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DECEMBER 2014 • COVERING THE I-4 CORRIDOR

Compass Research: Hope Begins in Orlando

Still Lake County’s leader in

SAFE CARE At Florida Hospital Waterman, our patients’ health and well being is our top priority. We know patients turn to us trusting we will do our best to get them back to their best. We’re committed to providing advanced, safe, compassionate care to each and every patient. And we’re proud to be recognized as Lake County’s safest hospital with the county’s only “A” Hospital Safety Score based on how well we protect patients from accidents, errors, injuries and infections. Visit FHWaterman.com to learn more about our commitment to safety and improving care in our community.

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DECEMBER 2014 COVERING THE I-4 CORRIDOR

 COVER STORY

Photo: DONALD RAUHOFER / FLORIDA MD

Headquartered in Orlando, Compass Research is paving the way for new medications and treatments for a variety of serious diseases and ailments. With more than 1,300 clinical research studies in the books, its latest study focuses on the prevention of Alzheimer’s disease. The study investigates the disease’s genetic biomarkers and evaluates the safety and effectiveness of an investigational drug designed to delay its progression. With Florida earning the ominous ranking of second in the nation with the number of annual Alzheimer’s cases, research like this spells good news for patients, families and the medical industry as a whole.

Photo: DONALD RAUHOFER / FLORIDA MD

17 TO JOIN OR NOT TO JOIN? THAT IS THE QUESTION WHEN ASSOCIATIONS COME CALLING 20 CURRENT TOPICS

DEPARTMENTS 2

FROM THE PUBLISHER

BEHAVIORAL HEALTH

PULMONARY & SLEEP DISORDERS

11 HEALTHCARE LAW 12 CANCER 14 FINANCIAL UPDATE: Insurance•Benefits•Wealth MGMT. 15 ORTHOPAEDIC UPDATE

16 MARKETING YOUR PRACTice 19 FOOT & ANKLE

FLORIDA MD - DECEMBER 2014

FROM THE PUBLISHER

am pleased to bring you another issue of Florida MD. This time of year is special to all of us regardless of religious persuasion. It is especially important to children. However, it can be a particularly distressing time for children that are neglected,

abandoned or live in abusive homes. The Children’s Home Society of Florida tries to make a better life for these children by finding them a loving home either temporarily through foster care or permanently through adoption. But there are a lot of children – nearly 20,000 – in Florida who can’t live safely with their families right now. They need more than Children’s Home Society of Florida … they need all of us. I hope some of you can find the time to assist this very worthwhile organization in its efforts to help these special children. To find out more information please visit www.chsfl.org. Have a wonderful holiday season and a happy, healthy and prosperous New Year. Best regards,

Donald B. Rauhofer Publisher

Coming UP Next Month: The cover story focuses on Orlando Foot & Ankle Clinics. Editorial focuses on Digestive Disorders and Diabetes.

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Publisher: Donald Rauhofer Photographer: Donald Rauhofer / Florida MD Contributing Writers: Ann Alexander, Sayed Mobin, MD, Jamie Huysman, PsyD, David S. Craig, PharmD, Jennifer Thompson, Troy A. Kishbaugh, Sarah L. Mancebo, Kevin Taylor, JD, Marni Jameson, Corey Gehrold 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 2012, Sea Notes Media. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Annual subscription rate $45.

Behavioral Health

Peace is an Achievable Goal! COVER STORY

By James D. Huysman, PsyD, LCSW “Peace” is a prevalent theme this time of year. “Peace on Earth”, “World Peace”, etc. are lofty ideals that we aspire to because they connect us with others outside of ourselves. However, neither can ever be achieved without each of us first developing “Inner Peace” or “Peace of Mind” - yes, that’s where it all begins! Regardless of all the messages soon to be taped to our office walls, the fact remains that peace is a gift that you must give to yourself. It can’t be ordered, bought or amortized over the course of the year. It seems that peace is a fleeting commodity in our profession. Many times I feel like I am either catching up or keeping up! Patients can be particularly difficult during this time of year. Some may be downright resentful that they are giving up their holiday time just to take care of their health. Bad attitudes can suck the enjoyment out of absolutely everything. Worse yet, when we get so caught up in making everything ‘just perfect’ for everyone else we are headed for trouble. The cycle plays out like this: desire for perfection leads to procrastination leads to paralysis! Where’s the peace in that? Some of us have been able to experience and maintain a personal sense of peace - through meditation, mindfulness, connecting with nature or faith in God, while others see it as an unachievable goal, something desired that’s always just out of reach.

choice. Choose peace. Give yourself that gift…every day…it is priceless. Wishing you peace, love and O2,

Dr. Jamie Dr. James Huysman, PsyD, LCSW, aka Dr. Jamie, is a fierce advocate of patient-centered healthcare. He is a popular conference speaker and media guest on caregiver burnout, compassion fatigue and addictions and healthcare reform. Dr. Jamie blogs for Psychology Today and sat on the NASW committee to establish national protocols for certification and standardization of caregiving practices. He writes for Florida MD and Today’s Caregiver magazines. He co-founded the Leeza Gibbons Memory Foundation and created the signature programming for its psychosocial drop-in model, Leeza’s Place, opening 8 national locations, each with a different funding partner, in a four year period. He co-wrote the acclaimed book, Take Your Oxygen First: Protecting Your Health and Happiness

Amazingly, we humans can be in the most beautiful, peaceful surroundings on earth yet be totally incapable of feeling peaceful at all. Peace, it seems is an inside job.

While Caring for a Loved One with Memory Loss, with

Have you noticed that whenever your mind is abuzz with worry or other distractions that what you’re focusing on seems to grow? There is an axiom for that! Feeding a problem will only make it grow stronger and therefore, seemingly unsolvable. By the same token, nurturing peace can put whatever is wrong into perspective and make room for solution.

Affairs for WellMed Medical Management in Florida, a

Acceptance and detachment are the master keys to peace. When we are able to cease trying to force outcomes by manipulation or control we begin to embrace peace. Acceptance is allowing people, places and things to be exactly what they are. Detachment (ideally with love) is the ability to be OK in whatever storm may be raging around you. Noted healer and author, Deborah King, offers this provacative affirmation, “Every day, in every way, I am getting better and better at holding whatever happens in an uplifting light”.

Gibbons and Dr. Rosemary Laird. He currently works as Vice President of Provider Relations and Government UnitedHealthcare company.

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Practice peace and you will come to know peace. Peace is a FLORIDA MD - DECEMBER 2014

COVER STORY

Compass Research: Hope Begins in Orlando By Ann Alexander Known as an international destination for thrilling theme parks, high-tech attractions and space exploration, Central Florida is also home to Compass Research – an innovative clinical research company on the cutting edge of exciting diagnostic and medical breakthroughs. Headquartered in Orlando, Compass Research investigates new medications before they are placed on the market by the Food & Drug Administration (FDA). Essentially, Compass Research offers hope to patients around the world and in every field of medicine.

