FloridaMD Medical/Business Magazine For Physicians October 2011

OCTOBER 2011 CENTRAL FLORIDA EDITION
Halifax Health
Center for Oncology
Tradition, Talent, Technology
Introducing
technology
that doesnt just
break down walls
it goes right
through them.
In our innovative new state-of-the-art operating suites, we can perform 3-Tesla MRI and 40-Slice CT scans before, after,
and most Importantly, durIng surgery. ThIs allows us to conrm the success of a braIn or spIne surgery before the patIent
ever leaves the room. Combined with other groundbreaking technologies, these operating suites provide our nationally
recognized neurosurgeons the best tools in the country to perform surgery with the highest levels of precision. In fact,
we are the only hospital in the Southeastern United States to offer this level of technology and patient safety.
Call (800) 626-6170 to speak to one of our patient care coordinators
about what treatment option might be best for you, or learn more
at NeurosurgicalRevolution.com.
FLORIDA MD - OCTOBER 2011 1
contents
OCTOBER 2011
CENTRAL FLORIDA EDITION
4
COVER STORY
DEPARTMENTS
21 FOR YOUR ENTERTAINMENT
35 CURRENT TOPICS
Many medical professionals and residents in East Central Florida may not be aware,
but the Halifax Health Center for Oncology in Volusia County ofers a very unique
cancer program. Tree aspects of the program that stand out are the long-standing
tradition with a Commission on Cancer accreditation since 1956, the unique talent of
the physicians and staf - and the technology including equipment, genetics and non
proft clinical trials.
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2 FROM THE PUBLISHER
9 PHARMACY UPDATE
10 MARKETING YOUR PRACTICE
12 MEDICAL MALPRACTICE ExPERT ADVICE
13 ORTHOPAEDIC UPDATE
14 HOT TOPICS IN DERMATOLOGY
16 DIGESTIVE AND LIVER UPDATE
19 WEALTH MANAGEMENT
22 FACIAL COSMETIC SURGERY

24 FERTILITY
26 PULMONARY AND SLEEP DISORDERS
FLORIDA MD - OCTOBER 2011
FROM THE PUBLISHER
Publisher: Donald Rauhofer
Photographer: Donald Rauhofer / FloridaMD
Contributing Writers: Jennifer Miller, Sam
Pratt, RPh, FIACP, Ross Clevens, MD, , Harinath
Sheela, MD, Sijo Parekattil, MD, Matt Gracey,
Jennifer Thompson, Tom Murphy
Designer: Ana Espinosa
Florida MD is published by Sea Notes Media,LLC,
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Notes Media. All rights reserved. Reproduction in whole or in part
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ADVERTISE IN FLORIDA MD
For more information on advertising in
the Florida MD Central Florida Edition,
call Publisher Donald Rauhofer at
(407) 417-7400,
fax (407) 977-7773 or
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Email press releases and all other
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PREMIUM REPRINTS
Reprints of cover articles or feature
stories in Florida MD are ideal for
promoting your company, practice,
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Call Florida MD for printing estimates.
I
Iam pleased to bring you another issue of Florida MD Magazine. Its hard to imag-
ine anyone who is not familiar with the March of Dimes and the work they do to
always reinventing themselves to create new programs and services. Coming up next
month is the annual March for Babies. Its a wonderful team-building opportunity for
-
tions on how you and your family can join the march or how to form a team for your
whole practice. I hope to see some of you there.
Warm regards,
Donald B. Rauhofer
Publisher/Seminar Coordinator
FROM THE PUBLISHER
ADVERTISE IN FLORIDA MD
For more information on advertising in
the Florida MD Central Florida Edition,
call Publisher Don Rauhofer at
(407) 417-7400,
fax (407) 977-7773 or
www.oridamdmagazine.com
Send press releases and all other
related information to:
Florida MD Magazine
P.O. Box 621856
Oviedo, FL 32762-1856
PREMIUM REPRINTS
Reprints of cover articles or feature
stories in Florida MD are ideal for
promoting your company, practice, ser-
vices and medical products. Increase
your brand exposure with high quality,
4-color reprints to use as brochure
pieces, and trade show handouts.
Call Florida MD for printing estimates.
Publisher: Donald Rauhofer
Associate Publisher: Joanne Magley
Photographer: Tim Kelly / Tim Kelly Portraits,
Donald Rauhofer / Florida MD Magazine
Contributing Writers: Joanne Magley, Sam
Pratt RPh, Mitchell Levin, MD, Jennifer
Thompson, Vincenzo Giuliano, MD, David S.
Klein, MD, Stephen P. Toth, CLU, Jennifer
Roberts
Florida MD Magazine is published by Sea Notes Medical Seminars,
PA, P.O. Box 621856, Oviedo, FL 32762. Call (407) 417-7400 for
more information. Advertising rates upon request. Postmaster: Please
send notices on Form 3579 to P.O. Box 621856, Oviedo, FL 32762.
Although every precaution is taken to ensure accuracy of published
materials, Florida MD Magazine cannot be held responsible for
opinions expressed or facts expressed by its authors. Copyright 2010,
Sea Notes Medical Seminars. All rights reserved. Reproduction in
whole or in part without written permission is prohibited.
Steps for New Users:
1. Go to marchforbabies.org
2. Click JOIN A TEAM
3. Search for your team name in the
search box.
4. Click on your team name
5.
password for future reference.
Some keys to success: Ask your friends,
family and colleagues to support you by
reason why people do not donate is that
no one asked them to give (dont be shy)!
Emailing them is an easy way to ask.
Youre done! Your personal page has been
created for you and you are ready to begin
fundraising!
Join more than a million people walking in March of Dimes, March for Babies and
raising money to help give every baby a healthy start! Invite your family and friends
to join you in March for Babies, or even form a Family Team. You can also join with
your practice and become a team captain. Together youll raise more money and share
a meaningful experience.
When
Saturday, April 24th
7am Registration 8amWalk
Where
Lake Lily Park, Maitland
For more information on March
for Babies please call:
Phone: (407) 599-5077
Fax: (407) 599-5870
Central Florida Division
341 N. Maitland Avenue, Suite 115
Maitland, FL 32751
2 FLORIDA MD MAGAZINE - MARCH 2010
I
am pleased to bring you a new issue of Florida MD. Tis month as we focus on cancer, I was
looking for an appropriate charity or non-proft to feature in this column. I recently became aware
of Rock Pink which was a perfect ft. As you will read below, Rock Pink is an Orlando-based 501(c)(3)
charitable organization that, among other things, helps under-insured and non-insured Central
Florida residents to obtain breast screenings and initial treatments for breast cancer. Please join me in
supporting this wonderful organization and their eforts to help women in Central Florida.
Best regards,
Donald B. Rauhofer, Publisher
Rock Pink is an Orlando-based 501(c)(3) charitable organization that is on a mission to bring music and humanity together center
stage while raising breast health awareness and supporting local breast cancer programs. Organizations like Libbys Legacy, the Young
Survival Coalition, Florida Hospitals Eden Spa, and MD Anderson - Orlando are among those who have received fnancial and
volunteer support from Rock Pink. Trough these partnerships, we ofer: education to the unknowing and unaware, distractions
for patients during difcult and painful cancer treatments, dignity and improved self-image to those who have already undergone
cancer treatments, and the ability for under-insured and non-insured Central Florida residents to obtain breast screenings and initial
treatments for breast cancer.
Rock Pink is an all-volunteer organization and all members, including our Board and Ofcers, receive no compensation for their
time. All of the monies received by Rock Pink, after expenses, go towards our mission.
Rock Pink attends events each year, reaching tens of thousands of Central Floridians, in an efort to raise breast health awareness
and communicate the importance of early detection through our mantra, Get to Know Your Breasts.
We are driven to focus on the

humanitarian aspect of those afected by breast cancer, as is evidenced by our Music and Humanity Initiative, which, among other
things, provides Apple iPads to cancer treatment centers. We are currently working on our second and third installment of this
initiative. In addition, we are in the process of identifying a viable partner to provide house-cleaning services to those Central Florida
residents whose lives are being afected by breast cancer.
To learn more about Rock Pink, please visit www.rockpink.com.
2
Coming next month: Our cover story features Zamip Patel, M.D., urologist/
andrologist at East Orlando Urology and Florida Hospital East Orlando. Also, there will be a Special
Feature by Halifax Health on Meaningful Use. Editorial focus is on Urology and Geriatric Medicine.
is you
The key
ingredient
First, bring together top local chefs from across Central Florida to showcase their culinary master-
pieces. Next, mix in a generous sampling of fine wines, craft beers and signature cocktails.

Finally, add in fabulous entertainment and a lively auction featuring one-of-a-kind packages, and
youve got a perfect recipe for a Signature Chefs Auction event.

This year, we are celebrating the Central Florida food culture by asking our chefs to feature locally
sourced ingredients and fresh, seasonal produce from Florida.

All proceeds benefit the March of Dimes mission to improve the health of babies by preventing
birth defects, premature birth and infant mortality.
The Recipe
The Basic Ingredients
THURSDAY, November 10, 2011

