Author Archive

Bridge Over Troubled Water

Retiree’s smile reconstructed using implant-secured fixed bridges.

Riccardo Billi, 55, left his native New Jersey to pursue business opportunities in Florida. He followed his relatives’ example and purchased a mobile home community, which he sold last year when he retired. He didn’t give up property ownership entirely. He simply scaled down his involvement to suit his retirement lifestyle.

Photo by Nerissa Johnson.

Retiree’s smile reconstructed using implant-secured
fixed bridges.

“Two of my uncles moved from New Jersey to Florida about ten years before I did,” Riccardo states. “They started buying properties and did very well. They owned one mobile home community together, sold it and doubled their money. Then they each bought their own community.

“When I sold my mobile home community, I had to reinvest the money, so I bought five homes all within a mile of my house to rent out. I started a corporation, and all five homes are under that corporation. I use a management company to manage the homes, but overseeing the corporation is essentially what I do now.”

As a property owner, Riccardo knows the importance of maintaining his properties and keeping them up to municipal codes. He wasn’t as vigilant about maintaining his teeth and recently faced the prospect of needing to reconstruct his smile. He points to a period in his early childhood as the commencement of his poor dental health.

“When I was four years old, I contracted whooping cough,” he explains. “I was very sick and almost died. Apparently, I was overmedicated with antibiotics, and my dentist said that ruined the enamel on my teeth.

“I got my first root canal at age twelve, and it was a horrible experience. For years after that, you couldn’t get me near a dentist. I had problems with my teeth almost all my life.”

Over time, the condition of Riccardo’s teeth deteriorated further, compounded by his distaste for dentists. But in 1996, while living in New Jersey, it became necessary for him to face his fear, and he underwent a significant amount of dental work.

“I had some teeth extracted and seven root canals,” Riccardo remembers. “My dentist also made four bridges for the top of my mouth and two for the bottom. The dental work was very expensive, thousands of dollars. I was working for the New York City Transit Authority at the time, and that was a lot of money for us.”

Unfortunately, Riccardo’s investment depreciated over the years. Because he smoked cigarettes for a long time, a habit he’s now quit, and drank coffee, his dental work became stained and unattractive. But those aesthetic issues were the least of Riccardo’s problems.

“After I moved to Florida, a couple of my bridges fell out,” he reports. “But I didn’t replace them right away. I decided to have my teeth redone when I sold the mobile home community. My uncle went to Dr. Brown, and he did an excellent job on my uncle’s teeth, so I decided to go to Dr. Brown as well.”

Amazing Process

Like his uncle, Riccardo chose Clark F. Brown, Jr., DDS, of Implant Dentistry of Florida in Melbourne. At Implant Dentistry of Florida, Dr. Brown works alongside William S. Vaughn, DMD, and Kim N. Doan, DMD, to provide a full range of dental services. They perform cosmetic and general dentistry, as well as all phases of dental implant surgery and smile restoration.

Dr. Brown performed a thorough evaluation of Riccardo’s dental health and determined his remaining teeth were unsalvageable. The dentist recommended removing the remaining bridges, extracting the teeth and replacing them with implant-secured fixed bridges. It would be the complete smile reconstruction that Riccardo needed.

“Riccardo came to us with natural teeth that were failing and existing bridges that were faltering, but we were able to extract his teeth, place the implants and secure his temporary bridges during one sedation visit,” Dr. Brown observes.

Implants are screw-like posts made of a titanium alloy that are placed in the jaw, where they fuse with the jaw bone. Once the fusion process is complete, the implant can function as a solid foundation for the restorations that will replace the missing teeth. Restorations can be anything from a crown for a single missing tooth, a bridge to replace multiple teeth or dentures to replace all the teeth.

“My overall experience at Implant Dentistry of Florida was great. With Dr. Brown, I had no fear at all.”  – Riccardo

“The dental implants must integrate with the bone,” Dr. Brown confirms. “It is a process called osseointegration, and that is when the bone actually grows and fuses to the implant. We can often secure temporary fixed bridges on the day of implant surgery when the entire arch of teeth is being replaced since they will all be attached to the same bridge that helps the implants support each other.

“There are several reasons why we might not install the final bridges on the same day. The main reason is that the bone and gums remodel during the healing process. It becomes more difficult to get the final bridges to look and fit perfectly if we do not wait for this remodeling to occur.”

During the implant surgery, Dr. Brown placed six implants in Riccardo’s upper arch and four on the bottom arch. Two of the implants placed in the upper arch were implanted at an angle, not straight up and down. Dr. Brown says this isn’t unusual when creating a full-arch bridge.

“Typically, posterior implants are put in at an angle when they will be securing a restoration that is fixed in place, meaning it is not removable except by a dentist,” Dr. Brown explains. “Angled implants give fixed bridges the most support with the fewest number of implants and support the bridges evenly from front to back.”

In opting to have multiple teeth extracted and multiple dental implants placed on the same day, Riccardo also elected to use intravenous conscious sedation to make the process easier and more comfortable. The IV conscious sedation allowed Dr. Brown to work without interruption because Riccardo was not anxious or agitated and experienced no discomfort.

“IV conscious sedation puts patients in a very relaxed state,” Dr. Brown describes. “While in that state, patients do not mind what is going on with treatment. They also have little memory of what occurred during the procedure after it is completed.

“With IV conscious sedation, patients are still breathing on their own. All their protective reflexes remain intact, and they are able to move and respond if we ask them to, so it is a very safe level of
sedation. We also use local anesthetic to numb the surgical areas after the sedation is in place, so they do not feel any discomfort.”

Enthusiastic Endorsement

Photo by Nerissa Johnson.

Riccardo Billi

Once implants are placed, they typically need between three and six months to heal and fuse with the bone before the abutments and final restorations can be placed on top of them. In Riccardo’s case, only three months were needed before Dr. Brown could create and insert his final bridges.

“Now, I have my permanent bridges, and I love them,” Riccardo raves. “They look great. They look very natural, and I have no problems chewing with them.”

Riccardo can eat most anything he wants because his bridges are fixed in place. Secured by dental implants, fixed bridges offer strong chewing power, and they don’t slip or move when people eat, like a denture would. They stay in place.

“My bridges are screwed in tight,” Riccardo says. “I can’t remove them. Dr. Brown has to do that. Once a year, I go to Dr. Brown’s office and have them removed so his staff can clean them. They clean everything underneath as well.”

In addition to reconstructing Riccardo’s smile, Dr. Brown also alleviated Riccardo’s misgivings about dentists. The retired property owner is now a regular patient at Implant Dentistry of Florida. Riccardo fervently endorses Dr. Brown and his practice.

“My overall experience at Implant Dentistry of Florida was great,” he enthuses. “With Dr. Brown, I had no fear at all. I was a little anxious before the implant surgery, but he told me what to expect, so it wasn’t that bad.

“I have no complaints at all about Dr. Brown and his staff at Implant Dentistry of Florida. Dr. Brown is genuinely a nice guy. He’s a gentleman and very pleasant to be around. He was very gentle and made me feel comfortable. I definitely recommend him.”

Born Again

New smiles created with Dentures in a Day.

Photo courtesy of Ralph Johnson.

Ralph Johnson

On July 12, 2014, Ralph Johnson, 64, was born again. On that warm summer day, the Brooklyn, New York native received a life-saving liver transplant. But Ralph’s new life was quickly threatened again when he developed graft-versus-host disease, a condition that is typically a death sentence for liver transplant patients.

“The graft is my new liver and the host is my body,” the retired law enforcement officer explains. “With graft-versus-host, my body’s immune system recognized that there was a graft in my body and immediately began attacking it. This occurred even though I was taking medication to suppress my immune system.

“But I was able to overcome the graft-versus-host disease after spending three and a half months in a hospice unit at the University of Pennsylvania. While there, I was given experimental drugs, including high doses of steroids, to save my life.

