Author Archive

The Dual Fix

Stretching protocol alleviates back and neck pain with one procedure.

San Francisco native and longtime Rhode Island resident Anne Bilsky had been working in the dental field for 35 years when she left to assist her husband with his commercial real estate business. Ten years ago, the couple sold their Rhode Island home and retired to Florida. Anne’s many years of work in dentistry, however, left a painful legacy.

Dr. Jeffrey P. Johnson of Johnson Medical Center in Venice treated Anne Bilsky and Steve Burns for lower back and neck pain using Sedative Stretching.

“After the initial stretching and three weeks of therapy,I can bend and touch my toes. I could barely touch my knees before.” -Steve

“Having been a certified dental assistant for all those years, my back and neck were always an issue because of the way I had to sit, move and be on my feet all day,” she shares. “As I got older, the problem became more chronic.

“I went to many chiropractors and physical therapists over the years and was grateful for what they did for me. Unfortunately, the relief they offered never lasted. I’d get a
chiropractic adjustment, and it would hold for a few days, maybe a week, then the pain came right back.”

When Anne’s chronic neck and back pain returned again earlier this year, she had what she describes as a particularly disturbing and agonizing episode.

“I had sciatica on my left side, and tremendous pain radiated across the upper left side of my back, down my left leg all the way to my knee,” she recalls. “It was a sharp, aching, burning pain that could be debilitating.

“I tried to walk, swim and play pickleball to keep moving, but at times, I couldn’t do much because of the pain I was in. If it subsided enough, I tried to walk my Australian Shepherd, Laddie, but I couldn’t walk with a purpose.”

Understandably, Anne became discouraged after physical therapy and traditional chiropractic treatments failed to bring her lasting relief from her back and neck pain. Then, several friends told her about a doctor who used a different type of treatment that worked wonders for them.

The doctor they recommended was Jeffrey P. Johnson, DC, of Johnson Medical Center in Venice. At his practice, Dr. Johnson offers a unique treatment protocol called Sedative Stretching, which is an expanded and comprehensive form of Manipulation Under Anesthesia, or MUA.

“Anne came to us with a long history of lower back pain that radiated into her left thigh and leg,” reports Dr. Johnson. “At times, her condition became disabling. She also suffered from chronic neck pain and stiffness, which radiated into both shoulders. Her neck condition had a very slow, insidious onset over many years.

“After evaluating her condition and reviewing her imaging studies, I determined she was a good candidate for Sedative Stretching and recommended it to her.”

“When I first met with Dr. Johnson, we spent a lot of time just talking about my health history, and he welcomed all the questions I asked,” Anne remembers. “After that, his assistant took me for x-rays, and ten days later, I went back for my consultation.

“At the consultation, he explained that I had a deteriorated disc in my lower back that was sitting right on my sciatic nerve, causing my back pain. Everything made perfect sense to me. Dr. Johnson then wrote up a healing plan for me, and we discussed the treatment. I agreed to do Sedative Stretching.”

A Different Path

Steve Burns has long been a snowbird, retreating to Florida to flee the cold, snow and dark skies of the winter months in his native Massachusetts. Hitting the links year-round was also a draw to the Sunshine State for the avid golfer. Earlier this year, however, even that wasn’t fun when ongoing back and neck pain flared with a vengeance.

Dr. Jeffrey P. Johnson of Johnson Medical Center in Venice treated Anne Bilsky and Steve Burns for lower back and neck pain using Sedative Stretching.

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

“I’ve had back issues for about thirty-five years,” discloses the online publisher. “It comes and goes, and the severity of the pain depends on what I do. My neck pain also comes and goes, but, generally, not as often as the back pain.

“The thing that really got me this time was my neck. It was really bad. I had a burning pain from the base of my skull down into my shoulder blades. It was intense. On a scale from one to ten, the pain was a twelve.”

Steve tried ridding himself of the neck pain through common pain-relieving treatments such as ice and heating pads, but the relief they brought was short-lived. As soon as he removed the ice or heat, the pain returned to its excruciating level.

“I had limited mobility in my neck as well,” he reports. “But it didn’t keep me from golfing. I’d have to be on a stretcher to stop playing golf. But it did affect my game. I could barely move my head from side to side. When I was driving, I had to shift my whole body to see what was on the side of me.”

One of Steve’s golfing buddies is Robert Wolf, who was featured in an article about Dr. Johnson and Sedative Stretching in the Spring 2018 edition of Florida Health Care News. While playing a round one day, Robert recommended the doctor and the procedure. Steve had been to many chiropractors for his back and neck pain, but none had given him lasting results, so he agreed to give Dr. Johnson’s unique technique a try.

“Steve came to our office with severe, acute neck pain that he described as deep and burning,” recalls Dr. Johnson. “Additionally, he was experiencing chronic lower back pain, which he’d been suffering with for the better part of his life. His lower back pain significantly intensified after standing or walking for more than a couple of minutes.

“Over the years, Steve had learned to deal with his neck and back pain and remained relatively active. This bout with neck pain was uncharacteristically severe, however, so I recommended Sedative Stretching to address both his neck and back pain.”

“Dr. Johnson was very thorough in his examination and very forthcoming,” says Steve. “He told me everything about Sedative Stretching and how and why it works. He had a very positive outlook and told me, I can fix your problems, especially your neck. No one else had ever said they could fix me.

“I thought he would fix my neck, then I’d return and have him fix my back, but he said, No. I’m going to do it all at one time. He explained that the Sedative Stretching procedure works on the entire spine, treating both the back and neck in one procedure.

“Most doctors want you to keep coming back and paying them. But Dr. Johnson said, Once you’re done, I don’t want to see you again unless maybe it’s in Publix® or out to dinner somewhere. That was refreshing to hear.”

A Host of Beneficiaries

Many people with various painful muscle and joint conditions can benefit from Sedative Stretching. 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.”

The sooner a person addresses the cause of their condition, the better. 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 when their typical daily activities cause a minor injury that leads to chronic, low-grade inflammation,” informs Dr. Johnson. “Many times, this occurs in early childhood and is a long-forgotten event.

“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.”

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,” observes Dr. Johnson. “This is evident everywhere while watching the way people walk, bend, twist and turn.”

Regrettably, many people wait until significant damage has occurred from excessive wear and tear before seeking appropriate care. Often, patients 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.

Unguarded Muscles

As part of the Sedative Stretching protocol, the patient is put under light sedation, sometimes 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 and are causing the pain.

“We use light, comprehensive stretching techniques while the patient is sedated,” notes
Dr. Johnson. “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.

There are typically a couple of weeks of rehabilitation following the procedure itself that are designed to reinforce the increased movement obtained from the treatment. During this time, patients are instructed how to perform stretching exercises to prevent the condition from recurring, offers Dr. Johnson.

“Patients regain the flexibility they had decades before by following this protocol, and typically, they return to activities they haven’t done in years,” he states. “This is truly correcting the original cause of their conditions.

“In almost all cases, more can be accomplished with one Sedative Stretching procedure than with years of other types of treatments.”

Notable Changes

As soon as their Sedative Stretching procedures were over, both Anne and Steve experienced notable changes in their conditions. For Anne, the treatment produced instant results.

“I felt immediate relief,” she marvels. “I immediately felt the pressure off that nerve in my back. I had an appointment with Dr. Johnson that same day, and every day for two weeks after the treatment. Every time I walked in, Dr. Johnson asked me how I was doing, and I just said, Thank you, thank you, thank you!”

Dr. Jeffrey P. Johnson of Johnson Medical Center in Venice treated Anne Bilsky and Steve Burns for lower back and neck pain using Sedative Stretching.

“Since Sedative Stretching, I can move my hips and legs and swing my arms. I’m on a mission to feel as good as I do now when I’m ninety-five.” -Anne

It took a little longer for Steve to feel the full effects of his treatment, but when he did, he was exhilarated. He was also amazed by the difference in his pain level after the procedure.

“Right after the Sedative Stretching, my pain was cut in half,” he reports. “Then I went back to see Dr. Johnson for some adjustments. After about the first week, my pain was gone completely, and it hasn’t come back. It’s been three weeks since I had the treatment, and the pain is totally gone. My pain score now is a zero. It’s perfect.”

That’s the same score Anne gives for her pain now, when before she says it hovered between eight and ten. With their pain alleviated, both Anne and Steve are able to perform activities they struggled with before treatment.

“I’m building up to doing forty-five minutes of my purposeful walking,” enthuses Anne. “I don’t walk with my dog when I do my purposeful walking, which involves fully moving my hips, legs and arms.

“Dr. Johnson told me that before treatment, I wasn’t walking with my hips. I couldn’t even move them; they were totally frozen. If I tried to purposefully walk, I’d tweak my side and be in pain.

“Since Sedative Stretching, I can move my hips and legs very purposefully and swing my arms. I’m on a mission to feel as good as I do now when I’m ninety-five.”

“After the initial stretching and three weeks of therapy, I can bend and touch my toes,” marvels Steve. “I could barely touch my knees before. I can bend to pick up a golf ball on the grass. I couldn’t do that before. That’s a big, big difference.

“I’m also extremely flexible in my neck now, which I was not prior to seeing
Dr. Johnson. I can now move my head and neck very freely. I’m very happy with where I am right now.”

Beyond Satisfied

Steve and Anne are grateful for the amazing results they achieved with Sedative Stretching. They’re also grateful for the wonderful treatment they received from the staff at Johnson Medical Center.

“I know several people who work at Johnson Medical Center are there because they initially went to Dr. Johnson for treatment,” comments Steve. “That speaks volumes in its own right.

“The entire staff is extremely friendly, helpful and professional. I’m always greeted warmly and treated very nicely. The office is run very efficiently. I can say it’s a pleasure going there now that I don’t hurt anymore.”

“Johnson Medical Center isn’t just an office or a practice,” agrees Anne. “When I first walked in, I discovered this wonderful, gentle, harmonious atmosphere, and I felt like I just wanted to sit for a while and feel the peace of it. And the staff is like a family.

