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Double Jointed

Stem cell therapy relieves lower back, knee pain.

Some people know early in life what they want to do for a career, and they follow clear paths to reach their goals. That wasn’t the case for Geraldine Duez. Her path wasn’t clear. For years, Geraldine worked in various capacities before finally finding her calling as a certified nursing assistant (CNA).

Photo by Jordan Pysz.

Geraldine Duez

“I started out working as a beautician and did that for a while,” Geraldine relates. “Then, I went to work in a factory and from there to working in an office, which I did for a few years. After that, I started my career as a CNA and worked in nursing for twenty years. I even did private care for a while. I retired as a CNA in 2015.

“I initially became a CNA because I knew there were jobs in that field. There’s always a need for nursing care. But I really enjoyed working in nursing because I got to know a lot of people, and I liked making patients happy.”

Geraldine hails from the Bluegrass State of Kentucky, but she and her husband moved north to Ohio after they were married. Eventually, the couple headed south to the temperate climate of the Sunshine State.

“After I married my husband, we lived in Toledo,” Geraldine confirms. “In 1997, we decided to move to Florida and get jobs down here. We continued to work in Florida until we were ready to retire.”

Retirement suited Geraldine, but she soon became hampered in her favorite activities, including working in her yard, by intense pain in her lower back and leg. The pain, her doctor told her, was the result of sciatica, a pinching of the spinal nerves supplying the legs by degenerated discs.

“The pain started on the left side of my lower spine and ran down my left leg,” Geraldine describes. “It really hurt. Sometimes, the pain started up when I was driving and made it hard to drive because it hurt so bad.

“I eventually had an MRI done in Port Charlotte, and it showed a lot of narrowing on the left side of my spine. The pain it caused was off and on, but it bothered me enough that I knew I had to get rid of it.”

Matters got worse for Geraldine before they got better, however. Over time, her troubling back pain was compounded by excruciating pain in her left knee.

“There was a burning pain on the left side of my knee,” she states. “At times, the pain was a nine on a scale of one to ten. Occasionally, it hurt at the bottom of that knee as well, but that pain occurred at different times. It wasn’t constant.

“Sometimes, my knee was unstable. I was afraid I might go down because it felt like my knee wasn’t going to hold me up. It usually held, but the feeling it might not was scary.”

Living with terrible back and knee pain took all of Geraldine’s energy. She finally accepted that she required a doctor’s care in order to find real relief, but she didn’t know where to turn. That changed when she picked up a copy of Florida Health Care News one day and read about Erick A. Grana, MD, of Regenerative Orthopedic Institute in Tampa.

“I read the article in the newspaper about Dr. Grana and his treatment and thought, Maybe he could help me,” Geraldine remembers. “When Dr. Grana reviewed my MRI, he said my back was pretty bad, but he could treat me with his procedure.
“I thought I might as well have my back and knee treated at the same time. Dr. Grana told me he would give me a discount to have both done, and I always like a deal.”

Natural Process

“Geraldine’s sciatica and knee pain were the result of degenerative arthritis,” Dr. Grana reports. “She was looking for a way to relieve her pain without resorting to surgery or heavy pain medications. She wanted a more natural way to ease the pain and manage the underlying arthritis.”

To address conditions like Geraldine’s, Dr. Grana uses regenerative medicine, which treats patients with a nonsurgical technique called stem cell therapy. This therapy uses the patient’s own specialized stem cells to promote the growth of new tissue in joints ravaged by arthritis or injury.

“Regenerative medicine treats disease and injuries by harnessing the body’s own healing powers,’’ Dr. Grana informs. “The natural healing process is accelerated by a combination of growth factors and bioactive cells in the form of stem cells and platelet-rich plasma (PRP).

“Stem cells are the body’s natural repair cells and are capable of healing and repairing tissue. They are also highly anti-inflammatory and release many growth factors within the joints that stimulate healing and repair.”

Stem cells are not assigned to be a specific type of cell. When placed in an area and stimulated appropriately, stem cells can develop as cells of that area, replacing the worn out or damaged tissue there. In joints, for example, stem cells can become cartilage cells and rebuild that deteriorated tissue. That’s the essence of regenerative medicine.

“About two weeks after the injections, I started to feel better. I had a lot of energy, and I was able to do all sorts of projects.” – Geraldine

Platelets are specialized cells found in blood. They are the cells responsible for clotting at the site of an injury, and they contain many healing substances and growth factors that can stimulate and assist stem cells in their regenerative activity.

“The process of using stem cells and PRP results in a safe, effective treatment,” Dr. Grana assures. “And unlike traditional surgery, which can result in blood loss, scarring and long, painful recovery periods, stem cell therapy requires only injections into the damaged joint.

“It also offers a much quicker recovery than surgery. Typically, patients begin to feel a noticeable decrease in pain after six weeks.”

Stem cell therapy is autologous, meaning it utilizes stem cells, PRP and growth factors taken from the patient’s own body. Using the patient’s own cells eliminates the chances of reactive side effects or rejection.

Dr. Grana extracts stem cells from the patient’s bone marrow or fat, while the PRP is taken from the patient’s own blood. After the stem cells are harvested, they are separated through a centrifuge and injected into the painful area to stimulate the regeneration of damaged tissue and the healing of tendons, ligaments, joints or spinal discs.

“When I was first introduced to stem cell therapy, I recognized its tremendous potential for patients who would otherwise have limited treatment options for pain relief,” Dr. Grana notes. “Patients with osteoarthritis, in particular, have very few choices other than surgery when the condition advances and damages the joint.

Photo by Jordan Pysz.

Geraldine, an active gardener, is reaping the benefits of her stem cell therapy.

“Surgery has potential complications, so when we treat arthritic joints without surgery, patients do much better. Not only can we relieve the patient’s pain, but we can also reverse some of the damage done by the osteoarthritis. This is accomplished by regenerating the cartilage and connective tissues in and around the joint area.”

Dr. Grana has developed a system for the delivery of stem cells and PRP into the pain generators in and around joints such as the knees, shoulders and hips. It’s called RegenaJoint. He used this technique on Geraldine’s left knee.

He has also developed a similar system to treat the spine called RegenaSpine, which he used on Geraldine’s low back and sciatic pain. RegenaJoint and RegenaSpine are both minimally invasive procedures that are performed right in the doctor’s office using a local anesthetic. Patients typically resume normal activities immediately following the procedure.

“Dr. Grana took fatty tissue from my stomach and took the stem cells from that,” Geraldine recalls. “Then he got platelets from the blood he took from my arm. He mixed the stem cells and platelets together and injected the combination into my back and knee.”

“I Feel Great”

“About two weeks after the injections, I started to feel better,” Geraldine reports. “I had a lot of energy, and I was able to do all sorts of projects. I trimmed a palm bush in the yard, then put rubber rings around its trunk. I also spread mulch, which made the yard look really nice. I carried all of the mulch and dirt I used, and I wasn’t in pain.”

Geraldine continues to reap benefits from her stem cell therapy, and today, she’s amazed by how much improvement she’s achieved. She recognizes Dr. Grana and his treatments for her success.

“I feel great,” Geraldine raves. “I no longer have any pain in my back or down my left leg. Every once in a while, my knee hurts a little in one place, but when I mentioned that to Dr. Grana, he said it takes time for the joint to heal. Unless it gets worse, there’s nothing to worry about.

“The stem cell treatment was successful. The knee pain I have left is only a one on a scale of one to ten, and I no longer get that feeling it’s going to give out on me. Unfortunately, now my right knee sometimes feels that way. I told Dr. Grana maybe next year, I’ll have that knee done, too.

“I recommend RegenaJoint and RegenaSpine and already have to a few people. And I have recommended Dr. Grana and Regenerative Orthopedic Institute as well.”

Burst Out of Back Pain

New spinal cord stimulator helps find comfort zone.

Through all the years she worked in retail, Leigh’s* biggest worry about a job-related health issue was aching legs from being on her feet all day. She never anticipated the bizarre accident that occurred in October 2001 that left her back and legs in ruins.

“A truck driver was bringing in a pallet of merchandise, and as I was coming from the office I heard someone yell, Watch out!” Leigh recounts. “But it was too late. The pallet fell on top of me. The pain in my back was instant, and it shot down my legs.