“The people at the hospital told me I might be the only person to survive graft-versus-host after a liver transplant. The staff at the University of Pennsylvania was great, but I also had a strong will to survive. I published a story about my experience in a journal for organ donation.”

The immunosuppressant medications Ralph took restricted his immune system’s ability to function so it wouldn’t attack his new liver. But with decreased immune system function, Ralph was susceptible to invading germs. Consequently, he developed infections in his mouth that affected his teeth. That soon prompted a search for a dentist to address his dental issues.

“There were bacterial infections in my teeth that had to be resolved to maintain my health,” Ralph confirms. “As a result of the infections, I was living with some discomfort, but it wasn’t overwhelming. Much of my concern was with the appearance of my teeth. Some of them needed to be replaced.

“I went online and began reading the reviews for Dr. Gaukhman and Venetian Dental. As I read the reviews, I became more and more impressed, so I set up an appointment.”

Ralph’s choice for dental care was Alexander Gaukhman, DMD, at Venetian Dental in Venice. Dr. Gaukhman, who offers exceptional general, cosmetic and restorative dentistry as well as emergency dentistry, also has offices in Sarasota and Osprey.

“To address my dental concerns, Dr. Gaukhman suggested we start fresh,” Ralph relates. “He recommended giving me a new look, a whole new smile, by removing my teeth and replacing them with dentures.”

After agreeing on that plan, Dr. Gaukhman began his treatment of Ralph by taking impressions of his teeth. From those impressions, a set of temporary dentures was fabricated in Venetian Dental’s on-site dental lab.

Two days later, after the temporary dentures were completed, Ralph returned for a second appointment during which his teeth were extracted and he was fit with the temporary dentures.

Same-Day Service

Venetian Dental’s on-site lab allows Dr. Gaukhman and his staff to fabricate full traditional dentures in just one day. Dr. Gaukhman explains that, historically, much of the time needed to deliver dentures to a patient involved simple transportation.

“After the dentist acquires all the information needed to fabricate a patient’s dentures, the usual procedure is to send that information to a dental lab,” Dr. Gaukhman informs. “The dentures are designed and prepared at the lab and then sent back to the dentist for fitting in the patient’s mouth. It can take up to two days to transport each way. Then, if adjustments need to be made, additional time is required to return the dentures to the lab.”

“My new dentures from Venetian Dental are outstanding. They look really good. People can’t tell they’re not real teeth.” – Ralph

Recognizing that such delays can be a hardship for patients, especially those in pain or who lose or damage a denture while visiting Florida on vacation, Dr. Gaukhman decided to offer dental lab services in his own office. This effectively eliminated transportation delays and allowed him to provide many patients with same-day service, or Dentures in a Day.

“Dentures in a Day are particularly beneficial when the patient is in pain with their teeth, when an infection is present and when the patient does not have time to wait for their dentures,” Dr. Gaukhman elaborates.

“In these cases, the patient comes to the office in the morning, and by the afternoon, their dentures are ready. And that’s the best thing about Dentures in a Day. Patients can come in with broken teeth, failing teeth or infections, and they leave with perfect smiles.”

With the Dentures in a Day option, Dr. Gaukhman schedules the patient for an early-morning appointment to take impressions and develop a treatment plan. While the dentures are being prepared in the Venetian Dental lab, the patient is able to leave the office to relax or take care of personal errands or business.

A second visit later in the day enables the dentist to perform an initial fitting of the dentures and to note any changes that need to be made. Once the adjustments are performed, the patient returns to the office later that same day to receive the finished dentures.

“With Ralph, we performed the work in two visits because he was not in pain and was not in a hurry,” Dr. Gaukhman explains. “Still, the bulk of the dental work was done in one day, because once his dentures were ready, he came in, we extracted his teeth and fit his traditional dentures the same day.”

Dr. Gaukhman notes that by fitting the temporary dentures immediately after Ralph’s teeth were extracted, the dentures act as a BAND-AID® of sorts. They help decrease bleeding and swelling because the gums can only swell to the point of the denture.

“In about three months, when my gums heal, I’ll get my permanent dentures. The procedure on my teeth wasn’t painful, but then I just survived three and a half months in a hospice unit unable to walk. Nothing can equate with that.”

Advanced Research

After friends of New Hampshire native Maurice Whipple invited him to Florida for a visit, he decided he liked the state so much that he wanted to retire here. Maurice bought a home and became a permanent Florida resident in the late 80s, but he still spends the hot summer months with his children up north.

These living arrangements have worked out well for Maurice. Unfortunately, not everything has worked out positively for him. For years, the retired electrical contractor had trouble with his teeth. Those issues eventually reached a point where he had to have his teeth replaced.

“My dentist told me I had very hard teeth, but they were prone to cavities, no matter how much I brushed and flossed,” Maurice shares. “I knew I was going to end up with dentures eventually, but I managed to put it off for a long time.

Photo by Jordan Pysz

Maurice can relax comfortably now that he has implant-secured dentures.

“It was around 2000 that I had to finally get my upper teeth pulled and replaced with a denture. Eighteen years later, my bottom teeth started heading south on me, and I knew I would eventually have to have them pulled out as well.”

While Maurice contemplated a denture for his bottom jaw, he also considered replacing his upper denture with an improved appliance. After learning about dentures secured by dental implants, he decided that implant-secured dentures were the better way to go.

“My old upper denture fit well, but it had this plastic part that covered the whole roof of my mouth to create a vacuum to hold it in place,” Maurice describes.

“That plastic part made me gag a lot, so I knew I needed to get rid of the roof part of my denture. I heard that implant-secured dentures don’t have that plastic part to them, so that’s why I looked into them.

“I called three dentists who offer implant dentures, and Dr. Gaukhman was the most experienced. He was also convenient. His office is located close to where I live. He also had the best deal and was very pleasant to work with. That’s the main reason I chose him.”

Dr. Gaukhman agreed that implant-secured dentures were a good option for Maurice.

“I told Dr. Gaukhman what I wanted, and he said, That’s what you should have,” Maurice remembers. “I did a lot of research before I made this move. I looked into individual dental implants, but that route was too expensive for me. Implant dentures addressed my concerns and were something I could afford.”

Classic Example

Dental implants are screw-like posts that are surgically placed into the jawbone to serve as the foundation for replacement teeth such as crowns and dentures. When secured by implants, dentures don’t slip or move; they stay in place when patients speak and eat. But that’s just one of the many advantages that implant-secured dentures have over traditional dentures.

“A drawback of traditional upper dentures is a decrease in taste,” the dentist describes. “The tongue is mainly responsible for discerning taste, but the palate also plays a role. Because traditional dentures cover the palate, patients can be deprived of sensing the full complement of tastes. Implant dentures, on the other hand, are horseshoe-shaped and do not cover the palate, improving taste.”

Another issue that can occur with traditional upper dentures is the gag reflex that Maurice often dealt with. Some patients, including Maurice, experience this problem due to the denture being over the palate. By not covering the palate, implant dentures eliminate this gag reflex.

Traditional lower dentures are generally more difficult to keep stable than upper dentures. Because there is no palate on the bottom of the mouth, less suction is produced to hold lower dentures in place naturally. As a result, they tend to slip while patients are eating and speaking.

“The dentures Dr. Gaukhman made for me look very natural. People don’t know they’re not real teeth. . . . Everything turned out perfectly.” – Maurice

“Adding dental implants stabilizes lower dentures, so they do not move around,” Dr. Gaukhman observes. “In addition, dentures secured by implants have stronger chewing capability than traditional dentures. Patients can eat foods they could not eat previously, improving their quality of life.

“Implant-retained lower dentures are generally secured with two implants. We typically secure upper dentures with four implants. It’s due to gravity that I can use two implants on the bottom but need four on the top.”

Dentures have to work with or against gravity. Lower dentures move down with gravity, so two implants are sufficient. Upper dentures have to work against gravity, so four implants keep them more secure.

”Maurice is a classic example of what we offer for implant-secured dentures,” Dr. Gaukhman asserts. “We gave him a new upper denture stabilized by four implants and a new lower denture stabilized by two implants.”

