinic Ophthalmology Sarasota Foot and Ankle Center Podiatry Gecko Joint & Spine Orthopedics Domingo E. Galliano, Jr., MD, FACS, FASCRS General Surgery For all health care professionals having articles in this publication that offer free or discounted services: THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS THE RIGHT TO REFUSE TO PAY, CANCEL PAYMENT OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION OR TREATMENT WHICH IS PERFORMED AS A RESULT OF, AND WITHIN 72 HOURS OF RESPONDING TO, THE ADVERTISEMENT FOR A FREE, DISCOUNTED OR REDUCED FEE SERVICE, EXAMINATION OR TREATMENT. Florida Health Care News is published by Florida Health Care News, Inc. Florida Health Care News, Inc., reserves the right to decline any advertising/marketing article. Florida Health Care News is provided for information only and should not be construed as health care advice or instruction. If you have questions concerning articles in this edition, feel free to call our contributing editors. Florida Health Care News provides a paid forum for health care professionals to present their ideas about various aspects of health care treatment and procedures. Florida Health Care News, Inc. is not responsible for the health care delivered by the contributing editors presented in this edition. Articles reflect the opinion of the sponsoring professional or organization and do not necessarily reflect the opinions of other contributing editors. Contributing editors have approved all text contained within their respective articles. © 2015 Florida Health Care News, Inc. All rights reserved. The contents of this publication, including articles, may not be reproduced in any form without written permission from the publisher. South Sarasota County Edition | Winter 2015 | Florida Health Care News | Page 5 BARIATRIC SURGERY W illiam “Ernie” Krug knew he had one foot in the grave when he tipped the scales at 410 pounds. That was more than 200 pounds overweight for his six-footone-inch frame. As a result, Ernie had developed a multitude of health issues ranging from Type 2 diabetes to sleep apnea, not to mention the fact that simple, everyday tasks had become almost impossible to perform. Shedding Excess Pounds Weight loss surgery was nothing short of a medical miracle for a Port Charlotte man who had a list of health issues due to excessive weight. ALEJANDRO J. GRUNEIRO, MD, P.A. Benefits of surgery “Weight loss surgery is the only proven long-term solution for permanent and sustainable weight loss,” according to Dr. Gruneiro. “It is the only procedure that will give you a permanent resolution for Type 2 diabetes, sleep apnea, hypertension and other illnesses related to morbid obesity.” Candidates for bariatric surgery must have a body mass index (BMI) PHOTO COURTESY OF WILLIAM “ERNIE” KRUG BEFORE AFTER FHCN PHOTO BY MARC EDWARDS “I couldn’t even bend over to tie my shoes,” Ernie says. “Sleeping, getting up from a chair, even walking became a daunting task. I couldn’t find clothes to fit. I was wearing a five-X and you can’t just walk into a store and find that on the racks. I had already had one heart attack because of the weight.” Ernie considers himself a “diet professional,” having gone off and on various diets over the years, losing 100 pounds here and there, but never being able to keep the weight off. “I was an expert at losing one hundred pounds if I wanted to, but all of the other elements were always missing, like knowing how to prepare food in a healthier way and choosing the right foods to begin with. Those things are part of the bigger picture.” Because of the health issues he was faced with, Ernie was taking several medications each day to maintain his blood sugar, blood pressure and keep his other physical ailments at bay. “I was taking a lot of medicines and that was expensive also,” Ernie recalls. “I was knocking on death’s door and I knew I had to get some much-needed help.” Ernie was referred to Alejandro J. Gruneiro, MD, and soon underwent bariatric weight loss surgery. greater than 35, which equals 100 pounds overweight. “Ernie was perfect for this procedure because he met all of the criteria we look for in a patient,” Dr. Gruneiro explains. “He had a long list of medical conditions, including Type 2 diabetes, joint pain and he had already had one heart attack. He was also more than two hundred pounds overweight. Surgery was the best option for him in order to keep the weight off long term. “The main illness that fifty percent of overweight patients have is diabetes,” Dr. Gruneiro states. “Ninety percent of diabetic, obese patients who undergo gastric bypass surgery are resolved of the Type 2 diabetes itself. They are insulin free when they leave the hospital. The diabetes and other medical conditions they have disappear post surgery because the hormone levels change. This was the case with Ernie.” Patients typically lose more than 80 to 90 percent of their excess weight after bariatric surgery procedures, according to Dr. Gruneiro. The surgery also reduces cardiovascular risk and improves life expectancy. Also, there is no age limit when it comes to having the surgery. “Age is not a limiting factor when it comes to bariatric surgery,” Dr. Gruneiro explains. “I have done this procedure on patients as young as eighteen and as old as seventy-two. It is a minimally invasive, laparoscopic procedure that requires a two-day hospital stay. Most patients recover within one week. “The benefits are life changing,” he continues. “Most patients, like Ernie, are on multiple medications and the procedure pays for itself within a few years by reducing medical costs due to these various obesity-related illnesses mentioned. Best of all, the long-term mortality rate seems to be lower for morbidly obese patients who undergo this surgery than for those who do not.” Dr. Gruneiro states patients are treated individually and recommendations are on a case-by-case basis. “I meet with every patient for pre-surgery counseling and I look very closely at their medical history and talk to them about their individual goals,” Dr. Gruneiro says. “This is how I determine which weight loss surgery is best for them, if any at all. Their best interests are my top priority.” In addition to gastric bypass, Dr. Gruneiro performs two other types of bariatric weight loss surgery: LAP-BAND® and sleeve gastrectomy. Lose weight, feel great Ernie says within a month of his surgery, he was free of all medications and his Type 2 diabetes was gone. “I no longer had to take a handful of pills several times a day and check my blood sugar,” Ernie raves. “I am so happy and I feel absolutely fantastic. Better than ever!” Ernie says he attends a support group every month where other weight loss surgery patients share their experiences and struggles with maintaining proper weight. “Your problems aren’t so bad when you hear someone else’s struggles,” he says. “We share our challenges and support each other. It’s really great.” In addition, Ernie says Dr. Gruneiro’s staff has taught him what foods to buy and how to prepare healthy meals. Weight Loss for Life FHCN PHOTO BY MARC EDWARDS If you would like more information on the best weight loss surgery for your needs, contact Dr. Alejandro J. Gruneiro and his staff at (941) 625-3411 or visit his office at 18308 Murdock Circle, Suite 109, in Port Charlotte. William “Ernie” Krug underwent bariatric bypass surgery and shed over 200 pounds, thanks to Dr. Alejandro J. Gruneiro. Alejandro J. Gruneiro, MD, is board certified by the American Board of Surgery in general and bariatric surgery. After earning his PhD in Biochemistry, Dr. Gruneiro received his medical degree from the State University of New York at Buffalo. He completed his surgical internship and residency at Southern Illinois University in Springfield, as well as a fellowship in minimally invasive surgery/bariatric surgery at Geisinger Medical Center, Danville, PA. Dr. Gruneiro is the Director of Bariatric Surgery at Peace River Regional Medical Center in Port Charlotte, and is a member of the American Society of Metabolic and Bariatric Surgery and the Society of Laparoendoscopic Surgeons. “It has been a complete lifestyle change for me,” he shares. “I look and feel better than I have in many, many years and I owe it all to Dr. Gruneiro. It took me about a year after my surgery