Author Archive

Reduce Radon Risks

January 21st, 2018

It’s a new year, and for most of us, that means making a resolution or two. Here’s an important resolution you may not have thought of: Resolve to test your home for radon. January is National Radon Action Month, and it’s a good time to take time to protect yourself and your family from this dangerous element.

So, what’s the deal with radon? Radon is a radioactive gas that can leak into your home from the surrounding environment. You can’t see or smell it, but in high concentrations, it can be deadly. In fact, radon is the second leading cause of lung cancer deaths behind smoking, killing approximately 21,000 Americans each year.

Radon is produced by the natural decaying of uranium, which is abundant in soil, rock and even water. Radon gets inhaled and accumulates in the lungs, where it irradiates the cells of the airways. It is this process that increases the risk for lung cancer. If you smoke AND your home has a high radon level (EPA Assessment of Risks from Radon in Homes), your risk for lung cancer is especially high.

There are no immediate symptoms of radon exposure. Lung cancer is the only health condition conclusively linked to it, and lung cancer can develop years after radon exposure. Lung cancer symptoms include persistent coughing, shortness of breath, hoarseness, coughing up phlegm tinged with blood and recurrent bronchitis or pneumonia. To date, no other respiratory illnesses have been definitively linked to radon exposure.

The amount of radon found in the soil around your home depends on the chemical makeup of the soil, and soil chemistry can be slightly different from house to house. The volume of radon that escapes from the soil and gets into your house depends on several factors. These include the weather, the amount of moisture in the soil and the suction power within your house.

To make its way into your home, the radon gas escapes the ground soil and seeps into the air. It then gets into your house through cracks and other holes in the foundation that might not be apparent. The gas can get trapped inside your home and build up to a dangerous level. Sometimes, radon can get into the house through well water; and in some homes, the actual building materials can give off radon, although this is not common.

It is estimated that nearly one out of every 15 homes in the US has an elevated radon level. The only way to be sure if your home is affected is by testing. The EPA and the Surgeon General recommend radon testing in all homes and schools. You can also find out about any radon problems in schools, day care centers, other child care facilities and many workplaces by visiting EPA – United States Environmental Protection Agency.

There are two general ways to test for radon, short-term testing and long-term testing. Short-term tests are left in your home for two days to 90 days, depending on the test. Short-term tests don’t tell you your year-round average radon level, but they can help you decided whether or not to make changes to your home to fix any problem. People typically do two or more short-term tests to confirm a radon problem.

Long-term tests are left in your home for longer than 90 days and give you a better idea of your yearly average radon level. You can do the testing yourself, or you can hire a professional tester to do the job for you. Do-it-yourself test kits are available at many home improvement and hardware stores or online. If you choose to hire someone, be sure to first check with your state radon office and ask for a list of qualified testers in your area.

If two consecutive short-term tests or a long-term test indicates a high level of radon in your home, it’s time to consider making repairs to mitigate the problem. There are several ways to reduce radon levels in your home. The most common method is by installing a vent pipe system and fan that pulls the radon from beneath your house and releases it outside. Sealing cracks in the foundation and other openings can make this repair more effective and cost-efficient.

Like the testing, you can choose to do the repair work yourself or hire a qualified radon mitigation professional. If you choose to do it yourself, there are many resources online that give you suggestions and directions for reducing radon levels in your home. More information can be found in this booklet and others from the EPA.

Excessive exposure to radon can be prevented through careful testing and, if necessary, repairs to your home. By taking a few common-sense steps, you can protect yourself and your family from an increased risk for lung cancer. That’s a New Year’s resolution that can save your life!

Pain When Bending or Squatting?

Vein compression affects women…and men, too!

Being a full-time manager at a national auto parts chain, Rich Fitzgerald works 55 hours a week, and most of that time is spent on his feet. The New York native believes those long hours standing had a negative effect on his legs.

Photo by Fred Bellet.

Rich can now bend and squat to work on his car without pain.

“I was having a lot of pain in my legs,” he recounts. “At the end of the day, they would be throbbing, and it was just unbearable to stand. My legs also felt heavy, like they had weights on them. I’ve always suffered from poor circulation, so sometimes there was a kind of numb feeling in my legs, but there were those pressure points on them that would throb.
“I didn’t have cramps too badly, but my legs would swell. If I bent down to pick up something, within a few seconds I would lose feeling in one of my legs. I also had visible varicose veins on my thighs. They were high enough that they never showed when I wore shorts, but I had some spider veins in my calves that bothered me.”
The discomfort in Rich’s legs made it difficult for him to get through a workday without elevating his feet. He realized he had a problem that needed to be resolved. A friend recommended Joseph G. Magnant, MD, a board-certified vascular surgeon who specializes in treating vein disorders. Dr. Magnant’s practice, Vein Specialists, which has offices in Fort Myers and Bonita Springs, is dedicated to the comprehensive modern evaluation and minimally invasive treatment of vein disorders.
Rich made an appointment with Dr. Magnant, who performed an ultrasound examination of his legs. The ultrasound confirmed Rich had venous insufficiency, which occurs when the one-way valves inside the leg veins that assist blood flow against gravity become stressed and begin to leak. While getting Rich’s medical history, Dr. Magnant learned about other symptoms Rich had been experiencing.
“I had bad abdominal pain,” discloses Rich. “I went to my regular doctor and to gastroenterologists, who did all the scans and tests. They couldn’t figure out why I was having the pain. I also had pain when I bent down or squatted. I even had a lot of issues with pain in my feet and had gone to a foot doctor.”
During his physical exam, Dr. Magnant noticed Rich’s right leg was several inches larger in circumference than his left leg. That, along with his patient’s abdominal symptoms, made the physician suspicious that Rich was suffering from a less recognized but more-prevalent-than-most-physicians-realize vein condition, iliac vein compression syndrome.
“Dr. Magnant wanted to do an ultrasound of my abdomen, so he used his new technology to see if there was any blockage in my pelvic veins,” notes Rich. “He went in through my jugular vein and used a small ultrasound catheter to check it out. He discovered I had a seventy percent blockage in my left common iliac vein.”
“I diagnosed Rich with a condition called May Thurner syndrome, a subcategory of a disorder known as pelvic congestion syndrome,” observes Dr. Magnant. “This syndrome occurs when the right iliac artery compresses the left common iliac vein, blocking its blood flow and resulting in symptoms of venous congestion in the abdomen, buttocks and legs.
“Most often, doctors think of pelvic congestion syndrome as a female disorder, but men can suffer from it as well. They essentially have the same circulatory anatomy, just different reproductive organs, but the presenting symptoms in men may be different.”
Symptoms of pelvic congestion syndrome in men include nonspecific pelvic pain, thigh and buttock pain, recurrent varicose veins, pain with bending or squatting, abnormal abdominal pressure and varicoceles, which are enlargements of the veins of the scrotum. The condition is confirmed using an advanced diagnostic tool called intravascular ultrasound, or IVUS.