Perfect Match

Maurice looked forward to getting his implant dentures, but in first meeting with Dr. Gaukhman, he made it clear he wasn’t looking forward to the dental work that would get him there. Dr. Gaukhman took care of that issue as well.

“I have my blood pressure under control, but when I go into a dental appointment where the dentist is going to work on my teeth, my blood pressure skyrockets,” Maurice acknowledges.

“So I told Dr. Gaukhman I wanted to be put to sleep when he did the drilling and other work, and he did that for me. He made me very comfortable. I didn’t experience the slightest bit of pain, not even after Dr. Gaukhman put in the implants.

“So I was real happy with Dr. Gaukhman’s process. When I got my upper denture eighteen years ago, the dentist pulled my teeth and put in my denture before my gums had completely shrunk back to their normal size after being swollen. As a result, I ended up with a loose denture.

“This time, Dr. Gaukhman placed the implants, then waited a few months until the bone adhered to the implants and my gums healed. He gave me temporary dentures to wear during that time.”

Maurice was in New Hampshire during the time his implants were healing, so when he returned to Florida, he was ready to receive his permanent dentures. He’s thrilled with the finished products.

“I got my permanent dentures in January, they fit perfectly, and I love them,” Maurice raves. “The bite is perfect, and they look good. Dr. Gaukhman pretty much copied the look of my old denture on the top, and for the bottom, he showed me sample teeth and let me pick what I wanted.

“Some were narrow teeth, and some were wider, but they matched up really well. The dentures Dr. Gaukhman made for me look very natural. People don’t know they’re not real teeth. I’m so lucky. Everything turned out perfectly.”

Maurice is especially pleased that his new upper denture has no plastic covering the roof of his mouth. He points out that one benefit of that is he can better taste his food. But that’s not even the best part for him.

“The main benefit of the implant denture for me is it eliminated the gagging I experienced for eighteen years with my old upper denture,” he says. “And my bottom denture doesn’t move in my mouth at all.

“I should have done this in 2000 instead of waiting. I definitely recommend Dr. Gaukhman and Venetian Dental. They did excellent by me. Nobody could do a better job than they did.”

Simply Outstanding

Dr. Gaukhman did well by Ralph as well. In one day, he gave Ralph a brand-new smile and relieved his dental discomfort. Like Maurice, Ralph is extremely pleased with the results of his treatment at Venetian Dental, and he’s already considering dental implants to secure his dentures. For right now, though, he’s happy with them the way they are.

“My new dentures from Venetian Dental are outstanding,” he raves. “They look really good. People can’t tell they’re not real teeth. I just light up with my new smile. I’m a smiley person anyway because I overcame some really critical medical situations and was given a gift of life. I feel so fortunate, so, yeah, I’m enjoying myself now. I have a lot to smile about.”

Ralph is also happy with his experience at Venetian Dental. He gives kudos to Dr. Gaukhman and his staff. 

“The Venetian Dental staff is professional,” Ralph describes. “They’re friendly, helpful, good people, and they made me feel very comfortable. And Dr. Gaukhman is outstanding. He’s personable and honest.

“And he’s very, very good at what he does. He was really understanding of my situation and took me under his wing. I’m very grateful to Dr. Gaukhman. I recommend him to anyone.”

Correct the Cause of Pain

Stretching protocol relieves neck and back pain, restores flexibility.

Photo courtesy of Lori Falcone.

Lori Falcone

Two years ago, Bronx, New York native Lori Falcone, 55, and her business partner expanded their company to include a power washing and paver sealing division.

Being a business owner can be stressful, and Lori tends to hold stress in her neck and shoulders, which caused severe neck pain and intense headaches. Lori also believes her genetics are partly to blame for the pain in her neck, shoulders and head.

“I’m short and I’m Italian, so I have no neck to begin with,” she states. “That’s always been a joke with me. I went to a chiropractor regularly, and every time I went, I asked them, Can you please pull my neck out of my shoulders? It looked like my shoulders were sewn to my earlobes.

“I got migraine headaches three to four times a week, and that’s a good week. When some people get migraines, they get nauseous or sensitive to light. When I got one, I couldn’t think or function. They were very debilitating. I went to neurologists. I got massages every week, and I went to a chiropractor. I got some relief, but it was never long-term.”

After taking up yoga a few years ago, Lori discovered she had a significant decrease in flexibility in her lower back as well. She didn’t have pain in her back per se, but she did have soreness and stiffness, especially first thing in the morning. Lori says that over time, she simply became accustomed to the discomfort in her lower back, unlike the pain in her neck and shoulders. Lori’s yoga instructor was surprised by her lack of flexibility.

“There’s one yoga pose where you put your knees up to your chest, then roll to the left and hold out your right arm,” Lori describes. “My arm was a foot off of the floor. It wouldn’t go down any farther. My yoga instructor said, That’s not where it’s supposed to be.

“I also couldn’t touch my toes when I bent over. The instructor said, When you bend over, you’re bending from the middle of your back instead of from your lower back, where you’re supposed to bend. I didn’t know I was doing that.

“But there was never as much pain in my lower back as there was in my neck and shoulders. That pain was debilitating. There were many times at bedtime when I’d be in tears because my neck and shoulders hurt so much. Sometimes, I cried myself to sleep.”

Lori was not achieving results from the treatment she was undergoing at the time. Her best friend, however, had visited Jeffrey P. Johnson, DC, at Johnson Medical Center in Venice and undergone his specialized treatment protocol for back and neck pain called Sedative Stretching. She told Lori about Dr. Johnson, who has expertise in Sedative Stretching, an expanded and comprehensive form of Manipulation Under Anesthesia, or MUA.

“My friend had been telling me about Dr. Johnson for a while, but I didn’t go right away,” Lori recalls. “Life just got in the way. But finally, I couldn’t take it anymore, so I went to Johnson Medical Center for an exam.

“When Lori originally came to our office, she was suffering with chronic, moderate-to-severe lower back pain that radiated into both of her hips,” Dr. Johnson states. “She attributed the cause of her back pain to a basketball injury she sustained when she was thirteen years old.

“Additionally, Lori was suffering with significant chronic neck pain and stiffness that radiated into both of her shoulders. On examination, she had a tremendous loss of range of motion throughout her neck and more severely in her lower back and sacroiliac regions.

“Because of the long-term effects of restricted spinal movement and function, Lori also was experiencing accelerated disc degeneration throughout her neck and lower back. Due to her medical history and previous care, I believed she was a good candidate for the Sedative Stretching procedure.”

“Dr. Johnson told me he’d have to work on me every day for a year to get the same benefit I’d get with one Sedative Stretching procedure,” Lori comments. “I did the math and compared one procedure to how much it would cost to go every day for a year to get the same benefit. I decided to give Sedative Stretching a shot.”

Failing Flexibility

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.”

“It’s best for people to address the cause of their condition as early as they possibly can,” 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.

“While they don’t always realize it, people will compensate how they move their bodies when this occurs,” Dr. Johnson reports. “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.”

Unguarded Muscles

Photo courtesy of Lori Falcone.

Lori Falcone

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, causing pain.

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

Dr. Johnson recommends that patients follow up the procedure by spending about two weeks in a rehabilitation program designed to reinforce the increased movements obtained from the treatment. During this time, patients are taught stretching exercises that prevent the condition from recurring.

“By following the recommended exercises, patients regain the flexibility they had decades before, and they generally return to activities they haven’t done in years,” Dr. Johnson asserts. “This is truly correcting the original cause of their conditions.”

“Absolutely Life-Altering” 

Lori underwent Sedative Stretching on May 9, 2019. She was amazed by how quickly she experienced positive results from the procedure. Others noticed a change in her as well.

“I felt a difference immediately,” Lori reports. “About a week after the procedure, I had my yoga instructor watch while I performed the pose where my arm was a foot off of the ground. I could put it down completely. When I bent over, she couldn’t believe the difference. She was absolutely floored by my increased flexibility.

