Author Archive

Retina Insight

Understanding some common disorders of the eye’s principal part.

Dr. Patel

He admits he might be biased, but to Nandesh N. Patel, MD, the retina is the most important part of the eye. The retina is a thin layer of specialized tissue that lines the back of the eye. It senses light as it enters the eye and sends it to the brain to process as images.

Dr. Patel is a board-certified ophthalmologist and fellowship-trained retina surgeon at Florida Eye Specialists & Cataract Institute. To him, the retina is unlike any other part of the body. He sees it as a rare, privileged site that merits special care.

“Think of the eyeball as a camera,” he describes. “There are two crucial elements: the lens to focus the light and the film to register the light that enters. The retina is the film. Any disease that compromises the quality of the film creates problems with the pictures processed by the eye, resulting in a reduction of vision.

“The retina is a critical structure and, as I tell my patients, with every body part there’s a disorder to go with it. Unfortunately, there are many disorders that affect the retina.”

The most common disorders are diabetic retinopathy and macular degeneration, the leading causes of blindness in adults.

Dr. Patel and his colleagues, board-certified ophthalmologists and fellowship-trained retina specialists Evan N. Dunn, MD, Marguerite Kohlhepp, MD, and Dan P. Montzka, MD, have expertise in treating these diseases and more.

Glucose Concerns

According to the Centers for Disease Control and Prevention, about 34.2 million people in the United States – just over 1 in 10 – have diabetes. Type 2 diabetes, which accounts for 90 to 95 percent of all diabetes cases, is the leading cause of blindness among ages 20 to 74 due to diabetic retinopathy.

Diabetic retinopathy is the most common eye disease associated with diabetes. It is caused by changes in the blood vessels of the retina. In some cases, abnormal blood vessels develop on the surface of the retina. In others, blood vessels begin to bleed or leak fluid.

“Anyone who has diabetes is at risk for developing diabetic retinopathy,” Dr. Dunn stresses. “And the risk increases with the duration of having the disease. The main reason: High glucose levels affect the blood vessels and make them unhealthy.

“Diabetic retinopathy generally has no symptoms in its early stages, so screening and early diagnosis are of incredible importance. We have treatments that will overturn poor visual outcomes, but they require early detection.”

There are two main types of diabetic retinopathy, nonproliferative and proliferative.

“The nonproliferative type is an early stage of diabetic retinopathy characterized by small outpouchings of normal blood vessels called microaneurysms and tiny areas of bleeding within the retina,” Dr. Dunn explains.

“These retinal changes may progress to a much more serious type of diabetic retinopathy that, if left untreated, may cause permanent vision loss. We monitor patients with this condition routinely to make sure that if worsening occurs we can treat it before the patients lose vision.”

Nonproliferative is the more manageable form of diabetic retinopathy, he adds.

“If a patient works to control the underlying diabetes with a primary care physician, then it’s possible to reverse some of the findings,” Dr. Dunn states.

With proliferative diabetic retinopathy, the patient experiences an advanced form of the disease marked by an extensive closure of retinal blood vessels. As a result, the retina begins to grow new, leaky blood vessels in an effort to resupply blood to the area where the original blood vessels closed. Partial or total vision loss may occur.

“Unfortunately, these new vessels are abnormal and are not able to supply the retina with normal blood flow,” Dr. Dunn informs. “Instead, fluid leaks into the vitreous, the gel that lies in front of the retina and behind the eye’s lens, causing a vitreous hemorrhage. Small scars also begin to develop on the retina and the vitreous, causing the retina to pull away from the back of the eyeball, resulting in a retinal tear or retinal detachment.

“Once you get into the proliferative states, aggressive treatment is necessary. Some patients will undergo regular treatments such as laser therapy, monthly injections of medication directly into the eye or, in extreme cases, surgery.”

The CDC reports that early detection and treatment of diabetic retinopathy can reduce the development of severe vision loss by an estimated 50 to 60 percent.

“Early detection and treatment are crucial to preventing vision loss,” Dr. Dunn confirms. “Generally, diabetic retinopathy does not exhibit any symptoms during its early stages. Sometimes, a change in eyesight does not occur until the disease has progressed. Proper monitoring of the eyes is the best prevention for diabetic retinopathy.”

Macular Degeneration

Another serious threat to sight as people age is macular degeneration. It occurs when a central area of the retina, called the macula, deteriorates and main images become less discernible.

“Think of the retina as being 10 layers thick with many blood vessels nourishing it,” Dr. Montzka describes. “Macular degeneration is a disease in which some of those layers essentially become diseased and waste away. As a consequence, some of the blood vessels pop and leak. The first situation, where the layers waste away, is what we consider dry macular degeneration. When blood vessels start popping and leaking, that’s wet macular degeneration. This type does considerable damage that translates into poor vision.”

Dry macular degeneration accounts for approximately 90 percent of cases.

Macular degeneration is more common in people 55 and older. Because it occurs so often as you age, it is also called age-related macular degeneration, or AMD.

Macular degeneration generally has no signs or symptoms in its early stages.

“Macular degeneration progresses like a slow-moving conveyor belt,” Dr. Montzka notes. “Every case of wet macular degeneration was at one time the dry form. Patients may have had the dry form for a long time without being aware of it. They are often shocked by the diagnosis because they had no corresponding symptoms.”

When there are symptoms, people might notice a gradual loss of their ability to see objects clearly, especially noticing a blurring of areas of type on a page of print, or dark or empty spaces that may block the center of their field of vision.

Some patients may notice that straight lines in the landscape – such as telephone poles, the sides of buildings or streetlight posts – appear wavy, crooked or distorted. Some may notice the need for brighter light when reading or a gradual loss of color intensity.

“For intermediate-level dry macular degeneration, specific vitamin supplements can help slow down the conveyor belt,” Dr. Montzka reports. “They don’t halt progression of the disease and they certainly don’t reverse it. But they can buy the patients more time. For example, if they would normally turn wet in five years, this treatment may give them 10 to 15 years, which is substantial.

Amsler Grid – Click for complete directions on how it works

“With the wet form, which is an end stage of the disease, we have a variety of medications that are injected directly into the eye on a monthly basis. These can help contain the amount of leakage and bleeding and can often result in a stabilization of the eye, but not improvement.”

Patients with macular degeneration should monitor their vision daily with a tool called an Amsler grid and notify their eye doctors about any changes as soon as possible.

An Amsler grid consists of a network of horizontal and vertical lines with a dot in the center. People look at the grid intently. If the lines begin to look wavy or distorted, or if there are areas missing, the individual’s macular degeneration may be progressing.

Surgical Situations

The retina specialists at Florida Eye Specialists & Cataract Institute treat medical and surgical retinal disorders. Diabetic retinopathy and macular degeneration are examples of medical retinal disorders. Retinal vein occlusion is another.

“A retinal vein occlusion is a blockage of a vein in the retina,” Dr. Patel describes. “This can lead to bleeding and leaking of fluid into the eye and interrupted blood flow to nerve tissue, which can then lead to a loss of vision. Without immediate medical intervention, a retinal vein occlusion can cause permanent vision loss.”

The blockage may be caused by a blood clot, or the walls of the blood vessel may be too narrow. Vein occlusions are more common in people who have diabetes, high blood pressure, high cholesterol and other health problems that also affect blood vessels. The most common treatment for a retinal vein occlusion is injection of a medication into the eye.

