Global Health Tribune - May 2012 Issue by Global Health Tribune

Global Health M AY I S S U E - 2 0 1 2

S er vin g: J upiter

Boca Raton

FaCes & eVenTs

Dr. Minnick Makes Strides for Breast Cancer

Dr. Kathleen Minnick, Brian Grosso and Connie Grosso. PAGE 4

BLOOD CLOT RISK

Boynton

Lantana

TRIBUNE

Lake Wor th

Belle G lade

Wellington

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Royal P alm Beach

Birth control in the form of a vaginal ring or skin patch may bring a higher risk of blood clots than birth control pills, a new study from Denmark suggests.

Dr. Bishop is standing with Carmine Priore, III. PAGE 6

PAGE 2

speCiaL

Dentist pulls out all of her ex-boyfriend’s teeth after split

SKIN CANCER

A Radiation Oncologist’s Perspective

St. Mary’s Medical Center Appoints Donna Small as Chief Nursing Officer PAGE 19

P alm Beach G ar dens

Birth control patch and ring may raise blood clot risk

“An Inaugural Celebration in PARADISE”

Alex Mirakian M.D. PAGE 8

PAGE 4

Time breastfeeding cover sparks controversy aWaRD

Wellington Regional Medical Center Awarded Primary Stroke Center Accreditation by The Joint Commission PAGE 5

PAGE 18

expansion

“We’re raising the roof,” says Palms West Hospital PAGE 14

Eric Goldman, Palms West Hospital CEO. GLOBAL HEALTH TRIBUNE P.O. Box 213424 Royal Palm Beach, FL 33421

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2 MAY ISSUE

• 2012

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BLOOD CLOT RISK

Birth control patch and ring may raise blood clot risk Birth control in the form of a vaginal ring or skin patch may bring a higher risk of blood clots than birth control pills, a new study from Denmark suggests.

n the study examining women over a 10-year period, a blood clot was twice as likely to appear in those who used a vaginal ring as in those who took birth control pills containing levonorgestrel, a synthetic form of the female hormone progesterone. And women who used a hormonal skin patch were 2.5 times more likely to have a blood clot than women taking those pills. Birth control pills in general are known increase women's risk of blood clots, but the study adds to a growing body of evidence that some forms of hormonal birth control increase the risk of clots more than others do. For any type of contraception that contains estrogen and progesterone, the risk of blood clots may have to do with the type of progesterone the pill contains, said Susan Jick, an epidemiologist at Boston University who has studied the safety of oral contraceptives. Because the findings pertaining to the vaginal ring and patch are relatively new, more research is

needed to confirm them, Jick said. However, experts emphasized that the risk of blood clots is very small from any type of hormonal birth control. "What women really need to know about all of these methods is that, overall, their benefits overwhelmingly outweigh their risks," said Dr. Elizabeth Raymond, a senior medical associate at Gynuity Health Projects, an organization that aims to make birth control safer and more widely accessible. Hormonal birth control is highly effective in

preventing pregnancy, which comes with its own risks, Raymond said, including an increased risk of blood clots. Blood clot risk In the new study, Øjvind Lidegaard of the University of Copenhagen and colleagues analyzed information on more than 1.6 million women between ages 15 and 49 who were followed from 2001 to 2010. During the study period, about 5,200 women had a blood clot. Among women who were not using hormonal contraceptives, there were two cases of blood clots yearly per 10,000 women. For women taking oral contraception with levonorgestrel, the rate of incidence tripled to six cases yearly. For women using vaginal rings, there were about eight cases yearly per 10,000 women, and among women using birth control patches, about 10 cases yearly per 10,000 women. Women who used progestogenonly intrauterine devices, or progestogen-only birth control implants, did not have an increased risk of blood clots compared with women not using hormonal contraception. The results held after the researchers took into account factors such as age that could affect

Student With Flesh-Eating Disease Will Lose Fingers Aimee Copeland, the Georgia student who contracted a rare flesh-eating disease after a zip line injury will lose her fingers. "Aimee will suffer the loss of her fingers, however physicians have hope of bringing life back to the palms of her hands, which could allow her the muscle control to use helpful prosthetics. They are awaiting a safe time

before embarking on surgery for this," said a post on the University of West Georgia Psychology website. Copeland, a 24-year-old graduate student at the school, has already lost her left leg and may also lose her remaining foot, according to her family. Despite being hooked up to a ventilator and unable to speak, Copeland's family said

Student With Flesh-Eating Disease Will Lose Fingers (ABC News)

she's showing signs of recovery. "Aimee appears to have normal brain function at this time, which is something I'm celebrating because within Aimee we have a very compassionate heart and an

a women's blood clot risk. However, the researchers were not able to account for everything that could affect the risk, such as weight, Raymond said. Last month the Food and Drug Administration said newer birth control pills such as Yaz and Yasmin that contain drospirenone, another form of would carry progesterone, revised labels indicating the pills may increase the risk of blood clots more than older types of birth control pills containing levonorgestrel. Women have many considerations when they choose a birth control method, including the cost, availability and convenience. "Some women have trouble remembering to take pills," she added, and might be able to use a ring or patch more consistently. Dr. Elizabeth Poynor, a gynecologist and pelvic surgeon at Lenox Hill Hospital in New York City, said women should speak with their health care provider about what form of hormonal contraception is best for them. Women with a family history of blood clots or stroke may be at increased risk for blood clots and should discuss this, Poynor said. The study appears in the British Medical Journal. incredible mind of intellect," said Copeland's father, Andy Copeland. Aimee Copeland was riding a homemade zip line near the Little Tallapoosa River May 1 when the line snapped, causing a fall that cut open her left calf. Doctors at a nearby hospital cleaned and closed the gash with 22 staples, but bacteria that burrowed deep into the wound caused necrotizing fasciitis, a rare but deadly infection that claimed her leg one week ago.

Global Health TRIBUNE

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CONTRIBUTING ARTICLES U.S. Department of Health and Human Services, ARA Content, Hispanic PR Wire, Centers for Disease Control and Prevention, METRO Editorial Services, Family Features © SEA PUBLICATIONS, INC. ALL RIGHTS RESERVED. Printed in United States.

Global Health Tribune is a newspaper published every month in Palm Beach county and surrounding areas. Copyright 2012, 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 does not accept responsibility for advertisement error beyond the cost of the advertisement itself. All submitted materials are subject to editing.

Have You No Decency, Sirs? (An Open Letter to the GOP)

By David Fagin

Writer, producer, musician

ifty years ago, when an exasperated Joseph Welch defiantly interrupted the drunk-withpower chief inquistor, sen. Joe McCarthy, and asked, "Have you no decency, sir? At long last, have you left no sense of decency?," the entire gallery burst into applause, signifying an abrupt end to an era of leaders who had abandoned their oaths in exchange for their own, personal glorification. In light of recent events, one

might say, it's once again time for that question to be dusted off and poised to the entire GOP.

As we've come to expect, the House passage of the Ryan Bill, which, at its core, is nothing more than the GOP's latest installment of How to Cut the Deficit by Helping the Rich and F&%king the Poor, is filled with all the usual ridiculousness brought on behalf of a party that's been deemed "the farthest right they've been in a hundred years." And, if that wasn't bad enough, this time, they're trying to do it on the backs of the sick and the elderly.

The republican plan to cut 6.1 trillion dollars in spending does not ask for a single cent from the richest class. Nor, do they ask for a dime from the defense budget or the big oil companies. Nope. All the spending cuts designed to "save our children's future" will come from the pockets and pro-

tection of health care, because, that's where the "real" problems lie.

The republicans of today have no problem whacking medicaid by 1/3, thereby exposing future generations of seniors to financial ruin, while leaving the rest of us to rely on "vouchers," which surprise - decrease in value over time. Seeing just how far they can go, they continue their assault on reason by suggesting we cut taxes for the upper class, and put them back to where they were when their ole pal "W." was in office.

Is it possible that an entire group of people are this clueless? The early 20th century political journalist, H.L. Menckin, probably said it best when he said, "Not all conservatives are stupid, but all stupid people are conservative."

It's no secret, republicans today are unabashed in their shameful

quest to protect the wealthy and the titans of industry. They're so far "off the grid" at the moment, it's easy to believe it would be even more gratifying if this could be achieved while simultaneously taking away what little remaining security those who've worked a lifetime have left.

A good word to define this type of "modern political virus" might be McConnellism. Thus, is there a more appropriate response to this willful abandonment, by virtually an entire political party, of representing their constituents to the best of their abilities, other than, "Have you no decency, sirs? At long last, have you left no sense of decency?" Shame on the lot of you. You are no different than the traitors in Braveheart who, for a price, turned William Wallace over to the crown. But, the democrats don't get off so easy.

Instead of calling the GOP out on their ever-increasing, reprehensible, lack of morality -which borders on plain evil - the dems seem content to debate each of these preposterous issues on merit, thereby legitimizing them. Which raises the question, "Who's worse? The idiot? Or, the one who argues with the idiot?"

Lest we forget, this is a party that, just in the past decade, has given us such memorable gifts as Bush/Cheney, Sarah Palin, Michelle Bachmann, Rick Santorum, Herman Cain, and now, the "Three Stooges;" McConnell, Boehner, and Ryan, and, still, where is our "Joseph Welch?" It certainly seems he/she/they will have to come from the underground, as, our current leaders seem to be too busy going tit-for-tat with idiots. And, in the end, guess who pays the price for that?

MAY ISSUE • 2012 3

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HAMMERTOES-The Mystery Unveiled... padding or toe covers with various material options are usually used.

Beyond that, wearing shoes with more space in the toes (larger toe box) or even undergoing physical therapy may be recommended. Finally, if all above treatments are not working, surgical options are needed.

Daniel Heck, DPM Podiatric Surgery

n an ideal world we all wish our toes were absolutely straight, fit into any shoe, and were completely pain free! As we approach summer, many people are more likely to wear open toed shoes.

This can showcase our tootsies, possibly unearthing mild to severe amounts of self conscious feelings if toes are not straight and ideal. Another scenario may include painful toes that are rubbing in shoes to the point of forming calluses, corns, or worse. If you fall into either of these categories you may have a condition called a hammertoe deformity.

Part of the mystery to be unveiled for why you have bent toes may depend on your foot type. All

you have to do is look down at your bare feet and observe what type of arches you have. Some have completely flattened or very high arches and in each respective extreme contribute to the probability of getting hammertoes. Also consider that women have higher prevalence in all age groups and tend to wear tighter fitting, high heeled, shoes.

The second toe usually is the most common one affected but can also be in combination with toes three and four. Injury, Diabetes, Rheumatoid arthritis, or any neurological disease affecting muscles of the foot or leg may increase the chances for

developing hammertoes.

In order to further understand this problem we need a quick background in toe anatomy. Toes are straight forward in that the combination of two joints and two tendons provide basic function.

Like our fingers, the second, third, and fourth toes have two joints per digit that allow for flexibility to bend as our foot leaves the ground during the walking cycle. A tendon on the top of the toe and the bottom oppose each other and cause the toe to bend up and down as needed. The two tendons together function as reigns of a horse keeping each

other in check but, when one overpowers the other, over time contracture of the toe begins. This explains how the hammertoe deformity occurs and next we move into how to fix it.

Effective conservative treatment for hammertoes depends on how advanced the condition has become. At first, the toes are flexible and various padding methods like crest pads, toe straighteners/loops, or even splints that can be utilized.

