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The Rhythm of the Beat

New service line broadens care for arrhythmia patients.

Every heart has a rhythm, and that rhythm is measured by the heart’s electrical system.

That’s what happens when special cells create electrical signals that travel along pathways to the heart’s upper and lower chambers. The signals prompt the chambers to fill up with blood, then eject it in a precise sequence. A completed sequence constitutes a heartbeat.

But sometimes, abnormal cells in the heart create abnormal electrical signals that cause irregular heartbeats called arrhythmias. There are different types of arrhythmias. Some are harmless, but others are life-threatening.

“People may have slow heart rhythms, which include bradycardia, complete heart block and pauses in heart rhythm,” notes Jared Collins, DO, a board-certified internist and fellowship-trained cardiac electrophysiologist at Lakewood Ranch Medical Center.

“There are fast arrhythmias as well, such as atrial fibrillation, atrial flutter and supraventricular tachycardia. There are heart rhythm disorders that come from the bottom of the heart, including ventricular tachycardia and ventricular fibrillation, which can be deadly.”

In some cases, people are born with excess conduction tissue in their heart that creates extra electrical signals, causing an arrhythmia. Most times, however, arrhythmias develop over time.

Many factors can contribute to arrhythmia development, including scarring of the heart from a heart attack, high blood pressure, hyperthyroidism, coronary artery disease, diabetes, smoking, drug abuse, excessive caffeine intake, stress and certain medications. Symptoms vary depending on the arrhythmia.

“Sometimes, arrhythmias have no symptoms, and the patient’s doctor discovers the condition on a routine examination,” Dr. Collins informs. “In other cases, there are noticeable symptoms. But having symptoms doesn’t necessarily mean there’s a serious heart problem. That’s determined through a thorough physical exam and testing.”

Noticeable arrhythmia symptoms include a feeling that the heart is racing or skipping beats, which is common with tachycardia; a slow heartbeat, which is a symptom of bradycardia; or shortness of breath, chest discomfort, dizziness, sudden weakness, sweating, fainting and sudden cardiac arrest, which can occur with ventricular fibrillation.

Identifying the source of the arrhythmia is necessary to determine the most appropriate treatment, Dr. Collins stresses.

“Everyone’s heart has its own native pacemaker system,” the doctor relates. “But over time, abnormalities in the normal heart rhythm can arise, and oftentimes, those abnormalities must be clearly defined.

“In those cases, invasive tests may be the best way to localize the abnormalities and determine where in the heart they’re coming from. We may need to study people’s electrical system in detail to determine treatment for their arrhythmia. We do that by stimulating the heart in various regions via catheters and evaluating how the heart reacts.”

The tests used are called electrophysiology, or EP, studies, and they’re among the services offered through Lakewood Ranch Medical Center’s new electrophysiology service line. The service line was introduced in July following the installation of new equipment in Lakewood Ranch Medical Center’s expansion of the cardiac catheterization/electrophysiology lab.

“This service line is a great benefit for our community,” Dr. Collins asserts. “It gives us the opportunity to treat patients at Lakewood Ranch Medical Center who previously had to be transferred to other facilities to receive those services. It further localizes specialty care.”

Abnormalities Ablated

“There are noninvasive methods for monitoring patients’ heart rhythms, including EKGs and Holter monitors, but those methods give us incomplete information,” Dr. Collins reports. “To get more in-depth data about a patient’s heart rhythm and electrical system so we can determine the best treatment, we often have to perform EP studies.

“Once those studies are completed and we have the information we need, we can more effectively treat the patient’s arrhythmia with medication, an implanted device or a procedure called radiofrequency ablation.”

Medications may be used to treat tachycardia, a fast heart rhythm. Medications will not cure the arrhythmia but are typically effective at reducing its symptoms and reestablishing proper electrical conductivity in the heart.

“Patients diagnosed with slow heart rhythms, or bradycardia, may benefit from an implanted cardiac device, such as a pacemaker,” Dr. Collins observes. “A pacemaker uses electrical pulses to prompt the heart to beat at a normal minimum rate.

“An implantable cardioverter defibrillator, or ICD, is a device that detects dangerously fast or chaotic heartbeats and delivers a shock to the heart to restore normal rhythm. We implant pacemakers and ICDs at Lakewood Ranch Medical Center.”

During radiofrequency ablation, catheters are inserted, typically through a vein in the leg, and worked up through the venous system into the heart. Through the catheters, the electrophysiologist stimulates the heart and localizes the areas where the abnormal signals are originating.

“We use radiofrequency energy to wipe out those areas and eliminate the abnormal signals they’re creating,” Dr. Collins explains. “We deliver heat energy to very localized regions of the heart to destroy the abnormal tissue without damaging the rest of the heart.

“Using radiofrequency energy, we’re able to cause controlled areas of scarring in the heart to ablate the abnormalities and leave the rest of the heart in healthy condition.”

The Sooner, the Better

To reduce the risk of developing arrhythmias, people should live a heart-healthy lifestyle. That includes exercising regularly, maintaining a healthy weight and eating a low-fat diet with plenty of fruits, vegetables and other vitamin-rich foods.

“If people smoke, they should quit,” Dr. Collins adds. “And they should limit their intake of alcohol and caffeine. Some people will notice an increase in symptoms when using products high in caffeine such as tea, coffee, soda and certain over-the-counter medications.

“They should avoid stimulants as well, which can be found in certain cough and cold medicines, and some herbal and nutritional supplements. Some of those products can lead to irregular heart rhythms. I recommend people consult their doctor or pharmacist to determine which products are best for them. They should also avoid illegal drugs.”

There are other factors that put people at risk for arrhythmias. These include stress because severe stress, anxiety or fear can cause the heart to beat out of rhythm, as can intense physical activity. People must find healthy ways to manage stress, and if certain physical activities lead to abnormal heart rhythms, those activities should be avoided.

“People should talk with their doctor about treating conditions that may contribute to the development of arrhythmias, such as coronary artery disease, hyperthyroidism, high blood pressure and diabetes,” Dr. Collins says. “Keeping these conditions under control can help reduce the risk for heart rhythm disorders.

“It’s important that people get regular physical exams and tell their doctor about any unusual symptoms they’re experiencing. Most arrhythmias are harmless, but others can be deadly. In any case, the sooner they’re discovered and treated, the better.”

Goodbye Eyeglasses

Clear vision ReSTOR®ed through cataract surgery.

Photo by Jordan Pysz.

Brenda is seeing glasses free following her “effortless” cataract surgery.

For the past four years, Brenda Lovell has been her own boss. She owns a consulting company through which she offers executive business coaching. She also serves as a consultant to various nonprofit organizations in the Tampa Bay area. Brenda helps leaders and organizations achieve excellence, however they define it.

“I’ve been an executive for global nonprofit organizations, and my focus has always been on leadership, team building and developing trust within teams so members can achieve and exceed their performance goals,” the Illinois native relates. “I reached an age when I wanted to work for myself, and consulting in this field was the best fit for my experience.

“I always wanted to work for nonprofits. I liked it because they typically have a for-profit arm to raise money to operate. I started my career in internal auditing and ended up moving into nonprofits, and I loved it. I particularly loved working for the global nonprofit associations.”

All was going well for Brenda until last July, when she accompanied her son on a college trip to California. She had experienced some minor clouding of her vision prior to that, but she noticed it was dramatically worse during the trip.

“I wasn’t having much trouble driving at night in places that were familiar to me, but I had trouble in California because I didn’t know the roads,” Brenda explains. “Headlights from other cars bothered me as well. Those were pretty much my only symptoms, but they caused me to go to my eye doctor.

“I ended up going to two eye doctors because the first couldn’t figure out what was wrong with my eyes. The second eye doctor finally diagnosed cataracts. That doctor knew Dr. Berger because he had worked with his office, so he recommended I visit Dr. Berger for cataract surgery.”