The ABCs of the FDA Before any new drug or medical device can be placed on the market, the FDA requires years of stringent investigation and testing. Compass Research is one of the sites performing those specialized studies. Founded in 2006 by Chief Medical Officer Craig Curtis, M.D. and CEO Sean Stanton, Compass Research has conducted more than 1,300 clinical trials over the years, thus safeguarding medications to treat health concerns from acne to the neurological complexities of Alzheimer’s disease. “Compass Research was established so that we could contribute to the treatments of tomorrow,” says Curtis. “We are working Pictured below from left to right, Chief Medical Officer Craig Curtis, M.D., CEO Sean Stanton and Director of Neurosciences Ira Goodman, M.D.

on the medications and diagnostic tools that the world will come to know in the years ahead.” To ensure safety and quality, several phases of testing are implemented for each new medication. The first phase involves research with years of laboratory experiments; once successful, the FDA approves continued research in people. At the conclusion of each phase, investigators submit their data and must receive FDA authorization before the next phase can begin. As testing proceeds with positive outcomes, more participants of varying ages, ethnicities and gender are added. Medications are typically studied for years before they are ultimately approved and placed on the market for physicians to prescribe.

More studies means continued growth Along with an expanding central clinic in downtown Orlando, Compass Research has recently grown to include an inpatient clinic (for overnight stays) in Leesburg and outpatient facilities in Leesburg and Oviedo. These additional clinics outside the metro area allow Compass Research to conduct all phases of research in locations convenient to patients and partnering physicians. “Compass Research has grown in size and presence to become one of the premier research sites in the world,” states Stanton. “With 224 employees, we have over 400 years of combined research experience.” The research team includes seven fulltime and eight part-time physicians and dozens of registered nurses (RNs), doctoral experts (Ph.Ds.) and clinical research coordinators (CRCs).

Physician partnerships welcome Local physicians are encouraged to become involved with Compass Research. “We have over 35 community partners in 15 different specialties,” says Curtis. “Our local physicians seem invigorated with the science and research being done as we investigate the treatments of tomorrow. And our physician partners help guide patients through the clinical trial process,” he adds.

Photo: DONALD RAUHOFER / FLORIDA MD

That large network of community-based physicians allows Compass Research to recruit qualified participants from special populations such as senior citizens and patients with a variety of illnesses including Alzheimer’s disease and dementia, Parkinson’s disease and other neurological disorders. The list of clinical research studies (current and completed) at Compass Research is impressive and includes nearly every element in the human body. From top to bottom, investigational studies have been implemented on treatments for the following: • Alzheimer’s disease, memory loss, mild cognitive impairment and dementia • Mood disorders (schizophrenia, depression and bipolar disorder) 4 FLORIDA MD - DECEMBER 2014

Photo: DONALD RAUHOFER / FLORIDA MD

COVER STORY

Dr. Ira Goodman, director of neurosciences at Compass Research, a Sub Principal Investigator on TOMMORROW study, an investigation exploring a new investigational method to see if it can predict the genetic risk for developing Mild Cognitive Impairment (MCI) due to Alzheimer’s disease.

• Migraine headaches, epilepsy, seizures and other neurological disorders

• Magnetic resonance imaging (MRI)

• Skin problems (acne and rosacea)

• Positron emission tomography (PET)

• Heart health (high blood pressure and high cholesterol)

• Single Photon Emission Computed Tomography (SPECT)

• Lung ailments (asthma and chronic obstructive pulmonary disease)

• Computerized tomography (CT)

• Smoking cessation

• Image guided radiation therapy

• Hepatitis and cirrhosis of the liver

• Radiotracer imaging

• Overactive bladder

Earlier treatment for Alzheimer’s on the horizon

• Colitis, constipation and Crohn’s disease • Women’s health (hot flashes, low sexual desire, polycystic ovary syndrome) • Men’s health (low testosterone and erectile dysfunction) • Pain, cancer and diabetes Through its clinical investigations, the Compass Research team has helped bring medications to market such as Zoloft, Paxil, Cymbalta, Lipitor and many more. What has contributed to its achievements? “We emphasize three elements that are crucial to the success of any study here at Compass Research,” says Stanton. “Our team is committed to patient safety, data integrity and protocol compliance.” Compass Research is also unique in its ability to offer advanced imaging procedures such as:

• Functional magnetic resonance imaging (fMRI)

• Diffusion tensor imaging (DTI)

While the clinical investigations at Compass Research include a broad variety of medications and illnesses, it also specializes in studies examining the diagnosis and treatment of neurological disorders; that is, diseases affecting the central and peripheral nervous systems. In the area of Alzheimer’s disease, Compass Research is the leading research center in the U.S. At any given time, 20 trials are underway testing treatments or diagnostic tools. One of its current projects is the TOMMORROW study, an investigation exploring the genetic risk, early diagnosis and treatment of Alzheimer’s disease. One of the leaders to this endeavor is Compass Research Director of Neurosciences Ira Goodman, M.D., a board-certified neurologist and diplomate of the American Board of Psychiatry and Neurology (ABPN). “The TOMMORROW study is a project we are excited to be conducting and are thrilled to offer hope to Alzheimer’s and dementia patients around the world,” Goodman says. FLORIDA MD - DECEMBER 2014

Photo: DONALD RAUHOFER / FLORIDA MD

COVER STORY

Dr. Marieke Cajal asks a potential TOMORROW study candidate a series of qualifying questions during a preliminary consultation. Medical history and memory-related issues are explored during this phase.

What is Alzheimer’s disease? According to Marieke Cajal, Ph.D., recruitment manager, neurodegenerative, dementia is a general term that describes a decline in mental abilities severe enough to interfere with daily life activities such as eating, dressing, conversing and even remembering. “Alzheimer’s disease is the most common form of dementia and accounts for 60 to 80 percent of cases and affects more than 5 million Americans,” she says. Alzheimer’s disease is currently an incurable illness that cannot be prevented or slowed. The disease not only affects the patients but their families too – and family members are frequently the first to notice something is not quite right. The first signs of the disease, usually a slight noticeable decline in memory and thinking skills, can be seen nearly a decade before an individual’s function becomes affected - this is known as mild cognitive impairment. By the time patients and their families start noticing real changes in memory, Alzheimer’s has already begun settling in the brain. As the disease advances, patients experience more and more difficulty in completing simple daily activities. “With this knowledge comes the realization that to really make an impact on this disease and reduce the number of patients affected – we need to act earlier before any symptoms are even visible,” says Cajal. Alzheimer’s disease is also the most expensive illness in the U.S., which adds urgency to the growing need for medical breakthroughs. “The TOMMORROW study will not only help us get at the 6 FLORIDA MD - DECEMBER 2014

root of Alzheimer’s but lead us to disease-modifying medications that will help slow its progress,” Goodman says.

TOMMORROW is here today The basis of the TOMMORROW study is to identify people who might be at a higher genetic risk for Alzheimer’s disease and dementia. The investigation centers on genetic markers in the blood; specifically the APOE and TOMM40 genes. This study will also determine the safety and effectiveness of an investigational drug designed to delay disease progression. Healthy seniors are primary study candidates and should enroll while he or she have normal thinking and memory capabilities -- or have only mild cognitive impairment. Participants who volunteer in this study are given a blood test for the APOE and TOMM40 genes. If the genetic markers are present (and other study criteria are met), the volunteer enters into a trial for five years of neurological testing. The trial will include an investigational compound designed to delay the onset of symptoms of before they occur. Patients diagnosed with probable Alzheimer’s also meet with Dr. Goodman and his team to discuss the mechanisms of the disease, treatment options, physical and mental exercise, diet and socialization. “We spend a lot of time with each patient and their family members,” Goodman says. “We emphasize all facets of treatment, not just pharmaceuticals. We hope to enhance each patient’s quality of life by every means possible. I joined Compass Research three years ago because its reputation for quality research was, and continues to be, unsurpassed.”