“When I stood up and tried to walk, I felt okay, but the district manager took me off work and sent me to the doctor and a neurologist. I ended up getting all this hardware put in my back because it turned out my spine was unstable.”

The surgery gave Leigh’s spine some much-needed stability, but it did little to relieve her pain. In fact, her pain only intensified.

“I could hardly stand up or stand in one spot,” she relates. “Then the doctors found out the rods and screws from the hardware they put in my back were loose. I had to have a second surgery to remove them in 2002.

“Then in 2003, they were going to put some type of cage in my back because, again, my spine wasn’t stable. But once the surgeon started the operation, he just sewed me back up without putting in the cage. He said, You need to retire, so I did.”

A few years later, Leigh had a fourth surgery on her back, but that failed to alleviate her excruciating pain. Eventually, the pain began interfering with many of her daily activities.

“I still did housework, but it wasn’t easy,” she describes. “I had to stop between tasks. Instead of getting everything done in one day, it took me two days. I love to cook, but instead of getting a meal out in one morning, I had to prepare it the day before so I wouldn’t have to stand on my feet so long.”

Leigh visited her doctor repeatedly throughout all this, and various therapies aimed at relieving her back pain were administered, but with little success. Finally, her doctor referred her to pain management specialist Mark Fallows, DO, of Pain Institute of Central Florida.

Serving area residents since 1990, Dr. Fallows is uniquely qualified to manage complex pain issues. He is certified by the American Osteopathic Board of Anesthesiology and the American Board of Interventional Pain Physicians (ABIPP), which has certified fewer than 400 physicians nationally. Further, Dr. Fallows is the only physician in Citrus County who is board certified in interventional pain management.

Secret Weapon

One of Dr. Fallows’ secret weapons for pain relief is the spinal cord stimulator, an implanted device that distorts pain signals going to the brain. The device is an upgrade on older stimulators that replaced pain with a tingling sensation called a paresthesia. Many patients found that sensation too strong and couldn’t tolerate it.

“The newer stimulators have very little sensation, or none at all,” explains Dr. Fallows. “This technology is called burst stimulation, and it takes care of vast amounts of the patient’s pain, but it doesn’t replace it with anything. Previously, we tried to mask pain with another sensation. We’re not masking it anymore, and that makes patients much happier.”

Dr. Fallows notes that the spinal cord stimulator is not a first-line treatment for back pain. It is generally offered after many other therapies have been tried and failed, which was the case with Leigh. He adds that it is most often considered once patients begin suffering functionally due to their pain.

“When back pain is impairing a patient’s ability to engage in the activities of daily living, it’s time to try the implant,” he confirms. “If patients can’t make it through the grocery store or if there’s a chance they can no longer live independently, they’re perfect candidates for the spinal cord stimulator.”

Though she was suffering from pain that radiated from her back all the way to her ankles, Leigh wasn’t eager to try the spinal cord stimulator when she first started to see Dr. Fallows four years ago.

“I wasn’t ready for anyone to touch my back because of the four surgeries,” she says. “But in 2017, my back got really bad. I couldn’t walk around the block; I couldn’t walk two houses. I couldn’t make it through the grocery store, and I couldn’t sleep at night. It even got to the point that my sister had to help me get out of a chair. That’s when I told him I was ready.”

“Before I got the stimulator, I couldn’t even walk in the grocery store. But now, I don’t even need a cart.” – Leigh

Leigh’s timing was just right. Approved by the Food and Drug Administration in October 2016, the burst stimulation device has proved to be a hit with patients who had been using older models.

In one study, patients who had been using traditional stimulators were asked to try the new technology and compare the two. Seventy to 80 percent preferred burst over the traditional stimulators. One reason is that burst does a better job of relieving back pain.

“The burst stimulator is seventy percent more effective than the old unit at reducing pain,” verifies Dr. Fallows. “That’s a huge increase. If there were a treatment in medicine that improved outcomes by twenty percent, we’d think that was incredible. Here, we have a technology that’s seventy percent better. That’s phenomenal!

“In addition, with the older stimulators, if patients coughed, sneezed or lay on their backs, the sensations from the stimulator became stronger. That’s called positionality, and the new technology doesn’t have it.”

Walking Farther

Before October 2001, Leigh never thought she’d appreciate walking as much as she does now. For years, walking any distance left her in agony. Thanks to her spinal cord stimulator, she is now able to walk longer and farther without intense pain in her back shooting down her legs. Leigh’s doing other activities she struggled with previously as well.

“Before I got the stimulator, I couldn’t even walk in the grocery store. But now, I don’t even need a cart,” she enthuses. “When my sisters and I go to the grocery store, we can park out in the lot and walk instead of using the handicapped spots.

“I can also make my bed and vacuum the floor; I just have to be careful. I can clean my house with no problem, and it doesn’t take me two days to prepare dinner. With the stimulator, my pain level is fifty percent better than it was. It’s awesome.

“I absolutely suggest the spinal cord stimulator for people in similar circumstances as me, and I definitely recommend Dr. Fallows and Pain Institute of Central Florida. I’m feeling great, thanks to them!”

*Patient’s name withheld at her request.

Back at It

Stretching protocol relieves aggravating, debilitating back pain.

Sheila Katko, 64, is semi-retired. She works part-time for a company that manages the release of patient medical records from hospitals to individual physicians. The Indiana native works from her Port Charlotte home, which became home three years ago when she relocated from Indiana to Florida.

Photo by Jordan Pysz.

Sheila Katko

“My husband really hates the cold, so he started coming down to Florida for the winters while I stayed in Indiana because I didn’t want to give up my job,” Sheila shares. “One year, I came down to Florida to stay for six weeks, and I was hooked.”

For years, Sheila dealt with a recurring back issue. Whenever she performed an activity for an extended period of time, her low back would become painful. Over time, however, she adapted to the discomfort and went on with her life. But three years ago, an incident occurred that caused pain she couldn’t live with.

“I don’t know what happened,” Sheila says. “I was outside with my dogs, and I experienced this excruciating pain in my lower back. I was just standing there. I don’t know if I twisted or did something else, but I just about fell over from the pain. It was awful.

“Recently, I called Dr. Johnson and told him, You really saved my life.” – Sheila

“The pain got worse and worse until I could barely walk. But if I sat for more than ten minutes, I’d be in agony. My lower back was constantly tight, and in the lower right side, it felt like somebody was stabbing me with a knife and then twisting it. The pain was intense. The only thing that helped at all was lying back on a recliner.

“I couldn’t function. I couldn’t walk my dogs. We couldn’t go out and have an evening out because I couldn’t sit. I could hardly go to the grocery store. If I bent down to get something, I couldn’t get back up. I had trouble sleeping as well. Every time I turned over, my back locked up. I was a decrepit, old lady, and I didn’t know what to do about it.”

Sheila’s doctor had a few ideas. One was to have Sheila complete a course of physical therapy. Upon completion of the course, however, Sheila was still in pain. She next visited a pain management specialist who tried easing the agony by performing a couple of specialty treatment techniques.

The doctor tried radiofrequency ablation, where they burn your nerves, and that worked for about two weeks,” Sheila describes. “Then the doctor gave me steroid injections, and those worked for a couple of weeks, but the pain returned yet again.”

Soon thereafter, Sheila’s husband heard about Jeffrey P. Johnson, DC, and his specialized treatment protocol for back and neck pain called Sedative Stretching. Dr. Johnson is a skilled and experienced chiropractor at Johnson Medical Center in Venice. He has expertise in Sedative Stretching, which is an expanded and comprehensive form of Manipulation Under Anesthesia, or MUA.

“I was skeptical about it at first, but my husband said, What have you got to lose? You’ve tried everything else, so I made an appointment,” Sheila recalls. “Dr. Johnson was so caring and kind. He took his time to explain everything to me, and he gave me a folder with all of the information about Sedative Stretching.”

“I remember Sheila very well,” Dr. Johnson states. “She came to us with back pain that began in 2016 and became progressively worse. She experienced pain within the first minute of standing and walking, and she was unable to walk or stand for more than ten minutes at a time. Since she had tried physical therapy and several pain management techniques without much success, I believed she was a perfect candidate for Sedative Stretching.”

“Dr. Johnson took x-rays and told me I had two joints that were fused a long time ago, maybe when I was a kid,” Sheila relates. “He also said there was a lot of scar tissue around all of the joints in my back. I also have scoliosis, which didn’t help with the pain.