IVUS and Angioplasty

IVUS is a catheter-based ultrasound technology. The catheter is a very slender tube with an ultrasound probe at its tip. Unlike the ultrasound used on the legs, which evaluates the veins from the outside through the skin, IVUS goes directly into the veins.
“During a diagnostic evaluation, the IVUS catheter is inserted into the femoral vein in the leg or, more rarely, through the jugular vein in the neck. A guide wire and IVUS catheter are negotiated through the venous system down to the designated iliac vein,” explains Dr. Magnant. “This is all done using fluoroscopy guidance under local anesthesia.
“When the catheter is in place, the information from the ultrasound probe is sent to a monitor that displays the image of the vein. IVUS allows me to look at the vena cava and iliac veins from the inside to identify blockages or compression.”
Once compression is identified, Dr. Magnant can insert a stent inside the area of compression, often at the same time as the diagnostic IVUS procedure, to open up the compressed vein and restore normal venous blood flow.
“We usually use a balloon to expand the stent to its appropriate diameter,” offers Dr. Magnant. “This aids in keeping the vein open.”
“The stent procedure was easy and went smoothly,” remarks Rich. “It was simple and not really painful at all. It only took about forty minutes, and as soon as I left Vein Specialists, I felt relief from my pain.”

Neighborly Advice

Kyle Kuhn made a home for himself in Sanibel after serving in the United States Air Force. In Sanibel, he works at a local restaurant doing a little bit of everything, but mostly working as a server and bartender. Like Rich, Kyle’s job keeps him on his feet for hours, and he believes that contributed to the changes he experienced in his legs.
“I had some pretty bad problems with my legs,” relates Kyle. “I’m also a personal trainer, so I work out a lot and stay pretty fit, but with these problems in my legs, my circulation would slow down and my legs would hurt.

Photo by Fred Bellet.

Kyle can now play with Tank without any discomfort.

“I also had restless legs, my veins were bulging and my legs were discolored. I had a lot of swelling and a lot of cramps, and I always had to elevate my legs at the end of the day. It was really hard to be on my feet as a personal trainer and server. I had to wear compression stockings every day.” He also labored against the pain to take his dog, Tank, out for walks.
Kyle’s neighbor had suffered with leg vein issues and had them successfully treated by Dr. Magnant. She recommended the physician to Kyle, so he made an appointment at Vein Specialists for a consultation.
“Dr. Magnant and I hit it off immediately,” recalls Kyle. “He had a soft spot for me because I was a veteran and had served our country. He told me he would try his best to help me out because I did not have insurance.
“I went to the Veterans’ Administration, and they weren’t going to approve my vein treatment, but Dr. Magnant personally wrote them a letter that got it approved. That was eight years ago.”
At that time, Dr. Magnant treated Kyle’s venous insufficiency with a minimally invasive procedure called endovenous ablation, a method of using heat to seal the leaky veins. It corrected the existing problems. Unfortunately, Kyle experienced a recurrence of his venous insufficiency, causing Dr. Magnant to become suspicious of a larger problem.
“I had two surgeries on both of my legs,” confirms Kyle. “Then, my left leg started giving me problems again, so I went back to Dr. Magnant. He did an ultrasound and said I had another leg vein that was growing fast and going to be a problem for me. He suggested we try the IVUS and abdominal venous stent.”
“Kyle presented initially with skin discoloration around his ankles and several varicose veins that appeared about to hemorrhage,” reports Dr. Magnant. “He also had swelling and pain and other typical symptoms of venous insufficiency. I performed ablation procedures on him, but we were both frustrated when that did not totally solve his problem.
“When IVUS became available, I believed he was an ideal candidate for it to see if he had something going on above his groin that was affecting his leg veins.
“We performed a pelvic ultrasound first through the abdomen, which suggested a severe left iliac vein narrowing. This was subsequently confirmed on Kyle’s diagnostic IVUS, which revealed an eighty percent narrowing in his left common iliac vein.”
When Dr. Magnant told Kyle about his findings, other symptoms he was experiencing suddenly came to Kyle’s mind. He never associated them with a vein condition until Dr. Magnant diagnosed him with pelvic congestion syndrome and explained its signs and symptoms.
“I’d been having cramps in my pelvis,” shares Kyle, “and my stomach and back were a little tight. I could feel it when I worked all day, then sat for a long period of time, or when I got up and down from a chair. I also had a lot of pressure in my abdomen and legs. I really had not experienced that before.”

Higher Disease

Before IVUS and iliac angioplasty technology became available, most vein specialists focused only on vein problems below the groin that were detectable with conventional ultrasound, notes Dr. Magnant.
“Few vein specialists today consider vein disease above the groin because there is no accurate way to make the diagnosis other than IVUS,” he states. “The investment includes fluoroscopy equipment and specialized training, which is often prohibitive for most part-time vein doctors.”

“The pain and cramping in my pelvis are gone. The stent procedure definitely helped.”- Kyle

Dr. Magnant’s practice focuses 100 percent on venous health, and its patients command the latest and most comprehensive tools to treat all vein disorders.
“Think of the veins from the groin to the ankle as the inflow,” informs the doctor. “Then, the veins from the groin up to the vena cava and heart are the outflow. It has only been in the last two or three years that vein specialists have considered issues with the outflow and higher diseases, such as iliac vein occlusion or pelvic compression syndrome.
“Pelvic compression syndrome has traditionally been thought of as a condition occurring in women, and, in fact, it occurs more often in women. Many doctors do not even ask their male patients about symptoms that may point to pelvic compression. However, it affects men as well. They should not be ignored in the evaluation of this condition.”
When a new patient arrives at Vein Specialists with symptoms of venous insufficiency, Dr. Magnant uses standard guidelines when completing the patient’s medical history and physicals. The guidelines include questions focusing on the signs and symptoms of pelvic congestion syndrome.
“Physical signs, or the visible indications, of this syndrome include large varicose veins on the groin, vulva or gluteal fold,” states Dr. Magnant. “There may also be leg swelling, which can result in a thigh discrepancy, as in Rich’s case. Other signs include stasis dermatitis and non-healing leg ulcers.
“Symptoms, or the warnings that are felt, include pain in the pelvis and abdomen with squatting or crouching, deep pelvic pain with intercourse; pain in the buttocks, posterior thigh or knee with prolonged sitting or standing; and hip and flank pain.”
It’s important to diagnose pelvic compression syndrome in men because varicoceles are common. Those varicosities can negatively affect sperm motility and lead to infertility, adds the doctor.
“As physicians, we need to change our mindsets,” asserts Dr. Magnant. “We cannot exclude from our thought processes the possibility that males may have pelvic congestion syndrome. With the IVUS and angioplasty technology we now have available, we can easily evaluate patients for this higher level of vein disease and treat it – in women and men.”