to get to the weight I really wanted to stay at. Today, I eat properly, rest better and exercise, all to his credit. He thinks a lot of his patients. He follows up with you and checks on you. He truly wants you to succeed.” Ernie’s wife, Sherry, also underwent gastric bypass with Dr. Gruneiro. “My wife lost about fifty pounds with gastric bypass. It has been a journey we have taken together.” Today, Ernie’s waist size is a 36, down from a 56 before surgery. “I have not worn a thirty-six-inch waist since eighth grade,” he notes. “I cannot say enough about Dr. Gruneiro. He saved my life.” FHCN–Judy Wade Health risks of severe obesity According to the Centers for Disease Control and Prevention, severe obesity – also known as morbid obesity – is the second-leading cause of preventable death in the United States, with cigarette smoking being the first. Women are affected at about twice the rate of men. Severe obesity is a chronic, lifethreatening disease that leads to medical conditions that cost approximately $100 billion in health care annually in the United States. Some 300,000 preventable deaths are attributed to the serious medical conditions brought on by severe obesity each year. This chronic disease often leads to or coexists with serious conditions such as: • Cardiovascular disease • Hypertension • Type 2 diabetes • High cholesterol • Respiratory problems, such as worsening of asthma and obstructive sleep apnea • Degenerative arthritis • Gallbladder disease • Infertility • Sleep apnea • Gastric reflux • Chronic pain • Depression • Impotence NOW ACCEPTING MEDICARE Page 6 | Florida Health Care News | Winter 2015 | South Sarasota County Edition SEDATIVE S Nonsurgical, Effe Without scalpels or stitches, Sedative Stretching induces releasing the scar tissue t V After Sedative Stretching, Jeff can bend and kneel to work on a car without being in excruciating pain. Benefits of Sedative Stretching Effective Sedative Stretching treatments provide powerful results: • Breaks up scar tissue and sensitive, injured areas adhesions surrounding the • Stretches persistent shortened joints and spine commonly muscles, tendons and caused by injury or previous ligaments surgery • Relieves pain from damaged • Corrects the cause of many intervertebral discs pain syndromes • Decreases the progression • Relaxes patient for more of osteoarthritic types of effective treatment of even degeneration Provided by Johnson Medical Center FHCN PHOTOS BY MARC EDWARDS Kim Elam enice auto mechanic Jeff Hazeltine works grueling hours in the auto repair shop he’s owned for the past 25 years. When he’s not bent over a car with his head in an engine and inhaling exhaust fumes, Jeff enjoys the fresh air from the deck of his boat or the seat of his Harley. There were times in between, however, when Jeff struggled with severe back pain from an injury he suffered early in his career. The pain sometimes kept him from the very activities that helped him cope with the physical and stressful demands of his job. “I got hurt really bad when I was working with the Nissan dealership,” he shares. “I was putting in a transmission and it slipped. Instead of letting it hit the floor, I caught it and I really hurt my lower back. “Back then, they were trying to get me to have surgery, but I don’t know anybody who has had a successful surgery, so there was no way I was going to do that.” Instead, he turned to long-time friend Jeffrey P. Johnson, DC, at Johnson Medical Center in Venice. For years, Dr. Johnson managed Jeff’s back pain with general chiropractic treatments, but the doctor always had his eye on a more permanent approach to relieving Jeff’s back pain. “Every now and then, I would hurt my back really bad and I’d go see Dr. Johnson,” says Jeff. “He would straighten it out, but he kept telling me, Let me really fix this before it gets too bad. “Finally, this last time, it was so bad, he said, Go get an MRI and let me show you how bad this is. So I got an MRI and he said, Look, you’re going to have to let me help you or you’re going to be in trouble.” The MRI just confirmed what Jeff already suspected by experience: he was at a major turning point. By this time, Jeff was struggling with sleepless nights due to the pain, and pain was interfering with most every other aspect of his life as well. “I hadn’t slept in like four weeks,” he explains. “I would literally have to take pain pills and drink Nyquil® to get my two hours of sleep because I was in so much pain. “I was down. I couldn’t do anything. I was not able, by any means, to be on the boat. I couldn’t ride my bike because the pain was so bad. I had to work, of course, and so I’d come to work, but I was just in absolute pain at all times. “There was no way to get comfortable. I don’t care what I did; there was no comfort zone. Sitting, standing, lying down – it didn’t matter. There was always just terrible pain. It was actually shooting. My nerves were pinched, and my left leg was absolutely numb and my foot was numb.” Jeff was afraid he would have to give in and have surgery, but Dr. Johnson had another option he thought Jeff should consider. Dr. Johnson offers his patients the noninvasive, pain-relieving treatment STOP THE PAIN For a consultation appointment, please call (941) 484-5333. Johnson Medical Center is located at 401 Johnson Lane, Suite 101, in Venice. called Sedative Stretching*. After years of prompting by Dr. Johnson, Jeff finally agreed to give the unique treatment a try. He was not the only one. Graphic designs Kim Elam parleyed years of study at respected art schools into a satisfying career teaching graphic design at Ringling College of Art and Design in Sarasota. JOHNSON MEDICAL CENTER JEFFREY P. JOHNSON, DC “I went to Parsons The New School for Design and The New School for Social Research,” she relates. “For graduate school, I went to Cranbrook Academy of Art.” For fun, the native of the Twin Cities area enjoys tennis and racquetball, but a nagging ache was starting to interfere with her activities, and she came to realize it was more than she could manage on her own. “I’d been experiencing hip pain for some time and things were accelerating,” describes Kim. “It accelerated to the point where I couldn’t walk up stairs without a lot of pain. It was starting to inhibit my tennis, and I didn’t want that to happen. I was at the point where I was taking over-the-counter medication every day and most nights for it. “I figured there had to be a better way to address the situation. I’d made changes in the kinds of shoes I wore to try and alleviate the problem and had started doing stretching exercises, but I realized that I needed more help than what I could do for myself. I wanted a solution that would be long-term and would both alleviate the pain and enable me to be as active as I wanted to be.” Kim’s attempts at stretching on her own proved unsuccessful. She found the exercises difficult to do and actually quite painful. She had heard about Sedative Stretching, so she logged onto the internet to learn more. In her search, she discovered Dr. Johnson at Johnson Medical Center. She scheduled an appointment. Dr. Johnson stunned Kim with his insight and thoroughness. He identified issues of which Kim was not even aware. “He put me at ease immediately,” notes Kim. “He didn’t just look at my hips. He looked at my shoulders and back as well, and discovered problems with my shoulders that weren’t painful but inhibited movement. I never knew that I didn’t have a full range of motion in my shoulders, particularly because I played tennis, although my tennis instructor had been encouraging me to stretch my shoulders because I couldn’t hold my arms straight above my head. “Dr. Johnson felt that he could help me and showed me the x-rays and began to do some in-office treatments to see if I’d be a candidate for Sedative Stretching. At the conclusion of two or three visits, he decided that I was, and I felt that I was as well.” Unique treatment Traditional treatments such as physical therapy, pain management techniques, medications, chiropractic and back surgery are successful in helping to relieve pain for a For more information, please visit w South Sarasota County Edition | Winter 2015 | Florida Health Care News | Page 7 STRETCHING ective Pain Relief relief by taking joints through their full range