“Of the surgical disorders, some of the more common are retinal tears and retinal detachments,” Dr. Patel states.

Katherine Lachut, Virginia Commonwealth University Ophthalmology

Retinal image of macular pucker

Other disorders include macular puckers and macular holes.

“Macular puckers and macular holes are not as catastrophic as retinal detachments or vitreous hemorrhages, where there’s a complete loss of vision that evolves quickly, sometimes within hours or days,” he says. “Macular puckers and macular holes are conditions that come on somewhat slowly and involve a disruption in the normal architecture of the macula.”

If a person develops a macular hole, then all of a sudden, they have a hole in the middle of their vision and they literally don’t see anything. There’s a blank spot dead center, which is very discomforting for the patient.

“The macular pucker is like scar tissue that develops on the macula and creates wrinkles,” Dr. Patel remarks. “This is due to the normal aging process. A wrinkled macula will make images appear wrinkled or distorted. Straight lines that look wavy is a common descriptor that naturally has repercussions if you are driving and want to stay within the lines.”

Macular puckers and macular holes can be corrected during a same-day surgical procedure called a vitrectomy. During a vitrectomy, the vitreous gel between the lens and retina is removed and replaced with a bubble of gas or air. Over a short time, the bubble will help to smooth out the retina and close the hole.

“We suspect a retinal tear as soon as we hear a patient report flashing lights or floaters, which are common complaints,” Dr. Patel relates. “Flashing lights and floaters can be due to normal changes of the eye, but one of five who presents with those symptoms will likely have a retinal tear to explain them.”

A retinal tear is a consequence of a normal, age-related process in which the vitreous is liquefied but inadvertently pulls at the retina. If a retinal tear occurs, it is critical that it is treated right away. If not, it can develop into a retinal detachment.

“The big, gaping hole in the retina allows fluid to pass through it,” Dr. Patel educates. “You find the fluid on the undersurface of the proverbial wallpaper, and the next thing you know, the wallpaper is falling off of the wall, and that’s a retinal detachment.”

Retinal tears are typically treated using a laser or freezing procedure. Retinal detachments are treated using vitrectomy.

Future Solutions

In 2021, Florida Eye Specialists & Cataract Institute expects to receive FDA approval for a treatment method for macular degeneration: an implanted delivery system for anti-vascular endothelial growth factor medications. Anti-VEGF medications help to halt the blood vessel growth characteristic of wet macular degeneration.

Dr. Kohlhepp

“The new treatment involves implanting a port into the eye to deliver the anti-VEGF medications, which we currently inject into the eye monthly,” Dr. Kohlhepp describes. “Having this implant system will decrease the number of appointments and injections that patients require. It will also enable the anti-VEGF medications to be released at a constant, low level over multiple months.”

It is projected that once the port is implanted, patients will return to Florida Eye Specialists & Cataract Institute every six months instead of monthly. At these six-month appointments, the patient’s port will be refilled with anti-VEGF medication.

“Also on the horizon is gene therapy for macular degeneration,” Dr. Kohlhepp states. “The principle behind gene therapy is to place genetic material into the eye to correct a genetic disease or deliver a gene that allows the body to produce a therapeutic protein that can treat a specific eye disease.

“We are currently using gene therapy for certain inherited retinal diseases. It has been proven safe and effective for diseases such as Lebers congenital amaurosis and retinitis pigmentosa. Trials are ongoing to develop gene therapy for macular degeneration.

For macular degeneration, gene therapy will enable the body to produce the therapeutic protein that inhibits VEGF.

“The protein will work similarly to the anti-VEGF medications Avastin, Lucentis and Eylea, which inhibit VEGF when they are injected into the eye,” Dr. Kohlhepp explains.

Most likely, gene therapy for macular degeneration will be administered in the office through injections, but will not require monthly injections.

© FHCN article by Patti DiPanfilo. FHCN file photos. mkb

Long-Distance Dentistry

New upper, lower dentures produce a smile that’s worth the drive.

As a high schooler, Doris Atkins prepared herself for the workforce by taking a variety of general business courses. At every turn during her career, however, employers steered her in one direction.

“When I got out of high school and went to work, I became a bookkeeper,” Doris, 83, remembers. “As I went into each job, they pushed me into bookkeeping and I just went along with it and stayed with it over the years.

“Up north, I worked for St. Christopher Hospital in Philadelphia and in private industry. We didn’t have computers then. We worked with ledgers and everything was entered manually. Still, it was a good job.”

Doris’ husband had a long career in law enforcement. He served on the highway patrol with the Philadelphia police for many years. Following his retirement in 1982, the couple relocated to Florida and bought a home in Venice.

“After we moved to Florida, I got a job with a home builder,” Doris recounts. “I worked for them full time for a while and eventually retired myself. About seven years ago, I sold my home because it was just too big for me. It had a pool and a lot of property, so I moved to Bradenton to live with my daughter and son-in-law. But I liked living in Venice. It was a great town.”

Doris still likes Venice, so much so that she recently returned to the seaside city to find a dentist to solve an ongoing issue with her teeth. Her problem involved existing dental work, which was failing and required replacement.

“I had a partial on the bottom for years, but it wore down the teeth it hooked onto,” Doris describes. “I was very self-conscious about that partial. I wouldn’t go anywhere without it. I had a full plate on the top as well, but it was old and cracked. Still, I wouldn’t go anywhere without my teeth.
“Finally, I visited two dentists. I went to one dentist further down in Venice and got an estimate. Then, I went to Dr. Gaukhman, and he took very good care of me.”

Alexander Gaukhman, DMD, is a general, cosmetic and emergency dentist at Venetian Dental, which has offices in Sarasota, Venice and Osprey. Dr. Gaukhman evaluated Doris’ dental situation and determined that she needed all new upper and lower dentures.

“The teeth that Doris had left on her bottom jaw were decayed and affected by periodontal disease and could not be saved,” Dr. Gaukhman recalls. “Another partial was not an option because there would be no teeth left on which to attach it.

“My dentures look really good. Nobody knows that my teeth are dentures.” – Doris

“So we agreed that we should extract all of her remaining lower teeth and create a lower denture for her. At the same time, we created a new upper denture for her as well because her existing upper denture was old and worn and needed to be replaced.”

Screw-Like Security

In general, upper dentures fit securely in the mouth because the palate creates sufficient suction to hold the appliance in place. That was the case with Doris. The new upper denture Dr. Gaukhman made for her fits perfectly and does not wobble or move.

“Lower dentures are often difficult to stabilize because the lower jaw is not designed for dentures,” the dentist observes. “There’s no palate due to the location of the tongue, and because of that less suction is produced. As a result, lower dentures tend to slip and slide.

“It’s rare when people can wear lower dentures that don’t bother them or stay tight without help. That’s why securing a lower denture with dental implants is the most effective way to stabilize it and why I recommended two implants to secure Doris’ lower denture.”

Dental implants are screw-like posts that are surgically placed into the jawbone to serve as the foundation for replacement teeth, such as crowns and dentures. When secured by implants, dentures don’t slip or move; they stay in place when people speak and eat. There are other advantages of implant dentures over traditional dentures, Dr. Gaukhman notes.

