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Firehouse Effect

High venous pressure can lead to non-healing leg ulcers.

While preparing for work one day in 2007, Linda Ettinger mindlessly scratched her right leg over what she thought was a mosquito bite. A few moments later, she looked down and saw blood flowing from an open wound on her leg and gathering on the floor. Her husband took her to the hospital, where the wound closed. It eventually healed, but not for long.

Douglas H. Joyce, DO, at Joyce Vein & Aesthetic Institute in Punta Gorda, treated Linda Ettinger’s venous ulcer by treating her leg veins with single-needle laser ablation.

Following vein treatment, Linda is walking more than five thousand steps a day.

“Over the years, I saw several wound care doctors, but it was always the same story,” the 66-year-old New Jersey native shares. “They treated the wound with medicine and scraped away the dead skin. It would be fine for a while, but it kept coming back. It would heal, then open up again.

“The wound looked like somebody stuck a fireplace poker in my leg. It was pretty deep, and it was bright red and oozed infectious stuff. At one point, I was on antibiotics for a year. It felt like a hole burning in my leg. There was a lot of pain.

“I couldn’t sleep on my right side, so I had a lot of sleepless nights. I couldn’t swim or ride my bike, and I had a hard time walking because of my leg. I couldn’t even stand for more than ten minutes because it was so painful.”

Just when Linda was losing hope, her husband heard about Douglas H. Joyce, DO, at Joyce Vein & Aesthetic Institute in Punta Gorda. At The Ulcer Center at JVAI, Dr. Joyce treats leg wounds resulting from venous disease.
Dr. Joyce is a skilled vein specialist who combines compassion and expertise to treat patients with venous disease.

After evaluating Linda’s legs using ultrasound mapping, Dr. Joyce determined her wound, or venous ulcer, was related to leaking veins in her right leg, a form of venous disease.

“There are two systems of veins in the legs,” Dr. Joyce informs. “There are the high-pressure, deep veins in the middle of the leg, and the low-pressure, superficial veins near the surface of the skin. The two systems are connected by veins called perforator veins.

“Perforator veins have valves in them that allow blood to move from the skin to the deep veins during rest. When people walk, the deep veins are squeezed by the large muscles of the legs, and high pressure is generated to send blood toward the heart. The valves in the perforator veins are designed to close at that time to prevent the flow of high pressure blood outward to the delicate skin veins.

“If the perforator valves fail, high-pressure blood flows directly to the delicate skin veins causing the symptoms of venous disease. These include swelling, pain, chronic varicose veins, discoloration and ulceration.”

At The Ulcer Center at JVAI, Dr. Joyce uses leading-edge procedures and state-of-the-art technology to treat patients and give them the best chance at a positive outcome. That technology includes a procedure Dr. Joyce pioneered called single-needle laser
This procedure is a noninvasive method of sealing the diseased veins responsible for advanced venous conditions, including ulcers. He used this technique to treat Linda’s leg veins.

Under Pressure

The development of venous ulcers is all about pressure, Dr. Joyce stresses.

“The pressure in the superficial veins under the skin is very low,” he observes. “This is evident when a person suffers a cut on their skin’s surface. The cut bleeds a little bit then stops. The force in these outside veins runs at about 15mmhg (blood pressure measurement).

“The pressure in the deep veins, on the other hand, can be higher by a factor of twenty or more. When a person walks, the leg muscles squeeze the deep vein and the pressure increases dramatically to move blood all the way uphill to the heart. The pressure in the deep veins can be more than two times the blood pressure in the arteries.

“If the superficial veins fall under high pressure, the nearby arteries, which have a lower pressure, cannot perform their function of circulating fresh blood,” Dr. Joyce continues. “Fresh blood brings in oxygen to nourish the skin and removes waste products. If these processes cannot occur, skin cells begin to wither and die.

“The perforator veins run straight from the deep veins to the surface veins. When they become enlarged and start leaking, they act like a pressure washer against the skin. Arteries cannot compete against that pressure, skin cells cannot get nourished and die, and the skin opens up as an ulcer.”

“Dr. Joyce told me I had high-pressure venous disease,” Linda relates. “With that, my blood wasn’t flowing correctly going back to my heart, and because of the pressure, the blood flow was like a firehose against my skin. That caused the wound to open up.”

Sealing the diseased perforator veins with single-needle laser ablation turns off the firehose and normalizes the pressure in the superficial veins. Arteries can then function to bring oxygen and other nutrients to the skin, and venous ulcers begin to heal.

Miracle Steps

Dr. Joyce’s single-needle laser ablation had a tremendous impact on the debilitating effects of Linda’s leg ulcer. She’s amazed by the improvement in her condition.

“Since I’ve been seeing Dr. Joyce, it’s like a miracle,” Linda marvels. “When I first started going to him, I could barely walk. I got a Fitbit® for Christmas, and now, I’m up to five thousand steps. My husband can’t believe how much better I’m walking. And my sleeping is wonderful now.

Douglas H. Joyce, DO, at Joyce Vein & Aesthetic Institute in Punta Gorda, treated Linda Ettinger’s venous ulcer by treating her leg veins with single-needle laser ablation.

Before Vein Treatment

“I love baseball, and my husband treated me to a couple spring training games. We had to stand and wait until the box office opened. I stood for an hour and a half, and it didn’t even bother me. Before, I couldn’t stand for ten minutes.”

Dr. Joyce and his staff at The Ulcer Center at JVAI partner with their patients’ wound care centers to see the wounds to closure. Once Dr. Joyce treats a patient’s diseased veins, the efforts of the wound care centers are more effective. After her procedure, Linda returned for additional wound care.    

“Dr. Joyce’s treatment has definitely been successful,” she enthuses. “My wound is almost healed. The wound care doctor is now going to put a skin graft on it, but he wanted to wait until Dr. Joyce was done treating the veins in my leg. At my next appointment, I’ll get the graft, then I’ll be completely healed.

“Dr. Joyce is very gentle, and his staff is amazing. Going to The Ulcer Center at Joyce Vein and Aesthetic Institute was a great experience for me. I tell my neighbors, if they have sores on their legs, don’t wait like I did. See Dr. Joyce. He’s absolutely wonderful.”

Skip Surgery

Noninvasive stretching protocol relieves pain, restores flexibility.

During his working years, Bill Lundgren owned an advertising and marketing agency, but he was always a musician at heart. After retiring and relocating from New Hampshire to Florida three years ago, Bill immediately began volunteering with a local arts organization, directing several musical performances.

Dr. Jeffrey P. Johnson of Johnson Medical Center in Venice treated Bill Lundgren and Pat Shehorn for lower back and neck pain using Sedative Stretching.

Bill Lundgren

Finally given a chance to live out his dream, Bill refused to let an agonizing back condition that dates back to his childhood stop him.

“When I was a kid, I fell out of a tree, landed on the sidewalk and crushed a vertebra,” shares the Rhode Island native. “I spent a few months lying flat in bed. I couldn’t get up, couldn’t do anything, in order for my back to heal.

“It has bugged me ever since, and over the last couple of years, the pain and stiffness in my lower back gradually increased. It got to a point where one area was basically solid as a rock and didn’t move at all. The muscles were frozen from guarding.

“The pain in my back was in the seven to eight range on a scale of one to ten. I’d also get radiating pains down my legs that were tens and literally put me on the floor. My legs would go out from under me and drop me to the ground.”

When it came to activities, Bill was bound and determined not to let his back pain stop him. He chose to keep going and not give in to the pain. There were times, of course, when he had to take it easy, but in general, he didn’t let the pain interfere with what he did. His willpower lasted only so long, however.