“Whenever I go in, the receptionist greets me with a wonderful smile, and Dr. Johnson’s assistant provides loving guidance and gets me situated. I’m never rushed. They’re always interested in me. There’s a gentle knowing that when one of us heals, we all heal.”

Dr. Johnson’s patients are beyond satisfied with the care they received from the chiropractic specialist and the results of his Sedative Stretching protocol. Both were quick to pass the word on to friends and family.

“I’ve already recommended Dr. Johnson and Sedative Stretching to a number of friends I golf with and some I don’t golf with,” notes Steve. “I’ve told at least a half dozen people about him.”

Anne adds her own perspective.

“Dr. Johnson is one of the most loving, compassionate and knowledgeable doctors I have ever met,” she says. “I always feel wrapped in his love and concern. I absolutely recommend him and his treatment.

“I feel blessed for having been led to Dr. Johnson and Johnson Medical Center. Sedative Stretching totally changed my life. For me, it was a miracle!”

A New Kind of “Super Glue”

New biomedical adhesive safely seals leaking leg veins through a single needle stick.

Enrique Marquez, 67, was born in Cuba but came to the United States as a child in 1964. He went on to become a college professor, retiring in 2013 after 35 years of teaching, including 21 at Florida Gulf Coast University. His retirement was interrupted earlier this year, however, when his legs began showing signs of disease.

Dr. Joseph Magnant of Vein Specialists in Fort Myers and Bonita Springs treated Enrique Marquez and Derrick* (alias) for venous insufficiency using the VenaSeal™ Closure System.

“My legs went back to their normal size, and the discoloration is going away. My legs look like they did when I was twenty-five years old.” – Enrique

“Diabetes is part of my family inheritance, from both my mother’s side and my father’s side,” shares Enrique. “When I first started having problems with my legs, I thought it was related to my diabetes, and I was very concerned.

“My legs became swollen, discolored and irritated. They were also painful, especially at night. I had infection in my legs and ran a fever, and my legs felt very hot and heavy. I also had some varicose veins, but I figured that at my age, that was normal. There were also areas of incredible inflammation.

“It was difficult for me to walk, exercise and do my daily activities. I had to take breaks and sit down because my legs felt like they were going to give out.”

As Enrique’s leg symptoms got worse, he became increasingly alarmed. Because he assumed his leg problems were associated with his diabetes, he worried about the potential complications, including limb amputation. He went to several doctors, but the first two had no answers for him. Finally, the third surprised him with an unexpected diagnosis.

“He told me, I don’t think your problem is diabetes; I think it’s really your veins,” Enrique explains. “Then he said. I’m going to refer you to Dr. Magnant.”

Joseph G. Magnant, MD, is a board-certified vascular surgeon who specializes in treating vein disorders. His practice, Vein Specialists, has offices in Fort Myers and Bonita Springs. The practice is dedicated to the comprehensive, modern evaluation and most advanced minimally invasive treatment of vein disorders.

Dr. Magnant examined Enrique and ordered diagnostic ultrasounds of both legs. The results showed that several of Enrique’s leg veins had leaking valves, which was the cause of his symptoms. Dr. Magnant then explained vein disease in detail to Enrique.

“When the one-way valves in the leg veins fail, it causes the flow of blood returning to the heart to be impeded,” describes the doctor. “That’s a condition called venous insufficiency. As a result of this condition, blood leaks out of the veins and pools in the legs. It may also leak out of the veins into the surrounding tissues, leading to a host of problems.

“Some of the signs and symptoms of venous insufficiency include varicose veins, swelling, achiness, heaviness, nighttime cramping, restless legs, thickening and discoloration of the skin, and skin ulcers.”

VenaSeal Procedure Advantages

After explaining the condition to him, Dr. Magnant recommended treating Enrique by using the VenaSeal Closure System, a minimally invasive treatment that seals incompetent veins by using a biomedical adhesive, or super glue.

Dr. Joseph Magnant of Vein Specialists in Fort Myers and Bonita Springs treated Enrique Marquez and Derrick* (alias) for venous insufficiency using the VenaSeal™ Closure System.

The VenaSeal Closure System is the least-invasive treatment for venous insufficiency.

This specially formulated, sterile cyanoacrylate glue is made for use in humans, and at the end of the procedure, which was first approved for use by the FDA in 2015, a glue/blood complex remains in the vein that breaks down over time.

“The VenaSeal system has not necessarily replaced the other procedures that are used to treat venous insufficiency such as endovenous radiofrequency or LASER ablation,” explains Dr. Magnant. “This is simply another tool in our chest of options. VenaSeal has been shown to be equally effective as the heat-based ablation techniques.”

VenaSeal has also turned out to have some advantages over the heat-based ablation procedures. Because the radiofrequency and LASER techniques use heat energy to seal problem veins, insulating liquid must be placed along the entire length of the vein. This is done to prevent thermal tissue injury and to anesthetize the area around the vein so the patients feel less discomfort.

“Placing that liquid along the veins requires about half a dozen needle sticks, which feel like bee stings,” informs Dr. Magnant. “But because there’s no heat with VenaSeal, there’s no need to infuse liquid around the vein. As a result, we only need to use one ‘bee sting’ per vein when the VenaSeal method is used. Therefore, VenaSeal is a good option for people who are terrified of needles or have a low pain tolerance.”

Another advantage of the VenaSeal system is that it can be used to close nearly the entire length of the great saphenous vein (GSV), which is the longest vein in the body. In the calf, the GSV wraps around a sensory nerve. This prevents specialists from treating the GSV below the mid-calf using heat ablation due to the potential for damaging the nerve. With VenaSeal, however, there’s no heat and therefore no risk of nerve damage.

“Using VenaSeal, we can treat a longer segment of the vein,” educates Dr. Magnant. “We can generally get all the way down to the ankle. This is especially helpful for people with stasis dermatitis whose skin discoloration is a sign of severe distal venous disease.”

Dr. Magnant notes that another group of people who may benefit more from VenaSeal are those with open wounds. In most cases, he says, leg wounds are the result of trauma to an area of stasis dermatitis, which is a common inflammatory skin presentation of venous insufficiency.

“In those cases, I want to close as much of the vein as possible,” says Dr. Magnant. “Our goal is to seal the diseased veins that are leaking blood into the surrounding tissue, which leads to difficulty in healing the skin breakdown and ulceration. Once we stop that leaking, wound healing occurs much more rapidly.”

It was the presence of stasis dermatitis that prompted Dr. Magnant to recommend VenaSeal as the best option for treating Enrique.

“I chose VenaSeal for Enrique because it’s a better option for those with severe stasis dermatitis,” offers Dr. Magnant. “He had significant stasis dermatitis with inflammation, thickening and discoloration of the skin of his ankles. He had two veins on each leg with severe venous insufficiency.”

“Dr. Magnant’s diagnosis put me at ease,” states Enrique. “He gave me a detailed description of the problem and showed me the ultrasounds. He discovered the exact veins that were problematic, and I was very impressed with that.

“After he explained the different procedures he could do to treat the veins and proposed the super glue, I did some research on it. I was concerned about the chemicals involved and if I would have any repercussions.

“I discovered, however, that the glue is an organic compound that has antibiotics, so there’s no chance of infection. Also, it’s absorbed by my cells. The science and logic behind the VenaSeal are impeccable.”

Return for Results

In 2003, Derrick*, 69, retired from the international sales company he managed. By 2007, the Bronx native tired of the winter weather and cost of living in Westchester County, New York, where he lived, and moved south to sunny Florida. Derrick wasn’t concerned about the appearance of bloated varicose veins and discoloration on his legs, but he was worried about the health of his legs.

Dr. Joseph Magnant of Vein Specialists in Fort Myers and Bonita Springs treated Enrique Marquez and Derrick* (alias) for venous insufficiency using the VenaSeal™ Closure System.

“The VenaSeal Closure System was an absolute success… I recommend it and Dr. Magnant.” – Derrick

“I had some ugly veins protruding from my legs,” he relates. “They weren’t swelling that much, but the veins were bulging. I didn’t notice any real heaviness or achiness in them, either, but I did have occasional cramps in my legs at night. I knew by the way my legs looked that they weren’t in healthy condition.

“Five years ago, I figured I had to do something about my veins. A friend who is a nurse had her legs treated by ]Dr. Magnant at Vein Specialists, and she highly recommended him, so that’s where I went.”

Unfortunately, Derrick was battling another health issue at the same time, so he postponed having his leg veins treated. Finally, in January of this year, he returned to Dr. Magnant with the same symptoms and asked the doctor to initiate treatment. Dr. Magnant began by evaluating Derrick’s leg veins using ultrasound.

“Derrick had varicose veins, leg cramps and stasis dermatitis,” offers Dr. Magnant. “His left leg was worse than his right in terms of varicose veins. The ultrasounds also showed severe venous insufficiency.

“As we began to discuss the treatment options, Derrick informed me that he was very afraid of needles and requested IV sedation for the procedures. We don’t offer that form of sedation, so I decided that VenaSeal was a better option for him because it can be done using a single needle stick.”

“Dr. Magnant told me there were two veins in my left leg and one in my right leg that were leaking and needed to be sealed,” says Derrick. “When he told me about the new procedure that uses this super glue to seal the veins, I said, Let’s do it.”

Derrick says the doctor completed his treatment during two forty-five-minute procedures, one for each leg, done two weeks apart. He says that approach worked perfectly. He adds that even though multiple needles weren’t involved, he still could not watch Dr. Magnant while he worked.

“I didn’t look while Dr. Magnant was performing the treatment,” admits Derrick. “I thought about other things while he was doing it. I knew Dr. Magnant was inserting a tube up into the veins in my legs and injecting the glue, which really wasn’t bad. I just felt a slight discomfort while he was doing that.

