Author Archive

Bird’s Eye View

Experience, equipment and technique key to success in complex cases.

Most transplanted northerners end up in Florida as part of some grand plan to escape the frigid winter cold back home. Deborah Lavery’s plan was to escape the frigid winter cold all right. But how she wound up in Palm Coast was more or less an accident.

Photo by Nerissa Johnson.

Deborah Lavery

“It was a fluke,” Deborah confirms. “I just wanted to be in a warmer place, and my husband and I were traveling south, looking around at different places along I-95, and at one point, I said, I’m tired of looking; let’s just get off here. That was in Palm Coast.”

Deborah made that decision in 2014, not long after she was forced to retire from her job as a certified nursing assistant – a position she held for more than 20 years – because of a rare autoimmune disease called birdshot chorioretinopathy.

Caused by an inflammation of the uvea, which is the part of the eye that supplies most of the blood to the retina, birdshot chorioretinopathy is largely hereditary and most often occurs in Caucasian people between the ages of 45 and 50.

In its early stages, it results in blurred vision and eye floaters, but over time, pain in the eyes, sensitivity to light, a loss of depth perception and a loss of peripheral vision can occur. In Deborah’s case, it led to all that and also contributed to the development of cataracts.

“It wasn’t from old age that I got the cataracts,” Deborah, 65, says. “It was from the steroid injections I had to get to correct the effects of the birdshot. But it was either that or go blind. That’s what the doctors told me.

“I got my first cataract in 2006. It was in my left eye, and because of the birdshot, I was more or less a guinea pig because the doctors really weren’t sure if the surgery was going to work.”

The surgery did work, but 11 years later, another cataract developed, this time in Deborah’s right eye. And this time, the effects were far worse, this second cataract causing such an impairment in Deborah’s vision that she wound up injuring herself.

“I had to give up driving, and there was one time where I walked into a wall,” Deborah says. “I thought I was walking through the doorway, but I wasn’t paying close enough attention and walked into the wall instead. It left a big bruise on my face.”

That incident prompted a search for a new eye surgeon in the Palm Coast area. With the help of her insurance company, Deborah soon found board-certified ophthalmologist Alexandra Kostick, MD, of Atlantic Eye Center.

A Challenging Case

“Deborah proved to be quite a challenging case because performing cataract surgery on someone with birdshot disease can actually make the disease worse,” Dr. Kostick informs. “The concern stems from the fact that there’s chronic inflammation in the eyes already.

“Now factor in that cataract surgery in and of itself causes inflammation, and you get the added concern that by doing a procedure that naturally causes inflammation in somebody who is already inflamed, you’re only going to exacerbate the problem.

“If that happens, if we make the birdshot worse and exacerbate the inflammation in the back of the eye, postoperative complications can develop that could leave the patient with retinal swelling and possibly even permanent vision loss.”

The increased risks associated with Deborah’s case meant she needed a specialist who is experienced, adept in advanced surgical techniques and has access to the most technologically advanced equipment available today.

She found just that in Dr. Kostick.

Recognized throughout the ophthalmologic field as one of its most accomplished surgeons, Dr. Kostick has been successfully treating complex cases such as Deborah’s for 23 years. She put that experience and much more to work in treating Deborah.

“She’s a great doctor, and I thank God every day that I met her. I recommend her to everyone I meet who has an eye problem. I literally hand her cards out like they’re candy. She’s a true specialist, and she treats you like family.” – Stephanie

To begin with, she worked in tandem with Deborah’s retinal specialist to ensure that for more than a month prior to surgery, Deborah’s birdshot condition was stable and under control. Then, during the surgery itself, she made use of a special device called the ORA.

ORA stands for Optiwave Refractive Analysis. It is a diagnostic device that provides accurate measurements of the shape of the eye during procedures such as cataract surgery after the cataract has been removed.

“The ORA fine-tunes the power and therefore narrows down the selection of the intraocular lens implant that is implanted in the patient’s eye after the natural lens has been removed,” Dr. Kostick educates. “And it’s done while I’m performing the surgery.

“There’s no way that our pre-op measurements can compete with that, because it helps to make the patient’s end result much, much better. A good end result, of course, includes the patient seeing extremely well, and that’s what we got with Deborah.

“She turned out perfectly, and that’s quite a success because with all of her inflammation, the implant power could have been completely wrong. But we were able to avoid all complications, in part because of the state-of-the-art equipment we have.”

Family-Like Atmosphere

Deborah was fit with a standard intraocular lens, or IOL, that corrected her distance vision to 20/20. She still wears glasses for reading but says her overall vision is better than it has been in years.

“I really can’t believe how well I’m seeing,” Deborah enthuses. “I can see birds and trees again. I can literally see all the way to the top of the trees. And I’m not walking into walls anymore. I really couldn’t be happier, and I’m extremely pleased with Dr. Kostick.

“She’s a great doctor, and I thank God every day that I met her. I recommend her to everyone I meet who has an eye problem. I literally hand her cards out like they’re candy. She’s a true specialist, and she treats you like family.”

A family-like atmosphere is a big part of what Dr. Kostick strives for at Atlantic Eye Center. She is proud to be treating the sons, daughters and grandchildren of patients she has been treating for years.

“Our patients become part of our extended family,” Dr. Kostick asserts. “We strive to make them comfortable by creating a very caring environment. They know they are going to be treated with a personal touch whenever they come here.”

A strong reputation in the community is also something the staff at Atlantic Eye Center strives to maintain.

“I think word of mouth is very important for doctors, and we pride ourselves on the referrals we get,” Dr. Kostick adds. “I can honestly say that my staff members go out of their way to ensure that people are cared for to our utmost capability.”

Want a Better Sex Life?

Noninvasive ED treatment improves sexual performance.