Craig E. Berger, MD, is a board-certified, fellowship-trained ophthalmic surgeon at Bay Area Eye Institute in Tampa. In addition to his practice, Dr. Berger was an adjunct assistant professor of ophthalmology at University of South Florida Eye Institute for 15 years. With these two positions, he developed extensive expertise in cataracts and cataract surgery.

A Common Problem

“Cataracts result from protein build-up in the lens of the eye, which prevents light from passing through and makes the vision look cloudy,” Dr. Berger informs. “Symptoms include cloudy or foggy vision, glare, difficulty seeing at night, loss of color intensity and double vision.”

Cataracts are a common problem, and most are related to aging. Other factors, however, such as diabetes, sun exposure, smoking and a family history, can cause the condition to develop at a younger age.

“Typically, cataracts become a problem later in life, but they actually start around the age of forty and progress at different rates in different people,” Dr. Berger notes. “For this reason, they can occur in younger people as well.”

Cataract surgery is generally done on an outpatient basis and involves the surgical removal of the affected lens and the replacement of the natural lens with a synthetic intraocular lens, known as an IOL.

Before recommending a replacement IOL, Dr. Berger explained to Brenda the advantages and disadvantages of the different lens options. The doctor also reviewed Brenda’s lifestyle and activities in order to find the best lens match.

“Before recommending a specific lens, I always consider the patient’s activities, hobbies, the type of work they do and their visual requirements first,” Dr. Berger says. “Then, I do a complete eye exam, looking at the patient’s tear film, the amount of astigmatism and the health of the retina, cornea and optic nerve.

“I recommend implants based on all of that information, and I encourage patients to take the time to gain a clear understanding of the benefits of each of the different intraocular lenses before making a choice. Something to keep in mind is that no one lens is ideal for everyone. Lenses come in many different sizes, with a variety of features and benefits.”

One of the things Brenda learned from Dr. Berger was that she could become glasses free after cataract surgery by choosing multi-focal IOLs to replace her cloudy natural lenses. Brenda was very interested in that option.

“I used reading glasses for quite a while; then, a few years ago, I got glasses for distance vision at night,” Brenda shares. “I used them as more of a convenience if I knew I was going somewhere and my eyes were tired, but I wasn’t required to wear them.

“Then, I got transition lenses that helped with near and distance vision, but I never liked them. I went back and forth between wearing them and taking them off, especially when I gave presentations.

“I would wear them to see the screen, but then I had to take them off to see the audience. That was very annoying. Those lenses never worked for me, so it was a goal to get rid of glasses altogether.”

Smooth Transition

Based on her lifestyle and personal wishes, Dr. Berger recommended for Brenda the ReSTOR IOL. This lens gives patients clear vision at all focal points, and enables patients to live glasses free.

“All ReSTOR lenses take away the need for glasses, even reading glasses,” Dr. Berger elaborates. “According to the manufacturer, they feature a pupil-adaptive design that precisely allocates light to the retina more like the natural human eye.

ReSTOR combines apodized (an optical filtering technique) diffraction and refraction technologies that allow for clear vision at both near and far distances. This helps focus light on the retina for images at various distances and creates a smooth transition of light between the distant, intermediate and near focal points.

Cataract surgery is typically performed one eye at a time, with the patient usually waiting a couple of weeks or more before having the second eye corrected. In Brenda’s case, Dr. Berger corrected her left eye first, last October. He then corrected her right eye in August of this year.

“The surgeries were effortless!” Brenda exclaims. “I was in and out, and even had lunch with the friend who drove me to the first surgery right after the procedure was done. Recovery was effortless as well.

“And since my cataract surgeries, I have 20/15 vision in my right eye and 20/20 in my left eye. My night vision is perfect. Headlights don’t bother me anymore. I don’t have any issues with my eyesight whatsoever.

“In fact, I can see so clearly now that I see dirt in my house that I’ve never seen before. Colors are also much brighter now, and I don’t have to wear any glasses at all. I didn’t know that was possible, so I’m very excited about that.”

Brenda is quite happy with the results of her cataract surgery. She credits Dr. Berger’s expertise for the procedures’ positive outcome.

“My cataract surgeries were totally successful,” she enthuses. “I‘ve already recommended Dr. Berger and Bay Area Eye Institute, as well as ReSTOR lenses. They’re absolutely wonderful.”

Cream of the Crop

Unique vacuum therapy relieves back pain.

Photo by Robert Clark/courtesy of Gary Reeder

Gary Reeder

Gary Reeder, 65, is a fourth-generation Manatee County tomato grower. Gary retired in July after 45 years in the business. He’s the Manatee County Farm Bureau president and previously served on the State Advisory Committee Board. But the career farmer didn’t always want to grow tomatoes.

“When I was growing up, I didn’t want anything to do with farming because all my weekends were spent working on the farm,” Gary relates. “I wasn’t thinking about doing that as my lifelong career, but I had no other real prospects. I worked for a little while in air conditioning but didn’t know if that was going to be my career. I really didn’t have a big idea of what I wanted to do. I wanted to get through college and go from there.

“Then, on a Sunday afternoon during my third semester in college, my dad called me and said, “Son, if I’m going to keep this farm going, I need your help. I’ll see you at breakfast tomorrow at six o’clock. What was I going to do? I was going to work for my dad. I was about twenty years old at the time. That’s how I started as a tomato farmer.”

Running a farm is grueling business, and Gary’s family farm, which started as 200 acres, grew to 600 acres with crops in the fall and spring. Gary was involved in every aspect of the farming process, which included extensive lifting and bending and hours spent riding on a tractor. An incident with a tractor when he was 25 had long-lasting repercussions for Gary.

“I went into a ditch on the tractor, and the seat bottomed out on me,” Gary recalls. “I’ve had back problems ever since, and they progressed as I continued doing physical labor and riding on tractors. There was always an aching pain in my back, but two or three times a year, the pain became excruciating.

“At those times, it was a stabbing pain. It felt like someone was sticking an ice pick into my back. And there was nerve pain running all the way to the bottoms of my feet. It usually took about a week to get over that, but the aching was constant.”

This pattern went on for many years, but this past year, Gary’s back pain reached a tipping point.

“There was pain pretty consistently since the tractor accident, but I was able to bear it and deal with it,” Gary states. “But last year, my back pain became critical. It hurt so bad, I couldn’t function properly. I could barely walk. I could hardly even move.”

Gary tried chiropractic treatment, physical therapy and steroid injections into his back, but none of those treatments brought him lasting pain relief. At that point, Gary’s doctor made the recommendation Gary dreaded.

“The last time I went for a steroid injection, the orthopedic surgeon told me the next step was surgery, but I didn’t want surgery,” Gary shares. “I wanted to find something else that would help me. I read about Dr. Aderholdt in Florida Health Care News, and that’s when I got involved with VAX-D® Therapy.”

Craig S. Aderholdt, DC, of Back Pain Institute of West Florida provides the most advanced treatments for patients in severe pain, such as Gary. Among those treatments is a unique, nonsurgical treatment called VAX-D Therapy, which is a patented, FDA-approved medical decompression technique for alleviating pressure on the discs of the spine.

“My MRI showed two moderately herniated discs in my lumbar spine and severe stenosis in my sacrum area,” Gary describes. “Dr. Aderholdt explained that the stabbing pain was my nerves getting pinched. There wasn’t enough room for them with the herniating discs and the narrowing in the spinal canal.

“Dr. Aderholdt told me he could help me with my pain. He’s very in tune with what he wants to accomplish with VAX-D Therapy, and he explained how it can help me and why it helps. I didn’t want to go through surgery for my back pain, so I started VAX-D Therapy.”

Negative Pressure

While VAX-D Therapy is a medical decompression technique, it is not a traction device, Dr. Aderholdt stresses. It works differently and achieves significantly better results, the doctor reports.

