Author Archive

Suffering from shin splints?

May 7th, 2018

It’s not just fitness fanatics adamant about getting in their daily jog who are in danger of developing shin splints. Anyone who has flat feet, poorly fitting shoes or weak ankles, hips or core muscles are susceptible to shin splints as well.Stock photo from

Referred to by some doctors as medial tibial stress syndrome, shin splints usually develop as a result of continuous force being applied to the shin bone (tibia) and the connective tissue that attaches the shin bone to the muscles around it.

That continuous force can lead to a swelling of the muscles around the tibia. When those muscles are swollen, more pressure is applied to the tibia and the result can be a variety of symptoms, most of which are more annoying than anything else.

For example, someone suffering from shin splints may feel nothing more than a dull ache in their shins or a swelling in the lower leg. Others, however, may experience sharp, jabbing pains in and around their shin during exercise or numbness in their feet.

In more severe cases, the shin of someone suffering from shin splints may feel hot or painful to the touch, the lower part of their legs may feel weak, or they may experience prolonged bone or muscle pain in the lower leg and calf.

In those more severe cases, some of which are the cause of small cracks or fractures in the bone, it may be best to consult a doctor. In most cases, however, shin splints can usually be treated by adhering to some common treatment methods.

The most effective treatment method is rest – and lots of it. Depending on the cause of your shin splints, the time needed to recover properly can be anywhere from three to six months. In less severe cases, however, a few weeks of rest may do the trick.

That may seem like a lot, particularly for a workout warrior type who is accustomed to hitting the gym three or more times a week or running every day, but there are other activities that can be done to maintain good fitness while shin splints are healing.

Riding a bike, swimming or using an elliptical machine provides many of the same cardiovascular benefits that running does, and none of those activities put the same degree of stress on the legs that running does.

In addition to rest, icing the area of the leg that is painful or uncomfortable for 20 to 30 minutes three to four times a day until the pain is gone helps to reduce the bothersome effects of shins splints, too.

As is the case with a lot of aches and pains, taking non-steroidal anti-inflammatory medicines such as ibuprofen, naproxen or aspirin if your doctor allows it will further advance the healing process as well.

With extensive use of all the above, though, some side effects such as bleeding and ulcers can develop. Always be sure to follow label directions specifically when using those over-the-counter aids and if possible consult your doctor before taking them.

Finally, for those whose shin splints are more a result of physical issues such as flat feet or poor-fitting footwear, the use of orthotic shoe inserts or a better fitting pair of shoes can make all the difference in the world.

You’ll know your shin splints are gone when you resume whatever constitutes normal activity and you can apply pressure to the area that used to hurt without feeling pain or run and jump without feeling any pain in or around the shins.

Prior to that, though, strengthening your core muscles and the area around your hips and increasing your intake of foods such as milk and yogurt that are high in calcium and Vitamin D can help prevent shin splints from coming back.

Remember, it’s not just weekend warriors and fitness fanatics who get shin splints. Anyone can get them. The good news is that no one has to suffer from them for very long.

Perfecting First Impressions

Procedure refreshes droopy, tired eyes.

A native of the East Coast of Florida, Mary* and her family moved to the Tampa Bay area about four years ago. A stay-at-home mom, Mary handles the massive job of rearing her three daughters and managing the household, and when there’s time, she and her husband enjoy outdoor activities such as camping, kayaking and hiking.Stock photo from
With her busy schedule, Mary had every reason to look exhausted, but her perpetually tired look had little to do with her many activities. Mary had an issue with her eyelids that interfered with her appearance.
“I’ve always had very heavy eyelids, like an awning over my eyes,” she describes. “Heavy eyelids run in my family. My grandmother’s were so heavy, they rested on her eyelashes.”
Mary didn’t care for the way her eyes looked, and the impression they made didn’t represent her emotions accurately. It was discouraging when people misinterpreted her expression, especially her children.
“My kids would say, Mom, are you mad? What’s the matter? You look angry. Are you upset about something?” she shares. “I wasn’t. I just had that look on my face all the time, especially when I was tired from running around.”
The extra weight on her eyelids had been a problem for many years, and years ago, she considered taking some steps to treat it. However, she wasn’t thrilled with the options she was given.
“My best friend’s mother had surgery done on her eyelids probably twenty years ago, and she had nothing but great things to say about it,” Mary recounts. “That was actually the first time I talked to someone about having something done. It was scary, though, because the first physician I spoke to wanted to do a ton of things that I didn’t think were really necessary. I just wanted the heaviness and the tiredness off my eyelids.

“I’m very happy with my eyes. My kids don’t ask me if I’m angry when I walk in the room, and it doesn’t feel like I have a sandbag on my forehead.” – Mary

“I wasn’t happy with the way the first doctor I saw wanted to proceed, so I put it off. Then I went to another doctor, and she said the same thing. She wanted to do a whole bunch of things. I didn’t like that either.”
Facing a host of procedures or nothing at all, Mary chose to do nothing. After she and her family moved to Tampa, she visited an ophthalmologist who offered her another option. The eye specialist recommended Mary see William P. Mack, MD, at the Mack Center in South Tampa.
“I went to an eye doctor, and she said, You’ve got to go to an oculoplastic surgeon. They really know what they’re doing,” states Mary. “I asked if she recommended anyone in the area, and she recommended Dr. Mack. I did some research online, and all arrows pointed to Dr. Mack, so I made an appointment for a consultation.”

Cosmetic Option

When she arrived at the Mack Center and met Dr. Mack, Mary was very impressed. She immediately came to understand why he was so highly recommended. Dr. Mack, who solves problems related to the eyelids every day, understood Mary’s condition well. Even better, he offered her the option she was seeking.
“Dr. Mack was very knowledgeable, personable and easy to talk to,” says Mary. “He didn’t want to add a bunch of other procedures like the other two doctors I had consulted. I was really happy about his approach. I just wanted to address the issue of my heavy eyes.”
Dr. Mack is an oculoplastic surgeon who has been fellowship trained by the American Society of Ophthalmic Plastic & Reconstructive Surgery.

Stock photo from

Blepharoplasty is a safe, effective option that helps patients with
drooping eyelids improve
their appearance.

