Author Archive

Meeting the Community’s Needs

New practice location is “one-stop shop” for cancer care.

Cancer Specialists of North Florida (CSNF) has provided quality cancer care to the region’s residents for more than 30 years. Last August, in response to an identified need, the practice expanded its network of cancer centers to include a new location in Palm Coast.

Dr. Marc A. Warmuth and Dr. Sameer M. Baig standing inside office

Dr. Marc A. Warmuth and Dr. Sameer M. Baig

“We realized that Palm Coast was an underserved area from an oncology standpoint and patients were driving to our centers in St. Augustine for cancer care,” observes Marc A. Warmuth, MD, a board-certified hematologist/oncologist with CSNF. “We opened the Palm Coast center to serve these patients in their own community.”

The primary goal of Dr. Warmuth and his colleague in Palm Coast, Sameer M. Baig, MD, is to conquer cancer by delivering an integrated approach to care. CSNF Palm Coast includes a large infusion suite where chemotherapy medications, aimed at destroying cancer cells, and other complementary therapies are administered. In addition, it houses a fully equipped laboratory and full-service pharmacy.

“We provide chemotherapy for all types of cancer,” Dr. Warmuth details. “We also deliver immunotherapy, a newer type of treatment that enhances the patient’s immune system to fight cancer. Additionally, we offer supportive care treatments such as growth factors to help the patient’s blood combat infection.”

“We deliver other medications in our infusion suite as well, including the biologic medicines that we use in hematology to treat blood disorders,” Dr. Baig elaborates. “We also coadminister some of the rheumatology and neurology medications, such as the specialized drugs for multiple sclerosis that must be given under a physician’s supervision.”

CSNF Palm Coast treats many types of blood disorders including those that are non-cancerous, such as iron deficiency anemia.

“We see quite a few patients who have failed oral iron therapy for their anemia and require intravenous iron,” Dr. Baig informs. “IV iron must be delivered in a controlled setting with a physician present.

“Treatment of benign blood disorders is one of the unmet needs in our Palm Coast community that is being addressed by our practice.”

Steady Growth

Since opening in August 2020, the Palm Coast center has steadily grown. Dr. Baig and Dr. Warmuth typically examine between 60 and 100 patients per week, and those figures continue to climb. Additional patients visit the center weekly for routine lab work, nursing assessments and treatments such as chemotherapy. Most weeks, the center operates at full capacity.

“One thing our patients really like about our practice is that every time they visit, they always see the physician; they always see me,” reveals Dr. Baig. “Oftentimes, patients must see different providers, so seeing the same physician is a privilege. Our patients appreciate being able to see the physician at every office visit.”

Patients at Cancer Specialists of North Florida also appreciate that the services offered at the Palm Coast location are convenient and geared toward their needs. In addition to medical care, the practice provides personalized nutrition and counseling services (provided respectively by registered dietitians and licensed clinical social workers) and financial assistance. Patients can complete all of their lab work at the in-house laboratory and fill their regular prescriptions as well as their cancer medications at the pharmacy.

“We opened the Palm Coast center to serve these patients in their own community.” – Dr. Warmuth

“One of our goals is to make things easy for our patients,” Dr. Warmuth asserts. “At our practice, patients can come in and get all the treatment they need. They don’t have to visit 10 different doctors and go to multiple labs and pharmacies to receive their care. We incorporate everything into a sort of one-stop shop.”

Supporting CSNF Palm Coast’s convenient, personalized services is a patient-friendly and centered team. Staff members are committed to the goals of the practice and its treating oncologists.

“Our staff is fantastic,” Dr. Baig raves. “Having terrific people in place who are doing their jobs really well instills confidence in our patients. They can see that we know what we are doing and are on top of our game, and that eases their mind.”

The Chemotherapy Option

CSNF Palm Coast cares for patients with all types of cancer, but the cancers the physicians most often treat, according to Dr. Baig, are breast, colon and lung cancer. Due to the intense Florida sun, they also treat many cases of melanoma skin cancer.

“These tend to be the most common cancers, and they are also the cancers for which there are fairly good screening protocols,” Dr. Baig explains. “So, it is natural that they are the cancers that are most often detected and presented by patients for treatment.”

Surgery to remove the cancerous tumors is typically the first treatment option for breast, colon and lung cancer, but chemotherapy is also an option in some cases, especially in cases of more advanced cancer. Improved technology has helped oncologists identify which patients will benefit most from chemotherapy.

“Having terrific people in place who are doing their jobs really well instills confidence in our patients.” – Dr. Baig

“We can now perform molecular tests on cancer cells to help us target the patient’s treatment,” Dr. Warmuth describes. “These tests, which just became available in the last few years, have altered our approach to cancer treatment significantly.”

“The sophisticated technology aids in identifying those cancers that will be ‘good actors’ and those that will be ‘bad actors,’” Dr. Baig adds. “Patients with cancers that are good actors will benefit from chemotherapy.

“Sometimes, however, people don’t seek treatment until their cancer is considerably advanced and has spread to other areas of the body. In those cases, systemic chemotherapy is the only option.

“The good news is that cancers caught in their early stages are often treatable and, in some cases, curable.”

©FHCN article by Patti DiPanfilo. Photo courtesy of Cancer Specialists of North Florida. js

 

Answering the Call

Holiday emergency dispatched with Dentures in a Day.

Robert Brown talking on his cell phone

Robert is thrilled with the comfortably snug fit of his new dentures

Robert Brown had already decided on a career in law enforcement, but before he could start his first job, the US military drafted him and asked him to spend two years serving and protecting a much larger constituency.

“It just so happens that they offered a three-month drop from my enlistment if I joined the police department when I got home, which was my intent anyway,” Robert shares. “So, instead of serving 24 months, I served 21 months.”

Robert’s military service included a year in Vietnam, where he fought with the Army’s 101st Airborne Division. Afterward, Robert worked in law enforcement for 47 years, first as a patrol officer and then as a detective for the city of Baltimore and the state of Maryland.

“In Baltimore, which is where I’m from, I became a detective in narcotics and violent crimes,” Robert elaborates. “Then, I was a detective in the state capital in Annapolis, where I did criminal investigations. I chose law enforcement because I wanted to help people. That’s the reason most people go into it, to serve the public.”

Robert, 74, retired in 2017 and relocated to the Sunshine State. Shortly after relocating, he turned his attention to some dental issues that stem from his days on the police force.

“My teeth were damaged several times over the years in work-related incidents,” Robert discloses. “I was hit in the face with a wrench and kicked in the teeth on the job. My teeth were also damaged in car accidents, and I didn’t really take care of them the way I should.

“My dentist didn’t do proper dental work, and I eventually had to get a partial upper plate. But the teeth it was attached to rotted away, and I had all my upper teeth removed and got a full upper plate. My lower teeth were all capped, but my molars eroded under the caps, and I ended up with only four teeth left.”

Robert’s dental situation got worse this past Thanksgiving, when he developed a severe toothache resulting in intense pain.

“It was a piercing, throbbing pain, and nothing I did for it helped,” Robert states. “I used aspirin and Orajel, but nothing took the pain away. I started looking for dentists with after-hours appointments trying to find one who would see me on Thanksgiving night. Dr. Gaukhman was the first to answer the phone.”

Alexander Gaukhman, DMD, is a skilled general, cosmetic and emergency dentist at Venetian Dental, which has offices in Sarasota, Venice and Osprey. He immediately identified the retired detective’s problem.

implant-supported lower denture

“Robert’s teeth were badly infected and could not be salvaged,” Dr. Gaukhman recalls. “My recommendation was to extract the teeth that night and immediately place two dental implants into his lower jaw. We would then create an implant-supported lower denture to replace his lost teeth.”

