Author Archive

Anxiety Amid COVID-19

April 3rd, 2020

A national survey conducted March 18 and 19 by the American Psychiatric Association (APA) showed that the COVID-19 pandemic is significantly affecting the nation’s mental health. In the survey, half of US adults reported high levels of anxiety.

Among the survey respondents, 48 percent reported feeling anxious about the possibility of contracting COVID-19 themselves, and 40 percent said they were anxious about becoming seriously ill or dying from the virus. In addition, 62 percent reported being anxious about the possibility of a loved one contracting the illness.

The president of the APA, Bruce J. Schwartz, MD, suggests that this level of anxiety is appropriate given the current circumstances in this country. But he warns that the rate of mental distress in America could surge if the COVID-19 crises continues much longer.

It’s the uncertainty surrounding the COVID-19 pandemic that can cause the physical, emotional and mental reactions in people. If you have a high level of anxiety, you may experience feelings such as anger, rage, confusion, helplessness, sadness, depression and guilt. Other symptoms of anxiety that may occur include:

  • Tenseness or nervousness
  • Constant exhaustion
  • Difficulty sleeping
  • Difficulty concentrating
  • Increased heart rate
  • Stomach upset
  • Constant crying
  • Isolation
  • Heavy use of alcohol and/or drugs

When these feelings don’t go away after a few weeks or get worse, it may be a good idea to seek professional help. Seek help from a trained professional if you or a loved one is unable to return to a normal routine, feel helpless, have thoughts of hurting yourself or others, or begin to use alcohol and drugs to excess.

People with pre-existing mental health conditions are especially vulnerable to stress and anxiety during crisis situations. During this current COVID-19 crisis, these individuals should continue with their treatment and be aware of new or worsening symptoms.

Here’s one example of worsening symptoms. A British charity for people with obsessive-compulsive disorder reports that it has received an increase in calls and emails from people with the disorder who were developing a new fixation on the coronavirus.

For help coping during these anxious times, try these tips, courtesy of HelpGuide article Coronavirus Anxiety:

  • Stay informed, but don’t obsess —  It’s important to check the news to stay informed about what’s going on, especially as circumstances change daily. You need to follow the news to know what to do to stay safe and help slow the spread of the virus. But there’s a lot of misinformation circulating and sensational reporting can fuel anxiety and fear, so be discerning about what and how much you read and watch.
  • Focus on things you can control – There are many things out of your control right now such as how long this crisis will last and how others will respond to it. Focusing on questions without clear answers will make you feel drained, anxious and overwhelmed. Try focusing on things you can control, such as following the recommended steps for preventing the spread of the virus.
  • Plan for what you can do – If you’re worried about your workplace closing, your children being home from school, having to self-quarantine or about a loved one getting sick, make note of these worries. Then, make a list of possible solutions and draw up an action plan. Concentrate your efforts on problems you can solve.
  • Stay connected – It’s been shown that social distancing is helping to curb the spread of the coronavirus, but being physically isolated can add to stress and anxiety. Make it a priority to stay in touch with family and friends. Schedule regular phone calls or chat via video or Skype. Connect with family and friends via social media. But don’t let the coronavirus dominate every conversation.
  • Take care of your body and spirit – The rules of staying healthy are especially important during times like these. Be sure to eat healthy, get plenty of sleep and exercise regularly. Practice a stress-relieving technique such as yoga, deep breathing or meditation to help keep stress at a minimum. Be kind to yourself if you’re experiencing more depression and anxiety than usual. Take time out for activities you enjoy, and try to maintain a normal routine while you’re stuck at home.
  • Help others – Focusing on others in need supports your community, and this is especially true in times of crisis. People who focus on others tend to be happier and healthier than those who act selfishly. Focusing on others can also make a positive impact on your mental health. Doing kind and helpful acts for others can help you regain a sense of control over your life and add meaning and purpose.

Remember, we’re all in this together!

Hot Shots

Intravitreal injections halt vision loss from diabetic retinopathy.

Roland Bavota, 72, dreamed of becoming a French chef. So, once he retired from his marine engineering job at Sun Oil Company, he headed directly to Tampa Bay Cooking Academy in St. Petersburg for four years of culinary training. Roland had big aspirations for that training.

Photo by Jordan Pysz.

Roland Bavota

“My plan was to open a restaurant,” he divulges. “But at the time, I was fifty-eight years old, and I realized that the restaurant business was more for younger men. It requires a great deal of time on your feet. So now, I just cook for family and friends. I make pretty good meals at home, which makes my wife happy.”

It was a brief stint as an assistant chef that keyed Roland into the rigors of restaurant work. He could have continued in that position full-time, which would have involved extensive traveling, but the demands of the job discouraged him, and family responsibilities took precedence.

“Right after I graduated from culinary school, I worked for Cirque du Soleil® for eight weeks as a trial to see how things work in a real kitchen,” Roland recounts. “They offered me a regular position, but I turned it down. I remember thinking, Here I am, fifty-eight years old with an opportunity to run away with the circus, but my wife won’t let me!

Roland, who is a Vietnam veteran, relocated from his native Baltimore, Maryland to Inverness in 2003. When he began having trouble with his vision two years ago, he visited the eye clinic at The Villages VA Clinic. Doctors there told Roland that he had diabetic retinopathy and required specialized care.

Stock photo from retinopathy is a complication of diabetes that affects the eyes. It’s caused by damage to the microcirculation of the retina from consistently high levels of glucose (sugar) in the bloodstream. The microaneurysms associated with diabetic retinopathy can leak fluid into the back of the eye, which can lead to vision loss, a condition known as diabetic macular edema, or DME.

“At that time, I was having difficulty seeing the crossword puzzle,” Roland recalls. “The little boxes in the puzzle, for instance, I couldn’t see the entire box. Some of the lines were missing. And I couldn’t make out the numbers inside the boxes. They were blurry. I couldn’t tell if it was a six, five or eight.

“I thought I simply needed a new prescription for my glasses, but the doctor at the eye clinic said, You’ve got some swelling in the back of your eyes from your diabetes. That’s not something we treat at the VA. They recommended an outside facility. It was Florida Retina Institute.”

The doctor at the VA eye clinic told Roland that his diabetic retinopathy would need to be treated. When Roland arrived at Florida Retina Institute, Matthew A. Cunningham, MD, a board-certified, fellowship-trained retina specialist, told Roland that the swelling in his retina could be treated with intravitreal injections.

“Like many patients with diabetic retinopathy, Roland came to us experiencing a decrease in his vision,” Dr. Cunningham remembers. “Upon examination, we discovered that he had DME, which is an accumulation of fluid in the central part of the retina. DME is the leading cause of vision loss from diabetic retinopathy.

“After performing some ancillary testing and discussing treatment options with Roland, we started him on a series of monthly intravitreal injections in both eyes. The aim of the injections is to decrease the swelling and leakage of the blood vessels near the center of the retina.”

A New Standard

The retina, which is the thin layer of tissue located at the back of the eye, functions like the film in a camera, Dr. Cunningham points out. It takes light that comes in through the lens and turns it into messages that are sent via the optic nerve to the brain, where the images are developed. Without a normal film in the camera to translate the light, the images can be distorted or blurred.

“The retina has multiple layers, and at its center is the macula,” Dr. Cunningham informs. “The macula is responsible for central vision acuity and color vision. A decrease in central vision causes problems with common daily functions such as reading and driving.

“When the macula is affected by DME, as was the case with Roland, people typically present with central vision loss or blurring of their central vision. There was a time when we solely used laser in the treatment for DME. But treatment for DME has changed over the years.

“Now, intravitreal injections are the standard of care. For those injections, we can use steroids or a class of medications called anti-vascular endothelial growth factor, or anti-VEGF. These injections have been found to work extremely efficiently to not only improve DME, but also to improve vision in patients who have DME.”

“Using the injections, my vision is excellent. I can see with no trouble at all. All the blurriness is gone.” – Roland

Retina specialists at Florida Retina Institute typically begin treatment of diabetic retinopathy and DME with anti-VEGF injections, and there are several anti-VEGF medications to choose from. If patients continue to experience leakage with anti-VEGF medications, the retina specialist generally switches to intravitreal steroids.

“When injecting steroids, we often use a steroid medication in the form of a pellet, called OZURDEX®,” Dr. Cunningham describes. “We implant the OZURDEX pellet in the vitreous cavity, and it lasts for three months. And just like we do with anti-VEGF injections, we implant the OZURDEX pellet in the office after we fully numb the patient’s eye, so it is a painless procedure.”