“He then explained that during Sedative Stretching, he’ll stretch all of my joints and get them moving again. And once they’re moving, they’ll break up that scar tissue. That made sense to me, so I decided to do the Sedative Stretching.”

Stock photo from kisspng.com.Inflammation in Excess

Sedative Stretching can benefit many people with painful muscle and joint conditions. Ideal candidates are those with conditions such as unresolved neck and back pain, herniated discs, spinal stenosis, sciatica, frozen shoulder, acute and chronic muscle spasm, headaches and failed back surgery syndrome. The procedure can also benefit people who want to regain lost flexibility or those who are “sick and tired of being stiff and sore.”

“It’s best for people to address the cause of their condition as early as they possibly can,” Dr. Johnson observes. “The chronic stiffness, tightness and pain cause excessive wear and tear on the joints of the spine and extremities, resulting in permanent degeneration and arthritis.

“People start losing flexibility after minor injuries incurred during their typical daily activities result in chronic, low-grade inflammation. Many times, this occurs in early childhood and is a long-forgotten event. Over time, these injuries develop into severe and sometimes debilitating conditions.”

Inflammation is part of the body’s natural healing process, which lays down a mesh of connective tissue, commonly known as scar tissue. Over time, layer upon layer of scar tissue can form in the muscles, tendons and ligaments around the joints, restricting the joints’ ability to move properly. These layers of scar tissue are called adhesions.

The warning signs and symptoms generally associated with adhesions include the slow and insidious loss of flexibility, as well as an increasing achiness and soreness. Most people will attribute this to normal aging. While it’s very common to become stiff and sore with age, it’s not normal.

“People will compensate how they move their bodies when this occurs, although they don’t always realize it,” Dr. Johnson notes. “This is evident everywhere while watching the way people walk, bend, twist and turn.
“Sadly, many people wait until significant damage from excessive wear and tear has occurred before seeking appropriate care. Often, people will utilize over-the-counter and prescriptive medications, which help alleviate their symptoms.

“Unfortunately, this gives the patient a false sense of being cured while the underlying scar tissue continues to cause excessive damage.”

Freeing Adhesions

During Sedative Stretching, the patient is put under light sedation, often called twilight sedation. With the patient relaxed, the affected joints are brought through their normal full range of motion, freeing the adhesions that have developed between the joints, causing pain.

Photo by Jordan Pysz.

Sedative Stretching has made it easier for Sheila to play with Maggie.

“We use light, comprehensive stretching techniques while the patient is sedated,” Dr. Johnson describes. “Since we don’t have to contend with 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.”

The Sedative Stretching procedure is coordinated by a highly trained team of medical professionals. Generally, there are multiple health care providers present, including an anesthetist and several nurses. Patients usually require only one procedure. It is very rare that patients require a second procedure to fully address their condition.

Dr. Johnson recommends that patients follow up the procedure by spending about two weeks in a rehabilitation program designed to reinforce the increased movements obtained from the treatment. During this time, patients are taught stretching exercises that prevent the condition from recurring.

“By following the recommended exercises, patients regain the flexibility they had decades before, and they generally return to activities they haven’t done in years,” Dr. Johnson informs. “This is truly correcting the original cause of their conditions.”

Photo by Jordan Pysz.

Lela “Ann” Young

Standing Engagement

Lela “Ann” Young, 72, spent most of her working years on her feet, first as a men’s hairstylist, then as an assistant to her husband.

“I retired a long time ago, but then I worked with my husband in his job as a manufacturer’s representative to the safety and industrial trade,” she confirms. “He worked a lot of trade shows and things like that, so I was on my feet a lot at those events.”

A Knoxville, Tennessee native, Ann relocated to Florida in 2017 by way of Atlanta, Georgia. The balmy Florida weather was the main motivating factor for the move.

“We had ice and snow in Atlanta, which we don’t miss at all, and we wanted beautiful weather year-round,” Ann explains. “We wanted to be able to play golf all year long, so Venice was the perfect place for us to live.”

Like Sheila, Ann had a longstanding issue with back pain. She can’t remember one defining injury that initiated the pain but does recall an incident 30 years ago that may have contributed to the problem.

“I fell back in the Eighties, but I don’t know if that had anything to do with it,” Ann relates. “I just know that my back hurt after I fell, and it hurt more and more as I got older.

“The pain was located in my lower back, and it hurt all the time. It just ached and hurt. I was always kind of humped over because of the pain, and for the most part, I just dealt with it and went on with my life as best I could.

“But the pain kept me from doing some things. I didn’t play golf as much because I always had to rest between playing, and the back pain affected my swing. My husband had to help me with the housework. He always vacuumed for me.”

Ann became curious when a few friends told her about Dr. Johnson and his Sedative Stretching. She also read an article in Florida Health Care News that gave her additional information, so she thought she’d give the doctor and his treatment a try.

“I’m more flexible since the Sedative Stretching procedure. I swing the golf club so freely now that I can’t believe it.” – Ann

“Ann told me that years ago, she fell on the ice and landed flat on her pelvis,” Dr. Johnson notes. “She’s had recurring lower back pain ever since. Her pain was a seven to nine on a scale of zero to ten. She continued to be active even though she was in constant pain.

“My examination revealed swelling throughout her lower back and pelvis. Her sciatic nerve was irritated and inflamed, and she lost significant range of motion in the lower segments of her spine. X-rays revealed severe disc degeneration in the last two segments of her spine as well as facet arthrosis.

“Ann also exhibited a decrease in her ankle reflexes and strength in her hip flexor muscles. I was convinced Sedative Stretching would help her.”

Stock photo from iStockphoto.com.

Dr. Johnson encourages his patients to do
stretches like these every day.

“Dr. Johnson was very concerned and interested in the story of my back pain,” Ann recalls. “He took some x-rays and found out things about my back that I didn’t realize were wrong with it and explained it all to me in detail.

“He is very knowledgeable and that made me feel very comfortable about what he was saying. He told me he thought Sedative Stretching could really help me. Nobody had told me before that they could help me, so I thought, Why not give it a chance? I’m glad I did.”

Vivid Memory

Ann remembers the day of her Sedative Stretching vividly. She got up early in the morning to arrive at the surgery center on time. The staff at the center prepped her for the procedure, then Dr. Johnson stopped by to go over some last-minute instructions. The doctor and his staff then performed the procedure. When it was over, Ann received a surprise.

“When I woke up, my back didn’t hurt,” she raves. “I couldn’t believe it.”

With her pain relieved, Ann regained her energy and drive and soon returned to the activities she previously avoided. She went back to the golf course and the housework, although her husband continues to do the vacuuming just to be helpful.

“Dr. Johnson asked me to wait two weeks before I started golfing again, which I did,” Ann reports. “Now, I play golf two or three times a week with no problems. My back is no longer humped. I’m straighter and I stand up straight. And I’m more flexible since the Sedative Stretching procedure. I swing the golf club so freely now that I can’t believe it.”

It took a little longer for Sheila to experience significant pain relief following her Sedative Stretching. Her pain was decreased somewhat immediately after the procedure, but she still felt occasional shots of pain in her lower back.

“I feel wonderful since my Sedative Stretching procedure. I’m no longer feeling decrepit. Instead, I walk my dogs, I get on my treadmill, I bowl, I sleep, and I go out with the girls.” – Sheila

“It actually took a couple of months before I really felt relief,” Sheila discloses. “One day, I was doing my regular stretching routine and as I lifted then lowered my right leg, I felt something in my back move, like slide up and down. Apparently, I got the joint really moving, and I’ve been doing great ever since.

Photo by Jordan Pysz.

Ann is swinging freely and pain free since undergoing Sedative Stretching.

“I feel wonderful since my Sedative Stretching procedure. I’m no longer feeling decrepit. Instead, I walk my dogs, I get on my treadmill, I bowl, I sleep, and I go out with the girls. I can get in and out of my car without pain. When I walk around, I think, Wow, I’m walking around and I’m not limping. I’m not bent over.

“It’s amazing how well the Sedative Stretching worked,” Ann says. “I think about how long my back had been hurting and how bad it hurt. And now that it doesn’t hurt anymore, I don’t even know how to describe how good it feels. It’s like a new life for me.