“Most of the stuff I did didn’t require me to be highly physically active,” Bill admits. “Schlepping equipment is one thing, but that’s short-lived, and I could usually find help, so it wasn’t generally a problem. But living with chronic pain, as anybody who’s been through it knows, is incredibly debilitating.”

As Bill’s back pain intensified, he sought advice from several medical specialists, including a neurologist and neurosurgeon. However, he wasn’t satisfied with what either physician told him.

“The neurologist performed an exam and told me there were many degenerative changes happening,” Bill states. “Then I saw a neurosurgeon, and the first thing he said was, Let’s fuse all the discs. I didn’t think that was the answer, because I’ve never heard of anybody who had that done that was happy with it.

“At that point, I started looking for other alternatives, and I have a good friend who suffered with a serious shoulder problem who went to Dr. Johnson and had his special stretching procedure. She was amazed by how much better she felt after that procedure, so I decided to make an appointment with Dr. Johnson.”

Jeffrey P. Johnson, DC, is a skilled and experienced chiropractor at Johnson Medical Center in Venice. Dr. Johnson has expertise in a specialized treatment protocol called Sedative Stretching. Sedative Stretching is an expanded and comprehensive form of Manipulation Under Anesthesia, or MUA.

“When Bill came in to the office, he described having lower back pain that radiated into the rear pelvic regions on both sides of his body and both front thighs,” Dr. Johnson reports. “He specified he had burning pain in the front side of his hip on his left side and said his left leg occasionally gave out on him.”

“Dr. Johnson performed an amazingly thorough neurologic assessment, and I’ve been assessed by a specialist,” Bill describes. “He took x-rays and showed me some of the things that were going on with my back. He showed me how some of the tissue had bonded together, so everything was frozen tight.

“Dr. Johnson is a real straight shooter. He said if he didn’t think he could help me, he wouldn’t recommend Sedative Stretching. Between his honesty and the fact that the process made sense to me when Dr. Johnson explained it, I decided to move forward with the treatment. I’m just sorry I waited so long.”

Limited Follow-Through

Pat Shehorn is a retired health care executive who continues to consult from her home in Chicago. During the chilly winter months, the snowbird leaves Illinois and travels to Florida so she can golf year-round. Pat struggled with back and neck pain for some time, but a problem with her golf swing was the final straw that sent her in search of help for her condition.

“The first clue something was wrong was when the middle finger on my right hand turned blue,” relates the Pittsburgh, Pennsylvania native. “Then about a month later, it happened to a finger on my left hand. We thought it was nerve impingement in my brachial plexus under my arm. Then my golf game went horribly wrong.

“I had a huge knot between my neck and shoulder, which was achy and sore to the touch. I also had lower back pain with tingling in the bottoms of my feet. I must have a high pain threshold because, although the pain was a six or seven, I was generally just uncomfortable. Mostly, I was losing mobility and flexibility.

Dr. Jeffrey P. Johnson of Johnson Medical Center in Venice treated Bill Lundgren and Pat Shehorn for lower back and neck pain using Sedative Stretching.

“My pain is much better as well. It’s down to a one, sometimes a two, and I can manage that. It’s a piece of cake.” -Pat

“As a result of the pain, tingling and stiffness, I had difficulty bending and stretching, and I was losing range of motion. I still did my daily workouts, but they just didn’t feel right. And I couldn’t follow through on my golf swing, and that affected my game.”

It was a neighbor who told Pat about Dr. Johnson. Pat was hesitant at first because she’d never been to a chiropractor. She was concerned because she thought all chiropractic adjustments were rough, and she didn’t want that. A quick call to Johnson Medical Center assured her that Dr. Johnson’s approach is gentle, so she made an appointment.

“Pat came to us complaining of neck pain and stiffness,” Dr. Johnson observes. “She had occasional tingling in her fingers and color changes in her right third finger and left fourth finger. She also experienced episodes of shooting pain down her right arm. In addition, Pat experienced lower back pain that radiated into her right gluteals and the side of her right hip.”

“Dr. Johnson performed a physical assessment and took x-rays, then came up with a treatment plan,” Pat recounts. “He said an alternative would be Sedative Stretching, but doing that was totally up to me. After about a month of treatment, I opted for Sedative Stretching. I was grateful Dr. Johnson was able to treat my neck and back during the same procedure.”

Scar Tissue Scourge

Many people with 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,” Dr. Johnson notes. “The chronic stiffness, tightness and pain cause excessive wear and tear on the joints of the spine and extremities, resulting in permanent degeneration and arthritis.

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

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

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

“People will compensate how they move their bodies when this occurs, although they don’t always realize it,” Dr. Johnson points out. “This is evident everywhere while watching the way people walk, bend, twist and turn.

“Regrettably, many people wait until significant damage from excessive wear and tear has occurred before seeking appropriate care. Often, people will utilize over-the-counter and prescriptive medications, which help alleviate their symptoms. Unfortunately, this gives the patient a false sense of being cured while the underlying scar tissue
continues to cause excessive damage.”

Twilight Treatment

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

“While the patient is sedated, we use light, comprehensive stretching techniques,” Dr. Johnson informs. “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.”

A highly trained team of medical professionals coordinates the Sedative Stretching procedure. 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.

Typically, there are 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.

“By following the recommended exercises, patients regain the flexibility they had decades before, and typically, they return to activities they haven’t done in years,”
Dr. Johnson emphasizes. “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.”

“Piece of Cake”

Following Sedative Stretching, Bill and Pat returned to Johnson Medical Center for their post-procedure rehabilitation. That included doing additional stretching and learning stretching exercises, which they were instructed to do at home.

Dr. Jeffrey P. Johnson of Johnson Medical Center in Venice treated Bill Lundgren and Pat Shehorn for lower back and neck pain using Sedative Stretching.

Bill has always been a musician at heart.

“After I had the procedure, I went back to Dr. Johnson every day for a week,” Bill remembers. “He repeated almost the same procedure as the Sedative Stretching, which was essentially rolling me into a tight ball to keep the adhesions from sticking again.”

“For the first two weeks following the procedure, I went to see Dr. Johnson five days a week,” Pat recalls. “Then, this past two weeks, I’ve been going three days a week. But I’m doing my stretching exercises three times a day, preceded by heat and followed by ice packs, to keep the inflammation down.”

Bill and Pat are glad they put their trust in Dr. Johnson and Sedative Stretching. Both patients achieved significant pain relief from their procedures, enough relief to live comfortably.

“Within a few days of the Sedative Stretching procedure, my pain dropped dramatically,” Bill raves. “Instead of being a seven or eight on the pain scale, I’m consistently down to around a three, which is bearable.”

“Things are good now,” Pat agrees. “I’m back to golfing, and I can bring my golf swing all the way through. My pain is much better as well. It’s down to a one, sometimes a two, and I can manage that. It’s a piece of cake.”

Pat was especially impressed by her improved range of motion and flexibility following Sedative Stretching.

“When I first saw Dr. Johnson, he asked me how I turned my head to drive,” Pat recollects. “I told him I used my mirrors to see. But since Sedative Stretching, I can turn my head, so I can see what’s behind me when I pull out. And my neck doesn’t hurt.

“Now, after stretching, I can bend over and touch my toes. It’s another sign that I’m much more flexible. Sedative Stretching was very successful for me. I wish I’d done it sooner. If anyone’s in pain, I recommend Dr. Johnson and Johnson Medical Center.”

“Sedative Stretching is an amazing treatment,” Bill enthuses. “I definitely recommend it to anybody who’s got spine problems. Who wants to go under the knife if you don’t have to. And it’s a lot easier if you can find somebody like Dr. Johnson. I wasted a lot of time with those other doctors, but not so with Dr. Johnson.
I’m a believer!”

Sparkling Gem

Resident’s dementia improves with personalized care.