“Oculoplastics is a specialized branch of plastic surgery that focuses around the eyes and face,” notes Dr. Mack. “My extensive training in eye and plastic surgery allows me to offer the optimal surgical options to achieve my patients’ aesthetic goals.”
“When eye contact is made, we immediately begin forming our first impressions,” observes Dr. Mack. “Judging someone to be tired, sad, angry or pleasant is largely based on the appearance of the area around the eyes. Eyes that are healthy and bright tell a different story than eyes that are puffy or drooping.
“People who have sagging eyelids, like Mary, often look like they’re frustrated or upset, though they might feel happy and content. As a result, first impressions of those people can often be skewed.”
Fortunately, the procedure called blepharoplasty, commonly known as eyelid surgery, is a safe, effective and cosmetically appealing option for patients with drooping eyelids to improve their appearance. Blepharoplasty is a surgical procedure that involves removing excess eyelid tissue. It can be done on both the upper and the lower eyelids and can have a dramatic impact on the appearance of the eyes and face.
“Blepharoplasty of the upper eyelid is a very satisfying procedure,” informs Dr. Mack. “It is performed in the Mack Center or a local surgical center. We give our patients medication to help them relax; we remove the excess tissue along the course of the upper lid and then stitch the incision closed.”
For some people, puffiness and loose skin can form under the eyes with age. Many factors – including sun damage and heredity – often accelerate these changes. Younger people may also have bulging lower eyelids due to congenital excess fatty tissue. Fortunately, there is help for those who would like a fresher, more youthful appearance: lower blepharoplasty.

True Reflections

Dr. Mack performed upper and lower blepharoplasty on Mary’s eyes, and she was very pleased with the procedures as well as the recovery following surgery. Mary is happy with how quickly her eyes healed.
“I didn’t have any pain,” Mary reports. “There was some swelling, but every day was a little bit better. Now, I can’t believe my before and after pictures. It is a huge difference, and it has only been three months.”
Mary is thrilled with her great results and with how she looks and feels. Her eyes better reflect her true emotions now.
“I’m very happy with my eyes,” she offers. “My kids don’t ask me if I’m angry when I walk in the room, and it doesn’t feel like I have a sandbag on my forehead.”
Mary is grateful to Dr. Mack and the staff in his office. While she had her procedure done at the surgery center, her follow-up appointments at the Mack Center always made her smile. Everyone went out of his or her way to make Mary’s experience as comfortable as possible, and she’s always willing to share her experience with others.
“I have recommended Dr. Mack already,” she comments. “My mom’s even thinking of flying down here so she can consult with him.”
After experiencing the procedure and seeing and feeling the results, Mary is delighted. There’s only one thing she would change: “I feel like I put it off too long, but I’m glad I finally did it. It was because I was directed to Dr. Mack. He is very professional and talented.”

An Uplifting Experience

Revolutionary, nonsurgical treatment melts double chin fat.

Working as the front desk receptionist at a busy facial cosmetic surgery practice gives Elise* a heads-up on breakthroughs in technology. Between her responsibilities of greeting patients, reviewing insurance, making appointments and assisting coworkers, she learns all she can about the exciting, new procedures and services offered by her employer, Dr. William Mack.Stock photo from

Recently, a groundbreaking procedure became available that hit Elise close to home. The procedure addressed an issue that had been nagging at her for years – her double chin. She tried diet and exercise to eliminate it, but to no avail.
“It bothered me because I could see it in pictures,” Elise shares. “I wouldn’t say that everybody else would notice it, but I think you notice little things about yourself that make you feel self-conscious. And with a double chin, it’s just so hard to get rid of it. Even if you lose weight, it still seems to be a problem area.”
Known clinically as submental fullness, double chin is a common condition that often goes untreated, according to Dr. Mack. It can make a person look older and can disrupt the balance of the face. It doesn’t discriminate either. Women and men of all ages can be affected by it and the fact exercise is seldom a cure.
Researchers have linked several factors to the development of a double chin, most notably aging and genetics. Whatever the cause, it leads to a great deal of stress in many people. According to a survey by the American Society for Dermatologic Surgery, nearly as many respondents were as bothered by double chin as by lines and wrinkles around the eyes.
The long-awaited solution to the problem that Elise and many others sought proved to be KYBELLA®, a highly anticipated treatment that in 2015 became the first FDA-approved, nonsurgical treatment for the reduction of excess fat under the chin.
“Prior to the release of KYBELLA, which is a type of drug called a cytolytic, the only treatment for submental fat, or neck fullness, was liposuction with a facelift or a chin lift,” notes Dr. Mack, a board-certified ophthalmologist who is fellowship trained in oculoplastic and facial cosmetic surgery.
“With KYBELLA, however, the drug is injected right into tissue, where it destroys the cell membranes. Therefore, when it is injected into the fat, the fat cells are destroyed. In this state, they can no longer store or accumulate fat, permanently eliminating the fat cells in the chin.”
A treatment with KYBELLA consists of a series of tiny injections of deoxycholic acid, a naturally occurring substance in the body. It helps the body break down and absorb fat and is now offered at the Mack Center.
“It’s a great addition to the Mack Center,” observes Dr. Mack. “I can add it to our complete treatment of cosmetic patients, from skin care to BOTOX® Cosmetic and fillers and facial cosmetic surgeries. For appropriate candidates, we’re achieving great results.”
With this new therapy available that addressed the nagging issue she’d long been battling, Elise’s interest was piqued. She opened up and made Dr. Mack and his clinical staff aware of just how interested she was.

Treatment Timetable

After an initial evaluation, Dr. Mack determined how many treatment sessions it would take to effectively resolve Elise’s condition. Most patients require two to four treatments spaced no less than a month apart, the surgeon notes. The sessions, however, are relatively short – approximately 15-20 minutes – they require no general anesthesia, side effects are minimal and there is little to no downtime.
“It’s a quick, easy procedure,” confirms Elise, who praises Dr. Mack for the careful approach he took when treating her.

“The fat is gone. I’ve seen photos of myself, and that little pouch of fat under my chin is no longer there.” – Elise

“I thought he was great,” she states. “First, he marks you with a chart underneath your chin. Then he maps out where the KYBELLA will go, telling you as he’s injecting each spot, We’re injecting here, here. And he asks periodically if you’re in any pain or discomfort.
“He checked on me while he was injecting the KYBELLA to make sure I was comfortable. He checked on me that evening to see about my swelling. He even checked up on me the following morning to make sure I wasn’t in any discomfort.”
Discomfort, Dr. Mack notes, is minimal, as is the post-procedure bruising and swelling, which are the most common side effects of KYBELLA treatment. They are side effects that resolve quickly, the doctor adds.
Elise agrees. She reports that her daily life was barely affected by having the procedure.
“I was back to work the next day and doing my activities with no downtime at all,” she says.