COVER STORY Are you interested in participating in a research study? Volunteers are a crucial component to research studies and there are many different reasons to participate in a research study, according to Goodman. “These are more than just studies,” he states. “A clinical research study is often a last resort treatment option for some patients and others find great satisfaction in advancing the future of medicine.” Volunteers who qualify to participate are carefully screened by study staff because each individual responds differently, candidates are considered from different ages, ethnic groups and genders. Successful candidates must also meet specific criteria for the medication being tested.

Participating in the TOMMORROW study

• During the dosing stage, participants receive either the investigational medication or a placebo (a replica with no active ingredients, sometimes called a “sugar pill”). The participant is required to attend site visits every six months and to answer questions via the telephone every three months in between site visits. The total amount of time involved in this study is approximately five years. • The final phase is follow-up. At the end of the study participants receive a physical examination and tests as well as a follow-up call two weeks after study completion. All personal information is confidential and will not be released without the patient’s written consent, as required by law.

Hope begins at home

Patients involved in the TOMMOROW study will experience different phases:

“We have been involved with bringing more than 50 medications, devices and diagnostics to the market,” affirms Curtis. “The best part of what we do is the detailed and unrushed care we provide and patients’ gain access to more advanced treatments.”

• The initial phase involves a screening and baseline. A physical examination is performed along with a medical history review and a blood test looking for the tell-tale Alzheimer’s genes -APOE and TOMM40.

Stanton agrees. “There seems to be a profound movement toward preventing versus treating illnesses. The advances coming in the near future are fantastic on all accounts. The patient, the practitioners and the providers all benefit from our work.”

Photo: DONALD RAUHOFER / FLORIDA MD

Volunteers who qualify for the study participate in cognitive-related exercises. In this photo, a patient is asked to recognize words and objects to assess his memory.

FLORIDA MD - DECEMBER 2014

Photo: DONALD RAUHOFER / FLORIDA MD

COVER STORY

Dr. Marieke Cajal reviews a patient’s cognitive test results for that day. Compass Research doctors take a hands-on, personal approach with patients for all of its medical research studies.

If you are interested in participating in any research studies, including the TOMMORROW study, please call Compass Research at 1-866-517-8463 to receive a complimentary 30-minute evaluation. Eligible participants must meet particular requirements based on each study. If qualified to participate, all studyrelated visits, tests and investigational medications are provided at no cost. Additional compensation is also available for time and travel. 

COMPASS RESEARCH LOCATIONS Orlando Clinic (downtown Orlando) 100 West Gore Street • Suite 202 • Orlando, FL 32806 Leesburg Clinic – Inpatient 2018 Tally Road • Suite 101 • Leesburg, FL 34748 Leesburg Clinic – Outpatient 708 Physician Court • Leesburg, FL 34748 Oviedo Clinic 2441 West State Rd 426 Suite 2011 • Oviedo, FL 32765 The Villages Clinic 8575 NE 138th Lane • Suite 201 Lady Lake, FL 32159 8 FLORIDA MD - DECEMBER 2014

Compass Research At a Glance: • • • • • • • • • • • • • •

224 Full-time employees 44-bed Phase 1 unit 30-bed inpatient psychiatry / Phase 1 unit Phase 2/3 outpatient clinics Multi-specialty (15 specialties represented) 15 Principal Investigators – 7 Full-time – 8 Part-time Site owners, investigators, and key staff work daily in the unit and are available 24/7 Strong, proven access to Special Populations Unique study capabilities Over 1,300 studies completed On-site QA/QC to ensure high quality data Clean FDA audit history Partnered with over 200 sponsors worldwide Worked with all major CROs – Preferred status with 3 global CROs

PULMONARY AND SLEEP DISORDERS

Exercise Induced Asthma By Syed L. Mobin, MD Asthma is a disease of airways where there is inflammation of the airways and reversible obstruction. There are different types of asthma like allergic asthma, non allergic asthma, exercise induced asthma, occupational asthma, cough variant asthma and steroid resistant asthma. Understanding the type of asthma is very important to achieve most effective treatment. Exercise induced asthma (EIA) is a term often used to describe episodic bronchoconstriction triggered by exercise and lasts through aerobic exercise. Exercise induced bronchoconstriction (EIB) sometimes used instead of EIA as EIB is a more accurate reflection of underlying pathophysiology.

Epidemiology

we attribute the allergic asthma. Large dry and cold air movement results in drying and cooling of the airway may be primary stimulus responsible for bronchoconstriction. This in turn is believed to trigger a cascade of events that results in airway edema secondary to hyperemia and increased perfusion in an attempt to combat drying and an effort to heat the airway. Other relevant observations regarding EIA include levels of bronchoconstrictive and inflammatory mediators like Leukotriene LTC4 and LTD4 are increased, peripheral TH2 lymphocytes are activated, eosinophils activation and influx is present. In contrast exhaled nitric oxide levels, which generally reflect airway inflammation, do not appear to correlate with development or severity of EIA.

EIA affects 12-15% of the population. 80% of symptomatic asthma has some degree of EIB. Even when those with rhinitis Clinical Manifestations and allergic asthma are excluded, a 3-10% incidence of EIA is seen in the general population. The magnitude of EIA is strongly The patients with EIA have bronchoconstriction which begins correlated with the underlying degree of airway hyper responsiveby 3 minutes and generally peaks within 10-15 minutes and reness and the presence of airway inflammation, as measured by the solves by 60 minutes. Typical symptoms are shortness of breath, number of airway eosinophils. Thus in many patients with mild chest tightness and cough. In most patients with EA, bronchoepisodic asthma, minimally increased airway responsiveness, and constriction if followed by a refractory period, during which remild airway inflammation, even strenuous exercise does not cause clinically significant bronchoconstriction. EIA seems to be more prevalent in some winter or sold weather sports. Some studies have demonstrated rates as high as 35% in competitive-caliber figure skaters, ice hockey players, and cross country skiers. Often times the stress of everyday life can be overwhelming. A particularly Pathogenesis traumatic event can change your life in an instant. We are here. Let us help you navigate through life’s sometimes unpredictable turns. UBC is a 112 bed EIA usually affect individuals who participate in sports that include an aerobic compopsychiatric inpatient and substance abuse/detox hospital. UBC offers children, nent. This condition can be seen in any sport, adolescents, and adult programs. We offer specialized treatment based on the but EIA is much less common in predomiindividual and treat the following common diagnoses as well as others: nantly anaerobic activities. EIA is probably triggered by the large volume of relatively ♦ ADHD ♦ Anxiety/Phobias cool, dry air inhaled during vigorous activity. ♦ Trauma Related Issues ♦ Depression This is supported by the fact that EIA is at♦ Substance Abuse Treatment ♦ Bi-polar Disorder tenuated when the inspired air is more fully humidified and closer to body temperature. (Adult) ♦ Co-occurring Disorders Certain sports played in cold and dry envi♦ Detox services ♦ Phobias ronments usually result in more symptoms (Adult) ♦ Grief manifestation for athletes with this condi♦ Adjustment Disorders tion. On the other hand when environment ♦ Anger Management is warm and humid, the incidence and severity of EIA decrease. The biochemical and or physical pathways that mediate these reTO SCHEDULE A FREE AND CONFIDENTIAL ASSESSMENT CALL 407-281-7000 sponses are not clear. Evidence may even exist to support the idea that the resulting cascades 2500 Discovery Drive t Orlando, FL 32828 are not the inflammatory pathways to which

UNIVERSITY BEHAVIORAL CENTER

FLORIDA MD - DECEMBER 2014

PULMONARY AND SLEEP DISORDERS peated exertion causes less bronchoconstriction. Refractory period is less than 4 hours. Inhibitory prostaglandins released during the refractory period probably protect against repeated episodes of EIA. Chemicals used in certain sports for environmental maintenance can predispose to EIA symptoms. These chemicals include chlorination to pools, insecticide and pesticide used in the fields, fertilizer used to maintain field. Certain medications can provoke or exacerbate bronchial reactivity in EIA as B blocker, Aspirin, NSAID, Diuretics, and Zanamivir.

