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105 U.S. Kids Died From Flu, CDC Says
MARCH ISSUE - 2013
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Anterior Cruciate Ligament Injuries in the Adolescent Athlete P 5
José Ortega, MD.
Health, Safety and Wellness within an Acute Care Hospital P10
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Six of the pediatric deaths were reported in the last week, and it's possible there will be more, said the CDC's Dr. Michael Jhung. P 2
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March 2013
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MEDICAL NEWS
105 U.S. Kids Died From Flu, CDC Says
T
he flu season is winding down, and it has killed 105 children so far — about the average toll.
Roughly 100 children die in an average flu season. One exception was the swine flu pandemic of 2009-2010, when 348 children died.
The CDC recommends that all children ages 6 months and older be vaccinated against flu each season, though only about half get a flu shot or nasal spray. All but four of the children who
T
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Deborah Lynn Staff Writer / Associate Editor (312) 351-2383 deborah@globalhealthtribune.com
The season started about a month earlier than usual, sparking concerns it might turn into the worst in a decade. It ended up being very hard on the elderly, but was moderately severe overall, according to the Centers for Disease Control and Prevention. Six of the pediatric deaths were reported in the last week, and it's possible there will be more, said the CDC's Dr. Michael Jhung .
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died were old enough to be vaccinated, but 90 percent of them did not get vaccinated, CDC officials said.
This year's vaccine was considered effective in children, though it didn't work very well in older people. And the dominant flu strain early in the season was one that tends to cause more severe illness.
The government only does a national flu death count for children. But it does track hospitalization rates for people 65 and older, and those statistics have been grim.
In that group, 177 out of every 100,000 were hospitalized with flu-related illness in the past several months. That's more than 2 1/2 times higher than any other
recent season.
This flu season started in early December, a month earlier than usual, and peaked by the end of year. Since then, flu reports have been dropping off throughout the country. "We appear to be getting close to the end of flu season," Jhung said.
U.S. Department of Health and Human Services, ARA Content, Centers for Disease Control and Prevention, METRO Editorial Services, Family Features © SEA PUBLICATIONS, INC. ALL RIGHTS RESERVED.
Global Health Tribune is a newspaper published every month in Palm Beach county and surrounding areas. Copyright 2013, 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.
Affordable Care Act Helping Prevent Disease
Affordable Care Act Making a Difference his week marks the third birthday of the Affordable Care Act. Across HHS, celebrating the law's efforts to give Americans more security by holding insurance companies accountable, bringing down costs across the system, and helping more families get the peace of mind of affordable health insurance. At Center for Disease Control and Prevention, especially celebrate the law's potential for prevention of disease and injury—prevention in communities and prevention in clinics. Three years later, it is wonderful to see that potential being realized.
It's better to prevent a disease than to try to cure one CDC works to prevent disease and injury in many ways. working with state and local health departments to detect and respond to outbreaks and help support community prevention activities. CDC also works to prevent disease by supporting the uptake of preventive services— recommended tests and screenings that can detect diseases early when they can be treated effectively, or vaccinations that protect against infectious diseases. Our science supports what we know intuitively—it is better to prevent a disease than try to cure it once it has struck.
Despite the proven benefits of these tests, screenings, and vaccinations, millions of Americans still do not get these services. For example, everyone know that screening for colorectal cancer is highly effective for people aged 50 to 75 years. But about one-third of Americans are not up-to-date with these tests.
Eliminating one barrier to preventive care – required copays and deductibles One barrier is out-of-pocket payments—required copays and deductibles. The Affordable Care Act eliminates cost-sharing for proven preventive services offered by new private health plans, making it easier for people to receive mammograms, flu shots, smoking cessation counseling, and many more preventive services. Medicare beneficiaries are also eligible for key preventive services at no out-of-pocket cost.
This week, HHS released a study showing that, because of the Affordable Care Act, approximately 71 million Americans received expanded coverage for preventive services in 2011 and 2012. And last year, more than 34 million seniors and people with disabilities on Medicare used at least one free preventive service. In time, this coverage will help save lives.
Improvements in our ability to track, detect and respond to disease threats The law also has supported CDC's work with its partners to sustain and enhance crucial public health initiatives. As two examples, we have made improvements to the nation's health and healthcare surveillance activities so we have better data on health status and healthcare activities, and we have enhanced the Community Preventive Services Task Force's capacity to assess and disseminate scientific evidence for community prevention activities.
