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These Eye Surgeons Help You Look Better

Oculoplastic specialists offer array of treatments to enhance appearance of eyes and face.

People get only one chance to make a first impression. Often, that impression is based largely on the appearance of their eyes and face. It’s no wonder people take special care of these delicate areas.

“Using a product such as JUVÈDERM, people not only get the benefit of a more youthful appearance, but the results are also very natural looking.”
– Dr. Applebaum

When age, genetics or sun exposure affects the eyes and face, fellowship-trained oculoplastic surgeons Robert J. Applebaum, MD, MBA, and Norberto Mancera, MD, at Florida Eye Specialists & Cataract Institute, spring into action. These physicians provide services designed to correct issues with or enhance the appearance of the eyes and face.

“Puffy or drooping eyelids can make people look old, tired or even mean,” Dr. Applebaum observes. “While puffy eyelids are often hereditary, they become more pronounced with age.”

To treat sagging eyelids, Dr. Applebaum and Dr. Mancera often recommend blepharoplasty, a safe, effective and cosmetically appealing eyelid surgery. By removing excess eyelid tissue, blepharoplasty can make a dramatic difference in the appearance of the face.

There are two types of blepharoplasties: upper and lower, Dr. Applebaum explains.

“Upper blepharoplasty is for removing excess skin and sometimes puffiness from the upper eyelids. It can be performed to create a more youthful appearance or to improve vision, because excess tissue can get in the way of vision and endanger the patient,” he informs.

Surplus skin on the upper eyelids can obstruct a patient’s peripheral vision.

“If you look in the mirror and see the skin of the upper eyelids approaching your eyelashes, that may well represent a loss of your visual field,” Dr. Applebaum warns. “Unfortunately, because the condition develops slowly, people may lose as much as 30, 40, even 50 percent of their visual field before they realize they need help.

“We measure vision loss by performing a visual field test. Peripheral vision is first checked with the eyelid in its natural position. Next, the eyelid is taped up and the vision is rechecked. If there is a difference of 12 degrees or more between the tests, the eyelid condition is considered a functional problem.”

Medicare and other insurance programs may cover the cost if the visual field is impaired due to excess skin. Whether motivated by cosmetic or functional issues, upper blepharoplasty is a relatively easy procedure performed at the institute, Dr. Applebaum reassures.

“We give our patients a derivative of Valium to relax them. With their eyes gently closed, we remove the excess tissue along the course of the upper lid and stitch the incision closed,” he details. “The scar is placed into the lid crease, so when the eyes are open, the scar is tucked away into the normal anatomical fold of the crease. The eyelid skin is the thinnest skin on the body; consequently, scarring is minimal.”

Realigning Fat Pads

Norberto Mancera, MD

Lower eyelid surgery, or lower blepharoplasty, is strictly a cosmetic procedure, Dr. Mancera notes.

“If we are operating on just the lower eyelids, the surgery takes approximately an hour. It takes longer than upper blepharoplasty, which takes about 20 minutes, because the lower lids have a more intricate anatomy than the upper lids,” the doctor explains.

There are two techniques for lower blepharoplasty.

“We can operate through the front and make an incision in the skin. Or we can do it from the back and make the incision in the conjunctiva, the membrane that covers the inside of the eyelid,” Dr. Mancera describes. “I prefer doing the procedure transconjunctivally because it eliminates visible scars and gives quick, easy access to the lower lid fat pads.”

During surgery, the physician may release the fat pads, reduce their size and/or reshape them to give the patient a more pleasant appearance.

“In some patients, we do what is called a fat pad transposition,” Dr. Mancera reports. “During a transposition, the fat pads remain in their original position, but we realign them and suture them to the cheek pad. This produces a better blending of the lower eyelid and cheek. It helps with any tear trough issues as well.”

The tear trough is the deep furrow between the lower eyelid and upper cheek. It may appear as a little divot or dark circle underneath the eyelid, which can give the eyes a sunken appearance. Moving the fat pads forward is like adding a permanent filler to the tear trough, improving the look of the eyes.

“Often, we perform upper and lower blepharoplasty in combination, which is a nice way to take years off the patient’s appearance,” Dr. Mancera proclaims. “And the effects of these procedures are subtle. Patients don’t look like they underwent significant plastic surgery.”

High-Intensity Light

Another technique for rejuvenating the skin of the face and around the eyes is intense-pulsed light, or IPL.

“Skin problems typically begin when people are in their 30s,” Dr. Applebaum reveals. “That is when production of collagen and elastin, the building blocks of skin, starts to decrease and skin cell turnover begins to decline. These conditions make it more difficult for the skin to recover from the effects of aging and injury caused by exposure to the sun and elements.”

These conditions result in the formation of brown age spots, discoloration of the skin, visible blood vessels on the surface, uneven skin tone, and fine lines and wrinkles. They also make small scars, such as those from acne, more visible. IPL can improve these concerns.

“IPL is not a laser-resurfacing technique,” Dr. Mancera stresses. “Instead of a laser, IPL uses high-intensity light at multiple wavelengths. The wavelengths and frequency of the light can be adjusted to address various skin conditions. IPL does not damage the surface of the skin, which can occur with laser techniques.”

While not a laser, IPL works on the same principles. Light is absorbed into specific skin cells, where it is converted into heat energy. The heat damages the walls of the targeted blood vessels and breaks up pigment cells. The affected vessels and pigment cells then rise to the surface, where they fade or are carried away by the lymphatic system.

“One of the biggest advantages of using IPL instead of lasers, which generally produce more noticeable results, is minimal downtime,” Dr. Mancera discloses. “Because IPL does not affect the surface of the skin, there is little redness following treatment. Patients can have an IPL treatment done over their lunch break and return to work afterward.”

Nonsurgical Services

In addition to surgical procedures, Dr. Applebaum and Dr. Mancera offer nonsurgical facial cosmetic services. These include BOTOX® Cosmetic injections and a variety of facial fillers. These options can help reverse changes associated with aging.

“BOTOX Cosmetic is a synthetic toxin that is altered so it is nontoxic to the body of a healthy person,” Dr. Applebaum informs. “It blocks the release of neurotransmitters that trigger muscle contractions and lead to wrinkles.”

Among the fillers used by the physicians are JUVÈDERM®, VOLUMA and Restylane®. Many fillers contain hyaluronic acid, a substance found naturally in the body that helps restore volume and hydration to the skin.

“Over time, materials in the skin, including the collagen and base membranes, break down, so the face begins to sag. We use fillers in the cheeks to add volume and give the face a nonsurgical lift,” Dr. Mancera describes. “We also use fillers in areas slightly lower on the face to decrease the appearance of fine lines and wrinkles around the nose and lips. Often, we use them in the lips to give the lips more fullness.

“Fillers can also enhance the appearance of the jawline, to give people a more angular jawline. For men, a jaw enhancement can really masculinize the face, and it can give women a slimmer appearance to the face and a more defined jawline.”

Another filler, KYBELLA®, is used to decrease the appearance of a double chin. It is injected into the fatty tissue of the chin, where it breaks down fat cells.

“Using a product such as JUVÈDERM, people not only get the benefit of a more youthful appearance, but the results are also very natural looking,” Dr. Applebaum assures. “Patients don’t look like they’ve had anything done.”

Contemplating Cataracts

Florida Eye Specialists & Cataract Institute’s eye specialists offer a vast selection of services using the most advanced technology. This includes the latest techniques and products for the treatment of cataracts.

Dilip “Dr. Samy” Rathinasamy, MD

“Cataracts are the gradual discoloration or clouding of the eye’s natural lens,” describes Dilip “Dr. Samy” Rathinasamy, MD, a board-certified ophthalmologist and cataract surgeon at the institute.

“Think of the lens as you would a window made of clear, thick, flexible plastic. As the elements take their toll on the plastic, it becomes discolored, distorting the images that can be seen through it. Eventually, the plastic becomes so discolored that you can’t see anything through it.

“A cataract develops in much the same way, which is why cataracts can cause blurry vision and even cause some people to notice more glare than usual, especially at night, with halos or starbursts around car headlights and lamps.”

Cataracts can also cause colors to appear faded or have a yellow or brownish tint. Reading may become more difficult as it becomes harder to distinguish the contrast between letters on the page and the background. Frequent prescription changes to eyeglasses or contact lenses may also signal the presence of cataracts.
Cataracts are treated during a surgical procedure in which the clouded lens is removed and replaced with an artificial intraocular lens, or IOL.