Diagnosis In patients with well documented asthma with typical asthma symptoms following exercise, formal exercise testing is not needed. In patients without documented asthma further assessment is needed if exercise induced asthma is suspected. An exercise challenge test is the most direct way to establish diagnosis of EIA. This usually involves 6-8 minute of ergometer or treadmill exercise, sufficient to raise the heart rate to 85% of the predicted maximum. A test is generally considered positive if the FEV1 falls by 10% or more. Although a fall of 15% is more diagnostic of EIA. Alternatively, surrogate tests to assess bronchial hyperresponsive, e.g., cold air hyperventilation, methacholine, histamine, Mannitol inhalation challenge may be performed, but not always correlate with the presence of EIB.

Management Patient education is crucial in the management of EIA. A major goal is ensure that exercise is not avoided by patients with EIA. Once the diagnosis is made, athletes should be encouraged to continue in their activities with the reassurance that proper treatment can allow for an unhampered performance for most individuals. In addition to reassurance, it is also important to teach individuals from aggravating activity and initiate treatment as necessary. This includes education about the proper choice of agents to abort an acute attack i.e., short acting beta agonist but not Leukotriene, receptor blocker, LABA or inhaled corticosteroid. Asthmatics should exercise as much as desired. Improved understanding of the pathophysiology of EIB has resulted in general recommendations than can help reduce its severity. Improving cardiovascular fitness reduce the minute ventilation required for a given level of exercise, thereby decreasing the stimulus for bronchoconstriction. Similarly bronchorestriction is lessened when the inspired gas is warmer and more humid. All patients with EIA should be instructed to use short acting Beta agonist 10 minutes before exercise. An alternative approach is prophylactic use of inhaled Cromolyn sodium 2-4 puffs taken 15-20 minutes before exercise. Equipotent doses of Formoterol, Sametrol appears to be effective in providing short term control of EIA. Long acting beta agonist and regular use of short acting beta agonist provide less effective protection against EIA than does intermittent use of short acting beta agonist. When poor control of asthma is the cause of exercise induced bronchospasm, the most effective method of achieving asthma control involves use of inhaled glucocorticoids. Studies have shown that inhaled glucocorticoid do not decrease exercise induced bronchospasm in a dose related manner. These findings indicate mechanism of EIA distinct from allergic asthma. Leukotriene modifying agents provide a therapeutic alternative in the setting of chronic asthma complicated by EIA. Leukotriene modifying agents appear superior to long acting beta agonist when treating asthmatics with EIA. In patients who require daily therapy for EIA it is suggested to use anti-Leukotriene agent or inhaled glucocorticoid rather than regular daily use of beta agonist alone. When exercise is unpredictable or repeated during the day, daily morning dose of Leukotriene receptor antagonist rather than a pre exercise inhaler is recommended. The prognosis for athletes with asthma is excellent. With proper interventions, most symptoms can be prevented and performance should not be limited for EIA, if this condition is treated properly. Newly diagnosed young athletes need to be educated that this condition should not be perceived as an insurmountable disability Syed L. Mobin, MD, completed his Fellowship at Mayo Clinic Rochester, MN and Mayo Clinic Jacksonville, FL and is board certified in Pulmonary Medicine, Critical Care Medicine and Sleep Medicine. He is Chairman of Internal Medicine Department at Florida Hospital and is Director of CFPG Institute of Sleep Medicine. Dr. Mobin is also the clinical assistant professor at University of Central Florida School of Medicine, a member of the American Academy of Sleep Medicine, the American College of Chest Physicians, the Society of Critical Care Medicine and a Mayo alumni. Dr. Mobin is practicing with the Central Florida Pulmonary Group and can be contacted at (407) 841-1100 or by visiting cfpulmonary.com. î Ž

Coming UP Next Month: The cover story focuses on Orlando Foot & Ankle Clinics. Editorial focuses on Digestive Disorders and Diabetes. 10 FLORIDA MD - DECEMBER 2014

Healthcare Law

Update on Florida Legislation Regarding Pain Management Clinics

By Troy A. Kishbaugh, JD, BCS and Sarah L. Mancebo, JD

The Florida Legislature passed House Bill 7095 in 2011 to address the problem of prescription drug abuse in Florida. According to the Drug Enforcement Administration (“DEA”), 49 of the top 50 practitioners dispensing oxycodone in the United States between certain periods in 2008 and 2009, were located in the State of Florida. The Florida Legislature responded to this statewide crisis by enacting laws that regulate prescription drugs, pain management clinics and physicians who practice in pain management clinics. The law now regulates all entities in the supply chain for prescription drugs, including wholesale distributors, painmanagement clinics, pharmacies, pharmacists and practitioners (physicians, dentists, veterinarians, osteopathic physicians, naturopathic physicians, and podiatrists). These laws also impose criminal violations. On October 1, 2010, the Florida Statutes first began to require “pain-management clinics” to register with the Florida Department of Health (“DOH”) as a pain-management clinic. The following year, in 2011, the Legislature amended the definition of a pain-management clinic to require registration for all publicly or privately owned pain-management clinics that (i) advertise in any medium for any type of pain-management services, or (ii) where in any month a majority of patients are prescribed opioids, benzodiazepines, barbiturates, or carisoprodol for the treatment of chronic nonmalignant pain, unless certain exceptions apply. Also, prescriptions for controlled substances must now be written on standardized counterfeit-proof prescription pads produced from a vendor approved by the DOH or electronically prescribed as set forth in the Florida Statutes. Physicians are also prohibited from dispensing Schedule II and Schedule III controlled substances, unless certain exceptions apply that are set forth in the Florida Statutes. The dispensing of these drugs illegally is a third degree felony and grounds for licensure discipline including, restriction, suspension, revocation, probation, fines, letters of reprimand, remedial education, or corrective action. By enactment of these laws, among others, the Florida Legislature is very serious about enforcing the laws regarding prescription drug abuse in the state. It is crucial for physicians to ensure they are complying with these laws. For more information about these prescription drug abuse laws, please contact Troy A. Kishbaugh and Sarah L. Mancebo with Gray Robinson’s Health Law Team.

