Author Archive

Well-Fitting Genes

DNA technology creates safe, purified hormone replacement.

As a boy, Craig* watched the birds in the air and was fascinated. He thought flying was the coolest thing and dreamed about soaring through the air himself. As a young man, the New York native attended college on a Navy scholarship and had the grades to go directly to flight school following graduation.

“I got my wings, and the rest is 25 years of flying history,” shares Craig, 50. “I served as a Navy pilot from 1992 to 2002, and I started working in 2003 for an aircraft manufacturer that makes Black Hawks and other types of helicopters. I’m a test pilot for them.”

Craig’s wife, Amber*, a Connecticut native, has her own career as a registered nurse. She’s been in the field for nearly 20 years. For a while, Amber was a travel nurse, so she had no qualms about relocating to the Sunshine State for Craig’s job.

“I worked in emergency medicine for 10 years, and I’ve been a surgical nurse for pretty much the past 10 years,” elaborates Amber, 44. “I miss the fast pace of emergency medicine, the thinking-on-my-toes aspect, but surgical nursing has its moments. It’s just not as insane as emergency medicine. Both specialties have their pros and cons.

“We moved to Florida 10 years ago. We always wanted to live in a warmer climate, and I can get a job anywhere, so when Craig’s job offered to transfer him, we went with it.”

It was five years ago when Craig initially noticed deviations in how he was feeling, which affected his overall well-being.

“I’ve always been very active and involved in martial arts, weightlifting, general exercise and fitness, but things started to change,” he states. “It was taking longer for me to recuperate from my workouts, and I was feeling more tired than normal. My libido wasn’t where I wanted it to be either.

“It was determined back then that my testosterone was diminished. I began hormone therapy, but I wasn’t happy with the doctors, the treatment or the results because I wasn’t feeling any better.”
Craig wasn’t the only one in misery.

“I began experiencing symptoms as well,” Amber confirms. “My biggest complaints were with my energy and libido.”

In a fortunate turn of events, Craig and Amber met Ramon Vazquez Jr., MD, through the hospital where Amber works. They learned that Dr. Vazquez offers hormone replacement therapy, or HRT, which treats low hormone levels.
Dr. Vazquez determined that low hormones were causing Craig’s and Amber’s uncomfortable symptoms.

“When asked about hormone therapy, some people think of body builders using testosterone to get bigger and stronger,” Craig observes. “But Dr. Vazquez’s therapy is strictly for maintaining my hormone level in the normal range. He sends me for bloodwork, monitors my level and adjusts my prescription to keep it in that normal range so I can live a healthy lifestyle.”

Three’s Company

“By the time women reach the age of 40, it is very common for them to notice changes similar to those described by the famous 1970s actress Suzanne Somers, star of the sitcom Three’s Company,” Dr. Vazquez informs. “These changes include fatigue, loss of energy, malaise, changes in hair texture and quality, hair loss, changes in skin and nails, and generally not feeling like yourself. Eventually, there’s weight gain and loss of libido as well.

“Ms. Somers wrote a book detailing the numerous medical regimens she went through here in the US that were ultimately just prescribing antidepressants. She recognized that her condition was not an issue of depression; it was an issue of hormones. Eventually, she found doctors in Europe who were willing to engage in hormone replacement therapy.

“I encounter the same motivation and the same symptoms in women – and men – in my practice every day, and in most cases, I prescribe HRT for them.”

For years, providers used extracts from the pituitary glands of animals to generate hormones for HRT. But there are serious complications associated with those hormones, including mental illness, and changes in heart and liver function.

“The hormones we use at my practice are derived from recombinant DNA,” Dr. Vazquez describes. “Recombinant DNA is the result of combining genetic material from multiple sources. Using this technique, we manufacture more purified, safer forms of the hormones because we copy the actual genes that produce the hormones.

“Using DNA technology, we have access to unlimited quantities of thyroid hormone for women and men; human chorionic gonadotropin [HCG], which stimulates the testes in men and ovaries in women; the individual sex hormones estrogen and testosterone; and many other essential hormones.”

Before prescribing HRT, Dr. Vazquez thoroughly evaluates the patient’s blood chemistry, liver function and overall health. He uses blood tests at regular intervals throughout treatment to monitor health and hormone levels, and tweaks the hormones as needed.
Dr. Vazquez offers several dispensing options for HRT.

“Men have the choice of injections or pellets,” the doctor explains. “I am not a fan of gels for men, particularly men in relationships. Generally, gels are placed in men’s armpits or a skinfold, but if their partners cuddle with them, they absorb some of those hormones.
“I do employ some gels with women because they can be placed on the women’s inner thighs and absorb well. Another option for women is sublingual hormones. They go under the tongue, where they dissolve. Unfortunately, many sublingual hormones are gelatinous and have a bad taste.

“Pellets are ideal. We simply place a pellet underneath the skin on the side of the leg, and they last up to five or six months. The pellets are slow-release. They provide a much more steady state of the hormones, and both women and men seem to find that much more appealing.

“Typically, the women come to see me first. Then, after they use the hormones for a while and experience results, they bring in their husbands.”

Holistic Approach

Craig decided to get his hormones via injection. In addition, he takes a medication called anastrozole by mouth. Anastrozole decreases the amount of the female hormone estrogen in the body. Too much estrogen can cause men to develop breast buds and other feminine traits.

“A holistic approach is required for men,” Craig reports. “You can’t just take testosterone by itself because there are side effects to that. I give myself a 1cc injection of testosterone once a week and take anastrozole tablets to decrease estrogen and balance out the negative side effects.

“It took about a month or five weeks after beginning Dr. Vazquez’s HRT to feel a difference. I guess it took a while for my body to metabolize the hormones. But when I’m on the HRT, I feel normal. And it enhances my libido for sure. Using the hormones makes a significant difference.”

“I get my hormones via pellets,” Amber relates. “It takes probably 48 hours after getting a pellet to notice a difference. I see an increase in my libido that fast. Then, within a week or so, I start feeling a difference in my energy. But the hormones in the pellets start to fade after five or six months, so I go back to Dr. Vazquez. He draws my blood, and if my hormone levels are at the low end, I get another pellet inserted.