The Center for Disease Control and Prevention also buttressed the nation's capacity to detect and respond to disease threats. As examples, we have enhanced the capacity of laboratories and skilled disease detectives, improved programs to address healthcare-associated infections,
and supported state health department innovation. The law has helped support efforts to prevent the leading causes of death and disease, supported programs to modernize our nation's immunization system and reduce tobacco use, and has empowered communities to implement evidence-based programs that help them be healthier places to live.
The Affordable Care Act has provided opportunities to bring the public health and health care systems together, a move with substantial potential to save lives. Million Hearts™, for example, is the joint CMS-CDC national initiative to prevent 1 million heart attacks and strokes by 2017. The Affordable Care Act provides the drivers and momentum to align improved cardiovascular disease prevention in clinical settings with simultaneous efforts in the community.
The Affordable Care Act created the National Prevention Council, comprised of heads of 17 federal agencies. The Council developed a National Prevention Strategy to catalyze actions by all sectors of society to support health and wellness and prevent disease. Already we have seen progress as states and localities have begun to adopt the Strategy to enhance prevention activities, and federal agencies have enhanced their prevention activities. DOD's announcement of its Healthy Base Initiative, for example, was part of the National Prevention Strategy.
More prevention means healthier people CDC, like our partners across HHS and the administration, agrees that reducing the uninsured will have substantial public health benefits, including improving access to important preventive services. New Health Insurance Marketplaces will expand health insurance coverage to millions of uninsured Americans. This means more prevention and healthier people.
While there are many successes of the Affordable Care Act at age three, there is still much work to do. The last three years have shown us that we have a solid foundation upon which to build.
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March 2013
Page 3
THE FORGOTTEN FOOT
Metatarsalgia
M
Arthur Hansen DPM, M.S.
etatarsalgia is a general term used to denote a painful foot condition in the metatarsal region of the foot (the area just before the toes, more commonly referred to as the ball-of-the-foot).
This is a very common foot disorder that we see in our practice. It can affect the bones and joints at the ball-of-the-foot. Metatarsalgia (ball-of-foot-pain) is often located under the 2nd, 3rd, and 4th metatarsal heads, or more isolated at the first metatarsal head (near the big toe). The most common location is just the second metatarsal head.
The main symptom of metatarsalgia is pain in the ball of your foot — the part of the sole just behind your toes. The pain may be sharp, aching or burning, and you may feel it in the area around the second, third and fourth toes or only near your big toe.
Metatarsal bones
Other symptoms of metatarsalgia include:
• Pain that gets worse when you stand, walk or run and improves when you rest • Sharp or shooting pain in your toes • Numbness or tingling in your toes • Pain that worsens when you flex your feet • A feeling in your feet as if you're walking on pebbles or have a bruise from a stone • Increased pain when you're walking barefoot, especially on a hard surface
Sometimes these symptoms can come on suddenly, especially if you've recently increased your usual amount of running, jumping or other high-impact exercise. However, the symptoms are more likely to develop over a period of months.
With this common foot condition, one or more of the metatarsal heads become painful and/or inflamed, usually due to excessive pressure over a long period of time. It is common to experience acute, recurrent, or chronic pain with metatarsalgia.
Conservative & Surgical Treatments Available Whirlpool with every visit!
The most common and consistent complaint we hear is that it feels like walking on a small rock in the shoe. This happens when the capsule around the joint gets inflamed and swollen and we walk on it. Anything that puts pressure or extra stress on the ball of our foot can cause this condition. These include:
• Being overweight • Wearing high heeled shoes • Digital deformities that create retrograde pressure on the metatarsal head • Extremely high arched feet • An orthopedic condition where a metatarsal is very long or declinated • Anterior ankle arthritis where the foot cannot be brought up into the ankle joint • Bunion deformities where big toe is weakened and extra stress is put on ball of foot • Athletics where there is high impact on the fore foot • Aging where the normal fat pad on the bottom of the foot gets thinner The first step in treating metatarsalgia is to determine the
Achilles tendon
cause of the pain. If it is something obvious like improper fitting footwear, the footwear must be changed. Footwear designed with a high, wide toe box (toe area) and a rocker sole is ideal for treating metatarsalgia. The high, wide toe box allows the foot to spread out while the rocker sole reduces stress on the ball-of-the-foot. Unloading pressure to the ballof-the-foot can be accomplished with a variety of footcare products. Orthotics designed to relieve ball-of-foot pain usually feature a metatarsal pad or a cut out under the affected metatarsal. The orthotic is constructed with the pad placed behind the ballof-the-foot to relieve pressure and redistribute weight from the painful area to more tolerant areas. Other products often recommended include gel metatarsal cushions and metatarsal bandages.