“Implant dentures provide added strength for biting and chewing,” he elaborates. “And because the dentures are stable, the patient experiences better speech, better aesthetics and greater self-confidence. They do not have to worry that the denture will come out during dinner, conversation or activity.”

For patients who still have their natural teeth, Dr. Gaukhman can place the implants on the day he extracts the teeth. In most cases, temporary dentures are also created at that time in Venetian Dental’s on-site laboratory.

“Typically, once the patient’s problem is diagnosed and the treatment is determined, impressions are taken of the teeth,” Dr. Gaukhman explains. “When the dentures are ready, which is usually the same day or the next day, the teeth are extracted and the dentures are placed right away. When done this way, the dentures serve as a bandage to minimize swelling and bleeding.

“For the next three to six months following that procedure, the patient wears temporary dentures until the implants fuse with the jawbone and the gums heal. Then the temporary dentures are replaced with the permanent appliances.”

Aim for Excellence

It’s been almost 13 years since Doris received her new traditional upper denture and lower implant denture from Dr. Gaukhman. She is still pleased with their look and feel.

“Dr. Gaukhman did a great job because my dentures look really good,” Doris raves. “Nobody knows that they’re not real teeth. I have no complaints at all. My denture on the top stays put, and my lower denture doesn’t move because of the implants.

Dr. Gaukhman used two implants, and when I put in my denture it snaps right in place. It doesn’t go anywhere.”

Doris had been very uncomfortable about her smile, even with dentists, but she found a provider she trusted completely in Dr. Gaukhman.

Lower denture with dental implants.

“I used to be very self-conscious when I sat in a dental chair,” Doris reminisces. “I would put my hand over my mouth – and those were dentists looking at me! But I’m very comfortable with Dr. Gaukhman. I’m so comfortable that I gladly drive from Bradenton all the way to Venice, which takes an hour and 15 minutes, just to see him. I do that because he’s so personable, kind and caring.

“He knows what he’s doing and makes me feel at ease. He works with me and does a very good job. I praise him for that. And his staff is excellent. They’re very nice and good at what they do. They’re also very accommodating and want to please you.

“If you call the office, you don’t have to wait to get an appointment. They get you in right away. But they don’t rush you; they want you to be comfortable. That’s their aim. I have no idea why anybody would want to go anyplace other than Venetian Dental.”

© FHCN article by Patti DiPanfilo.

A Brief Overview of COVID-19 Testing

January 18th, 2021

As the number of COVID-19 cases in this country continues to surge, there has been a rush of Americans seeking to get tested for the coronavirus that causes it. If you’re considering testing but are confused about the various types of tests and what they do and when to get them, here’s a brief overview that might help.

The first thing you need to understand is that there are different types of tests that are used at different times. Certain tests are used to detect if you are currently infected with SARS-Cov-2, the virus that causes COVID-19, and there are different tests that can determine if you’ve already had the virus.

If you want to know if you are currently infected, there are two types of tests: molecular tests and antigen tests. Molecular tests are typically performed using nasal swabs or throat swabs, but some test saliva or another bodily fluid. Molecular tests look for genetic material that can only come from the virus, which will be present if you are infected.

Antigen tests, which are done using nasal or throat swabs, identify antigens from the virus. Antigens are protein fragments that initiate an allergic response in the body. Antigen tests are more likely to miss an active COVID-19 infection compared to molecular tests. It may be recommended that you get a molecular test if your antigen test is negative but you have COVID-19 symptoms, which include cough, shortness of breath and fever.

You can get these tests from your doctor or state or local health department. Most states have set up testing centers throughout the community to provide easy access for residents. Many centers offer the rapid COVID-19 test, which is an antigen test that provides results the same day as opposed to the 3-5 day wait time for most nasal swab tests. The FDA has also approved a COVID-19 home testing kit.

On the other hand, antibody tests look for antibodies to the virus in your blood, which may indicate that you’ve previously been infected by the coronavirus. Antibodies are proteins made by the immune system that help fight foreign invaders such as viruses. They may help ward off future attacks by the viruses and keep you from getting the diseases they cause a second time.

Unfortunately, researchers are uncertain about how much immunity antibodies to the coronavirus provide against getting COVID-19 again. Research suggests that coronavirus antibody levels may wane over just a few months. Confirmed and suspected cases of reinfection have been reported, but remain rare. Researchers are working to better understand this phenomenon.

Antibody tests are not a good way to determine if you are currently infected with the coronavirus because it can take 1-3 weeks after infection for your body to make antibodies. You may test negative but have an infection in its early stages. Further, you can test positive for antibodies even if you had an asymptomatic infection.

Antibody tests are available through your doctor or a verified laboratory. Typically, results are available within a few days.

The tests for COVID-19 are new and it’s unclear how accurate they really are because there are no “gold standard” tests to compare them to. In addition, these tests were made available by Emergency Use Authorization by the FDA. Under an EUA, the makers were permitted to market the tests even though they didn’t receive formal approval due to a public health emergency.

Studies show that the rate of false negative results with molecular tests vary depending on how long the infection has been present but ranged from 20 percent when testing was performed five days after symptoms began to up to 100 percent when testing was done earlier in the infection. False negatives are more common with antigen tests, which is why they are not favored by the FDA as a single-use test for active infection.

The reported rate of false negatives with antibody tests ranges from 0 to 30 percent depending on the research study and when in the course of the infection the test was done. Having an antibody test too soon after infection can lead to false negative results.

Most people who develop COVID-19 have a relatively mild form of the disease and don’t need any special treatment or hospitalization. In addition to symptoms of fever, cough and shortness of breath, they may also experience a sore throat and tiredness that may last one to two weeks. Other people who are infected may be asymptomatic.

But for some people, COVID-19 is a severe illness that requires hospitalization, sometimes in an intensive care or special COVID unit. The risk for this is higher for people who are older and have chronic health conditions such as diabetes.

Whether you test positive or negative for the coronavirus, take steps to protect yourself and others. Wash your hands often, avoid close contact with others, cover your mouth and nose with a mask when around others, cover coughs and sneezes, clean and disinfect, and monitor your health daily. And follow CDC guidelines if symptoms develop.

Healing Power Of O2

Pressure increases oxygen level in blood, accelerating wound healing.

In the early 1970s, Joseph* graduated from a St. Johns County community college, which he attended on an art scholarship. In 1976, he joined the Army. There weren’t many jobs for an artist in the Army, so he took his career in a different direction.

Dr. Milanick, left, and Mitch reveal the hyperbaric chambers
they use at Hyperbaric Health Services.

“It was right after Vietnam,” Joseph, 64, remembers. “I didn’t want to sleep in a hole or get shot at, but I wanted to get the GI Bill so I could go back to school. There was nothing available with my art degree, so I became a corpsman and served in a hospital as an eye specialist. And I was good at it.

“After the Army, I worked as an aide for a while and then returned to school and became an LPN [licensed practical nurse]. I went to work on the medical floor at a hospital in Palatka, where I did all manner of tasks. Over the years, I’ve worked with children as well as geriatric patients.”

But the Florida native was forced to give up his LPN duties early this year when a wound spontaneously erupted on his left leg and would not heal. Initially, Joseph treated the open wound himself, but eventually it became so problematic that he consulted his primary care provider.

