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The Obama Impact on Health Care
No. 3 • March • 2009
SERVING BROWARD, PALM BEACH COUNTIES AND SURROUNDING AREAS
www.floridahealthnews-online.com
President Barack Obama is joined by White House Domestic Advisor Melody Barnes and firefighter Travis Ulerick of Dublin, Ind., as he addresses the White House Forum on Health Reform, in the East Room at the White House.
Heartburn and reflux
Chronic heartburn can lead Page 3 to serious complications
Grand Opening of Independent Imaging, LLC and Advanced Page 5 Diagnostic Solutions
Also in this issue Chronic Cough
Immunization Guidelines for adult patients: Latest annual update Grand Opening Celebration At Palomino Park Medical Center
Disney On Ice: Worlds of Fantasy
2 MARCH • 2009
FLORIDAHEALTHNEWS-ONLINE.COM
“
The Obama Impact on Health Care He's shown real leadership”, Senator Joe Lieberman told The Associated Press in an interview. "Bottom line: I think Barack Obama, president of the United States, is off to a very good start”. Billionaire Warren Bufferr, whose Berkshire Hathaway Inc. posted its worst results ever in 2008, said the economy “has fallen off a cliff” and that efforts to stimulate recovery may lead to inflation higher than the 1970s. There is division among the Democrats about the omnibus spending Bill. Appears that the world has gone topsy turvy. Everything is the opposite of what was projected and predicted. President Obama came into office with many promises, offering hope and change to the beleaguered voters. Based on his word and predictions, he won the popular vote. However, we have to take a wait and see attitude. Granted that President Obama came into office at a time when the economy was crumbling, the war in Iraq depleted our Treasury of billions. We have national debt in trillions of dollars - yet the President Approval ratings are still high enough to support his plans. Every American is hoping that he or she will be rescued out of their financial predicament. No doubt President Obama has the good of the nation as his first priority- but we have to weigh all his actions, and plans to see how they really come into play. The rescuing of the banks, AIG and other companies, appears to be a money pit- the more money they throw into it the more it
By Lauren Armstrong
wants. Almost like feeding a beast with an unlimited appetite. As some scholars write- it may be better to let some banks and institutions fail, regroup and get back up in a new transformative manner. Money should instead be leveraged into resolving problems. The crumbling infrastructure of our highways and bridges need added attention. Infusing money into universities and higher centers of learning is necessary so that the cost of education goes down, and more young people can afford college education. The housing market has tumbled and is being rescuedhowever this is causing tremendous resentment among those who have planned their budgets and spending so that they would be in over their heads- the rescue has to be planned and directed at homeowners who were genuinely misled by the greedy banks and mortgage companies. This will take a lot of work- but is well worth the investment. As for healthcare- giant reforms are being planned. The idea and vision is good, but a lot must be put into place before this must happen. Medicare may have to be overhauled - all aspects must be reviewed to excise fraud, and over charging. Medical costs can come down if doctors did not have to pay such high costs for malpractice, and if insurance companies would be rational with their pay outs for claims. There is a lot on the President’s plate- let’s hope that the country does not get indigestion instead.
ADVERTISING SALES Sergio Aguilar Phone: (561) 716-5054 sales@floridahealthnews-online.com CONTACT US P.O. Box 542527 Lake Worth, FL 33454-2527 Phone: 561-716-5054 info@floridahealthnews-online.com WEB SITE www.floridahealthnews-online.com CONTRIBUTING ARTICLES U.S. Department of Health and Human Services, Contexto Latino, ARA Content, Hispanic PR Wire, Centers for Disease Control and Prevention, METRO Editorial Services, Family Features, Florida Health News is a newspaper published every month in Broward, Palm Beach, and surrounding areas. Copyright 2009, all rights reserved by SEA Publications, Inc. Contents may not be reproduced in any form without the written consent of the publisher. The publisher reserves the right to refuse advertising. The publisher accepts not responsibility for advertisement error beyond the cost of the portion of the advertisement occupied by the error within the advertisement itself. The publisher accepts no resposibility for submitted materials. All submitted materials are subject to editing.
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Immunization Guidelines for adult patients: Latest annual update FACTS
8,000,000 Americans with type 2. Diabetes have not reached the blood sugar level target. (By ADA, American Diabetic Association). 13,000,000 diabetic people in the USA are overweight.