Shared Experiences

Thanks to Dr. Magnant’s keen assessment, Rich and Kyle were diagnosed and treated for pelvic congestion syndrome. The men shared experiences with the IVUS and angioplasty procedures, and they shared positive results from their treatments.
“After my stent procedure, my abdominal pain went away,” describes Rich. “My circulation also improved, and I had been having trouble with that since I was eleven. Now, I can bend down in a squat position for twenty or thirty minutes, then get up and I’m perfectly fine. The procedure was life-changing.
“Since I had the procedure, I can go work out after work and work fifteen-hour days if I need to with no pain whatsoever. I don’t have any issues with my feet anymore, either.”

“Now, I can bend down in a squat position for twenty or thirty minutes, then get up and I’m perfectly fine. The procedure was life-changing.” – Rich

The IVUS and angioplasty were successful for Kyle as well. He says he no longer has trouble standing or walking around all day at work. And he doesn’t have to struggle through pain when he takes Tank out for a walk. Overall, he’s happy with the outcome of his procedure.
“The pain and cramping in my pelvis are gone,” he states with enthusiasm. “The stent procedure definitely helped. And the swelling in my legs is gone. My legs look and feel great now.”
“If I could talk to anyone thinking about the iliac stent procedure, I would tell them to do it because it definitely made a big difference in my life. And I would recommend Dr. Magnant in a second.”
Rich concurs.
“My time at Vein Specialists was a totally good experience,” he says. “I definitely recommend Vein Specialists and Dr. Magnant. I wouldn’t go to anybody else!”

Bright, New Smile

Crowns improve appearance, function and health.

A Brandon business owner for nearly 20 years, Tracy Halfman cared about the appearance of her smile. When the Oshkosh, Wisconsin native realized she’d stopped showing her teeth when she smiled for photos, she admitted she was embarrassed by them and wanted to restore them.

Photo by Fred Bellet.

Tracy Halfman

“Over time, my teeth became stained from various things I ate and drank,” she describes. “I had several crowns in my mouth already, but the colors didn’t match. I had a couple of other teeth that needed crowns, so I became interested in getting my teeth redone.
“I have some friends who’ve had their teeth done, and their teeth match and are whiter. I was impressed with how good my friends looked and how much the dental work changed their smiles.”
Tracy started seeing different dentists, looking for options to restore her teeth. She was given several recommendations that included orthodontics, whitening her existing teeth, getting new crowns on all her teeth and getting new teeth.
Confused, she mentioned her concerns to her regular dentist, David L. Walker, DMD, of Walker and Raynal, DMD, who practices along with Eric C. Raynal, DMD.
“I went in there to get my teeth cleaned and other basic dental work,” observes Tracy, “and I talked to Dr. Walker about improving my smile.”
Tracy was happy to have Dr. Walker examine her mouth and give her a recommendation to restore her smile. In his evaluation, he noted that most of Tracy’s dental issues were caused by normal deterioration over time rather than decay and neglect.
“She had some damage that occurs with aging,” he states. “There was natural wear and tear, fractures and chipping that happened through the years. It made some of her front teeth less aesthetically pleasing than she wanted.”
“Dr. Walker suggested full crowns across my front top teeth so they would match,” discloses Tracy. “I elected to keep my bottom teeth the same. Dr. Walker said it’s nice to have a little bit of quirk so my crowned teeth don’t look fake. He made me a tray to use on the bottom for whitening to match the bottoms to the top a little better.”

Restoration Options

“Restoring unappealing or failing teeth improves appearance and function,” relays Dr. Walker. “It also improves one’s overall health.
“If patients have crowding or spacing between their teeth, food can get caught in between,” he comments. “Periodontal disease and decay are more prevalent among people who have these types of tooth irregularities. Restoring those teeth, therefore, not only makes the smile more pleasing, it also helps keep the mouth healthier.”

“I love my results! I can tell I’m smiling more now.” – Tracy

Dr. Walker notes there are two primary types of restorations to make unappealing or failing teeth more aesthetic and functional – crowns and veneers. Veneers are thin sheets of porcelain that cover just the front of the tooth; crowns cover the entire tooth. The condition of the tooth is the main factor in determining which restoration is recommended.
“I would choose a crown over a veneer if the tooth is broken down due to decay, or has old fillings or fractures,” explains the dentist. “A tooth that has a large filling in it has a tendency to develop cracks in the existing enamel and eventually fracture. A crown covers the entire tooth, holding it together and preventing it from cracking and fracturing.
“A veneer covers three-fourths of the tooth’s surface, leaving one side of the tooth exposed. We use the same all-porcelain substance for veneers as for crowns, which is BruxZir® Anterior Solid Zirconia, a very strong, durable and aesthetic material. Aesthetically, there is really no difference between a crown and a veneer.”
The process to install the two restorations is essentially the same. First, the patient is numbed with a local anesthetic. Then, the tooth is prepared to receive the crown or veneer. This involves reducing, or cutting down, the natural tooth so the restoration fits around the existing tooth.
“Preparing for a crown or veneer means reducing anywhere from half a millimeter to two millimeters of tooth structure,” confirms Dr. Walker. “For veneers, it is just done on the front of the tooth. For crowns, it is done all the way around the tooth.
“We create temporary crowns or veneers so the patients have something to wear between the time the teeth are prepared and the laboratory finishes the final restorations. It is a pretty quick process for patients to go from having smiles that are not aesthetically pleasing to something that looks good and is functional.”
“They do all the work the same day,” reports Tracy. “I was there about five hours. It wasn’t painful. It was just hard to keep my mouth open while they were working in it.
“That day, Dr. Walker made me temporary crowns, so I didn’t have to leave the office with ugly teeth in my mouth while the new ones were being made. That took about two weeks. Then, it was about an hour appointment to put in the permanent crowns.”

A Perfect Fit

When Tracy returned to Walker and Raynal, DMD to get her permanent crowns, she was excited, especially when the fitting went exactly according to plan.

Photo by Fred Bellet.

Tracy loves her new crowns, and her dog, Jammer, also approves.

“My crowns fit perfectly. Dr. Walker had to do some alignment of my bite to make sure everything fit,” she recounts, “and they look great!”
Except for a few close friends, Tracy hasn’t told many people about the restoration work done on her upper front teeth. For the most part, no one has commented. She knows it’s because her new crowns look and feel natural.
“Having your teeth restored is not something you go around and tell a bunch of people, and so far, no one’s really noticed,” she shares. “But a couple of people have told me, There’s something different about you. You look really pretty. I think it’s maybe your smile.”
Another thing Tracy likes about her new crowns is that they’re never going to stain. They’re always going to stay nice and white. “That’s much better than having to constantly whiten your teeth in order to keep the shade you want.
“I love my results! I can tell I’m smiling more now,” she enthuses. “I’m extremely satisfied and happy I did the smile restoration. I recommend
Walker and Raynal, DMD for this or any dental work. They’re great!”