“Dr. Vazquez is very professional and accessible. He sits down with us and discusses our conditions in detail. He loves to teach us about his treatment and go over the pros and cons. We’re both very happy with him.”

© FHCN article by Patti DiPanfilo. mkb
*Patients’ names changed at their request.



Pelvic Pain? It may be your VEINS!

Kaila Simpson was 24 when she started her career as a sales associate for a tech company. Following that, she did sales for several startups and then, 3½ years ago, she landed at an IT research and advisory firm in Fort Myers.

“My job involves working with tech CEOs on their strategic initiatives,” Kaila, 30, details. “We discuss their growth goals, and I align them with my company’s resources so they can apply our insights to their products, marketing and sales strategies. I typically work with five to eight clients a week.”

A native of Bright, Indiana, 45 minutes outside of Cincinnati, Kaila is highly successful in her professional life. Conversely, she’s been struggling for some time in her personal life. She was dealing with endometriosis and polycystic ovary syndrome, two gynecological conditions that can cause severe pelvic pain, and then began experiencing pelvic and back pain that went beyond what is typical for those disorders.

“In addition to abdominal pain and painful intercourse, I was also having a lot of pain in my pelvic area that radiated into my lower back,” she describes. “I got a sharp, stabbing pain persistently four times a day: in the morning, at midday, in the afternoon and at night. It was a pain that would make me buckle over. On a scale of one to 10, it was a solid 10! The rest of the time my pain was an eight out of 10.

“I like to run and dance, but with the pain, I didn’t run as much because I couldn’t take a lot of impact. Dancing took a back seat as well, but I was able to keep swimming.”

‘My OB-GYN did a CT scan and saw a cluster of varicose veins in my pelvis. He told me I had something called pelvic congestion syndrome and referred me to Dr. Magnant to identify what was causing it and to determine a treatment plan.”

Joseph G. Magnant, MD, is a board-certified vascular surgeon at Vein Specialists in Fort Myers and Bonita Springs. He is dedicated to the modern and comprehensive evaluation of leg vein disorders and pelvic venous congestion and uses the most advanced minimally invasive treatments.

“For many years, most pelvic pain in women was attributed to endometriosis until proven otherwise,” Dr. Magnant notes. “What’s new today is that we’re able to diagnose patients, specifically young women such as Kaila, with iliac vein compression, or what is called May-Thurner syndrome, or MTS. It’s one of the most common causes of pelvic congestion syndrome.

May-Thurner Syndrome

“With MTS, the right common iliac artery anatomically crosses in front of the left common iliac vein, from left to right. On the other side of that vein is the lumbar spine. In a certain percentage of patients, there’s significant compression of the vein against the spine by the artery, which blocks blood flow through the vein resulting in increased pelvic venous pressure.

“The left common iliac vein drains the left leg and pelvis, and its compression results in painful symptoms in the legs, back and pelvis. In addition, when blood is unable to get out of the left leg, new collateral blood vessels form to shunt the blood from the left side of the pelvis and leg to the right side of the pelvis into the right iliac vein. Those collaterals are essentially pelvic varicose veins and can wrap around the pelvic organs such as the ovaries, vagina, uterus, bladder and bowel. These are the same areas often affected by endometriosis.

“That’s why it’s so important for physicians not to just label patients as having “idiopathic” pelvic pain or “psychogenic” pelvic pain and leave it at that. We have found that many of those patients we have evaluated have treatable causes for their symptoms, further emphasizing the importance of considering pelvic congestion syndrome due to iliac vein compression or MTS in this group of patients.”

Diagnostic Findings

To determine the underlying cause of Kaila’s pain, Dr. Magnant performed an extensive evaluation that included two ultrasound procedures. The first was an iliac vein duplex scan, which is performed through the skin of her abdomen to examine the pelvic veins.

“This scan allows us to look deep inside the pelvis and visualize venous blockages,” Dr. Magnant informs. “There are certain criteria we follow to determine if there’s significant narrowing of the veins. Kaila met all the criteria.

“Her left common iliac vein was compressed more than 50 percent. It had an hourglass deformity, where it’s big on the two ends, but in the middle, where it’s being squeezed against the spine, it’s small. It was like a five-lane highway being narrowed down to one lane with increased velocity of the blood flow in the middle. She also had varicose veins in her pelvis. These three findings are consistent with MTS as the cause of pelvic congestion syndrome.”

The second scan was an intravascular ultrasound, or IVUS. During IVUS, a catheter the size of a pen tip is placed through an IV into a vein in the thigh and fed through the venous system into the inferior vena cava, the large vein that carries deoxygenated blood from the lower half of the body back to the heart.

“Since the procedure, my lower back pain has gone away.” – Kaila

“When we pulled the catheter back into Kaila’s left common iliac vein, we could see that the blood vessel was compressed almost like a pancake, as the artery pressed it against the spine,” Dr. Magnant describes. “We then measured blood flow in both the normal vein channel and the compressed channel and learned that Kaila had a reduction in flow in the 80 to 90 percent range.”

Once Dr. Magnant determined that Kaila had a significant blockage, he opted to proceed with a balloon angioplasty to stretch the scarred and compressed vein and improve the blood flow.

“We placed a special balloon through the narrowed area and expanded it to stretch out that area of the vein,” Dr. Magnant explains. “But stretching the area is not sufficient treatment as the vein often collapses under the continued pressure of the artery, so a stent is always required to prevent this from occurring. The stent serves as a strut, or internal brace, to keep the vein from collapsing against the pressure of the artery.”

“I’m Dancing Again”

Once Kaila received this IVUS stent treatment from Dr. Magnant, her pain decreased significantly within just a few short days. Soon, she resumed many of the activities she had put on hold because of her pelvic congestion symptoms.

“Since the procedure, my lower back pain has gone away and the painful intercourse has vastly improved,” she reports.

“Thanks to Dr. Magnant, I’m back running again. I can just about do a 5K right now, and I’m working up to a 10K. I’m also dancing again, and it’s awesome. Dr. Magnant is phenomenal. He gave me an in-depth explanation of what we were going to do and why we were going to do it, and it solved the problem.”

© FHCN article by Patti DiPanfilo. mkb

A Silent Killer

Unexplained leg pain or swelling? It could be a DVT.

A deep vein thrombosis, or DVT, is a clot that can obstruct blood flow in a deep vein.