9939 Universal Blvd
Orlando, FL 32819
6:00 p.m. to 10 p.m.
Attire: Cocktail/Business
2011 Sponsors .......
A COPY OF OUR OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLI NG 1-800-435-7352 TOLL-FREE WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT.
REGISTRATION NUMBER CH569
facebook.com/marchofdimescentralflorida twitter.com/marchofdimescfl
For sponsorship opportunities, table sales or to reserve your tickets
please visit www.marchofdimes.com/florida or call 407-599-5077 ext. 33
COVER STORY
Halifax Health Center for Oncology
Tradition, Talent, Technology
By Jennifer Miller, Staff Writer
Many medical professionals and residents in East Central
Florida may not be aware, but the Halifax Health Center for
Oncology in Volusia County ofers a very unique cancer pro-
gram. Tree aspects of the program that stand out are the long-
standing tradition with a Commission on Cancer accreditation
since 1956, the unique talent of the physicians and staf - and
the technology including equipment, genetics and non proft
clinical trials.
Tere is no longer a one-size-fts-all approach to cancer
treatment. Oncologists at Te Center for Oncology personalize
treatment plans to ofer each patient the best possible outcome
for his or her unique circumstances. Individualized treatment
strategies may include surgery, chemotherapy, radiation ther-
apy, hormonal therapy, targeted therapy, biological therapy or
any combination of these. Regardless of the combination, the
physicians at Te Center for Oncology are dedicated to help-
ing patients heal. Dr. Joyce Battle, M.D., Radiation Oncologist,
shares, Te three worst words in medicine are you have cancer.
Cancer patients are often so nervous and anxious. Our goal is to
get them to smile before they walk out our doors.
Te Center for Oncologys programs include outpatient medi-
cal and radiation oncology services, the areas only robotic trained
gynecologic oncology program, the Breast Health Center, coun-
seling and support groups, screening and detection services, Tu-
mor Registry cancer data system and the Josephine Field David-
son Cancer Resource Library. Halifax Health also ofers the areas
only specialized inpatient oncology unit on the main campus in
Daytona Beach and four outpatient service centers located in
Daytona Beach, Ormond Beach, Port Orange and ofered joint-
ly with Bert Fish Medical Center in New Smyrna Beach.
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Halifax Health - Center for Oncology Daytona Beach Location
Patients who hear the three worst words in medicine you have cancer can be
comforted by the world class care available right here at home.
TRADITION
Te Center for Oncology at Halifax Health Medical Center is
the second oldest accredited cancer program in the state of Flori-
da, having been accredited through the American College of Sur-
geons Commission on Cancer since 1956. In 1998, stereotactic
radiosurgery, the most precise, non-invasive method of reaching
tumors and other problem areas deep within the brain, was frst
introduced to the Central Florida region by Halifax Health. With
approximately 4,000 employees, Halifax Health is one of Central
Floridas largest employers and is consistently ranked in the Or-
lando Sentinels Top 100 Companies for Working Families.
Halifax Health received the HealthGrades Distinguished Hos-
pital for Clinical Excellence Award, ranking it in the top fve per-
cent of all hospitals in the nation for clinical outcomes. National
Research Corporation has named Halifax Health Medical Center
as Volusia and Flagler counties most preferred hospital, present-
ing the hospital with their Consumers Choice Award every year
since 1996. Te Center for Oncology was one of the frst ra-
diation oncology facilities certifed by the American College of
Radiology and is currently certifed by the American College of
Radiation Oncology.
Halifax Health Center for Oncology is a leader in oncol-
ogy treatment advancements. Recognized accomplishments in-
clude being the frst and only dedicated inpatient oncology unit
in the area and creating the frst clinical trial/research program,
Community Clinical Oncology Program (CCOP), a network for
conducting cancer prevention and treatment clinical trials estab-
lished through a federal grant in 1984.
Te Center for Oncology is proud to consistently be a frst
in the area ofering the frst and only cancer genetics screening
in our area, the frst da Vinci Robotic Surgery System to cover
multiple counties in Central Florida, the frst and only full time
Gynecological oncology services treating multiple counties in the
area, the frst stereotactic radiosurgery program, the frst nuclear
oncology program, the frst use of PET/CT for radiation oncol-
ogy patient simulations for radiation therapy treatments, the frst
treatment with partial breast radiation therapy, including both
the frst use of the mammosite device and the frst use of the SAVI
device as well as the frst use of robotic radiation therapy.
Another unique service ofered by the Center for Oncology is
a full time, oncology trained, registered dietician. Adequate nu-
trition can help ensure maintenance of strength and energy and
help promote healing. Patients at Halifax Health beneft from
this service which promotes the understanding that nutrition is
just as crucial during cancer recovery as it is during treatment.
TALENT
We think of ourselves as a family of professionals working
together to provide comprehensive cancer care, Gregory Favis,
M.D., Halifax Health Medical Oncologist.
Physicians and staf afliated with Halifax Healths cancer cen-
ter possess more years of collective experience than any center in
the area. Te teams experience is specifc in utilizing the most
efective and up-to-date cancer fghting technologies and tech-
COVER STORY
niques such as stereotactic body radiation therapy (SBRT), ste-
reotactic radiosurgery (SRS), image-guided radiotherapy (IGRT),
and intensity-modulated radiation therapy (IMRT).
Te professionals at Halifax Health are academically driven.
Dr. Battle believes, Halifax Health will become more academic
in the next 10 to 15 years. We are already teaching third and
fourth year medical students.
Te ten physicians, including GYN, Medical and Radiation
Oncologists bring with them almost two hundred years of experi-
ence treating and diagnosing all types of cancer. Patients coming
to the Halifax Health Center for Oncology are seeing oncolo-
gists who trained and worked at facilities such as the Harvard
Joint Centers, Vanderbilt, Mayo Clinic, Fox Chase Cancer Cen-
ter, Mallinckrodt Institute of Radiology, and many other nation-
ally know centers of excellence.
Our exceptional staf of pharmacists, physicists, dosimetrists,
nurses, therapists, and support staf are board certifed and li-
censed in their areas of specialization. In addition to their knowl-
edge, you will not fnd friendlier, more compassionate profession-
als caring for cancer patients during this challenging time in their
life.
TECHNOLOGY
NOT-FOR-PROFIT CLINICAL TRIALS
Halifax Health is leading the way in clinical trials and research.
Catherine McQuade collaborates with Joanne Smith
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Oncologists afliated with the center
are participating in life-saving research
and trials through the Community
Clinical Oncology Program (CCOP).
Te program was established through
a federal grant in 1984 allowing pa-
tients of the center to take advantage
of clinical trial and research opportu-
nities that are not available elsewhere
in the area.
Te programs current clinical trials
focus mainly on breast, gastrointes-
tinal/colon and lung cancers. Many
of the trials involve combining drugs
with various treatment methods. Over
the years, Central Florida patients
have benefted from this program by
having easy access to emerging break-
throughs in cancer treatment. In some
cases, this is the diference between
surviving cancer and death.
HEREDITARY CANCER RISK ASSESSMENT
Hereditary cancers occur when a person is born with a change
or mutation in a single copy of a protective gene pair. Because
people with an inherited mutation have only one working copy
of a protective gene, damage to that remaining gene may occur
in fewer steps and over a shorter period of time. Tis change can
increase the risk for certain cancers in diferent parts of the body.
Te medical community uses the term genetic susceptibility to
describe the fact that people with an inherited mutation have an
increased risk for cancer.
Te change does not increase the risk for every type of cancer
and not everyone who is born with a gene change will develop
cancer; risks vary according to the exact mutation that was in-
COVER STORY
herited. Many other factors afect the risk of cancer in someone
born with a gene mutation. Scientists do not know all the factors
that determine whether or not a person with a gene change will
develop cancer over the course of his or her lifetime.
Te term hereditary cancer syndrome describes an inherited
gene mutation that increases the chance to develop one or more
types of cancer. For instance, the main hereditary breast cancer
syndromescaused by mutations in the BRCA1 or BRCA2
genesare also associated with an increased risk for ovarian
cancer. Te main hereditary colon cancer syndrome, called He-
reditary Nonpolyposis Colorectal Cancer (HNPCC), can also be
associated with an increased risk for ovarian cancer or uterine
cancer. Other, rarer cancer syndromes can be associ-
ated with a wide variety of cancers.
Te Hereditary Risk Assessment Program at
Halifax Health Center for Oncology currently
ofers testing and counseling for patients at risk of
hereditary forms of breast, ovarian, melanoma and
colorectal cancers.
NOVALIS Tx LINEAR ACCELERATOR
Halifax Health Center for Oncology is continu-
ally searching for the latest, state-of-the-art technol-
ogies for treating patients. Te newest technology
in the radiation oncology department is the Nova-
lis Tx, a powerful radiosurgery system that delivers
high-intensity radiation to precisely treat lesions,
without afecting surrounding healthy tissue. Hali-
fax Health is again a frst in bringing this technology
to the area.
Te Novalis Tx ofers many advantages to the pa- P
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Dr. Kelly Molpus GYN Oncologist Consults with Patient
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NovalisTx
COVER STORY
tient. Benefts include a non-invasive, versatile combination of
technologies for the treatment of a wide range of malignancies
and other potentially debilitating conditions, no harm to nearby
healthy tissue, as well as no need for traditional surgery. Sharp,
precise beams of radiation can treat millimeter-sized lesions or
tumors with sub-millimeter accuracy when targeting afected tis-
sues and areas. More power, delivered at a higher speed equals
less treatment time. Te system also features adaptive gating, a
very important component that corrects patient positioning so
the target is not afected by movement of the patient.
Te Novalis Tx is combined with the Exac Trac Imaging Sys-
tem to ensure accuracy of one millimeter. Te Exac Trac system
along with the Novalis Tx employs several highly sophisticated
imaging sources, robotics and software to pinpoint the exact loca-
tion of the tumor and position the patient properly for treatment.
With the combination of these technologies, multiple beams of
radiation converge on the tumor to destroy the cancer non-inva-
sively. Charles Hechtman, Ph.D., M.D., Radiology Oncologist at
the center explains, High precision, multiple volumes of radia-
tion can be delivered directly and precisely to the tumor without
surgery through this highly sophisticated equipment.
Previously, patients receiving radiation treatment would have
been required to endure metal brackets being attached to the
skull and drilling into the skull. With the Novalis Tx system, this
is not required anymore. Rohit Khanna, M.D., Neurosurgeon at
Halifax Health says, Patients used to be extremely apprehensive
of the process of bracing and drilling into the skull. Patients can
be more comfortable with the non-invasive treatment procedure
we ofer with the Novalis Tx.
SAVI BREAST BRACHYTHERAPY
Another example of leading tech-
nology available at Halifax Health
is SAVI Breast Brachytherapy. Te
SAVI breast brachytherapy ap-
plicator is the latest advancement
in the delivery of radiation therapy
for early-stage breast cancer. SAVI
uses multiple catheters to precisely
target radiation where it is needed
most, while minimizing exposure to
healthy areas, like the skin or chest
wall. Tis allows radiation oncolo-
gists to customize treatment based
on each patients anatomy. SAVI
treatments are normally delivered
twice a day over a 5-day course,
reducing treatment time by several
weeks.
Breast brachytherapy uses radia-
tion to treat the lumpectomy cavity
and the surrounding tissue from the
inside out. Each catheter indepen-
Mesh Mask for Novalis Tx
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dently delivers radiation to the tissue, which enables physicians
to direct radiation to the tumor while minimizing exposure to
healthy areas.
By allowing the radiation oncologists and surgeons to custom-
ize treatment for each patient, SAVI may increase the number of
women who are able to choose APBI (Accelerated Partial Breast
Irradiation) as a treatment option. When therapy is individual-
ized, physicians can provide patients with a higher quality of care.
Rebecca Wall, a patient able to take advantage of the SAVI treat-
ment at Halifax Health shares, Doctors at the Center for Oncol-
ogy customized the SAVI treatment for my tumor. Tey were
able to fght my cancer with the exact dose I needed. SAVI isnt
available everywhere. Fortunately, I was treated at Halifax Health
and was able to take advantage of this life-saving treatment.
Te SAVI treatment is signifcant for women. It results in good
cosmetic outcomes, reduces the potential for side efects typically
associated with radiation therapy and requires no anesthesia. For
doctors, the devices single-entry insertion maximizes ease of use.
SAVI utilizes multiple catheters that independently deliver radia-
tion to the tissue, providing physicians with superior dose control
and the ability to customize radiation treatment for each patient
allowing physicians to provide better clinical care.
DA VINCI
SI ROBOTIC SURGERY
Halifax Health Medical Center has used the da Vinci Si
Robotic Surgery System for many surgical procedures including
gynecologic oncology procedures, general gynecologic procedures
and prostate procedures. Te da Vinci Si Robotic System is the
worlds only robotic surgical system with 3D high-defnition
vision.
8
Most surgeons using the da Vinci Si System agree that there
are numerous benefts to patients who have their procedures com-
pleted with the new technology, rather than having traditional
open surgical procedures. Tese include: smaller incision, less
pain, quicker recovery time, less blood loss, generally shorter hos-
pital stay and quicker return to normal activities of daily life. In
fact, a 2003 study found that da Vinci cut blood loss about 75
percent, reduced the time patients needed a catheter by 50 per-
cent and got patients out of the hospital quicker. Not everyone
requiring surgery will qualify for the da Si Vinci System. Te
best surgical method will be decided after careful consultation
between surgeon and patient. Patients at Halifax Health have ac-
cess to this option that can signifcantly reduce surgical impact,
hospital stays and recovery times.
THE CANCER RESOURCE IN CENTRAL
FLORIDA
Oncologists at Halifax Health possess decades of combined ex-
perience in treating patients with the latest and proven cancer
fghting treatments and therapies. Te center ofers outpatient
medical and radiation oncology services, a specialized gyneco-
logic oncologist, breast health and hereditary cancer risk assess-
ment, support groups, clinical research, screening and detection
services, Tumor Registry cancer data system and the Josephine
Field Davidson Cancer Resource Library.
At Halifax Health, cancer care is comprehensive and state-of-
the-art. Te Center for Oncology serves as the leading cancer care
provider in Volusia County, with a long history of treating all
types of patients and cancers. Accredited by the Commission on
Cancer since 1956, it ofers some of the most advanced oncology
and neurosurgical capabilities in the state as well as the country.
Whatever the cancer, physicians and staf at Halifax Health
Center for Oncology have the experience and expertise to help
patients become cancer survivors.
CONTACT INFORMATION:
Halifax Health Center for Oncology
303 N. Clyde Morris Blvd.
Daytona Beach, FL 32114
386.254.4211
halifaxhealth.org/oncology
Comprehensive Oncology care since 1956
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COVER STORY
PHARMACY UPDATE
Sam, I Have Shingles, Now What??
Shingles is an acute infection caused by the herpes zoster virus,
the same virus that causes chickenpox. It is most common after
the age of 50 and the risk rises with advancing age. Shingles oc-
curs because of exposure to chickenpox or reactivation of the her-
pes zoster virus, which remains dormant in nerve roots for many
years following chickenpox. People with shingles are contagious
to others who have NOT had chickenpox and they can catch
chickenpox from close contact with a person who has shingles.
Shingles is a very painful condition that involves infammation
of sensory nerves. It causes numbness, itching or pain followed by
the appearance of clusters of little blisters in a strip pattern on one
side of the body. Te pain can persist for weeks, months or years
after the rash heals and is then known as post-herpetic neuralgia
(PHN), a condition that can be more painful than shingles.
Treatment includes antiviral (acyclovir, famciclovir, or valacy-
clovir) and pain medication. Te antiviral medications are efec-
tive only if given early, usually 24-72 hours after a rash devel-
ops. Each patient may experience slightly diferent symptoms of
shingles, therefore use of compounded medications allow for the
personalization of appropriate ingredients to treat each patient
individually. Studies have suggested that the more severe and
painful the shingles rash is, the greater the chance of long-lasting
PHN. Reducing the possibility of developing PHN is another
reason to treat the symptoms aggressively as soon as possible.
Dosage forms can be modifed in strength and vehicle to meet
the individual needs of each patient. One topical treatment com-
bines the following ingredients:
Ketoprofen: Non-steroidal anti-infammatory
Lidocaine: Local anesthetic
Carbamazepine: NMDA and Sodium Blocking
Amitriptyline: Reduces nerve pain by blocking NE reuptake
2-deoxy-D-glucose: Reduces the viruss ability to replicate
Glycosylated proteins are not required for the herpes simplex
virus to attach but do increase viral penetration and infectivity.
Te 2-deoxy-D-glucose has been shown to decrease the viruss
ability to replicate by reducing surface glycoproteins, thereby al-
tering the interaction between the virus and the cell. One study
showed a reduction of 65-70% in the amount of glycoproteins
entering the cell. Without these glycoproteins, the cell depletes its
ATP, a source of energy used by the cell to replicate.
While vaccination can prevent a person from ever contracting
shingles, compounding medications of-
fers options if a patient develops shingles.
Initiation of therapy at in the rash or blis-
ter stage is critical for optimal outcomes.
http://www.ncbi.nlm.nih.gov/pubmed/6293188
http://www.sciencedirect.com/science/article/pii/0042682282903002.
Carin Duncan Bralts, PharmD Candidate University of
Florida is currently on rotation at Pharmacy Specialists.
Currently, Sam Pratt, RPh, FIACP at Pharmacy Special-
ists is the only Full Fellow of the International Academy of
Compounding Pharmacists in the Central Florida area. Call
Pharmacy Specialists to check with a clinical pharmacist for
suggestions and reccomendations. For additional informa-
tion please call (407)260-7002, FAX (407) 260-7044, Phone
(800) 224-7711, FAX (800) 224-0665.
By Sam Pratt, RPh, FIACP and Carin Duncan Bralts, Pharm D Candidate
MARKETING YOUR PRACTICE
To Pay or Not to Pay: Are Lobby
Videos Really Worth It?
By Jennifer Thompson, President of Insight Marketing Group
Lets be honest with each other for a second: waiting around is
a large part of the patient experience when they come to your of-
fce. I know, I know you do everything you can to maximize ef-
fciency and minimize wait times for patients who doesnt? Te
fact of the matter is they still wind up waiting. Whether its for
60 seconds or 25 minutes, what are you doing during that time
to keep them informed and entertained? Aside from magazines
and brochures, many ofces have a television in their lobbies.
Te question then becomes, is it worth it to have custom content
created?
Te answer is unfortunately not clear cut, depending on several
factors we will explore below. In my professional opinion (what-
ever thats worth) patient waiting time no matter how long
should be turned into a valuable learning experience. Whether
that means posters, brochures and/or a professional video loop is
up to you and your staf.
INFORMED PATIENTS = INCREASED APPOINTMENTS
Te two biggest benefts to having a lobby video for your prac-
tice are that informed patients will generally make more appoint-
ments because they know whats available to them, and on top
of that, theyll stay loyal because they feel as if they know you.
Videos are a great way to splice in entertaining patient education
pieces, facts about your practice and all the services you ofer your
patients never knew about. Its also an easy way to gently repeat
a call to action telling them to schedule their next appointment
several times in just a few minutes.
YOU GET WHAT YOU PAY FOR
If you choose to do custom videos, youll obviously want to
make sure theyll hold your patients full attention and contain
professionally produced, high quality clips. Tis is one of the
most difcult aspects of choosing to do a custom lobby video be-
cause if the patient doesnt pay attention, you wasted your money.
Youll want to go with a reputable company that has experience
producing these kinds of videos for healthcare ofces so that you
are all on the same page, trying to reach the same audience with
the same message.
Te video clips should be tastefully produced, easy to under-
stand, visually interesting and brief. Youll lose interest if your
videos are longer than just a few minutes so keep in mind the
sheer quantity of clips, tips and health information youll have
to prepare to have a decent video playing if youre doing it all on
your own. Tat said, when your content achieves the goals it set
out to do, it can be one of the most important in-house market-
ing pieces youve ever invested in.
ALTERNATIVES TO COMPLETELY CUSTOM VIDEOS
Although youll be able to stress your exact message in a com-
pletely custom video, they are rather expensive (not to mention
the headache of trying to coordinate
footage and interviews with multiple
doctors in one practice). Te alterna-
tive to custom video is semi-custom
loops, which are already created. Tere are two options if youre
interested in this route: subscription services and DVDs.
Subscription services allow you to pull from a library of
canned content and splice in your own either text or video
based, depending on your service provider and the plan you have
with them. Most of them will even impose your logo on the vid-
eos to give it more of an authentic feel; and you have complete
control over what clips and facts are displayed to patients. Te
downside is that the content can be limited and you may not
be able to create a message that cross-promotes your other ser-
vices. Tese services will also require that your TV(s) of choice be
hooked up to a high-speed internet connection.
Te other option is to order DVDs that come complete with
content. Tese, like the subscription services, show canned foot-
age and clips with your logo imposed on them. Tis is the cheap-
est route to take and thus the least customizable. In other words,
to change the DVD content, youll have to order more. Some
services will allow for you to send in information and clips to
help cross-promote or show interviews with doctors/patients, but
that option comes with a steeper price tag. Some positives are that
the DVDs are set to continuously loop and all youll need to play
them on your respective TV(s) is a DVD player.
THINGS TO CONSIDER
If you choose to have a lobby video, make sure its long enough
so people in the waiting room dont see the content more than
once. Tats when theyll start to get irritated and, no matter the
length, suddenly feel as if theyve been there forever. You should
also consult with your stafyou know, the people who will have
to hear the video ten times a day. If theyre unhappy or annoyed,
the patients will know.
After reading this article about the pros and cons, ups and
downs and lefts and rights of creating a lobby video, hopefully
you now have a better idea of what youre going to do. Now the
only question you have to answer regarding a lobby video is if its
really worth it to you.
LOOKING FOR MORE INFORMATION?
Contact Jennifer Tompson today for a free consultation
and marketing overview at 321.228.9686 or e-mail her at
Jennifer@InsightMG.com.
About the Author: Jennifer Thompson is a Central Flor-
ida small business owner, serving as President of Insight
Marketing Group, a full-service marketing company fo-
cused on medical office marketing, community outreach
efforts, and grassroots public relations. In this capacity she
is responsible for developing and implementing the long-
term strategic vision for the organization, which includes
publishing Insight Magazine, the companys community-
based monthly news magazine, and hosting their weekly
small business networking/mentoring group, Coffee Club.
In November 2010, Jennifer was elected to the Orange
County Board of County Commissioners.
MARKETING YOUR PRACTICE

