Author Archive

Dodging Deductibles

Make the most of your insurance before the new year.

Most people with health insurance have a deductible. That’s the amount people must pay for covered services before their insurance plan starts to pay. The deductible is generally assessed at the beginning of each plan year, often in January. To make the most of their insurance benefits, people try to have their routine health services
completed by the end of their plan year.

Photo by Nerissa Johnson.

Cathryn “Kim” Fellinger

“Once people meet their deductibles, their insurance generally pays a percentage of covered services,” informs Barbara Borden, center director at LAD imaging, a fully accredited, outpatient imaging center in Deltona. “If people need services, the end of the year is a good time to get them because they’ve got their deductibles again at the first of the year.
“In addition, some people have health reimbursement arrangements [HRAs] with their employers. An HRA is an employer-funded benefit that reimburses employees for out-of-pocket health expenses. Others have flexible spending accounts where employees contribute money from their salaries to go toward deductibles. These accounts also run on a yearly basis.”
It makes good financial sense for people to get all of their health needs addressed before a new deductible is assessed. However, Barbara encourages them to schedule their appointments throughout the year instead of waiting until the last few months. She suggests they begin the process as soon as their current deductibles are met.
“There can be problems when everybody waits to get their services at the end of the year,” she notes. “Schedules get busy. Physicians get busy. Patients are competing with many others for appointment times. Sometimes, because they waited, patients have trouble getting appointments and get kicked into the new year and a new deductible.
“Getting things done when people want to do them can be difficult; I know how life is. Family, work and other factors get in the way, but patients need to make plans for themselves and their families. They need to take the time to get the services done that they’ve been postponing, before the end of the year.”
At LAD imaging, the staff wants to help its patients get the most of their insurance, so they make an effort to accommodate everyone who needs imaging services any time of year. They’re open on Saturdays and offer extended hours, with morning and evening appointments, during the week to accommodate those who work. For some exams, walk-in service is also available.

Christmas in June

Before retiring on 11/11/11, Cathryn “Kim” Fellinger lobbied for state employee issues before the legislature of the State of Ohio, from which she is a native. Upon retirement, she relocated to Florida and soon began looking for a local, free-standing imaging center. She found one through the West Volusia Regional Chamber of Commerce.
“At a Chamber of Commerce event, I met Diane, a representative of LAD imaging,” Kim relates. “I discovered that LAD imaging is close to where I live, easy to get to and easy to get into and out of. Those are things I think about now that I didn’t think about when I was younger. Everybody at LAD imaging is friendly.”
Kim is an active participant in her health care. She’s faithful about getting her routine screenings, such as mammograms. She also suffers from scoliosis and has regular MRIs to check the progression of the curvature in her spine. She counts on LAD imaging to provide these tests, and Kim tries to get them done by the end of her insurance plan year.
“My insurance actually runs differently than most,” she describes. “It’s not a calendar-year benefit program; mine runs from July first to June thirtieth. It’s different for me to deal with providers because they’re used to people doing everything toward the end of the calendar year.
“Insurance works best for me if I get as many of the services I know I need done early and meet my deductible, so most of what I need done during the rest of the plan year is covered.
“On one hand, it’s generally easier for me to get appointments during the year because I’m not going head-to-head with the crush of people who wait until the last minute to use their benefits. I actually have a bit of an advantage.
“On the other hand, it’s harder for me to get in at the end of the year, not because of my insurance, but because of everybody else’s. If it’s December and I need something done, I have to make sure I have enough lead time because everyone else is trying to get in for their own reasons. I know I have to book an appointment way ahead of time.”

“If people need services, the end of the year is a good time to get them because they’ve got their deductibles again at the first of the year.” -Barbara

Even though Kim is typically not having services performed at the end of the calendar year, she sometimes finds herself at the end of her insurance plan year needing to schedule imaging exams or other services.
“I tend to do what everybody else does,” she admits. “My benefit year ends in June, and I try to get services in before the end of the year. One time, I tried to get my MRI done before the end of June, but it wasn’t ordered until June, and it just didn’t happen for a variety of reasons.
“So, I do the same thing. The timing just looks different. I don’t have the crunch everybody has in December.”

Ongoing Education

LAD imaging serves the community with a wide range of diagnostic imaging tests. These include traditional x-rays, computed tomography (CT), mammography, DEXA scans (bone density), high-field MRI and magnetic resonance angiography (MRA), ultrasound (including four-dimensional OB images) and vascular studies.
“No matter what imaging exam the patients require, when they come to LAD imaging, each scheduled procedure is thoroughly explained to them before the test is started,” assures Barbara. “This gives patients a better understanding of how the images are being acquired, how they will be used and what they can show.
“We also strive to educate the medical community about the advanced procedures we can perform here and how we can expedite referring physicians’ results if one of our radiologists notices something suspicious. In that way, physicians are able to move quickly toward helping their patients receive the appropriate treatment.”
Providing quality patient care is LAD imaging’s top priority, stresses Barbara. The center is fully accredited by the American College of Radiology®, and it participates in most insurance plans, including Medicare and Medicaid.

Never Say Never

Coexisting eye diseases don’t bar patients from floater procedure.

Kevin Donato likes to joke that at the printing and advertising specialty business he owns, they’ll print anything but money. That’s okay for Kevin. Money isn’t what’s most important to him. He’s more concerned about his health, especially the health of his eyes, which have been problematic since his childhood.

Photo by Nerissa Johnson.

Kevin Donato

“I never had great eyesight,” Kevin shares. “I have astigmatism, and I had eye surgery when I was very young. There was a tendon that was pulling my right eye and causing me to be cross-eyed. That tendon had to be surgically pulled back to put my eye straight.
“I go to the eye doctor every year, and I’ve always worn glasses and contact lenses. Now, I wear a reading contact in my right eye, and a contact for distance in my left eye. I’m comfortable with that because I don’t like wearing reading glasses to read or use the computer.”
About eight months ago, Kevin began noticing a spot moving across his vision in his right eye. Initially, he thought it was the result of being overly tired and spending too much time in front of the computer. The irregularity continued, however, despite getting rest and taking breaks from the electronics.
“When a contact moves off your eye, your vision becomes blurry just for the second it’s not in place,” he describes. “That’s what this spot was like, but it lasted closer to ten seconds. My vision would be blurry, then it would be clear, then blurry again. Something went across my line of sight that caused this to happen. It went on twenty-four seven.
“I struggled with the blurry spots in my right eye because the only way I could read was with my left eye, which was my distance eye. I had to wear reading glasses again.”
Frustrated, Kevin went to his eye doctor, who told him the spot moving across his eye was an eye floater. His eye doctor recommended Kevin make an appointment with Peter J. Lowe, MD, a board-certified ophthalmologist at Retinal Eye Care Associates who subspecializes in diseases of the retina and vitreous. She explained that Dr. Lowe uses a noninvasive procedure called laser vitreolysis to remove the eye floaters from his patients’ eyes.

Eye Floaters Explained

An eye floater is basically the debris that’s left after what Dr. Lowe calls “a vitreous detachment.”
“The vitreous is a cellophane-like lining on the inside of the eye,” he explains. “As the eye naturally ages, or after surgery, most commonly to remove cataracts, the cellophane lining will sometimes come loose. Typically, it stays in small, almost completely transparent sheets. Sometimes, however, it clumps up into larger debris fields and casts shadows against the retina.”