The first thing Tom* did upon returning to the United States following his 14-month tour of duty in Southeast Asia during the Vietnam War was kiss his high school sweetheart. Later that same day, he went out and married her.

“I actually proposed in a letter I sent from overseas about six months before I came home,” the former US Marine Corps sergeant reveals. “She said yes in her next letter back to me, and we later decided we’d get married as soon as I got back, first thing.”

Stock photo from iStockphoto.com.
Natives of Central Florida, Tom and his wife have “been going strong,” as Tom puts it, ever since. They now have three grown children, a granddaughter, and a grandson on the way. There’s just one problem.

For the better part of the year that followed his 69th birthday last August, Tom had trouble developing and maintaining an erection strong enough to have sexual intercourse. The issue is known as erectile dysfunction, or ED, and it’s more common than many think.

Studies show that more than half of all men will experience some form of erectile dysfunction during their lifetime and that the chances of dysfunction are even greater among men suffering from hypertension, diabetes and cardiovascular disease.

Studies show that smoking, heavy consumption of alcohol and drugs (either illicit or prescription) can also cause erectile dysfunction, which is typically the result of circulatory impairment in the blood capillaries or urogenital areas of the penis.

For years, medications such as VIAGRA® and CIALIS® have been the first line of defense against ED. If those prove unsuccessful, the next treatment option is generally injections into the penis. If that fails, the last resort has long been a penile implant.

Tom wanted nothing to do with the injections or implants, so after visiting a urologist, he first tried correcting the problem by taking CIALIS. “The CIALIS worked okay for a while,” Tom says, but he didn’t like the headaches that often came as a result of using it.

On the advice of his urologist, Tom considered trying another medication, but he soon took it upon himself to begin researching the problem and other forms of treatment. That’s when he stumbled on Extracorporeal Shock Wave Therapy or ESWT.

“I was searching the internet and finally found this website for a place that didn’t treat erectile dysfunction with pills or injections,” Tom says. “I figured it wouldn’t hurt to give them a try, so I called and made an appointment.”

Acoustic Pressure Wave Technology

The practice Tom found is Alpha Medical Group. With offices in Palm Coast, Leesburg and Jacksonville, it specializes in the administration of ESWT, or APWT which treats erectile dysfunction through the use of acoustical wave therapy.

Using a small, handheld device, the acoustical waves are delivered through a series of short, virtually painless pulsations that not only open the blood vessels in the penis but stimulate the nerve endings to enhance sensitivity and enhance the feeling of an orgasm.

“The treatment is based on the same technology that’s used to break up gallstones,” says Scott Hollington, MD, at Alpha Medical Group. “The device transmits acoustical waves that break up the plaque and calcium that have built up inside the penis’ blood vessels.

“It works like a little jackhammer. Once that plaque and calcium are broken up, you get better blood flow, and it’s that improved blood flow that leads to better, longer-lasting erections.”

In addition to providing better blood flow through existing blood vessels, ESWT also stimulates the growth of new nerve tissue, which is vital for achieving and maintaining healthy erections.

Dr. Hollington points out that it can also be used to treat Peyronie’s disease, which is what occurs when scar tissue builds up in the penis and causes an abnormal bend, or curvature, to the penis that can impede urination and/or ejaculation.

“By making certain adjustments to the machine’s settings, we can treat the fibrous tissue the same way we treat blood vessels and break down the scar tissue that may be causing that irregular shape,” Dr. Hollington informs.

ESWT treatments only take about 10 to 15 minutes to complete, but prior to providing any such treatment, Dr. Hollington begins his care for patients such as Tom by doing a Doppler ultrasound exam to determine the amount of vascular compromise in the penis.

“We look for something similar to what a cardiologist looks for in the heart, which is an occlusion of seventy percent or more,” Dr. Hollington informs. “If we see that, we go ahead with the treatment, and we reevaluate the blood vessels after completion of the treatment.”

Remarkable Results

ESWT calls for patients to receive two treatments per week for three weeks. Patients are then evaluated 12 weeks later and if necessary, they can be given a second, third or even fourth round of treatments.

Dr. Hollington says many patients opt for subsequent rounds of treatment, though most experience an improvement in sexual function after just one round. Overall, 83-percent of all men treated with ESWT experience a reversal of their condition, the doctor notes.

Tom is one of those who reported positive results after just one round of treatments. He says he may opt to have another round of ESWT treatments but that right now, his performance is more than satisfactory.

“I just turned seventy a couple months ago, and in the bedroom, I feel like I’m half that age,” Tom exudes. “It’s really remarkable what this ESWT does for you. And the treatments are all very quick and virtually painless. A few minutes and you’re out of there.

“And one of the best things is how professional the technicians at Alpha Medical Group are. Let’s face it, this is a touchy subject for men. It’s not something anybody is going to brag about. But they put you at ease, and make you feel comfortable.

“I can’t thank Dr. Hollington and his staff enough for treating me so well and for giving me back this part of my life. They did a great job, and I recommend them and ESWT for anyone who has a problem with ED.”

*Patient’s name withheld at his request.

Closing Time

Minimally invasive procedures repair damaged veins.

Rachael Becker is proof you don’t have to be of an adult age to get varicose veins. Rachael’s first varicose vein appeared when she was still in high school.

Patient photo courtesy of Rachael Becker.

Rachael Becker

“It was in my right calf, and I wouldn’t go so far as to say it sidelined me, but I played soccer in high school and when I played, I definitely noticed it,’’ Rachael says. “As time went on, the pain and swelling just got worse and worse.”

Now 36 and a single mother of three, Rachael eventually developed several bulging veins that grew decidedly worse every time she gave birth. Eventually, the pain and swelling in her legs became debilitating.
“They got so swollen and painful that it was hard to walk,’’ she says. “Going to theme parks, even taking the kids to the park was difficult.”

