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ON THE COVER: UCF Lake Nona Hospital
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MORE CANNABIS DISPENSARIES = FEWER OPIOID DEATHS
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HOW TO RECOGNIZE POTENTIALLY CRITICAL SLEEP DISORDER CASES
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MITIGATING THE RISKS OF CERVICAL INSUFFICIENCY
COVERING THE I-4 CORRIDOR
COVER STORY
In early 2021, Central Florida celebrated the grand opening of UCF Lake Nona Medical Center (now UCF Lake Nona Hospital), a full-service acute care hospital intended to revolutionize and improve access to medical care in the Lake Nona area. Just over one year later, the hospital has achieved that goal by a wide margin, and it continues to serve as an example of how a focus on innovation and positive patient experiences can contribute to better health outcomes. Before the hospital began construction in 2018, no other facilities in the Lake Nona area were designed to serve the adult patient population: Nemours Children’s Hospital and Orlando VA Medical Center, the two primary hospitals in the area, provided care for children and veterans respectively. To serve the region’s unmet need, the UCF Lake Nona facility opened with 64 inpatient beds and a 24/7 20-bed emergency department, with ample capacity for expansion in future years. As its name suggests, the hospital maintains a partnership with University of Central Florida Academic Health that allows tomorrow’s healthcare professionals to benefit from the expertise, clinical knowledge and practices available through the UCF College of Medicine, as well as from HCA Florida Healthcare’s network of more than 11,000 physicians.
PHOTO: PROVIDED BY UCF LAKE NONA HOSPITAL
PHOTO: PROVIDED BY UCF LAKE NONA HOSPITAL
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MAY/JUNE 2022
DEPARTMENTS 2
FROM THE PUBLISHER
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PULMONARY AND SLEEP DISORDERS
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MARKETING YOUR PRACTICE
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DERMATOLOGY
14
PEDIATRICS
FLORIDA MD - MAY/JUNE 2022
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FROM THE PUBLISHER
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am pleased to bring you another issue of Florida MD. Sometimes a patient may have the opportunity to participate in a clinical trial. Sometimes a patient may need specialized treatment that is not available in Central Florida. And sometimes there’s no money for that patient to get to those places. Fortunately there is Angel Flight Southeast to get those patients where they need to go. I asked them to tell us about their organization and how you, as physicians, can help. Please join me in supporting this truly wonderful organization. Best regards,
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ANGELS ON EARTH HELP PATIENTS GET TO LIFESAVING MEDICAL TREATMENT Everyone knows angels have wings! But did you know in Florida and many parts of the nation they have engines and tails with dedicated volunteers who donate lifesaving services every day? Leesburg, Fla.-based Angel Flight Southeast is a network of approximately 650 pilots who volunteer their time, personal airplanes and fuel to help passengers get to far-from-home medical care. A member of the national Air Charity Network, Angel Flight Southeast has been flying passengers since 1993. Almost all of its passengers are chronic-needs patients who require multiple, sometimes 25-50 treatments. Passengers may be participating in clinical trials, may require post-transplant medical attention or are getting specialized treatment that is not available near home. Each passenger is vetted to confirm medical and financial need and is often referred to Angel Flight Southeast by medical personnel and social workers. Angel Flight Southeast “Care Traffic Controllers” arrange flights 24 hours a day, 365 days a year. In the event of a transplant procedure, the Care Traffic Controllers have precious minutes to reach out to its list of volunteer pilots who have agreed to be prepared on a moment’s notice to fly a patient to receive his or her potentially lifesaving organ. The organization is completely funded through donations by individuals and organizations. A typical Angel Flight Southeast pilot donates $400 to $500 in services-per-trip. In fact, Angel Flight Southeast has earned the Independent Charities of America Seal of Approval as a good steward of the funds it generates from the public. Each $1 donated generates more than $10 worth of contributed services by Angel Flight Southeast. The charity always seeks prospective passengers, volunteer pilots and donations. For additional information, please visit https://www.angelflightse.org or call 1-888-744.8263.
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Publisher: Donald Rauhofer Photographer: Donald Rauhofer / Florida MD Contributing Writers: : John “Lucky” Meisenheimer, MD, , Daniel T. Layish, MD, Orlando I. Ruiz-Rodriguez, MD, Cole Douglas Greves, MD, Joseph G. Khoury, MD, Sonda Eunus, MHA, Michael Patterson NHA, OTR/L, CEAS, , John Meisenheimer, VII Art Director/Designer: Ana Espinosa Florida MD is published by Sea Notes Media,LLC, 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 cannot be held responsible for opinions expressed or facts expressed by its authors. Copyright 2022, Sea Notes Media. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Annual subscription rate $45.
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COVER STORY
At UCF Lake Nona Hospital, Florida’s Healthcare Future Is Bright By Staff Writer In early 2021, Central Florida celebrated the grand opening of UCF Lake Nona Medical Center (now UCF Lake Nona Hospital), a full-service acute care hospital intended to revolutionize and improve access to medical care in the Lake Nona area. Just over one year later, the hospital has achieved that goal by a wide margin, and it continues to serve as an example of how a focus on innovation and positive patient experiences can contribute to better health outcomes.
PHOTO: PROVIDED BY UCF LAKE NONA HOSPITAL
Before the hospital began construction in 2018, no other facilities in the Lake Nona area were designed to serve the adult patient population: Nemours Children’s Hospital and Orlando VA Medical Center, the two primary hospitals in the area, provided care for children and veterans respectively. To serve the region’s unmet need, the UCF Lake Nona facility opened with 64 inpatient beds and a 24/7 20-bed emergency department, with ample capacity for expansion in future years.
united in their commitment to serving our patients and caring like family,” said Chuck Hall, national group president at HCA Healthcare, when the change was announced. “This transition reflects our mission and our commitment to all we serve as we continue to work together to deliver top-quality care for patients across the Sunshine State.”