“Then a month after my Sedative Stretching procedure, I ran into someone I hadn’t seen in a while. She looked at me and said, Oh my God! You have a neck.”

As part of Dr. Johnson’s follow-up care, patients are taught specific stretching exercises to prevent their conditions from returning. Lori performs her prescribed stretching routine religiously, and it’s helped maintain the benefits she received from her Sedative Stretching procedure. Together, the procedure and her routine stretching have significantly improved Lori’s quality of life.

“I feel fantastic now,” she raves. “I don’t get the debilitating migraine headaches, and if I feel one coming on, I can get rid of it by stretching. I don’t have the tension in my shoulders anymore. I’m feeling great now. I don’t wake up with pain, and I don’t go to bed with pain.

“I’ve already recommended Dr. Johnson and his Sedative Stretching. My husband has had it done. I recommend this procedure to anyone who goes to a chiropractor and hasn’t been evaluated for Sedative Stretching. They should speak with Dr. Johnson to determine if they’re a candidate for it. It was absolutely life-altering for me.”

Sure Shot

Injection surmounts nurse’s sexual, urinary dysfunction.

As a young child, Iris* battled a chronic illness and spent long stretches of time in a hospital pediatric unit. The gentleness and compassion with which the hospital staff cared for Iris made a lasting impression on her and provided the motivation behind her choice of career.

“I wanted to be a nurse since I was five years old,” the Missouri native, now 56, relates. “I saw it as a good way to help others and give back to the community. I worked as an ICU nurse for thirty-three years before retiring four years ago after a heart attack. Nursing was a very fulfilling career and was very good to me.”

Being a nurse, Iris understood the consequences of the hysterectomy she was forced to undergo at age 39. She knew that without female reproductive organs to create the hormones necessary for her body to function optimally, she would require hormone replacement therapy. But Iris wasn’t interested in pharmaceutical hormones. She desired a more natural option.

“I was raised by my Native American grandmother, and she had a natural remedy for everything. She had a root or herb to treat any illness,” Iris recalls. “Alternative therapies always interested me even though I was a traditional western medicine nurse. I believe God put curative plants on this earth so we could heal ourselves.”

Instead of medical hormone replacement, Iris chose to treat her hormone deficiency using bio-identical hormone replacement therapy, or BHRT. Bio-identical hormones are plant based and lab-modified to be chemically identical to the body’s intrinsic hormones. All-natural BHRT is just as effective with fewer side effects than drug-based hormone therapy.

Having a hysterectomy at a young age plunged Iris into sudden menopause, which affected her physically and emotionally. BHRT eased most of the symptoms related to her menopause, such as hot flashes, mood swings and night sweats, but Iris’ condition went beyond that. She also had trouble functioning sexually, and she found she required more than BHRT to treat that.

“I was experiencing hyposexual desire disorder, a lack of interest in sex,” Iris shares. “I also had trouble with arousal as well as a lack of vaginal lubrication. And when I did have sex, reaching orgasm was difficult and took a long time. It got worse as I got older.

“These symptoms persisted despite the BHRT. And they really affected my quality of life because sexual health is important to overall well-being. They made me feel like I wasn’t a complete woman.”

In addition to her sexual symptoms, Iris also suffered with urinary dysfunction since having children. She had difficulty holding urine and sometimes experienced leakage. She hoped for an answer to both her sexual and urinary symptoms.

“I knew Dr. Dean from working with her at the hospital when she practiced internal medicine,” Iris notes. “I started following her when she transitioned into alternative medicine because of its interest to me. I went to her with my concerns.”

Iris turned to Melissa Dean, MD, at Dean Wellness Institute, where Dr. Dean and her staff have been providing patients with a holistic approach to wellness for more than 15 years. In addition to Iris’ BHRT, Dr. Dean recommended the O-Shot®, a natural way to treat sexual and urinary dysfunction using platelet-rich plasma (PRP).

Lasting Benefits

“Vaginal dryness, urinary incontinence and problems with arousal and achieving orgasm are issues that often affect women as they age,” Dr. Dean notes. “Many times, these conditions can be treated effectively with hormones, including BHRT. But sometimes, women taking hormones are still unable to achieve orgasm.

“The O-Shot, which is short for Orgasm Shot, uses PRP to regenerate the nerves in the vaginal area and around the clitoris. Regenerating these nerves heightens sensation and, as a result, improves the woman’s ability to achieve orgasm.”

“Since I got the O-Shot, I feel much better. My sexual desire has returned, as has my ability to have an orgasm.” -Iris

The O-Shot utilizes PRP from the patient’s own blood, not from synthetic fluids. To obtain PRP, blood is drawn from the patient and placed in a special centrifuge, which separates the plasma from the red blood cells.

“As the blood is spun in the centrifuge, the red blood cells drop to the bottom of the test tube, and the plasma rises to the top,” Dr. Dean explains. “We call that ‘liquid gold’ because many growth factors are found in that plasma. Then, that platelet-rich plasma is removed and injected into the area of the body being treated. In the case of the O-Shot, it is the vagina and clitoris.

“When giving an O-Shot, I first numb the woman’s vaginal area so she does not feel the process taking place. Some of the PRP is injected intravaginally to regenerate tissue and increase moisture. PRP – with its growth factors – is also injected around the clitoris to bring back to life the nerves that have lost sensitivity over time.”

The O-Shot is also effective for urinary incontinence by helping to tighten, or strengthen, the bladder muscles and stop leakage, Dr. Dean adds.

Because the O-Shot uses PRP from the patient’s own blood, there is no negative reaction to the injection. And because it’s all-natural, there are no side effects to the treatment.

“The benefits of the O-Shot generally last between nine months and one year, sometimes longer,” Dr. Dean reports. “Results vary depending on the woman and the intensity of her symptoms. The O-Shot can be repeated as needed.”

“Sexual dysfunction is a very personal issue. It’s private and intimate, and can be difficult to talk about,” Iris states. “But Dr. Dean and her staff were so understanding and made me feel very comfortable. So I tried the O-Shot, and it made a huge difference in my sexual and urinary health.”

“A Complete Woman”

Iris reports that her treatment at Dean Wellness Institute was very successful. While BHRT is managing her menopausal symptoms, the O-Shot has her urinary symptoms under control and has heightened her sexual responsiveness.

“Since I got the O-Shot, I feel much better,” Iris enthuses. “My sexual desire has returned, as has my ability to have an orgasm. I feel like a complete woman again. My urinary symptoms have significantly improved as well. I can hold my urine for a long time now, so the frequency, and urgency to urinate are much better.

“My experience with Dr. Dean and Dean Wellness Institute was excellent. In addition to BHRT and the O-Shot, she has an array of alternative therapies for many health conditions. I definitely plan to use her more in the future.”

*The patient’s name was changed at her request.

Healthy Returns

Hospital program aids multiple trauma patient’s recovery.

Photo by Nerissa Johnson.

The staff at Encompass Health accommodated all of Zander’s needs.

On what started out as a typical Saturday last year, Alexander “Zander” Vaglivielo finished lunch with a buddy and headed out on the road. Shortly thereafter, a car suddenly pulled out in front of Zander’s truck. In an instant, the truck flipped over and smashed into a telephone pole, leaving Zander, 18, severely injured.

“The impact crushed my left hip and left elbow, and broke my back,” says Zander, who also suffered a series of internal injuries, among them a lacerated kidney and lung. He suffered several broken ribs as well, and his spleen was so damaged, it had to be removed. Zander’s condition was serious.

“I was in the hospital for two weeks,” he relates, “including almost a week in the intensive care unit.”

“When Zander went to the hospital, he was in pretty bad shape with his injuries, and he was on a ventilator,” states Zander’s mother, Stacey. “The doctor explained that basically, everything in his stomach got shoved up into his chest on impact, and then his diaphragm exploded. They had to pull everything back up out of there to stabilize him.”