“For many patients, chiropractic adjustments alone can actually relieve their pain,” observes Dr. Aderholdt, who is one of the few doctors in the country who offer the unique VAX-D treatment.

“But for select people with sciatica or herniated, bulging or degenerated discs, VAX-D Therapy has proven extremely effective. Gary was a good candidate because the treatment can alleviate low back pain as well as neck pain, numbness, tingling and pain radiating down the arms and legs.”

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

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

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

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

Patient Satisfaction

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

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

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

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

The doctor points out that VAX-D Therapy has the added benefit of eliminating the need for surgery in many cases.

“Gary wanted to avoid surgery, and that is something that VAX-D allows,” Dr. Aderholdt states. “With surgery, there is the potential for serious complications. VAX-D is noninvasive, so those complications are avoided.”

The VAX-D treatments proved to be extremely effective for Gary’s herniated discs and spinal stenosis. Just as he hoped, they alleviated his pain, allowed him to avoid surgery on his back and vastly improved his quality of life.

“When I first started with Dr. Aderholdt, they asked me about my pain level on a scale of one to ten,” Gary remembers. “At that time, I told them it was an eight. But after three months of VAX-D Therapy, I was one hundred percent back pain free, and that constant ache that I had is gone as well. I haven’t felt this good in fifty years.

“The last x-ray Dr. Aderholdt ordered showed my discs went from two millimeters to a centimeter thick. The discs had also filled back up with fluid and are not herniated anymore, so there’s no more back pain. And there’s plenty of room for the nerves, so I no longer have nerve pain to the bottoms of my feet.

“My range of motion is phenomenal as well – one hundred percent better than what it was. And to think – four months ago, I could barely move. I could hardly walk. VAX-D Therapy has been one hundred percent successful for me. I’m incredibly happy with my results.”

Gary is also happy with his treatment at Back Pain Institute of West Florida. He says he “absolutely” recommends Dr. Aderholdt and VAX-D Therapy to others with back pain.

“I’ve already recommended it to four people, and three of them are doing the therapy with Dr. Aderholdt right now,” Gary reports. “With VAX-D Therapy at Back Pain Institute of West Florida, I’m completely pain free. It’s amazing.”

Repeat Customer

Veteran relies on “natural bypass” to curb lingering heart symptoms.

Photo by Jordan Pysz

During his many visits, George has gotten to know Dr. Guo (left), Dr. Amarchand (center left) and Debbie McCall (right).

As a youngster, George Niebler toured a United States Navy ship that was on display for an open house. George’s experience aboard the vessel left a lasting impression so great that he went on to serve in the Navy for 28 years.

“The best part about being in the Navy was traveling the world,” George, now 76, shares. “Many of the places we went are my favorite, not just one. I really liked the Philippines and Japan. I lived in Morocco for two years and in Spain for a year, and I liked those places as well. I enjoyed moving around.

“When I retired from the Navy in 1987, I started looking for another job. I saw an opportunity to become a vocational teacher at a trade school and took it. I taught for fourteen years and retired for good in 2004. Now, I spend my free time doing yardwork, working around the house and volunteering.”

But George is haunted by his past. In 1992, he suffered chest discomfort and was sent for a cardiac catheterization. It revealed several of the coronary arteries in George’s heart were severely clogged, and he was sent for surgery. The surgery was successful at bypassing George’s blocked arteries, but his heart symptoms returned years later.

“In 2008, I began experiencing difficulties again,” George recalls. “I started feeling short of breath and a lack of energy. I had slight chest pain as well. I was forced to slow down from many of my activities, including working in the yard and around the house.

“I’ve been volunteering at Regional Medical Center at Bayonet Point for fourteen years. My job is to be the hospital mailman, so I walk three to four miles a day delivering mail. In 2008, I actually had to use oxygen to complete my volunteer tasks.

“Also at that time, the doctor found some additional artery blockages in my heart, but they said it was too risky to open me up again. Instead, my cardiologist referred me to Dr. Amarchand for his treatment.”

L. Amarchand, MD, a board-certified cardiologist and internist in Brooksville, offers his patients a unique treatment protocol and surgical alternative for relieving symptoms such as George’s. It’s a safe, noninvasive, circulation-boosting technique called enhanced external counterpulsation, or EECP.

Dr. Amarchand uses EECP to treat patients with heart disorders such as congestive heart failure, blocked coronary arteries and angina pain. Using EECP, Dr. Amarchand has an impressive record of success in maintaining his cardiac patients’ heart health and independence.

Measured Rhythms

To Dr. Amarchand, George’s problem was clear: He had a lack of oxygenated blood flowing through his heart. And that can cause symptoms such as a loss of energy, shortness of breath, a tightening or pressure in the chest and weakness.

“It’s not unusual for people to restrict their activities as these symptoms get progressively worse in order to reduce their discomfort,” Dr. Amarchand asserts. “As a result, their quality of life quickly diminishes. EECP can reverse these symptoms by working like a natural bypass procedure.

“Through the use of EECP, more than twelve million Americans have found relief from their symptoms, had their energy restored and received other benefits.”

“Within a couple of weeks of beginning EECP, my breathing ability was much better. I became much more active as well.” – George

EECP is delivered through a series of 35 hour-long sessions over the course of seven weeks. During an EECP session, the patient reclines, fully clothed, on a cushioned table while listening to music or watching a movie.

Compression cuffs are wrapped around the patient’s calves, thighs and buttocks to apply pressure in rhythms carefully timed to the patient’s heartbeat.

“The pressure propels more blood upward and into the coronary arteries, enlarging the arteries and improving collateral circulation,” Dr. Amarchand educates. “It helps the patient’s own circulatory system bypass coronary artery blockages and opens up the underused collateral blood vessels.”

“During an EECP session, I lie on a table with cuffs on my legs that constantly expand and contract,” George describes. “Each session takes an hour. I can watch TV if I want, or I can bring in a radio with earphones and listen to that. There’s no pain at all with the treatment.”

EECP is the perfect option for individuals who want to try a noninvasive procedure before resorting to open heart surgery, Dr. Amarchand observes. “It’s also good for those who have not achieved relief with prior surgical procedures such as bypass and angioplasty, and for patients who aren’t candidates for surgery.

“According to studies done on the procedure, eighty-five percent of patients completing EECP treatments obtain substantial and sometimes dramatic relief from their heart-related symptoms,” Dr. Amarchand reports. “The same percentage realizes increased exercise tolerance, mental alertness and reduced need for nitroglycerin to relieve angina pain.”

Because it’s noninvasive, EECP can be repeated as often as needed, Dr. Amarchand says of the treatment that is both FDA-approved and Medicare-reimbursed. However, the doctor points out, its beneficial effects can last from three to five years.

Stressless Delivery

George’s first round of EECP was completed in 2008. At the time, George experienced results quickly and benefitted significantly from the therapy. He achieved so much benefit from EECP that he was encouraged to repeat the treatment to keep his collateral blood vessels open and maintain the therapy’s positive results.

“Within a couple of weeks of beginning EECP, my breathing ability was much better,” George remembers. “I became much more active as well. Today, I feel good. I don’t have the shortness of breath. I haven’t had any chest pain, and I have a lot more energy. I can do my job at the hospital without oxygen. I can walk the three to four miles to deliver the mail, and it’s stressless.

“When I first had EECP, it was recommended I have the therapy on a yearly basis to prevent my symptoms from recurring. I’ve been going back to
Dr. Amarchand every year for the past eleven years.”

A course of EECP treatment is delivered over seven weeks, and George received the treatment 12 times. With all the visits to Dr. Amarchand’s office, George got to know the practice’s physicians and staff quite well. He says he enjoys working alongside Dr. Amarchand and Dr. Tong Guo, who operates the EECP equipment and oversees the procedure.