THE HEART OF INNOVATION IN A BOOMING INDUSTRY
With more than 20 million residents and a steadily rising population, Central Florida’s need for healthcare services continues to grow. UCF Lake Nona Hospital is committed to serving that need not only through improved capacity, but also improved quality: innovative medical procedures; modern, patient-centric accommodations; and an inclusive, collaborative approach to care. In just one year since opening, the hospital has already found its way as a popular outpatient and inpatient surgical destinaAs its name suggests, the hospital maintains a partnership with tion with four 660-square-foot surgical suites for general surgery, University of Central Florida Academic Health that allows toorthopedics, gynecological, spine, bariatric, breast, neuro, oncolmorrow’s healthcare professionals to benefit from the expertise, ogy, colorectal, gastrointestinal, thoracic, urological, vascular and clinical knowledge and practices available through the UCF Colother specialties. Additionally, this state-of-the-art facility hosts lege of Medicine, as well as from HCA Florida Healthcare’s netthe most advanced diagnostic and imaging services available inwork of more than 11,000 physicians. cluding 3D mammography, interventional radiology, DEXA, In March 2022, UCF Lake Nona Hospital went through its CT, Fluoroscopy, MRI, nuclear medicine, ultrasound and more. latest significant change, joining HCA Florida Healthcare hospiUCF Lake Nona Hospital already earned high honors from tals across the state in adopting a new name, logos and brand that HCA Healthcare’s prestigious Unit of Distinction Awards, for represents the connection to one of the nation’s leading collaboraboth its Emergency Services and Surgical Services departments. tive healthcare networks. These awards recognize and celebrate top-performing departments in leadership, professional practice and operations, where some “Our Florida colleagues and physicians have always been 94,000 nurses are employed. UCF Lake Nona Hospital recently celebrated its one year anniversary and is part of The 24/7 Emergency Department HCA Florida Healthcare’s network of more than 11,000 physicians. consistently ranks among the top three in the enterprise for patient satisfaction out of HCA Healthcare’s 183 hospitals. As part of its pioneering approach to medicine, UCF Lake Nona Hospital is among the first facilities in the country to offer incisionless brain surgery for patients living with essential tremor and Parkinson’s tremor. Approved by the FDA in 2016, the noninvasive treatment uses MRI-guided focused ultrasound to significantly improve symptoms of tremor in just a few hours with minimal side effects. In the Family Birthing Unit, ex4 FLORIDA MD - MAY/JUNE 2022
COVER STORY pecting mothers can labor, deliver and recover from birth in spacious all-in-one suites, which offer family-friendly accommodations and a range of options to support mothers’ birth preferences. In the hospital’s bariatric department, a skilled team of surgeons also provide more options for Central Florida patients living with obesity, helping to improve their quality of life, prevent and treat obesity-related diseases, and save lives through compassionate and stigma-free treatments.
PHOTO: PROVIDED BY UCF LAKE NONA HOSPITAL
“The field of medicine is constantly changing, and new therapies and best practices are being identified every day. It’s our duty to help patients navigate the many options available and to support them in making informed decisions about their care,” says Dr. Steve Pierre, chief of staff at UCF Lake Nona Hospital. “By staying on the leading edge of medical science, we are continuing to invest in the wellbeing of our patients and the community.”
THE CUTTING EDGE OF INCISIONLESS NEUROSURGERY UCF Lake Nona Hospital pioneered Central Florida’s very first incisionless brain surgery procedure last May, MRI-guided focused ultrasound for the advanced treatment of essential tremor (ET). Former school teacher Patricia Hawley, 82, had journaled her entire life and 15 years ago lost her ability to write due to ET. Hawley was one of the more than 10 million Americans (an estimated 3% of the population) who live with ET, making it the most common movement disorder in the nation. After the two-hour procedure, Hawley was immediately able to return to writing, steadily hold a cup of coffee and resuming many of the normal everyday activities so many of us take for granted. When Jen Stratton was six years old, she was diagnosed with ET, a condition that would shape the rest of her life. Her involuntary shaking often posed a hurdle in the normal activities of her daily life, from dating and starting a family to beginning her career in the financial sector. “What I struggle with the most is the perception others have of me in social situations,” she said. “My body reacts to a little bit of nervousness with a lot more tremor than I have when I’m resting, so I can be perceived as not being able to handle a normal interaction with other people. I just want my inside to match my outside.” Because her tremor was so unpredictable, Stratton said it was “a bit of a guessing game” as to whether she could handle everyday tasks on any given day. Sometimes, she could cook and put on cosmetics, but at other times the shaking was so severe it prevented her from typing or unlocking the front door of her house. Although Stratton had tried medication to relieve her ET in the past, she found they caused too many unwanted side effects to be worth the benefit. She had also refused surgery for many years, concerned that it might worsen her tremor or lead to unexpected problems. However, she reconsidered when she heard about the noninvasive treatment offered at UCF Lake Nona Hospital in 2021. The procedure, which was approved by the FDA in 2016 and by the Centers for Medicare and Medicaid Services (CMS) in July
Patricia Hawley was the first patient in Central Florida to undergo MRI-guided focused ultrasound at UCF Lake Nona Hospital. Above is Hawley’s before and after writing sample from the life changing twohour incisionless procedure.
2020, presents minimal risks, making it a strong alternative to existing surgical treatment options. “This non-invasive therapy is a game changer for individuals who live with tremor and for whom medication alone will not work and surgery is not an option,” said Nizam Razack, MD, JD, FACS, neurosurgeon at UCF Lake Nona Hospital, who performs the procedures. “There are no incisions or holes made to the skull, meaning a reduced risk of infection and clot formation – which can be associated with traditional neurosurgical procedures.” Tremors may be caused by abnormal activity in the brain tissue of the thalamus, which inhibits a patient’s motor control. Using a MRI scan and a metal frame for a fixed point of reference, the surgeon can precisely target that area of the brain with a focused beam of ultrasound, which disrupts the activity causing the tremor. MRI-guided focused ultrasound can lead to immediate improvement of symptoms in just a few hours, and it requires no anesthesia or incision. Side effects are also minimal, although the patient should be monitored for a few hours in case of temporary nausea, headache, numbness, difficulty swallowing or unsteadiness in walking. In most cases, patients can go home on the same day. Currently, focused ultrasound treatment is approved for use on only one side of the brain. Not all patients qualify for focused ultrasound treatment, and factors like skull thickness and skull density ratio may impact eligibility. For those patients, the provider may recommend an alternative treatment, such as deep brain stimulation (DBS), thalamotomy or gamma-knife surgery (GKS). “This procedure is a new tool in our arsenal to help restore quality of life and independence for essential tremor and Parkinson’s FLORIDA MD - MAY/JUNE 2022
