WHAT IS THE VALUE IN SEEING A

Laura Pratesi is a Doctor of Audiology and the owner of Citrus Hearing Clinic in Clermont. Many people may be unsure of what a “Doctor of Audiology” does and to answer that question we asked Dr. Pratesi to explain.

“A Doctor of Audiology is someone who has undergone an intense four-year postgraduate degree program, with clinical duties a major part of their instruction. Ultimately, our job is to make sure patients receive the hearing and balance healthcare they need. We also coordinate with other healthcare professionals to be sure there are no underlying medical concerns that may be contributing to a hearing or balance problem. Contrary to what many believe, my job is not about selling hearing aids. My job is making sure, if a patient needs a hearing aid, they walk out with the right one.

“There are no ‘bad’ hearing aids, but I have seen a lot of bad programming. For instance, only about 55% of offices out there are doing actual ‘real-ear measurements.’ Real-ear measurement involves inserting a tiny microphone into a patient’s ear canal to know exactly how and what a patient is hearing—there is no other accurate way to check the prescription in a hearing aid. Of course, I want my patients to be comfortable with their hearing aid, for it to look good, but mostly I want it to work.”

If we are to believe the ads we read and the commercials on TV, hearing loss, hearing aids, even tinnitus have become commonplace nowadays. We wanted to get a better feel for that and so we asked Dr. Pratesi what was going on.

“Hearing problems can be caused by so many factors. Sometimes it’s a physical cause; a birth defect, an ear infection, or a punctured eardrum. The big childhood diseases like chickenpox, mumps, or measles could be at fault. The problem can be sensorineural, in which the cochlea has been damaged, either from exposure to harmful noise levels or certain medications—there are over 300 medications that are toxic to our ears. Even aspirin can cause problems. The world we live in has made age-related hearing loss almost ubiquitous.”

Sounds like hearing problems are almost unavoidable.

“We can take steps to protect ourselves. Earplugs are a great place to start. Loud concerts, mowing the lawn, even your occupation can expose you to hazardous noise levels. Did you know hairdressers and dentists— because of the hair blowers and the drills—often have problems?

“Hearing is one of your five senses. Protect what you have. If you suspect a problem, don’t wait. I tell everyone I know to get a baseline hearing test right now, whether they suspect a problem or not. That information will be incredibly valuable. It may discover a problem that’s just beginning. Or, at the least, provide a healthy snapshot should a problem ever arise in the future.”

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One of the biggest concerns today is the escalating costs of health care. At Lakeview Internal Medicine, we have been designing ways to make the health-care system more efficient and doing certain procedures in our office to decrease the cost of health care. We can provide integrated care in one office without giving the patient the runaround. We have been slowly building up our specialist network, and it’s worked out well. Actually, patients love it. They feel that the care is more complete, and it has helped keep costs down for patients and for Medicare.

One of the biggest expenses of the Medicare dollar is visits to the hospital. At our offices, we have been giving intravenous uids to patients who have been having gastroenteritis or diarrhea, we have been giving them antibiotics for pneumonia, and we are treating wound infections in our offices instead of sending patients to the hospitals.

We have many specialists now so we can provide all this care under one roof, specialties such as doctors treating infectious disease; nephrologists, a kidney specialist; a rheumatologist for joints and muscles; endocrinologists for diabetes and all the glands; an ear, nose, and throat specialist; and a cardiologist. Ultrasounds, blood tests, labs, echocardiograms, stress tests—they’re all done here in the office.

We also are able to prevent a lot of patients from winding up in the hospital unnecessarily, and specialists are not doing unnecessary tests on patients. And we are trying to keep abreast of the newest changes in the health-care technology arena.

Also, a multi-specialty group is better for patient care because all the records are in one place and it is easy access for the specialists and it is easy to follow for the patients. The patients are very happy because they don’t have to keep asking for their records, and our practice doesn’t have to make multiple records requests from other specialist offices.

This is the era of medicine we are entering, where we can provide comprehensive care, better care, and the most cost-effective level of care.

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If you are a pet owner, it probably seems like yesterday when you brought that adorable kitten or puppy home. You remember it running around the yard with endless energy, exploring its new surroundings. Unfortunately, there will come a time when your furry friends slow down.