Robert agreed to proceed with Dr. Gaukhman’s treatment plan.

Stabilizing Dentures

While treating Robert, Dr. Gaukhman noticed that Robert’s existing upper denture was old and deteriorating. The dentist recommended replacing the appliance, but unlike Robert’s lower denture, Dr. Gaukhman didn’t suggest implants to secure his upper denture.

“Generally, upper dentures fit securely in the mouth without dental implants because the palate creates sufficient suction to hold the appliances in place,” Dr. Gaukhman acknowledges.

Lower dentures are a different story.

“These are often difficult to stabilize because the lower jaw is not designed for dentures,” Dr. Gaukhman maintains. “There’s no palate in the lower jaw due to the location of the tongue, and because of that, less suction is produced. Consequently, lower dentures tend to slip and slide.

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

Dental implants are screw-like posts made of titanium alloy surgically placed into the jawbone. They serve as the foundation for replacement teeth, such as crowns and dentures. Dentures secured by implants don’t slip or move; they stay in place when patients speak and eat.

Robert’s situation was an emergency, which made him a perfect candidate for Dentures in a Day, Venetian Dental’s single-visit smile-restoration technique. As part of the Dentures in a Day process, Dr. Gaukhman places the implants on the same day he extracts the teeth. Typically, temporary dentures are also created that day in Venetian Dental’s on-site laboratory.

“We begin the process by taking impressions of the patient’s teeth,” Dr. Gaukhman details. “It takes a few hours for the lab to fabricate the dentures, but once they’re ready, we extract the teeth, put in the implants and place the dentures right away. This way, they act 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. At that point, the temporary denture is 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.”

“Like Natural Teeth”

By the time Robert’s treatment was completed, he received a new traditional upper denture and an implant-supported lower denture. He’s thrilled with
the outcome.

“The teeth in my dentures are fantastic,” he raves. “They look great, like natural teeth. My treatment at Venetian Dental was absolutely successful, and I’m happy with the results.

“I’ve never encountered a staff that’s as nice and as accommodating as the people at Siesta Dental.” – Robert

“I’ve now got a removable upper denture and a lower denture that snaps down over the posts and stays in place. I don’t need to use Polident® or other adhesive. I take my dentures out at night, but otherwise they fit snugly and are comfortable.”

Robert gives kudos to Dr. Gaukhman and his staff for their excellent care and kind treatment. He’s especially thankful that they took the time during a holiday to see him and rescue him from his pain and misery.

“Dr. Gaukhman is a very concerned gentleman,” Robert describes. “He’s a good, thorough dentist and treats me with care. I’ve never encountered a staff that’s as nice and as accommodating as the people at Venetian Dental.

“Anytime I call, they get me in as soon as possible. They work around my schedule and are very helpful. If I had to, I would have the same treatment done all over again by them. They’re that good.”

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

Seeing The Big Picture

Neurologist’s integrative philosophy produces best treatment plans.

Board-certified neurologist and pain management specialist Kai McGreevy, MD, founded McGreevy NeuroHealth in 2015 in an effort to deliver patients from the pain and discomfort that keeps them from fully participating in life.

Dr. Kai Mcgreevy standing next to one of his diagmostic machines.

The nervous system includes nerves that run from the brain to the feet. As a result, Dr. McGreevy addresses problems from head to toe.

With offices in St. Augustine and Palm Coast, Dr. McGreevy uses his expertise to create winning game plans that address his patients’ most pressing issues, most of which are related to neurologic conditions and pain disorders.

“Patients generally come to us for treatment of an acute injury or chronic problem,” Dr. McGreevy observes. “The treatment we deliver may be a cure, or it may be palliative to provide a better quality of life. In every case, our goal is to reduce or eliminate pain and suffering.”

McGreevy NeuroHealth stands apart from other neurology and pain management centers because it doesn’t focus solely on the patient’s presenting complaint. Instead, Dr. McGreevy assesses the patient’s entire health history. This emphasis is central to Dr. McGreevy’s neurohealth philosophy.

“Neurohealth is the viewpoint of the patient as a whole rather than a specific system or organ,” Dr. McGreevy elaborates. “In the field of medicine today, physicians often get locked into their specialties and concentrate only on their niche areas. They can sometimes lose sight of how the body’s various systems are interconnected.”

Dr. McGreevy’s neurohealth philosophy appreciates this integration. He begins with a thorough knowledge of the nervous system, then dives deeper and examines how the nervous system relates to the rest of the body. Understanding the complete picture drives Dr. McGreevy’s choice of treatment for his patients.

“The nervous system is a complex and far-reaching network of specialized cells,” Dr. McGreevy enlightens. “It includes everything associated with the brain and mental health. It also includes the spinal cord and peripheral nerves, which run all the way down to the feet.

Society for Vascular Surgery

Your vascular system is made up of vessels that carry your blood throughout your body. Arteries carry oxygen-rich blood away from your heart. Veins carry oxygen-poor blood back to your heart. Your blood leaves the left side of the heart and is pumped out to the rest of your body.

“As we learn more and better understand the nervous system, we realize that there’s significant interplay between it and other systems in the body.”

An example is the vascular system, which involves blood vessels running throughout the body. The nervous system depends on an adequate passage of blood from those vessels to thrive, the doctor points out.

“Specialists evaluating patients for neurologic diseases or pain disorders must understand the interplay of these systems to achieve the highest likelihood that their treatments will benefit the patient,” he continues.

Dr. McGreevy takes the relationship between neighboring body systems into account when evaluating patients under his neurohealth philosophy. But the neurologist wants to know even more, so he’s furthering his education to enhance his expertise.

“I’ve been building the neurohealth philosophy at McGreevy NeuroHealth for several years,” Dr. McGreevy relates. “And I’ve been extending my academics to better appreciate the interplay of systems and how it affects neurologic and pain disorders.”

To that end, Dr. McGreevy has added several subspecialty certifications to his resumé. In addition to his certification in neurology and pain management from the American Board of Psychiatry and Neurology, Dr. McGreevy has earned certification in headache medicine, brain injury medicine and neuroimaging from the United Council for Neurologic Subspecialties.

“In learning more about these subspecialties, I gained a more comprehensive understanding of how the nervous system works and how it malfunctions,” Dr. McGreevy discloses. “Now, I better comprehend the mechanisms and pathology of neurologic disorders so I can target my treatment. These certifications enhance patient care at McGreevy NeuroHealth.”

To determine what’s wrong with the nervous system, physicians often must take a closer look at it through imaging modalities such as MRI, CT, PET scans and ultrasound. This is where Dr. McGreevy’s neuroimaging certification is especially valuable. By completing the additional education, he developed expertise in interpreting images.

“The neurologist’s clinical examination identifies the specific details of the imaging study,” Dr. McGreevy asserts. “The clinician asking the questions knows exactly what to look for, so his interpretation of the images is more accurate. When sending the images out for interpretation what the neurologist is seeking can get lost in translation.

“The goal behind my earning these subspecialty certifications is to make patient care at McGreevy NeuroHealth more cohesive, to provide a continuous flow of information that ultimately benefits the patient.

“Neuroimaging is my newest certification. It is another example of how I am further developing our neurohealth philosophy. It also represents the direction McGreevy NeuroHealth is headed in the future.”