“Sedative Stretching was one hundred percent successful for me. I’ve already talked to a few people about the procedure and about Dr. Johnson. He is a very genuine person who really cares about people and wants to help them.

“He is also a very dedicated person, and he made me feel better when I didn’t think anyone or anything could make me feel better. It should make everyone feel good to know that there’s someone out there who can really help them.”
Sheila notes that Dr. Johnson and his stretching protocol made a huge difference for her as well.

“Before my Sedative Stretching procedure, I was at my wit’s end,” she relates. “I didn’t think any surgery would help, and I was just not going to go on opioids. I had taken so much ibuprofen for the pain that I actually damaged my kidney, and I can’t ever take ibuprofen again.

“Recently, I called Dr. Johnson and told him, You really saved my life.

Eye Floater Laser

Scott Geller, MD, teaches the technique worldwide.

With more than 20,000 documented eye floater laser sessions completed, Dr. Scott Geller, a board-certified ophthalmologist, has the largest and longest clinical series of eye floater laser sessions in the United States, and probably worldwide.

Photo by Jordan Pysz.

Dr. Geller has performed more than 20,000 documented eye floater laser sessions.

“I became interested in this niche ophthalmic specialty after I was trained by the professors in Switzerland who were using lasers to cut membranes in diabetic patients,” Dr. Geller explains. “They never thought of applying it to eye floaters.”

Some doctors and patients credit Dr. Geller with inventing the technique.

“I just applied the training and techniques I learned to eye floaters, and have had amazing success,” Dr. Geller says. “I have presented my results and technique at major scientific meetings worldwide starting with the International Congress of Ophthalmology in Singapore over twenty-five years and thousands of cases ago.”

Dr. Geller’s last presentations were at the prestigious Florida Society of Ophthalmology and the Orione Ophthalmic Congress in Italy, where he performed eye floater laser sessions on selected patients.

“Almost all ophthalmologists use lasers in their practice, but they can’t treat eye floaters with the precision and predictability required to do the best job possible, because most YAG lasers are not configured to work in the vitreous gel, where floaters are created,” Dr. Geller states.

Worldwide Patient Base

Recently, a major ophthalmic laser manufacturer has devised a laser for floaters.

“The problem is, there have been no training courses for ophthalmologists who might be interested in this area,” Dr. Geller notes. “And that can lead to complications.”

Dr. Geller was the principal author of the only presentation on this subject at the American Academy of Ophthalmology in 2012.

“I have tried the other lasers, and if they were superior, I would purchase one immediately,” Dr. Geller says. “I use the Swiss made LASAG laser. It is definitely, in my hands, superior to the others out there. And I have two of them.”

Dr. Geller has a worldwide patient base. He has treated patients from Europe, Russia, China, Japan and most recently, an anesthesiologist from Brazil.

Dr. Geller always welcomes colleagues to observe or just call if they need to refine their own technique.

“Laser treatment of eye floaters is fascinating,” Dr. Geller says. “I look forward to doing this every day.”

Article submitted by Scott L. Geller, MD.

Right on Time

Laser-assisted gum therapy restores healthy smile.

Most modern watchmakers spend their time repairing watches instead of actually making them. At 65 years of age, Cameron* is just old enough to remember when it was the other way around and watchmakers were considered true artisans.Stock photo from iStockphoto.com.

“My grandfather was a watchmaker and so was my father,” Cameron says. “I learned the trade from them and actually made a few watches myself when I first got into the business. After a while, though, I mostly just repaired high-end factory-made watches.”

Even while doing mostly repairs, Cameron always maintained his great appreciation for the skill that went into making a handmade timepiece. That’s why he has a collection of them that dates back more than two centuries. Not surprisingly, Cameron runs his life in a very timely fashion as well.

“I tend to be very precise in everything I do,” he says. “For example, I’ve always had my teeth cleaned every three months – like clockwork – because I had periodontal disease and knew I had to go in more often than most people to keep my gums and teeth healthy.”

Diligence aside, Cameron recently began to question the quality of care he was receiving during those cleanings. The development of an infection under a lower molar that had to be pulled is what sparked his concern.

“I thought it was really odd that I would get an infection when they were allegedly treating me for gum disease at the time,” Cameron explains. “When I had to have four more bottom teeth pulled and a bridge placed, I became even more suspicious.”

Cameron’s suspicion lingered for more than a year. Finally, after retiring and moving from Michigan to Florida, he sought some answers after his wife read an article in Florida Health Care News about a procedure to treat periodontal disease.

“The article was about Dr. Farag and the LANAP® procedure to heal infected gums,” Cameron says. “I was intrigued by the information and made an appointment at Advanced Dentistry of Fort Myers.”

Repair with LANAP

“When I first saw Cameron, I did a complete oral examination on him, as I do on all of my new patients,” explains Joseph H. Farag, DMD, of Advanced Dentistry of Fort Myers. “This includes x-rays, an oral exam and a personal consultation. I determined through those x-rays that Cameron had advanced stages of periodontal disease.”

Periodontal disease is an inflammatory progression that can become a chronic or an acute problem. The American Academy of Periodontology (AAP) estimates that between 50 and 75 percent of Americans have some form of periodontal disease, some through no fault of their own.

“Being a smoker, Cameron was already at a high risk of developing periodontal disease,” notes Dr. Farag. “Based on the severity of the pockets and the bone loss he had along his gumline, he was the perfect candidate for the LANAP treatment option.”

When healthy gums adhere closely to the teeth, they don’t become loose in the jawbone. When people develop gingivitis, a mild form of periodontal disease, the gums become irritated, red and swell. They may even bleed a little bit when brushing.

As periodontal disease progresses, the bone is lost around the tooth, bleeding when brushing increases and pockets around the teeth develop. If left untreated, gingivitis may lead to a second, more serious stage called periodontitis.

A surgical procedure in which the infected portion of the gums is cut away and the gums are sutured can be performed to repair the effects of severe periodontal disease, but research studies show that a laser-assisted dental gum treatment such as LANAP is superior to conventional surgery in a number of ways.

LANAP, which stands for laser-assisted new attachment procedure, is an FDA-approved, two- to three-hour-long periodontal treatment in which the entire gumline is treated by making three passes across the gums with a special dental laser and sonic equipment.

During the first laser pass, the energy from the laser kills any bacteria in the gums, vaporizes the diseased gum tissue and dehydrates the tartar on the tooth, making it brittle and easy to remove. This is also the step during which the diseased lining of the tissue is removed.

During the second phase, the tartar is removed with a vibrating, fine-tipped, ultrasonic instrument, while the pockets are flushed with an antimicrobial substance that stops the growth of new bacteria.

Finally, during the third pass, an antimicrobial seal is created that prevents re-infection and releases growth factors from blood cells that help regenerate the attachment between the gums and the teeth.

The entire procedure, Dr. Farag emphasizes, is painless. So is its aftermath.

“The great thing about the LANAP procedure is the speed of recovery and the tissue response,” Dr. Farag educates. “It doesn’t take weeks or months. It literally takes just a couple of days, which is truly amazing.

“When the bacteria or the tartar or the insult that is causing the inflammation and infection is removed from the tissue to the point where it’s sanitary, which is what the laser does, the tissue heals ever so quickly.

“The analogy I use with patients is, say you cut yourself while working in the garden or just because you work with your hands a lot. You get that cut and if you don’t clean it and don’t put NEOSPORIN® on it, you’ll go for days and it will burn and get irritated.

“It will eventually heal, but it will take a lot longer, and you’ll feel it. But if you get a cut and you clean it, sanitize it, disinfect it and routinely put an antimicrobial on it and keep it clean, it will heal very quickly without pain and without scarring.

“That’s what LANAP does. It cleans, disinfects and sanitizes, and the body just heals up really quickly afterward, which is something that is very hard to do in the mouth because our mouths are not a clean environment. They’re filled with bacteria.

“And when there’s that constant flow of bacteria in the mouth, it just makes it harder for the gums to heal. But when you remove the bacteria and the tartar and the plaque, they heal quickly.”

Follow-Up to Good Health

As is typically the case, Cameron’s LANAP procedure was completed in one day. That would not have been the case had he opted for traditional surgery, which regularly results in a recession of the gums, according to Dr. Farag.