Pathology Lab Results Patient: SP Age: 63 Sex: Male
Before Diet After Diet
Lipid Panel Result 08/28/2009 Ref Range Result 09/20/2010
Cholesterol H 278 (80-199)mg/dL 180
Triglycerides H 199 (30-150)mg/dL 82
HDL Cholesterol 51 (40-110)mg/dL 55
LDL Cholesterol H 187 (30-130)mg/dL 109
VLDL Cholesterol 40 (10-60)mg/dL 16
Risk Ratio(CHOL/HDL) H 5.5 (0.0-5.0)Ratio 3.3
Body Scan Results
Tissue Fat % Tissue (g) Fat (g) Lean Muscle (g)
8/26/10: 26.3% 83,019 21,864 61,155
9/24/10: 21.1% 78,045 16,449 61,596
Please Note: Gain of 441g of muscle and a fat loss of 5,415g in 30 days! Individual results may vary.
For information call 407-260-7002 or email Sam@makerx.com.
Start Weight Sept. 2010: 207 lbS. end Weight dec. 2010: 166 lbS.
Coming next month: Our cover story features Zamip Patel, M.D., urologist/andrologist at East Orlando Urology
and Florida Hospital East Orlando. Also, there will be a Special Feature by Halifax Health on Meaningful Use. Editorial focus
is on Urology and Geriatric Medicine.
MEDICAL MALPRACTICE ExPERT ADVICE
Florida Workers Comp Rates
on the Rise?
By Tom Murphy
In the insurance industry, like life, things tend to be cyclical.
After more than seven years of declining rates and premiums, the
National Council on Compensation Insurance (NCCI) recently
recommended a rate increase of 8.9% in Florida, to take efect on
January 1, 2012.
Te workers compensation line in Florida, as well as through-
out the country, faces three major challenges:
1. Deteriorating Underwriting Results For the frst time since
2001, the combined loss ratio for private carriers has risen to
115%. Tis is unstable in the current economic environment.
Carriers start to see proft at about 100% or less.
2. Political Environment Te establishment of the new Federal
Insurance Ofce will most certainly increase the possibility of
greater regulation for property and casualty companies.
3. Frequency of Claims For the frst time in thirteen years, the
national claims-frequency level has increased and looks to be
trending that way.
Tese three factors, in addition
to others such as the Patient Pro-
tection and Afordable Care Act
(PPACA), have created an uncertain environment for the future
of workers compensation rates in Florida and will lead to a rate
increase for 2012. Tis may be the start of a trend and the chang-
ing cycle that appears to be inevitable, based upon history.
Tom Murphy is a workers compensation and medical mal-
practice insurance specialist agent with Danna-Gracey, Inc.,
an independent insurance agency based in downtown Delray
Beach with a statewide team of specialists dedicated solely to
insurance coverage placement for Floridas doctors. He can
be reached at (561) 276-3553 or (800) 966-2120 or Mur-
phy@dannagracey.com.
Central Florida
Pulmonary Group, P.A.
Serving Central Florida Since 1982
Specializing in:
x Asthma/COPD
x Sleep Disorders
x Pulmonary Hypertension
x Pulmonary Fibrosis
x Shortness of Breath
x Cough
x Lung Cancer
x Lung Nodules
Daniel Haim, M.D., F.C.C.P.
Daniel T. Layish, M.D., F.A.C.P., F.C.C.P.
Francisco J. Calimano, M.D., F.C.C.P.
Francisco J. Remy, M.D., F.C.C.P.
Ahmed Masood, M.D., F.C.C.P.
Syed Mobin, M.D., F.C.C.P.
Eugene Go, M.D., F.C.C.P.
Mahmood Ali, M.D., F.C.C.P.
Steven Vu, M.D., F.C.C.P.
Ruel B. Garcia, M.D., F.C.C.P.
Tabarak Qureshi, M.D., F.C.C.P.
Kevin De Boer, D.O., F.C.C.P.
Andres Pelaez, M.D.
Pranav Patel, M.D., F.C.C.P.
Our physicians are Board Certified in Internal Medicine,
Pulmonary Disease, Critical Care Medicine, and Sleep Medicine
Downtown Orlando: 326 North Mills Avenue East Orlando: 10916 Dylan Loren Circle Altamonte Springs: 610 Jasmine Road
407.841.1100 phone | www.cfpulmonary.com | Most Insurance Plans Accepted
Robotic and Computer Assisted Hip and
Knee Replacement Surgeries
By Valerie Moses
In a world where innovation has become the norm, the public is
constantly seeking the next revolutionary product or service. Tis
trend extends to the medical feld when patients, who hear about
a new procedure or technique in the media, begin to request the
technology for their own treatment. While some advancements
in technology will ultimately change the way we practice medi-
cine, others such as robotic and computer assisted hip and knee
replacement surgeries are still in their earliest stages and may
not be the answer that patients are looking for. So, what should
you tell patients when they ask about a robotic surgery?
Jefrey P. Rosen, M.D., a board certifed orthopaedic surgeon
specializing in hip and knee surgery at Orlando Orthopaedic
Center ofers his opinion saying, Despite their theoretical ad-
vantages, there is no study completed that proves that they actu-
ally improve clinical outcomes. He goes on to say that robotic
surgeries, specifcally for hip and knee replacement surgeries, are
still in their infancy and are surely going to be refned as time
goes on. For today, he stresses that the skill and judgment of the
surgeon are not replaced by the robotics systems yet.
Dr. Rosen has specialized in hip and knee replacement surgery
with Orlando Orthopaedic Center since 1985. Te Washington
D.C. native is a member of the American Medical Association,
Orange County Medical Society, American Academy of Ortho-
paedic Surgeons, Robert P. Kelly Orthopaedic Society and Amer-
ican Association of Hip and Knee Surgeons, where he is a leader
in the feld.
In his years of experience, Dr. Rosen has seen several improve-
ments in technology come and go, and believes that computer
assisted and robotic orthopaedic surgeries will have to undergo
further development before they can be performed for the main-
stream.
Both types of surgery utilize computers with GPS-like tracking
devices in order to mark the bones and instruments to make the
most precise cuts. However, while computer assisted surgery still
relies on the surgeon to make the cuts and implant the devices,
robotic surgery actually uses a robotic arm to perform the bone
cuts, with the surgeon acting almost as an assistant to the robotic
device, says Dr. Rosen.
If performed properly, these procedures can potentially pro-
vide greater precision, but they also have their disadvantages. Not
only are these surgeries signifcantly more expensive than routine
surgery (computer assisted surgery alone adds about $1,500 to
each case, and the robot costs $1 million for the hospital to pur-
chase), but they increase the operating time and thus the risk
of infection. In addition, some doctors have reported that when
the computer overrode the clinical judgment of the surgeon, im-
plants were incorrectly placed.
Hip and knee surgeons
have been generally doing a
very good job for many years
in performing hip and knee
replacement surgery, and
statistically the results prior
to navigation and robotic
surgery have been excellent,
says Dr. Rosen. Newer is
not always better, and sur-
geons need to advise their
patients that the latest and greatest, as reported in the popu-
lar press, may not actually be in their best interest. Despite the
theoretical advantages, there is no real proof so far that computer
assisted surgery or robotic orthopaedic surgery improves the fnal
outcome.
When deciding whether or not to perform one of these surger-
ies, doctors must consider several factors, balancing the advantage
of a more perfect implant replacement against the increased cost
and surgical time, as well as the risks and complications associ-
ated with any new type of procedure.
Of course, robotic and computer assisted surgeries do have the
potential for accuracy, and could be helpful in the future.
Accuracy of implantation is critical to good results after total
joint surgery, says Dr. Rosen. A poorly or incorrectly placed
implant will fail or function poorly, leading to pain, poor motion,
deformity or revision surgery. Patients beneft from anything that
helps to ensure proper implant alignment and placement.
Dr. Rosen notes that the surgery may prove to be worth its cost
over time, however.
Te ongoing compromise continues to be to balance new
technology with the cost of that technology. Can we prove a ben-
eft, and how much does it cost? If the robot benefts 90 percent
of its patients, then spending $1 million for the equipment is
probably worth it, he says. If it benefts only 1 percent of pa-
tients, then probably not.
Ultimately, according to Dr. Rosen, the future of computer as-
sisted and robotic surgeries is really too early to tell.
Many innovations in medicine have come and gone, but
many, such as arthroscopic surgery, laparoscopic surgery and
robotic prostate surgery, have proven signifcant beneft and are
now the standard of care, he says. We dont have enough experi-
ence with the newest procedures yet to determine their worth.
For additional information please call (407) 254-2500 or
visit www.orlandoortho.com.
ORTHOPAEDIC UPDATE
Jeffrey P. Rosen, M.D.
Board Certifed in Orthopaedic Surgery
Specializing in Sports Medicine and
Joint Replacement
Collaborative Research and Targeted
Therapies May Offer New Hope
for Melanoma Patients
By Erica Mailler-Savage, MD
Every eight minutes, someone in the United States is diagnosed
with melanoma, and in 2010, 8,700 patients are expected to
die from melanoma. Tus far, treatment with chemotherapy,
immunotherapy, and radiation has been less than promising. It
has been over a decade since a new drug has been available to treat
metastatic melanoma, but in 2011, two new targeted therapies,
ipilimumab and PLX4032, are expected to be FDA approved.
Ipilimumab, owned by Bristol Myers-Squibb, is a monoclonal
antibody that blocks CTLA-4 (cytotoxic T-lymphocyte antigen
4), a helper T-cell marker that inhibits cytoxic T-cell activation,
masking the tumor cells from the bodys T-cell immune response.
Ipilimumab is the frst drug that has shown overall survival beneft
in melanoma in a Phase III trial, yet only 24% of patients were
still living after 2 years. Ipilimumab is also being researched for
use in small cell and non-small cell lung cancer and metastatic
hormone-refractory prostate cancer.
PLX4032, owned by Genentech/Roche, is a BRAF inhibitor.
About 50% of melanoma patients have a mutation in BRAF, an
anti-apoptotic protooncogene. Tis selective inhibitor induces a
response in about 90% of patients with a BRAF mutation, with
partial or complete regression of tumors. Unfortunately, most
patients relapse after 7 months, likely because a second separate
mutation fuels the cancers growth.
With the introduction of these two new drugs has also come
a novel collaboration, born out of the growing realization
that there is likely no single drug that will be the bullet to kill
melanoma. Combination therapy, similar to the treatment of
HIV with cocktail regimens, will likely be the only solution.
Earlier this year, the Melanoma Research Foundation
(MRF) announced a new consortium, the Melanoma Research
Foundation Breakthrough Consortium, which brings the
research community and pharmaceutical companies together to
pool knowledge and resources in the hope of generating new
breakthroughs in the treatment of melanoma more rapidly than
before.
Te MRF Breakthrough Consortium brings 10 academic
centers that specialize in melanoma together with the major
pharmaceutical companies that have promising individual
therapies for melanoma, breaking down barriers that normally
hinder collaborations between companies and the research
community.
It is currently standard practice for pharmaceutical companies
to have a drug approved individually before testing it in
combination with other therapies, especially if it is a competitors
drug. Since it is not uncommon to invest nearly a billion dollars
to develop new drugs, it is in a companys fnancial interest not
to collaborate. What if, for instance, Company As drug is safe,
but when combined with Companys B drug, it creates toxic side
efects that then renders it unsafe?
Te Consortium also allows researchers to partner together to
conduct laboratory research and clinical trials, and to share data
and information. In a competitive environment of tenure and
research grants, it is currently not in the research communitys
interest to collaborate either.
In addition, academic institutions often do not have the capacity
to test investigative drugs without support from pharmaceutical
companies, and pharmaceutical companies have not been able
to test combination therapies of investigational drugs without
support from research and academic institutions. Cooperation
between academia and industry will allow systematic testing of
Melanoma
HOT TOPICS IN DERMATOLOGY
Dr. Varnagy is a bilingual board-certifed Vascular Surgeon who specializes in minimally
invasive arterial and venous disease treatments, lower extremity revascularizations,
and carotid and aneurysm repairs. As an internationally-acclaimed expert, Dr Varnagys
work has been published in numerous medical journals and holds highly regarded
positions within the most prestigious societies.
To refer a paTienT, call 407-303-7250
Se Habla Espaol
2501 North Orange Avenue, Suite 402 | Orlando, FL 32804
www.Vascincf.com
Specialties:
Circulation disorders
Arterial aneurysms
Endovascular treatment of thoracic
& abdominal aortic aneurysms
Peripheral vascular disease
Carotid artery disease
Aortic, mesenteric, renal &
peripheral arterial reconstruction
Thoracoabdominal aortic aneurysms
State-of-the-art capabilities
Non-invasive, diagnostic testing
Minimally invasive arterial &
venous therapy
Open surgical techniques
Alan Wladis, MD and Mark
Ranson, MD proudly welcome
DaViD Varnagy, MD, facS
to their team of dedicated arterial
and vein specialists.
FPMG_11_3418_VICF_Varnagy_FLA_MD.indd 1 8/18/11 11:21 PM
HOT TOPICS IN DERMATOLOGY
combination therapies in a more efcient
and cost-efective manner.
Unfortunately, since the creation of
the Breakthrough Consortium, a new
challenge faces the academic and phar-
maceutical communities the design of
the clinical trials themselves. As a recent
New York Times article heartbreakingly
elaborated in its story of two cousins with
melanoma, one who lived after receiving
PLX4032 and one who died after be-
ing placed on dacarbazine in the control
arm of the study, the research commu-
nity may need to reconsider how research
with these drugs is done.
Defenders of the traditional randomized
controlled non-crossover clinical trial note
the research communitys past experience
with bone marrow transplants and breast
cancer. Bone marrow transplants seemed
so efective initially that breast cancer
patients were calling for them to be
ofered to all patients, but a later clinical
trial showed that they were less efective
than chemotherapy and in some cases
caused death.
Opponents feel that PLX4032 is in a
diferent category, as no other drugs for
melanoma have been efective, and that
patients should be able to cross over to
PLX4032 in the studies if they are not
doing well on the dacarbazine, which is
known to be inefective. Complicating
matters more, Roche recently announced
that they would not be willing to ofer the
drug for compassionate use, citing fears
that prospective trial candidates might
undergo chemotherapy just to qualify for
the drug without undergoing the trial.
Despite the newest challenge for the
Breakthrough Consortium, it is clear with
these two new targeted therapies that we
are closer to an efective treatment for
metastatic melanoma. With increased
collaboration, and a dedication to patients
and science instead of self-interest,
metastatic melanoma patients can have