of motion, that causes patients’ pain. majority of patients, educates Dr. Johnson: “However, for those patients who are simply not responding to those techniques, there is another solution that is noninvasive. That treatment is Sedative Stretching.” Patients with unresolved neck and back pain, herniated discs, spinal stenosis, sciatica, frozen shoulder, acute and chronic muscle spasm, headaches or failed back surgery syndrome are good candidates for the Sedative Stretching procedure. “Adhesions and scar tissue keep some patients’ joints from moving and functioning properly,” informs Dr. Johnson. “Typical daily activities can be enough to result in localized pain and inflammation. With that inflammation, part of the body’s natural healing process is to lay down a mesh of fibrotic tissue, commonly known as scar tissue [see Spotlight on scar tissue]. Although this tissue is beneficial, some patients naturally form an excessive amount of it, while others suffer repeated injuries or recurring chronic conditions that can cause layer upon layer to form in the muscles, tendons and ligaments around the joints, restricting the joints’ ability to move. “This build-up of scar tissue can restrict and limit the joints’ normal range of motion more and more over time.” Using Sedative Stretching, doctors can take the affected joints through their normal full range of motion while the patient is under light sedation, sometimes called “twilight” sedation, freeing the adhesions that have occurred between the joints that are causing the patient’s pain. “Once patients are sedated, we’re able to use light, comprehensive stretching techniques,” says the doctor. “Because we don’t have to fight against tense, guarded muscles, we are able to free up the scar tissue and mobilize the joints without causing the patient any discomfort. This would be impossible to do without the use of sedation. “There are typically multiple doctors present during the procedures, including the anesthesiologist, and several nurses, so Sedative Stretching is definitely a team approach. Also, most patients require only one procedure. It is very rare that patients require a second procedure to fully address their condition.” Following the treatment, there are typically a couple of weeks of subsequent rehabilitation to reinforce the movement obtained from the procedure. During this time, patients are instructed on how to perform stretching exercises to prevent the condition from recurring. “The patients are then placed on a strengthening program to rehabilitate the muscles around the regions that were addressed during the procedure,” explains Dr. Johnson. “This also helps to prevent their condition from returning. “Patients following this protocol are regaining the flexibility they had decades before, and typically, they are completely pain free.” Generally, more can be accomplished in ten minutes of Sedative Stretching than with years of other stretching techniques, observes Dr. Johnson: “And ten minutes can add years to the life of a person’s spine and skeletal system.” Easy and pain free Kim couldn’t believe how easy the Sedative Stretching procedure was. While the patient is sedated during the procedure itself and generally has no memory of it, many patients anticipate discomfort afterward, which Dr. Johnson assures is rarely the case. “It was simpler than I thought,” reports Kim. “I was told I would not experience pain when I woke up, and I found that a little hard to believe, but it was true. I didn’t have the soreness that I expected, and I found that the range of motion and the kind of stretching I could do with both my shoulders and my hips was much improved. “I am amazed. It hasn’t been very long, but since that day, I haven’t needed any over-the-counter pain medication. Walking is a lot more comfortable. My range of motion is better and I’m just delighted. I’m dedicated to the process of stretching daily, and I’m on a course now that’s going to allow me to be active without having the pain I was experiencing.” Kim has also made a return to the tennis court. Jeff remembers little of his experience except waking up without pain. “All I remember is lying there talking to the doctor, and then I woke up and I was pain free,” he marvels. “It was unbelievable. At first, I thought maybe it was because of the drugs that I was pain free, but the next day, I was still pain free and then I realized that they had nothing to do with it. He was able to relieve the pain and jump-start this thing big time. “I have no problems at all anymore. I’m absolutely pain free today. I am blown away because I didn’t expect it. I knew it would help, but I never expected it to go this far. It’s just awesome.” Spared surgery Both Kim and Jeff appreciate Dr. Johnson and his staff at Johnson Medical Center for their excellent care. They are especially grateful that Dr. Johnson was able to treat their conditions and keep them from needing surgical intervention. “The staff are wonderful,” Kim comments. “They put you at ease immediately. His assistants who helped with the stretching seemed to have a sixth sense to know just how far they can go and are very encouraging as well. I’ve been very impressed. I am delighted that it didn’t take surgery or medication to get me to this point. Jeffrey P. Johnson, DC, is a graduate of Life Chiropractic University in Marietta, GA, with additional training through the National College of Chiropractic in Chicago. His training included: Manipulation Under Anesthesia, proprietary substances and chiropractic adjunctive physiotherapy. He earned his undergraduate degree from the University of South Florida in Tampa. Dr. Johnson holds certification from the National Board of Chiropractic Examiners and is a member of the National Academy of Manipulation Under Anesthesia Physicians, the American Chiropractic Association, the Florida Chiropractic Association, the American Board of Disability Analysts, and other professional and civic organizations. He has been in practice since 1986. www.DRJPJ.com or call (941) 484-5333. With her range of motion restored, Kim is back on the tennis court. Spotlight on scar tissue With injuries and surgeries, inflammation and swelling typically occur. Specialized cells, called fibroblasts, lay down layers of fibrous connective tissue, which is commonly referred to as scar tissue or fibrotic adhesions. It can form on any tissue of the body, including skin, muscles, tendons and ligaments. Scar tissue is inferior to normal, healthy tissue for several reasons: it is thicker, less elastic and weaker than the original tissue. It results in significant joint dysfunctions that can lead to many other conditions. The condition that results from fibrotic adhesions (scar tissue) presents a prime candidate for Sedative Stretching. “I truly believe Dr. Johnson has his patients’ welfare foremost in his mind and makes recommendations that he feels are going to help them.” Jeff has been a patient of Dr. Johnson for years, but the skilled, compassionate chiropractor still manages to impress him. “He’s just a super person,” states Jeff. “He’s a very professional, very likeable guy. He’s just a super guy. “I’m glad I finally listened to him. If he couldn’t help me, I knew it was going to be surgery, and I just did not want to have surgery. I’m afraid of it. I’m so glad he mentioned this to me because I was so bad, and he hoped he could save me from having to go under the knife and he did. “This definitely works,” he adds. “If you have issues like I had, if anybody has that, I strongly, strongly recommend seeing him because there’s no surgery done, nothing, and literally, I walked out of there pain free. It’s unbelievable.” FHCN–Patti DiPanfilo *Sedative Stretching is also known as MUS (Manipulation Under Sedation) and/or MUA (Manipulation Under Anesthesia). Jeff Hazeltine Page 8 | Florida Health Care News | Winter 2015 | South Sarasota County Edition DERMATOLOGY Eliminate Skin Cancer Mohs Micrographic Surgery is a fast and effective treatment option for patients with skin cancer. A native of Ohio, Gilbert Lee Slack spent many summers vacationing in the Sunshine State before retiring to Florida over three decades ago. KATE ROSS, MD The Mohs advantage “Skin cancer is the most common cancer found today,” educates Kate Ross, MD, of LA Plastic Surgery & Dermatology. “It’s very important to get screened annually because one in five Americans will get skin cancer in their lifetime. It’s very easily treated when caught early. But when caught late, it can have long-lasting effects or even shorten your lifespan.” After examining Gilbert, Dr. Ross determined that he had several basal cell carcinomas on his cheek, shoulder and ear. The cancer on his ear, she says, was very aggressive and needed to be removed quickly. Therefore, the best treatment plan, Protect your skin for life Dr. Ross is pleased to offer her expertise in Mohs Micrographic Surgery to new patients. For more information about LA Plastic Surgery & Dermatology, please call (941) 954-4500. Offices are located at 1274 N. Palm Ave. in Sarasota and 4701 Manatee Ave. West in Bradenton. FHCN PHOTO BY MARC EDWARDS “I used to come down here on vacation when I was a teenager,” Gilbert recalls. “And then my wife and I married and we continued to come down every summer, even after our daughter was born. We came on family vacations year after year. We just loved the warm weather here. We always knew we wanted to retire here. We used to say, Why would anyone want to live in Ohio when they can live in Florida?” he laughingly recalls. When his daughter, Hope, graduated in 1983, the family moved here permanently. Ever since his teenaged years of basking in the sunshine on the Gulf shores, Gilbert admits wearing sunscreen wasn’t a thought, nor was it much of an option. “No one wore sunscreen back in my day,” Gilbert shares. “It was available, barely, but the threat of skin cancer was not as prevalent as it is today and no one even thought twice about it. “One day, I went to the doctor because I had multiple skin tags on both of my legs and I needed them removed,” he continues. “They were uncomfortable and sometimes painful. I had them for years before I had them removed. While I was there, the doctor noticed a spot on my cheek and wanted me to have it checked out, so they sent me to LA Plastic Surgery and Dermatology. It turns out that it was basal cell carcinoma, and I had several lesions, actually, that needed to be removed.” Gilbert wears a hat and long-sleeved shirt outdoors to protect his skin from harmful rays. she felt, was Mohs Micrographic Surgery. Squamous cell carcinoma develops With the highest success rate in the outer layer of the skin and usually of all skin cancer treatments, Mohs appears as scaly or crusted patches with a Micrographic Surgery is considered the red, inflamed base. It can also present as a most advanced skin cancer treatment growing tumor, a non-healing ulcer or just as currently available. The procedure, which a crust. This form of skin cancer is generally requires a physician to be specially trained found in sun-exposed areas, including the in surgery, pathology and reconstruction, face, neck, arms, scalp, backs of the hands makes use of microand ears. According scopic technology to the Skin Cancer “Sun exposure, to trace the edges of Foundation, approxhereditary factors and skin the cancer, ensuring imately 40 to 60 that all tumors are percent of squamous type determine skin cancer completely removed, cell carcinomas get risks,” Dr. Ross emphasizes. their start as untreated down to the root of the malignancy. actinic keratoses (AK). On the skin, actinic keratosis usually “The Mohs procedure was invented by Dr. Frederic E. Mohs,” Dr. Ross presents as a rough, scaly, reddish spot, explains. “He created this technique of occasionally with bumps or small, hornremoving a very small margin of skin like growths, which sometimes leads to a around the cancer, and then sectioning misdiagnosis of dry skin or a rash. Often, that skin in a way that you can check patients who consult their doctors about all of the margins, all of the tissue, and treatment for sun damage find themknow that the cancer is one hundred selves with a diagnosis of precancerous percent out before the patient leaves the lesions. And because there is really no office. The procedure itself minimizes way of predicting which lesions will turn the potential for both scarring and cancerous, all should be treated. re-growth. It is performed in-office and Malignant melanoma is the most takes very little time to complete.” serious and deadly type of skin cancer. The cure rate for Mohs surgery is the Any one or more of these changes occurhighest of all surgical treatments for skin ring in a new or existing pigmented (tan cancer. The procedure not only minimizes or brown) area of the skin, or in a mole, the risk of recurrence, but it can also elim- may indicate the presence of a malignant inate the costs of more serious surgery for melanoma: Change in size, color, shape, recurrent skin cancers. elevation, surface, surrounding skin, sensation or consistency. Types of skin cancer “Both basal cell and squamous cell Basal cell carcinoma most often appears cancers are very easily treated with Mohs on sun-exposed areas such as the face, surgery,” Dr. Ross explains, “especially on scalp, ears, chest, back and legs. These areas like the face, neck, hands or other tumors can have several different forms. highly visible areas, where you want to The most common appearances of basal leave as much healthy skin as possible.” cell carcinoma are those of small, domeshaped bumps that have a pearly-white Screening and prevention color, or pimple-like growths that heal, According to the Skin Cancer Foundation, only to come back again and again. skin cancer occurs when unrepaired DNA damage to skin cells triggers mutations, or genetic defects, that lead the skin cells to multiply rapidly and form malignant tumors. Each year, there are more new cases of skin cancer than those of breast, prostate, lung and colon cancers combined. “Sun exposure, hereditary factors and skin type determine skin cancer risks,” Dr. Ross emphasizes. “The frequency of screenings is based on the individual; however, I highly recommend annual screenings if you have any kind of family history of skin cancer.” Performing regular self-exams can raise awareness to new or changing moles or spots, which can be a sign of skin cancer. The primary method of preventing skin cancer, Dr. Ross explains, is the avoidance of ultraviolet light, especially during its peak hours between 10 a.m. and 4 p.m. She advises wearing wide-brimmed hats and sunglasses outdoors and applying sunscreen that provides protection from both UVA and UVB rays and has a sun protection factor (SPF) of 30 or higher. Gilbert says he is pleased to have Dr. Ross as his dermatologist and advises others to respect the dangers of the sun. “When I was young, having a tan was the best thing ever, but nowadays, that’s not such a good thing,” Gilbert reminds. “I am so thankful that Dr. Ross caught the cancer quickly and took care of it just as fast. It is a really nice office with a wonderful staff. They are true professionals and care about their patients.” FHCN–Judy Wade Kate Ross, MD, is board certified in dermatology. She received her undergraduate degree from the University of Florida and her medical degree from the Florida State University College of Medicine. Dr. Ross served an internship in internal medicine at the University of South Florida, as well as her residency in dermatology. She is a member of the American Society for Mohs Surgery and the American Academy of Dermatology. Please visit LA Plastic Surgery & Dermatology online at www.myskinsdoc.com. South Sarasota County Edition | Winter 2015 | Florida Health Care News | Page 9 MINIMALLY INVASIVE SPINE SURGERY NO MORE LIMITATIONS Leading disc replacement center offers a procedure that relieves intractable pain and restores mobility. D odie Boesch had some serious problems with neck pain…but it didn’t end there. “I had severe neck pain and it was radiating through my left arm, causing numbness and tingling,” she describes. “I was in so much pain. Every night, I would take some kind of pain medication – I had a narcotic, and I had muscle relaxers. I had to sleep with my arm propped up, and even then it was really bad, restless sleep.” SCOTT S. KATZMAN, MD, P.A. Long-term data “Patients who have neck problems like disc herniation, cervical stenosis, foraminal stenosis and radiculopathy are treated by most surgeons in the country with the fusion [ACDF] procedure,” Dr. Katzman