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PHOTO: PROVIDED BY UCF LAKE NONA HOSPITAL
tremor patients,” said Dr. Razack. “Whether focused ultrasound patients are self-referred or referred by their neurologist, the procedure still requires a lot of management. Patients need to continue to return to their neurologist for ongoing observation and medication.” In 2021, Stratton visited UCF Lake Nona Hospital for her own focused ultrasound treatment. “I’m so excited to watch the tremor turn off,” she said ahead of the procedure. “I want to do normal things without having to make accommodations, like meeting someone, shaking their hand and giving them a glass of water without it being noticeable that I’m having a severe tremor.” Innovation in medicine is a driving principle for UCF Lake Nona Hospital, and its advanced treatment options for tremor relief have the potential to benefit a wide range of local patients. Lake Nona is home to a large population of older adults, who are at a higher risk of being diagnosed with ET or Parkinson’s tremor, In the Family Birthing Unit, expecting mothers can labor, deliver and recover from birth in spacious all-in-one suites, which offer family-friendly accommodaand noninvasive treatment options such as focused ultions and a range of options to support mothers’ birth preferences. trasound can significantly improve independence, ability and quality of life. CARING FOR FAMILIES FROM DAY ONE “For patients who qualify, MRI-guided focused ultrasound When UCF Lake Nona Hospital opened its state-of-the-art provides an incisionless treatment option, performed on an outFamily Birthing Unit last year, it represented a new beginning patient basis with a short recovery time and, often, immediate reboth for the hospital and for the families it served. Featuring sults,” Dr. Razack said. “Not only are we the first hospital in Cenmodern, suite-style facilities, the new unit is designed to provide tral Florida to offer focused ultrasound for essential tremor, we’re a more comfortable, supportive, and private experience for exalso one of the very few centers nationally capable of providing pecting parents and their families. the procedure. By expanding access to this treatment here in our At the Family Birthing Unit, mothers can labor, deliver and region, we can help restore independence and provide relief for recover in one of six all-in-one suites, which come equipped with individuals suffering from debilitating and progressive tremors.” everything the family needs for a safe birth. The spacious rooms feature a range of amenities for patients and visitors, room serRenata Gonzalez gave birth to baby Gabriel at UCF Lake Nona Hospital’s Family Birthing Unit. vice, WiFi, 55-inch smart TVs with streaming services, and space for one guest to stay overnight. “You could tell right away the staff is very qualified and that they know what they are doing,” said Renata Gonzalez about her experience delivering her baby at UCF Lake Nona Hospital. “I would definitely recommend to other new moms; it was a wonderful experience! I enjoyed every aspect of the process, and I felt pampered and secure at all times.” For overnight births and those requiring around-the-clock care, the Family Birthing Unit is staffed 24 hours a day and seven days a week by a dedicated obstetric physician and team who can provide care until the patient’s personal physician arrives. Parents with specific birth preferences, including low-intervention births, can be accommodated as well. As part of UCF Lake Nona Hospital’s commitment to supporting parents before, during and after a birth, the Family Birthing Unit offers maternity, childbirth and newborn care classes for the whole family, including siblings. Mental health care is also available for mothers experiencing postpartum depression symptoms, which impacts an estimated one in eight women. “We don’t just deliver babies in our hospital,” said Sally Robertson, Director of Women’s Services at UCF Lake Nona Hospital. “We take care of women at all ages and stages.” 6 FLORIDA MD - MAY/JUNE 2022
PHOTO: PROVIDED BY UCF LAKE NONA HOSPITAL
COVER STORY
COVER STORY STIGMA-FREE ACCESS TO LIFESAVING TREATMENT Obesity, characterized by a BMI of 30.0 or higher, is a common disease that impacts more than one in four adults statewide. This widespread public health risk is expected to become more prevalent over time, according to the Florida Department of Health.
Samantha Brantley, her mother and father all underwent bariatric surgery with world-renowned bariatric surgeon Dr. Keith Kim in 2017. When Samantha needed a bariatric revision surgery this year, she again sought out the expert care of Dr. Kim. He performed Samantha’s second surgery at UCF Lake Nona Hospital. “My whole family was large. It was a continuous trend and I didn’t want it to go on any longer,” said Samantha, who lost 100 pounds. “It’s one of the best decisions I ever made.” Because of the stigma associated with overweight and Samantha Brantley underwent bariatric surgery at UCF Lake Nona Hospital obesity, it can be difficult for patients to seek medical with world renowned bariatric surgeon Dr. Keith Kim. treatment. Those who do often begin with low-intervention options such as diet and exercise plans, with or withthe patient to select an appropriate treatment option based on out medication therapy. However, lifestyle modifications may health and lifestyle needs. As part of the treatment process, panot produce an effective and permanent treatment for severe tients are screened for eligibility and counseled extensively about obesity in some patients, making bariatric surgery (also called nutrition, exercise and supplementation requirements to ensure a “weight loss surgery”) an effective and lifesaving option. safe procedure and a healthy recovery. Founded on a belief in supporting whole-person health, and not solely weight loss, UCF Lake Nona Hospital’s bariatric department offers several minimally invasive surgical options, including Roux-en-Y gastric bypass, sleeve gastrectomy, and duodenal switch surgery. Patients who have already undergone bariatric procedures can also undergo revisional surgery to correct complications or have a gastric band removed.
Surgery is not a stand-alone treatment for obesity, and UCF Lake Nona Hospital’s bariatric team works collaboratively with
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Living with obesity can be limiting and isolating in daily life, and it can also lead to a range of related complications, such as joint pain, difficulty breathing, cholesterol problems, hypertension, sleep apnea and fatigue. Adults with obesity are at a higher risk for severe weightrelated illnesses like type 2 diabetes, heart disease and cancer, as well as an increased risk of premature death.