greater hope than ever before.
Erica Mailler-Savage, MD, is a board-certifed Dermatologist and fellowship-
trained Mohs surgeon specializing in skin cancer removal. Her practice,
Comprehensive Dermatology & Dermatologic Surgery, recently opened
in Winter Park, Florida. Prior to moving to Winter Park, Dr. Mailler-
Savage was a practicing physician and clinical instructor at the University
of Cincinnati. She may be contacted at (407) 339-7546 or by visiting www.
comprehensivedermorlando.com.
Disorders of the gastrointestinal (GI) tract may be associated
with osteoporosis. Pathophysiologic factors specifc to GI diseases
include the frequent onset of IBD and celiac disease in childhood
or young adulthood; impaired absorption of nutrients vital to
bone health, such as calcium and vitamin D; the use of glucocor-
ticoids in the treatment of IBD; and the chronic infammatory
state of IBD and untreated celiac disease.
Te development of bone densitometry has made it possible to
measure bone mass and assess its contribution to fracture risk. It
is generally accepted that bone mass is the single best predictor of
in vitro skeletal strength and of fracture risk. Dual-energy X-ray
absorptiometry (DXA) is the current gold standard technique for
measuring bone mass. Measurements are usually obtained at the
femoral neck and lumbar spine, and less often from the forearm
and total body. Bone mass measurements are typically reported
as Z score, refecting the number of standard deviations (SDs)
above or below the mean for an age-matched population, or T
score, refecting the number of SDs above or below the mean for
a young adult population (corresponding to peak bone mass).
Caution must be exercised when extrapolating data from DXA
in the postmenopausal state to DXA in GI diseases. Tere is no
consensus on the diagnosis of osteoporosis in men or even on the
appropriate reference population for generating the T score. Te
use of serum and urine measures of bone metabolism is largely
confned to research studies. A complete blood count, serum to-
tal alkaline phosphatase level, calcium level corrected for serum
albumin level, creatinine level, testosterone level (in males), and,
in selected cases, 25-(OH)-vitamin D level and protein electro-
phoresis can be reliably measured in most hospital laboratories
and should be obtained in patients with suspected skeletal com-
plications of GI disease to screen for other causes of low bone
density.
Te single most powerful predictor of a future osteoporotic
fracture is the presence of previous such fractures. Such factors
as advanced age, family history of osteoporosis, lack of exercise,
smoking, and hypogonadal states increase the risk of osteoporo-
sis in patients with GI disease and the general population alike.
Other risk factors that warrant consideration in patients with GI
disease include malnutrition, low body weight, low intake or ab-
sorption of dietary calcium and vitamin D, and corticosteroid
use.
SUMMARY OF BONE DISEASE IN
INFLAMMATORY BOWEL DISEASE
1. Osteomalacia and vitamin D defciency are not common in
IBD (including Crohns disease) and are unlikely to be im-
portant causes of most cases of diminished bone mineral den-
sity (BMD) in IBD (level B evidence).
Osteoporosis in Gastrointestinal
Disease
2. IBD has only a modest efect on
BMD, with a pooled Z score of 0.5
(level A evidence).
3. Te overall prevalence of osteoporosis (T score <2.5) using
DXA is approximately 15%, but is strongly afected by age,
being higher in older subjects (level A evidence).
4. At diagnosis, the prevalence of diminished BMD is low (level
B evidence) and when followed longitudinally, changes in
BMD are similar to those expected (level B evidence).
5. DXA is a marker of diminished bone mass and fracture risk,
but is not the only marker of fracture risk and should be used
to predict fracture risk in concert with other clinical variables
(level D evidence).
6. Males and females are at similar risk for osteoporosis (level A
evidence).
7. Crohns disease and ulcerative colitis carry comparable risks
for osteoporosis (level B evidence).
8. Corticosteroid use is the variable most strongly associated
with osteoporosis (level A evidence). However, it is difcult
to distinguish corticosteroid use from disease activity in terms
of causal impact on bone density, because the 2 are closely
linked.
9. Biochemical bone markers do not correlate sufciently well
with current BMD or rate of bone loss for routine use (level
B evidence).
10. Te ileoanal pouch procedure after curative colectomy in ul-
cerative colitis may be associated with an improvement in
DXA (level C evidence).
11. Calcaneal ultrasonography has not been as well evaluated as
DXA, but possibly could help select patients for DXA (level
B evidence).
12. Pediatric DXA should be adjusted for bone age, or else BMD
will typically be underestimated (level B evidence).
13. Te overall incidence of fractures in a population-based study
is 1 per 100 patient-years, but this rate is strongly afected
by age, being more common in subjects over age 60 (level A
evidence).
14. Te overall relative risk of fractures is 40% greater than that
of the general population and increases with age (level A evi-
dence).
15. Crohns disease and ulcerative colitis carry comparable risks
for fracture (level A evidence).
16. Males and females share a comparable risk for fracture (level
A evidence).
By Harinath Sheela, M.D.
DIGESTIVE AND LIVER UPDATE
SUMMARY OF BONE DISEASE IN CELIAC DISEASE
1. Osteoporosis is more common in patients with untreated
celiac disease than in the general population (level A evi-
dence).
2. Vitamin D defciency is common in celiac disease, but the ac-
tual prevalence of osteomalacia in celiac disease is unknown
(level B evidence).
3. Among newly diagnosed patients, the prevalence of osteopo-
rosis using DXA is approximately 28% at the spine and 15%
at the hip (level B evidence).
4. In adults with a known diagnosis of celiac disease treated with
a gluten-free diet, the prevalence of osteoporosis detected us-
ing DXA is still increased compared with that in controls
(level B evidence).
5. At the time of diagnosis of celiac disease, children and adults
have similarly low BMDs; however, children are more likely
than adults to have fully restored bone mass after a gluten-
free diet (level B evidence).
6. Patients with celiac disease exhibit an increased BMD after
initiating a gluten-free diet (level A evidence). Te greatest
increase occurs in the frst year (average of 5%), but fnal
BMD remains below average, with fnal Z scores of approxi-
mately 1.0 for the spine and 0.5 for the hip (level B evi-
dence).
7. Body mass index consistently correlates with BMD at both
diagnosis and follow-up (level A evidence).
8. Axial bone mass increases more than appendicular mass dur-
ing gluten-free diet therapy (level B evidence).
9. Subjects with asymptomatic celiac disease are at increased
risk for osteoporosis (level B evidence).
10. Te high prevalence of osteoporosis among patients with ce-
liac disease, in asymptomatic subjects, provides a rationale
for gluten-free diet therapy for those who do not have overt
malabsorption (level D evidence).
11. Males and females are at equal risk for osteoporosis; post-
menopausal females are at greatest risk (level B evidence).
12. Typical serological abnormalities that correlate with dimin-
ished BMD include elevated parathyroid hormone (PTH)
level and 1,25(OH)2-vitamin D and diminished 25-OHD.
Levels of 25-OHD, calcium, and possibly PTH should be
measured in newly diagnosed celiac disease and in patients
where elevated levels warrant increased attention to bone
health (level B evidence).
13. Te precise incidence of fracture in celiac disease is unknown
but is estimated to be 40% by age 70, which is more than
twice the expected incidence for the general population (level
B evidence).
14. Te value of calcaneal ultrasound as a screening test for frac-
ture risk in celiac disease is unknown (level D evidence).
15. DXA is a marker of diminished bone mass but is not a proven
marker of fracture risk in patients with celiac disease (level B
evidence).
SUMMARY OF BONE DISEASE IN
POSTGASTRECTOMY STATES
1. Postgastrectomy patients typically have a number of risk fac-
tors for osteoporosis, and bone disease may not necessarily be
a sequela of the surgery per se. Nonetheless, postgastrectomy
patients are at risk for bone disease (level A evidence).
2. Osteoporosis and osteomalacia may both occur postgastrec-
tomy. Te incidence of osteomalacia is approximately 10%
20% (level B evidence). Te incidence of osteoporosis is un-
known but may be as high as 32%42% (level B evidence).
3. Postgastrectomy states are associated with an increased risk of
fracture and thus patients postgastrectomy should be evalu-
ated for possible underlying bone disease (level B evidence).
4. Tere is no diference in the risk of postgastrectomy bone dis-
ease between patients with a Billroth I procedure and those
with a Billroth II procedure (level A evidence).
5. Tere is no diference in the risk of postgastrectomy bone dis-
ease between partial gastrectomy and total gastrectomy (level
A evidence).
6. Tere is no apparent risk of postgastrectomy bone disease as-
sociated with acid-reducing procedures such as vagotomy in
the absence of gastrectomy (level B evidence).
7. Serum calcium and phosphate levels are most often normal in
postgastrectomy states, although calcium levels may be nor-
mal as a result of mobilization of calcium from bone (level A
evidence).
8. Serum alkaline phosphatase (SAP), vitamin D metabolite,
and PTH levels are variable in postgastrectomy states (level A
evidence).
MANAGEMENT
Tere is a paucity of therapeutic intervention studies specif-
cally aimed at bone health in GI diseases. Most therapy studies
of sufcient size are in populations of postmenopausal women or
corticosteroid-using patients who do not have GI disease. Tere
is a need for studies that assess interventions directed at improv-
ing bone health in patients with GI disease specifcally and that
use fracture prevention as endpoints.
Te following steps outline a possible approach to managing
osteoporosis in GI disease:
1. All patients should receive education on the importance of
lifestyle changes (e.g., engaging in regular weight-bearing ex-
ercise, quitting smoking, avoiding excessive alcohol intake),
as well as vitamin D and calcium supplementation (level D
evidence).
2. DXA scans should be selectively ordered in IBD patients based
on a thorough risk factor assessment (level D evidence).
3. DXA scans are likely unnecessary in patients with newly di-
agnosed uncomplicated pediatric celiac disease, but should be
considered for adults with newly diagnosed celiac disease 1
year after initiation of a gluten-free diet, to allow for stabiliza-
tion of bone density (level D evidence).
4. Patients who are at least 10 years postgastrectomy, especially
postmenopausal females, males over age 50, and patients with
low-trauma fractures should undergo DXA testing (level D
evidence).
5. In patients with IBD and celiac disease, serum calcium level,
corrected for albumin, should be measured at diagnosis. In
IBD, celiac disease, and postgastrectomy states in which the
patient is found to be osteoporotic or has a low-trauma frac-
ture, screening for other causes of low bone density should be
performed through a complete blood count, total SAP level,
calcium level, creatinine level, 25-(OH) vitamin D level, pro-
tein electrophoresis, and testosterone level (in males) (level D
evidence).
6. Serum measurements of PTH are unnecessary unless a patient
is found to have an abnormal serum or urinary calcium level
(level D evidence).
7. Implementation of a gluten-free diet in celiac disease and cor-
rection of nutritional defciencies is necessary in all GI dis-
eases (level A evidence).
8. Corticosteroid dosing in IBD should be kept to a minimum,
and other immunomodulatory agents should be considered to
help withdraw patients from corticosteroids once corticoste-
roid dependence becomes evident (level D evidence in IBD;
level A evidence regarding fracture risk reduction by minimiz-
ing the corticosteroid dosage for other non-GI diseases).
9. Vitamin D and calcium supplementation should be given to
those deemed to be at high risk for osteoporosis or with prov-
en osteoporosis. Younger men and premenopausal women
require 1000 mg/day of elemental calcium, whereas men and
women over age 50 require up to 1500 mg/day. Vitamin D
400 to 800 IU/day is usually an adequate replacement dose
in healthy individuals; it can be obtained from many multi-
vitamin preparations (level D evidence in GI disease, level B
evidence regarding nonvertebral and vertebral fracture risk re-
duction by optimizing calcium and vitamin D intake in older
men and women).
10.Estrogen therapy has received FDA approval for the preven-
tion of osteoporosis in postmenopausal or hypogonadal pre-
menopausal women, but must be balanced against the signif-
cant risks (level D evidence in GI disease, level A evidence for
vertebral and nonvertebral fracture risk reduction in generally
healthy postmenopausal women).
11.A selective estrogen receptor modulator (SERM) has been
approved by the FDA for the prevention and treatment of
osteoporosis in menopausal women (level D evidence in GI
disease, level A evidence for vertebral fracture risk reduction
in osteoporotic postmenopausal women). A bone disease spe-
cialist should participate in the decision to choose a SERM in
patients with GI diseases.
12.Testosterone should be used to treat hypogonadism in males
(level D evidence).
13.Bisphosphonates are FDA-approved for the prevention and
treatment of osteoporosis in patients with known osteopo-
rosis, patients with atraumatic fractures, and patients who
cannot withdraw from corticosteroids after 3 months of use
(level D evidence in GI disease, level A evidence regarding
vertebral and nonvertebral fracture risk reduction in post-
menopausal women).
14.Nasal or subcutaneous calcitonin can be considered as an al-
ternative treatment approach when the preceding antiresorp-
tive agents are contraindicated or poorly tolerated (level D
evidence in GI disease, level A evidence regarding vertebral
fracture risk reduction in postmenopausal women).
15.Fluoride is not recommended as treatment for osteoporosis
associated with GI disease (level D evidence in GI disease, no
consistent evidence for fracture risk reduction in postmeno-
pausal women.
Harinath Sheela, MD moved to Orlando, Florida after
fnishing his fellowship in gastroenterology at Yale Univer-
sity School of Medicine, one of the fnest programs in the
country. During his training he spent signifcant amount
of time in basic and clinical research and has published
articles in gastroenterology literature.
His interests include Infammatory Bowel Diseases (IBD),
Irritable Bowel Syndrome (IBS), Hepatitis B, Hepatitis
C, Metabolic and other liver disorders. He is a member of
the American Gastroenterological Association (AGA), the
American Society for Gastrointestinal Endoscopy (ASGE)
and the American Association for the Study of Liver Dis-
eases (AASLD) and Crohns Colitis foundation (CCF).
Dr. Sheela is a Clinical Assistant Professor at the University
of Central Florida School of Medicine. He is also a teaching
attending physician at Florida Hospital Internal Medcine
Residency and Family Practice Residence (MD and DO)
programs.