“When he finished the procedure, I felt great. Dr. Magnant’s assistants put the compression stockings on me, which I wore for two weeks, and everything was fine. Wearing the compression stockings made my legs feel even better. After that, there was no pain, no anything.”

Absolute Success

When Dr. Magnant told Enrique about his venous insufficiency, he immediately thought of his years as a teacher, spending 16 hours a day on his feet. Enrique is convinced the experience led to his vein damage, which accumulated over time.

Dr. Joseph Magnant of Vein Specialists in Fort Myers and Bonita Springs treated Enrique Marquez and Derrick* (alias) for venous insufficiency using the VenaSeal™ Closure System.

Both Enrique and Derrick benefitted from the VenaSeal procedure available at Vein Specialists.

Enrique was encouraged when Dr. Magnant told him the problem was one he could cure and that the result would leave him with healthier, stronger and even better-looking legs. Dr. Magnant’s predictions for Enrique’s recovery were right on target.

Enrique is amazed by the appearance and function of his legs as they continue to improve through the recovery process.

“Now, I have no pain, swelling or marks on my legs, and the veins are gone,” he marvels. “My legs went back to their normal size, and the discoloration is going away. My legs look like they did when I was twenty-five years old.

“I had my second procedure two and a half weeks ago, and I’m back to my normal life with a few precautions. Dr. Magnant just told me not to do any heavy lifting for three weeks so I don’t hurt my legs. But I’m back to exercising at the gym and doing my
regular activities with no problems.

“The last time I saw Dr. Magnant, he said my recovery was going fantastic.”

Derrick’s VenaSeal procedures were done in March, so his recovery is further along than Enrique’s. Derrick is also pleased with his results and states, “I have a couple of other veins that are protruding now, but they aren’t the ones Dr. Magnant sealed. Dr. Magnant may do another procedure on those veins. I’m going back to see him in September for the final touches.

“I’m very happy with the way my legs turned out. I didn’t notice that much swelling or heaviness in my legs before treatment, but since I had the VenaSeal procedures done, they feel lighter and look thinner.”

Derrick and Enrique agree that the VenaSeal Closure System was a good option for treating their venous insufficiency. They also match in their approval of Dr. Magnant and his staff at Vein Specialists.

“The VenaSeal Closure System was an absolute success,” enthuses Derrick, “and it’s the least-invasive treatment. I recommend it and Dr. Magnant. He’s the best. He’s down-to-earth, very easy to get along with and knowledgeable.

“So is his staff. They were very helpful and comforting. The ultrasounds were done professionally, and everything done in preparation for the procedures was done professionally. It made me feel very comfortable.”

“I have developed a strong appreciation for Dr. Magnant,” adds Enrique. “He is a caring doctor with incredibly good manners. He is also very patient and extremely thorough. He explained everything to me because he wanted me to understand the problem and how it was going to be treated. I feel very comfortable being under Dr. Magnant’s care.”

Both Enrique and Derrick benefitted from the VenaSeal procedure available at Vein Specialists. They also had excellent experiences with Dr. Magnant and his team. Derrick has a few thoughts to sum it all up.

“The VenaSeal Closure System is a great procedure,” he says, “and Dr. Magnant is a great doctor. If anyone has a vein that’s a problem, Vein Specialists is where they should go.”

*Patient’s name withheld at their request.

A Thing of the Past

Minimally invasive treatment eliminates need for vein stripping.

For 20 years, Elena Tewmey worked in the county sheriff’s office. In 2009, she left her post to become a stay-at-home mom to her two young children. Beginning in 2007, when she was pregnant with her first daughter, the foot pain and swelling in her feet and ankles, which she’d had for years, intensified. Elena blamed the intensification on her pregnancy, but after she delivered her daughter, it only got worse.

Dr. Vijay Narasimha of Surgical Associates of Tampa Bay in Brandon treated Elena Tewmey’s varicose veins.

After vein treatment, Elena has resumed her active lifestyle

“I’ve had the swelling for the last six or seven years,” the Tampa native elaborates. “I didn’t realize how bad it was until the doctor recommended I wear support socks. At first, I thought the swelling was a fluke, so I took off the socks and pledged not to wear them. But by the end of the day, after not wearing them, my ankles were heavy, blue and swollen.

“My feet were achy all the time. The meaty portions of my feet, especially my left foot, were always hurting. It almost felt like they were bruised, like I stepped on a stone, and my foot was on the stone at that instant. It always felt like somebody was pushing on the bottom of my foot with a rock, and not a smooth rock.

“I wasn’t able to run because it hurt too much, and I hadn’t done it for probably four years. But I promised myself I would someday get back to running.”

In addition to the pain and swelling she was experiencing in her feet and ankles, Elena also noticed a blue area on the inside of her left thigh that bothered her. The area was identifiable as a varicose vein. Elena’s husband encouraged her to have her leg examined, and her research brought her to Surgical Associates of Tampa Bay in Brandon, where she met Vijay B. Narasimha, MD.

“Elena came to us complaining of pain, swelling and heaviness in her ankles and feet, more so on the left side,” notes Dr. Narasimha. “She had a troubling varicose vein on her left leg as well.

“We went ahead and performed an ultrasound of her left leg, and it showed her great saphenous vein was incompetent, meaning there was significant reflux, or backward flow. The reflux started in the groin area, and there were also multiple incompetent branches associated with it. Because of this abnormal finding, I recommended treatment.”

Incompetent veins are those in which the one-way valves in the leg veins have weakened and can no longer keep the blood from flowing backward and pooling in the legs. Fluid that pools in the tissue of the legs is what leads to the symptoms of pain, swelling, discoloration of the skin and, of course, varicose veins.

“After the ultrasound, Dr. Narasimha said he could feel lumps under that varicose vein on my left thigh, and he said that my veins were really leaking,” states Elena. “I was somewhat surprised. I’m forty-six, and in my mind, varicose veins are a problem for people in their seventies or eighties. I chose to take care of this problem before I got any older.”

To treat the leaky veins in Elena’s left leg, Dr. Narasimha chose a minimally invasive procedure and scheduled it for mid April. Elena notes a quick turnaround in her condition.

“I started seeing results within two to three days of the procedure.”

Battling Leaky Veins

In the past, there was only one option to treat varicose veins, and that was to strip out the affected veins, reports Dr. Narasimha. Vein stripping is a serious and painful procedure that requires a long period of recovery and leaves an unsightly scar. Today, vein physicians have a variety of techniques that are minimally invasive, require little downtime and result in minimal to no scarring.

“One of these options, and the one I selected for Elena, is ablation,” Dr. Narasimha relates. “There are different techniques of ablation, including radiofrequency ablation and endovenous laser ablation.

“With radiofrequency ablation, radio waves are used to produce heat energy to shrink the incompetent veins. Laser ablation uses a laser to generate the heat and seal the veins. At my practice, I use radiofrequency to do ablations.

“I can’t say enough good things about . . . Dr. Narasimha and Surgical Associates
of Tampa Bay. Thanks to them, I feel like a new woman.” -Elena

“The primary reason is that patients who have had the treatment using the laser reported a little more pain and bruising post procedure. However, both techniques are safe and effective.”

Another treatment option is chemical ablation, also known as sclerotherapy, during which specialized medications called sclerosants are injected into the problem veins under ultrasound guidance. These medications shrink the targeted veins.

“Nowadays, we have even newer agents in our armamentarium for treating varicose veins,” notes Dr. Narasimha. “One very new treatment is a specialized glue to safely seal the veins. To use the glue, the physician places a small catheter into the target vein, injects the glue, which is a medication, then withdraws the catheter.

“Once the glue is injected and hits the warmth of the blood, it begins to thicken, and that shuts down the problem vein.”

Varicose veins are a very common condition, especially in women, informs Dr. Narasimha. The good news, he adds, is that they’re treatable.

“People don’t have to suffer from aching, heavy, swollen legs,” he says. “They also don’t have to risk the complications of leaky varicose veins, such as discoloration and thickening of the skin, eczema and ultimately ulcers.

“If varicose veins are treated, swelling and ulceration can be avoided. The discoloration, or pigmentation, can also be avoided. This is important because once the legs get that pigmentation, it’s permanent. It’s like a tattoo. The color will remain for life.”

Like a New Woman

When Dr. Narasimha told Elena that the pain, swelling and heaviness in her left ankle and foot were related to her varicose vein, she was surprised. She was shocked again when Dr. Narasimha’s radiofrequency ablation left her relieved of those symptoms.

Dr. Vijay Narasimha of Surgical Associates of Tampa Bay in Brandon treated Elena Tewmey’s varicose veins.

“I told my husband, This is absolutely amazing. It’s like my left foot isn’t even there,” she raves. “It’s wonderful.

“About two weeks after the procedure, I felt well enough to try a little jog. I didn’t plan to go fast, just do my two-mile jog around the neighborhood, and I made it. When I got in the house, my husband asked me how I felt. I told him my right foot hurt, but I didn’t even feel my left foot.”

Another thing that amazed Elena was how inadvertently she found out about her incompetent veins. For years, her symptoms consisted of the foot pain, and swelling and heaviness in her ankles. She assumed these symptoms were due to all the standing and walking she did with her family.

“I just had that one varicose spot on my left leg,” she comments. “Had I not seen that spot, I never would have known my symptoms were from a vein issue. I’m a mom. I’m always moving. I just associated my foot pain with being on my feet all the time.

“I think my age played a role in not getting my left leg checked out earlier. I felt that I was young, so the symptoms were not an issue. I also believed vein problems were not going to happen to me because they happen to older people. Now that I feel better, I wish I’d had my legs checked out sooner.

“I can’t say enough good things about my procedure, Dr. Narasimha and Surgical Associates of Tampa Bay. Thanks to them, I feel like a new woman.”

Dental Trifecta

Respected dentist targets aesthetics, function and fear.