“LANAP is a much faster, more effective and safer method of treating gum disease,” he concludes. “But a procedure such as this is really just the first step along the road to good oral health.

“In order to keep the gums healthy, people need to keep their teeth clean. That requires daily commitment. Without that commitment, a treatment such as LANAP is not going to be effective long term.

“That’s why, when we sit down with someone and discuss treatment options for gum disease with them, I want to be assured that the patient is committed to taking care of their teeth. Patients need to be committed to keeping the teeth healthy long term in order for any treatment to be effective.”

Patients are encouraged to have their teeth cleaned regularly, brush and floss daily and be aware of any sudden changes to their oral health. Dr. Farag adds that many times, such as with Cameron, patients are diligent about home care, yet have no idea of the extent of their situation.

“I have patients tell me they brush and floss at home and still get the pockets where the bacteria sit. This was the case with Cameron. He thought he had it under control, but sadly, that was not the case.”

Getting Back to Normal

Dr. Farag advised Cameron that periodontal disease is not something that just goes away without proper treatment and then follow-up care.

“He has to maintain good brushing habits at home and keep his appointments, or it will recur,” Dr. Farag stresses. “He seems committed to doing that.”

Part of Cameron’s treatment plan includes wearing a night guard in order to preserve his bite.

“His teeth were shifting position due to significant bone loss,” Dr. Farag explains. “Once we hold those teeth in their proper position, they will all heal as a unit. We stabilize the teeth by doing this.”

Cameron says he is more than pleased with the care Dr. Farag and his staff have provided.

“Dr. Farag is really informative, and he knows what he is doing,” Cameron asserts. “I know that he is not lying to me, and I trust him. That goes a long way compared to the care I used to get in Michigan.

“I recommend Dr. Farag to anyone. The LANAP is really great, and there was no pain at all involved. I’m happy with my results!”

*Patient’s name withheld at his request.

Fast Action Saves Sight

Retinal detachment: What you don’t know could cost you your vision.

Every year, nearly 25,000 people in the United States experience retinal detachments, a true medical emergency that can threaten their sight. For some, symptoms begin gradually and may be barely noticeable. Others will experience a sudden and dramatic decrease in their vision, creating an obvious urgency to seek care.

Graphic courtesy of The Eye Institute for Medicine & Surgery.

A tear or hole in the retina can allow fluid to enter and weaken the retina’s attachment. When this happens, the retina can’t compose a clear picture from incoming light, and vision becomes blurred and dim.

“There is no question that a retinal detachment left untreated can lead to vision loss that can become permanent in the absence of timely and expert care,” states Gary J. Ganiban, MD, chief of vitreoretinal surgery at The Eye Institute for Medicine & Surgery.

The retina is a thin, interior layer of tissue at the back of the eye. Its job is to process light through special cells called photoreceptors that detect qualities such as color and light-intensity. That information is sent through the optic nerve from the retina to the brain, which creates the images we see.

Retinal detachment occurs when the retina pulls away from its normal position and is cut off from nourishing blood vessels. The interior of the retina can also be harmed by the appearance of tears or holes, conditions that may progress when left untreated.

Dr. Ganiban emphasizes that whether the retina is affected by a small tear or full detachment, the injury can occur suddenly and without warning. “There is no pain or redness of the eye associated with these conditions,” notes the doctor.

“However, in many cases, there are warning signs, and these signs should not be ignored,” adds Dr. Ganiban. Patients with retinal detachments may experience sudden changes in their field of vision. They may notice an increased number of tiny specks called floaters, which may seem like moving cobwebs, strings or strands. Some have described what looks like a curtain coming down over a portion of their vision.

These symptoms can occur before the retina fully detaches, explains Hetal D. Vaishnav, MD, director of clinical research and preventive medicine at The Eye Institute for Medicine & Surgery.

This is when time will be critical.

“If a patient or referring doctor suspects a retinal detachment, a key to helping ensure that vision is maintained or regained is to schedule an examination with a retinal specialist as soon as possible,” advises Dr. Vaishnav.

“The bottom line is that in many cases, a thorough, dilated eye examination will reveal the retinal hole or tear prior to it developing into a full detachment. Then a procedure can be performed through a laser or freezing probe to seal the tear and help prevent any further separation of the retina.”

Gentler Repair Procedure

A trend in retinal surgery to repair retinal detachments has been to move away from a treatment known as a scleral buckle and toward a procedure called vitrectomy. A scleral buckle involves placement of a tiny device on the eye’s outer surface that helps close the retinal break. Vitrectomy removes most of the vitreous, the clear, gel-like substance inside the eye.

Vitrectomy offers numerous advantages for most patients who need surgery for retinal detachment, says Dr. Ganiban. One is that removing the vitreous reduces traction on the repaired retinal tear. This makes future retinal tears less likely.
The vitrectomy procedure frequently takes less time than other methods, which often means the risk of complications is reduced, he adds.

“Vitrectomy surgeries heal relatively rapidly due to minimal surgical trauma,” states Dr. Ganiban. “Very little cutting is required, and frequently, stitches aren’t required. Compared to a scleral buckle, vitrectomy is very gentle.

“Another advantage of vitrectomy is that the shape of the eye isn’t altered and therefore there shouldn’t be a change in the patient’s eyeglass prescription. With a scleral buckle, the eye may become elongated, causing induced myopia, which is nearsightedness, and/or a visually significant astigmatism.”

The Ganihand for Better View

A medical innovation developed on the Space Coast by Dr. Ganiban is now aiding eye surgeons during vitrectomy procedures. The surgeon’s view of the back of the eye and affected structures is critical during retinal repairs. Traditionally, this enhanced view is achieved with the help of a surgical technician. The technician applies slight pressure to the sclera, the eye’s outer, white surface, with a cotton tip applicator or scleral depressor made of stainless steel. The surgeon can then see the back of the eye through the patient’s well-dilated pupil.

This method is decades old but can be cumbersome and inefficient. In most cases, it increases the length of the surgery.

Dr. Ganiban knew there had to be a better way and designed a hands-free scleral depressor device. During surgery, the instrument is secured to the speculum that keeps the patient’s eye propped open. It features a custom light pipe to ensure the surgeon has an ideal view of the interior eye without the need for a surgical assistant.

There are now multiple versions and sizes of the Ganihand in development to ensure the device will be suitable for all related surgical applications.

“It is my sincere hope that my new instrument will help surgeons all over the United States and the world to improve their surgical outcomes, minimize complications and restore vision that otherwise may not have been regained,” says Dr. Ganiban.

Article submitted by The Eye Institute for Medicine & Surgery.

Quick, Easy and Effective

Safe, nonsurgical treatment relieves hemorrhoids.

For the better part of the ten years he suffered from hemorrhoids, Jason* told no one of the condition, not even his wife or his doctor.

“I guess like a lot of people I was too embarrassed to talk about it,” Jason confides. “It was definitely a problem, though. I’d wake up in the middle of the night, itching like crazy. I tried hemorrhoid cream, but it didn’t do anything. It was horrible.”

Now retired, Jason spent his working years in the broadcasting industry, where he managed radio and television stations. One day, he heard about HemWell America and had a revelatory moment.

“I said to myself, That’s me. I’m not telling my wife about this; I’m not telling anybody,” Jason recalls. “So I went home that night and told my wife, I’m having a little problem down there and I’m going to make an appointment with HemWell.”

Outpatient Procedure

“Hemorrhoids are swollen veins in the rectum or anal canal and they’re extremely common,” notes Linh B. Nguyen, MD, of HemWell America. “In fact, more than fifty percent of people age fifty or older have them to some degree.”

Most sufferers are understandably reluctant to try the available treatment options, some of which have traditionally been both painful and inconvenient. Fortunately, Dr. Nguyen offers microcurrent electrolysis (MCE), an FDA-approved, nonsurgical method for treatment of hemorrhoids. The noninvasive, relatively painless outpatient procedure has been helping patients for more than 20 years and is completed right in the doctor’s office.

“A low current is applied to the base of the hemorrhoid, causing a chemical reaction that induces the hemorrhoid to shrink,” the doctor explains. “This method doesn’t cause the agonizing pain often associated with traditional hemorrhoid surgery and is covered by most insurances and Medicare.

“In addition to being well tolerated by patients, this method does not require anesthesia, and it’s highly effective, safe and convenient. Up to ninety percent of people who have it done get relief from their hemorrhoids, and it can be safely repeated as needed.