WEALTH MANAGEMENT
Infation: How and When to
Hedge Against Rising Prices
By Tyson Smith
Te very signifcant fscal and monetary US government re-
sponse to the most recent economic slowdown and market
decline has many investors concerned about infation: when
it will set in, how signifcant it might be, how a portfolio can
be protected. Below we attempt to answer some of these ques-
tions. However, every client situation and investment portfolio
is unique. Terefore, we recommend discussing this topic with
your fnancial advisor to determine what actions, if any, are
needed to help protect your portfolio against infation.
WHY INFLATION MATTERS
Infation, the rate of increase in the price of goods and ser-
vices over time, has become a hot topic in recent months. Gen-
erally, a low level of infation, 2-3% annually, is accepted and
even preferred to zero or negative infation (defation). However,
given the Federal Reserves signifcant monetary stimulus in re-
cent months, an injection of liquidity meant to stabilize fragile
fnancial markets, there is now concern about higher levels of
infation.
High levels of infation erode purchasing power; as prices move
higher, every dollar buys less. Tis can be harmful to the overall
economy and to individuals. For the economy, wage infation
1

can hurt proftability leading companies to pass increased costs
on to consumers by raising prices further. For individuals, real
investment returns
2
are negatively impacted by infation. Addi-
tionally, purchasing power erosion is particularly impactful for
those on a fxed income as they can buy fewer goods and ser-
vices.
NEAR-TERM INFLATION OUTLOOK
Given low interest rates and signifcant monetary stimulus
many believe infation will undoubtedly occur, the question is
when. For several reasons, many economists and professional
investors believe infation is unlikely to set in until 2011 or be-
yond. Bairds strategists also do not see the threat as imminent.
First, given the high level of unemployment wage infation is
unlikely in the near term. Wages represent 45-50% of the US
gross domestic product (GDP). For infation to be sustainable
wages must move higher, which is unlikely with unemployment
hovering around 10%. Put simply, companies do not need to
raise wages to attract or retain labor when available labor is in
large supply.
Second, while monetary stimulus
injected large amounts of capital into the fnancial system, rela-
tively little of that capital is in circulation. Instead, many banks
have held onto that capital to improve their balance sheet metrics
rather than lend it out. Even as that money supply does make its
way into circulation going forward, the Fed has halted further
monetary stimulus so the growth will come down.
Lastly, debt levels remain high and an increase in interest rates
would lead to signifcant decrease in demand for loans. Tis,
coupled with households showing a desire to reduce their overall
debt, will likely mute infation.
HEDGING AGAINST INFLATION
Tere are several methods investors can use to hedge against
infation. Below we describe a few of the more common hedging
methods.
Treasury Infation Protected Securities (TIPS) Treasury
bonds for which the principal and coupon payments are
adjusted to ofset infation. TIPS are issued by the Treasury,
backed by the US government, and adjusted biannually ac-
cording to CPI.
3

Gold Te price of gold generally has an inverse relationship
with the value of the US dollar. Terefore, as high infation
weakens the value of the US dollar, the price of gold moves
higher.
Currency As the US dollar weakens during infationary pe-
riods, investing in other currencies such as the euro, yen or
pound can act as a hedge to the overall portfolio.
Commodities After an economic downturn, commodity
prices rise as demand recovers. Tus, price appreciation from
investing in oil, natural gas or precious metals can ofset price
erosion from infation.
Short Duration on Bond Ladders Te Federal Reserves pri-
mary method for controlling infation is raising interest rates.
4

As interest rates rise, proceeds from maturing bonds can be
reinvested at higher interest rates; maintaining a shorter-dura-
tion bond ladder results in reinvesting at higher rates sooner.
Non-US Debt Securities Exposure to non-US fxed income
can provide diversifcation for portfolios consisting primarily
of US bonds, which can be impacted by rising US interest
rates should infation occur.
WEALTH MANAGEMENT
CONSIDERATIONS
While prices are generally expected to rise going forward, there are two important factors to consider when deciding if and how to
hedge a portfolio against infation.
Investor Risk and Return Objectives. Individuals with a fxed income are most at risk for purchasing power erosion in an infationary
environment because their income does not adjust to rising prices as does a typical wage or salary. For these individuals, some type of
infation hedging is likely prudent.
Current Valuation. For several of the hedging methods discussed above, prices have moved signifcantly in recent months as inves-
tors have anticipated the efects of infation. For perspective, in 2009 TIPS appreciated 11.4%, the price of gold increased 25.0% and
commodities rose 18.9%.
5
Terefore, while infation hedging over the long-run might be prudent for some investors, it is important
to be mindful of the recent strong investment performance and valuations in each strategy.
As mentioned earlier, every client situ-
ation is diferent. Terefore, we encourage
you to discuss infation with your Financial
Advisor to determine what changes, if any,
are needed in your portfolio.
If you have questions or need more in-
formation, please contact your Financial
Advisor.
1
When workers demand higher wages to ofset the
decreased purchasing power of their current in-
come.
2
Total investment return minus the infation rate.
3
Consumer Price Index, calculated by the Bureau of
Labor Statistics.
4
Raising interest rates encourages saving, which
slows growth of the money supply.
5
TIPS measured by the Barclays Capital US TIPS
Index; Commodities measured by the Dow Jones
UBS Commodity Index.
Article provided by Robert W. Baird
& Co. for Tyson Smith, Vice President,
Financial Advisor at the Orlando of-
fce of Robert W. Baird & Co., mem-
ber SIPC. He has 12 years of fnancial
services industry experience, and can
be reached at 407-481-8286 or 888-
792-0098.
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FOR YOUR ENTERTAINMENT
Te Orlando Philharmonic presents American Voices, the third concert in the 2011- 2012 Super Series, on Saturday, November 12
at 8:00 p.m. in the Bob Carr Performing Arts Centre, located at 401 W. Livingston Street, in downtown Orlando.
Maestro Christopher Wilkins leads the Orlando Philharmonic Orchestra in this community collaboration for Te Zora Neale Hur-
ston Legacy Concert. Also on the program are the combined choruses of Te Negro Spiritual Scholarship Foundation Master Sing-
ers, under the direction of Edward Washington II, and the Florida Opera Teatre Chorus, under the direction of Robin Stamper.
Rooted in Florida soil and bursting with folk melodies of Appalachia and a Native-American name for the North Ameri-
can continent Zora Neale Hurston would have been proud of this musical celebration of our Central Florida culture.
-- Christopher Wilkins
Te concert features two compositions by Adolphus Hailstork: Celebration and the world premiere of Zora! Were Calling You (Eliza-
beth Van Dyke, librettist). Also on the program - Appalachia by Delius and the much-loved Appalachian Spring by Copland.
Zora Neale Hurston is known as an American folklorist, anthropologist and author during the time of the Harlem Renaissance.
She was a seed for change in the Black culture especially in African-American feminist circles. She published four novels and more
than 50 published short stories, plays and essays but she is perhaps best known for her 1937 novel Teir Eyes Were Watching God. Ms.
Hurston moved to the Central Florida community of Eatonville when she was three years old. Eatonville has the distinction of being
the frst all-Black town to be incorporated in the United States. Troughout her life, her accomplishments and successes put the tiny
town of Eatonville in the spotlight as a sort of utopia and she glorifed the town in her stories as a place where black Americans
could be independent of the white culture and attain sovereignty amid the bigotry.
Te Negro Spiritual Scholarship Foundation Master Singers, under the direction of Edward Washington II, is a professional
ensemble of post-secondary singers of all ages and backgrounds. Using a repertoire of arranged Negro spirituals and other selected
works, the Master Signers ofers its mem-
bers performance opportunities along with
intellectual stimulation, professional devel-
opment and musical growth.
Te Florida Opera Teatre Chorus is
a young but growing opera company com-
posed of 40 plus professional, semi-pro-
fessional and student singers along with a
number of talented local residents who in-
dulge their passion for music and opera as
an avocation. Te chorus frst performed for
the Orlando Philharmonics production of
La Bohem in the spring of 2011 and will
be a part of its production of Verdis Rigo-
letto in the spring of 2012. Tey are led by
Florida Opera Teatres Chorus Master and
Music Director, Robin Andrew Stamper.
Te Super Series is sponsored by Darden
Restaurants Foundation, the Concert
is sponsored by Te Pabst Charitable
Foundation for the Arts and the Na-
tional Endowment for the Arts.
For tickets call the Orlando Philhar-
monic Box Ofce at (407) 770-0071 or
visit online at www.OrlandoPhil.org.
Box Ofce hours are Monday Friday,
9:30 a.m. to 5:00 p.m.
Orlando Philharmonic Presents A Musical