Adults Get Bullied, Too!

January 16th, 2018

We all know bullying is a rampant problem in our schools, and most everyone – from students to political leaders – is working on effective ways to combat that issue. But did you know bullying can be a problem in the workplace as well? Yes, adults can be victims of bullying, too!Stock photo from istockphoto.com.

The American Psychological Association defines bullying as “a form of aggressive behavior in which someone intentionally and repeatedly causes another person injury or discomfort.” Discomfort is the operative word when it comes to bullies at work. There are several types of adult bullies and different ways they bully others.

One type is the physical bully. These bullies may simulate violence, such as raising a hand like they’re going to hit you or throwing objects in your direction. They may sexually harass you, violate your personal space or loom over you. Some of these bullies use their titles or positions of authority to intimidate or harass others.

Verbal bullies use words to make people uncomfortable. They might threaten, shame, insult or tease you in a hostile way. Maybe they criticize you constantly or use sarcasm, or racist, sexist or other demeaning language to dominate or humiliate you.

Passive-aggressive bullies are harder to spot because they do their bullying on the sly. These bullies behave OK outwardly, but bully subtly. These are the people who spread gossip and lies about you, and use condescending eye contact, facial expressions and gestures toward you. They might deliberately try to embarrass you, leave you out at social gatherings or sabotage your work, success and advancement.

Secondary, or ancillary, bullies are also common in the workplace. These are the employees who don’t initiate the bullying, but join in on the abuse. Secondary bullies generally participate in the bullying to suck up to the primary bullies in order to avoid becoming victims themselves.

Don’t forget cyber bullies. They’re at work, too. A lot of these verbal and passive-aggressive behaviors can be spread through company email, websites and social media, as well as by phone and text. Without intervention, it becomes a living, breathing cycle of abuse.

There’s are negative emotional and psychological impacts of bullying in the workplace. It’s pretty obvious it can lead to reduced job performance. But studies show it can also result in anxiety, depression and even PTSD in the person at the center of that abusive cycle.

What are you supposed to do if you’re getting bullied at work? This article includes ten tips for dealing with workplace bullies, and it’s worth a quick read. Here is a small sampling of its list of solutions:

  • Don’t get emotional. Bullies thrive on getting others all worked up, so stay calm and rational. It may help diffuse the situation.
  • Document everything. This tip is common to many of the articles I read on the subject of dealing with workplace bullies. Keep a journal or diary, something in writing, that notes everything that occurred with dates. If things get really bad, take it to Human Resources. Don’t leave your journal in the office, though.
  • Get counseling. Talking about what’s happening to you will help you manage the stress. This is especially important if you’ve already started feeling anxious or depressed. Some companies have counseling services available on site or close by for their employees.
  • Do your best work. If a bully is trying to make you look bad, don’t make it easier for him or her with a poor performance on the job. Don’t do things you can control like come in late, take long lunches or miss deadlines on your projects.

These steps and the others in the article may not change things right away, so be patient. Also, be assertive. If you consistently present a confident self and remain calm, your bully may back down. He or she is not going to change, but your reaction to them can, and that can make a world of difference for you.

The House Call

A benefit of the concierge practice.

Retired orthopedic surgeon Dr. Thomas Williams was not feeling well. He was not in any pain, and thought it might help to get some sleep. When his wife, Nancy Schauer, realized he had slept for 24 hours, she wasn’t sure what to do. She considered calling the paramedics because it was the weekend, but decided to call Thomas’ doctor first and ask for his suggestion.

Photo by Fred Bellet.

Thomas and Nancy appreciate the concierge model of medical practice.

“I called our family doctor because I didn’t know what to do,” remembers Nancy. “He said he would meet me at the office. But I couldn’t get Thomas to move in bed, much less get out of it, so Dr. Zimmer came here instead.”
Thomas’ doctor is Michael A. Zimmer, MD, a board-certified
internist with Zimmer Medical Services in St. Petersburg. Dr. Zimmer offers a model of medical practice called concierge medicine. This model is based on a limited membership, so physicians can spend more time with patients, allowing for more personalized patient care.

Immediate Treatment

“Nancy called me on a Sunday afternoon and asked me to come over,” recalls Dr. Zimmer. “I took my little black bag with instruments for a physical examination and headed over there. I took a history and examined Thomas. He had pneumonia and needed to be treated immediately. I formulated a treatment plan and put it into action.”
From his laptop, Dr. Zimmer sent electronic prescriptions to Thomas’ 24-hour pharmacy, and Nancy picked them up so treatment could begin immediately. Thomas’ condition required anti-inflammatory and antibiotic medications, as well as medication for his nebulizer breathing treatment.
“The morning after the house visit, I got a phone call saying Thomas was doing ninety-nine percent better, which was great news,” reports Dr. Zimmer.
The house call is not a conventional method of providing care in today’s health care environment. However, the concierge concept enables doctors to provide that service in appropriate circumstances.
“By having a reduced number of patients, it frees up more of my time,” explains Dr. Zimmer. “In the traditional practice model, I would never be able to make a house visit. Now, my schedule is structured so I can if necessary. I can better personalize the care I provide.”

“It was really helpful to be able to call Dr. Zimmer and have him come over.” – Nancy

Dr. Zimmer impressed Thomas and Nancy with his willingness to make a house call in their situation. They’re very pleased with the doctor’s practice model and personalized care.
“Dr. Zimmer’s house call was fabulous,” states Nancy. “He treated Thomas with the medicines he would have gotten in the hospital without having to go to the hospital.”
“I was incoherent, so I don’t remember much,” adds Thomas. “I only know Dr. Zimmer showed up in my condo. He treated me and kept me out of the hospital. I probably saved Medicare seven or eight days in the hospital,” comments Thomas. “All the treatment I would have gotten there I did myself, and I was much more comfortable at home. It was a win-win situation for everybody. The concierge concept worked much better.”

Reduce Swelling and Improve Circulation

Physician recommends compression pumps to his patients.

Board-certified internist Fariborz Delbakhsh, MD, treats a full range of medical conditions at his Summerfield practice, Delcare. Among the most common are persistent leg edema, lymphedema and venous disease. Standard treatments for painful limb swelling, common to all these conditions, never completely resolved the problem, which challenged the doctor.

Photo by Michelle Brooks.

Dr. Delbakhsh uses the
compression pumps in
combination with his medical care.