Rachael didn’t seek medical attention for the problem until after she woke up one day and could barely stand. A hospital visit resulted in the detection of a blood clot.

Advised to see a specialist to care for the blood clot, Rachael visited Sukhender Singireddy, MD, at Suncoast Vein & Vascular Clinic. After treating the clot, Dr. Singireddy took on the task of treating Rachael’s vein issues.

In-Office Solutions

“During my examination of Rachael’s legs, I found she had multiple bulging veins as well as leaking valves in the long vein running the length of her right leg, a condition known as venous insufficiency,’’ Dr. Singireddy says.

To correct the problem, an endovenous laser ablation (EVLA) was performed. EVLA uses heat energy to cauterize the vein. it is a minimally invasive in-office procedure that is performed under local anesthesia while the patient is slightly sedated.

Before and after images courtesy of Suncoast Vein & Vascular Clinic.“Once we clean and prep the legs, we insert a catheter into the defective vein,’’ Dr. Singireddy explains. “We then use ultrasound guidance to make sure the catheter is in the right location and advance the catheter all the way up to the groin.

“Through the catheter, we insert a very thin laser fiber up to the groin and apply local anesthesia around the defective vein. After that, we slowly withdraw the catheter, cauterizing the vein and basically shutting it down.”

Dr. Singireddy also removed the bulging veins that ran from Rachel’s thighs to her ankles using a microphlebectomy procedure. During a microphlebectomy, local anesthesia is applied along the course of the vein. Small punctures are then made in the skin and through those punctures, a tool that looks like a crochet hook is used to remove the vein bit by bit.

Most patients begin to experience relief from their pain and swelling within a few days of undergoing these procedures. That was the case with Rachael, who describes the results of her treatments as “amazing.”
“When I saw the before and after pictures, I was shocked,’’ she says. “I’d kind of forgotten how bad my legs looked. Now, my legs look and feel great, and I’m moving around normally and doing all the things I want and need to do.”

Suncoast Vein & Vascular also offers radiofrequency ablation and a glue treatment called VenaSeal® as alternatives to the laser treatment as well as cosmetic sclerotherapy for the treatment of spider veins.
The VenaSeal treatment shuts down the defective veins without using heat so there is less risk of damaging the adjacent nerves causing numbness. This treatment alone requires no stocking use.

The Best of Both Worlds

Perfect home for an independent active lifestyle or those needing a little assistance.

The Matanzas High School lacrosse team compiled a respectable 9-7 record before bowing out of the state playoffs after one game this past spring. The Pirates’ season might not have been as successful as it was were it not for Ron Coyle.

Photo by Nerissa Johnson.

Ron Coyle

A former college lacrosse player at Rensselaer Polytechnic Institute, Ron has spent each of the last 25 years, including the past two at Matanzas, passing on his expertise in the sport of lacrosse as a volunteer assistant coach.

It’s one of the many activities that keep this 88-year-old former computer systems manager from feeling his age.

“Age has never bothered me,” Ron says. “A lot of that is because I take good care of myself. But I think the fact that I’m so active and I’m always busy doing something is one of the big reasons I feel as good as I do.”
In addition to his work as an assistant lacrosse coach, Ron is also an active member of a Palm Coast area camera club, an amateur magician and the president of the Resident Council at Sabal Palms Assisted Living & Memory Care, where he now lives.

Ron took on that last duty not long after he moved to Sabal Palms last October. That move came at the behest of his children, who worried his active lifestyle was making it hard for him to keep his two-story home in order.

“The house was getting to be too much for me,” Ron explains. “So, my daughter started looking for a place and found Sabal Palms. We both checked it out and agreed it was the right place for me.”

Five Levels of Care

Sabal Palms Assisted Living & Memory Care is a senior living community. It offers studio, one- and two-bedroom suites and five levels of customized care as well as specialized care for those residing in its secured memory care community referred to as “Journeys”.

The care levels begin with minimal assistance, such as medication management, transportation and housekeeping and move up to include incontinence care and shower assistance. The community also has a complete fitness room with exercise equipment, a piano lounge, wine bar, game room and more.

Yoga, cooking, painting and music classes are among the vast array of daily activities open to all residents, who are also treated to a movie each night in the community’s theater, where popcorn is always served.
The use of the fitness room was instrumental in helping Ron get back on his feet. When he first arrived, he was coming off a month-long hospital stay due to a bout with
pneumonia and needed to get himself back in shape for lacrosse season.

“I was actually in a wheelchair when I first got here, but I got rid of that pretty quickly after I started doing physical therapy there,” he says. “Now, I’m back driving again and doing all the things I like to do.”
Ron, who has been performing magic since he was in college, says he plans to put on a magic show for the residents at Sabal Palms later on this year. It’s one of the ways he intends to show his appreciation for all that’s done for him there.

“It’s really a great lifestyle,” he says. “I don’t have to worry about laundry or cleaning or cooking. All that is taken care of for me, and the food is great. I really like it here, and I can come and go as I please and do all the things I like to do.

“I go out and take pictures; I coach; I do my magic. It’s a great situation for me, and the care here is exceptional. Everyone is very friendly and helpful. Like I said, I really like it here. It’s home now.”

One for All

Complete dental care available in this patient-centered office.

Tucked away deep inside its state’s southern pocket, Beckley, West Virginia sits just a tad north of the Virginia border in the heart of coal-mining country. For as long as Henry* can remember, his father worked that town’s coal mines.

Photo by Nerissa Johnson.

Dr. Patel seeks to build long-term relationships with all his patients based on trust, respect and friendship.

“He was a mine superintendent there, and after I got out of high school, I worked there for five or six years, too,” Henry says. “I wasn’t actually in the mines, though. I would have to go in from time to time, but I mostly worked various jobs outside the mines.”