PULMONARY AND SLEEP DISORDERS
Idiopathic Pulmonary Fibrosis – Current Approach to Therapy By Daniel T. Layish, MD Idiopathic pulmonary fibrosis (IPF) is also known as usual interstitial pneumonitis (UIP). There are estimated to be 48,000 new diagnoses of IPF per year in the United States, with 40,000 deaths per year. About two thirds of patients with IPF pass away within five years of diagnosis. For many years, combination therapy with prednisone and azathioprine had been used. However, the PANTHER trial revealed convincingly that combination therapy with prednisone and Imuran actually resulted in greater mortality, more hospitalizations, and more serious adverse events than placebo. Therefore, combination therapy with azathioprine and prednisone is no longer recommended. For a while, treatment of IPF had been essentially supportive including supplemental oxygen, pulmonary rehabilitation and vaccination against Streptococcus pneumoniae and influenza. Lung transplant can also be considered when appropriate. Pirfenidone (Esbriet) is an antifibrotic agent, which has now been shown in several clinical trials to reduce disease progression and improve progression free survival in patients with IPF. Pirfenidone inhibits the synthesis of transforming growth factor Beta, which plays a role in cell proliferation and differentiation. There have been two previous phase III trials of Pirfenidone that seem to have conflicting results. One study (published in 2010) showed that Pirfenidone slows disease progression while another study (published in 2011) did not meet its end point. However, this last study did have some trends that were in a positive direction; this resulted in the FDA requesting the “ Assessment of Pirfenidone to Confirm Efficacy and Safety in Idiopathic Pulmonary Fibrosis Study” (ASCEND). The result of this study was published in the New England Journal of Medicine. In the ASCEND study, 278 patients with IPF were randomized to receive Pirfenidone 2403 mg per day for 52 weeks. 277 patients were randomized to receive Placebo. The primary endpoint was forced vital capacity and secondary end points included 6-minute walk test distance, progression free survival, dyspnea, overall mortality and disease specific mortality.The proportion of patients who had an absolute reduction of at least 10% in predicted forced vital capacity (FVC) or who died was 47.9% less in the Pirfenidone group as compared to the Placebo group. In addition, the average decrease in FVC from baseline was lower in the Pirfenidone group versus the Placebo group (235 versus 428 mL). Furthermore, the proportion of patients who had no decline in FVC was 132% higher in the Pirfenidone group than in the Placebo group and there was also less decline in the 6-minute walk distance in the Pirfenidone group compared to the Placebo group as well as better progression free survival. However, there was no significant difference in dyspnea score and all cause mortality or disease specific mortality between the two groups. There has been a pooled analysis of data from all three Pirfenidone trials, which revealed that the overall risk for death at 52 weeks was lower in the Pirfenidone group versus the placebo 8 FLORIDA MD - MAY/JUNE 2022
group with a hazard ratio of 0.52. In this pooled analysis Pirfenidone improved both all cause mortality and disease specific mortality. The most common side effects included gastrointestinal and skin related adverse effects, but these rarely led to treatment discontinuation. Unfortunately, patients on Pirfenidone do not necessarily perceive improvement and Pirfenidone is certainly not a cure for this serious illness. Nevertheless, it appears to be a good option for slowing down the progression of this serious condition. Another new option for treating UIP/IPF is Nintedanib (OFEV®) This is a tyrosine kinase inhibitor that targets growth factors including the vascular endothelial growth factor receptor, fibroblast growth factor receptor and platelet derived growth factor receptor. In May 2014, Luca Richeldi et al published the results of two 52 week randomized, double blind phase 3 studies of nintedanib (150 mg twice/day) versus placebo in the New England Journal of Medicine. 1066 patients were enrolled in a 3:2 randomization. The adjusted annual rate of change in FVC was negative 115 ml with Nintedanib versus negative 240 ml with placebo. Diarrhea occurred in over 60 percent of patients on Nintedanib but led to discontinuation in less than five percent. The most frequent serious adverse reactions reported in patients treated with OFEV® (more than placebo), were bronchitis (1.2% vs. 0.8%) and myocardial infarction (1.5% vs. 0.4%). However, in the predefined category of major adverse cardiovascular events (MACE) including myocardial infarction, fatal events were reported in 0.6% of OFEV® treated patients and 1.8% of placebo-treated patients. Therefore, the clinician must weigh the risk/benefit ratio of using this medication in a patient with known coronary artery disease (or cardiovascular risk factors) carefully. In conclusion, IPF/UIP is a relatively common and progressive pulmonary disorder. Pirfenidone and Nintedanib are two new agents that appear to slow down the progression of this disease. Further research needs to be done to identify agents that can reverse pulmonary fibrosis. Since Nintedanib and Pirfenidone seem to have similar efficacy, most clinicians choose one over the other based on side effect profile and dosing considerations. References available upon request
Daniel Layish, MD, graduated magna cum laude from Boston University Medical School in 1990. He then completed an Internal Medicine Residency at Barnes Hospital (Washington University) in St.Louis, Missouri and a Pulmonary/Critical Care/Sleep Medicine Fellowship at Duke University in Durham, North Carolina. Since 1997, he has been a member of the Central Florida Pulmonary Group in Orlando. He serves as Co-director of the Adult Cystic Fibrosis Program in Orlando. He may be contacted at 407-841-1100 or by visiting www.cfpulmonary.com.
More Cannabis Dispensaries = Fewer Opioid Deaths By Michael Patterson, NHA, OTR/L, CEAS A recent study in the British Medical Association Journal (BMJ) shows increasing access to marijuana dispensaries is associated with a significant reduction in opioid-related deaths. (link below) Association between county level cannabis dispensary counts and opioid related mortality rates in the United States: panel data study | The BMJ Researchers reviewed opioid mortality and cannabis dispensary prevalence in 23 US states from 2014 to 2018. The study concluded that counties where the number of legal marijuana shops increased from one to two experienced a 17 percent reduction in opioid-related fatalities. Increasing the dispensary count from two to three was linked to an additional 8.5 percent decrease in opioid deaths.
is expected to exceed 70,000 people, and opiates are legal via prescription. Society is tired of being lied to about cannabis. They are tired of politicians protecting the illegality of cannabis, and pharmaceutical companies pitching drugs that have side effects worse than the disease or condition for treatment. As more and more facts and data emerge on the positive benefits to society and health that cannabis offers, the legalization trend of cannabis will continue in the USA and globally. Michael Patterson NHA, OTR/L, CEAS is CEO of US Cannabis Pharmaceutical Research and Development LLC. (uscprd.com). He is a healthcare executive with 25+
“Higher medical and recreational storefront dispensary counts are associated with reduced opioid related death rates, particularly deaths associated with synthetic opioids such as fentanyl.” Per the study, it’s a finding that “holds for both medical and recreational dispensaries.”
years experience in: Cannabis-Hemp investment, Law,
“While the associations documented cannot be assumed to be causal, they suggest a potential association between increased prevalence of medical and recreational cannabis dispensaries and reduced opioid related mortality rates,” the researchers wrote. “This study highlights the importance of considering the complex supply side of related drug markets and how this shapes opioid use and misuse.”
subject matter expert in the Global Cannabis and Hemp
“Our findings suggest that increasing availability of legal cannabis (modeled through the presence of medical and recreational dispensary operations) is associated with a decrease in deaths associated with the T40.4 class of opioids, which include the highly potent synthetic opioid fentanyl. This finding is especially important because fentanyl related deaths have become the most common opioid related cause of death.”
ANALYSIS This study is one of many that continues to demonstrate that cannabis is a benefit to society not a detriment. Most states that have legal medical cannabis programs allow use of cannabis as a substitute for the use of opiates. Opiate addiction and deaths in the USA have destroyed countless lives, families, and communities. The lies regarding the safety of opiate use by Pharmaceutical companies are now coming out in litigation across the country by US States demanding restitution from the many effects of the opioid plague. There has never been a single recorded death in human history associated with the use of cannabis, and it is still illegal based on US federal law. Meanwhile, the opiate death toll for 2020
Regulation, Compliance, Operations, & Management, Skilled Nursing, Pharmacy, Laboratory, Assisted Living, Home Healthcare, & Healthcare Analytics. He is a Industry with Gerson Lehrman Group (glg.it) & Guidepoint. He is an editorial board member of the American Journal of Medical Cannabis, licensed Nursing Home Administrator, & licensed Occupational Therapist in 4 states.