In time however, the toe may become more contracted and rigid which can lead to shoe gear irritation. Simple tube shaped

The good news is that this surgical option is a simple procedure. It is called an arthroplasty and removes part of the contracted joint to regain motion and relieve symptoms with recovery times minimal in normal circumstances.

Hopefully your upcoming summer is filled with open toed shoe gear as desired but if there are questions about those hammertoes you have options! Our practice or your local podiatrist can help you to navigate the options to better foot health. Call to make your appointment

(561) 433-5577 WEST OFFICE:

3347 SR 7, Suite 204 Wellington, FL 33449 EAST OFFICE:

2326 South Congress Ave. Suite 1-A West Palm Beach, FL 33406

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4 MAY ISSUE

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Advanced Cardiac Care: It Takes a Team

ay is a special month. Why? We celebrate EMS Week, which is May 20 to 26 this year. EMS providers are the first point of contact for many, if not most, of a hospital’s critical patients; they are the front lines of health care. During some of patients’ most vulnerable, stressful and painful moments, EMS providers offer the first chance for hope when life is fragile. When EMS and hospital teams form true partnerships, patients can benefit.

This is the case at Palm Beach Gardens Medical Center, which has been using an advanced EMS communication, the LIFENET System, since 2008. The LIFENET System offers critical additional minutes to prepare the hospital’s team for appropriate intervention even before the patient arrives. EMS and the hospital work together to help patients get the cardiac treatment they need quicker.

With this technology and collaboration, Palm Beach Gardens Medical Center has been able to reduce time to treatment, known as door-to-balloon time (D2B), for patients who experience a dangerous type of heart attack known as STEMI or ST segment elevation myocardial infarction the more

Dentist pulls out all of her ex-boyfriend’s teeth after split

severe type that is identified by an electrocardiogram (ECG) test. During a STEMI, the coronary artery is completely blocked by a blood clot and essentially all the heart muscle being supplied by the artery begins to die.

The American Heart Association (AHA) estimates that close to 400,000 people in the U.S. experience STEMI every year. The quicker patients receive treatment, which may include balloon angioplasty and stent placement in the cardiac catheterization lab, the more likely they are to have a positive outcome. D2B is a measurement in emergency cardiac care that starts with the patient's arrival in the emer-

gency department and ends when a catheter is inserted, restoring blood flow to the heart. The American Heart Association and American College of Cardiology recommend a guideline of treatment in 90 minutes or less. Palm Beach Gardens Medical Center is consistently performing with a D2B time of less than 60 minutes.

Much of this success can be attributed to the hospital’s collaboration with local EMS and both teams’ utilization of the LIFENET System. Hospitals depend on EMS teams; they are a critical piece of the life-saving care that they can provide, especially in cardiac cases. During EMS Week and throughout the year, Palm Beach Gardens Medical Center recognizes its EMS teams for the tremendous front line work they do to care for patients and increase their chances for improved outcomes.

f you're planning a trip to the dentist, it might not be the wisest decision to make your appointment with the person with whom you just broke up. A Polish woman is facing three years in prison after she removed all of her ex-boyfriend's teeth during dental surgery just days after their breakup.

"I tried to be professional and detach myself from my emotions," Anna Mackowiak, 34, told the Austrian Times. "But when I saw him lying there I just thought, 'What a bastard' and decided to take all his teeth out."

Marek Olszewski, 45, reportedly showed up at Mackowiak's dental office complaining of toothache just days after he broke up with her. She then allegedly gave him a "heavy dose" of anesthetic, locked the door and began removing all of his teeth one at a time.

"I knew something was wrong because when I woke up I couldn't feel any teeth and my jaw was strapped up with bandages," Olszewski said.

"She told me my mouth was numb and I wouldn't be able to feel anything for a while and that the bandage was there to protect the gums, but that I would need to see a specialist," he said.

"I didn't have any reason to doubt her, I mean I thought she was a professional."

Adding to his trauma, Olszewski said his new girlfriend has already left him over his now toothless appearance. "And I'm going to have to pay a fortune on getting indents or something," he said.

Mackowiak is currently being investigated for medical malpractice.

Dr. Minnick Makes Strides for Breast Cancer here is nothing better than an Italian meal to bring people out for a cause. On Saturday, April 21, the cause was Breast Cancer. Dr. Kathleen Minnick and Bosom Buddies, II, Inc. made such a cause a family affair at the American Cancer Society in West Palm Beach.

With the wonderful Italian food, great desserts, door and raffle prizes, this event was nothing less than a complete success. Dr. Minnick also had some

incredible support in making this event the success it was in the form of her patients, family and friends. Everyone seemed to pitch in from making the gift baskets, cooking, serving or simply attending the event. Part of the proceeds from the dinner will go to Making Strides Against Breast Cancer. If you would like to support Dr. Minnick and the fight against breast cancer, please visit her website at www.breastabc.com.

Barbara and Frank Bregoli.

Dr. Kathleen Minnick, Brian Grosso (Dr. Minnick's husband) and Connie Grosso.

Tristan Pontieri just can't get enough!!!

Nicole Naum (NurseOnCall) and Dulce Grimes.

Claudia Cieslak and Elaine English loved their door prizes.

Miss Danielle Peskowitz.

Lori and Almog Veig.

Skylar and Faith Kemph won a basket of goodies.

Heidy Shetty and Wanda Drago.

Rowan Pontieri is waiting for dessert.

Nicole Naum and Karen Crofford from NurseOnCall.

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Tenet Florida Hospitals Recognize National Hospital Week and National Nurses Week National Hospital Week and National Nurses Week to be celebrated May 6-12

CORAL SPRINGS, Fla. – May 6, 2012 – During the week of May 6th to the 12th, hospitals across the nation will be celebrating both National Hospital and National Nurses Week. Tenet Florida sends its gratitude to all of the nurses and hospital staff that together, make Tenet Florida a strong healthcare system. For Hospital Week, this year’s theme is “Making Miracles Happen,” which is what Tenet Florida hospitals do each day. National Nurses Week celebrates with the theme “Nurses: Advocating, Learning, Caring.” Each of Tenet’s five hospitals in Palm Beach County (Delray Medical Center, Good Samaritan Medical Center, Palm Beach Garden Medical Center, St. Mary’s Medical Center, and West Boca Medical Center), and five hospitals from Broward County to Miami-Dade County (Coral Gables Hospital, Hialeah Hospital, North Shore Medical Center, North Shore Medical

Center FMC Campus, and Palmetto General Hospital) will be hosting different activities to commemorate these occasions.

“It’s most appropriate that Hospital and Nurse Week are jointly celebrated, as both are essential in the care of our patients and communities,” said Marsha Powers, Senior Vice President of Tenet Florida. Tenet Florida hospitals understand the importance of recognizing nurses and all hospital staff that are at the heart of our hospitals’ ability to deliver high quality health care.”

Accompanying National Hospital Week, the largest health care event in the nation, National Nurses Week was established in honor of Florence Nightingale, the founder of modern nursing, who displayed activism, leadership, and a caring disposition. This week of celebration aligns with National Hospital Week, which was established to celebrate the history, technology and dedicated professionals that make hospitals beacons of confidence and care

Wellington Regional Medical Center Awarded Primary Stroke Center Accreditation by The Joint Commission

Wellington Regional Medical Center’s Stroke Program has earned The Joint Commission’s Gold Seal of Approval™ for accreditation as a Primary Stroke Center demonstrating compliance with The Joint Commission’s national standards and guidelines for health care quality and safety.

To achieve this prestigious certification, Wellington Regional underwent rigorous on-site evaluation by Joint Commission reviewers with expertise in stroke care. The decision for certification is based on evaluation of compliance with the standards and clinical practice guidelines developed by the American Heart Association/American Stroke Association

“We are so pleased to receive this distinction from The Joint Commission and to be recognized for our commitment to providing effective and timely stroke care for our patients,” said Jerel Humphrey, Chief Executive

Officer. “This is a major step toward maintaining excellence and continually improving the care we provide.”

Each year, 795,000 people experience a new or recurrent stroke. Stroke is the nation’s fourth leading cause of death and the leading cause of serious, long-term disability in the United States. A stroke occurs when the blood supply to the brain is interrupted or severely limited, depriving the brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. Early treatment can make a big difference in limiting

damage and the potential for complications.

Wellington Regional Medical Center’s Stroke Center works to spread awareness about stroke symptoms and prevention through community lectures and screenings. In recognition of Stroke Awareness Month in May, Wellington Regional Medical Center will be offering free screenings for cholesterol, glucose and blood pressure on Saturdays, May 5, 12 and 19 from 9AM-12Noon. Please call 561-798-9880 for more information.

6 MAY ISSUE

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“An Inaugural Celebration in PARADISE” By Deborah Lynn

hen Palms West Chamber of Commerce and the Greater Lake Worth Chamber of Commerce merged in February, everyone knew that incredible things were to come. On April 27, the newly formed Central Palm Beach County Chamber of Commerce proved just that with “An Inaugural Celebration in PARADISE.”

Central Palm Beach Chamber Members.

Judi Schumacher, Daryl Moore, Jeff Moore and Hilary Bedford.

Dr. Jeffrey Bishop with outgoing Chairman, Carmine Priore, III.

Jeff Moore and Dr. Shekhar Sharma.

Paul Walczak, Dean Tendrich, Robert Campion, and Kevin Bell.

As the International Polo Club was used as the backdrop for such a momentous celebration, you could easily see how beautifully and seemingly effortlessly everything just fit together. The night proved to be a spectacular event that mixed the old with the new, the changing of the guards, or simply put, the installation of an amazing new team of leadership. At the helm, Dr. Jeffrey Bishop as the new Chairman of the Board of Directors. Not only did they make a wonderful choice in Dr. Bishop, but any man that thanks his mother for giving him life and his best friend and wife, Charlene, is amazing in my eyes.

Central Palm Beach Chamber Members.

Jessica Clasby, Dr. Shekhar Sharma, Dr. Kishore Dass and Dr. Mariano Ibarrola.

Michelle Delgreco, Julee Schneider, Sal Degreco and Krystale Lorson.

Carmine Priore, III and Jaene Miranda.

Scott and Lisa Muehlberger

Mayor of RPB, Matty Mattioli, Ray Liggins, Councilman Jeff Hmara and Carolyn Hmara.

Elaine and Ron Tomchin.

David O'Keefe and Eric Gordon.

Palomino Park's finest.

David & Anabel Lopez and Roger Plevin.

Seema & Dr. Kishore Dass.

Phyllis Carr and Erica DiCosmo.

Jerel & Linda Humphrey and Dr. David Soria.

Dr. Jeffrey & Charlene Bishop, Shariffa & Dr. Ishan Gunawardene.

MAY ISSUE • 2012

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Clearing Arteries Without Major Surgery

By Waqar Khan, MD

Board-Certified Interventional Cardiologist

ardiovascular diseases occur when a fatty substance called plaque builds up on the walls of the arteries. Plaque causes the arteries to harden and narrow, which can impede the flow of oxygen-rich blood through the body. In addition, pieces of plaque can break away, creating blood clots that obstruct arteries. Over time, these diseases can trigger lifethreatening problems. Coronary artery disease may disrupt blood flow to the heart and cause heart attacks. Peripheral artery disease (PAD) affects circulation in the legs.

People with PAD are at greater risk for nonhealing wounds, infections and amputations. Carotid artery disease, which occurs when plaque builds up in the arteries in the neck that supply blood to the brain, can lead to debilitating strokes.