“For patients with these disorders, I generally recommend compression stockings, optimize their water and electrolyte balance, and prescribe diuretics,” elaborates Dr. Delbakhsh. “Many times, I noticed their swelling did not get better, and it was frustrating. Then, I found out about Acute Wound Care and the compression pumps they offer.”
Acute Wound Care is an in-home, fully accredited home medical equipment provider specializing in hospital-grade compression devices and specialty wound care dressings. The compression pumps are prescription devices and are approved by Medicare and covered by many commercial insurers.
“Our compression pumps remove fluid that has accumulated in the legs or arms,” describes Alyssa Parker, certified compression therapist with Acute Wound Care. “The pump’s limb-sized sleeves gently massage the limb, draining any excess fluid back into the body’s circulatory system so it can be naturally eliminated. Compression pumps increase circulation in the affected limbs while alleviating many painful symptoms.”
“I noticed that after using these pumps, my patients had significant improvement in terms of diminished fluid retention in their legs,” relates Dr. Delbakhsh. “The swelling improved, as did the venous blood flow, wound healing, pain and overall mobility.”

Assisting Circulation

Alyssa agrees that patients with lymphedema, venous disease and other conditions leading to poor circulation had few options beyond the standard therapies for limb swelling. That’s a treatment hole Acute Wound Care’s compression pumps fill. The safe and painless pumps not only reduce fluid retention in the limbs, they also improve overall blood flow.
Compression Pump photo courtesy of Acute Wound Care“The pumps assist circulation by contracting the leg muscles, assisting blood flow back toward the heart,” explains Alyssa. “There, the blood is collected, sent to the lungs to be oxygenated and then returned to the body’s organs and tissues. To aid blood flow, the pumps have multiple chambers. Each chamber fills up with air, from the foot to the groin. Then, each chamber releases, and the pattern repeats in a rhythmic fashion.
“In addition to the circulation boost, many patients will see a noticeable difference in the swelling and in the size of their limbs after their first forty-five-minute pumping session.”
Acute Wound Care is proud of its hands-on approach to patient care. Not only does a compression therapist go to patients’ homes to set up the equipment and instruct them on how to use it, they also adjust the pump’s pressure level to the patients’ comfort.
“When we go out to the homes, we set the pressure based on the severity of the condition and the physician’s prescription,” notes Alyssa. “We then adjust it so the patients are comfortable and will actually meet the requirements of the treatment and so they get great results.”

Experienced Confidence

Dr. Delbakhsh reports he’s been recommending Acute Wound Care’s compression pumps to his patients for more than a year and getting great results.
“I encourage my patients to use the pumps to reduce limb swelling and improve circulation,” he confirms. “The compression pumps are great, safe, noninvasive devices I use to supplement the medical treatment of my patients.

“The compression pumps are great, safe, noninvasive devices I use to supplement the medical treatment of my patients.” – Dr. Delbakhsh

“I have gotten feedback from my patients, and they agree the devices and the outcomes are positive. Acute Wound Care does a great job of following up, so we are all very pleased with them and their product.”
The doctor says he is so satisfied with Acute Wound Care, he endorses them and their compression devices to physicians as well.
“I’m thrilled with Acute Wound Care and their pumps, and recommend other physicians try them, too. They help doctors improve their quality of care and the quality of their patients’ lives.”

Down with LDL!

Lower cholesterol and the risk for cardiovascular disease.

John Dacko is a lieutenant medic with the Brevard County firefighters. Each year, he undergoes a physical exam to ensure his fitness for duty. Part of
that exam is routine bloodwork. Over the past few years, John grew concerned over a specific result in that bloodwork.

Photo by Nerissa Johnson.

John likes the orange and mixed fruit flavors of
Cholesterade.

“My cholesterol was slowly creeping up over the past two or three years,” discloses the Miami native. “The doctor started to really focus on my cholesterol and suggested changes in my lifestyle. For one, she recommended I cut out red meat and eggs and start eating more whole grains.
“I started working out five days a week, but with my schedule at work working a twenty-four-hour shift every third day and helping raise two young girls at home, it was difficult to get on a good diet and stay on it. So, I wasn’t able to change my eating habits. My total cholesterol stayed around one hundred eighty to one hundred ninety, even with working out regularly.”
We all have, and need, cholesterol in our blood. Cholesterol is a waxy substance made naturally in the liver. People also get cholesterol from animal-based foods they eat. Extra cholesterol can combine with fat and other elements in the blood to form plaque, which often builds up on the walls of the arteries and blocks blood flow. Plaque in the arteries of the heart or brain can lead to heart attack or stroke.
Cholesterol doesn’t travel through the bloodstream alone. It must be attached to a protein, and together, they’re called a lipoprotein. LDL stands for low-density lipoprotein, which means there is a lower amount of protein compared to cholesterol; essentially, a low density of protein. It’s often called the “bad” cholesterol because it tends to help form the plaque in the arteries. Doctors prefer low levels of LDL in their patients’ blood.
“I was talking about my concerns with my cholesterol levels with my father-in-law. He had been using Cholesterade®, and suggested I give it a try,” states John. “He said it may help lower my cholesterol, so I started taking it.”
“A large portion of the cholesterol issue in this country and worldwide happens to be from genetics,” describes Richard Goldfarb, MD, medical director of Go Epic Health, makers of a revolutionary cholesterol-lowering product called Cholesterade. “Since people can’t change their genetics, the focus is on decreasing total cholesterol circulating in the body.
“If a person’s cholesterol is only slightly elevated, the suggested treatment is generally a diet of low-fat foods and exercise. It is recommended to exercise three to four times per week for forty minutes each time.”
When cholesterol is on the higher side, treatment often involves medication, primarily statins. Unfortunately, these medications have many side effects, including muscle aches, liver damage, increased blood sugar, headaches and dizziness.
“Statins have been the gold standard for years to lower cholesterol,” confirms Dr. Goldfarb. “However, they have so many side effects. Cholesterade is a product developed several years ago by the inventor of Gatorade®, Dr. Robert Cade, who himself suffered from high cholesterol levels in his blood.
“With the formulation Dr. Cade created and clinically studied, he was able to lower his own cholesterol and decrease his level of statins, and eventually stopped taking them.
“We suggest people take Cholesterade with each meal,” instructs Dr. Goldfarb, “so that even with a fatty meal, it is able at that time to bind with the exogenous cholesterol. The cholesterol is then eliminated from the body through the GI tract.
“I don’t always get the three servings a day they recommend, but I usually take one in the morning and one when I get home from work. If I can remember to catch the third serving during the day, I will.”