The goal at Florida Eye Specialists & Cataract Institute is to fit patients with an IOL that minimizes or eliminates their dependency on glasses. To help achieve that objective, the institute uses the LENSAR® laser system, a leading-edge femtosecond technology.

“The LENSAR’s functions and precise laser incisions enable surgeons to remove cataracts with increased safety and position the IOLs with greater accuracy,” explains Ana-Maria Oliva, MD, a fellowship-trained corneal and refractive surgeon with the institute. “These innovations lead to better vision following surgery.”

“Cataract surgery can be life-changing for patients. That’s one of the things I find so satisfying and rewarding about what I do.” – Dr. Oliva

The LENSAR automates certain aspects of cataract surgery that were traditionally done by hand, so the procedure is more efficient, more effective and safer.

“The laser makes the initial incision into the eye,” Dr. Oliva details. “It can also create the capsulotomy, which is the opening into the thin, fragile membrane, or capsule, that holds the cataract. And it does so with exceptional precision.

“A capsulotomy done by hand can be less than perfect. The importance of having a perfect capsulotomy is that the IOL can then sit in a more optimal position, which ultimately gives the patient better vision.”

The LENSAR is useful in other ways as well.

“To correct astigmatism, which is an irregular shape of the cornea that leads to blurry vision, surgeons sometimes make limbal relaxing incisions, which are tiny cuts in the cornea to reshape it,” Dr. Samy explains. “The corneal reshaping done by the LENSAR can reduce astigmatism and help people see more clearly after surgery.”

Toric Technology

Another advancement to the femtosecond laser is it enables even more precise placement of IOLs following cataract removal. This feature is designed for use with toric lenses.

“Toric lenses are another way to correct astigmatism.” Dr. Samy says. “They have different strengths in different parts of the lens, which make up for the asymmetric power of the misshapen cornea.

“Using the femtosecond laser technology, doctors are able to put markings on the capsule to better align the toric lens. This provides even more precise placement of the lens for correcting astigmatism.”

Dr. Oliva points out that the laser performs the most crucial portions of the surgery with unmatched precision within seconds of the click of a button. It is a nice adjunct to the surgeon’s skills and expertise.

“Cataract surgery can be life-changing for patients,” she reports. “That’s one of the things I find so satisfying and rewarding about what I do. I’m happy to be able to restore clear sight to patients with such a quick and easy surgery.

“Technology has advanced the treatment of astigmatism apart from cataract surgery as well. Doctors are able to perform imaging on the operative eye in the office using corneal topography and use the image as a guide on the day of surgery.

“We take a picture of the eye, then superimpose it on the eye during surgery and apply our measurements. When patients lie down, their eyes rotate. With this technology, we can adjust for any rotation. This enables more precise limbal relaxing incisions for correcting astigmatism.”

Latest Lenses

Technology has also led to vast improvements in IOLs, which are made of acrylic or silicone and are coated with special material to protect the eyes from the sun’s ultraviolet rays.

The IOL has two parts: the optic, or central area responsible for refraction, and side structures called haptics that hold it in position. Like contact lenses, IOLs are available in various focusing powers.

“The most commonly used IOLs are monofocal lenses, which correct for one focal range, typically distance vision,” Dr. Samy points out. “This results in excellent vision for driving and most daily activities, but people may require reading glasses for very small print. One way to get around that is the monovision approach, where the doctor corrects one eye for distance and one eye for reading.”

Then there are multifocal lenses.

“Most multifocal lenses are bifocals that correct either distance and intermediate vision or distance and near vision,” Dr. Samy educates. “They generally permit the patient to be less dependent on glasses.”

A trifocal lens, the Alcon PanOptix®, has different focusing powers on the optic to enable crisp, clear vision at all zones: distance, intermediate and reading, similar to progressive eyeglasses.

“The PanOptix became available in the United States in late 2019 and is the only trifocal lens approved for use in the US,” Dr. Oliva reports. “It has quickly become a popular lens choice because it virtually eliminates the need for glasses following cataract surgery.

“People have more active lifestyles and use their computers and smartphones with greater frequency. They want to be able to see at all distances following cataract surgery, and they do not want the hassle of glasses.”

The main drawback to multifocal lenses is they sometimes produce visual disturbances, such as rings and halos around lights at night. But a new multifocal lens, the Alcon AcrySof® IQ Vivity®, recently came on the market with a significantly lower risk of nighttime visual side effects.

“The Vivity is a new generation of multifocal lens that we refer to as an extended depth of focus lens,” Dr. Samy explains. “It uses innovative technology that bends light rays entering the eye, allowing light to focus properly on the retina. The retina converts light rays into electrical signals and sends those signals to the brain, which interprets them as images.”

The Vivity corrects blurriness and gives patients clear distance, near and intermediate vision, often eliminating the need for glasses. Another benefit is it can be used with patients who have other eye conditions.

“Most multifocal lenses are contraindicated in patients with eye disease, but people with eye conditions such as glaucoma, macular degeneration and diabetic retinopathy are still candidates for the Vivity,” Dr. Samy elaborates. “These patients would not be candidates for traditional multifocal IOLs.”

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

Hear, Hear For Doctors Of Audiology

They’re highly trained hearing care professionals who can lead you through the big-box noise.

Steve Kennedy is a people person. He enjoys talking to people and engaging with them socially. Those traits have served him well for the 30-plus years he’s worked as a sales executive. His enthusiasm extends to his private life as well. In his free time, the 58-year-old Florida native loves to travel, exercise and watch the local sports teams compete on TV.

Steve says is hearing is “much better and much clearer” with his new hearing aids.

“I enjoy traveling and seeing new places, and there are many beautiful places out there,” Steve shares. “Nashville is a great town to visit. Glacier National Park in Montana is absolutely breathtaking. Hawaii is gorgeous. I like St. Thomas in the US Virgin Islands very much, too.

“My job is demanding. I work a lot of hours, so I watch sports to relax. I’m a big Tampa Bay Buccaneers and Tampa Bay Lightning fan. I root for the Florida State Seminoles in college football. And I really enjoy working out. I lift weights and perform cardio activities.”

About 10 years ago, Steve noticed some issues with his hearing. He was having difficulty hearing speech in crowded settings such as restaurants. It affected him on the job as well.

“I work in a professional environment and deal with large corporations, so my hearing is very important to me,” Steve maintains. “I must be able to hear what my clients are saying and understand what they want to accomplish.

“My hearing challenges were making it difficult to comprehend what people were saying, particularly the nuances of what they were saying. Numbers were especially hard for me to understand. And in sales, it’s very important to understand numbers. I realized I needed to address these hearing challenges.”

At the time, Steve bought hearing aids from a big-box store. They were basic devices with minimal functionality. Several years later, when Steve required updated hearing aids, a friend recommended he visit Trinity Hearing & Balance Center.

Trinity Hearing & Balance Center is the New Port Richey practice of Kelly Hansen, AuD. Dr. Hansen and fellow audiologists Nikki Goldowski-Richa, AuD, and Kayla Dub, AuD, CCCA, specialize in hearing care, including the fitting of hearing aids. They also treat all types of balance disorders.

Best Practices

Unlike big-box stores and many other hearing aid practices, Trinity Hearing & Balance Center is staffed by doctors of audiology. These are highly trained professionals who are skilled in the diagnosis and treatment of hearing and balance disorders in adults and children.

“The primary difference between an audiologist and a hearing aid specialist is education,” Dr. Dub explains. “Doctors of audiology complete an additional eight years of school beyond high school to receive their doctorate. They also complete more than 2,000 hours of hands-on clinical experience by the time they graduate.

“Compared to someone who simply fits hearing aids, doctors of audiology look at the patient as a whole. They perform diagnostic testing, auditory rehabilitation and cochlear implantation. And at Trinity Hearing & Balance Center we also focus on vestibular disorders.”

“The experience was much more professional than at the big-box store; it was revelational.” – Steve

The education of doctors of audiology includes research on best practices in the recommendation and fitting of hearing aids and follow-up care. Trinity Hearing & Balance Center follows the best practices identified through this research.

“Best practices involve more than choosing the devices. They also include the personal care,” Dr. Dub points out. “We can perform the most advanced audiometric testing and recommend the best hearing aid technology, but if they are not fit properly, the patient will not be satisfied. One size does not fit all when it comes to hearing aids.

“Our patients also receive as much follow-up care as necessary for them to be completely comfortable with their hearing devices. We see patients one week after the fitting to make any fine-tuning adjustments. We then follow them every three to four months to clear their ears and clean the hearing aids so they get the best life out of their devices.”