Troy A. Kishbaugh , JD, BCS

Troy A. Kishbaugh, JD, BCS, is an equity shareholder and Chair of the Health Care Practice Group with Florida’s leading law firm, GrayRobinson P.A. Troy focuses his practice in the area of health care law which includes, medical/health Sarah Logan Mancebo, JD corporate law issues, Medicare/ Medicaid, fraud and abuse, false claims, billing and reimbursement, corporate compliance, PPACA, HIPAA, health information technology, EMTALA, Stark, self-disclosure and exclusions, and daily hospital operational issues. He may be contacted by calling (407) 244-5673; troy.kishbaugh@gray-robinson.com or by visiting www.gray-robinson.com. Sarah L. Mancebo, JD, is an attorney in the Health Care Practice Group with Florida’s leading law firm, GrayRobinson P.A. Sarah focuses her practice in the area of health care law which includes, medical/health corporate law issues, Medicare/Medicaid, fraud and abuse, false claims, billing and reimbursement, corporate compliance, PPACA, HIPAA, health information technology, EMTALA, Stark, self-disclosure and exclusions, and daily hospital operational issues. She may be contacted by calling (407) 2445642; sarah.mancebo@gray-robinson.com or by visiting www.gray-robinson.com. 

Be sure and check out our website at www.floridamd.com! FLORIDA MD - DECEMBER 2014 11

CANCER

Rethinking the Opioid Paradigm in Cancer Pain Management By David S. Craig, PharmD For thousands of years opioids have been used for managing various acute and chronic painful conditions and today remain one of the most useful tools in the armamentarium for treating cancer pain. In the early 1980â&#x20AC;&#x2122;s, the World Health Organization (WHO) developed the 3-step cancer pain relief ladder, which was designed to assist practitioners to more effectively manage cancer pain by using a stepwise approach (i.e. stepping up for moderate and severe pain, or stepping down for pain that was mild to moderate) and to provide guidance to when either strong or weak opioids may be necessary. Although this concept has been around for almost 30 years, today many countries in Europe, Asia, and Latin America continue to struggle to provide adequate supplies of opioids, such as morphine, to their citizens affected with cancer or other life-limiting diseases. (1) It is estimated by the WHO that adequate pain relief can be achieved by at least 75% of cancer patients who receive analgesics based on this approach.(2) However, new evidence suggests that exogenous opioids like morphine, oxycodone, etc., as well as endogenous opioids may play a role in cancer progression by stimulating tumor growth.(3, 4) Because many cancer patients require opioids to manage their pain, until recently, it had been impossible to assess the clinical effects of opioids on tumor progression before the introduction of peripheral opioid antagonists, such as methylnaltrexone, into clinical practice.(4) With the availability of peripheral opioid antagonists such as methylnaltrexone, and other similar tools, researchers are now able to more thoroughly investigate the influence of opioids on tumor growth in humans without having to compromise pain control.

Genetics, Pain, and Cancer Progression Genetic differences in opioid receptor subtypes, metabolism, and drug-transporter pathways may explain why patients have a better response to one opioid versus the other, and despite having identical tumor sizes and/or cancer stages, patients may report large differences in pain intensity due to genetic influence on pain perception, interpretation, and signaling pathways. Mu opioid receptors, which are responsible for the majority of analgesia from opioids, exist mostly presynaptically in the periaqueductal gray region, and in the superficial dorsal horn of the spinal cord. Mu receptor activation by either endogenous or exogenous opioids produces analgesia, but if the Mu Opioid Receptor (MOR) genetic polymorphism A118G is present, it can result in morphine and possibly endogenous opioid resistance. Therefore, cancer patients with the A118G genetic polymorphism may have improved survival compared those who do not. This hypothesis was recently tested in a study of 2,039 women in the Carolina Breast Cancer Study, 5% of African Americans and 24% of European American women had one or two copies of the G allele. Of the women with the A/A genotype and invasive cancer, 17% (291 of 1,682) died of the disease versus 8% (27 of 345) of the women with the G allele (p<0.001).(6) The authors concluded that the survival difference they observed may have been influenced by endogenous opioids and that opioid pathways

World Health Organization: Pain Relief Ladder. Found at: http://www.who.int/cancer/palliative/painladder/en/index.htm

12 FLORIDA MD - DECEMBER 2014

CANCER may be involved with tumor growth.

Opioids and Tumor Growth How opioids actually influence tumor growth is not entirely clear, however, studies evaluating opioid receptors found that stimulation of opioid receptors on endothelial cells results in angiogenesis (7-9) and that opioids appear to suppress a number of aspects of immune system function, and some of these effects have been shown to be mediated by opioid receptor activation.(10) In addition, stimulation of Mu-opioid receptors on immune cells reduces macrophage and lymphocyte proliferation and cytokine secretion.(10,11) Activation of Muopioid receptors in brainstem regions modulates hypothalamic-adrenal-pituitary axis function and increases peripheral glucocorticoids, (12 which may compromise immune function and promote tumor growth.

Where Do We Go From Here? Although the link between endogenous and exogenous opioids and tumor growth is not entirely clear, these studies do provide a signal that some correlation may in fact exist. Given that opioids are one of the most effective analgesics in managing cancer pain, there are several unanswered questions 1) Do opioids negatively impact cancer survival? 2) Do we need a new cancer pain management paradigm that solely utilizes non-opioid options? 3) Are weak opioids better treatment options then strong opioids? Given this new information, the challenge for clinicians is how to best balance the potential risks associated with opioids, given this potential influence on tumor growth, and provide adequate pain control to reduce the pain and suffering that many of our cancer patients unfortunately experience. References available upon request. David Craig, PharmD is a Clinical Pharmacist Specialist within the Department of Pharmacy at Moffitt Cancer Center. He earned his Bachelor of Science from the University of Florida and a Doctor of Pharmacy from the University of Tennessee. In addition, he completed post-graduate training at Duke University Medical Center and at Moffitt. Recently, he completed the Mayday Pain and Society Fellowship, sponsored by the Mayday Fund, in 2012. He currently also serves as a Clinical Assistant Professor Department of Pharmacy Practice, and Clinical Advisor/Mentor within the University of Florida College Of Pharmacy. David is currently serving in various capacities within the American Pain Society and is the current editor for E-News, the society’s monthly newsletter. In the past, he has served on the Board of Directors and recently completed a 2-year term as Secretary within the American Pain Society. He currently serves as a peer referee for The Cochrane Collaboration - Pain, Palliative and Supportive Care Review Group (PaPas), and as a consultant to the FDA and the NIH Centers of Excellence in Pain Education (CoEPEs). He is also currently a peer reviewer for a number of well-known medical and pharmacotherapy journals and is an active member of the Journal of Pain and Palliative Care Pharmacotherapy editorial board. 

