Author Archive

End The Agony Of De-Feet

Peripheral nerve stimulation implant alleviates neuropathy pain.

Charles Thompson began his career in the food service industry at a young age. After dropping out of school, Charles went looking for a job. He found one washing dishes at a New York City restaurant. At one point, Charles went from dishwasher to restaurant manager, but his first love was the kitchen.

“I learned how to cook on the job,” shares Charles, now 61. “I worked as a cook at Rockefeller Center in New York for about 20 years.”

One day, while he was on his way to work in the fall of 1996, Charles was severely injured in a bus accident. The incident altered his future, bringing an end to his career and his life without pain.

“I was going to work at Rockefeller Center,” Charles recounts. “The bus driver was speeding, and I was bounced and tossed around in the back of the bus. A seat cushion came loose, and something hard hit me in my lower back. I couldn’t go back to work because of the injury, so I’m now on disability.”

Unable to work, Charles eventually relocated to his favorite vacation spot in Florida: St. Augustine, where he became heavily involved with his church, Tabernacle Missionary Baptist.

His back injury, however, often interfered with his activities at church and elsewhere.

“The pain was severe,” he reports. “It ran from my back down my left leg, and on a scale of one to 10, it was a seven or eight. In 2019, my primary care doctor sent me to Dr. McGreevy to take a look and see if he could help me.”

During a thorough evaluation that included an MRI review, Dr. McGreevy discovered that Charles’ pain was being caused by a herniated disc in his lumbar spine that was contacting a nearby nerve root. To ease that pain, Dr. McGreevy initially treated Charles with epidural injections and other modalities.

“The injections helped a lot,” Charles confirms. “I wasn’t experiencing any pain, so I was feeling much better. Then, while driving on New Year’s Eve, I was rear-ended. It knocked everything Dr. McGreevy had fixed out of place, and I started feeling pain again.

“This time, the pain went down my leg and into my left foot. I had tingling and numbness in that foot and couldn’t walk for long periods of time because of it. I would do a little walking, but I’d eventually start dragging my left foot because it hurt so bad. It got so bad that I had to use a wheelchair to get around in stores and other places because the injections weren’t doing anything for my foot pain.”

As 2020 moved forward, Charles became increasingly miserable due to the pain in his left foot. He exhausted all conservative measures, including several courses of physical therapy.

Ultimately, Charles turned back to Dr. McGreevy for help.

Dr. McGreevy determined that the cause of Charles’ crippling left foot pain was neuropathy. A condition that affects more than 20 million Americans, neuropathy results from damage to the peripheral nerves that run from the central nervous system – the brain and spinal cord – to the rest of the body. As Charles learned, the most common symptoms are numbness, prickling and tingling in the feet or hands.

Nerve Entrapment

Charles’ peripheral nerve stimulator has him out of the wheelchair and walking again.

There are many potential causes for neuropathy, Dr. McGreevy asserts, including diabetes, vascular problems and trauma. In Charles’ case, Dr. McGreevy performed a diagnostic ultrasound and identified the source as nerve entrapment of the superficial peroneal nerve, which supplies the top surface of the foot.

“This nerve entrapment was mimicking Charles’ low back pain pattern, causing pain down his leg and neuropathy in his foot,” Dr. McGreevy confirms. “Charles had some risk factors for vascular disease as well, so we ran several tests to rule out specific blood flow issues into his lower extremity. Those tests turned out normal.”

Dr. McGreevy elected to perform a diagnostic nerve block to confirm that the pain arose from the superficial peroneal nerve entrapment. Charles received significant pain relief from the nerve block. Nerve blocks are temporary, however, so in an effort to alleviate Charles’ pain over the long term, Dr. McGreevy recommended peripheral nerve stimulation.


No Signals, No Sensation

Similar to spinal cord stimulation, peripheral nerve stimulation involves the placement of a small electrode near the nerve targeted for treatment. The electrode is placed underneath the skin within a few millimeters of the nerve.

“When turned on, the electrode delivers pulses of high-frequency electrical stimulation that essentially halts the pain signals in the nerve and prevents the signals from traveling toward the spinal cord and up to the brain,” Dr. McGreevy explains. “If there’re no pain signals, there’s no pain sensation.”

Unlike spinal cord stimulation, peripheral nerve stimulation does not require a battery implanted near the hip. The technology is so sophisticated that the workings of electrical stimulation are inherent within the lead placed inside the leg.

“There is an external, wearable antenna assembly, which is very soft and easy to hide under the clothes,” Dr. McGreevy explains. “This powers the stimulator beneath the skin. It powers the receiver, which is made of a very fine material and is located within the electrode itself.”

The peripheral nerve stimulator is controlled by the patient using a handheld remote. This signals the external antenna assembly to send electrical pulses through the implanted electrode to the targeted peripheral nerve to block pain signals.

“Before the peripheral nerve stimulator is implanted, patients are given a trial run to determine if they will experience significant pain relief with an implanted electrode,” Dr. McGreevy informs. “A stimulator trial is considered successful if patients report at least 50 percent pain relief.

“Charles received greater than 80 percent pain relief and was enthusiastic about finally getting a permanent solution to his pain problem. We proceeded with the implantation and he experienced greater than 80 percent relief from the permanent stimulator as well.”

“It’s Working Great”

Charles’ peripheral nerve stimulator was a huge success.

“It’s working great,” he reports. “Where my pain level used to be a seven or eight, it’s now a two or three, so I can do a lot of things without feeling any pain in my foot. Most importantly, I can walk, so I don’t need to use the wheelchair to get around anymore.

“The overall procedure and being at the surgery center were great, too. I had a wonderful experience. The staff checked on me regularly to see if I needed anything. They treated me well. They were all concerned about how I felt.”
Charles also has good things to say about the neurologist.

“Dr. McGreevy is a phenomenal doctor,” he raves. “He did a wonderful job. He broke down everything for me. He told me step-by-step what’s going to happen and what to look for. And he was encouraging. He told me, I’m going to take care of you. I’m going to take care of your left foot so you’ll be able to walk without severe pain.

“He’s a great doctor, and he got me up and running again. I wouldn’t go anywhere else.”

© FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. mkb

Beware Of Hernias

Learn the facts and figures in this Q&A.

A hernia is a defect of the abdominal wall that allows a protrusion of an organ or structure. It’s a common ailment, with more than 1 million repair surgeries performed in the United States each year.

Adults and children can develop hernias as a result of heavy lifting, straining, coughing or any unusual stress that causes a sudden increase of intra-abdominal pressure.

Some hernias are congenital, or present at birth, whereas others develop as a result of a predisposition for hernia. And anyone who has surgery may experience a weakening of tissue at the incision site that could result in a hernia.

Adults and children can develop hernias as a result of heavy lifting, straining, coughing or any unusual stress that causes a sudden increase of intra-abdominal pressure.

Adults and children can develop hernias as a result of heavy lifting, straining, coughing or any unusual stress that causes a sudden increase of intra-abdominal pressure.