Despite the use of a numbing agent on his eyes, Roland says he was “freaked out” by the idea of Dr. Cunningham sticking a needle into his eyes. But he quickly adds that his fears were soon eased by Dr. Cunningham’s professionalism and manner.

“Dr. Cunningham has a certain way about him,” Roland says. “He had a comforting demeanor when he explained exactly what the injections were and what happens during the injection procedure. With his encouragement, I began injection therapy that same day.”

In keeping with Florida Retina Institute’s usual treatment protocol, Dr. Cunningham began Roland’s injection therapy with anti-VEGF injections. But Roland’s right eye did not respond to the various anti-VEGF injections, so Dr. Cunningham soon switched to OZURDEX injections in that eye.

Photo by Jordan Pysz.

Injection therapy has greatly improved Roland’s vision

“When Dr. Cunningham performs the pellet procedure, he does the injection from the side of the eye, then turns the needle and places the pellet,” Roland explains. “He told me that without the pellets, my right eye would leak.”

“My Vision Is Excellent”

Roland has been seeing Dr. Cunningham for injection therapy for close to two years now. He receives the injections every five to six weeks, and the combination of anti-VEGF injections and steroid pellets has worked wonders for him. Not only has his vision loss been halted, his vision has also improved with treatment.

“Using the injections, my vision is excellent. I can see with no trouble at all,” Roland raves. “All the blurriness is gone. I play guitar and drive a motorcycle, so my eyesight is very important to me. I need clear vision to see the road and read the music.

“I still wear glasses, but my vision is fine, so I can do the crossword puzzle with no problem. I have no trouble seeing the boxes and numbers now. I do a crossword puzzle every morning as a brain exercise.”

Roland is grateful to Dr. Cunningham for the exceptional outcome of his treatment. He has a high regard for the retina specialist.

“Dr. Cunningham is very knowledgeable, and his skill set is top-of-the-line,” Roland says. “He not only treats my symptoms and problems, he also treats my entire psyche, which calms me down. He treats my feelings and anxieties and goes through the entire treatment process with me. He makes me feel comfortable, important and special. It’s great to find that in a doctor.

“Dr. Cunningham told me that diabetic retinopathy is not something that heals, so I imagine I’ll be getting injections forever. But I couldn’t get any better care than what I get from Dr. Cunningham. He really cares about his patients. I absolutely recommend Dr. Cunningham and Florida Retina Institute.”

Visual Trifecta

New trifocal lens frees sheriff’s deputy from glasses.

In July 1979, six weeks after graduating high school, Milo Millovitch entered the United States Air Force. At the time, Milo planned to stay in the service four years, then move on. But he wound up devoting nearly 24 years to the military.

Photo by Jordan Pysz.

Milo Millovitch

“While in the service, I worked as an Air Force firefighter,” Milo shares. “It’s the same as a civilian firefighter except we fight fires on the different aircraft in a base’s inventory, anything from fighter jets to bombers to cargo planes to helicopters. The aircraft involved depended on where I was stationed.”

While still on active duty, Milo joined the Hillsborough County Sheriff’s Office as a reserve deputy. He enjoyed that immensely, so he put himself through eight months of part-time academy at Hillsborough Community College. Upon graduation, he took the state law enforcement exam and passed.

“I had already submitted my application to Hillsborough County, and shortly after I retired from the Air Force, I was accepted for employment as a patrol deputy with the sheriff’s office,” Milo recounts. “I’ve been with them for going on seventeen years now.”

To assist Milo in performing his job duties, his patrol vehicle is equipped with sophisticated technology, including a state-of-the-art computer. It’s through this computer that Milo is dispatched to his service calls, and information about those calls is updated.

“I look at that computer constantly,” Milo reports. “Typically, I wear sunglasses, but I was noticing that if I wanted to look down at the computer screen or view something detailed, I had to put my sunglasses on my head and put on reading glasses. Without the glasses, the computer, books, newspapers, anything up close was blurry.

“I was overdue for an eye exam, so I made an appointment at Florida Eye Specialists and Cataract Institute. They told me my eyesight had diminished a little, which was normal with age. I asked if I qualified for LASIK® laser surgery, and they said I did. They set me up for an appointment with Dr. Mathews.”

Priya M. Mathews, MD, is a board-certified, fellowship-trained cornea specialist and cataract and refractive surgeon at Florida Eye Specialists & Cataract Institute. Dr. Mathews performed a thorough examination of Milo’s eyes and reported her findings.

“Dr. Mathews said, I have good news and bad news,” Milo recalls. “She said, The good news is you would potentially qualify for LASIK. The bad news is you have cataracts. I didn’t see that coming. Beside the slight reduction in my vision, everything looked pretty normal. I just had to use reading glasses. But I did notice that at night, some objects had a fuzzy edge to them.”

Clouds in the Eye

“Cataracts are the gradual discoloration or clouding of the eye’s natural lens,” explains Gregory L. Henderson, MD, founder of Florida Eye Specialists & Cataract Institute. “A good way to describe a cataract is in comparison to a window made of clear, thick,
flexible plastic.

“As the elements take their toll on the plastic, it becomes discolored, distorting the images that can be seen through it. Eventually, the plastic becomes so discolored that it’s impossible to see anything through it. A cataract develops in
much the same way.”

“Today, I have the eyesight I had when I was eighteen. And I’m fifty-eight now, so I’m very happy with the outcome of my cataract surgery.” – Milo

“People with cataracts might experience murky or blurry vision,” adds Ana-Maria Oliva, MD, a board-certified ophthalmologist and corneal and refractive surgeon at Florida Eye Specialists & Cataract Institute. “They might notice more glare than usual, especially at night, with halos or starbursts around car headlights and lamps.

“In addition, colors may seem faded or have a yellowish or brownish tint to them. Reading may also become more difficult, as it becomes harder to distinguish the contrast between the letters on the page and the background. Frequent prescription changes to eyeglasses or contact lenses might also signal the presence of cataracts.”

“Fortunately, surgery to replace the clouded, natural lens with a clear, synthetic lens relieves these vision issues,” Dr. Henderson assures.

Dr. Mathews explained to Milo that his decreased vision and fuzzy edges were the result of his cataracts. She told him she could perform cataract surgery using a standard monofocal lens, which corrects for one particular distance, but he would still need glasses to see either close up or far away.

“I told her that I really wanted to get away from glasses, period,” Milo states. “That’s when she told me about a new multifocal lens that just came out. She gave me information about the lens, and I ultimately said, That’s what I want to do.

Popular Choice

The cataract surgeons at Florida Eye Specialists & Cataract Institute use the most advanced technology available to provide patients the best opportunity for a superior outcome from their cataract surgery. An example of this technology is the PanOptix® trifocal lens by Alcon.

“The PanOptix trifocal intraocular lens became available in the United States in late 2019, and it is the only trifocal lens approved for use in the US,” Dr. Mathews relates. “It has quickly become a popular lens choice because it virtually eliminates the need for glasses following cataract surgery.

“People today have more active lifestyles and use their computers and smart phones with greater frequency. They want to be able to see at all distances following cataract surgery, and they do not want the hassle of glasses.

“The PanOptix trifocal lens gives people . . . near, intermediate and distance vision, eliminating the need for spectacles.” – Dr. Mathews

“The PanOptix trifocal lens gives people that luxury because it gives them near, intermediate and distance vision, eliminating the need for spectacles. The PanOptix uses different locations on the lens, called the optic, to enable clear vision at these three different focal points.

“To qualify for the PanOptix lens, patients must have otherwise healthy eyes and no significant irregularities of the cornea or retina. Patients with eye diseases such as macular degeneration are not candidates for this lens. It is primarily for individuals who live active lifestyles and really want to see at multiple distances without glasses following cataract surgery.”

People with small abnormalities of the cornea such as astigmatism may be candidates for the PanOptix because it also comes in a Toric lens. Toric lenses correct astigmatism.

“With astigmatism, the cornea is more oval shaped like a football rather than round like a basketball,” describes Dilip “Dr. Samy” Rathinasamy, MD, a board-certified ophthalmologist at Florida Eye Specialists & Cataract Institute. “This irregular shape typically results in blurred or impaired vision at any distance, which can also lead to headaches.

“Toric lenses work to correct astigmatism because they have different strengths in different parts of the lens. These different strengths make up for the asymmetric power of the misshapen cornea that is characteristic of astigmatism.”