Like a diamond, there are many facets to Paul Agan’s life. The Elmira, New York native is a veteran of the US Air Force who made a post-service career working at AT&T®. He’s an electronics guy and a handyman, and he loves to stay active. Fishing is one of his favorite pastimes. When this diamond started to dull, it was difficult for his family to watch.

Lulu Agan discusses her father, Paul Agan’s experiences as a resident at Grace Manor Port Orange, an assisted living and memory care community.

The intimate setting at Grace Manor has proved to be a perfect fit for Paul.

“We first noticed that something was going on with Dad in 2015,” remembers Lulu Agan, Paul’s daughter. “He began behaving in ways that were out of character for him. He started getting lost and confused about where he was. He was always losing things, like his keys. These changes sent up some red flags.

“That’s when we had Dad tested, and the results showed he had lower moderate dementia. At first, he was able to continue living at home with my mom. When he started forgetting to take his pills, we arranged for part-time home care for him, which turned into daily care.

“Dad’s condition progressed and he became more disoriented, so we decided, and Dad agreed, it was time for assisted living. My project was to find the right place for him.”

Lulu took her responsibility to heart and assessed every assisted living facility in the area. After she completed her evaluations, one facility was at the top of her list: Grace Manor Port Orange. Grace Manor is an assisted living and memory care community that provides specialized care for residents with Alzheimer’s disease and other forms of dementia.

“I knew Grace Manor was the right place because it was smaller than the others and more intimate,” she explains. “Also, I went there unannounced about eleven times at various times of day, and I could see that the staff really cared about the residents.

“I was nervous about Dad’s reaction to Grace Manor. I knew in his mind he thought he was going to a nursing home; but when he walked into Grace Manor, he was ecstatic. He loved it immediately. He couldn’t believe a place like Grace Manor existed.”

It took no time for Paul to feel at home at Grace Manor. From the moment he arrived, he began making friends and participating in the activities offered by the community.

“My Dad is super social,” describes Lulu. “He makes a point to talk to everybody, help them and get them on the dance floor when there’s music. He’s very active and social at the community, and he’s having fun.

“There are four guys he hangs out with, but there’s one guy in particular, John, that he hangs out with most. They always encourage each other to do things, like go out into the courtyard and take walks. John’s also a veteran, so he and my dad have bonded.”

Life Enrichment

Dedicated to Grace Manor residents is a team of specially trained resident assistants. Members of this team use various methods to align themselves with whatever the resident is experiencing in the moment. The goal is to help the resident struggling with the effects of dementia to feel calm, reassured and not so alone.

“Grace Manor is a step between our resident’s family home and a full-time nursing facility,” notes Danielle Ashby, president of Grace Manor. “We’re here for individuals with memory issues who need specialized care and can no longer be at home. We provide the caring assistance they require so they can live as independently as possible.

“In addition, Grace Manor has a life-enrichment program for its memory care residents. The program offers specific activities that cater to those with cognitive impairments such as Alzheimer’s and other types of dementia. As part of the program, the staff works with residents on a variety of sensory activities.”

Shadow boxes displayed outside their suites are a personal touch for residents with memory issues. These memory boxes are filled with photos and mementos that have personal significance for the resident. For residents with memory impairments, the boxes also help them locate their suites.

Not only do the memory boxes help the residents, they also give the staff a wider perspective about the people they’re caring for.

“The memory boxes let the staff know that at one time the resident was a doctor, a lawyer, a police officer, a very important mother to young children,” explains Danielle. “We want to remember to see them as more than just our residents. The staff gets a little bit of insight about who they are and the things they accomplished when they were younger.

“We ask the family to post or provide pictures of the residents and their family members. We have a lot of people with wedding photos and pictures of their kids. It’s a memory box, so people include the things that mean something to them. One man has a medal from his time in the Army in his.”

Family Away from Family

When Paul first walked into Grace Manor, he was thrilled by what he experienced. Since that day, he’s made friends, engaged in activities and generally flourished as a resident. As Lulu points out, this diamond is sparkling again.

“Dad loves it at Grace Manor,” she enthuses. “It’s amazing, and since he’s been there, he’s doing much better.

“For one thing, the staff follows a very consistent schedule. They feed Dad on schedule and give him his pills on schedule. He’s also being very physically active, having fun and acting social. Because of all that, his dementia has significantly improved. It’s unbelievable, and he’s only been there since December.”

The improvement in her father’s condition isn’t the only reason Lulu is happy with Grace Manor. She’s also grateful for the personalized treatment he receives from the nurses and staff who care for him each day. She believes they go above and beyond to make her father feel comfortable and at home.

“I’m beyond satisfied with Grace Manor,” Lulu states. “The staff is great. Dad has a very good relationship with everybody on the staff. He jokes around with them and knows all of them by name.

“The support the Grace Manor Port Orange staff gives my father is amazing, especially the support they provided to him after my mom passed away two months ago. They are truly a family away from family.”

Grace Manor was a good choice for Lulu and Paul for another reason as well. Lulu points out that theirs is a family in which all of the children live out of town, away from their father. It’s important to them to be sure they’ve selected a memory care facility that meets their father’s physical, mental and emotional needs.

“Knowing Dad’s in an awesome environment, he’s thriving and his brain is getting better gives us huge peace of mind,” she relates. “It’s something other families looking to make the assisted living decision should consider. I wish I made it earlier because I think my mom would have thrived at Grace Manor, as well.

“I want to tell others looking for assisted living for a parent, if you find the right facility, such as Grace Manor Port Orange, there’s nothing to fear.”

All in the Family

Education and support for families facing substance abuse.

Substance abuse is an insidious disease. It will creep into someone’s life and rob them of their physical and mental health. In the process, it damages their families and relationships. It destroys their self-confidence and well-being. It carries the prospect of death.

Louise Wallowitz, director of family services at Riverside Recovery of Tampa, discusses how substance abuse affects the entire family and how family therapy helps.

Louise Wallowitz

At Riverside Recovery of Tampa, substance abuse is well understood. Riverside Recovery of Tampa is a comprehensive center offering a full continuum of care to treat all aspects of the disease. Staff members engage clients in a Residential Treatment Program and an Intensive Outpatient Program, as well as through ongoing therapy and support services.

The staff at Riverside Recovery of Tampa realize substance abuse affects more than the individual afflicted with it. It affects that person’s entire family as well. Its consequences impact the family’s communication and dynamics. That’s why the staff at Riverside Recovery of Tampa have developed a wide-ranging Family Services Program to educate and support families facing this disease.

“Many families believe substance abuse is their loved ones’ problem, and if they just get better, everything will be fine,” says Louise Wallowitz, LMHC, CAP, director of family services at Riverside Recovery of Tampa. “We get the families involved in treatment so they can begin to understand it really is a family disease.”

Often, Louise notes, parents of individuals with substance abuse get caught up in what they did to cause their loved ones to have the disease. Staff of Riverside Recovery of Tampa Family Services focus instead on educating families about risk factors for the development of substance abuse.

“For one thing, research shows that genetics play a big role in substance abuse,” Louise observes. “We also teach families about the different parts of the brain and what happens when the prefrontal cortex, which is responsible for executive functioning, is damaged or its growth is stunted. If that occurs, their loved ones are not going to make good decisions.

“Through education, we help family members really understand what’s going on neurologically and realize that substance abuse is a disease, not a weakness. Then they can recognize that what they’re seeing is not really their loved ones. They’re seeing how the disease affects their loved ones’ brains and, therefore, their behavior.

“There are also environmental risk factors, including peer pressure. And if people are already genetically at risk for substance abuse, it’s likely their use will be a lot different than that of someone who uses drugs or alcohol while in college and then stops.”

As part of the education process, the Riverside Recovery of Tampa Family Services staff use a variety of videos and printed materials. These resources assist families in comprehending how their loved ones’ brains are not functioning at full capacity, which contributes to their substance abuse.