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How to Recognize Potentially Critical Sleep Disorder Cases By Orlando Ruiz-Rodriguez, MD As a pulmonary sleep disorder specialist, a common complaint I treat is snoring. It’s probably no surprise that it’s among our most prevalent sleep disorder complaints. A snoring issue may sound minor — merely an inconvenience to spouses and partners whose sleep patterns are disrupted due to resulting noise and movement. Sleep issues, however, become problems when they disrupt a person’s ability to safely and successfully perform normal activities such as working, driving or going to school. And, many cases of snoring and other sleep disturbances are associated with potentially critical cardiopulmonary medical conditions. Left untreated, severe sleep disturbances can result in cardiac-related complications including sudden cardiac death, stroke, atrial fibrillation, ventricular tachycardia and all-cause mortality, according to data from the Wisconsin Sleep Cohort, an ongoing longitudinal study of the causes, consequences and natural history of sleep disorders, particularly sleep apnea. Potentially serious sleep conditions can go undetected if not for the keen ears of an exhausted spouse or partner who, out of sheer frustration, reaches out for medical assistance, paired with the diligence of healthcare providers who know how to identify warning signs. Treatments for sleep issues, depending on their severity and potential to contribute to cardiopulmonary problems, vary. For sleeplessness, treatments may include short-term medication therapy and (preferably) talk therapy for long-term relief without the risk of drug dependencies and side effects. For more serious sleep breathing problems, treatments are more aggressive and may require sleep studies, physical therapy, supportive appliances — such as CPAP machines, MAD devices (mouth guards) and airway stents — or even nerve stimulation surgery. Here, I’ll help you identify sleep issues and triage potentially life-threatening signs that might need a referral to a pulmonary sleep specialist.
THE WIDE RANGE OF SLEEP DISORDER PATIENTS There’s not a single population that’s exclusively prone to potentially dangerous sleep disorders. In my practice, I see a very wide range of patients: from their teens into their 20s, all the way into their 90s and beyond. But, as people age, more males present with a sleep disorder spectrum. According to population data from the Wisconsin Sleep Cohort, as many as 15-30% of males and 10-30% of females meet a broad definition of obstructive sleep apnea (OSA).
LOW INCIDENCES OF SELF-REPORTING Cases are not always self-reported. Only 20% of the OSA affected population reports sleep disordered breathing to a physician. (This includes about 9% of males, 5% of females reporting 10 FLORIDA MD - MAY/JUNE 2022
a spouse or partner’s problem, and 5% of females reporting their own issues). That’s why it’s important for your practice to triage sleep disorders and identify red flags warning of potentially serious cardiac and pulmonary conditions. Because odds are, they may go unreported.
WHAT SLEEP SPECIALISTS ENCOUNTER As I mentioned earlier, initial sleep complaints — snoring, insomnia and next-day tiredness — often only scratch the surface of a potentially serious cardiopulmonary problem. An abbreviated list of sleep complaints referred to me include: • Insomnia • Snoring with difficulty sleeping • Obstructive sleep apnea (OSA) • Hypersomnia, including narcolepsy, idiopathic hypersomnia, Klein Levin Syndrome and other related disorders • Sleep Paralysis • Movement disorders • Spectrum conditions
DIAGNOSIS METHODS To diagnose a patient’s sleep disorder and rank its severity and risks for cardiopulmonary events, even if not self-reported, I triage them through precise assessment tools. In particular, I use two assessment tools: the Epworth Sleepiness Scale (ESS) and the STOP-Bang Questionnaire. The ESS is a self-administered questionnaire built on eight key questions. It asks patients questions about their levels of daytime sleepiness while engaged in eight different activities. These activities range from sitting and reading, watching television, sitting in a public place, riding in a car as a passenger and lying down, to sitting and talking with someone, sitting after a meal without alcohol consumption and sitting in a stopped car in traffic. Questions are ranked from 0-3. The higher a patient’s overall ESS score, the more likely their average sleep propensity in daily life (ASP) is high, which can signal a potential sleep disorder that prompts further evaluation. The STOP-Bang Questionnaire digs deeper into potential inpatient and outpatient medical issues such as blood pressure, breathing issues, BMI, birth gender, and more to gain a more precise assessment and objective data on a patient’s overall health risks. There also is another useful sleep disorder screening tool, known as the POPPY Study, an acronym for the Pharmacoki-
netics and Clinical Observations in People Over Fifty Study. Often used to screen for comorbidities in patients over 50 with or without HIV infection, the POPPY Study takes into account quality of life and is also used to more broadly evaluate factors such as the prevalence of Restless Legs Syndrome, insomnia and sleep apnea. These scales are valuable not only for specialists, but for primary care providers who may know about other patient conditions and complaints that can serve as guides for sleep disorder diagnoses.
EARLY RECOGNITION OF SLEEP DISORDERS CAN IMPROVE PATIENT OUTCOMES With an understanding of sleep disorder diagnosis tools and their associated rankings, providers — from general practitioners to specialists — can make more precise data-driven health assessments when forming patients’ treatment plans and gauging the potential need for more advanced care. Solving for more than a ‘bad night’s sleep’ or loud snoring, the use of tools, such as the ESS, BANG-Stop and POPPY Study, serves to fill in the blanks of sleep disorders and their possible connections to more serious cardiopulmonary comorbidities, even in patients with unreported sleep disturbances. Consider working these tools into your practice. And, if in doubt, contact a pulmonary sleep specialist to help rule out or establish the presence of a life-threatening cardiopulmonary cause of sleep disturbances. Orlando Ruiz-Rodriguez, MD, FCCP, is a board-certified pulmonary/critical care/sleep medicine specialist with Orlando Health Medical Group Pulmonology and Sleep Medicine. He specializes in pulmonary, critical care and sleep medicine. He also provides critical care to patients with critical medical illness and acute or life-threatening pulmonary conditions. Dr. Ruiz may be contacted at (321) 841-7856.
Check out our redesigned website at www.floridamd.com!