“They’re Fantastic”

“When I visited Trinity Hearing & Balance Center for the first time and worked with the doctors, the experience was much more professional than at the big-box store; it was revelational,” Steve reflects.

“The technology they use is amazing. They also shared information with me about the advances in hearing aids, which enabled me to make a far-more educated decision about my hearing health care.”

Recently, Dr. Dub fit Steve with new top-of-the-line, rechargeable, over-the-ear hearing instruments. They include features that accommodate Steve’s active lifestyle.

“These hearing aids adjust so I can hear better in the different environments I’m in,” Steve enthuses. “The devices connected to my phone with Bluetooth so I can actually take calls through my hearing aids, which is nice for a sales professional. I can listen to music when I’m working out as well.

“My hearing is much better and much clearer with my new hearing aids. Now, when I discuss numbers with my clients, I have a much clearer understanding than I did before.”

Steve has high praise for the doctors of audiology at Trinity Hearing & Balance Center.

“They’re fantastic,” he raves. “They’re always quick to see me if I need help with my hearing aids or have issues with my ears. I wish every health care provider could provide the pleasant experience I get at Trinity Hearing & Balance Center. I’m a huge fan of what they do for people.”

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

Dental Implants Keep Lower Denture Secured

After a broken tooth, gum infection, extractions and loose denture, her two-year dental odyssey ends.

Nina* turned her affinity for numbers into a career. After earning a two-year degree in accounting from Oakland University, the second largest university in the Detroit metropolitan area, Nina held accounting positions at several companies in her native Michigan.

“I chose accounting because I like numbers. I like math and did very well in math in high school,” explains Nina, 82. “I retired from the corporate office of a child care organization called Childtime Child Care (now Childtime Learning Centers). It was a group of 357 child care centers across the country.

“I was a cash management accountant for Childtime for 12 years. I moved money from the bank when needed and pulled in funds from the 357 centers. When I retired in 2001, I moved to Florida to get away from the cold weather. I don’t like the winters in Michigan.”

Despite her disdain for the Midwest chill, Nina often travels back to the Great Lakes State to visit family and friends. During one trip in 2020, Nina experienced a worrying dental predicament.

“My daughter was driving me home to Florida when a tooth broke off underneath the gum,” Nina reports. “I went to my dentist, who told me I needed to visit an oral surgeon. He arranged an appointment with one who was supposedly covered by my insurance, but that wasn’t the case. I couldn’t believe it.”

Then the COVID-19 pandemic hit, and her dentist was required to close his office. Shortly after, Nina developed another dental problem: a severe gum infection. She’s convinced the broken tooth was responsible.

“The infection got really bad and caused me a lot of pain,” she recalls. “I could eat soft food and soups, but I couldn’t chew anything hard.”

Several weeks later, her dentist’s office reopened, but that came with a surprise.

“My dentist didn’t come back. He retired,” she laments.

“My upper denture works very well. And it looks very natural. I’m very happy with it.” – Nina

Soon, the pain became unbearable.

“I woke up on a Saturday morning and couldn’t handle it anymore,” Nina says. “My sister-in-law searched online for emergency dentists and found Venetian Dental. We got an appointment that day.”

Venetian Dental is the practice of Alexander Gaukhman, DMD, a general, cosmetic and emergency dentist who has offices in Venice, Sarasota and Osprey. After evaluating Nina’s situation, Dr. Gaukhman recommended a treatment plan to solve her problem.

“Nina’s existing dental work, which included partial upper and lower dentures, was compromised due to the gum infection,” Dr. Gaukhman recalls. “The condition also caused her remaining natural teeth to fail, and they were not savable.

“My recommendation was to extract her remaining teeth and create full upper and lower dentures, with the lower denture secured by dental implants. Nina chose, however, to proceed with traditional dentures on the top and bottom.”

That became problematic for Nina over the ensuing months.

“My bottom denture wouldn’t stay put,” she relates. “Whenever I chewed, it would come loose. One day, I was eating chicken salad. It became loose and went sideways in my mouth. If it wasn’t so big, I would have swallowed it.

“Dr. Gaukhman said that’s pretty standard. If you’re going to have problems with your dentures staying in, it’s going to be your bottom denture that you have trouble with.”

So, she returned to Venetian Dental in 2022 and received two dental implants to secure her lower dentures.

Stabilizing Lower Dentures

Dental implants are root-shaped, screw-like bodies that are surgically placed into the jawbone, where new bone naturally grows around them to form the foundation for an abutment and replacement teeth.

The replacement teeth can be a crown that is cemented or screwed onto the abutment, a partial bridge that can be affixed to one or more implants, or a full denture that can be fastened to a series of implants.

Unlike upper dentures, which fit securely in the mouth because the palate creates sufficient suction to hold the appliances in place, lower dentures often require implants to remain in place.

“There’s no palate in the lower jaw due to the location of the tongue, so less suction is produced,” Dr. Gaukhman asserts. “Consequently, lower dentures tend to slip and slide if they’re not supported by dental implants.

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

In addition to staying in place when patients speak and eat, dentures secured by dental implants provide added strength for biting and chewing, according to Dr. Gaukhman, who notes several other advantages of implant-secured dentures.

“Because the dentures are stable, patients experience better speech, better aesthetics and greater self-confidence,” he says. “And they don’t have to worry about the denture coming out during dinner, conversation or activity. Also, while teeth decay, implants never do.”

End-Result Anticipation

In most cases, Dr. Gaukhman offers patients Dentures in a Day, Venetian Dental’s single-visit smile-restoration technique. That process allows for the placement of the implants on the same day the teeth are extracted. Typically, temporary dentures are created that day in an on-site laboratory.

“We begin the process by taking impressions of the patient’s teeth,” Dr. Gaukhman describes. “It takes a few hours for the lab to fabricate the dentures, but once they’re ready, we extract the teeth, seat the implants and place the dentures right away. This way, the denture acts as a bandage to minimize swelling and bleeding. Moreover, patients do not need to walk around without teeth.

“The patient wears the temporary denture for three to six months following the implant procedure. The time allows the implants to integrate with the jawbone and for the tissues to heal. The temporary denture is then replaced with a permanent appliance that attaches to the implants. Once the permanent dentures are placed, we make any necessary adjustments to ensure a perfect fit.”

Dr. Gaukhman didn’t use the Dentures in a Day technique with Nina. Following the extraction of her remaining teeth, she was fit with a full upper denture. Since then, she received the lower implants and a temporary lower denture.

“My upper denture works very well, and it looks very natural,” Nina relates. “I’m very happy with the work Dr. Gaukhman did.”

Until the pandemic, Nina spent many evenings singing karaoke. Now, she enjoys the activities arranged by her senior living community, including playing a card game called Hand and Foot. She’s also involved in making blankets for the homeless.

“I’m 82 years old. I feel that it’s time for me to give back for all the wonderful things that have happened to me in my life,” Nina shares.

She includes meeting Dr. Gaukhman among those good things that have happened to her. Nina has great respect for the dentist who answered her call in an emergency.

“Dr. Gaukhman is a very good dentist,” she raves. “He was very reassuring and took good care of me. I highly recommend him and Venetian Dental. In fact, I recommended the practice to my brother, who’s a patient there now.”

Palate Pleaser

Frank O’Brien spent the better part of a 47-year career in technology with a company that makes scale inhibitors for industrial water treatment systems. The inhibitors keep limescale and mineral crystals from forming on water pipes to ensure proper function.

In his free time, Frank takes pleasure in his favorite activities, including woodworking.

“It was a technical position involving lots of legwork,” elaborates Frank, 63. “While with that company, I did work for the oil and gas industry and the fracking industry. Then one day, the company decided it didn’t need me anymore.

“Everything went down when COVID hit. After that, they let me go. It was July 8, 2020. I was actually planning to retire in August, but my company beat me to it. They gave me a jump-start on retirement.”

Frank then decided to sell his home in Georgia and move to Florida, where he inherited a house from family. So far, he’s enjoying “every day being Saturday” because it allows him to take pleasure in his favorite pastimes.

“I do woodworking as a hobby,” he relates. “Sometimes, I sell my stuff, but mostly I do it for fun. I also like to fish and use my metal detector around Nokomis Beach. I’ve found a Pandora ring and lots of costume jewelry along with bottle caps and change. I throw everything I find in a box. Someday, I’ll count the change and see how much is there.”

While Frank knows how to relish his time, he also knows all too well the discomfort of longtime dental problems. He’s been struggling with his teeth since childhood.