“Dr. Guo is one of the doctors who initiated EECP in the United States, who got it approved by the FDA and the insurance companies,” George relates. “He’s very nice and helpful, as are his wife and the woman who performs the treatments when Dr. Guo isn’t available. I highly recommend them and the treatment.

“I’m very impressed by EECP therapy. Getting it done regularly, I haven’t had a return of my heart symptoms, and I will continue to visit Dr. Amarchand and have EECP yearly. It’s been very helpful for me.”

Confidence Builder

Conservative measures restore deteriorating smile.

Photo byFred Bellet.

Diana Poteet

Diana Poteet, who is looking forward to turning 80 next year, has a sunny disposition to match the sunny places she’s resided. She was born in San Francisco, California and moved to pre-statehood Hawaii in 1953. She remained in Hawaii until two years ago, when she returned to the US mainland and relocated to the Sunshine State.

While living in Hawaii, Diana followed a diverse professional path.

“Career-wise, I was a teacher of little ones,” she shares. “I liked the preschool to kindergartners. But as the years went by, I tried other things as well. I worked for a law firm for a number of years and spent some time in retail, but I retired from corporate McDonald’s® for the Pan-Pacific Basin. And I enjoyed raising my three children as well.

“Twelve years ago, my dad and brother passed on, so I moved in and cared for my mom. When she passed away, I made the move to Florida. One of the things I really enjoy about Florida is the change of seasons. All those years I lived in Hawaii, it was always summer. The seasons and the temperature changes in Florida are absolutely wonderful.”

The change of seasons wasn’t the only change Diana was looking for when she moved to Florida. For years prior to making the move, her sunny disposition had always been clouded by a ragged smile that embarrassed her. Her problems stemmed from a distrust of dentists that began as a child and kept her from routine dental care throughout most of her lifetime.

“As a young girl, I had some unfortunate experiences that led to me not going to the dentist for years at a time,” Diana confesses. “My mother made me go, but once I was on my own, I didn’t. I only went to the dentist when I was in pain, which wasn’t wise, and my teeth really deteriorated. I eventually lost some teeth, so I could only enjoy soft, pureed or liquid food, and I stopped smiling in public.

“When I moved to Florida, one of my agreements with my family was that I would take care of my teeth. I had put it off and put it off and finally, my son asked around about a dentist, and a coworker recommended Dr. Bedi. My son visited him first and couldn’t believe how wonderful he was. He said, Mom, you’re going, so I went. Everything about it was a plus.”

Satnam S. Bedi, DMD, at Anchor Dental Care in Spring Hill, offers a comprehensive range of dental services to restore patients’ smiles. Dr. Bedi and his staff understand that some people get anxious about going to the dentist, so they take a slow, reassuring approach with each patient to make them comfortable and gain their trust.   

“He’s giving me the confidence to get back out there, and I’m really excited about it.” – Diana

“The staff at Anchor Dental Care is a team of four people who clearly care for each other,” Diana describes. “In my mind, if they care that much for each other, they’re going to care for me as well. They were polite, courteous, kind, and they understood my situation.

“Dr. Bedi has a wonderful smile and delightful eyes. A dentist’s eyes say a lot about him. To me, Dr. Bedi’s eyes say, I’m a good man.”

The caring positivity of Dr. Bedi and his staff relieved Diana’s unease about going to the dentist. She was able to relax and allow Dr. Bedi to evaluate her dental situation and determine a treatment plan to restore her smile.

Next Steps

The first thing Dr. Bedi does with new patients is talk. Through this discussion, the dentist identifies the patient’s chief complaint as well as their goals for dental treatment. Using the information he gathers, Dr. Bedi creates a treatment plan to achieve those goals.

When Dr. Bedi creates treatment plans for his patients, he chooses the most conservative approach possible to reach the treatment objective. That was true in Diana’s case as well.

Photo by Jordan Pysz.

Left to right:
Rachelle Weiner, CDT, CDA;
William Hemme, dental assistant;
Satnam S. Bedi, DMD, MS;
Marlo Waldron, receptionist

“When Diana came to us, she had not seen a dentist in many years,” Dr. Bedi recalls. “Initially, we sat down with her and talked about the restoration process. We wanted her to be comfortable so she would begin to believe in us and what we could do for her.

“Once Diana was ready to proceed, we made a comprehensive record of her teeth. We took impressions, x-rays and a CT scan to examine her bone structure. Diana had a number of failing teeth, as well as some missing teeth. There was also infection present in some of her teeth, which had to be extracted.

“My recommendation was to save the teeth that were still viable and to replace the rest, on both the upper and lower arch, with dentures anchored to her remaining teeth. I put metal coverings on those remaining teeth so we could use them for denture support.”

“I was very happy to hear that Dr. Bedi was going to be able to save a good number of my natural teeth on the top and bottom because that’s important for my overall oral health,” Diana exudes.

“At first, Dr. Bedi thought he might need to do root canals to save some of those remaining teeth, but it turned out that none of them needed that. Imagine my delight. I appreciate that he didn’t do the extra procedures.”

Dr. Bedi’s decision to take a more conservative route and use Diana’s existing teeth rather than surgically placed anchors to support her dentures saved Diana from having to undergo additional oral surgery.

“By taking this approach, Diana came to trust us,” Dr. Bedi says. “When patients trust us and feel comfortable, we can proceed with the next steps in their treatment and ultimately reach their desired goals.”

Food, Glorious Food

After years of being restricted to a mostly liquid diet, Diana’s goal was to enjoy the luxury of eating whatever she wished. She was also anxious to show off her sunny disposition with a smile that matched it.

“With my new dentures, I’m looking forward to the whole world of wonderful food coming my way during the holidays,” says Diana, who is already feeling more confident and plans to be a lot more social with her new smile.

“When I first moved to Florida, there were a few places I didn’t go to because my front teeth were gone,” Diana relates. “I’m planning to go to those places now, and I’m planning to do some other things, like work in a thrift shop as well.

“I’m also a member of Beta Sigma Phi sorority, and I plan to become active again. I know those ladies would’ve accepted me, but I wasn’t comfortable with my smile. But with my new dentures, Dr. Bedi is opening those doors for me again.

“He’s giving me the confidence to get back out there, and I’m really excited about it.”

Treating the Previously Untreatable

Proven laser procedure painlessly dissolves eye floaters.

As the facilities manager for Rainforest Cafe® in Sunrise, Truman Griffith ensures the diners are entertained while they eat. The New Jersey native has worked for the restaurant chain for more than 18 years. He has moved from New Jersey to Virginia to Tennessee and most recently to Florida for work, but he doesn’t mind because he loves his job.

Photo by Jordan Pysz.

Truman can see clearly now that his eye floaters have been dissolved.

“Being a themed restaurant, Rainforest Cafe uses animation, a light show and a water show,” Truman describes. “I’m responsible for keeping those shows operating for our guests. I really like what I do because it’s challenging.”

In the last few months, Truman noticed changes in his eyesight that made his job even more challenging. The problem began in his right eye. He started to see strange spots that interfered with his vision. He subsequently developed similar spots in his left eye.

“Now there were dark spots floating around in both of my eyes,” Truman relates. “In my right eye, the spots looked like curled fingers in the center of my vision no matter which way I looked. In my left eye, they were more all over my eye, like clouds in my entire visual field.

“The spots were quite bothersome, especially in the daytime. If I was outside working or driving in sunlight, I was really bothered by the spots. They were more visible in bright light than dim light. When I watched TV, they glowed from the light of the TV, and when I read with the lights on, the spots made it difficult to see the print.

“I couldn’t give up working or driving, but the spots made it difficult and were very annoying when they blocked my vision. At times, it was like there was a bunch of gnats flying around me because the little black dots moved as I moved my eyes. It was like I was seeing things.”