Wearing compression stockings helps reduce swelling.

It’s also a “silent killer,” according to Samuel P. Martin, MD, founder and medical director at Vascular Vein Centers.

“It is the single largest cause of death in hospitalized patients with another admitting diagnosis,” Dr. Martin reports.

“That’s because a clot in the leg or pelvis, which typically occurs after an abdominal, pelvic or orthopedic operation, trauma or stroke, can break off, pass through the heart and block blood flow to the lungs. When that happens, it’s called a pulmonary embolus, or PE. A PE can cause shortness of breath and/or chest pain, and if it’s large enough, it can cause death.”

As many as 900,000 people, or one to two per 1,000, could be affected by a DVT each year in the US, according to the Centers for Disease Control and Prevention. Up to 100,000 Americans will die as a result of a DVT with a PE, two-thirds of them in a hospital or within a few weeks of hospitalization. Half of those who develop a DVT will have long-term consequences, such as swelling, pain, discoloration and skin changes around the ankle of the affected leg. One-third of those with a DVT will have a recurrence within 10 years.

“Clots in the legs occur for a variety of reasons,” Dr. Martin observes. “Some people inherit a tendency to clot, referred to as thrombophilia. Cancer, obesity, pregnancy, prolonged travel and a sedentary lifestyle also present significant risks for DVT.”

A clot can be completely asymptomatic (“silent”) or it can cause sudden leg swelling, pain, aching or fullness and pressure in the leg. There can also be warmth of the leg in the area of discomfort or skin discoloration of the lower leg. People experiencing any of these signs or symptoms should consult a physician immediately.

Risks and Remedies

The risk for a DVT is significant for patients with a history of orthopedic operations on the back, hips or knees, abdominal or pelvic procedures, and in trauma cases.

Prevention involves early mobilization, pneumatic compression of the legs while in the operating room and afterward, and use of blood-thinning medications, especially in those with a previous or family history of clots and in cancer patients.

“Long trips with little movement, especially with constricting garments or associated with dehydration, increases the risk for developing clots as well,” Dr. Martin warns.

“Compression stockings, hydration and frequent movement or flexing the foot can help a great deal. This is especially important in overweight or obese people and in pregnant women because of a higher risk for clots.

“The risk for deep vein clots in the legs can be reduced by maintaining a good body weight, staying active and exercising regularly, not smoking, knowing your potential risk factors and discussing them with your health care provider. Wearing compression stockings helps reduce swelling and can be incorporated into a healthy lifestyle.

“If people have signs or symptoms of a DVT, they should make an appointment with a physician, particularly a vascular specialist, and a Doppler ultrasound exam should be performed. The diagnosis of a DVT in the leg cannot be made on physical exam alone.”

Clots in the deep veins require medical therapy, Dr. Martin emphasizes. The provider may prescribe an anticoagulant, or blood thinner, such as Heparin or Coumadin or one of the newer anticoagulants, such as XARELTO®, ELIQUIS® or PRADAXA®. In addition, people should stay active, wear compression stockings and elevate their legs when possible.

Article and photos courtesy of Vascular Vein Centers. mkb

Think On Your Feet

What diabetic patients need to know to maintain foot health.

Diabetes is a disease that can affect a person’s heart, kidneys, eyes, nerves and feet. However, with adequate medical care, home management, exercise and proper diet, most people with diabetes can lead a normal and full life.

Because the disease can result in a decrease in circulation and/or a decreasing sensation in the feet, foot issues are among the more common complications caused by diabetes.

“Part of managing the disease should include routine foot screenings,” explains board-certified podiatric surgeon Robert P. Dunne, DPM, of Lake Washington Foot & Ankle Center. “Most patients watch what they eat, take their medications as prescribed and exercise, but many fail to see the importance of having a physician evaluate their overall foot health.”

According to the American Podiatric Medical Association, more than 65,000 diabetic patients per year will have a lower limb amputation, and the odds of a second amputation within three to five years increases by 50 percent.

This is why it is essential to keep an eye on your lower extremities and take care of any issues that may occur.

“Seeing a podiatrist can greatly reduce a patient’s risk of having a lower limb amputation,” Dr. Dunne emphasizes.

“When it comes to corns, callouses and routine nail care, patients often don’t give a second thought to taking care of these issues themselves. But many times home treatment can lead to greater issues, including ulcers and infection. This will typically stem from the patient nipping the skin without realizing it as a result of neuropathy that often accompanies diabetes.”

Early Intervention

There are other complications directly related to diabetes that can present themselves such as peripheral neuropathy, peripheral vascular disease (PVD) and peripheral artery disease (PAD).

Many of these issues can be avoided by seeing a podiatrist regularly for routine care.

Lake Washington Foot & Ankle is a comprehensive podiatric clinic offering treatment for everything from bunions to hammertoes.

“We treat ingrown toenails, warts and neuromas,” Dr. Dunne assures.

“Our patients come first, and we recommend that they take action now if they have a problem,” Dr. Dunne informs. “Many people are intimidated by treatment for fungal nails because of known side effects to the liver and other organs. These medications are no longer the only option, and alternate treatments are available.”

Article courtesy of Lake Washington Foot & Ankle Center. mkb


Eye Floater Laser

We Are The Experts… 20,000 laser sessions and counting.

Scott L. Geller, MD

Scott Geller, MD, is the board-certified ophthalmologist who brought an advanced laser technique for the treatment of eye floaters from Switzerland to the US and refined it to the precise level it’s at now. He specializes in a field that few eye doctors can.

“Patients often ask me, Why can’t my local doctor laser eye floaters,” Dr. Geller states. “The answer is because this is a niche area of interest, and most ophthalmologists will not take the time to really study and perfect it.

“It’s a bit like plastic surgery. Any intern can make an incision and stitch skin, but it takes years of experience to size up a patient, know exactly how to modify a technique and get the absolute best result possible.”

Dr. Geller has that experience. In Switzerland, he studied the treatment of diabetic retinal membranes under Franz Fankhauser, a pioneer in the use of the YAG Laser in the eye. Since then, Dr. Geller has performed more than 20,000 eye floater laser procedures, the largest clinical series of patients, possibly worldwide.