“I had a bad experience with a dentist when I was 8 years old, and it stuck with me,” Frank reveals. “As a result, I neglected my teeth for years. I always brushed my teeth. I just never went to a dentist for cleanings.

“Eventually, I developed gum disease and things started going downhill. I underwent surgery and a deep cleaning by a periodontist in Georgia. I didn’t want to go through that again, so I began seeing a dentist every three months.”

Frank ultimately wanted to restore his smile. Upon relocating to Florida, he began looking for a dentist to do the job. His research led him to Dr. Gaukhman.

“I came across a story about Dr. Gaukhman’s practice in Florida Health Care News and decided to make an appointment,” Frank relates. “By then, I had suffered significant bone loss in my upper jaw due to the gum disease. Some of my teeth were loose, and Dr. Gaukhman said they were eventually going to fall out.”

Dr. Gaukhman evaluated Frank’s situation and created a solution for restoring Frank’s smile.

“Frank’s upper teeth were badly damaged from periodontal disease and bone loss and could not be salvaged,” Dr. Gaukhman reports. “His bottom teeth were not as severely damaged and were savable. My recommendation was to extract his upper teeth and replace them with a full denture.

“However, Frank didn’t want the denture to cover the roof of his mouth, or palate. Therefore, to replace his lost teeth, I recommended a dental implant-supported upper denture, which is horseshoe-shaped and doesn’t overlay the palate.”

Discerning Taste

Upper dentures typically stay secure without implants due to the suction produced by the palate. There are instances, however, where implants are recommended.

“Because traditional dentures cover the palate, patients can be deprived of sensing the full complement of tastes,” Dr. Gaukhman reports. “Implant dentures, on the other hand, leave the palate uncovered, improving taste.”

Another issue with traditional upper dentures is the gag reflex. Some patients experience this due to the denture being over the palate. By not covering the palate, implant dentures eliminate this.

“Other benefits of implant-secured upper dentures include better stability because the denture is anchored directly to the jawbone,” Dr. Gaukhman observes. “Implant dentures also prevent bone atrophy and do not rub against the gums. And they’re more convenient because they don’t require messy adhesives to
hold them in place.”

Lower dentures can typically be stabilized with two dental implants. Upper dentures, on the other hand, have to work against gravity so four implants are generally used to keep them secure. In treating Frank, Dr. Gaukhman placed four implants in the upper jaw.

“A Better Way to Go”

Prior to placing an implant, some patients require a bone graft designed to enhance the volume of the jawbone so that it can properly support the implant. Bone grafts are typically done when the implants are placed. The implants then need three to six months to heal to where they can support a prosthetic. During the healing period, patients are usually fit with temporary replacement teeth.

Because he sustained significant bone loss in his upper jaw, Frank required bone grafts. He was fit with a temporary upper denture to wear until his bone grafts and implants are strong enough to hold the permanent denture.

“I knew this process was going to take time,” Frank discloses. “A lot of healing goes on after the teeth are removed and the implants are placed. My bone has to heal around the implants to anchor them.

“Still, I thought this was a better way to go than having a standard denture, which I’d have to hold in place using Fixodent® or another adhesive. My permanent denture will click onto the implants. It’ll snap in and out, making cleaning very easy. I’m pretty happy with my treatment so far, but I’m looking forward to getting my final upper denture.”

Frank is quite happy with the provider he discovered in Florida Health Care News.

“Dr. Gaukhman is great. Very knowledgeable,” Frank raves. “He fully explained everything about the denture process before we started. His staff is very courteous and focused, and the hygienists who clean my teeth are very thorough. The care I get from Dr. Gaukhman and his staff is great. I highly recommend them.”

© FHCN article by Patti DiPanfilo. Frank’s photo by Jordan Pysz.mkb
*Patient’s name changed at her request.

Skip Hip Replacement With Stem Cell Therapy

Facing surgery for arthritic joints? Learn about the option of regenerative medicine.

With zero pain in her left hip, Karen is back to golfing at a tournament level.

In the early 1990s, Karen Chapdelaine applied for employment at Polk Community College (now Polk State College) in Winter Haven. She was hired as a temp to assist in updating some of the school’s outdated computer software. From there, one thing led to another.

“Once I was on board at the college, I quickly advanced into supervisory positions in admissions and records,” recounts Karen, 68. “Then, in 2001, I transferred to Indian River State College and went on to serve as registrar for 15 years.

“Indian River State College is an amazing school. It makes a huge impact in our community. I loved everything about my job there, including the faculty, staff and students. It was a very rewarding experience.”

Karen retired in 2016 and spends her days enjoying life with her husband on Florida’s Treasure Coast. She’s always been active; she especially likes to hike, jog, golf and garden. But last year, a chronic condition became disabling and put a halt to her favorite pastimes.

“I retired at 62 because my mom’s health was failing, and my sister and I took turns taking care of her,” Karen recounts. “During that time, I went from being very active to being very sedentary, and arthritis set in, specifically in my left hip.

“Over time, the arthritis became crippling. It became so debilitating that when I walked across a room I had to stop, hold on to something and catch myself. It totally limited me getting around the house.

“At different times the pain was sharp, aching and stabbing. It was an eight or nine on a scale of one to 10. I was in continual pain, and my mobility was rapidly declining. I couldn’t do any of the activities I wanted to do. My hip finally got so bad that I started seeking treatment options.”

Karen tried chiropractic care, which provided short-lived relief. She also visited an orthopedic specialist, who immediately told her she needed a hip replacement.

“I began the process and went through the surgical prescreening because I thought surgery was my only option,” Karen remembers. “Then, in the span of three weeks, my chiropractor, eye doctor and neighbor all said, You might want to try stem cell therapy. I thought, This is a signal that I should try it. I wasn’t looking forward to getting a new hip anyway.”

After doing research, Karen discovered that Regenerative Biologics Institute (RBI) in Vero Beach offers stem cell injections for arthritis. She made an appointment and met with Jason Griffeth, MS, a regenerative medicine scientist at RBI.

“Ms. Chapdelaine rated her hip pain as severe to extreme,” Jason reports. “She could barely walk across a room without intense discomfort and was told she needed a hip replacement, but she didn’t want surgery. She was seeking an alternative, which we provide.”

Proprietary Therapies

RBI is one of the few clinics in the country with stem cell scientists and physicians working together to provide the best possible stem cell-based regenerative therapies for arthritic or injured joints.

“We offer these regenerative therapies as an alternative to surgery,” Jason states. “For patients with severe arthritis facing joint replacement, we recommend TruGenta® Injection Therapy. Ms. Chapdelaine fell into that category, so we recommended this therapy for her.”

Patients with severe arthritis have little cartilage remaining in their joints. Typically, the cartilage has degenerated over time due to wear and tear. Jason says TruGenta Injection Therapy contains millions of regenerative cells, growth factors and healing properties that have the potential to form new tissue, including cartilage.

“I got the stem cells in April and was playing golf at a tournament in October.” – Karen

“TruGenta therapy uses mesenchymal stem cells retrieved from the patient,” he explains. “For this therapy, we combine those stem cells with platelet rich plasma (PRP), which is taken from the patient’s blood, and inject the resulting mixture into the damaged joint using ultrasound guidance.

“To understand how it works, think of growing grass on dirt. You plant the grass seeds and then add fertilizer. That’s what we’re doing biologically. The stem cells are the seeds, which we fertilize with platelets and growth factors from the PRP. Once injected into the joint, the stem cells multiply. As the joint space gets crowded, those cells begin to fuse and can form new tissue.”

The stem cells used in TruGenta Injection Therapy also release therapeutic proteins that help reduce pain and inflammation in the damaged joint. This creates an optimal environment for the therapy’s long-lasting regenerative effects.

“Traditional orthopedic treatments such as cortisone and gel injections only mask the symptoms and can even harm the joint,” Jason contends. “TruGenta therapy and our other regenerative therapies treat the underlying cause of pain, which results in lasting relief.”

In addition to TruGenta, RBI offers other regenerative therapies for various stages of arthritis.

“For early stages of arthritis, we recommend PlateletPro PRP Therapy,” Jason relates. “This therapy uses PRP that we’ve optimized for healing. We’ve improved the process of extracting the healing properties from blood and then minimizing factors that have no impact on healing, such as white and red blood cells.

“PlateletPro PRP has been shown in studies to delay the need for joint replacement.”

For moderate arthritis, RBI offers GFX Injection Therapy. This is a variation of PRP that combines PRP with amniotic fluid-derived growth factors.