Obvious Difference

Many patients notice visible chin fat reduction in four to six weeks, but Elise saw a difference even sooner. Her double chin responded quickly to the treatment, and she couldn’t be happier. She is thrilled with what the first treatment achieved.
“I would say within a couple of weeks, I noticed changes,” Elise proclaims. “Then, probably at the one-month mark, between four to six weeks, I could really tell. There was a definition in my chin that hadn’t been there before. A tightening of the skin is also something that happens with KYBELLA.

Stock photo from

Before and After

“Since my treatment, I’ve noticed a great difference in the fat going away. I am very pleased with the results. I mean, the fat is gone. I’ve seen photos of myself, and that little pouch of fat under my chin is no longer there. I’m not self-conscious about it anymore.”
That new definition has given Elise greater confidence. Now, when she looks at herself, she sees a smoothly contoured chin, and she’s thrilled. Even the people who never saw the problem have picked up on the change in her.
“People have noticed that it’s no longer there.”
Elise has a message for others who are in a situation similar to hers or are feeling down because of the way they look. She thinks this treatment could help them, too.
“I would tell anybody who feels self-conscious about having a double chin that KYBELLA is something they would really appreciate having done. I can’t be more pleased with the results I’ve had.”

*Patients’ names withheld at their request.

Smile with Confidence

Family practice specializes in making healthy, attractive smiles.

Growing up, Billie “B.J.” Bowser never liked losing a tooth and waiting for a new one to grow in. The results were never what she expected or hoped for.

FHCN file photo.

B.J. has confidence in her smile.

“I can remember losing teeth, and the adult teeth would never appear,” B.J. recalls. “I always had gaps in my smile. It was awful growing up with that. I have my two adult front teeth, but the ones on the sides of those never grew in.
“I always had gaps there as a young child and pre-teen. I hated having my picture taken because of that, and it was really tough growing up with that. You really have no idea how your smile impacts your life.
“I’ve seen dental specialists since I was fifteen years old. I got my first bridge at that age. I’ve had three others since then, but none of them were ever a natural, perfect fit or gave me the look I wanted.”
Working in the health care field, B.J.’s job requires public speaking engagements. In recent years, however, she became embarrassed by how her teeth looked. In addition, B.J. and her husband recently adopted two children they were fostering and have become a family. For her speaking engagements and those family photos she’ll be taking, B.J. wanted to look her best.
“I want the confidence I have in my life right now to match a confident smile,” B.J. adds. “I mean, I always had a great smile when I was a child, but once I lost my baby teeth, my smile was never the same.
“I was always uncomfortable every time I opened my mouth. The teeth weren’t the right shape or color, and my bite was off. It never felt like me. But I could never find a dentist who would take the time and put forth the effort to do the work the right way.”
B.J.’s search for the right dentist who would put in the time and effort to give her the smile she always wanted finally ended one day when she read an article in Florida Health Care News about Katrine Farag, DMD, of Advanced Dentistry of Fort Myers.
“I had no idea where to turn to find a skilled dentist who could permanently fix my issue once and for all,” B.J. relays. “But then I read the article about Dr. Farag and I thought to myself, If she can help that person, I think she can help me, too.”

Better Appearance, Function

“When I met with B.J. initially and examined her mouth, the first thing that struck me was that her bite was off,” Dr. Farag shares. “The reason her bite was off was because the existing bridgework was not made properly. The shapes of the teeth were too rounded and did not match her face cosmetically. The size and color of the teeth were also not flattering for her.
“B.J. is just forty years old and has been living with this for years. She is much too young not to be happy and to be self-conscious about her smile. I wanted to restore the confidence she had lost. The bridge she had obviously needed to be replaced, not just for aesthetic reasons, but because it did not fit properly in her mouth.”
Dr. Farag recommended creating a new, six-unit bridge to attach to the adjoining teeth.

“I never make a decision for someone without them being part of the process. It’s their smile.” – Dr. Katrine Farag

“We took a full set of x-rays and made models of B.J.’s existing bridge to send to the lab for a mock-up of an improved look.”
Prior to the models being sent to the lab, Dr. Farag and B.J. chose the shape and color of the teeth for the new bridge.
“B.J. did not want her smile to look fake or unnatural, so we chose the shade and size carefully. I always involve my patients with their dental health,” continues Dr. Farag. “I never make a decision for someone without them being part of the process. It’s their smile.”

A Permanent Fix

The entire process, from start to finish, was completed in three visits.
“I had the temporary bridge in, before the permanent bridge was completed, and that temporary provided me the perfect outlook toward the final product!” B.J. exclaims. “I was so excited!”
Now that the final bridge has been placed, B.J. is ecstatic over the look and feel of her permanent bridge. She is grateful to Dr. Farag for her expertise and chairside manner.
“Dr. Farag was amazing from the moment I sat in the dental chair,” B.J. raves. “She listened to my concerns, and we worked together to come up with a solution. It’s a dental partnership because she involved me in the entire process.”
B.J. says she has a newfound confidence she has never experienced before.
“Once I had the permanent fixture placed, I could not believe how it looked,” she says. “It is amazing to me! I can go to a restaurant and order anything I want and not worry about my bite or about chewing or anything. I feel one hundred percent confident again, thanks to Dr. Farag!”

Add Years to Your Smile

Like B.J., Debi Grover knows how important it is to have a smile you’re confident with. As an investment REALTOR® and design consultant, she works face to face with people all through the day, so her smile is important to her.

Photo by Jordan Pysz.

Debi is no longer embarrassed to smile.

“With my job, I greet people every day, and a lot of times, the first thing we notice about a person is their teeth,” Debi says. “There came a time not long ago when that became a concern for me because I had suspected for a while that I had periodontal disease.
“I didn’t have any bleeding or anything like that when I brushed, but I had extreme plaque buildup, and I knew that over time, damage had been done to my gums. I wanted to be able to smile and not feel like I had to hide my teeth.
“The most important thing to me was saving my natural teeth. I got to a point where I knew I needed to find a dentist who could help me do that.”
Debi began the process by doing some homework, researching LANAP® laser-assisted gum treatment online. That’s where she came across Advanced Dentistry of Fort Myers.
“I read that they are very skilled and knowledgeable in treating gum disease with this laser, so I made an appointment in the hope that I would gain some additional knowledge about it.”
Debi met with Joseph H. Farag, DMD, at Advanced Dentistry of Fort Myers to discuss this option and decide if it was the right treatment for her.