Team Effort

Staff at Riverside Recovery of Tampa work as a team to help their clients beat substance abuse and believe their clients’ families are a key part of that team. Riverside Recovery of Tampa Family Services provides several opportunities for families to become part of the effort.

“There are two family groups per week, and it’s mandatory for family members to attend at least one group to visit their loved ones,” Louise describes. “Every five weeks, we offer a family weekend. That’s a three-day weekend when families receive a lot of education about substance abuse and how to live with someone battling it.

“During family weekend, families learn how to communicate with their loved ones in a healthy way. They learn about boundary setting, building contracts and most important, how to support their loved ones in a positive way without enabling.”

During the family weekend, Riverside Recovery of Tampa Family Services staff educate families about the neuroscience of substance abuse and the changes that occur in the brain. Staff explain how substance abuse recovery does not happen overnight. It takes two years for the brain to heal and create new pathways responsible for behavior.

“Part of our instruction is to educate families about the holistic approach implemented with our clients,” Louise states. “That approach includes therapies such as yoga, meditation, exercise, eating right and getting better sleep. There’s evidence these activities help in the recovery process. An educated family can support their loved ones in this process.

“We encourage family members to continue coming to the group even after their loved ones leave Riverside Recovery of Tampa to get ongoing support. We also encourage them to seek outside support such as that from Alcoholics Anonymous® or Narcotics Anonymous®.”

Throughout the recovery process, Riverside Recovery of Tampa Family Services staff work to develop relationships with family members that close the gaps between their loved ones and their therapists.

“Sometimes, family members pick up on things in conversation that the therapists miss or misunderstand,” Louise relates. “Closing the gaps in communication decreases the chance for relapse.

“Family involvement is crucial to their loved ones getting well. We see an increase in success when everyone is working together. Families must be a part of treatment because substance abuse is a family disease, and everybody plays a part in offering support.”

Road to Recovery

The comprehensive recovery process at Riverside Recovery of Tampa begins with the Medical Detox Program, then the Residential Program, which varies in length, Louise notes. From there, clients transition into Day/Night Treatment (PHP), which is a day program during which clients return to Riverside Recovery of Tampa from 8:00 a.m. to 4:30 p.m.

“At that point, we provide additional support and encouragement to clients to live sober lives and to regularly attend twelve-step meetings, some of which we hold in-house,” Louise relates. “This part of the program is individualized and aimed at a slow transition back into life for clients. It could last two to four weeks, depending on the client.

“Next, clients transition into the Intensive Outpatient Program, which requires nine hours of therapy per week, or three nights a week. Following that is Aftercare, when many alumni take part, which adds support for the clients. That’s good for the alumni as well because the longer they remain engaged with us, the longer they’re away from substances.”

The program at Riverside Recovery of Tampa focuses on abuse of drugs and alcohol, but substance abuse often coexists with other disorders such as depression and anxiety.

“In most cases, it’s a dual diagnosis,” Louise confirms. “Clients will come in with substance abuse, but also depression, anxiety, bipolar or another disorder. While we’re treating the substance abuse, we’re also stabilizing these disorders or whatever the secondary diagnosis might be.”

Creative Modalities

As part of the treatment at Riverside Recovery of Tampa, clients are shown they can live happy, normal, healthy lives without the use of drugs and alcohol. The center offers amenities and activities to guide them in this discovery.

The center has a half-court basketball court, a yoga studio, an exercise room with weight and elliptical machines, and a swimming pool. Construction has started on a deck overlooking the Hillsborough River, which will allow clients to enjoy scenic views while taking part in outdoor activities.

“We show our clients they can have a lot of fun while sober and clean, doing things like working out, playing basketball, swimming or fishing, and they can enjoy them clear-minded,” Louise comments. “They will actually have more fun than if they were drunk or high.

“We do the deep work here. We get to the root cause of what’s going on with people and show them their lives are not over. With the help of Riverside Recovery of Tampa, people with substance abuse can be happy and laugh and enjoy life again.”

The Riverside Recovery of Tampa staff are able to address clients’ needs in creative ways as well, including art therapy and physical therapy. Unfettered by limiting program restrictions, Riverside Recovery of Tampa can use any treatment modality it sees fit to help improve a client’s physical and mental health.

Diziness Denied

Unique treatment alleviates vertigo.

One morning this past December, Suzanne Keane woke up to an unusual, uncomfortable feeling as she arose from her bed. She felt intensely dizzy, and her room seemed to be spiraling around her. It was a bout of vertigo that continued to plague her in the ensuing days.

Suzanne Keane’s vertigo was treated by Kelly Hansen, AuD, at Trinity Hearing & Balance Center in New Port Richey.

Suzanne Keane

“The entire room was spinning,” the 78-year-old Westchester County, New York native describes. “When I looked up, the whole ceiling was spinning as well. It was a horrible sensation that made me nauseous, and I wanted to throw up. I felt I was losing my balance. Thank God I was close to the bed.

“Later, when I bent down to clean out the litter basket, the room started spinning again. Whenever I put my head down to pick up something, I got lightheaded and the room would spin. It happened when I was getting up out of bed and when I was lying down. The whole room would spin on me. I wouldn’t call vertigo a physical pain, but on a discomfort level from one to ten, it was a fifteen.”

At first, Suzanne did nothing about her condition, but it got progressively worse, to the point where Suzanne was regularly waking up with a dizzy, nauseous feeling. Her daughter finally said, Enough is enough. You’re going to see someone about this. A friend recommended Trinity Hearing & Balance Center in New Port Richey.

It was at Trinity Hearing & Balance Center that Suzanne met Nikki Goldowski-Richa, AuD. Dr. Goldowski-Richa put Suzanne through an hour and a half of extensive testing and determined that loose crystals in her right ear were causing her vertigo.

“In the past, I had heard doctors and nurses say there was no cure for vertigo, and that there was no such thing as crystals in your ears that are in the wrong place as a cause of vertigo,” Suzanne shares. “But in doing these tests, Dr. Goldowski-Richa determined that was the cause of my vertigo and so she made an appointment for me to come back. 

“When I went back, Dr. Goldowski-Richa put me in a special chair they have in their office that’s one of thirteen in the entire United States. This chair is called the Epley Omniax System. They fastened me in and put me in different positions. Somehow, my eyes were hooked up to a computer they read while they tilted me, which put the crystals back in their proper place.”

Dr. Goldowski-Richa provided Suzanne with step-by-step directions of the therapy protocol. She made Suzanne feel at ease.

“While I was in the chair, Dr. Goldowski-Richa explained everything she was doing,” Suzanne confirms. “She said, I’m going to move the chair in different directions such as to the right and to the left. She let me know every move she was going to make and how I might feel when she did it.

“I’m very proactive about my health, as is my daughter who was with me, and we asked a lot of questions during treatment. There was never any impatience with us. Dr. Goldowski-Richa answered all our questions thoroughly with patience, empathy and understanding.”

Repositioning Particles

Dr. Goldowski-Richa tested Suzanne using state-of-the-art equipment and, based on the results and Suzanne’s symptoms, diagnosed her with benign paroxysmal positional vertigo (BPPV). BPPV is the most common cause of episodic vertigo. The condition is caused by small crystals of calcium carbonate that get into the inner ear balance mechanisms. When these particles become loose in the ear canals, causing symptoms, they must be repositioned.

“I use an advanced, software-driven machine, the Epley Omniax System, to diagnose and treat dizziness and balance disorders such as BPPV,”
Dr. Goldowski-Richa informs. “This system allows me to pinpoint the location of the particles and develop a detailed plan for repositioning them. Trinity Hearing and Balance Center is one of very few centers in the country to have this system.”