Brandon native Nancy Douglas went to a local chain dental practice and had a partial denture made to replace the missing teeth in the back of her mouth. Sadly, the partial never fit correctly, and the chain practice was uncooperative about adjusting it. Because it was so uncomfortable, Nancy rarely wore the denture and eventually misplaced it.

Dr. Amir Boules at Oakfield Dental in Brandon used cosmetic dentistry with all-ceramic crowns to create new smiles for Robert and Nancy Douglas of Seffner.

Robert and Nancy are very happy with their new smiles.

Nancy’s fortunes turned, however, when a friend recommended a highly respected Brandon dentist, Amir Boules, DMD, of Oakfield Dental. Nancy found Dr. Boules exceedingly more sensitive and understanding than the dentists at the chain practice. Dr. Boules made Nancy a new partial to replace her missing back teeth.

“Dr. Boules was a very nice guy,” recalls Nancy, “and he knew what he was doing. He told me he didn’t care if I came back a hundred times to have my partial adjusted, he wanted it done right.”

After her positive experience at Oakfield Dental, Nancy recommended Dr. Boules to her husband, Robert, who wanted to have his smile restored. The thing that kept Robert from having the cosmetic dentistry done before was his fear of dentists. Nancy assured Robert that Dr. Boules was very kind and gentle.

“When I was fifteen, I fell and knocked out an upper front tooth,” relates Robert. “At the time, the dentist put on a cap that was kind of big. I called it a Chiclet® because it was wider than my other teeth.

“When that dentist was doing his thing, he shot Novocain® up into my nose, and it was awful. I guess he hit an air pocket or something, but it was incredibly painful. I always feared dentists after that. I didn’t like them and got anxious about going to them.”

As time went on, the teeth adjacent to Robert’s crown yellowed, but the crown itself remained a bright white. In addition, his other teeth shortened from years of grinding.

With Nancy’s coaxing, Robert made an appointment at Oakfield Dental and met with Dr. Boules. The dentist evaluated Robert’s situation and prepared a dental treatment plan. He took extra care to be respectful and soothing with his fearful, new patient.

“Robert was not happy with his smile and was looking to restore it,” notes Dr. Boules. “He was particularly concerned about a crown he had for a long time that no longer looked pleasing. Also, his adjacent teeth showed a significant amount of wear. I recommended all-ceramic crowns for his four upper teeth.”

“Dr. Boules made me feel comfortable,” reports Robert. “He was very gentle and talked me through everything he did.”

Nancy watched with interest as Dr. Boules revitalized Robert’s smile. It made her realize her own smile was lacking, so she returned to Oakfield Dental to have Dr. Boules perform cosmetic dentistry on her front teeth.

“Nancy had extra spacing between her upper teeth, and they also showed a bit of wear on them,” describes Dr. Boules. “She was looking to restore her teeth with all-ceramic veneers or crowns. We opted for the all-ceramic crowns.” 

Aesthetics and More

When most people hear the term cosmetic dentistry, they think simply of restorations and treatments to improve the appearance of a person’s smile. However, cosmetic dentistry is just as much about restoring dental function and oral health, observes Dr. Boules.

“The best cosmetic appearance occurs when the teeth make proper contact with each other and form a healthy bite,” he explains. “When teeth are not properly aligned and there is spacing, the small gaps between the teeth can become food traps.

“The food traps become a recurring issue that is hard to keep clean. The combination of trapped food and bacteria can collect and lead to tooth decay, gum disease and infection. Allowing a dentist to restore the natural contour of the teeth gives people a healthier oral profile as well as a more aesthetic appearance.”

The all-ceramic crowns used at Oakfield Dental are superior in several ways to the type of crown that was the standard of care for many years. Traditional crowns are made of metal substructures with porcelain baked over the top of them.

“Now that I’ve got my crowns, I smile more to show off my pretty, new teeth.” -Robert

“There are several problems with traditional crowns that can occur over time,” asserts Dr. Boules. “If patients have any gum recession, the metal substructure will start to show as a dark color around the gumline.

“Traditional crowns can also discolor with years of wear and are susceptible to chipping. In addition, they do not fully reflect light due to the metal underneath, so they can look somewhat opaque, even when color-matched with the rest of the teeth.”

The crowns used at Oakfield Dental are made of an all-ceramic material and have no metal substructure, so they better reflect light and look more natural. The technology of the materials used has improved and is much stronger than the porcelain-fused-to-metal design, so it resists discoloration and chipping.

“Because the crowns we use have no metal, there’s never a dark gray color to show through when the gums recede,” points out Dr. Boules. “The material is all-ceramic and all one color, a tooth color. With recession, people just see more of the ceramic or natural tooth color.”

Fear Forgotten

The treatment Dr. Boules recommended for Robert is now completed. Robert is so pleased with his final results, he wants to exhibit his smile to the rest of the world.

“I’m pretty proud of my new crowns,” he offers. “They look very natural. The color matches my other teeth, which helps them blend in.

“Now that I’ve got my crowns, I smile more to show off my pretty, new teeth.”

Nancy still has temporaries on her four front teeth, but she’s inspired by Robert’s results. She has no doubt her permanent crowns will look as good as her husband’s.

“So far, I think it’s awesome,” she enthuses. “I haven’t gotten my permanent crowns yet, but Robert got his, and they look really good. They look very natural, like they’re real teeth.”

Robert reports that his fear of dentists has been allayed since going to Dr. Boules. He’s grateful that Nancy told him about this dentist and his practice, so he’s sharing that good news with others.

“Between Dr. Boules and his staff, they really eased my fear,” he confirms. “Now, I can go to the dentist at pretty much any time. In fact, I’m going for a cleaning soon. Everyone there helps. They talk to me when they’re doing their work, and they’re all very friendly.

“I’m very happy with my treatment, and I recommend it. I also recommend Dr. Boules and Oakfield Dental. I already told a couple of people about them.”

“I already recommended Oakfield Dental to my sister and a friend of my husband,” adds Nancy. “Dr. Boules is a very nice dentist. He knows what he’s doing and makes you feel comfortable. What a difference between his office and that chain practice. I’m so happy I chose Dr. Boules and Oakfield Dental.”

Adding to the Family

New eye clinic is looking out for residents of Riverview.

People are excited about living in Riverview now. It’s an up-and-coming town just east of Tampa and south of Brandon that is experiencing rapid growth with new homes, restaurants and entertainment venues cropping up almost daily. Its population has exploded according to the latest census data. Of course, more people means more needs, especially health needs.

Dr. Charles Luxenberg and Dr. Ronni Chen talk about the new Florida Eye Specialists & Cataract Institute facility in Riverview and some of the eye disorders they treat there.

Dr. Chen’s specialty is working with children such as Michael (right).

In response to these mounting needs, Florida Eye Specialists & Cataract Institute, based in Brandon, opened a comprehensive eye clinic in Riverview, expanding its family of regional eye care centers. Florida Eye Specialists & Cataract Institute at Riverview was christened on April 9, 2018.

“We are a full-service center, taking care of a complete range of eye disorders,” notes Charles A. Luxenberg, MD, a board-certified ophthalmologist at the Riverview clinic. “We perform routine eye exams and prescribe glasses, but we also treat more serious conditions such as diabetes-related eye diseases, cataracts and glaucoma.”

“It’s exciting for Florida Eye Specialists and Cataract Institute to have a location in Riverview,” states Ronni M. Chen, MD, a board-certified ophthalmologist who is fellowship trained in pediatric ophthalmology. “I’m excited to provide specialty pediatric eye care here in Riverview. I think it provides a great service to children and families in the area.”

The clinic is brand-new and has four spacious exam rooms. Physicians in multiple specialties, including retina specialists, will rotate through the clinic, so Riverview residents won’t have to travel for specialty eye care services. The physicians have the highest level of technology available for testing and treatment.

“We have a piece of equipment called an OCT that takes three-dimensional pictures of the retina and a state-of-the-art peripheral visual field machine,” describes Dr. Luxenberg. “We’ve also got two lasers, an argon laser and a YAG laser. These lasers are used to treat various eye conditions.

“Our primary technician has years of experience, including working at Bascom Palmer Eye Institute, which is one of the best eye care centers in the country. We also have a very friendly staff. I believe Florida Eye Specialists and Cataract Institute at Riverview is a great place to come for eye care.”

“The clinic is easily accessible, and there is ample parking,” adds Dr. Chen. “We offer a very welcoming environment for children and their families. I think every family that comes to visit us at this location will have a great experience.” 

Pressure Problem

One of the conditions Dr. Luxenberg will concentrate on treating at Florida Eye Specialists & Cataract Institute at Riverview is glaucoma. It is a common condition; it’s estimated that more than three million Americans aged 40 and older are living with the disorder.

“I believe Florida Eye Specialists and Cataract Institute at Riverview is a great place to come for eye care.”– Dr. Luxenberg

Glaucoma is an insidious disease that causes damage to the sensitive optic nerve, leading to a gradual loss of sight. Most often, glaucoma is associated with increased pressure in the eye, which injures the optic nerve, the conduit made up of millions of nerve fibers that carries messages from the retina, the light-sensitive tissue at the back of the eye, to the brain.

“Glaucoma is the degeneration of optic nerve fibers that send signals to the brain, enabling vision to occur,” elaborates Dr. Luxenberg. “The degeneration usually affects the nerve fibers that serve our peripheral vision first, then later, in advanced stages, our central vision. Blindness can occur in advanced stages of glaucoma.”

Pressure builds in the eye when there is a back-up of the eye’s natural fluid. This fluid, which is called aqueous humor, flows between and nourishes the lens and cornea. It then drains back into the bloodstream through a honeycomb of channels called the trabecular meshwork. Thus, it is produced inside the eye and escapes through the eye’s drainage canals. This drainage system allows the pressure to maintain a certain level.

If the drainage canals become clogged, which can happen over time or suddenly, and the outflow of fluid is obstructed, the resulting increased pressure can lead to the development of glaucoma and to damage of the optic nerve.