ADVANCED TREATMENTS Treatments for people with cardiovascular diseases have changed dramatically over the past two decades. Traditionally, doctors performed invasive open surgeries to bypass blocked arteries or remove plaque from the blood vessel walls. Today, interventional cardiologists are able to offer minimally-invasive options that restore blood flow to vital organs and tissues.

Wellington Regional Medical Center has expanded its interventional program to offer more of these cutting-edge procedures close to home. Waqar Khan, MD, is an interventional cardiologist who performs procedures to open narrowed or blocked arteries in the heart, legs and neck, and is one of only a few physicians trained to perform the latest interventional procedures in the carotid arteries.

“Major surgery isn’t the only option for patients with severe or symptomatic cardiovascular diseases,” Dr. Khan says. “There are now less invasive ways to treat these serious illnesses and improve patients’ health and quality of life.”

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RESTORING BLOOD FLOW TO THE HEART During interventional procedures in the coronary arteries, doctors make needlesized openings in the groin or the wrist and then use X-ray imaging to guide thin catheters through the blood vessels to the heart. They may use small, inflated balloons to compress plaque against the vessel walls, or remove the plaque using lasers, knives or rotational devices. Tiny metal tubes called stents are also used to hold the arteries open. These procedures have evolved significantly since they first became widely used in the mid-1990s. Improved surgical instruments make it easier for doctors to perform the procedures. Stents last longer and give doctors more treatment options. For example, many newer stents are coated with medications that prevent the formation of scar tissue that can reobstruct treated arteries. “Before drug-coated stents were developed, treated vessels closed in 10 to 15 percent of patients,” Dr. Khan says. “The closure rate in patients who receive the new stents has dropped to 5 or 6 percent.” With a proven track record of success, interventional procedures have become the standard of care for many patients who experience or are at risk for heart attacks. “Fifteen years ago, 70 percent of patients

Dr. Khan is board certified in cardiology and interventional cardiology. He completed a residency in internal medicine at the University of Texas Health Sciences Center in Houston, Texas. He was fellowship trained in cardiology and interventional cardiology at the University of Texas Medical Branch, Galveston, Texas, and the Cardiovascular Institute of the South, Lafayette, Louisiana. He also completed a peripheral vascular medicine and interventional fellowship at St. Elizabeth’s Hospital, Tufts University School of Medicine, Boston, Massachusetts. In addition, he holds a masters in public health from the University of Texas School of Public Health, Houston, Texas. To make an appointment with Dr. Khan, please call Direct DoctorsSM Plus at 561-798-9880.

with blockages in the coronary arteries had open-heart bypass surgery, while only 30 percent had interventional procedures,” Dr. Khan says. “Today, we treat 80 to 90 percent of patients with stents, and they typically do as well or better than patients who have open surgery.”

BEYOND THE HEART In the past, surgeons treating patients with PAD either bypassed blockages in the legs or scraped out the plaque clogging the arteries. These procedures required many incisions, and results were inconsistent. Open surgery was the recommended treatment for most patients with coronary artery disease. Surgeons made incisions in the neck to remove the fatty plaque deposits. With the success of interventional procedures in the coronary arteries, doctors began using balloons, stents and other interventional devices in the peripheral arteries in the legs as well. More recently, doctors have adapted these techniques for the carotid arteries. “Interventional procedures help save legs and improve the quality of life in patients with PAD, as well as help prevent catastrophic strokes in patients with carotid artery disease,” Dr. Khan says. He performs these interventional carotid procedures at Wellington Regional.

PATIENTS REAP SIGNIFICANT BENEFITS Patients who undergo these innovative procedures generally require less anesthesia, have smaller scars and typically experience less pain, fewer complications and faster recoveries. “Many patients are able to go home the same day or after just one night in the hospital,” Dr. Khan says. “These procedures are easier on patients, so they’re often good options for people who shouldn't have invasive surgery.”

Article as it appeared in Wellington Regional Medical Center’s Health News, May 2012.”

Waqar Khan, MD MPH FACC Board Certified, American Board of Internal Medicine / Cardiology Diplomate, American Board of Internal Medicine / Interventional Cardiology

One of Houston's most prestigious double-board certified interventional Cardiologist, Dr. Waqar Khan, has recently relocated to south Florida. With his state-of-the-art cardiology and vein services, he offers "one stop shopping for cardiovascular health and wellness." Among his numerous awards and honors, Dr. Khan has been named one of Houston's Top Doctors every year since 2004. If you are looking for more personalized care from your Cardiologist, give Dr. Khan a call.

SERVICES • Consultations • Echocardiograms • Vascular Studies • Stress Tests and Nuclear Stress Tests • Holter Monitoring and EKG’s • Permanent Pacemaker Insertions and Evaluations • Heart Catheterization and Angioplasty/Stents • Peripheral Angioplasty and Stents • Carotid Artery Angiograms and Stents • Sclerotherapy and Varicose Vein Treatments

he also takes medicare, medicaid, hmo's and most commercial insurance.

Office: (561) 424-5555 • Fax: (561) 424-5550 www.FloridaHearts.com 1395 S. State Road 7, Suite 400 • Wellington, FL 33414 14428 S. Military Trail • Delray Beach, FL 33484

8 MAY ISSUE

• 2012

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Skin Cancer A

Alex Mirakian M.D.

south Florida Radiation oncology

Kishore K. Dass, MD.

Board-Certified Radiation Oncologist Diplomate, American Board of Radiology

Alex Mirakian M.D.

Board-Certified Radiation Oncologist. Diplomate, American Board of Radiology

Basal Cell and Squamous Cell Carcimomas. Introduction

• Common disease community wide – greater than one million skin cancers diagnosed in 2010 in the U.S. with less than 1000 associated deaths, a high incidence in Florida • Multiple subtypes exist within each of the BCC and SCC categories • Multiple treatment modalities available – with surgery the commonest recommended • Radiation or x-ray therapy (XRT) is as efficacious as surgery, and allows for preservation of function with good to excellent cosmetic outcomes (no scars) • Several indications for XRT exist – as primary treatment, after surgery in patient’s at high risk of recurrence, for recurrent disease or for palliation when locally advanced disease is symptomatic

• Clinical examples

Basal Cell Cancer – left ear

Basal Cell Cancer – left forearm

s a native of Australia, with the highest rates of skin cancer incidence in the world, I am very familiar with the many facets of skin cancer diagnosis and treatment. Moreover, the importance of avoidance and protection from the sun’s damaging rays need to be continually taught and emphasized to the sun worshippers of our beautiful state of Florida. In particular, our youth need to understand the impli-

• Adnexal or sweat gland cancers - <1% (sebaceous, eccrine, apocrine) • Other rare benign and malignant skin tumors – DFP (dermatofibrosarcoma protuberans), cutaneous lymphoma (T cell variants), Kaposi’s sarcoma, desmoid (aggressive fibromatosis), keloid, angiosarcoma, Langerhans histiocytosis etc

Treatment Methods Ulcerative Squamous Cell Cancer – right shin

Scaly Squamous Cell Cancer – right shin

Risk Factors

UV Radiation – resulting in most cancers developing in sun exposed areas, and linked to use of indoor tanning booths especially in the young Exposure to chemicals – arsenic, tar etc Genetic disorders – xeroderma pigmentosum, basal cell nevus syndrome etc Immunosupression – transplant patients, AIDS etc Chronic irritation/infection in areas of trauma

Pathology (nonmelanomatous cancers)

• BCC – locally recurrent, one third develop another BCC subsequently • SCC – 5% chance of distant spread, can also exist as in situ cancer or pre-cancer (Bowens disease), keratoacanthoma (grows rapidly) • Merkel Cell Cancer – neuroendocrine tumor with a high local and locoregional recurrence rate and propensity to spread distantly

• Surgery – local excision, Moh’s microdissection • XRT – external beam radiation, HDR (high dose rate) brachytherapy • Curettage and electrodissection (for small superficial cancers) • Photodynamic therapy (mostly for pre cancerous regions) • Topical chemotherapy (for wide spread pre cancerous disease mostly) • Cryotherapy – liquid nitrogen (mostly for actinic keratoses or areas of chronic sun damage) • Biological agents eg. Vismodegib (new treatment FDA approved for treatment of BCCs that have spread to other parts of the body, relapsed after surgery, or cannot be treated with surgery or radiation)

What influences treatment choice?

• Lesion size – eg. very large cancers may need surgery with skin grafting +/- XRT • Lesion location – head and neck vs. trunk vs. limbs • Desired functional outcome • Desired cosmetic outcome – eg. absence of scars • Treatment practicality/cost • Patient factors – eg. mental state, age, performance status, anticoagulation status

Indications for Radiation Use

• Primary therapy – to the primary cancer +/- the draining lymph node region • Adjuvant therapy – if high risk for local or locoregional recurrence (lymph node spread) - following surgery (positive or close margins, perineural infiltration, bone/cartilage invasion, muscle invasion, poorly differentiated or high grade cancers)

A Radiation Oncologist’s Perspective cations of both acute and chronic exposure to the potentially deadly solar rays that many come to embrace here in the sunshine state. I would like to provide, therefore, a brief overview of the commonest and most significant of the skin cancers that develop in the members of our community from my standpoint as a radiation oncologist, hopefully broadening the scope of possible treatment options to our interested readers. This will include the two commonest types, basal cell and squamous cell cancers (BCCs and SCCs) along with the most deadly and third commonest – malignant melanoma.

• Recurrence after surgery • Locally advanced disease – Surgery + XRT may be needed • Inoperable patients – used to control disease locally or palliation

Treatment results

• Many large studies in the past have demonstrated equivalence in cure rates for external beam radiation and surgery in the order of 95% and higher with over 10 years of follow up • Large cancers generally have a lower control rate when treated with radiation alone and may need to be combined with surgery • Adjacent lymph node regions are not generally treated electively except for large ulcerating SCCs and recurrence after surgery - XRT is used if large or multiple involved lymph nodes have been removed surgically from a lymph node region eg. the armpit or groin and for lymph node spread in the head and neck region • For Merkel Cell cancers – 20% of patients are found to have lymph node involvement at diagnosis - High rates of local, locoregional and distant recurrences are common even after wide local excisions - XRT following surgery using wide margins around the surgical site has reduced local recurrence rates down to only around 10% at the margins

Older techniques include -

• Superficial XRT – 50 kV • Deep XRT – orthovoltage 80250 kV

Less commonly used - :

• LDR (Low Dose Rate) – seeds, ribbons of differing radioactive elements placed on or into the skin surface usually for several days at a time

A Large Flap and three Leipzig Applicators for HDR Brachytherapy Use

Brachytherapy

• HDR (High Dose Rate) – administered via pliable flaps and applicators and placed directly on the skin surface over the skin cancer being treated - utilizes an iridium-192 radiation source housed in a small lead lined unit which is delivered by remote into the flap or applicator with treatment times of 5-10 mins.