The Epley Omniax System includes the chair Suzanne described, which rotates to put patients in nearly any position. The doctor then monitors the patient’s eye movements for signs of dizziness. This enables the doctor to determine which positions lead to symptoms and, in the case of BPPV, which ear is affected.

“The chair is computer controlled, so it can put patients in the very precise positions necessary to move the crystals that are loose in the ear canals back where they belong,” Dr. Goldowski-Richa educates. “This approach is also less physically demanding than previous treatment methods.

“The chair allows us to easily put patients in these precise positions without placing strain on their necks or backs. It is also much more comfortable for the patients than being moved around a table, which is the way we used to reposition the crystals.”

Highly Credentialed

Trinity Hearing & Balance Center’s philosophy and dedication to patient care are what set it apart from other hearing centers.

“Trinity Hearing and Balance Center is proud to be an AudigyCertified™ practice,” Kelly Hansen, AuD, states. “We are one of only two hundred and fifty clinics in the nation to hold this certification.

“AudigyCertified professionals are among the country’s most experienced hearing care professionals, its members possessing some of the industry’s highest credentials. Our expertise is measured by our commitment to patient satisfaction, continuing education and the expert application of current technologies.

“We work side by side with our patients to help find a solution to their hearing problems,” Dr. Hansen adds. “Many patients who have gone through our Patient for Life® program experience greater satisfaction with their hearing technology and a greater quality of life.”

“Like a Miracle”

Treatment using the Epley Omniax System at Trinity Hearing & Balance Center was very successful for Suzanne. She experienced positive results right away, which continued to improve and lasted over time.

“When Dr. Goldowski-Richa tilted me in the chair, my eyes moved rapidly as the crystals in my ear went back where they belonged,” Suzanne relates. “When my eyes stopped moving,
Dr. Goldowski-Richa knew she succeeded with the repositioning, and I experienced relief immediately.

“When I came out of Trinity Hearing and Balance Center after the treatment, I didn’t have vertigo anymore. It was unbelievable, like a miracle. I felt better that day and even better the next day.

“Dr. Goldowski-Richa told me not to sleep on the side that was affected, my right side, for three days afterward, but that was it. She said if the vertigo came back, which she said was a possibility, I should just return to the office and she would treat me again.

“Now, I feel fantastic. I have no problems with vertigo at all.
Dr. Goldowski-Richa and the staff at Trinity Hearing and Balance Center are just wonderful. I never felt rushed and I always felt I was getting the most phenomenal care. I highly recommend them.”

The Silent Thief of Sight

Clinical study investigates glaucoma treatment.

Glaucoma is the second leading cause of blindness in the United States, but of the millions of people affected by it, many are unaware the condition is present.Dr. Lee Shettle of Shettle Eye Research, Inc. in Largo is conducting a clinical study of an investigational treatment for glaucoma and ocular hypertension.

“Nearly four million people are estimated to have glaucoma, but half don’t know it,” confirms Lee Shettle, DO, a board-certified ophthalmologist at Shettle Eye Research who conducts clinical research in partnership with ophthalmic pharmaceutical companies.

Dr. Shettle’s research aims at assisting ophthalmic pharmaceutical companies in developing new medical eye drops to treat various eye conditions such as dry eye disease and ocular inflammation. He is currently enrolling patients in a clinical study testing treatments for glaucoma.

Glaucoma is a condition where increased pressure in the eye causes damage to the optic nerve, which can lead to blindness if untreated.

“The increased eye pressure is caused by either an overproduction of eye fluid called aqueous humor or a decrease in drainage of aqueous through the trabecular meshwork,” explains Dr. Shettle, who has been practicing general ophthalmology in Largo since 1994. “In a healthy eye, aqueous humor exits the eye at the same rate as the eye’s ciliary body produces it, so there is always a balance in pressure within the eye.

“With glaucoma, aqueous either passes too slowly through the trabecular meshwork or the ciliary body produces an increased amount of aqueous humor. You can think of it as a faucet being turned on too high or the drain in the sink being clogged, resulting
in a build-up of fluid.

“Glaucoma has no obvious visual symptoms in its early stages. As it progresses over many years, damage occurs to the optic nerve, resulting in loss of peripheral vision. Without treatment, this loss of vision can progress to blindness, robbing people of their vision slowly and quietly. It’s a silent thief of sight.”

Types of Glaucoma

There are different types of glaucoma, including open-angle glaucoma, also called wide-angle glaucoma. This is the most common type and represents about 90 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’s 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 believe it’s related to reduced blood flow to the optic nerve. Congenital glaucoma is hereditary and often diagnosed in very young children. It results when the eye doesn’t form properly during development. Secondary glaucoma is the result of another condition, such as diabetes.

Some people are at greater risk for developing glaucoma.

“Glaucoma is more common in certain populations,” Dr. Shettle expresses: “The people at highest risk for glaucoma include African-American and Hispanic patients over the age of forty; everyone over the age of sixty; and, especially, anyone with a family history of glaucoma, particularly if a parent or sibling has the disease.”

People are also at greater risk for glaucoma if they have certain medical conditions, such as diabetes, heart disease and high blood pressure. Other risk factors include having had a previous eye injury, being farsighted or nearsighted and taking steroid medications for a long time.

Halting Progression

Treatment for glaucoma aims to slow the disease progression. It may include medicated eye drops, a laser procedure or surgery.

“For patients with mild glaucoma, the use of medicated eye drops or a laser treatment to lower intraocular pressure may be all that’s needed to keep the disease under control,” Dr. Shettle states.

Medicated eye drops alter the production of fluid and lower pressure in the eye. They work in one of two ways: by either decreasing the production of aqueous humor or by increasing the amount of aqueous humor exiting through the trabecular meshwork.

Trabeculoplasty and iridotomy are two laser procedures used to treat glaucoma. During trabeculoplasty, the laser is applied to the drainage tissue, where it starts a physical and chemical reaction that improves drainage function.

Iridotomy treats narrow-angle glaucoma. During this procedure, the laser is used to create tiny holes in the iris to improve the flow of fluid within the eye.

In more advanced stages of glaucoma, patients may require a procedure called surgical trabeculectomy in which surgeons create a small hole in the eye wall. The wall is covered by a flap of tissue that serves as a trap door through which excess fluid drains to an area under the eye’s surface.

“As it is with most conditions, early detection is critical when treating glaucoma,’’ Dr. Shettle emphasizes. “And treatment is crucial to prevent the progression of this common eye disease.”

Because glaucoma in its early stages has no symptoms, people with the disease often don’t seek medical attention until some vision loss has begun.

“Screening for glaucoma should be part of all routine eye exams, which every patient should have at least every year or two, based on their risk,” Dr. Shettle observes. “Tests for glaucoma include measuring the eye pressure as well as analyzing the optic nerve for changes.”



New hearing instruments can finally stop the ringing in your ears.

Dominick Luca retired and moved to Florida in 2012 after working more than 30 years in the engineering division of the City of New York. Most of his career, Dominick was an operating engineer, but he worked his way up and eventually began managing boiler plant and air conditioning systems in office buildings, college campuses, hospitals and other public spaces.

Patient photo by Jordan Pysz.

With his hearing instruments, Dominick says he hears like he’s 20 years old again.

His was a long, loud career that began when Dominick was young and a new recruit in the US Navy. There, he got his initial work experience with heating systems, sweating over the boilers on the ships to which he was assigned. Between his Navy service and his service to New York City, Dominick spent decades in high-decibel sound. It wasn’t without consequences.

“With all the years of working on machinery, not wearing hearing protection as much as I should have while doing things like welding, hammering and bending metal, and from the constant pounding and banging of metals, my ears took abuse,” he shares.
“I noticed I had a hearing loss, and I found myself constantly asking people to repeat themselves. I also noticed since I retired that my right ear was ringing. It was a nuisance and making me a little nuts, because it was twenty-four hours a day. It was maddening to live with it.”