Get back on your Feet!
Plantar fascia ligament
Calcaneus (heel bone)
Once we have something in the shoe to try to prevent the excessive pressure and continual injury then other modalities can be used concurrently. These include OTC medications like Motrin of Aleve.
Sometimes a visit to the podiatrist is indicated. X-rays can show if there is an orthopedic condition causing the pain. They also show us if the joint has gone through any changes. For the more painful joints, sometimes a small steroid injection can give relief. Most of the time (90%), conservative care can give good long lasting relief. For the occasional chronic condition that doesn’t get better with conservative care and is painful everyday, there are some surgical options that are very successful.
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March 2013
Page 5
ORTHOPAEDIC NEWS
Anterior Cruciate Ligament Injuries in the Adolescent Athlete José Ortega, MD
Board Certified, Fellowship Trained Orthopaedic Surgeon Sports Medicine Specialist
José Ortega, MD is a Board Certified, Fellowship Trained Orthopaedic Surgeon and Sports Medicine Specialist. He received his MD Degree from The University of Puerto Rico School of Medicine and completed his Sports Medicine Fellowship at the Cleveland Clinic Foundation where he specialized in Arthroscopic Reconstructive Surgery of the shoulder and knee. His area of expertise includes all Arthroscopic rotator cuff and instability repairs, knee ligament reconstruction, meniscal and cartilage injury management, as well as non-invasive treatment of shoulder and knee arthritis.
K
By José Ortega, MD
nee injuries are very common in contact sports. Even though high percentages are bone bruises and sprains, others can cause significant structural damage and dysfunction. Some of these injuries can potentially end the season for the athlete. These injuries can involve ligaments, tendons, meniscus or cartilage.
In recent studies, the highest incidence of anterior cruciate ligament tears was among female soccer players followed by football players. ACL injuries have the potential to be associated with meniscus tears and cartilage damage. If left untreated or misdiagnosed these injuries can lead to instability, further joint damage and ultimately arthritis.
The role of the orthopedic surgeon is to repair and/or reconstruct these structures so that the athlete returns to sports activities as soon as possible. However, the management of these injuries in the adolescent and skeletally immature is challenging. Younger athletes with open growth plates require different methods of reconstruction to avoid damage to the growth plates and minimize the change of premature closure or growth arrest. With newer techniques and fixation devices, we now have a much better chance to avoid such complications. Dr. Ortega is Board Certified in Orthopaedic Surgery and holds a Sports Medicine Subspecialty Board Certification.
Dr. Ortega is on staff at Palms West Hospital, Wellington Regional Medical Center, Palms Wellington Surgical Center and Palms West Surgicenter. He serves on the Board of trustees of Palms Wellington Surgical Center and has also served as the Team Physician for the Wellington High School football team since 2009. Dr. Ortega is Board Certified by the American Board of Orthopaedic Surgery, with additional Board Certification in Sports Medicine. He is distinguished as a Fellow of the American Academy of Orthopaedic Surgeons. Dr. Ortega is also active in Orthopaedic Research and has presented numerous lectures at both national and international levels. Dr. Ortega is fully bilingual.
Jose Ortega, M.D., FAAOS Diplomate American Board of Orthopedic Surgery
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March 2013
DEVELOPMENT
www.GlobalHealthTribune.com
Robbin Lee, RN, MBA Appointed Chief Operating Officer for Wellington Regional Medical Center
W
ellington, FL – February 21, 2013 Wellington Regional Medical Center has recently hired Robbin Lee as Chief Operating Officer. She will be an integral part of Wellington Regional’s leadership team leading patient satisfaction and quality initiatives. With more than 20 years of combined clinical and administrative experience, Lee brings extensive healthcare management and leadership
Robbin Lee, RN, MBA.
skills to the team. She has had an extensive career in healthcare, most recently as the Chief Operating Officer of HCAowned hospitals, Lawnwood Regional Medical Center in Fort Pierce and JFK Medical Center in Atlantis for the last eight years. Previously, she was the Chief Executive Officer of Northlake Medical Center in Atlanta, Georgia, Senior Vice President of Operations of Stamford Health System in Stamford, Connecticut and Associate Administrator of
Emory Healthcare in Atlanta, Georgia.