“There was an ulcer on my left shin caused by bad circulation in my leg,” Joseph confirms. “It was oval-shaped and about 4½ to 5 inches wide. It caused a burning sensation, like nerve pain, but because there was no circulation down there, I really didn’t feel it that much. I bandaged the wound myself but it didn’t get any better, so I went to my doctor.

“My doctor ordered x-rays and other tests to make sure there wasn’t an infection in my bone. I went to a hospital for wound care with antibiotics for a long time, and the ulcer still didn’t heal. After that, I saw a cardiologist, who performed an arteriogram and ablation and inserted a stent to hold open the artery in my leg.”

When the wound continued to fester despite these treatments, his primary care provider referred him to Hyperbaric Health Services in Palatka. That’s where he met with S. Mitchell “Mitch” Hall, CHS, a certified hyperbaric specialist, who recommended treating Joseph’s leg through a comprehensive wound care regimen that included hyperbaric oxygen therapy.

“Upon first examining Joseph’s wound, I recognized immediately that it was compromised of oxygen,” Mitch reports. “I felt certain that by combining hyperbaric oxygen therapy – which uses 100 percent oxygen under pressure – with our advanced wound care techniques, we would be able to heal his wound in a relatively short time.”

Reversing Hypoxia

Oxygen is the primary converter of fuel for the body’s cells, which is why it is imperative that cells have a sufficient amount. Cells compromised of oxygen cannot function and will either go dormant or die, a condition called hypoxia. An area of compromised cells is a wound. To heal, wounds need a steady flow of oxygen.

“We carry oxygen around our bodies via hemoglobin attached to our red blood cells,” Mitch describes. “But hemoglobin is limited. It can carry only up to four molecules of oxygen, and once it’s full, it’s full. It doesn’t matter how much oxygen you breathe on the surface, you’re not going to get any more oxygen than that.

“Hyperbaric oxygen therapy shrinks the volume of gas containing oxygen molecules. Additionally, the added pressure causes saturation of the blood plasma, which can then carry the oxygen molecules in a much greater volume. Through this process, we get up to 1,200 times the amount of oxygen into the blood plasma and, as a result, into your body to heal your wounds.”

This increase in oxygen immediately sparks a reversal of the hypoxia. The process also acts on the individual’s DNA, which is present on thousands of genes that have roles in the healing process.

“The increased pressure induces the development of new blood vessels in a process known as angiogenesis,” Mitch explains. “The new blood vessels allow for more blood flow to the compromised area, so even when you’re not under pressure in the hyperbaric chamber, you’re experiencing additional blood flow to your wound. That reduces inflammation and promotes collagen, bone and cartilage repair by mobilizing stem cells.”

Hyperbaric oxygen therapy is an adjunct to the advanced wound care techniques used at Hyperbaric Health Services. These techniques include debridement of the wound, regularly removing nonviable tissue so that viable tissue can flourish.

“We offer patients a variety of biologic modalities and various forms of biological and surgical debridement,” Mitch relates. “We use select dressings and, in some cases, what’s called a wound VAC, or negative pressure therapy. During this treatment, we place a patch attached to a small battery-operated pump over the wound, which causes a slight negative pressure that draws out the nonviable fluids and encourages the bed of the wound to grow.

“In addition, we use the latest technology in artificial and biological skin grafting. We perform DNA sequencing on wound cultures to find the specific bacteria DNA that make a wound unique. And knowing that, we can target the wound with the proper antibiotics. When we add hyperbaric oxygen therapy, it’s very effective wound healing.”

Heartfelt Approval

Joseph completed 30 hyperbaric oxygen therapy sessions over a 90-day period. During that period, the open wound on his leg started to heal. The ulcer isn’t totally gone yet, but Mitch and his team have made steady progress toward that goal.

“During the procedure, they started by putting me in this big acrylic tube, and then they changed the pressure,” Joseph recalls. “It’s like being in a submarine, and they pump the tube full of 100 percent oxygen, which gets down into the wound and helps it heal. And it works; it just takes time. It’s not like Star Trek. You can’t just wave a wand over the wound and make it better. Rather, it’s a slow process. The staff explained how the nature of some wounds, like those from bad circulation, makes them slower to heal. But after about a month and a half, I could see a difference.

“Today, my wound is still there, but it’s much better. It’s shrunk to about a third of the size it was. The burning nerve pain is better as well. I’m still receiving wound care at Hyperbaric Health Services once a week. Hyperbaric oxygen therapy is just one part of its entire wound care strategy.”

“By using the combination approach with Joseph, we were able to get his wound under control in three months, compared to the many months he spent trying to treat it with other therapies,” Mitch reports. “He is receiving regular maintenance on his wound currently.”

As Joseph continues to be treated at Hyperbaric Health Services, he emphasizes how positive his experience with them was.

“I’m very satisfied with the folks at Hyperbaric Health Services,” he says. “Everybody there is great, and they treat me like family. They’re highly professional and totally above board. I definitely recommend them and already have. I’d recommend them to my family!”

*Patient’s name changed at his request.

Raise Your Glaucoma IQ

January 11th, 2021

Glaucoma is a group of progressive diseases that can damage your eye’s optic nerve and cause vision loss, even blindness. There are many theories, but the exact cause of glaucoma is unknown. It is most often related to a build-up of pressure inside your eye. When this pressure, called intraocular pressure, or IOP, remains high over time, it begins to harm optic nerve fibers.

IOP increases when the fluid inside your eye, called aqueous humor, which normally flows out of your eye through a mesh-like drainage channel called the trabecular meshwork, gets blocked and cannot leave the eye. As a result, the fluid builds up and IOP increases. In some case, however, glaucoma can occur in people who have normal IOP.

Another theory suggests that glaucoma is caused by an inadequate amount of blood flow to the optic nerve.

About 3 million Americans have glaucoma. It’s expensive and damaging to vision. It costs the US economy $286 billion every year in direct costs and productivity loses, and it’s the leading cause of irreversible blindness in the world.

There are two main types of glaucoma: open-angle glaucoma and angle-closure glaucoma.

Open angle glaucoma is the most common type, affecting approximately 95 percent of patients. In this type of glaucoma, fluid does not drain properly due to changes in and along the drainage passageway. There are typically no early symptoms of open-angle glaucoma, so you can have it for years and not know it. It is often called “the silent thief of sight.”

With angle-closure glaucoma, your eye doesn’t drain like it’s supposed to because the drain space, or angle, which is located between your iris and cornea, becomes too narrow and can become blocked. This can occur suddenly, which is called acute angle-closure glaucoma, or over time, called chronic angle-closure glaucoma.

Anyone can develop glaucoma, but there are certain factors that increase your risk for developing it. You are more likely to get it if you are over age 40, have a family history of glaucoma, have diabetes, take certain steroid medications such as prednisone, have had an injury to your eyes, have high eye pressure, or are nearsighted or farsighted. There are other risk factors as well.

Glaucoma-related damage to the optic nerve generally starts with a loss of nerve tissue in a specific pattern called cupping. This is when the center of the optic disc, called the cup, becomes larger, leaving less room for the remaining optic nerve fibers. It’s common for you to experience blurry spots in your peripheral, or side, vision when this occurs. This is often the first symptom of glaucoma.

As your glaucoma progresses, it may begin to affect your central vision, which is needed to see details and for activities such as driving and reading. Advanced glaucoma can lead to permanent blurred or dimmed vision or even to blindness.