Done in Six Sections

Dr. McGreevy determines which, if any, imaging tests are necessary once he completes a review of the patient’s history and performs a complete neurologic examination.

“The questions we ask the patient prior to the neurologic examination drive the exam,” Dr. McGreevy contends. “Using the patient’s history, we try to identify a pattern to the symptoms that correlates to a specific disorder. Then, we look for more answers in the neurologic exam, which typically tells us if imaging is needed.”

The neurologic exam is an exhaustive evaluation consisting of six sections. The first is the mental status exam. During this section, Dr. McGreevy performs various bedside tests to glean information about functions such as learning and memory, attention and concentration, language, speech and executive functioning.

“After the mental status exam, we proceed to the cranial nerve exam, which is broken down into 12 parts for the 12 cranial nerves,” Dr. McGreevy informs. “The cranial nerves are responsible for multiple functions including vision and eye movement, balance and coordination, taste and smell.”

Next is the motor exam, where Dr. McGreevy tests the nerves involved with muscle movement. Weakness in a particular muscle or muscle group, a limb or one side of the body gives Dr. McGreevy a clue about the patient’s condition.

He then moves on to the sensory exam.

Thalamus (indicated with green)

“Patterns of sensory loss tell us a lot about the location of the patient’s disorder,” Dr. McGreevy educates. “For instance, if the patient experiences a pattern of sensory involvement where one side of the body feels numb, there’s likely a problem in the deeper part of the brain known as the thalamus.”

Next, Dr. McGreevy tests deep tendon reflexes. Reflexes that are absent indicate certain types of dysfunction, while hyperactive reflexes are suggestive of other disorders. This part of the exam helps the neurologist localize the patient’s issue, whether it’s related to the peripheral nerves, the spinal cord, or the brain.

“The last section of the neurologic exam evaluates coordination and gait,” Dr. McGreevy reveals. “We test coordination with exercises such as finger-to-nose and rapid alternating movements. Gait testing is an evaluation of the patient’s stride and walking. There are many clues about pathology found by examining the gait.”

Sometimes, the history and neurologic exam give the neurologist clear answers about the patient’s condition. In those instances, imaging may not be necessary to make a diagnosis.

“That’s not always the case, however,” Dr. McGreevy emphasizes. “There are times when the neurologic exam provides confusing or conflicting information that doesn’t correlate to the patient’s symptoms, or we discover something that the patient didn’t report. With this uncertainty, we rely on diagnostic testing to help us decipher what’s going on. Neuroimaging, in particular, is a big piece of that diagnostic picture.”

Planned Expansion

McGreevy NeuroHealth offers comprehensive x-ray and ultrasound testing and interpretation, and plans are underway to add a complete MRI suite.

“Our goal is to have a full neuroimaging center to support our clinical neurology center,” the neurologist elaborates. “Neuroimaging will advance our pain management goals as well. Many of the spine-related conditions we treat involve fractures, disc herniations, nerve root impingement and arthritis. These conditions can be more accurately evaluated using MRI.

“Having MRI on site will be very fruitful. Our patients will then receive a thorough neurologic history, examination and imaging in one location. That will result in an accurate answer to the patient’s problem and will drive management much faster.”

Ultrasound Opportunities

The nervous system includes nerves that run from the brain to the feet, so McGreevy NeuroHealth addresses problems from head to toe. To identify the cause of these problems and better direct treatment, Dr. McGreevy often employs targeted ultrasound.

“Often, we automatically attribute back and limb pain to the spine, but that’s not always true,” Dr. McGreevy insists. “We implement musculoskeletal ultrasound to seek out mimickers of spine and extremity pain, including injuries to joints, muscles, tendons, ligaments and peripheral nerves. Many times, pain is referred from these structures or may compound spinal pain problems.”

Musculoskeletal ultrasound also enables Dr. McGreevy to see how body parts such as joints, muscles, tendons and ligaments work in a dynamic fashion.

“Ultrasound is unique to MRI and CT for this purpose because MRI and CT are static images,” Dr. McGreevy notes. “With ultrasound, we can take high-resolution, moving images while the patient is performing a physical maneuver such as flexing the joint. This allows us to visualize mechanical problems with the joint or soft tissues.

“The beauty of musculoskeletal ultrasound is that I can actually see the potential problem in real time. The problem may be a nerve entrapment or adherence of a nerve to a specific structure, as in carpal tunnel syndrome. I can also identify a degenerated rotator cuff in the shoulder or meniscus in the knee causing chronic pain.

“The problem may be an underlying rheumatologic disorder such as rheumatoid arthritis or lupus creating joint swelling or inflammatory fluid not due to wear and tear. Having the overall neurohealth concept allows us to catch systemic conditions and sometimes leads us to the identification of downstream pain or neurologic problems.”

Problems with the vascular system can also be pinpointed using ultrasound.

“Identification of vascular diseases is critical because vascular conditions often present acutely and may lead to serious life-threatening or limb-threatening problems,” Dr. McGreevy stresses. “Pain is often the presenting symptom. Therefore, pain physicians should be equipped to identify vascular conditions early and manage them aggressively.

“We use vascular ultrasound to seek out causes for leg pain such as peripheral artery disease (PAD), blood clots or venous insufficiency that can mimic spine and nerve problems. Sometimes, we employ leading-edge laser and radiofrequency vein ablation treatments to ameliorate leg pain, discomfort, swelling, heaviness, fatigue and cramping.”

Ultrasound also allows Dr. McGreevy to investigate the carotid arteries and blood pathways leading to the brain. Sometimes, he discovers disease early to protect against stroke and conditions that develop later in life such as vascular dementia.

When vascular disease in the head is diagnosed early, preventive measures can be instituted that help maintain brain health and even prolong life. These measures may include lifestyle changes, medications or surgery.

Complementary Testing

McGreevy NeuroHealth may use complementary tests to assist in making a diagnosis. These include electromyography, or EMG, and nerve conduction studies to evaluate large fiber nerve problems and spinal nerve root issues. They also help localize sources of pain, numbness, tingling and weakness.

“We also use autonomic nervous system testing for detecting disease involving small nerve fibers and vessels,” Dr. McGreevy reports. “These problems can be seen with autonomic disorders not readily assessed by EMG or ultrasound, warranting specific treatment.”

Electroencephalography, or EEG, allows Dr. McGreevy to evaluate brain function to understand the brain’s susceptibility to epilepsy and other seizure disorders presenting as spells involving memory lapses, blank staring, speech arrest, vertigo and confusional states. Sometimes these symptoms are subtle, and an interruption of signals is the underlying cause.

“We follow a big-picture approach, which allows for targeted, effective treatments that are efficient and improve outcomes.” – Dr. McGreevy

“The eVox is particularly useful in patients with cognitive complaints in association with headache, traumatic brain injury (TBI), mild cognitive impairment, memory disorders, attention deficit disorder, depression, anxiety, and stress and pain conditions,” Dr. McGreevy states. “We know that cognitive problems occur in neurologic and psychiatric conditions such as stroke, multiple sclerosis, Parkinson’s disease and epilepsy.”

Easing stress and anxiety profoundly reduces the experience of pain. Addressing these components are crucial for overall management of the problem. Identification of regions of interest that are firing abnormally may be targeted for correction through a noninvasive treatment such as EEG neurofeedback, which is available at McGreevy NeuroHealth.

“With EEG neurofeedback, the patient can be taught brain-training approaches, akin to physical therapy for the brain,” Dr. McGreevy describes.