“There are different types of glaucoma, including open-angle glaucoma, also called wide-angle glaucoma,” describes Dr. Luxenberg. “This is the most common type and represents about ninety percent of cases in the US. Other, less common types include closed-angle glaucoma, normal-tension glaucoma, congenital glaucoma and secondary glaucoma.

“Closed-angle glaucoma, also called narrow-angle glaucoma, occurs when there is a blockage in the eye, causing a sudden rise in eye pressure. Closed-angle glaucoma is an emergency and requires immediate medical attention to prevent permanent damage to the optic nerve and vision loss.”

The cause of normal-tension glaucoma is not completely understood, but most doctors and researchers believe it is related to reduced blood flow to the optic nerve. Congenital glaucoma is hereditary and is often diagnosed in very young children. It results when the eye does not form properly during development. Secondary glaucoma is the result of another condition, such as diabetes.

Lasering in on Glaucoma

With annual eye exams, glaucoma can usually be detected in early stages that have not yet been noted by the patient. Treatment started at this time can usually prevent progressive vision loss. Treatment is directed toward lowering the intraocular pressure with medical eye drops and/or various surgical procedures.

Dr. Charles Luxenberg and Dr. Ronni Chen talk about the new Florida Eye Specialists & Cataract Institute facility in Riverview and some of the eye disorders they treat there.

From left, Vanessa Cepeda, Giovanni Caputi, Dr. Luxenberg, Casey Keefe.

“I believe it is better to treat glaucoma with a laser, which is highly effective, than it is to treat it with drops,” observes Dr. Luxenberg. “Using the laser saves people the cost, irritation and inconvenience of the drops. It also prevents allergies and damage to the surface of the eye that can occur from the preservatives in the drops.

“With the laser, our goal is to reduce eye drop therapy and substitute it with one-time laser therapy that works twenty-four seven and is very safe and effective.”

The results of the laser treatment can last for the rest of the patient’s life, or it can last six months, depending on the extent of the patient’s condition. Dr. Luxenberg uses a technique that enables him to repeat the procedure if necessary.

“I initially treat half of the circumference of the eye and see how patients respond,” he explains. “If they get a good result, which happens in about ninety-eight percent of cases, we wait and watch. If their pressure starts creeping up again, I can laser the other half of the eye. After that, we continue to use the drops.

“If patients are already using drops, the laser procedure may enable them to discontinue one of the drops. So, if they’re on one drop, they can eliminate it, and if they’re on two types of drops, we can reduce it to one type of drop.”

To treat open-angle glaucoma, the laser increases the effectiveness of the filter that allows the fluid to flow out of the eye. This decreases the build-up of fluid and, thus, the pressure in the eye.

“We can use the same laser for narrow-angle glaucoma, but we use it differently,” informs Dr. Luxenberg. “For this, we make a hole in the iris, which prevents the single closure attack. We use the same laser but two different procedures for the most common types of glaucoma.”

Beating Blepharitis

Another common condition being treated at Florida Eye Specialists & Cataract Institute at Riverview is blepharitis, an infection of the eyelids and eyelashes. Blepharitis commonly occurs simultaneously with dry eye. If left untreated, these conditions can lead to permanent eyelid and tear gland dysfunction as well as corneal damage.

Blepharitis is most commonly caused by an overgrowth of bacteria that live along the margins of the eyelids and at the base of the lashes. Not only do these bacteria cause the symptoms of blepharitis, they also produce the substances that inflame the oil glands, called Meibomian glands, in the eyes, causing dry eyes. There are different types of blepharitis.

“Blepharitis can affect the outside front of the eyelid where the eyelashes are attached,” reports Dr. Luxenberg. “This is referred to as anterior blepharitis. It can also affect the inner eyelid where secretions are released, which is called posterior blepharitis.

Posterior blepharitis is the type associated with bacterial infection and symptoms of dry eyes. The inner eyelid is where the Meibomian glands are located.

“Blepharitis should be taken seriously because of its link to dry eyes and because it can lead to complications,” asserts the doctor. “These include sties, lashes falling out, lashes growing in the wrong direction because the base of the lash gets scarred, and lashes growing inward toward the eye and damaging the cornea.”

The eye complications associated with blepharitis and dry eye can be treated and possibly prevented if eyelid hygiene is properly undertaken. For years, hygiene options included cleaning the lids with diluted baby shampoo or eye scrub pads.

Two years ago, an eye physician in Jacksonville invented a mechanized system for scrubbing and massaging eyelids infected with blepharitis bacteria. It works far better than both baby shampoo and scrub pads. It’s called BlephEx®, and it’s used at Florida Eye Specialists & Cataract Institute at Riverview.

During a BlephEx treatment, a medical-grade micro sponge is dipped in a solution similar to that in the eye scrub pads. The sponge is placed on a small tool that resembles a drill, but instead of a drill bit, there’s the soft sponge. The tool gently spins to scrub and massage the eyelid margins, cleaning and exfoliating the eyelids and lashes and relieving symptoms.

“I’m excited to provide specialty pediatric eye care here in Riverview.”– Dr. Chen

“The BlephEx removes all the debris around the base of the eyelashes and helps keep the lids cleaner,” confirms Dr. Luxenberg. “That takes away the food for the bacteria causing the redness and inflammation around the eyelids that occur with blepharitis and dry eye.

“We do a one-minute cleaning of the lid margins in one direction, then press a button and the machine spins in the opposite direction. We go back over the lids, and the sponge removes everything that was loosened on the first pass. I’ve seen really great improvement in blepharitis and dry eye using the BlephEx.”

Kid Focused

As a pediatric ophthalmologist, Dr. Chen sees children and teens from birth to age 18. Generally, she first sees a child for an eye exam when he or she is around five years old and has failed a routine vision screening by a family doctor or at school. Recommendations for starting routine eye exams for children vary depending on their backgrounds.

“If there’s no family history of eye problems, children usually get screened by their pediatricians prior to entering kindergarten,” she educates. “That’s how many initial eye concerns are caught, and the children are sent to us for further evaluation.

“If there is a family history of eye muscle problems, we recommend a screening by a pediatric ophthalmologist some time before the child’s second birthday. This way, we can pick up on any issues before they become big problems.”

Dr. Chen treats all of the eye conditions that are commonplace during childhood and adolescence. Three that can be corrected easily with eyeglasses are myopia, hyperopia and astigmatism. These are all refractive errors – vision problems caused by the eye’s inability to properly focus light on the retina to form a clear image.

Myopia is also known as nearsightedness, and hyperopia as farsightedness. Astigmatism is an irregularity that forms in the corneal tissue, causing part of the cornea to be steeper along one axis than another.

“I also treat other routine eye conditions, including eye infections, blocked tear ducts, chronic tearing and foreign bodies children may get in their eyes while playing outside,” shares Dr. Chen. “Two of the most common eye disorders I see at the Riverview clinic are amblyopia and strabismus.”

Amblyopia, also called lazy eye, results when the eyes’ acuity develops unevenly. The brain accepts the visual images from the stronger eye and ignores the images from the weaker eye. Affecting four in every 100 children, the condition can be treated with eye drops or by placing a patch over the stronger eye, forcing the weaker eye to work harder.

“It is important to recognize and treat amblyopia during early childhood,” stresses Dr. Chen, “because experience has shown later interventions to be ineffective.”

Strabismus, or crossed eye, occurs as frequently as amblyopia and results from a misalignment of the eye muscles, which interferes with the ability of the eyes to work together. One eye may appear to drift, seemingly looking up, down, in toward the nose or out toward the cheekbone.

Children coping with strabismus may squint one eye in bright sunlight or complain of eyestrain or headaches when trying to read. If the affected eye goes untreated, the child may develop amblyopia as a result of strabismus.

“Strabismus can occasionally be treated with eyeglasses that force the affected eye to work in concert with its partner,” says Dr. Chen. “But the condition most often requires eye muscle surgery to align the eyes properly. Although this surgery is safe and effective, some children require more than one surgical procedure to fully correct the condition.”

On the days Dr. Chen provides her services at the Riverview clinic of Florida Eye Specialists & Cataract Institute, the office becomes a child-friendly oasis. The environment and the personnel are all dedicated to the needs of children.

“We have children’s movies playing, and we have a playroom for them,” describes
Dr. Chen. “I’m a fellowship-trained pediatric ophthalmologist who’s been in practice for twenty-one years, and my staff is specially trained to make the exams as easy as possible for the children.

“Children don’t have to know how to read for us to determine if they need glasses. We have the objective exam and dilated eye exam, which allows us to take measurements. Then we have a technique called preferential looking. We show them a toy and see if they object to covering their preferred eye and respond with their other eye.”

For Dr. Chen, being a pediatric ophthalmologist is very satisfying. In addition to working with children, pediatric ophthalmologists can make a significant impact on a child’s future.

“The thing I like most about working with children is that you can really make a huge difference in their lives,” she acknowledges. “If you can improve the ability of a child to see, you can impact how they perform in school. For teenagers, if they have misaligned eyes and you straighten them, it can really make a difference in terms of their self-esteem.

“It’s something unique to pediatrics versus general ophthalmology. You get to be a small but special part of a child’s life.”

These services for children, as well as comprehensive care for adults, are now available at Florida Eye Specialists & Cataract Institute at Riverview.

You’ve Got Mail!

With concierge medicine, patients can consult doctor anytime via email.

It was the height of flu season when Barbara Marshall began to feel a little under the weather. Her symptoms included chest congestion and a nagging cough. To be safe, she chose to alert her doctor about the change in her health. She fired off an email describing her symptoms and asking for advice.

With Dr. Zimmer’s concierge service at Zimmer Medical Services in St. Petersburg, patients like Barbara Marshall have more access to the doctor. They can consult with him on minor acute or chronic conditions by email.

The concierge model offers Barbara (left) easy access to Dr. Zimmer.