Celebration of Central Florida Culture
5 Convenient Locations:
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www.orlandoortho.com 407.254.2500
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22
FACIAL COSMETIC SURGERY
For most young adults, getting a tan is as common as getting
a haircut or a manicure. Investing time in their appearance in
order to look their best is a rite of passage that no generation has
circumvented. Today, more than ever, teens and young adults are
bombarded with warnings that tanning is the most avoidable risk
factor in the prevention of skin cancer. Unfortunately, studies
confrm that Americas youth forego this advice in favor of the
bronzed look.
Tis year, more than 1 million new cases of skin cancer will be
diagnosed in the United States exceeding the incidence of all
other cancers combined. It is estimated that there will be nearly
125,000 new cases of melanoma diagnosed in the US in 2011.
While many health issues are complex and involve multiple
factors, in the case of skin cancer we know that ultraviolet light is
the culprit and that avoiding excessive exposure is the cure. Yet
despite this knowledge, the number of skin cancers continues to
rise each year. Even more disheartening is the fact that young
adults continue to tan both by natural sunlight and in tanning
beds despite the known health risks.
A national study published in the September 2003 issue of Ar-
chives of Pediatric Adolescent Medicine found that among 6,903
non-Hispanic white adolescents between the ages of 13 and 19
indoor tanning is not only prevalent, but infuenced by demo-
graphic factors such as the use of controlled substances (e.g., al-
cohol, tobacco and marijuana), appearance-related factors (e.g.,
dieting), and psychosocial factors (e.g., cognitive ability).
Overall, when taking the national population into consider-
ation, the number of young women who reported using a tan-
ning booth at least once far outweighed the number of young
men who engaged in this activity (36.8 percent vs. 11.2 percent,
respectively). Te number of young women who reported using
tanning booths also increased with age. Te study found that 47
percent of young women aged 18 to 19 years old reported using a
tanning booth three or more times, compared with 11.2 percent
of 13- to 14-year-old girls.
Geographic region greatly infuenced the likelihood of using
an indoor tanning facility, with adolescents in the Midwest and
South being two to three times more likely to use tanning booths
than the rest of the country. In addition, teens that attended a
rural high school were more likely to report using an indoor tan-
ning facility than their counterparts at urban high schools.
Tis study confrms that despite the risk, indoor tanning seems
to be increasingly popular with young people and particularly
young women. Its unfortunate that the pressure these teens face
Skin Cancer in Young Adults
By Ross A. Clevens, M.D.
to conform to cosmetic ideals pre-
sented in popular culture and advertising is so powerful, even
with all we know about the dangers of tanning.
Indoor tanning is a booming business in the United States,
generating estimated revenues in excess of $5 billion dollars a
year. Most salons use bulbs in their tanning beds that emit a sig-
nifcant amount of UVB and UVA radiation both of which are
associated with the development of skin cancer and premature
aging. In fact, the Department of Health and Human Services
has added UV radiation from the sun or artifcial light sources
such as tanning beds and sun lamps to the governments list of
known carcinogens.
Te manufacturers of indoor tanning equipment are regulated
at the federal level. Once manufacturers sell the equipment to a
tanning salon, it is generally up to the states to regulate their op-
erations. While 29 states regulate tanning salon operators, the leg-
islation varies in severity and there is limited enforcement. While
some states go so far as to prohibit access to tanning booths by
minors without parental consent, some require salon owners to
post warning signs in a visible location in the salon, and others
may only establish educational and training standards for tanning
salon operators.
Te American Academy of Dermatology Association (AADA)
recently issued a new position statement on indoor tanning, en-
couraging states to aggressively pursue legislation that protects
children and urging the Food and Drug Administration (FDA)
to take action that will ban the sale and use of tanning equipment
for non-medical purposes. Specifcally, the AADA supports the
following requirements for indoor tanning facilities:
No minor should be permitted to use tanning devices.
A Surgeon Generals warning should be placed on all tanning
devices.
No person or facility should advertise the use of any Ultravio-
let A or Ultraviolet B tanning device using wording such as
safe, safe tanning, no harmful rays, no adverse efect,
or similar wording or concepts.
Research has shown that indoor tanning is dangerous, and
there should be laws to protect children from engaging in this ac-
tivity as there are from other unhealthy behaviors such as drink-
ing or smoking.
THE REALITY OF SKIN CANCER:
Skin cancer (melanoma) is one of the fastest-growing cancers.
23
Cases in young people have doubled in the past 20 years.
Skin cancer accounts for one in 10 of all cancers in 20 to
24-year-olds.
Skin damage in early years can lead to skin cancer later
on.
WHAT YOU CAN DO, ADVICE FROM THE
TEENAGE CANCER TRUST:
1. Wear a high-factor sun cream of SPF15 or higher.
2. Cover up. If youre out in the sun, wear a T-shirt, hat and
sunglasses.
3. Seek shade between 11am and 3pm.
4. Avoid sunbeds as they they expose your skin to harmful UV rays which increase your risk of skin cancer. Using a sunbed once a month
can increase your risk by more than 50 percent.
Ross A. Clevens, MD, FACS, is a Board Certifed Facial Plastic and Reconstructive Surgeon having completed his undergradu-
ate education at Yale University, his medical degree at Harvard Medical School and his M.P.H. in Health Policy and Manage-
ment also at Harvard University. Dr. Clevens completed his residency in Head and Neck Surgery and an advanced fellowship in
Facial Plastic and Reconstructive Surgery at the University of Michigan where he also served as Chief Resident.
Dr. Clevens is a nationally recognized educator, author, lecturer; he has served as President of Te Florida Society of Facial
Plastic and Reconstructive Surgeons, Chief of Staf at Wuesthof
Medical Center, President-Elect of the Brevard County Medi-
cal Society, and has held numerous leadership positions with
the American Academy and the American Board of Facial Plas-
tic and Reconstructive Surgery.
Dr. Clevens has been in private practice in Central Florida
since 1996. At the Clevens Center for facial Cosmetic Surgery
he has established a practice grounded in patient-centered care.
Clevens states that his staf is his great asset knowledgeable
professionals who impart compassionate care with exceptional
customer service.
Dr. Clevens leadership and commitment to excellence tran-
scends to his philanthropic endeavors through participating
in numerous charitable organizations in our community. Dr.
Clevens recently joined a humanitarian and medical mission
trip to East Africa. Having the opportunity to afect profound-
ly the lives of others through the application of his education,
training and judgment proved to be a deeply gratifying and
humbling experience.
He can be contacted by calling (321) 727-3223 or by visiting
www.DrClevens.com or www.FloridaFaceAndBodySpecialists.
com.
FACIAL COSMETIC SURGERY

FERTILITY
Male Infertility: Current Concepts and New
Robotic Microsurgery Treatment Options Now
Available at Winter Haven Hospital (Part 4 of 4)
WHAT IS MALE INFERTILITY?
Approximately 15% of all couples face infertility issues. Up to
50% of infertility in couples may be due to male factors. Male
infertility focuses on the male factors that may contribute to the
couples infertility issues. Infertility treatment is a team approach
involving female infertility and male infertility specialists with
one goal in mind - to help the couple have a child.
WHAT CAUSES MALE INFERTILITY?
A number of factors may lead to male infertility. Tese may
range from genetic and physiologic to environmental causes. Te
careful evaluation and examination of male infertility patients is
geared to assess any of these possible causes and to rectify them
if possible.
WHAT KINDS OF TREATMENT OPTIONS ARE
AVAILABLE?
Winter Haven Hospital in conjunction with the University
of Florida has developed a new center for urology and robot-
ics institute with a serious commitment to the development of
new diagnostic and surgical treatment options for Male Infertil-
ity. Te center is the leading program in the world performing
robotic assisted microsurgery to correct various types of male
infertility and testicular conditions over 600 procedures have
been performed so far (the largest experience of this kind in the
world). Tis article is the frst part of a 4 part series dedicated
to discussion of various unique treatment options ofered at the
center:
1) Robotic assisted microsurgery for vasectomy reversal and
congenital obstruction repair (such as cystic fbrosis vasal ob-
struction)
2) Robotic assisted microsurgical varicocelectomy for the treat-
ment of varicoceles in men
3) Robotic assisted microsurgical testicular sperm extraction
(Robotic Micro TESE) to detect and collect sperm from the
testicle in men who have no sperm in the ejaculate
4) Chronic testicular and groin pain novel robotic assisted
microsurgical targeted neurolysis or denervation of the sper-
matic cord to treat this condition
Tis issue focuses on subtopic 4:
ROBOTIC ASSISTED MICROSURGICAL
DENERVATION OF THE SPERMATIC CORD
FOR CHRONIC ORCHIALGIA: A PROSPECTIVE
OUTCOMES RESEARCH STUDY
Levine et al. have shown microsurgical denervation of the
spermatic cord (MDSC) as an efective treatment option for
chronic orchialgia. Pathology and anatomical studies have iden-
tifed specifc nerve bundles within the spermatic cord that may
be responsible for chronic pain in these men. We present out-
comes for a robotic assisted MDSC approach (RMDSC) utiliz-
ing a mapped nerve protocol to maximize preservation of vessels
and lymphatics.
Te Study design was a Prospective outcomes research study
with the primary endpoints of elimination in pain impacting
quality of life (assessed utilizing a standardized validated pain
assessment tool: PIQ-6, QualityMetric Inc., Lincoln, RI), op-
erative duration, hydrocele formation and testicular atrophy. A
four-arm RMDSC technique developed (daVinci Si high defni-
tion, Intuitive Surgical, Sunnyvale, CA). Analysis of 316 RMD-
SC cases from Oct08-July11 was performed (median follow up
8 months: 1 to 23). Selection criteria: chronic testicular pain
(>3 months), failed standard pain management treatments and
negative urologic workup. Pain scores and physical exam were
performed preoperatively and then postoperatively at 1, 3, 6, 9
&12 months.
84% (266/316) of the patients had a signifcant decrease in
their pain (complete elimination of pain or > 50% reduction in
pain) by 6 months post-op. Median operative duration was 15
min (7-150). 1 patient developed a hydrocele postoperatively.
Tere were two testicular artery and one vasal injury. Tese were
all repaired intra-operatively with robotic assisted microsurgical
techniques. Tese patients recovered postoperatively without
any further sequela. No patient has developed testicular atrophy
postoperatively. Te 4th robotic arm allowed the surgeon to con-
trol one additional instrument (micro Doppler) leading to less
reliance on the microsurgical assistant.
Mapped nerve robotic assisted microsurgical denervation of
the spermatic cord is feasible and the preliminary results appear
By Sijo J. Parekattil, M.D.
promising. Te four arm robotic approach allows the microsurgeon to
maneuver multiple instruments simultaneously.
Sijo J. Parekattil, MD, is Director of Urology & Robotic Surgery
for Winter Haven Hospital and University of Florida, Winter Haven,
FL, and is an Assistant clinical professor of Urology and an Adjunct
professor of Bioengineering. He has dual fellowship training from
the Cleveland Clinic Foundation, Cleveland in Laparoscopy/Robotic
Surgery and Microsurgery and was an Electrical Engineer prior to
his medical training and thus has interests in surgical techniques
incorporating technology, robotics and microsurgery. Dr. Parekat-
til also runs a dedicated Male Infertility and Groin Pain/Testicular
Pain Clinic at Winter Haven Hospital, Winter Haven (863-292-
4652 or www.roboticinfertility.com) As an infertility patient himself
at one point, he is truly dedicated to these patients. He may also be
contacted at sijo.parekattil@winterhavenhospital.org.
Figure 1. View for the surgeon in the robotic console. This