“With astigmatism, one axis of the cornea is steeper than the other,” Dr. Mathews adds. “Toric lenses must be specifically oriented in the exact axis where the astigmatism is located. Extensive preoperative testing assists the surgeon in placing the Toric lens at the exact same axis as the astigmatism.

“Once preoperative decisions are made and it has been determined that the patient is a good candidate for the PanOptix lens, placing the lens is pretty straightforward. The PanOptix, whether it’s a general trifocal or a Toric lens, is implanted the same way as any other lens. Implanting the Toric has one extra step of aligning the lens at the exact axis of astigmatism. but it does not make cataract surgery more difficult in any way.”

Photo by Jordan Pysz.

Milo says he made the “right decision” in choosing the PanOptix lens.

Spotlight on Brightness

Dr. Mathews performed cataract surgery on Milo’s right eye first, on December 30. Surgery on his left eye was performed two weeks later, on January 16. But Milo noticed a significant improvement in his vision after the initial surgery on his right eye.

“That night, it was like somebody turned on an LED spotlight because everything was much brighter,” Milo reports. “If I covered my left eye, everything looked bright. But if I covered my right eye and just looked through my left, it was like somebody pulled down a shade. There was a shadow over everything in the room.

“Once I had the second eye done, my vision became even brighter. I think initially, my right eye compensated for my left eye, so everything seemed bright. But once I had surgery on both eyes, everything really came into focus, and my vision improved tremendously.

“Today, I have the eyesight I had when I was eighteen. And I’m fifty-eight now, so I’m very happy with the outcome of my cataract surgery.”

When Milo’s journey began, he didn’t know he had cataracts, nor did he realize how they were dulling his vision. But choosing to undergo cataract surgery with the PanOptix lens turned out to be a good decision for him.

“I’m very happy with my decision,” Milo confirms. “Between cataract surgery and the trifocal lens, I can read again and look at my computer screen without having to put on glasses. I’ve gathered up all my glasses and donated them, so hopefully, somebody else can benefit from them. But I’m glasses free.

“Since surgery, my eyesight has improved one hundred percent. I’m ecstatic with my vision now. The procedure by Dr. Mathews was time and money well spent.”

Double Play

Microstent for glaucoma treatment safe and effective.

Until 2016, young men and women vying for entrance into the University of Central Florida College of Medicine in Orlando had to go through Ronald Portervint. The Missoula, Montana, native worked in the school’s admissions office, where he processed all relevant data on applicants for the admissions committee’s review. Ronald retired in August 2016.

Photo by Jordan Pysz.

Ronald is seeing glasses-free following
cataract surgery.

“My job was to gather all the information so that the committee, which includes medical doctors and PhDs, could get an idea of what the applicants were like,” Ronald explains. “The information also helped the committee determine what questions to ask the applicants in their interviews.

“Mostly, the committee looked for people who were not only knowledgeable but dedicated to the medical field, people who genuinely wanted to help people and were not motivated solely by financial gain.

“When I first started fifteen years ago, there weren’t so many students applying to the medical school. But by the end of my career, there were more than five thousand applicants each year for one hundred and twenty available slots, so admissions was quite a process.”

Shortly before retiring, Ronald began getting his annual eye exam at Brandon Eye Associates. At the time, he became a patient of Amy Martino, MD, a board-certified, fellowship-trained eye surgeon who discovered during a routine exam that he had two eye disorders, glaucoma and cataracts.

Cataracts are the clouding of the eye’s natural lens. Treatment involves surgery to remove the affected natural lens and the replacement of that lens with a clear, synthetic lens implant.

Glaucoma is characterized by increasing eye pressure due to a build-up of fluid. The most common form is open-angle glaucoma, which occurs when the eye’s drainage system becomes blocked.

“When I first saw him, Ronald had very high eye pressure, measuring in the thirties,” Dr. Martino reports. “Normal is twenty-one or less, so I started him on pressure-lowering eye drops. But over the years, the medications either became ineffective or he became allergic to them, so it became necessary to change the medications to stronger ones to try to control his pressure.

“Then, about three months ago, we decided to proceed with cataract surgery to improve his vision and to treat his glaucoma by implanting stents to lower his eye pressure. The stent I chose for Ronald was the Hydrus® Microstent. It is FDA approved for patients with mild to moderate primary open-angle glaucoma who are also undergoing cataract surgery.”

Drain Opener

Healthy eyes constantly produce a fluid called aqueous humor that flows across the front of the eye. The eyes also drain this fluid through specialized tissue called the trabecular meshwork and through the eye’s natural drain, Schlemm’s canal. This canal is located at the angle where the iris, the colored part of the eye, meets the white of the eye, or sclera.

“With glaucoma, Schlemm’s canal is typically clogged and not working properly, so fluid accumulates in the eye, causing pressure to increase,” Dr. Martino explains. “Consistently high eye pressure damages the optic nerve, which can cause a slow, permanent loss of vision over time.”

The Hydrus Microstent is designed to treat the clogging of the canal and reduce the pressure that can damage the optic nerve. It is inserted during a procedure that’s in a class of relatively new and less invasive glaucoma surgeries called microincisional glaucoma surgery, or MIGS. During surgery the Hydrus Microstent is implanted into the Schlemm’s canal to help improve outflow of fluid in the eye, thereby lowering pressure.

“The Hydrus was approved for use in the United States about two years ago, and I was the first surgeon in Hillsborough County to implant it,” Dr. Martino reports. ”It is very safe. Implanting it at the time of cataract surgery does not pose any additional risks over cataract surgery alone.

“It is also effective. The Hydrus lowers eye pressure and enables patients to get off of their glaucoma eye drops in eighty percent of cases. It is more effective than the other, similar devices available, and it’s easy to implant for surgeons like me who are comfortable working in the angle of the eye.”

The mechanism of action of the Hydrus Microstent is similar to that of a cardiac stent. If there’s a blockage in a coronary artery of the heart, cardiologists place a stent, which expands in the artery, opens up the blocked blood vessel and improves blood flow. In much the same way, the Hydrus Microstent opens up the clogged Schlemm’s canal and improves fluid drainage from the eye.

“Using the Hydrus was quite effective for Ronald,” Dr. Martino notes. “At his most recent follow-up appointment, his eye pressure measured around ten to twelve, and it was in the thirties before surgery. In addition, he was using two different glaucoma eye drops before surgery. Now, he uses no eye drops.”

“Surgery with the stents reduced my eye pressure tremendously,” Ronald verifies. “Before surgery, my pressure was very high. The week after surgery, it was twelve.”

Goodbye to Glasses

Prior to undergoing cataract surgery, Ronald did not notice that he was experiencing any of the symptoms most commonly associated with cataracts, which include glared or blurred vision, especially at night.

Ivantis Hydrus

The Hydrus Microstent by Ivantis (left)
is tiny compared to a dime

“But after I had the cataract surgery on my first eye, my vision brightened substantially, and I realized there had been a yellowish haze over everything!” Ronald exclaims. “I had that first surgery on December 4 and the second one, on my right eye, December 18.”

For Ronald, one of the biggest benefits of having cataract surgery was that it allowed him to become glasses-free. Saying goodbye to glasses was a satisfying outcome for a man who wore them for more than 30 years.

“Since my surgery, my vision is good, very good,” Ronald enthuses. “I can read everything and see pretty well at a distance without glasses. I don’t need them at all.”

To better control his glaucoma, the stents were placed in Ronald’s eyes at the same time he had the cataract surgeries. Robert remains concerned about his eye pressure and the future of his vision, but Dr. Martino always puts him at ease.

“Dr. Martino is very knowledgeable, and she’s concerned about more than the health of my eyes,” he says. “She cares about my overall health as well. She’s very professional and always treats me well. I certainly recommend Dr. Martino and Brandon Eye Associates to anyone with eye problems like mine.”

Easy Transition

Loyal patient extols benefits of concierge medicine.

David Harb, 52, is general manager for the entertainment company Live Nation North Florida. His main responsibility is to oversee the operation of the MIDFLORIDA Credit Union Amphitheatre in Tampa.

Photo by Jordan Pysz

David Harb

“It’s my job to make sure the facility functions smoothly during shows and events,” David describes. “I also ensure that the building is properly maintained.”