Because everyone is at risk, Florida Health Care News turned to David A. Napoliello, MD, a specialist in minimally invasive surgery, to learn more about hernia repair. Dr. Napoliello, who practices in Venice, Sarasota and Lakewood Ranch, is certified by the American Board of Surgery and is a fellow of the American College of Surgeons.

In this Q&A, the doctor describes hernias and procedures to repair them in greater detail. 

Q. Dr. Napoliello, what is the most common type of hernia? A. The most common type of hernia is called an inguinal hernia. It is a defect or weakness in the abdominal muscle wall through which intestine and fat layers protrude, forming a visible bulge in the groin area. 

To visualize the dynamics of it, think of a bicycle tire. The abdominal wall is like the thick outer wall of the tire. Should the tire get damaged, the inner tube can push through the weakened area or crack and form a small bubble. If the abdominal wall becomes weakened, the thinner, flexible tissue that lines the inside of the abdomen and holds the intestines in place, called the peritoneum, can bulge into the outer wall. In the tire, it is easy to see that the inner tube can become strangled by the pressure of the edges of the crack through which it is protruding. It is the same with a hernia. 

Q. What are some of the other common types of hernias? A. An umbilical hernia takes place when abdominal contents protrude through the naturally occurring tiny opening behind the belly button. Incisional hernias can take place when a previous surgery leaves an abdominal wall defect that allows the abdominal contents to protrude through it and bulge out. 

Q. How does a person know when he or she has a hernia? A. A person may suspect a hernia if he or she notices a bulge under the skin. Additional symptoms may include discomfort or pain during any of the following: lifting heavy objects, sneezing or coughing, straining while using the toilet, standing or sitting for long periods of time. Because delayed treatment can sometimes result in the intestine being trapped inside the hernia sac, resulting in gangrene, any bulge should be brought to a physician’s attention immediately so diagnosis and treatment can begin. If left untreated, some complications from hernias can be fatal. 

Q. Will a small hernia ever heal itself? A. No, a hernia does not heal itself or improve over time without intervention. The only exception to this may be small umbilical hernias in young children. 

Q. What treatments are available for hernias? A. Surgeons may choose one of several hernia repair techniques, depending on the patient and the size of the hernia. 

In the past, the only hernia repair option available was called a tension repair. In this open surgical procedure, the physician makes an incision at the site, pushes the protruding tissue back into place and stitches the tissue layers together. The potential disadvantages of this type of surgery are relatively long recovery periods, relatively high recurring rates and discomfort following surgery. 

Today, we can offer a variety of minimally invasive open, laparoscopic and robotic procedures. 

Q. Please describe the minimally invasive open procedures. A. Unlike the tension repair, minimally invasive open procedures are tension free because the stitches or sutures used do not put tension on the sides of the defect to keep it closed. Instead, special mesh patches are used that limit the size of the required incision. These procedures offer lower recurring rates, quick recovery and only minor discomfort following the surgery. Additionally, some approaches allow the patient to avoid general anesthesia. 

Q. Can you comment on laparoscopic surgery and robotic surgery? A. There are two main options for laparoscopic surgery. In the transabdominal approach, the physician makes a small incision and slides a thin telescope, called a laparoscope, through the abdominal wall into the abdomen. For the preperitoneal approach, the laparoscope slides in between the tissues of the abdominal wall. With both approaches, the doctor views the hernia and surrounding tissue on a video screen. 

Robotic surgery can be considered a type of laparoscopic surgery with better access and sewing techniques when needed, with the surgeon using a console nearby.

Q. What are the advantages of laparoscopic surgery? A. Depending on the patient, of course, there are several. Because it requires only small incisions, it will likely mean less pain and a shorter recovery time, and because the physician has the advantage of looking through the laparoscope, previously undiagnosed hernias may be discovered. Additionally, the laparoscopic approach allows us to manage recurrent hernias and optimize any repeat surgery because we do not have to go through the same incision site. 

Q. Can surgery be done on an outpatient basis? A. Yes, and it is usually performed in less than an hour. 

Q. Do you have a preference between the minimally invasive open procedure and the laparoscopic procedure? A. It depends on the patient. I specialize in minimally invasive surgery techniques and completed my fellowship in minimally invasive and advanced laparoscopic surgery. In fact, I was involved in training surgeons using the laparoscopic approach when it was first developed. I provide patients with information on open, laparoscopic and robotic procedures, and we make the decision together.

Q. Have there been any improvements to these surgical techniques in recent years? A. Definitely. Scientific improvements to hernia repair include the addition of very lightweight artificial meshes and biologic meshes such as processed skin grafts. Other improvements to decrease chronic pain associated with hernia repairs include the addition of absorbable tacking devices and dissolvable sutures, which help to decrease the risk of nerve entrapments and chronic pain. The surgical robot and revisiting no-mesh repairs are also highlights of current hernia surgery. 

Q. Once the surgery has healed, will the patient experience any diminished quality of life? A. No, most patients will be able to return to a normal routine. In fact, data show that within a week’s time, most people will feel well. Because I am conservative, I recommend that my patients avoid any physical strain for four weeks.

© FHCN staff article. js

Pull The Trigger

Anesthetic injections take aim on fibromyalgia, muscle knots.

Though it has always been used primarily as a girls’ name, there was a time in the early 1970s when, according to records obtained by Parents magazine, 321 boys were running around the United States with the first name Erin.

Never before or since have so many boys in the US had that name, and Erin Briggs, who was 15 years old at the time, was among the girls who got caught up in some of the confusion created by the fad.

“At the start of school every year, they were always trying to send me to shop class because they thought Erin was a boys’ name,” Erin relates. “So I’d go to shop class, and the next thing I know they’re sending me to home economics again.”

“Dr. Khalaf digs and digs until he finds out what’s causing the problem, then he treats the cause.” - Erin

Erin says that Dr. Khalaf “digs and digs” until he finds out what’s causing the problem, then he treats the cause.


Erin wouldn’t have minded staying in shop class. After all, she once dreamed of becoming a pilot and flying B-52 bombers. She soon realized that her chances of doing that and a few other things were rather slim.

“They wouldn’t even let me play peewee football, so I was always being deterred from following through with things like that,” she says. “I figured, If I can’t even get into shop class, they’re never going to let me fly an airplane.

Erin, 59, eventually changed course and became a paralegal and administrative assistant. Meanwhile, outside of work, she became a very active person, one who prefers to do her own yardwork and home repairs. She also became quite active in the church.

About 20 years ago, her ability to work and maintain an active lifestyle became impaired by a host of health issues, not the least of which was fibromyalgia, a neurological disorder that causes fatigue and pain throughout the body.

“I also have degenerative disc disease, spinal stenosis, bursitis, really bad osteoarthritis, and neuropathy,” Erin reports. “The list goes on and on. I even had a knee replacement that didn’t go well, and now I have scar tissue pushing on the nerves.