Henry worked those various jobs until he got out of college and became a teacher. After five or six years of teaching, his career as an educator took a turn that, much like his career in the coal-mining industry, left him on the outside looking in.

“I really liked teaching, but I found out there wasn’t a whole lot of money in it, so I eventually started working for a company selling textbooks to schools,” he says. “I did that for probably twenty years. It was an interesting job. I liked it a lot.”

One of the things Henry liked about that job was that it brought him to Florida. His initial stay in the Sunshine State was brief, but when Henry and his wife, Irene*, retired seven years ago, they returned to Florida and made Palm Coast their new home.

In the course of settling into retirement, Henry and Irene began looking for a new dentist. They eventually settled on Jayraj J. Patel, DMD, the owner of Palm Coast Family Dentistry. The couple has been seeing Dr. Patel regularly ever since.
“I started out seeing Dr. Patel for cleanings and fillings, routine stuff like that, but during his first examination of me, he told me there were some problems with some teeth that were going to have to come out or they’d start giving me trouble,” Henry says.

Triple Trouble

The news didn’t come as a shock to Henry. His previous dentist had told him the same thing regarding two teeth – the lateral incisor and the eye tooth – in the upper left side of his jaw. Henry was also missing the first premolar on the upper left side.

“All the teeth were in a row, and they all fell in his smile zone, meaning you can see them when he smiles,” Dr. Patel informs. “The problem was the two that remained were going bad because of poor periodontal health and had to come out.

“They didn’t have to come out immediately. In fact, we first did the cleanings to get Henry’s periodontal health back in order. But I told him that this was a situation where it would be best to take them out and replace them before they became a problem.”

In addition to the two failing teeth on the upper left, Henry also had a problem in his lower left arch, where he had previously lost a back molar and was using a wisdom tooth to chew his food. Mostly, though, he was chewing on the right side of his mouth.

“That’s a situation that’s not good for long-term success either because if you chew on just one side, those teeth are eventually going to fail and then you’ll need treatment for those teeth, too,” Dr. Patel informs.
“The other issue there is that the bite is no longer balanced, and that imbalance can negatively affect the jaw joint. So, this was another problem where it was in Henry’s best interest to have the issue taken care of sooner rather than later.”

Cognizant of the potential for future problems, Henry agreed that the time had come to correct the flaws in his smile and function. He also agreed with Dr. Patel’s suggestion that dental implants would provide the best solution for both issues.

Dental implants are titanium, root-shaped bodies that are surgically placed into the jawbone. The implant supports an abutment and a crown, which is cemented to or screwed into the abutment, creating a new tooth.
Once they have been placed in the jaw, the bone grows around the implant creating a solid foundation for replacement teeth, which can be a crown for a single tooth or a bridge, partial or full denture when replacing multiple teeth.

In Henry’s case, Dr. Patel extracted the two failing teeth on Henry’s upper arch, then fit him with two implants. Those implants became the foundation for a three-tooth bridge. He later fit Henry with a single implant that served as the base for a new lower left molar.

In both cases, Dr. Patel pretreated the area where the implants were eventually placed by performing a bone-grafting procedure. The bone graft builds up the jawbone and creates a more stable foundation for the implant.

An “Amazing” Process

The work on Henry’s upper arch began in October 2017. After a brief period, during which he wore a temporary bridge, Henry was fit with his permanent bridge in March 2018. By May, Henry also had a new, implant-supported molar on his lower arch.

“The process is really quite amazing, and I couldn’t be happier with the outcome,” Henry says. “I literally cannot tell the difference between the teeth Dr. Patel put in for me and my real teeth. It’s something I will definitely do again if the need ever arises.

“And I would definitely want Dr. Patel to do the work. My wife and I have grown pretty fond of him. He’s very down-to-earth and very personable. With a lot of dentists, you’re kind of in and out. That’s not the case with Dr. Patel. He really gets to know you, and we like that.”

Dr. Patel got to know Irene as well as he got to know Henry after she, too, became a patient of his. He has worked to maintain her good periodontal health, restored a few broken or failing teeth and performed general maintenance on some others.

“Henry and Irene have both been with me since December 2016, and they are emblematic of what we do for our patients here,” Dr. Patel says. “First of all, we are a very family-oriented practice. We want to treat the entire family, and we treat patients like family.”

“The other thing is that we are a comprehensive dental practice. Not only do we perform general maintenance to help you maintain good periodontal health, but we also do fillings and crowns, and we have the equipment here to do same-day crowns.”

“We also have the ability to do more involved work such as what we did with Henry. We’re a one-stop shop, and that’s important because it means fewer visits to the dentist. And we always strive to make sure your visits here are a pleasant ride.”

*Patient’s names withheld at their request.

Recession Correction

“Tunneling” technique improves smile, oral health.

For as long as she can remember, Carolyn Landolfo has had problems with her teeth. As a child, she fought a constant battle with decay. During her teenage years, overcrowding became an issue. In time, so did gum recession.

Photo by Nerissa Johnson.

Dr. Carolyn Landolfo

The latter two issues followed Carolyn into adulthood, where the 56-year-old cardiologist eventually began a new battle with decay, largely as a result of her gums receding to a point where they left the roots of her teeth exposed.

“I had what I would describe as disfiguring gum recession because the color of the teeth above the normal gumline was darker than the rest of the teeth and so, in terms of my smile, I was always very self-conscious about the way I looked,” Carolyn reveals.

She was also concerned because the root of a tooth is more susceptible to decay than the crown, which is not covered with enamel. Without enamel the protective dentin can literally be brushed away with normal brushing.