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Financial Update: Insurance • Benefits • Wealth Management

Notable Numbers By Kevin Taylor, JD

The basic law of supply and demand says that if there is a low supply and a high demand, the price of a commodity will be high. In contrast, the greater the supply and the lower the demand, the lower the price will be. It is the latter example that has pushed the price of a barrel of oil from a closing high of $107.26 on 6/20/14 to last Friday’s (11/28/14) close of $66.15, a remarkable 38.3% drop (and $41.11 a barrel) over a 5-month period. When the 12nation OPEC oil cartel met on Thanksgiving Day in Austria, it was widely expected to admit that the global surplus of oil forced their hand to implement production cuts. But instead OPEC concluded to hold firm with its daily oil production of 30 million barrels, great news for American consumers but worrisome data for US oil producers that could be compelled to lay off workers at lower oil prices (source: BTN Research). On 6/23/14, stock strategist Brian Belski forecasted that the US stock market had another 10 years to go with an expected +10.5% average annual return. Belski doubled-down on that previous prediction last Monday (11/24/14) when he announced that he now believes US markets are 6 years into a 20-year bull market run, i.e., the “biggest stealth bull market” of his Wall Street career. A 20-year bull would be twice as long as the longest bull (9 ½ years) in the USA since 1950 (source: BTN Research). After contracting 2.1% in the 1st quarter 2014 (quarterly change express as an annualized result), the US economy has bounced back with +4.6% growth and then +3.9% growth in the 2nd and the 3rd quarters this year (source: Commerce Department).

Notable Numbers for the Week: 1. NATURAL GAS - America tripled the amount of electricity generated from natural gas in 2013 when compared to 1990’s production, while the amount generated from coal over the 23-year period was unchanged. Natural gas generated 373 million megawatt hours in 1990, rising to 1.114 billion megawatt hours in 2013 (source: EIA). 2. POLITICAL RESULTS - With 1 Senate race to be decided, Republicans control the Senate 53-46 beginning next year. With 3 House races to be decided, Republicans control the House 244-188 beginning next year (source: CNN). 3. IMMIGRATION – Nevada’s population has a larger percentage of undocumented immigrants (7.6%) than any other US state. California and Texas (6.3%) are tied for # 2 on that list (source: Pew Research Center). 4. PROBLEM IN TWO YEARS - The Social Security Disability Insurance (SSDI) trust fund is projected to be depleted by the 14 FLORIDA MD - DECEMBER 2014

4th quarter 2016. Payroll taxes collected on behalf of the SSDI beyond 2016 would be sufficient to pay disability benefits equal to 81% of scheduled benefits (source: Social Security 2014 Annual Report). Securities and Investment Advisory Services offered through NFP Advisor Services, LLC, Member FINRA/SIPC. NFP Advisor Services, LLC is not affiliated with The Vaughn Group, Inc. This material represents an assessment of the market and economic environment at a specific point in time and is not intended to be a forecast of future events, or a guarantee of future results. Forward-looking statements are subject to certain risks and uncertainties. Actual results, performance, or achievements may differ materially from those expressed or implied. Information is based on data gathered from what we believe are reliable sources. It is not guaranteed by NFP Advisor Services, LLC as to accuracy does not purport to be complete and is not intended to be used as a primary basis for investment decisions. It should also not be construed as advice meeting the particular investment needs of any investor. The indices mentioned are unmanaged and cannot be directly invested into. Past performance does not guarantee future results. The S&P 500 is an unmanaged index of 500 widely held stocks that is generally considered representative of the US stock market. Copyright © 2014 Michael A. Higley. All rights reserved.

Kevin Taylor, JD, is a principal at The Vaughn Group, Inc. and manages the wealth management department. Before becoming a financial advisor, Kevin practiced law in Orlando, focusing on tax, estate, and asset protection planning for ultra-high-net-worth families. As a financial advisor, he has presented educational seminars and made presentations to the Florida Bar Association, regional Estate Planning Councils, the National Association of Retired Employees, the Arthritis Foundation, and the National Business Institute. Kevin graduated from the University of Florida with a B.A. in Economics, a J.D. with Honors, and a Masters of Laws in Taxation. He can be reached via email at kevin@ vaughngroup.com or by phone at (407) 872-3888. The Vaughn Group, Inc.’s offices are located at 1407 E. Robinson St., Orlando, FL 32801. 

ORTHOPAEDIC UPDATE

iFuse SI Joint Fusion Surgery Helps Change Lives By Corey Gehrold Fixed. Thankful. Amazed. These are just a few of the words used by sacroiliac (SI) joint fusion patients to describe what they’re feeling after recovering from their minimally invasive SI joint fusion surgery with the iFuse implant system.

G. Grady McBride, MD

“I’m so thankful to have my life back and get back to the things I love to do,” says Gail Page, a recent patient of G. Grady McBride, M.D., at Orlando Orthopaedic Center. Using this quick, minimally invasive procedure, Dr. McBride and his fellowship trained spine surgeon colleagues are able to fuse a joint in the pelvis, offering almost instant relief from lingering pain and discomfort. “Prior to having surgery, I was in horrible pain,” confesses Gail. “Now I can get out and do all of the things I love and I don’t feel tired at the end of the day. There is no pain.”

What is SI Joint Fusion Surgery? SI joint fusion surgery is accomplished using the iFuse Implant System. This system is designed to stabilize and fuse the SI joint, reducing or eliminating discomfort for patients. The SI joint links the iliac bones of the pelvis to the sacrum, which is the lowest part of the spine above the tailbone. “More or less, this area serves as a shock absorber to prevent impact forces during walking from reaching the spine and creating pain,” says Dr. McBride. “Like any other joint in the body, the SI joint can become damaged; and what we’ve found is the iFuse procedure can really help patients get back to enjoying their life once they’re healed.” Prior to surgery, Gail was very active walking, shopping and theme park hopping. But the pain became so consistently unbearable she was barely able to get out of bed or in and out of her car. “I was in horrible pain before surgery,” she says. “I was even feeling somewhat depressed because I couldn’t do the things I wanted to do.” But Gale’s not alone. Recent research has suggested the SI joint is a pain generator in up to 25 percent of low back pain cases and up to 43 percent of post-lumbar and lumbosacral fusion patients.

How is the SI Joint Fusion Surgery Performed? The SI joint fusion with the iFuse Implant System is performed by inserting small titanium implants across the SI joint to maximize stability and weight bearing capability. The entire procedure is performed through a small incision and will be completed in under an hour.

Gail Page recently underwent an SI joint fusion surgery with the iFuse Implant System. Just 11 weeks later she is back to enjoying her everyday activities without pain.

Surgeons use a specially designed system to guide the instruments that prepare the bone and insert the implants. Once the incision (typically 2-3cm long) is made, your physician will use fluoroscopy to place the implants and fuse the SI joint. “Fluoroscopy gives us real-time moving images of internal structures using X-rays,” says Dr. McBride. “It’s essential to allowing us to place the joints in the exact positions they need to be to maximize strength and stability while avoiding any unnecessary tissue disruption that would lead to increased pain and longer recovery periods for patients.”

What is the Recovery Process for an SI Joint Fusion Surgery? According to Dr. McBride, most patients resume most of their basic daily tasks within six to eight weeks. There may be some limitation on more strenuous activities including return to work for three to four months depending on postsurgical progress and occupation. “Healing is different for every individual, but we feel confident in producing positive outcomes following surgery with these timelines,” says Dr. McBride. For Gail, she was back doing her favorite activities without pain just 11 weeks after surgery. “I am very thankful that I have regained my life,” she says. “I highly recommend Orlando Orthopaedic Center and Dr. McBride for giving me my life back.”  FLORIDA MD - DECEMBER 2014 15

Marketing Your Practice

Little Known Secrets to Choosing the Right Promotional Piece By Jennifer Thompson Do you leave promotional products like notepads and pens at other offices when you visit? How do you make sure you’re getting the right products? The goal of any promotional product, or “leave-behind”, is to make the recipient remember you. Whether they’re a referral partner or a potential patient at a health fair, you want them to use your product and call on your office when they need you… otherwise, what good is the product you wasted money on?