explains. “This surgical technique requires placement of a device into the disc space, typically locking it into position with screws and plates.” Rather than a fusion, Dr. Katzman prefers to use an artificial disc implant made of a combination of titanium and ultra-high-molecular-weight polyurethane. He explains that artificial disc replacement has become a well-established procedure in recent years, comparable to total knee or hip replacement. “Disc replacement has actually been FDA-approved for years, although there are not many surgeons offering this procedure yet in the US,” notes the doctor, who has been performing artificial disc replacement for over a decade. “We now have between ten and fifteen years of data showing its effectiveness. Depending on the patient, I may use the BRYAN Cervical Disc System from Medtronic, the Prodisc-C from DePuy Synthes or the Mobi-C from Globis.” The skilled surgeon explains that the replacement procedure has significant advantages over traditional fusion surgery. “A fusion doesn’t move; an artificial disc does. Fusion requires a brace for several months; an artificial disc requires none. A fusion can stress the adjacent segments of the spine; with an artificial disc, there’s no extra stress.” Artificial disc replacement is performed on an outpatient basis with no significant restrictions. Patients are able to resume normal activities within days, not months. “Because the disc itself is moveable, the patient is able to move right away,” emphasizes Dr. Katzman. “Unlike spinal fusion, which requires a lengthy recovery and limits mobility permanently, the disc replacement procedure enables patients to return to activities very quickly. It’s an impressive advance, and one that renders the old fusion procedure virtually obsolete. We are now one of the leading centers in the world that is performing disc replacement.” Don’t wait Everything went beautifully, assures Dodie, noting that after the procedure, she found out more about what happened before she came out from the anesthesia. “I was told that after the surgery, Dr. Katzman went out and spent quite a bit of PHOTO COURTESY OF DODIE BOESCH Unsure where to turn, Dodie began with a trip to a primary care physician, expecting to get a referral. However, it wasn’t that easy. “He told me that an x-ray was all I needed,” she laments. “So I got an x-ray, but he didn’t see anything on that, because an x-ray does not show herniated discs. I’m not even sure what he was looking for. He treated me with steroids and sent me home with pain medication.” That didn’t work, so Dodie tried another provider. “I went to see a different primary care physician and he ordered an MRI,” she remembers. “I had it done on November 8th, 2013, and once he got the MRI, he sent me to a neurologist in Raleigh who immediately recommended surgery.” More than once, Dodie got a recommendation to get a spinal fusion procedure called anterior cervical discectomy and fusion, or ACDF. However, she just wasn’t sold. “I went to another neurologist’s office, because I wanted to have more than one opinion,” says Dodie. “They immediately recommended fusion surgery, too. But I had also been researching artificial disc replacement online.” She decided she was actually willing to travel all the way to Florida for the right surgeon. “I spend half my time in Louisiana and half my time in North Carolina,” she explains. Dodie consulted Scott S. Katzman, MD, of the Center for Artificial Disc Replacement. “I had lots of conversations with different people in their office,” she reports. “Dr. Katzman even gave me a call and spoke with me. The more I talked to them, the more they worked with me and with my insurance company to get approval for an artificial disc replacement. “My sister took me down to Florida,” continues Dodie. “I told her, These people are really great. They have been awesome on the telephone. And when we got there, everything was perfect. Dr. Katzman spent as much time as we needed. He answered every single question and explained everything to us that we needed to know. After that conversation, I was very happy to be working with him and totally comfortable about having the procedure.” Dodie is doing well today thanks to successful artificial disc replacement. time with my sister, talking about the procedure and how it went, which she told me about the next day. When I woke up, I had no pain in my left arm, and at that point, I knew he’d fixed it.” Dodie certainly wishes she had undergone disc replacement sooner, but she’s glad it worked out so well. “Dr. Katzman said that he wanted me moving the next day,” she recalls. “I had to fly back to Louisiana two days after surgery. I took pain medication for about the first four days, but I flew home with no problem and I was back to work in a week!” Today, Dodie still seems amazed by just how successful the artificial disc replacement procedure has proven for her. “I don’t have any limitations,” she marvels. “Dr. Katzman didn’t give me any. Well, actually, he said no skydiving or tackle football for the first six weeks. So I can skydive now,” she adds with a laugh. Dodie is most grateful to Dr. Katzman and his staff, and says that she appreciates everything they did for her, from her initial consultation through Center for Artificial Disc Replacement Call (888) 975-2127 for all locations: 3500 Tyler St. Hollywood 652 Palm Springs Dr. Altamonte Springs A leader in minimally invasive spine surgery 3355 Burns Rd., Suite 304 Palm Beach Gardens 6903 W. Colonial Dr. Orlando 2401 Frist Blvd., Suite 7 Fort Pierce her final appointment. “He did not have office hours on the day we were leaving, but he still made special arrangements to meet with me before I flew back. He made sure everything was good before I left.” She recommends that others follow her lead and not suffer needlessly. “I took November, December, January and part of February to make the decision to have the procedure,” concludes Dodie. “And four months in pain is like four years. Knowing what I know now, I wouldn’t have waited as long as I did.” FHCN–Michael J. Sahno Scott S. Katzman, MD, is board cer tified by the American Board of Orthopaedic Surgery. He completed his undergraduate studies at the University of California at San Diego and earned his medical degree at Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA. Dr. Katzman served his general surgery internship at the University of California, San Francisco, and his residency in orthopedic surgery at the University of Arizona Health Sciences Center, Tucson, where he also completed a spine mini-fellowship. Dr. Katzman has published and lectured extensively on topics in orthopedic surgery, and he is a leader in the development of minimally invasive joint replacement techniques. Learn more online at www.centerforartificialdiscreplacement.com or www.advancedhere.com Page 10 | Florida Health Care News | Winter 2015 | South Sarasota County Edition Eye Floaters? E ye floaters − those tiny specks or strings that float into your field of vision periodically − can be concerning. Typically caused by age-related changes to the vitreous humor, the thick fluid inside the eye, eye floaters become more common with age. But can they cause blindness? SOUTH FLORIDA EYE CLINIC SCOTT L. GELLER, MD FHCN PHOTOS BY MARC EDWARDS “By our usual definition, of course not,” says Scott Geller, MD, a boardcertified ophthalmologist at South Florida Eye Clinic in Fort Myers who has a special interest in the treatment of eye floaters. “But imagine if you only had one good eye. Imagine that the floater in it was so large that when it came across your field of vision, you could not even see the big E on the eye chart. Imagine if it were a car on the highway or a road PODIATRY FHCN PHOTO BY MARC EDWARDS Make the call There is no need to drive to Fort Myers or Tampa for the latest in laser toenail fungus treatment. The FDA-approved PinPointe FootLaser is now available at the Sarasota Foot and Ankle Center, which has three offices to serve you: 693 Old Englewood Road in Englewood, 3428 17th Street in Sarasota and 1601 Rickenbacker Dr. in Sun City Center. To schedule a consultation at the Sarasota or Englewood office, call (941) 3664888. For the Sun City Center office, call (813) 634-8980. Laser treatment for eye floaters is safe