Dr. McGreevy spends a significant amount of time establishing a diagnosis to understand the patient’s pain condition and determine the most targeted treatment. The neurologist uses all treatments available within the practice of interventional pain management including fluoroscopic-guided facet blocks, epidural steroid injections, radiofrequency ablation, spinal cord stimulation and kyphoplasty.

As the field of pain management expands, Dr. McGreevy also offers advanced therapies including peripheral nerve stimulation for nerve entrapment and neuropathic pain syndromes.

Regenerative Treatments

“In addition to these interventions, we also have regenerative treatments specific to failing joints, tendons, ligaments and soft tissues,” Dr. McGreevy acknowledges. “Often, patients do not need surgery to fix shoulder, knee, foot or ankle problems, or conditions such as carpal tunnel syndrome. Sometimes, I can perform minimally invasive injection treatments under ultrasound guidance instead.

“Sometimes, the intervention uses hydrodissection to free up a nerve from entrapment by a scarred muscle or tough bands of tissue. Degenerating tendons may be treated with treatments such as tenotomy, fenestration or by other regenerative means. Here we stimulate the body’s natural immune responses to produce growth factors for repair and healing. This is helpful for syndromes such as rotator cuff problems, tennis elbow or knee meniscus symptoms.”

On rare occasions, the use of musculoskeletal ultrasound allows for identification of masses suspicious for cancer that may be causing pain, and early identification may lead to surgical correction. With ultrasound, Dr.‌McGreevy can see all the structures in the extremities, including blood vessels, nerves, muscles, tendons, ligaments and
bone surfaces.

“Using ultrasound, I can direct the needle to within a millimeter of the structure I am approaching,” Dr.‌McGreevy divulges. “That cannot be done with MRI or CT. Not only is that not feasible with those modalities, those tests are much more expensive to use.

“We follow a big-picture approach, which allows for targeted, effective treatments that are efficient and improve outcomes. And we are doing this in a manner that takes advantage of the sophisticated diagnostics available. This approach also enables us to cut down on health care costs.

“That big-picture approach is best defined by our neurohealth philosophy. Through that philosophy, we combine the benefits of neurology and pain management with musculoskeletal medicine, vascular medicine and mental health care to optimize our ability to help patients.”

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

The Scoop on Group B Strep

July 27th, 2021

Group B Streptococci, or group B strep (GBS), are bacteria that naturally live in your body’s gastrointestinal, urinary and reproductive systems. In most cases, these bacteria come and go and are harmless. They don’t cause you to feel sick or experience symptoms. But for some infants and adults with certain medical conditions, GBS can cause a serious illness called GBS disease.

GBS disease is most common in newborns who contract it from their mothers during childbirth. About 1 in 4 pregnant women carry GBS bacteria in their body. When infants get GBS disease within six hours of birth, it is called early-onset GBS disease. When they develop it days, weeks or months later, it is referred to as late-onset GBS disease.

Infants with early-onset GBS disease often display symptoms on the day of birth. Babies with GBS disease may show some of these symptoms: unstable body temperature (may be high or low), pale skin or bluish tint to the skin, difficulty breathing, difficulty feeding or refusing food, abnormal heart rate and listlessness or irritability.

Infants with GBS disease are at risk for serious complications, such as meningitis, an infection of the fluid and membranes protecting the brain and spinal cord; pneumonia, an infection of the lungs; and sepsis, an infection of the blood. Long-term complications include developmental disabilities and hearing loss. Two to three of every 50 babies, or 4 to 6 percent, who develop GBS disease will die.

The best ways to prevent GBS disease in infants are to test mothers for GBS bacteria during pregnancy and give IV antibiotics during labor to women at increased risk. The American College of Obstetricians and Gynecologists recommends testing women for GBS bacteria when they’re 36 to 37 weeks pregnant. IV antibiotics given during labor help protect babies from infection.

In adults, most cases of GBS disease occur in those who also have other medical conditions such as diabetes, heart disease, congestive heart failure, HIV, liver disease and cancer or a history of cancer. Being obese also increases your risk for developing GBS disease. In addition, adults 65 years of age and older are at increased risk compared with adults under 65.

GBS disease can cause sepsis and pneumonia in adults as well. It can also cause skin and soft tissue infections, and bone and joint infection. Rarely in adults, GBS can cause meningitis.

Symptoms of GBS disease in adults vary depending on which part of the body is affected. Symptoms of sepsis include fever, chills and low alertness. With pneumonia, you may experience fever, chills, cough, difficulty breathing and chest pain.

Skin and soft tissue infections often appear as a bump or area on the skin that may be red, swollen or painful. It may also be warm to the touch and be full of pus or other drainage. You may also have a fever with these infections. Symptoms of bone and joint infections include pain in the affected area, fever, chills, sweating and stiffness or inability to use the affected joint.

To definitively diagnose GBS disease, your doctor will take a sample of your blood or cerebrospinal fluid (CSF), the clear liquid that surrounds and protects the brain and spinal cord. To obtain a sample of CSF, your doctor will perform a lumbar puncture, or “spinal tap.” GBS disease is diagnosed if GBS bacteria grow from laboratory cultures of these body fluids.

Infections due to GBS disease are typically treated with antibiotics such as penicillin and ampicillin. Sometimes, people with soft tissue and bone infections due to GBS disease may need additional treatment, such as surgery.

In most cases, there’s no way to prevent GBS disease in adults. The GBS bacteria generally ebb and flow in your body and cause no problems. However, prevention is extremely important in cases of newborn GBS disease.

According to the US Centers for Disease Control and Prevention, a woman carrying GBS bacteria who receives antibiotics during labor has only a one in 4,000 chance of delivering a baby who develops GBS disease. Without antibiotics, the risk increases to one in 200.

Currently, there’s no vaccine for GBS disease, but researchers are working on developing one.

‘A Valuable Tool For Pain Relief’

Computer-controlled VAX-D’s vacuum effect eases pressure on spinal discs.

Betty Sickle in her kitchen cooking.

Betty can now stand long enough to cook comfortably.

When Betty Sickle married, she vowed to share in the parenting of her husband’s four sons, ages 7 to 12. But once the boys got older and the youngest joined the Navy, Betty was left with no one to care for, which left her with plenty of time on her hands.

“There wasn’t as much to do around the house anymore, so I told my husband I wanted to go to beauty school,” shares Betty, 78. “That’s something I’d wanted to do since high school, but my husband wasn’t in favor of it at first. He finally agreed once I convinced him I could make the job pay off.

“After I got my license, my husband wanted me to buy a salon, but I didn’t want to work that hard and I didn’t want to be in charge of other people. I convinced him to build a room onto our house, and we turned that into a one-person salon. I enjoyed the work a lot, so that’s what I did for 20 years.”

Betty and her husband began spending their winters in Florida after her husband retired in 1990. Betty closed the salon and retired herself in 2003, not long after her husband passed away. She relocated to the Sunshine State permanently in 2004 but not before experiencing a harrowing, life-altering event.

“In the spring of 2003, I was working in the garage and climbed up a six-foot ladder,” she recalls. “I fell from the ladder to the garage floor and injured my back. I didn’t do anything about it at the time. I was busy picking up loose ends after my husband passed and putting the house up for sale. But that’s when my back problems started. There was aching pain.”

Over time, Betty’s back pain grew steadily worse.

“I lost the ability to do anything,” she recalls. “Everything became painful for me. I couldn’t stand for more than five minutes without needing to sit down. I couldn’t do the dishes, cook or do my housework because my back would spasm and tighten up.