Even the great ophthalmic institutions at the University of South Florida in Tampa and the Bascom-Palmer Eye Institute in Miami cannot make that claim. As a result, Dr. Geller has also lectured and trained eye surgeons worldwide in this specialized skill and treated patients from as far away as Siberia.

“Bringing the laser to the US sparked a great breakthrough in ophthalmology,” Dr. Geller states. “The laser revolutionized the treatment of various eye conditions, making them easier and safer. When using this laser, there is no risk of a blinding infection inside the eye.

“The patients who are referred to my practice are visually disabled by large floaters and membranes in the eye. They are not the common specks or strings the average person might see against a clear sky. These floaters are often directly in the patient’s center of vision.

Because of that, the obstruction to vision that these large floaters cause can be extreme. They can be especially hazardous to someone who is driving, someone who is performing other dangerous tasks that require precise vision or someone who has only one functioning eye, has suffered an eye injury or suffers from macular degeneration or lazy eye [amblyopia].

“We excel in clearing these obstructions, even in the most difficult of cases. In fact, we have a documented case of a patient with macular degeneration and dense eye floaters whose vision was improved. Even his retina specialist found it unbelievable.”

Understanding the Patient

Some eye specialists and institutions offer to treat patients with eye floaters by performing a vitrectomy, a surgical procedure to remove a gel called the vitreous humor that fills the cavity of the eye. This improves access to the retina, allowing the physician to perform a number of repairs. But it can cause complications, especially in patients who are on blood thinners or have other issues.

Others simply follow their routine of measuring the patient’s vision and checking for retinal tears or detachments. In those cases, barring anything unusual, the doctor says the retina looks fine and the floater will either fade or the patient will get used to it.

“And to that, the patient typically responds by saying, 1” Dr. Geller relates. “And while it’s true that, for many patients, the floaters do fade or the patient simply gets used to them, that’s not always the case.

“That’s why ophthalmologists need to listen to the patient’s problem and thoroughly examine the vitreous gel, where eye floaters are formed. If the ophthalmologist measures only the patient’s best vision on an eye chart, they may not correctly diagnose the problem and dismiss the patient out of hand, telling them that nothing needs to be done, which may leave the patient bewildered and frustrated.

“This is one of the areas of ophthalmology that is routinely ignored by many ophthalmologists, and the reason for this is simple: They don’t take the patient’s visual acuity with the floater in the visual axis. At South Florida Eye Clinic, we always take that step. We measure the patient’s worst vision on the eye chart to see exactly how bad the vision gets with the floater obstructing it. That’s why my patients with macular degeneration or lazy eye report improvement of their overall vision.”

Dr. Geller also specializes in fixing cases that did not have a satisfactory outcome.

“Many ophthalmologists have no extensive, formal training, and they think they can just jump into this specialty,” Dr. Geller explains. “They are often too busy with other procedures like cataract surgery and glaucoma treatment to devote the time necessary to become an expert at this. As a result, the outcome of their treatment of eye floaters is often less than optimal. But I specialize in the treatment of eye floaters, and I invite any ophthalmologist or optometrist to visit and observe the procedure.”

So what is the procedure like?

“It’s quite easy compared to a traditional cutting operation,” Dr. Geller reports. “I start by placing a special lens on the eye, where the laser pulverizes the opacity or creates a ‘window’ in the line of vision. Pain or even mild discomfort is unusual during this procedure, and we pride ourselves on a high level of concern for patient comfort.”

A Doctor and a Teacher

Dr. Geller has lectured all over the world – in Italy, France, Germany, the Czech Republic, Turkey, China and Mexico – on the technique he developed to treat eye floaters and has treated patients referred to him from all of those countries.

Eye Floater Diagram

“My first scientific presentation was at the 1989 International Congress of Ophthalmology in Singapore,” he adds. “It was followed by lectures at several conferences in China, including the prestigious Shanghai Eye and Ear Institute.

“Other major meetings included the 1997 European Congress of Cataract and Refractive Surgery in Prague; the 1999 Florida Society of Ophthalmology; the 2001 European Congress of Ophthalmology in Istanbul; the 2010 World Congress of Ophthalmology in Berlin; and the 2010 American Society of Cataract and Refractive Surgery in Boston. There was also a peer-reviewed presentation at the American Academy of Ophthalmology in Chicago in 2012.”

One of Dr. Geller’s lectures covered the onset of disabling eye floaters in patients who recently had cataract surgery.

“I gave my first presentation on this at the World Congress of Ophthalmology in Berlin, 2010,” Dr. Geller reveals. “I also presented a paper at the prestigious American Society of Cataract and Refractive Surgery that documented and described unnecessary post cataract surgery scarring and membrane due to a missed diagnosis of eye floaters.

“My hope is that this important information will prevent future mistakes for the benefit of patients. I have even seen patients who had missed eye floater diagnoses, and they felt they were talked into cataract surgery that did not deal with their real problem.”

Approximately 50 percent of the patients Dr. Geller sees are post-cataract surgery patients.

Finding Dr. Geller

Patients seeking treatment from Dr. Geller are advised to call rather than email his office, but Dr. Geller confides that patients often find him in a roundabout way.

“Recently, a man in West Palm Beach went to the satellite clinic of a world-famous Miami eye institute,” the doctor reports. “They told him they couldn’t do anything for him except vitrectomy, but they also told him there’s an ophthalmologist on the west coast of Florida who can treat your eye with a laser. “It wasn’t a direct referral, but the patient managed to find me and was ecstatic with his results.

“Subsequently, I uploaded a video of his procedure to and, which can be found among dozens of videos I’ve posted.”

Dr. Geller cautions that not all patients can be helped with his laser procedure, though he is pleased to report that, partially due to his meticulous patient selection process, his results are excellent.

“Laser treatment of eye floaters is fascinating,” Dr. Geller says. “I look forward to doing this every day.”

Dr. Geller says that while his greatest satisfaction comes from helping patients who have been told by their own ophthalmologists that nothing can be done, he actually welcomes the opportunity to share his technique with others in his field.

“Other ophthalmologists need only call me, or ask one of my patients about their results,” he says. “I’m proud of our track record and of the patients we’ve helped.”

Article submitted by Scott L. Geller, MD. FHCN file photo. mkb

XEN® at Work

Eye stent relieves high pressure of glaucoma.