and effective. sign. By the statutory definition of legal word to more ophthalmologists that this blindness, that would qualify, if only for is a safe technique,” he explains. “And the short period of time the floater was even more than that, we need to educate in your field of vision.” ophthalmologists that in many instances, Patients with eye floaters of this size − eye floaters can disable. even if their vision is perfect − are actually “The current ophthalmic dogma is quite disabled, stresses Dr. Geller. “Most that an ophthalmologist will say, Well, I ophthalmologists don’t seem to under- have floaters; what are you complaining stand that when a patient is complaining about? So they write off the patient and of serious eye floaters, but their vision is tell them it will go away. In most cases, 20/20, they are actually having a real prob- this is true, but the patients that come to lem,” he says. “It’s not something that’s me have serious problems.” only in their mind.” When eye floaters are severe, some Dr. Geller should know: he is one ophthalmologists may offer a vitrecof the most recognized eye floater laser tomy, the surgical removal of the gel specialists in the United States and where the floaters reside. However, this around the world. is rare because the “We have had has some “THE LARGEST SERIES operation patients come from serious drawbacks all over the world to and complications, OF EYE FLOATER our facility in Fort and it is an expensive, LASERS WORLDWIDE” Myers for treatment,” invasive procedure. says Dr. Geller. www.vitreousfloaters.com However, the com“Many patients come plication rate for laser from countries where medicine is social- treatment of eye floaters is very low. ized, and there is a lack of training and Furthermore, there is no risk of infecproper equipment. During the past tion with laser since there is no cutting twenty years, we have treated thousands with a scalpel. of patients and have performed nearly Dr. Geller has treated many meditwenty thousand laser sessions.” cal doctors for their eye floaters as well. “When other doctors and ophthalMaster of floater treatment mologists come to you for their own Dr. Geller is a master of this treatment problems, I would say that speaks for modality. He has trained doctors from itself. We love doing laser surgery on Holland, Italy, the United States and eye floaters, and love dealing with our Central America. “We need to spread the patients on a personal basis.” FHCN Scott L. Geller, MD, is board certified by the American Board of Ophthalmology. He is a graduate of Ohio Wesleyan University and Rush Medical College. While in medical school, he was awarded a student fellowship to study tropical medicine at a missionary hospital in India, and pursued additional studies at the famous Brompton Hospital in London, England. He interned at Presbyterian Hospital, Pacific Medical Center, San Francisco, CA, and completed his residency in ophthalmology at Sinai Hospital of Detroit, which was affiliated with Wayne State Medical School and Kresge Eye Institute. Dr. Geller was fellowship-trained in anterior segment and refractive surgery with Dr. William Myers of the Michigan Eye Institute. Dr. Geller is a fellow of the American Academy of Ophthalmology, and has presented papers on eye floater laser treatment at the International Congress of Ophthalmology, European Congress of Cataract & Refractive Surgery, European Congress of Ophthalmology, and the Florida Society of Ophthalmology. For eye floater solutions... Call Dr. Geller at (239) 275-8222 or toll-free at (877) 371-3937. South Florida Eye Clinic is located at 4755 Summerlin Rd. in Fort Myers. www.vitreousfloaters.com Eliminate Toenail Fungus F Alice and Edward Hicks are no longer embarrassed by their toenails. OPHTHALMOLOGY PinPointe™ FootLaser™ is the only FDA-approved laser treatment for toenail fungus. or years, Alice and Edward Hicks both suffered from an embarrassing fungus that caused their toenails to thicken, yellow and become brittle. “It was yucky-looking,” admits Edward, 77, who retired from the Kennedy Space Center several years ago, “this yellowish, brownish thing underneath your toenails. And on my wife’s feet, [the toenails] were deteriorating.” The couple, who have been married for more than 53 years, tried in vain to banish the unsightly fungus on their own using a variety of over-the-counter medicines. “It wasn’t getting any better,” Edward observes. “It looked ugly.” They learned about Dawn Chiu, DPM, a board-qualified podiatric surgeon at the Sarasota Foot and Ankle Center, through a Florida Health Care News article last year. Fed up with their unsightly toes, both Edward and Alice decided to make an appointment. PinPointe treatment Dr. Chiu diagnosed them with onychomycosis, a common disorder caused by microscopic fungi. Affecting about 35 million Americans, the condition typically begins when the fungi enter the nail bed through a tiny break in the nail. In time, it causes the nails to become yellow, thick and brittle – and it won’t go away without treatment. The PinPointe FootLaser is the only FDA-approved laser to treat onychomycosis. Moreover, the Sarasota Foot and Ankle Center, with offices in Sarasota, Englewood and Sun City Center, is one of the only practices in the area to offer it. SARASOTA FOOT AND ANKLE CENTER DAWN CHIU, DPM, AACFAS ARTHUR D. CLODE, DPM, AACFAS The treatment is simple and painless. After grinding down the nail, “we pass the light repeatedly in crisscross patterns so that we know it gets good coverage for each toenail,” explains Dr. Chiu. “The patient will feel a warm sensation, but no pain.” There are no side effects, and there is no need for blood tests. Though the laser kills the underlying fungus, the toenail will not clear immediately because it needs time to grow out, which can take nine to 12 months. Patients are seen about every three months and retreated as necessary. Between visits, they use an antifungal nail solution at home to keep the fungus at bay and accelerate healing. Edward and Alice are both pleased with Dr. Chiu and the Sarasota Foot and Ankle Center. “Any questions, she’ll answer them,” says Edward. “She gets right to the point, no messing around. She’s definitely very, very knowledgeable. I highly recommend her.” The couple, who volunteer with the Wildlife Center of Venice in their free time, have almost finished their treatment – and both are thrilled with the results. “You can’t see anything on my toes now,” notes Alice. “It’s growing out.” “Both toes are just about completely grown out,” agrees Edward. “We’re very happy with the results so far.” FHCN–Melanie Casey BEFORE AFTER PHOTOS COURTESY OF SARASOTA FOOT AND ANKLE CENTER Dawn Chiu, DPM, AACFAS, is a board-qualified podiatric surgeon and Associate of the American College of Foot and Ankle Surgeons. She graduated from the University of California, Davis with a degree in zoology and received her Doctor of Podiatric Medicine degree from the California College of Podiatric Medicine in San Francisco. Dr. Chiu completed her podiatric surgical residency at Frankford Hospital in Philadelphia. Dr. Chiu is a member of the American Podiatric Medical Association, Florida Podiatric Medical Association and American Diabetes Association. Arthur D. Clode, DPM, AACFAS, is a board-qualified podiatric surgeon and Associate of the American College of Foot and Ankle Surgeons. He earned a degree in biological sciences from Florida International University and a Doctor of Podiatric Medicine degree from the California College of Podiatric Medicine in San Francisco. He completed his podiatric surgical residency at Golden Glades Regional Medical Center in Miami. Dr. Clode is a member of the American Podiatric Medical Association, Florida Podiatric Medical Association, American Diabetes Association and is treasurer of the Manasota Podiatry Association. To learn more about the PinPointe FootLaser, visit www.sarasotafoot.com. South Sarasota County Edition | Winter 2015 | Florida Health Care News | Page 11 ORTHOPEDICS Stem Cells Offer Alternative to Surgery Stem cell and PRP therapy is a leading-edge method to relieve pain and avoid invasive surgery. P amela Kirscher was dealing with severe knee pain. “I injured my knee and went to an orthopedic doctor,” she recalls. “I hobbled in on crutches, and