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FEATURED ARTICLES

Winter 2019

(see Trust Worthy, page 4)

Michael Burrock

KATRINE A. FARAG, DMDJOSEPH H. FARAG, DMD

Trust Worthy

Comprehensive, personalized care earns inherited patient’s faith

For regular business travelers and occasional vacationers alike, finding just the right hotel room for just the right price can

sometimes be a di� cult process. Michael Burrock is in the business of making that process a little easier.

Michael develops hotel reservation software programs, and over the years, the three start-up companies he’s either owned or been a partner in have been associated with some of the world’s best-known hotel chains.

“Right now, we’re working mostly with Motel 6 and Best Western®, but we’ve also worked with Sandals®, Wyndham® and Westin® hotels,” says Michael, who stands out from the majority of his fellow software developers for one very speci� c reason.

At 74, Michael is nearly 50 years older than the average software developer. He’s very active and health-conscious, and as a result, the Bokeelia resident says he neither feels like he’s 74 nor looks like he’s 74.

“I don’t mean to be boastful, but I don’t look my age,” says Michael, who willingly gives a lot of the credit for his more youthful appearance to the dentist who has spent the past couple years shap-ing his youthful-looking smile.

That dentist is Katrine A. Farag, DMD, who inherited Michael as a patient when she took over a previous practice and opened Advanced Dentistry of Fort Myers. Michael says Dr. Farag made the transition from his previous dentist a breeze.

“I have to admit, I had some concerns about having to transition to a new dentist because I was very happy with my old one,”

Michael explains. “But I was immediately comfortable with Dr. Farag. She’s very personable, knowledgeable and thorough.”

It was about that time that Michael was making a new commitment to proper oral health, so he decided once and for all to have his bottom teeth repaired. Having long since developed a great degree of trust in Dr. Farag, he turned to her to do the work.

“One of the things I really like about Dr. Farag is that before she does any work for you, she always does a great job of explaining all your options and what the pros and cons are of each choice,” Michael exudes. “She, of course, did that in this case as well.

“And what she told me was that because both of the lower front teeth were infected, it made the most sense to pull the front teeth and replace them with a bridge because the bridge would be more structurally sound and have a much better appearance.”

Con� dent that Dr. Farag’s recommen-dation would enhance both his oral health and his appearance, Michael agreed to have Dr. Farag pull his lower two front teeth and � t him for a permanently � xed bridge.

� e time required for the gums to heal after two infected teeth are pulled is about eight weeks. Michael was given a tempo-rary bridge to wear during that time and was � t for the permanent bridge in July.

“The bridge we gave him is com-pletely � xed,” Dr. Farag says. “It’s � rmly cemented and anchored to other, healthier teeth, and one of the great things about it is that it’s made of ceramic, which allows us to be in control in a way that lets us align everything perfectly.

Finishing the JobDr. Farag � rst began treating Michael in 2016, and over time, she eventually earned Michael’s trust, � rst by doing the follow-up work for a laser gum treatment that was performed by his previous dentist and then by doing some general maintenance work.

“We followed up on his gums to make sure they stay healthy so that he would not need the surgery again, and did a � lling on one tooth, a � lling on a smaller tooth and some minor things on a tooth that had cracked,” Dr. Farag recalls.

“All along, though, his lower front teeth were very misaligned and not really in great shape. It was something he had put off taking care of for a long time, even with the previous doctor, and it was a� ecting his smile.”

It wasn’t just Michael’s smile that was impacted by the problems he had with his lower front teeth. His ability to eat was eventually a� ected as well when one of those teeth became loose and the area around it very painful.

Gulf Coast AudiologyOtotoxicity

South Florida Eye ClinicEye Floater Laser

Hal L. Bozof, DPMEliminate Hammertoes

Advanced Orthopedic CenterDisc Restoration

Psychiatric Associates of Southwest Florida

Defeating Depression

Bell Tower Dental CareA Crown Jewel

Vein Specialists

6Shattered Masses

Back, Leg or Foot Pain?

In-Home Compression Pumps

Get Going with GAINSWave

2Urology Experts

9Acute

Wound Care

Gulf Coast Men’s Health

11

Comprehensive Dentistry

O n a pleasant afternoon in early November, Luz Jimenez was enjoying a fun fall adventure at

Walt Disney World®. She was hosting family members visiting from her native Colombia. Suddenly, she was hit with excruciating pain. It was so severe, it forced the 58-year-old mother of three to rush to the nearest hospital.

“I was in the park when I started to feel the pain,” Luz con� rms. “It was terri-ble. I had to leave and go to the emergency room. � e doctor there told me I had a large kidney stone. I have a long history of kidney stones, but this one was big.

“I didn’t want to stay in Orlando because my urologist, Dr. Miranda-Sousa, was in Cape Coral, where I live. The doctor gave me something for the pain, and I went home. Right away, I made an appointment to see Dr. Miranda-Sousa.”

Luz’s physician is board-certified urologist Alejandro Miranda-Sousa, MD, of Urology Experts. Because of her history of kidney stones, Luz needs to be followed carefully by a urologist. She discovered Dr. Miranda-Sousa after going online to look for urologists in the area. To her, Dr. Miranda-Sousa stood out from the crowd.

“I had a urologist in Miami, where we lived for thirty-two years,” Luz relates. “Two years ago, we moved to Cape Coral, and I started looking for a doctor here. I searched the internet, and found Dr. Miranda-Sousa. I’m so happy I did because he’s a good doctor.”

During Luz’s appointment at Urology Experts, Dr. Miranda-Sousa performed a complete evaluation of her condition. He also ordered an x-ray to con� rm the pres-ence and location of her stone.

“When Luz came to see me, she was in severe pain,” Dr. Miranda-Sousa notes. “She had a stone in her ureter that was blocking urine drainage from the kidney into the bladder. We discussed the need to break up the stone and unblock the kidney. I told her there was a nonsurgical proce-dure that does this that is safe and e� ective.

“� e procedure is a newer, nonin-vasive technique that breaks up stones very nicely and minimizes side e� ects, as well as potential injury to adjacent organs. It’s called extracorporeal shock

Urology ExpertiseAs one of the premier urology centers in Southwest Florida, Urology Experts o� ers comprehensive urologic services to get

patients back on the road to health. Dr. Alejandro Miranda-Sousa and his sta�

strive to provide patients with the best possible care and treatment. Dr. Miranda-Sousa and his sta� are driven by a passion for clinical excellence and patient service.

Fort Myers Colonial Center Dr.

Suite

Cape Coral Del Prado Blvd.

Suite

Bonita Springs Health Center Blvd.

Suite

(239) 226-2727

Alejandro Miranda-Sousa, MD, is certi� ed by the American Board of Urology. He graduated from the prestigious Universidad Peruana Cayetano Heredia School of Medicine in Lima, Peru. He also completed his residency

in urology in Lima. Dr. Miranda-Sousa completed his internship, residency and fellowship in neu-rourology and urodynamics at the University of South Florida. He is a diplomate of the American Board of Urology, with a fellowship in urody-namics and neurourology, and a member of the American Urological Association and the Florida Urological Association.

ALEJANDRO MIRANDA-SOUSA, MD

SHATTEREDKidney stones obliterated using sound wave technology

wave lithotripsy, or ESWL. � e technol-ogy has been around for years, but the method of delivering the treatment has recently been advanced.”

“In the past, Dr. Miranda-Sousa worked to resolve my kidney stone prob-lem conservatively,” Luz recounts. “Now, he was going to try the new therapy. I agreed because I was in the worst pain I’ve ever felt. My kidney had been blocked for four days, and that made me very uncomfortable.”

Rolling StonesKidney stones are very common. In the United States, stones a� ect an estimated one in every 500 people. One in eight men and one in 16 women will develop a stone at some point in their lives.

“There are many symptoms asso-ciated with stones in the urinary tract,” Dr. Miranda-Sousa alerts. “� ese include severe pain in the back and side that radi-ates into the lower abdomen, pain that comes in waves, dark or red urine, need-ing to urinate often but urinating only small amounts, bad-smelling urine, and fever and chills if there’s an infection.”

Generally, stones are discovered when patients go to the emergency room with pain that then goes away. Most patients who have one episode of pain will have another. It’s best to treat those stones before they cause an acute condition that can be trickier to treat.

“Sometimes, patients have little stones they pass,” Dr. Miranda-Sousa reports. “� ese patients need to take steps to prevent an attack of pain from hap-pening again. � ey can start by drinking more � uids to reduce their risk of getting new stones or prevent any small stones they already have from getting larger.

“Some stones cause trouble and some don’t. When they cause trouble, it’s often an acute episode that needs intervention. Treatment of stones can be invasive or noninvasive. � e choice depends on certain factors.”

To determine an appropriate approach to treatment, Dr. Miranda-Sousa evaluates the location and size of the stone, any medical issues the patient has and how acute the condition is, including whether or not there’s an infection.

day. Following the procedure, patients are asked to take it easy for twenty-four hours, but most return to work and activities the day after that.”

Kidney stones often recur, however. Fifty percent of the time, they come back within � ve years. ESWL can be performed again if stones recur.

“I understood the concept behind the procedure because I’ve had lith-otripsy before,” Luz states. “But I never had it done this new way. ESWL resolved my kidney stone problem because it broke up the big stone and moved some little ones.

“I feel so good now. ESWL is the best procedure to have. I recommend it to anyone with kidney stones.”

Luz is happy to recommend Dr. Miranda-Sousa and his staff at Urology Experts as well. Because of their expertise and quality patient care, Luz says she has an excellent experience whenever she visits the practice.

“Dr. Miranda-Sousa is the best doc-tor,” she says. “Every time I’m there, he shows real interest in me. � e sta� is so friendly and nice. I feel lucky because I found them. I’m also very grateful for them because I feel so much better now.” FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. nj

ESWL resolved Luz’s painful kidney problem without surgery.

Revolutionary ApproachWhen ESWL was � rst introduced in the early 1980s, it revolutionized the treatment of kidney stones. Using ESWL, patients who in the past required major surgery to remove their stones could be treated e� ectively with a noninvasive approach that didn’t require a single incision.

“With ESWL, we don’t have to cut into the body,” Dr. Miranda-Sousa verifies. “Instead, it uses high-energy sound waves applied from the out-side to break up stones into very small pieces that are easily passed by the patient through urination.

“� e success rate with this approach is usually very good. In about eighty-� ve to ninety percent of cases, stones break up and clear without any invasive procedures required.”

During modern ESWL, patients are put to sleep with general anesthesia or are heavily sedated, and a local anesthetic is used. Patients are taken to an operating room where they lie on a special stretcher that has the lithotripsy machine, or lithotripter, attached. The lithotripter works through an area approximately one inch in size, and it delivers its sound waves through that area.

“When we treat patients, we move the stretcher up, down, left, right, for-ward and backward,” Dr. Miranda-Sousa describes. “We move the patients so that the location of their stones aligns with the sphere through which treatment is deliv-ered. We use x-ray to constantly know the location of the stones we are treating.”

Dr. Miranda-Sousa uses a stan-dard number of shocks during an ESWL treatment. This amount has been proven to be safe and effective for patients. The procedure takes 45 minutes to an hour to perform.

“Once the patient’s stones are bro-ken up, the very small fragments pass anywhere from two days to six weeks following the procedure, depending on how many small fragments there are,” Dr. Miranda-Sousa reports. “� e more there are, the longer it takes.

“ESWL is an outpatient procedure. Patients generally go home the same

Page 2 | Florida Health Care News | Winter 2019 | Lee County Edition Urology

Visit Psychiatric Associates of Southwest Florida online at www.pasw� .com

Leading-Edge Treatments in

Caring PracticePsychiatric Associates of Southwest Florida is committed to care in a compassionate environment that respects patients’ humanity. The staff utilizes the most up-to-date science, providing hope and healing for conditions such as treatment-resistant depression and post-traumatic stress disorder. Therapies include ketamine, TMS and TBS. If you’re suff ering from depression or another disorder that is making it diffi cult to enjoy life or to function, contact the center to discuss how you may be helped. The offi ce is in Fort Myers at:

6804 Porto Fino Circle Suite 1

(239) 332-4700

PSYCHIATRIC ASSOCIATES OF SOUTHWEST FLORIDA

ROBERT POLLACK, MD

DEFEATING DEPRESSIONLeading-edge magnetic pulse therapy o� ers relief

The dawn of antidepressants began rather by accident in 1958 when a team of researchers treating patients for tuberculosis discovered their patients became almost euphoric when

given a drug called isoniazid.Since then, more than two dozen drugs have been

designed speci� cally for the treatment of major depres-sion, which now ranks as the most common mental illness throughout the world, according to the World Health Organization (WHO).