“Now, I sleep through the night, and when I wake up in the morning I’m pain-free.” – Betty

“On a scale of one to 10, there were days when the pain was a 10, and it wasn’t any better at night. I couldn’t sleep through the night because the pain would wake me up. There was never any relief from the pain, and I had no stamina because my back muscles had become so weak.”

Betty tried physical therapy and pain management injections, but those treatments failed to provide substantial relief. She then consulted with three surgeons, but they would not operate over concerns of blood loss and that the extensive recuperation period would be too much for Betty to handle at her age.

Exasperated, Betty was just about to abandon her search for a remedy when she learned about Craig S. Aderholdt, DC, of Back Pain Institute of West Florida and a unique spinal treatment he offers called VAX-D® therapy.

“I saw a copy of Florida Health Care News on the counter at the pharmacy, and the article headline read, Say No to Back Surgery,” Betty remembers. “I took it home and read it, then I called and made an appointment with Dr. Aderholdt.”

Innovative Technology

Dr. Aderholdt provides the most advanced treatments for patients in severe pain, including VAX-D therapy, a patented, FDA-approved medical decompression technique for alleviating pressure on the discs of the spine.

“When Betty came to our practice, she was suffering with a very painful low back condition caused by osteoarthritis,” remembers Dr. Aderholdt, one of the few doctors in the country offering VAX-D. “Based on the physical exam findings, Betty’s history of symptoms and the results of her x-ray, I recommended VAX-D therapy for her.”

Dr. Aderholdt emphasizes that VAX-D, or vertebral axial decompression, is not a traction device. It works differently than traction and achieves substantially better results.
“Chiropractic adjustments alone can relieve the pain for many patients,” Dr. Aderholdt asserts. “But for select people with conditions such as sciatica or herniated, bulging or degenerated discs, VAX-D therapy has proven extremely successful.”

VAX-D is effective at alleviating low back and neck pain, the doctor explains. It also helps with numbness, tingling and pain that radiates down the arms and legs. Betty experienced significant low back pain due to degenerated discs and was considered an excellent candidate for the therapy.

During VAX-D, the patient relaxes on a comfortable, computer-controlled table, secured by a pelvic belt or patented cervical collar, depending on the area being treated.

Carefully specified tension and pressure changes guide the use of VAX-D, allowing the therapist to focus the decompression at the exact level of dysfunction. Most sessions last about a half-hour.

The computer enables the table to make subtle but targeted movements that create a powerful vacuum within the disc space. This vacuum gently draws the disc back to its proper orientation, pulling nutrient-rich spinal fluid into the disc and stimulating repair cells that effectively mend the disc.

“No other treatment can create such a powerful vacuum,” Dr. Aderholdt contends. “There are imitators, but VAX-D’s vacuum effect is the most powerful. That is what makes VAX-D such a valuable tool for pain relief. Further, VAX-D doesn’t allow the muscles to contract the way other machines can. In fact, it is the only nonsurgical treatment that has been clinically proven to reduce disc pressure to negative levels.

“In my opinion, VAX-D is one of the most effective nonsurgical medical treatments for low back pain, neck pain and sciatica. This innovative technology is one more tool I can offer patients as we work toward relieving pain and maintaining the health of the lumbar and cervical spine.”

Studies show that VAX-D has been effective in treating more than 88 percent of patients. Many report a significant reduction in back or neck pain after only a few treatments.

Dr. Aderholdt stresses, however, that actual healing takes longer because bulging or herniated discs require a series of sessions to fully reposition.

“Some patients think they will get relief after a handful of sessions and they can just quit, but that’s not the case,” he insists. “Patients must follow through with all of the required treatments to get the full benefit.”

Headshot of Betty Sickle

Betty Sickle

“No More Back Pain”

Unlike previous treatments, VAX-D gave Betty substantial relief from her symptoms.

“I have no more back pain,” she affirms. “Now, I sleep through the night, and when I wake up in the morning I’m pain-free. I still don’t have all my stamina back because my muscles got weak over the years from not being able to do anything. But I can do anything I want now as long as I stop and rest my body when I need to. I can cook, do the dishes, do my household duties and run the vacuum cleaner.

“Dr. Aderholdt gave me a back brace to wear when I’m doing anything strenuous, and I make sure to wear that. Once I get my stamina back, I’ll be the person I want to be again.”

The person Betty wants to be again does a lot of yard work and gardening. Those are two of her greatest passions. She’s confident
Dr. Aderholdt’s VAX-D therapy will allow her to resume those activities.

“VAX-D has already done wonders for me,” Betty enthuses. “And afterward, they would put me on a hydromassage table, and that’s very relaxing. I always left those sessions feeling better than I did when I went in.

“And I really can’t say enough about Dr. Aderholdt. He’s very friendly and knowledgeable. And he is truly concerned about helping me. He listens to me and he’s honest. I have confidence in him.”

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

Simply Sarcoma

July 20th, 2021

Sarcoma is a type of cancer that develops in connective tissue, the tissue that holds the body together. Connective tissue is located everywhere in the body, so sarcoma tumors can arise anywhere. But they most often form in the bones, muscles, tendons, cartilage, nerves, fat and blood vessels of the arms, legs, chest and abdomen.

There are two main types of sarcomas: soft tissue sarcomas and bone sarcomas, also called osteosarcomas. There are many different subtypes of soft tissue sarcomas based on the tissues in which they originate, but these cancers share certain microscopic characteristics, produce similar symptoms and are typically treated in the same ways.

Osteosarcoma is a primary bone cancer; it develops in new tissue in growing bone. Many other cancers found in the bones are cancers that have spread, or metastasized, from other cancerous organs, such as the breast, kidney, lung, prostate and thyroid. Osteosarcoma often affects the long bones of the arm or leg, or the bones of the pelvis. Osteosarcomas are most commonly diagnosed in children.

Sarcoma is rare in adults, accounting for about 1 percent of all adult cancers, but rather common in children, making up about 20 percent of childhood cancers.

The American Cancer Society estimates about 13,460 new soft tissue sarcomas will be diagnosed in the US in 2021 and about 5,350 Americans will die from the cancer. According to the National Cancer Institute, an estimated 3,610 people of all ages in the US will be diagnosed with primary bone sarcoma this year, with an estimated 2,060 deaths.

The cause of most sarcomas is unknown, but several factors have been identified that put you at a higher risk for developing a sarcoma. These include a history of radiation therapy; history of genetic disorders such as neurofibromatosis, tuberous sclerosis, Li-Fraumeni syndrome or retinoblastoma; exposure to chemicals such as phenoxyacetic acid in herbicides and chlorophenols in wood preservatives; and history of lymphedema (swelling) in your arms or legs.

Sarcoma symptoms vary depending on the type of sarcoma and where in the body it develops. Often, it causes no noticeable symptoms in its early stages. The first sign may be a painless lump under the skin, but as the lump grows, it may press against nerves or muscles and cause pain. You may experience trouble breathing if the tumor is located in your chest or abdomen.

Symptoms of osteosarcoma include intermittent pain in the affected bone, which may be more intense at night; swelling; fever; a fracture for no apparent reason; and a limp if the tumor is located in your leg. If your child experiences bone pain that doesn’t get better, gets worse at night, or is in one arm or leg rather than both, see a doctor for an evaluation.

Adults who experience this type of pain should visit a doctor eight away.

To diagnose sarcoma, your doctor will first perform a thorough medical history and physical examination. Your doctor may also order certain tests to help in making a diagnosis. These tests may include x-rays, CT or MRI scans, bone scans, PET scans and/or biopsies.