“One of the best things about it is that there is no need to take any special preparation to clear the bowels. Patients can have the procedure done and go back to work immediately, so there is no downtime. The entire procedure takes approximately twenty minutes.”

“Feel Like New”

“Dr. Nguyen makes you feel very comfortable during the procedure,” says Jason, who reports that the MCE treatment was not only painless but immediately effective.

“I felt like a new person when I walked out of the doctor’s office after the procedure,” he says. “The itching was gone.”

Also gone is Jason’s unwillingness to talk about hemorrhoids. In fact, he talks about them freely now, in case it helps others.

“I tell people that this is the most comfortable treatment and it’s not an embarrassing situation,” he notes. “If you’re putting treatment off because of embarrassment, don’t wait another second. Pick up the phone and get it done because it’s not embarrassing at all.”

*Patient’s name withheld at his request.

Hope for Depression

Revolutionary TMS therapy doing the job antidepressants haven’t.

Rebecca Coupe moved to Florida from Ohio in 1996 to escape the harsh Midwest winters. She planned to spend her days basking in the warm sunshine, but chronic back issues kept Rebecca from enjoying the subtropical lifestyle.

Her incessant back pain forced Rebecca to quit her job long before she had planned to and dramatically altered her lifestyle. Annoyed by the discomfort, she lost the desire to see or even talk to anyone and soon found herself confined to her home.

Rebecca Coupe was treated for major depression with TMS by Boris Kawliche, MD, at Brandon TMS & Psychiatry.

Rebecca has her life back after treatment.

“When I say I am retired, I was kind of forced into it,” she admits. “Physically, I couldn’t do anything because of the pain, so I had to retire. My back hurt almost every day, and I was irritable all the time. I just had no ambition or desire to do anything.”

Unable to afford surgery, Rebecca struggled through the pain and eventually fell into a deep depression. It wasn’t until she found something that motivated her to get out and interact with people again that she realized some relief.

“I started volunteering for the American Veterans [AMVETS] service organization. My son is in the US Army, and I enjoyed spending my time giving back to those who served so selflessly. It helped to take my mind off the pain and ease the depression.”

In 2013, Rebecca says, her daily life began to unravel again, this time as a result of a bout with double pneumonia. That, coupled with her ongoing back issues, left her weak and fragile and feeling unlike herself.

“I started to get depressed because I was on oxygen all the time and had a portable tank I had to drag behind me everywhere,” Rebecca recalls. “I never left the house. It was easier that way. I was cooped up. I was forced to stop volunteering because I was so sick.”

On the advice of her primary care physician, Rebecca sought help for her depression from Boris Kawliche, MD, at Brandon TMS & Psychiatry.

“Dr. Kawliche prescribed antidepressants, and they did work for a while. I felt better some days – good enough to at least be able to function with some normalcy day-to-day.”

But when her back pain magnified, Rebecca says she was forced to undergo surgery. That was when things took a turn for the worse.

“It was my fourth back surgery,” Rebecca informs. “Afterward, I felt about as low as a person could get mentally. I would get up at eleven in the morning, stay up until about two in the afternoon and then go back to bed.

“Then, I would get back up later and make dinner, crochet a little bit or read a book, and stay awake watching television until eleven at night and just repeat the same thing the next day. I used to be so active. Suddenly, all of that was gone, and I felt useless.”

During her recovery period following back surgery, Rebecca didn’t take any medication for her depression because of the potential interference with her pain medications. One day, when she was at her pain management doctor for a
follow-up visit, Rebecca was advised to go back to see Dr. Kawliche.

“My pain management doctor could see I was struggling mentally,” Rebecca shares. “That’s when I went back to see Dr. Kawliche, and he told me I was a strong candidate for transcranial magnetic stimulation, or TMS,” Rebecca confirms. “I discussed it with my husband, and he was on board with it.”

The TMS Era

A new chapter in depression treatment, TMS began in the 1980s when a researcher at the University of South Carolina discovered how magnetic pulses could stimulate part of the brain that is underactive in people with depression.

The Food and Drug Administration approved the noninvasive therapy in 2008 for people with treatment-resistant depression and those who can’t tolerate the side effects of antidepressants.

Once the patient is settled into a comfortable chair, a paddle-shaped device with a magnetic coil is placed on the prefrontal cortex. It emits a magnetic field, similar to that of an MRI, in short pulses to stimulate the brain. These magnetic pulses are delivered intermittently in a precise sequence that is computer-generated.

The magnetic pulses are precisely targeted to the prefrontal cortex, which is the part of the brain associated with mood regulation and cognitive functions. Research studies have shown this area can be underactive in depressed people.

TMS treatments last approximately 30 minutes, and patients typically receive a total of 36 treatments over a period of six to eight weeks. Patients are treated five times per week for the first six weeks and are gradually weaned off the treatment in the final weeks.

“Most people start to notice changes within two or three weeks after beginning treatment,” notes Dr. Kawliche. “They say, I have more energy. I’m thinking a little clearer. My motivation is better. I feel like doing things.

“As the treatments continue, the brain gets used to maintaining a higher level of functioning through the repetition of treatments. This helps create muscle memory and oxygen flow to parts of the brain that may have been weakened by the depression.

“This treatment is truly unique. Not only does it help alleviate symptoms of depression, it also regulates sleep and helps stimulate blood flow to the brain. And it’s a painless treatment that, for many patients, works far better than antidepressants.”

Antidepressant medications have become a common treatment, but a large percentage of people with depression fail to respond to the medications. Either that or they stop working after a while.

Statistics show that in patients who have tried three antidepressants that have either not worked or have stopped working, the chances of a fourth such medication working effectively are just seven percent.

“The chances of TMS working in those patients are much better,” Dr. Kawliche says. “For those patients, there is a much better chance that they will regain the function and enjoyment in life they had prior to their depressive episode, which is why TMS can be life-changing for these patients.”

Getting Her Life Back

“I had TMS treatments five days a week for six weeks, and started feeling better after about two weeks,” Rebecca reports. “It was a huge commitment, but I followed through with the entire treatment plan to the end, and I’m glad I did.

“By the end, I felt like I could get up and get moving every day. I wasn’t just lying around doing nothing all day the way I used to. I was slowly getting my life back because I felt rejuvenated.”

Rebecca says TMS was a life-changing treatment for her.

“I am back to my old self again now,” she says. “I am doing yard work again, volunteering again and enjoying all of the daily activities I had shelved for so long. I still see Dr. Kawliche every six weeks or so for follow-up care, but I feel great.

“I owe a lot to Dr. Kawliche,” Rebecca emphasizes. “TMS was a lifesaver for me because I had exhausted the use of antidepressant medications. This was kind of a lastresort effort, and it worked! I finally have my life back, and I could not be happier. I feel great!”

Time Warp

ED therapy gives senior youthful attitude.

After working construction most of his life, Emory Allen spent the last few years of his career running his own business and working for a large contracting company, from which he retired. The North Carolina native, who spent his young-adult years in Southern France with the Army, always felt proud when clients turned to him for his construction expertise.

irst story: Dr. Robert Lupo of Physical Medicine Center in Tampa treated Emory Allen’s erectile dysfunction (ED) using GAINSWave® therapy.

Emory has renewed vim and vigor.

“I had a lot of fun doing construction, so I started my own construction company,” the 74-year-old Emory recounts. “The name of it was Professional Industrial Contractors. Clients I did work for included Coors® Brewery, Gerber® Baby Food and Frito-Lay®. I also worked on several ethanol plants, a few bakeries and many other projects.”

As Emory got older, he faced a few common health issues that sometimes affect men as they age, including prostate disorders. In Emory’s case, treatment for those disorders contributed to a frustrating problem – erectile dysfunction (ED).

“I hadn’t been able to do anything in the bedroom since I had prostate surgery fifteen years ago,” Emory confirms. “My wife was very understanding because we have more than sex going on in our relationship.
We’re best friends.”

“That’s true,” Emory’s wife confirms. “The sex wasn’t as good as it was in the past, but there’s more to our relationship than that. That made it easier for me to be understanding about Emory’s problem.”

For years, the couple lived with an incomplete sex life, then Emory learned about a treatment that offered significant improvement without pills or surgery. The treatment was provided by Robert C. Lupo, DC, of Physical Medicine Center in Tampa.