A Georgia native, Lee earned her Master’s Degree in Business Administration at Emory University in Atlanta. She began her healthcare career as a unit nurse at Georgia Baptist Medical Center, also in Atlanta. Throughout her career, she has earned numerous honors and awards, and has served on various community boards. She resides in Palm Beach County with her husband.
About Wellington Regional Wellington Regional Medical Center is a progressive acutecare facility and medical center that has served Palm Beach County and the surrounding region since 1986. A thriving community hospital, Wellington Regional is proud to offer the advanced technologies of a bigcity hospital and the personalized care of a hometown provider. For more information about Wellington Regional Medical Center, please contact the hospital at 561.798.8500.
Tenet Florida Hospitals Good Samaritan Medical Center Observe National Doctors’ Day Receives Get With The Guidelines Gold Plus Quality Achievement Award
West Palm Beach, FL March, 2013 — Good Samaritan Medical Center earns 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. Get With The Guidelines is a quality improvement initiative that provides hospital staff with tools that follow proven evidencebased guidelines and procedures in caring for heart failure patients to improve outcomes, prevent future hospitalizations and prolong life.
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 12-month intervals and have achieved 75 percent or higher compliance with four of nine Get With The GuidelinesHeart Failure Quality Measures to improve quality of patient care and outcomes.
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 thyroid management counseling as well as referrals for cardiac rehabilitation before being discharged.
“Building an excellent reputation in heart and vascular care takes time, effort and commitment,” said Good Samaritan Medical Center Chief Executive Officer,
Mark Nosacka. “Receiving the Get With The Guidelines- Heart Failure Gold Plus designation is a testament to the more than 90 years that Good Samaritan Medical Center has provided comprehensive programs and services dedicated to the diagnosis and treatment of cardiac and vascular conditions.”
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.
Miami-Dade, Broward and Palm Beach Counties, FL. -March 30, 2012 – Tenet hospitals in Florida celebrate National Doctors’ Day by paying tribute to its physicians for their service, skill and compassion. Through this year’s national theme of simply, “Thank You,” the outstanding group of physicians across the Tenet Florida network will be celebrated with various events and activities at Coral Gables Hospital, Delray Medical Center, North Shore Medical Center FMC Campus, Good Samaritan Medical Center, Hialeah Hospital, North Shore Medical Center, Palm Beach Gardens Medical Center, Palmetto General Hospital, St. Mary’s Medical Center and West Boca Medical Center. “On behalf of all of our hospitals, and all of our employees, I would like to extend my heartfelt appreciation to our physicians, the gatekeepers of healthcare in South Florida,” said Marsha Powers, senior vice president of operations of Tenet’s Florida region.
“I believe strongly in the value of a straight forward ‘thank you’ echoing the sentiment of this year’s national theme, though our appreciation is far-reaching and effervescent.”
Celebrated on March 30 each year, Doctors’ Day was officially established in 1991 when President George Bush issued a proclamation in observance of the day. March 30 marks the anniversary of the first use of general anesthesia in surgery by Dr. Crawford W. Long in 1842.
National Doctors’ Day is commonly celebrated in healthcare organizations as a day to recognize the contributions of doctors to individual lives and communities. “We encourage our community members to join us in thanking our physicians for the very important service they provide,” Powers concludes.
We would like to congratulate Eric Goldman and the entire staff at Palms West Hospital on their continued success.
Bill Tavernise 561-209-8304
BillTavernise@keyes.com
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Bob Wolff 561-352-0620
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March 2013
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Page 7
MEDICINE
SFRO Survivorship Clinic Open House South Florida Radiation Oncology Survivorship Clinic held an open house on Saturday, February 23. Nurse Practitioner, Judy Armstrong, runs the clinic for SFRO. It's Judy's knowledge, compassion and reputation that has helped to make the clinic such a huge success.
The clinic is located at 3355 Burns Road, Suite 105 in Palm Beach Gardens. For additional information, you can give them a call at 561-775-7748 or just visit their website at www.SFROLLC.com.