when he saw my MRI, he said it looked like I needed surgery.” WELLINGTON CHEN, MD JOHN LIEURANCE, DC Pamela, however, didn’t want to go through an invasive procedure. She had heard about platelet-rich plasma therapy (PRP), a revolutionary treatment that can relieve pain by promoting long-lasting healing of musculoskeletal conditions. “I told the orthopedic doctor I’d like to try PRP,” she says, “and he admitted that if it were his knee, he would probably look at that option, too.” Pamela then consulted Gecko Joint & Spine in Sarasota. “What was unique about them was that they use ultrasound,” she continues. “One doctor does the ultrasound while another does the PRP injection. They also enriched my plasma from bone marrow and injected that.” The treatment was successful, and Pamela avoided knee surgery. However, it wasn’t long before she suffered a much more serious injury. “About a year later, I was relocating my business and moving furniture on my own when I dislocated my left shoulder,” she says. “It took about seven hours to get seen in the emergency room, and I had significant nerve damage, a labral tear and a torn rotator cuff. I was in so much pain. It was excruciating.” Pamela returned to her trusted physicians at Gecko Joint & Spine soon afterward. “I went in and got an injection in my shoulder, again using the ultrasound, and I’m sure it helped speed up the healing. So I avoided surgery again. To me, any time you can avoid surgery, with all the scar tissue and Stem cell lectures are available two times per month. Call (941) 330-8553 for dates and to RSVP to explore how stem cells can work for your orthopedic needs. possible complications, that’s a good thing.” About regenerative medicine Gecko Joint & Spine has developed a system for delivery of stem cells, platelet-rich plasma and bone marrow into and around joints, such as shoulders, knees and hips, as well as the spine. “We have actually been pioneering regenerative medicine, starting with prolotherapy in the late Nineties,” reports John Lieurance, DC. “We started using platelet-rich plasma therapy about seven years ago, before anyone in our area even knew about it. Then we began to add stem cells from bone marrow around four years ago. It’s been a natural evolution.” Dr. Lieurance works closely with his colleague, Wellington Chen, MD, treating each patient as a team. The physicians use ultrasound to guide the injection to the exact location in the body in real time, ensuring the most effective result possible. “Ultrasound diagnostic guidance is one of the things that makes our practice truly unique,” confirms Dr. Lieurance. “It’s important that patients understand that their treatment is going to be done for the right condition and that every injection is going to be accurate.” There are also specific aspects of the processing of blood, plasma and bone marrow products that make Gecko Joint & Spine exceptional in the field. “The way our different products are processed is unique,” reflects Dr. Lieurance. “We were recently involved in a study through Harvard Medical School’s Bio Sciences Research Center. The way we process our PRP is third generation. It is done so that there are no red blood cells, and the platelets are highly concentrated. It’s much better than what you would typically receive from a physician who has just started offering PRP therapy, for example.” In fact, the doctor notes that it’s important to consult a practice that has expertise in stem cell therapy when treating conditions such as Pamela’s. “There are many practices now dabbling in PRP,” he cautions. “But at Gecko Joint and Spine, that’s all we do: nonsurgical orthopedic regenerative medicine.” Dr. Lieurance adds that Pamela’s knee treatment and shoulder treatment both proved to be successful. “She had a meniscus tear in her knee when she first saw us,” he explains. “She healed up nicely from that after treatment, so when she injured her shoulder, she returned to see whether it would also work for that. FHCN PHOTOS BY MICHELLE BROOKS Pamela Kirscher Pamela is working out in her fitness studio without pain after stem cell therapy. “Pamela’s shoulder injury was fairly extensive. She had a torn a rotator cuff and torn labrum, which is the cartilage that holds the shoulder joint together. She could very easily have undergone surgery for either of those, but because the stem cell procedures worked so well for her, she was able to avoid surgery a second time. She has recovered completely.” “It was wonderful” Pamela is extremely thankful she was able to return to Gecko Joint & Spine for treatment following the shoulder injury. “All they did in the emergency room was take care of the emergency situation,” she reports. “They got my shoulder back into the socket, and gave me pain medication and a sling. Unfortunately, because I had to wait so long in the ER, the shoulder – all the way into the neck and the left side of my body – was numb clear down to my fingers. I had major nerve damage because of the delay.” When she had the ultrasound test for her shoulder at Gecko Joint & Spine, Pamela was able to see the area that required treatment. “First, you have a consultation to determine whether the PRP would be appropriate,” she explains. “With the ultrasound, they could actually see the rotator cuff and labral tears. You get the blood drawn, and it takes about an hour or so for them to process it. Then they numb the area before it’s injected. “They’ve got a large TV screen, and I could see on the screen what was going on. Dr. Chen did the injection and Dr. Lieurance was guiding with the ultrasound. I could actually see the needle going in and see exactly where the Pain relief without surgery To learn more about regenerative medicine, please call Gecko Joint & Spine at (941) 330-8553. The office is located at 2033 Wood St., Suite 210, in Sarasota. solution was going in. I was numbed up,” she reminds, “so it wasn’t bad. Maybe some people don’t want to watch it, but I found it pretty interesting.” Thanks to the treatment, Pamela is back to full activities, including her admittedly strenuous work. “I own a fitness studio here in Sarasota, SuperSlow Zone, so I know how to rehabilitate with exercise after an injury. I began slowly exercising and building my strength back up, and it’s fine now. I didn’t need any further treatment.” She thanks Drs. Lieurance and Chen, both for providing the right solution for her and for their compassionate manner. “I thought it was wonderful,” says Pamela. “They’re a great team!” FHCN–Michael J. Sahno J o h n L i e u ra n ce, D C , received his Doctor of Chiropractic degree from Parker College of Chiropractic and his naturopathic degree through St. Luke’s Medical School. Dr. Lieurance’s musculoskeletal ultrasound training includes over 300 hours of study through the American Association of Orthopedic Medicine, the American Osteopathic Association of Prolotherapy Regenerative Medicine and other associations. He is also a board-eligible chiropractic neurologist through the Carrick Institute of Neurology. He is the developer of Functional Cranial Release, and teaches and certifies these methods to physicians around the world. Dr. Lieurance has practiced in Sarasota for the past 20 years. Wellington Chen, MD, is board cer tified by the American Board of E m e r g e n c y M e d i c i n e. After receiving his medical degree from the University of Pennsylvania, he completed his internship and residency with the University o f Fl o r i d a Co l l e g e o f Medicine, Depar tment of Anesthesiology. Dr. Chen’s training in regenerative orthopedics was through the University of Wisconsin School of Medicine with the Hackett Hemwall Foundation. He has also studied with The Orthobiologic Institute in Los Angeles. Dr. Chen has been specializing in the field of prolotherapy and regenerative injection therapy for a decade. Visit Gecko Joint & Spine on the web at www.geckojointandspine.com. Page 12 | Florida Health Care News | Winter 2015 | South Sarasota County Edition GENERAL SURGERY EFFECTIVE TREATMENT FOR FECAL INCONTINENCE J eanne VerSchneider never was able to determine what caused the incontinence problem that plagued her. “It could have been childbirth, but nobody ever determined that,” she explains. “I had the problem for seven years and I was at my wit’s end.” Jeanne