Your eye doctor may use several painless tests to diagnose glaucoma in addition to a dilated eye exam and visual field test. Tonometry measures eye pressure; gonioscopy examines the drainage area of the eye, and optical coherence tomography (OCT) creates a three-dimensional image of the optic nerve and retina to evaluate the degree of cupping and ocular damage.

Glaucoma is treated using medications, laser therapy, and surgery. Medications, which may include eye drops or pills, lower eye pressure by reducing the amount of aqueous humor produced in the eye. They also help increase the outflow of fluid from the eye..

A laser procedure called trabeculoplasty opens clogs in the trabecular meshwork so fluid can drain out of the eye. Laser iridotomy, which is used for angle-closure glaucoma, creates a tiny opening in the iris to allow the drainage angle to open.

During a glaucoma surgery called trabeculectomy, the doctor creates a new channel in your eye to allow the fluid to drain, which eases IOP. Another surgical procedure your doctor may choose involves implanting a tube to help drain fluid from your eye.

Glaucoma treatment cannot restore vision you may have already lost, but it can help prevent any further vision loss.

Because glaucoma has no early symptoms, people at high risk should see their eye doctor for a dilated eye exam and visual field test at least every one to two years or as directed by their doctor. Don’t let glaucoma steal your sight. See your eye doctor today!

Be Aware of Birth Defects

January 6th, 2021

According to the Centers for Disease Control and Prevention, birth defects affect one in every 33 babies born in the US, which is about 3 percent of all babies. The CDC also reports that birth defects are the leading cause of infant death in the US, accounting for 20 percent of all infant deaths. This blog takes a closer look at birth defects and offers a few strategies to prevent them.

A birth defect is a problem that forms when a baby is developing in the womb, so it is present at birth. Every 4½ minutes, a baby is born with a birth defect in the US. A birth defect can affect how the baby’s body looks, works, or both. Some birth defects are relatively harmless and require little or no treatment. Others require immediate surgery and a lifetime of care.

The March of Dimes notes that birth defects can occur at any time during a woman’s pregnancy, but most happen during the first three months, or the first trimester. During that time, the baby’s organs are developing. But birth defects can occur later in pregnancy as well as the organs continue to grow and develop.

In many cases, birth defects are the result of genetics, as mutated genes get passed from the parents to the baby. The mother’s behavior during pregnancy, such as smoking, using illicit drugs, or drinking alcohol; exposure to certain medications or toxic chemicals; having certain types of infections during pregnancy, including sexually transmitted infections; or a combination of these factors, can also lead to birth defects. The cause of some birth defects is unknown.

Being 34 years old or older may put you at an increased risk for having a baby with a birth defect, as can having certain health conditions such as diabetes, high blood pressure and seizure disorders.

Birth defects can be structural or developmental. Structural defects include conditions involving body parts that are missing or malformed. Common structural birth defects include:

Heart defects – The walls, valves, or blood vessels of the heart form abnormally. This affects how well the heart can pump blood through the body.
Cleft lip and cleft palate – If the tissues of the roof of the mouth or lip don’t merge properly during development, an opening or split can result.
Spina bifida – This is a neural tube defect, which involves the brain and spine. With spina bifida, the spine does not form and close properly, affecting the spinal cord and nerves.
Clubfoot – A shortened Achilles tendon causes the foot to point inward and under instead of forward.
Sickle cell disease – The normally round red blood cells are shaped like sickles or crescent moons. These sticky cells get stuck in the small blood vessels, which blocks blood flow and oxygen delivery to organs and tissues.

Down syndrome is a common developmental birth defect. Down syndrome, in which an extra chromosome 21 is present, causes delays in physical and mental development. Another developmental birth defect is cerebral palsy. This condition is most often caused by abnormal brain development before birth. It affects movement, balance, and posture.

Some birth defects can be detected during pregnancy using prenatal ultrasound. Your doctor may employ a more sensitive test such as amniocentesis or chorionic villus sampling (CVS) to look for birth defects before your baby is born. Most birth defects can be positively diagnosed through a physical exam and newborn screening test after birth, but some defects are not detectable until the child is older.

If something is detected on your baby’s newborn screening test, more in-depth testing, called diagnostic testing, will be needed to determine if there’s a problem. If the diagnostic testing is positive for a defect, your doctor will guide you through the next steps. When a birth defect, such a heart defect, is found early, it can often be treated and more serious problems can be prevented.

Not all birth defects can be prevented, but there are steps you can take before and during pregnancy to reduce the risk. The CDC suggests that women Commit to Healthy Choices to Help Prevent Birth Defects. Here are some of the CDC’s tips:

• Manage health conditions, such as diabetes and high blood pressure, and adopt healthy behaviors, including quitting smoking and stopping alcohol, before becoming pregnant. Continue these behaviors during pregnancy.
• Strive to reach and maintain a healthy weight. Women who are obese before pregnancy are at a higher risk for complications during pregnancy. Obesity also increases the risk of several serious birth defects.
• Take 400 micrograms of folic acid every day one month before and during pregnancy. Folic acid can help prevent major birth defects of the developing brain and spine.
• See your health care provider regularly when planning a pregnancy and begin prenatal care as soon as you suspect that you are pregnant. Be sure to tell your provider about any medications that you are taking.
• See your provider regularly throughout your pregnancy. Talk to your provider about any vaccinations you may need. The flu vaccine and the Tdap (tetanus, diphtheria and pertussis) vaccine are specifically recommended during pregnancy to protect women against infections that can cause birth defects.

Breathing Easier

Nonsurgical heart ‘bypass’ relieves angina pain, boosts energy.

It’s been almost 26 years since Myriam Reyes Galarza left her native Puerto Rico and relocated to Florida. Her move was motivated by her need to nurture a loved one who was already residing here.

EECP treatments have given Myriam
the energy to perform her activities –
and complete them.

“My daughter was having a baby, and I thought, No one is going to take care of her like me,” Myriam, 64, remembers. “I came to Brooksville to care for her and her baby, and I’ve lived here ever since.”

Myriam could quickly pack up and reroute her life to Florida in part because she was no longer working. Carpal tunnel syndrome, for which she underwent surgery in 1991, forced Myriam to give up her job at a jewelry store in Puerto Rico.

“I used to be a secretary for Gordon’s Jewelers,” she confirms. “I did accounts receivable, which involved a little bit of everything, including all the inventory and dues. We’re talking about the 1980s, so we didn’t have computers or even an electric typewriter.

“I did all the work by hand using a manual typewriter. “I did that for six years for Gordon’s, but I had to stop working after I developed carpal tunnel. I have the condition in both hands and arthritis as well.”

Carpal tunnel and arthritis aren’t the only health issues that affected Myriam’s everyday life. She was also born with a heart murmur that has caused symptoms, such as angina, shortness of breath, chest tightness and loss of energy.

About 14 years ago, Myriam’s heart problems resulted in a visit to a specialist who performed an angioplasty and placed two stents. That resolved the angina, but in the years since, a tiny artery behind one of the stents became clogged.

“It’s not big enough to operate on, but it caused me to easily become short of breath,” Myriam reports. “My chest was also very tight, especially at night. So five years ago, Dr. Amarchand recommended that I do EECP, which went very well.”