Carolyn was plagued by all of those issues for years. It wasn’t until a friend told her of a new area periodontist – John Thousand IV, DDS, of Dental Specialists of North Florida – that she found a solution to her problem.

Immediate Effect

“The technique I use is called tunneling,” Dr. Thousand says. “It’s a painless grafting procedure in which we tunnel underneath the gums and slide graft material in there that thickens the gums.

“When you pull the gums back down, the roots are no longer exposed, and the effect is immediate. When the patient goes home, they can look in the mirror and see immediately that their gums are back to where they should be.”

That is precisely the effect the procedure had on Carolyn. After being fitted with braces to correct the overcrowding, she now has a smile she’s proud of, one she says she probably would not have had she not met Dr. Thousand.

“My gums look so much better now, and I haven’t had a cavity since I had the gum procedure,” she says. “To me, that was the most important part of my restoration, even bigger than the bite correction and the braces.

“It’s made a huge difference, and it wasn’t until I found Dr. Thousand that I even learned of this procedure. No other dentist I’d been to ever suggested anything like it, so I was very fortunate to have found him.

“He’s an exceptional dentist. He’s very careful and meticulous, and his level of expertise and enthusiasm for wanting the best outcome is really unique. I’ve already referred several friends and associates to him because I think so highly of him.”

Case in Pointe

Painless, in-office laser treatment corrects toenail fungus.

When a two-liter bottle of soda fell out of a grocery bag and onto her right big toe one summer day several years back, Sandy Oliver knew it would take a while for the resulting cracked toenail to heal and look normal again.
She just didn’t expect the healing process to take more than 20 years.

Photos by Jordan Pysz.

Sandy Oliver

“This all started at a water park in Texas,” Sandy relates. “I had taken my kids there for the day, and when this bottle of soda fell out of the sack, I wasn’t wearing anything on my feet, so my toe wasn’t protected at all. Let me tell you, that really hurt.

“What happened later is that a fungus got in there, so even after that big toe healed, it still wasn’t right. It became all black and then the fungus spread to some other toes. It got so bad that it hurt to wear shoes, which made it hard to walk.”

The situation eventually forced Sandy to visit a podiatrist, who prescribed an oral antifungal medication. The medication eliminated the fungus, but it also made Sandy feel ill. She felt worse when the fungus returned a few months later.

Reluctant to try another medication, Sandy tolerated the fungus and its effects for years. It wasn’t until after she moved to Florida and read about a laser treatment performed at Sarasota Foot and Ankle Center that she once again sought medical aid.

Weapon of Choice

“Sandy first came to us a little more than a year ago wanting to try our PinPointe™ FootLaser® therapy, which is my preferred weapon of choice in the battle against toenail fungus,’’ says Dawn Chiu, DPM, at Sarasota Foot and Ankle Center.

“I prefer it because unlike oral medications, which can upset a person’s stomach the way they did with Sandy, the laser treatment kills the underlying fungus without causing side effects, and there’s no need for the patient to take a blood test beforehand.”

Before and after images courtesy of Sarasota Foot and Ankle Center.The in-office laser treatment lasts only a few minutes, during which time the laser is passed over the nail in a crisscross pattern to ensure full coverage. Patients usually feel a warm sensation on their toe while the laser treatment is in progress, but no pain.

Afterward, patients can resume normal activities. When combined with topical ointments, the laser treatment has an 80 percent success rate. Sandy, who had the treatment performed on all of her toes in November 2017, is factored into that success rate.

“My toes look and feel great again, and I’m really happy about that because I moved to Florida to be near the beach,’’ Sandy exudes. “I love the white sand beaches and the blue water of the west coast, and now, I can really enjoy them.

“I’m so glad I found this treatment because I was thinking I was going to have to put up with that fungus problem forever.
Dr. Chiu and her staff couldn’t be more professional and kind. They’re all great, and I highly recommend them and the laser treatment.”

Avoid Knee Replacement

Stem cell therapy provides long-sought relief from chronic knee pain.

Whenever he hears the song “The Load-Out” by Jackson Browne, Taylor* gets a little nostalgic. Sometimes, he even gets a bit misty-eyed. That song, recorded live during a concert in 1977, describes the life of the members of the road crew for a rock and roll band. It’s a life Taylor was living at the time the song was released.

Stock photo from iStockphoto.com.
“Man, that was a wild time,” Taylor reveals. “I didn’t work for a band as big as Jackson Brown’s band. I was one of three roadies for a band that was usually billed as the opening act for bigger bands, but it was a lot of fun. I got to meet a lot of rock stars, and I saw a lot of the country. It was hard work, though.

“We’d get into a town sometimes just a few hours before the show was to begin, and we’d have to hustle out of the bus and set everything up. Then we’d have to tear it down in a hurry, sometimes before the main act went on. We hauled pianos, drums, amps – all that stuff. It was quite a workout doing that most every night.”

Taylor, now 66, took on the job of a roadie shortly after he got out of the Marine Corps at the age of 24. A friend talked him into it, thinking it would be a good summer job. When the band’s list of gigs extended through the fall and winter, Taylor and his friend hung on and ended up staying with the band until it broke up in 1980.

Following the breakup, Taylor transitioned into a career in construction. He carried into that new job a long list of memories and some interesting stories, including one about the winter night in Providence, Rhode Island, where he slipped on the ice while pushing a trunk with the band’s soundboard in it.

“It was raining when we got into Providence, but by the time we were ready to leave, the rain had turned to snow and the loading ramps in the back of the arena were all iced over,” Taylor remembers. “We were hustling as always to get out of there, and I just slipped and fell straight down on my right knee on the pavement.”

For years thereafter, Taylor dealt with what he describes as “mostly annoying” pain in his right knee. He tolerated that pain all through his time working construction and into his role as the manager and eventually owner of a company that sets up event and party tents. Then, a few years ago, the pain began to intensify.