“These growth factors help stimulate healing and repair in the joints,” Jason describes. “They also recruit other stem cells from around the body to the area that is injected.

“All of RBI’s regenerative therapies renew the health of arthritic joints, restore function and allow patients such as Karen to avoid or delay major surgery, including joint replacement.”

“It’s Miraculous”

After visiting the staff at RBI, Karen canceled her hip replacement and scheduled TruGenta therapy. She received an initial injection of stem cells and PRP, and has since received two PRP booster injections, roughly six months apart. She’s extremely happy with the results.

“Stem cells take time to regenerate and grow new tissue, so I took it easy for the first month or so,” Karen reports. “Within two months, though, I felt definite pain relief. Within three months, I was starting to move around normally again. Within six months, about the time I was ready for my first booster, I was already feeling 80 to 90 percent better.

“At that point, I was doing really well and was back to doing what I wanted to do. I got the stem cells in April and was playing golf at a tournament in October.

“Today, I have zero pain in my hip. I feel really good and have no limitations. I can hike, golf, mow the lawn and more. It’s miraculous because I had become totally disabled. I couldn’t function without intense pain.”

Karen is thrilled with her outcome. She’s also impressed with Jason’s expertise and empathetic manner.

“Jason was very thorough. And he was very conscientious about making sure I had exhausted my options and really wanted to pursue stem cell therapy,” Karen raves. “I really appreciate his honesty, professionalism and sincerity. He’s absolutely devoted to this process and really knows his stuff.

“I’ve recommended RBI and its stem cell injections to many of my friends in pain.”

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

DTM Spinal Stimulator Gives Superior Relief

New approach proves to be a profound responder for back pain.

In the early 1980s, when Peggy Alesso was deciding on a career path, nursing and teaching were among the most common professions for women. Peggy opted for nursing, which she practiced for nearly 30 years before retiring in 2012.

“Most of the time, I was a pediatric nurse,” Peggy elaborates. “I worked in a hospital, a doctor’s office and a school in Point Pleasant, New Jersey, where I’m from. The best part of my job was caring for the kids.”

For the past 25 years, Peggy and her husband have been snowbirds, traveling to Florida during the winter. During their stay in Florida in 2021, Peggy suffered an intense flare-up of pain from a chronic back condition.

“I’ve had lower back pain for years,” she shares. “I was diagnosed with spinal stenosis, and I have scoliosis as well. I basically ignored the pain until last year, when it became so bad it hampered my lifestyle. Standing and walking were next to impossible, and I couldn’t do the things I love to do, including golfing, fishing and riding my bike.”

Spinal stenosis is a narrowing of the spaces within the spine that creates pressure on the spinal cord and nerve roots, causing pain.

Scoliosis is a sideways curvature of the spine. It can sometimes put pressure on the spinal nerves that leads to pain, numbness and a tingling sensation from the back, down the legs to the feet.

“My pain was extreme,” Peggy continues. “When asked, I always said it was an eight on a scale of one to 10 because I’m not sure what a 10 could possibly feel like. Eight was enough. The pain was a very bad aching, and it was constant.”

Peggy’s pain was exacerbated by rheumatoid arthritis, a condition that causes the immune system to attack its own tissue, including that of the spinal joints. Pain medication eased her pain somewhat, but all other attempts to alleviate it failed.

“I received three injections into my spine that were supposed to help, but they didn’t do anything,” Peggy laments. “I tried physical therapy as well, but that didn’t do much either.”

Peggy was facing surgery when she saw an article in Florida Health Care News about Harold J. Cordner, MD. A board-certified pain management specialist at Florida Pain Management Associates, Dr. Cordner has an arsenal of noninterventional and interventional services for managing pain. One is spinal cord stimulation.

Multiple Targets

Conventional spinal cord stimulation, which has been around for more than 30 years, uses electrical waves to block pain signals in nerves. After examining Peggy, Dr. Cordner asked if she would consider participating in a study his practice was conducting to determine the effectiveness of a new form of stimulation programming called differential target multiplex (DTM) stimulation.

“Only 10 percent of the spinal cord is made up of nerve cells, or neurons. About 90 percent of the cells are glial cells. Historically, we have only targeted the neurons with spinal cord stimulation, so we were only addressing 10 percent of the spinal cord,” Dr. Cordner details. “Research has found that glial cells are responsible for creating and modulating chronic, severe pain.

“We can alter the activity of glial cells with certain medications and gene therapy. The goal of the study was to determine if we could normalize their activity from a chronic pain state to a non-pain state by stimulating them with different waveforms or pulse widths of electricity.

“Over 10 years, we did research to determine the exact combinations of electrical parameters to reverse chronic pain. We then performed a study on patients to compare conventional stimulation to the new DTM therapy.”

During the one-year study, half of the patients enrolled received DTM stimulation and half received conventional stimulation. The average patient in the study had experienced chronic back pain for more than 12 years and tried multiple treatments. The results of the study revealed the DTM patients received superior relief.

“About 51 percent of patients with conventional stimulation received 50 percent or greater pain relief,” Dr. Cordner reveals. “About 84 percent of patients in the DTM group achieved the same pain relief.

“When we consider profound responders, those that achieved 80 to 100 percent pain relief, 35 percent of patients in the conventional stimulation group reached this goal. In comparison, 69 percent of the DTM patients achieved 80 to 100 percent pain relief. These results are remarkable. They have never been seen before in any spinal cord stimulation study.”

Conventional spinal cord stimulation uses either one waveform or one frequency of electricity at a time. No other device can apply different parameters to different cells concurrently, Dr. Cordner explains.

“DTM stimulation is unique because it is designed to deliver different electrical parameters at the same time,” the doctor maintains. “DTM stimulation targets both the neurons and glial cells — multiple targets — at once for enhanced back and leg pain relief.

“This newer type of stimulation offers hope to those patients who did not respond to conventional spinal cord stimulation in the past or are not getting the pain relief they once did with conventional spinal cord stimulation.”

“We are conducting another study using DTM for patients with diabetic neuropathy, so if patients are interested in participating, they can call our office at (772) 388-9998 for a consultation.”

“Functional Again”

Before implanting a permanent stimulator, Dr. Cordner performs a weeklong trial in which a lead that conducts the electrical waves is introduced into the epidural space through a retractable needle. Peggy, who was in the DTM group in the study, underwent the trial.

“The trial run gave me pain relief, so we went ahead and implanted the permanent stimulator,” Peggy enthuses. “That was done in early spring, and it’s made a big difference in my life because I don’t have the pain I used to have.

“My pain level is usually about two out of 10 now, but it’s nothing like the eight that I was dealing with before, and that has allowed me to be functional again.

“I’m walking and riding a bike again, and I hope to start playing golf again soon, so I’m very satisfied with my treatment. While my back is not 100 percent, it’s much, much better. I’m very happy with it.”

Peggy is also happy with the pain management specialist who helped ease her chronic back pain.

“Dr. Cordner is knowledgeable and good at what he does,” she raves. “He’s very caring and specific about details. He explains things very well. What he tells you is clear and concise. I highly recommend him and Florida Pain Management Associates.”

© FHCN article by Patti DiPanfilo.mkb

Rehab Team Treats Cancer Patient With COVID

Comprehensive oncology program at Encompass Health equipped with advanced technologies .

Since her diagnosis in 1999, Evelyn* has battled chronic lymphocytic leukemia, or CLL. It is a cancer that starts in special white blood cells called lymphocytes, which are produced in the marrow, the spongy tissue inside bones.

In 2021, the 81-year-old was forced to take on a second enemy: COVID-19.

“My CLL was being treated with powerful chemotherapy, which left me susceptible to any germs that were floating around, including the coronavirus,” Evelyn shares. “Sure enough, last September, I developed a terrible infection that turned out to be COVID-19.

“The infection took over my entire body and mind. All of my senses were affected, and I couldn’t breathe. I lost my appetite, I couldn’t think straight, I couldn’t walk, either. One day, I fell and smashed my head on the glass doors to my patio and started bleeding profusely.”

The fall prompted an emergency visit to a hospital that lasted two weeks. During that time, her chemo treatments were suspended as doctors tried to prevent the coronavirus from taking her life.

“I was in bad shape,” Evelyn reveals. “I lost a lot of weight and was on my deathbed. The doctors and nurses at the hospital told me I was very close to dying.”

Evelyn was in such bad shape that she was not allowed to go home following her discharge from the hospital. She first needed to recover the strength and function she lost to the cancer and coronavirus.