As an engineer with the Merchant Marine, Sean Grace bears responsibility for the operation of a self-contained city at sea. The merchant vessels transport goods and materials throughout the world and require an array of personnel to sail efficiently.

Sean Grace

“We have three departments: the deck department that navigates the vessel, the steward department that feeds the crew and the engineering department that provides the propulsion,” Sean relates. “Engineering also repairs any equipment and maintains the generators, which produce our electricity, and the evaporators, which make our water.

“In addition, we do extensive training and drilling in anticipation of an emergency, such as a fire, because we can’t call the fire department in the middle of the Pacific or Atlantic. My job is like the movie Groundhog Day. It’s the same thing repeating over and over, but it’s a very intensive job in a very isolated environment.”

Sean, 54, started his career as a wiper, an entry-level position, making him a junior member of the engineering crew. Over time, he worked his way up to second engineer. With the advancement, Sean became a licensed officer and joined a trade union, the Marine Engineers’ Beneficial Association, which requires a yearly physical. During one of those exams, Sean learned he had glaucoma, an eye disease associated with high pressure in the eye.

“I had no symptoms that I was aware of,” Sean says. “Occasionally, I got a sharp pain in my eye, but then it would go away and not happen again for six months or a year. In retrospect, I realize that was a sign, but there were no overt or glaringly obvious signs that I was suffering with glaucoma.”

Initially, Sean visited a specialist in his native New York who prescribed two eye drop medications to reduce the pressure. Later, he moved to Florida and bought a home in Brandon, so he began seeing the eye specialists at Brandon Eye Associates. When the high pressure persisted, doctors added a third medication.

“I normally work for three or four months at a time, sometimes longer,” Sean states. “I’d get a 90-day supply of medication and then go to work, and sometimes I’d run out. There were other times when, due to the nature of my job, I wasn’t able to take my drops as regularly scheduled, so my pressures remained high.

“Not long ago, we were sailing in Asia, and I wasn’t home in Brandon for about a year. When I got back, my pressures were up again. And I actually lost some field of vision on the periphery, so my doctor at Brandon Eye Associates, Dr. Jennifer Landy, suggested that I see Dr. Ilyas and get a certain procedure.”

Haroon Ilyas, MD, is a board-certified, fellowship-trained eye surgeon at Brandon Eye Associates. He measured Sean’s eye pressure and evaluated his compliance with treatment.

The doctor recommended using the XEN® gel stent, which is implanted during a minimally invasive glaucoma surgery (MIGS), to reduce Sean’s eye pressure when medications aren’t controlling the disease.

Normal pressure is typically around 21 millimeters or less, the doctor explains. Sean’s pressures were in the 30s.

“Because his glaucoma was progressing, we elected to use the XEN stent, which is a surgical implant designed to lower high eye pressure in open-angle glaucoma when medication treatment is not controlling the disease,” Dr. Ilyas says.

“The XEN stent is an exciting option to decrease medication burden and cost for patients, and it eliminates compliance problems.”

Eyelash-Sized Conduit

Open-angle is the most common type of glaucoma. It occurs when the drainage angle formed by the cornea and iris remains open but the specialized tissue responsible for draining the fluid of the eye, the trabecular meshwork, is partially blocked. As a result, fluid builds up and pressure increases. Elevated eye pressure eventually damages the optic nerve and retinal ganglion cells, causing vision loss.

“The trouble with open-angle glaucoma is that the early signs are typically never noticed by patients,” Dr. Ilyas notes. “It is a slow, progressive disease that causes vision loss, and the only way we know of definitively controlling it is to lower the eye pressure.”

In Sean’s case, that wasn’t happening with medication, so Dr. Ilyas opted for the XEN gel stent. The eye surgeon performed the procedure on Sean’s left eye in early November.

“My left eye is done and my pressure is excellent. And it’s being maintained without any of the maintenance medications or drops.” – Sean

“The XEN gel stent is a small tube, about the length of an eyelash,” Dr. Ilyas describes. “When this tube is surgically inserted into the eye, it becomes soft and flexible. It draws fluid from inside the eye to outside the eye, which helps lower eye pressure.

“The XEN stent is made of porcine gelatin cross-linked with glutaraldehyde, an organic compound. It is placed under the conjunctiva, the clear membrane that covers the white of the eye, and is designed to remain in the eye permanently.”

MIGS to insert the XEN gel stent can be performed as a standalone operation or during cataract surgery. Sean’s surgery was a standalone procedure.

“I was awake for the surgery, but they numbed my eye,” Sean recalls. “Dr. Ilyas said, Let me know if you feel anything. At one point, I did feel a little something, so I let him know, and he numbed my eye a little more. I’ve been recovering for about a month now, and I’m only using a steroid drop in my left eye.”

“The goal with Sean was to lower his eye pressure surgically so he can stop using the eye drops and won’t have to worry about forgetting them when he gets busy at work,” Dr. Ilyas discloses. “We were successful in doing that in his left eye, and he plans to have surgery on his right eye.”

Sean enjoys playing guitar when he’s not working with the Merchant Marine.

Excellent Recovery

For Sean, surgery and the XEN gel stent succeeded in reducing the elevated pressure related to glaucoma. As a result, he’s been able to discontinue the medications in the operative eye.

“My left eye is done and my pressure is excellent,” Sean raves. “And it’s being maintained without any of the maintenance medications or drops. The pressure in my right eye remains high, with medication.”

The recovery process includes massaging the operative eye three to four times a day. Dr. Ilyas explained to Sean how this helps.

“As I understand it, the eye has fluid going through it continuously day and night, and the massaging helps to push fluid out and keep the pressure down,” Sean says. “Dr. Ilyas said I only have to do the massaging for a couple of months and then my eye will regulate itself.

“I highly recommend this procedure to anyone with glaucoma, and I highly recommend Dr. Ilyas and Brandon Eye Associates. I have nothing but the highest praise for them. They take great care of me!”

FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. Xen graphics courtesy of mkb

Comfort Zone Ahead

Customized, personable care helps build strong relationships with patients.

A retired nurse, Frances Allen knows what qualities to look for when it comes to finding a reputable and skilled dentist.