As soon as Truman realized the spots weren’t going away, he sought advice from his eye doctor, who recommended he visit Peter J. Lowe, MD, a board-certified ophthalmologist at Retinal Eye Care Associates. Dr. Lowe subspecializes in diseases of the retina and vitreous. He knew what Truman’s spots were. They were vitreous eye floaters.

“The vitreous is a cellophane-like lining on the inside of the eye,” Dr. Lowe explains. “As the eye ages, or after eye surgery, most commonly to remove cataracts, the cellophane lining will often come loose. Typically, it stays in small, almost completely transparent sheets. Sometimes, however, it clumps up into larger debris fields and casts shadows on the retina. Those are eye floaters.”

An eye floater is essentially the debris that’s left after “a vitreous detachment.” To treat eye floaters, Dr. Lowe uses a noninvasive procedure called laser vitreolysis, which works by dissolving the floaters from the patients’ eyes.
“Dr. Lowe is very knowledgeable, and he explains everything,” Truman states. “He made sure I understood what the possibilities were of fixing my problem. He explained that with vitreolysis, most people achieve vision correction and relief from their floaters.”

“The treatment does not dissolve all of the vitreous,” Dr. Lowe says. “We can, however, significantly diminish or eliminate the cloudiness that occurs when there are clumps of vitreous floaters in the eye.

“We can dissolve the larger opacities that interrupt patients’ vision, leaving only a small amount of residual debris. Patients need to be told what they can and cannot expect from the treatment. Setting realistic goals is important to the procedure’s success.”

Study Validated

“Truman came to us with different types of eye floaters in each eye,” Dr. Lowe observes. “The floaters in his right eye were finger-like strands, which are small bands of collagen floating in the liquid of the eye. The floaters in his left eye were larger, cloud-like clumps that created a duller, more diffuse loss of visual clarity than the strands, which moved back and forth through his vision.

“Many different types of floaters develop when the vitreous detaches from the underlying retina. Sometimes, the vitreous breaks up into large clumps of floating opacities. Other times, it gathers and forms cloud-like opacities that obstruct vision to a greater degree. The cloud-like opacities were responsible for the problems in Truman’s left eye, and the strand-like floaters were causing trouble in his right eye.”

To treat Truman’s eye floaters, Dr. Lowe performed laser vitreolysis twice in his right eye to dissolve the strand-like floaters and twice in his left eye to dissolve the cloud-like opacities he found there. Dr. Lowe explains that the procedure can be performed multiple times without adverse effects if necessary to achieve a successful outcome.

“Dr. Lowe is very knowledgeable, and he explains everything. … He explained that with vitreolysis, most people achieve vision correction and relief from their floaters.” – Truman

Laser vitreolysis is safe, effective and FDA approved for eye floaters. The procedure has been validated academically through research studies conducted at two nationally recognized institutions.

“One study was conducted by The Ophthalmic Consultants of Boston, and the other was done at Rush University Medical Center in Chicago,” Dr. Lowe informs. “Both studies confirm the efficacy of vitreolysis and show there is a place for laser vaporization in the treatment of chronic eye floaters when performed by someone with experience.”

Dr. Lowe is the only retinal specialist currently performing this procedure and is the first physician in Palm Beach County to offer it. He has been performing this procedure since 2011.

“These studies confirm my clinical impression of the procedures as well as the subjective observations of hundreds of satisfied patients,” Dr. Lowe points out. “Taking these findings together, it can be said that vitreolysis is the only nonsurgical treatment for chronic vitreous floaters.”

Great Eyes

“My vitreolysis procedures went well,” Truman recalls. “It only takes a few minutes, and there’s no pain involved. The procedure itself was like seeing a bunch of camera flashes. I held still so Dr. Lowe could focus the laser on each floater he saw and dissolve it.

Using laser vitreolysis, Dr. Lowe significantly improved Truman’s vision, and he can now see clearly. Truman is no longer bothered by the finger-like floaters or the clouds that obstructed his vision and annoyed him before treatment.

“My vision is much, much better,” Truman enthuses. “It’s rare that I see a floater in my left eye, and my right eye’s great. Now, I can watch TV, drive and be outside without all the distortion. I don’t see the different shapes in front of me, and I don’t have anything blocking my vision. I don’t feel like I’m looking through a bunch of hairs all the time.

“I’m very happy with my results. I absolutely recommend Dr. Lowe and laser vitreolysis to anyone with chronic eye floaters.”

Pair Up

Minimally invasive laser procedures eliminate back pain.

Larry Solie grew up on a ranch, so he’s no stranger to responsibility and hard work outdoors. Every day, he toiled in the garden and cared for the horses. It was a natural transition when he became executive director of a wilderness program for troubled teens.

Photo by Jordan Pysz.

Larry felt immediate relief from his laser spine surgery.

“The program operated over a fifty thousand acre spread in Central Oregon,” Larry describes. “We worked with three hundred teens a year. They learned tracking and navigation skills, how to build fires without matches and many Native American-style ways of living in the wilderness.

“Before I took over that program, I was headmaster at a school for troubled boys. During that time, I met the founder of the wilderness program – an ex-ranger who wanted help with his business. We formed an alliance to cross-train our kids, and I eventually bought his program.”

Larry expanded the program, which was featured on a television series in 2003. The show garnered national recognition for Larry’s program as well as the attention of larger organizations doing residential and
wilderness-based programming. Larry left his program in the capable hands of one of those organizations and retired in 2006.

Unfortunately, all those years of working on the ranch and hiking and sleeping on the hard ground in the wilderness took a toll on Larry’s back. That distress was compounded by damage done to his back during his military career.

“I served during the Six-Day War, and we got banged around on my ship quite a bit,” Larry recalls. “When my ship was torpedoed, I suffered an injury to my spine that didn’t show up until later. Couple that with the walking and lifting I did, and the strain on my back really got bad.

“The first symptom I noticed was weakness in my right leg, followed by numbness and cramping in both legs. I also experienced pretty intense pain in my back and down my left leg. There were stabbing, sharp pains, then there were dull pains. It ran the gamut, but the pain was a ten on a scale of one to ten. If I lifted something, I could guarantee I’d be in pain for days. I’m a very active person. It was difficult for me to just sit still.

“My wife and I like to go boating and travel, and I draw and paint outside, but with a bad back, I didn’t do much but sit on ice and take pain pills. It got to the point that my wife said, Look, I want to travel, but if you want to sit here in pain, I’ll get you a subscription to the newspaper. That prompted me to seek treatment.”

Larry already had an idea where he’d go for help with his bad back. His daughter worked for Physician Partners of America, and Larry knew their surgeons performed minimally invasive laser spine surgery. Larry made an appointment and met with Dr. James St. Louis, director of the practice’s Minimally Invasive Spine Group.

Attachment Point

The affected nerve is identified after listening to the patient’s symptoms and using MRI to pinpoint the specific nerve.

“Upon evaluating Larry, I discovered that a damaged disc in his lower spine was pinching the nerves exiting through the openings in the spinal column, which are called foramen,” Dr. St. Louis explains. “Pressure on the nerves caused the pain in his back and numbness down his legs.

“To address Larry’s condition, I chose to perform two minimally invasive laser spine procedures, a laminotomy and a foraminotomy. The goal of performing those procedures was to ease the pressure on Larry’s nerves and relieve his painful symptoms.”

A lamina is a part of the vertebral arch. A pair of laminae join with the bony projections that jut from the middle of the vertebrae, called spinous processes, to provide a point of attachment for the spine’s muscles and ligaments. A laminotomy is the removal of some of the lamina to relieve pressure from the bone pressing on the spinal cord.

“I felt immediate relief. And my recovery was very quick. I walked out of surgery with no pain in my back or down my legs.” – Larry

“Minimally invasive laser laminotomy is performed through a half-inch incision in the back,” Dr. St. Louis explains. “The incision is carefully placed with the help of a special x-ray called C-arm fluoroscopy. Laminotomy is carried out using a scope with a camera, and the surgeon operates while visualizing images from the camera on a computer screen.