David’s been seeing the same primary care provider for more than 25 years. His mother worked for the physician as a nurse and recommended him. David’s doctor is Michael A. Zimmer, MD, a board-certified internist at Zimmer Medical Services in St. Petersburg.

Dr. Zimmer practices concierge medicine, a practice model in which physicians see fewer patients, which allows them to spend more time with their patients. David was happy to transition to Dr. Zimmer’s concierge practice.

“The personal care is what I like most about concierge medicine,” David states. “Dr. Zimmer really takes care of his patients and makes things happen. He took good care of me when I suffered nerve problems in my neck. He got me in to see the right specialists very quickly, and he made the process easy.”

Under the traditional model of care, internists often see 25 to 30 patients a day, which gives them little time to spend with each patient during a scheduled appointment. It isn’t enough to really examine them and talk about their symptoms and health needs, Dr. Zimmer observes.

“When you have that many people to care for, you have little time available to discuss the details related to their care,” the internist confirms. “Internal medicine physicians nationwide typically have fifteen-minute blocks to follow up with patients. It is very difficult to do a comprehensive evaluation of all the patients’ complex issues.”

The concierge model of care, on the other hand, is based on a limited membership, so physicians have fewer patients to see, allowing them to spend more time with each patient.
“With fewer patients, doctors can provide each patient with longer visits to address all their different health issues and answer all the questions they have regarding their care,” Dr. Zimmer elaborates.

“Physicians make themselves available to members of the practice not only through extended office visits, but also by email and telephone. They are also available after hours at night and on weekends and see patients according to their medical needs.”

“One thing that impresses me most about Dr. Zimmer is his incredible attention to detail,” David says. “And he follows up and makes sure his patients are doing okay. It makes me feel like I’m being well taken care of, and that’s a nice feeling to get from a doctor.

“The results of the treatment on my neck were great. I underwent surgery and feel much better.

Dr. Zimmer made the right decisions for me. I trust him with my health and my life. That’s why I’ve stayed with him all these years.”

The CBD Story

March 23rd, 2020

It seems like everywhere you look these days, there are ads for products containing CBD. I get emails almost every day hawking these products. But what do we really know about CBD and how does it work? Here’s a little overview of what I’ve learned about it, and it just touches the surface of the CBD story.

CBD, an abbreviation for cannabidiol, is one of the major active ingredients of cannabis, essentially marijuana. CBD is a vital constituent of medical marijuana, but it’s actually derived from the hemp plant, a close relative of the marijuana plant. Unlike its common co-ingredient tetrahydrocannabinol (THC), CBD doesn’t cause a “high.” CBD and THC are called cannabinoids.

In recent years, CBD has been reported to have beneficial effects on a wide variety of health disorders, including epilepsy, Parkinson’s disease, post-traumatic stress disorder, anxiety and chronic pain. Researchers are still studying CBD’s exact method of action on the body, but one thing they’ve uncovered is its effect on the body’s natural endocannabinoid system (ECS).

The ECS is a complex cell-signaling system in the body. It plays a role in regulating a range of functions and processes including sleep, mood, appetite, memory, and reproduction and fertility. There are three main components involved with the ECS: endocannabinoids, receptors and enzymes.

Endocannabinoids, or endogenous cannabinoids, are molecules that are similar to plant cannabinoids, but are made naturally by the body. The two key endocannabinoids are anandamide (AEA) and 2-arachidonoylglyerol (2-AG). These molecules work to keep the body’s internal functions operating efficiently.

There are special receptors found throughout the body that the endocannabinoids can bind to, signaling the ECS to perform a function. The main receptors are CB1 and CB2. CB1 receptors are found primarily in the central nervous system, the brain and spinal cord. CB2 receptors are located primarily in the peripheral nervous system and immune cells.

CB1 and CB2 act as a lock, and the endocannabinoids are the keys. AEA and 2-AG can bind to either receptor, but their effects depend on where in the body the receptor is located and which endocannabinoid binds to it.

Benefits of activating CB1 receptors include relieving depression, reducing fear and paranoia, and lowering inflammation, blood pressure and anxiety. Targeting a CB1 receptor in a spinal nerve may also ease pain.

Changes in CB2 receptor function affects many human diseases including cardiovascular, gastrointestinal, neurodegenerative, psychiatric and autoimmune. Targeting a CB2 receptor in the immune cells can alert you that inflammation is present, which is common with many autoimmune disorders.

In addition, activating CB2 receptors induces immune system cells called macrophages to destroy the beta-amyloid protein that makes up the plaque found in the brains of people with Alzheimer’s disease.3

THC and CBD work on these endocannabinoid receptors as well. THC can bind to either CB1 or CB2 receptors. By doing that, THC has effects on the body and brain. Some of these effects are positive and some are not so positive. THC can bind to receptors and help reduce pain and stimulate appetite, but it can also make you paranoid and anxious.

The way CBD interacts with the ECS is still being investigated, but researchers do know that CBD doesn’t bind to CB1 or CB2 receptors directly. Most researchers believe CBD works by preventing AEA and 2-AG from being broken down, allowing them to have a stronger effect on the body’s proper functioning.

One of the indirect ways CBD induces therapeutic effects is by activating special receptors in the body called TRPV1 receptors. These receptors are involved in regulating pain, body temperature and inflammation.

CBD also inhibits fatty acid amide hydrolase (FAAH), which creates higher levels of the cannabinoids such as AEA, also known as the “bliss molecule.” It plays a role in the neural generation of pleasure and motivation. It also performs other important functions related to eating and embryo implantation during pregnancy.

Because CBD has an effect on the ECS, it helps to promote balance, or homeostasis, in the body. It also reduces the sensation of pain and inhibits inflammation. Research continues on the methods of action of CBD on the body. And as more information is uncovered, more practical uses for CBD may also be discovered. Stay tuned!

Hands Down

Photos by Nerissa Johnson

Robert Wedyck

Carotid artery narrowing cause of retiree’s stroke.

Robert Wedyck was a professional “foodie.” For years, he worked in consumer product sales, hawking everything from candy to Christmas trees. But he spent most of his career in the employ of Winter & Company, a wholesaler that offers a wide variety of merchandise but specializes in food products. Robert’s job in food sales suited him well. 

“I’ve got the food business in my blood; I grew up in it,” he muses. “When I was fifteen, I made pizzas at a deli. Then, I worked at a grocery store as a stocker, checker and third man, so I have a huge food background. When I got out of college and started looking for a job, I found one with a food broker, which launched my career.”

Originally from Wisconsin, Robert lived most of his adult life on the North Shore in Chicago, Illinois, where he serviced large corporate accounts such as Costco® Midwest. In 2013, he retired and relocated to St. Augustine, where many of his family members lived. But Robert wasn’t content to sit around and do nothing in his retirement.

“I was only fifty-eight, which is a little young to retire,” he admits. “I wanted to do something until I retired for good, so I got a job with Enterprise Rent-A-Car® in Palm Coast. That was the first job I had that didn’t involve food. I retired from Enterprise at the end of November and turned sixty-five on December 19.

“But health issues began bothering me before I retired, starting around October. For one thing, I suffer with chronic pain syndrome. I was seeing a pain doctor, but I finally told him I needed more help.”

Robert’s pain doctor recommended Kai McGreevy, MD, a board-certified neurologist and interventional pain specialist at McGreevy NeuroHealth, which has offices in Palm Coast and St. Augustine. Dr. McGreevy uses a variety of techniques to relieve his patients’ pain and address their neurological disorders.

McGreevy NeuroHealth is fully accredited by the Joint Commission on Accreditation of Healthcare Organizations, the gold standard in certifying the practice as a facility that is centered on patient care, safety, accountability and satisfaction.

“Dr. McGreevy was treating me for pain when one day, my left hand just stopped working,” Robert recalls. “I could feel my hand. There was no numbness or tingling, but it just wouldn’t work. I couldn’t make it move.”

“A few months prior to this, Robert gradually developed mild weakness and numbness in the first three digits of his left hand,” Dr. McGreevy reports. “Nerve conduction studies showed electrical slowing of the median nerve across the left wrist, and a carpal tunnel ultrasound confirmed the swollen nerve and the diagnosis of carpal tunnel syndrome.

“Our Neurodiagnostic and Musculoskeletal Laboratory utilizes insurance-covered, reasonably priced yet leading-edge technology to identify entrapped nerves and muscle problems. The syndrome was managed conservatively and Robert’s symptoms improved, eliminating the
need for surgery.