A Natural Solution

Cholesterol is a major risk factor for cardiovascular disease, and cardiovascular disease is a killer. In the US alone, one person dies every 40 seconds from cardiovascular disease. It claims more lives than all types of cancer and lower respiratory disease combined. If it were eliminated, the average life expectancy of Americans would increase by seven years. One way to lower the risk of cardiovascular disease is by lowering cholesterol.
“Cholesterade is a natural solution for lowering cholesterol,” notes Dr. Goldfarb. “It is a non-drug solution and, in fact, is a good way to reduce a person’s dosage of statins or eliminate them altogether. Cholesterade is a powder that is mixed in water to deliver nutritional compounds in an efficient manner.”
“I like the orange flavor as well as the mixed fruit flavor. I like them both,” shares John. “When you add Cholesterade to water, it mixes completely, so there’s no gritty taste in your mouth. It goes down smoothly, and is much better than most of the other dietary fiber supplements on the market.”
Cholesterade includes a patent-pending delivery technology called Go-Somes. Go-Somes has demonstrated an ability to enhance nutrient bioavailability. Go-Somes spheres are multi-layered and hold fiber that is released into the gastrointestinal tract to help remove cholesterol from the body.
“Cholesterade has also proven to have additional benefits. People can manage their weight and even lose weight with this product. They have also been able to normalize their blood pressure, and quite a few feel more energetic. We don’t see these positive benefits with prescription medications.”
Recently, Go Epic Health created a new formulation with the addition of pro-enzymes. These pro-enzymes make the product better tolerated by the GI system by not irritating the GI flora. In addition, it improved the transdermal delivery, creating yet another benefit for users.
“With the addition of these pro-enzymes, we are seeing even better results in a shorter period of time,” reports Dr. Goldfarb. “In four to six weeks, we have seen dramatic results in many of our patients.

“This past April, when I had my bloodwork checked, my overall cholesterol dropped over forty points!” – John

“There have been advancements to Dr. Cade’s initial recipe for Cholesterade. What Dr. Cade created back in the time he studied a natural remedy for increased cholesterol, we have been able to improve. We carry on his tradition and continue to improve some of the ingredients to make the benefits last longer.
“At Go Epic Health, we believe that in Cholesterade we have something dramatic to fight cardiovascular disease by treating the problem of increased cholesterol in the blood.”

Remarkable Results

John has been drinking Cholesterade faithfully for a year and a half. He is excited about the results he’s achieved already.
“This past April, when I had my bloodwork checked, my overall cholesterol dropped over forty points!” marvels John. “It was at one hundred eighty-nine in 2016 and went down to one hundred forty-eight in 2017. My total cholesterol went down because my LDL went down over thirty points.
“I don’t see a family doctor regularly, so I rely on my county physical, and I don’t get one until March or April 2018,” reports John. “It will be exciting to show them my results and introduce them to Cholesterade as an alternative to some of the other things they recommend for lowering cholesterol.
“Cholesterade is working remarkably well. My numbers are impressive, and I will continue using Cholesterade.”

Defeat Dizziness

Last June, Gina Trani began having trouble with her sinuses, which she expected at that time of year. What she didn’t expect was that this year, severe dizziness came with the package. She woke up one morning so dizzy and disoriented, she had to call in sick to work, something she never did, for four days straight.Graphic from istockphoto.com.
“When I got out of bed, the room was spinning,” she recounts. “I slowly tried to get ready for work, then sat back down. I thought, This is crazy. I was not feeling well. I was sweating and having a panic attack because I was alone.
“I had to stay home because I couldn’t drive. The dizziness was horrible. I felt like I was falling off a building.”
Four days later, Gina went to an area clinic, where they ruled out a brain tumor as the cause of her condition. They also recommended she visit an ear, nose and throat physician. The ENT prescribed medication for her sinuses, which helped that problem somewhat. It did little to eliminate the dizziness, and her symptoms continued to come and go.
“When I would stretch or turn my head a certain way, or lie in bed and turn to the right, it was like, Whoa, it’s still there,” notes Gina. “But it’s like having a panic attack. I didn’t want to think about it because I was afraid it was going to come back.”
The recurrent symptoms impacted Gina’s routines significantly. They affected her ability and desire to participate in normal, everyday activities.
“This dizziness changed my life,” confirms Gina. “I was afraid of falling. I didn’t want to go far from home because I was afraid of driving. That limited me socially. I couldn’t go to the gym or do yoga. When I walked, I kept my head down and walked quickly. I looked like I was drunk.”
Later in the year, at a routine physician appointment, Gina told the doctor about her dizziness, and he gave her some sage advice. He said, If it comes back, you need to see Dr. Hansen at Trinity Hearing and Balance Center.
Another episode of dizziness in November prompted Gina to make an appointment at Trinity Hearing & Balance Center, where she met with Nikki Goldowski, AuD, a colleague of Kelly Hansen, AuD. Dr. Goldowski and Dr. Hansen are doctors of audiology who specialize in treating hearing loss and dizziness.
“When Gina came in, she was experiencing a great deal of unsteadiness and difficulty with balance,” observes
Dr. Goldowski. “She was also having a hard time focusing and concentrating. Every time she tried to tip her head back, lie down or roll over in bed, the dizziness would start all over again.”
Dr. Goldowski tested Gina using state-of-the-art equipment and, based on the results and Gina’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,” notes
Dr. Goldowski. “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.”

Precise Positions

The Epley Omniax System includes a chair that rotates to put patients in nearly any position. The doctor then monitors the patients’ 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 loose in the ear canals back where they belong,” explains Dr. Goldowski. This approach is also less physically demanding than previous treatment methods.
Graphic from istockphoto.com.“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 them.”
“When Dr. Goldowski put me in the chair, she told me everything she was going to do,” states Gina. “I would wear goggles, and she was going to put me in different positions. She even informed me of all the positions I was going to be put in.
“I was a little nervous at first, but Dr. Goldowski was so compassionate. It’s very unusual to find doctors and staff who are so caring and nice.”
When both ears are affected, as in Gina’s case, treatment is most effective when one ear is treated at a time.
“I treated Gina’s right ear the day of her first appointment. She came back a week later, and that side tested normal,” reports Dr. Goldowski. “I then treated her left ear, and after that treatment, her dizziness was completely gone.”

Nationally Certified

Trinity Hearing & Balance Center’s philosophy and dedication to patient care set it apart from other hearing centers.
“Our center is proud to be an AudigyCertified™ practice,” acknowledges Dr. Hansen. “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, 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.
“Many patients who have gone through our Patients for Life™ program experience greater satisfaction with their hearing technology and a greater quality of life.”

“I felt great immediately. When I left Trinity Hearing and Balance Center, it was like my whole personality changed. I was amazed that a treatment like that could make me feel so much better.”-Gina

One of the most unique aspects of Audigy’s service is e-patient®, which brings their Patients for Life program into the digital world.
“The e-patient program, a component of Patients for Life, is an educational tool we provide for patients,” educates Dr. Hansen. “It is a treatment-focused software tool that enables us to quickly and effectively explain products and procedures to patients. E-patient has excellent visuals to show the patient how their hearing works and what happens when someone has a hearing loss.
“E-patient also offers an overview of what’s going to happen during the patient’s appointment.”