“I no longer do any of the legwork associated with putting up the tents and taking them down, which is a good thing because I probably wouldn’t have been able to do it if I needed to,” Taylor explains. “That’s how painful my knee got. It went from being a two or three on a scale of one to ten to a nine.

“It hurt from the moment I stepped out of bed every morning and all through the day. Something as simple as walking to my truck to go to work each day became agonizing. I think I have a pretty high tolerance for pain and can usually push through things like this pretty well, but this stopped me in my tracks.”

Taylor’s ever-debilitating pain prompted a trip to his primary care physician who recommended he visit an orthopedic surgeon. The surgeon ordered an MRI that showed Taylor was suffering from arthritis and a vast deterioration of cartilage. His recommendation for repair was knee replacement surgery.

“That was not what I wanted to hear,” Taylor says. “I thought I might need some kind of surgery, but I didn’t think I was looking at a total knee replacement. After hearing that, I decided to get a second opinion. It was during my search for another doctor that I discovered a place in Sarasota that does a treatment that can help you avoid surgery.”

“They do a tremendous job of explaining the therapy and how it works and what to expect, and they were right on the mark with me. I’m so glad I chose stem cell therapy over surgery. This was so much easier, and I feel fabulous.” – Taylor

The place Taylor found is Advanced Rejuvenation, a state-of-the-art wellness clinic, where a highly trained team of physicians has been specializing in regenerative injection treatments for nearly two decades and is now considered to be at the forefront of nonsurgical regenerative therapy.

“Taylor came to us with significant arthritis in his right knee,” recalls Ronald S. Bramson, DPM, at Advanced Rejuvenation.

“He was in a lot of pain and was having trouble not just walking but standing. He was leaning on his left leg because he was favoring the right knee so much.

“The good news was that by looking at his x-rays and MRI, we were able to determine that he still had some cartilage left in his right knee. There wasn’t a lot, but he had enough there to make him a candidate for stem cell therapy. Almost as soon as we suggested it as a treatment, Taylor said he was up for it.”

The Body’s Building Block

Stem cells are the most basic of the human body’s building blocks. They are the foundation of all the body’s tissues and organs and can be collected either from the patient or from placenta tissue. Dr. Bramson has experience with both types of cells and understands which option is best for each condition.

“Stem cells harvested from the placenta tissue can be a good option, but people should be leery about doctors promoting these types of cells because most of the companies selling them are not legitimate,” Dr. Bramson informs.

“We do use those types of stem cells here, but they have been highly vetted and sent for outside testing. That’s why our preference is to use the patient’s own stem cells, and we perform the collection procedure right here.”

When injected into damaged tissue, stem cells support the natural healing process by regenerating the damaged tissue and calming down chronic inflammation. That’s why more and more physicians are beginning to use them as an alternative to replacement surgery for failing joints such as knees, hips and ankles.

Stem cells can also be used to regenerate cartilage, tendon, muscle and new tissue in the shoulders, wrists, spine, pelvis, feet, etc. In addition to its versatility, one of the major advantages of stem cell therapy is that the simple injection treatments can be done in a doctor’s office. Afterward, patients are able to return to normal activity within days.

Unlike those who opt for surgery, most patients receiving stem cell therapy notice a reduction in pain and an increase in comfort within a month of the treatment. Most also continue to feel the effects well beyond that period. It is important to note that not all patients are good candidates for the procedure.

Anyone who has absolutely no cartilage left in their knee or has suffered a tear of more than 50 percent of the rotator cuff in their shoulder would be encouraged to try other options first. That was the position Taylor thought he was in when he first visited Advanced Rejuvenation a little more than a year ago, and he wasn’t alone.

Dealer’s Choice

A native of Pleasantville, New Jersey, Calvin* retired and moved to Florida five years ago after working for more than 30 years as a blackjack dealer at a popular Atlantic City casino. All those years of standing on his feet dealing cards took a toll on Calvin’s knees. It was a toll he began to pay shortly before retiring.

“I was about two years from retirement when the pain started to set in,” he says. “At first, all I had to do was take some aspirin or ibuprofen, and that would pretty much take care of it, but after a while, that kind of stuff wasn’t doing me any good any more. The pain was making it hard for me to complete my shift.

“I was already counting down the days to retirement, but for a while there, I was thinking I might have to retire early. I didn’t want to do that, so I started wearing a knee brace – one of those neoprene sleeves. That helped me for a while, but the pain never really went away. Then, after we moved to Florida, it only got worse.”

“I have been pain free for close to a year now. And it’s not like I haven’t been testing my knees. As soon as I started feeling better, I got back on the golf course, and it wasn’t long after that that I started playing a little tennis again.” – Calvin

Calvin, 70, came to Florida hoping to spend a lot of time playing golf and tennis. His knee pain derailed those plans. When the pain got so bad Calvin couldn’t walk to his mailbox to get the mail without needing to rest, he decided the time had come to visit a doctor. Like Taylor, the news he received was rather distressing.

“The doctor did a real thorough examination and took x-rays and everything. When he came into the exam room, he said, It looks like you’re going to need surgery,” Calvin remembers. “He said the cartilage in both my knees was just about gone and that it was virtually bone on bone. But that wasn’t even the worst news.

“He said that from the time I had the surgery until I was completely healed would be six months to a year. I heard that, and I was thinking that at my age, it might take me two or three years to recover because older people like me just don’t heal as quickly as they do when they’re younger.

“I’m the kind of guy who likes to stay active, and I really wanted to get back to playing golf and tennis and so I said, Thank you, but I’m going to see if there’s anything else I can do before I agree to have surgery. It was after that that I found out about Advanced Rejuvenation and decided to see what they can do for me.”