More than 350 million people su� ered some sort of depressive episode last year, according to the WHO, which notes that in the United States alone, approxi-mately 16 million people experience at least one episode of major depression each year.

� e e� ects, of course, can range from mild melancholy to debilitating, and for many of those who struggle with major depression, the standard treatments such as antide-pressant medications and talk therapy simply don’t work.

For those who have sought relief from depression but not found it through those standard practices, there is new hope, and it can be found in the o� ces of Robert Pollack, MD, at Psychiatric Associates of Southwest Florida.

Something NewAt his Fort Myers-based practice, Dr. Pollack embraces the use of many emerging therapies based on pioneering discoveries about the brain in his treatment of depres-sion, which he emphasizes is an actual illness.

“Depression is a brain disease,’’ Dr. Pollack reiterates. “It’s not an adjustment disorder. It’s not somebody who’s feeling sad. In the same way that cancer and diabetes are illnesses, depression is an illness, and it’s treatable with a multitude of therapies.”

� ose therapies include genomic testing, which can determine which antidepressant will work best for a patient, and intravenous infusions of an anesthetic agent called ketamine that can alleviate suicidal thoughts and acts more quickly than many antidepressants.

Dr. Pollack is one of an ever-growing number of mental health professionals who have begun offer-ing treatment for major depression through the use of transcranial magnetic stimulation (TMS) and theta-burst stimulation (TBS).

Discovered by a team of researchers at the Medical University of South Carolina in the 1980s, TMS uses short 10Hz magnetic pulses while TBS uses 50Hz pulses to rouse the part of the brain that is underactive in people who su� er with depression.

� ese magnetic pulses are similar to those used in MRI stimulation, and are delivered through a paddle-shaped device with a magnetic coil that is placed on the prefrontal cortex while the patient rests in a comfortable chair similar to a dentist’s chair.

Approved by the US Food and Drug Administration in 2008 for people with treatment-resistant depression and those who can’t tolerate the side e� ects of antidepressants, TMS can also be used to treat a host of issues such as chronic pain, � bromyalgia and bipolar disorder.

� e biggest di� erence between the noninvasive TMS and TBS treatments, the latter of which gained FDA approval in 2018, is the amount of time required for each treatment session and the number of sessions prescribed during a typical treatment period.

TMS treatment sessions last approximately 19 min-utes each, and a typical TMS treatment protocol calls for patients to receive a total of 36 treatments over a period of six to eight weeks.

TBS treatment sessions last only three minutes and are typically administered once a day at 120-percent of motor threshold, which is the stimulation strength at which a minimal motor response is evoked.

“Put simply, motor threshold is the amount of energy required to apply a current to the left temporal area that results in your right thumb wiggling involuntarily,” Dr. Pollack educates. “When we see that wiggle, we know we’ve hit the right spot.”

TBS treatments were originally administered twice a day for ten days at 80-percent motor threshold, but Dr. Pollack says it was recently discovered that fewer treatments at the higher threshold worked better.

“With the advent of more and more people receiving these treatments, it was determined that one hundred twenty percent of motor threshold is more e� ective, and I have found that to be accurate,” he states.

“We recently had a patient who received ten treatments at one-hundred-twenty percent of motor threshold, and his mental health score went from four-teen to six, with six meaning there is basically nothing wrong with you. It was amazing to watch.”

Safe and EasyEqually amazing is the overall e� ect of TMS and TBS treat-ments. Studies show that about 40 percent of patients receiving these treatments become completely asymptomatic, while about 60 percent feel better but are still not at a level where they consider themselves to be completely asymptomatic.

In addition to their e� ectiveness, TMS and TBS treatments are also safe and easy on the body. � e most common side e� ect is some mild to moderate scalp dis-comfort stemming from the treatment applications.

Dr. Pollack has found that the only trepidation some patients express about TMS therapy lies in their fear that it may be similar to electroconvulsive therapy, or ECT. Dr. Pollack assures the two therapies are quite di� erent.

For starters, TMS is done in the doctor’s o� ce while the patient is awake. ECT must be done in a hospital or surgery center because the patient must be anesthetized. � e biggest di� erence, however, is in what the two treatments deliver.

ECT causes the patient to go into a seizure. TMS, through its electromagnetic induction, avoids seizures and instead stim-ulates and exercises the part of the brain involved in mood regulation in a way that brings about positive changes.

“And when you’re done with a TMS or TBS treat-ment, you simply get up out of the chair, walk out of the o� ce and go home or back to work,’’ Dr. Pollack explains, “� at’s one of the beauties of it and why it, and some of these other treatments, are becoming so popular.

“You know, for years, � nding the right medication or treatment for someone su� ering from depression or anxiety or any mental health disorder was a lot like trying to trap a ball of mercury under your thumb.

“It was very di� cult, because it involved a lot of trial and error. But it’s a whole lot better now because of genomics and because of treatments such as ketamine, TMS and TBS. � ese are the tools that are allowing us to hit the nail on the head and give people the relief they need.” FHCN article by Roy Cummings. Photo from pixabay.com. nj

“Depression is a brain disease.

It’s not an adjustment disorder.

It’s not somebody who’s feeling sad.

In the same way that cancer and diabetes

are illnesses, depression is an illness,

and it’s treatable with a multitude

of therapies.”

– Dr. Pollack

Robert Pollack, MD, has practiced psy-chiatry since 1977 and is the founder and CEO of Psychiatric Associates of Southwest Florida. He earned a Bachelor’s degree in Biology at Yale University and a medi-cal degree at Downstate Medical Center College of Medicine in Brooklyn, NY. He then completed a residency in psychiatry at the University of Florida, where he served as chief resident and medical faculty member. Dr. Pollack is a Life Fellow of the American Psychiatric Association and board certi� ed in psychiatry by the American Board of Psychiatry and Neurology.

Lee County Edition | Winter 2019 | Florida Health Care News | Page 3Depression

Katrine A. Farag, DMD, earned her Doctor of Dental Medicine degree from Nova Southeastern University after completing her undergraduate studies in neuroscience at Vanderbilt University. She is a member of the Florida Academy of Cosmetic Dentistry. Dr. Farag stays up-to-date on the latest tech-nologies and is a certified Invisalign® provider. Dr. Farag has worked in public health, as well as private practice. She has provided both pediat-ric and adult dental care in southwest Florida for more than eight years.

Joseph H. Farag, DMD, earned his Doctor of Dental Medicine degree from the University of Florida College of Dentistry, Gainesville, FL after completing his undergraduate degree at Florida Atlantic University, Boca Raton,

FL. Dr. Farag served an implant residency at the Misch Institute and is trained in advanced laser dentistry. He is a member of the American Dental Association, American Association of Dental Practitioners, American Academy of Operative Dentistry, the International Association of Dental Researchers, and is a Diplomate of the International Congress of Oral Implantologists.

Find them on the web at www.advanceddentistryo� tmyers.com

Drs. Farag and Farag look forward to hearing from readers of Florida Health Care News. For more information or to schedule an appointment, call them or visit their offi ce, which is conveniently located in Fort Myers at:

16601 San Carlos Blvd.

(239) 466-3131

Welcoming New Patients

For most of the 20th century, x-ray technology had been used for medical and dental diagnostics and is still regularly used today. X-ray imaging is a photograph that can penetrate soft tissue such as skin and muscle,

but records hard, organic material such as bone, resulting in an image of the skeletal structure.

While its a� ordability, simplicity and accessibility are all advan-tages of conventional x-ray, its one major disadvantage is that its images are only two-dimensional. � ey provide clinicians with the height and width of the targeted area, but not with a depth perception.

Fortunately, that problem has recently been resolved by something called cone beam CT, or CBCT. � is technology also uses x-ray beams to penetrate soft tissue, but unlike its prede-cessor, it produces 3-D imaging, with signi� cantly less radiation and more cost e� ectiveness than a medical scan.

“� is three-dimensional technology enables us to make better diagnoses and more accurate treatment planning for everything from periodontal disease to oral pathology to dental implants,” says Dr. Joseph Farag, “and we have this cone beam technology right here in our o� ce.”

Dr. Farag explains the use of the CBCT for implants: “Once we have our patient’s CBCT scan, we use a system called SimPlant® by Materialise, which helps us determine the perfect location for every implant. � en, for more complex cases, we use a computer-generated surgical guide.

“Once we design these implant cases, we send the � le to a specialized laboratory where they fabricate the guide out of a poly-mer material. During surgery, we place the guide in the patient’s mouth, which ensures that we place the implants in the exact position we had originally planned on the computer software.

“With the guide, it takes the guesswork out of the equa-tion. � e guide � ts the patient’s teeth perfectly. It is pre-drilled and already measured to give me the exact positioning for the implants. � ere are no discrepancies.”

Cone Beam CT

“Now, he has perfectly straight lower teeth. To look at Michael, you would never know how crooked his real teeth were. What I’m happiest about, though, is that he’s happy to have that look, because I know he was unhappy with that crooked smile.”

Ecstatic might be a better way to describe how Michael feels about the new look of his lower front teeth. He says the new bridge � ts perfectly, has alleviated any eating problems he was having and has greatly enhanced his con� dence.

“Dr. Farag did an excellent job,” Michael enthuses. “� e pro-cedure wasn’t painful at all, and I’m no longer having any pain or discomfort when I’m chewing. A number of people have told me how great my teeth look now.”

Match Made PerfectMichael was so pleased with the work Dr. Farag did to improve the health and appearance of his lower teeth that he recently returned to have her do some aesthetic work on his two upper front teeth as well.

“I call those my bunny teeth, and they’re sound structurally; there was nothing wrong there,” Michael explains. “But one was a little discolored and the other one was a little worse than that, so I asked her what could be done about it.”

Dr. Farag determined that capping the two front teeth would be the best option for Michael, who agreed with her assessment. As part of that process, Dr. Farag also matches the color of the patient’s other teeth so they are aesthetically perfect.

“We have a variety of di� erent shades to choose from, and it’s mostly a judgment call we make in making that match,” Dr. Farag informs. “Sometimes, we even step outside to see what the teeth look like in natural light to make sure we’re getting it right.

“� en, once I think I’m pretty close with the match, I let the patient try them, just to make sure they love the color before they’re married to them with permanent cement.”

Michael says he couldn’t be happier with the results of Dr. Farag’s work. Not only did she improve his oral health, but she gave him the aesthetically pleasing smile he’s always wanted. He adds that he would recommend her to anyone looking for a dentist.

“She’s a very happy, upbeat person, and the o� ce is a comfort-able place to go to where everyone is very positive,” Michael says. “And as far as her work goes, she’s very diligent and an absolute perfectionist. Everything has to be exactly right.

“She always does what’s necessary to make you feel comfortable and not experience any pain or discomfort. She’s very considerate, very much in tune with her patients that way, so I would suggest that anybody who has any anxiety about going to the dentist go see Dr. Farag. She has a way of taking all of your anxiety away and making everything very easy.”FHCN article by Roy Cummings. Photos by Jordan Pysz. mkb

Trust Worthy

For Michael, the transition to a new dentist was easier than he expected.

(continued from page 1)

Page 4 | Florida Health Care News | Winter 2019 | Lee County Edition

Barry LevineExecutive Publisher

Gina L. d’AngeloCFO/HR

Roy CummingsEditorial Supervisor

Michelle BrooksCreative Director

Brian LevineProject Coordinator

Patti DiPanfiloAnnette MardisEditorial Staff

Laura EngelProduction Assistant

Nerissa JohnsonGraphic Designer

Nerissa JohnsonJordan PyszFred BelletPhotography

Steve TurkMario Hill

Kent BoothRobert MizeRick Bowser Distribution

Advanced Dentistry of Fort Myers

Comprehensive Dentistry

Urology ExpertsUrology

Psychiatric Associates of Southwest Florida

Depression

Advanced Orthopedic CenterOrthopedic Surgery and

Sports Medicine

Vein Specialists Vascular Surgery

Hal L. Bozof, DPMPodiatry

Acute Wound CareCompression Therapy

South Florida Eye ClinicOphthalmology

Gulf Coast AudiologyHearing Care

Gulf Coast Men’s HealthErectile Dysfunction

Bell Tower Dental CareImplant, Restorative and

Family Dentistry

215 Bullard ParkwayTemple Terrace, FL 33617

(813) 989-1330

Florida Health Care News

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Florida Health Care News, Inc., reserves the right to decline any advertising/marketing article.