Barbara was comfortable doing this because she’s a patient of Michael A. Zimmer, MD, a board-certified internist and head of The Zimmer Medical Group in St. Petersburg. Dr. Zimmer uses a different model of medical practice called concierge medicine.

“The concierge model is based on a limited membership, so physicians can spend more time with their patients,” explains Dr. Zimmer. “It also enables physicians to be more accessible to patients at more convenient times in more convenient ways, including by email. This allows for more personalized care and a quicker response to patients’ needs.”

Having easy access to Dr. Zimmer is an aspect of concierge medicine that Barbara finds especially helpful. When she emailed him about her flu-like symptoms, she was given an appointment immediately.

“Dr. Zimmer provides his email address as part of his concierge service, and it works out beautifully,” reports Barbara, a business owner and native of Belgium. “When I write to him or his staff, they’re very responsive. I get an answer within twenty-four hours.”

Expedient Communication

Like Barbara, many of Dr. Zimmer’s patients use the email feature to consult with the doctor about new symptoms. Others use it to keep him apprised of existing conditions.

“Oftentimes, patients have questions about acute conditions or the management of certain chronic conditions such as high blood pressure, diabetes and asthma,” elaborates
Dr. Zimmer. “Using email, patients are able to report symptoms or clinical findings, such as measurements of blood pressure, peak flow for asthma and blood sugar for diabetes.

“Acute conditions such as uncomplicated urinary tract infections or simple upper respiratory infections can be handled easily through email. In many cases, we can save our patients from having to make office visits.

“Using email is a very expedient way of communicating with my patients,” continues Dr. Zimmer. “The technology is easy and allows my patients to contact me anytime. I regularly review my messages, so I can respond to patients’ concerns promptly and properly.”

Trusted and True

When Barbara alerted Dr. Zimmer of her symptoms by email, he suspected she might be suffering from a condition other than flu. After he saw her, he properly diagnosed her with viral bronchitis. He treated her appropriately, and she responded positively.

“I feel excellent now,” raves Barbara. “I’m completely recovered.

“Dr. Zimmer took time with me and asked a lot of questions. He determined the right diagnosis and the right treatment. He provided the right resources, so I could feel better. His team was superb from the minute I walked in the door to when I departed. I trust Dr. Zimmer with my life.”

Protocol for Pain

Non-narcotic treatment eliminates long-lasting, post-cancer pain.

Sherry Penoff is no stranger to pain. The software developer has suffered with fibromyalgia and chronic back pain, has already had one aching hip replaced and recently discovered that instigating osteoarthritis is now destroying the cartilage in the other.

 Dr. Arpit Patel of Florida Pain Medicine in Brandon, Wesley Chapel and Zephyrhills treated Sherry Penoff for post-cancer pain.

Dr. Patel’s therapy allowed Sherry to remain active through cancer treatment.

She thought she’d battled the worst pain of her life, but then came devastating news and the realization she hadn’t.

“It was May 2015,” states the Indiana native. “I was diagnosed with breast cancer. To treat it, I went through a mastectomy, chemotherapy and radiation.

“Having your breast removed is extremely painful. I also went through reconstruction surgery, which is also very painful. But when I started my chemotherapy, that brought on a whole new level of pain.

“Sometimes, it was a burning pain, and sometimes, it was just a general aching. When my nerves started regenerating, it felt like more of a stabbing pain. There were times when I hurt all over, and I would have to close my eyes and try to relax and calm myself. On a scale of one to ten, my pain was usually a seven or an eight.”

The excruciating pain Sherry experienced affected her everyday life in many ways. There were some activities she was unable to perform, but there was one key activity she maintained that gave her hope during this difficult time in her life.

“I was able to continue working,” Sherry relates. “I had to stop cleaning the house, and I had to stop gardening, and being a very caring person, not being able to do things for others was very difficult for me.

“I got in trouble with my family quite a few times for doing things I wasn’t supposed to be doing, but I was able to keep working, and that was the most important thing for me and my family – that I was able to be a productive person.”

Sherry was able to work because she had a guardian angel who helped her deal with her post-cancer pain. After her mastectomy and before beginning her chemotherapy, Sherry’s cancer physician referred her to Arpit Patel, DO, a double board-certified pain management specialist at Florida Pain Medicine.

Two-Pain Plan

“The first thing Dr. Patel did was develop a plan,” reveals Sherry. “His plan was to manage my post-surgery pain and wean me off of the morphine I was taking for it. His goal was not only to control the pain, but also to reduce the use of that drug.”

Many people who suffer with cancer pain don’t just deal with it during their battle with the cancer and its treatment. In many cases, the pain lasts for weeks, months and even years afterward. According to Dr. Patel, much of it is a combination of neuropathic and nociceptive pain.

“Neuropathic pain originates from a nerve,” he explains. “It may be from a disc pushing on a nerve that goes from the back down the leg, or from any type of insult to the central or peripheral nervous system. Many times, neuropathic pain presents as an electric, burning sensation, as opposed to nociceptive pain, which is more musculoskeletal.

“Nociceptive pain generally starts right away after an injury or surgery. Neuropathic pain starts later, often several months after the patient has been diagnosed. However, we target it early in the treatment plan to keep it from getting worse down the road.”

Dr. Patel notes that cancer pain can be difficult to treat because many of the chemotherapy medications and most types of radiation have long-lasting side effects. Radiation can cause a tightening of the joints and tendons in the treated area, called fibrosis, and many chemotherapy medications lead to drug-induced neuropathy.

“The challenge of cancer pain is that it’s a puzzle,” offers the doctor. “Each patient is unique and reacts differently to cancer treatment. We cater our protocols and treatment plans according to each patient’s reaction and symptoms.”

For Sherry, Dr. Patel created a treatment plan that addressed not only her cancer pain but also her other pain problems. He also sought to return her to her activities of daily living without resorting to high doses of opioid medications.

“I treated Sherry with a combination of tricyclic antidepressants along with a muscle relaxant,” discloses Dr. Patel. “Many people think these antidepressants are used just for psychiatric reasons, but at very low doses, they are quite effective for neuropathic pain. I used those for her neuropathic pain and added the muscle relaxant for her nociceptive pain.

“We aim to get our patients pain free, but our true goal is to restore function, so our patients can live life again. If Sherry’s able to move, she’ll be able to do the activities she was doing before her cancer and post-cancer pain. That’s what we care about most.”

“One of the things I really liked about Dr. Patel is that rather than prescribe large doses of opioids, which cause my joints to ache anyway, he gave me a muscle relaxant,” says Sherry. “That helped with the pain and helped me relax. He came up with this alternative because I didn’t want to take big doses of opioids.”

Working Through It

A breast cancer diagnosis took Sherry by surprise in May 2015, and so did its persistent complications. Fortunately, Sherry’s cancer doctor thought ahead and got Dr. Patel involved early on. The pain management specialist was able to create a plan to help Sherry manage the pain of her disease and its aftermath. The plan was effective, and Sherry responded positively.

“I feel great now,” she enthuses. “Of course, I have follow-up appointments with both my cancer doctor and Dr. Patel, but I’m doing great. My pain level from my breast cancer right now is a zero.”

Although she’s found relief from her post-cancer pain, Sherry still suffers from her other chronic ailments, the fibromyalgia and hip and back pain. Because she still has pain with these issues, she’s slowly getting back to activity, but isn’t yet back to full function.

“I’m not doing housework yet, but I have done some gardening,” relates Sherry. “My family still has to help me with most things because I still have the back and hip pain to deal with. Dr. Patel is giving me injections for that.”

Sherry says she’s already recommended Dr. Patel to some of her friends in pain. She adds that she appreciates the pain management specialist’s calming influence during this stressful period in her life. She is grateful he was an integral part of her cancer treatment.

“Dr. Patel is very smart and sensitive,” she describes. “His bedside manner is so caring, and he listens to his patients. He’s sympathetic with them, and he helps them any way he can. He really helped me.

“I went through a mastectomy, chemotherapy and radiation, and because he helped me manage my pain, I was able to continue working through it all. I only took a few weeks off before the mastectomy. If it hadn’t been for Dr. Patel and Florida Pain Medicine, I would have been on short-term disability.”

Need New Hip Joint?

July 9th, 2018

Positioning system makes replacement surgery more precise.

The number of Americans having hip replacement surgery has grown steadily over the past eighteen years. It’s estimated that this year, more than 300,000 people will undergo the procedure, up from 138,000 in 2000. The procedure, fortunately, has matured as well.

A recent advancement to hip replacement surgery was the release and FDA approval of a technology that helps surgeons determine the most accurate alignment of the replacement implants. This technology is the optimized positioning system or OPS™.

The inspiration behind OPS is the fact that no two people move the same way, and this can make a significant impact on the proper positioning of the hip implants. OPS is designed to account for the differences. It tailors the implant placement to each patient.

OPS factors in that no two people move the same way.

The hip joint has two essential parts, the ball and the socket. The ball of the joint is the head of the femur, or thigh bone. The socket, or acetabulum, is a concave depression in the pelvis, in which the ball sits. The ball and socket are the parts that are replaced during surgery and must be positioned appropriately for the best outcome.

To get the proper position, hip replacement surgery using OPS begins long before the procedure is performed. An extensive preoperative evaluation is first performed to determine how the patient’s femur, pelvis and spine work together during routine daily activities. This evaluation provides a specific functional simulation of the patient’s movement.

This information is essential to achieving optimum results during surgery. If the implants aren’t positioned precisely during surgery, there’s a greater risk for complications such as premature wear, implant loosening and dislocation, as well as nerve impingement.

The preoperative evaluation also includes imaging such as x-rays and CT scans to generate pictures of how the patient’s hip moves in three dimensions. The imaging captures the anatomical geometry around the person’s hip joint.

Using all of the information gathered from the preoperative evaluation, surgeons create exact 3-D models of the patients’ anatomy. They then use these models as guides to optimize implant position during the hip replacement procedure.