She did that at Encompass Health Rehabilitation Hospital of Treasure Coast, an acute rehabilitation hospital that is well-equipped to treat patients with cancer and infectious diseases, including COVID-19.

“Encompass Health has comprehensive rehabilitation programs as well as designated teams to care for COVID patients,” observes Dawn Bucaj, RN, BSN, the business development director at Encompass Health.

“Evelyn was able to take advantage of those programs during her stay here. Based on her specific needs, our multidisciplinary team put together the course of treatment that would benefit her the most.”

Dedicated Team

Cancer can affect a patient’s physical, mental and functional abilities, Dawn asserts. To better care for patients experiencing a range of cancer-related conditions, Encompass Health can provide rehab to patients who have an oncology diagnosis. It provides advanced technologies and treatments targeting all affected areas for an improved
quality of life.

“Our team of experts gets to know each patient’s prognosis and future treatment plans. They discuss expectations and short- and long-term goals with patients,” Dawn details. “The team then creates a personalized plan of care, addressing specific needs for a comprehensive approach to rehabilitative care.

“Once admitted into our hospital, patients are evaluated in several areas, including their diagnoses, complications of immobility and inactivity, and issues resulting from medical treatment such as chemotherapy, which could result in chemo-induced myopathy. We care for many patients who experience muscle weakness, which can translate into falls, due to the treatment they’re receiving.”

Sometimes, patients go to Encompass Health to get stronger before undergoing cancer surgery or chemotherapy. Other times, they choose Encompass Health after a hospital admission, cancer treatment, surgery or when dealing with a debilitating disease such as COVID-19.

“COVID patients admitted to our hospital are isolated,” Dawn notes. “They are cared for by a designated team that includes nurses and other clinical personnel, all the way down to the housekeeping staff. We have dedicated teams just caring for these patients to make sure there’s no cross-infection.

“As long as Evelyn was on isolation precautions, she received therapy in her room. Once she was no longer contagious and was capable of taking on more physical and occupational therapy, she was able to take advantage of our vast gyms and equipment. Our therapy programs are tailored to the individual patient.”

The team at Encompass Health works with oncologists in the area as well as the Scully-Welsh Cancer Center at Cleveland Clinic Indian River Hospital. Patients can also be admitted directly from home.

“Patients don’t need to be in the hospital and don’t need a referral,” Dawn emphasizes. “They can admit to Encompass Health to get stronger as a means of fighting their cancer and the side effects of its treatments, or to battle the debilitating effects of an infectious disease such as COVID.”

The public can tour Encompass Health any day of the week without an appointment or take a virtual tour on its website.

“The website is informative and enables one to connect with a staff member who can help determine the appropriate level of care for you or your loved one,” Dawn states. “Remember to always ask for Encompass Health by name.”

“I’m Doing Great”

Evelyn is extremely pleased with her stay at Encompass Health as well as the staff at the rehab hospital.

“It’s been a few months since I was discharged, and I’m doing great because Encompass Health took good care of me and really nurtured me,” she raves. “The nurses and therapists were beautiful people, very caring.

“They taught me exercises and took me to a big room where I received different types of therapy. When I left, they sent people to my home to continue the therapy to help me walk again. I’m back to almost normal. I can walk, drive, eat and sleep, and my breathing is normal.

“The staff at Encompass Health did a super job. They were wonderful and very professional. At Encompass Health, I had the best of the best — the best hospital and the best therapists and nurses supporting me.”

After Evelyn recovered from COVID-19, her oncologist resumed her chemo. But this time around, he started her on an experimental drug that put Evelyn’s cancer into remission.

“That amazing new chemotherapy took the CLL away,” she enthuses. “It’s no longer affecting my bone marrow. But I have to give glory to God; He healed me. So many people were praying for me. And it worked!”

© FHCN article by Patti DiPanfilo. mkb
*Patient’s names changed at her request.

Embolization Procedure Shrinks Fibroids

Minimally invasive approach relieves symptoms without hysterectomy or ablation risks.

Jody Donnelly

Jody Donnelly was in college studying to be a dental hygienist when one of Brevard County’s top-producing real estate agents approached her with a proposal.

“He said I had a good personality and was really knowledgeable about the community because I grew up here,” Jody remembers. “He suggested I give real estate a try, so I shifted gears, attended real estate school, earned my license and never looked back.

“I’ve been a full-time Realtor in Brevard for 22 years now, and I love what I do. I love guiding people through the purchasing or selling process, and I always have their best interests at heart. I work hard to get my clients the best terms and conditions — top dollar for their property if they’re selling and lowest price if they’re buying.”

Before she settled on real estate, Jody dipped her toes in other fields.

“I’ve had multiple jobs because I’ve been working since I was 14,” she reveals. “Before I became a Realtor, I was a cocktail server on a casino boat out of Cape Canaveral for four years. I loved that job. It was fun.”

Unfortunately, Jody struggled for years with a situation that was anything but fun. During her menstrual cycle, she experienced extremely heavy bleeding and severe cramping that incapacitated her for days. The problem came to a crescendo two years ago.

“The bleeding was so heavy the first two days of my period that I couldn’t even leave the house and go to work,” Jody laments. “I wore a pad and super-plus tampon, but I was changing them out every 30 minutes. The bleeding was so bad it caused me to become anemic.

Anemia is a low level of hemoglobin, a protein in red blood cells that delivers oxygen to the body’s tissues. For women, a normal hemoglobin level is between 12.3 to 15.3 grams per deciliter of blood. Symptoms of anemia include headaches, fatigue and pale skin.

“My hemoglobin level was 5,” Jody says. “I was really depleted. I was tired all the time, too. I slept constantly, and I started looking very pale.

“As time went on, my monthly cycles just got worse, and my periods got even heavier. I had really painful cramps as well. They were so severe that they left me curled up in a ball and crying for two days. So, I brought the problem to the attention of my doctor.”

Jody’s OB-GYN ordered an ultrasound and discovered she had multiple uterine fibroids, which are benign growths in the uterus. The physician recommended a procedure called ablation during which radiofrequency energy is used to burn the fibroids one by one. Jody wasn’t comfortable with that option, so she sought a second opinion.

“I went to another OB-GYN who recommended a hysterectomy (surgical removal of the uterus),” Jody reveals. “I didn’t want to undergo major surgery, either, so I did some research and found a website that described a procedure called uterine fibroid embolization. Wondering if anybody in the area offered it, I did a Google search and found Dr. Dunfee.”

Brian L. Dunfee, MD, is a board-certified vascular and interventional radiologist at Interventional & Vascular Center in Melbourne. He and his partner, board-certified vascular and interventional radiologist Robert J. Kennedy, MD, use minimally invasive, image-guided techniques to treat conditions such as uterine fibroids.

“When I consulted with Dr. Dunfee, he explained that women can bleed severely from an ablation of fibroids,” Jody relates. “It can be very dangerous. I think that’s why the second OB-GYN was pushing the hysterectomy. That’s also why I’m so grateful I found the information about uterine fibroid embolization and Dr. Dunfee.”

Blocked Blood Flow

“Ms. Donnelly came to us in July 2020,” Dr. Dunfee reports. “She had been suffering from heavy bleeding, cramping and chronic anemia for nearly 10 years. Through our examination, we determined she was an excellent candidate for uterine fibroid embolization, which she agreed to move forward with.”

Uterine fibroid embolization is a minimally invasive, same-day procedure that can be performed at Interventional & Vascular Center while the patient is under moderate, or twilight, sedation.

“During the procedure, we make a tiny incision into an artery in the groin and insert a small tube, or catheter, into the vascular system,” Dr. Dunfee describes. “Using fluoroscopy guidance, we navigate the catheter through the vascular system and into the uterine arteries, which supply the fibroids as well as the uterus.

“Once we reach the uterine arteries, we inject little gelatin-like beads called Embosphere® Microspheres. These beads settle in the arteries’ capillary beds and block blood flow to the fibroids while still allowing normal flow to the uterus. As the fibroids lose their blood supply, and the oxygen in it, they start to suffocate and shrink, which ultimately relieves symptoms.”

The procedure takes between 30 and 60 minutes to complete. Afterward, patients are taken to a recovery area for approximately two hours, after which they can go home. They leave with only a little bandage over the incision site in the groin.

“Uterine fibroid embolization is 98 to 99 percent effective at shrinking fibroids without major surgery, major scarring or any of the complications associated with hysterectomy or myomectomy, which is another treatment option for fibroids,” Dr. Dunfee notes.

“Myomectomy involves cutting out the fibroids, but they often regrow. That’s why we believe embolization is the best way to go.”