At the hospital, Zander underwent several surgeries to treat his injuries and stabilize his condition. Once stabilized, he moved to Encompass Health Rehabilitation Hospital of the Treasure Coast in Vero Beach to begin rehabilitation.

“We chose Encompass Health because my grandma works there, and my grandpa’s been in the hospital there a few times,” Zander states. “We knew it was a good place.”

Encompass Health is an acute-level rehabilitation hospital. It’s the only facility in the area that offers that level of care. It also has a specialized multiple trauma rehabilitation program for patients such as Zander.   

Challenges Addressed

“When a person suffers multiple traumas, it’s a life-altering experience,” observes Dawn Bucaj, RN, BSN, senior rehab liaison at Encompass Health. “Patients with multiple traumas require a combination of approaches that address more than one challenge at a time.

“Our multiple trauma rehabilitation program uses a wide range of therapies and technologies to tackle multiple challenges. The program’s treatment team designs a comprehensive therapy plan for each patient based on their specific needs. By following the plan, patients can reach their recovery potential.”

The multiple trauma treatment team is led by a physician who directs specially trained clinicians, including rehab-certified nurses, physical therapists, occupational therapists and speech-language pathologists. Each patient’s recovery is different, so the rehab approaches taken by the Encompass Health multiple trauma team are individualized.

“We tailor a fully coordinated program of rehab treatments to ensure each patient receives the best care for their particular needs,” Dawn informs. “The approach we take is personalized to the patient’s condition and abilities.

“Our patients receive daily visits by two physicians and twenty-four-hour rehab nursing care. Their tailored rehab programs include three hours of therapy per day, every day. Therapy is started based on the patient’s current level of ability.”

The multiple trauma treatment team works with patients and their families to educate, train and help patients perform daily activities.

“The treatment team believes it’s particularly important for patients to be close to their support systems,” Dawn explains. “That’s why we partner with the patients and their loved ones to set attainable goals.”

As a hospital, Encompass Health provides complete inpatient care as well as rehabilitation services. In that way, it is unlike most nursing homes and rehabilitation centers.

“That difference leads to greater patient satisfaction and superior outcomes,” Dawn says. “To receive the advantages of Encompass Health’s multiple trauma rehabilitation program, it’s important for patients and families to ask for us by name.”

Atypical Patient

At Encompass Health, Zander received both occupational and physical therapy. Throughout his stay, he was confined to a wheelchair, so his therapists focused on strengthening his upper body and teaching him ways to manage his daily activities from the wheelchair.

“When I arrived at Encompass Health, I couldn’t walk and wasn’t allowed to put pressure on my leg,” Zander remembers. “The therapists taught me how to transfer from a wheelchair into a car, bed and shower, and how to do other, similar activities.”

At the time of his accident, Zander was 17. He wasn’t a typical patient at Encompass Health, but that wasn’t an issue for him or the staff.

“I was a little younger than most patients at Encompass Health, but the therapists were really nice, and everybody made me feel comfortable and at home,” he reports. “I was at Encompass Health for a week.”

“The weekend Zander was at Encompass Health was homecoming weekend, which was really difficult for him,” Stacey describes. “I got permission and held homecoming for him and his girlfriend right there. I decorated his entire room and had the event catered by Outback Steakhouse®. The staff at Encompass Health was just so accommodating.”

Today, Zander is healthy again and pursuing a career in construction. He recalls his time at Encompass Health Rehabilitation Hospital of the Treasure Coast fondly.

“My overall experience at Encompass Health was very good,” he exudes. “I’ll go back if I ever need to.”

Cold Turkey

Implant-retained overdentures replace broken, failing teeth.

Photo by Nerissa Johnson.

Edgar Kiley

As its director of asset management, Edgar Kiley oversees the programs, maintenance and modernization of public housing units for a local public housing authority. The New Jersey native has been living and working in Florida for 13 years and doing that job for seven. While Edgar enjoys living in Florida, there are times he really misses New Jersey.

“I actually miss the wintertime every once in a while,” Edgar confesses. “I love winter: the cold, the snow, everything. I just like that time of year. It’s my favorite, actually. If the temperature never got above sixty degrees, I’d be really happy. I’m kind of unique in that way. But Florida is nice, too.

“I moved here while I was married to my previous wife. We wound up getting divorced, but I stayed here because I like it so much. I went scuba diving on Christmas once and sent pictures back to my family in New Jersey saying, It’s Christmas and I’m scuba diving. Enjoy the cold weather.”

Prior to beginning his current job, Edgar spent most of his career in construction. Workers in construction rarely take time off for health concerns because they don’t get paid if they don’t work and typically don’t receive health benefits. Edgar didn’t see a dentist routinely for those very reasons. Eventually, the neglect caught up with him, and one by one, his teeth began to fail.

“When a tooth would go bad, I’d just pull it, which caused my other teeth to move and then they’d go bad,” he describes. “For a while, I was still able to eat normally, but then I mostly had to eat on my right side.

“Then I lost a couple of teeth on that side, and I started chewing on my left side. Eventually, the teeth on that side went bad as well, and pretty soon, I ran out of sides to keep jumping back and forth to.”

Edgar’s wife watched him struggle with his failing teeth. While he was on the brink of losing yet another tooth, she took the advice of a coworker and recommended Edgar visit Alfons Bucaj, DMD, at Dental Implant Center of Vero Beach.

“Dr. Bucaj gave me several options,” Edgar states. “He said he could remove the one tooth that was going bad and continue to take care of each tooth as it failed. Another option was to use standard partial dentures.

“Finally, he said he could pull out all my teeth, put in dental implants and give me a full set of replacement teeth that just snapped into place. He left it up to me, so I told him to take out all of my teeth, put in the implants and give me a full set of new teeth.”

Hybrid Flexibility

Dental implants are screw-like posts that are surgically implanted into the jawbone and serve as the foundation for replacement teeth. Over time, the implants fuse with the jawbone to become one solid unit that has great strength and stability.

One of the benefits of implant-retained dentures is that the implants are made of titanium, which means they will not decay the way natural teeth do and will never require endodontic treatment, or root canals.

“Dr. Bucaj is different than all the other dentists I’ve gone to in my lifetime. He talks to me as an equal, a peer.”– Edgar

“Implants also have a decades-long survival rate,” Dr. Bucaj notes. “In ninety-nine percent of cases, they last for a lifetime supported in the jaw. The forces of the bite are much better as well. Implant-retained dentures increase chewing ability by nine times compared to conventional dentures. That can make a big difference in quality of life.”

Dentists can reconstruct an arch with a prosthesis that is fixed and never comes out or a traditional denture that is taken out nightly for cleaning. A removable, implant-retained overdenture is an intermediate option for restoring an upper or lower arch that Dr. Bucaj recommended for Edgar.

“The removable overdenture is a hybrid,” Dr. Bucaj explains. “It’s partially fixed because of the implants and partially removable. It provides the flexibility of coming out for cleaning, but the security of staying in place during eating and speaking.”

Implant-retained overdentures can be secured with as few as two implants, though some patients require more. The number of implants used depends on the denture and the aim of the end result.

“Edgar wanted minimal intervention that would give him dentures that were removable, but would stay in place when he spoke and ate,” Dr. Bucaj informs. “In his case, I used two implants on each arch, which is a minimal amount, but gives maximum results.”

Complete Trust

“Getting implants is a pretty impressive process,” Edgar says. “I understood exactly what Dr. Bucaj did with the implants in my jaw because I’ve done the same thing in construction. I’ve put anchors in concrete, which is basically the same physics, same engineering. It’s pretty amazing.”

Once they are placed, dental implants typically need between three and six months to fuse with the jawbone. During that period, patients receiving an overdenture usually wear a temporary denture. Edgar is currently in that phase of the process.

“The temporary dentures I have now slip in over my gums,” Edgar describes. “I glue them in with a little adhesive, wear them all day, then take them out at night and throw them in a cup to clean them.