Types of Radiation Delivery

External Beam Radiation (XRT) – delivered using large

linear accelerators that create their own beam of radiation of varying energies • Electrons – by far the most commonly used radiation modality with energies between 6 -21 MeV and administered as a direct beam to the skin cancer using an appropriate margin usually between 1-1.5cm • Photons – usually in the head and neck region or for lymph node areas with energies of 6MV most commonly and with intensity modulated beams and image guidance using margins of around 2cm; these beams are more deeply penetrating than electrons

Linear Accelerator used to produce electrons and photons

Truebeam Linear Accelerator latest device used in clinical practice

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Technique/Dose

Electrons – direct single beam, 1-1.5cm margins - surface lead shielding to protect surrounding tissues - bolus material placed over skin to increase dose as necessary - lead eye shields

Photons – multiple beams, 2 cm margins - 3D conformal/IMRT for nodal basins/head and neck/base of skull coverage Dose – can range from 20 Gray in a single treatment (rarely used) to 60-70 Gray in 30-35 daily treatments over 6-7 weeks - Most treatments last for 3-6 weeks for XRT depending on the desire for degree of cosmetic outcome, practicality of daily attendance, cost etc HDR Brachytherapy – flap or applicator placed over the skin cancer then connected to treatment unit - Treatments last 5-10 minutes - Does not require lying down - Radiation is delivered usually for 10 daily treatments over 2 weeks

Use of lead surface shielding to protect surrounding tissues: -

Electron Therapy – Frequently Asked Questions

What is Electron Therapy ?

Electrons are a type of radiation with a unique property in that they are deposited in the superficial tissues of the body like the skin and underlying fat, without penetrating deeper into more sensitive organs unless high energy beams are used What types of skin cancer can be treated with Electrons?

Electrons are usually used to treat the commonest nonmelanomatous skin cancers such as basal cell cancers and squamous cell cancers which are usually located in the face and neck but can be used to treat in any location in the body. Occasionally patients with melanoma are also treated.

What is the cure rate?

The chance of cure is about equivalent to surgery which is greater than 95% for most small skin cancers. How are the Electrons delivered?

Electrons are produced by a large radiation machine with the patient usually lying on a table (and much less commonly sitting

in a chair) and directed towards the area of the body containing the skin cancer. The machine never touches the body and is usually housed in a large room such that claustrophobic patient’s need not be concerned.

How long is the treatment course?

The length of the treatment course differs for each individual patient, but is usually between 3 to 6 weeks given on a daily basis, Monday to Friday, with each treatment each day lasting only a few minutes. Are there any side effects ?

Side effects are usually very minimal with some reddening of the skin which occurs gradually through treatment and lasts for approximately 1 to 2 weeks after completing the treatment course. The skin then heals and returns to its normal appearance over the next few weeks. About 5% of patients may notice some residual discoloration of the skin depending on their skin color which may be permanent.

Electron therapy has a longer track record and is typically used in preference, but HDR brachytherapy is a useful alternative particularly for patients who have reduced performance status or are limited for time

• External Beam XRT - Allows for treatment of larger cancers and nodal regions, - Longer treatment courses can reduce long term toxicity especially for delicate areas such as the head and neck region and face - It has a long track record having been studied more extensively with very minimal long term toxicity

• HDR Brachytherapy - shorter duration, - can be more practical, - smaller margins used, - good - excellent cosmesis especially for small cancers but larger cancers with larger treatment areas may at risk of reduced cosmetic outcome

What is the cosmetic result?

The cosmetic outcome is usually excellent with better results with a longer course of treatment. Treatment over 6 weeks allows for smaller doses to be delivered each day allowing the skin to heal appropriately between each day of radiation treatment. Am I radioactive after treatment?

No. With each Electron delivery the cancer cells are damaged by the radiation but are not rendered radioactive. The patient is therefore able to come in contact with friends and relatives with safety after each treatment.

SCC L Lat Ankle pre treatment

How often can I be treated?

Electron treatment to small areas of the skin in different locations around the body can be performed multiple times. Radiation to the same site however is limited to one to two courses of treatment usually. What if the cancer comes back?

Patients referred to our radiation treatment centers are seen promptly within one to two days after which treatment can usually be commenced the following day.

SCC L Lat Ankle 6 months post electron therapy

BCC L Forehead pre treatment

THE FACTS* - Melanoma is a rare skin cancer but potentially the most fatal and mainly affects the older generation (35 and older) but many young people can also succumb to this disease. - Average age at diagnosis is around 60 yo - Almost 75% of patients diagnosed are between the ages of 45 and 85. - Fair skinned people are 25 times more likely to be afflicted than dark skinned people. - Nearly 60,000 people were diagnosed in 2007 in the U.S. mostly in the northern states and 8,500 died from melanoma - One in 5000 people are diagnosed each year and lifetime risk is 1 in 55 - The highest rates of death occur in the oldest age groups - Death rates have been stable in the last few years but incidence is increasing steadily - Overall 5 year survival rates relative to the general population are around 90% but depend on the initial stage of the disease (that is whether it has spread to lymph nodes or other organs) WHO’S AT RISK? Light or fair skinned people Presence of multiple moles 35yo and older Those severely sunburned frequently in youth Men over women Family history of melanoma Prior history of melanoma in the individual Depressed immunity from medications or other diseases

Typically they have irregular dark coloration, irregular borders, can be flat or raised above the skin, and occur on the trunk, head and neck or limbs

Any dark colored mole that’s grown, changed color, become ulcerated/ itchy/bled/ changed shape or developed surrounding satellite lesions – should be seen by your doctor WHAT CAN BE DONE?

Which type of Radiation should be used – External Beam Radiation (Electrons) or HDR Brachytherapy? Both are excellent treatment options as an alternative to surgery with advantages and disadvantages of their own.

Are you fair skinned, have numerous moles, a family history of melanoma or were you sunburned frequently as a child ? If you answered YES to any of the above, then you may be at increased risk of developing malignant melanoma as you continue to age.

WHAT’S IT LOOK LIKE? / HOW DO YOU KNOW YOU MIGHT HAVE IT?

In the unlikely event that the cancer returns, there is still an option for further radiation therapy or excision by your dermatologist or plastic surgeon. Does it take long to start the treatment course ?

Malignant Melanoma

BCC L Forehead 6 months post HDR brachytherapy treatment

First line treatment is surgical removal with appropriate margins of clearance and usually a sentinel lymph node biopsy (sampling of first draining lymph node in adjacent lymph node region) is performed to see if there has been regional spread of the disease

If there are positive lymph nodes detected then, the surgeon may remove the remaining lymph nodes and interferon therapy may be recommened Radiation is usually delivered – - to the lymph node region after removal of large or multiple involved lymph nodes - following recurrent disease - following surgery for certain high risk subtypes of melanoma to the primary site - for palliation to help relieve symptoms in patients with stage IV disease Many experimental agents are constantly being studied and trialed including: vaccines and other biological agents to help activate the immune system

Chemotherapy is not very useful but is occasionally used especially if the cancer has spread to other organs

CONCLUSION

Radiation therapy is an important and underutilized treatment option in patients with skin cancer including malignant melanoma

It should be considered in the following situations to provide equivalent cure rates to surgical treatments and excellent functional and cosmetic outcomes in non melanomatous skin cancers: - for cancers of the head and neck, particularly the face and below the knees where vascular supply is poor and surgical removal may be complicated by poor wound healing and chronic ulceration - wherever there is concern about the cosmetic outcome especially scar formation from surgical removal - whenever there is concern about a functional outcome eg. in delilcate areas such as the inner angle of the eye, eyelids, lips, ears and nose - patients who don’t want surgery for whatever reason - patients on long term anticoagulants (blood thinning agents) who would be at risk if stopped for a surgical procedure

WHAT TO DO ? AVOID THE SUN!!

- Avoidance measures from a very young age - Resist tanning booths which are banned in some countries like Brazil - Check your own skin or get a family member to look if you’re concerned - See your physician if you’re concerned about any skin lesion

PROTECT YOURSELF

- Sunscreen (SPF 30 + minimum) applied frequently and reapplied after swimming, - Use of a shirt, hat, sunglasses, and shady areas - Yearly medical skin examinations with photographs of suspicious moles/lesions especially if you are a high risk individual eg fair skinned, family history etc.

10 MAY ISSUE

• 2012

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Melanoma – not just a skin cancer T

Cindy Collins, Ph.D., R.D.

Experimental Health Psychology / Nutrition

Cindy Collins, Ph.D., R.D.

Experimental Health Psychology / Nutrition

Cynthia Collins earned both her Bachelor of science in Biology and master of science in human nutrition at the University of Florida, gainesville. she began her career in nutrition at the national institute of health, Clinical Research Center : University of Virginia, Charlottesville. after several years of specializing in gastrointestinal disorders and oncology, she returned to school at the University of Tennessee, Knoxville and completed her Doctor of philosophy in experimental psychology,, health psychology. she holds honors in several leadership societies: omicron Delta Kappa, phi Kappa phi and gamma Delta sigma. she received honorable mention for doctoral research from the american psychological association: her dissertation title: hope, Coping style and Dietary Behaviors in postgastrectomy stomach Cancer patients. her other research endeavors have included scales of Quality of Life and the immune system (salivary iga), Knowledge about Cancer, Carnitine metabolism, Folate metabolism, Calcium supplementation and colonic transit. she blends nutrition science and health psychology in her interactions with patients. her support groups are designed to impart knowledge, instill hope and assist with coping styles, and enhance quality of life at all stages in cancer management. she is certified to teach progressive Relaxation and mindfulness meditation. her memberships include american psychological association, american Dietetic association, society of Behavioral medicine. she is licensed in the state of Florida for nutrition, and as a Registered Dietitian at the national level.

he National Cancer Institute (NCI) at the National Institute of Health defines melanoma as cancer that begins in the melanocytes, or pigment-producing cells of the body. Though we usually associate this cancer with the skin, it can be found elsewhere in the body including the eye and the intestinal tissue. They estimate there will be 76,250 new cases and 9,180 deaths by the completion of 2012.

The NCI states that illnesses linked to diet kill 3 out of 4 Americans every year. This includes illnesses other than cancer, such as heart disease, high blood pressure, stroke and diabetes. The Health Behaviors Research Branch of the NCI coordinates research on lifestyle behaviors and their effect on cancer prevention. They also investigate intervention strategies for all types of cancer. They study diet, physical activity, sleep, and sun safety and their relationship to melanoma.

An interesting link on the NCI website takes you to Cancer Control P.L.A.N.E.T. which has resources for cancer control for health professionals (http://cancercontrolplanet.cancer.gov/diet.html). The association between a healthy diet and decreased morbidity and mortality from the four leading causes of death listed above is confirmed in the section on scientific evidence. The majority of studies show that diets low in overall fat, saturated fat, trans fat and cholesterol and high in fruits, vegetables and whole grains with high fiber play a role in this health benefit.

Other sources emphasize the role of sun exposure in health and the interaction with dietary factors. Michael Holick, M.D., Ph.D. in his book The UV Advantage (iBooks, 2003) recommends 30 minutes a day in the sun before the application of sunscreen, in order to stimulate the production of Vitamin D in the skin. Most surveys reveal marked deficiencies of Vitamin D in Americans. This vitamin is vital for bone, muscle, immunity and has recently been linked with cancer protection. Andrew Weil, MD (www.drweil. com) recommends striking a balance between the benefits of the sun while still protecting oneself from its harmful effects. He notes

that supplementation with mixed carotenoids (forms of Vitamin A) and mixed tocopherols and tocotrienols (forms of Vitamin E) can help protect the skin from sunburn.