“The bottom line is that I’m a hot mess. For years my body has felt like it’s falling apart on me. It got so bad about nine years ago that I had to give up my job and go on disability because I couldn’t do some of the work anymore.

“I was always dropping a pen because of the pain in my hands. My neck would hurt from sitting while on the phone and typing at the same time. It became too painful to even do temp work, which I tried for a while and liked but had to give up.”

Erin says she’s had more bad days than good. In recent years, however, Erin has been enjoying more good days thanks to the care she’s received from Majid R. Khalaf, MD, of Spine & Joint Treatment Center.

Pain Management Specialist

Dr. Khalaf specializes in minimal and interventional treatments and procedures for pain. Erin was referred to him in 2007 by her primary care physician, who was limited in his ability to treat her array of health issues.

“The problem was that my primary care physician was only allowed to give me three trigger point injections at a time, and I needed more than that,” Erin reveals. “I needed about 12, so my doctor referred me to Dr. Khalaf.”

Also known as a TPI, a trigger point injection is used to treat fibromyalgia and painful knots of muscles in the arms, legs, lower back and neck. By injecting a small amount of anesthetic and steroid into areas called trigger points, the pain is relieved.

In treating Erin, Dr. Khalaf eventually discovered that injections of a cocktail of two anesthetics that work on different time schedules and “a tiny amount” of steroids worked best in alleviating her pain and discomfort.

“We’ve worked over the years to get the medication just right, and now I get injections twice a week for my fibromyalgia and injections once every two weeks for the other issues I have,” Erin reveals.

Dr. Khalaf says treating fibromyalgia can be challenging because the pain it causes has a tendency to jump from one area of the body to another. That has definitely been the case with Erin, he says.

“One day, she’ll come in for pain in her lower back and then sometimes it’s in her thighs,” Dr. Khalaf confirms. “Sometimes it’s in her shoulders or in the middle of her thoracic area. It’s all over her body.”

Feel the Heat

Dr. Khalaf initially treated Erin for neck and shoulder pain resulting from a failed neck surgery. He used radiofrequency ablation, where an electrical current produced by a radio wave heats a spot on a nerve to stop it from sending pain signals to the brain. 

“Her neck is a lot better now,” Dr. Khalaf reports. “She doesn’t even complain about her neck, except for the areas where the fibromyalgia causes her pain, which is around the shoulder area in the trapezius muscle and the middle of her back and thoracic area. 

“For that we do the trigger point injections. The unfortunate thing is that we can’t cure this disorder. We can only help someone manage their pain. And there’s no one-size-fits-all approach to it because everyone is different.”

When Erin first visited Dr. Khalaf, her quality of life was greatly diminished because of the horrendous pain. She has now regained the ability to live the active life she desires, albeit in small doses. Erin again does yardwork and gardening, goes to the gym and walks. She also occasionally rides her bicycle and participates in water aerobics.

 “And it’s all thanks to Dr. Khalaf that I can do any of that. He’s fantastic and so is everyone on his staff. I love them all, and they’ve become like family to me. They’re all terrific people,” she says.

“I couldn’t be happier with the care that I receive there because Dr. Khalaf doesn’t just treat your symptoms. If you go in and tell him your pinky hurts, he’s going to find out why your pinky hurts and treat that. Dr. Khalaf digs and digs until he finds out what’s causing the problem, then he treats the cause. 

“He listens so well. I absolutely think the world of him.”

© FHCN article by Roy Cummings. Photo by Jordan Pysz. js

Seals of Approval

Craig Nichols

Craig Nichols

Ablation techniques close damaged veins, reroute blood to bring leg relief.

Before the COVID-19 pandemic, Craig Nichols worked part time for a car rental company in Punta Gorda. His primary responsibility was to shuttle customers to the office so they could pick up their rental vehicles.

“When the customers finished with the vehicles and returned, I took them wherever they needed to go,” recounts Craig, 79. “I also transported cars to and from a branch in Arcadia. I worked there about three years.”

Prior to that job, Craig made his living in sales for the frozen potato industry. For years, he crisscrossed the country selling French fries.

“My career started in Portland, Maine,” Craig relates. “From there, I went to Baltimore for four years and then to Chicago for 20 years. I traveled throughout the Northeast when I lived in Maine. While in Baltimore, I branched out to the Carolinas and the middle of the country. When I moved to Chicago, I headed up sales for the entire United States.

“My company had factories from the East Coast to the West Coast, and I frequently brought customers to those factories. I was constantly flying around the country, which is why, in my opinion, I ended up with leg issues.”

Craig is convinced that the changes in air pressure that occur in an airplane contributed greatly to the leg problems that began 25 or 30 years ago and got worse over time. 

“I developed severe swelling in my legs, and that caused all kinds of problems, such as aches and pains and stiffness,” Craig describes. “It cut down on my mobility a great deal as well. It pained me to walk very far. 

“Working in sales, I was going in and out of airplanes and in and out of airports sometimes four times a week. When you park at Chicago O’Hare International Airport and have to get to Gate C30, it’s about a 2½-mile walk. It’s a monster, and there’s no other way to get there but to walk. It was detrimental to my legs.”

After retiring, Craig became a much-less-frequent flyer. But his leg condition worsened. Eventually, he developed open wounds on his legs. He sought advice from several physicians but wasn’t satisfied with their answers. 

“The best suggestion I received was to visit Dr. Joyce,” Craig reveals. “As soon as I walked into his office, I felt comfortable with him and with his initial interview. Dr. Joyce recommended some procedures on my veins, and I said, Let’s get this done.”

Douglas H. Joyce, DO, is a board-certified vascular surgeon at Joyce Vein & Aesthetic Institute in Punta Gorda. Dr. Joyce specializes in treating venous disease with minimally invasive procedures. This type of treatment has been proven to treat non-healing vascular leg ulcers. 

“Craig presented with tremendous swelling in his legs, which were also painful,” Dr. Joyce reports. “The skin on his legs was inflamed and weeping. Craig also had a history of venous ulcers. He had an active ulcer on his left leg and several healed ulcers on his right leg.

“We assessed his legs with ultrasound and identified several veins that were not working correctly. We recommended two procedures to seal those incompetent veins and reroute the blood flow through healthy veins.”

Like a Soaker Hose

There are two vein systems in the legs: the high-pressure central vein system deep in the muscles and the low-pressure superficial vein system just below the skin. The superficial drains into the central through perforator veins.

Leg veins contain one-way valves that prevent blood from flowing backward and pooling. If these valves are weakened or damaged, blood refluxes into the veins instead of flowing toward the heart, a condition called venous insufficiency. In cases of venous insufficiency, the affected veins leak and blood collects in the legs, causing swelling and discomfort.

“People with venous insufficiency present in many different ways,” Dr. Joyce discloses. “Some present with skin changes on the legs. Others present with pain as well as some degree of swelling. Some people present with leg swelling alone.