image shows the dissection of the spermatic cord this is a
simultaneous dual view format. The top view is a 3D 12-15x
digital magnifcation view and the lower image is a 16-20x
optical magnifcation view.
Figure 2. Robotic assisted microsurgery (the robot is used
instead of an operating microscope)
FERTILITY
November 10-11, 2011
8:30 a.m. - 5:00 p.m.
PULMONARY AND SLEEP DISORDERS
the bronchial wall and aiming at the
edge of the intraluminal lesion. Laser
pulses of 1 second or less are used to
vaporize the tissue. Tis is possible be-
cause the energy from the laser is rela-
tively well absorbed by water.
Te major disadvantages of the Nd: YAG Laser is the opera-
tors inability to predict the extent of deep tissue damage based
upon the surface appearance. If the power density increases at
sufcient depth below the surface of the target tissue, the tem-
perature can increase above boiling point of water. Explosion of
a pocket of steam causes popcorn efect which may result in
tissue perforation, rupture and hemorrhage.
PROCEDURE
Te choice of rigid versus fexible bronchoscopy depends
on the bronchoscopistss experience and preference, as well as
whether vaporization or resection of the lesion is planned. When
resection of the lesion is planned, rigid bronchoscopy is used and
when vaporization of the lesion is planned fexible bronchoscopy
is used.
After it has been determined whether the procedure will be per-
formed via rigid or fexible bronchoscopy, appropriate personnel
need to be recruited. Mostly the resection teams are comprised
of a bronchoscopy, and anesthesiology who is experienced with
interventional pulmonary techniques and airway management,
and endoscopy nurse familiar with the equipment, and a second
endoscopy nurse who assists the bronchoscopist and controls the
laser settings.
Once the patient is sedated and the airway is secured, the pro-
cedure can begin. Muscle relaxants and paralytic agents can oc-
casionally be helpful in preventing the patient from coughing
or moving during the procedure. Te use of these medications
should be minimized as much as possible.
Bronchoscopic laser resection should only be performed by
bronchoscopists who have advanced training and experience.
Bronchoscopists and team members should remain familiar with
techniques, potential complications and necessary precautions.
Precautions during laser resection include wearing protective
goggles, protecting patients eyes, avoiding injury from acciden-
tal laser scatter, and minimizing the risks of combustion.
Te fraction of inspired oxygen should be kept below 40%
during laser fring.
Video systems allow all personnel to observe the procedure
Bronchoscopic laser resection is used to relieve airway obstruc-
tion due to benign or malignant intraluminal airway obstruc-
tion, particularly exophytic proximal airway lesions, but have
little or no role when the obstruction is caused by an extrinsic
compression.
Malignant disease-Airway obstruction from bronchogenic
carcinoma is the most frequent indication for laser resection. It
is typically employed in patients who have exhausted their thera-
peutic options, although some may be eligible for salvage che-
motherapy, brachytherapy or surgical resection. Other malignant
causes of central airway obstruction that have been managed by
laser resection include adenoid cystic carcinoma, mucoepider-
moid carcinoma, endobronchial metastasis from melanoma, co-
lon, kidney and breast cancer.
Benign disease- Airway obstruction due to a benign lesion may
also be amenable to laser resection. Such lesions include a for-
eign body, stenosis due to granulation tissue, intubation injuries,
post radiation strictures, or strictures due to bronchial resections
or web-like structures from inhalation injuries or infections.
Patients who have benign strictures due to causes other than
infection should always be considered for open surgical resec-
tion. Candidates for bronchoscopic laser resection include those
who are not candidates for open resection because of age, poor
medical status, fear of surgery, extent, location, and degree of
the stricture.
Te laser that is most commonly used for bronchoscopic laser
resection is the Nd: YAG Laser (Neodymium, Yptrium, Alumi-
num, Garnet Laser). Its energy is delivered through fexible fbers
that are inserted through a rigid or fexible bronchoscope.
Te wave lengths of this laser (is 1,064 nm) is invisible, thus a
red helium neon beam is used to indicate where the laser energy
will be applied.
Nd: YAG Laser can remove an obstructing airway lesion in
two ways:
LASER RESECTION
Laser resection involves directing the laser at the target lesion,
devitalizing the lesion via photocoagulation of the feeding blood
vessels and then extracting the devitalized tissue through the
bronchoscope. Tis is possible because the laser penetrates tis-
sue to a depth of up to 10 mm in an inverted cone fashion and
provides reliable photocoagulation at this depth.
VAPORIzATION
Laser vaporization entails aligning the laser beam parallel to
Bronchoscopic Laser Resection
By Daniel Haim, M.D., FCCP
Be sure and check
out our NEW
and IMPROVED
website at
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which makes it easier for assistants to anticipate any difculties
or complications. Many bronchoscopic laser procedures are
performed in less than one hour.
COMPLICATIONS
Complications are infrequent, but they include hemorrhage,
airway wall perforation, airway wall necrosis, and fstula formation.
Arterial air embolism rarely complicates bronchoscopic laser
resection, but can lead to myocardial ischemia or cerebrovascular
accidents.
OUTCOMES
Outcome data is sparse, but in one large study in patients
with malignant airway obstruction it was found that the airway
patency improved and symptoms were palliated in over 90% of
patients. Mortality was less than one percent within seven days
from the procedure.
Emergency laser resection can favorably afect healthcare
utilization. Rapid patient improvement is frequently observed.

Y. Daniel Haim, MD, graduated from Sackler School
of Medicine in Tel-Aviv, Israel. He completed an Inter-
nal Medicine Residency at St. Lukes-Roosevelt Hospital
in New York, New York. He then did a fellowship in pul-
monary and critical care medicine at Temple University
Hospital in Philadelphia, Pennsylvania. Ten in 1995,
he joined Central Florida Pulmonary Group in Orlan-
do. Dr. Haim is the current President Elect of Florida
Hospitals Medical staf, a member on the Tumor Board,
and Assistant Professor at UCFs school of Medicine. Dr.
Haims special interests include interventional bronchos-
copy, which includes laser ablation, airway stents, and
ultrasounds. Additionally, Dr. Haim is involved with
research involving another area of interest, pulmonary
fbrosis.
Dr. Haim may be contacted at 407-841-1100 or by vis-
iting www.cfpulmonary.com.
PULMONARY AND SLEEP DISORDERS