The preoperative evaluation is the first step in the hip replacement using OPS process. The second step is using the system during the procedure itself. During surgery, the 3-D model, which is unique to each patient, is combined with a laser guidance system. Surgeons match up the laser points to ensure the optimized plan is accurately recreated during surgery.

Need for OPS

The most common reason for needing hip replacement surgery with OPS is deterioration of the hip joint from arthritis. The most common type of arthritis is osteoarthritis, also known as “wear and tear” arthritis. Osteoarthritis generally develops with age. It’s estimated that more than 28 million Americans suffer from the disorder.

Osteoarthritis can develop in any joint in the body, but it most often affects weight-bearing joints such as knees and hips. The hip is one of the largest joints in the body, and like other joints, its surfaces are covered with a smooth cushioning material called articular cartilage. This cartilage enables the bones to slide over one another more easily.

Joints also contain another cushioning substance called synovial fluid. This fluid lubricates the joint cartilage and aids in movement. With osteoarthritis, the articular cartilage begins to wear away, and the synovial fluid begins to thin out. This results in the bones of the joint rubbing together without cushioning. Damaged bone may also start to grow. These resulting growths are called bone spurs.

All of the damage to the hip joint is degenerative; it gets worse over time. It also causes pain, swelling and other symptoms that get progressively more intense. Additional symptoms of osteoarthritis include tenderness around the hip, limited range of motion, a grating sensation with movement and difficulty walking.

The doctor can generally diagnose osteoarthritis through a complete history and physical exam. The doctor will confirm the findings with an x-ray of the patient’s hip.

Treatment for osteoarthritis generally begins with lifestyle modifications, such as switching from high-impact activities to lower-impact activities and losing weight. Other conservative treatments include doing physical therapy, using support such as a cane when walking and taking anti-inflammatory and/or pain medications.

If conservative treatments fail to relieve symptoms, the doctor may suggest surgery. Surgical options include hip resurfacing and total hip replacement.

Laser Specific

Nonsurgical procedure relieves pain and improves appearance of varicose veins.

Pittsburgh, Pennsylvania native Robert Vamos spent a career in the supply end of the automotive industry in Michigan before retiring in 2012 and relocating to Florida. Here, he started a new career in real estate. But showing properties became somewhat uncomfortable when he began experiencing numbness and aching in his feet and legs.

 Dr. Kai McGreevy of McGreevy NeuroHealth in St. Augustine treated Robert Vamos and Patti Adornetti for venous insufficiency and varicose veins.

Free of leg pain, Robert can walk Layla again

“I contracted a disease from Type 2 diabetes called Charcot foot syndrome, which is a type of neuropathy, or loss of sensation, in my legs and feet,” says Robert. “As a result, I lost the arch in my right foot. And for some reason, my legs always ached terribly after that.

“My podiatrist referred me to Dr. McGreevy, and he ran a bunch of tests on me. He determined that the nerves in my L4 and L5 lumbar vertebrae were pinched. I wasn’t having any pain in my back, just a little stiffness maybe, but Dr. McGreevy said the pinched nerves were contributing to the aching pain in my legs.”

Kai McGreevy, MD, is a board-certified neurologist and pain management specialist at McGreevy NeuroHealth in St. Augustine. Dr. McGreevy uses a variety of techniques to relieve his patients’ pain. For Robert, he recommended a nonsurgical procedure called radiofrequency ablation.

During radiofrequency ablation, radio waves are used to produce heat that is delivered through a probe to the target spinal nerves. In Robert’s case, the target was the nerves exiting the spinal cord near the vertebrae of his lower back. The heat from the probe creates a spot on the nerves that impedes the transmission of pain signals to the brain. This reduces discomfort from the affected area of the spine.

“Dr. McGreevy said he hoped to avoid surgery for me, and he wanted to try the radiofrequency procedure to put the pinched nerves to sleep,” confirms Robert. “He said the pain relief would last from six months to two years. For me, it lasted a year and a half. Just recently, my legs started hurting again, and he gave me a second radiofrequency treatment. Dr. Kai McGreevy of McGreevy NeuroHealth in St. Augustine treated Robert Vamos and Patti Adornetti for venous insufficiency and varicose veins.

“This time, however, he noticed a varicose bump on my right leg and didn’t like the way it looked. He said, I’ve done artery studies and nerve studies, so let’s do a vein study. He did and found that the veins in both of my legs weren’t working properly. He also detected swelling in my ankles, which he said would have been worse if I wasn’t swimming a mile every day.”

Leg veins are responsible for pumping blood upward, against gravity, toward the heart. They get help from the power of leg muscle contractions. To further assist with this task, there are a series of one-way valves in the leg veins that keep the blood from flowing in reverse.

“With age, heredity or long hours of sitting or standing, these valves can weaken, and blood can flow backward and collect in the legs and ankles, causing symptoms,” describes Dr. McGreevy. “This condition is called venous insufficiency.”

Venous Diagnosis

Venous insufficiency is a very common condition. It is estimated that more than 30 million Americans suffer with symptomatic venous insufficiency. Venous vascular disease is five times as prevalent as peripheral arterial disease, or PAD, and more than two times as prevalent as coronary artery disease.

Its symptoms include pain, aching, swelling, heaviness, nighttime cramps, restless legs, discoloration and, in later stages, skin ulceration, but it is “hugely underdiagnosed,” according to Dr. McGreevy.

“Many of its symptoms are invisible and misunderstood by patients,” the doctor notes. “In some cases, the condition is misdiagnosed by physicians, who attribute the signs and symptoms of venous disease to different disorders.”

Treating veins was a natural evolution for Dr. McGreevy. Many symptoms of venous insufficiency mimic those of other disorders, including neurologic problems. Dr. McGreevy often sees patients who come to him with “nerve” issues that turn out to be venous disease, so he is trained to treat vein issues and nerve conditions.

“Symptoms of venous insufficiency, the things that can be felt by the patient, can result in sensory changes such as numbness, tingling, weakness and fatigue,” he acknowledges. “These are all things patients describe to me every day when I examine them and do nerve conduction studies.

“These symptoms may appear neurologic at first glance, but there’s no perfect box they fit into, so I don’t make assumptions that they’re caused by nerve injury. If I test and discover these symptoms are not nerve related, they can be generated from multiple sources.

“If these symptoms are accompanied by visible signs such as swelling in the legs, I look at other possible sources. I have to rule out a cardiac condition such as heart failure, as well as a liver condition, protein imbalance and other disorders that can lead to leg swelling.

“In the absence of those sources, there’s a high index of suspicion for venous insufficiency, the treatments for which are generally covered by insurance. And not just for pain relief, but also for prevention because there are complications that can occur later in life that are very expensive to treat.”

After seeing some of the visible signs of venous insufficiency and learning that Robert was also experiencing aching and heaviness in his legs, Dr. McGreevy performed a Doppler venous ultrasound examination that allowed him to see the flow of blood from Robert’s legs toward his heart

 Dr. Kai McGreevy of McGreevy NeuroHealth in St. Augustine treated Robert Vamos and Patti Adornetti for venous insufficiency and varicose veins.

Robert Vamos

The simple, noninvasive exam revealed what Dr. McGreevy described as “significant reflux” in Robert’s legs. He then suggested that Robert undergo a procedure called endovenous laser ablation, or EVLA, in which the doctor introduces a sterile laser fiber into the problematic vein via a tiny puncture in the leg.

Laser energy is delivered through this fiber, gently collapsing and sealing the vein. Blood flow from the sealed vein then reroutes through other, healthy veins in the leg, which reduces the impact of venous insufficiency on the patient.

“It relieves the symptoms, including pain, swelling, fatigue, itching and weakness,” explains Dr. McGreevy. “It also improves the aesthetics of the legs, reducing any discoloration and breakdown of the skin, as well as the appearance of varicose and spider veins.”

Robert says he has a very strong will, and as a result, he refused to let any of the symptoms caused by his venous insufficiency alter his active lifestyle. As soon as the EVLA treatment was completed, however, he realized how easy it was to relieve the pain and discomfort associated with the disease.

“Dr. McGreevy did the procedure right in his office, and there was very little discomfort associated with it,” verifies Robert. “I could have walked right out of his office and gone to the golf course. I didn’t need to take any pain medication or anything like that. Afterward, I had to wear compression stockings for a couple of weeks, but that was it.”

“I Trust Him Wholeheartedly”

In 2015, Patti Adornetti was involved in a serious auto accident that left her badly injured and ended her career as a high production print specialist for Xerox® Corporation. The Cleveland, Ohio native suffered severe pain in her legs and back, which required surgery, and eventually, she turned to Dr. McGreevy for help with pain management.

“I’ve been Dr. McGreevy’s patient for going on two years,” relates Patti. “The doctor who performed my back surgery recommended him.”

 Dr. Kai McGreevy of McGreevy NeuroHealth in St. Augustine treated Robert Vamos and Patti Adornetti for venous insufficiency and varicose veins.

Patti has been relieved of both her back and leg pain.

During that two-year period, Dr. McGreevy used several pain management techniques to help keep Patti’s back pain at bay. At the same time, however, Patti was being bothered by another uncomfortable issue.

“Over the years, I developed pain in my legs, and about a year and a half ago, the varicose veins on my legs started to become more and more intense,” she states. “The discomfort was becoming intense as well.

“The pain was mostly a tired and achy feeling, but it became more of a stabbing pain at night, especially when I was trying to sleep. During the day, my legs ached and felt heavy, like their weight had doubled.

“As the pain got worse, I had to give up doing some of the activities I used to do routinely. It became difficult for me to do things I liked, including kayaking, walking and riding my bike.”

One day, while driving to McGreevy NeuroHealth for a pain management appointment, Patti saw a message about varicose veins, and it got her thinking. That day, as she talked with Dr. McGreevy, she casually said, “I want to do something about my varicose veins.” In response, the doctor explained that he treated vein concerns as well as nerve disorders.