Frustrated, Dominick sought the advice of his trusted family physician, who immediately referred Dominick to Dean M. Knoblach, board-certified Hearing Instrument Specialist at Knoblach Hearing Care in Largo. When Dominick met Dean, he understood why his doctor was so quick to recommend him.

“Dean was very interested in making sure he knew exactly what was happening with me,” describes Dominick. “He started by doing several tests. He’s up-to-date on all the technology. He has all types of equipment to help him determine what’s needed. He found that I had particular differences between my left and right ears.”

Dominick added, “It knocked out the tinnitus and by the time he was done tuning these devices, my hearing was crisp and clear. It’s been years since I was able to hear this well.”

Tinnitus Troubles

For many, common tinnitus comes in the form of a buzzing, ringing or even cricket-like sound. In reality, it is a phantom sound without any real acoustic stimulation, which also means the person who suffers from it can’t just walk away from it.
For some, it comes and goes by the time of day, and for others it stays all day and night for years. Chronic tinnitus sufferers can experience severe problems such as anxiety, insomnia and eventually severe depression.

“More than fifty million Americans experience tinnitus, and studies show most of those people also have diminished hearing,” informs Dean.

Until just recently, there’s been little help for tinnitus. Now, with the advent of digital tinnitus maskers, total relief can be just a hearing exam away.

“Several manufacturers now carry this feature in their high-end models, but there is a definite difference in these models’ abilities to get the job done,” Dean states. “Since more than ninety percent of all tinnitus involves some sort of acoustic trauma, each and every case is different.

“It’s our job at Knoblach Hearing Care to determine what combination of particular technology and settings is necessary to properly address each individual’s needs. There is never one model that works for all, but with the right technology and proper settings, nearly all cases are correctable.”

Maximum Benefit

The combination of hearing instrument and masking device Dean recommended for Dominick was a perfect fit. Dominick is amazed by the difference it makes when he uses his instruments compared to when he leaves them out.

“The devices are just wonderful,” Dominick offers. “I don’t wear them at night, but during the day I wear them and I’m tinnitus free. They’ve been one hundred percent effective for me.”

Dominick’s hearing has benefited as well. He relays that he’s back to hearing like he did as a younger man.

“My ears suffered from abuse all those years, but with these devices, it’s like I’m twenty years old again,” says Dominick. “I can hear, and I don’t ask people to repeat themselves. Because these devices muffle the tinnitus, it helps to hear more crisply what people are saying, even in a crowd.”

While he’s extremely thrilled with the result of his trips to Knoblach Hearing Care, Dominick stresses that he was also pleased by his visits there. He says Dean and his staff are worthy of praise as well.

“It’s a fantastic facility that is focused on total customer satisfaction, from Dean’s diagnosis right down to the work of the receptionist,” reports Dominick. “They smile. They make you laugh. They’re all perfectionists. I would give them five stars. I would recommend them without a doubt.”

WATS Happening in Esophageal Cancer

May 8th, 2019

Do you get heartburn after you eat? Maybe you get it once in a while, or maybe you’re one of the 15 million or more Americans who get it every day. That’s about 20 percent of the US population. If you get heartburn often, you may have a condition called acid reflux. If your heartburn is seriously bothering you, you may have gastroesophageal reflux disease, or GERD.

GERD occurs when acid from your stomach persistently flows, or refluxes, back up into your esophagus, your food tube. What happens is that certain factors, including being overweight, smoking and taking certain medications, weakens the round muscle separating your stomach and esophagus that normally keeps the acid in its place.

GERD doesn’t typically kill you, but it can cause an alteration in the tissue of your esophagus that can turn into esophageal cancer, which is rare but deadly. The alteration occurs when GERD keeps getting worse and the cells lining your esophagus change so that they’re more like cells of the intestines. This is called Barrett’s esophagus.

Barrett’s esophagus can be a precursor to esophageal cancer, the fastest growing cancer in the United States. It starts with a precancerous condition called esophageal dysplasia. Dysplastic cells are those that begin to change and can over time deteriorate further into cancer cells.

Fortunately, esophageal cancer can be effectively treated if caught in its early stages. The way to do that is by visualizing your Barrett’s esophagus using an endoscope and taking samples of the tissue to look for cancer cells.

Detecting cancer cells in Barrett’s esophagus can be tricky, however, because the cells are often flat and spotty in the way they are distributed in the tissue. Getting as many cells as possible in a sample increases the likelihood your doctor will find any cancerous ones.

In the past, samples for biopsy were taken using forceps and pinching off bits of tissue at certain intervals. This method’s chief drawback is that it only gets samples from a small percentage of the total area of the esophagus. Recently, a new system for obtaining cells for biopsy was introduced that can sample up to 70 percent of the affected Barrett’s tissue.

The new technology is called wide-area transepithelial sampling (WATS), and it works with computer-assisted 3-D analysis. That makes it WATS3D. WATS3D uses a special, minimally invasive brush that doctors scrape around the esophageal wall in an up and down motion,. This gathers samples from a wide area and from the tissue layers where dangerous, precancer cells develop.

The samples taken by WATS3D are then analyzed by the computer system. The maker of WATS3D borrowed technology from the US Strategic Defense Initiative, also known as the Star Wars program, and a unique algorithm the WATS3D computer uses to analyze the samples.

The computer has a special neural network, or “brain,” that can see virtually the entire sample. The computer scans the sample three dimensionally and takes the 200 most suspicious areas and projects them on a monitor for the pathologist to read. The images provide crucial information about the cells’ structure that helps doctors accurately detect cancer.

WATS3D has been shown to be an effective tool in the fight against Barrett’s esophagus and esophageal cancer. In one study, using WATS3D increased detection of Barrett’s esophagus by 83 percent and of precancerous esophageal dysplasia by 88 percent. That’s a huge improvement.

It doesn’t take much time, either. WTAS3D is performed during a standard endoscopy. It adds about five minutes, if that, to the time it takes to do the endoscopy. That sounds pretty reasonable to me to increase your chances of catching esophageal cancer in its earliest stages.

Soothing Sensations

SoftWave® therapy heals painful elbows.

Stay-at-home mom Melinda* retired once her children became adults, but the New York native continues to maintain a busy household. Recently, out of nowhere, Melinda developed severe pain in her right elbow, which was eventually diagnosed as golfer’s elbow.Dr. Mel Richardson used TRT OrthoGold™ SoftWave® therapy to treat Melinda’s and Natalie’s (aliases) painful elbow conditions.

“I can’t say I’m a golfer. I play maybe once every couple of months, so I don’t know how I got golfer’s elbow,” Melinda muses. “I was in so much pain, it almost brought me to tears at times. It was a constant, aching pain, and when I raised my elbow to bend it, the pain intensified.

“I couldn’t do anything with my elbow, and sleeping at night was terrible. There was always pain. If I moved my elbow a certain way, like to bring a cup to my mouth to take a drink, I could barely do it, it hurt so bad. Then, it got to where I could hardly hold a cup without pain.

“I couldn’t clean my floors because using a mop really hurt. Anything that bent my elbow back and forth was painful. It was difficult to eat, drink or do anything with my right hand, and I’m right-handed. The pain was a nine on a scale of one to ten.”

Having lived in Vero Beach for almost 40 years, Melinda was well acquainted with the local medical community. That included lifestyle optimization specialist Mel Richardson, MD. Dr. Richardson told Melinda about a new treatment he offers called SoftWave therapy that showed tremendous success at relieving patients’ pain.