“I’m now able to read the computer screen, a magazine and my phone without reading glasses. And I don’t see a blurry spot running across my eye anymore.” – Kevin

Most acute floaters go away on their own, “passing uneventfully as the jelly that holds them dissolves,” adds Dr. Lowe. “So, we’re only talking about a small percentage of patients in whom the floaters are either large enough or numerous enough to create a significant visual problem.
“No one can really point to any given patient and say floaters will be a problem for that person, nor can anyone point to any individual floater and suggest that it’s going to be a problem as time goes on. Floaters come in different sizes and shapes, and different people have different levels of concern. A floater is not a disease. I tell people it’s a dis-ease. So, it’s relative to the individual how uneasy seeing a floater makes them.
“Often, I see patients who develop floaters after cataract surgery. They are most often very anxious or depressed thinking they are going to have to live with a large spot moving in and out of their line of sight for the rest of their lives, yet they are often the easiest to successfully treat.
“In younger patients who’ve never had any prior eye problems, they often demonstrate even more of what you’d call ‘white-knuckle syndrome.’ They’ve looked up floaters or visual blurring on the internet, and they’ve read about everything from retinal detachment to hemorrhages. Everybody always expects the worst to come out of a doctor’s mouth. So, they’re often surprised that vitreous detachments and vitreous floaters are a normal physiologic change in the eye as it ages.”
Kevin’s initial concern regarding floaters stemmed not so much from the existence of the floater itself but the procedure that had to be done to eliminate it. When his eye doctor told him that Dr. Lowe performed a laser treatment to eliminate eye floaters, Kevin became worried by the idea of someone using a laser on his eye. As a result, he put off calling Dr. Lowe for months.
“It was in October that I was recommended to Dr. Lowe,” Kevin explains “I knew I needed to reach out to him, but I didn’t do it right away. Then in March, I was out on my boat, and I had a moment when I just had it with the floater. I couldn’t deal with it anymore. When I got back into town, I called Dr. Lowe and made an appointment.”
During their consultation, Kevin expressed his concerns about laser vitreolysis to Dr. Lowe. The retina specialist carefully explained how the procedure is performed. He noted that it takes ten to 15 minutes to complete, requires no incisions and causes no discomfort.
Dr. Lowe estimated he’s performed more than 500 of those procedures over the past five-plus years.
“I was still very nervous about it,” relates Kevin, “but Dr. Lowe took time with me. He told me how he’ll put a lens on top of my eye and have me look left and right. Then, he’ll dissolve the floater with the laser. He took an extra step and went through the entire procedure, doing everything but use the laser. That trial run made me more comfortable with the process and helped me know I could do it.”

Ideal Candidates

“Kevin had a very complex ocular history,” notes Dr. Lowe. “He’d been seen by other ophthalmologists early in his life and had surgery for strabismus, which is when the eyes aren’t perfectly aligned.

Photo by Nerissa Johnson.

Kevin’s eye floater is gone and his vision is now clear.

“More recently, he was having problems seeing from his right eye because it was getting cloudy. In addition to a little latent eye turn, he had a fairly large central floater obscuring the visual pathway in that eye.”
At first, Dr. Lowe wasn’t sure Kevin would be a candidate for laser vitreolysis due to his strabismus because with that, Kevin had an inherent suppression of vision in his right eye. But after performing a thorough examination and finding no other clinical problems with Kevin’s eye, Dr. Lowe proceeded with the treatment.
“Kevin had already adapted to the visual weakness he had since his youth,” observes Dr. Lowe. “Then, when the floater came along, it totally threw off the way he was seeing with two eyes. After treatment, he experienced significant visual improvement and was able to see clearly again from his right eye.
“When I first started doing laser vitreolysis, I concentrated on ideal patients, such as patients who’d developed floaters after perfect cataract surgery,” he states. “As I gained more experience, I became comfortable treating patients with other coexistent eye problems. The message now is never say never.”

Excellent Eyesight

After all was said and done, Kevin’s concerns regarding laser vitreolysis were relieved through the kind attention he received from Dr. Lowe. Thanks to the doctor, Kevin became comfortable with the steps of the procedure, and he’s glad he did. He says he couldn’t be happier with the outcome.
“The floater is gone,” Kevin raves. “My vision is nice and clear now, and I don’t have any issues. I’m very excited. The procedure was a big success, and my eyesight has been excellent ever since.
“I’m back to wearing the reading contact in my right eye and a distance contact in my left eye. I’m now able to read the computer screen, a magazine and my phone without reading glasses. And I don’t see a blurry spot running across my eye anymore. I’ve been out in the sun many times since the procedure and haven’t had any issues with my eyes.”
Kevin is proud of himself for overcoming his fear, but he gives Dr. Lowe most of the credit. He says Dr. Lowe is unlike many physicians and adds that the doctor has tremendous empathy for his patients.
“Doctors sometimes get a bad reputation because they don’t always have good bedside manners, but not Dr. Lowe,” enthuses Kevin. “His bedside manner is exceptional, and I told him that in my final follow-up appointment. That’s why I decided to go through with laser vitreolysis.
“I’m especially grateful for the time Dr. Lowe took with me to go through that dry run. With his help, I set my mind to go through the procedure. I’m very appreciative of that.”

Laser Legwork

Painless treatment seals varicose veins.

New York native Barry Clymer has a job that involves a lot of legwork. He wasn’t too surprised then when his legs started to swell, and his leg veins began to pop out.

Photo by Nerissa Johnson.

Barry Clymer

“I’m not vain; I don’t really care how my legs look, but I was concerned about the swelling,” says Barry, a warranty administrator for a local car dealership. “I went to my primary care physician, who said the swelling was from my varicose veins. He referred me to Vein Treatment Center of Palm Coast.”
Vein Treatment Center of Palm Coast is the practice of Charles I. Stein, MD, and N. John Collucci, DO. The doctors began their care for Barry by ordering an ultrasound of his legs. The results showed that the tiny, one-way valves that help move blood back up toward the heart were not functioning properly. This was causing blood to pool in Barry’s legs and his veins to enlarge, a condition called venous reflux disease.
“I met with Dr. Stein, who confirmed that the problem was with my leg veins,” shares Barry. “He explained everything he and Dr. Collucci could do for me, why they should do it and how they would do it.”

Painless and Effective

The procedure Dr. Stein and Dr. Collucci recommended for Barry’s varicose veins is called endovascular laser treatment, or EVLT. During these minimally invasive procedures, a high-energy laser directs heat into the affected veins, which seal shut within a week and are slowly absorbed by the body. Blood is then rerouted through healthy veins nearby.

“Now, the swelling is pretty much gone, and my varicose veins are all gone.” – Barry

EVLT requires no incisions, stitches or anesthesia, only a few Novocain® injections. The doctors strive for a two-hour maximum for each in-office procedure.
“We work on the worst area first,” notes Dr. Stein. “Then, if a second procedure is necessary, we’ve eliminated much of the blood supply. This makes the second procedure easier.”
“I was awake during the whole thing,” states Barry. “First, they numb the area pretty well. Then they use the laser to close off the veins. It didn’t hurt at all.”
Following EVLT, patients are advised to avoid strenuous activities, hot tubs, swimming pools and sunbathing for a number of days. Most can return to work or other routines the same day.
“Now, the swelling is pretty much gone, and my varicose veins are all gone,” reports Barry. “My legs look and feel fine. Dr. Stein told me I’d get my sexy legs back.
“My treatment from Dr. Stein and Dr. Collucci was a success. I absolutely recommend them and Vein Treatment Center of Palm Coast.”

Milling Miracles

Bright, beautiful, new smiles are just one visit away.