A Leave-Behind is a Complementary Piece One of the keys to success in the medical field with promotional products (and all giveaways for that matter) is making sure they don’t focus of what you’re doing. Huh? In other words, your promotional products should serve as the last piece of the puzzle that really sends you over the edge. When you’re making your office visits, be sure to have some type of handout as well, such as a brochure or rack card, that explains what you do. That should be the main component of what you’re leaving behind with the promotional product as a leave-behind to act as something to remember you by. Don’t try to cram your entire mission statement, phone, fax, website, doctor bios, specialties and hours on a pen. It’s just not going to work.

Choosing the Right Promotional Product You want these products to set you apart and keep you in the mind of your referral partner and/or your potential patient. How do you do that? • Bring Something Unique – If every office is giving away pens, what sets your office apart? Take this opportunity to bring something unique to the table. Be memorable because the idea is to give something that people will be excited to use and will pick up often. Think outside of the box and give something that you’d like to receive yourself. For instance, if you’re an orthopaedic office, how about giving a candy dispenser filled with little bone-shaped candies to your top referral partners? • Follow the Trends to Success – It’s always best to do a little research before spending a decent-sized chunk of change on widgets and giveaways. One of the most popular things for this year will be a focus on safety. Consumers (see: patients) want to know more than ever how products will affect their overall health. Any product that comes with a focus on safety or puts their health first, is a plus. This can range from anything including a flashlight to a bandage dispenser to a cheap fitness tracker. • Think Like Your Audience – We know that more people are bringing their lunch to work these days when compared to years past. They’re also making their own coffee instead of vis16 FLORIDA MD - DECEMBER 2014

iting a chain coffee shop; so, consider putting your logo on something practical that puts more money in their wallets. They’ll use it more and appreciate the thought on top of that. Think of a quality lunch bag/cooler with your office’s logo on it being used at hundreds of spots around your office. • Partner with a Cause – Think of one specialty or disorder your office focuses on and choose something that backs that cause. For instance, if you deal with cardiovascular disease, give a heart keychain away at an event with a note explaining if the recipient visits your office, you’ll donate a portion of their bill back to the American Heart Association. It doesn’t have to be any large sum, remember, it’s the thought that counts.

More Tips for Promotional Product Success Now that you know what product to purchase, how is it going to look? How many should you order? Here are a few tips to help you decide: • Design Matters – Your product is no good if no one wants to look at it. Choose colors, textures and designs carefully. You don’t want anything too cluttered, disorganized or just plain painful to look at. Usually a logo, phone number and web address are sufficient. Depending on the product, you may be able to squeeze in a marketing tagline or a few of your specialties, but anything else will be ignored. • Leave Plenty – If the office manager of your visit really likes what you’re giving away make sure to leave plenty. Like, a lot. The idea is to give them away and make sure they’re used. If you have to give four away when you were expecting to give one, so what? It’s all about getting your name out there… besides, the more you give away, the sooner you can order new swag. Leaving something behind can increase the patients that come in. It’s as simple as that. After some careful research, planning and plotting, you should be well on your way to a promotional products plan that works well and doesn’t break the bank. And, if all else feels, you’ll have enough drink koozies to last a lifetime. Looking for more ways to attract and retain more patients? Check out DrMarketingTips.com for free articles, webinars, ebooks, audio blogs and more for your practice.

Jennifer Thompson is co-founder and chief strategist for DrMarketingTips.com, a website designed to help medical marketing professionals market their practice easier, faster and better. 

To Join or Not to Join? That Is the Question When Associations Come Calling By Marni Jameson What’s in it for me? Admit it. The question crosses your mind when you’re asked to support a cause. It’s human nature, especially this time of year, when every organization has a hand out for a donation or dues. It’s natural to pull back and ask why should I contribute. What’s in it for me besides a tax deduction? I can’t speak for other causes, but, as the executive director of the Association of Independent Doctors, a national nonprofit that supports the interests of independent physicians, I have given the “Why join?” question a lot of thought. Sure, we have lofty goals aimed to benefit all Americans. Many of our members – who now span eight states – joined to support those goals, which include working hard at the national and state levels to reverse the trend of medical practices being acquired by hospitals. We are also working to increase parity and transparency in health-care costs, and are educating consumers about how this affects them and the role they play.

“Well that’s fine,” you say to yourself, “but the association will do that whether I join or not.” I hear you. I am not tone deaf to the fact that not everyone likes to give money to a cause strictly for the greater good -- great though that good may be. That awareness brings me to the three more reasons your membership can benefit you specifically. 1. An A.I.D. membership can save you money. As more smart business owners realize that when physicians go to work for hospitals, their businesses lose customers, they are stepping up to help independent doctors stay independent. The following businesses have all joined A.I.D., and are offering members substantial discounts in these areas. • Malpractice insurance. MagMutual, one of the major providers of medical malpractice insurance, offers A.I.D. members a 10 percent discount off their insurance upon renewal. Thus, if your malpractice insurance costs $30,000

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a year (average for a cardiologist), you save $3,000. A physician membership to A.I.D. is $1,000. You do the math. • Banking. New Traditions Bank gives unique consideration to A.I.D. physician members looking for financing to help them stay independent. • Marketing. Hart Marketing & Communications, a firm that specializes in the marketing of medical practices, offers a 10-15 percent discount on its services to A.I.D. members. • Credentialing. PracticeWorx, a firm that handles the paperwork and hassles of credentialing of new physicians, and the paperwork surrounding the process of securing 20 to 30 different health plans, provides A.I.D. members a substantial discount off standard pricing. 2. An A.I.D. membership puts you in good company. Besides saving you money, membership also puts you in a group of like-minded colleagues. Numerous studies show that independent physicians are happier than employed physicians because they have more freedom to practice medicine without the pressure of meeting quotas set by hospital employers, and can therefore maintain a purer doctor-patient relationship. By refusing to “sell out,” independent physicians enjoy a level of integrity, independence and respect that those acquired by institutions don’t have. You get to be part of that group. 3. An A.I.D. membership gives you a voice. Independent doctors are by nature autonomous. Thus, they don’t have the lobbying clout large health systems have. But with our association they do. Though we only formed last year, we have been asked to represent the interests of independent doctors nationally on Capitol Hill. And we are giving voice to our members by participating in one of the nation’s leading anti-trust cases involving a health system’s acquisition of a large medical practice. The case, which is being decided right now, will have a far-reaching impact on the future of independent doctors. Finally, while we speak out on behalf of our members, none of them risks the potential retaliation from their area hospitals. We guard the privacy of those members who want their membership confidential. There’s no directory. We don’t share our members’ names with anyone. Oh, and did I mention it’s tax deductible? www.aid-us.org. Join me next month when we look at a high court’s decision in an anti-trust case involving the purchase of a large medical practice by a major health-care system. It’s a verdict the nation has been waiting for, which will be felt nationwide.