“Legs swell because the incompetent veins experience intense pressure and begin to stretch. The spaces between the cells of the vein wall grow larger as the vein stretches. Consequently, the vein becomes porous. It’s like a soaker hose in a garden. Water comes out of the holes in the hose.”

Initially, water leaks out of the veins into the surrounding tissues, which causes the leg to swell. Then, blood leaks from the veins and deposits iron under the skin, which causes the discoloration of the legs that is common with venous insufficiency.

“We begin treatment of venous insufficiency by sealing the leaking superficial veins, such as the great saphenous vein and small saphenous vein, using a standard laser ablation closure technique,” Dr. Joyce informs. “During this procedure, we slide a laser fiber along the length of the vein and use laser energy to seal the entire vein.”

To seal incompetent perforator veins, which are typically responsible for venous ulcers, Dr. Joyce uses a technique he developed called single-needle laser ablation.

“We first numb the skin,” Dr. Joyce explains. “Then, we take a specifically designed needle, and using ultrasound guidance, place it through the skin into the perforator vein. We apply anesthetic, then turn on the laser for 15 to 20 seconds, which spot-welds the area of vein being treated.

“Venous insufficiency is a significant disease of the legs that can lead to serious complications, including infection and a breakdown of the skin. Individuals experiencing swelling, pain, skin discoloration, restless legs at night or ulcers would do well to visit a physician that specializes in veins rather than someone who treats veins on the side.”

“No Swelling Whatsoever”

Craig can attest to that. His decision to seek out Dr. Joyce worked out well.

“Dr. Joyce explained that some of my veins were working properly and some were not,” Craig recalls. “He blocked off the bad veins and steered the blood into my good veins. 

“Once Dr. Joyce completed my treatment, I experienced a great deal of relief in my legs. Now, I have no swelling whatsoever, no aches or pains, and no sores on my legs. Everything works perfectly.”

Craig is as thrilled with the doctor and his staff as he is with the outcome of his procedures.

“Dr. Joyce is extremely knowledgeable and talented. I’m so glad I found him,” Craig enthuses. “I feel very comfortable with him. I listen to what he says, I do what he suggests and it works. 

“The entire staff at Joyce Vein & Aesthetic Institute is excellent. I’ve touched base with all of them during the course of my treatment. Like Dr. Joyce, they’re also very good and knowledgeable.”

© FHCN staff article. Photo by Jordan Pysz. Before and after images courtesy of  Joyce Vein & Aesthetic Institute. mkb

No Age Limit On Life

Modern meds help 88-year-old with leukemia stay healthy and productive.

Prior to the COVID-19 pandemic and the advent of ride-sharing services such as Uber and Lyft, it wasn’t unusual for 10,000 yellow taxis to dot the busy streets of New York City at any moment.

About half that many roam those roads these days, and Brooklyn native Joseph* finds that hard to believe.

“I drove a cab in New York City for 32 years, from 1954 to 1986, and back then they were about the only cars you saw on the street, especially in Manhattan,” Joseph says. “That just goes to show you nothing stays the same forever.”

Joseph, who started a small limousine service with his brother-in-law in 1980, once thought he’d live forever in the Big Apple, but he sold the business a few years ago and moved to Florida.

About a year ago, shortly after celebrating his 88th birthday, Joseph received some distressing news.

“I had just visited my primary care doctor for my annual checkup, and about two days after the checkup, my doctor called me and said he had some concerns about my bloodwork,” Joseph explains. “He said something about my platelets being low.”

Platelets are the cells that circulate throughout the blood and bind together to form a clot whenever someone suffers a cut or scrape. A normal platelet count ranges between 150,000 and 450,000 per microliter of blood. Joseph’s count was 83,000.

A platelet count that low could be the result of certain medications, liver dysfunction or even cancer such as leukemia or lymphoma.

Concern over the latter possibility prompted the doctor to recommend that Joseph visit Florida Cancer Specialists & Research Institute. It was there that Mamta T. Choksi, MD, began her care by ordering a flow cytometry test.

Virtually Symptom Free

Designed to diagnose and classify blood cell cancers, the flow cytometry test confirmed the primary care physician’s concerns that Joseph, despite showing virtually no symptoms, was suffering from chronic lymphocytic leukemia, or CLL.

“The symptoms we usually see with CLL are things like fever, chills, night sweats, a feeling of unwellness and unexplained weight loss,” Dr. Choksi educates. “Out of those five, Joseph only had an unexplained weight loss of about 10 pounds.

“This is a man who has been relatively healthy for his age, a man who never smoked and doesn’t drink. This confirmed the diagnosis, so the next thing we did was order a CT scan of his chest, abdomen and pelvis to see the extent of the disease.”

The CT scan would reveal the condition of Joseph’s lymph nodes. In people with CLL, the lymph nodes can be enlarged. So, too, can the spleen. In Joseph’s case, the CT scan showed slightly enlarged lymph nodes. That further confirmed the diagnosis and helped lay the foundation for a treatment plan.

Dr. Choksi notes that there was never any hesitation in creating a treatment protocol for an octogenarian.

“Some people may wonder why we would treat someone at the age of 88 with this condition, but again, this is a relatively healthy 88-year-old man,” Dr. Choksi reasons. “There was no good reason not to treat him.

“The only concern we had in putting together a treatment plan was that he had a history of heart disease. Because of that, we needed to avoid certain medications, but we were still able to put together an effective treatment plan for him.”

Dr. Choksi called for Joseph to receive a combination of two drugs: GAZYVA® (obinutuzumab) and VENCLEXTA® (venetoclax), which earned FDA approval for use in patients such as Joseph in 2019.

GAZYVA was administered intravenously once a week for six months. VENCLEXTA is a pill that can be administered in a variety of doses that increase incrementally in cycles. In Joseph’s case, he began with a 20-milligram dose.

“During Cycle 1, which is the first four weeks, you go from 20 milligrams to 100 milligrams,” Dr. Choksi explains. “Then for Cycle 2, you start with a 200-milligram pill, and then in two weeks from Cycle 2 onward, you can go up to 400 milligrams.

“That is the recommended dose, and (Joseph) tolerated the treatment well in terms of how he felt. But his platelet counts fell even further, to 20,000, which is something this medication can do until it starts working in the bone marrow and the patient starts to get better.”

You Can Do It

The additional drop in platelet count, which could have led to a risk of increased bleeding, forced Dr. Choksi to scale back Joseph’s treatment by suspending the use of VENCLEXTA for three weeks, then limiting his dosage to 100 milligrams after that.

That allowed Joseph’s platelet count to rise again, and while it added another three months of treatment using VENCLEXTA to his regimen, the results were just what he and Dr. Choksi were hoping for.

“Even with the lower dose of VENCLEXTA, he responded quite well and continues to have a good quality of life,” Dr. Choksi reports. “And that is our goal because we are not going to cure this condition.

“The best we can do is keep it under control to the point where the patient still enjoys their life and we increase their durability or survival rate. And that’s why age is not a factor in considering treatment for any kind of cancer, including blood cancer or leukemia.