Judy Lynne Revell made a career of helping others. She worked as a nurse for 45 years and planned quality assurance for a company that owned assisted living facilities for 17 years. Before retiring, she spent ten years helping people lose weight, quit smoking and overcome other concerns as a clinical hypnotherapist.

Photo by Nerissa Johnson.

Judy Lynne Revell

“I was living in Kentucky then, but I didn’t like the snow anymore,” Judy shares. “My friend and I did the snowbird thing for a couple of years, then two years ago, we retired and moved to Florida.”
After Judy arrived in Florida, she realized she had some dental issues that needed attention. She found a dentist in Port Orange who took care of her most pressing needs, but she wasn’t happy with his work or the results.
When more problems arose shortly thereafter, Judy didn’t want to go back to the dentist she saw in Port Orange, but she didn’t know where else to turn. Then she got an idea while sitting in her doctor’s waiting room.
“I was reading Volusia Health Care News and saw Dr. Lester’s article. It also had a picture of him,” she relates. “I thought, I’m not in any better shape now, and I need to do something. I might as well give this dentist a shot because he looks like a nice guy.
The dentist Judy admired was Stephen P. Lester, DDS, of Park Avenue Dentistry in Edgewater. She called Park Avenue Dentistry and was warmly greeted on the phone, which impressed her. She was even more impressed when she arrived at the practice, saw the surroundings and experienced the staff’s customer service.
“I was just stunned by the people and the atmosphere,” she comments. “The place was like a spa. The staff was so nice, and Dr. Lester was such a sweet, charming guy. He did the financial thing there as well, but Dr. Lester’s total was much more reasonable. He told me there were some things that, in his professional opinion, just weren’t necessary. I thought, This is a good deal.
Judy agreed to Dr. Lester’s treatment plan, which included three crowns and the replacement of a missing tooth with an all-porcelain bridge. The bridge was created in a single dental visit, which astounded Judy. She found
Dr. Lester’s in-house fabrication equipment, the E4D® Dentist Chairside CAD/CAM System, very impressive.
“Dr. Lester has all this incredible, brand-new equipment in his office that I’ve never seen before,” she marvels. “He made the bridge right there. That just floored me. Being in the health care industry, we don’t generally do things very quickly. That was just amazing to me.”

Retooled Technology

CAD/CAM technology has been used for years to design and manufacture products such as tool and auto parts. More recently, CAD/CAM technology was retooled for use in dentistry to meet the growing need for comfort and convenience in the dental office. That fueled the development of in-office CAD/CAM systems such as the E4D.
“The E4D system is a technology that creates porcelain restorations quickly and easily right in the dentist’s office, often in one visit,” describes Dr. Lester. “It can make dental crowns, inlays, onlays, veneers and even bridges.”
The system consists of three main parts – the computer system, the software and the milling unit. These parts work in concert to create the finished restoration, in Judy’s case, a bridge.
“Judy wanted a bridge because she had a place in her mouth where a tooth was missing,” notes Dr. Lester. “She lost the tooth years ago and decided she finally wanted to have that space restored. She already had her mind made up before she came to us that she wanted a bridge for that space.
“A bridge is exactly what its name suggests. It’s a restoration that spans the gap where one or more teeth are missing. A bridge includes two crowns for the teeth on either side of the gap. These teeth anchor the bridge.”
The process of making Judy’s bridge with the E4D system began with Dr. Lester using a high-tech laser to quickly and accurately scan Judy’s teeth into the computer. Dr. Lester then used the E4D software to design her bridge.
The computer took Dr. Lester’s design and prepared it for the milling machine, which cuts the restoration out of a block of porcelain. For Judy, this all happened during the same dental appointment.
“Using the E4D system has a number of benefits for our patients,” observes Dr. Lester. “They don’t have to put that messy goo in their mouths to make the impressions of their teeth. Instead, it’s done digitally.
“And they don’t have to wear temporary restorations, which always want to fall off at inconvenient times. They also don’t have to return for a second visit because often, their restorations can be designed and made in a single day.”

Positive Porcelain

Conventional dental restorations, including bridges, were made from porcelain fused to metal, but today’s technology, such as the E4D system, has enabled the creation of all-porcelain bridges. All-porcelain bridges are stronger, longer-lasting and more pleasing to the eye. All-porcelain bridges are often the preferred form of restoration for missing teeth.
“The bridge I made for Judy is all-porcelain,” reports Dr. Lester. “This material is stronger and more natural looking than the materials used previously to make bridges and other dental restorations. It provides longer-lasting and more aesthetic results.”
There are several positive reasons for using the all-porcelain material to create dental restorations such as bridges. For one, the natural appearance of the all-porcelain material makes the bridge nearly indistinguishable from the patient’s other, natural teeth. The metal under porcelain-fused-to-metal bridges tended to show through at the edge of the gums.
“All-porcelain bridges are fitted above the edge of the gums, which helps ensure the teeth and gums stay healthy with minimal risk of infection,” points out Dr. Lester. “They are also a good choice for anyone with an allergy to metal.”

Happy Camper

As part of his treatment plan for Judy, Dr. Lester placed three crowns on her teeth, and she’s pleased with how they turned out. What has Judy most excited is the new bridge that replaces the tooth that had been missing for years.
“The bridge is absolutely great,” she raves. “I don’t even know it’s there. Nobody knows it’s there. People cannot tell. I’m just a real happy camper.”

Photo by Nerissa Johnson.

One visit is all it took to put a smile back on Judy’s face.

Not only is Judy satisfied with the results of Dr. Lester’s dental work, she’s also delighted by how positive her experience was at Park Avenue Dentistry. She says the dentist and his staff went out of their way to make sure her visits were comfortable and easy.
“Dr. Lester and his team did everything so that I experienced a minimal amount of discomfort,” she says. “I just got Novocain® during treatment. I can’t get sedation because I react badly to it, but I didn’t care what Dr. Lester did. He could’ve drilled all of my teeth. He’s probably the best dentist I’ve ever had, and I’m seventy-six years old.”
Judy says that as a patient, she is made to feel very comfortable and welcomed at Park Avenue Dentistry. She reports that that hospitality extends to the family and friends who accompany the patients.
“The worst patient couldn’t possibly come up with anything bad to say about the way Dr. Lester and his crew treat me and my friend, who goes with me,” she offers. “They have a nice, little area that’s set off. It has a recliner and a TV, and that’s where the people who come with you can go.
“Today, I’m referring another patient to Dr. Lester. He’s great. He has a charm about him, and he’s so calm and gentle. I don’t hesitate for anything to refer people to Dr. Lester and Park Avenue Dentistry.”

Prostate Cancer Prospects

December 3rd, 2018

In October, we got a glimpse of what was happening in research on breast cancer. This week, I thought I’d give you an update on what’s being studied in prostate cancer. Prostate cancer, as we learned recently, is the second most common cancer in men behind skin cancer and the second leading cancer killer in men, behind lung cancer.

Studies are ongoing as researchers look for the causes and new treatments for prostate cancer, as well as for more effective ways to detect and prevent it. Research is being done in universities and medical centers all over the world. The American Cancer Society breaks down some of the work currently underway. Here’re are a few examples.

On the genetics front, research into the link between gene changes and prostate cancer is helping scientists better understand how this cancer develops. Knowing this might help other scientists design medications that target those changes. It also might help develop tests to detect abnormal genes that can then help identify men at high risk for prostate cancer.

The use of the PSA test is also being studied. Researchers are looking at better ways to measure the total amount of PSA in your blood. They’ve suggested using newer tests that are more accurate than the PSA test. The newer tests include the phi, which combines the results of total PSA, free PSA and proPSA.