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RESPONSIBLE FOR PAYMENT HAS THE RIGHT TO REFUSE TO PAY, CANCEL PAYMENT OR BE

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Winter 2019

Comprehensive Dentistry

Gregory P. Gebauer, MD, is a fellowship-trained spine sur-geon with specialized training in operative and non-oper-ative treatment of spinal disorders. After completing a Bachelor of Science degree in Mechanical Engineering from Lafayette College in Easton, PA,

Dr. Gebauer earned a Master of Science degree in Biomedical Engineering from Rutgers University in New Brunswick, NJ. He received his medical degree from the University of Medicine and Dentistry of New Jersey, where he was elected to the Alpha Omega Alpha Honor Medical Society, the Gold Humanism Society and received the Roy V. Lorenco Dean’s Award. He continued his orthopedic surgical training at Johns Hopkins University Hospital in Baltimore, MD. While in Baltimore, Dr. Gebauer served on the orthopedic team caring for the Baltimore Orioles and com-pleted a trauma rotation at the Adam Crowley Shock-Trauma Center. He completed his training with a combined orthopedic and neurosurgical spine fellowship at the prestigious Rothman Institute at Thomas Je� erson University Hospital in Philadelphia, PA. Dr. Gebauer has authored more than 35 journal articles and book chap-ters. He is a member of various professional organizations, including the North American Spine Society and the American Association of Orthopedic Surgeons.

KENNETH D. LEVY, MDRONALD M. CONSTINE, MD

DALE A. GREENBERG, MDNICHOLAS J. CONNORS, MD

ROBERT P. STCHUR, MDGREGORY P. GEBAUER, MD

JASON E. REISS, DOSTEVEN R. ANTHONY, DO

LEE M. JAMES, DOJASON M. MLNARIK, DO

Advanced Orthopedic CenterREPAIR RESTORE RECOVERY

The sta� of Advanced Orthopedic Center welcomes new patients and is happy to answer questions about joint replacement, joint revision, sports medicine and surgery of the spine. To schedule an appointment, please visit or call one of their o� ces.

Port Charlotte 1641 Tamiami Trail, Suite 1

(941) 629-6262

Punta Gorda350 Mary St., Suite F

(941) 639-6699Visit Advanced Orthopedic Center on the web at www.advancedorthopediccenter.com

Give Them a Call!

Replacement surgery relieves pain without loss of motion

T he car accident that left Michael Koenig with a bad case of whiplash happened so long ago that Michael,

now 53, has forgotten most of its details. For as long as he can remember, Michael has had to live with a constant reminder of that crash.

Michael was amazed at how quickly he was able to return to his normal routine following ADR surgery.

“I was maybe twenty-four or twenty-five when the accident happened,” Michael relates. “Somebody pulled out of a convenience store right in front of me somewhere, and ever since, the whiplash I su� ered has caused me some neck issues that have gotten progressively worse.

“� e worst of it started almost two years ago. I began experiencing this pain that ran all the way down both arms and into my hands, but it was mostly in my right arm. It eventually got to a point where it was nonstop. I was even losing sleep because I was waking up in the mid-dle of the night in pain.

“It was a� ecting my dexterity, too. I try to be more active than sedentary, and not long before this started, I had started going skeet shooting. After a while, I didn’t feel like I could do that anymore because it was too painful for me to hold the ri� e.”

A resource manager for the Charlotte County Community Services department, Michael � rst tried correcting the problem himself by performing stretching exercises and scaling back on some of his activities. � at didn’t work, though.

Neither did physical therapy. Michael spent nearly two months visit-ing a physical therapist who eventually realized the work he was doing was actually making Michael’s situation worse. � at’s when Michael turned to Advanced Orthopedic Center for help.

“I’ve actually been a patient of theirs before,” Michael says of Advanced Orthopedic Center. “I’ve had a cou-ple of sports-related injuries and was referred to them by my insurance com-pany. When I called about this problem, I was referred to them again.”

Upon his return to Advanced Orthopedic Center, Michael met with Gregory P. Gebauer, MD, who had last treated Michael for some lower back problems in 2013. Michael’s lat-est issue presented the doctor with a whole new challenge.

Feeling the Pinch“Michael’s MRI showed that he had a signi� cant disc herniation at C5-6 that was actually narrowing the nerve tunnel,” Dr. Gebauer reports. “� e disc herniation itself was what was causing his neck pain, but it was also pinching the nerves as they exited the spine.

“� at was what was causing the pain to run down into his arms and even his hands. By the time I saw Michael again, he had been dealing with this for about a year, and it was something that was get-ting progressively worse.”

Dr. Gebauer began his treat-ment of Michael’s neck and radiating arm pain by prescribing yet another round of physical therapy. When that failed to deliver the desired results, Dr. Gebauer recommended surgery to replace the damaged discs.

“There are medicat ions that can be tried, and sometimes steroid injections will help, but the surgery is really the best option for some-one who is young such as Michael,” Dr. Gebauer states. “In those cases, it can be done on an outpatient basis.”

The surgery Dr. Gebauer recom-mended is called arti� cial disc replacement, or ADR, which includes the removal of the problematic discs and the replacement of those discs with arti� cial discs.

Dr. Gebauer says surgeons have traditionally performed a fusion sur-gery on patients such as Michael where the problem discs are removed and the vertebrae are fused together to heal into a single, solid bone. � ere is a drawback to that surgery, however.

“� e limitation of that surgery is that it takes away motion,” Dr. Gebauer edu-cates. “� e motion loss is only about one or two percent each year, but over ten, twenty, thirty years, there’s a risk of the next level wearing out and having other problems in the future.

“� e disc replacement option pre-serves the motion in the discs, and it allows us to get that pressure o� the nerves while you still have normal motion. And hopefully, those other levels aren’t going to wear out as much.”

Back to NormalADR surgery is performed through a small incision made in the side of the throat and takes about an hour to complete. Dr. Gebauer says patients who undergo ADR surgery typically experience a sig-ni� cant reduction in neck and arm pain within two weeks.

“For me, the recovery was even quicker than that,” Michael states. “I felt immediate relief. � e doctor warned me that there might be some post-surgical soreness in my neck, but my post-surgical pain was nonexistent.

“I know I sound like a commercial, but for me, it was amazing how quickly I felt relief from the pain I was having in my neck and arms and how quickly I was able to get back to my normal routine. I didn’t have any downtime at all.”

Michael says the surgery has allowed him to expand his list of activities. He has

Do You Have Arthritis?The symptoms of arthritis vary depending on which joint is a� ected. In many cases, an arthritic joint will be painful and in� amed. Generally, the pain develops gradually over time, although sudden onset is also possible. Other signs can include:

not yet returned to skeet shooting, but he says that is in the plans for the winter and spring months, when it gets a little cooler outside.

“I have no regrets whatsoever about having the surgery,” Michael enthuses. “All the pain and sti� ness in my neck is gone, and I don’t have any pain or numbness run-ning down my arms and hands anymore.

“I knew I was doing the right thing by going back to Advanced Orthopedic Center to have this taken care of. They took care of me when I had my back problems, and they took care of me again when I had a neck problem. I highly recommend them.”FHCN article by Roy Cummings. Photo by Jordan Pysz. mkb

• Pain with motion• Pain that � ares up with

vigorous activity• Tenderness when pressure

is applied to the joint

• Joint swelling, warmth and redness

• Increased pain and swelling in the morning, or after sitting or resting

• Di� culty walking

Serving patients in the southwest Florida area since , our t o p - n o t c h s u r g e o n s o f f e r comprehensive orthopedic care to all ages. Our courteous and caring staff is ready to assist and ensure your satisfaction.Our Specialties Include:

• Spine surgery• Sports medicine• Total and partial joint

replacement• Foot and ankle care• Hand care• Upper extremity fracture care• General orthopedics• Interventional pain

management• Trauma surgery

Welcome to Advanced Orthopedic Center

Lee County Edition | Winter 2019 | Florida Health Care News | Page 5orthopeDiC sUrgery anD sports meDiCine

John Ganos

JOSEPH G. MAGNANT, MD, FACS, RPVI

Visit their website, weknowveins.com, or email them at info@weknowveins.com

Smooth Out Your Problem Veins

Dr. Joseph Magnant welcomes all questions regarding this article as well as other topics related to veins. Call or visit one of the two

Vein Specialists locations:

Fort Myers1500 Royal Palm Square Blvd., Suite 104

Bonita Springs3359 Woods Edge Circle, Suite 102

(239) 694-VEIN (8346)

Take your FREE virtual vein consultation from the privacy and comfort of your own home at

eVein screening.com

Get started today and scan the QR code.

Follow them on:

Joseph G. Magnant, MD, FACS, RPVI, is a fellow of the American College of Surgeons and is board certi� ed by the American Board of Surgery in vascular surgery. He earned his medical degree from Medical College of Virginia. He completed a general surgery residency at Medical College of Virginia Hospitals and a fellowship in vascu-lar surgery at Dartmouth-Hitchcock Medical Center, Lebanon, NH. Dr. Magnant of Vein Specialists focuses exclusively on vein evaluation and modern treatments in a dedicated, outpatient, vein-centered facility. Dr. Magnant is an active member of the American College of Phlebology, Society for Vascular Surgery and Society of Vascular Ultrasound.

John Ganos was a busy entrepreneur in his native New Hampshire. He owned multiple retail businesses, from restaurants to a convenience

store to a tobacco shop. He retired 12 years ago, but not before the standing and stress of his work left him with multiple health issues. Still, he was taken aback when a new symptom emerged.

“I have a number of problems with both my legs,” John shares. “In my right leg, I have a bad arch in my foot, a very arthritic knee with a torn ACL, a chronic pulled ham-string and peripheral neuropathy. My left leg isn’t as severe, but I do have a somewhat bad knee and neuropathy.

“I was experiencing pain in my knee from the arthritis and ACL, but most of the uncomfortable symptoms in my right leg were from the neuropathy, including numb-ness, heaviness and weakness. � en, this new burning sensation started in my calves. I thought it was neuropathic in nature because that’s what precedes nerve damage.”

All along, John was receiving treat-ment for his leg pain from an orthopedic surgeon. Doctor and patient often dis-cussed John’s leg issues as well as strategies to treat them. At one appointment, John o� ered a possible new diagnosis.

“� ere’s a fellow who worked for me who told me about Dr. Magnant and his vein specialty, and I brought it up to the

orthopedic surgeon,” John remembers. “I asked him if he thought my symptoms could be from a vein problem.

“As I understood it, idiopathic periph-eral neuropathy, which isn’t caused by chemotherapy or diabetes and is what I have, is sometimes caused by a lack of cir-culation. I said, Perhaps I should investigate if I have a circulatory problem in my legs. I mentioned Dr. Magnant’s name, and the orthopedic surgeon said, “Dr. Magnant is who we recommend.”

Joseph G. Magnant, MD, is a board-certif ied vascular surgeon at Vein Specialists in Fort Myers and Bonita Springs. Vein Specialists is a practice dedicated to the comprehensive, modern evaluation and most advanced minimally invasive treatment of vein disorders.

When John met Dr. Magnant, he found the doctor pleasant and very precise. Dr. Magnant carefully explained what he does to diagnose vein problems and treat whatever he discovers. He also gave John an idea of what could be expected from treatment.

“First, Dr. Magnant suggested I have an ultrasound scan of my legs, and he discov-ered the valves in my leg veins were leaking,” John says. “He con� rmed my right leg was worse than my left, and that I was having some leaking exactly where I was experienc-ing the new pain and burning symptoms.