Colonoscopy was strongly associated with fewer deaths from left sided colorectal cancer. Colorectal cancer is the second most common cause of cancer death in North America. People increasingly use the internet for health information and services, including the convenient purchase and delivery of prescription drugs. Unregulated internet health information and self indication via vogue internet pharmacies could be dangerous to one’s health.
Patients with diabetes should get education about proper foot care and regularly inspect their foot.
What is cellulitis?
Cellulitis is an infection of the skin and underlying tissues. It may follow a break in the skin or a surgical woung but may also occur whitout an obvious break in the skin.
Risk factors for cellulitis / infection of skin
Trauma - lacerations, burns, abrasions, open fractures Intravenous drug use Animal / human bites
Predisposing conditions, that is diabetes mellitus, peripheral artery disease, chronic veinous, insufficiency, swelling (edema), cirrhosis of the liver. Previous history of cellulitis
The full texts of the recommendations for each vaccine are available at www.cdc.gov/vaccines/pubs/ACIP-list.htm and the full Adult Immunizations Schedule is available at www.cdc.gov/nip/recs/adultschedule.htm. New changes are discussed below. Herpes Zoster
New language states that a previous episode of shingles is not a contraindications to zoster vaccination. We lack good evidence about the interval between the last episode of shingles and immunization. Most experts recommend at least a 12-month interval.
Human Papillomavirus
Occupational exposure does not increase health worker’s risk for human papillomavirus. They should receive vaccine only for a standard indication.
Pneumococcal polysaccharide vaccine
The recommendations for use of this vaccine have undergone many versions, including the following.
Asthma
The pneumococal polysaccharide vaccine (PPV23) is recommended for all persons age 65 years or older, as well as for younger persons who have certain underlying medical conditions. There has been uncertainty about whether to vaccinate patients 19 to 65 years of age who have asthma (particulary because asthma is an indication for influenza vaccine). The answer now is yes. The most compelling rationale is a recent nested case-control study demonstrating that adults with asthma experienced a significantly increased risk for invasive pneumococcal infection (such as bacteremia) than did adults of similar age without asthma.
The result suggest that asthma is an independent risk factor for serious pneumococcal infection. Approximately 16 million adults in the United States have asthma. Notably, most asthmatic adults who develop invasive pneumococcal disease already have another condition for which PPV23 is recommended–but they often do not receive it. Making asthma an indication for pneumococcal vaccination wil resolve previous ambiguity.
Smokers
The new guidelines also address cigarrete smoking as an indication for pneumococcal vaccination. Population based surveillance studies consistently report that approximately half of otherwise healthy adults younger than 65 years of age who develop invasive pneumococcal disease are smokers. The intensity of smoking (number of cigarettes smoked daily) and cumulative smoking exposure (pack-years of smoking) both progressively increase the risk for invasive pneumococcal disease. Quitting smoking reduces the risk for pneumococcal infection. The longer the abstinence, the less the risk for invasive pneumococcal infecion. Thus, smoking seems to be a strong independent risk factor in immunocompetent adults. Although many smokers have other risk factors that make them eligible for PPV23, smoking status is easy to indentify as an indication for vaccine, and current smokers should be vaccinated with PPV23. About one fifth of the U.S. adult population smokes cigarettes, so physicians face a considerable challenge to provide them with protection against invasive pneumococcal infection.
Influenza vaccine
Currently, about 83% of the U.S. population is eligible for annual influenza immunization. Several new recommendations will increase the number of people who are eligible.
Children
The new recommendation is to vaccinate all children age 5 years through 18 years. This recommendation will be of particular interest to internists who care for adolescents.
Caregivers
Another new recommendation is to vaccinate all persons who live with or provide care to persons who are at increased risk for influenza-related complications. the rationale is to reduce transmission of influenza virus from the family member or caregiver to the high-risk individual. Among the caregivers who should be vaccinated are health care workers. At last count, only 42% of health care professionals acknowledged having received influenza vaccine. The traditional “vaccination season”, wich extends from late September through Thanksgiving. Because influenza infections peak most commonly in February, it is appropiate to extend the “vaccination season”, into December and January and even beyond).