“Once the incision is made, we insert a series of tubes to dilate the muscles that sit on top of the bone and create an opening in the lamina using a laser, small drill and a kerasin. We use rongeurs to remove the pieces of bone that were in the lamina.”

To relieve pressure on spinal nerves, Dr. St. Louis uses the kerasin to remove some of the bone surrounding the foramen where the nerves exit the spinal cord. This is a foraminotomy. Because laminotomy and foraminotomy are performed minimally invasively, recovery is short and complications are rare.

“I typically instruct patients to walk for an hour the day after surgery in three twenty-minute intervals,” Dr. St. Louis informs. “Total recovery time depends on the patient’s degree of activity. If they’re returning to a desk job, they can go back within a week. If they do manual labor, they must wait anywhere from two weeks to a month.”

Dr. St. Louis makes a point of noting that Physician Partners of America accepts Medicare, so patients with Medicare don’t have to pay large out-of-pocket sums for their laser surgery. This is important because many of the conditions that require procedures such as laminotomy and foraminotomy are common in older adults.

“As people age, they often develop bone spurs that can pinch the spinal cord or spinal nerves and cause pain,” the doctor observes. “In addition, every nerve travels through a tunnel, and over time, that tunnel shrinks and puts pressure on the nerve. Laminotomy and foraminotomy remove the bone spurs and open up the tunnels, freeing the nerves and relieving pain.”

Photo by Jordan Pysz.

Larry Solie

“Immediate Relief”

Dr. St. Louis thoroughly explained what was causing Larry’s back and leg pain, and detailed how laser laminotomy and foraminotomy would repair the problem. Larry agreed to undergo the procedures and was amazed by how quickly he noticed a difference in his condition.

“I felt immediate relief,” Larry enthuses. “And my recovery was very quick. I walked out of surgery with no pain in my back or down my legs. At first, I attributed most of the relief to the anesthesia, but the pain hasn’t returned. There’s zero pain now, when before it was a ten.”

Larry no longer suffers with discomfort in his back or legs, so he’s able to perform his favorite activities. Those include working in the garden, shades of his days on the ranch.

“My wife doesn’t call me a gardener,” Larry relates. “She calls me a landscaper because what I do requires a lot of physical activity. We walk daily as well. And I recently picked up an airbrush. I’ve been an artist all my life, so I’m moving into a different level of art.

“I’m looking forward to getting back to boating and traveling. I had to cancel a couple of trips due to my back pain, but that’s all behind me now. I highly recommend Dr. St. Louis and his team at Physician Partners of America. They provided me with pain relief and in turn gave me my life back.”

Balancing Act

Sleep soundly, feel less pain with medical marijuana.

Before she became a stay-at-home mom, Tracey Leibowitz had a bright career creating visual displays for retail stores. It was a profitable job that motivated the Boston, Massachusetts native to relocate to Florida in 1996.

Photo by Jordan Pysz.

Tracey Leibowitz

Life was going great for Tracey until she suffered a setback in 2003. That was the year she was involved in a serious car accident that resulted in broken ribs and other severe injuries. Two years later, she sustained a concussion. The combination of those injuries left Tracey in chronic pain and unable to sleep, which she treated naturally.

“I never took medication,” she maintains. “I was what many consider a health nut. I used to be macrobiotic, vegetarian and vegan. Now I’m a pescatarian. I was very aware of my health and if I was in pain, I found alternative methods to treat it, such as doing gyrotonics or taking ginger.

“Those methods usually worked fantastically for me, and I never had a problem, but after the car accident and the concussion, I started getting headaches. I never got headaches until the concussion. I developed peripheral neuropathy as well. And I’ve always had trouble sleeping.”

In addition to those issues, Tracey has battled carpal tunnel syndrome since she was a teenager. She treated that by using creams and wearing wrist braces, but as she aged, the inflammation in her wrists increased. To combat the problem, Tracey switched to an anti-inflammatory diet, one that contains specific foods that don’t promote inflammation.

But a few years ago, Tracey reached a point where her natural remedies were no longer providing adequate relief of her symptoms. She then began exploring other options.

“When I looked up treatments for inflammation online, I got results for CBD oil, so I started researching it,” Tracey relates. “Over time, I started ordering CBD products from California. I noticed I was sleeping better when I took them. My doctors dismissed the CBD oil, but I continued to research it and use it.

“Medical marijuana has changed my existence, … It’s been phenomenal for me.” –Tracey

“I began to feel a little pain relief using the CBD products, but I was really having trouble sleeping. I finally realized, I can’t live like this anymore. Then, my gyrotonics instructor told me about Dr. Zotovas. She described the doctor’s background and how Dr. Zotovas helped her. My instructor said, You have to go to this doctor. She will really help you.”

Following her instructor’s recommendation, Tracey made an appointment with Andrea Zotovas, MD, at South Florida Medical Marijuana MD, which has offices in North Palm Beach and Stuart.

Dr. Zotovas uses medical marijuana to treat a wide range of disorders including chronic pain, insomnia and anxiety.

“When Tracey first came to me her primary concerns were pain and trouble sleeping,” Dr. Zotovas notes. “Medical cannabis can relieve both of those issues and more. It all hinges on the endocannabinoid system, which is the body’s system for maintaining balance or homeostasis.

“The endocannabinoid system has receptors that are prepared to accommodate the components of marijuana including CBD and THC. As part of this system, the body actually makes its own THC and CBD, but in some people, these substances are depleted or out of balance. Medical cannabis restores that balance, so patients feel better.”

Sweet Dreams

The benefits of treating pain with medical marijuana are well-documented, but what many people may not know is that medical marijuana is equally effective as a treatment for insomnia, which affects about 30 percent of all people in the United States alone.

“It’s a big problem, and it affects our general health,” Dr. Zotovas says of insomnia. “When we don’t get a good night’s sleep, all our other health problems get worse. Then, additional problems arise from those.

“But standard sleeping medications are not great. They cause dependency and can alter the normal sleep architecture, so people don’t get a restful, restorative night’s sleep. Medical marijuana works far better. It’s not habit-forming and people feel rested and energized for the day ahead after using it.”

Medical marijuana is an excellent sleep aid because it restores the patient’s natural sleep cycle. Dr. Zotovas recommends specific strains of marijuana, called indica, for sleep because they are relaxing and sedating, promote a good night’s sleep and don’t cause daytime drowsiness.

“The indica strains are like a couch,” Dr. Zotovas elaborates. “They make people relaxed and drowsy so they can sleep. Opposite those are the sativa strains, which are used during the day for pain, anxiety, headaches and lack of concentration. Many times, these symptoms are side effects of or are intensified by a lack of sleep, so patients often use both indica and sativa strains.”

Insomnia can be either primary or secondary. Primary insomnia is not caused by an outside trigger. The patient simply can’t sleep. Secondary insomnia may be caused by many factors, including stress or trauma.

“Medical cannabis is very effective for primary insomnia because it is relaxing and restores a normal sleep cycle,” Dr. Zotovas observes. “And if there’s a stressor causing the problem such as anxiety or depression, medical marijuana effectively treats both of those disorders.

“Certain medications can also have a side effect of insomnia including those for cancer, diabetes, asthma, COPD, blood pressure and overactive thyroid disease. We can mitigate those side effects naturally with medical marijuana.

“It all goes back to the endocannabinoid system, which works as a lock and key mechanism. The cannabinoids unlock the endocannabinoid receptors, which promotes particular states in the body. That state may be relaxation and sedation with the indica strains of cannabis or improved focus, and decreased pain and anxiety with the sativa strains.”

Photo by Jordan Pysz.

With the help of Dr. Zotovas and her medical marijuana, Tracey feels 100 percent better.