“I Got My Life Back”

Jody underwent a uterine fibroid embolization performed by Dr. Dunfee in September 2020. The procedure produced the desired result as Jody’s fibroids slowly began to shrink and her bleeding and cramping decreased substantially.

“Today, my cycles are normal … and I have no cramps. The difference is amazing.” – Jody

“Her anemia resolved as well,” Dr. Dunfee concludes. “She was very happy with the ease of the procedure and how it allowed her to avoid undergoing a hysterectomy.”

She’s even happier with the results.

“Today, my cycles are normal,” Jody enthuses. “My periods are so light that I no longer have to miss work because of them. And I have no cramps. The difference is amazing, like night and day. I got my life back. I can’t believe how much this procedure changed my life.”

Jody is equally thrilled with her doctor at Interventional & Vascular Center.

“Dr. Dunfee is the best doctor in the world,” she raves. “I feel like I hit the lotto when I found him. He’s amazing. He makes me feel like family. When my husband and I met him for the consultation, we felt so comfortable with him and confident that he knew his stuff.

“I absolutely, 100 percent recommend Dr. Dunfee to anybody looking to have this procedure because, hands down, he’s the best.”

© FHCN article by Patti DiPanfilo. Photo courtesy of Jody Donnelly. mkb


Prostate Procedure Improves BPH Symptoms

Minimally invasive treatment resolves frequent urination without complications of surgery.

Lawrence* is a man of God. He has devoted his life to serving the Lord as a preacher of the Word. Now that he’s retired, the longtime minister continues to commune with his Savior while tending to the beautiful flowers he grows in his garden.

Three years ago, however, Lawrence’s faith was tested when he began to experience distressing urinary symptoms that interfered with his sleep and eroded his quality of life. He prayed for a solution to his problem, which grew worse over time.

“It got to the point where I was getting up 10 times a night to use the bathroom,” laments Lawrence, 90. “I couldn’t sleep for more than an hour or two at a time. As a result, I was tired during the day and had no energy for gardening or other activities.”

A urologist determined that Lawrence had an enlarged prostate, a gland that is typically the size of a ping-pong ball and sits beneath the bladder in men. The condition is called benign prostatic hyperplasia, or BPH.

The urethra, the tube that carries urine from the bladder out of the body, passes directly through the prostate. When that gland is enlarged due to BPH, it crushes the urethra and affects urination.

Common symptoms of BPH include a frequent or urgent need to urinate, frequent need to urinate at night, difficulty starting a urine stream or having a weak urine stream, and an inability to completely empty the bladder.

To treat his BPH, Lawrence’s urologist recommended a transurethral resection of the prostate, or TURP. This surgery involves shaving some of the prostate tissue to create a bigger channel for the urethra to pass through so urine can drain efficiently. There are side effects associated with TURP, however, including erectile dysfunction (ED); retrograde ejaculation, where semen goes into the bladder instead of through the penis; and urinary incontinence.

“My father underwent a TURP years ago and ended up incontinent,” Lawrence shares. “I didn’t want that, so I refused to have that surgery. I was determined to not undergo a procedure that would render me unable to hold my urine.”

In time, Lawrence’s prayers were answered. A friend told him about a minimally invasive technique for eliminating BPH symptoms called prostate artery embolization. He Googled providers that offered the technique and discovered Vascular & Interventional Physicians in Viera. That’s where he met with Derek Mittleider, MD, FSIR, RPVI, the practice’s chief of vascular and interventional radiology.

Pressure Eased

“TURP continues to be the most common treatment for BPH, but it does not need to be the treatment of choice because of its potential complications,” Dr. Mittleider asserts. “It is also commonly used because most men do not know that prostate artery embolization is an effective alternative.”

Prostate artery embolization involves placing a small tube into an artery in the patient’s wrist. Using x-ray guidance, an interventional radiologist snakes the tube from the wrist down to the pelvis and into the arteries that feed the prostate.

“Once the tube is in the prostate arteries, we inject very small, round beads that get stuck in the artery walls and block circulation to the prostate,” Dr. Mittleider explains. “Because the prostate is getting less blood flow, it begins to shrink. This eases the pressure on the urethra, and the urinary symptoms resolve. Ultimately, quality of life also improves.

“The beads are made of resin, a plastic-like material that is completely inert, so there is no risk for an allergic reaction to the beads, which do not break down. They simply remain in the prostate arteries forever.”

Recovery from the minimally invasive embolization, which requires two to three hours to perform, is quick and relatively painless.

“After the procedure, we place a small bandage on the patient’s wrist to place pressure on the entrance wound,” Dr. Mittleider describes. “Patients can get out of bed immediately. They are not bound to bed for four to six hours as they are when we enter through an artery in the groin. Once that bandage comes off, generally after one to 1½ hours, the patient can go home.

“Some men complain of minor irritation when urinating after the procedure, but this is short-lived and resolves quickly. We can prescribe medication to help with the discomfort, but it is not a long-term side effect.”

“I’ve gone from getting up 10 times a night to getting up two to three times, which is doable.”- Lawrence

Dr. Mittleider notes that ED is common in men with BPH, but prostate artery embolization can often improve erectile function.

“When the prostate grows large, it takes much of the blood flow within the pelvis, and the other reproductive organs, including the penis, get an insufficient infusion of blood,” the doctor elaborates. “As a result, men can end up with ED. About a third of all men who have prostate artery embolization actually see an improvement in their ED. It is the only procedure to treat prostate issues that has this benefit.”

Dramatic Improvement

Dr. Mittleider performed Lawrence’s embolization three years ago. Since then, his symptoms have improved immensely, and he has not required any additional treatments.

“I’ve gone from getting up 10 times a night to getting up two to three times, which is doable,” Lawrence enthuses. “I’m not urinating like an 18-year-old man, but for someone who is 90, I’m very satisfied with my function. I’m able to sleep for long stretches, so I’m not tired during the day and can work in my garden. My quality of life has increased considerably.

“I’m grateful to Dr. Mittleider for his expertise and skill with this procedure. I highly recommend him and Vascular & Interventional Physicians, as well as prostate artery embolization to any man with symptoms of BPH.”

© FHCN article by Patti DiPanfilo. Graphic courtesy of Vascular & Interventional Physicians. mkb
*Patient’s name changed at his request.

Ease Discomfort Of Dry Eye, Ocular Rosacea

Nurse’s eyes are ‘happy’ after LipiFlow and Intense Pulsed Light treatments.

Sharon Taranto

A longtime cardiac intensive care nurse, Sharon Taranto saw daily how patients suffered, and she desired to help. So, she became a nurse practitioner specializing in pain management. For the past year, she’s been practicing telemedicine, conferring from home with patients via the internet.

“I interview the patients, go over their pain history and determine what we can do for them,” Sharon describes. “I’m able to prescribe some medications over the phone but not all medications due to DEA (Drug Enforcement Administration) restrictions.

“I work four 10-hour days. I sit in front of the computer, read patients’ charts and talk with them on the screen.”

When first offered the opportunity to work from home, Sharon expressed concern about the long hours staring at a monitor. Her concern stemmed from uncomfortable eye issues she feared would worsen through extensive computer use.

“My eyes had been bothering me for about five years,” Sharon explains. “They itched and burned and were pink. They were dry and hurt as well. Then my eyelashes started getting crusty.

“I was concerned about that situation getting worse because people tend to forget to blink when they’re staring at a computer because they’re so intent on reading what’s on the screen. I thought, Can I even do this job?

“To help ease the problems with my eyes, I tried warm compresses, artificial tears and ocular scrubs with baby shampoo, but my condition didn’t improve. Then I went to the best source of information on anything: the hair salon.

“While I was getting my hair cut, I described my symptoms. One of the ladies at the salon said, I bet you have what I have: dry eye. You need to visit Dr. Ramsower. I made an appointment and sure enough Dr. Ramsower diagnosed me with dry eye disease.”

Modern and Advanced

Dr. Jenifer Ramsower is the founder of Dry Eye Center of Florida, the only clinic in Central Florida dedicated to the diagnosis and treatment of dry eye disease. It is at this new and modern facility that the latest research and technology are combined to successfully relieve symptoms and achieve the best outcomes.

Dr. Ramsower, who has provided comprehensive eye care in Brevard County since 2005, has spent the past 10 years researching and studying dry eye disease and the most advanced treatments for it. She explains that an inadequate amount of oil, water or both is what causes dry eye disease.