“Dr. Magnant was very knowledgeable and accurate. He understood the particular risks treatment could have for me because I’ve had some very serious heart surgeries and take multiple heart medications. He said he could work around the risks with the right treatment for the condition I had.”

Once he identi� ed the problem veins, Dr. Magnant recommended a minimally invasive procedure called endovenous ablation to seal John’s leaky blood vessels.

“During endovenous ablation, we guide a very thin catheter through a tiny needle

placed in the vein via a small punc-ture in the leg,” D r . M a g n a n t explains. “Using either radiofre-quency or laser energy, we gen-tly collapse the d i sea sed ve ins , which are even-tual ly absorbed by the body.”

A f t e r D r . M a g n a n tdescribed endo-venous ablation, John agreed to move forward with the procedure. He knew exactly what to expect during the procedure because D r . M a g n a n t exp la ined each step in the process beforehand. Even so, he was surprised by the ease of the treatment.

“Dr. Magnant came up with a treatment plan that worked around my particular health conditions and was the best course of action for me,” John relates. “� e procedure on my right leg was done using a catheter with a laser. On my left leg, he just used injections with a chemical because that leg wasn’t as bad.

“I was very surprised that the laser pro-cedure was actually a pleasant experience. I had no serious discomfort at all compared to procedures I’ve had in the past, like arthroscopic surgery. Dr. Magnant’s treat-ment wasn’t difficult, and the effect was immediate. � e new burning sensation in my calves disappeared immediately. I was very pleased.”

� nd a physician, and Dr. Magnant’s o� ce used to be across from mine. I did my back-ground work on him and liked his pro� le. I met him at an introductory session he held and was very impressed with him and his sta� , so I made an appointment.”

As he did with John, Dr. Magnant began his treatment of Elise with an ultrasound examination of her leg. He identi� ed the problem areas, which included the greater saphenous vein, the major vein in the lower leg, and its branches. For Elise, the doctor recommended a phlebectomy in addition to endovenous laser ablation.

“Phlebectomy is another minimally invasive procedure,” Dr. Magnant assures. “During phlebectomy, we make a series of small nick incisions in the skin around the vein, which we numb � rst. We insert a special instrument with a tiny hook on it though the incisions and remove the prob-lem vein in small sections.”

“The varicose veins were on the front and side of my leg, and they were getting bigger,” Elise recounts. “And I was getting more of them. I had to make a decision to have the procedures done so they didn’t get worse.”

Elise decided to go ahead with the pro-cedures. She didn’t � nd the phlebectomy particularly painful or stressful, and she says Dr. Magnant and his surgical sta� were instrumental in that. � ey helped her under-stand exactly what was happening, which helped her relax.

“Dr. Magnant was kind, friendly and very interactive,” Elise describes. “He kept me occupied during the procedure, and the OR sta� made me feel very comfortable. Dr. Magnant explained what he was going to do, then started numbing my leg. � en he removed the parts of the vein. � e procedure wasn’t bad at all.”

Diff erent PathsJohn and Elise got to Dr. Magnant and Vein Specialists via di� erent paths. John su� ered with symptoms for years and went to many doctors before considering his symptoms might be related to venous disease. Elise wit-nessed the e� ects of varicose veins on family members and chose to act before her veins had more serious complications.

“When I met John, he told me he’d been experiencing discomfort in his legs for a long time and had been to pain manage-ment physicians, orthopedic surgeons and neurologists,” Dr. Magnant reports. “He also had obvious signs of venous disease includ-ing fatigue, heaviness and skin changes.

“John was also experiencing neu-ropathy symptoms such as burning and numbness, and venous disease is on the list of causes for neuropathy that gets worse as the day goes on. Unfortunately, with many physicians, it’s not at the top of their minds that their patients with these symptoms might have vein issues.”

Elise could see the bulging varicose veins on her right leg and the swelling that occurred with them. She didn’t have the cramping pain, heaviness or skin changes that often also occur with venous disease.

However, these symptoms could develop over time, along with ulcers on the skin, if she didn’t have her veins treated.

“It was appropriate with today’s mod-ern technology to evaluate and treat Elise before she began experiencing leg pain and skin changes,” Dr. Magnant observes. “� e ultrasound technology is very accurate in terms of identifying and stratifying the disease, and the procedures for sealing veins are leading-edge and well supported.

“Elise got in front of this disease because she saw in her own family the ravages of untreated venous disease in the pre-endovenous closure era. She didn’t want to wait until she was one of those patients with severe disease. John, on the other hand, went undiagnosed, su� ered years of discomfort and came in with late-stage disease.”

Sources of PainPatients who seek treatment at Vein Specialists often have multifactorial issues causing pain. � e issues can be orthopedic or neurologic, and in many cases, patients seek the care of pain management specialists to control their discomfort. Pain in areas such as the back, buttocks, pelvis, legs and feet can, however, be related to venous disease.

“Pain is one of the most common symptoms of venous disease,” Dr. Magnant stresses. “In the legs, it occurs when blood from leaking veins pools in the legs over time. In the pelvis, pain can occur from blockages in the veins keeping blood from � owing freely. � is pain can also radiate to other areas of the body. � ese types of pain are often misdiagnosed, so patients turn to orthopedics or pain management for treatment.

“What happens in many cases is that physicians aren’t aware of the other signs and symptoms of venous disease such as heavi-ness, fatigue and skin changes. � erefore, they don’t recognize venous disease as a possibility when their patients present with pain. � ey simply treat the pain.”

Pain from venous disease can, however, be di� erent than that of orthopedic disease

and other conditions that might lead to pain management, points out Dr. Magnant. Orthopedic disease, whether it’s in the ankle, knee or hip, is usually worse after prolonged immobility, such as lying down, sleeping or sitting in a chair.

“With orthopedic disease, when you stand up, there’s a sti� ness that generally works its way out a little bit as you walk,” Dr. Magnant o� ers. “However, by walk-ing, you put stress on the a� ected joint, so eventually, it’s going to hurt more.

“Venous disease is generally better after sleeping or elevating the legs for a period of time, and gradually gets worse as the day wears on. It’s improved by walking, and gets worse with sitting or standing.”

Whether patients have orthopedic, neu-rologic or another type of pain, Dr. Magnant recommends all those with painful condi-tions in their legs seek a vein evaluation. He suggests they have this done before turning to long-term care with orthopedic surgeons and pain management specialists.

“� ere are many di� erent sources of pain – leg pain, lower back pain, pelvic pain – and there are many di� erent treatments,” Dr. Magnant notes. “Many pain manage-ment physicians and orthopedic surgeons try to remedy their patients’ discomfort in ways that are much more invasive than the treatments we use to seal veins.

“Before trying a procedure that burns their nerves or a surgical intervention, patients do well to get a vein evaluation � rst. � is way, they can see if there’s something correctable with a much simpler and more de� nitive procedure that has a higher likeli-hood of a permanent result.”

Genuine OutcomesFollowing his endovenous laser ablation, John noted a signi� cant improvement in his leg discomfort. He’s grateful to Dr. Magnant for this success and for preparing him so well for the procedure. John’s also grateful Dr. Magnant took his other health condi-tions into consideration when creating his treatment plan.

“Dr. Magnant’s vein treatment gave me genuine relief from the burning sensation in my legs, and now it’s gone,” John enthuses. “When I had the procedure, Dr. Magnant described it to me, and I experienced no problems whatsoever with it. It was exactly what he said it would be.

“I think the key to my successful treatment was realizing that I had mul-tiple issues, not just one, and they’re all operating in conjunction with each other. It was important to determine which symptom was coming from which con-dition. It worked out very well for me.”

The outcome of Elise’s treatment at Vein Specialists was genuine as well – genuine joy. She’s excited by how good her right leg looks and feels since her proce-dures were done and has become far more active since the swelling and fatigue have disappeared.

“The varicose veins are gone,” Elise mar-vels. “My right leg looks exactly like my left leg. � ey’re a good matched set now. I don’t have to worry about the swell-ing anymore. I haven’t taken a long car ride yet, but sitting down, I don’t have the swelling in my foot and around my ankle like I used to. And I don’t have the rock-hard calves anymore. It’s a big di� erence.

“I started walking last February, and I could only walk about a mile a day back then. Now, I walk three miles every other day, and my leg doesn’t bother me.”

Like John, Elise is grateful to Dr. Magnant for her positive outcome, but she goes further and praises his sta� as well.

“Dr. Magnant is very, very good, and he’s built an excellent team at Vein Specialists, from the front office to the OR team,” she comments. “They’re professional, talented and friendly. The physician assistant was my contact, and I just loved her. She made me feel very comfortable. It’s just a very comfortable environment in that office.”

For Elise and John, treatment at Vein Specialists was the answer to their leg prob-lems. � ey both walked away from their procedures with improved circulation and healthier legs. It’s something they’re both willing to talk about.

“My results are excellent,” Elise relates. “� e procedures were an absolute success for me. I’ve already recommended them to � ve other women.”

John has been spreading the word about Dr. Magnant and Vein Specialists as well.

“Getting rid of that burning sensation in my legs was something Dr. Magnant was

very helpful with,” John says. “I recommend him to anyone.”FHCN article by Patti DiPanfilo. Photos by Jordan Pysz. Before

and after images courtesy of Vein Specialists. mkb

*The patient’s name was changed at her request.

AFTERBEFORE

Back, Leg or Foot Pain? Your veins may be the problem

Proactive ProfessionalOriginally from Kentucky, Elise* lived most of her life in Alabama. Her son attended the University of Alabama, and the two are huge Alabama football fans. Elise loved to spend time with her son watching the games, but whenever she sat that long, she experienced unpleasant symptoms in her leg.

“I had really bad varicose veins in my right leg, which caused extreme swelling in my leg and foot when I sat for long periods of time,” Elise discloses. “If I rode in a car for more than two hours, my leg would swell up, and my calf would get rock hard. I could bounce a quarter o� of my calf, it’d be so hard. Sometimes, my leg also felt very tired.

“When I’d bump my leg against a piece of furniture and hit one of the varicose veins, the pain was excruciating. It made me sick to my stomach. I’d want to sit down and cry, it hurt so bad.”

Having worked in health care for 37 years, Elise knew that varicose veins were not healthy for leg circulation. � e condition ran in her family, and her mother su� ered with severe varicose veins, so Elise realized hers would just get worse over time.

“I decided to be proactive and have my leg checked,” she states. “I started research-ing physicians in the area. I didn’t want just anyone cutting into my leg, especially if we had to remove the vein, which I expected was going to happen.

“I’m a retired health care professional, so it’s nothard for m e t o

Page 6 | Florida Health Care News | Winter 2019 | Lee County Edition vasCUlar sUrgery

John Ganos

JOSEPH G. MAGNANT, MD, FACS, RPVI

Visit their website, weknowveins.com, or email them at info@weknowveins.com

Smooth Out Your Problem Veins

Dr. Joseph Magnant welcomes all questions regarding this article as well as other topics related to veins. Call or visit one of the two

Vein Specialists locations:

Fort Myers1500 Royal Palm Square Blvd., Suite 104

Bonita Springs3359 Woods Edge Circle, Suite 102

(239) 694-VEIN (8346)

Take your FREE virtual vein consultation from the privacy and comfort of your own home at

eVein screening.com

Get started today and scan the QR code.

Follow them on:

Joseph G. Magnant, MD, FACS, RPVI, is a fellow of the American College of Surgeons and is board certi� ed by the American Board of Surgery in vascular surgery. He earned his medical degree from Medical College of Virginia. He completed a general surgery residency at Medical College of Virginia Hospitals and a fellowship in vascu-lar surgery at Dartmouth-Hitchcock Medical Center, Lebanon, NH. Dr. Magnant of Vein Specialists focuses exclusively on vein evaluation and modern treatments in a dedicated, outpatient, vein-centered facility. Dr. Magnant is an active member of the American College of Phlebology, Society for Vascular Surgery and Society of Vascular Ultrasound.

John Ganos was a busy entrepreneur in his native New Hampshire. He owned multiple retail businesses, from restaurants to a convenience

store to a tobacco shop. He retired 12 years ago, but not before the standing and stress of his work left him with multiple health issues. Still, he was taken aback when a new symptom emerged.