Frances Allen

“My local dental office changed hands, and I was no longer satisfied with the care I was receiving,” she explains. “I wasn’t happy with my smile. I had some discoloration along the top in the front, and I grew tired of looking at it. I was always smiling with my lips, never showing my teeth. When I asked them for a plan to fix things, they always put me off.”

In addition to the discoloration, Frances says she was waking up with jaw pain almost daily.

“I was grinding my teeth at night, which was causing other issues with my bite,” Frances adds. “I decided I needed to find a dentist who could create the makeover I always wanted.”

Frances read an article in Florida Health Care News about Stephen Blank, DDS, who practices cosmetic and functional dentistry in Port St. Lucie.

“From everything I read in the article, his patients seem to love him, and that was important to me. I want a dentist I can talk to and who truly cares enough to listen,” Frances relates.

She made an appointment and quickly discovered it was the right move.

Initial Exams

Dr. Blank conducts a thorough examination on new patients to determine their dental needs and develop a custom treatment plan, just as Frances wanted.

The 90-minute assessment includes a complete oral examination, including TMJ, bite and soft-tissue evaluations; computerized periodontal measurements; digital x-rays; an intraoral video tour that allows the patient to see what the dentist sees; and an oral hygiene evaluation.

“The goal is to build a solid dental relationship that allows each patient to achieve the best oral health possible and, with proper care, maintain that level of health for a lifetime,” Dr. Blank assures. “It’s not your typical five-minute dental exam.”

Afterward, Frances said it was the most thorough exam she ever received.

“I had a one-on-one meeting with Dr. Blank in a very relaxing atmosphere,” Frances confirms. “He discussed my x-rays, talked about what I was facing and presented all of the options. He made me feel comfortable. He wanted me to be sure about the decision I was about to make.”

Dr. Blank says crowns were the best option for Frances, given her history with grinding.

“I hated the shape of my teeth and the discoloration,” Frances continues. “A lot of them were uneven because of the grinding. After talking with Dr. Blank, I took his recommendation and chose to proceed with crowns.”

Crowning Achievement

During Frances’ diagnostic visit for the crowns, Dr. Blank designed the size, shape, color and position of the restorations. Models of her teeth and photographs of her mouth were taken and sent to the lab for a wax-up.

“With Frances, we did what we call a smile design visit, where we take measurements of the teeth and follow that with a full series of photographs. We then did a mock-up of the teeth with some temporary resin so we could guide the lab to create the results we wanted.

“From that smile design visit, we ordered a wax-up of the teeth that fulfilled Frances’ cosmetic need. That way, Frances was able to see how her teeth would look in the end.”

On Frances’ next visit, her teeth were prepared for placement of the restorations. Impressions were made for the lab, and resin temporaries that match the wax-up were created for her to wear home.

Dr. Blank says this allows the patient to take their new teeth home for a “test drive.”

“Thanks to Dr. Blank and his great staff, I’m not hiding my smile anymore.” – Frances

“The temporaries give patients the opportunity to see how their new smile will look,” Dr. Blank comments. “At the temporary stage, changes can be made, such as adding a bit of length or a little curvature or a slight reduction. We give the lab instructions on coloring, translucency and brightness. Then, the teeth are scanned and digital images are sent to the laboratory. In most cases, scanning has replaced the need for the gooey rubber impressions.”

Dr. Blank assures that today’s products provide durability and longevity to patients.

“Dental aesthetics have come a long way from when I was in dental school,” Dr. Blank says. “Today’s crowns are made of all-ceramic porcelain materials, so 10 years from now, if the gum line shrinks at all, Frances will not see a dark area above the top of the crown, which often occurs with crowns made with metal components. Today, products are created for longevity and with better aesthetics than ever before.”

A final aspect of Frances’ treatment plan was the creation of a bite guard to protect her teeth from further damage due to nighttime grinding.

“The bite guard takes the beating, so to speak, so that her new crowns do not suffer any damage,” Dr. Blank explains. “And her jaw will no longer ache when she wakes up each morning.”

Frances says she is delighted with how her bite guard has improved the way her jaw feels.

“No other dentist ever recommended a bite guard before,” Frances says. “That is just one example of how Dr. Blank goes the extra mile to make sure all bases are covered. The bite guard works great, and I have no more morning jaw pain.”

Connecting with Patients

Frances is delighted with her new smile.

Dr. Blank, who has been practicing in Port St. Lucie for more than 35 years, emphasizes that an important aspect of his success is the relationships with his patients. He stresses the importance of delivering customized, personable care.

“I want people to understand all of their options and be educated before making any decisions,” he emphasizes. “Everyone is different, and not every option is going to fit well with every person. I do my very best to understand a person’s long-term wants and needs. I give them eye contact and explain to them from start to finish what to expect, and I hold nothing back. I’m honest because I know that is what people want in a dentist. Honesty and integrity, both of which I strive to bring to the table.”

Frances says Dr. Blank is more than a dentist – he’s a true professional.

“He’s not at all a stuffed shirt,” she says. “He’s very personable and is interested in you as a person. His staff is very professional, also. Thanks to Dr. Blank and his great staff, I’m not hiding my smile anymore.”

Back On Track

Eye procedures repair retinal tears that derailed vision.

James Turner was employed by CSX for more than 20 years, serving primarily in the coal-mining regions of Kentucky, West Virginia and Tennessee. In 2010, James received a promotion and was transferred to the railroad’s corporate headquarters in Jacksonville.

James says that Dr. Moreno went “beyond expectations”
in treating his retinal problems.

“I joined CSX as an assistant trainmaster in the small town of Russell, Kentucky, and moved up from there,” James shares. “An assistant trainmaster supervises the trains and engine crews. Eventually, I became a safety manager, regional manager and locomotive shop superintendent. Here in Jacksonville, I was their chief mechanical officer.”

James retired from CSX this past June, but he wasn’t ready to give up working altogether. After a few months of leisure, James found another job that suits his talents.

“I’m working at Amtrak,” he states. “I’m a supervisor and superintendent. Retirement is nice, but I’m only 59 and I really miss working. I figure I’ll work for another year or two and then try retirement full time.”

James might not be ready to retire, but he’s at the prime age for cataracts to begin forming. His cataracts progressed to the point that he required surgery, but he developed complications about a month later.