“Ironically, Robert woke up the morning of his routine office visit with a worrisome issue in the same hand, weakness above and beyond his baseline carpal tunnel syndrome,” Dr. McGreevy continues. “He was not sure what was wrong, but something was different. I suspected that the new issue was also neurological in nature.”

Highly Suspicious

Dr. McGreevy began his evaluation of Robert’s new problem with a complete “head-to-toe” neurological exam, considering both central- and peripheral-nervous-system causes for Robert’s symptoms.

“I suspected a brain condition because Robert displayed a specific pattern of weakness that was more dense and distinguishable from carpal tunnel syndrome,” the doctor reports. “The weakness

preferentially involved wrist and finger extensors in an upper motor neuron pattern with abnormal reflexes on the left side of his body that localized to the right hemisphere of his brain.

“I listened to Robert’s neck with a stethoscope and detected a low-pitched, gruff-sounding vibration known as a bruit coming from his right carotid artery. It was subtle enough to be missed by other

Ultrasound and MRI photo courtesy of McGreevy NeuroHealth.

“The MRI showed that Robert suffered an acute ischemic stroke in the right hemisphere
of his brain.”

physicians who may not know when or how to detect this important sign. Had Robert presented to the ER, a primary care physician or a chiropractor, he might have been sent home misdiagnosed with carpal-tunnel-syndrome relapse and later suffered a much larger problem.”

In addition to performing the exam, Dr. McGreevy also reviewed Robert’s medical history. He noted Robert’s age and that he had high blood pressure and high cholesterol, which are risk factors for vascular events.

“In medical school, we are taught that the history is eighty percent of the diagnosis, emphasizing the importance of good history-taking,” Dr. McGreevy observes. “We not only look at lesion localization, we pay close attention to the timeline of symptom presentation. In this case, that was an acute onset of left-handed weakness. Stroke, transient ischemic attacks, seizures and migraines are mostly responsible for acute presentation of neurological disease.”

The information discovered in Robert’s medical history added fuel to the neurologist’s suspicion that the problem was the result of a brain condition.

“At that point, I ordered an urgent MRI of Robert’s brain, which confirmed my suspicion,” Dr. McGreevy acknowledges. “The MRI showed that Robert suffered an acute ischemic stroke in the right hemisphere of his brain.”

“Dr. McGreevy’s examination was very thorough,” Robert remembers. “He ran many tests to find my exact problem. He checked my carotid arteries to see if they were clear. It turned out they were blocked, and that led to a small stroke.”

Dr. McGreevy is the medical director of the Vascular Laboratory at McGreevy NeuroHealth. He has achieved the Registered Physician in Vascular Interpretation (RPVI) certification that only a few neurologists in the country can claim. This is the same credential obtained by other specialists including cardiologists, vascular surgeons and radiologists.

This vascular imaging designation ensures the knowledge and skills necessary to deliver the highest standard of patient care and safety. It also establishes Dr. McGreevy’s expertise in interpreting vascular disorders using ultrasound of the intracranial, carotid, aortic and extremity blood vessels. He can detect stroke risk, blocked arteries, aneurysms, peripheral artery disease and venous insufficiency.

“When it was happening, I had no idea I was having a stroke,” Robert remembers. “But looking back, I did have some double vision before it all took place. Hindsight is 20/20.”

Two-Penny Pencil

Ultrasound and MRI photo courtesy of McGreevy NeuroHealth.

Carotid Artery Ultrasound

“Sure enough, Robert’s MRI showed multiple, small injuries scattered throughout the right hemisphere of his brain,”
Dr. McGreevy observes. “The diagnosis was acute ischemic stroke. The question became, What caused it?” Dr. McGreevy set out to answer that question.

“Neurologists are like detectives,” he says. “We systematically look for clues based on our knowledge of a very complicated map of the nervous system and meld it with the patient’s symptom presentation. The skill set is specific to the neurologist, allowing for precise problem localization, differential diagnosis and selection of appropriate imaging, with specific treatment to follow.”

The brain in particular is a delicate organ that has very little tolerance for oxygen deprivation, the neurologist educates. When oxygen delivery to a region of the brain is reduced for even a short time, brain cells in that area die. This is called a stroke and it’s the fifth leading cause of death in the United States.

The most common cause of stroke is lack of oxygen to brain tissue due to a blockage of blood flow. The blockage can arise from different problems, such as abnormally thickened blood, blood clots that form in the heart‘s chambers and travel to the brain, cholesterol plaque that breaks off of a carotid artery and travels to the brain, or similar plaque originating within the brain arteries.

“In neurology circles, we often chant the real estate mantra, Location, location, location,” Dr. McGreevy notes. “In Robert’s case, understanding the regions of the brain affected and the anatomy involved helped to narrow the possibilities for the source of his stroke.

“Robert’s imaging revealed multiple tiny strokes scattered throughout his right hemisphere, most likely due to traveling clot material known as emboli originating outside the brain’s vascular system.”

Dr. McGreevy rationalized that it was unlikely that multiple vessels in the brain suddenly narrowed enough with clot material to cause multiple strokes at the same time. Likewise, the strokes were statistically unlikely to stem from the heart, where blood clots tend to travel to both sides of the brain. The emboli more likely originated from unstable plaque in the right carotid system, the main highway to the respective brain hemisphere.

“Only an experienced neurologist could quickly solve this puzzle,” Dr. McGreevy stresses.

Several months before his stroke, Robert underwent a carotid artery ultrasound in the Vascular Laboratory at McGreevy NeuroHealth.

“The imaging test suggested that Robert had fifty to sixty-nine percent stenosis, or moderate narrowing caused by plaque build-up in his right carotid artery,” Dr. McGreevy reports. “This is typically managed conservatively using blood-thinning medication and controlling blood pressure, cholesterol and sugar levels.

“After Robert’s stroke diagnosis, we performed a new carotid ultrasound in our laboratory, and there was a difference in the degree of narrowing and shape of the plaque in his right carotid artery. On the new ultrasound, the narrowing was greater than seventy percent.

“My recovery started with Dr. McGreevy seeing that something was wrong and getting me to the right people for treatment.”– Robert Wedyck

“We know this because the speed of blood flow through the narrowing was much faster and the flow pattern was turbulent. We also appreciated the fact that the progression of narrowing was over just a few months, when it typically takes years to progress that much. This was an indicator that the underlying process was worsening quickly despite conservative measures and warranted emergent intervention.

“It was crystal clear that the diagnostic studies confirmed my suspicion based on history and examination. Due to the degree of stenosis and unstable plaque, I referred Robert to a vascular surgeon for evaluation.”

The vascular surgeon performed a CT angiogram, which confirmed Dr. McGreevy’s findings. Robert’s stenosis was blocking smooth blood flow to his brain and required surgical intervention. A procedure called carotid endarterectomy was recommended.

Carotid endarterectomy is a procedure to remove built-up plaque from the carotid arteries, Dr. McGreevy explains. During endarterectomy, the clogging plaque is excised from the carotid artery through a small incision in the front of the neck.

“The vascular surgeon removed a substantial amount of built-up plaque from my right carotid artery,” Robert reveals. “It was as thick as a pencil and about an inch long.”

“Phenomenal” Experience

After diagnosing his stroke, Dr. McGreevy arranged for Robert to receive immediate emergency care at a local hospital. Robert says he owes his life to Dr. McGreevy.

“All of Dr. McGreevy’s testing got me into the hospital and led to treatment by the vascular surgeon,” Robert confirms. “And the vascular surgeon’s care led to me being seen by a heart specialist. Between them, they took care of several serious problems that could have killed me.

“The heart specialist discovered that two major arteries in my heart were blocked and required stenting. He told me that if I would’ve had a heart attack, I would likely have died from it. And the vascular surgeon said that if I didn’t do the carotid artery procedure, plaque could break off and cause a major stroke, which could severely disable or even kill me.”

Dr. McGreevy affirms that vascular disease in one vessel territory is often a sign of vascular disease elsewhere, as similar risk profiles create similar pathology throughout the body. This is why McGreevy NeuroHealth pays attention to patients’ entire neurological health.

“We also understand that time is brain, so we act quickly,” Dr. McGreevy emphasizes. “In Robert’s case, the brain appeared to have the ability to adapt to injury as long as it was detected and treated quickly. This is known as cortical plasticity, a topic on the forefront of neurology research, which I am very passionate about.

“Robert’s situation highlights the fact that we have the skills and technology in this area of neurology, so we should use it. Robert is such a great guy, and I am very happy that he achieved such an excellent outcome.