The challenge of Adult Immunization
The delivery of vaccines to patients at risk is not only part of both patient safety and quality of care, but it is also the standard of clinical care. The Adult Immunization initiative Physician Advisory Board to the American College of Physicians and the Infectous Diseases Society of America have released a joint statement on the importance of adult immunization. The statement has been endorsed by 17 other medical societies representing various practice areas, including many subspecialties of internal medicine. The statement proposes several standards: All phisicians should periodically conduct an immunization review with their adult patients. Its purpose is to educate patients about the benefits of vaccination status is concordant with recommended practice.
Heartburn and reflux FLORIDAHEALTHNEWS-ONLINE.COM
This allows stomach acid to back up and cause:
• A burning sensation behind the breastbone • A sour taste in the mouth • The sensation of food re-entering the mouth
Chronic heartburn can lead to serious complications
Complications of reflux
In some people, acid in the lower esophagus actually causes tissue damage. Certain complications can then result: • Chronic bleeding and anemia. • Scar information and narrowing of the lower esophagus. This is called a stricture. It usually is treated by dilatation, a procedure to widen the area. • Barret’s esophagus can occur when reflux irritates the lower esophagus over a long period of time. The stomach lining then actually grows into the esophagus. In these cases, there is a slight, but definite, risk o cancer developing. • Lung problems can develop when reflux
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• Stop using all tobacco; nicotine weakens the LES. • Avoid fatty foods, alcohol, coffee, chocolate, and peppermint. • Elevate the head of the bed 8” to 10” so gravity keeps stomach juices out of the esophagus while the patient sleeps. Extra pillows, by themselves, are usually not helpful. • Certain prescription or over the counter medications can weaken the LES or aggravate reflux. Review all medications you are taking with the physician.
About 15 million Americans experience heartburn every day. It occurs when muscles in the lower end of the esophagus abnormally weaken or relax.
Left untreated, chronic heartburn can result in gastroesophageal reflux disease (GERD). In addition to heartburn, GERD causes chest pain, difficulty swallowing, coughing, anemia, ulcers and regurgitation of food or sour liquid. Over a period of years, GERD can lead to Barrett’s esophagus, a condition that increases the risk of esophageal cancer.
MARCH • 2009
Treatments tailored to you special needs
results in stomach fluid tricklin into the breathing tubes. It often occurs at night when a patient is lying down. This causes wheezing, bronchitis, and even pneumonia.
Treatment of reflux
There are general measures the patient can take to reduce reflux: • Eat smaller and more frequent meals. • Do not lie down immediately after eating, and avoid eating for several hours before going to bed. • Excessive bending, lifting abdominal excersises, girdles, and tight belts all increase abdominal pressure and provoke reflux. • If overweight, lose weight. Being overweight promotes reflux.
If needed, we’ll identify when your heartburn occurs and how much acid is involved through a test known as pH monitoring. The test checks the acid levels in your esophagus over 24 hours or longer, It is based on a disposable pH capsule that transmits data from your esophagus to a small receiver worn on your belt. Using this information, we’ll design a personalized treatment plan just for you.
Defeat GERD with endo-suturing
Although hearthburn and GERD are often treated with long-term medications or surgeries, we offer a simpler solution known as endo-suturing. During this painless oupatient procedure, we’ll tighten your lower esophagus to prevent acid from flowing out of the stomach and into the esophagus. The procedure requires only local anesthesia, and most people return to normal activities the next day… without needing to continue taking heartburn medications. As pioneers in this area, we have performed more than 1,000 of these procedures, letting people
Krishna Tripuraneni, M.D., MBA
who were once troubled with GERD enjoy the pleasures of a good meal.
Get the expert compassionate care you deserve
The board-certified gastroenterologists at Palm Beach Gastroenterology Consultants have the training, experience and resources to diagnose and treat heartburn, GERD and other digestive disordes. And we do it all from one central location. Our in-house endoscopy center is staffed by nurses, anesthesiologists and other caregivers and equipped with the latest medical technology. We also offer advanced procedures not available at other area practices, and we’re dedicated to uncovering and correcting the underlying cause of your heartburn, not just treating the symptoms. Don’t let chronic heartburn undermine your health and lifestyle. Call (561) 795-3330 today to schedule a convenient appointment.
Krishna Tripuraneni, M.D., M.B.A. Thomas J. Flannery, M.D., M.B.A. Maria Valdes, M.D.