“I have a number of problems with both my legs,” John shares. “In my right leg, I have a bad arch in my foot, a very arthritic knee with a torn ACL, a chronic pulled ham-string and peripheral neuropathy. My left leg isn’t as severe, but I do have a somewhat bad knee and neuropathy.

“I was experiencing pain in my knee from the arthritis and ACL, but most of the uncomfortable symptoms in my right leg were from the neuropathy, including numb-ness, heaviness and weakness. � en, this new burning sensation started in my calves. I thought it was neuropathic in nature because that’s what precedes nerve damage.”

All along, John was receiving treat-ment for his leg pain from an orthopedic surgeon. Doctor and patient often dis-cussed John’s leg issues as well as strategies to treat them. At one appointment, John o� ered a possible new diagnosis.

“� ere’s a fellow who worked for me who told me about Dr. Magnant and his vein specialty, and I brought it up to the

orthopedic surgeon,” John remembers. “I asked him if he thought my symptoms could be from a vein problem.

“As I understood it, idiopathic periph-eral neuropathy, which isn’t caused by chemotherapy or diabetes and is what I have, is sometimes caused by a lack of cir-culation. I said, Perhaps I should investigate if I have a circulatory problem in my legs. I mentioned Dr. Magnant’s name, and the orthopedic surgeon said, “Dr. Magnant is who we recommend.”

Joseph G. Magnant, MD, is a board-certif ied vascular surgeon at Vein Specialists in Fort Myers and Bonita Springs. Vein Specialists is a practice dedicated to the comprehensive, modern evaluation and most advanced minimally invasive treatment of vein disorders.

When John met Dr. Magnant, he found the doctor pleasant and very precise. Dr. Magnant carefully explained what he does to diagnose vein problems and treat whatever he discovers. He also gave John an idea of what could be expected from treatment.

“First, Dr. Magnant suggested I have an ultrasound scan of my legs, and he discov-ered the valves in my leg veins were leaking,” John says. “He con� rmed my right leg was worse than my left, and that I was having some leaking exactly where I was experienc-ing the new pain and burning symptoms.

“Dr. Magnant was very knowledgeable and accurate. He understood the particular risks treatment could have for me because I’ve had some very serious heart surgeries and take multiple heart medications. He said he could work around the risks with the right treatment for the condition I had.”

Once he identi� ed the problem veins, Dr. Magnant recommended a minimally invasive procedure called endovenous ablation to seal John’s leaky blood vessels.

“During endovenous ablation, we guide a very thin catheter through a tiny needle

placed in the vein via a small punc-ture in the leg,” D r . M a g n a n t explains. “Using either radiofre-quency or laser energy, we gen-tly collapse the d i sea sed ve ins , which are even-tual ly absorbed by the body.”

A f t e r D r . M a g n a n tdescribed endo-venous ablation, John agreed to move forward with the procedure. He knew exactly what to expect during the procedure because D r . M a g n a n t exp la ined each step in the process beforehand. Even so, he was surprised by the ease of the treatment.

“Dr. Magnant came up with a treatment plan that worked around my particular health conditions and was the best course of action for me,” John relates. “� e procedure on my right leg was done using a catheter with a laser. On my left leg, he just used injections with a chemical because that leg wasn’t as bad.

“I was very surprised that the laser pro-cedure was actually a pleasant experience. I had no serious discomfort at all compared to procedures I’ve had in the past, like arthroscopic surgery. Dr. Magnant’s treat-ment wasn’t difficult, and the effect was immediate. � e new burning sensation in my calves disappeared immediately. I was very pleased.”

� nd a physician, and Dr. Magnant’s o� ce used to be across from mine. I did my back-ground work on him and liked his pro� le. I met him at an introductory session he held and was very impressed with him and his sta� , so I made an appointment.”

As he did with John, Dr. Magnant began his treatment of Elise with an ultrasound examination of her leg. He identi� ed the problem areas, which included the greater saphenous vein, the major vein in the lower leg, and its branches. For Elise, the doctor recommended a phlebectomy in addition to endovenous laser ablation.

“Phlebectomy is another minimally invasive procedure,” Dr. Magnant assures. “During phlebectomy, we make a series of small nick incisions in the skin around the vein, which we numb � rst. We insert a special instrument with a tiny hook on it though the incisions and remove the prob-lem vein in small sections.”

“The varicose veins were on the front and side of my leg, and they were getting bigger,” Elise recounts. “And I was getting more of them. I had to make a decision to have the procedures done so they didn’t get worse.”

Elise decided to go ahead with the pro-cedures. She didn’t � nd the phlebectomy particularly painful or stressful, and she says Dr. Magnant and his surgical sta� were instrumental in that. � ey helped her under-stand exactly what was happening, which helped her relax.

“Dr. Magnant was kind, friendly and very interactive,” Elise describes. “He kept me occupied during the procedure, and the OR sta� made me feel very comfortable. Dr. Magnant explained what he was going to do, then started numbing my leg. � en he removed the parts of the vein. � e procedure wasn’t bad at all.”

Diff erent PathsJohn and Elise got to Dr. Magnant and Vein Specialists via di� erent paths. John su� ered with symptoms for years and went to many doctors before considering his symptoms might be related to venous disease. Elise wit-nessed the e� ects of varicose veins on family members and chose to act before her veins had more serious complications.

“When I met John, he told me he’d been experiencing discomfort in his legs for a long time and had been to pain manage-ment physicians, orthopedic surgeons and neurologists,” Dr. Magnant reports. “He also had obvious signs of venous disease includ-ing fatigue, heaviness and skin changes.

“John was also experiencing neu-ropathy symptoms such as burning and numbness, and venous disease is on the list of causes for neuropathy that gets worse as the day goes on. Unfortunately, with many physicians, it’s not at the top of their minds that their patients with these symptoms might have vein issues.”

Elise could see the bulging varicose veins on her right leg and the swelling that occurred with them. She didn’t have the cramping pain, heaviness or skin changes that often also occur with venous disease.

However, these symptoms could develop over time, along with ulcers on the skin, if she didn’t have her veins treated.

“It was appropriate with today’s mod-ern technology to evaluate and treat Elise before she began experiencing leg pain and skin changes,” Dr. Magnant observes. “� e ultrasound technology is very accurate in terms of identifying and stratifying the disease, and the procedures for sealing veins are leading-edge and well supported.

“Elise got in front of this disease because she saw in her own family the ravages of untreated venous disease in the pre-endovenous closure era. She didn’t want to wait until she was one of those patients with severe disease. John, on the other hand, went undiagnosed, su� ered years of discomfort and came in with late-stage disease.”

Sources of PainPatients who seek treatment at Vein Specialists often have multifactorial issues causing pain. � e issues can be orthopedic or neurologic, and in many cases, patients seek the care of pain management specialists to control their discomfort. Pain in areas such as the back, buttocks, pelvis, legs and feet can, however, be related to venous disease.

“Pain is one of the most common symptoms of venous disease,” Dr. Magnant stresses. “In the legs, it occurs when blood from leaking veins pools in the legs over time. In the pelvis, pain can occur from blockages in the veins keeping blood from � owing freely. � is pain can also radiate to other areas of the body. � ese types of pain are often misdiagnosed, so patients turn to orthopedics or pain management for treatment.

“What happens in many cases is that physicians aren’t aware of the other signs and symptoms of venous disease such as heavi-ness, fatigue and skin changes. � erefore, they don’t recognize venous disease as a possibility when their patients present with pain. � ey simply treat the pain.”

Pain from venous disease can, however, be di� erent than that of orthopedic disease

and other conditions that might lead to pain management, points out Dr. Magnant. Orthopedic disease, whether it’s in the ankle, knee or hip, is usually worse after prolonged immobility, such as lying down, sleeping or sitting in a chair.

“With orthopedic disease, when you stand up, there’s a sti� ness that generally works its way out a little bit as you walk,” Dr. Magnant o� ers. “However, by walk-ing, you put stress on the a� ected joint, so eventually, it’s going to hurt more.

“Venous disease is generally better after sleeping or elevating the legs for a period of time, and gradually gets worse as the day wears on. It’s improved by walking, and gets worse with sitting or standing.”

Whether patients have orthopedic, neu-rologic or another type of pain, Dr. Magnant recommends all those with painful condi-tions in their legs seek a vein evaluation. He suggests they have this done before turning to long-term care with orthopedic surgeons and pain management specialists.

“� ere are many di� erent sources of pain – leg pain, lower back pain, pelvic pain – and there are many di� erent treatments,” Dr. Magnant notes. “Many pain manage-ment physicians and orthopedic surgeons try to remedy their patients’ discomfort in ways that are much more invasive than the treatments we use to seal veins.

“Before trying a procedure that burns their nerves or a surgical intervention, patients do well to get a vein evaluation � rst. � is way, they can see if there’s something correctable with a much simpler and more de� nitive procedure that has a higher likeli-hood of a permanent result.”

Genuine OutcomesFollowing his endovenous laser ablation, John noted a signi� cant improvement in his leg discomfort. He’s grateful to Dr. Magnant for this success and for preparing him so well for the procedure. John’s also grateful Dr. Magnant took his other health condi-tions into consideration when creating his treatment plan.

“Dr. Magnant’s vein treatment gave me genuine relief from the burning sensation in my legs, and now it’s gone,” John enthuses. “When I had the procedure, Dr. Magnant described it to me, and I experienced no problems whatsoever with it. It was exactly what he said it would be.

“I think the key to my successful treatment was realizing that I had mul-tiple issues, not just one, and they’re all operating in conjunction with each other. It was important to determine which symptom was coming from which con-dition. It worked out very well for me.”

The outcome of Elise’s treatment at Vein Specialists was genuine as well – genuine joy. She’s excited by how good her right leg looks and feels since her proce-dures were done and has become far more active since the swelling and fatigue have disappeared.

“The varicose veins are gone,” Elise mar-vels. “My right leg looks exactly like my left leg. � ey’re a good matched set now. I don’t have to worry about the swell-ing anymore. I haven’t taken a long car ride yet, but sitting down, I don’t have the swelling in my foot and around my ankle like I used to. And I don’t have the rock-hard calves anymore. It’s a big di� erence.

“I started walking last February, and I could only walk about a mile a day back then. Now, I walk three miles every other day, and my leg doesn’t bother me.”

Like John, Elise is grateful to Dr. Magnant for her positive outcome, but she goes further and praises his sta� as well.

“Dr. Magnant is very, very good, and he’s built an excellent team at Vein Specialists, from the front office to the OR team,” she comments. “They’re professional, talented and friendly. The physician assistant was my contact, and I just loved her. She made me feel very comfortable. It’s just a very comfortable environment in that office.”

For Elise and John, treatment at Vein Specialists was the answer to their leg prob-lems. � ey both walked away from their procedures with improved circulation and healthier legs. It’s something they’re both willing to talk about.

“My results are excellent,” Elise relates. “� e procedures were an absolute success for me. I’ve already recommended them to � ve other women.”

John has been spreading the word about Dr. Magnant and Vein Specialists as well.

“Getting rid of that burning sensation in my legs was something Dr. Magnant was

very helpful with,” John says. “I recommend him to anyone.”FHCN article by Patti DiPanfilo. Photos by Jordan Pysz. Before

and after images courtesy of Vein Specialists. mkb

*The patient’s name was changed at her request.

AFTERBEFORE

Back, Leg or Foot Pain? Your veins may be the problem

Proactive ProfessionalOriginally from Kentucky, Elise* lived most of her life in Alabama. Her son attended the University of Alabama, and the two are huge Alabama football fans. Elise loved to spend time with her son watching the games, but whenever she sat that long, she experienced unpleasant symptoms in her leg.

“I had really bad varicose veins in my right leg, which caused extreme swelling in my leg and foot when I sat for long periods of time,” Elise discloses. “If I rode in a car for more than two hours, my leg would swell up, and my calf would get rock hard. I could bounce a quarter o� of my calf, it’d be so hard. Sometimes, my leg also felt very tired.

“When I’d bump my leg against a piece of furniture and hit one of the varicose veins, the pain was excruciating. It made me sick to my stomach. I’d want to sit down and cry, it hurt so bad.”

Having worked in health care for 37 years, Elise knew that varicose veins were not healthy for leg circulation. � e condition ran in her family, and her mother su� ered with severe varicose veins, so Elise realized hers would just get worse over time.