A number of researchers are devoting their studies to the association of nutrients and other chemicals and melanoma. Many of those studies involve animal models. Recently the antidepressant fluoxetine was shown to have antioxidant properties, preventing the activity of melanoma in mice spleen cells. (http://reference.medscape. com/medline/abstract/20803706)

In addition, human studies focus on the role of antioxidants in preventing and slowing the progression of cancer. There is now ample evidence that the cellular byproducts called free radicals and reactive oxygen species (ROS) may produce the pathology behind some cancers. The amino acid taurine (found in proteins) has been shown to act as an antioxidant, thus combating free radicals and ROS. In 2008, the Journal of Clinical Pharmacological Therapy illustrated an increased level of ROS in melanoma patients as compared to healthy controls. The authors believe the likely source of the ROS was the cancer tissue itself. These ROS are suspected of enhancing the progression of the melanoma. After surgery for the removal of all melanoma tissue,

the level of ROS decreased. (http://reference.medscape.com/medline/abstract/19239181) (http://reference.medscape.com/medline/abstract/18315784)

There is a need for many more studies to pinpoint the role of antioxidants in cancer prevention and intervention. Current research on melanoma and other cancers warrants the recommendation to consume a diet rich in antioxidant nutrients. Vitamin and mineral antioxidants include Vitamins A, C, E, beta-carotene and selenium. Naturally rich bioactive antioxidants also found in foods include polyphenols (flavonoids, catechins and anthocyanadines), glucosinolates, resveratrol, lutein, and lycopene. The following foods are the short list of sources containing these antioxidants! Antioxidants can also be found in supplement form; look for those extracted from whole foods. (MD Anderson Cancer Center) Brightly pigmented fruits and vegetables to include: mango, cantaloupe, orange, grapefruit, kiwifruit, strawberries, grapes, cranberries, blueberries, tomato, watermelon, apricot, broccoli, cauliflower, carrot, squash, sweet potato, collard and turnip greens, spinach and kale, red and green peppers, brazil nuts, peanuts, seafood, soy, green tea, dark chocolate, wheat germ.

Delray Medical Center Named One of the Nation's 100 Top Hospitals by Thomson Reuters

Delray Medical Center also among only 12 hospitals nationwide to earn the Everest Award for high performance and fastest long-term improvement

Everest Award for achieving both the highest current performance and the fastest long-term improvement over five years. The Thomson Reuters 100 Top Hospitals® study evaluates performance in 10 areas: mortality; DELRAY BEACH, Fla. – May medical complications; patient 03, 2012 – Delray Medical safety; average patient stay; Center was named one of the expenses; profitability; patient nation’s 100 Top Hospitals® by satisfaction; adherence to clinical Thomson Reuters, a leading standards of care; post-discharge provider of information and mortality; and readmission rates solutions to improve the cost and for acute myocardial infarction quality of healthcare. In addition, (heart attack), heart failure, and the hospital was one of only 12 pneumonia. The study has been hospitals nationwide to earn the conducted annually since 1993.

“It’s a true honor to be named one of the country’s 100 Top Hospitals by Thomson Reuters, and be one of only a handful of hospitals around the country to earn the Everest Award,” said Mark Bryan, CEO of Delray Medical Center. “It is Delray Medical Center’s mission to remain a national health care leader committed to top performance and patient quality.” To conduct the 100 Top Hospitals study, Thomson Reuters researchers evaluated 2,886 short-term, acute care, non-federal hospitals. They used public information — Medicare cost reports, Medicare Provider Analysis and Review (MedPAR) data, and core measures and patient satisfaction data from the

Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. Hospitals do not apply, and winners do not pay to market this honor. The winning hospitals were announced in the April 16 edition of Modern Healthcare magazine. “This year, the concentration of 100 Top Hospitals award winners has shifted significantly, with Texas, Florida, and California housing the most winners,” said Jean Chenoweth, senior vice president at Thomson Reuters. ”A major change in performance geographically is an encouraging indication that the bar for quality care has been raised once again.”

Based on comparisons between the study winners and a peer group of similar high-volume hospitals that were not winners, it was found that if all hospitals performed at the level of this year’s winners:

• More than 186,000 additional lives could be saved. • Approximately 56,000 additional patients could be complication-free. • More than $4.3 billion could be saved. • The average patient stay would decrease by nearly half a day. More information on this study and other 100 Top Hospitals research is available at www.100tophospitals.com.

Erase Your Skin Cancer More than 98% of skin cancers can be cured with treatment at South Florida Radiation Oncology.

Skin cancer is the most common form form of cancer in the U.S. It can develop develop in anyone. anyone. So you you need to to be aware aware of any any change in your your skin. Any Any change in a mole or any any sudden sudden growth growth on the skin should be taken taken very very seriously and and seen by by your your dermatologist dermatologist for for an accurate accurate diagnosis. Different Different types of skin cancer require require different different approaches, approaches, and and a multidisciplinary multidisciplinary team team of experts to to treat treat them. Our experienced professionals professionals routinely routinely diagnose and and treat treat skin cancers cancers with the most advanced advanced treatments. treatments. South Florida Radiation Radiation Oncology Oncology physicians physicians use state-of-thestate-of-theart treatment treatment planning and and radiation radiation technology technology to to erase erase cancer from from your your life. life. With With innovative innovative radiation radiation therapies therapies like like HDR brachytherapy brachytherapy and and electron electron therapy, therapy, you you get get shorter shorter treatment treatment times, times, greater greater comfort comfort and and minimal recovery recovery time. time. So you you can get back to to living your your life. life. Our team team of expert radiation radiation oncologists has a powerful powerful arsenal arsenal of weapons weapons to to fight cancer. cancer. We We combine leadingleadingedge technology technology with inspired, inspired, compassionate compassionate care care at eight convenient convenient locations. locations. If you’re you’re concerned concerned about a change in your your skin, make make an appointment today. today. We’ll We’ll find find the treatment treatment option option that is right for for you you—and —and erase erase your your skin cancer. cancer. Isn’t Isn’t it time time you you got back to to living your your life? life? Call us today today to to explore explore all the advanced advanced treatment treatment options options at South Florida Radiation Radiation Oncology. Oncology.

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Port Port St. Lucie Lucie

| Stuart | Wellington Wellington Wellingt

12 MAY ISSUE

• 2012

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Palm Beach Surgical Associates Expanding their Horizons

By Deborah Lynn

aving been around for almost 30 years, Palm Beach Surgical Associates has a solid, well-rounded team of surgical experts that are constantly at the forefront of technology. Dr. Jack Zeltzer is the senior member of the group and focuses on the treatment of vascular disease. He currently serves as Chief of Surgery at Wellington Regional Medical Center and is the President of the Palm Beach County Medical Society.

Dr. A. Mariano Ibarrola performs both general and vascular surgery. He is an expert in many areas, including laparoscopic surgery, pancreatic, biliary and colorectal procedures.

PALM BEACH SURGICAL ASSOCIATES

dectomies. Laparoscopy is also offered to those patients that may not be a good candidate for a more invasive type of surgery due to having other existing conditions, such as heart disease.

On the vascular side, they offer quite a broad range of interventional services that again are meant to be minimally invasive.

Those services include the full gamut of bypass surgeries along with angioplasties, atherectomies and stent placements. They also utilize devices to remove the plaque from vessels by using simple punctures. However, the crowning jewel in

exCeLLenCe is oUR goaL vascular is the way that aneurysms are handled. Instead of making an incision from the breast bone to the pubis, they now use a refined technique by putting two puncture holes in the

groin, accessing the arteries and placing a stent inside the aneurysm. This technique makes the world of difference for the patient’s recovery time and movement.

The team currently has privileges at Palms West Hospital and Wellington Regional Medical Center. As Dr. Zeltzer is a huge advocate for Wellington and so aptly stated, “Wellington is at the epicenter of where things are happening and that is why we decided to locate our practice here on the grounds of Wellington Regional Medical Center.”

If you would like more information about their practice or to make an appointment, please call their Wellington office at 561-798-1515, or their Lake Worth office at 561-964-2211. Or, you can visit their website at www.palmbeachsurgical.com.

Meet Our Doctors

Dr. Arul Chidambaram is also a general and vascular surgeon. His expertise is vast and includes the area of dialysis access and hemodialysis. He is also the goto guy as they embark upon robotic surgery.

With the recent addition of Dr. Scott Meisel, they now have cornered the market in surgery. Dr. Meisel, being a specialist in critical care surgery and wound care. Although the practice has always been involved in wound care, they are hopeful they will be a pinnacle in this area as well, which encompasses burns and hyperbaric therapy.

As Dr. Zeltzer so eloquently stated, “We all work together to decide what is best for the patient and the group. The patients belong to the practice and not the individual physician, so there is no hoarding. We are a proud band of brothers, all for one and one for all.” The team is consistently focusing on current techniques and technology and incorporating them into their daily practice. In doing so, they are giving their patients the best surgical options available today.

They currently perform a wide range of services from general to vascular surgery. This encompasses a comprehensive practice that includes many procedures from resection of complex pancreatic tumors to simple lumps and bumps. In general surgery, they have embraced the use of laparoscopy to keep in line with the minimally invasive concepts for simple and more complex procedures. These include, but are not limited to; gallbladder, colon resection, pancreatic tumors, breast surgery, hernia repair and appen-

Jack Zeltzer M.D., FACS Vascular Surgeon

Dr. Jack Zeltzer is a Board Certified surgeon who specializes exclusively in the treatment of Vascular Disease. Dr. Zeltzer has been serving the medical community and his patients for the past 30 years. he currently serves as the Chief of surgery at Wellington Regional hospital and has in the past served as the Chief of surgery at JFK hospital. in addition to serving on many important Committees at the hospitals where he is a staff member, he currently serves as president of the palm Beach County medical society. he preforms a variety of procedures to treat many aspects of Vascular Disease affecting both arteries and veins. These conditions can involve the carotid arteries in the neck, abdominal aorta, aneurysms, blocked arteries in the legs, and varicose veins and ulcers. included among the many tools avaliable are minimally invasive balloon angioplasty, stent placement, artherectomy and laser therapy to treat blocked or narrowed arteies and aneurysms and veins. When necessary, bypass surgery can be performed as well. he and his partners also provide wound care/ hyperbaric services at the Wound Care Center at Wellington Regional hospital. Dr. Zeltzers main office is conveniently located on the campus of Wellington Regional hospital with a satellite office in atlantis/Lake Worth area.

Mariano Ibarrola, M.D., FACS

General and Vascular Surgeon

Dr. ibarrola is a Board Certified general and Vascular surgeon who has been associated with palm Beach surgical associates for over 15 years. he completed eleven years of surgical training at the medical College of Virginia and mexico national University. his surgical practice involves general surgery for a wide range of conditions including gastrointestinal, breast, neck, thyroid/parathyroid, skin malignancies and hernias. Vascular interventions include arterial, venous and dialysis procedures. Dr ibarrola’s extensive surgical experience encompasses a special interest in pancreatic, biliary,colorectal and minimally invasive surgery for gastrointestinal and solid organ disorders for benign and malignant conditions. The future of general and Vascular surgery has been embraced by Dr ibarrola with Laparoscopic or minimally invasive surgery used to repair complex abdominal wall or common inguinal hernias, extensive gastric and colonic resections, treatment of solid organ problems such as splenic, adrenal, or liver conditions and transanal endoscopic microsurgery. Vascular interventions include procedures for disorders of carotid, aortic, and peripheral arteries in a tradional open approach or, when indicated and possible, less invasive endovascular intervention.

ARUL CHIDAMBARAM, M.D., FACS, FRCS (Ed)

General and Vascular Surgeon

Dr. Chidambaram, m.D., FaCs, FRCs ed is a Board Certified general surgeon. he has been in surgical practice in Wellington for 11 years. his range of practice includes benign and malignant disease of thyroid/parathyroid, breast, stomach, small bowel, colon and rectum. he also performs repair of ventral abdominal hernias and inguinal hernias as well as removal of gallbladder with keyhole technique. For patients with renal failure he performs access procedures, for both hemodialysis and peritoneal dialysis. he does take care of patients with peripheral Vascular Disease and performs surgery for carotid stenosis , venous and arterial disorders of the extremities. he also has been trained and certified to oversee hyper bariatric oxygen therapy and wound care patients.