Firmly Planted

The dizziness Gina suffered was life-altering. She couldn’t imagine how some people lived with the condition. She didn’t have to live with it, however. Her treatment with the Epley Omniax System brought her quick relief.
“I felt great immediately,” she marvels. “When I left Trinity Hearing and Balance Center, it was like my whole personality changed. I was amazed that a treatment like that could make me feel so much better.
“I’m back to the gym, and on the treadmill. I’m not afraid to move my head, and I’m not scared of falling. It’s great.”
Now that Gina feels firmly planted on solid ground, her social life is back on track, and she no longer looks like she’s been drinking when she walks. She’s so happy with her results, she’s telling the world about her experience.
“Everyone at Trinity Hearing and Balance Center was very friendly including the receptionist, who was the first person I met,” she says. “I didn’t have to wait long, which was nice. Dr. Goldowski brought me right in. She had a student with her, but she made it comfortable even though there was somebody else in the room.
“I want to get the word out to help others. I tell people on Facebook about the center because I wouldn’t have known about it if not for my doctor.
“I can’t tell enough people because they might know someone with vertigo, and the chair is worth a try. It’s better than medicine. Trinity Hearing and Balance Center was life-saving for me!”

Back to Business

Multiple modalities return patients to activities quickly.

One August day in 2005, while working as a corrections officer, Stephan Miller’s boot caught the edge of an uneven floor, and he went down. The fall injured his neck, lower back, shoulder and foot. Excruciating pain shot through his entire body. The pain intensified as time went on, and initial therapies failed to give him lasting relief.

Photo by Fred Bellet.

Stephan proudly serves
as a member of the
American Legion Honor Guard.

“My entire body was racked with pain,” confirms the New Jersey native. “I went to a sports medicine facility for treatment. They started with a couple of shots and physical therapy, but they couldn’t tell if the pain was coming from my shoulder or my neck. Everything was hurting.”
The sports medicine physician also tried epidural nerve blocks in Stephan’s neck, shoulder and lower back, but they weren’t as effective as he’d hoped.
“The pain was extreme. On a scale of one to ten, it was over a ten,” he declares. “I could walk, but I couldn’t stand for more than a few minutes. I had to lie down.”
A curvature of Stephan’s spine complicated his back condition, and he was told he required surgery. During two separate procedures he underwent while still living in New Jersey, he had five metal rods placed in his spine. Even after surgery, however, he had severe pain and was forced to retire because he could no longer function at his job.
In January 2013, Stephan relocated to Florida for a more comfortable retirement, but he needed to find a physician to manage his ongoing pain. His workers’ compensation case worker recommended Maulik Bhalani, MD, founder and CEO of Florida Pain Medicine. Stephan was anxious to see what Dr. Bhalani suggested to control his pain.
“Stephan presented with pain in his low back and neck related to a work injury,” reports Dr. Bhalani. “He had a cervical disc herniation compressing a nerve root in his neck, which radiated pain signals down his arm. He also had degenerative disc disease with arthritic changes in both his neck and lower back.
“He was looking for effective treatment for his pain, and he wanted to avoid any additional surgery. My main goal was to get him back to a functional status using conservative treatment modalities.”
“My pain was persistent. It would come and go, but it always came back,” relates Stephan. “One day, I’d be walking normally, then the next day, I’d be walking really slowly in agony.
“Dr. Bhalani performed two nerve ablations in my lower back, and nerve blocks in my neck, which helped. I’m also on pain medication, and the doctor gave me a muscle relaxant for when the pain is bad enough to take it. That helps as well. I was very pleased with what Dr. Bhalani and Florida Pain Medicine offered me.”

Multimodal Approach

Dr. Bhalani stresses that the approach at Florida Pain Medicine is complete, compassionate and comprehensive care based on the most up-to-date
knowledge of pain and how to alleviate it. Florida Pain Medicine’s physicians go beyond relying on one or two methods to treat patients. Instead, they’re able to use multiple therapies in the appropriate combinations to help their patients restore function and relive life.
“When people come to us with disabling pain that leaves them dysfunctional and unable to work, we take a multimodal, multidisciplinary approach to their care,” verifies Dr. Bhalani. “We focus on what we can do to reduce their pain and get them back on their feet or back to work quickly.
“I often start with medications, but I specifically avoid narcotic-based medications, or opioids. Rather, I consider non-narcotic, non-sedating pain medications, but add other analgesics to the regimen. These include nerve pain medicines, muscle relaxants and anti-inflammatories.”

“I like Dr. Bhalani and his staff. They’re very nice, friendly and professional. I’d rate them as excellent.” – Stephan

Physicians at Florida Pain Medicine choose among the available modalities for their patients on a case-by-case basis. In Stephan’s case, he responded well to the medications, but Dr. Bhalani added several other therapies to his treatment plan in order to achieve the best possible results.
“For Stephan, I included interventional pain procedures, specifically lumbar radiofrequency ablation and cervical epidural steroid injections,” describes
Dr. Bhalani. “Those were followed up with physical therapy to maintain his improvement. The aim was to get him to and keep him at a functional status where he is able to do the things he enjoys.”
Radiofrequency ablation is a needle-based, minimally invasive procedure. It uses thermal energy to damage the sensory nerve endings in the areas where pain originates. Destroying these nerves provides long-term pain relief.
“Relief from a radiofrequency ablation lasts anywhere from six months to a year or even longer,” notes Dr. Bhalani. “Eventually, the nerves grow back, but they tend to grow very slowly, especially in older adults. The ablation can be repeated if necessary.”
Cervical epidural steroid injections are injections of pain-relieving, anti-inflammatory steroid medications into the epidural space at the base of the neck. They are used to help relieve pain in the neck, shoulders and arms caused by pinched or inflamed nerves in the cervical spine. These can result from conditions such as herniated discs, spinal stenosis and arthritis.

Giving Back

The damage done by Stephan’s work injury has left him with nearly constant pain. He knows he will always have some pain, but his treatment at Florida Pain Medicine made it manageable. With Dr. Bhalani’s help, Stephan’s function has been restored, and he’s back to reliving his life.
“Pain is an ongoing thing for me, but now it’s only about a five, and I can tolerate that,” states Stephan. “Before I went to Florida Pain Medicine, my pain level was anywhere from a seven to a ten.
“Right now, I’m comfortable. I’m able to walk and function, and I help out wherever I can. I’m retired from work, but I volunteer with the American Legion Honor Guard.”
Even though he still has some pain to manage, Stephan is very pleased with the results of his treatment at Florida Pain Medicine. “I consider my treatment successful. I was in the United States Air Force for seven years and was a volunteer firefighter for more than twenty-five years. I’m so happy I’m capable of giving back to the veterans through the American Legion!
“I like Dr. Bhalani and his staff,” adds Stephan. “They’re very nice, friendly and professional. I’d rate them as excellent. I definitely recommend Dr. Bhalani and Florida Pain Medicine.”