“I was already a patient of Dr. Lupo for chiropractic services,” Emory relates. “One day, I was in the waiting room and saw an article in Florida Health Care News about Dr. Lupo and his GAINSWave® therapy, so I asked him about it. He said it works like the treatment that’s used to break up kidney stones, except that it breaks up the plaque that builds up in the blood vessels of the penis.”

“GAINSWave is a unique treatment that uses sound-wave technology to clear the tiny microvessels in the urogenital region,” Dr. Lupo describes. “This increases circulation to the penis, which improves sensitivity and the quality of the erection, intensifying the entire sexual experience.”

Emory was given a sample GAINSWave treatment and later returned for five subsequent treatments during which he says, “Things started looking up.”

Performance Tune-Up

Sexual health can affect overall well-being, so the impact of untreated erectile dysfunction, as well as decreased sensitivity and performance, can extend beyond the bedroom.

“Everyone wants to feel good, be healthy and have great sex,” Dr. Lupo reports. “In fact, studies have shown that good sexual energy does many things for health and well-being. These include decreasing stress, providing a stronger-functioning immune system, improving sleep, increasing self-esteem and happiness, and much more.”

Difficulties in the bedroom are not limited to men in their 70s, such as Emory. Even men in their 30s and 40s can begin to lose sensitivity or have trouble achieving and maintaining the strong erections necessary for great sex. It’s important that men experiencing these symptoms seek the advice of a medical professional.

“Trouble with erections is a sign that blood flow issues, hormonal changes or other serious conditions are beginning to develop,” Dr. Lupo notes. “We offer bio-identical hormone therapy as well as GAINSWave to get men suffering with treatable conditions back on track and working like they’re supposed to.”

Dr. Lupo stresses that while GAINSWave is an excellent treatment for men with ED, it is also very effective for achieving sensitivity and volume improvement in younger men.

“Some younger men come in to tune-up their sexual functioning and improve their experience,” he says. “They simply want to keep their bodies in good working order, which leads to better performance in the bedroom. These men report that GAINSWave provides a very dramatic result.”

GAINSWave helps improve a man’s sexual health in another way as well. It also stimulates the growth of nerve tissue vital for increasing sensitivity and achieving and maintaining healthy erections.

Stronger, Longer, Better

Men have experienced a renewed ability for healthier erections after only a few GAINSWave treatments, Dr. Lupo points out. Just two painless treatments per week over a three-week period are all most men need to restore or improve erectile function.

“GAINSWave’s ability to improve blood flow, increase new vascularization and increase nerve sensitivity in the urogenital region has been pretty phenomenal,” the doctor asserts. “The erection ability is stronger, longer, better and more impressive. It’s taking men back to more youthful times in their lives without the necessity for medications.”

The noninvasive therapy is also used to successfully treat a painful syndrome that causes curvature of the penis called Peyronie’s disease that is the result of scar tissue.

Dr. Lupo says GAINSWave uses the same technology that has been effective for years in the US and Europe to treat plantar fasciitis; heel, knee and elbow pain; scar tissue, tendonitis and connective tissue injuries.

“GAINSWave emits concentrated blasts of sound waves akin to ultrasound or sonar technology,” he explains. “These sound waves travel faster than the speed of sound, and when applied through the correct number of pulses, frequency and energy, they can have a positive effect on tissue to restore blood flow and nerve sensitivity.

“We’re very encouraged by how GAINSWave has been used to treat hundreds of patients without harmful side effects. Any man who wants to restore youthful performance should call us to explore this option.”

Fountain of Youth

Men gain the most benefit from GAINSWave when they finish the full course of treatment. Many men, however, experience positive effects after just a few treatments. Emory was one of those men who noticed benefits from GAINSWave early on.

“After two or three treatments, I started to see a difference,” he recalls. “I began having some sensation down there, the blood started flowing and things started getting better. Right now, I’m doing very well for an old man.

“I’m almost seventy-five years old, and everything works! The GAINSWave must have broken up all of those calcium plaque deposits in my penis because everything is up now, and my wife is happy.”

“It’s wonderful,” his wife says. “Our sex life is back to the way it was years ago.”

Emory credits his excellent results to Dr. Lupo. He thinks very highly of the doctor and trusts him completely. Thanks to
Dr. Lupo, Emory always has a good experience at Physical Medicine Center.

“Dr. Lupo is a good, honest man,” Emory states. “He has high morals. His good character means a lot to me. He’s very good, and so is the GAINSWave treatment. I recommend them both.”

Pleasure Without Pain

Specialized treatments foil complex headache syndrome.

Gary Brinson, 60, was a warehouse supervisor for a fertilizer plant until 2012, when he fell at work and his world turned upside down. Injuries he suffered from the fall disabled him. They also worsened pain he was experiencing beforehand.

Photo by Nerissa Johnson.

Gary Brinson

“I was already having massive headaches,” the Indiana native shares. “Then when I fell, I broke my shoulder. But when I tried to do physical therapy, I couldn’t do it because my neck and head hurt too bad. And when I tried to do physical therapy on my neck, I couldn’t because my shoulder hurt too bad.

“I had surgery on my shoulder and neck. During the neck surgery, the surgeon went through the front and put in bone grafts as well as plates, cages and screws. But I was still having headaches, so he went in through the back of my neck and put spacers in my vertebrae.”

Unfortunately, neither neck surgery eased Gary’s headaches. His problem, according to his orthopedic surgeon, was severe arthritis leading to degenerative disc disease. The damaged discs in his neck were placing pressure on the delicate nerves going into his head. That caused the painful symptoms he was experiencing.

“My neck was stiff, so I couldn’t turn my head without excruciating pain,” Gary describes. “The pain was constant. It felt like someone was trying to pull off my forehead. And my wife says that I was grouchy.
“The headaches came from the back of my skull. They went through the sides of my head right into my eyes. They were debilitating. On a scale of one to ten, they were at least an eight or nine on most days. All I could do was lie in bed with my eyes closed and try to sleep, or put in my earbuds and listen to music real low to take my mind off the pain.

“I couldn’t drive or ride in a car for very long. If I sat in a chair, I had to get up after a while and move. I had to alternate positions and movements often to keep from stiffening up and hurting worse. I couldn’t ride my motorcycle, and I’ve been riding since I was ten. It’s my passion. We bought a brand-new bike in 2011, and it was just sitting out in the shed.”

After the neck surgeries failed to give Gary relief from his headaches, his orthopedic surgeon referred him to Kai McGreevy, MD. Dr. McGreevy is a board-certified neurologist and pain management specialist at McGreevy NeuroHealth, which has offices in Palm Coast and St. Augustine.

“If I do get a headache, I just adjust the stimulator with the remote control. The further up I adjust it, the more pain it takes away.” – Gary

Dr. McGreevy uses a wide range of advanced therapies to treat pain and many other conditions associated with nerve disorders.

“Gary had undergone cervical fusion surgery in the past, but areas above the fusion were now degenerating,” Dr. McGreevy reports. “Imaging revealed arthritis in his upper cervical spine. Arthritis in this area of the spine can refer pain up into the occipital region at the back of the head, and that can trigger headaches. We call this cervicogenic headache syndrome.”

Initially, Dr. McGreevy treated Gary’s headache syndrome with conservative measures, including medication and physical therapy. He tried interventional techniques, such as epidural injections and facet nerve blocks, as well, but none of these treatments provided the desired relief.

“I received a little pain relief with the injections,” Gary states. “It felt wonderful to get any relief at all, but then the pain got to a point that we had to try something else. That’s when Dr. McGreevy suggested occipital nerve stimulation.”

Photo by Nerissa Johnson.

With his occipital nerve stimulator Gary is
“enjoying life” again.

Occipital nerve stimulation works through an implanted device that interferes with pain signals traveling from the occipital nerves at the base of the skull to the brain. The interruption eases both neck pain and headaches. Before a permanent stimulator is implanted, Dr. McGreevy provides patients with a stimulator trial.

“In setting me up for the trial, Dr. McGreevy placed the wires over the nerves in my neck and taped the battery to my back,” Gary explains. “For four days, I was headache free, so I decided to go with the permanent stimulator.”