L. Amarchand, MD, is a cardiologist and internist in Brooksville, where he offers patients a treatment protocol and nonsurgical alternative for relieving symptoms such as Myriam’s. It’s a safe, noninvasive, circulation-boosting technique called enhanced external counterpulsation.

Enhanced External Counterpulsation Process

Dr. Amarchand uses EECP to treat patients with heart conditions 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.

“Recently, I lost my energy and became very tired,” Myriam shares. “I didn’t really have angina pain. It was more like my chest was really tired. I like to do housekeeping, work in the garden and sew, but I felt too tired to finish what I started. Dr. Amarchand recommended that I do EECP again.”

Collateral Enhancement

The source of Myriam’s problems was a lack of oxygenated blood flowing through her heart, the doctor says. That situation can cause symptoms such as a loss of energy, shortness of breath, a tightening or pressure in the chest, and weakness.

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

“More than 12 million Americans have found relief from their symptoms, had their energy restored and received other benefits through the use of EECP.”

EECP is delivered through a series of 35 sessions over seven weeks. During each one-hour session, the patient reclines 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 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.”

“The treatment is not painful,” Myriam recalls, “and you lose weight. I lost 6 pounds.”

EECP is the perfect option for individuals who want to try a noninvasive procedure before resorting to open-heart surgery, Dr. Amarchand notes.

“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,” he says.

“According to studies done on the procedure, 85 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.”

Dr. Amarchand stresses that EECP’s beneficial effects can last three to five years. However, because it is noninvasive, the protocol can be repeated as often as needed. EECP is FDA-approved and Medicare-reimbursed.

“Life-Changing for Me”

To achieve the best results, patients must complete all 35 treatment sessions, although some symptom relief can be felt after a few sessions. That was true in Myriam’s case.

“EECP was life-changing for me!” she raves. “By the second or third treatment, the tiredness in my chest was gone. Now, my blood pressure is normal and I feel energetic. I now have the energy to perform my activities, and when I start something, I’m able to finish it. That makes me happy.”

Myriam describes Dr. Amarchand as “an excellent doctor” and lauds him for his knowledge and patience.

“He definitely knows what he’s doing,” she reports. “If he needs to explain something to me, he takes time doing it. On top of that, his office is extremely organized, and he has very friendly people working for him. It’s so nice when I walk in the front door and they know me by name.

“And Dr. Amarchand has the best technology. He has better equipment than the hospital. I hated getting stress tests at the hospital because I always got a bad sensation, like I was choking. But when Dr. Amarchand does the test in his office, it’s completely different. I hardly feel anything. I absolutely recommend Dr. Amarchand – and his EECP.”

Digital Dentistry

Same-day process gives nurse sparkling smile, increased confidence.

Patricia Killian’s own childbirth experiences inspired her career as an obstetrics nurse.

“The nurses with me were wonderful, and I thought, I want to be a baby nurse, too,” she remembers. “I always wanted to be a nurse; my mother was a nurse, and I specialized in delivering babies. I love working with the laboring moms, helping them get through the experience and then seeing a nice crying baby at the end.”

Patricia, 57, began her career in 1999 as a travel nurse, a position she held for 17 years. But in 2016, she opted to settle down in Trinity. She now works in the OB department at a hospital there.

“As a travel nurse, I worked with mothers across the United States, including those on Native American reservations and in community and private hospitals,” Patricia recounts. “Having those different experiences was the favorite part of my career.

“The Trinity hospital was my last travel assignment. I enjoyed it so much – the community and the hospital – that I decided it was a great place to stay. I was also getting older and wanted to spend more time with my parents. And being from Upstate New York with all of the snow, Florida really appealed to me.”

In general, Patricia was quite comfortable with her life in Trinity, but her teeth were causing her considerable distress. As it turns out, she has a long history of dental issues.

“After I had my two children, I suffered with terrible perinatal gingivitis,” Patricia relates. “I underwent two or three bone scrapings but still lost a lot of teeth. And I experienced jaw problems because I was missing teeth. There was always pain when I ate, and there were many foods I wasn’t able to eat.

“Eventually, it got to the point where all the teeth that I had left were bad. They had to go despite all the dental treatment and years of surgeries that I went through. I decided it was time to get all new teeth.”

A colleague at the hospital told Patricia about Coastal Jaw Surgery, where she met with board-certified oral and maxillofacial surgeon Michael A. Pikos, DDS. Dr. Pikos is a global leader in dental implants and surgical reconstruction.

Dr. Pikos is also known for the smile restoration process called Same Day Teeth®.

“Same Day Teeth is an innovative treatment that allows for placement of dental implants and new teeth on the same day,” Dr. Pikos expounds. “It restores the aesthetic appearance of the smile and provides optimal functionality.”

Patricia also met with Coastal Jaw Surgery’s prosthodontist, Philip J. Hedger, DMD, MS. Dr. Hedger is the tooth replacement specialist and “smile architect.” He designs the new teeth patients receive as part of the Same Day Teeth process. Patricia Killian’s own childbirth experiences inspired her career as an obstetrics nurse.

“The nurses with me were wonderful, and I thought, I want to be a baby nurse, too,” she remembers. “I always wanted to be a nurse; my mother was a nurse, and I specialized in delivering babies. I love working with the laboring moms, helping them get through the experience and then seeing a nice crying baby at the end.”

Patricia, 57, began her career in 1999 as a travel nurse, a position she held for 17 years. But in 2016, she opted to settle down in Trinity. She now works in the OB department at a hospital there.

“As a travel nurse, I worked with mothers across the United States, including those on Native American reservations and in community and private hospitals,” Patricia recounts. “Having those different experiences was the favorite part of my career.

“The Trinity hospital was my last travel assignment. I enjoyed it so much – the community and the hospital – that I decided it was a great place to stay. I was also getting older and wanted to spend more time with my parents. And being from Upstate New York with all of the snow, Florida really appealed to me.”

In general, Patricia was quite comfortable with her life in Trinity, but her teeth were causing her considerable distress. As it turns out, she has a long history of dental issues.

“After I had my two children, I suffered with terrible perinatal gingivitis,” Patricia relates. “I underwent two or three bone scrapings but still lost a lot of teeth. And I experienced jaw problems because I was missing teeth. There was always pain when I ate, and there were many foods I wasn’t able to eat.

“Eventually, it got to the point where all the teeth that I had left were bad. They had to go despite all the dental treatment and years of surgeries that I went through. I decided it was time to get all new teeth.”

A colleague at the hospital told Patricia about Coastal Jaw Surgery, where she met with board-certified oral and maxillofacial surgeon Michael A. Pikos, DDS. Dr. Pikos is a global leader in dental implants and surgical reconstruction.

Dr. Pikos is also known for the smile restoration process called Same Day Teeth®.

“Same Day Teeth is an innovative treatment that allows for placement of dental implants and new teeth on the same day,” Dr. Pikos expounds. “It restores the aesthetic appearance of the smile and provides optimal functionality.”

Patricia also met with Coastal Jaw Surgery’s prosthodontist, Philip J. Hedger, DMD, MS. Dr. Hedger is the tooth replacement specialist and “smile architect.” He designs the new teeth patients receive as part of the Same Day Teeth process.