Turn Off the Switch

Injection calms pain of hyperactive sympathetic nervous system.

Megan Stewart has been a pediatric speech-language specialist for more than 13 years. For the past two, she’s been helping students in the Duval County Public School System. On November 4 last year, Megan was the one needing help after she twisted her left ankle while jogging.

Photo by Nerissa Johnson.

Megan Stewart

“I went out for a run, stepped on a magnolia seed and rolled my ankle,” she discloses. “I was only a block or so away from home when I fell, so I was able to get home. Initially, the pain was just what you’d expect from rolling your ankle, but it got progressively worse as the evening went on.
“Eventually, it became a shooting, aching, burning pain – the most intense pain I’ve ever felt in my entire life. I’ve had three kids and two C-sections, so I’ve experienced some pain. This was debilitating. I couldn’t stand up and walk.”
With such excruciating pain, Megan suspected she’d hurt herself seriously. She went to the doctor the next day, and he discovered she’d broken a bone and torn three ligaments in her ankle. The injury significantly limited her mobility.
“I continued working, but I had to stop all additional physical activity,” she relates. “I was on crutches and was also given a knee scooter. I used that at work because the pain was so intense, I couldn’t put any pressure on my foot or ankle. Even shower water or the sheets on my bed touching my ankle increased the pain.
“I couldn’t do anything. I couldn’t play with my three sons. I couldn’t go outside and play with the dogs. I was basically laid up for three months. I’d go to work on my knee scooter, then come home and lie on the couch with my leg up to help alleviate the pain. I was down for the count.”
Megan underwent the typical treatment for her injury, including remaining non-weight-bearing, wearing an immobilization boot, taking anti-inflammatory medications and doing physical therapy. However, she never realized significant pain relief, and her ankle did not show the signs of improvement she expected.
“I kept getting that stabbing, shooting, burning pain,” she states. “My ankle felt like it was on fire, but it was very cold to the touch at the same time. It was bizarre. My ankle was also discolored and swollen.
“My orthopedic doctor suspected complex regional pain syndrome, so he sent me directly to Dr. McGreevy, who agreed with that diagnosis based on my symptoms, as well as an examination.”

Hyperactive Nerves

Kai McGreevy, MD, is a pain management specialist at McGreevy NeuroHealth in St. Augustine and Palm Coast.
Dr. McGreevy is board certified in neurology and pain medicine by the American Board of Psychiatry and Neurology. He described the condition to Megan.
“Complex regional pain syndrome [CRPS] is a complicated disorder that often occurs after a crush injury and prolonged booting,” explains Dr. McGreevy. “It presents with a constellation of symptoms, including pain hypersensitivity, reduced range of motion, swelling, color and skin changes, and temperature changes in the affected extremity.

Photo by Nerissa Johnson.

Megan has no limitations on using her ankle.

“Megan was a classic case of CRPS. At our clinic, we do basic neurological testing and an extensive diagnostic workup on our patients. This is done in order to exclude other, treatable syndromes before we jump to the conclusion of CRPS.
“With CRPS, the sympathetic nervous system becomes hyperactive. It’s like turning on a switch, and the end result is chronic pain, but a special type of pain. With CRPS, even a very light touch, such as a cool breeze, can set off the very sensitive pain cycle.”
Dr. McGreevy had a recommendation to treat Megan’s CRPS. He suggested an effective tool called a lumbar sympathetic block (LSB), and Megan agreed to the procedure.

The Magic Shot

A lumbar sympathetic block is a minimally invasive procedure performed by injection under x-ray guidance, notes Dr. McGreevy. During an LSB, pain-relieving medication is guided to an area of the spine called the lumbar sympathetic plexus, which is a collection of nerves found at the region of the lumbar vertebrae L2, L3 and L4.
“The lumbar sympathetic plexus is where sensory, or feeling, symptoms are processed,” elaborates the doctor. “With an LSB, sensory information is blocked at that lumbar level of the spine, which prevents pain signals from getting to the brain. The result is reduced pain. Other symptoms of CRPS are also improved.”
“I just lay on my stomach on an examination table so Dr. McGreevy had access to my spine,” describes Megan. “He injected me with medication to numb the area. He used x-rays to make sure he was getting into the specific area in my spine where the particular nerves were located.”
Generally, the relief provided from an LSB lasts three to six months or longer. The treatment can be repeated if the symptoms of CRPS return, which doesn’t always occur. In some patients, the pain and other symptoms are reduced indefinitely. LSB is safely and easily performed by a qualified interventional pain management physician.
“With Megan, the diagnosis was very clear-cut,” confirms Dr. McGreevy. “I think that is one of the main reasons she had such a positive response to the LSB. A proper diagnosis is the most critical factor in whether a patient will have a chance at long-lasting relief and a return of function.”

Phenomenal Results

When Megan received her LSB, she responded quickly. Now, her ankle feels normal, and she’s back to all of her activities. She’s even back to running, but she watches more closely for magnolia seeds in her path.
“My results are amazing,” she marvels. “I started to get warm sensations in my ankle almost immediately, which was a big deal because during the whole process, it had been really cold. Within two weeks, I was feeling the full effect of the nerve block. I started getting increased range of motion in my ankle and was able to move it.

“I had phenomenal results from Dr. McGreevy and my lumbar sympathetic block. I couldn’t ask for anything better!” – Megan

“I soon had significantly decreased pain and was able to start putting pressure on my ankle and foot again. It was January 2017 when I had the procedure, and since then, I’ve had no side effects. I’ve been able to restart my exercise regimen and have had no relapses as far as pain. I have zero limitations.”
The outcome of her treatment thrilled Megan, but she’s also very pleased by the care she received from Dr. McGreevy. She describes him as very down-to-earth and interested in his patient’s needs and concerns.
“Dr. McGreevy is very caring,” she adds. “He takes the time to listen to his patients and listen actively and wholeheartedly, so you can tell he is really paying attention to what you’re saying. If he’s unclear of something or needs more information about what you’re describing, he asks follow-up questions. I never feel rushed when I’m in his office.”
After her positive experience, Megan has some words of recommendation to others in situations like hers. She suggests they seek Dr. McGreevy’s opinion and consider the LSB for pain relief.
“It’s like the shot was magic, and it took everything away,” she enthuses. “I’d tell people that if they have debilitating, life-altering pain and they have the opportunity, especially if Dr. McGreevy thinks it would help them, a sympathetic nerve block is definitely something to try.
“I had phenomenal results from Dr. McGreevy and my lumbar sympathetic block. I couldn’t ask for anything better!”

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