“Deeper, Better Sleep”

Tracey carefully followed Dr. Zotovas’ recommendations for using medical marijuana for relief from her pain and insomnia, and before long she began to see significant improvement in both. The benefits continued to accrue as Tracey became more comfortable using cannabis products.

“Medical marijuana has changed my existence,” Tracey raves. “I don’t wake up with pain. I don’t go to bed with pain. I lived with pain for so long I almost didn’t realize how much pain I was in until I felt the relief, When I did, it was so amazing, I almost forgot I had pain.

“And now I’m sleeping at night. I have deeper, better sleep, and there’s no weird feeling the next day, no grogginess. I’ve always had trouble sleeping, even when I was a little girl, but medical marijuana changed all that. It’s been phenomenal for me.”

With the help of Dr. Zotovas and her medical marijuana, Tracey feels 100 percent better. Now, she shares her story openly with others who may be experiencing similar symptoms.

“I recommend medical marijuana one hundred and ten percent,” she enthuses. “I can’t recommend it to enough people. I told my parents about it and anybody else who would listen.

“And I absolutely recommend Dr. Zotovas. With the accident and everything, I’ve been to a lot of doctors over the years, and she listens. She’s understanding and helpful, an amazing doctor. Dr. Zotovas has taken me down a road that’s made me better.”

Hitting a Trifecta

Trio of eye procedures corrects vision, relieves symptoms.

Like the sports cars he tinkers with, Charles Boggess, 61, has a few parts that aren’t original. The 61-year-old Florida native and tractor-trailer driver was given a new kidney in 1998. Sixteen years later, he received two corneal transplants to correct a series of problems that began years earlier.

Photo by Jordan Pysz.

Charles is seeing clearly under the hood.

“I started using reading glasses when I was pretty young,” Charles relates. “And I’ve worn regular eyeglasses for nearsightedness since I was thirty. Around 2014, my vision became really blurry. I kept getting new glasses prescriptions, but they didn’t clear up my vision. I eventually went to a new eye doctor, and he figured out I had Fuchs’ dystrophy.”

Fuchs’ dystrophy is a condition that causes the cornea, the clear, protective outer layer of the eye, to swell and become cloudy. In a healthy eye, the cells of the cornea’s endothelial layer pump fluid away from the cornea to keep it clear. With Fuchs’ dystrophy, this layer changes and fails, and fluid builds up, causing hazy vision and eye discomfort.

“It was like living underneath the water, like the filters in my eyes quit working,” Charles describes. “Everything was very blurry. The doctor told me whatever glasses I got weren’t going to work until I got my Fuchs’ dystrophy cleared up. I went to the eye center in Stuart, and the doctor referred me to Dr. Salinger.”

Clifford L. Salinger, MD, a cornea specialist, is the founder of The Dry Eye Spa & V.I.P. Laser Eye Center in Palm Beach Gardens. Dr. Salinger has expertise in treating Fuchs’ dystrophy using partial thickness corneal transplants. That’s what he used to treat Charles’ diseased corneas. Charles was immediately impressed when he met Dr. Salinger.

“I really liked Dr. Salinger,” Charles states, “especially when I learned he flies to different countries to teach doctors how to do the special corneal transplants he performs. He has to be pretty good at the procedure to do that.”

“The partial thickness corneal transplant procedure we perform is called Descemet stripping automated endothelial keratoplasty, or DSAEK,” Dr. Salinger reports. “This is a newer, more advanced method of performing a corneal transplant that involves removing and replacing only the inner lining of the cornea.

“Because it involves transplanting just the inner corneal lining, DSAEK is safer than traditional corneal transplants. There is less trauma to the cornea, so there are fewer risks associated with DSAEK. Healing is faster, and patients have fewer limitations to their lifestyle after the procedure.”

Dr. Salinger performed a DSAEK on Charles’ right eye in September 2014. He performed the surgery on Charles’ left eye in December of that same year. Afterward, Charles gained excellent distance vision in his right eye, but not so in his left eye.

“After the transplant surgeries, I could see very well in the distance with my right eye, but I had quite a bit of astigmatism in my left eye and still couldn’t see in the distance,” Charles shares. “Distance vision is very important for a truck driver, so Dr. Salinger recommended another procedure to correct the astigmatism in my left eye to improve its distance vision. Another reason I wanted both eyes corrected for distance was to keep from having to wear glasses all the time.”

Photo by Jordan Pysz.

Charles Boggess

LASEK with an “E”

“There’s a misconception that if people still need to wear glasses following surgery, whether it’s cataract surgery or DSAEK, they are stuck wearing glasses forever,”

Dr. Salinger notes. “That’s a myth. There are many things we can do, including laser vision correction procedures, that minimize or eliminate dependence on glasses.”

Generally, when people think about laser vision correction procedures, LASIK® laser surgery comes to mind. LASIK corrects vision by reshaping the cornea, which changes its focusing power on the retina, the light-sensitive tissue at the back of the eye.

During LASIK, surgeons use a laser to create a thin flap on the corneal surface. Then, the laser removes some of the tissue underneath the flap to reshape the cornea.

But that’s not the procedure Dr. Salinger selected for Charles. Instead, he chose another laser surgery with a slower healing process that he determined would be better and safer for Charles’ left eye.

“Mr. Boggess was looking to become less dependent on glasses,” Dr. Salinger asserts. “Since he had Fuchs’ dystrophy and underwent previous cornea surgery with the DSAEK, we concluded a procedure without a flap called LASEK, also known as PRK, was the better option for him.”

“When performing LASEK, we first remove the cornea’s surface skin layer, the epithelium, then we apply the laser to the corneal surface. There’s no cutting, no flap,” Dr. Salinger verifies. “We place a bandage contact lens on the eye for better comfort and to assist in healing. The cornea’s skin layer then needs time to heal, but it heals more slowly than it does with LASIK.

“Typically, the eye surface heals within a week after surgery. The bandage contact lens is then removed and vision continues to improve for weeks to months following the procedure. For Charles, LASEK was safer in the short term and the long term.

“It was essential for Mr. Boggess’ professional life that we perform the laser vision correction to balance his two eyes for distance. If we didn’t, he would feel unsafe on the road, and that feeling would be worse at night and in bad weather. That’s definitely not a good scenario for a truck driver.”

Tear-Stained Cheeks

Veteran registered nurse Sharon Piergeorge, 65, jokingly suggests that her desire to work in the medical field was governed by genetics. She says it was passed down to her through her parents.

Photo by Jordan Pysz.

Sharon and her Golden
Retriever, Dunlop, “paws” between
their visits to area medical centers.

“My dad was a physician, and my mom was a nurse, so I think I inherited my interest in nursing from them,” Sharon affirms. “I worked as a nurse for a long time, and I still keep my license active, even though I’ve been retired for years. I’m not going to let my license expire.”

While Sharon no longer works in a nursing capacity, she still spends a lot of time in health care facilities. But now, she volunteers to lift patients’ spirits with the help of her Golden Retriever, Dunlop.

“Dunlop is a certified therapy dog, and she loves her job,” Sharon elaborates. “And she’s fantastic at her therapy work. She always brings a smile to everyone’s face. Now, I’m back in the hospital with my favorite companion. The volunteer work is very rewarding for me, for both of us.”

While Sharon is thrilled with her new vocation, she didn’t always look the part. Some people thought she was sad because her eyes were constantly tearing. But she wasn’t sad at all. While it may seem contradictory, excessive tearing is actually a common symptom of dry eye disease.

“I’ve had dry eyes for a very long time,” Sharon says. “I couldn’t wear contact lenses because they would stick to my dry eyes. The condition must be hereditary because my father had horrible dry eyes.

“The dry eye got to the point that my eyes were constantly watering, from morning till night. I didn’t have any pain or other symptoms, just the tears pouring down my cheeks all day. People would stop me and ask, Are you okay? because I always looked like I was crying. That went on for years.