LANAP Zaps Disease

Periodontal disease is an inflammatory process that can be a chronic or an acute problem. According to Dr. Farag, periodontal disease is an infection of the tissue that supports the teeth. The American Academy of Periodontology (AAP) estimates that more than 70 percent of Americans have some form of periodontal disease, some through no fault of their own.
“Debi had moderate to advanced stages of periodontal disease,” describes Dr. Farag. “We offered her the option of conventional surgery to repair the gums or the LANAP laser-assisted treatment option. Because Debi had already researched LANAP, she knew right away she wanted that procedure done.”
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 healthy tissue as well as diseased tissue.
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.
Healthy gums adhere closely to the teeth, supporting them so they don’t become loose in the jawbone. When people develop gingivitis, a mild form of periodontal disease, it causes irritation, redness and swelling. As periodontal disease progresses, the bone is lost around the tooth and the pockets around the teeth get deeper. If left untreated, gingivitis may lead to a second, more serious stage called periodontitis.
Research studies show that laser-assisted dental gum therapy is superior to conventional surgery in a number of ways. The most notable to the patient is that they don’t lose their gumline. “We do not want the gums to recede, which can make the teeth appear longer,” says Dr. Farag. “The goal is healthy gums that reattach naturally to the teeth.
“During the first laser pass,” continues Dr. Farag, “three goals are accomplished. First, the energy vaporizes the diseased lining, leaving the healthy tissue intact. Second, it dehydrates the tartar on the tooth, making it very brittle and easy to remove from the tooth. Third, it kills the bacteria on the gum that is exposed to the laser.
“During the second step, an ultrasonic instrument is used. Its fine tip vibrates and removes the tartar, breaking it away from the tooth. We then flush with an antimicrobial substance that stops the growth of new bacteria. In this step, we affect the bone around the tooth and remove the diseased lining of the tissue.
“The third step involves another pass with the laser at a different setting. This last pass stops any bleeding and creates the best antimicrobial seal possible, preventing re-infection and releasing growth factors from the blood cells to regenerate the attachment.”
Debi’s procedure was completed in one day.
“That is the other advantage of this procedure, as opposed to the conventional surgery,” Dr. Farag educates. “Debi’s gums were treated in about three hours, as opposed to multiple visits with the conventional surgery. This is faster and there’s less discomfort afterward.”

Feeling Confident Again

Dr. Farag emphasizes the importance of follow-up dental care after having periodontal disease treated.
“When we sit down and discuss treatment options for gum disease, I want to be assured by that patient that they are committed to taking care of their teeth afterward,” he describes. “The laser treatment is the first step in getting the teeth healthy. The patient needs to be committed to keeping the teeth healthy long-term in order for it 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.
“In order to keep the gums healthy, people need to keep the teeth clean. That requires daily commitment,” Dr. Farag reiterates.
Debi says she has a renewed desire to maintain a healthy mouth now that the procedure is complete. She looks forward to continuing her care with the team at Advanced Dentistry of Fort Meyers.
“Dr. Farag and the entire staff are personable and knowledgeable, and they make me feel confident.”

Alternative to Surgery

New procedure eliminates pain from spinal stenosis.

At 75, Michael* wasn’t ready to feel old. Yet, maddening back pain made it difficult for him to feel youthful and stay active. The pain from his back traveled all the way down his right leg, which affected his walking and put a stop to his morning exercise routine. Even standing was painful, and Michael found himself instead sitting in his chair doing nothing. When he tried to cook, he had to lean over his kitchen sink, which provided some relief from the agony in his back and leg.Stock photo from
“I really enjoy cooking for my family,” Michael shares. “It’s something I have always tried to do several days a week, but the pain I would get in my back when I stood too long at the stove forced me to stop cooking as much as I used to.”
Michael’s primary care physician suggested a few options to help ease his pain. But when a trial of conservative treatments, including heat and ice, physical therapy and pain medications, failed to deliver lasting results, Michael’s doctor recommended he visit Harold J. Cordner, MD. Dr. Cordner is board certified in pain management and anesthesiology, and practices at Florida Pain Management Associates in Sebastian and Vero Beach.
At Florida Pain Management Associates, all patients who come in with severe back and leg pain are given a careful evaluation that includes a thorough history and physical examination, as well as imaging studies such as x-rays and an MRI. After his evaluation, Dr. Cordner was able to confirm his initial suspicion; Michael was suffering from spinal stenosis.
The spine is made up of 24 small bones called vertebrae. The vertebrae are stacked one on top of the other with an open canal in the middle through which the spinal cord runs. On the back of the vertebrae are projections of bone called spinous processes. Between these sections of bone are openings called neural foramen, where the spinal nerves exit the spinal cord and travel to the rest of the body.
Spinal stenosis is the narrowing of the spinal canal and the neural foramen. Because these spaces become narrower, the nerves become crowded or pinched, causing symptoms.
“Generally, the symptoms are back pain with leg weakness or a feeling of heaviness or pain into the legs,” describes Dr. Cordner. “Sometimes, the patient just has back pain; other times, the pain radiates into the legs. The pain is typically worse with prolonged walking or standing, and is relieved as soon as the patient sits down or leans forward.”
Spinal stenosis is most often caused by the wear and tear of arthritis that occurs with aging. To make up for the degenerative changes caused by arthritis, the body sometimes grows new bone to help support the vertebrae. These new bone pieces are called bone spurs. They can narrow the openings for the spinal cord and nerves. Arthritis can also cause the ligaments in the spine to become larger, which can irritate the nerves and cause symptoms.

A New Option

Traditionally, treatment for spinal stenosis begins with nonsurgical steps, such as physical therapy, anti-inflammatory medications, chiropractic manipulation and steroid injections. When all nonsurgical efforts have failed, surgery is generally the next step.
“The treatment for spinal stenosis was often epidural steroid injections,” confirms Dr. Cordner. “If those did not help, patients would undergo a decompressive laminectomy. However, there are patients who are elderly or have other diseases or complicated medical illnesses who cannot get cleared for or are too sick to have surgery.”
During a laminectomy, the surgeon removes some of the bone, and any bone spurs and/or pieces of ligament that are compressing the nerves. Doing this opens up the space for the nerves and relieves pain. However, it requires one large or multiple smaller incisions and a lengthy recovery, and may fail.
Now, Dr. Cordner offers an alternative to laminectomy. It’s a new, minimally invasive procedure to treat patients with spinal stenosis who have back and leg pain that is relieved by bending forward or sitting.
“The procedure uses an implanted device that decompresses the spine,” states Dr. Cordner. “The device goes in and opens up, enlarging the space where the spinal nerves exit as well as the central canal.”