“Wearing them, I learned I can’t chew on only one side. I have to chew on both sides to keep the dentures balanced. But other than that, they’re good. I can eat anything, including steak. I can actually eat better with my temporary dentures than I could before I had my teeth pulled and the work started. It’s just a lot easier now.”

The permanent overdenture will make the job of eating even easier for Edgar, who says he has developed complete trust in Dr. Bucaj and his staff.

“Dr. Bucaj is different than all the other dentists I’ve gone to in my lifetime,” he shares. “He talks to me as an equal, a peer. While he doesn’t talk down to me, he explains everything I don’t understand. What a pleasant, wonderful man.

“Dr. Bucaj’s entire staff is wonderful. They’re really nice to talk to, and they set me at ease. Going to Dental Implant Center of Vero Beach is like going to visit friends and family more so than going to a dentist. It is a very nice experience.”


Massaging Moments

Lymphedema, venous disease can cause limb swelling; compression pumps can help.

Photo by Jordan Pysz.

Sally Youngstrom

Ten years ago, Binghamton, New York native Sally Youngstrom survived a battle with non-Hodgkin’s lymphoma. Along the way, however, she developed lymphedema, a condition that causes excess fluid in the lymph vessels.

Caused by her cancer, the lymphedema affected Sally’s arms and legs, but especially her legs, causing them to be constantly swollen and uncomfortable.

“The swelling in my right leg was really bad, and my left leg wasn’t that good either,” Sally relates. “My right leg was larger than my left leg. You could see it in my pant legs. The one on the right side was really tight.

“I started to wear compression stockings, which helped, and I also had procedures on my leg veins. But last August, I underwent knee surgery. After the surgery, the swelling was even worse and eventually became out of control.

“I knew I had to do something about it, so I asked my vein specialist what could be done. He recommended a compression pump from Acute Wound Care.”

Acute Wound Care is a fully accredited home medical equipment provider specializing in hospital-grade compression devices and specialty wound-care dressings. The compression pumps, which reduce swelling caused by conditions such as lymphedema and venous disease, are prescription devices. They are approved by most insurers.

Rhythmic Patterns

Acute Wound Care’s easy-to-use compression pumps remove fluid that has accumulated in the patient’s legs or arms, observes 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,” Alyssa explains. “This alleviates swelling and many painful symptoms.

“The pumps are highly effective and noninvasive, and for the legs, they are much easier to use than compression stockings. Patients generally use the pump twice a day for forty-five minutes, usually in the morning and in the evening. While using the pump, patients simply sit back with their limbs raised to further assist with decreasing swelling.”

The sleeves of the compression pump contain multiple chambers. During treatment, each chamber fills up with air. Then, each chamber releases, and the pattern repeats in a rhythmic fashion, forcing any excess fluid out of the limbs.

“The pump also boosts circulation by contracting the leg muscles, assisting blood flow back toward the heart,” Alyssa notes. “Results are often apparent immediately. Many patients 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 are in the patient’s home, we set the pressure based on the severity of the condition and the physician’s prescription,” states Alyssa. “We then adjust the pump so the patients are comfortable and will actually meet the requirements of the treatment, so they get great results.”

Physician Endorsed

Physicians throughout Florida have been recommending Acute Wound Care’s compression pumps to their patients for years and have been getting great results.

“Many doctors have told me they’ve encouraged their patients to use the pump to reduce limb swelling and improve circulation,” Alyssa confirms. “They say the compression pumps are safe, noninvasive devices that greatly supplement the medical treatment they provide to those patients.

“One physician even told me he received feedback from his patients, and they agree the devices and the outcomes are positive. He said the patients also appreciate how good a job Acute Wound Care does of following up and mentioned that all are very pleased with Acute Wound Care and its product.

“That same doctor said he’s so satisfied with Acute Wound Care that he strongly endorses them and their compression devices to other physicians. He said he’s personally thrilled with Acute Wound Care because they help doctors improve their quality of care and the quality of their patients’ lives.”

“I Have Ankles Again”

Sally has been using her compression pump from Acute Wound Care for four months and is thrilled with the results. Because she works full-time, she generally uses her device once a day instead of twice, but she uses it for longer than 45 minutes.   

“Since I’ve been using the pump, I can’t believe the difference in the size of my legs. I have ankles again.” – Sally

“The compression pump is wonderful,” Sally raves. “I use it for an hour or an hour and a half, and when the session is over, I can really see a change. Since I’ve been using the pump, I can’t believe the difference in the size of my legs. I have ankles again.”

Because Sally’s leg swelling is effectively managed with her compression pump, she can enjoy her favorite activities without discomfort. She has plans to return to even more activities soon.    

“I’m dancing, playing a little golf and walking, things I like to do when I’m not working,” she reports. “My husband and I have a motorhome and do some traveling with it. That got curtailed due to my leg and knee problems, but we’ll probably get back into that now as well.

“I couldn’t be more pleased with the care I received from everyone at Acute Wound Care. And I couldn’t be happier with my results. The compression pump works, and it was very successful for me. I just wish I got it sooner.

“I absolutely recommend Acute Wound Care and their compression pumps to anybody in a situation like mine.”

Orthopedic Issue?

Fixing your veins may improve your orthopedic recovery and outcome.

Photo by Fred Bellet.

Without the cramping and pain in their legs, Cliff and Rhonda are enjoying boating more.

Thirty-four years as a career firefighter wasn’t enough for Cliff Linzalone. Although he “retired” two years ago, he continues to volunteer with a company in nearby Alva. He’s also a member of a regional search and rescue team.

As for Cliff’s wife, Rhonda, she works in the cafeteria of a local school, where she spends a lot of time on her feet. At one point, she began experiencing uncomfortable issues with her legs. She also had several unsightly varicose veins that annoyed her.

“A few years back, I had swelling, achiness and heaviness in my legs,” she describes. “I was also having leg cramps, and I would get restless legs at night that kept me awake. I had some trouble walking because my legs would cramp up and hurt, and then they would swell. I also had big, green veins on my legs.”

For years, Rhonda simply “tolerated” the issues with her legs, but she recently decided to get rid of the ugly veins. A coworker recommended Joseph G. Magnant, MD, a board-certified vascular surgeon who specializes in treating vein disorders.

Dr. Magnant’s practice, Vein Specialists, is dedicated to the modern evaluation and minimally invasive treatment of leg vein disorders. Vein Specialists has offices in Fort Myers and Bonita Springs.

When Rhonda met with Dr. Magnant, she learned he could treat her varicose veins as well as her other leg issues. He told her all of her symptoms were caused by a disorder affecting her veins called venous insufficiency.

Veins are the blood vessels that return deoxygenated blood to the heart and lungs. Inside the veins are one-way valves that assist blood flow against gravity. Venous insufficiency occurs when these valves fail, creating pressure that builds up in the veins. This leads to signs and symptoms such as varicose veins, swelling, heaviness, achiness or cramping, discoloration, restless legs and frequent nighttime urination.

After an ultrasound evaluation, Dr. Magnant confirmed that Rhonda had venous insufficiency in both legs. He recommended a treatment called endovenous ablation, a minimally invasive procedure that uses radiofrequency energy to close leaking veins and reroute the blood through healthy veins.

Following the procedure, Rhonda’s symptoms improved tremendously, but she continued to follow up with Dr. Magnant to have several small spider veins treated. At one follow-up appointment, she brought Cliff with her.

Secondary Injury

Photo by Fred Bellet.

Rhonda Linzalone

During one of Rhonda’s procedure appointments, Dr. Magnant came out to the waiting room to speak with Rhonda’s husband Cliff and noticed his swollen, disfigured and discolored right leg and ankle. He asked Cliff about it, and Cliff explained that he had been in a motorcycle accident ten years earlier, and nearly had his right foot severed off as a result of a badly injured ankle. Despite receiving appropriate limb-saving treatment from an orthopedic surgeon, the ankle had been swollen and painful ever since.