“After surgery on my right eye, I noticed floaters that looked like black dots,” James describes. “There were also faint light flashes that looked almost like dishwater was floating around in front of my eye.

“I went back to the place that did my cataract surgery, and they performed a laser treatment to seal a retinal tear. Three weeks or a month later, I started having the same issues with my left eye. They said the retina in that eye was starting to detach and sent me to Florida Retina Institute.”

At Florida Retina Institute, James met with Tomas A. Moreno, MD, a board-certified, fellowship-trained retina specialist. Dr. Moreno performed a second laser procedure for a new retinal tear in James’ right eye and recommended cryotherapy to seal the tear and prevent a retinal detachment in the left eye.

Cryotherapy freezes the retinal tear and creates a scar around it to avert a detachment. Because James’ tear was quite large, Dr. Moreno was not sure the procedure would work, but he wanted to try that before a more invasive procedure known as a vitrectomy.

“Dr. Moreno moved pretty quickly because if the tear was not treated promptly, I could lose the vision in my eye,” James recalls. “Dr. Moreno said there was a 50/50 chance at best that the procedure would work, and unfortunately it didn’t, so a few days later he performed full-blown surgery on me.”

Peeling Wallpaper

James condition was due to changes in a jelly-like fluid inside the eye called vitreous. The vitreous is attached to the retina, the light-sensitive membrane that sits like wallpaper on the back wall of the eye. As people age, the vitreous begins to liquefy and tug at the retina, causing it to peel off the wall.

“Some parts of the vitreous attach to areas of the retina pretty forcefully,” Dr. Moreno educates. “When the jelly detaches from the retina, those parts of the jelly can be very adherent to the retina and cause it to tear.

“A retinal tear can lead to bleeding or pigment inside the eye, which is what people see as floaters. In addition, the retina cannot sense pain, so when it is getting abnormally tugged by the jelly, the only signal it can produce is a flash of light. If people notice flashing lights or a new onset of floaters, they should see a retina specialist right away for an evaluation.”

The vitreous can move through the tear, go behind the retina and lift it away from the back of the eye. That is the cause of a retinal detachment.

Vitrectomy repairs a retinal tear or detachment.

“If people notice flashing lights or a new onset of floaters, they should see a retina specialist right away for an evaluation.” – Dr. Moreno

“During a vitrectomy, we enter the eye with tiny instruments, including a light and a small knife,” Dr. Moreno describes. “We cut out the jelly, which removes the traction against the retina that is causing the tear or detachment, and replace the jelly with plain fluid.

“We flatten the retina against the back wall of the eye, essentially putting the wallpaper back on the wall. We place a gas bubble in the eye, which acts like a Band-Aid to push the retina against the wall and allow it to stick properly. Then, we use a laser to spot-weld the tear so it does not detach again.

“James did very well following his vitrectomy. He is seeing 20/20 or 20/25 in each eye. He saved his vision because he came to us early, as soon as he began to experience symptoms. Had he waited, he could have lost vision in both eyes.”

“Beyond Expectations”

James underwent two laser procedures for retinal tears in his right eye, one by doctors at the practice that performed his cataract surgery and one by Dr. Moreno at Florida Retina Institute. Those treatments were sufficient to seal the tears and resolve his symptoms. But that wasn’t the case with his left eye, which required a vitrectomy.

“I haven’t had any more issues with tearing in my right eye since the laser treatments,” James confirms. “When I continued to have some detachment in my left eye after the freezing therapy, Dr. Moreno performed a surgery where he went into my eye and placed a gas bubble. Then he went all around the retinal tears and sealed them.”

James sought help as soon as he noticed the floaters and flashing lights in his vision, and that early intervention prevented further damage that could’ve cost him his eyesight. He’s grateful that his cataract surgeon referred him to Florida Retina Institute. “Dr. Moreno went beyond expectations, and I don’t say that very often about people in the medical world,” James exudes. “He was extremely patient in telling me what was wrong with my eyes and what steps he could take to help correct them and save my vision. He took time to explain the procedures and all their risks and benefits, and that’s what I wanted to hear: the facts.

“I went to the Florida Retina Institute offices in Jacksonville and St. Augustine. They’re very nice places. The housekeeping is immaculate, Everything is super clean, especially with COVID. The staff is extremely polite, just as good as Dr. Moreno. I absolutely recommend Dr. Moreno and his team at Florida Retina Institute.”

Time Used Wisely

It only takes a moment to learn the benefits of slow-cadence workouts.

When Barbara Robinson had a routine bone density test a few years ago, the results indicated some loss. She was surprised – and concerned.

Barbara built bone density using the 20 Minutes to Fitness slow-cadence strengthening system.

“I considered myself physically fit,” says the 77-year-old from Sarasota. “I walk a couple of miles several times a week and I play golf. I thought that was enough.”

Then she saw an ad for 20 Minutes to Fitness in Lakewood Ranch and thought, This sounds almost too good to be true, Barbara recalls. “I had a meeting with one of the trainers and we talked about the program. I decided to try it because it seemed ideal for what I was concerned about.”

The type of training used at 20 Minutes to Fitness is referred to as slow-cadence training, and there’s plenty of science behind it.

In this training, weights are lifted in a series of ultra-slow movements, with the targeted muscles doing all the work with each repetition. Specialized equipment (designed for use in physical therapy) with a patented double-stacking weight system is used, with each repetition lasting 20 seconds.

This combination of slow movements and specialized equipment eliminates the benefits of gravity and momentum, so the muscles have to do all the work. Therefore, in just a few minutes on each piece of equipment, the muscle group being worked reaches peak performance.

And that’s the point.

As muscle fatigue is achieved, the body recovers over a period of three to six days. During this recovery period, a series of physiological changes takes place that supercharges the body to burn fat and rebuild muscle.

“Participants get the maximum benefit with just one 20-minute workout per week,” assures Angela Begin, part-owner of 20 Minutes to Fitness.

Rebuild Bone

The slow-cadence strengthening system helps control arthritis, fight symptoms of diabetes, improve memory function, build strength, reduce back pain and more.

It is especially useful for those at risk for osteoporosis, a condition in which bones become more porous and susceptible to fractures – particularly in the hip, spine and wrist.

According to the National Osteoporosis Foundation, more than 52 million Americans are afflicted with this silent disease, and studies suggest that about half of the women and up to a quarter of the men 50 and older will break a bone due to osteoporosis.