“I went to an eye doctor, and we tried everything under the sun to help my dry eyes – everything from plugs to RESTASIS® and Xiidra®, but nothing worked. After that, my doctor said there was nothing else we could do. I was at my wit’s end. Fortunately, someone recommended Dr. Salinger, and I went to see him at once.”

When Sharon met with Dr. Salinger, he explained that the oil glands in her eyelids had become clogged with debris. They weren’t releasing enough of the oils necessary to keep a good, consistent tear film on her eyes’ surfaces, which keeps the eyes moist. The lack of a consistent tear film was causing Sharon’s eyes to be dry and irritated, which made them tear up.

Thermal Pulsation

Initially, Dr. Salinger treated Sharon’s dry eye disease with a regimen that included preservative-free, over-the-counter, sterile artificial tears; hot compresses, lid cleansings, vitamin supplements specifically for dry eye, and anti-inflammatory eye drops to reduce the inflammation that contributes to the evaporation of tears.

“That treatment protocol improved Sharon’s symptoms somewhat, but only incrementally,” Dr. Salinger reports. “We finally recommended treatment with the LipiFlow® and went ahead and performed it in January 2019.”

The LipiFlow Thermal Pulsation System from TearScience® combines the controlled application of therapeutic heat with a gentle, pulsating massage. These two functions work to liquefy then remove clogging debris from the glands in the eyelids, enabling them to function efficiently.

“LipiFlow is a revolutionary breakthrough for treating chronic dry eye disease,” Dr. Salinger asserts. “It relieves dry eye symptoms by removing blockages of the eyelid’s oil glands. Opening and clearing the blocked glands enhances the natural production of the oils needed to restore a healthier tear layer on the surface of the eye.

“LipiFlow can be performed in different ways. Many doctors perform LipiFlow only. We perform a three-step process that includes treatment with the LipiFlow. Step one in the process is a very thorough deep cleaning of the eyelids. Step two is treatment with the LipiFlow itself.”

The third step is an expression of the oil glands by the doctor immediately after the LipiFlow while the gland material is still warm and relatively viscous. This step is done to remove any clogging material the LipiFlow may have left behind.

“We believe that by doing step one and step three in combination with the LipiFlow treatment, individuals get more benefit sooner than if we didn’t do all three steps,” Dr. Salinger observes. “The benefits also last significantly longer when the three-step process is used.” The results are astounding.

Dr. Salinger reports that 90 percent of people experience measurable improvement after one LipiFlow treatment at The Dry Eye Spa & V.I.P. Laser Eye Center. About half of those patients notice improvement within one month. For the other half, it may take two to three months. For a very small percentage, it may take longer.

Miracle Cures

Sharon noticed a significant difference in her dry eye symptoms shortly after completing her three-step LipiFlow process. She continues to follow Dr. Salinger’s instructions for aftercare to maintain the results she achieved from the process.

“Within two months of getting the LipiFlow, my tearing stopped,” Sharon enthuses. “It’s such a relief to not have tears pouring down my cheeks all day.

“Every morning – and I’m religious about it – I put warm compresses on my eyes to keep the oils in my glands flowing freely. I take fish oil and use over-the-counter eye drops three or four times a day, then I’m good to go. I’m perfectly fine now. My eyes aren’t tearing anymore. The difference is like night and day.”

Like Sharon, Charles noticed an improvement in his vision soon after having treatment – in his case, the LASEK surgery, which Dr. Salinger performed in August of this year.

“I noticed a difference right away because the distance vision in my left eye was very blurry,” Charles states. “After a few weeks, I could see well enough to read road signs. And that’s the main thing I needed. And my vision just keeps getting better every day.

“The corrections Dr. Salinger made for my distance vision affected my near vision. I do have to wear reading glasses, but I don’t mind that at all. I don’t have to wear regular glasses, and that’s what I wanted.”

“I absolutely recommend Dr. Salinger and The Dry Eye Spa and V.I.P. Laser Eye Center, and already have,” Sharon says. “Three or four of my friends have gone to him.

“Dr. Salinger’s treatment is amazing. My dad had horrible dry eyes, and he was basically told he had to live with it. But today, people don’t have to live with it. There are new things such as the LipiFlow that can help resolve it. It’s like a miracle.”

Diabetes and Your Eyes

November 18th, 2019

The US Centers for Disease Control and Prevention (CDC) reports that more than 100 million adults in this country are living with diabetes or prediabetes. Of those, 30.3 million – that’s 9.4 percent of the US population – have full-blown diabetes.

Another 84.1 million US adults have prediabetes. That’s a condition that, if left untreated, can lead to type 2 diabetes within five years. More than a third of adult Americans has prediabetes, and most of them don’t know they have it.

Why should we take note of these figures? Because consistently high blood glucose (sugar) levels, the hallmark of uncontrolled diabetes, can cause serious injury to your body’s nerves and blood vessels, impairing circulation and damaging your heart, liver, brain cells and eyes.

Most serious eye diseases related to diabetes begin when high blood glucose damages the eye’s tiny blood vessels. The four main eye diseases that can threaten the vision of a person with diabetes are diabetic retinopathy, diabetic macular edema, glaucoma and cataracts.

Diabetic retinopathy is the most common cause of vision loss for people with diabetes and the leading cause of blindness for all adults in the US. It occurs when high glucose blocks the tiny blood vessels that nourish the retina, the part of your eye that detects light and sends signals to your brain. These damaged blood vessels can begin to swell and leak fluid. This stage is called non-proliferative diabetic retinopathy.

In some cases, non-proliferative diabetic retinopathy progresses into the proliferative stage. That’s when the eye grows new blood vessels to make up for the blocked vessels in a process called neovascularization. But the newly formed blood vessels are highly unstable and leak and bleed easily.

These leaking blood vessels may even hemorrhage into the jelly-like material that fills the center of your eyes, called the vitreous. Blood in the vitreous results in dark spots that can block vision.

Diabetic retinopathy can also cause scar tissue to form in the back of your eye, which may pull the retina away from the back of the eye. This is called a retinal detachment, and it’s a serious complication that can cause loss of vision if not repaired quickly.

As the unstable blood vessels in your retina continue to bleed, they eventually cause the macula, the area of the retina that enables you to read, drive and see faces, to swell. This condition is called diabetic macular edema. Over time, this condition can destroy your sharp vision and lead to partial vision loss and eventually blindness.

The natural lenses of your eyes are clear structures that provide sharp vision. But over time, they can become cloudy, a condition called cataracts. People who have diabetes can develop cataracts at an earlier age than people without the disease, and people with diabetes are two to five times more likely to develop cataracts. It’s believed that high glucose levels cause protein deposits to build up on the lenses, leading to the cataracts.

Sometimes, blood from the leaking vessels blocks the normal drainage channels for fluid in the eyes. As a result, fluid builds up and pressure in the eye increases, which can damage the optic nerve and affect vision. Glaucoma is a group of eye diseases related to increased eye pressure. Having diabetes nearly doubles your risk of developing a type of glaucoma called open-angle glaucoma.

The best way to prevent vision loss from these eye diseases is to control your blood glucose levels and get regular exams by your eye doctor to look for swelling and changes in the blood vessels in your eyes.

To help control your diabetes, eat a healthy and balanced diet, exercise regularly and maintain a healthy body weight. High blood pressure and high cholesterol can affect your blood glucose level, so take all medications your doctor prescribes for these conditions and get them checked regularly. Don’t smoke and drink alcohol in moderation.

Regular eye exams can help find problems early, when they’re easier to treat. Early detection can save your vision. See you eye doctor yearly or as often as your doctor recommends. Call your eye doctor right away if you experience any of the following symptoms:

  • Black spots in your vision
  • Flashes of light
  • “Holes” in your vision
  • Blurred vision


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