The most common forms of treatment for sarcomas are surgery, radiation therapy and chemotherapy. Most sarcoma tumors are removed with surgery. The goal is to remove the tumor and a safe margin of healthy tissue surrounding it so that no obvious or microscopic cancer cells remain.

Radiation therapy uses high-energy x-rays to kill cancer cells while minimizing damage to healthy cells. It may be used before surgery to shrink tumors or after surgery to kill any cancer cells that may have been left behind. Radiation therapy can be internal (placed inside the body) or external (delivered by a machine outside the body).

Chemotherapy is a systemic treatment that uses anti-cancer drugs to kill or slow down the growth of rapidly multiplying cancer cells. It may be used with radiation therapy before surgery to shrink tumors or after surgery to kill remaining cancer cells. Chemotherapy is also used when the cancer has metastasized to other areas of the body to reduce pain and discomfort.

The outlook for people with sarcomas depends on several factors including the type, extent and location of the cancer. Many people live for longer than five years after diagnosis and thanks to new medical discoveries, the survival rate continues to improve. As with other cancers, your outlook is better if the sarcoma is diagnosed and treatment is started when the cancer is in its early stages.

Unlike other types of cancer, lifestyle factors such as exercise and diet don’t appear to play a significant role in the development or prevention of sarcoma. But adopting healthy lifestyle habits is still a good idea for maintaining your overall health, so do it anyway!

Rediscover Your Eyesight

Replacement lenses after cataract surgery bring dramatic vision improvement.

David Hatala is 70 years old and still working full time. A “big data architect” for a national furniture chain, he remains on the job because he loves his work and finds it riveting.

Headshot of David Hatala

David Hatala

“I retired for a couple of years but got bored out of my mind,” David recounts. “My wife said, You need to get back into it because if you retire, you’ll die. If you keep working, you’ll live longer. So, I took her advice and went back to work. I’ve always found what I do to be fascinating and have always loved it. I enjoy it so much that I wish I was 30 or 40 years younger.”

When he was younger, David learned that he is nearsighted in one eye, farsighted in the other and has astigmatism in both. Astigmatism is an imperfection in the curvature of the cornea that affects how light reflects onto the retina and forms images.

Because of his uneven vision, David has worn glasses since he was a teenager. Several years ago, he began wearing progressive lenses that allow the wearer to adjust for close-up work, middle-distance work and distance vision.

Recently, David noticed subtle changes in his vision that were due to another problem.

“I developed cataracts,” he shares. “I started experiencing issues seeing road signs in the distance. My nighttime vision was also affected. The bright lights of oncoming cars had streaks. There were horrible star patterns and glare.”

David kept his glasses prescription current, and that solved the problem for a while. Gradually, however, he lost the ability to focus – to the point that even corrective lenses couldn’t help his eyesight.

“I enjoy working on cars, and for about 10 years I couldn’t focus under the cars even with my glasses,” David bemoans. “I couldn’t see the detail of the nuts and bolts and how they fit together. And in my job, I do a lot of close-up work on computer monitors, which is very demanding on my eyes. I finally
got computer glasses, which I didn’t like. When I had them on and looked up from the screen, everything was blurry, and that made me nauseated.

“Colors blurred and lost their intensity. White looked amber, like an old photo or a photo taken with a sepia-colored filter to make it look old. My vision kept getting worse.

It went from 20/20 to 20/30 to 20/40. When I finally hit my threshold, I asked my eye doctor if he could fix my vision. He said, Yes, and I said, I’m ready.

David’s eye doctor is Craig E. Berger, MD, a board-certified, fellowship-trained ophthalmic surgeon at Bay Area Eye Institute in Tampa. Outside of his practice, Dr. Berger spent 15 years working as an adjunct assistant professor of ophthalmology at the University of South Florida Eye Institute. Through his work in those positions, he developed extensive expertise in cataracts and cataract surgery.

Three In One

“Cataracts are the result of protein buildup in the natural lens of the eye,” Dr. Berger describes. “This buildup prevents light from passing through the lens and makes the vision look cloudy. Symptoms include cloudy or foggy vision, glare, difficulty seeing at night, loss of color intensity and double vision.”

Cataracts are a common problem typically related to aging. More than half of all Americans will have cataracts by age 80. But other factors, such as diabetes, sun exposure, smoking and family history, can cause the condition to develop at a younger age.

“Generally, cataracts become a problem later in life, but they actually start around the age of 40 and progress at different rates in different people,” Dr. Berger expounds. “For this reason, they can occur in younger people as well.”

Treatment for cataracts involves the surgical removal of the affected natural lens and its replacement with a clear, synthetic intraocular lens, or IOL. Cataract surgery is generally performed on an outpatient basis on one eye at a time, typically a few weeks apart.

“I can’t believe how vivid colors are now and how brilliant the contrast is.” – David

Before recommending a replacement IOL for David, Dr. Berger met with him and described the advantages and disadvantages of various lens options. The doctor also reviewed David’s lifestyle and activities to find the best lens match for him.

“I always consider the patient’s activities, hobbies, the type of work they do and their visual requirements before I recommend a specific lens,” Dr. Berger elaborates. “Then I do a complete eye exam. I look at the patient’s tear film, the retina, the cornea and the optic nerve. I also look for astigmatism.

“I recommend implants based on all of that information, and I encourage patients to take the time to gain a clear understanding of the benefits of each of the intraocular lenses before making a choice. It is important to note that no one lens is ideal for everyone. Lenses come in many sizes, with a variety of features and benefits.”

For David, Dr. Berger recommended a new trifocal IOL called the PanOptix®, which provides clear vision at all three focal points. It virtually eliminates the need for glasses following cataract surgery.

“David also had astigmatism in both eyes, so we chose the toric version of the PanOptix lens because toric IOLs correct astigmatism,” Dr. Berger details. “This lens choice provided David’s best chance to become glasses-free following his surgery.”

Fabulous Finish

Dr. Berger performed cataract surgery on David’s left eye on June 15, 2020, and his right eye seven days later. Not long after the procedures, David realized a dramatic change in his vision.

David Hatala standing by his car and holding his dog.

The PanOptix trifocal lens enables David to focus on every nut and bolt in the cars he’s working on.

“It’s been just incredible, like rediscovering eyesight and colors,” David raves. “The color fading is gone. White is white; it’s no longer amber. I can’t believe how vivid colors are now and how brilliant the contrast is. For me, that was a big improvement.

“Since the surgery, I haven’t used the computer glasses one time. I look at five or six feet of computer monitors in one workstation, and I can see them all. I love it!
“My vision is excellent now. Just this past weekend, I was working on one of my cars and I could focus on everything.

It was fabulous, like I was 35 again. Because these PanOptix lenses are trifocal, I can see whether something is two inches, three feet or 30 yards away – without glasses.

“I’m an engineer by trade. Dr. Berger is an engineer as a medical professional, and I appreciate that. He’s very exact and detailed. He understands how things work and he explains it to me when I ask. I’ve got immense respect for Dr. Berger and his talent as a surgeon and ophthalmologist. I absolutely recommend him.”

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

Leg Pain? It Could Be Your Veins

Address venous insufficiency through minimally invasive treatments.

Molly* dreamed of becoming a legal secretary. She prepared for her career by taking all the business law classes and general business courses offered by her high school. The preparation paid off. She got a job as a legal secretary right out of school.