“I decided to be proactive and have my leg checked,” she states. “I started research-ing physicians in the area. I didn’t want just anyone cutting into my leg, especially if we had to remove the vein, which I expected was going to happen.

“I’m a retired health care professional, so it’s nothard for m e t o

Lee County Edition | Winter 2019 | Florida Health Care News | Page 7vasCUlar sUrgery

Tips To Keep Toenail Fungus From Spreading:

BEFORE

AFTER

Eliminate HammertoesIn-o� ce procedure eliminates unsightly, painful condition

E llie Cherwick has always hated her feet.

“I’ve never really liked the way they look,’’ Ellie laments.

“And I’ve always had problems with them.’’

One of those problems is hammer-toes, which is a bending or curling of the toes that often results in the formation of corns or calluses as the toe deformity presses unnaturally against the patient’s footwear and/or the ground.

The condition is one that Ellie’s mother and daughter have had to deal with as well, and for years, Ellie dealt with it rather simply by wearing closed-toe shoes to mask the hammertoes’ unsightly nature.

“Mostly, I just hated the way they looked,” Ellie explains. “They weren’t uncomfortable, so I never had much pain, until recently. I guess they just got a lot worse over time, so I decided to do some-thing for myself and get them repaired.”

Ellie’s decision resulted in a visit to her long-time podiatrist, Hal Bozof,

DPM, who says hammertoes are typically caused by an irregular and potentially permanent shortening of tendons and muscles that results in the deformity of the toe joints.

“� is contracture is often the cause of a muscle imbalance in the foot that causes the toe to dorsally contract, meaning the toe pushes up and the end of the toe ham-mers to the ground,” Dr. Bozof explains. “Frequently, it is inherited or the cause of wearing shoes that are the wrong � t.”

Dr. Bozof adds that hammertoes can develop at any age. � ey can occur in people as young as 30 or even 20 years of age, he says.

“It can develop at a young age, espe-cially in women who wear high heels a lot,” Dr. Bozof explains. “� e older we get, the more likely the hammertoes are to get worse. � ey are more prevalent in women, but I do see men with them as well.

“Hammertoes can become very painful,” the doc-tor continues. “Sometimes, they can rub against

the inside of the shoe, causing a corn to occur. Unless the a� ected toe is straight-ened out, there will inevitably be an issue with corns or calluses.

“Sometimes, an ulcer can form as well. � is results in extreme discomfort caused from the toe hammering against the ground and can lead to an infection. Also, painful calluses may develop on the bottom of the foot due to the underlying contracture of the hammertoes.”

Progressive ProcedureDr. Bozof says hammertoes are very common and notes that in the past, treatment for them was done surgically and typically required four to six weeks of recovery time. Today, however, there is a pain-free, in-o� ce procedure that eliminates hammertoes quickly.

“This new p r o c e d u r e starts with the application of a local anesthetic that numbs the toe,” Dr. Bozof explains. “After that , a very small opening requiring no

Ellie happilyshows off her feet

stitches is made to release the tendon, which allows the toe to straighten out.”

Dr. Bozof says that following the procedure, the patient’s toe is put in a bandage that is worn only for a day. He adds that most patients can walk on the foot with the treated toe the very same day, “usually without any pain.”

Ellie con� rms that the procedure was indeed painless and adds that she is back to enjoying working in her yard and wear-ing most any shoe she wants again.

“I couldn’t wait to get a pedicure once the procedure was � nished,” Ellie says. “Dr. Bozof does great work. I am ecstatic with the results! I love my feet again!”

Symptoms of fungal nail infections vary. Symptoms will depend on the type of

infection and may eventually cause discomfort.

Symptoms can include:

W hile serving in the United States Armed Forces, Chet Young did three tours of duty in

Vietnam. At some point, during at least one of those tours, Chet was exposed to Agent Orange, a hazardous material that can cause diabetes, kidney disease and many other chronic conditions.

Years later, when he � rst learned he had indeed contracted Type 2 diabetes, the diagnosis came as no surprise to Chet, who more recently thought a problem with toenail fungus was being caused by his dia-betes. He soon found out di� erently.

“I have my feet examined on a regular basis because diabetes can cause circula-tory issues and problems with the feet,” he explains. “When the fungus appeared, I assumed the two were connected, but they’re not.”

After moving to Fort Myers a few years ago, Chet was referred to Hal L. Bozof, DPM, a board-certi� ed podiatric physician, for treatment. Dr. Bozofexplained to Chet that toenail fungus can be di� cult to eliminate.

Laser Advantages“It typically grows in a dark, warm, moist environment,” Dr. Bozof explains. “Once it gets under the skin or nail, that’s a perfect place for the fungus to thrive. It can then spread from one toenail to the next. Oftentimes, the fungus will develop underneath the nail plate.”

Historically, treatment for fungal nails has included topical medications, oral agents (pills) or surgical removal of the nail plate, which have been relatively ine� ective.

Chet can wear fl ip-fl ops once again and no longer has to hide his feet.

Goodbye

Hal L. Bozof, DPM, is board certi� ed by the American Board of Podiatric Surgery and the American Academy of Wound Management. He is a fellow of the American College of Foot &

Ankle Surgeons. He completed his undergraduate degree at Memphis State University, Memphis, and received his Doctor of Podiatric Medicine degree from the Dr. William Scholl College of Podiatric Medicine, Chicago. He completed a podiatric surgical residency at Baptist Memorial Hospital of Memphis. Dr. Bozof is a member of the American Podiatric Medical Association, Florida Podiatric Medical Association and American Academy of Pain Management.

For more information, visit Dr. Bozof’s website at www.docbozof.com

Do You Have Hammertoes, Foot Pain or

Toenail Fungus?Dr. Hal Bozof is Lee County’s leading provider of podiatry services. He and his staff can help you get back on your feet. For more information regarding the array of services he can provide, call or

visit his o� ce in Fort Myers at:

2540 Winkler Avenue(239) 278-4100

Se Habla Español

“The most efficient way to kill the fungus is with the Fox Laser, which we use in my office,” Dr. Bozof explains. “It is essentially pain free, and there are no side effects. It takes only a short time per treatment and may require two or three sessions, depend-ing on how many nails are treated and the extent of the fungus.

“� e laser produces heat that pene-trates the nail plate and thereby kills the fungus, which lives in and underneath the toenail,” continues Dr. Bozof.

“One of the most impressive features is that there is no recovery time,” adds Dr. Bozof. “Shoes can be worn immedi-ately after the treatment, unlike having the nails removed.”

Toenails grow very slowly. It can take up to a year or more to grow a new toe-nail, which is why it can be so hard to get rid of toenail fungus. � e fungus often doesn’t go away until a new toenail can grow back.

Chet is thrilled with the care he received and says that the fungus condi-tion has been resolved and his nails are now normal once again.

“I don’t have to be embarrassed about my feet anymore!” he exclaims. “I can wear sandals and � ip-� ops and not be worried about how my feet look. It’s a relief!”FHCN staff article. Ellie’s photo by Jordan Pysz. Chet’s photo by

Nerissa Johnson. Before image courtesy of Ellie Cherwick. mkb

• Wash your feet daily and dry completely

• Cut nails regularly and do not share clippers

• Alternate shoes• Discard old shoes that may

carry fungus• When using public showers,

wear fl ip-fl ops

• Yellow or white streaks in the nail bed and throughout the nail plate.

• Build-up of bits and pieces of skin and nail fragments (debris) under the nail.

• A discolored and thickened nail that may separate from the skin underneath the nail.

• A brittle, broken, crumbly and/or thickened nail.

• Discomfort, especially when wearing closed-toe shoes.

Page 8 | Florida Health Care News | Winter 2019 | Lee County Edition poDiatry

Visit Acute Wound Care on the web at

www.acutewoundcare.com

or call them directly:

Toll Free (855) 949-HEAL (4325)

Locally (239) 949-4412

Are You Su� ering From

Chronic Limb Swelling?

Hannah enjoys doing puzzles after therapy.

Reduce limb swelling and improve circulation

H annah Heit spent more than 40 years as a registered nurse, first in pediatrics and later in quality assur-

ance, reviewing several departments. � e Kentucky native lived most of her adult life in Michigan, and it was from there she relocated to Florida and retirement. All those years on her feet as a nurse, however, had a profound e� ect on her legs.

“A few years ago, my legs started swelling, and they were uncomfortable,” she shares. “I didn’t really have any pain, but I couldn’t wear shoes because my feet were as big as my legs. My legs were also discolored from the ankle to about mid calf. � ey were a kind of bluish-red color.”

Initially, Hannah was told she had venous insu� ciency, a condition in which the veins in the legs are unable to do their job of pumping blood back to the heart. Blood leaks and pools in the legs, causing symp-toms such as swelling and discoloration. Subsequently, Hannah underwent vein sur-gery to treat her insu� ciency she reports.

“I was told to put my legs up at night, but I couldn’t always do that,” Hannah adds. “I was also supposed to wear these special compression hose, but I couldn’t wear them because it was too much trouble getting them on and o� .”

The swelling and discomfort in Hannah’s legs continued after surgery, so she eventually sought the advice of her primary care provider.

“� e nurse practitioner I saw in my internist’s o� ce looked at my legs and said, You have lymphedema, excess � uid in your lymph vessels,” notes Hannah. “I’m not sure, but it may have been caused by the venous insu� ciency. � e nurse thought I would bene� t from a compres-sion pump. She called the company that provides them and got me all set up.”

� e company the nurse practitioner contacted was Acute Wound Care, a fully accredited home medical equipment provider specializing in hospital-grade compression devices and specialty wound-care dressings. � e compression pumps are prescription devices and are approved by Medicare and covered by many com-mercial insurers.

“Our easy-to-use compression pumps remove � uid that has accumulated in the legs or arms,” describes Alyssa Parker, cer-ti� ed compression therapist with Acute Wound Care. “The pump’s limb-sized sleeves gently massage the limb, drain-ing any excess � uid back into the body’s circulatory system so it can be naturally eliminated. Compression pumps increase circulation in the a� ected limbs while alleviating many painful symptoms.

“� e pumps are both highly e� ec-tive and noninvasive, and for the legs, they are much easier to use than com-pression stockings. Patients generally use the pumps twice a day for forty-� ve

minutes, with an interval of at least two hours between treatments, so it is usually done in the morning and in the evening. While using the pumps, patients simply sit back with their limbs raised to further assist with circulation.”

Once Acute Wound Care received Hannah’s prescription, a compression therapist contacted her to review the next step and answer any questions. After that, the therapist delivered the device, set it up and explained to Hannah how to use and care for it.

Healthy DiscoveryThe nurse practitioner who diagnosed Hannah’s lymphedema treats a full range of medical conditions at the practice, including lymphedema, persistent leg edema and venous disease among the most common.

For patients with these disorders it’s generally recommended to try con-servative therapy first. Examples are compression stockings, optimizing water and electrolyte balance, and diuretics. � e compression device is a great treatment option for those who have tried conser-vative therapy and still have persistent swelling or poor circulation.

Many patients have significant improvements in terms of diminished � uid retention in their legs or arms after using the compression pump. With con-sistent compression therapy the swelling improves as well as the venous blood � ow, wound healing and overall mobility.”

Circulation SupportAlyssa agrees that patients with lymph-edema, venous disease and other conditions leading to poor circulation once had few options beyond the standard therapies for limb swelling. � at’s a treatment hole Acute Wound Care’s compression pumps � ll. � e safe and painless pumps not only

reduce � uid retention in the limbs, they also improve overall blood � ow.

“� e pumps assist circulation by con-tracting the leg muscles, assisting blood flow back toward the heart,” explains Alyssa. “� ere, the blood is collected, sent to the lungs to be oxygenated and then returned to the body’s organs and tissues.

“To aid blood � ow, the pumps have multiple chambers. Each chamber � lls up with air, from the foot to the groin. � en, each chamber releases, and the pattern repeats in a rhythmic fashion.

“In addition to the circulation boost, many patients will see a noticeable dif-ference in the swelling and in the size of their limbs after their � rst forty-� ve-min-ute pumping session.”