Product photos courtesy of Florida Pain Management Associates.

Superion InterSpinous Spacer

Product photos courtesy of Florida Pain Management Associates.

The Superion InterSpinous Spacer is placed where the vertebrae have collapsed. There it opens up and pushes the bones apart.

The device is the VertiFlex® Superion® InterSpinous Spacer System. The Superion spacer is an H-shaped implant made of a titanium alloy that fits between two adjacent bones in the lower back. It is designed to limit movement of the spine when the patient stands and walks, and to open up the nerve spaces, relieving symptoms. VertiFlex describes the Superion as a “Safe and effective alternative when conservative treatment has failed and laminectomy is too aggressive.”
“During the implant procedure, I make a small incision in the back and clear out some tissue between the spinous processes,” explains Dr. Cordner. “Then, I insert the device through a small tube about the size of a dime. As I engage it and screw it open, two arms emerge that push the spinous process bones apart, and that creates more room inside the spinal canal and the neuroforamen.
“The ideal candidate for this procedure is a patient who has spinal stenosis that is worse with standing or walking, and relieved with bending over a little bit. These are patients who are walking in the stores leaning over their shopping carts, which helps ease the pain.”
Such was the case with Michael, as he mentions he found relief when he would bend over, but not when he was standing up straight.
Implanting the Superion device is a simple, outpatient procedure with less tissue damage and blood loss than surgery, and a rapid recovery time.
There was a similar device in the past called the X-StopPK®. However, there were drawbacks to it. In some cases, it moved out of its implanted position. With the Superion, there have been no reports of the devices moving out of position in the thousands of cases that have been performed to date.

Product photos courtesy of Florida Pain Management Associates.

The Superion InterSpinous Spacer is placed where the vertebrae have collapsed. There it opens up and pushes the bones apart.

There are four years of data to support the effectiveness of the Superion InterSpinous Spacer. According to studies, 48 months after having the procedure done, patients’ leg pain was reduced 79 percent, and patient satisfaction was 87 percent.
“Thus far, there have not been any patients whose condition deteriorated after the procedure, which certainly can happen with back surgery,” stresses Dr. Cordner.
“The Superion is the only FDA-approved, standalone device for the treatment of moderate lumbar spinal stenosis. Medicare has approved it as well, and I am the only physician in Indian River County certified to do this procedure.”

Nonsurgical Relief

For Michael, Dr. Cordner was the answer to a prayer, and the Superion spacer was a godsend. He became one of those patients in the “satisfied” category.
After having the device implanted, Michael’s pain is gone. He is now able to get out of his chair and take his morning exercise walks. He can cook without leaning over his sink, and he no longer feels the aching all the way down his leg.
“It’s been a miracle for me, it truly has,” Michael raves. “I am so thankful that I found Dr. Cordner. I feel better than ever, and I no longer have to live with pain!”
Michael is back to being active and feeling more youthful. And that’s affected his attitude about his age as well.
He remarks, “Seventy-five isn’t old at all!”

* Patient name witheld at their request.

Plantar Warts

Don’t let them go untreated.

Verruca plantaris, or plantar warts, can be painful and embarrassing.
The most common breeding grounds for plantar warts are communal showers, floors in public swimming pools, even your shower at home. Breakouts can also occur among people who share gym or athletic facilities or in settings where bare feet are the rule. Stock photo from
“Warts can occur on any compromised skin surface, but they are most common on the bottoms of the feet and on the hands,” explains board-certified podiatric surgeon Robert P. Dunne, DPM, who has offices in Melbourne and Palm Bay. “They tend to invade the skin through small abrasions or cuts, some that you may not even realize you have.
“The plantar wart can be quite painful since you are putting pressure on the area by simply standing. Paring them down can often relieve some of the pressure, but a more aggressive treatment may be required.”
Dr. Dunne treats a wide variety of podiatric complaints such as fungal nails, tinea pedis (athlete’s foot), dermatitis; heel, foot and ankle pain; tendonitis, plantar fasciitis, hammer toes, bunions and other bone issues.
“There are several treatment options for a plantar wart, but not all are invasive,” the doctor reveals. “Treatments can be oral, such as Tagamet®, or topical, such as salicylic acid or retinoid cream. There is also a slightly invasive procedure called cryotherapy, which causes the wart to scab and fall off, or an invasive procedure, where there is an excision of the wart. Both of these procedures are done in the office in just a few minutes.”

Risk Factors for Plantar Warts

There are many risk factors for plantar warts, especially in our Florida environment.
“Age can be a factor in the development of a wart,” explains Dr. Dunne. “Children are more susceptible because they have not built up an immunity to the virus.”
Dr. Dunne accentuates that “there are several over-the-counter and home remedies that people can use to treat plantar warts, but we strongly caution those who are susceptible to infection or persons with diabetes not to try these without consulting their doctor.”
People with weakened immune systems are particularly susceptible to the virus, he notes. People should keep in mind that warts are contagious and, if affected, one should take precautions so as not to spread the virus.
Preventative measures include: not touching other people’s warts; not sharing towels, shoes or socks; wearing flip-flops in the shower (if affected, this should be at home or in a community shower setting), covering the wart to prevent exposure and not scratching or picking at the wart, which can easily cause them to spread.
Lake Washington Foot & Ankle is a comprehensive podiatric medicine clinic offering treatment for everything from bunions to hammertoes. “We treat ingrown toenails, warts and neuromas,” assures Dr. Dunne. “We also do clinical trials for onychomycosis [fungal toenails] in an effort to find better and more effective treatment for this ailment.
“Our patients come first, and we recommend they take action now if they have a problem.”

Article courtesy of Lake Washington Foot & Ankle Center.

Hi-Tech Smiles

Leading-edge technology allows for comprehensive dental care.

Matilda Cox spent nearly 50 years serving a variety of physicians as a medical secretary. During that time, she regularly took advantage of the opportunity she was given to observe countless surgical procedures and operations.
Matilda, 73, recently had those tables turned on her. This time, instead of being one of those observing a medical procedure, she became the star in an instructional video produced for post graduate dental studies.
And it was all because of a strawberry seed.

Matilda’s photo by Nerissa Johnson.