In most cases today, doctors use transrectal ultrasound (TRUS) to guide the needle during a biopsy. A newer technique making biopsies more accurate is the color Doppler ultrasound. An even newer approach being studied enhances the Doppler technique by injecting a contrast agent with microbubbles that helps improve the images.

New treatments for early-stage prostate cancer are also being studied. One is high-intensity focused ultrasound (HIFU). HIFU kills prostate cancer cells by heating them with highly focused ultrasonic beams. HIFU has been used in other countries for a while, but is just now being studied for use in the US. It’s being looked at for safety and effectiveness.

There have been some breakthroughs in prostate cancer research in the news recently, and I thought I’d share a few I found with you. These are the reported results of specific research studies recently concluded. These studies offer good news for some men with prostate cancer.

One article reported on a clinical trial on a new technique for radiation therapy. This innovative form of treatment delivers the radiation in only five treatment sessions. A typical course of radiation treatment is 37 sessions.

This clinical trial looked at the effects of stereotactic ablative radiotherapy, which is a highly targeted form of radiation therapy that uses several beams of radiation at one time. The multiple beams intersect at the tumor and deliver a high dose of radiation to the cancer. At the same time, the surrounding, healthy tissue receives only a very low dose.

Another study looked at the effectiveness of immunotherapy on an especially aggressive form of prostate cancer. Men with this form have a much worse survival rate than men with other forms of prostate cancer. Researchers found these men may respond unusually well to this type of therapy, giving them the possibility of an effective form of treatment.

The research found that men with this form of prostate cancer have specific faults in their tumors that make their DNA error prone and unstable, so their survival is half as long as other men with advanced prostate cancer. However, their unstable tumors are more likely to trigger an immune response, which makes them good candidate for immunotherapy.

More good news for men with aggressive prostate cancer, this one a non-metastatic, castrate resistant form with a quickly rising PSA level. Castrate resistant means your cancer no longer responds to the treatments to reduce testosterone, on which your cancer feeds. This form of cancer has not had an effective treatment to date.

Now, a study out of Northwestern University Medicine may have a treatment. The study showed that a medicine currently used to treat men with advanced metastatic prostate cancer significantly lowered the risk of metastasis or death when used in men with this aggressive form of prostate cancer.

The results, the researchers noted, showed several benefits for patients, including a decline in PSA levels and less need for additional anticancer treatments, which can have a negative impact on your quality of life. The lead researcher stated that more study is needed to determine if long-term survival is impacted.

These are just a few examples of the research being done to get a better understanding of prostate cancer and its treatment. If you’re a man at risk for prostate cancer or if you’ve already been diagnosed with it, take heart. Much is being done to get you through it successfully.

Vanishing Venous Disease

Leg wounds disappear at dedicated ulcer center.

For most of his career, David O’Keefe worked in an oil refinery in his native New Jersey. He was in charge of processing operations and ensuring the plant ran smoothly. His job required long hours of standing and frequent trips up and down ladders. After years of stress on his legs, he began having difficulty performing the duties of his job.
“I’ve always been active,” David reports. “I played rugby and other sports. But with that, work and just getting older, my legs eventually got to where I couldn’t stand for long periods of time. I certainly couldn’t climb ladders in the refinery, so they retired me.”

Photo by Jordan Pysz.

David is walking longer and biking farther
after vein treatment.

The heaviness and fatigue in David’s legs were just the beginning. Eventually, his legs began to swell and ache, and the veins in his legs became quite prominent.
“I developed varicose veins later on, and they were very painful,” David describes. “The pain affected my activities. I couldn’t cut the grass or anything like that. I couldn’t go shopping or walk the length of Fishermen’s Village without having to sit down.
“I kept riding my bicycle because that was my primary exercise. I just rode through the pain, then I would get home and have to sit with my legs up for a good hour. We have a pool, so I soaked in that after a bicycle ride as well.
“Over time, my legs became increasingly swollen and painful, and as the years went on, I ended up with an open wound on my left leg.”
David initially sought help for the problem from his primary care physician, who suspected the issue might be a sign of a problem with David’s leg veins. That physician referred David to Douglas H. Joyce, DO, of Joyce Vein & Aesthetic Institute in Punta Gorda. Dr. Joyce is a skilled vein specialist who combines compassion and expertise to treat patients with venous disease.
“Dr. Joyce explained that I had a condition called venous insufficiency,” David recalls. “The blood wasn’t moving out of my leg veins toward my heart because the check valves in the veins weren’t working properly. The blood was spilling back in my legs and going where it shouldn’t go, causing the pain, swelling and wound.

“I’m exceedingly happy. The swelling in my left leg is down remarkably. . . . I don’t have any pain at all now, and I can do pretty much everything that was impossible before.” – David

“I told Dr. Joyce that I had a doctor one time who told me he could fix my legs with an amputation, which didn’t sound very good. He just cringed and said, We don’t do that anymore. That made me feel much better. With Dr. Joyce, I was very relaxed.”
At Joyce Vein & Aesthetic Institute, venous disease is not treated with amputations or even vein stripping, a procedure during which the problem veins are forcibly removed from the leg. Instead, Dr. Joyce uses advanced, minimally invasive treatments to close leaking veins and return circulation to proper working order.
“Our approach is to start with ultrasound mapping of the legs,” notes Dr. Joyce. “We identify any veins that are not working correctly and then use a procedure to divert the blood away from those veins. We close them so that blood only runs through veins that are working properly.”

The Exercise Effect

“David is a very athletic guy who loves to ride his bicycle but was experiencing a lot of pain with exercise, along with swelling,” says Dr. Joyce. “Pain with exercise is a high indicator that there’s a problem in the leg veins that can lead to other, major problems, including leg wounds, or venous ulcers. When David came in, he had a longstanding ulcer on his left leg.”
Dr. Joyce explains that leg veins are like a ladder, with one side being the high-pressure deep veins and the other the low-pressure superficial veins. The perforator veins are the rungs in between. The perforators have valves that keep blood flowing from the low-pressure veins to the high-pressure veins.
“If those valves aren’t working properly, the blood goes from the high-pressure side over to the low-pressure side,”
Dr. Joyce informs. “When it does, it hits the veins under the skin at one point, so the pressure at that spot becomes extremely high. This can lead to skin breakdown and ulcers.”
Dr. Joyce notes that exercise accentuates the movement of blood from the deep veins to the superficial veins. When people ride a bike, run, work out on a stair-stepper or do a similar exercise, they pump significant amounts of blood out of the legs up toward the heart.

“I know this disease. Let me help you remove it from your life.”-Dr. Joyce

“When people exercise, the muscles where the deep veins are located work harder and pump more blood through the deep veins,” confirms Dr. Joyce. “When there are abnormal perforator veins, more blood gets forced backward into the superficial veins. This extra blood can damage the superficial veins and the surrounding skin. The skin eventually breaks down, and patients can end up with venous ulcers.”
At Joyce Vein & Aesthetic Institute, Dr. Joyce concentrates the treatment of leg ulcers from venous disease in The Ulcer Center at JVAI. There, Dr. Joyce uses leading-edge procedures and state-of-the-art technology to treat patients and give them the best chance at a positive outcome.
“At The Ulcer Center at JVAI, we correct everything that’s wrong in the leg veins so that on the follow-up ultrasound, veins that were not working properly are gone. The patients are left with an efficient system for draining blood out of the legs. That’s why our patients experience such significant improvement.”
Dr. Joyce is a pioneer in treating all of the causes of venous disease of the leg. He has even developed several treatment techniques, including single-needle laser ablation. This procedure is a noninvasive method of sealing the diseased veins responsible for advanced venous conditions. This is the procedure he used to treat the ulcer on David’s leg.