Dr. Chidambaram has hospital privileges at Wellington Regional and palms West hospital. in addition to the office on the campus of Wellington Regional, he has a satellite office located in atlantis Florida.

Scott Meisel, D.O. General Surgeon

Dr. meisel is Board Certified general surgeon specializing in general surgery and Board Certified in surgical Critical Care. Dr. meisel has been with palm Beach surgical associates for the past year. Dr. meisel earned his medical Degree in new York at the new York College of osteopathic medicine. he completed his residency and Burn/Wound Care surgery Fellowship at nassau University medical Center. Further he completed his surgical critical care fellowship at stony Brook University medical Center. he has a strong interest in laparascopic minimally invasive surgical procedures with regards to the management of Colorectal disease, hernia and gallbladder disease. Dr meisel is also trained and provides expertise in advanced wound care management at The Center for Wound Care and hyperbaric medicine at Wellington Regional medical Center.

Dr. meisel has hospital privileges at both Wellington Regional and palms West hospitals. he is available at our Wellington office on the campus of Wellington Regional medical Center.

MAY ISSUE • 2012 13

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Melanoma - The Dark Truth By Charles Griff, M.D

is a Diplomate of the American Board of Dermatology and a Fellow of the American Academy of Dermatology.

Dr. Griff has been practicing medical, cosmetic, and surgical dermatology in West Palm Beach since 1998. His journey to South Florida has been punctuated by stops at some of the most elite institutions in the world. Growing up in Harrisburg, Pennsylvania, he attended Susquehanna Township High School where he graduated first in his class. Dr. Griff was also a national caliber competitive swimmer and golfer at that time. His academic success continued at Bucknell University where he was class valedictorian. After graduating with the highest honors from the University Of Pennsylvania School Of Medicine in 1992, Dr. Griff completed his medical internship at Harvard University’s Beth Israel Hospital in Boston, Massachusetts. He subsequently served as chief resident during his dermatology residency at New York University (NYU), one of the world’s most highly regarded dermatology departments. Following his residency training, Dr. Griff served as a clinical professor, and was responsible for dermatology resident education at NYU. As an academician, Dr. Griff lectured across the country, authored numerous publications, and was featured in several well-known magazines. After several fulfilling years at NYU, Dr. Griff relocated to South Florida in 1998 to pursue private practice. He cares for patients using the skills and knowledge acquired from years of handling the most challenging cases in academic medicine. Out of the office, Dr. Griff takes pleasure in the South Florida lifestyle with his family, and enjoys boating, fishing, and marathon training. Diagnosed with insulin dependent diabetes as a teenager, he takes pride in being one of a handful of insulin dependent diabetics to complete over 30 marathons and 12 full Ironman Triathlons at an elite level.

DEAR DEBORAH: i work in sales and am in the field all day. i go in and out of offices and meet with so many people, half of which are married. is it ever okay to ask married clients out for dinner or a drink? - Is it okay to socialize?

Dear Is it okay to socialize: This one can be tough to answer since everyone reads into things and situations differently. i personally don’t find anything wrong with meeting a married client or co-worker for dinner or a drink as long as you do not cross a line. The one obvious problem is that they may misread your intentions. since you are asking this question, i will assume that your intentions are innocent, however your clients may not be – so be careful.

here are three common forms of skin cancer -- basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. Each arises from a different cell type within the skin. A basal cell carcinoma arises from the basal cell, squamous cell carcinoma arises from the squamous cell and melanoma arises from the melanocyte. Since May is melanoma awareness month and Monday, the seventh of May, was melanoma Monday, the topic of melanoma is clearly on everyone’s mind.

In 2010, there were over 70,000 cases of invasive malignant melanoma diagnosed in the United States. The incidence of melanoma continues to rise at an alarming rate of 5-7% a year. The lifetime risk of developing a melanoma if you were born in 1935 was 1 in 1500, and recently, in 2010, the lifetime risk is roughly 1 in 70. No wonder dermatologists are so busy. It is the fifth most common cancer in men and the sixth most common in women. Incredibly, 75% of patients with melanoma are under the age of 70. More alarming is that melanoma is the number one cause of cancer in young women age 25-29 and the number two cause in young men. Melanoma accounts for over 7,000 fatalities a year in the United States.

As we have seen, melanoma affects all ages and all people. Although melanoma is more common in Caucasians than African-Americans and Asians, it may strike anyone. Risk factors include being a white, fair-skinned individual who has a higher rate of sunburn than tanning. Caucasians with blonde or red hair and abundant freckling are most prone to melanoma.

There are many factors that may contribute to the development of malignant melanoma. As with many things in life, we can certainly blame our parents for it. Recently, there has been more and more literature and information linking many inherited genes to the development of melanoma. Now, it is well accepted that genetics play a significant role in melanoma development. Since we cannot choose our parents and cannot do any-

DEAR DEBORAH: i’m an older woman and find it difficult to attract a man that i want to spend quality time with. What is your opinion on hookups? i’m not a kid anymore and frankly, i am not worried about what people think of me. so, what is your view on going out with a man and just having casual sex? - What is your opinion?

Dear What is your opinion: as you are asking me this question, you obviously do care about what other people think of you. With that being said, you are an adult and have to do what makes you happy. if that means simply having casual sex, than that is a personal choice that you will have to make. Whatever you decide to do, make sure that you and your partner understand exactly what it is that you expect

thing to significantly alter our genetic predisposition, we will examine other factors that we may be able to control. Other factors that may contribute to the development of melanoma include ultraviolet radiation exposure, duration of time in sunlight, and frequent sunburns. So as I tell all my patients, the sun is much better for my business as a dermatologist than it is for your skin! As mentioned, all melanomas arise from the melanocyte. There are five different forms of melanoma:

1. Superficial spreading melanoma 2. Nodular melanoma 3. Lentigo maligna melanoma 4. Acral lentiginous melanoma 5. Mucosal lentiginous melanoma

Close to 70% of melanomas are of the superficial spreading variant. These are the ones that we try to re-teach the alphabet while looking for symptoms of the disease—the A,B,C,D,E’s of skin lesions so that this type of melanoma may be identified at an early stage. This type typically evolves from a pre-existing nevus or mole. The warning signs for development are Asymmetry, irregular Border, variegated Color, enlarging Dimension, and Evolution. These melanomas can arise on any body surface; however, in men, they occur most commonly on the upper back and in women, on the thigh. Nodular melanoma accounts for 10-15% of cases. These are usually the thicker dark brown or black lesions. Lentigo maligna melanoma also accounts for 1015% of cases. They are usually found in the most sun-exposed areas. Acral lentiginous melanoma occurs on the hands, feet, and nails. These are the most common form of melanoma in AfricanAmericans. It is this type of melanoma that killed Bob Marley. Finally, there are Mucosal lentiginous melanomas, accounting for 3% of lesions. These may arise on any mucosal surface including the mouth,

from one another, so there will be no problems in the future. good luck.

DEAR DEBORAH: i am a single woman and have such a crush on my doctor. since this is a medical paper, i was wondering what to do about it? i’m hoping that if a doctor reads this, they’ll respond and give me some advice. i want to know how to approach this situation. i have a wedding to attend and need a date. should i ask him to go with me? - HELP Dear HELP: if there are any physicians reading this question and would like to give your opinion, please email me at questions@globalhealthtribune.com. however, in my opinion, this is an ethical issue. Bottom line, a physician

esophagus, vagina, penis, and anus. So much for sun-exposure being responsible for all melanomas!

Once a melanoma has been diagnosed, it must be staged. The staging of cutaneous melanoma has frequently been revised by the American Joint Committee on Cancer. Regardless of the changes, the most important factor in staging is the thickness (Breslow Classification) of the lesion. Obviously, the thicker the lesion, the poorer the prognosis.

If detected early, melanoma can be cured with a simple local surgical excision. The prognosis of a particular lesion can best be predicted based on three factors: 1. Depth of invasion 2. Presence or absence of ulceration 3. Presence or absence of lymph nodes

Although melanoma has the reputation of being a dangerous, quickly fatal disease, if detected at an early stage—stage IA (less then one millimeter in thickness and no ulceration or metastases), the five-year survival rates are 95% or more. On the other hand, if you ignore a lesion or fail to see your dermatologist on an annual basis for a routine skin evaluation, and the lesion is found in stage IV with metastases, the five-year survival rate is less than 10%.

Surgery is the definitive treatment for early stage melanoma. A wide local excision is the standard of care for a primary melanoma. The size of the margin and the need to test the lymph nodes depends primarily on the depth of invasion. For a melanoma penetrating more than 1 millimeter, a sentinel lymph node biopsy is standard. For deeper, more advanced or metastatic lesions, adjuvant therapy is recommended. Adjuvant therapies can be multiple and may include chemotherapy, immunotherapy, or radiotherapy.

In summary, the take home message is the following; limit sun exposure and use sunblock, and watch yourself closely for any pigmented lesion changing shape, size, or color or any lesion that is just looking different. SEE YOUR DERMATOLOGIST EARLY AND ANNUALLY! These important steps cannot prevent melanoma; however, they can lead to early detection and to an extremely high probability of cure.

Dea r Debora h should not date a patient – period! This applies to both male and female physicians. if there is mutual interest, before you even go out on a date, you should find another physician. You have to realize that people look up to their physicians and put a great deal of trust in them. This is probably just an infatuation on your part, so i suggest that you let those thoughts go.

DEAR DEBORAH: When is it the right time to tell someone that you love them? is it ever too soon? i’m afraid if i tell her, it will backfire on me. - Is it ever too soon? Dear Is it ever too soon: i believe that one should simply follow his or her heart. if you

feel something for someone, then by all means let them know. You should never be afraid to express yourself to your partner. i feel that you should always appreciate the openness and honesty within your relationship. if they are not receptive to your love, or you uttering the words, “i love you” then they are probably not the right person for you - regardless of whether it is a week, a month or a year. as for backfiring, i can only see that happen if one party tries to manipulate the other. For example, “if you love me, you’ll rub my back.” Don’t ever allow someone to take advantage of you for loving them.

Dear Deborah is a monthly advice column written by Deborah Lynn with a common sense approach to dating. If you have any questions or comments, please forward them to: questions@globalhealthtribune.com as we would love to help.

14 MAY ISSUE

• 2012

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“WE’RE RAISING THE ROOF,” says Palms West Hospital By: Erica Whyman

oxahatchee, Florida--- New construction projects are often marked with ceremonious “breaking of the ground,” events. Palms West Hospital though took a unique spin on this concept, and instead welcomed the community to their “Raise the Roof” Commencement, celebrating the 4th floor vertical expansion project to the Palms West Hospital East Tower. The community, local dignitaries, staff, and media enjoyed breakfast and coffee, while CEO, Eric Goldman, explained the exciting expansion that will bring a new 32-bed medical/surgical floor, allowing for an additional 14 beds to the current Pediatric Unit and 2 Pediatric ICU beds. The project will also include a renovation and expansion to the laboratory and four additional beds to the Adult ICU Department.

Palms West Hospital executives

Dr. Carmine Priore, PWH Board Chairman.

Community, local dignitaries, staff, and media invited at the event.