VerSchneider DOMINGO E. GALLIANO, JR., MD, FACS, FASCRS BOARD CERTIFIED, COLON AND RECTAL SURGERY • BOARD CERTIFIED, GENERAL SURGERY • BOARD CERTIFIED, SURGICAL CRITICAL CARE • DIRECTOR, COLONRECTAL PHYSIOLOGY LAB & PELVIC DISORDER CENTER Even more socially isolating than the better known condition of urinary incontinence, fecal incontinence is among nature’s most debilitating health problems. “I was really a prisoner in my home,” confides Jeanne. “It was terrible because I had no control whatsoever.” Judith Cushman suffered like Jeanne did, but for a much longer period. “I had the problem for probably thirty years or more,” she recalls. “It got to the point where I didn’t want to go places if I didn’t drive myself because I never knew when it was going to happen.” Feeling just as isolated as Jeanne, Judith kept the problem to herself. “I never told anyone because I was so embarrassed,” she says, “and I didn’t actually think anyone else had that kind of problem.” Fortunately, both patients consulted Domingo E. Galliano, Jr., MD, FACS, FASCRS, who sought diligently for a solution for them until one became available in 2011. About incontinence “Quite a number of conditions can affect the colorectal area,” observes Dr. Galliano. “One of the most distressing – and taboo – is that of fecal incontinence/constipation and pelvic floor dysfunction.” Fecal incontinence can be caused by a variety of factors, explains Dr. Galliano. “The bowel function is controlled FHCN PHOTOS BY MARC EDWARDS Judith Cushman by three things: the sphincter, a muscle which keeps stool from leaking; the rectum’s storage capacity, or how much the rectum can stretch and hold stool before it must be released; and rectal sensation, the feeling that one must void a bowel movement. If anything interferes with these three factors, then fecal incontinence, constipation and pelvic floor dysfunction can occur.” The problem is more common than one might think. “It affects as many as five and a half million Americans,” notes Dr. Galliano. “Damage to the nerves in the area, weak or damaged muscles, inflammatory bowel disease and irritable bowel syndrome (IBS) are all examples of possible causes of fecal incontinence.” InterStim Therapy Fortunately, says Dr. Galliano, a recently approved technique offers hope for those dealing with the troublesome condition of fecal incontinence. “The FDA has now approved InterStim® Therapy for Bowel Control,” announces Dr. Galliano. “The InterStim system has been used as a treatment for urinary incontinence and bladder control since 1997, and we are pleased to offer this option to fecal incontinence patients. With InterStim Therapy, patients discover new freedom from the embarrassing and socially isolating symptoms of fecal incontinence.” Like the spinal cord stimulators used for severe chronic nerve pain, InterStim Therapy employs an implant consisting of a neurostimulator and a thin lead wire. The pacemaker-like device is implanted under the skin in the Gentle, effective care Dr. Galliano welcomes your inquiries regarding this article. He can be seen at 18308 Murdock Circle, Suite 108 & 109, in Port Charlotte. For more information or to schedule a consultation appointment, please call (941) 625-3411. Domingo E. Galliano, Jr., MD, FACS, FASCRS, is board certified in colon and rectal surgery by the American Board of Colon and Rectal Surgery and by the American Board of Surgery in general surgery. He is also board certified in Surgical Critical Care. After completing undergraduate work and receiving his medical degree, magna cum laude, Dr. Galliano completed a five-year general surgery residency at Jersey City Medical Center, NJ. He completed a fellowship in colon and rectal surgery at Greater Baltimore Medical Center, Baltimore. He also completed a fellowship in advanced colon and rectal surgery at the Cleveland Clinic, Florida. Dr. Galliano is a clinical assistant professor at the University of South Florida College of Medicine, Tampa. He has been in private practice in Port Charlotte since 1989, and he is affiliated with Fawcett Memorial Hospital, Peace River Regional Medical Center, and Charlotte Regional Medical Center. www.gallianosurgery.com lower back near the sacral nerves, and the patient can control his or her level of stimulation with an external remote. “Clinical studies have shown that sacral nerve stimulation reduces episodes of fecal incontinence and increases quality of life in patients with this condition,” notes Dr. Galliano. “Fecal incontinence, constipation and pelvic floor dysfunction typically respond well to noninvasive treatment,” he assures. “The key is finding a specialist who is board certified in colon and rectal surgery able to diagnose the problem and find a treatment that will restore bowel control or, at the very least, substantially reduce the severity of symptoms. “We may recommend InterStim for patients with chronic fecal incontinence who have failed, or who are not candidates for, conservative treatments such as dietary modifications and medications. The best approach is to develop an individualized treatment plan, which is the basis of our practice. “Jeanne’s InterStim procedure was the first in Florida, and the second such procedure performed here in the US,” reports the surgeon. “She had waited seven years to have it performed, as the FDA did not approve it for that specific diagnosis until April 2011. We had been seeing her as a patient since 2005. Now that she has had the procedure, she is one hundred percent better. Judith had been a patient of ours since 2006, and she has enjoyed comparable results.” 100 percent relief Jeanne and Judith are thrilled with the effectiveness of the InterStim Therapy. “I’ve had it for almost a year, and it’s been absolutely fantastic,” says Judith. “I couldn’t be happier. My life has become so much easier.” Jeanne agrees: “What a difference,” she says. “It gave me my life back. Thank God I’m normal again!” Both women express their thanks to Dr. Galliano and his staff for their help, noting that they are both highly experienced and sympathetic. “They’re a wonderful group of people who work together,” assures Judith. “I had a very, very good experience. I really can’t say enough good things about them. They really care, and that means a lot.” “Dr. Galliano is a terrific person,” adds Jeanne, “and I love him dearly. He’s a very good doctor and he’s brilliant in what he does. I hope more people who have this problem will go to him because he certainly knows how to help. He’s wonderful.” FHCN Several painless diagnostic tests can help diagnose fecal incontinence or constipation: Anal rectal manometry: evaluates the strength of the pelvic floor, the muscles controlling bowel movements, and only takes about 15 minutes. Anal elec tromyography: helps determine two things – whether the nerves supplying the sphincter muscles are intact and whether the muscles contract and relax normally. Pudendal nerve latency test: allows the physician to determine if nerves controlling the anal sphincter muscles have been damaged. Defecography: tests the motion of the pelvic floor and is performed in the radiology department using x-rays; takes about 15 minutes. Anorectal ultrasound: used to take images of the anatomy of the internal and external sphincter muscles. Urodynamics: tests for urinary problems. Colonic transit study: tracks how food moves through the colon, allowing the physician to detect constipation or problem areas. SmartPill®: a wireless motility capsule for colonic and whole gut transit time. Surgical and nonsurgical treatment options for fecal incontinence/constipation include: InterStim sacral nerve stimulation: a form of nerve stimulation via electrical impulses; for fecal incontinence only. Pelvic rehab: a behavioral treatment used for incontinence and constipation through which physicians and nurses work with patients to help them understand the condition and learn specific methods to bring the rectum back to a healthy level of function. The Secca® procedure: delivers heat energy into the anal canal to improve the barrier function of the muscles. The procedure has a much quicker recovery time than standard corrective surgeries; for fecal incontinence only. Sphincteroplasty: surgical repair of a damaged sphincter muscle; for fecal incontinence only.