“Walking into Coastal Jaw Surgery was like a big smile,” Patricia describes. “Dr. Pikos and Dr. Hedger were super nice and supportive. They didn’t make me feel bad about my dental situation. They said, We can help you.

“They gave me options, which included dentures, but I thought I was too young for a full set of dentures. I didn’t want teeth that I had to put in and take out. Instead, I wanted all my teeth pulled and a whole new set of teeth. I decided to go with Same Day Teeth.”

Virtual to Reality

Many dental practices offer dental implants, but the doctors at Coastal Jaw Surgery set themselves apart by using an advanced approach. Unlike many others, the dentists at Coastal Jaw Surgery use a fully digital process for planning and performing implant surgery.

“We use a computer software-based approach,” Dr. Pikos verifies. “Our diagnostic work is done this way, and our treatment is carried out using models and guides created by the software. We begin by taking digital impressions of the patient’s mouth and getting a cone beam CT scan. That information is introduced into the software at the lab we use in Reno, Nevada. We then have an online meeting with myself, Dr. Hedger and the lab.”

During that meeting, all of the patient’s data is combined. Using that information, the software simulates the final result and identifies the steps to achieve it.

“We begin with the end in mind and literally work backward,” Dr. Pikos reports. “And all of the steps are predetermined. Most dentists do the process differently, using an analog approach as opposed to our all-digital process.”

Model Approach

To assist Dr. Pikos further, the lab creates a detailed, 3D model of the patient’s mouth and “performs” the implant surgery on it. From this, the lab creates precise surgical guides that detail the steps of the surgery.

“The guides act like a flight simulator, allowing me to perform the surgery virtually,” Dr. Pikos explains. “It’s like doing the surgery in my mind. Then, on the day of surgery, my brain links the virtual with reality. My brain thinks I already performed the surgery, which technically I did. Because of that extra virtual step, the surgery is executed in a very precise mode.

“We knew ahead of Patricia’s procedure what we needed to do to achieve an excellent result with our Same Day Teeth process: a brilliant smile and full function.”

Patricia says she loves her new teeth.

“They look really natural,” she raves. “They’re about the same color as my teeth were before. I didn’t go with the real pearly white because that’s not me. Everything is good with my new teeth. I feel better. I smile more. I’m more confident, and I can eat anything I want. I even chew gum.

“I’m ecstatically happy. I totally recommend Dr. Pikos, Dr. Hedger and Coastal Jaw Surgery!”

Holiday Drinking: Time for Wisdom and Moderation

December 22nd, 2020

The holidays are marked by festive celebrations with family, friends and coworkers. Typically, alcohol flows freely at these celebrations, and it’s not uncommon to drink more at these events than you do during the rest of the year. But binge drinking has negative physical and emotional effects, and puts you – and others – at risk.

Most people know that drinking too much is bad for your liver. Consistent heavy drinking causes different types of inflammation in the liver, such as fatty liver, alcoholic hepatitis, fibrosis and cirrhosis. And any damage to the liver, including damage caused by alcohol, can lead to liver cancer.

Drinking affects other parts of your body as well. A single episode of binge drinking can damage your heart and throw off your heartbeat. In fact, the rate of deadly heart attacks spikes during the winter holiday season. This phenomenon is known as holiday heart syndrome. Binge drinking can also lead to high blood pressure and even stroke.

Further, a night of binge drinking can impair your immune system’s ability to fight infection for up to 24 hours, putting you at increased risk for colds, flu and other infections. Too much alcohol can also worsen medical and psychiatric conditions. Alcohol is a depressant and can exacerbate symptoms of depression and anxiety. It can also affect blood sugar levels in the blood of people with diabetes.

And that’s not all. Alcohol lowers inhibitions, and for some people, drinking too much releases pent-up anger and frustration. After drinking, these people may act on the their anger, which can result in violence and physical injury. And with lowered inhibitions, you’re more likely to engage in risky sexual behaviors, which can result in contracting a sexually transmitted disease.

Drinking too much can also be deadly. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), an estimated 88,000 Americans die from alcohol-related causes annually. That makes alcohol the third leading preventable cause of death in the US.

In addition to having negative effects on your health and wellbeing, binge drinking is expensive. NIAAA notes that alcohol misuse costs the US $249 billion a year, and 75 percent of those costs are related to binge drinking. These costs include lost productivity, health care costs and criminal justice costs.

Another serious concern related to holiday drinking is the increase in people drinking and hitting the road. NIAAA reports that drunk drivers play a role in 40 percent of traffic deaths over Christmas and New Year’s. The institute notes that this figure is an increase of 12 percent over the rest of December.

The US Department of Transportation elaborates on NIAAA’s statistics. They report that 300 Americans die each year in the handful of days surrounding the Christmas and New Year holidays. They go on to report that an average of 27 people die each day in December due to drunk driving accidents. NIAAA notes that there is a 155 percent increase in DUI violations on New Year’s Eve alone.

One thing you should know about alcohol; it sneaks up on you. Typically, people don’t realize that their critical decision-making abilities and driving-related skills are already diminished long before they show any overt signs of intoxication. You may think you’re “okay to drive,” but you’re just fooling yourself. Your reflexes and judgment are impaired by the alcohol even if you don’t “feel” it.

Impairment is not determined by what you drink, but by the amount of alcohol you drink over time. Binge drinking is when you drink enough alcohol to bring your blood alcohol level up to the legal limit for driving, which is 0.08 in most states. Generally, this works out to about five alcoholic drinks for men and four drinks for women in less than two hours.

And don’t think that you’ll sober up and be able to drive once you’ve stopped drinking and had a cup of coffee. In reality, alcohol continues to affect your brain and body long after you’ve finished your last drink. The alcohol in your stomach and intestines continues to enter your bloodstream, resulting in impaired judgement and coordination for hours.

Coffee isn’t the answer. Caffeine may help with drowsiness in the short-term, but it does nothing to counter the effects of alcohol on decision-making and coordination. And then, when the caffeine wears off, you’ll feel post-caffeine sleepiness, which only compounds the depressant effects of the alcohol. Then, you can easily nod off or lose attention if you get behind the wheel.

You don’t have to skip the holiday party or abstain from alcohol altogether, but consider these tips for safer drinking:

• Have a snack before you leave for the party. When you drink on an empty stomach, the alcohol quickly passes from your stomach into your small intestine, where it is absorbed into the bloodstream and begins to affect your body.
• Make your first drink nonalcoholic. It keeps you from gulping down your first alcoholic drink.
• Alternate alcoholic and nonalcoholic drinks. Nonalcoholic drinks help counter the dehydrating effects of alcohol.
• Eat throughout the night. Food can slow the absorption of alcohol and reduce the peak level of it in your body by about one-third.
• If you are in an awkward situation, don’t escape by making a beeline to the bar. Walk around the room, mingle with other guests, check out the decorations, etc.
• Establish a designated driver who isn’t drinking or take a ride-share home and to the party.

You can still enjoy alcohol during the festivities, just use wisdom and moderation to keep yourself – and others – safe this holiday season!

Stuck On Excellence

Expertise, manner considered when choosing physician to treat legs.

Annette* began her career with Johnson & Johnson at its subsidiary Ethicon, where she attached microscopic needles to tiny sutures used during eye surgery. When Ethicon cut back its workforce five years into her tenure, Annette transferred to Johnson & Johnson’s Band-Aid plant.