“With the treatments, we have now, the response rate is higher and side effects are lower, so patients of any age can maintain a good quality of life. That’s what we were seeking in treating Joseph and it’s working well for him.

“In fact, he should be an inspiration to others out there. Learning that you have cancer or leukemia is a scary thing, but we can help you. And if this 88-year-old man can live a good life, so can you.”

Joseph is living a good life and says he has Dr. Choksi and the staff at Florida Cancer Specialists & Research Institute to thank for that.

“I really could not be more pleased with how I’ve been treated,” Joseph says. “I didn’t feel bad to begin with, and now I feel just as good as I did before. I also feel fortunate that I was treated so well by Dr. Choksi and her staff. They’re great people.”

© FHCN article by Roy Cummings. js
* Patient’s name changed at his request

His & Hers Procedures

Specialist performs ‘amazing’ husband-and-wife skin cancer reconstruction.

When the area around their Fort Lauderdale home became a bit too crowded for their liking, Marilee Kishner and her husband, Richard Kishner, MD, packed up and moved to Vero Beach. After that move, Marilee rediscovered an old hobby.

A recently retired interior designer, Marilee rekindled another aspect of her artistic side and began painting abstracts again. She even dedicated a section of their new home to her passion, ostensibly turning that area into an art studio.

“I’m still in the pre-infancy stage of getting back to the more artistic and creatively free-spirited side of my world,” Marilee says. “I’m starting from scratch with a completely blank canvas and no limitations. It’s very exciting.”

Marilee Kishner and her husband, Richard Kishner, MD

Marilee Kishner and her husband, Richard Kishner, MD

In addition to painting, Marilee likes to play golf. So does her husband, a neurologist who still practices medicine but doesn’t work anywhere near as hard as he did during the 30 some years they lived in Fort Lauderdale.

“I actually still work in Fort Lauderdale, but I only go down there once or twice a month to do procedures,” Dr. Kishner explains. “A lot of the work I do now is through telemedicine. It’s been that way since COVID-19 started.”

Dr. Kishner also likes to fish when he can, but he recently learned that all his time in the sun came at a cost: the development of a lesion growing on his left lower eyelid.

“It looked like a small pimple, white and raised above the skin a bit,” Dr. Kishner details. “At one point, I visited my dermatologist in Fort Lauderdale about it and, after he looked at it with his skin scope, he said, That doesn’t look bad; it’s nothing to worry about.

“But over time it got somewhat bigger, and then, from me rubbing on it while washing or drying my face, it started to bleed. That’s when I knew it was a problem. That was just after we moved to Vero Beach, and at first, I couldn’t get in to see anybody about it.”

While searching for a provider to examine the growth, Dr. Kishner told a friend that he also needed to find an eye doctor in the Vero Beach area. The friend suggested he visit Alexander D. Blandford, MD, at the Center for Advanced Eye Care.

Dr. Kishner’s friend could not have made a better recommendation because Dr. Blandford is a board-certified oculofacial plastic surgeon who specializes in cosmetic and reconstructive surgery around the eyes and face.

In addition to eyelid lift (upper eyelid), under eye bag removal (lower eyelid) and brow lift, his specialties include cosmetic laser procedures, BOTOX® Cosmetic, dermal filler injections, orbital surgery, tear-drainage system surgery, and skin cancer removal and reconstruction.

Removal and Reconstruction 

Dr. Kishner and Marilee visited Dr. Blandford simultaneously for annual eye examinations. After learning of his fellowship training in oculofacial plastic surgery, however, Dr. Kishner asked Dr. Blandford to examine the growth that had been worrying him.

“It was growing, non-healing, red and flaky, so a biopsy was performed and it came back as a form of skin cancer called nodular infiltrative basal cell carcinoma,” Dr. Blandford reports. “It also had some depth to it, and after discussing options, Dr. Kishner was referred to a local Mohs surgeon for the removal.”

During Mohs surgery, microscopic layers of skin are repeatedly removed and examined until the borders of the tissue removed no longer contain cancerous cells.

Dr. Kishner underwent the procedure within days of his examination. The surgery left him with a defect on the eyelid that could have prevented the eye from closing if not properly reconstructed. To restore eyelid function and appearance, Dr. Kishner returned to Dr. Blandford.

Using a procedure known as local flap surgery, Dr. Blandford rearranges healthy tissue surrounding the defect so it covers the defect and avoids a skin graft. This allows for faster healing and, when done correctly, leaves the patient looking as if no surgery was performed. 

Dr. Blandford used his expertise to achieve such an outcome with Dr. Kishner.

“We used a local flap and kept the incisions below the eyelashes in what we call the relaxed tension lines,” Dr. Blandford explains. “Those are the lines that are normally present in our face. By using those lines, the incision lines are less conspicuous once they heal.

“In Dr. Kishner’s case, we had a functional goal and a cosmetic goal, and we were able to achieve both with one surgery. His eyelid functions normally, and it’s almost impossible to see the incision lines because of where they were placed.”

Dr. Kishner says the defect he was left with following Mohs surgery was “about the size of a nickel.” He was naturally concerned that he might be scarred forever. That is no longer a concern.

“Dr. Blandford did an unbelievable reconstruction job,” Dr. Kishner raves. “He put that thing back together like an origami puzzle. You would never know I had surgery of any kind in that area.”

Quiet, Confident Manner

The reconstruction project Dr. Blandford performed on Dr. Kishner was not the last he would provide for the couple. A few months after Dr. Kishner’s case was completed, Marilee learned she also had a skin cancer that required Mohs surgery and reconstruction.

A dermatologist discovered Marilee’s cancer on the right nasal ala, the external wing-shape wall on the side of each nostril. Marilee chose Dr. Blandford to do the skin cancer removal and reconstruction, largely because of the “tremendous job” he did treating her husband. 

“When I told the dermatologist I wanted Dr. Blandford to do the whole thing, he said, I trust Dr. Blandford,” Marilee recalls. “He also said Dr. Blandford is going to do the pathology knowing exactly how he wants to suture it up, and that’s exactly what Dr. Blandford did.”

Dr. Blandford removed the skin cancer by working with a pathologist, who examined the excised skin cancer using a technique called frozen section margin control. Margin control is important prior to reconstructive surgery to decrease the risk of recurrence.  Once clean margins, meaning noncancerous tissue, were found, Dr. Blandford again performed a local flap surgery to repair the defect. In this case, he made incisions in the ala groove, the natural line between the nasal ala and the cheek.

“There’s a natural arch there,” Dr. Blandford explains. “It’s not a true relaxed skin tension line, but a flap can be advanced into the groove to hide the incision.”

Marilee’s surgery was performed in August. She healed quickly, and by the middle of September was already looking as if she had never had surgery. She considered the doctor’s work a piece of art.

“It’s amazing. I never expected it to look so good so quickly,” Marilee enthuses. “My husband and I are very happy with everything Dr. Blandford has done for us. He’s very good, and just the way he presents himself is very comforting.