It happens to them like it happens to us. When we age, our health care needs change considerably because we’re more prone to developing health conditions that may negatively affect our quality of life.

Same with pets. If you want to ensure that your beloved dog or cat lives a longer, happier life, it must receive adequate care during its golden years.

Fortunately, Dr. Cara Erwin-Oliver of Belleview Veterinary Hospital has extensive experience when it comes to caring for geriatric pets and she is a strong believer in preventive pet health care.

“Pet care is always important, but that is especially true during a pet’s older years,” says Dr.

Erwin-Oliver, who has worked at the family-owned practice for 13 years. “Dogs become geriatric patients at approximately age 8, cats around age 9. When an older dog or cat does not feel well, pet owners sometimes chalk it up to old age. But age is not a disease. There is a reason your pet doesn’t feel good. So, let’s fix it. It is always better to prevent a problem from occurring or treat it early rather than wait.”

The doctor recommends yearly blood profiles of geriatric pets to monitor organ functions. She looks at liver enzymes, kidney enzymes, blood cell counts, glucose levels, thyroid levels, and electrolytes. Doing this helps her detect numerous diseases in their early stages such as diabetes, kidney disease, blood disorders, liver disease, thyroid disorders, and Cushing’s disease, to name a few.

“Problems start at a cellular level. Detecting these diseases early is important because we can combat many of them with proper nutrition and nutritional supplements.

Diabetes is a good example. If a dog or cat has slightly elevated glucose, we may be able to regulate it by diet alone. If that doesn’t work, we have the option to treat medically.”

Besides blood profiles, Dr. Erwin-Oliver also conducts a thorough exam of the patient, including auscultation of the heart and lungs. She performs parasite screenings to detect intestinal parasites—a major problem in Florida. She uses urinalysis to detect kidney disease, diabetes and UTI’s.

Belleview Veterinary Hospital was founded in 1993. Today, Dr. Rick Erwin and his daughter Dr. Cara Erwin-Oliver have a thriving practice located at 10725 SE 36th Avenue. FOR

WHAT IS A FUSION BIOPSY?

We asked Edward D. King, MD, vice president of Ocala’s Advanced Urology Institute about this state-of-the-art new treatment for prostate patients.

Dr. King says, “Transrectal ultrasound—MRI prostate fusion biopsy is the new standard of care for the detection of prostate cancer.

The only definitive diagnosis comes from biopsy, and these only work if cancer cells are detected. Until now, traditional approaches were notoriously hit or miss.

A PSA blood test as well as a digital rectal exam performed by a patient’s personal physician, feeling for any obvious prostate abnormalities such as areas if induration or nodularity are the first tests.

The Prostate-Specific Antigen is a protein produced by both healthy and malignant prostate glands and measures the amount of that protein in the blood. A PSA of 4.0 or less is considered “normal.” Test results above 4.0 may indicate prostate cancer. But even that can be inconclusive. Fully 10 percent of patients who present with prostate cancer have normal-ranged PSAs readings.

Next, using a transrectal ultrasound probe for guidance, a biopsy needle is inserted into the prostate and biopsies performed in a systematic pattern with the hope that tissue samples provide answers. Unfortunately, 15 to 20 percent of the areas of cancer can be missed.

Enter fusion biopsy.

This cutting-edge technique combines the superior image results of a high-definition multi-parametric MRI—with real-time ultrasound images allowing for visualization of areas suspicious for cancer which would otherwise be invisible on ultrasound alone.

Sophisticated software in a machine called a UroNav by Invivo overlays the super-detailed MRI images, fuses them, with ultrasound images obtained from a trans-rectal probe administered in an outpatient setting. The result allows an examining physician to guide biopsy needles with pinpoint accuracy to access any suspicious areas or lesions revealed by MRI.

One reason it is not offered by most urology practices is cost. But the benefits—the higher detection rate of prostate cancers, lower incidence of repeat biopsies, superior accuracy— are fast making it the gold standard for the detection and monitoring of prostate cancer.

Dr. King recommends patients with prostate concerns consult a urologist immediately.

If a biopsy is in order, find a clinic with a high-definition MRI and physicians skilled in fusion biopsy along with a radiologist experienced in multi-parametric MRI prostate imaging.

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