Matilda starred in her own dental restoration.

“It was sometime last spring that I was eating strawberries, and one of the little seeds got stuck in the gap between my gum and one of my teeth on the right side down there on the bottom,” Matilda recalls.
“I thought I’d brushed or flossed it out, but after a couple of days, the area around that tooth began to swell, and the swelling just wouldn’t go away. No matter how much I brushed or flossed, that area remained swollen and very tender to the touch.”
Matilda wrestled with the problem for several months, partly because the pain and swelling occasionally disappeared for brief periods. Finally, after the pain returned with a vengeance last summer, she decided to seek professional help.
As she has since 2011, when his sterling reputation and the location of his office near her place of work in Melbourne made him a convenient choice for a routine checkup, Matilda sought the aid of Richard Leong, Jr., DDS.
Dr. Leong is a general and implant dentist who practices comprehensive, full-treatment dentistry, including full mouth reconstruction. He is also a teacher who often videotapes his work so it can be used as a guide for students at The Atlantic Dental Research Clinic in West Palm Beach. He teaches a three-year curriculum for post graduate students.

Seeds of Infection

It was in that dual role as both dentist and teacher that Dr. Leong took on the challenge presented to him by Matilda, who had already seen Dr. Leong for help with that tooth five years earlier after a portion of the tooth had broken off at the gumline.
Presented with a series of options that included removing the tooth and having a bridge made or removing the tooth and replacing it with an implant, Matilda opted at the time to try to save the tooth by having it restored from the spot where it had broken off.
The job was an extensive one that required the use of a laser to do a crown-lengthening procedure where Dr. Leong had to remove some of the bone around the edges of the tooth to create the structure needed to place a crown over it.
The procedure was a success; however, the tooth began to break down yet again five years later. Both breakdowns came as a result of a root canal done years earlier by another dentist who didn’t go as deep into the root as necessary.
The result of the second breakdown was an infection that again weakened the tooth, this time to the point where Dr. Leong was left with no other choice but to remove the tooth and replace it either with a bridge or an implant.
Building a bridge was the safest option, but in order to create a secure setting for the bridge, Dr. Leong needed to replace the crown on the tooth behind the infected tooth and build a crown for the tooth in front of the infected tooth.
Matilda opted for the implant, which had some challenges of its own. The most difficult was installing the implant, which needed to be placed at just the right angle to avoid hitting a major nerve resting underneath the infected tooth.
The procedure was one that required Dr. Leong to make use of several of his most technologically advanced instruments, including a CT scan to determine the proper placement of the implant, as well as a special blood treatment for the bone grafting.
“Anybody that does a lot of implants has to have a CT scan because you have to know the volume and density of the bone as well as the width and height of it,” Dr. Leong educates. “If there are any insufficiencies, you need to graft in more bone, or the implant won’t last as long as it should, or it may be a failure.
“As for the blood technique, that’s a new procedure in which we draw blood from the arm and centrifuge that blood down to make a blood product called platelet-rich fibrin, which is a product high in growth factors. We then mix that with the bone grafting material so the bone heals faster and stronger.
“It’s because of all the equipment that I’m able to know exactly what I need to do to place the implants properly. Because of the CT scan, for example, we know we can place the implant in the bone at exactly the right angle to avoid certain areas where we could have problems. The best is that it all turned out very well for her. She’s utilizing the tooth now and she’s very happy, which makes me happy.”

Ecstatic Patient

Matilda is more than happy with the results. She’s ecstatic that the underlying problems that twice caused the tooth to break down have finally been resolved and that she has a dentist whose techniques are always on the leading-edge of technology.
“He’s really on top of things as far as all the different techniques,” Matilda expounds. “I think he’s a pioneer. He’s ahead of the field with all that he does, and he’s really thorough. I just think he’s wonderful.
“I like that he’s a teacher and is passing his knowledge along to the next generation of dentists. Being in the medical field myself, I know that’s important, and I have to admit, it was kind of neat to be in the training video.
“I’ve been working for doctors since I was twenty-two years old, so I’ve always been interested in things like that. And when you consider the work that had to be done in my situation, well, it made a lot of sense to use me as an example for the students.”


Barbara Farley says faith brought her and Dr. Leong together many years ago. She and her husband, Mike, first met Dr. Leong through the church they all attend, and they got to know each other better while part of a mission trip to Israel.

Barbara’s photo by Jordan Pysz.

Barbara is able to participate in Sunday
readings at her church once again.

“Mike was actually the first one of us to go to see Dr. Leong,” Barbara explains. “That was several years ago, and he was very pleased with the work that was done, so he encouraged me to give Dr. Leong a try as well.
“I was going to a periodontist before that because my husband and I have both had periodontal disease, but he was only a periodontist. We both wanted a dentist who could do a little more for us if need be.
“That’s one of the great things about Dr. Leong. He does everything. You don’t have to go from one doctor to another if you have a problem. And because I already knew him through the church and knew what a wonderful human being he was, the choice was easy.”
That choice quickly proved to be the right one. During one of her first visits to
Dr. Leong, Barbara was undergoing a deep tissue cleaning in an effort to keep her periodontal disease in check when Dr. Leong noticed a hole in her bridge.

Quick Fix

Dr. Leong managed to fix that problem quickly and easily. He was also quick to repair a problem that arose for Barbara a few years later, on the day before she was about to leave for a vacation.
“On that occasion, he was able to go in and extract my tooth, place two implants and do a root canal, all in one day,” Barbara says. “Dr. Leong is right there to take care of any problem you have with your mouth.”
Barbara’s most recent dental issue proved to be a little more problematic, in part because of neglect. After a tooth broke off on the lower left side of Barbara’s mouth, she allowed it to go untreated for a while. As a result, the surrounding bone disintegrated.
“The tooth had broken off and was lost, but she still wanted that tooth replaced,” Dr. Leong relates. “That’s a difficult process because when there’s no bone, there’s nothing to support either an implant or a partial denture.
“We considered all her options and because the partial denture option was not amendable to her, we decided that in this case the best option was a specific type of implant that requires less bone but also requires quite a bit of surgery.”
Dr. Leong started his work by first removing the broken tooth. He then utilized the platelet-rich fibrin technique he used with Matilda to graft new bone into that space in an effort to create a structure that could hold the implant.
As was the case with Matilda, the process of placing the implant was a risky one that required great skill because the area Dr. Leong was working on was very close to a major nerve. As with Matilda, he achieved his objective.
“We managed to do what was necessary by placing into that space a blade implant,” Dr. Leong confirms. “A blade implant is an implant that works well where there is a small amount of bone present. That implant was later crowned.
“After that work was completed, I provided further support along the right-hand side of the bottom jaw by placing a bridge and crowns there. Now, she can chew normally on both sides of her mouth, and her teeth no longer wiggle.
“Barbara has had quite a bit of work done over the years, and it has all been very successful for her.”
Because of the impact he is able to have on his patients’ health and comfort,
Dr. Leong says that comprehensive care is a cornerstone philosophy of his practice.