Acute Wound Care is proud of its hands-on approach to patient care. Not only does a compression therapist go to patients’ homes to set up the equipment and instruct them on how to use it, they also adjust the pump’s pressure level to the patients’ comfort.

“When we are in the patient’s home, we set the pressure based on the severity of the condition and the physician’s pre-scription,” states Alyssa. “We then adjust it so the patients are comfortable and will actually meet the requirements of the treatment, so they get great results.”

Doubly EndorsedHannah has been using her compression device from Acute Wound Care for more than a year now. She says she is pleased with the results she’s getting from it. She’d like to use it more often than she does, but she’s established a treatment schedule with her doctor that works well for her.

“The usual treatment with the compression pump is twice a day for forty-five minutes,” relates Hannah. “But I do it once a day for an hour. � e limb sleeves feel � ne when I have them on, and then my legs are nice and small when I take them o� . � e swelling goes down signi� cantly.”

In addition to reducing the swelling, the compression pump treatments have also relieved much of Hannah’s leg dis-comfort and have enabled her to wear shoes again. The discoloration, which is related to her venous insufficiency, remains and may take years to fade, if it does at all. However, the circulation in her leg veins has improved with treatment, aiding her venous insu� ciency.

“I’ll continue using the compres-sion pump,” she comments, “and I

“The pumps assist circulation by contracting

the leg muscles, assisting blood flow back

toward the heart.”

The pumps are non-invasive

and highly e� ective

recommend it to others with conditions like mine. I recommend Acute Wound Care, too. I had no problems with any part of their process.”

Physicians throughout Florida have been recommending Acute Wound Care’s compression pumps to their patients for years and have been getting great results.

“Many doctors have told me that they’ve encouraged their patients to use the pumps to reduce limb swelling and improve circulation,” Alyssa con� rms. “They say the compression pumps are great, safe, noninvasive devices that sup-plement the medical treatment they’ve provided to those patients.

“One even told me that he received feedback from his patients, and that they agree the devices and the out-comes are positive. He said the patients also appreciate how good a job Acute Wound Care does of following up and mentioned that all are very pleased with Acute Wound Care and its product.

“� at same doctor said he’s so sat-is� ed with Acute Wound Care that he strongly endorses them and their com-pression devices to other physicians. He said he’s personally thrilled with Acute Wound Care because they help doctors improve their quality of care and the quality of their patients’ lives.”FHCN article by Patti DiPanfilo. Photo by Jordan Pysz.

Photo of pump courtesy of Acute Wound Care. mkb

Lee County Edition | Winter 2019 | Florida Health Care News | Page 9Compression therapy

Drianis Duran, AuD, is a board-certi� ed audiologist with clinical expertise in the areas of hearing loss and dizziness and balance disorders. She holds credentials from the American Board of Audiology, the American Academy of Audiology, the Academy of Doctors of Audiology and the Florida Academy of Audiology. She has also received certi� cation from the American Institute of Balance.

Visit Gulf Coast Audiology on the web at www.gulfcoastaudiology.com

Find out if your hearing problems can be eased with one of the many models of state-of-the-art hearing instruments available at Gulf Coast Audiology. Dr. Duran invites readers of Florida Health Care News to call for a consultation or to visit her at her offi ce in Fort Myers at:

8900 Gladiolus Dr.Suite 201

(239) 267-7888

Hear Better Now

DRIANIS DURAN, AUD

OTOTOXICITY: An often overlooked cause of hearing loss

W hile in the midst of a year-long bout with pneumonia that even-tually left her with an

incurable lung disease called bronchiecta-sis, Sherry Howard worried more about retaining her ability to breathe than retaining her ability to hear.

“You can live without your hearing, but you can’t live without your lungs,” Sherry reasoned at the time.

While that may be true, Sherry soon learned that as a result of the strong cock-tail of antibiotics she was required to take to rid her of the pneumonia, her hearing would become greatly compromised as well. And for Sherry, that meant trouble.

“Hearing is rather critical for me because I work as a receptionist, answer-ing the phone for a group of about one hundred doctors,” Sherry explains. “� at’s why, when my doctor told me I was at

a high risk for losing my hearing, I did everything he told me.”

One of the � rst things Sherry’s doctor told her to do was visit a hearing special-ist and get a baseline hearing test. � e hearing specialist Sherry’s doctor recom-mended was Drianis Duran, AuD, at Gulf Coast Audiology in Fort Myers.

“Our role was to monitor the stability of Sherry’s hearing while she was being treated, because some medications are ototoxic, meaning they’re toxic to the ear, speci� cally the cochlea, the auditory nerve and some-times the balance nerve,” Dr. Duran reveals.

“� is ototoxicity can result in hearing loss, ringing in the ears, even vertigo. In some cases, these side e� ects are revers-ible, but many are not. In those cases, we work with the person on their hearing loss through the use of hearing devices.”

Sudden Change When Sherry � rst visited with Dr. Duran, her baseline hearing test showed she had near per-fect hearing. A little more than a month later, however, Sherry didn’t need a test to know things had changed dramatically.

“I was in about the � fth or sixth week of this six-week IV antibiotic treatment

that I was getting when all of a sud-den, I just couldn’t hear,” Sherry says. “I wasn’t totally deaf. I still had some hear-ing, but everything was very mu� ed.”

� e sudden loss of hearing prompted Sherry to reach out to Dr. Duran, who discovered during yet another exam-ination that Sherry’s hearing loss was permanent. But Dr. Duran had some good news for Sherry, too.

“Sherry was very lucky in that she didn’t lose all of her hearing,” Dr. Duran says. “She still had a lot of residual hear-ing, and we were able to treat that with hearing aids once her antibiotic treat-ments were done.”

Sherry chose a pair of Phonak devices that rest behind the ear but contain a small receiver that � ts inside the ear canal.

“I’ve had my hearing aids for about three years now, and they have been a godsend,” Sherry exudes. “If I didn’t have these hearing aids, I probably wouldn’t be able to work, but with them, I can carry on a very normal life.

“I feel very fortunate that I was sent to Dr. Duran. She’s fabulous and did a great job of helping me at a time when I was very, very sick. She came highly recommended, and I highly rec-ommend her as well for anyone who has a hearing problem.”FHCN article by Roy Cummings. Photo by Jordan Pysz.nj

A bout with pneumonia

cost Sherry her perfect hearing.

Hearing aids restored it

For Eye Floater SolutionsSouth Florida Eye Clinic is located

in Fort Myers at:

4755 Summerlin Rd. Call Dr. Geller at:

(239) 275-8222or toll-free at:

(877) 371-3937

Scott L. Geller, MD, is board certi� ed by the American Board of Ophthalmology. He is a graduate of Ohio Wesleyan University and Rush Medical College. While in medical school, he was awarded a student fellowship to study tropical medicine at a missionary hospital in India, and pursued additional studies at the famous Brompton Hospital in London, England. He interned at Presbyterian Hospital, Paci� c Medical Center, San Francisco, CA, and completed his residency in ophthalmology at Sinai Hospital of Detroit, which was a� liated with Wayne State Medical School and Kresge Eye Institute. Dr. Geller was fellowship-trained in anterior segment and

refractive surgery with Dr. William Myers of the Michigan Eye Institute. Dr. Geller is a fellow of the American Academy of Ophthalmology, and has presented papers on eye � oater laser treatment at the International Congress of Ophthalmology, European Congress of Cataract & Refractive Surgery, European Congress of Ophthalmology and the Florida Society of Ophthalmology.

SOUTH FLORIDA EYE CLINICSCOTT L. GELLER, MD

Dr. Geller has performed more than 15,000 documented � oater laser sessions.

Scott Geller, MD, teaches the technique worldwide

“L aser treatment of eye � oat-ers is fascinating,” says Scott Geller, MD, a board certified ophthalmologist

with a specialty clinic in Fort Myers. “I look forward to doing this every day. And our

reputation has become worldwide with the advent of the internet. We’ve had a steady � ow of patients from Europe, Canada, and even Russia, China, Arabia, and Israel.”

Dr. Geller can rightly claim to have started this niche area of ophthalmic surgery, with the largest, continuous clinical series, having performed more than 15,000 documented eye � oater laser sessions.

“I’m always asked why this useful treatment modality is not more widely available, or why some doctors try it but give it up,’’ Dr. Geller explains. “The answer is simple: there are no courses for training, and there is a lack of proper equipment.”

Dr. Geller was trained directly by the professor who researched laser inside the human eye at the famous University Eye Clinic in Bern, Switzerland.Dr. Geller adds: “� ey never thought this would be applica-ble to eye � oaters, but I proved them wrong.”

Dr. Geller uses the Swiss made Lasag laser.

“I have tried others, but there is absolutely no doubt in my mind this is the most versatile and precise instrument,’’ he notes. “In fact, I have two of them, and

I � y in the engineers from Switzerland to update and service them yearly.”

A Doctor and an EducatorDr. Geller has personally trained the most experienced ophthalmologists in the US, as well as the top surgeons from Italy and Holland, who have visited his Florida facility.

“I am concerned about colleagues rushing into some-thing new without having a formal preceptorship,’’Dr. Geller says. “It is easy to push the button, but not so easy to get the optimal result and avoid complications.”

To improve physician education, Dr. Geller gave an hour-long course this year at one of the country’s major ophthalmology associations.

“This was the first course of this quality anywhere in the US,’’ notes Dr. Geller. “And I am going back to Italy, where I was invited to lecture at a major

SCAN THIS TO YOUR

SMARTPHONE TO SEE ACTUAL

PATIENTS

See what Dr. Geller’s patients say about the Eye Floater Laser at www.vimeo.com/eye� oaters and on the Scott Geller MD YouTube channel.

ophthalmology meeting. � is is the fourth invitation, and I will also consult and treat patients there, as I have in the past.”

Dr. Geller welcomes other ophthalmol-ogists to come and observe, and to call if they need advice on di� cult cases.Article submitted by Scott Geller, MD. Photo by Jordan Pysz. mkb

is not

acceptable.”

“Live with it

Page 10 | Florida Health Care News | Winter 2019 | Lee County Edition

hearing Care

ophthalmology

Get Going with GAINSWave®

NICHOLAS H. KALVIN, MDMICHAEL J. CANNONE, DO

Nicholas H. Kalvin, MD, attended DePauw University in Greencastle, Indiana for his undergraduate educa-tion in pre-medicine. He then earned his medical degree from The Ohio State University College of Medicine in Columbus. He finished a rotating internship at The Ohio State University Medical Center, then completed a res-idency at the world-famous Bascom Palmer Eye Institute with the University of Miami Medical School Department of

Ophthalmology. Dr. Kalvin joined the US Naval Reserve in 1955 and was called to active duty in 1960. Dr. Kalvin attended the US Navy School of Aviation Medicine and graduated as a � ight surgeon. He is certi� ed by the American Board of Ophthalmology and is a lifetime member of the American Medical Association and the Florida Medical Association.

To learn more about Gulf Coast Men’s Health and the services provided, visit them online at gulfcoastmenshealth.com

Care With Discretion and Professionalism

The staff at Gulf Coast Men’s Health understands that erectile dysfunction is a personal matter that affects men’s lives in so many ways. Gulf Coast Men’s Health has the solution. For more information or to schedule an appointment, call or visit their offi ce in Fort Myers at:

4100 Center Pointe DriveSuite 110

(239) 245-7840

Drug-free, noninvasive therapy is e� ective option

Patrick* is the man. He’s a motorcycle-riding hearing aid specialist from New Jersey. He’s been living in Florida for 28 years and working in the hearing aid business for more than half

of them. At 60, he doesn’t consider himself old, but the diabetes he’s been battling for 15 years was beginning to a� ect his abilities in the bedroom.

“� ings were happening to me that I didn’t like,” he con� des. “I was experiencing ED, erectile dysfunction. It was frustrating because there were times I could per-form and times I couldn’t. It was also frustrating for my partner, even though she said she understood. I’m not so old to not worry about ED. I still feel young, and sex is a part of my life.

“I started looking up di� erent treatments, like the blue pill, VIAGRA®. I took that, but I didn’t like the aftermath – the feeling of pressure building up in my head and how everything turned a slight blue. I looked at other avenues to see what else was out there, and I tried this, that and the other thing.”