“I went to work for the FBI,” recounts Molly, 70. “But to get promotions within the government, you have to move around. I stayed with the FBI for two years and then worked in the General Accounting Office.”

While Molly was technically a legal secretary, her job with the GAO involved statistics, which she didn’t particularly enjoy. She stuck it out in the GAO for 3½ years and then accepted a position in one of then-President Jimmy Carter’s programs. When Carter left office in 1981, Molly moved on to the Small Business Administration.

“While I was working with the government, a friend recommended me to a patent and trademark law firm in Washington, DC,” Molly relates. “As a legal secretary, I did everything to make the attorneys’ lives easier. I helped them with their calendars, scheduled their appointments and helped prepare patent applications. I loved my job.”

She didn’t love the daily commute, though. Molly lived 59 miles from her office, and over time the drives and long hours she put in each day wore her down.

“When I went in for my interview, I had to sign an agreement that I would work eight to 15 overtime hours a week,” Molly shares. “I was 36 when I started with the law firm, so it was no problem at the time. But as I got older, it became harder. By the time I was 61, I was ready to retire. That was in 2011.”

Following retirement, Molly made another dream a reality by relocating to the Sunshine State. Shortly after, however, a distressing leg issue hampered her dream life in Florida.

“My legs hurt,” Molly expounds. “I couldn’t even touch my legs because they hurt so bad. It felt like muscle pain, but it wasn’t. I was in so much pain that I wouldn’t even go shopping anymore. It wasn’t worth it. I wouldn’t go to restaurants. I couldn’t get out of the chairs because my legs hurt so bad. On a scale of one to 10, my leg pain was a 50.

“The procedure didn’t hurt at all, and I had no bruising.” – Molly

“It also felt like there was water inside my legs. My ankles and feet swelled up terribly. I was miserable all the time, and the pain kept getting worse. I used so much Aleve® that it stopped working. The pain reached a point that I was afraid I would have to start using a walker.”

For years, Molly complained to various internists about the pain and swelling in her legs, but she never received any advice that helped.

“All I ever heard was, You’ve got to lose weight,” she recalls. “So I lost weight, but that didn’t help the pain. Then, I got a new internist, and he referred me to Dr. Sharma.”
Ravi Sharma, MD, is a board-certified cardiovascular surgeon at Premier Vein Centers in Homosassa and The Villages®. Dr. Sharma has expertise in blood vessel disorders affecting the legs.

“When I called to make an appointment, Dr. Sharma answered the phone,” Molly remembers. “I told him I was in a lot of pain and was scared of doctors. He talked to me for 35 minutes. He made me feel so relaxed that by the time I went in for my appointment, I wasn’t scared anymore.”

Ultrasound Indications

Dr. Sharma began his evaluation by ordering an ultrasound of Molly’s legs. The ultrasound indicated that a number of deep leg veins were leaking and restricting blood from flowing back toward her heart, a condition called venous insufficiency.

Chronic venous insufficiency has multiple causes.

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

There are many signs and symptoms associated with venous insufficiency. Signs, which can be seen, include bulging varicose veins as well as swelling, thickening and discoloration of the skin of the ankles or legs. Symptoms, which are felt, include throbbing, aching, stinging, burning, itching, nighttime leg cramps
and restless legs.

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

Advanced Treatments

Dr. Sharma offers this advice to people seeking care for any of these signs or symptoms.

“It is crucial that people choose surgeons who specialize in venous diseases and only venous diseases,” he contends. “I recommend staying away from physicians in large practices that offer a variety of services and perform venous treatment as a side service. Vein treatment must be tailored to the individual. There is no one-size-fits-all approach.

“In addition, the physicians people choose should be experienced in the advanced procedures available to treat venous diseases. They must also express genuine concern and compassion for their patients. Physicians with these qualifications achieve the best outcomes.”

A range of advanced, minimally invasive treatments are available at Premier Vein Centers. These options include microphlebectomy, endovenous laser ablation (EVLA), sclerosing injections and VenaSeal™.

Microphlebectomy has replaced vein stripping, an outdated, more invasive procedure during which doctors removed the large veins by making big gashes across the leg, often leaving sizable scars.

“With microphlebectomy, the incision is tiny – about the size of the tip of a scalpel – and we can do much more through that small incision,” Dr. Sharma maintains. “And with this procedure, patients end up with tiny marks on the skin or no scars at all.”

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

Sclerosing injections are used to treat spider veins, which are small twisted veins that are visible through the skin.

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

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

At Premier Vein Centers, which provides a free initial consultation and accepts most insurance, including Medicare, Dr. Sharma relies on his expertise to determine which procedures will work best based on each patient’s symptoms and health status. All advanced treatments offered at Premier Vein Centers are performed in a comfortable office setting and result in little or no downtime and discomfort.

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

Return to Form

Molly was among those pleasantly surprised by the ease of the procedure. She admits that she had heard some “horror stories” about old-fashioned venous treatments but was relieved when Dr. Sharma’s methods proved to be pain-free.

“When Dr. Sharma turned off the machine and said, That’s it, I couldn’t believe it,” she enthuses. “It was so easy; the procedure didn’t hurt at all, and I had no bruising. I had the procedure one day, and the next day I was driving and meeting friends for lunch. I was so impressed.”

Dr. Sharma began Molly’s treatment in March. It didn’t take long for her to return to all of her activities without restrictions.

“I’m back to helping my friend with her cleaning business full-time. I do the vacuuming for her,” Molly reports. “I’m doing more now than I’ve done in a year, and I’m doing it without having to use any pain medicine. And I don’t have any swelling in my right foot, either.”

One of the treatments Dr. Sharma chose for Molly was microphlebectomy. Molly is delighted that there are no scars on her legs from the procedure. There are only small marks that are barely visible.

“They look like pinholes from tiny pins,” Molly describes. “My friends can’t believe it.

“I told Dr. Sharma that I’d love to visit his office and talk to new patients who are scared to undergo some of these procedures. I’d tell them, Relax. Dr. Sharma is a good doctor. He’ll make you feel comfortable. Everyone there makes you feel comfortable. The atmosphere at Premier Vein Centers doesn’t feel like a doctor’s office. The staff is fun. They joke around, and I love it!”

© FHCN article by Patti DiPanfilo. Before and after images courtesy of Aerolase. mkb
*Patient’s name changed at her request.

Arthritis: Not Just a Seniors’ Disease

July 12th, 2021

It’s probably pretty common for people to equate the term arthritis with osteoarthritis, the wear-and-tear form of arthritis that’s common in adults as we get older. But that’s just one type of arthritis. There are many more, including types that specifically affect children. In general terms, that group of disorders is referred to as childhood arthritis or juvenile arthritis.

The most common type of juvenile arthritis is juvenile idiopathic arthritis or JIA. JIA affects approximately one in 1,000 children under age 16 in the United State or about 300,000 children. JIA is an autoimmune disorder in which the body’s own immune system attacks a joint’s cells and tissues, specifically the synovium, the tissue lining the inside of the joint.

In response to the immune system attack, the synovium makes more fluid than needed inside the joint, and that excess fluid leads to swelling, pain and stiffness. This inflammation can eventually damage cartilage and bone, causing joint dysfunction. Without appropriate treatment, JIA can affect a child’s overall growth and development. JIA can also affect a child’s eyes.

There are several subtypes that fall under the JIA umbrella. They all involve chronic or long-lasting joint inflammation. To be considered chronic, the inflammation must have been affecting the joints for more than six weeks. The three main subtypes are characterized by their symptoms and number of joints involved.