Everything Under One Roof

“We provide a comprehensive service so that, when patients come into the office, I am able to help them in all areas,” he explains. “As a result, they don’t have to travel to many different places to have their dentistry completed. The protocols keep improving, so techniques become faster and better.”
Dr. Leong utilizes many of today’s leading-edge advancements in implantology in his own practice, as well as personally developing new techniques. Before and after images courtesy of Dr. Leong.
“My office is equipped with all of the latest technology. We are very high-tech, and I want others to know that I do a lot more than just cleanings or fillings. I specialize in comprehensive dentistry in order to meet the growing and changing needs of my patients. Their needs always come first.”
For Barbara, the combination of excellent care and technical skill has proven to be exactly what she was looking for in a dentist.

Twenty Years of Trust

“I would say my husband and I have been going to Dr. Leong for over two decades now,” Barbara says. “Everyone in that office is so personable and caring. Most people dread going to the dentist, but I never feel that way.
“Dr. Leong stays on top of every new skill, and he’s just a very giving person in everything he does,” she adds. “He’s a very caring person who loves helping people with their teeth.”

Oral Cancer Concerns

April 10th, 2018

Let’s discuss something we don’t usually think about and don’t often hear about: oral cancer, or more specifically oral cavity and oropharyngeal cancer. Often grouped together, these cancers are not among the most hyped, but they’re disfiguring – and deadly – just the same.Stock photo from

Where are we talking about? The oral cavity, essentially the mouth, includes the lips, inside lining of the lips and cheeks, teeth, gums, front two-thirds of the tongue, floor of the mouth under the tongue, and bony roof of the mouth, or hard palate.

The oropharynx is the top part of the throat that starts in the back of the mouth. It begins where the oral cavity ends. The oropharynx generally includes the area behind the wisdom teeth, the last third of the tongue, the back part of the roof of the mouth (soft palate), the tonsils, and the side and back wall of the throat.

Anatomy of the pharynx (throat). The three parts of the pharynx are the nasopharynx, oropharynx, and hypopharynx.

There’s a lot we don’t know about what causes cancer, but we know it often occurs when mutations in certain genes cause certain cells to grow out of control, causing tumors to form. What researchers are trying to pin down in most cases is what causes the mutations in the first place. That’s a really simplistic explanation.

Here, I’m going to tell you about risk factors and symptoms, so maybe you can catch an oral cancer in its early stages. Then, I’ll give you a few strategies for prevention, but if you want the full scoop on oral cavity and oropharyngeal cancer, read this information from the American Cancer Society.

One of the things you’ll read is that the American Cancer Society estimates 51,540 American will get oral cavity or oropharyngeal cancer in 2018, and an estimated 10,030 of them will die from it. Fortunately, the death rate has actually been declining over the last ten years. These cancers are much more common in men than women.

Let’s start with risk factors. What traits and behaviors put you at greater risk for becoming one of those estimated 51,500 people to get one of these cancers. The top two risk factors are using tobacco and drinking alcohol. The tobacco risk increases the more you use it and the longer you’ve done so.

Also, about seven out of ten people with oral cancer are heavy drinkers. The risk is increased even more in people who use tobacco and drink heavily. Some studies suggest the combination leaves people as much as 100 times more at risk than people who don’t smoke or drink.

There are some genetic syndromes that can lead to oral cancer, and a weakened immune system can make a person more susceptible. Risk also increases with age and is affected by an unhealthy diet. Researchers are now finding that infection with the HPV virus is a rising risk factor for some forms of oral cavity and oropharyngeal cancer.

These cancers generally appear as a growth or sore in your mouth that doesn’t go away. It can be on anywhere in your mouth, including your lips, tongue and cheeks Here are a few other symptoms to watch out for:

  • White, red or speckled patches in your mouth
  • Unexplained bleeding
  • Loss of feeling
  • Pain or tenderness
  • Difficulty chewing or swallowing
  • Hoarseness or persistent sore throat
  • Lump in the neck

There are other signs and symptoms as well.

Oral cavity and oropharyngeal cancer are generally treated with chemotherapy, radiation, or surgery, or a combination of these treatments. The choice of treatment depends on the patient’s age and how advanced the cancer is, it’s stage. Treatment can leave you disfigured or with problems speaking or eating. Additional treatment may be necessary.

Today, patients also have the benefit of biological and targeted therapies. These therapies kill cancer cells without damaging the surrounding healthy tissues.

Some of the risk factors can’t be controlled, but these are things you can do to reduce your risk or find oral cancer early. These include:

  •  Limit your tobacco use
  • Drink alcohol in moderation
  • Eat a healthy diet with lots of vegetables
  • Protect yourself against HPV infection
  • Examine your mouth at least once a mouth and look for lumps or spots
  • See your dentist regularly. The dentist can often spot suspicious areas in your mouth before you do.

You don’t want to be one of the 51,500 who will get oral cavity or oropharyngeal cancer this year, and you especially don’t want to be one of the 10,000 who don’t make it. Now that you know about these cancers, be aware of your risk factors and on the lookout for symptoms.

OsteoStrong® – Osteoporosis Solution

The drug-free program is an effective way to rebuild lost bone.

Susan Koontz was fit, healthy and in her late 50s when she received distressing results several years ago from what she thought would be a routine bone density screening.

Photo by Jordan Pysz.

OsteoStrong has helped Susan ward off osteoporosis.