However, slow-cadence training helps combat the onset of osteoporosis and can even reverse bone loss.

“Nearly two dozen cross-sectional and longitudinal studies have shown a direct and positive relationship between the effects of resistance training and bone density,” according to the National Institutes of Health.

“The workout goes down deep into the muscle fiber,” Angela educates. “The fast twitch fibers pull on the bone, and this increases the production of osteoblasts (bone-forming cells), which increases bone density.”

Barbara is proof that it works.

“When I had my bone density scan last year, I was elated because I had improvement in my neck area and significant improvement in my hip area,” she raves.

Angela recalls that Barbara came in very skeptical at first, “as most of our clients do.”

“However, after training at 20 Minutes to Fitness for two years, she had an 11 percent increase in bone density, which is significant,” Angela says. “Usually, doctors are happy with 4 percent.”

Barbara, who works part time for the Baltimore Orioles during spring training, informs that her goal was to not have any more bone loss.

“An overall feeling of wellness came with building my strength” – Barbara

“I was pleasantly surprised that not only had I accomplished that, but I had improvement,” she proclaims. “The slow-cadence weight movement really works!”

In addition to building back bone density, Barbara says she is stronger and feels better all around.

“An overall feeling of wellness came with building my strength,” she says. “I’m not a big person – about 5 feet, 120 pounds – and right now with the leg press I’m moving 300 pounds.”

She also added about 30 yards of distance to her golf swing, “an unexpected plus.”

One-on-One Encouragement

In addition to being an effective, quick and relatively sweatless workout, slow-cadence training is appropriate for all fitness levels and ages, from teenagers to octogenarians.

“No one is too old, too young, too in or out of shape to benefit from this program,” Angela asserts.

Trainers “challenge people at their fitness levels,” she continues. “We can start as low as 20 pounds. It depends on the person and how strong they are when they come in. But we’re going to challenge them at their level and continue challenging them.”

With a commitment of less than a half-hour once a week, the 20 Minutes to Fitness workout is shorter than traditional workouts. And with a fitness professional at your side the entire time, it’s also much safer.

“You have a coach with you keeping you safe, making sure that you’re doing things properly, staying in perfect form on safe, specialized equipment,” Angela notes.

Barbara joined gyms in the past but “did not use the weight equipment because, frankly, I was concerned about hurting myself,” she admits. At 20 Minutes to Fitness, “there is a trainer with me every moment to make sure that I’m doing it correctly and that my posture is correct, so I don’t hurt myself.”

In addition, 20 Minutes to Fitness offers a complimentary orientation, and there are no annual contracts or membership fees.

“Come in and learn a little bit about this unique system, learn the science and try it out,” Angela encourages. “There’s no obligation to continue, and it’s a great way to make an educated decision about whether or not this will work for you.”

Barbara is not only pleased that she has improved her bone density, strength and overall well-being through her weekly workouts at 20 Minutes to Fitness, but she is also impressed with the staff and her experience there.

“They’re encouraging. They’re pleasant,” she enthuses. “Sometimes, I amaze myself. As we’re training, I find that I can do more than I thought I could. I can do that one more rep when I thought I was finished. The overall facility and the staff have been wonderful.”

Feeling Safe With Fillings

Getting ahead and going beyond the FDA’s warning on amalgam.

At Advanced Dental Cosmetic Center, both J. Terry Alford, DMD, and H. Gene Steele, DDS, stand in the forefront of patient safety. For example, out of concern for his patients, Dr. Alford stopped using dental amalgam, which contains mercury, more than 35 years ago.

As it turns out, Dr. Alford was well ahead of the curve.

On Sept. 24, the FDA identified certain groups as being at increased risk for harmful effects from dental amalgam fillings. Those include pregnant women and their developing fetuses; nursing mothers and their newborns; women planning to become pregnant; children, especially younger than 6; people with neurological ailments such as multiple sclerosis, Alzheimer’s or Parkinson’s disease; people with impaired kidney function; and those with a heightened sensitivity (allergy) to mercury or the other components in amalgam, which include silver, tin and copper.

“The FDA stated what some have been saying for a long time, that amalgam releases small amounts of mercury vapor over time,” notes Dr. Steele. “Elemental mercury has long been known to be toxic, and warnings have been issued about exposure.”

Dental amalgam is about 50 percent elemental mercury. In its September 2019 scientific review, “Epidemiological Evidence on the Adverse Health Effects in Relation to Mercury from Dental Amalgam,” the FDA recognized that mercury in dental amalgam can convert inside the body into toxic methylmercury, which is the same type of mercury the FDA warns about in fish. Furthermore, the FDA recognized the bioaccumulation effects of mercury.

“With environmental sources of mercury already exposing patients, dental amalgam is another source that can contribute to toxic levels,” Dr. Steele warns. “Environmental sources include high-mercury fish, occupational exposures and waste incinerators.”

At a scientific advisory committee meeting in November 2019, a group called Consumers for Dental Choice persuaded the FDA to take another look at its amalgam policy. The FDA learned of the bans on amalgam use in children issued by the European Union, Vietnam and Tanzania as well as other changes around the world on amalgam rules. These included phase-out dates set by the Philippines, Ireland, Slovakia, Finland, Nepal, Moldova, the Czech Republic and New Caledonia.

As a result, the FDA advisory committee made recommendations to patients about the risks of dental amalgam, especially in vulnerable populations, and agreed that the use of dental amalgam should end.

“It’s important to note that the FDA does not recommend removal of existing amalgam fillings in good condition unless considered medically necessary, as with hypersensitivity to the amalgam material,” Dr. Steele observes. “Removing dental amalgams may result in a temporary increase in exposure to mercury vapor released during the removal process.

“In our practice, to ensure the safest environment possible when amalgams need to be removed, water is used to suppress mercury vapors and high-speed evacuation is used to capture mercury vapor that may be emitted and capture particles of solid amalgam.”

The FDA also does not find that the available evidence supports a complete ban on future use of dental amalgam.

“Patients can feel safe at Advanced Dental Cosmetic Center because we far exceed the recommended precautions for patient safety,” Dr. Steele assures. “Our choice of filling material is just one of many things we do to keep our patients safe.”

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