Dr. Carmine Priore, Palms West Hospital Board Chairman, also spoke at the event discussing Palms West Hospital’s continued commitment to providing quality healthcare to the growing community. Donning hard hats, Eric Goldman, CEO, Dr. Carmine Priore, PWH Board Chairman and Dr. Ramprasad Gopalan, PWH Chief of Staff, commemorated the event by signing a piece of steel that will be used in the construction project. All in attendance were also welcomed to sign the steel that will become an everlasting part of Palms West Hospital History.

Eric Goldman, Palms West Hospital CEO.

Palms West Hospital executives signing the steel.

Local dignitaries signing the steel.

West Boca Medical Center Receives Get With The Guidelines Gold Plus Quality Achievement Award Award demonstrates West Boca Medical Center commitment to quality care for heart failure patients

BOCA RATON, FL APRIL 27, 2012— West Boca Medical Center has received the Get With The Guidelines®-Heart Failure Gold Plus Quality Achievement Award from the American Heart Association for its excellence in the treatment of patients with heart failure.

This award is given only to hospitals that achieve 85 percent or higher adherence to all Get With The Guidelines-Heart Failure Quality Achievement indicators for two or more consecutive 12month intervals and have achieved 75 percent or higher compliance with four of nine Get With The Guidelines-Heart Failure Quality Measures to improve quality of patient care and outcomes.

“The goal of the American Heart Association’s Get With The Guidelines program is to help healthcare providers implement appropriate evidence-based care and protocols that will reduce disability and death and improve the quality of life for patients.

Get With The Guidelines is a quality improvement initiative that provides hospital staff with tools that follow proven evidence-based guidelines and procedures in caring for heart failure patients to improve outcomes, prevent future hospitalizations and prolong life. Under Get With The Guidelines– Heart Failure, heart failure patients are started on aggressive risk reduction therapies such as cholesterol-lowering drugs, betablockers, ACE inhibitors, aspirin, diuretics, and anticoagulants in

the hospital. They also receive alcohol/drug use and thyroid management counseling as well as referrals for cardiac rehabilitation before being discharged.

“The West Boca Medical Center team is to be commended for this commitment to improving the quality of care for their patients,” said Lee H. Schwamm, M.D., chair of the Get With The Guidelines National Steering Committee and director of the TeleStroke and Acute Stroke Services at Massachusetts General Hospital in Boston.

Published scientific studies are providing us with more and more evidence that Get With The Guidelines works. Patients are getting the right care they need when they need it. That’s resulting in improved survival.”

“West Boca Medical Center is dedicated to making our cardiac unit among the best in the country, and the American Heart Association’s Get With The Guidelines program is helping us accomplish that by making it easier for our professionals to improve the long-term outcomes of our cardiac patients,” said hospital CEO, Mitch Feldman. “We are pleased to be recognized for our dedication and achievements in cardiac care.”

Get With The Guidelines–Heart Failure helps West Boca Medical Center’s staff develop and implement acute and secondary prevention guideline processes. The program provides hospitals with a web-based patient management tool, decision support, robust registry, real-time benchmarking capabilities and other performance improvement methodologies toward the goal of enhancing patient outcomes and saving lives.

This high-tech, evidence-based approach enables West Boca Medical Center to improve the quality of care it provides heart failure patients, save lives and ultimately, reduce healthcare costs by avoiding re-hospitalization.

According to the American Heart Association, about 5.7 million people suffer from heart failure. Statistics also show that, each year, 670,000 new cases are diagnosed and more than 277,000 people will die of heart failure.

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• 2012

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Have You Passed Out Lately? or low blood pressure and the brain being deprived of blood and oxygen briefly, causing the vasovagal attack. Although this condition is definitely not dangerous to the health of a person, it can cause injuries if one falls, is in a swimming pool or even driving a vehicle. How do you prevent it? Unfortunately, there is really no way to do so. How do you treat it? That will depend upon the individual’s underlying medical condition which needs to be determined in order to diagnose the exact cause of the vasovagal attacks.

Shekhar V. Sharma, M.D. Board Certified in Internal Medicine

ave you ever fainted or passed out in your life? Whether you have or have not, I think you’ll find my article will educate you about fainting.

Let me tell you a few more conditions that can cause syncopal attack. The first is an arrhythmia of the heart like Asystole, where the heart stops beating completely for a brief period of time. Secondly, there are other heart arrhymias, which are irregularity of the beats of the heart. Ventricular Tachycardia and Fibrillation is a highly malignant heart rhythm that could be dangerous to ones life. Valvular defects of the heart like mitral valve prolapse and severe aortic stenosis, which is a condition where the Valvular opening of the main artery of the heart gets very tight preventing blood flow to the rest of the body, especially to the brain thereby causing fainting attacks. Another condition affecting the heart is IHSS,

Fainting or passing out in medical terminology is called syncope. Syncope is a symptom of an underlying condition, which could be as benign as a vasovagal attack. Although rare, this is a physiological condition that could happen to anyone and not associated with any disease as such. It’s more of a reaction caused by increased vagal stimulus of the heart which causes it to slow down, called bradycardia. This does affect the nerves to the blood vessels in the legs making them dilate or widen, thereby resulting in hypotension

which is Idiopathic Hypertrophic Subaortic Stenosis. There are various other heart conditions, including one condition called Sick Sinus Syndrome, which can cause one to faint and requires a pacemaker to take over.

Neurological reasons for passing out could be a seizure, hemorrhagic stroke, like a subarachnoid hemorrhage, which is always associated with severe headaches and can occur spontaneously. Lung conditions like pulmonary embolism can cause one to pass out as well. This is a condition that requires treatment in a hospital.

So, let me give you some interesting case histories and I would like for you to analyze the question and see if you can answer them correctly. You will find the answers to the questions on the following page. Case one: Has a severe headache and passes out without any warning. What do you think it could possibly be? Case two: John was sitting on the sofa watching TV when all of a sudden, he starts acting confused and stares blankly at the TV screen. He then starts slurring his speech, gets weak on

later, without any complaints. This is an actual case of mine, having seen this woman in the emergency room of which still has made an impact on me. What do you think happened?

one side and then passes out. What do you think happened?

Case three: Jack is watching TV and staring blankly. He suddenly stops speaking, passes out and starts shaking uncontrollably on one side of his body. What happened to him?

Case four: A young lady that has never had any previous health issues, but takes birth control pills, is sitting down reading a book. She then passes out and wakes up a few minutes

Case five: An elderly gentleman wakes up late at night to urinate. While standing up, urinating, he passes out in the bathroom. Why did he pass out?

I have so many case histories that I had encountered in my life as a physician. Many are extremely complex and unusual cases that I had to handle both in the hospital and in my office. I will be sharing some of those cases with you in the coming issues of the newspaper.

Again, please turn to the next page for the correct answers.

Dr. Sharma is a Board certified Internist that has been in practice for the past 19 years. His office is accepting new patients: Palomino Park, 3347 State Road 7 Suite 200 Wellington, FL 33449 and for an appointment please call

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MAY ISSUE • 2012

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Wellington Regional Medical Center Welcomes Director of Business Development

ellington Regional Medical Center is pleased to announce that Beth Mourelatos has recently joined the hospital’s leadership team as Director of Business Development. In this role, she will work to identify opportunities for growth of new and existing service lines and direct implementation of strategic hospital initiatives including physician alignment

Beth Mourelatos.

and recruitment. Having worked in the healthcare industry for several years, Ms. Mourelatos brings a solid foundation in sales, marketing and physician outreach to this role. Previous experience includes Physician Relations and Business Development positions within both Hospital Corporation of America and Tenet Healthcare. Beth began her career in the med-

ical industry as a Medical Device Sales Representative for Wright Medical Technology. “We are delighted to welcome Beth to our team at Wellington Regional. Her outstanding business development acumen makes her a perfect fit for our hospital,” stated Jerel Humphrey, Chief Executive Officer. Owned and operated by its parent company, Universal Health

Services, Inc. of King of Prussia, PA, Wellington Regional Medical Center is a 158 bed, acute care hospital accredited by The Joint Commission. A $50 Million expansion project is underway to add a 3story, 103,000 square foot addition to the existing hospital which will provide 80 private patient beds with the latest amenities. For more information call 561-472-2505.

Bethesda’s Center for Women & Children Launches New Family-Centered Maternity Care Program New Program Promotes Bonding between Moms and Babies at Birth

Ribbon-Cutting & Dedication Ceremony Friday, May 11, 2012 1:00 p.m. Parent Education Resource Center – Bethesda Center for Women & Children

(Boynton Beach, FL) – Just in time for Mother’s Day, one of the busiest maternity hospitals in South Palm Beach County is introducing a new concept in the care of new mothers and their newborns called FamilyCentered Maternity Care.

This new program keeps new mothers and babies together from the moment of birth, and keeps them together in the same room and cared for by one mother-baby Registered Nurse. All baby care happens in the mother’s room. This mother-baby nurse helps new families understand their newborn’s needs and allows for individualized care during the newborn’s first days of life. “There is something that is so special about the bond that hap-

pens between a mother sees her newborn for the first time, and now, Bethesda is enhancing that bond to make it even stronger for the entire family,” said Geralyn Lunsford, Vice President, Patient Services.

As part of Family-Centered Maternity Care, the newborn is placed skin-to-skin on the mother’s chest, allowing for the most intimate and tender contact between mother and infant. This “magic hour” is the time when babies are alert, giving parents

Answers to “Have You Passed Out Lately?” by Dr. Shekhar Sharma Case One: Subarachnoid hemorrhage, which is a very dangerous bleed between the skull and the brain. In some cases, this condition can lead to death.

Case Two: John experienced a transient ischemic attack of the brain, which means lack of blood supply to the brain - transiently or briefly. Case Three: Jack had a seizure.

Case Four: This unfortunate lady had a condition called pulmonary embolus, which is a clot in the heart, caused by birth control pills. Incidentally, this is one of the complications from taking birth control pills.

and babies the best opportunity to get to know each other.

Advantages of FamilyCentered Maternity Care: • Care that adapts to the mother and baby, promoting family bonding • More support and opportunity for successful breastfeeding • Better communication between the obstetrician, pediatrician and nursing team Developed by nationally renowned expert Celeste R.

Phillips, RN, of Phillips & Fenwick, in Santa Cruz, California, there are now several hundred Family Centered Maternity Care programs around the country. In helping Bethesda transform its maternity center, Phillips has been working with Bethesda’s nursing staff since January to help them transition to this new form of mother-baby care. She has taught all Bethesda’s nursing and support staff and makes periodic calls to check on their progress.

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Case Five: This gentleman has a condition called micturition syncope, which is a vasovagal response, as mentioned above. That is a phenomenon of passing out when the elderly gentleman urinated that potentially could have stimulated his vagus nerve, which causes slowing down of the heart rate as well as a drop in the blood pressure and that causes one to faint briefly.

Congratulations to those that answered correctly. If you have any questions regarding any of the cases discussed, please contact either my Wellington office at 561-795-9087, or my Belle Glade location at 561-996-7742 and I would be happy to discuss them with you.