HELPING YOUR PATIENTS

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FOOT & ANKLE

MLS (Multi-wave Lock System) Laser Offers Patients State-of-the-Art Care by David Moats, DPM, FACFAS As the Medical Director and Co-Founder of the Orlando Foot & Ankle Clinic I believe in practicing medicine the old fashioned way, but with a “Star Wars” twist. I strive to treat patients with care and respect, taking the time to really listen to their concerns and customizing a treatment plan specifically for them. Where does the “Star Wars” factor come in? Well I am happy to announce that I am one of the first Podiatrists in the Orlando area to have brought the MLS (Multi-wave Lock System) laser into my practice in order to offer patients state-of-the-art care while often avoiding the need for invasive surgery. With outstanding patient care at its core, my 27 years of practice is focused on treating and healing foot and ankle conditions so that my patients can return to the pain-free lives they want to live. Since starting my practice in 1987, I have been dedicated to being up-to-date on procedures, new findings and improvements in the way we practice medicine and surgery so that my patients receive the best possible care. Today I can say that I have never been as excited to help patients as I am with this new laser system. I was introduced to the MLS Laser by a colleague who had been having great successes with these treatments in Texas. Then, while attending a seminar, I had a first-hand experience with this laser system. I was suffering myself from plantar fasciitis flare-up (pain in the ligament of the heel and arch) and being somewhat skeptical, I had a MLS laser treatment done on myself that very day. I felt no pain, no heat, hardly anything special while getting the 10 minute laser application. But, when I stood up almost all my pain was gone! That is when I knew I had to add this to my practice to help as many patients as I could. On average, my patients who are being treated with the MLS Laser are experiencing over 85-90% improvement in their condition. This laser can be used to treat and reduce the pain and inflammation/swelling of plantar fasciitis, neuromas, diabetic neuropathy, arthritis, sports injuries, tendon and ligament injuries, achilles tendonitis, and even post-operatively. One of my patients, an 85 year-old man, had experience painful diabetic neuropathy for over 12 years and had tried many medications but the medicines did not help and even made him feel drowsy and sluggish all the time. But after 10 MLS laser treatments, his pain was gone for the first time. He was finally able to go for long walks again. Another patient, a 45 year-old woman could not enjoy yoga or tennis for the last six months due to an ankle injury, but after a course of laser treatments all her pain was gone and she was hitting the courts again! An additional patient had seen three other doctors for plantar fasciitis (heel pain) that he had suffered with for years. He had already been through all the proper and usual treatments and came to me to schedule surgery. I actually talked him out of the surgery and after 10 laser treatments, he was cured. Every patient always asks “How does this really work?” Well the answer is surprisingly simple. This class 4 double pulsating

synergistic laser system that has two lasers synchronized together and uses light to favor and accelerate the body’s natural healing processes. The laser beam is moved over the skin so that the light energy (photons) penetrates the tissue where it interacts with various molecules (chromophores) that cause different biological effects. It produces a photochemical, photothermal and photomechanical effect. This results in many benefits that include: an anti-inflammatory effect, analgesic(pain relieving) effect, accelerated tissue repair and cell growth, improved vascular activity, increases metabolic activity, stimulation of trigger points and acupuncture points, reduced scar tissue formation, improved nerve function, immune-regulation, and faster wound healing. A typical treatment session lasts about 8 to 10 minutes with about 10 sessions to complete a treatment protocol. Once the diagnosis and protocol have been set, the machine will deliver the exact and correct amount of laser dosage to the afflicted area. Then the double pulsating laser treatment begins. You can see some of the red light of the laser on your skin, but once the room lights are turned off you can truly see the laser and area being treated. There is no pain at all with the laser, no heat, no downtime as many of my patients have gone straight from the laser treatment suite to work or even a theme park. A few patients (myself included) feel some painless tingling but that is about it for sensations. Most patients are Pictured above is David B. surprised that they begin feeling Moats, DPM, the Medical better right after the first treatDirector and senior doctor ment and by the third for fourth at Orlando Foot and Ankle are much improved. Clinics performing a MLS laser treatment on a patient. To be honest, I was skeptical at the beginning but now the successes are so numerous that I want anyone with a foot or ankle problem to know that this is available. It has been so successful that I now do half the number of certain surgeries since the laser arrived. Please call my office at 407-423-1234 to schedule an evaluation to see if you qualify for this revolutionary MLS laser treatment plan. I want to keep your feet and ankles as pain free as possible so that you can do your day to day activities and exercise as much as you desire. David B. Moats, DPM the Medical Director and senior doctor at Orlando Foot and Ankle Clinics. Dr. Moats has been in practice for over twenty years and works out of our East Orlando and Kissimmee Offices. To make an appointment please call us at 407-423-1234.  FLORIDA MD - DECEMBER 2014 19

CURRENT TOPICS

Nemours Awarded Top Hospital Distinction by Leapfrog Group Only Children’s Hospital in Southeast to Earn Premier Recognition for Safety and Quality Nemours Children’s Hospital was one of just nine children’s hospitals in the country to make the annual Top Hospital List from the Leapfrog Group. This elite distinction is awarded to hospitals nationwide for demonstrating excellence in hospital safety and quality through the Leapfrog Hospital Survey. The awards, which are given annually, will be announced at Leapfrog’s Annual Meeting and Top Hospital Awards tonight, in Washington, D.C. “I am beaming with pride over this honor for Nemours,” said Roger Oxendale, president of Nemours Children’s Hospital. “Each day we set out to deliver the safest possible care for patients and families. The Top Hospital award from the Leapfrog Group is an important recognition of the hard work of many Associates who work very hard to achieve that goal.” “Leapfrog’s Top Hospital award is widely acknowledged as one of the most prestigious distinctions any hospital can achieve in the United States. It recognizes institutions for their excellence in quality of care and patient safety, as well as their commitment to transparency. By achieving Top Hospital status, Nemours Children’s Hospital has proven it’s a premier institution and deserves to be recognized for its dedication to the families and patients in Florida,” said Leah Binder, president and CEO of The Leapfrog Group. The Top Hospital award is given to less than seven percent of all eligible hospitals. Nemours Children’s Hospital was one of 94 Top Hospitals recognized nationally. The list includes: • 24 Top Rural Hospitals • 61 Top Urban Hospitals • Nine Top Children’s Hospitals The selection is based on the results of The Leapfrog Group’s annual hospital survey, which measures hospitals’ performance on patient safety and quality, focusing on three critical areas of hospital care: how patients fare, resource use and management structures established to prevent errors. Performance across many areas of hospital care is considered in establishing the qualifications for the award, including rates for high-risk procedures and a hospital’s ability to prevent medication errors. The Top Hospital award is not given to a set number of hospitals, but rather, to all urban, rural and children’s hospitals that meet the high standards defined in each year’s Top Hospitals Methodology. To see the full list of institutions honored as a 2014 Top Hospital, please visit HYPERLINK “http://www.leapfroggroup. org/tophospitals” www.leapfroggroup.org/ tophospitals .

About The Leapfrog Group The Leapfrog Group (www.leapfroggroup.org) is a national nonprofit organization using the collective leverage of large purchasers of health care to initiate breakthrough improvements in the safety, quality and affordability of health care for Americans. The flagship Leapfrog Hospital Survey allows purchasers to structure their contracts and purchasing to reward the highest performing hospitals. The Leapfrog Group was founded in November 2000 with support from the Business Roundtable and national funders and is now independently operated with support from its purchaser and other members. The Hospital Safety Score (www.hospitalsafetyscore.org) is an initiative of The Leapfrog Group. 

20 FLORIDA MD - DECEMBER 2014

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