“He has a very quiet, very confident manner, and when he explained everything to me, he always stopped and asked, Do you have any questions? Do you understand what I’m saying? And if I did have a question, he took his time and explained it all. I never felt like he was in a rush to get through the conversation. 

“After the procedure, I received multiple follow-up calls from Dr. Blandford checking to see that everything was OK, and I really appreciated that.”

As a physician, Dr. Kishner rates other doctors more critically than Marilee. But just as his wife found favor with Dr. Blandford, so too did Dr. Kishner, who gives the surgeon high marks for professionalism.

“He’s a doctor’s doctor,” Dr. Kishner notes. “He does a very thorough evaluation. He speaks to you in clear tones, and he’s extremely meticulous. He cares as much about the results as the patient does.

“I happily recommend him, and the group as a whole is very good, too. The day after my surgery was a Saturday, and I woke up that morning feeling something tugging a little bit around the surgical site, so I called his office.

“One of his partners answered the phone and said, Come on over immediately. He looked at it, took care of it and could not have been nicer. And this was early Saturday morning, so I’m sure I messed up his golf day. But he had no complaints, and he could not have been more helpful or more professional.”

© FHCN article by Roy Cummings. Photo by Jordan Pysz. mkb

Manatee Memorial Hospital Offering New Heart Care Treatment

November 16th, 2021

Manatee Memorial Hospital is now offering patients with severely calcified coronary artery disease a new treatment that uses sonic pressure waves to safely break up calcium blockages that can reduce blood flow in the heart.

The new shockwave technology, known clinically as intravascular lithotripsy or IVL, allows physicians to fracture the problematic calcium and safely expand the artery so that blood flow can be restored through the placement of a stent without unnecessary complications.

S. Jay Mathews, MD, performed the first IVL procedure with the help of Manatee Memorial Hospital’s Heart and Vascular team in August. James Nguyen, MD, Anthony Pizzo, MD, Enrique Rivera, MD, Jeffrey Rossi, MD, and Gino Sedillo, MD, are also trained in this procedure. Currently, the hospital has completed 55 procedures.

“Our cardiology team is steadfast in its commitment to give our patients access to the latest cardiovascular innovations to treat heart disease,” said Tom McDougal, CEO, Manatee Memorial Hospital. “It is exciting to be able to offer this treatment option to our patients with severely calcified coronary artery disease.”

Heart disease is the leading cause of death for both men and women, according to the Centers for Disease Control and Prevention. Each year, more than 600,000 people in the United States die of heart disease.

As people with heart disease, specifically coronary artery disease, grow older and their disease progresses, plaque in the arteries evolves into calcium deposits, which can narrow the artery.

Physicians often use stents to open an artery, and of the approximately 1million patients that undergo a stent procedure each year, 30 percent have problematic calcium that increases their risk for adverse events.

“Our cardiology team is steadfast in our commitment to give our patients access to the latest cardiovascular innovations to treat heart disease. It is exciting to be able to offer this treatment option to our patients with severely calcified coronary artery disease.”

Tom McDougal
Manatee Memorial Hospital

Calcium makes the artery rigid and more difficult to reopen with conventional treatments, including balloons, which attempt to crack the calcium when inflated to high pressure, and atherectomy, which drills through the calcium to open the artery.         

While atherectomy has been available for several decades, its use remains low, as it can result in complications for patients who are undergoing stent procedures. 

Manatee Memorial Hospital, a member of the Manatee Healthcare System, has served the residents of Manatee and surrounding counties for over 68 years. The hospital opened a new Emergency Care Center in December 2018 to accommodate our growing community and the first Interventional Radiology Suite with biplane in Manatee County, in January 2019 to support advanced stroke care and vascular disease.

The hospital’s range of medical services includes emergency medicine for all ages; cardiac; cardiovascular; stroke; surgical; orthopedics; outpatient and inpatient radiology services; rehabilitation; respiratory care; sleep services; oncology; wound care and women’s and children’s services including the only Level II Neonatal Intensive Care Unit in the county. For more information visit

Physicians are on the medical staff of Manatee Memorial Hospital, but, with limited exceptions, are independent practitioners who are not employees or agents of Manatee Memorial Hospital. The hospital shall not be liable for actions or treatments provided by physicians. For language assistance, disability accommodations and the non-discrimination notice, visit our website.

Divine Intervention

Pastor’s healing accelerated through faith and long-distance expertise.

As he walked to the pulpit to give his sermon on Pentecost Sunday three years ago, Pastor Donnie Lewis of the Lakeside Assembly of God in Moultrie, Georgia, felt a tingling sensation in his left foot, as if it had fallen asleep.

With the help of PT assistant Glenn Guterman (left), Donnie is slowly regaining the ability to walk.

He didn’t think much of it at the time, but later that evening, while he was hosting a gathering of parishioners from neighboring churches, Donnie noticed that the tingling sensation had traveled from his left foot to his left knee.

“I was also starting to feel it in my right leg,” Donnie reveals. “By the end of that service, I was walking around like that “Oldest Man” character that Tim Conway used to play on The Carol Burnett Show. I was just shuffling along very slowly.

“So I went home that night thinking I just needed to get some rest. Then, at about 3 or 4 o’clock in the morning, I woke up to go to the bathroom. Except when I got out of bed, I couldn’t feel my legs at all. I took one step and hit the floor.”

A visit to the emergency room followed. At first, doctors thought Donnie, 59, was simply dehydrated. When fluids failed to rectify the problem, a specialist who happened to be on call at the hospital that morning was brought in to examine him.

The specialist recognized symptoms of Guillain-Barré syndrome, a rare condition sparked by a bacterial or viral infection that causes the immune system to attack the nerves.
“From what the doctors told me, I probably got it from a steak salad I’d eaten that had some bad lettuce in it,” Donnie explains. “The lettuce was brown and slimy, and I scraped it away and just ate the steak, but it still got to me.”

Mission Trip

As it did with Donnie, Guillain-Barré syndrome can result in long-term paralysis that can extend all the way to the shoulders.

Donnie was diagnosed with the rarest form of the disease, acute motor axillary neuropathy, or AMAN, which takes the longest to recover from. Three years later, in fact, Donnie is still recovering. Though he has regained strength and mobility throughout his upper body, he still cannot stand or walk independently.

That said, Donnie often wonders where he’d be in his recovery had two friends not interceded and offered their services. Those friends are licensed physical therapists Charles C. Donley, PT, and Paul Ernandes, PT, PhD, of Regional Rehab in Spring Hill.

“I’ve known Donnie for many years,” Charles discloses. “We played softball together and did ministry together before he relocated to Georgia. When Paul and I heard what had happened to Donnie, we went to Georgia to see him. We called it a mission trip.”

During that visit about a year and a half ago, Charles and Paul treated Donnie using two of their practice’s signature devices, the Class IV deep tissue therapeutic laser and the HIVAMAT® 200 deep oscillation therapy device.