Photos by Nerissa Johnson

Robert has regained use in his left hand

“My recovery started with Dr. McGreevy seeing that something was wrong and getting me to the right people for treatment,” Robert enthuses. “Otherwise, those conditions could have gone unchecked, and I might not be alive today. Every time I see Dr. McGreevy, I thank him.”

Once Robert’s stroke risk factors were under control and his carotid artery stenosis was treated, the function in his left hand returned. Physical and occupational therapy assisted with his recovery as well. Today, Robert says he feels great.

“Thanks to my team of doctors and all that Dr. McGreevy did for me, I feel wonderful,” he raves. “Dr. McGreevy and his team at McGreevy NeuroHealth are phenomenal.”

Retina Review

Age-related macular degeneration steals central vision.

Photo by Nerissa Johnson.

Dr. Jeroudi is an expert in the treatment of age-related macular degeneration.

It’s not uncommon for people in their 50s, 60s and 70s to develop age-appropriate “wear and tear” on their retinas, the light-sensitive layer of nerve tissue at the back of the eye. But in some of those people, this wear and tear marks the beginning of a vision-stealing eye condition called age-related macular degeneration, or ARMD.

“ARMD is an acquired degeneration of the central part of the retina that leads to central vision impairment,” elaborates Abdallah M. Jeroudi, MD, a board-certified, fellowship-trained retina specialist at Florida Retina Institute. “For reasons we do not fully understand, people with ARMD develop significantly more wear and tear on their retinas than the average person who does not have the condition.

“The slow, progressive eroding of the retina that occurs with ARMD is much like the eroding of the knees of your favorite pair of jeans. In the same way that, over time, your jeans wear and develop bare spots, ARMD leads to atrophy at the center of the retina, which diminishes vision.”

There are many risk factors for ARMD. The biggest, of course, is age. The risk for ARMD increases from two percent for people ages 50 to 59 to almost 30 percent for people ages 75 and older. Other risk factors include smoking, female gender, Caucasian ancestry, farsightedness, high blood pressure, light-colored eyes, coronary artery disease and having a family history of ARMD.

“Smoking is a huge risk factor,” Dr. Jeroudi stresses. “People with ARMD who smoke are twice as likely as non-smokers to develop significant vision loss related to macular degeneration.

“Smoking and other ARMD risk factors cause damage to the supporting layer of cells underneath the retina, called the retinal pigment epithelium, which in turn damages the overlying retina. Technically, retinal pigment epithelial cells are located throughout the eye, but ARMD only affects those in the central retina. As a result, ARMD impacts central vision.”

Central vision is responsible for the most detailed vision. It’s what is used when a person writes checks, drives a car, reads a book or watches television. ARMD does not harm peripheral vision, which is used to see landscapes at a distance or navigate while walking at home or outdoors.

Typically, ARMD is diagnosed though an eye exam. People in the early stages of macular degeneration often describe general symptoms such as blurry vision or a feeling that their vision just isn’t “right,” especially when reading. They may experience distortion of their vision, which often prompts an eye exam appointment.

“During an eye exam, we dilate the patient’s pupils to get a good look at the back of the eyes, where the retina is located,” Dr. Jeroudi informs. “We look for specific findings consistent with ARMD, including little yellow spots on the retina called drusen. Drusen are the hallmark finding for macular degeneration. That is how we identify it.”

Cracks in a Sidewalk

There are two forms of ARMD, Dr. Jeroudi notes. There’s the non-exudative, or dry, form and the exudative, or wet, form. Dry ARMD is much more common, accounting for 85 to 90 percent of ARMD cases. People with dry ARMD can, over time, progress to wet ARMD.

“Smoking is a huge risk factor. People with ARMD who smoke are twice as likely as non-smokers to develop significant vision loss related to macular degeneration.” – Dr. Jeroudi

“Dry ARMD is further divided into early, intermediate and advanced stages,” Dr. Jeroudi reports. “With the early stage, we typically see a small amount of drusen on the retina. With the intermediate stage, there are significantly more drusen scattered on the retinas of both eyes.

“With the advanced stage of dry ARMD, there are not only numerous drusen all over the retinas, there are also pigmented granules and areas of wear and tear on the retinas that are causing atrophy.”

Wet ARMD presents with the same findings as advanced dry ARMD, but in addition, unstable blood vessels begin to grow from the pigment epithelial layer underneath the retina. The process of new blood vessel growth is called neovascularization.

“Imagine cracks in a sidewalk,” Dr. Jeroudi describes. “With neovascularization, unstable blood vessels grow through the cracks and leak fluid and blood onto the retina, severely affecting the central vision very rapidly. Contrast that to dry ARMD, which affects vision very slowly over years.”

Currently, there is no treatment for dry ARMD. But retina specialists are concerned about progression to wet ARMD, so they recommend special eye vitamins that are shown to help reduce the risk of progression.

“This vitamin formulation is called AREDS2, and it contains Vitamin C, Vitamin E, copper, lutein, zeaxanthin and zinc,” Dr. Jeroudi observes. “We also ask our patients with dry ARMD to avoid smoking because it increases the risk of neovascularization.”

Treatment for wet ARMD is aimed at stopping the unstable blood vessels from leaking and causing significant damage to the retina. It involves intravitreal injections, which introduce medication directly into the eye cavity to shrink the blood vessels and stop neovascularization.

“These injections may sound scary, but the needle we use is only several human hairs thick,” Dr. Jeroudi assures. “And before we begin the injections, which we perform right in our office, we make sure the patient’s eyes are completely numb using special numbing drops. We have a great track record of success in keeping our patients comfortable for this procedure.

“Intravitreal injections, like care for diabetes and high blood pressure, is not a one-and-done treatment. There is no cure for wet ARMD, so it can only be controlled and managed. Initially, injections are performed about every four weeks until blood vessel activity is controlled. Then, the injections are given at longer intervals to manage the control. Spreading out the injections also reduces the burden of treatment on the patient.”

In addition to quitting smoking, Dr. Jeroudi also encourages his patients with dry ARMD to make certain lifestyle changes to reduce the risk of progression to wet ARMD and maintain their vision.

Positive Prognosis

“Patients with a diagnosis of macular degeneration should protect their eyes from the sun by wearing sunglasses, control their high blood pressure and eat a healthy diet,” he urges. “It has been found that a poor diet is associated with decreased ocular health.

“We also ask patients to monitor their vision for any new distortion when looking at straight lines. Many retina specialists give their patients a special grid called an Amsler grid, which resembles a piece of graph paper. Patients are instructed to report back if the straight lines on the grid appear wavy, which may signal progression of the ARMD.”

Dr. Jeroudi recommends that patients also monitor for any new blind spots in their vision. He suggests patients check their vision, one eye at a time, once a week. By doing this, they may catch the early signs of wet ARMD.

“Routine monitoring enables us to quickly diagnose wet ARMD and begin treatment right away,” he says. “And that greatly improves the patient’s
vision prognosis.”

Tropical Paradise

Implant denture has advantages over traditional lower denture.

Photo by Jordan Pysz.

Donna Kiehl

Donna Kiehl and her husband built a successful nursery business from a small collection of bromeliads about the size of a table. Today, they fill orders for the tropical flowering plant from all over the world via mail order and sell them from a store on the couple’s Venice property.

“We’ve been selling bromeliads and other tropical plants for about thirty-five years total,” Donna shares. “We started the business in St. Petersburg but moved it to Venice when we went there to purchase a bromeliad collection. As it turned out, the property in Venice was also for sale, and we ended up buying it as well.

“It all started because my husband has had a love for bromeliads since he was young. He saw one on his parents’ property and was fascinated with the plant and its bloom. He researched bromeliads and how to grow them, then started collecting them.”

Donna, 63, who hails from Warminster, Pennsylvania, about 13 miles north of Philadelphia, relocated to Florida when she was 12. As an adult, Donna was diagnosed with Sjögren’s syndrome, an autoimmune disease where the immune system attacks the body’s own cells. The most common symptoms of Sjögren’s syndrome are dry eyes and dry mouth. The dry mouth negatively affected Donna’s oral health.

“Because of the dryness in my mouth, my teeth started to go bad, and I started to lose them,” she relates. “That’s pretty much what happens with Sjögren’s. I didn’t have enough saliva to protect my teeth. I was told that, eventually, all of my teeth would go bad.