FLORIDA MD - MAY/JUNE 2022 11
MARKETING YOUR PRACTICE
What Does Your Branding Say About Your Medical Practice? By Sonda Eunus, MHA, CMPE Your brand is the identity that you create for your practice. It is crucial to identify the core values that you want your brand to represent, because this is how it will be perceived by your target audience and the community at large. Here are some questions to consider when building your brand: • How do you want your practice to be perceived? • What core values do you hold most important to your WHY? • What does your brand look like? Colors, fonts, and shapes matter. • What does your brand sound like? When choosing your brand colors, be aware of the following color associations: • Red — Red stands for passion, excitement, and anger. It can signify importance and command attention. • Orange — Orange stands for playfulness, vitality, and friendliness. It is invigorating and evokes energy. • Yellow — Yellow evokes happiness, youth, and optimism, but can also seem attention-grabbing or affordable. • Green — Green evokes stability, prosperity, growth, and a connection to nature. • Light Blue — A light shade of blue exudes tranquility, trust, openness. It can also signify innocence. • Dark Blue — Dark blue stands for professionalism, security, and formality. It is mature and trustworthy. • Purple — Purple can signify royalty, creativity, and luxury. • Pink — Pink stands for femininity, youth, and innocence. It ranges from modern to luxurious. • Brown — Brown creates a rugged, earthy, old-fashioned look or mood. • White — White evokes cleanliness, virtue, health, or simplicity. It can range from affordable to high-end. • Gray — Gray stands for neutrality. It can look subdued, classic, serious, mysterious, or mature. • Black — Black evokes a powerful, sophisticated, edgy, luxurious, and modern feeling. (www.99designs.com)
WHAT IS YOUR BRAND’S PERSONALITY? Think of your Business brand as a person. What is this person’s personality like? How does he or she dress, talk, and act in public? Here are just a few examples of a personality that your brand 12 FLORIDA MD - MAY/JUNE 2022
may have: • • • •
Serious and Professional Warm and Friendly Cool and Quirky Funny and Playful
However, you choose to represent your brand, make sure that it is authentic to who you are. For example, if you are playful and like to crack jokes, infuse your marketing with humor and you will find that people respond positively to jokes, memes, and quotes that are applicable to them. For example, for pediatric practices, we have found that moms just can’t get enough of memes that make fun of their kids! You can add some (goodnatured) jokes and memes to your social media posts and you will see some great engagement. Similarly, if you want your brand to be viewed as serious and professional, you will want to consistently share valuable and informative content that educates your audience. You can choose to do so by looking for speaking opportunities to help build credibility and position you as the expert in your field, making educational videos and sharing them on your website, Youtube, and social media, or by writing educational articles and contributing to reputable publications. If you’re going for warm and friendly, you will want to be seen engaging with your social media followers, being active in Facebook groups and other online groups, hosting community events, supporting great causes, etc. If cool and quirky is your thing, you want to stand out from your competitors. You can use some colors that are not typical for your industry, create and share some fun videos, such as “funny (HIPAA-compliant) things that patients say”, paint your waiting room to inspire awe upon arrival, etc. Keep in mind that for any brand personality, it is important to keep it consistent across your website content, social media posts, marketing materials, and any other communication that you may have with your audience. Sonda Eunus is the Co-Founder of Pro Medical Marketing – an Internet Marketing Agency specializing in Medical practices. She has a Masters’ in Healthcare Management and is a MGMA Certified Medical Practice Executive. She has been heavily involved in operating her family’s Pediatric practices from an early age. She is passionate about helping medical practices grow and does so by sharing her experience in her writing, speaking, and consulting. Learn more about Sonda and Pro Medical Marketing at www.promedicalmarketing.com.
DERMATOLOGY
Not All Basal Cell Carcinomas Are Created Equal
Lucky Meisenheimer, M.D. is a board-certified dermatologist specializing in Mohs Surgery. He is the director of the Meisenheimer Clinic – Dermatology and Mohs Surgery. John Meisenheimer, VII is a medical student at USF.
Nodular basal cell carcinoma. FLORIDA MD - MAY/JUNE 2022 13
PHOTO: JOHN MEISENHEIMER, VII PHOTO: JOHN MEISENHEIMER, VII
Occasionally a patient will tell me their “doctor friend” recommended that they don’t need treatment for a basal cell carcinoma because it will never hurt you. “Doc, he said it’s only a basal cell carcinoma.” Dermatologists fully recognize this as a genuinely cringe-worthy statement. You don’t need to see too many people missing various parts of their facial anatomy to know this advice is blatantly wrong. Even in this modern time of medical miracles, people still die from neglected basal cell carcinomas. When pressed for the name of their “doctor friend,” it usually comes up as I don’t remember their name, or it ends up being “Doctor Google.” It is true a superficial basal cell carcinoma on the torso probably would take years and years for it to cause any sort of significant morbidity to a patient. But, on the other hand, even a small basal cell on the torso will continue to grow if left untreated slowly. What might have been a simple, inexpensive procedure now, a decade later, has turned into a monster of aggravation, discomfort, and cost. Although metastatic disease risk is low with basal cell carcinomas, it is certainly not zero. Several people die each year from basal cell carcinoma. Even more, patients can have disfiguring bouts with cancer losing various parts of anatomy such as nose, ears, eyes, etc. What a lot of patients and even some physicians are not aware of is that not all basal cell carcinomas are created equal. There are several different histologic growth patterns. These Infiltrative Basal Cell carcinoma of the forehead. varying histologic types can each behave differently and require different treatment plans. As mentioned before, a superficial basal cell carcinoma is probably not going to cause a great deal of physical damage unless neglected for long periods. There are other types of basal cell carcinomas; morpheaform and sclerosing basal cell carcinomas with infiltrating growth patterns. These cancers left untreated can cause a significant amount of morbidity in shorter periods measured in months, not years. Aggressive basal cell cancers can also become neurotropic, meaning that they “wrap” around a nerve and can track down its length. Neurotropism can be particularly dangerous, especially if Pathology of an infiltrative this is on the face and affecting a nerve that happens to pass through basal cell carcinoma. a foramen into the brain. Clearly, not a good scenario. Superficial Multifocal BCC. Basal cell carcinomas, limited to the skin, tend to be very amenable to treatment in a variety of different ways. Even as a Mohs surgeon I can think of at least half a dozen different ways that I have treated basal cell carcinomas. Not all basal cell carcinomas need Mohs surgery. Each case of basal cell carcinoma should be evaluated individually and in consideration as to the best method of treatment based on its histologic growth pattern, location, and physical condition of the patient. The great news about basal cell carcinoma, even though it is the most common type of skin cancer and millions are treated each year, only a tiny percentage of these end up causing death in paNeurotropic basal cell carcinoma. tients. When someone says I would much rather have a basal cell Sclerosing basal cell carcinoma. carcinoma than a melanoma, there is a caveat; if you die from a basal cell carcinoma, you are just as dead as if you were to die from melanoma. Happily, most of the time, with early diagnosis and treatment, you don’t have to die from either. Basal cell carcinoma is called cancer for a reason. Give it its respect that it is due, or otherwise, you may regret saying, “oh, you don’t have to worry about it, it’s only a basal cell carcinoma.”
