Same-Day Crowns Same-Day Crowns

Transcription

South Sarasota County Edition
For additional health care information, visit us on the web at
TAKE ME HOME!
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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
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Effective Pain Relief
Domingo E. Galliano, Jr.,
MD, FACS, FASCRS
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Medical Center, Inc.
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with HYALGAN®
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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
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.
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
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
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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
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
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
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
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.
“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.
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
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
“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
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.
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.
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
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.

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