“My gums were receding as well, and it looked awful. My teeth were turning color, and I hated looking in the mirror and hated smiling because my smile was horrible. So, I looked into getting a dentist who would remove my teeth and give me dentures.

“I received a copy of Florida Health Care News in the mail, and in it were a couple of interviews with people telling their stories about working with Dr. Gaukhman. That’s how I found him and decided to go to him.”

Alexander Gaukhman, DMD, of Venetian Dental in Sarasota, provides exceptional general, cosmetic and restorative dentistry as well as emergency dentistry. Dr. Gaukhman also has dental offices in Venice and Osprey.

“Donna came to us believing that her teeth were unhealthy and probably not salvageable,” Dr. Gaukhman remembers. “I confirmed that it was not worth the time and expense to try to save them. We agreed that the best option was to extract her failing teeth and replace them with dentures. After that, she would not have to worry about her teeth for at least five years.”

“Initially, Dr. Gaukhman pulled my upper teeth and made a denture for the top,” Donna recalls. “We did the top in January 2018. We waited to do the bottom because those teeth weren’t quite ready to come out. But they were starting to turn as well.

“And before long, my bottom teeth began to break. Having no saliva made them go bad sooner than anticipated. But we waited to do the bottom until I got a cavity in the front and it started hurting. That was in July of last year.”

Snap-On Convenience

In most cases, upper dentures fit securely because the palate enables the creation of sufficient suction to hold the appliance in place. That was the case with Donna, whose upper denture fits just fine and does not wobble or move.

“Lower dentures are often more difficult to stabilize,” Dr. Gaukhman reports. “The lower jaw is not designed for dentures because there is no palate, due to the location of the tongue, and less suction is produced. As a result, lower dentures tend to slip and slide.

“It is rare when people can wear lower dentures that do not bother them or stay tight without help. That’s why securing a lower denture with dental implants is the most effective way to stabilize it and why I recommended two implants to secure Donna’s lower denture.”

“I’m very happy with the outcome of my treatment at Venetian Dental. On a scale of one to ten, I would rate my experience a twenty!” – Donna

Dental implants are screw-like posts that are surgically placed into the jawbone to serve as the foundation for replacement teeth, such as crowns and dentures. When secured by implants, dentures don’t slip or move; they stay in place when people speak and eat. There are other advantages of implant dentures over traditional dentures, Dr. Gaukhman notes.

“Implant dentures provide added strength for biting and chewing,” the dentist observes. “And because the dentures are stable, the patient experiences better speech, better aesthetics and greater self-confidence. They do not have to worry that the denture will come out during dinner, conversation or activity.”

For patients who still have their natural teeth, Dr. Gaukhman can place the implants on the day he extracts the teeth. In most cases, temporary dentures are also created at that time in Venetian Dental’s on-site laboratory.

“Typically, once the patient’s problem is diagnosed and the treatment is determined, impressions are taken of the teeth,” Dr. Gaukhman explains. “When the dentures are ready, which is usually the same day or the next day, the teeth are extracted and the dentures are placed right away. When done this way, the dentures serve as a bandage to minimize swelling and bleeding.

“For the next three to six months following that procedure, the patient wears temporary dentures until the implants fuse with the jawbone and the gums heal. Then the temporary dentures are replaced with the permanent appliances.”

Implant dentures can be fabricated to fit one of two ways: to be fixed or removable. There are pros and cons to both options, Dr. Gaukhman states.

“Removable dentures snap on and off the implants,” he informs. “They can be made and fit relatively quickly. The patient can remove the teeth, clean them with a toothbrush and put them back in the mouth within minutes. They are easier to maintain than fixed dentures. I made a removable denture for Donna.

“Fixed dentures, on the other hand, stay in the mouth at all times. They take much longer to fabricate and are harder to clean. They must be cleaned by professionals. But because they can only be removed by a dentist, they are more secure.”

“When Dr. Gaukhman did my bottom denture, he went ahead and put in the dental implants,” Donna reports. “Then, he fit the temporary denture right away. I got my permanent denture in November. I just snapped it in.”

“They Look Awesome”

With her treatment completed, Donna reports that she’s thrilled with the dentures Dr. Gaukhman created for her at Venetian Dental.

“I love them, absolutely love them,” she raves. “They look awesome, and my smile is great. I get compliments all the time on my teeth, my smile and how happy I look now. And the Sjögren’s doesn’t bother the dentures at all.

“My treatment was successful, and I recommend implant dentures to others in situations similar to mine. And I most definitely recommend Dr. Gaukhman. In fact, I have already recommended him to a friend who was having issues with her teeth.

“I’m very happy with the outcome of my treatment at Venetian Dental. On a scale of one to ten, I would rate my experience a twenty!”

Sophisticated Development

Advanced vacuum therapy allays back pain and more.

Photo by Jordan Pysz.

Since undergoing VAX-D Therapy, Dr. Rowell has resumed his
favorite activities

Theodore F. Rowell, DC, had been a chiropractor since 1972. He served patients in Michigan, Arizona and Georgia for nearly 48 years. It’s fair to say that he is quite discerning when it comes to choosing a chiropractor for his own needs, which he recently needed to do after aggravating an existing injury.

“It was an old injury from an auto accident many years ago,” Dr. Rowell elaborates. “As a result of that injury, there was a badly deteriorated disc in my low back. But it was treatable through traditional chiropractic channels such as adjustments and manipulations.

“Then five years ago, I suffered a bad fall while working in my yard. That reinjured my low back and damaged it to the extent that adjustments just weren’t helping enough. The pain was debilitating.

“Most of the time, the pain was an eight to ten on a scale of one to ten, and I couldn’t function. I couldn’t stand up straight. Within a few minutes of going into a store and walking around, my low back and buttocks became so numb that I had to sit down. The pain interfered with my life greatly, and I suffered like that for almost six years.”

When Dr. Rowell moved to Florida last year, he set out to find a chiropractor to treat his painful back condition. But he narrowed his search to those who offered a specific type of treatment, a modern version of a therapy he used more than 30 years ago. That’s how he discovered Craig S. Aderholdt, DC, of Back Pain Institute of West Florida.

At Back Pain Institute of West Florida, Dr. Aderholdt provides the most advanced treatments for patients in severe pain. Among those treatments is the unique, nonsurgical VAX-D® Therapy. It is a patented, FDA-approved medical decompression technique for alleviating pressure on the discs of the spine that Dr. Rowell is familiar with.

“Within a couple of weeks of beginning VAX-D Therapy, I began to feel some improvement in my condition, and it gradually got better and better.” – Dr. Rowell

“When I was practicing thirty, thirty-five years ago, chiropractors and researchers developed a treatment protocol called disc distraction,” Dr. Rowell recalls. “It was a technique for improving the alignment of the spine, especially in the low back, where the spinal discs had degenerated to the point where little disc actually remained.

“Disc distraction was a manual procedure that stretched and worked the damaged area back to where it could regenerate and rehydrate with fluid. Consequently, patients received relief of chronic, painful back conditions. VAX-D Therapy is the newly created and highly sophisticated development of the disc distraction technique I used all those years ago.

“Dr. Aderholdt is the only chiropractor in the state of Florida who utilizes VAX-D Therapy as far as I know. We became friends, and he started treating me.”

Maximum Benefit

VAX-D Therapy may be a medical decompression technique, but it is not a traction device, Dr. Aderholdt emphasizes. It is different because it works differently and achieves significantly better results, the doctor asserts.

“Chiropractic adjustments alone can actually relieve the pain for many patients,” notes Dr. Aderholdt, who is one of the few doctors in the country, not just the state, who offer the unique VAX-D treatment.

“But for select people who suffer with conditions such as sciatica or herniated, bulging or degenerated discs, VAX-D Therapy has proven extremely effective. Dr. Rowell was a good candidate because the treatment is effective at alleviating low back pain. It also helps with neck pain, numbness, tingling and pain radiating down the arms and legs.”

The treatment is straightforward. During VAX-D Therapy, the patient relaxes on a comfortable, computer-controlled table, secured by a pelvic belt or patented cervical collar, depending on the area to be treated. Carefully specified tension and pressure changes guide the use of VAX-D, allowing the therapist to focus decompression at the exact level of spinal dysfunction.

The VAX-D system is computerized, which enables the table to make subtle but targeted movements. These movements create a powerful vacuum within the disc space. This vacuum gently draws the disc back to its proper orientation, pulling nutrient-rich spinal fluid into the disc and stimulating repair cells that effectively mend the disc.