1157 South Rd. 7-US 441 Wellington, FL 33414 Phone: (561) 795-3330 Fax: (561) 795-1030
1200 S. Main Street, Suite 102 Belle Glade, FL 33430 Phone: (561) 996-5600 Fax: (561) 996-6498 www.gi-trip.com
Chronic Cough
4 MARCH • 2009
HEALTH
C
One can have chronic cough due to various reasons. Chronic cough due to chronic bronchitis is defined as cough for at least three consecutive months in a year for three years.
hronic bronchitis can be caused by cigarette smoking and also occupaciontal exposure to chemicals, fumes and sometimes second hand cigarette smoke.
I have seen patients in my practice who have had chronic cough and were diagnosed to have chronic
bronchitis, but in few instances I have found that these patients actually have chronic post nasal drip which was the prime cause of their malady, in some instances, I have seen chronic cough caused by reflux of acid from the stomach or even food contents aspirate into the lungs causing sleepless nights, in other words known as insomnia. These conditions can be easily handled in an effective manner, if diagnosed by a cognizant physician. Some antihypertensive medicines can cause cough: Treatments for chronic cough could be varied depending on the etiological factors.
FLORIDAHEALTHNEWS-ONLINE.COM
Last but not least, I have to reiterate that chronic cough, if left untreated, can be quite disabling and people must be aware that in most instances chronic cough can be either contained or treated. Dr. Sharma is Board Certified in Internal Medicine and has been practicing in the Western Communities for the past 19 years.
His offices are located in Wellington at 3347 State Road 7, Suite 200, Wellington, FL 33449 • Tel: (561) 795-9087 • Fax: (561) 753-8730. In Belle Glade at 425 SE 2nd Street, Belle Glade, FL 33430 • Tel: (561) 996-7742 • Fax: (561) 753-8730
PALM BEACH PRIMARY CARE ASSOCIATES, INC. State of the Art Office Building with Imaging Center, Cardiology, Cath Lab and Sleep Lab Coming Up
Shekar V. Sharma M.D. Board Certified in Internal Medicine
SPECIALIZING IN: • Cholesterol Management • Diabetes • Cardiac Care • EKG/24 Hour Heart Monitoring/Spirometry • Hypertension • Geriatric Concerns • Osteoporosis ACCEPTING NEW PATIENTS
Southern Blvd.
State Road 7
The Mall at Wellington Green
N
PALM BEACH PRIMARY CARE ASSOCIATES
Lake Worth Rd.
Florida’s Turnpke
Forest Hill Blvd.
On Staff: At Palms West Hospital, Wellington Regional Medical Center 9 AM - 5 PM MONDAY - FRIDAY SAME DAY APPOINTMENTS AVAILABLE 24 HOUR SERVICE AVAILABLE
3347 State Road 7 Suite 200 Wellington, FL 33449
Tel: (561) 795-9087 • Fax: (561) 753-8730
MEDICARE AND MOST MAJOR INSURANCES ACCEPTED
425 SE 2nd Street, Belle Glade, FL 33430
Tel: (561) 996-7742 • Fax: (561) 753-8730
MARCH • 2009
FLORIDAHEALTHNEWS-ONLINE.COM
Secreening Guidelines for the Early Detection of Prostate Cancer
M
The prostate-specific antigen (PSA) test and the digital rectal examination (DRE) should be offered annually, beginning at age 50, to men who have a life expectancy of at least 10 years.
en at high risk (AfricanAmerican men and men with a strong familiy history of one or more first-degree relatives diagnosed with prostate cancer at an early age) should begin testing at ate 45.
For men at average risk and high risk, information should be provided about what is known and what is uncertain about the benefits and limiations of early detection and treatment of prostate cancer so that they can make an informed decision about testing.
• Yearly mammograms are recommend starting at age 40.
• A clinical breast exam should be part of a periodic health exam, about every three years for women in their 20s and 30s, and every year for women 40 and older. • Women should know how their breasts normally feel and report any breast changes promptly to their health care providers. Breast self-exam is an option for women starting in their 20s.
• Women at increased risk (e.g., family history, genetic tendency, past breast cancer) should talk with their doctors about the be-
nefits and limitations of starting mammography screening earleir, having additional tests (i.e., breast ultrasound and MRI), or having more frequent exams.