Systemic JIA. This type affects about 10 to 20 percent of children with JIA. It generally begins with a high fever that can be accompanied by a rash. This type may cause inflammation of internal organs such as the heart, liver, spleen and lymph nodes as well as the joints. It affects boys and girls equally and rarely affects the eyes.

Oligoarticular JIA. This is the most common type of arthritis in kids and teens. It involves fewer than five joints in its first stages, most often the knee, ankle and wrist joints. It affects about 50 percent of children with arthritis and is more common in girls than in boys. It may spread to involve more joints and can also cause inflammation of the eyes. Many children outgrow this type by adulthood.

Polyarticular JIA. About 30 percent of children with JIA have this type. It affects five or more joints, often the same joints on both sides of the body. This type can affect the neck and jaw joints, as well as the small joints of the hands and feet. It can begin at any age and is more common in girls than in boys.

Symptoms vary depending on the type of JIA the child has, but there are some general symptoms, including:

• Joint stiffness, especially in the morning or after resting
• Pain or tenderness in the joints
• Joint swelling
• Limping
• Persistent fever
• Rash
• Fatigue or reduced activity level
• Eye redness, eye pain or blurred vision

The exact cause of JIA is unknown. Researchers believe that some children possess certain genes that make them more susceptible to developing the disease, then exposure to something in the environment, such as a virus, triggers the disease to begin. It’s not hereditary, however. It’s rare for more than one child in a family to develop JIA.

Early diagnosis and treatment are key to controlling inflammation, preventing joint damage and keeping the child as healthy and functional as possible. There is no one test for JIA. Doctors diagnose the condition using a variety of methods. They generally begin their assessments by taking a thorough medical history of the patient and performing a full physical examination.

Doctors may also order certain tests. These may include laboratory tests on blood, joint and tissue fluids to rule out other conditions as the cause of the symptoms. X-rays may be taken as well to look for any injuries or unusual development of the bones of the joints.

The goal of treatment for JIA is to reduce swelling, relieve pain, prevent damage and maintain function of the joints. There is typically a team of health care professionals involved in the child’s treatment, including physical and occupational therapists, dietitians, social workers and even school nurses working in concert with the child’s doctor.

Because JIA is an autoimmune disorder, medication is often used in its treatment. If only a few joints are involved, doctors may begin by injecting steroids directly into the affected joints to reduce inflammation and relieve pain. Another option is adding a group of medications called disease modifying drugs or DMARDS.

DMARDS may be used when many joints are involved or when the JIA doesn’t respond to the steroids. DMARDS include drugs such as methotrexate and the biologics such as Enbrel, Remicade and Humira. These medications cause side effects and children taking them must be monitored closely.

Physical and occupational therapy also play a role in the treatment of JIA. Physical therapy exercises are important because they help in recovering and preserving range of motion and function of the joints. They also maintain muscle tone, and strong muscles aid smooth joint movement. Occupational therapy teaches the child ways to perform daily activities with limited joint function.

It’s clear that arthritis is not just for seniors. Many children struggle with painful, swollen and inflamed joints as well. If you know a child struggling with arthritis, be understanding and supportive. Help them if they ask for it, but for the most part, allow them to perform activities on their own. With treatment, children with arthritis can live normal, healthy lives.

Face The Facts About Aging

Radiofrequency microneedling treatment remodels skin on deeper levels.

Cigdem Gali

Fourteen years ago, Nadine Johnson switched careers and became a stay-at-home mom to her two young sons.

“I wasn’t able to spend as much time as I wanted with them when I was working,” relates Nadine, 45. “My most important job is to take care of them and raise them correctly, so I stayed at home.”

Today, the boys are ages 15 and 14, but they still demand a great deal of Nadine’s time and attention. Recently, something else caught Nadine’s attention. She noticed changes associated with aging that left her unhappy with her appearance.

“My lower face was starting to hang a little,” Nadine describes. “There was some jowling and overall sagging, and I looked tired and drawn. I needed something to tighten my skin, just a little refresher and pick-me-up.”

Nadine wasn’t interested in surgery. She searched online for less invasive options and discovered Morpheus8, an advanced microneedling treatment. Another search revealed GaliDerm Aesthetics & Plastic Surgery in Royal Palm Beach. Nadine was impressed with the practice’s reviews and made an appointment.

At GaliDerm Aesthetics & Plastic Surgery, Nadine met with Cigdem Gali, MSPA, PA-C, a physician assistant specializing in aesthetic medicine. Cigdem agreed that Morpheus8 was an excellent option for Nadine.

“Nadine’s face was showing early signs of normal aging,” Cigdem reports. “There was some laxity in the skin of her lower face, as well as her neck. We wanted to focus our treatment on those areas.”

Advanced Technology

Morpheus8 combines advanced radio-frequency technology with microneedling to remodel the skin on its deeper levels. It revitalizes the underlying scaffolding of the skin by triggering the production of collagen, a primary building block of skin, and elastin.

By targeting the deeper layers of the skin, Morpheus8 increases the skin’s strength and elasticity. This tightens sagging skin, smooths wrinkles on the face and body, and transforms complexions to give people a more youthful appearance.

In addition to sagging facial skin, Morpheus8 can also be used to treat acne or acne scars, sun damage, enlarged pores, nasolabial folds, sagging in the neck, jowls and stretch marks. It also helps maintain or extend the results of a face-lift.

Most anyone in relatively good health is a candidate for Morpheus8, which can also be used to remove excess fat on the abdomen, arms, legs, chest and buttocks. Essentially, any area with irregularities such as stretch marks or rough texture can be treated.

The treatment is applied using a handpiece covered with a matrix of tiny microneedles. As the microneedles puncture the skin, radiofrequency energy exits the needles and travels into the deeper layers of the skin.

The Morpheus8 handpiece used at GaliDerm Aesthetics & Plastic Surgery surpasses other microneedling devices on the market in depth of penetration, reaching 9 mm with heat.

Standard microneedling reaches approximately 3 mm.

It is in those deeper layers of the skin where the radiofrequency energy produces more collagen and elastin. These building blocks increase cell turnover to heal and renew the skin.

Although it involves penetration by microneedles, Morpheus8 treatments require no anesthesia or incisions. The provider simply applies a numbing cream to the skin to ensure optimal comfort during treatment.

Morpheus8 is typically not painful, but treatment may result in patients experiencing a degree of redness on their skin that is similar to that which comes after a day at the beach.

“A Million Times Better”

Morpheus8 produces quick results after a short treatment period that requires no downtime afterward. Those results are often visible within a few days, but the most notable improvements appear after three weeks. The full benefits usually remain visible for three months, although the skin tightening can last up to two years.

“When I met with Cigdem she was so nice and so honest,” Nadine remembers “She wasn’t just trying to sell me something. She explained everything about the Morpheus8 treatment and gave me realistic expectations.”

At GaliDerm Aesthetics & Plastic Surgery, Morpheus8 is delivered anywhere on the body in three treatments given one month apart. Nadine followed that schedule and, as expected, began to notice improvement soon after the first treatment.

“Then, after each additional treatment, I looked better and better,” she reveals. “Morpheus8 really helped me look more contoured. Just as I hoped it would, Morpheus8 slimmed my lower face and helped tighten up some of my loose skin.

“Now, my face looks a million times better. I don’t have the jowling I had before, and my skin overall looks much tighter and younger.”

© FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. Before and after images courtesy of GaliDerm Aesthetics & Plastic Surgery.js
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