PHOTO: JOHN MEISENHEIMER, VII
PHOTO: JOHN MEISENHEIMER, VII
By John “Lucky” Meisenheimer, MD and John Meisenheimer, VII
PEDIATRICS
Infantile Scoliosis By: Joseph G. Khoury, MD WHAT IS INFANTILE SCOLIOSIS?
Infantile Scoliosis is a curvature of the spine that develops during the first few years of a patient’s life with no structural abnormalities of the spine. The child is not born with scoliosis. There is likely to be a subtle underlying genetic abnormality in the structure of collagen, but the exact cause is not yet known. This is combined with environmental factors such as back sleeping and hypotonia/hypomobility in the first months of life which leads to the curvature. WHAT MAKES INFANTILE SCOLIOSIS DIFFERENT FROM OTHER KINDS?
Children in the first few years of life are growing at nearly twice the rate of those in their adolescent growth spurts. Scoliosis worsens with growth. Therefore, because of the rate of growth and large amount of growth remaining, the potential for curve progression into a very severe range is higher with infantile scoliosis than with adolescent scoliosis. In addition, the alveoli are still multiplying and growing during this period of growth so the potential for infantile scoliosis to affect lung function is very high. With severe curves, cardiac functional can also be affected (cor pulmonale). Also, this type of scoliosis is often noticed much later, and curves can be improperly attributed to poor trunk control or simply dismissed by health care providers as developmental variations that the child will outgrow.
curve and therefore respond better to bracing and/or experience significant delays to growing rod surgery. Early referral to a Mehta trained physician is critical to get the best results. Even for those that are detected and referred later, significant benefits are experienced but the best results come from early detection and referral. WHAT IS MEHTA CASTING LIKE FOR THE CHILD AND FAMILY?
It is definitely not easy to be in a Mehta cast. The cast is applied under general anesthesia every 2-3 months depending on age. The cast cannot get wet. There are only a few days break between removing a cast and applying the next one so that the curve doesn’t have a chance to relapse. Bathing must be done with wash clothes or wipes. Hair must be washed in the sink. There is a robust support community of other parents that help the new patients get adjusted and helps answer other questions.
WHAT IS THE TREATMENT FOR INFANTILE SCOLIOSIS?
Unlike adolescent scoliosis, infantile scoliosis can be treated with casting, rather than bracing, to reduce the size of the curve or even cure many curves completely. This type of casting is called Mehta casting after the doctor who popularized this technique. This is only possible because of the rapid rate of growth in the first few years of life. If children are referred promptly to a physician with experience in Mehta casting, the chances of reducing or curing the curve are much higher. Mehta casting first became available in the United States in 2004 when the mother of a patient with Infantile Scoliosis noticed the excellent results reported by Dr. Mehta in the United Kingdom and requested this treatment be done for her child. This mother funded a trip by Dr. Mehta to the United States to teach several physicians who then spread the knowledge and techniques to others. Before this, treatment in the United States often consisted of bracing or sometimes Risser casting, both of which were far less effective and often resulted in early surgery called “growing rod surgery” (figure 4). WHAT ARE THE RESULTS OF MEHTA CAST TREATMENT?
If casting begins before 18 months of age, the chances of curing the curve completely are 75%. The cure rate drops to 35% for patients between 18 and 36 months and 23% for those over 36 months of age at the beginning of treatment. For those who are not cured, many experience significant reductions in the size of the 14 FLORIDA MD - MAY/JUNE 2022
Despite these hardships, young children are very resilient and adapt quickly to the cast. These children run and play with other children very soon after adapting to the cast. WHAT IS THE TAKEAWAY MESSAGE?
Scoliosis screening should be a part of every well child evaluation regardless of age. It is frequently included for older children (forward bending test) but not considered part of the newborn or infantile well child visits. This can easily be accomplished by
PEDIATRICS laying the newborn prone across the examiners lap to look at the spine and can take just 5 seconds. Any curvature noted or certainly any concern on the part of the parent should prompt a referral to a Mehta casting trained specialist or at least a supine AP scoliosis X-ray should be obtained because early detection and referral are key to the success of treatment. Case Study: This patient was referred to me at 13 months of age with a 33-degree curvature which was first noticed by his parents at 10 months of age (figure 1). Mehta casting was initiated immediately. His first in cast x-ray shows partial improvement of the curve in cast (figure 2). His final in cast x-ray shows near complete resolution of the curve (figure 3). This patient was able to avoid early growing rod surgery and its associated complications. He will FIGURE 1 likely wear a brace part time throughout his growing years, but he is likely to be able to avoid surgery completely because of his early referral. Example of growing rod surgery (figure 4). Implants are present at the top and bottom only to avoid early fusion of the spine which will result in loss of spinal growth. The implants need to be lengthened at the overlapped connector section every 6 months throughout growth until the patient is old enough for a final fusion surgery.
FIGURE 2
FIGURE 3
FIGURE 4
Dr. Khoury is a pediatric orthopedic surgeon at Nemours Children’s Health and has been practicing Mehta casting treatment for infantile scoliosis since 2004. He was trained directly by Dr. Mehta and has trained dozens of physicians in the technique. He has spoken nationally, written extensively on the topic of infantile scoliosis, and specifically about Mehta cast treatment. Call (407) 650-7715 to refer a patient to Dr. Khoury.