“I ran the high-speed production line,” the 63-year-old New Jersey native shares. “The Band-Aid material came in one big roll, which I threaded into the machine. The machine cut the Band-Aids into three sizes and put them into boxes, which were then weight checked and sealed. I placed the finished boxes on a skid, took the skid to the warehouse and started again.”

Annette’s jobs at Johnson & Johnson were perfect for her because she likes to work with her hands, even during her free time.

“I’m a really crafty person; I enjoy doing crafts,” she reports. “I used to do needlepoint and cross-stitch, but now I’m into Zentangle, which involves drawing various designs. I may draw a flower and then keep doing the entire page with flowers, or I could divide the page into three or four different patterns. I love it because it makes me feel comfortable.”

Annette worked at the Band-Aid plant for a little more than 10 years before Johnson & Johnson closed it and moved operations to South America. Instead of a layoff, Annette took early retirement at 56. Two years later, after her husband retired, they moved to Florida.

“We have a nice home in Florida in The Villages®,” Annette reports. “I love it. My neighbors are excellent; they’re like family. We have holidays, including Christmas, together. One neighbor will host Thanksgiving and one will have Easter. We make it like a family gathering because our kids are scattered all over.”

For years, Annette’s legs have been peppered with spider veins, small blood vessels that become damaged and are visible on the surface of the skin. Unhappy with their appearance, Annette twice had her spider veins treated while living in New Jersey. Recently, she began experiencing other symptoms in her legs.

“I began to feel a lot of pain in the back of my left leg,” Annette recounts. “I thought maybe it was a blood clot, but I kept letting it go. I said, It will get better, but instead it got more painful. I didn’t have bulging veins on my leg, but there were a few visible veins below my left knee. My ankles were also swelling a little.

“It didn’t matter if I was being active or doing nothing, I still felt that pain in my left leg. It was there if I walked a lot, and it was there at night when I watched TV and put my legs up on the recliner. It was scary.”

Scary enough to eventually prompt Annette to seek medical attention. She chose to visit Ravi Sharma, MD, a board-certified cardiovascular surgeon at Premier Vein Centers who impressed Annette with his previous treatment of her husband’s bulging varicose veins.

Dr. Sharma, who has expertise in blood vessel disorders affecting the legs, has offices in Homosassa and The Villages. During Annette’s first visit, Dr. Sharma ordered an ultrasound that showed a number of her leg veins were leaking and disabling the proper flow of blood back toward Annette’s heart, a condition called venous insufficiency.

“Dr. Sharma found one major vein in my left leg that wasn’t working properly and a big vein in my right leg that was affected,” Annette reports. “Then he said, This is what we have to do to fix the problem, and recommended a laser procedure.”

Damaged Valves

“The venous insufficiency that Annette was suffering from occurs when deep leg veins, which lie in groups of muscles, cannot pump blood back to the heart,” Dr. Sharma describes. “Chronic venous insufficiency has multiple causes.

“The blood in leg veins can pool after long periods of sitting or standing. This increases the venous blood pressure and weakens the vein walls and valves, thereby damaging the valves. Damaged valves prevent proper blood flow back to the heart.”

Venous insufficiency has many signs and symptoms, indicators that the veins are not functioning properly. Signs, which can be seen, include bulging varicose veins, swelling, and thickening and discoloration of the skin of the ankles or legs. Symptoms are felt, and they include throbbing, aching, stinging, burning, itching, nighttime leg cramps and restless legs.

“If patients are experiencing any of these signs and symptoms, it is critically important that they have their leg veins assessed,” Dr. Sharma contends. “Leaving the condition untreated can lead to more serious complications, including leg ulcers, infection and a breakdown of the skin.

“And when seeking a physician for care, it is crucial that people choose surgeons who specialize in venous diseases and only venous diseases. I recommend staying away from physicians in large practices that offer a wide variety of services and perform venous treatment as a side service. The physicians people choose should also be experienced in the advanced procedures available to treat venous diseases.

“In addition, they must also express genuine concern and compassion for their patients. Physicians with these qualifications achieve the best outcomes.”

Based on her husband’s experience with Dr. Sharma, Annette was convinced he met those qualifications and more.

“Dr. Sharma is very knowledgeable,” she reports. “I can ask him any question, and he knows the answer. It helps that he’s a cardiovascular surgeon. I figured if he can work on the heart, he knows all about veins. And he’s very easy to talk to. My husband felt very comfortable with him, and so do I.”

Insignificant Incisions

To address varicose and spider veins, Premier Vein Centers offers a range of advanced, minimally invasive treatments. These options include microphlebectomy, endovenous laser ablation (EVLA), sclerosing injections and VenaSeal.

Microphlebectomy has replaced vein stripping, an outdated, more invasive procedure during which doctors removed the large veins by making big gashes across the leg, often leaving sizable scars.
“With microphlebectomy, the incision is tiny – about the size of the tip of a scalpel – and we can do much more through that small incision,” Dr. Sharma assures. “And with this procedure, patients end up with tiny marks on the skin or no scars at all.”

EVLA is performed using a sterile laser fiber that is introduced into the incompetent vein through a small puncture in the leg. Laser energy is then delivered through the fiber, painlessly closing the vein in less than an hour, using local anesthesia.

Sclerosing injections are used to treat spider veins.

Dr. Sharma uses ultrasound-guided sclerotherapy (UGS) to guide the injections that gently close the problem vessels.

VenaSeal is a non-thermal closure system that relieves symptoms by delivering small amounts of a specially formulated medical adhesive, or “super glue,” to the diseased vein. This permanently seals the vein. This procedure does not require multiple needle sticks, and in some cases, support stockings are not necessary.

Using his expertise, Dr. Sharma determines which procedures will work best based on each patient’s symptoms and health status. These advanced treatments are performed in a comfortable office setting and result in little or no downtime and discomfort.

“Our patients are often very relieved to discover that there is no general anesthesia involved in our minimally invasive treatments,” Dr. Sharma says. “And they are happy to learn that they can resume activities right away following the procedure.”

Premier Vein Centers provides a free initial consultation and accepts most insurance, including Medicare.

“It Doesn’t Hurt”

Using EVLA, Dr. Sharma sealed two incompetent veins in Annette’s left leg and one vein in her right leg. He is still treating her residual spider veins with UGS, but Annette is very excited about the results of the completed treatments.

“My legs feel great,” she raves. “I have no problems with them and I’m doing everything now. I can walk up and down steps. I can walk distances, and it doesn’t hurt. I walk every day, and I try to do five miles when I walk. I don’t have any pain when I sit down to watch TV and put up my feet. And the swelling in my ankles is gone.


“My legs feel great.” – Annette


“I still have some spider veins, but they’re OK. As long as I don’t have pain, I’m not worried about spider veins.”

During Annette’s procedures, Dr. Sharma engaged her in conversation as he worked, which eased Annette’s anxiety.

“Dr. Sharma talked to me, and I talked back to him as well,” she confirms. “He and his assistant had me giggling about this and that the whole time, which I found very calming.

“I would recommend Dr. Sharma to anybody because he’s a very good doctor. He’s friendly and has a great attitude. He always has a smile and something nice to say. The same is true for his staff. All of them are excellent.”

*Patient’s name changed at her request.
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