“I use a leading-edge SoftWave therapy device called TRT OrthoGold that is changing treatment for pain and has proved to be useful and, in fact, highly effective in treating many pain syndromes and health conditions,” Dr. Richardson announces.

Highly Successful

TRT OrthoGold SoftWave therapy is a noninvasive procedure that utilizes specific frequencies of acoustic waves to initiate improved blood flow to an injured area of the body. The additional blood flow results in profound changes at the cellular level.

“The acoustic waves are similar to those used to break up kidney stones and work in two ways,” explains Dr. Richardson. “First, they enter the injured tissue and trick the cells into releasing the anti-inflammatory chemicals and proteins the body naturally produces.

“These chemicals decrease inflammation in the injured area, which relieves pain. This benefit occurs quickly, when the treatment is performed. The second thing the sound waves do is attract stem cells from around the body to the injured area.

“The stem cells heal and regenerate damaged tissue, but they take time to fully regenerate, so the maximum benefit of the treatment occurs anywhere from six to twelve weeks following therapy.”

In addition to relieving pain, TRT OrthoGold SoftWave therapy treats a variety of health conditions.

“TRT OrthoGold SoftWave therapy has been shown to heal fractures and stomach ulcers, even infected tissue such as that with osteomyelitis,” Dr. Richardson notes. “It can help with vascular disease and is even being used during open heart surgery and following heart attacks to prevent scar tissue development.

“This therapy can be used to treat plantar fasciitis and peripheral neuropathy as well. It has a ninety- to ninety-five-percent cure rate for all types of pain syndromes as well as these other conditions. That sounds too good to be true, but research backs it up.”

TRT OrthoGold SoftWave therapy is a different type of treatment for erectile dysfunction (ED), which is a significant problem with this country’s aging population, reports Dr. Richardson. SoftWave therapy works when medications fail and is less painful than other ED treatments.

“With many common ED devices, a numbing cream or local anesthetic must be used to numb the area before utilizing the device,” Dr. Richardson informs. “The TRT OrthoGold is pain free. No anesthetic is necessary.

“TRT OrthoGold SoftWave therapy requires about six treatments over a six-week period and is very effective. It has an eighty- to ninety-percent success rate for ED treatment. It can also be used to treat pelvic pain and urinary incontinence in women without surgery.”

“The machine was like an ultrasound,” Melinda describes. “Dr. Richardson rubbed it on my elbow, and when he hit certain points, the pain went crazy. As he kept rubbing, the pain subsided and subsided until it was almost gone. There were probably three really hot spots in a tiny area of my elbow.”

Tennis Elbow, Too

Like Melinda, Natalie* is a stay-at-home mom, although Natalie is not yet retired. She’s still actively caring for her son, husband, two dogs, a cat and two fish. Like Melinda, Natalie began experiencing pain in her right elbow. But Natalie was diagnosed with tennis elbow, a condition differentiated from golfer’s elbow by the exact location of the pain on her arm.

“I play tennis every day, Monday through Friday, and I started having pain in my elbow after getting a new racquet and new strings,” Natalie recalls. “It was mostly an aching pain, but there were times it was sharp, especially when I tried to grip a cup or hold something. The pain was a six or seven on a scale of one to ten.

“Because of the pain, I couldn’t vacuum or do my daily chores. I had to eat with my left hand because I couldn’t grip or hold things in my right hand. I had to give up playing tennis for three months. Instead, I stayed home, iced and rested my elbow, and did exercises.

“I tried doing physical therapy here in Vero Beach and ended up seeing an orthopedist in New Orleans. Then, I went to my brother, who’s a physical therapist in New Orleans. The exercises and physical therapy helped, but that’s all before Dr. Richardson’s machine came along.”

Natalie met Dr. Richardson when a family member went to him for neck pain treatment. Natalie and her family became good friends with Dr. Richardson, so when he suggested the new TRT OrthoGold SoftWave therapy for her elbow, Natalie was eager to try it.

“Dr. Richardson used an ultrasound head with gel on my elbow,” Natalie relates. “The treatment is like small sonic booms, and it regenerates blood flow in the painful area. I just had my third treatment, and it really helped.”   

Total Turnaround

Melinda and Natalie experienced severe pain in their elbows that conservative treatments such as ice and physical therapy failed to alleviate. They struggled with their activities because of the pain, but TRT OrthoGold SoftWave therapy brought their lives full circle.

“I feel so much better,” Melinda raves. “I’m able to do everything now. This weekend, I’m going to clean out a storage unit. I couldn’t even think about doing that a month ago. Whatever Dr. Richardson did worked. Where my pain was a nine before, it’s down to maybe one. I’d have this treatment again in a heartbeat if I ever needed it. I’ve already recommended it to a couple people. I recommend Dr. Richardson, too.”

Natalie experienced a similar turnaround after her TRT OrthoGold SoftWave therapy.

“My elbow feels good now,” she enthuses. “The pain level is down to zero. I have no pain, and I’m back to playing tennis. I tape my arm when I play, just for a little added security and peace of mind, but there’s no pain. TRT OrthoGold SoftWave therapy was certainly successful for me. I definitely recommend it and Dr. Richardson to anybody in pain.”

*Patients’ names withheld at their request.

A Stable Foundation

Implant-secured dentures improve confidence, functionality.

Since he was a child, Nick Hoot, 79, had a serious problem with the enamel on his teeth. That led to the formation of cavities and eventually to tooth loss. The retired insurance agent and minister was a frequent visitor to the dentist’s chair from the time he was about ten years old. He had his share of dental procedures and appliances.   

Photo by Fred Bellet

Nick Hoot

“I’ve always had really bad enamel,” Nick confirms. “I kept losing my teeth, so I started wearing partials and bridges while I was still young. Then, at twenty-five, I decided enough was enough, and I had full dentures put in, upper and lower. Over the years, I’ve had several sets of dentures made.

“My wife and I are snowbirds from Indiana, and last March, while we were in Florida, I broke my lower denture in half when I bit down on a piece of cucumber. I didn’t want to be without dentures, so I looked around for an emergency dentist. I discovered Venetian Dental, which advertised twenty-four-hour emergency service. I remember thinking, This Dr. Gaukhman may be the only dentist in the nation that does that.”

Alexander Gaukhman, DMD, of Venetian Dental is a skilled and experienced dentist who offers exceptional and affordable general, cosmetic and restorative dentistry at his offices in Venice, Sarasota and Osprey. As Nick soon discovered, he also provides quick, quality emergency dental care.

Nick contacted Venetian Dental the evening of his mishap, which was a Saturday, and spoke with a dental assistant who agreed to meet him at the office immediately. The dental assistant warned Nick that gluing his denture together wouldn’t hold, but Nick insisted on the repair. The denture broke again the next morning as Nick chewed his breakfast cereal.

“On Monday, I called Venetian Dental and went in for an appointment,” Nick recalls.
“Dr. Gaukhman took x-rays and performed an examination. He said, Nick, you’re no longer a candidate for lower dentures. I said, What! I’ve got to have teeth.

“My new dentures look wonderful to me. My wife agrees, and she’s my greatest critic. People can’t tell that I have dentures.” – Nick“He explained that because I’d been wearing dentures for so long, I had worn down my lower gums, and there were two nerves that were within millimeters of being exposed. He told me if those nerves became exposed, there’d be no limit to the pain I’d be in. I said, What can I do? He suggested a lower denture retained by four dental implants.”

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. They are considered the most effective way to secure dentures because when secured by implants, dentures do not slip or move; they stay in place when patients speak and eat.

Not Uncommon

Nick’s situation was not unique. Many people with lower dentures have difficulties keeping them secure. This is because there is no palate in the bottom jaw due to the location of the tongue; therefore, less suction is produced. As a result, lower dentures tend to slip and slide.