“It was just a coincidence,” comments Patti. “I only said something because I saw that message. After he told me he did vein treatment as well, I told him, Good. I’ll have you take care of my veins, because I trust him wholeheartedly.”

Just as he did with Robert, Dr. McGreevy began his treatment of Patti’s veins with an ultrasound examination. The examination revealed that Patti, too, was suffering from significant reflux in her superficial veins and was therefore a good candidate for EVLA.

“At the time of the procedure, the technologist did the preparation, such as numbing the area, and then Dr. McGreevy stepped in and took care of the veins,” Patti reports. “He used a laser to treat the veins and relieve the pain. Dr. Kai McGreevy of McGreevy NeuroHealth in St. Augustine treated Robert Vamos and Patti Adornetti for venous insufficiency and varicose veins.

“The procedure wasn’t bad at all. The worst part of it was when they numbed me because they had to give me several shots to numb the area around the veins. I couldn’t even feel it when Dr. McGreevy came in and did his part. I didn’t feel any real pain after the treatment, either.”

Robert and Patti were already seeing Dr. McGreevy for pain management when their venous insufficiency was detected. In Robert’s case, the aching pain in his legs had two contributing factors – his varicose veins and the pinched nerves in his back.
Dr. McGreevy treated both factors, and Robert responded positively. His pain was alleviated, and the swelling in his legs dissipated.

I feel great right now,” he enthuses. “I no longer have any of that aching pain in my legs. I achieved really good results. But, I had both the radiofrequency ablation and my veins treated at the same time, so if you ask me which one helped me more, I couldn’t tell you. I just know the combination of the two really helped.

“Dr. McGreevy told me the radiofrequency ablation can be repeated if necessary, but the results of the vein treatment will last forever. I go back in another week, and Dr. McGreevy will perform another ultrasound of my legs to be sure the veins are no longer leaking.”

Back on Track

The EVLA was a success for Patti as well. She reports that her legs feel good since the treatment. She’s also very pleased with the aesthetic results she’s achieved so far, and Dr. McGreevy told her it will only get better. He said it will take about a year for her legs to be completely healed and functioning optimally.

 Dr. Kai McGreevy of McGreevy NeuroHealth in St. Augustine treated Robert Vamos and Patti Adornetti for venous insufficiency and varicose veins.

Patti Adornetti

“My legs look great,” she marvels. “My right leg had very big, bulging veins, and they’re completely gone. There are no varicose veins in my right leg at all. My left leg had bad veins, as well. There are still a few little pieces of vein visible on my left leg, but they will eventually work their way out once everything has properly healed.

“The pain is phenomenally better than it was before,” she raves. “I would say it’s about a two out of ten now, when it used to be seven or eight.”

With Dr. McGreevy managing her back pain and since achieving relief from the achiness of her varicose veins, Patti’s been able to return to her active lifestyle. She’s thrilled because she likes to stay active for fun and fitness.

“I’m back to doing the activities I had to stop doing before,” she confirms. “Now, I’m finding it easier to walk and bike again.”

Both Robert and Patti are impressed by Dr. McGreevy and his staff at McGreevy NeuroHealth. They find the neurologist to be knowledgeable, kind, understanding and worthy of their trust.

“Dr. McGreevy is a wonderful doctor,” states Robert. “He’s very gentle, and he explains everything he’s doing as he goes along. He’s a pain specialist, and as people get older, a lot of us get different kinds of pain in our bodies that Dr. McGreevy can treat. I recommend him to anybody, and I already have to numerous people.”

“Everybody at McGreevy NeuroHealth is great,” notes Patti. “I think Dr. McGreevy is a fantastic doctor. He listens to me. Of all the doctors I’ve been to over the years, he’s definitely one of the best. I wouldn’t have gone to another doctor. Dr. McGreevy is definitely the only doctor I would let touch my legs. He’s a great physician, and I recommend him one hundred percent!”

Three Shots and You’re Out … of Pain!

Series of injections alleviates agony of pinched spinal nerves.

Patricia Dougherty had friends living in St. Augustine, and visiting them occasionally was all she needed to fall in love with the city. So, when she retired from her investment relations job in New York City, she knew exactly where to go. In Florida, Patricia enjoyed her retirement until a mishap occurred six months ago.

: Dr. Kai McGreevy of McGreevy NeuroHealth in St. Augustine treated the pain in Patricia Dougherty’s low back radiating into her right leg using transforaminal epidural steroid injections (TFESI).

Patricia Dougherty

“It was very strange,” she recalls. “I was going to the gym three days a week, playing tennis and having a wonderful life. Then, I went to bed one night, woke up the next morning and could barely walk. I had no idea what happened. I didn’t know if I did something to my back in my sleep, or if it was something that had built up over time.

“I was in excruciating pain, and it radiated down my right leg and into my ankle. On a scale of one to ten, the pain hovered between an eight and a ten. I couldn’t do anything. Just walking around my house was painful, and I couldn’t stand for any length of time. At night, my ankle would throb, so I wasn’t getting much sleep either.

“At the beginning of the year, I was scheduled to start volunteering at the museum downtown, but I couldn’t do it because of the pain. I had to put those plans on hold. The only time I didn’t have pain was when I lay on the couch with my leg up. It was a very difficult time, not the way I planned on spending my retirement.”

Looking for answers, Patricia went to an orthopedic surgeon, who ordered x-rays and an MRI. He diagnosed a herniated disc. To treat it, the doctor gave Patricia several epidural injections into her back and sent her for physical therapy.

“The therapy helped a little,” she reports. “When I went back to the orthopedic doctor, I told him I had some relief, but it wasn’t enough. I still couldn’t function. He thought I might need another level of treatment, so he referred me to Dr. McGreevy.”

Kai McGreevy, MD, is a board-certified pain management specialist at McGreevy NeuroHealth. Dr. McGreevy has a variety of advanced therapies at his disposal to treat pain, especially that associated with nerve disorders. He suspected Patricia’s intense pain was caused by pressure on the spinal nerves at the site of the herniated disc.

“Patricia’s pain continued to get worse after conservative measures,” notes Dr. McGreevy. “Those included physical therapy, anti-inflammatory medications, heat and ice, and a home exercise program. Patricia’s pain worsened to the point where she was experiencing numbness and tingling in her leg. These facts pointed to nerve involvement.”

Distinctive Technique

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 with 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. That is what happened to Patricia, observes Dr. McGreevy.

“After an evaluation, Patricia’s orthopedic surgeon determined that she had degenerative disc disease and a herniation at one site on her spine,” he describes. “When I reviewed the MRI, I saw that the leaking disc material was threatening the nerve root at L4/5 in her lower back, and this was most likely the cause of her pain.

“I followed up with a nerve conduction study that confirmed Patricia had not only a chronic injury, but also an acute-on-chronic injury, meaning she has an ongoing and a recent injury to the surface of the nerve root. Something had to be done quickly to help repair that nerve root. Otherwise, it could lead to serious problems with movement in her right leg.”

To repair Patricia’s nerve root and relieve her pain, Dr. McGreevy suggested a series of three specialized injections called transforaminal epidural steroid injections. These minimally invasive injections are very 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,” informs the doctor. “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.

: Dr. Kai McGreevy of McGreevy NeuroHealth in St. Augustine treated the pain in Patricia Dougherty’s low back radiating into her right leg using transforaminal epidural steroid injections (TFESI).

Patricia says the steroid injections worked great for her.

“Transforaminal is a technical approach to the target nerve. With the classic epidural, the labor or interlaminar epidural, the needle is positioned right at 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, however, enables the physician to safely position the needle slightly off midline so the area injected is closer to the site of the injury. This approach also minimizes the risk of a common complication of interlaminar epidurals called postdural puncture headaches. At the same time, it produces improved outcomes for patients with nerve root inflammation. Dr. McGreevy is specially trained in this approach.

Fading Memory

Now that Patricia has completed her transforaminal epidural steroid injections, she understands why the treatment is done as a series of three shots. Because she was patient and went through all three, she’s sleeping again and back to most of her activities.

“The results of the injections appear progressively,” she relates. “By the third shot, I had considerable relief. Now, I’m back to the gym three days a week, and I volunteer at the museum one day a week. I can now stand and walk for hours.

“I’m still afraid to play tennis, but that’s just me. Playing tennis was the last thing I did before this back thing happened, so psychologically, I’m not ready to get back to it.”

Patricia remembers when her pain level topped the scale of one to ten, but since her injection therapy, that memory is starting to fade. Her level of pain since completing the treatment barely registers on the scale.

“My pain now is between zero and one,” she says. “I might get a little pain, but that’s really only when I push myself too hard during exercise. Dr. McGreevy told me to be careful. I needed to get back to my normal routine slowly.

“When I start feeling good, I think I’m fine, then I get a little twinge and realize, Maybe I’m not one hundred percent yet, but I’m ninety-nine percent.”

Grateful for her recovery, Patricia lauds the pain management specialist and his staff for their knowledge and sensitivity. She says she knew she was in good hands during her initial appointment at McGreevy NeuroHealth, where she was wowed by Dr. McGreevy’s approach to her situation.

“I was so impressed by Dr. McGreevy’s thoughtfulness,” she states. “Not just thoughtful in being kind, but thoughtful in thinking through my issue, what other factors might be involved and what he could do about it. He approached my case in a very methodical, thoughtful way, and I appreciated that. Plus, he listened to me. I felt heard.”

Patricia also praises the staff at McGreevy NeuroHealth for making her visits positive and productive.

“The steroid injections worked great for me,” she shares. “I’ve already told a few of my friends with back issues about McGreevy NeuroHealth.

“Dr. McGreevy has a good staff around him. Everybody at McGreevy NeuroHealth knows what they’re doing and does it well. They also treat people well. They’re all very kind and understanding. The people who go to that office are in pain and need a little comfort, and the staff is very caring. I absolutely recommend them.”

Page 1 of 21
1 2 3 4 5 6 21