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Time breastfeeding cover sparks controversy

his month Time magazine cover features Jamie Lynne Grumet, a 26-yearold woman breastfeeding her three-year-old son. Grumet was one of four mothers photographed by Time for a cover story on "attachment parenting," an approach--outlined by 1992's "The Baby Book" by Dr. Bill Sears--that recommends extended breast-feeding, co-sleeping and "baby wearing." Time's cover line for the May 21 issue asks, "Are You Mom Enough?" The provocative cover, published online Thursday, was met with the predictable Twitter jaw-drop. "Love the Time cover," AllThingsD.com's Peter Kafka wrote. "In the cringiest way possible." "Anybody else slightly slackjawed over this week's Time cover?" The Atlantic Wire's Adam Clark Estes asked rhetorically. "Breastfeeding your 3-year-old is one thing," the Daily News' Bill Hammond wrote. "But putting a picture of him doing it on the cover of Time?" "The kid on the cover of this week's Time magazine is really going to hate middle school," Gavin Purcell observed. "Heads up, parents!" John

Cannon warned. "If you're planning to take your kids grocery shopping, you will have to explain this Time mag cover." "I would be way more impressed with Time if they put a mom on the cover in the typical age bracket of 'attachment parenting,'" Salon's Irin Carmon tweeted. "Not a 26-year-old." Time managing editor Rick Stengel defended the decision for the cover. "We used an image that represents the attachment of a mother and child," Stengel said on MSNBC's "Morning Joe." MSNBC showed the cover but blurred the breast out during the broadcast. ABC's "The View"

covered it up, too. "I don't wince when I look at the picture," he continued. "I think it's provocative. I think it's a little whimsical. I think she represents an outlier of women who are breastfeeding beyond one year. The cover is meant to get your attention. It gets your attention. I think this is a legitimate debate. It's a debate lots and lots of women are having." It's not the first time Time has put a breastfeeding mom on its cover. In 1999, the magazine's cover featured a woman breastfeeding her baby for a special report on the war in Kosovo. And Time has featured breasts on its cover before for stories related to breast cancer. It's worth noting that the international cover of Time's May 21 issue does not feature a breastfeeding image--it's new French president Francois Hollande. Nonetheless, it's likely going to get Time magazine censored at some newsstands. New York's Hudson News has a history of covering up magazines in its window display that put scantily clad women on their covers. In 2006, the Grand Central Terminal newsstand put sheets of paper over three consecutive issues of FHM.

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New Weight-Loss Sensation: Man Drops 100 Pounds With Diamond Dallas Page's Yoga Program

n Internet weight-loss sensation that involves a new, high-intensity form of yoga has led a once-obese man to drop a 100 pounds. Arthur Boorman, 47, has managed to lose the weight using DDP, or Diamond Dallas Page, which is a pumped-up form of yoga that forgoes all of the gongs and serenity typically associated with the Hindu physical and spiritual discipline. "It's a different kind of yoga. We make a joke: 'It ain't your momma's yoga,'" Boorman said. DDP was invented by Diamond Dallas Page, an extreme former wrestler who thought yoga could use a new intensity. We all know yoga can build strength and flexibility, but it can also be the key to significant weight loss by creating a slow, deep resistance to each movement, getting the body working against itself. Page's program capitalizes on this. These days it's hard to imagine that not many years ago, Boorman was a Gulf War veteran with some serious back issues. At that time he plunged into some dark days, becoming so obese that at one point, he couldn't walk without leg braces. Boorman thought yoga could help his back pain, but no studios wanted to work with him because he couldn't stand on his own.

"I was up late, on a search engine just typing different things, and I typed in yoga and broken back, and up popped Dallas' page," he recalls. Boorman soon got the Page's DVDs, and slowly and surprisingly he saw himself shrinking, tightening and strengthening. After his weight loss, Boorman has now moved from DDP student to teacher. But he must warn his pupils that there is nothing soothing or meditative about his class. "It's like the Marines, yoga for the Marines," Claire, one of Boorman's students, said. Stacey Morris had the same shock as Boorman when she lost significant weight through DDP. At her peak two years ago, she weighed more than 300 pounds; now she has gone from size 28 to a size 8.

As America's waistline expands, costs soar EW YORK - U.S. hospitals are ripping out wall-mounted toilets and replacing them with floor models to better support obese patients. The Federal Transit Administration wants buses to be tested for the impact of heavier riders on steering and braking. Cars are burning nearly a billion gallons of gasoline more a year than if passengers weighed what they did in 1960. The nation's rising rate of obesity has been well-chronicled. But businesses, governments and individuals are only now coming to grips with the costs of those extra pounds, many of which are even greater than believed only a few years ago: The additional medical spending due to obesity is double previous estimates and exceeds even those of smoking, a new study shows. Many of those costs have dollar signs in front of them, such as the higher health insurance premiums everyone pays to cover those extra medical costs. Other changes, often cost-neutral, are coming to the built environment in the form of wider seats in public places from sports stadiums to bus stops. The startling economic costs of obesity, often borne by the non-obese, could become the epidemic's second-hand smoke. Only when scientists discovered that nonsmokers were developing lung cancer and other diseases from breathing smoke-filled air did policymakers get serious about fighting the habit, in particular by establishing nonsmoking zones. The costs that smoking added to Medicaid also spurred action. Now, as economists put a price tag on sky-high body mass

A regular sized wheelchair (L) is pictured alongside an oversized one in the children's and women's maternity ward at the University of Alabama Hospital in Birmingham, Alabama.

indexes (BMIs), policymakers as well as the private sector are mobilizing to find solutions to the obesity epidemic. "As committee chairmen, Cabinet secretaries, the head of Medicare and health officials see these really high costs, they are more interested in knowing, 'what policy knob can I turn to stop this hemorrhage?'" said Michael O'Grady of the National Opinion Research Center, coauthor of a new report for the Campaign to End Obesity, which brings together representatives from business, academia and the public health community to work with policymakers on the issue. The U.S. health care reform law of 2010 allows employers to charge obese workers 30 percent to 50 percent more for health insurance if they decline to participate in a qualified wellness program. The law also includes carrots and celery sticks, so to speak, to persuade Medicare and Medicaid enrollees to see a primary care physician about losing weight, and funds community demonstration programs for weight loss.

MAY ISSUE • 2012

WWW.GLOBALHEALTHTRIBUNE.COM

Upcoming Medical Fundraising Events for May 10 – June 10, 2012 MAY May 10

Junior Diabetes Research Foundation. 5th Annual Young Professionals Bachelor and Bachelorette Auction. Rome Nightclub at Roxy’s, downtown West Palm Beach. Tickets are $30.00 in advance or $40.00 at the door (includes two cocktails and appetizer buffet). For additional information, go to www.facebook.com/theauction, or www.jdrf.org.

National Multiple Sclerosis Society South Florida Chapter. CBM of America, Inc. MS Golf Tournament. Boca Lago Country Club, Boca Raton. For additional information, contact 954-7314224, or visit www.nationalmssociety.org.

May 11-12

Stamp Out Hunger Food Drive. Collect and bag non-perishable food items and place them by your mailbox. Your carrier will pick them up and bring them to a local food pantry. For additional information, visit their website www.helpstampouthunger.com.

Muscular Dystrophy Association. 18th Annual Ed Morse Automotive Golf Classic to benefit the MDA. Breakers West Golf Course, West Palm Beach. Cost is $300.00 per player. For additional information, call Lauren at 561-742-3748.

May 16

Juvenile Diabetes Research Foundation & The Children of Christel House. 13th Annual Charity Golf Tournament. Cost is $250.00 for an individual and $950.00 for a foursome. PGA National Resort & Spa, Palm Beach Gardens. For additional information for this two-day event, contact Martha Storey at 561-912-8078 or at martha.storey@bluegreencorp.com.

May 18-19

Cleaning for Cancer. CFC Annual Gala. Cost is $300.00. Fontainebleau, Miami Beach. For additional information, contact Nadege Desravines at 561-573-7783, or ndesravines@cleaningforcancer.org. Or, visit their website at www.cleaningforcancer.org.

May 24

Alzheimer’s Community Care. 2012 Alzheimer’s Educational Conference. Palm Beach Convention Center, West Palm Beach. Family Caregivers pay $30.00 for a one-day pass or $50.00 for a two-day pass. General attendance is $125.00 for a one-day pass or $195.00 to attend both days. For additional information, call 561-683-2700.

May 31 Boys & Girls Clubs of Palm Beach County. 23rd Annual Golf Classic Auction Party, Putters of the Caribbean. Ballen Isles Country Club, Palm Beach Gardens. Cost is $75.00 per person or $1,000.00 to sponsor a table. For additional information, call 561-683-3287. Or, visit their website at www.bgcpbc.org. Cleaning for Cancer. 2nd Annual Golf Tournament. PGA National Resort & Spa, Palm Beach Gardens. For additional information, contact Nadege Desravines at 561-573-7783, or ndesravines@cleaningforcancer.org. Or, visit their website at www.cleaningforcancer.org.

May 12

Cancer Alliance of Help and Hope. 3 Guitars (a night of blues music). Mos’Art Theater, on Park Avenue in Lake Park. Cost is $20.00. Please call 561-748-7227 for additional details. Or, visit their website at www.cahh.org.

Palm Beach Atlantic University. Alumnae Afternoon Tea. The Country Club at Mirasol, Palm Beach Gardens. Cost is $75.00. For additional information, please contact Breanne at 561-8032016 or e-mail breanne_fairfax@pba.edu.

JUNE Boys & Girls Clubs of Palm Beach County. Boca Raton Golf Tournament. Boca Raton Country Club, Boca Raton. For additional information, call the Special Events Department at 561-683-3287. Or, visit their website at www.bgcpbc.org.

June 1

June 7 Gulfstream Goodwill. Goodwill Inaugural Golf Tournament & Ladies Fashion Show Luncheon. Eastpointe Country Club, Palm Beach Gardens. Cost is $500.00 for a foursome, or $30.00 for the fashion show. For additional information, contact Iva Grady at 561-848-7200, or by e-mail to igrady@gulfstreamgoodwill.com.

If you would like to add a medical event or fundraiser to our Upcoming Events section, please e-mail your information to info@globalhealthtribune.com. This is a free section.

ST. MARY’S MEDICAL CENTER APPOINTS DONNA SMALL AS CHIEF NURSING OFFICER

WEST PALM BEACH, Fla. –April 10, 2012— St. Mary’s Medical Center is proud to announce the appointment of Donna Small, RN, MSN, as the hospital’s new chief nursing officer (CNO). In this role, Small will assume the operational responsibility of nursing care at St. Mary’s Medical Center and the Palm Beach Children’s Hospital. As a key member of the administrative team, Small will facilitate and direct nursing leadership and continue the high quality of nursing care from pediatric to adult medical and specialty services at St. Mary’s. “Donna comes to St Mary’s Medical Center with significant experience as a CNO and hospital administrator,” said chief executive officer Davide M. Carbone. “She is well-versed in strategic planning, communication, process improvement, and has exceptional clinical experience, which will all be tremendous assets to St. Mary’s nursing care.”

Before joining St. Mary’s Medical Center’s administrative team, Small served as CNO for over eight years at a 409-bed, level two trauma hospital in south Florida. In this position, Small made major achievements in meeting the organization’s strategic goals to maximize quality patient care by ensuring the effective delivery of nursing systems.

Donna Small, RN, MSN

Before this CNO position, Small served as the vice president/assistant director of nursing at a 407-bed facility in North Miami. Prior to that, Small was the director of nursing at West Boca Medical Center. Small earned a bachelor’s degree in nursing from Lynn University and a master’s degree in Business in Healthcare Administration from the University of Phoenix. She is a member of the American Organization of Nurse Executives; the American College of Healthcare Executives; South Florida Organization of Nurse Executives; The Florida Atlantic University Nursing Advisory Board; and is an active board member for the Broward Health Foundation.

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1395 State Road 7, Wellington On the campus of Wellington Regional Medical Center WellingtonRegional.com Physicians are independent practitioners who are not employees or agents of Wellington Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. *American Cancer Society, July 2010