“My foot was ninety percent severed in the accident, and I eventually had eight different operations to save it,” Cliff clarifies. “After that, my ankle blew up to twice its normal size. It was always swelling and hurting. My leg from the knee down looked like a diabetic’s leg; it was really discolored.

“I lived with it every day and did what I had to do because I was a firefighter, but I did it with a lot of pain. Every time I went to the orthopedist, he told me it was all because of the trauma. He said the ankle wasn’t getting the right blood flow because of the injury.”

When Cliff accompanied Rhonda to her appointment at Vein Specialists, he wore shorts, which made his swollen, discolored leg visible. When Dr. Magnant looked over from Rhonda and saw it, he knew he had to speak with him.

“Cliff was willing to proceed with an evaluation, and our venous ultrasound revealed he had significant, treatable venous insufficiency,” shares Dr. Magnant.  “His problem was pretty straightforward. I performed an endovenous ablation with a ClosureFast catheter  (radiofrequency), just like I did for Rhonda.”

Orthovenous Disease

“The symptoms of venous insufficiency and orthopedic disease are different,” explains Dr. Magnant. “Orthopedic disease, whether it’s in the ankle, knee or hip,

Photo by Fred Bellet.

Cliff Linzalone

is usually worse after prolonged periods of immobility, such as riding in a car, sitting in a chair or sleeping. When you stand up, there’s a stiffness that generally works its way out a little bit as you walk. However, by walking, you put stress on the joint, so eventually, it’s going to hurt more.

“Venous disease is generally better after sleeping or elevating the legs for a period of time, and gradually gets worse with sitting or standing and as the day wears on. It’s improved by walking, elevation and compression hose.”

“After I had the vein procedure, all my symptoms cleared up.” – Cliff

Dr. Magnant notes that arthritis is a common orthopedic condition that frequently affects the hip, knee and ankle, as well as other parts of the leg. The population most often affected by arthritis are those in their 40s through 80s.

“Venous disease is very common in this age group, as well,” observes the doctor. “We have developed an excellent working relationship with orthopedic surgeons in Southwest Florida and are often asked to evaluate their total joint candidates prior to surgery. In some cases, we are asked to consult on their patients postoperatively as well to rule out deep vein thrombosis, or DVT, with ultrasound.

“Patients may be negative for DVT yet have undiagnosed venous insufficiency as a contributing factor to their residual leg swelling postoperatively. Some of these patients may benefit from formal venous evaluation and minimally invasive vein treatment such as what we used with Cliff.

“Why not consider a thorough venous evaluation to determine whether or not some of the discomfort is vein-related and treat it? Then, you can eliminate the venous symptoms and improve treatment of the orthopedic condition.”

If venous insufficiency is detected and treated before surgery, it leads to more than symptom relief. It results in improved wound healing, which reduces swelling postoperatively.

“Patients have better mobility in the postoperative period if there’s less swelling,” notes Dr. Magnant. “Therefore, physical therapy, walking, range of motion, recovery – everything that goes along with an orthopedic intervention – are improved.

“In addition, the risk of DVT blood clots and the complications related to them, such as pulmonary embolism and death, is reduced.”

Enjoying Life Again

The endovenous ablation procedures performed by Dr. Magnant improve circulation in the legs and eliminate symptoms. Rhonda and Cliff are delighted by the outcomes of their procedures.

“My results are great,” comments Rhonda. “Now, I can sleep through the night without any pain or discomfort. My legs look a lot better, too. I’m happy with the way the procedure turned out.”

“My results are excellent,” agrees Cliff. “My ankle is normal size now; it’s not all swollen. Everyone who sees it tells me, Your leg is skinny! They used to call it a cankle because it was always twice the size from the leaking and swelling.

“The blood flow is really good now, and my leg isn’t discolored and doesn’t look like a diabetic’s leg anymore.”

Not only did Cliff’s procedure make his leg more attractive, it also gave him more mobility. Since his surgery, Cliff can be on his feet for hours without the pain and cramping that hampered him before.

“After I had the vein procedure, all my symptoms cleared up,” he confirms. “Now, I can walk most of the day without any problem. A couple of weeks after surgery, I went to Walt Disney World® and walked all over the place all day.”

Dr. Magnant stresses the importance of a venous evaluation for patients with orthopedic ailments because people with bone and joint disorders often have a co-existing venous disease. Rhonda agrees.

“Everybody should look into their veins as a cause of their symptoms because venous disease can cause a lot of trouble,” she suggests. “Dr. Magnant is a great doctor, and I really like him.”

“Absolutely, we recommend Dr. Magnant and Vein Specialists,” says Cliff. “We already have.”


Arthritis: Not Just a Seniors’ Disease

October 2nd, 2019

It’s probably pretty common for people to equate the term arthritis with osteoarthritis, the wear-and-tear form of arthritis that’s common in adults as we get older. But that’s just one type of arthritis. There are many more, including types that specifically affect children. In general terms, that group of disorders is referred to as childhood arthritis or juvenile arthritis.

The most common type of juvenile arthritis is juvenile idiopathic arthritis or JIA. JIA affects approximately one in 1,000 children under age 16 in the United State or about 300,000 children. JIA is an autoimmune disorder, where the body’s own immune system attacks the joints’ cells and tissues, specifically the synovium, the tissue lining the inside of the joints.

In response to the immune system attack, the synovium makes more fluid than needed inside the joints, and that excess fluid leads to swelling, pain and stiffness. This inflammation can eventually damage cartilage and bone, causing joint dysfunction. Without appropriate treatment, JIA can affect a child’s overall growth and development. JIA can also affect a child’s eyes.

There are several subtypes that fall under the JIA heading. They all involve chronic or long-lasting joint inflammation. To be considered chronic, the inflammation must have been affecting  the joints for more than six weeks. The three main subtypes are characterized by their symptoms and number of joints involved.

Systemic JIA. This type affects about ten percent of children with JIA. It generally begins with a high fever that can be accompanied by a rash. This type may cause inflammation of internal organs such as the heart, liver, spleen and lymph nodes as well as the joints. It affects boys and girls equally and rarely affects the eyes.

Oligoarticular JIA. This types involves fewer than five joints in its first stages, most often the knee, ankle and wrist joints. It affects about 50 percent of children with arthritis, and it’s more common in girls than in boys. It may spread to involve more joints, and it can also cause inflammation of the eyes. Many children outgrow this type by adulthood.

Polyarticulat JIA. About 30 percent of children with JIA have this type. It affects five or more joints, often the same joints on both sides of the body. This type can affect the neck and jaw joints, as well as the small joints of the hands and feet. It can begin at any age and is more common in girls than in boys.

Symptoms vary depending on the type of JIA the child has, but there are some common symptoms, including:

  • Joint stiffness, especially in the morning or after resting
  • Pain or tenderness in the joints
  • Joint swelling
  • Limping
  • Persistent fever
  • Rash
  • Fatigue or reduced activity level
  • Eye redness, eye pain or blurred vision

The exact cause of JIA is unknown. Researchers believe that some children possess certain genes that make them more susceptible to developing the disease, then exposure to something in the environment, such as a virus, triggers the disease to begin. It’s not hereditary, however. It’s rare for more than one child in a family to develop JIA.

Early diagnosis and treatment are key to controlling inflammation, preventing joint damage and keeping the child as healthy and functional as possible. There is no one test for JIA. Doctors diagnose the condition using a variety of methods. They generally begin their assessments by taking a thorough medical history of the patient and performing a full physical examination.

Doctors may also order certain tests. These may include laboratory tests on blood, joint and tissue fluids to rule out other conditions as the cause of the symptoms. X-rays may be taken as well to look for any injuries or unusual development of the bones of the joints.

The goal of treatment for JIA is to reduce swelling, relieve pain, prevent damage and maintain function of the joints. There is typically a team of health care professionals involved in the child’s treatment, including physical and occupational therapists, dietitians, social workers and even school nurses working in concert with the child’s doctor.