Everything Is Possible

After his treatment at Joyce Vein & Aesthetic Institute, David had a near total turnaround in his condition. He’s still in the healing stages, but he’s very pleased with his outcome so far.
“I’m exceedingly happy,” raves David. “The swelling in my left leg is down remarkably. I’m almost to a normal size leg, and the wound is healing. It went from two and a half inches to three quarters of an inch down to about a quarter of an inch. I don’t have any pain at all now, and I can do pretty much everything that was impossible before.
“Now, I’m able to walk aimlessly at Fishermen’s Village, which is a pretty big accomplishment for me. I can go to the store and shop, and I don’t have to sit down. I forgot what it felt like to stand and walk without pain. Life is a lot easier when you can walk well.”
David never gave up his bicycle, but now, he can ride long distances without pain in his legs. He’s taking advantage of that. Now that his legs are feeling better, he rides 15 to 20 miles every day and enjoys it. He’s grateful for Dr. Joyce and his single-needle laser ablation technique.
“I’ve already recommended Dr. Joyce and Joyce Vein and Aesthetic Institute to people I know who have similar conditions, even to those who don’t live in this state,” David enthuses. “I tell them what Dr. Joyce’s treatment did for me. It changed my life!”

Tailored Treatments

After years of compensating for her increasingly blurry eyesight, Diana* finally accepted the need for cataract surgery early in 2018. At the same time, the New Zealand native and former snowbird from Upstate New York was also experiencing other issues with her eyes that further compromised her vision.Stock photo from
“My eyes were really bothering me, and not just from the cataracts,” she reflects. “There was also terrible itchiness, redness, grittiness and a feeling there was something stuck in my eyes all the time. All of these symptoms were related to my dry eye disease.
“I was having a lot of difficulty with my vision. Some of that was because of the cataracts and some of it was due to the dry eye. They both contributed to my vision being blurry and not as good as it should be.”
According to Diana, dry eye disease is a nasty disorder to have. She tried treating hers with popular, over-the-counter eye drops but never received lasting relief from them. The symptoms always returned.
“People can’t treat dry eye with over-the-counter drops and live normally with it,” she shares. “It doesn’t work that way. The dryness, redness, burning and feeling of something in my eyes never went away with the over-the-counter medications. They were just a temporary fix.”
When Diana consulted with the ophthalmologist who was to perform her cataract surgery, he suggested she have her dry eye treated before surgery. Not treating the dry eye before cataract surgery may lead to less accurate measurements, less than ideal results and worsening of the dry eye condition.
Diana’s doctor told her about a new treatment for dry eye called LipiFlow®, then referred her to Clifford L. Salinger, MD, founder of The Dry Eye Spa & V.I.P. Laser Eye Center in Palm Beach Gardens.
Dr. Salinger specializes in dry eye disease, which afflicts millions of Americans. He provides extensive education and testing, as well as comprehensive treatment for the disorder. Among the treatments he provides is the LipiFlow Thermal Pulsation System from TearScience®.
“Dry eye disease, also called ocular surface disease, is caused by a combination of factors,” Dr. Salinger points out. “Among those are a reduction in the quantity of tears on the surface of the eyes and a decrease in the quality of the tears produced. Tear quality includes the composition and amount of oils in the eye’s tear layer.
“LipiFlow is a revolutionary breakthrough for treating chronic dry eye disease. 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.”
“I spoke to my ophthalmologist about LipiFlow, then did some research,” states Diana. “I also read an article about Dr. Salinger in Florida Health Care News and saw that he also expresses the oil glands in the eyelids. I wanted to do whatever would make my eyes better, so I called and made an appointment.
“I told Dr. Salinger I wanted to have the LipiFlow as soon as possible. I believed it was going to be a good solution for me.”

The Finish Line

“Diana came to us in mid March of this year with significant dry eye disease in both eyes,” notes Dr. Salinger. “Her cataract surgeon was savvy enough to understand that significant dry eye disease affects the cataract surgery in several critical ways.
“First, it makes the surgery more challenging. Second, healing after surgery is slower. Third and most important, dry eye alters the measurements and calculations necessary to determine the appropriate lens implant strength for the best uncorrected vision following surgery.
“The ophthalmologist rightly told Diana to treat her dry eye first to improve the condition of her eyes’ environment and stabilize the disease. Then her surgery, healing and choice of implant would be more straightforward.”
After doing several tests to determine the extent of Diana’s condition, Dr. Salinger began her on a comprehensive therapy for her dry eye disease. For Diana, this included hot compresses, lid hygiene with special cleaning agents, vitamin supplements, a mild steroid drop for inflammation, and antibiotic drops and ointment.
“After two weeks of treatment, Diana was still having quite a bit of discomfort because the surfaces of her eyes were so dry,” reports Dr. Salinger. “So, on April third, we did the LipiFlow treatment, and she did very well with it.”
The three-step LipiFlow treatment takes about an hour, with cleaning of the eyelids before the procedure and expressing the oil glands in the eyelids afterward.
“During the LipiFlow procedure, an eyepiece contacts the outer eyelid and contains a soft, flexible bladder that intermittently inflates to provide controlled pressure and massage,” explains Dr. Salinger. “Heat is also applied to the inner surface of the lid because of its proximity to the glands.”
Both of these functions work to liquefy then remove clogging debris from the oil glands.

“I have no symptoms whatsoever since LipiFlow treatment.”– Diana

“Other doctors don’t typically perform the expression of oil glands, but we find that adding this step enhances the benefits of LipiFlow more rapidly, and they last longer,” observes Dr. Salinger. “This step can double or triple the duration of the treatment’s benefits.”
Dr. Salinger saw Diana three weeks after her LipiFlow procedure for a follow-up appointment. When he examined her eyes, they showed a great deal of improvement already.
“Diana was experiencing less redness, burning, tearing and overall discomfort,” he offers. “She returned to the office at five weeks post-treatment and said she was thrilled with the comfort in both eyes.”
With this substantial improvement in Diana’s dry eye symptoms, Dr. Salinger was able to cut back on some of the other treatments in her comprehensive therapy plan.
“We’re finding that eighty to ninety percent of our patients are getting significant improvement of their dry eye disease, although many don’t reach it as quickly as Diana,” Dr. Salinger asserts. “She was more motivated than the average person because she saw the finish line as the chance to have vision-correcting cataract surgery.”

Doctor Recommended

Retired business owner and snowbird Bruce Davis didn’t have dry eye disease like Diana. He struggled with another condition – distorted vision in both eyes. It was an issue that started in his youth.

Photo by Jordan Pysz.

German measles at six led to Bruce’s vision problems as an adult

“I had German measles when I was six, and the high fever caused changes in my corneas that left me with pretty bad eyesight,” explains the York, Pennsylvania native. “It made me terribly nearsighted, so I’ve worn glasses or contact lenses since I was a kid, and with either the glasses or contacts, I actually had pretty good vision.”
He did until recently, when Bruce, 69, noticed he was having issues while wearing his contacts, which he preferred over glasses. The issue was one that annoyed him more than hurt him.
“If I wore my contacts for eight to ten hours, they would become uncomfortable,” he describes. “They didn’t feel dry necessarily, although eye drops helped. They were just uncomfortable, and I’d have to take them out. I asked some opticians about possible treatments, and they suggested I see Dr. Salinger.”
Bruce took the opticians’ advice and made an appointment at V.I.P. Laser Eye Center. He was amazed by the thoroughness and precision of Dr. Salinger’s approach to testing and treatment.
“I thought Dr. Salinger was a wonderful doctor,” comments Bruce. “He’s very detail-oriented and careful about getting things right. We had a lot of problems getting the prescription correct on my left eye, but he never gave up on it. He just kept testing and testing until he got a result that satisfied us.
“After the testing, Dr. Salinger said that LASIK® surgery would work for me. But given my age and the fact that I’m in the first stages of cataracts, he left the decision up to me. I decided to have it done.”