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 Nick, whose upper denture fits just fine and does not wobble or move. The problems with his lower denture, however, spread beyond its lack of stability.

“Adding to Nick’s lower denture problem was the fact that he didn’t have enough bone in his lower jaw to support a denture, which is a very common occurrence,” Dr. Gaukhman reports. “However, he did have just enough bone to place dental implants. Had he waited a couple more years, we wouldn’t have been able to place implants without a bone graft.”

Implants are made of a titanium alloy that fuses with the patient’s bone to become a solid unit. For most patients at Venetian Dental, implants are placed on the day of tooth extraction. The dentures are also created at that time. Nick was an exception because he had no teeth to extract.

“In general, once the patient’s problem is diagnosed and the treatment is determined, I take impressions,” Dr. Gaukhman explains. “When the dentures are ready, which is usually on the same day or the next day, I extract the teeth and put the dentures in right away.

Photo by Fred Bellet

Nick received emergency care from Dr. Gaukhman at Venetian Dental.

“The dentures act as a bandage to stop bleeding and limit swelling, and for the next three to six months, I keep the patients in temporary dentures until the implants fuse and the gums heal. Then, I replace the temporary dentures with the permanent appliances.”

Dr. Gaukhman began that process with Nick last April, placing four implants, two of which were capped with abutments to secure the temporary denture. In October, Dr. Gaukhman placed abutments on the two remaining implants and fit Nick with his permanent denture. In January, Nick returned for some final tweaks to ensure the denture fit perfectly.

Overcoming Anxieties

Retired insurance agent Joel Lustgarten is a native of New York City. While in college at the University of Miami, he met his wife. He’s been in Florida ever since. While living in Sarasota a few years ago, Joel decided his long-term dental issues needed to be resolved. There was just one problem: At the time, he didn’t like dentists.

“I’m seventy-one years old, but I’m a big baby, particularly with dentists,” Joel admits. “But I needed a lot of work done because, when I was a kid, my dentist was my stepfather’s brother, and he put a lot of crowns in my mouth.

Patient photo by Jordan Pysz.

Dr. Gaukhman and his kind staff helped Joel overcome his fear of dentists.

“That was about fifty-five years ago and, of course, nothing lasts forever. Well, a few years ago, the crowns started breaking off. I also broke one tooth and had an abscess in another.

“I didn’t have pain so much, but I had trouble chewing. It was hard to eat steak and roast beef. Not that I didn’t eat them, but it was difficult, so I decided I had to take care of these problems.”

Joel knew he required quite a bit of dental work to restore his teeth and smile. Because he was not a fan of dentists, he sought one who was experienced with fearful patients. A friend recommended Dr. Gaukhman.

“I started going to Dr. Gaukhman in 2016,” Joel relates. “He is the kind of dentist I was looking for, because he helped settle my fears. As part of his personality, he doesn’t make a big deal over anything. He’s calm and says, Don’t worry. We’re going to take care of this and make sure you’re happy.”

During his consultation appointment with Dr. Gaukhman, Joel told the dentist to start work on his upper teeth because they were worse than his bottom teeth. After discussing options, the dentist recommended a denture that is measured, created and fit in a single appointment.

“Dr. Gaukhman gave me alternatives, including a removable bridge or dental implants,” Joel remembers. “After hearing about implants, I decided to make the commitment and go with them.”

Palate Pleasers

“Joel’s main concern when he first came to the office was with his upper teeth,” verifies Dr. Gaukhman. “They were in poor condition and failing, and there was infection in some of them. They weren’t worth saving.

“I suggested removing all of his upper teeth and placing a denture. When he agreed, I immediately took an impression of his teeth to shape the denture. We did the extractions and placed the denture immediately.

“We were able to save many of Joel’s lower teeth, so I made a bridge for his bottom jaw. We decided to put a few implants on the bottom to make that bridge more secure.”

After hearing about their benefits, Joel opted for the stabilizing dental implants. While upper dentures generally don’t require implants to remain stable, they do have a few shortcomings that can be rectified by securing them with dental implants.

“One issue with traditional dentures is a decrease in taste,” Dr. Gaukhman notes. “The tongue is mainly responsible for discerning taste, but the palate also plays a role. When a traditional denture is made for the upper jaw, it covers the palate, which can deprive patients of sensing the full complement of tastes.“[Dr. Gaukhman] is the kind of dentist I was looking for, because he helped settle my fears.” – Joel

“Another issue that can occur with traditional dentures is a gag reflex. Some patients experience this due to the denture being over the palate. An implant-retained upper denture is shaped like a horseshoe instead of fully covering the palate. It frees up the taste buds and eliminates the gag reflex.

“Joel’s initial denture was a traditional denture, then he decided he wanted a higher quality of life. He didn’t want the denture to cover his palate, so we placed four implants in his upper jaw. That gave us leeway to make a new denture without a palate.”

Traveling Trust

When Joel’s friend recommended Dr. Gaukhman, he had no idea what a great find it would turn out to be. Joel’s grateful for the patience and care the dentist and his staff take with him and how they help him through his treatment despite his anxiety.

“From the beginning, I thought Dr. Gaukhman was a really nice guy,” he comments. “Another thing I like about his office is they use a team approach to their patients. The staff is excellent and obviously trained by Dr. Gaukhman. Going there is a nice experience. I rate it between very good and excellent.”

Joel says he’s happy with the work Dr. Gaukhman has done for him. He likes his upper denture and feels much more confident when he smiles.

“I’ve gotten compliments on it,” he enthuses. “I don’t want anyone to know what I had done, but when I get compliments, I know Dr. Gaukhman did a good job. I’m very, very pleased. I can also eat steak and roast beef now without difficulty. I really have no limitations on what I can eat.”

Last June, Joel moved from Sarasota to Singer Island in Palm Beach County. Few things take him away from his life on the beach, but one of them is his dentist. Joel is so pleased with Dr. Gaukhman that he kept him as his dental provider even after relocating.

“Now, I get in my car and drive back to Sarasota to see Dr. Gaukhman,” he shares. “For my last appointment, I left Palm Beach at 4:30 in the morning and got to his office for my 9:00 appointment right on time.

“Not only do I recommend him, I’m also willing to travel back and forth five hundred miles just to see Dr. Gaukhman at Venetian Dental.”

Denture Delight

For years, Nick lived with lower dentures that didn’t stay secure in his mouth. They slipped and slid and wore down his lower gums, nearly exposing sensitive nerves. It was obvious to anybody who looked at him that he was wearing dentures. He doesn’t have to worry about that anymore.

Stock photo from kisspng.“My new dentures look wonderful to me,” he raves. “My wife agrees, and she’s my greatest critic. People can’t tell that I have dentures. They’re wonderful.”

Like Joel, Nick is not limited in the foods he can eat with his implant-retained lower denture. The dental implants hold his lower denture securely, which improves his biting and chewing functions.

“I can eat anything I want,” Nick says. “I can eat steaks. I can chew them just fine. I probably shouldn’t, but I like crunching up hard candy. I can do that with my new denture. I can eat corn on the cob with no problem. Now, I can chew most anything you put in front of me, so I’m a very happy camper.”

Nick is absolutely delighted with his new dentures, and he’s extremely pleased with Dr. Gaukhman, his staff and everything about Venetian Dental.

“The facilities at Venetian Dental are wonderful, but even more so are the people who work there,” Nick attests. “They’re among the most talented, considerate and kind people I’ve ever run into. And since I’ve been involved with partials and bridges since I was young, I know what I’m talking about when I talk about dental people.

“Everyone at Venetian Dental is exceptional, from Dr. Gaukhman on down the line. My treatment was very successful. I absolutely recommend Dr. Gaukhman and his staff at Venetian Dental. In my mind’s eye, they’re superior.”

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