Beginning at 50, men and women should follow one of the following examination schedules:
• A fecal occult blood test (FOBT) every year • A flexible sigmoidoscopy (FSIG) every five years. • Annual fecal occult blood test and flexible sigmoidoscopu every five years* • A double-contrast barium enema every five years • A colonoscopy ever ten years
Grand Opening of Independent Imaging, LLC and Advanced Diagnostic Solutions Independent Imaging, LLC and Advanced Diagnostic Solutions announced the Grand Opening of their state of the art facility located at The Palomino Professional Park at 3347 State Road 7 – Suite #100 in Wellington, Florida with a Grand Opening Celebration at the facility.
T
he facility offers a wide array of diagnostic testing with the most advanced equipment in the industry. The new GE Signa EXCITE 11.0 MRI Scanner operates at a higher field strength allowing clearer more detailed scans which improves information used by physicians for diagnosis. Not only does this technology improve clinical productivity and image quality, it has unprecedented scanning speed. In an MRA study of the brain, scanning time was reduced by 50%. It also offers dedicated applications for Breast MRI’s and Functional MRI’s. The Aquillion 64 Slice CT Scanner offers
* Combined testing is preferred over either annual FOBT of FISG every 5 years alone.
People who are at moderade or high risk for colorectal cancer should talk with a doctor about a different testing schedule
GET BACK ON YOUR FEET!
DEXA Bone Density examination.
By Staci Martin, contributing writer.
The Aquillion 64 Slice CT Scanner.
the most advanced multislice technologies on the market. It produces high speed, high resolution imaging with the best low contrast resolution at the lowest dose. It is designed to improve patient comfort and safety while offering uncompromised performance. In addition, it features special capabilities for cardiac coronary scans, virtual colonoscopy, and 3D reconstruction. One of the most exciting areas of this advanced facility is The Women’s Center at Independent Imaging/Advanced Diagnostic Solutions. It offers women the latest in Digital Mammography, DEXA Bone Density, Breast MRI, Breast Biopsy and Obstetric Ultrasound in a comfortable, qualified, tranquil setting. The center also offers physicians and patients Digital XRay, Nuclear Medicine, Cardiac Stress Tests, MRA and Ultrasound. The premiere radiologists at this facility are Dr. Jonathan S. Huber, Dr. Eric M. Baumel, Dr. Thomas M. Kirchner, Dr. Eric S. Grimm, Dr. Adam S. Mandel, Dr. Kyle R. Gormezano, and Dr. Scott D. Ruehrmund. For further information on this facility, please contact Independent Imaging/Advanced Diagnostic Solutions at 561.795.5558.
Podiatric Physicians & Surgeons
LA PODIATRY GROUP, LLC Dr. Arthur Hansen Dr. Daniel Heck
Dr. Lori Lane Dr. Paula DeLuca
Personal & Gentle Care For: Diabetic Foot Care, Hammer Toe, Fracture Care, Ingrown Nails, Bunions, Ankle/Heel/Foot Pain, Poor Circulation, Neuropathy, WOUND Care, Custom Molded Orthotics/Diabetic Shoes
Whirpool with every visit!
Conservative & Surgical Treatments Available
(561) 433-5577
3347 State Rd 7 Suite 204 Wellington, FL 33449
2326 S. Congress Ave. Suite 1-A West Palm Beach, FL 33406
Medicare - Medicaid - HCD - PPO & Most Insurances Accepted
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Independent Imaging/Advanced Diagnostic Solutions are proud to announce the Grand Opening of our State of the Art Diagnostic Center at 3347 State Road 7 in Wellington, Florida.
• • • • • • •
High Field MRI 64 Slice CT Scans Digital XRay Nuclear Medicine Cardiac Stress Tests MRA Ultrasound
...and announcing "The Women's Center at Independent Imaging/Advanced Diagnostic Solutions" offering Digital Mammography,DEXA Bone Density, Breast MRI, and Obstetric and Breast Ultrasound in a private and relaxed setting...
Please call 561.795.5558 to schedule an appointment or speak to one of our associates
Grand Opening Celebration
6 MARCH • 2009
FLORIDAHEALTHNEWS-ONLINE.COM
&
At Palomino Park Medical Center
A n i t a H e s s el b e r g , R N . B S N . , a n d S a n d r a W i l k e R N , o f C e n t e r f o r W o u n d C a r e a n d H y p er b a r i c M e d i c i n e a t We llington Re gio na l Me dic a l C e nte r.