Those treatments were very different from what Donnie was receiving from his therapists in Georgia, and Charles and Paul offered to provide them regularly if Donnie wished. Last November,
Donnie accepted.

“Donnie just called us up one day and said, I want to come to Spring Hill and get treated by you guys,” Paul remembers. “He actually started coming in January, and now he comes down each week for about three days and we treat him with the laser and the HIVAMAT, in conjunction with other more conventional therapies.”

The laser uses specific wavelengths of red and near-infrared light to stimulate the body’s natural ability to heal cells. It works by releasing nitric oxide, which removes congestion and swelling, promotes rapid healing and reduces discomfort while increasing blood circulation.

The HIVAMAT creates gentle impulses that relax muscles and penetrate all tissue layers to remove the inflammatory byproducts that cause pain in cells. In treating Donnie, Charles and Paul asked licensed physical therapy assistant Glenn Guterman, PTA, to target the spinal cord.

“The idea was to throw as much energy into the spinal cord and the nervous system as possible to stimulate everything,” Paul explains. “Glenn has really pushed Donnie through the ringer, but it’s been paying off.”

Accelerated Healing

Since seeking aid from Regional Rehab, Donnie has slowly increased strength and mobility throughout his upper body. He has also regained the ability to stand and walk with the aid of a walker and supervision.

Donnie uses a wheelchair as he still lacks the physical strength to move independently from a sitting to a standing position without aid, but he and the therapists at Regional Rehab are working toward that goal and are confident they’ll achieve it soon.

“I grew up playing football and was an avid golfer before all this happened, but recently, the guys at Regional Rehab had me up and walking 300 feet,” Donnie reports. “It’s a great achievement.

“One of my goals now is to wheel myself to the pulpit some Sunday, and when I ask the congregation to stand, I want to stand with them. I’m not there yet, but that day is coming and it’s coming soon. I have God and the people at Regional Rehab to thank for that.

“Charles, Paul and Glenn and everybody there have been an incredible help. In the time I’ve been going to Regional Rehab, I feel like I’ve had an acceleration in my healing. I believe it’s because they do such a good job with the treatments and keeping me active.”

Donnie also works out at the YMCA back in Moultrie.

“In the time I’ve been going to Regional Rehab, I feel like I’ve had an acceleration in my healing.” – Donnie

“I walk in the pool and do some upper body work with weights, and just as I used to do before all this happened, I was working out to the point of exhaustion, to the point where I couldn’t do one more rep,” he says.

“Then Paul told me that a workout like that is great for your muscles, but terrible for your nerves. I was probably delaying my recovery working out the way I was, so I really appreciated him helping me with that because it’s probably expedited my recovery as well.”

The help Donnie has received from Regional Rehab is also allowing him to help others. He’s so determined to succeed in his quest to regain full use of his body that he’s become a source of inspiration for others struggling with similar difficulties.

“For whatever reason, the Lord has given me an incredible opportunity to provide hope and encouragement to others through this, so I have hospitals calling me all the time, asking me to come and visit people and share my story with them,” Donnie notes.

“I’m more than happy to do it, of course, and one young man that I visited said to me, You know, you’re probably more influential now from a wheelchair than you were from a pulpit. If that’s the case, then that’s a tremendous positive that’s come from all this.”

© FHCN article by Roy Cummings. Photo by Jordan Pysz. js

Your Orthopedic Services Destination

Treatment available for all joints and forms of arthritis or injury.

Over two decades, the number of people undergoing total hip replacement surgery in the country each year has more than tripled, from 138,700 in 2000 to about 450,000 in 2020, according to government data.

Michael A. Retino, DO

That’s projected to increase to approximately 625,000 by 2040, in part because people are living longer. The US population of people 65 and older jumped from 34 million, or 12.4 percent, in 2000 to 52 million, or 16.3 percent, in 2020.

Add it all up and it means an increase in demand for physicians such as Michael A. Retino, DO, an orthopedic surgeon on staff at Manatee Memorial Hospital, where he does what fewer and fewer orthopedic surgeons do. Put quite simply, he does it all.

“I’m a general orthopedic surgeon,” says Dr. Retino, who brought his vast knowledge and surgical skill set to Manatee Memorial two years ago following nearly 20 years of performing the same array of services in Cleveland.

“I’m different from physicians who do subspecialty work in that I perform hip, knee and shoulder replacements; I do anterior cruciate ligament reconstruction and rotator cuff repairs; I repair carpal tunnel issues and perform knee and shoulder arthroscopy.

“I can tackle just about anything, and the advantage that provides for patients is that they don’t need to see three different orthopedic surgeons for each of their different complaints. As long as they’re comfortable with me, I can address their other joint needs.

“At the same time, we need to fully appreciate the fact that there are still many orthopedic conditions and situations that require the expertise of a sub-specialty fellowship-trained surgeon.”

Many of Dr. Retino’s patients do have other needs. He estimates that about 80 percent of the patients he treats for one bothersome issue return to him for treatment of a similar ailment in another part of their body.

“There are a lot of times where I’ll perform a knee replacement on a patient,” he relates, “and as they’re walking out the door they’ll say, I’m really glad I finally got this knee taken care of; now can you do my shoulder or fix this carpal tunnel issue?

“And, of course, I tell them, Yes. We repair shoulders and carpal tunnel issues as well. And again, the patient doesn’t need to restart the process of finding a surgeon they trust to treat them properly and feel comfortable with.”

Surgical and Nonsurgical

Dr. Retino performs all of these surgeries as well as many nonsurgical procedures at Manatee Memorial’s Center for Orthopedic and Spine Surgery, where the services menu is one of the most extensive in all of medicine.

In addition to being outfitted for hip, knee and shoulder replacement surgeries, the center is set up to treat all forms of arthritis and traumatic orthopedic injuries, including the fracture and dislocation of all joints and extremities.

In addition, the center has the equipment to perform spinal surgery or treat other issues of the spine, including degenerative and congenital disorders such as spinal stenosis, ruptured or herniated discs, fractures, infections and tumors.

It’s equipped for foot and ankle surgeries and has everything necessary to treat a variety of podiatric conditions, including bunions, hammertoes, ankle injuries, diabetic foot disorders, ligament fractures and other traumas.

The center is similarly prepared to treat issues with the hands, elbows and shoulders, including tendon and instability problems as well as sports-related injuries and overuse syndromes.
At Manatee Memorial, the care for patients requiring surgical as well as nonsurgical orthopedic services doesn’t begin and end with the procedure. For certain surgeries, it begins prior to the procedure and extends beyond its completion.

For patients requiring hip, knee and shoulder replacements, for example, Manatee Memorial offers a presurgical education program that helps patients and their caregivers prepare and recover.

“It’s an example of old-fashioned caring,” Dr. Retino says of Manatee Memorial’s presurgical education program.

The program is coordinated by Andrew Stritzl, RN, BSN, whose goal is to ensure patients remain safe ahead of, during and after surgery.