Adjustable Relief

When a patient is fit with an occipital nerve stimulator, one electrode lead is placed in their cervical epidural space and two smaller leads are inserted under the skin on each side of their head. The leads cover an area called the occipital ridge that runs along the back of the head where the base of the cranium sits, Dr. McGreevy observes.

“The first lead overlies the occipital nerves as they move off into the head,” the doctor explains. “The two smaller leads serve as peripheral nerve stimulators as they extend over the occipital ridge. We position the leads this way to cover the cervical pain as well as the headache pain.

“All three leads are attached to the same battery. With occipital nerve stimulators, the battery is placed either in the area of the low back or over the buttocks.”

Gary received 100 percent relief from his occipital nerve stimulator trial. That made him an excellent candidate for stimulator implantation, which was performed by a neurosurgeon in late 2018. Two weeks following implantation surgery, after Gary had time to recover, the stimulator was activated.

“During Gary’s recovery period, he was still having daily headaches,” Dr. McGreevy informs. “But the moment the stimulator was turned on, he noticed dramatic relief from his headache pain, as well as a significant decrease in headache severity and frequency. If he starts to get a headache, he simply changes the stimulator’s setting to reduce the headache’s impact.”

“The occipital nerve stimulator is amazing,” Gary offers. “It has an adjustable remote control, and if I start hurting, I just turn it up a little bit. If the headache is really bad, I can turn it up a little more. I adjust the stimulation to my pain level. It’s been a godsend.”

Retirement at Risk

During her working career, Elaine Johnson, 76, managed the production of a major corporation’s proposals for projects up for bidding. Merging data from multiple sources, editing text and inserting graphics on tight deadlines was stressful work.

A West Virginia native, Elaine strongly believes the stress of her job greatly contributed to a long-term issue with back pain, one that she long kept at bay through the use of a combination of therapies.

Photo by Nerissa Johnson.

Elaine Johnson

Over time, though, her pain intensified and eventually threatened to interrupt her laid-back retirement lifestyle, where she was content to relax with her husband, volunteer in the community and work in her garden.

“For at least twenty-five years, I experienced muscle spasms in my back,” Elaine divulges. “Twice a month, I went to a chiropractor and a massage therapist, and they pretty much kept the spasms down. But after I moved to Florida, my back got worse.

“The pain became excruciating. My back ached and throbbed, and it was unbearable. It was like a toothache, and to me, that’s one of the worst pains you can have. The pain throbbed, stopped for a couple of seconds, then throbbed again. And I never knew when it was going to start up.

“It hurt to do everything because of the throbbing. The pain kept me out of the garden and interfered with my sleep. Then, I didn’t want to get up in the morning because my back hurt so bad. The pain was really severe for about eight months, and during that time, I didn’t do much of anything except go to doctors.”

“It’s been more than two years, and I haven’t had any back pain. On a scale of one to ten, the pain was a ten before the injections. Now, it’s zero.” – Elaine

Among the doctors Elaine visited were a neurologist, a pain management specialist and an orthopedic surgeon. These physicians used several techniques in their attempt to relieve her pain, including physical therapy and injections to block the irritated nerves in her back. Unfortunately, their treatments didn’t provide the relief Elaine desired.

“I’d been to every physical therapist in the region,” Elaine remarks. “I even tried acupuncture, but nothing helped. The only medication I take on a regular basis is an antidepressant, and the neurologist switched it to one that’s good for pain, but that had no effect. At that point, my family doctor recommended Dr. McGreevy.”

“When Elaine came in, she reported pain in the region of her thoracic spine, which is the mid back,” Dr. McGreevy discloses. “This area was tender to the touch, and her pain was made worse with coughing, sneezing and bearing down. She described the pain as an electric shooting sensation in the middle of her back that radiated around to her side.

“Elaine’s MRI showed disc herniation as the result of degenerative disc disease. Because she had already tried conservative measures, including physical therapy and over-the-counter anti-inflammatories, we recommended specialized injections called transforaminal epidural steroid injections to relieve the inflammation surrounding the spinal nerve roots exiting her damaged discs.”

Slightly Off Center

The cushioning discs between the vertebrae of the human spine have a hard, outer layer and a soft, jelly-like, inner core. Over time or because of an injury, the outer layer can break open, or herniate. When this happens, some of the jelly-like material leaks out and puts pressure on nearby tissues, including nerves. That’s what happened to Elaine, Dr. McGreevy informs.

“Not only did Elaine’s MRI show her disc herniation, it also pointed me to the inflamed nerve roots exiting those discs that were the likely cause of her pain,” he notes. “I performed a nerve conduction study to confirm those were the nerves involved, then we moved on and began the series of injections.”

Photo by Nerissa Johnson.

Elaine, shown here with Lucky, feels fortunate to have found Dr. McGreevy

Transforaminal epidural steroid injections are specifically placed in the back by a trained specialist using fluoroscopic (continuous x-ray) guidance.

“In the injections, we use the combination of a nerve pain blocker and a steroid, which is a potent anti-inflammatory,” Dr. McGreevy explains. “That combination offers pain relief as well as reduced swelling of the spinal nerves. This takes the pressure off the irritated nerve roots and provides relief, which can last for months.

“Transforaminal is a technical approach to the target nerve. With the classic epidural, the labor or interlaminar epidural, the needle is positioned right at the midline of the spine. The problem with that is the medicine doesn’t necessarily get to the site where the disc is encroaching upon the nerve root.”

The transforaminal approach enables the physician to safely position the needle slightly off midline so the area injected is closer to the site of the injury. It is a technique that produces improved outcomes for patients with nerve root inflammation that Dr. McGreevy is specially trained in.

“Transforaminal epidural steroid injections are performed under local anesthesia,” the doctor reports. “The injections are very comfortable, they take less than five minutes to perform and their results speak for themselves.”

On the Road Again

When Dr. McGreevy performed Elaine’s transforaminal epidural steroid injections, he explained that she might not gain relief from her pain right away, and he was right. Once they did take effect, though, the relief proved to be long-lasting.

“I received the nerve blocks two years ago in January,” Elaine recalls. “About three weeks later, I was driving along when all of a sudden I realized I wasn’t in pain anymore. I remember it well. It was February 12, 2017 when my back stopped hurting, and it hasn’t hurt since.

“It’s been more than two years, and I haven’t had any back pain. On a scale of one to ten, the pain was a ten before the injections. Now, it’s zero.”

With zero pain, Elaine can sleep soundly at night and be active during the day. She credits her turnaround to Dr. McGreevy and his injections.

“Today, I feel really wonderful, and I’m out there gardening whenever I can,” she relates. “My massage therapist says I’m the healthiest seventy-six-year-old she knows.

“I absolutely recommend these injections to anybody with back pain, and I’ve endorsed Dr. McGreevy a number of times already. When people on Facebook ask about a neurologist or somebody for back pain, I recommend Dr. McGreevy and McGreevy NeuroHealth all the time. They’re wonderful!”

Gary achieved dramatic pain relief from his treatment at McGreevy NeuroHealth as well. Before he received his occipital nerve stimulator, Gary’s pain hovered at an eight or nine. But with the device, his pain level is significantly lower and easily managed. And because the stimulator is implanted, there’s nothing keeping him from the open road.

“On a daily basis, my pain averages maybe a two now,” he states. “If I do get a headache, I just adjust the stimulator with the remote control. The further up I adjust it, the more pain it takes away. It’s incredible. I feel like a new person.

“I’m back to riding my motorcycle, which I love to do. My wife recently retired, and we bought a camper, so we’re enjoying life as best we can. With her being retired and me being disabled, the only things interrupting our schedules are our doctor appointments.”

Like Elaine, Gary has high regard for Dr. McGreevy and his staff.

“Dr. McGreevy is awesome,” he raves. “He’s very knowledgeable, he takes the time to fully explain everything and he answers all of my questions. He makes sure I understand exactly what’s going to happen and what kind of results I should expect.

“The staff at McGreevy NeuroHealth is wonderful. They’re friendly, helpful and patient oriented. Whenever I go to the office, it’s just like going home. They always make me comfortable.

“I’m on several groups on Facebook for spinal cord stimulators for the back and neck, and those are wonderful sources of information. I’ve recommended Dr. McGreevy to a large number of people because he is an awesome doctor. I’m very appreciative that my orthopedic surgeon sent me to him.”

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