Because JIA is an autoimmune disorder, medication is often used in its treatment. If only a few joints are involved, doctors may begin by injecting steroids directly into the affected joints to reduce inflammation and relieve pain. Another option is adding a group of medications called disease modifying drugs or DMARDS.

DMARDS may be used when many joints are involved or when the JIA doesn’t respond to the steroids. DMARDS include drugs such as methotrexate and the more recently developed biologics such as Enbrel, Remicade and Humira. These medications cause side effects and children taking them must be monitored closely.

Physical and occupational therapy also play a role in the treatment of JIA. Physical therapy exercises are important because they help in recovering and preserving range of motion and function of the joints. They also maintain muscle tone, and strong muscles aid smooth joint movement. Occupational therapy shows the child how to perform daily activities with limited joint function.

It’s clear that arthritis is not just for seniors. Many children struggle with painful, swollen and inflamed joints as well. If you know a child struggling with arthritis, be understanding and supportive. Help them if they ask for it, but for the most part, allow them to perform activities on their own. With treatment, children with arthritis can live normal, healthy lives.

Fact vs Fiction

Debunking myths surrounding macular degeneration.

Photo by Jordan Pysz.

Elias C. Mavrofrides, MD

Without the retina, vision is impossible. The retina is the light-sensitive layer of tissue that sits at the back of the eye. When light hits the retina, it

triggers impulses that pass through the optic nerve and travel to the brain, where the visual images are developed.

At the center of the retina is the highly specialized macula, which enables central vision for detailed tasks such as reading, driving and recognizing facial features. The macula can deteriorate due to aging and other factors. The condition that results is macular degeneration.

“Macular degeneration is a weakening in the center of the retina, the macula” describes Elias C. Mavrofrides, MD, a board-certified, fellowship-trained retina specialist at Florida Retina Institute. “Generally, when we talk about macular degeneration, we mean weakening of the retina as people get older.

“There are some types of macular degeneration that occur in younger individuals, but for the most part, we think of people who are elderly and age-related macular degeneration. Weakening of the macula affects the strongest part of our vision, which is why macular degeneration can be so debilitating.”

“Macular degeneration is the leading cause of blindness in US citizens over the age of sixty,” elaborates Matthew A. Cunningham, MD, another board-certified, fellowship-trained retina specialist at Florida Retina Institute. “While it is usually an age-related condition, it also has a genetic component. In some families, macular degeneration is inherited.”

Age and heredity are non-modifiable risk factors for macular degeneration. Nothing can be done to change those. But there are modifiable risk factors as well, including diet and smoking. Smoking is known to contribute to the development of macular degeneration as well as to make it worse.

Wet and Dry

“There are two forms of macular degeneration – the non-exudative and the exudative, otherwise known as dry macular degeneration and wet macular degeneration,” Dr. Cunningham describes. “The majority of patients affected with this disease have the dry form.

“Dry macular degeneration essentially occurs when deposits of material called drusen form under the retina and begin to damage the surrounding tissue. This damage can lead to distortion of vision and vision loss, and to the development of wet macular degeneration.”

Wet macular degeneration develops in about ten percent of patients who have the dry form. With wet macular degeneration, abnormal blood vessels begin to grow underneath the retina in a process called choroidal neovascularization. These abnormal blood vessels can leak fluid or bleed, which can cause sudden vision loss.

“Wet macular degeneration is the more aggressive form,” Dr. Mavrofrides notes. “People with this form can develop swelling and bleeding in the retina that can lead to scarring and deteriorating vision. This vision loss occurs more rapidly than the vision loss with dry macular degeneration.”

Dr. Cunningham points out how many people mistakenly believe it’s worse to have the wet form of the disease. The retina specialist explains why that isn’t necessarily true.

“I tell my patients they can lose vision from both forms of macular degeneration, but the way they lose it is different,” he says. “With dry macular degeneration, patients develop atrophy, and with that, they lose tissue. Significant tissue loss in the center of the retina will cause vision loss.

“With wet macular degeneration, vision loss is typically due to bleeding and scar tissue formation. The main difference is that dry macular degeneration progresses at a much slower pace. But patients can lose the same amount of vision from both forms.”   

Circulating Misconceptions

There are other misconceptions about macular generation that commonly circulate among patients. Many of these myths are aided by non-factual internet sites and misleading pamphlets sent to patients in the mail. One such misconception is that nothing can be done for macular degeneration. Another is that people who get it are destined to lose vision.

“People often think of macular degeneration as being devastating to everyone’s vision,” Dr. Mavrofrides observes. “In actuality, a very large number of people have milder cases of the disease and never experience severe vision problems.

“The diagnosis of macular degeneration in and of itself does not mean a patient is going to have severe vision problems. The degree of the condition, whether it is mild, moderate or severe, is a better indicator of how much patients should be concerned about their vision.”

Dr. Cunningham and Dr. Mavrofrides also debunk the myth that nothing can be done for macular degeneration. Today, they say, there are effective treatments for the disease.

“There are two forms of macular degeneration – the non-exudative and the exudative, otherwise known as dry macular degeneration and wet macular degeneration.” – Dr. Cunningham

“For patients with dry macular degeneration, the vitamin supplementation known as AREDS 2 was found to reduce the risk of converting from dry macular degeneration to wet,” Dr. Cunningham discloses. “But a myth we hear frequently from patients is that AREDS 2 can actually reverse dry macular degeneration and improve vision. That is simply not true.

“With wet macular degeneration, we found that the level of a molecule called vascular endothelial growth factor, or VEGF, is up-regulated. And by decreasing the level of VEGF with injections of medications that are antibodies against VEGF, we can cause regression of the abnormal blood vessels. However, we cannot make them disappear. This is not a cure.”

“When I first started in practice fifteen years ago, these injections were not available,” Dr. Mavrofrides remembers. “There was very little we could do to keep patients from progressing from good vision to permanently damaged vision in a short period of time.

“Today, multiple medications are available that we can inject into patients’ eyes to control the progress of wet macular degeneration. These injections are not a cure. They will not fix all of the damage in every patient, but they have been proven over and over in numerous studies to be extremely beneficial in controlling wet macular degeneration.”

Not There Yet

Dr. Mavrofrides and Dr. Cunningham are quick to caution patients about claims of “cures” for macular degeneration. They stress that there are no miracle cures for this disease. They are myths, and patients should not be misled by such claims. The doctors also caution against unapproved treatments and trials, even those that seem to show promise, such as stem cell therapy.

“There is a growing cohort of stem cell clinics popping up across the US, and I am very careful to tell my patients that stem cells are not an FDA-approved drug therapy,” Dr. Cunningham reports. “These clinics promise that by injecting stem cells into patients’ eyes, they can reverse the damage done by macular degeneration.

“I stress to my patients that this claim has not been proven in randomized clinical trials. And I am very emphatic in telling them to be extremely careful about becoming involved in experimental trials at stem cell clinics. In the future, stem cells may have a very powerful role in the treatment of macular degeneration. But they do not have a role in treatment at this time.”

Dr. Mavrofrides also has concerns about unapproved treatments for macular degeneration, including stem cell therapy.

Photo by Jordan Pysz.

Matthew A. Cunningham, MD

“Sometimes, patients with more severe cases of macular degeneration do research, trying to find a miracle cure that does not exist,” he observes. “They tell me about vitamins that claim to reverse severe macular degeneration or eye drops that reverse it or even electrical current therapies. These things are the equivalent of snake oil. They do not consistently hold up under good scientific analysis or provide significant benefits.

“Stem cells are often brought up as a treatment for macular degeneration. We certainly hope that the technology continues to improve, and stem cells will one day be beneficial for macular degeneration. However, preliminary treatments have caused more damage to the retina and more vision loss, not improvement.

“The retina is an extremely complex piece of tissue, and its organization is very important to proper function. There is more involved than simply injecting stem cells into the retina to reverse the weakness. The retinal tissue also has to be very well organized, and it is very difficult to repair the complexity of the retina.”

And without the retina, vision is impossible.

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