7he Voltoct|ce lnsutonce lxetts
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Cancer patients in and around Seminole County now have more options when it comes to receiving cancer care. MD Anderson Or-
lando is beginning full-time medical oncology services at South Seminole Hospital under the care of oncologist Dr. Asad Sheikh. In addi-
tion, thoracic surgical oncologist Dr. Luis Herrera and breast cancer oncologist Dr. Rebecca Moroose will provide cancer care at the hospital
on a part-time basis in their respective specialty areas.
For the past year Dr. Herrera has been providing thoracic oncology services one day a week here at South Seminole Hospital, but with
the growing number of cancer patients in Seminole County this area needs additional oncology options, said Clarence Brown, MD, Presi-
dent and CEO of MD Anderson Orlando. We continue to see the number of men and women diagnosed with cancer climbing. By
having these services at South Seminole Hospital, cancer patients can now receive the best cancer care available right in their own neighbor-
hoods.
Te MD Anderson Orlando oncologists will be housed in the Physician Medical Ofce Building adjacent to South Seminole Hospital.
MD Anderson Orlandos main facility is located on the downtown Orlando Health campus and the cancer treatment facility already has
a full-time oncology presence at Dr. P. Phillips Hospital.
MD Anderson Cancer Center Orlando Provides
Full-Time Services at South Seminole Hospital
Equipped with the newest in surgical and imaging technology, operating suites serve
as a one-of-a-kind space for surgical advancement
CURRENT TOPICS
Advanced Neurosurgical Center at Florida Hospital
Orlando Revolutionizes Brain and Spine Surgery
Florida Hospital Orlando is leading the way for advanced
brain and spine surgery with the opening of a 35,000-square-
foot, cutting-edge neurosurgical center that will revolutionize
operating room efciency and precision of care. As one of the
most technologically advanced neurosurgical spaces in the nation,
it features eight operating rooms outftted with the latest intra-
operative imaging systems. It will also be home to the InnovatOR
Suite, a one-of-a-kind live surgical environment for clinicians and
industry to innovate product development.
Florida Hospital Orlando has created a destination surgical
platform for neurosurgery and for other specialties, said Beth
Weagraf, senior vice president, Florida Hospital Orlando. No
other surgical facility brings the newest, most advanced technologies
together under one roof with a dedicated team of physicians and
clinicians. Our facility will be one of the few in the nation and the
world with the ability to treat the most difcult of pathologies.
For patients, this center means immediate access to life-saving
procedures done more efectively than ever before with new imag-
ing technology that will decrease the chances of additional surger-
ies. Alice Reen, two-time brain tumor survivor and professional
tennis player, can attest to the fears patients face entering the op-
erating room before brain surgery and to the reassurance one can
fnd in knowing she has expert care.
Neurosurgery is a daunting and terrifying idea to a patient,
said Reen, who underwent surgery and received gamma knife
treatment from Dr. Melvin Field in 2011 when a previous be-
nign brain tumor resurfaced years later. I received incredible care
through this facility and am so impressed that Florida Hospital
has taken its care to yet another level in opening this neurosurgical
center.
Te neurosurgical center opens as part of the Florida Hospital
Neuroscience Institute and will serve as a destination for the most
complex neurological cases for adults and children. Sophisticated
imaging technology will be used for both diagnostic and intra-
operative purposes. Te intra-operative 3-Tesla MRI provides
surgeons with real-time clinical information through high-resolu-
tion images not previously available with this technology. Unlike
traditional MRI systems, which can only take images before or af-
ter surgery is completed, images are taken during the procedure,
eliminating the need to move patients from the sterile surgical
environment and signifcantly reducing the risk of infection. Te
system allows physicians to confrm the success of a surgery while
the patient is still on the operating table. Tis extensively decreases
the chance that a patient will need to return for a second or third
procedure. In addition to the MRI, two other operating rooms will
utilize an intra-operative, 40-slice CT scanner for surgeons to gain
a complete 360 degree neurosurgical view of the patient during
surgery.
While Reens 30-year battle with her tumor is hopefully over,
she knows the new surgical suites at Florida Hospital Orlando will
provide the best in surgical care for all patients facing neurological
issues. I understand the feeling patients have when they are told
they need more surgery, no matter how many years have passed
since the frst one, said Reen. Tis hospitals investment will
mean so much to the worried patients that will seek treatment and
can be comforted by the advancements in surgery available here.
Designed not only to deliver precise and reliable neurosurgical
care, the new center at Florida Hospital Orlando ofers a unique
surgical suite to be utilized by surgeons of all specialties to develop
improved practices and approaches to surgery through partner-
ships with industry leaders. Te InnovatOR Suite will provide
clinicians and medical industry leaders a space for research and
29
CURRENT TOPICS
Continued from page 28
Florida Hospital Memorial Medical Center to Open
New Port Orange Facility
Jasmin Baker is getting a very special present for her 8th birthday
this year: a life without sickle cell disease. Jasmin recently received
the frst bone marrow transplant to cure sickle cell disease in Cen-
tral Florida just in time for her special day. Now, Jasmins dreams
of swimming and playing outside with her brothers are possible
thanks to the Pediatric Cellular Terapy Program at Florida Hos-
pital for Children.
Jasmin has spent most of her life in and out of the hospital be-
cause of the efect sickle cell disease had on her body, said Mariah
Baker, Jasmins mother. I couldnt have imagined a better birthday
present for my little girl than a life without sickle cell disease.
On September 30th, Jasmin will turn 8 years old and on Oc-
tober 1, she will celebrate the 100th day since her bone marrow
transplant. Te 100th day is a major milestone that patients look
forward to after transplant because it marks a successful transplant
and an end to an intense regimen of medications.
Unlike most little girls, Jasmin was never able to play sports or
play outside in the Florida summer sun because of her sickle cell
disease. Patients with sickle cell disease must be careful in extreme
temperatures and cannot become overheated because the cells in
their blood can become easily clotted causing a variety of severe
development on product collaboration for anything from micro-
scopes to surgical tables. Innovative collaboration has already be-
gun to introduce new surgical operating designs which improve
surgical room utilization. Current partners for the InnovatOR
Suite include IMRIS, BERCHTOLD Corporation, Karl Storz,
Stryker and Leica Microsystems.
Te ability of our operating rooms to serve multiple purposes
for neurosurgery, imaging and innovative product development
will greatly improve the safety and efectiveness of surgery, said
Dr. Melvin Field, surgical director at the Florida Hospital Neu-
roscience Institute. Te medical industry will be watching our
InnovatOR Suite to learn more about the research and product
collaboration happening between several partners in a live surgical
setting.
Common conditions that will beneft from this technology in-
clude brain tumors, epilepsy, spinal disorders and blood clots from
strokes. Florida Hospital Orlando is the frst hospital in the South-
east to ofer the 3-Tesla MRI by IMRISneuro.
To learn more about the state-of-the-art neurosurgical center
at Florida Hospital Orlando, visit www.FutureOfNeurosurgery.
com.
Florida Hospital Memorial Medical Center (FHMMC) is pleased to announce the expansion of a new location in the Port Orange
Pavilion. Te 5800 sq ft facility will host a variety of clinical services and departments, including imaging, laboratory services, rehabilita-
tion and sports medicine, as well as family practice physician ofces and pediatric sub-specialists. Te clinic will ofer extended hours
designed to accommodate working families within Port Orange and the surrounding communities. Additionally, the site will share space
with physicians from Florida Hospital for Children who will travel to the new Pavilion location to provide care in a variety of specialties,
by appointment only.
Tis is a tremendous opportunity to expand our nationally-recognized services into the southeast Volusia County community, re-
marked Mark E. LaRose, President and Chief Executive Ofcer at FHMMC. We realized there was a need for a multi-disciplinary facility
that catered to working families by ofering extended hours and comprehensive services in one convenient location.
Te facility is scheduled to open October 17 in the northeast corner of the Pavilion, located between Belk and Hollywood Teatres,
across from Coldstone Creamery. Te clinics hours are Monday through Tursday, 7 a.m. to 7 p.m., and 7 a.m. to 5 p.m. on Fridays.
Long-time Volusia County family practice physician, Johnna Mantineo, DO, will relocate her Daytona Beach ofce into the new Port
Orange location and is accepting new patients. Mantineo is one of several physicians within HealthCare Partners, the multi-specialty
physician group employed by FHMMC.
A variety of pediatric sub-specialists from Florida Hospital for Children, based in Orlando, will also add to the comprehensive scope
of services that families will have access to at the clinic. Families can schedule appointments with a variety of pediatric physicians in areas
such as pediatric cancer, neurology, general surgery, orthopaedics, endocrinology and urology to make it easier to see expert physicians
close to home. Tese visit are by appointment only.
Were thrilled to bring some of the nations top pediatric sub-specialists to Port Orange, said Florida Hospital for Children Adminis-
trator Marla Silliman. Our goal is to provide families with access to world class physicians in their own backyard.
Girl Gets Once in a Lifetime Birthday Present: A Cure
to Her Sickle Cell Disease
7-year-old receives Central Floridas frst bone marrow transplant to cure sickle cell disease
Continued on page 32
A new test is giving doctors and patients a clearer picture of Parkinsons disease, and Parkinsons syndrome. Nuclear medicine specialists
at Orlando Regional Medical Center (ORMC) are now using DaTscan the frst Food and Drug Administration-approved imaging agent
to help diagnose patients with suspected Parkinsonian syndromes, such as Parkinsons disease a neurodegenerative disorder that aficts
nearly 1.5 million Americans, with an additional 50,000 to 60,000 new cases identifed each year. ORMC is the frst hospital in Central
Florida certifed to perform the test.
With a more timely diagnosis we can manage the disease earlier, which leads to better outcomes for patients, said Mary Hart MD,
nuclear medicine chair, ORMC.
DaTscan, by GE Healthcare, is performed by injecting a tiny dose of a radioactive tracer, followed by a painless imaging procedure called
SPECT (single photon emission computed tomography), to search for dopamine transporters (DaT). Dopamine, a brain chemical respon-
sible for movement control diminishes in patients with Parkinsons disease causing tremor, slowness of movement, muscle stifness and
balance problems. Te tracer binds to the dopamine transporters and the scan produces images that provide visual evidence of the presence
of dopamine transporters. Te entire procedure requires three to four hours.
A normal image resembles two large commas or crescents in the brain, said Dr. Hart. Because dopamine levels drop in patients with
Parkinsons disease and other Parkinsonian syndromes, one or both of the normal crescents is not visible or may appear more like a period
or oval.
While a diagnosis of Parkinsons syndromes presents a challenge, the confrmation of the correct diagnosis can make a diference in treat-
ment and progression of the disease.
DaTscan studies show upwards of 90 percent accuracy in diagnosing early, mid and late stages of Parkinsons disease, said Dr. Hart.
When presented with more reliable diagnostic data from the DaTscan, studies show that the treating physician alters his choice of treat-
ment more than 40 percent of the time. Tis evidence based afect on clinical management is important because it shows that the procedure
leads to more appropriate treatment for improved outcomes.
More defnitive testing may avoid or end years of expensive testing for a conclusive diagnosis, which can be delayed for as many as six
years. Clinical examinations, particularly early in the disease when symptoms are slight, can be inconclusive or misleading. Incorrectly label-
ing Parkinsons syndromes as an unrelated movement disorder, such as essential tremor, can delay efective treatment.
Knowledge is power, especially in the case of medical conditions, said Dr. Hart. Tis test helps patients and their families face, and
overcome the fears and frustrations inherent with uncertain diagnoses. If we can confrm that a patient does not have Parkinsons disease,
or Parkinsons syndromes, it is a big relief. Confrmation of Parkinsons disease is just as critical to know because it helps the patient and
family members plan for the future.
ORMC offers new test to help identify
Parkinsons disease
CURRENT TOPICS
A new drug combined with a high-tech brain scan singles out disease
Music and Angry Birds Helping Chemotherapy
Patients at MD Anderson Orlando?
Yes, thanks to a generous donation from Rock Pink
Rock Pink, a 501(c)(3) charitable organization whose mission
is to raise breast health awareness and support local breast cancer
charities, has donated Apple iPads to MD Anderson Cancer Cen-
ter Orlando to serve cancer patients undergoing treatment. Te
donations are part of Rock Pinks music and humanity initiative.
Te 10 Apple iPads donated by Rock Pink will provide patients
at MD Anderson - Orlando the opportunity to watch television
and movies, stream live music, play games, read books, and surf
the Web all in the hopes of ofering a positive distraction during
chemotherapy, radiation, and other difcult cancer treatment ses-
sions. Rock Pink Roster Bands megaphone, Traverser, and Tina
Nicole Band, amongst others, donated their albums for the music
and humanity project and will be featured on the iPads.
Given the commitment of MD Anderson - Orlando to do ev-
erything possible to provide the highest level of quality and com-
passionate care to cancer patients, said Mark Hollamon, Rock
31
CURRENT TOPICS
Pink Founder, a partnership with Rock Pink was a natural ft.
We look forward to giving more in the future and intend to be a
long-time supporter of MD Anderson - Orlando.
We are very appreciative of Rock Pinks donation of this tech-
nology which will certainly beneft our patients undergoing cancer
treatment, said Clarence Brown, III, MD, President and CEO,
MD Anderson Orlando. We know that the fght to beat can-
cer depends upon patients maintaining a strong positive attitude.
Te entertainment that these iPads will provide will certainly
bring many smiles to the brave faces of cancer patients who walk
through our doors.
1st Annual Multispecialty
Robotic Microsurgery Symposium
Robotic Assisted Microsurgical & Endoscopic Society (RAMSES)
On behalf of the Robotic Assisted Microsurgical & Endoscopic Society, it is with great enthusiasm and pleasure that we invite you to
attend the 1st Annual Multispecialty Robotic Microsurgery Symposium, November 4 6, 2011, at Disneys Boardwalk Resort in Lake
Buena Vista, Florida. Microsurgeons from the felds of hand, plastics, reconstructive, ENT, urology, gynecology, ophthalmology, vascular,
orthopedics, pediatrics and peripheral nerve will be in attendance. Tis is a grassroots multi-institutional physician lead group aimed at
driving the development and implementation of new robotic assisted microsurgical tools and platforms. Our goal is to develop the potential
application of robotics in microsurgery in an evidence based collaborative manner.
Tis multi-specialty meeting will be unique, since we will be ofering an educational opportunity for all who have an interest in robotic
assisted microsurgical and endoscopic procedures:
TOPICS TO BE COVERED:
Urology (male infertility, chronic testicular and groin pain, vasectomy reversal, prostate cancer nerve preservation, peyronies disease,
erectile dysfunction)
ENT (trans oral surgery for tumors without removing the jaw, trans-axillary thyroidectomy)
Hand surgery (microvascular repair, nerve repair, harvest of muscle for tendon transfers, free tissue transfer, carpal tunnel)
Vascular surgery (microvascular surgery)
Orthopedics (minimally invasive approaches to shoulder and elbow surgery, hand surgery)
Gynecology (tubal reversals, hysterectomy)
Ophthalmology (eye surgery, orbital tumor surgery)
Anesthesiology (robotic assisted intubation and central line access)
Over 50 distinguished speakers from over 30 academic institutions worldwide including the University of Florida, Cleveland Clinic,
MD Anderson, Mayo Clinic, University of South Florida, Tulane, University of Strasbourg, Northwestern, Loyola, etc.
Presentations from industry thought leaders
Live televised robotic microsurgical case
First ever biosynthetic cadaver and tissue microsurgery training
Demonstrations and hands-on training with new (frst time being presented) robotic microsurgery tools (micro doppler probes, micro
ultrasound probes, biosynthetic nerve wraps, micro hydrodissection tools, enhanced optical magnifcation systems, accessory robotic arm
tools, etc).
As well as the scientifc sessions, attendees are encouraged to catch up with colleagues and visit with exhibitors at the Welcome Reception
on Friday. In addition, dont miss out on Saturdays reception, which will be located at the LEGO Mansion at the recently opened LEGO-
LAND! (Te park will remain open for an additional 2 hours that evening for RAMSES attendees). Come and learn from international
experts; sharpen and practice new techniques; consult with colleagues on innovative solutions; network with your peers; and, enjoy time
with old and new friends in your feld. Come support this physician driven initiative to ensure that we can lead the future development of
microsurgery.
We hope you will join us this year in Lake Buena Vista!
Michael Bednar, MD Stacey Berner, MD Philippe Liverneaux, MD Sijo J. Parekattil, MD Gustavo Ruggiero, MD Jesse C. Selber, MD, MPH
*Obtain detailed meeting information and/or register quickly and easily online at www.roboticmicrosurgeons.org.
NOVEMBER 4 6, 2011 DISNEYS BOARDWALK RESORT LAKE BUENA VISTA, FL
ADVERTISERS INDEx
Central Florida
Pulmonary Group . . . . . . . . . . . . 12
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Cosmetic Surgery . . . . . . . . . . . . 18
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Danna-Gracey. . . . . . . . . . . . . . . 27
Digestive & Liver Center
of Florida . . . . . . . . . . . . . . . . . . 10
Florida Hospital Neuroscience
Inststute . . . . . . . Inside Front Cover
FloridaMD.com . . . Inside Back Cover
Halifax Health
Cancer Center . . . . . . . . Back Cover
HIPPA Seminar . . . . . . . . . . . . . . 25
Jewett Orthopaedic . . . . . . . . . . 32
Last Diet ad . . . . . . . . . . . . . . . . 11
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Vascular Institute of Central
Florida, David Varnagy MD . . . . . . 15
medical issues, including death. Jasmin was also prone to infections and spent a majority of her time in and out of the hospital. But now her
sickle cell disease is ofcially a thing of the past.
People who have sickle cell disease often face a wide range of health issues from shorter life expectancies to constant hospitalizations
from infection to intense pain, said Dr. Paul Gordon, medical director of the Pediatric Cellular Terapy Program at Florida Hospital for
Children. Post-transplant, she is doing wonderfully and is expected to live a normal life. She can now do many of the activities that she
couldnt do before, such as sports.
Jasmin will no longer have to sufer through constant infections and hospitalizations as a result of her sickle cell disease.
I have always wanted to go swimming but I never could because of my sickle cell disease, said Jasmin. But now that I am better, I can
do a lot more things that I couldnt do before. Im really excited to also play with my brothers and my dog.
Florida Hospital is the only hospital in Central Florida to ofer bone marrow transplants. Bone marrow transplants can be used to treat
more than 70 cancerous and non-cancerous diseases, including sickle cell disease.
I feel so blessed to have found Dr. Gordon and his team, said Mariah Baker. Jasmins life is forever changed because of her transplant.
Now she can be the little girl that she was always meant to be.
"Jewett made my family
feel like we were part
of their family."
Go to www.jewettortho.com
and see the OLenicks full story
Stirling Center
701 Platinum Point
On Rinehart Road
Lake Mary, FL 32746
A tradition of care powered by innovation
407.206.4500
www.jewettortho.com
Jewett has a WALK-IN to make your summer easy
and stress free!
No appointment necessary!
Monday - Thursday: 7:30am - 8:00pm
Friday: 7:30am - 4:00pm
Saturday: 9:00am - 3:00pm
fl-md-jewett-july_Layout 1 6/30/11 10:57 AM Page 1
Visit Our New Website at
FloridaMD.com
Your Medical Business Resource
Practice Management Advice
Financial Information
Pod Cast Interviews with
Specialists and Professionals
Medical Classifeds
Back Issues with
Informative and
Interesting Stories
For Information Please
Email: info@foridamd.com
or call 407.417.7400
CURRENT TOPICS
Visit Our New Website at
FloridaMD.com
Your Medical Business Resource
Practice Management Advice
Financial Information
Pod Cast Interviews with
Specialists and Professionals
Medical Classifeds
Back Issues with
Informative and
Interesting Stories
For Information Please
Email: info@foridamd.com
or call 407.417.7400
Be Afraid Cancer.
Be Very Afraid.
Well Never Stop Fighting For You
We are the most experienced oncology program in East Central Florida. No one in the area has been combating
cancer longer than Halifax Health - Center for Oncology. Turn to us whether you are seeking diagnosis, treatment
or post cancer care. We are committed to helping you every single step of the way. Our physicians and staff
have experience, expertise and the passion to battle cancer. Were with you in this fight.
Meet the Physicians
Halifax Health physicians are exceptional because they bring collaboration, academic focus and skill to every
case. Hear the areas most established cancer team talk about their personal approaches to treating patients,
get their perspectives on cancer and see their unique dedication to fighting cancer at cancerhatesus.org.
Individuals and families affected by cancer can take comfort in the fact that Halifax Health - Center for Oncology
offers the most advanced treatments and a team of experienced practitioners. We work hard to fight cancer and
thats why cancer hates us. Get the details at cancerhatesus.org.
Halifax Health is becoming
an academic center for
cancer treatment.
- Dr. Joyce Battle
Most of the time my patients
become my friends, I trust
them and they trust me.
- Dr. Greg Favis
Halifax Health is a
comprehensive cancer
center that is supported by
multiple specialties.
- Dr. Boon Chew
There is virtually nothing
we cant treat here at
Halifax Health.
- Dr. Charles Hechtman
Each patients journey
through cancer is unique and
we help them in that journey.
- Dr. Ruby Ann Deveras
Halifax Health offers the most
advanced technologies for
fighting cancer, like the da
Vinci
robot.
- Dr. Kelly Molpus
At Halifax Health, Im able
to treat patients in a manner
that is better than I couldve
hoped for.
- Dr. Walter Durkin
You need compassion for
patients to support them
and I enjoy working with
my patients.
- Dr. Abdul Sorathia
We lead the state in
multidisciplinary cancer
care and the Novalis Tx
is a continuation.
- Dr. Brad Factor
The goal is to deliver the
best care in a kind and
thoughtful manner.
- Dr. Richard Weiss
1011-1531

FloridaMD Medical/Business Magazine For Physicians October 2011

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FloridaMD Medical/Business Magazine For Physicians October 2011

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OCTOBER 2011 CENTRAL FLORIDA EDITION

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