T h e e v e n t w a s a t t e n d e d b y o v e r 4 0 0 g u e s t s . T h e o p e n i n g c el e b r a t i o n w as a b i g s u c c e s s .
K r is h na Tr ip ur a n e n i, M .D . , M .B . A. , le a d in g G a s t r oe nt ro lo g is t , She k ha r S har ma, M.D ., and Is ha n Guna wa rde ne , M.D.
D e n i s e W r o n o w s k i a n d P a t r i ci a I b r a h i m , o f B e t h e sd a H ea r t I n st i t u t e .
La wr enc e Strong, DO, FAOCD a nd Eliza be th R eis inger, DO , FAO CD, of De rma tology Ce nte r o f W el l i n g t o n .
D r. D a nie l Gh ira gos s ia n a nd Cha ndr a Ve nu gopa l, M. D., cu tting t he s y mbolic r ibbon o f Inde pe n de nt Ima g ing Ad va nc e d Dia gno st ic Solut ions , a c c omp an ie d by the M a yo r of We llin gton, Da re ll Bow e n a n d f ri e n d s .
Mr. Ke v in Sta te n VP Ba nk of Ame rica ; Ms . Ta mmy Lew itt adminis tra tor C a rd i o l o g y Pa rt n e r s ; Mo h a n P i l l a i , Ad mi n i s tr a to r P a l o m i n o P a r k a n d R e n a i ss a n ce H e a l t h S y st e m s s t af f .
Tom Ine rne y, of Me dica l Home c a re Supply, w ith his fa mily.
John Kline, Jac ky Kline of Cardinal Health Nuc lea r Me dicine Division and Tom Cornell, of Pegas us Biologics.
Ra njita S harm a (c e nte r), of Pa lm Be ac h Prima r y Ca re , a c c ompanie d by C ar oline G h e s q u ie r e a n d J a c q u e li n e A r n o u x , o f R e n a i s s a n c e H e a l t h S y s t e m s .
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K i m L e i s u r e ( c e n t e r ) , o f A l l F o r O n e H o m e H e a l t h C a r e an d f r i e n d s .
Pe te r D e nge l, of Zoll Life c or.
MARCH • 2009
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Ma rc Ta nne r a nd J o se p h Mund e n, of Or a c le Dia gn os tic La bor a tor ie s.
We llington Offic ials ta king pa rt in the s y mbolic r ibbon c utting of Pa lm Be a c h Prima r y Car e Ass oc iate s , include d the Ma yor of We llington Mr. Bow en, Mar gar et Ste inbe rge r, D r. Is ha n G una w ar dene , R anjita a nd D r. She k har Sha rma , Gr ac e Edwa rds , Dr. Sa ndra Aneti, D r. Kris hna Tr ipur ane ni, Moha n Pilla i, Ga il Impemba , Dr. Ja v ier Pre tte lt a nd frie nds .
I n d ep e n d e n t I m a g i n g , L L C a n d A d v a n c e d D i a g n o s t i c S o l u t i o n s o f f e r s a w i d e a r r a y o f d i ag n o s t i c te s ting w ith t he mos t a dv a nc e d e quipm e nt in the ind us tr y.
S u s h a m a Ve n u g o p a l , M . D . a n d C h a n d r a Ve n u g o p a l , M. D . , o f Ca r d i o l o g y Pa rtn e rs .
T h e M a y o r o f W e l l i n g t o n , D a r e l l B o w e n , sp ea k i n g a b o u t g r ea t f a c i l i t i e s w i l l b r i n g P a l o m i n o P a r k M e d i c a l C e n t e r to We llin gton c o mmunit y.
S h ek h a r S h a r m a , M . D . o f P a l m B e a ch P r i m a r y C a r e A s s o c i a t e s a c c o m p an i e d b y C r ai g C u d e n , o f H ea l t h c a r e D ev e l o p m e n t P a r t n er s .
Is ha n Gu na wa r de ne , M.D . c utt ing the s y mb olic r ibbon of Adv a nc e d Me dic a l, P.A., a c c ompa nie d by We llingt on O f f i c i a l s a n d f r i e n d s.