“Nothing else can create such a powerful vacuum,” Dr. Aderholdt observes. “That is what makes VAX-D such a valuable tool for pain relief. There are imitators, but the vacuum effect is the most powerful one known.

“VAX-D doesn’t allow the muscles to contract, like other machines can. In fact, it is the only nonsurgical treatment that has been clinically proven to reduce disc pressure to negative levels.”

“When I get a VAX-D treatment, I lie on a table with a belt around my pelvis, strapped to the lower portion of the table,” Dr. Rowell describes. “My upper body is immobilized by a harness, which fits snugly, but comfortably, around my shoulders and underarms.

“Guided by the sophisticated computer, the lower portion of the VAX-D table moves toward my feet while the upper portion stabilizes me. As the table spreads apart, it gently stretches my spine to rehabilitate and rehydrate my old, injured discs and joints. VAX-D Therapy also uses a cervical mechanism in a similar fashion to treat neck injuries and pain.

“Because the treatment is computerized, I receive the maximum benefit from each visit.”

Secondary Condition

Photo by Jordan Pysz.

VAX-D Therapy is straightening the irregular curvature in
Barbara’s neck.

Barbara Owens, 62, was born in Waterford, a small industrial city ten miles south of Erie in the northwest corner of Pennsylvania. After high school, Barbara left Pennsylvania for Indianapolis, Indiana to attend Butler University. Upon graduation, Barbara moved to Chicago, Illinois, where she got a job with an import-export business.

“That’s where I met my future husband,” Barbara recalls. “When he was transferred to Long Beach, California, we moved to Los Angeles, where I lived for twenty-five years. In LA, I worked for a medical software company with clients across the United States. I traveled all over the country training doctors on new software for patient billing.”

Following a divorce from her husband, Barbara moved to Cincinnati, Ohio to be closer to her sister, who lived in Indianapolis, and her parents, who lived in Kentucky. She later moved to Kentucky to take care of her ailing mother and then moved along with her sister to Florida in October 2018.

Like Dr. Rowell, Barbara brought with her to the Sunshine State an existing back injury that required ongoing chiropractic care. But she soon learned that she also had a silent cervical condition that could lead to severe pain and instability in the future if not treated.

“The curvature in my neck is almost gone, and the vertebrae, which were nearly touching each other, are now separating… VAX-D Therapy is working
for me.” – Barbara

“When I was in high school, I slipped on some stairs in the school and pulled the ligaments in my low back,” Barbara relates. “I’ve been going to a chiropractor for that injury for quite a few years, so when I moved to Florida, I knew I needed to find one here. I heard about Dr. Aderholdt and his VAX-D Therapy, so I decided to check him out.

“Dr. Aderholdt took x-rays and told me my back was good, but he noticed that my neck had a curvature to the left. I didn’t have any pain in my neck at the time, but he said that if I didn’t take care of that curvature, I would have trouble with pain down the road. He suggested we take care of it with VAX-D Therapy.”

Barbara agreed, so Dr. Aderholdt used the therapy’s cervical modality to address Barbara’s neck condition. She was delighted to discover that the treatment was not uncomfortable. In fact, she often found it relaxing.

“With the VAX-D system, they put a collar around my neck while I lie on a bed,” Barbara says. “The collar attaches to something on the back of the VAX-D machine so that when they turn it on, it gently pulls my neck. It doesn’t hurt at all. In fact, I tend to fall asleep while I’m having VAX-D Therapy.”

Complications Avoided

Each VAX-D treatment lasts about half an hour, and the treatments have a long track record of leaving patients such as Barbara and Dr. Rowell satisfied, Dr. Aderholdt points out. Long-term studies show that VAX-D is effective in more than 88 percent of patients who go through the treatment.

“I consider VAX-D one of the most effective nonsurgical medical treatments for low back pain, neck pain and sciatica today,” Dr. Aderholdt asserts. “This revolutionary technology is one more tool I can offer my patients as we work toward relieving pain and maintaining the health of the lumbar and cervical spine.”

Many patients report a significant reduction in back or neck pain within only a few treatments, although the total healing process takes longer, Dr. Aderholdt stresses. The reason it takes a longer period of time, the doctor says, is that bulging or herniated discs require a series of VAX-D sessions to fully reposition themselves.

“Some patients think they will get relief after a handful of sessions and they can just quit, but that’s not the case,” he observes. “Patients must follow through with all of the required treatments to get the full benefit.”

Dr. Aderholdt notes that VAX-D Therapy has the added benefit of eliminating the need for surgery in many cases.

“Many patients with severe back or neck pain want to avoid surgery, and that is something that VAX-D allows,” he states. “With surgery, there is the potential for serious complications. Because VAX-D is noninvasive, those complications are avoided.”

Full Function Regained

Dr. Rowell is among those who began to feel relief early on in the VAX-D Therapy process. But he followed Dr. Aderholdt’s recommendation and completed the entire course of treatment. And he’s glad he did.

“Within a couple of weeks of beginning VAX-D Therapy, I began to feel some improvement in my condition, and it gradually got better and better,” Dr. Rowell enthuses. “I started treatment daily for a couple of months, then as I improved, we stretched it out to three times a week and then once a week.

“Now, I’m getting regular adjustments from Dr. Aderholdt to sustain the pain relief I achieved. I periodically get a VAX-D treatment, maybe once a month, to maintain my newfound health and the improved condition I’ve developed.

“The VAX-D treatments have helped me to avoid aggravating my low back, which feels pretty good. My pain level is now zero to one on a scale of one to ten. Occasionally, I have a little soreness in the old injured area, but it’s not debilitating or keeping me from functioning.”

Far from it, in fact. Dr. Rowell says that since receiving VAX-D Therapy, he has resumed his favorite activities, which he had to forsake when his low back pain was so intense.

“Now, I enjoy walking and bike riding,” he shares. “I also enjoy shopping. I like to go to the flea market and places like that. I like fishing and go whenever I can. And when I’m fishing, I stand a lot and twist my body quite a bit. I can do those things again that I wasn’t able to do in the past.”

Dr. Aderholdt’s goal with Barbara was to use VAX-D Therapy to gradually straighten out the unhealthy, leftward curvature in her neck and prevent any painful condition from developing in the future. The treatment is succeeding.

“I’ve been receiving VAX-D Therapy since last year, and Dr. Aderholdt has taken several x-rays,” Barbara relates. “We’ve noticed that my neck is almost upright like it should be. The curvature in my neck is almost gone, and the vertebrae, which were nearly touching each other, are now separating, and that’s a good thing. VAX-D Therapy is working for me.

“Sometimes, I get pain in my lower shoulder on my right side, but Dr. Aderholdt treats that with an adjustment, and the pain goes away. Other than that, I have no problems. I’m actually doing quite well. I lost fifty pounds, so I feel very fit.”

Barbara is thrilled to be feeling so well. She now has plenty of energy for the activities she enjoys most.

“I love bowling, and I like biking and swimming,” she says. “I also enjoy walking my dog. He’s a Dachshund named Rolf.”

VAX-D Therapy was successful for Barbara and Dr. Rowell, and both patients are complimentary of Dr. Aderholdt, his staff and his unique treatment.

“When I met Dr. Aderholdt, I really liked him,” Barbara raves. “He’s a very nice gentleman, very caring. He wanted to make me well, so I felt very comfortable being there. The people in the office were also very nice. I’m glad I decided to go to Back Pain Institute of West Florida.”

“When I first started going to Dr. Aderholdt, I talked to some of the other patients in the office’s waiting room,” Dr. Rowell reports. “Invariably, they told me about their improvements using VAX-D Therapy. Almost everybody was getting better, and they were happy to tell me about it.

“Dr. Aderholdt is a very fine doctor of chiropractic, well-grounded in the healing principles of chiropractic care. He’s a graduate of Life Chiropractic College, which I’m proud to say some of my donation dollars helped to found many years ago.

“I’m glad I found Dr. Aderholdt. He’s very dedicated to helping as many people as he can regain better health and have a happier, healthier life with chiropractic care and the use of VAX-D Therapy.

“I wish I could have had this modern advantage when I was in practice. I could have helped thousands instead of hundreds of people relieve their pain and stress with it, so I highly recommend VAX-D Therapy and Back Pain Institute of West Florida. I’ve spoken to several people already about Dr. Aderholdt, and I recommend him highly as well.”

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