“We’re very thoughtful about the surgical process here, so we’re always looking for ways to fine-tune that process, so we can get good, solid outcomes,” Dr. Retino adds. “One way to do that is by doing more with preop education.”

One of the objectives of the presurgical education program is to avoid complications, such as infection of the surgical site. Manatee Memorial is achieving its goal in that area, including where Dr. Retino works.

For example, the hospital recently earned The Joint Commission’s Gold Seal of Approval for total hip and knee replacement certification for a second time by demonstrating continuous compliance with the commission’s performance standards.

The Gold Seal is a symbol of quality that reflects a health care organization’s commitment to providing safe and successful patient care. Dr. Retino says Manatee Memorial has earned its awards, in part, by creating a successful working environment.

“The people at Manatee Memorial Hospital do a great job, and it’s not just me saying that; it’s the patients.”- Dr. Retino

“When you’re performing surgical cases two to three times a week, you want to do them where you have good people and the facilities and postoperative care are outstanding,” he says.
“That’s what I have at Manatee Memorial. The staff is accommodating and cordial. It’s a good group of people, and they do all they can for the benefit of the patient. Believe it or not, it’s not like that everywhere you go. But it’s like that at Manatee Memorial.”

According to Dr. Retino, the hospital is equally accommodating to doctors by making MRI, CT scan and X-ray services readily available when needed. And when specific components are required to ensure a successful surgery, the hospital makes sure the doctor has them as well.

“They allow surgeons to determine what they want to use and what’s best for their patients,” Dr. Retino confirms. “Not all hospitals do that. Some look more at cost-effectiveness and not so much at what is best for the patient.

“Some hospitals say, We can get these implants cheaper so you’re going to be using these whether you like them or not. A doctor can get a bit handcuffed that way in some places. That’s definitely not the case at Manatee Memorial. They are great. When I first came here, for example, I asked, Will you let me use a certain system to put this wrist fracture back together? The answer was, Sure, no problem.

“They’re very good streamlining those situations and provide us with everything we need. As a result, my patients have been very happy with the care they’ve received there. The people at Manatee Memorial are providing a great service to the community.”

Before and After Care

COVID-19 protocols remain in effect at Manatee Memorial Hospital; masks must be worn while in our facility.

That service includes an extensive postsurgical rehabilitation program that begins well ahead of surgery. During his presurgical education program, Andrew’s focus is on pre- and postsurgery preparedness.

“We go over what patients need to do before and after surgery to help reduce the risk of getting an infection. We cover what to expect in the hospital after surgery with a focus on rehab and the goals of functional safety,” Andrew explains. “The roles of physical therapy and occupational therapy are discussed as well as individualized discharge planning.”

Andrew says the tremendous support the program receives from surgeons such as Dr. Retino is one reason Manatee Memorial is achieving its goal of creating better patient outcomes. Dr. Retino says those results are largely a result of great teamwork.

“The people at Manatee Memorial Hospital do a great job, and it’s not just me saying that; it’s the patients,” Dr. Retino notes. “We get tremendous reports from our patients following surgeries and procedures.

“And they’re not saying things like, My nurse was great, but I didn’t like the doctor. We’re getting great reviews on everything from the surgical staff to the anesthesiologist, the physical therapist, the rehab team and the home services staff.

“Everyone is on the same page, and when you have that, the patient can expect a well-structured quality of care. Overall quality and patient safety are key, and Manatee Memorial Hospital provides that.”

Another thing that patients under Dr. Retino’s care can expect is his personal attention throughout the process.

“I give you quality, compassionate care,” Dr. Retino assures. “And, if I operate on you, you’re going to see me afterward. You’re not going to see a physician assistant; you’re not going to see a medical assistant; you’ll see me. I’ll see you seven to 10 days after your surgery and then at three-week intervals until you’re happy and we get you up and running.”

That way, if there are concerns, the doctor will learn firsthand.

“I don’t want to hear about problems from my physician assistant or a medical assistant,” Dr. Retino says. “Continuity of care is huge, and the quality and continuity of care are big pluses at Manatee Memorial, so it will be me taking care of you from beginning to end.”

© FHCN article by Roy Cummings. Photos by Jordan Pysz. mkb

New Smiles At Warp Speed

Get restorations in a day that live long and prosper.

Many people have something about their smile they would like to change. It might be simple or very complex. Thankfully, many of the more intricate alterations can be made in a day thanks to CEREC® CAD/CAM technology.

CAD/CAM (computer-aided design/computer-aided manufacturing) was first used in dentistry 30 years ago. At the time, it was quite complex. But its benefits progressed rapidly because of CEREC (Chairside Economical Restoration of Esthetic Ceramics).

CEREC uses CAD/CAM technology to produce digital dental impressions and ceramic restorations such as crowns, veneers, inlays and onlays in a matter of minutes.

“On the sci-fi television series Star Trek, Dr. Leonard McCoy would scan a sick crew member or alien with a handheld ‘tricorder’ and immediately diagnose a sickness,” Dr. Alford relates. “Then he’d turn a button on the ‘tricorder’ and immediately fix the illness.

J. Terry Alford, DMD, of Advanced Dental Cosmetic Center in Bradenton, has been a CEREC dentist for nearly three decades. He was one of the first dentists in America to embrace this innovation that enhances the patient experience.

“We can’t do that in dentistry just yet, but thanks to CEREC and CAD/CAM technology, we have come a long way. For those who have this advanced technology, we can literally repair someone’s smile in a day.”

It typically takes two to three weeks to fashion a new smile using standard dental procedures. CEREC allows that work to be done in a fraction of the time. It also produces superior results, according to Eddie Corrales, a CEREC pioneer and industry leader in California.

The reason is that CEREC allows for the use of biocompatible and natural-looking ceramic materials that can be milled through a 3D printer in 15 to 20 minutes per tooth.
Neverthless, Dr. Alford still does a few things the old-fashioned way.

“We still take pictures and molds of the mouth before we start,” the dentist reports. “Then we begin the smile design process before we actually sit down to do the work in the clinic. We create and design the smile in the lab using modern cosmetic principles, then present the new smile to the patient. The patient takes an active role in the design.”

CEREC technology can be used to fabricate veneers, crowns, inlays and onlays.

Then, just as the physician in Star Trek scanned his patient, Dr. Alford scans his patient’s mouth, and the computer designs a smile to match what was created in the proposal. The design of the teeth is then sent to a 3D printer and milled.

Eddie, who works closely with Dr. Alford, then adds his incredible artistic touch to make the teeth naturally vibrant, beautiful and, often, whiter that the originals. And it only takes one visit to the dentist to build the smile the patient has always wanted.

“Not everyone needs this kind of treatment,” stresses Dr. Alford, clinical director of Advanced Dental Cosmetic Center. “Most often, simple bonding or whitening can give the patient a pretty smile. But for those who do need and desire a quicker result, we have it.”

Article courtesy of Advanced Dental Cosmetic Center. mkb
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