She had osteopenia, a symptomless condition that put her at risk for developing osteoporosis, which causes bones to become more fragile and prone to fractures.
Dealing with brittle bones would be life-altering for anyone, but Susan is an avid water-skier, wakesurfer and wakeboarder. She also competes in canine agility competitions with a Border Collie that she says is “way faster than me, so I’m basically doing a forty-five-minute sprint around the course, twisting and turning. People fall all the time.”
After being told that working with weights would strengthen her bones, Susan hired a personal trainer and began intensive workouts twice a week. They didn’t help.
“Two years later, I go back for another scan, and the doctor calls me and says, You’ve got osteoporosis, and you need to get on medicine now,” she recalls. “I saw myself becoming a little old lady doing nothing in my house, and that’s not the life I want.”
While Susan usually shuns prescription drugs because of the potential side effects, her doctor insisted she start taking a generic version of Fosamax® to slow her bone loss while increasing her bone mass.
“About three hours after the first dose, I felt like I had the flu,” Susan reports. “I didn’t have any immediate side effects from the second one, so my doctor figured I was good.”
Later, however, she developed severe acid reflux, which she’s still fighting to control, and her doctors advised her to stop the medication. Instead, they wanted to inject Susan with the antibody Prolia®, which her mother was receiving for her osteoporosis.
“But she’s ninety,” Susan notes. “I’m sixty.”
Susan’s research led her to reject Prolia because it can cause anemia, digestive tract and skin issues and weakness and pain in the back, muscles, arms or legs.
Then she became intrigued after reading about OsteoStrong, a unique place where people can improve their overall health by focusing on the one thing everyone has in common: their muscular-skeletal system. OsteoStrong is not weight training, a diet, supplement, pharmaceutical remedy or medical therapy.
“Honestly, I was skeptical,” Susan admits. “I decided to give it a year and see where I end up.”

Resistance-Based Activities

Susan’s once-a-week sessions involve resistance-based pushing and pulling with her arms and/or legs on four bio-mechanical machines, during which she safely exerts pressure four to 12 times her body weight.
“It’s long been a medical fact that when you put certain forces on the bones, the body responds by growing new bone tissue,” explains Mark Brady, president of OsteoStrong in South Pasadena.
“For a person who weighs one hundred pounds to develop new bone, they would have to create a resistance of well over four hundred pounds,” Mark continues. “That simply can’t be done for ninety-nine percent of all people in a gym environment because it involves weights that they couldn’t physically move or, if they could, they’d be at high risk of injury.

Photo by Jordan Pysz.

Thanks to OsteoStrong, Susan can train her dog, Dallas.

“It takes only about ten minutes to complete an OsteoStrong session, but in that time, the response is nothing short of amazing. On average, our studies have found that OsteoStrong improves people’s bone density from three to seven percent a year. Also, people will increase their strength by an average of seventy-three percent over their first year at OsteoStrong.”
Susan was excited to achieve improvement in her bone density after a year of OsteoStrong, and that was after missing at least ten sessions because she travels frequently.
“This year, I’m going to try to make all my sessions and see how far I can go,” vows Susan, who “wouldn’t hesitate” to recommend OsteoStrong. “It works for me. I’m hoping I’ve got a lot of life in this body yet, so I need my frame to support my activities.”

Preventing Osteoporosis

Like Susan, Lynn Hummel found out she had osteopenia after a routine bone density screening and rejected her doctor’s recommendation that she take Fosamax.

Lynn’s photo courtesy of Lynn Hummel.

Lynn is amazed at the increase in her bone density.

Lynn, who was diagnosed at 51 and has a family history of osteoporosis, instead turned to OsteoStrong, incorporating her sessions into her Friday lunch hour.
Six months later, Lynn’s screening showed dramatic results.
“My bone density had gone up ten percent!” she exclaims. “My doctor couldn’t believe the difference.”
Lynn also noticed other positive effects from OsteoStrong. For instance, aches and pains that unfortunately had been part of her life seemed to disappear.
“After a little while, I realized, Oh man, I don’t hurt like I used to. My knees stopped hurting like they usually did,” marvels Lynn, who works as a bookkeeper. “My balance also improved – I’ve not always had a good center of balance, and I could really tell the difference – and my strength went up dramatically.”
Such success stories are par for the course at OsteoStrong, Mark confirms.
“People who come here seeking help for what is typically low bone density have the wonderful results of not just correcting that, but also getting significant improvements in balance, strength and pain-free joints,” he expounds. “One improvement doesn’t come without the others. It’s all a result of what we do here.”
OsteoStrong sessions build myofibril muscle, Mark informs. Myofibrils are cylindrical structures that extend along the complete length of each muscle cell or fiber. Myofibrils are composed of thick and thin myofilaments, which are responsible for muscle contraction.
“Women aren’t going to grow bulky muscles,” Mark stresses. “They’re going to have stronger muscles.”

Joint and Back Pain Reversed

Mark further notes that while some 85 percent of all OsteoStrong clients – men and women alike – have osteopenia or osteoporosis, the sessions also benefit people with bones damaged by cancer, other illnesses and treatments such as chemotherapy. What’s more, OsteoStrong is ideal for those suffering from any back-related pain.
“At the end of the day, it doesn’t matter how you got here; it’s what you can do to stop it that matters,” Mark asserts. “People who have pain with their joints or backs will see a substantial reduction or elimination of the issue from what we do here. I’m a prime example. I had severe sciatica for twenty years, and since I started to use our bio-mechanical machines, I haven’t had any symptoms at all in the past year.”

“It works for me. I’m hoping I’ve got a lot of life in this body yet, so I need my frame to support my activities.” – Susan

Building muscle through OsteoStrong provides a stronger framework to better support the lower back and the rest of the skeletal system, Mark states.
Lynn, meanwhile, is not only thankful to be feeling better, she’s also thrilled that she got there without relying on medication.
“The difference OsteoStrong sessions made for me was amazing,” she raves. “I’ve stayed away from developing osteoporosis, and I’d really like to keep it that way.”

Burst Out of Back Pain

New spinal cord stimulator helps to find comfort zone.

Through all the years she worked in retail, Linda Nelson’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.

Photo by Jordan Pysz.

Thanks to the stimulator, Linda can vacuum the floor without pain.

“A truck driver was bringing in a pallet of merchandise, and as I was coming from the office, I heard, Watch out!” Linda recounts. “But it was too late, and the pallet fell on top of me. The pain in my back was instant, and it also 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 Linda’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, Linda had a fourth surgery on her back, but still she continued to suffer from 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 it 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.”
Linda visited her doctor repeatedly throughout all this, and they tried various therapies aimed at relieving her back pain, 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). ABIPP 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, however, 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.”

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

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 Linda. 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 down to her ankles, Linda 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.”
Linda’s timing was just right. Approved by the Food and Drug Administration in October 2016, the burst stimulation deviceGraphic courtesy of Abbott. 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, Linda 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 father without intense pain in her back shooting down her legs. Linda’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!”

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