Calvin first visited Advanced Rejuvenation last June. On the advice of a friend, he went there looking to learn about the treatments they offer. By the time he left, he was convinced his best option was to skip surgery and give stem cell therapy a try. Two days later, he made an appointment to have the stem cell injections.

Stock photo from iStockphoto.com.Pain Free Again

Calvin received his stem cell injections last July. He distinctly remembers a day about three weeks later when he woke up, got out of bed and realized the agonizing knee pain he was so accustomed to feeling was suddenly less intense. That pain continued to dissipate over the next few weeks to a point where now, he no longer feels it at all.

“I have been pain free for close to a year now,” Calvin enthuses. “And it’s not like I haven’t been testing my knees. As soon as I started feeling better, I got back on the golf course, and it wasn’t long after that that I started playing a little tennis again. I’m still only playing doubles to lessen the impact, but I’ll be playing singles again soon.”

Taylor’s activity level has been given a boost from stem cell therapy as well. After agreeing to the treatment and receiving an injection into his right knee last January, he felt good enough to begin a light walking regimen last March. Now, he’s jogging lightly on a treadmill for about 30 minutes three days a week.

“Because of the work I did for so long, I was always in pretty good shape and never really had a problem with my weight,” Taylor explains. “That changed as my knee pain increased. I must have put on twenty pounds or more during that time, but I’ve lost most of what I gained since my knee pain has disappeared and I’ve started working out.

“I just feel a whole lot better overall since I had the stem cell therapy. It’s really changed my life. My knee pain had become like a constant companion, something I was always wrestling with no matter what I was doing. Now, I don’t feel it at all, and let me tell you, I don’t miss it either. I feel great.”

Taylor chose to have the stem cell therapy in part because he knows two people who had bad experiences with knee replacement surgery. He says one of those friends had to have the surgery repeated while the other has yet to regain the kind of pain-free functionality Taylor has. That’s why he says he’d recommend stem cell therapy to anyone.

“And I highly recommend they get it done at Advanced Rejuvenation,” he says. “The whole staff there is great. They do a tremendous job of explaining the therapy and how it works and what to expect, and they were right on the mark with me. I’m so glad I chose stem cell therapy over surgery. This was so much easier, and I feel fabulous.”

Calvin echoes those sentiments. He says that from the moment his consultation began, he was impressed with the staff and their attention to detail. He says he can see now why many consider stem cell therapy the wave of the future in terms of eliminating debilitating joint pain.

“The folks at Advanced Rejuvenation know what they’re doing, and they do it exceptionally well,” he raves. “I’ve already recommended them to a couple of friends, and I’ve told them all, before you go see a doctor who will probably recommend surgery, save yourself some time and frustration and go to Advanced Rejuvenation first. They’ll take care of you the right way.”

*Patient’s names withheld at their request.

Reaching New Heights

Dental reconstruction plan improves smile and function.

The 300 block of 9th Avenue in New York City has long been one of the busiest blocks in the United States. For years, it was the site of the New York Station on the Hudson River Railroad Line, the spot from which Abraham Lincoln’s funeral train departed for Springfield, Illinois on April 25, 1861.

Patient photos by Nerissa Johnson.

Jaime Lugo – AFTER

That station is long gone, but in its place stands the Morgan General Mailing Facility, which just happens to be the largest mail sorting facility in the country. For 37 years, Jaime Lugo worked at that facility, the last 23 as a senior manager.

“I was in charge of all the mail processing there from four o’clock in the afternoon until midnight,” Jaime explains. “I had about fourteen hundred employees working under me, and anything that happened between those hours, it was on me to take care of it.”

Jaime’s nearly four-decade-long career with the US Postal Service came to an end in 2005, when he retired and moved to Florida. A little more than a decade later, he decided to get busy correcting a very noticeable dental issue.

“Ever since childhood, I’ve always had small teeth because I’ve always grinded my teeth,’’ Jamie reveals. “Even as an adult I’ve grinded my teeth and for years now, my family and friends have always mentioned it and said I should do something about it.

“It wasn’t anything that really bothered me. It’s not like I was ever embarrassed by it. But I knew it was something I should probably address at some time or another and so I eventually decided, Why not get it fixed?”

Jaime’s decision to repair his teeth came as he was growing frustrated with the dentist he’d been seeing since he first arrived in Florida years earlier. He wasn’t necessarily looking for a new dentist, but he found a new one nonetheless in a rather unique way.

“I like to go bike riding, and one day, I was riding my bike and saw this dental office that I’d been passing for years and suddenly thought, It’s time to try something new,” Jaime recalls. “That’s how Dr. Blank became my dentist.”

Stephen G. Blank, DDS, has practiced dentistry since 1982. He practices cosmetic and functional dentistry and willingly embraces leading-edge technologies as part of his commitment to providing the best care possible for his patients.

Before image courtesy of Dr. Blank.

Jaime Lugo – BEFORE

The Muscles Win

“When I first examined Jaime, I found that all his teeth had been worn short,” Dr. Blank reports. “His lower incisor, for example, measured five millimeters tall, which is about half the size of a typical, healthy lower incisor.

“That was a result of the fact he has very square jaws and very strong muscles. In cases like that, the muscles always win out over the teeth. When patients clench or grind, the muscles are always busy rubbing teeth against one another, and the teeth lose out because they can’t grow back.”

Jaime’s issues were not unique. It’s typical for people with strong, square jaws to grind their teeth. If the problem is detected early, the grinding can be abated by fitting the patient with a bite guard appliance they often wear at night while sleeping to protect the teeth.

Jaime had never been fit with such an appliance. As a result, his teeth had become so worn that he looked as if he didn’t have teeth even when he smiled. That wasn’t the only aesthetic issue caused by his worn-down teeth.