ED is the inability to achieve or sustain an erection suitable for sex. It’s essentially a circulatory problem. Under normal circumstances, when the penis is stimulated, it in� ates with blood into two large chambers, resulting in an erection. With ED, that blood � ow is impeded.

For years, medications such as VIAGRA and CIALIS® were the � rst line of defense against ED. If med-ications were unsuccessful, the next treatment option was generally injections into the penis. If they failed, the last resort approach was penis implants.

“I was really thinking about going under the knife and having the implants put in,” admits Patrick. “I didn’t want to do it, but I didn’t want my partner to leave me, and I didn’t want her to have to go on like that. I knew I had to get help.”

Sonic SolutionPatrick did an internet search for ED and found Gulf Coast Men’s Health in Fort Myers. � ey o� er another, better option for treating men with ED called GAINSWave therapy, which is drug-free, noninvasive and virtually painless.

“I was kind of hesitant to go to Gulf Coast Men’s Health at � rst because I thought there’d be a woman out front, and as a guy, I didn’t want to open up to someone of the opposite sex,” Patrick relates.

“But I went in, and sure enough, it was a guy who greeted me. I talked with him for a while and then

another guy came out and we talked some more. After that, I decided to give the GAINSWave therapy a shot.”

“GAINSWave therapy works to improve blood � ow by directing sound waves to the penis and sur-rounding areas,” describes Lou Cambino, a nurse at Gulf Coast Men’s Health. “� e treatment also stimu-lates the growth of new nerve tissue, which is vital for achieving and maintaining healthy erections.

GAINSWave uses low-intensity shockwaves, or sound waves, to improve circulation in the penis. It works through the physical vibration from sound.

“It’s the same as a sonic boom when a jet passes by except in this case, the sound waves are created by a convex metal plate,” explains Nicholas H. Kalvin, MD, medical director at Gulf Coast Men’s Health. “� is metal plate sends radiating sound waves an inch into the penis tissue, give or take a quarter of an inch.

“The sonic boom from a jet rattles the windows,” he adds. “The rattling of the GAINSWave sound waves stimulates stem cells in the penis to wake up, reproduce and repair damaged cells. It also stimulates blood vessels to rejuvenate and the endothelium to create new blood vessels. GAINSWave improves the vascular and cellular health of the penis.”

� e sound waves also help stimulate the tissue in the penis by breaking up scar tissue and plaque. When this is done repeatedly over a brief period of time, it restores the tissue of the penis and improves blood � ow.

“Sometimes, men who have not had good erections or intercourse for a long time start to lose sensitivity during sex,” observes Dr. Kalvin. “Another bene� t of GAINSWave ther-apy is that by increasing blood � ow, the nerve endings in the penis are also stimulated, improving sensitivity of the penis.”

A GAINSWave treatment session takes about 20 min-utes. A course of therapy is generally six sessions twice a week for three weeks. However, older men with more comorbidities, such as lifetime smoking, diabetes, high blood pressure and heart disease, may need more sessions.

“For younger men, one course of six sessions is gen-erally su� cient,” states Dr. Kalvin. “However, men in their seventies, eighties or nineties with health issues have to be more realistic. It may take them twelve, eighteen, twenty-four or even thirty treatments. But it does work. More than seventy percent of men who have GAINSWave therapy respond to it.

“Results do not happen right away,” the doctor cau-tions. “It takes several treatments, but most men notice a signi� cant change in their status between treatments six and eight. � e e� ect of the GAINSWave therapy will last one to two years. Some clinics recommend a refresher ultrasound treatment every three to six months.”

“� ere are some clinics o� ering GAINSWave that say it’s a cure,” warns Lou. “I wish I had a cure for men with ED. What GAINSWave really does is drop the men’s conditions down a notch or two in severity. Maybe it brings them back to where the medications are e� ective for them again. � e bottom line is that GAINSWave therapy restores proper blood � ow, and that’s what’s most important.”

GAINSWavetreatments help stimulate stem cells and break up scar tissue

and plaque

Back in TimeFor someone who was considering penis implants, GAINSWave therapy at Gulf Coast Men’s Health saved Patrick from surgery. He also responded amaz-ingly well to the treatment.

“Even after the � rst session, I felt something going on,” Patrick enthuses. “By the third or fourth session, it was like a kick-start. Everything started performing correctly at the right time. I went to Gulf Coast Men’s Health and gave Lou the biggest hug because he told me it would work.

“My partner is absolutely loving it. I’m back to who I used to be. It’s like I’m twenty years old again. I can’t believe it.”

Patrick is so thrilled with his results that he plans on returning to Gulf Coast Men’s Health on a routine basis for a tune-up.

“I’m absolutely satis� ed with my sex life now,” he mar-vels. “But I’m going to continue with GAINSWave therapy. I’m going to go back for sessions probably every three to four months just to be sure everything stays the way it is now.

“I recommend GAINSWave therapy to anybody who is starting to have a little issue here or there. � ey need to get in to Gulf Coast Men’s Health before the problem gets really bad. I think what they’re doing there is phenomenal.”FHCN article by Patti DiPanfilo. Photo courtesy of Pixabay. mkb

*Patient’s name withheld at his request.

Lee County Edition | Winter 2019 | Florida Health Care News | Page 11ereCtile DysfUnCtion

Michael J. Andersen, DDS, earned his undergraduate degree from Ohio University and his Doctor of Dental Surgery degree from Case Western Reserve University, Cleveland. Dr. Andersen also completed a post-doctoral program in advanced general dentistry at CWRU. He is a member of several professional associations, including the American Dental Association, and is past president and a board member of The Society for the Preservation of Oral Health.

Before After

All-porcelain crowns look more natural,last longer than predecessors

A s a young woman growing up under the communist regime in the Czech Republic, Zorka* had little access to quality dental care. So, whenever a problem arose, she had no

choice of provider or in� uence on treatment decisions.“I grew up during the communist time, and the way

they treated our teeth was horrible,” she describes. “When I was eighteen years old, I had an abscess in the front. � ey took the nerve out, and my tooth was black after that. So, I was an eighteen-year-old girl with a black tooth.”

A Crown Jewel

Here For YouDr. Andersen and his staff at Bell Tower Dental Care welcome your questions about implant, restorative and family dentistry. To learn more or to schedule an appointment, call or visit their offi ce in Ft. Myers:

5245 Big Pine Way,Suite 103

(239) 332-5660

appearance of the teeth can also make a world of di� erence in a patient’s outlook.

People can become self-conscious when they aren’t happy with their smiles, and they may not let themselves laugh or have as much fun as they otherwise would. Unattractive teeth can de� ate their self-esteem and cause them to reserve their smiles. By designing all-porcelain crowns for Zorka, Dr. Andersen could improve her function and her smile.

“Most crowns made in the past had metal understructures with por-celain built up over the top of them,” re� ects Dr. Andersen. “But patients would complain about the black lines or exposed metal that would eventually be revealed as their gums receded with age. In addition, women particularly have a tendency toward metal allergies, which means that the crowns could cause an allergic reac-tion around the gums, resulting in redness and pu� ness.

“Fortunately, today’s all-porcelain crowns are very strong, durable and more natural looking. � erefore, our o� ce uses only all-porcelain crowns.”

In those cases when patients decide they want their anterior crowns to be a little longer, shorter, wider or rounder than their natural teeth, Dr. Andersen can prepare what is called a wax-up, or a wax model of how the enhanced teeth will look.

Next, the teeth are prepared for the new restorations. Old dentistry is removed to ensure there is no decay underneath, and � llings are replaced with a buildup, which is

a � lling replacement that goes underneath the crown to complete the preparation.

Impressions are then made for the laboratory, and temporaries are made for patients to wear while the actual crowns are being created. � e temporaries are not only functional, but also give the patients an opportunity to con� rm that their new smile design feels and looks like they hoped.

� e dentist with the artist’s eye points out, “We do not use an in-house crown-making device because we feel we can’t get the custom shading and individualized forms we are looking for from it.

“Instead, we share a private laboratory with two other dentists where we can have the skilled technician

create exactly what we want for our patients. � is takes a little longer, but our patients feel it is worth the wait.”

The temporaries are removed once the crowns are � nished. � e crowns are

then � tted, with any slight adjustments that need to be made being done at that time. Finally, the crowns are permanently placed.

All-porcelain crowns, when shaded appropriately, blend in per-fectly with the patient’s surrounding teeth.

“� e crowns are made of trans-lucent porcelain without metal underneath, so they reflect light more like tooth enamel,” informs Dr. Andersen. “That gives the all-porcelain crowns a much more natural

appearance. No one knows the patient has the restorations.”

Simple SatisfactionWhen she � rst moved to Florida, Zorka tried a few dentists, but they fell short of her expectations. � ey and their sta� s didn’t have the “right stu� .” When she went to Dr. Andersen, however, she discovered a practice with the whole package.

“� e o� ce is very friendly,” comments Zorka. “I feel very comfortable there. � ey have a nice o� ce and a good team. I highly recommend them.

“Dr. Andersen doesn’t waste time. He does the appointments in a short time in the way it has to be done, and you don’t have to go over and over again.”

Zorka is also impressed with how Dr. Andersen has stayed on the forefront of dentistry as it has advanced over the years.

“I have a lot of experience [with dentistry], because I’ve been doing this for a long time,” she remarks. “I’ve seen the technology and how everything has improved, with things like implants. I don’t know if he even did implants when I started with him, but when I needed one, he did it. And the � nal result is very good.”

Zorka is most thrilled with the all-porcelain crowns Dr. Andersen used to restore her failing teeth. For the � rst time in her life, she now has a smile she is proud of.

“I love them,” Zorka enthuses. “� ey replaced my teeth and I’m very happy. � e front looks good. � ey’re comfortable. � ey stay. � ey’re easy to take care of. I wish I had all crowns.” FHCN article by Patti DiPanfilo. Before and after images courtesy of Bell Tower

Dental Care. mkb

*The patient’s name was changed at her request.

In 1979, Zorka left Prague and moved to New Jersey. � ere she found a dentist who began the process of rehabilitating her smile. He began by tackling that highly visible black front tooth.

“I came to America with pretty bad teeth,” she admits. “My dentist in New Jersey put a crown on my tooth, but it was the old-fashioned crown where you glued it right on top.”

About ten years ago, Zorka moved again, this time to Naples, where she operates an upscale hair salon. � e move meant she needed to � nd a new dental provider. Because she required so much dental care, she didn’t want just any dentist.

“When I came to Florida, I didn’t have anybody and I didn’t go for a while,” she notes. “I saw a few people, but I wasn’t too happy. � en my neighbor recommended Dr. Andersen, and I’ve been going there since. He helps me keep my bad teeth together.”

Zorka’s white knight is Michael J. Andersen, DDS, a dentist with an artist’s touch who practices in Ft. Myers at Bell Tower Dental Care. Dr. Andersen has a keen eye for aesthetics, having earned his undergraduate degree in � ne arts before pursuing his dental degree and post-doctoral education in advanced dentistry.

When she � rst met him, Zorka knew right away that Dr. Andersen was exactly what she was looking for in a dentist.

“I was very impressed with the fact that he didn’t push a lot of things like the other o� ces were,” she states, “because in my mouth, a dentist can do a lot of work. He just focused on the problem I had and he � xed that, and then, little by little, he did a little bit more.

“Then there was my smile,” Zorka shares. “My front teeth were very, very bad and just looked horrible. I couldn’t really � nd anybody who wanted to do a big job like that, but Dr. Andersen did, and he did it in like two or three visits, and he did a beautiful job.”

Form and FunctionDr. Andersen recognized that Zorka’s case was a chal-lenge, but he was not deterred. He was determined to restore her smile, so he prepared a thorough treatment plan as a roadmap to get there.

“For one thing, I was going to have to replace the existing crown she had on her front tooth,” Dr. Andersen explains. “Many of her other teeth were failing and were also going to need restorations. � ey were going to have to be protected with crowns.”

In addition to safeguarding the teeth, the crowns would make a huge difference in the aesthetics of Zorka’s smile, Dr Andersen adds. Improving the

For more information, visit www.belltowerdentalcare.com

MICHAEL J. ANDERSEN, DDS

Page 12 | Florida Health Care News | Winter 2019 | Lee County Edition implant, restorative anD family Dentistry