Correction and Cataracts

“Bruce came to us asking, Am I too old for laser vision correction?” relates Dr. Salinger. “The answer used to be purely based on age, but not anymore. Age is a factor, but it’s not an absolute. The presence of cataracts is also a factor.”
Dr. Salinger explains that if a person has cataracts that are already significantly developed, then doing laser vision correction is not appropriate because surgery reshapes the cornea. As cataracts develop, they can affect the vision as well, making people slightly more myopic, or nearsighted.

“I no longer have to wear glasses or contacts!” – Bruce

“If we reshape the cornea with a laser while the lens is changing, we’re running in circles, like a dog chasing its tail,” offers the doctor. “We’re chasing the change in the lens as it becomes a full-fledged cataract. That’s not good practice.
“People who have little change associated with cataracts, as Bruce did, can still be measured for laser vision correction. However, in the presence of even early lens changes, we can’t predict how quickly the cataracts will develop and interfere with the surgery’s results. We anticipated that Bruce had a good amount of time because his lens changes were so minimal. He wanted to move forward with LASIK.”

Safety and Precision

LASIK corrects vision through a laser that changes the curvature of the cornea. A small flap in the cornea is created first, which is made by the eye surgeon, who cuts corneal tissue with a surgical blade.
The V.I.P. Laser Eye Center offers iLASIK – an all-laser vision correction that eliminates the need for the eye surgeon to use a surgical blade in preparing the cornea. With iLASIK, the flap is created by an ultra-fast laser. It offers even more precision and safety in achieving freedom from glasses.
“LASIK is already one of the safest and most accurate surgical procedures currently available,” informs Dr. Salinger. “The iLASIK technology improves safety even more and also contributes to significantly better results.
“Bladeless LASIK offers multiple benefits, but the biggest are a more uniform separation of the layers of the cornea, a more uniform flap thickness and a smoother surface after the flap is created,” he adds.
A goal of laser vision correction is to make people less dependent on corrective lenses. One way to do that is with monovision, which corrects one eye for distance vision and one eye for near vision.
“We proposed monovision to Bruce, but he didn’t like that idea,” remembers Dr. Salinger. “He wanted both eyes corrected for distance vision. He believed he would feel off balance with monovision. I warned him that, in all probability, his near vision would be compromised after surgery, but he wasn’t deterred.
“We did the LASIK procedure on February 22, 2018, and six days after the procedure, he was 20/20 in his right eye and 20/20 plus in his left eye. With both eyes open, he was reading most of the 20/15 lines on the chart, and against all odds, he was reading the absolute smallest print on the reading card, which is equivalent
to contract-size print.”

Wonderful Feeling

Immediately after getting the LipiFlow treatment, Diana’s eyes started feeling better little by little. Then, all of a sudden, she realized a burst of relief. She was amazed by the experience and by the treatment’s ultimate results.
“My eyes feel wonderful,” she marvels. “Dr. Salinger always asks me how I’m doing on a scale of one to ten, with ten being the best. When I last saw him, I said,
Dr. Salinger, you get a ten plus! The difference in my eyes is remarkable.
The comprehensive therapy plan created by Dr. Salinger, which included the LipiFlow procedure, eased the uncomfortable dry eye symptoms Diana suffered. She notes how extensive they were prior to treatment and how much better
they are now.
“The redness I had wasn’t just in the eyes,” she describes. “It was all along the edges, too, but it’s all gone now. The itching, grittiness and feeling of something in my eyes are all gone. I have no symptoms whatsoever since LipiFlow treatment. It’s wonderful.
“I know my vision will improve more after cataract surgery, but I got some improvement since the LipiFlow. Now, my eyes don’t get as tired as they used to when I’m reading or watching television. My vision is better in that respect.”
Like Diana, Bruce has become more independent as a result of Dr. Salinger’s work. He says his vision is better than ever and that he has become virtually glasses free.
“I no longer have to wear glasses or contacts!” Bruce exclaims. “I do wear glasses for reading, but I don’t mind that because my distance vision is excellent. I’m delighted with it now.”
Both Bruce and Diana are grateful to Dr. Salinger and his staff for their successful outcomes. They are also more than pleased with their experiences at The Dry Eye Spa & V.I.P. Laser Eye Center.
“I recommend the LASIK procedure and V.I.P. Laser Eye Center,” enthuses Bruce. “The staff is wonderful. They explain every step they’re doing and the results they’re getting. I’m delighted with the entire process. Dr. Salinger and his staff are just top-shelf, and I’m really pleased with my results.”
As Diana prepares for her cataract surgery, she knows it will go more smoothly now that she’s had her dry eye treated. She’s pleased with the difference the treatment has made in her daily life already.
“With the dry eye, my eyes were uncomfortable all the time; it was a twenty-four-hour thing,” she relates. “Now that I’ve had the LipiFlow with Dr. Salinger at The Dry Eye Spa and V.I.P. Laser Eye Center, it’s a really, really good feeling.”

*Patient’s name was changed to protect her privacy.

Paradise Found

Minimally invasive techniques relieve nagging leg pain.

Health enthusiast Charlene Litwin’s decision to move from Chicago to Florida was based primarily on her desire to be closer to her son, but the opportunity to live under perpetually sunny skies amid picture postcard settings played a part in it as well.

Photo by Nerissa Johnson.

Charlene Litwin

“I love Florida,” Charlene exudes. “I love the climate; I love the palm trees.”
A vitamin consultant and health and wealth coach, Charlene arrived here eight years ago dreaming of daily walks along sun-splashed beaches, but those walks and many of her daily activities were soon hampered by severe leg pain.
“The problem with my legs was going on for quite a while,” Charlene admits. “I was having tremendous pain when I walked. I would get cramping, specifically in the side of my calf on my right leg, as well as some cramping in my left leg.
“The pain was the worst thing because I was used to walking two to three miles; then, all of a sudden, I couldn’t walk. I couldn’t go more than maybe an eighth of a block – a very short distance – and my legs would cramp. I work at a nutrition store and do a lot of walking when I’m working. I had to hold onto a cart for support.”
Charlene also had a few ugly varicose veins in her legs, and experienced some heaviness and swelling, but she was most concerned about the pain and how it restricted her mobility. It wasn’t the external aesthetics Charlene worried about; it was what was going on deep inside her legs that troubled her.
“I went through testing to see if there was any problem with my arterial blood flow, and that was okay,” she reports. “Then, I met a nurse at another physician’s office who was very knowledgeable and told me about Ashton Vein Center. She said they could evaluate my leg situation, so I took her advice and went there for an evaluation.”
Ashton Vein Center is the practice of Thomas Ashton, MD. Dr. Ashton practiced general surgery for 20 years before dedicating himself to the modern evaluation and treatment of venous disorders, which he’s been doing for the past 20 years. During that time, Dr. Ashton has performed more than 10,000 procedures on leg veins.
During his initial examination of Charlene, Dr. Ashton ordered an ultrasound examination of her legs. The results showed the tiny, one-way valves in the leg veins that help move blood out of the legs up toward the heart were not functioning properly. As a result, blood was pooling in Charlene’s legs, causing swelling and pain. This is a condition called venous insufficiency.
The most common sign of venous insufficiency is varicose veins. Other signs and symptoms include swelling, pain, throbbing, stinging, burning, heaviness, nighttime cramps and restless legs. In its later stages, there may be discoloration of the skin around the lower legs or ankles and, eventually, a breakdown of the skin.