“The only thing that keeps your chin from reaching your nose is the teeth in the middle, so with his teeth being as worn down as they were, his chin was getting closer to his nose all the time,” Dr. Blank describes. “His face was actually collapsing.

“What we needed to do was rebuild his teeth. Our goal was to give Jaime back the missing tooth structure he’d lost in both arches over the years and thereby increase the vertical dimension, or the height from the nose to the chin.”

Jaime agreed with the reconstruction plan, which began in April 2018 with a smile design visit. Dr. Blank measured all of Jaime’s upper and lower teeth, took photos and created impressions to be used in the creation of a wax model of each arch.

“Dr. Blank did a great job. He’s so professional and caring. He told me if I ever had a problem with anything to visit the office and he would follow up. He’s really exceptional, and I highly recommend him.” – Jaime

Using the wax models as a guide, ceramic crowns were made to fit over the existing teeth with the lowers treated first to help accommodate Jaime’s desire to break the treatment in half.

During a second visit, Dr. Blank prepared Jaime’s teeth for the crowns and fit him with temporary crowns. During the third visit, the temporary crowns were removed, and Jaime received his permanent all ceramic crowns.

Never Too Late

About six months later, Jaime’s upper teeth were prepared, and crowns were placed during a second series of appointments. The result is a full, bright, new smile that Dr. Blank might not have been able to produce the way he did had Jaime waited much longer to address the grinding issue.

Patient photos by Nerissa Johnson.

Jaime’s full mouth restoration has given him a bright new smile.

“If the teeth get too short and I prepare them to accept crowns, there may not be enough tooth left to grab the crown,” Dr. Blank explains. “When patients wait too long, the teeth are too short, and crowns may come off. So, you need to have a certain amount of tooth to do this.

“Thankfully, Jaime’s teeth were not too worn down. Had his teeth gotten much shorter, his prognosis would have been worse. So, he’s a good example of why it’s never too late to come in and get a consultation to find out what can be done.

“A lot of people think their teeth are too far gone, and they stop caring for them. But I always tell patients, Keep caring for your teeth just in case we can fix them, because it gives us more to work with and gives the patient the best chance for a good outcome.”

Jaime got what he describes as an excellent outcome. He says the days of him smiling and no one seeing his teeth are over. He now has a “beautiful,” healthy smile that looks natural and that he is proud to show off.

“Dr. Blank did a great job,” Jaime enthuses. “And he wasn’t pushy at all. When we were discussing the options I had and the best way to go about repairing the problem, he gave me the chance to make the decision that I was most comfortable with.

“That was really important to me, because this was an investment. Dr. Blank is just so professional and caring, and he told me if I ever had a problem with anything to visit the office and he would follow up. He’s really exceptional, and I highly recommend him.”

Strong Connection

Connective tissue graft lays groundwork for bright, new smile.

The flip side of the devastating 2008 housing crisis is that it created a buying opportunity for real-estate investors everywhere. New Jersey-born Jann Rudd was among those who had the wherewithal to take advantage of that opportunity.

Photo by Nerissa Johnson.

Jann Rudd

“I had already done a couple of projects back in New Jersey, where I would find a commercial building or residence, renovate it and then rent it out or flip it,” Jann says. “In 2010, I started buying down here in Florida, and I eventually moved here.”

When Jann made that move, she brought with her a dental problem that she believes has its roots in her early teenage years, when her first set of braces didn’t provide the permanent fix they were designed to.

“I’ve had braces three times – the last two when I was in my forties – because my teeth kept moving back,” Jann explains. “I think it may have been a result of all that moving around, but my gums started to recede, particularly on one of my front teeth.

“I wasn’t very happy with my teeth in general and was looking to get some cosmetic work done, but the dentist told me, You can’t do anything cosmetically until you get your gums taken care of. That’s when he recommended that I go see Dr. DeTure.”

Dr. DeTure is C. Nicholas DeTure, DMD, of Stuart Periodontics. He specializes in repairing damaged gums. After meeting and examining Jann, he recommended repairing her receding gumline through a connective tissue graft.

Before and after images courtesy of Stuart Periodontics, P.A.

Jann Rudd – Before & After

Doctor Preferred

Considered the most common treatment for repair of receding gums and exposed roots, the connective tissue graft typically begins with the dentist removing tissue from beneath a flap cut in the roof of the patient’s mouth.

Synthetic or donor tissue can also be used during this procedure, but tissue taken from the patient provides a more stable, long-term solution, according to Dr. DeTure, who says the incision made in the palate heals quickly and comfortably.
After the connective tissue is obtained, another incision called a pinhole incision is made near where the gums are damaged or receding and creates space for the connective tissue.

“This is called the pinhole dissection technique, and once that pinhole incision is made, the graft material is threaded through that pinhole and into the space that we created,” Dr. DeTure explains. “The gums hold that material in place while it heals.”

Another reason Dr. DeTure prefers using the patient’s own tissue for this procedure is that it tends to heal, fill in and mature more quickly than synthetic or donor tissue. In most cases, the gums heal in about two weeks and fill in completely after a few months.

Jann agreed to the procedure, which was early last spring. By the fall, her gums had filled in to the point where she was ready to get the desired cosmetic work done. She says she could not be happier with the outcome.

“The outcome is an A-plus,” she raves. “Dr. DeTure did his magic and absolutely put my gums back the way they were supposed to be. I couldn’t be happier with how I look now, and it would not have been possible without him.

“A lot of people wouldn’t say this about a dental procedure, but it was a really good experience. The procedure itself was all very painless, and Dr. DeTure could not have been nicer or more caring or considerate.

“He called me the night before the procedure to ask if I had any concerns and called me again after it was over to make sure I was comfortable and everything was all right. I’ve never met another dentist or doctor like him.”

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