FLORIDA MD - MAY/JUNE 2022 15
Mitigating the Risks of Cervical Insufficiency By Cole Douglas Greves, MD, FACOG As an OB-GYN, I have a tremendous respect for the intricacies of pregnancy and childbirth. Having a baby can be one of the most amazing and joyous experiences. But for some, it can be a difficult and anxious time. As part of a Maternal-Fetal Medicine group, I am able to help guide women and families through the stress and uncertainties of a high-risk pregnancy — understanding each woman’s unique challenges and providing the appropriate treatment at every step along the way. I also value the partnership with a woman’s primary OB-GYN, with a shared goal of a safe pregnancy and delivery, and a healthy mother and baby. Affecting about 1 in 100 pregnancies, cervical insufficiency is defined as painless, cervical dilation in the absence of persistent uterine contractions. During pregnancy, the cervix, which is the opening of the uterus into the vagina, normally stays firm and closed until late in the third trimester. In preparation for the baby’s birth, the cervix becomes thinner and softer, shortens and dilates, creating the birth canal for the baby to pass through during delivery. Cervical insufficiency, also known as incompetent cervix, is a condition that occurs when these changes take place too early in the pregnancy. Cervical insufficiency can put expectant mothers at higher risk for pregnancy loss or premature birth. Because these changes are usually painless, cervical insufficiency often isn’t detected until it’s too late — when it is seen on an ultrasound or when a woman experiences downward pressure in the pelvis that signals dilation and positioning of the fetus into the birth canal. Almost 25 percent of miscarriages in the second trimester are due to cervical insufficiency. The good news is that there are treatment options available that can help prolong the pregnancy of a woman with cervical insufficiency, ideally to full term. With cerclage, a procedure that can help prevent the cervix from opening too soon, we can mitigate the risks of cervical insufficiency and hopefully keep the baby in place as long as necessary. CAUSES OF CERVICAL INSUFFICIENCY Since there usually is not a definitive cause and effect relationship, it’s difficult to predict who will experience cervical insufficiency. Factors that may cause the condition include: • Biological makeup and how the cervix interacts with the hormones produced during pregnancy. • Past cervical trauma, including injury or past cervical surgery, such as surgeries to remove pre-cancerous or cancerous cells. This has become somewhat less common in recent years, as many women are now vaccinated against the human papillomavirus (HPV) that is linked to cervical cancer. • Genetics also may play a role. If a close family member has had cervical insufficiency, preventive measures may be advised. The model scenario for diagnosing cervical insufficiency is to spot signs of early cervical change during the mid-pregnancy ultrasound that usually takes place at 18-20 weeks. If cervical insufficiency is suspected, a follow-up transvaginal ultrasound can provide an accurate evaluation of the cervix and its length. Based 16 FLORIDA MD - MAY/JUNE 2022
on what is seen on the ultrasound or if there is a history of cervical insufficiency, a decision will be made either to monitor the situation or move forward with treatment. TREATMENT OPTIONS FOR CERVICAL INSUFFICIENCY
Depending on how advanced the cervical insufficiency is, the recommended first option, particularly for a first pregnancy, could be progesterone vaginal suppositories. Progesterone is a hormone that can help stabilize the structure of the cervix and reduce inflammation, potentially preventing cervical insufficiency from progressing. If progesterone treatment fails, the next step may be transvaginal cervical or abdominal cerclage. Cerclage is a treatment option for cervical insufficiency that can help prevent the cervix from opening too soon. The Center for Maternal-Fetal Medicine at Orlando Health Winnie Palmer Hospital for Women & Babies provides expertise in all types of cerclages and is one of few in Florida to offer transabdominal cerclage. In a transvaginal cerclage, the weakened cervix is stitched shut and/or reinforced through the opening to the vagina. Usually performed during the 12th to 14th week of pregnancy, a transvaginal cerclage is the preferred method, if possible, since it is less invasive with no abdominal surgical incision needed. A transvaginal cerclage stitch is typically removed around 37 weeks of pregnancy in anticipation of a vaginal delivery. A transabdominal cerclage is a surgical procedure in which the cervix is accessed through an incision in the lower abdomen. The cervix is then encircled with a stitch to reinforce it and help ensure that it remains closed during the pregnancy. For women who have no cervix or a history of incompetent cervix with previous unsuccessful vaginal cerclage placement, including those who have experienced pregnancy loss, this procedure can be performed prior to pregnancy. If performed during pregnancy, transabdominal cerclage placement will typically be done between the 9th and 14th week. Transabdominal cerclages require a Cesarean section delivery for every pregnancy going forward and are normally kept in place until a woman reaches the end of her childbearing years. Cerclage can be very effective at helping women with cervical insufficiency maintain or prolong their pregnancies. With regular monitoring throughout the duration of the pregnancy, we can help ensure a successful progression, safe delivery, and healthy mom and baby. Cole Douglas Greves, MD, FACOG, a board-certified clinical perinatologist, is director of the Fetal Care Center, part of the Center for Maternal-Fetal Medicine at Orlando Health Winnie Palmer Hospital for Women & Babies. Dr. Greves has more than 15 years of experience with cerclage procedures — including those placed transabdominally – which is available at only a handful of hospitals. He also has conducted extensive research in other areas and is a fre-
quent presenter at medical conferences and meetings. After earning his medical degree from the University of North Dakota School of Medicine in Grand Forks, Dr. Greves completed his OB-GYN residency at Orlando Health and a fellowship in Maternal-Fetal Medicine at the University of Rochester – Strong Memorial Hospital in Rochester, New York.
2022
EDITORIAL CALENDAR
Florida MD is a monthly medical/business digital magazine for physicians.. Florida MD is emailed directly to healthcare providers in Orange, Seminole, Flagler, Volusia, Osceola, Polk, Brevard, Lake and Indian River counties. Cover stories spotlight extraordinary physicians affiliated with local clinics and hospitals. Special feature stories focus on new hospital programs or facilities, and other professional and healthcare related business topics. Local physician specialists and other professionals, affiliated with local businesses and organizations, write all other columns or articles about their respective specialty or profession. This local informative and interesting format is the main reason physicians take the time to read Florida MD. It is hard to be aware of everything happening in the rapidly changing medical profession and doctors want to know more about new medical developments and technology, procedures, techniques, case studies, research, etc. in the different specialties. Especially when the information comes from a local physician specialist who they can call and discuss the column with or refer a patient. They also want to read about wealth management, financial issues, healthcare law, insurance issues and real estate opportunities. Again, they prefer it when that information comes from a local professional they can call and do business with. All advertisers have the opportunity to have a column or article related to their specialty or profession.
JANUARY –
Digestive Disorders Diabetes
FEBRUARY –
Cardiology Heart Disease & Stroke
MARCH –
Orthopaedics Men’s Health
APRIL –
Surgery Scoliosis
MAY –
Women’s Health Advances in Cosmetic Surgery
JUNE –
Allergies Pulmonary & Sleep Disorders
JULY –
Neurology / Neuroscience Advances in Rehabilitation
AUGUST –
Sports Medicine Robotic Surgery
SEPTEMBER – Pediatrics & Advances in NICUs Autism OCTOBER –
Cancer Dermatology
NOVEMBER – Urology Geriatric Medicine / Glaucoma DECEMBER – Pain Management Occupational Therapy
Please call 407.417.7400 for additional materials or information. FLORIDA MD - MAY/JUNE 2022 17
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