Generating Awareness

“Varicose veins and other venous problems in the legs are the most common medical conditions on the planet,” declares Dr. Ashton. “It’s estimated that up to sixty percent of the population will have a vein problem in their legs at some time in their life.
“There are about three hundred and fifty million people in the United States, which means that two hundred and ten million have venous disease. Only a very small fraction of those people, however, are recognized as having the problem.”
Venous insufficiency is under-recognized, underdiagnosed and undertreated, explains Dr. Ashton, who says the absence of treatment can have serious consequences. It is a risk factor for other, dangerous conditions that can cause distressing illness or even death.

“I’m doing fabulously. Shortly after the procedure, I was able to walk three or four times as much as I could before.” – Charlene

“People with venous insufficiency are thirty times more likely to develop a blood clot than people with healthy veins,” asserts the doctor. “That’s a significant risk because blood clots can be fatal.
“People with chronic insufficiency are also much more likely to develop ulcers, or open wounds, around their ankles, especially if the venous insufficiency is left untreated. Ulcers occur when the skin on the legs breaks down. They can become infected, and the infection can spread to other parts of the body.”
To treat leaking veins and prevent these complications, Dr. Ashton and his team at Ashton Vein Center offer a full array of minimally invasive procedures to gently close the leaking veins and divert blood flow to healthy veins. One procedure uses a laser and is called endovenous laser ablation, or EVLA. Another technique uses radiofrequency energy to seal the incompetent veins.
“A newer procedure, called VenaSeal™, uses a biologic adhesive to close the veins,” notes Dr. Ashton. “This technique works like an instantaneous closure. Once we’re done with the procedure, patients can walk right out of the office, and unless they’ve got a great deal of swelling, they don’t even need to wear compression stockings.
“Sometimes, we combine procedures based on the patient’s anatomy. For example, the laser procedure works very well with straight veins, but it’s better to use the VenaSeal on veins that twist and turn. We customize the treatment to fit each patient’s needs.”
After Charlene received clearance from her cardiologist, who did some previous studies on her arterial blood flow, Dr. Ashton proceeded with his treatment, choosing EVLA and VenaSeal to treat Charlene’s venous insufficiency. The procedures were very effective for Charlene, and she’s very excited about their outcome.

Beyond Belief

“I’m doing fabulously,” she raves. “Shortly after the procedure, I was able to walk three or four times as much as I could before. I walked probably a whole block, maybe even more. The treatment was a success beyond belief. I didn’t expect results that quickly. Now, I can walk a couple of blocks, and I walk all over the store for nearly six hours.
“I’m still progressing. Dr. Ashton said it will take at least six months until I fully recover. He closed off the bad vein that was taking away the circulation, so new circulation, called collateral circulation, can flow. That increases each day, so I’m getting better and better every day.”

Photo by Nerissa Johnson.

Charlene was delighted by her experience with Dr. Ashton and his staff.

For Charlene, visiting Ashton Vein Center was a delightful experience. Not only did she achieve great results from her treatment, she also received great customer service from the vein specialist and his staff.
“Dr. Ashton and his team at Ashton Vein Center are wonderful,” Charlene relates. “Dr. Ashton has a great bedside manner, and he explained everything about the procedure to me before he did it. And the procedures they do there are noninvasive.
“Years ago, they weren’t able to do it that way. But Dr. Ashton and his nurse have done so many of these newer procedures that when I had mine done, I felt next to nothing. It was virtually painless. It was just amazing.
“And the procedure helped as far as the appearance of my legs, too. Cosmetically, they certainly are better. But it’s what Dr. Ashton did for my ability to walk that makes me most happy. It’s so wonderful. I’m so grateful.
“I highly recommend them. I have their cards, and if anybody approaches me at work, I always recommend Dr. Ashton and Ashton Vein Center. I couldn’t
possibly think of anybody better.”

Solving Psoriasis

Treating the patient is as important as treating the disease.

Like many other Americans, Elizabeth Roe knows what it’s like to have few resources growing up. As a native Floridian, recreation for her as a kid was going to the beach. Unfortunately, she paid a high price for spending so much time in the sun.

Photo by Nerissa Johnson.

Now that her psoriasis is being managed, Elizabeth feels even better about herself.

“Back then, there wasn’t any sunscreen, and I have very fair skin, so I burned a lot,” she shares. “I got skin cancer from the sun damage.”
It was the skin cancer that first prompted Elizabeth to see Jason L. Welch, MSN, NP-C, a certified nurse practitioner specializing in dermatology. She initially saw Jason when he worked at a dermatology practice in New Smyrna Beach, but she followed him when he left to help start a new practice, Blue Ocean Dermatology, in Port Orange.
“At first, my insurance didn’t cover Jason, so I stayed at the old office and saw the new doctor, but I wasn’t happy,” Elizabeth reports. “At that point, I found out where Jason moved and started to see him even though my insurance didn’t cover it. I liked him that much.”
About ten years ago, Elizabeth began getting the scaly plaques of psoriasis all over her body. Her skin’s reaction to the disorder was intense, uncomfortable and unsightly.
“The psoriasis was awful. I had the scales and plaques pretty much everywhere,” she says. “It got to the point I could barely move my arms; it was like they’d stick to my sides. It was so itchy and painful. It was also ugly and embarrassing, so I tried to cover it. I wore long-sleeved shirts and long pants.
“I was embarrassed to have people look at my skin, and you could tell they were repulsed by the looks on their faces. I felt uncomfortable but didn’t really feel bad about myself or lose confidence.”
Jason first tried treating Elizabeth’s psoriasis with topical creams, but they had limited effect on the condition. He then opted to treat her with an injectable biologic, a medication used to treat moderate to severe psoriasis.
“I was confident Jason would find a treatment that worked for me if he just kept trying,” states Elizabeth. “I trusted him to come up with something, and the biologic totally cleared up my psoriasis.”

Late Onset

Psoriasis is an autoimmune condition caused by the abnormal functioning of the body’s immune system. Skin symptoms occur when the immune system becomes overactive and begins generating immature skin cells that start piling up on each other, creating scales and plaques that are dry, itchy, and can be unsightly.
When psoriasis affects large portions of the visible skin, sufferers may become very self-conscious of their appearance. Like Elizabeth, they might wear clothes to try to hide their skin. In some cases, psoriasis that is very visible, such as on the face, can lead to serious self-image and emotional problems.
“Sometimes, people develop a negative body image and low self-esteem because of the visual disturbances caused by psoriasis,” cautions Jason. “Some people even become depressed. They start withdrawing from social contact because they don’t want others to see their skin.