“The tear film must contain a proper balance of water and oil,” Dr. Ramsower informs. “A thin oil layer is the result when the oil glands in the eyelids — the meibomian glands — become blocked and do not function properly. This is called meibomian gland dysfunction, or MGD.”

During her initial visit with Sharon, Dr. Ramsower conducted a thorough eye evaluation, which led to the discovery of several issues, including MGD.

“In Ms. Taranto’s case, she was producing a sufficient amount of tears, but the oil layer of her tear film was severely inadequate,” Dr. Ramsower reports.

In addition to MGD, Sharon was also experiencing a buildup of debris along her eyelashes that caused irritation and itchiness. She also had ocular rosacea, which causes inflammation at the lid margin that can plug up oil glands and cause an unstable tear film.

“Rosacea is abnormal blood vessel growth in the skin,” Dr. Ramsower details. “It is common in the nose and cheek area and can travel up toward the eyes and cause inflammation of the eyelids. Eighty percent of rosacea patients suffer from MGD and dry eye disease.”

Dr. Ramsower treated the debris along Sharon’s eyelashes. To address MGD and ocular rosacea, Dr. Ramsower used a combination of two FDA-certified advanced treatments. One is the Johnson & Johnson® LipiFlow® Thermal Pulsation System. The other is the Lumenis® Optima Intense Pulsed Light (IPL), which decreases inflammation.

“During a LipiFlow treatment, we place sterile activators inside the patient’s eyes,” Dr. Ramsower explains. “This 12-minute automated treatment in the office is computer controlled and an extremely precise way to clear meibomian gland obstruction and restore healthy gland function.

“Lumenis Optima IPL helps to seal off the abnormal blood vessels that cause inflammation in the surrounding ocular tissue. Improved meibomian gland function, greater tear stability and a reduction of dry eye symptoms have been reported following treatment.”

“It’s Heaven”

Sharon received the LipiFlow and IPL treatments from Dr. Ramsower.

“I wanted to hit my condition as hard as we could,” Sharon explains. “It’s been almost four months since my treatment, and I have none of that crustiness. My eyes are no longer pink. They aren’t dry, and they don’t burn or hurt. It’s heaven.

“Before, I was always aware of my eyes because they bothered me. Now, I just do what Dr. Ramsower recommends for a daily routine: washing with tea tree foam and using heat pads on my eyes, and I’m not aware of my eyes anymore. She also taught me to take breaks from the computer and blink regularly. Now, my eyes are happy.”

Sharon has high praise for the doctor that eased her uncomfortable eye symptoms.

“Dr. Ramsower is a wonderful lady,” Sharon raves. “She’s very compassionate and gentle. I can’t say enough about her and her staff. Dr. Ramsower is the person to go to for dry eye disease, no doubt. I absolutely recommend her and Dry Eye Center of Florida.”

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

Painless Eye Injections Halt A.M.D. Vision Loss

Learn about age-related macular degeneration and the disease’s progressive breakdown of the retina.

Injections of EYLEA into Kathryn’s left eye have her seeing well enough to paint.

Military service is a time-honored tradition in Kathryn Horn’s family. Both grandfathers, her father and two brothers were in the military. So was her father-in-law and husband, who retired from the Navy.

Kathryn never enlisted, but she served the military, nonetheless.

“I was a civilian employee with Military Recreation Services for 34 years; I was one of their cooks,” Kathryn elaborates. “We prepared food for the country clubs and other eating facilities within the military.

“After he got out of the Navy, my husband worked for Lockheed Martin, which is a government contractor, and we moved around a lot. As such, I’ve cooked in many places, from (Naval Station) Pearl Harbor to a little base in the German Alps to Washington, DC.

“I liked my job because I like to cook, and I like working with people. Besides, I grew up around military bases.”

Another, less impressive trait that runs in Kathryn’s family is macular degeneration, an eye disease that causes a progressive breakdown of the macula, the center portion of the retina, which is the light-sensitive layer of nerve tissue that lines the back of the eye.

“My father and two of his brothers had macular degeneration and went blind from it,” Kathryn shares. “My mother’s two sisters and brother had it as well, so it runs on both sides of my family.”

Kathryn’s bout with the disease began several years ago when she and her husband were living in Maryland.

“I was having a hard time seeing out of my left eye because everything was wavy and blurry,” Kathryn relates. “I went to a retina specialist who at first thought the issue was related to my diabetes. Then he said, No, It’s wet macular degeneration.

“After my husband and I retired and moved to Florida 11 years ago, I was referred to Florida Retina Institute and Dr. Barnard. The vision in my left eye was really bad by the time I saw Dr. Barnard.”

Exciting Development

Thomas A. Barnard, MD, is a board-certified, fellowship-trained retina specialist at Florida Retina Institute, which has offices in Titusville, Daytona Beach, Orange City and Lake Mary. Through evaluation and testing, Dr. Barnard confirmed the previous retina specialist’s findings.

“When we first saw Ms. Horn, she had decreased vision in her left eye due to wet macular degeneration,” Dr. Barnard recalls. “Her vision was so poor she could only count fingers with that eye.”

Like other parts of the body, the retina changes as people age. Sometimes, these changes can have negative effects on vision.

“These changes generally occur in people over the age of 40,” Dr. Barnard discloses. “That’s why the condition Ms. Horn was diagnosed with is also referred to as age-related macular degeneration, or AMD.

“Genetics account for at least half of all cases of AMD, so people with family members who have AMD are at higher risk for developing it. That said, certain lifestyle factors such as sun exposure, diet, activity level, cholesterol and blood pressure can increase risk as well.”

There are two types of AMD: dry and wet. About 85 percent of patients diagnosed with the disorder have the dry form, which occurs due to natural degenerative changes to the retina and typically causes blurry or sometimes distorted vision. It begins with the formation of small protein deposits under the retina called drusen.

There is no known cure for dry AMD, but its progression may be slowed with a special formulation of vitamins called AREDS2, which were determined by National Eye Institute researchers in a six-year clinical trial called Age-Related Eye Disease Study 2.

In rare cases, dry AMD can progress to the more-serious wet form.

“With wet AMD, the body tries to grow new blood vessels to help nourish the degenerating tissue in the back of the eye,” Dr. Barnard explains. “However, these blood vessels are abnormal and leak into the retina, destroying central vision.

“In addition to blurry or distorted vision, wet AMD can also cause dark spots to form in the field of vision. The good news is that the wet form can be treated, and further vision loss can be prevented as long as we catch it early enough.”

Treatment of wet AMD typically involves injections into the eye of medications that block vascular endothelial growth factor, or VEGF, a protein that makes the body grow blood vessels.

Anti-VEGF medications suppress the formation of blood vessels that become abnormal with wet AMD,” Dr. Barnard educates. “But these medications only stay inside the eye for a certain amount of time before the body flushes them out. As a result, anti-VEGF injections must be given continually at certain intervals. Each person is different, so the interval between injections is specific to each patient.”

“I live north of Tampa and drive all the way to Titusville on the other side of the state to see Dr. Barnard because I trust him.” – Kathryn

There are three FDA-approved anti-VEGF medications used at Florida Retina Institute: bevacizumab (brand name AVASTIN®), ranibizumab (LUCENTIS®) and aflibercept (EYLEA®).

Kathryn is receiving an injection of EYLEA into her left eye every three months.

“I don’t feel anything when I get an injection,” Kathryn reports. “They put numbing drops in my eye and then give me an injection that further numbs my eye. Then I get the medication injection.

“If anybody told me 11 years ago that I would sit in a chair and let someone give me a shot in my eyeball I would’ve told them they were crazy. But Dr. Barnard does such a wonderful job I really don’t mind it at all.”

According to Dr. Barnard, an exciting development in the treatment of AMD is on the horizon.

“Within the next few months, there will be a new treatment available for dry AMD: a medication injection that can prevent the condition from progressing,” the doctor effuses. “The drug is awaiting FDA approval.”

“A Big Improvement”

Since starting the EYLEA injections, Kathryn has noticed a dramatic change in the vision in her left eye.

“There’s been a big improvement,” she enthuses. “I can see quite well out of my left eye now. Dr. Barnard has managed to get my wet AMD under control. I still have my eyesight, and I’m doing really well. I have no pain, no blurry spots, nothing. And I don’t have to wear glasses, except to read.

“I live north of Tampa and drive all the way to Titusville on the other side of the state to see Dr. Barnard because I trust him. He’s done a fantastic job. His staff is very pleasant and welcoming. I’ve never had a bad experience at the practice. I highly recommend Dr. Barnard and Florida Retina Institute.”

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