“I didn’t feel bad about myself because of the psoriasis, but now that I look better, I feel even better about myself.” – Elizabeth

“Another problem with psoriasis is that people can go most of their lives without symptoms and then, all of a sudden, when they’re thirty-five or forty, they start developing it. If they have jobs that frequently put them in front of other people, the appearance of the scales can be devastating.
“People need to know that dermatologists can get psoriasis identified and under control.”
At Blue Ocean Dermatology, the skin specialists have many treatment tools for psoriasis at their disposal. They have one of the area’s only specialty lasers for treating the disorder. The laser is especially useful for the condition affecting the scalp, where it’s difficult to affectively target steroid creams.
“We also have a narrowband UVB light box that’s effective for psoriasis,” notes Jason. “In addition, our staff has expertise in the many biologics, and we stay on top of the literatures and the current best practices for treating psoriasis.”

Perfect Situation

As it turned out, following Jason to Blue Ocean Dermatology was an extremely fortunate decision for Elizabeth. When topical psoriasis treatments failed, Jason found a treatment that was effective on her symptoms. She is very pleased with her outcome.
“Since I started the biologic, my situation is perfect,” raves Elizabeth. “My skin is completely clear now. And with the psoriasis cleared up, I feel better because it doesn’t hurt anymore.”
Being without the pain and itchiness is just part of the excellent results Elizabeth achieved. She is also happy to once again have skin that looks healthy. She’s grateful to Jason and his staff.
“I didn’t feel bad about myself because of the psoriasis, but now that I look better, I feel even better about myself,” she relates. “I don’t have to worry about how people are going to react to seeing my skin. I don’t have to hide it, which makes things a lot easier for me.
“Jason is very concerned about his patients,” she adds. “I followed him because I trusted him. The staff is fantastic. Everyone in that office is great. They’re very kind and welcoming. I recommend Jason and Blue Ocean Dermatology to everyone.”

Tailored Physical Therapy

Individualized rehab regimen results in full recovery from joint replacement surgery.

Doug Wigley, 64, remains active professionally in the real-estate and property management field. He’s active physically as well. He likes outdoor activities, such as golfing, snow-skiing and boating. Doug’s age and demanding activities assisted in the development of arthritis in many of his joints. Some required surgical intervention.
“At one point, my right knee became very painful,” he shares. “It was very arthritic, and I dealt with a lot of pain for a long time. I was constantly taking Aleve® and Tylenol® just to get through the day. My knee pain began limiting my activities. I knew I had to have my knee done. I put off surgery for as long as I could, but in May 2017, I had my knee replaced.”

Photo by Nerissa Johnson.

Outside of dunking a basketball, there is nothing Doug can’t do since undergoing therapy.

After total knee replacement surgery, Doug began his rehabilitation with physical therapy at home. When it was time to find a physical therapy center for outpatient rehab, he had no doubt about where he would go. He chose Barr & Associates Physical Therapy because of a loved one’s prior excellent experience with them.
“I have a loved one who pitched for the Seabreeze High School baseball team, and he had a shoulder injury prior to the start of the 2014 season,” explains Doug. “The folks at Barr and Associates Physical Therapy were able to rehab him to the point where he was selected MVP for the baseball team that year. And he didn’t have to have surgery.
“My loved one had great success at Barr and Associates Physical Therapy, so it was a no-brainer for me to go there after my knee surgery. And it couldn’t have gone better.”
The physical therapists at Barr & Associates Physical Therapy developed an individualized treatment plan designed to not only improve the mobility of Doug’s new knee, but return him to the activities he loves. With that goal in mind, Doug was motivated to fully participate in his therapy. It paid off for him.
“Six months after my knee was replaced, and with Barr and Associates Physical Therapy’s help, I went snow-skiing in Colorado,” he reports. “I was also back on the golf course and back to swimming and boating. I knew getting the knee done would take away the arthritis pain, but there was no guarantee on mobility. I really had to follow the physical therapist’s instructions to get that.”
Just as Doug was enjoying his pain-free and mobile new knee, his right hip began giving him trouble. He blamed his hip problem on the fact that he’d become active again following his knee surgery. Doug’s hip pain was so severe, he couldn’t put off surgery like he did with his knee. His doctor told him he needed a hip replacement immediately.
“I had stabbing, agonizing hip pain,” Doug describes. “Just getting out of a seat was agony. They did an MRI at the hospital that showed my hip was full of arthritis and told me it had to be replaced right away.
“The hip surgery was at the end of April of this year. I didn’t do any in-home physical therapy this time. I went straight to Barr and Associates Physical Therapy after my surgery. It was the same situation as with my knee. I started rehab around the first of May, and on May eleventh, I danced at my niece’s wedding.”

Individualized Therapy

The therapists at Barr & Associates Physical Therapy recognize that each person who walks through their door is different. They each have their own impairments, needs and goals for rehab. During a lengthy evaluation, the therapists take time to learn those facts so they can tailor individualized treatment plans.
“The evaluations are critical for determining what the patients want from their therapy,” notes Jacob Barr, DPT, at Barr & Associates Physical Therapy. “Some may want to go back to playing golf or other activities. We must take everybody’s situation into account.
“With knee and hip replacements, we generally begin treatment by getting back as much range of motion as we can. We use many hands-on techniques, or manual therapy, such as massage and passive range of motion to get the joints moving again.”

I constantly recommend Barr and Associates Physical Therapy to people. My advice to them is: Just go.” – Doug

Patients often arrive at Barr & Associates Physical Therapy using walkers or canes. The therapists want the patients to progress to walking without those devices as quickly and safely as possible. They use exercises and techniques that focus on the patient’s gait and balance.
“Based on the patient’s impairments and limitations, we use basic strengthening exercises,” relates Dr. Barr. “We also teach them a home exercise program to improve their strength and range of motion. As they progress, we may assist their rehab with some of the equipment we have.
“We have parallel bars, and if their balance is off, we have a special machine for working on balance. With many patients, they’re learning to walk all over again. We might use our antigravity treadmill, which uses air pressure to unweight the patients so we can do gait training with them.”
If the patients are experiencing a lot of pain, the therapists have various treatments to decrease it. These include laser therapy, electrical stimulation and kinesio taping.
“It starts with determining the patient’s goals,” states Dr. Barr. “If they have activities they want to return to doing, they generally get more involved. They want to work on their rehab and achieve those goals. The therapists get them actively involved and keep them motivated. That’s what happened with Doug, and he got excellent results.”

Twice Is Nice

Arthritis twice forced Doug to have joints replaced, and twice he chose Barr & Associates Physical Therapy for his rehab. Due to the dedication of the physical therapists and their ability to keep Doug motivated, he’s able to do more than he ever thought possible after two total joint replacement surgeries.
“I’m beyond my goal after my hip surgery, and I’m so happy,” he marvels. “I would have been happy just to be pain free, but I’m way beyond that. I’m doing cardio. I’m biking. I just couldn’t be happier.
“I can do my activities, thanks to the physical therapy I got at Barr and Associates Physical Therapy and the exercises they gave me to do. I continue with the exercises, and now, I’m completely pain free in my right hip, and my right knee as well.”
It’s not just the physical therapists at Barr & Associates Physical Therapy that Doug admires. He has high praise for everyone at the practice.
“The people there are pleasant, professional and organized,” Doug offers. “They’re on time. You start right away, and you get your full session. They answer any questions you have, and they’re very attentive.”
Being pain free has Doug feeling great. He’s also pretty pleased to participate in his favorite activities again. He really put his new joints to the test when shortly after his hip rehab, he and his family took a trip to Ireland. Doug successfully walked across the country sightseeing with no trouble from his hip or knee. He takes his good fortune in stride.
“There’s nothing I can’t do now,” he boasts. “To be honest, I still can’t dunk a basketball, but I never could. I constantly recommend Barr and Associates Physical Therapy to people. My advice to them is: Just go.

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