Deborah Payiapakis with Judy Armstrong.
Judy Armstrong, Sarah Trulaske and Kathy.
Massage therapist, Tara Pocius with Judy Kephart.
Raquel Rivera, Dr. Cindy Collins and a guest.
Vendors were on hand.
Wendy Bright.
Susan Nefzger and Katiann Susich.
Samir Qureshi and Mary Martinez.
Page 8
March 2013
ONCOLOGY NEWS
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Focus on Breast Cancer Treatment Multi Modality Clinics
I
Kishore K. Dass, MD
Eugene Shieh, MD
t is our mission at South Florida Radiation Oncology to provide state-of-the art technology and treatment techniques to deliver the best possible care in order to achieve the best possible outcomes for our patients. For breast cancer, we have implemented a multidisciplinary approach in our Multi Modality Clinics (MMC’s).This approach is a very beneficial one for patients because the process begins at diagnosis.
1) Expedited Patient Care
Board-Certified Radiation Oncologist
The benefits of the MultiModality Clinic for breast cancer include:
Board-Certified Radiation Oncologist
2) Comprehensive Care: Prior to starting treatment, the patient is seen and evaluated by all specialties, establishing an overall treatment plan.
3) Optimal Patient outcomes
Currently, the standard of care treatment for breast cancer after breast conserving therapy is whole-breast external beam radiation therapy. The alternative option of accelerated partial breast radiation (APBI) is being explored in a current clinical trial, NSABP B-39. This trial
The Importance of Sleep for a Cancer Patient passionflower
A
By Corrie Trottier, MS, RD
diagnosis of cancer affects many aspects of the cancer patient’s wellbeing. One important item is sleep. Sleep patterns can be disrupted for many reasons. For instance, patients with a diagnosis of prostate cancer may experience frequent urination throughout the night. A diagnosis of breast cancer can result in anxiety which could also prevent someone from getting a good night’s sleep.
The herb passionflower (passiflora incarnate) has become popular in both America and Europe for its use with anxiety and insomnia. Passionflower is purported to increase the chemical gamma aminobutyric acid (GABA) in the brain.
GABA lowers the activity of the brain cells and results in relaxation. Passionflower can be purchased over the counter at a health food store and comes in the form of a tea, infusion, liquid extract, and tincture.
In a study with 91 participants that had symptoms of anxiety, an herbal European product that contained passionflower reduced symptoms of anxiety when compared to a placebo. In another recent study patients who were given passionflower prior to surgery experienced less anxiety and recovered from anesthesia at the same rate as though given the placebo. Passionflower may be a useful consideration for patients who are not sleeping well through the night or who are experiencing anxiety.
will help determine if APBI will become a standard of care option for women with newly diagnosed breast cancer. According to Dr. Eugene Shieh, board certified radiation oncologist, “For the properly selected patient, APBI is generally very well tolerated and allows for the completion of
radiation therapy in an expeditious manner of 5 days as compared to 5-7 weeks with traditional external beam radiation therapy. .”
The physicians of South Florida Radiation Oncology have significant experience treating breast cancer patients with external beam radiation therapy
and Accelerated Partial Breast Radiation. If you are interested in receiving more information about your diagnosis and treatment options, please contact us at 1-877-930-7376, or visit our website at www.sfrollc.com. Please follow us on Facebook and Twitter!
West Boca Medical Center Appoints William Gruitza as the Hospital Compliance and Privacy Officer
Boca Raton, FL (March 2013) – West Boca Medical Center’s commitment to quality patient care is strengthened with the appointment of William J. Gruitza as both the Hospital Compliance and Privacy Officer. Gruitza has extensive experience in the law field working as an associate attorney focused on the Health Insurance Portability Accountability Act, HIPAA/HITECH Policy & Procedure Development and HIPPA audit preparation and risk assessments. Gruitza joined West Boca Medical Center to continue to implement the systems, processes and policies, of Tenet’s Ethics and Compliance Program. “We are proud to announce William Gruitza to implement the company’s ethics and compliance program at the hospital. His experience and leadership with Federal
healthcare compliance and the Health Insurance Portability Accountability Act is a tremendous asset to the hospital,” said CEO Mitch Feldman of West Boca Medical Center. “The appointment of William moves the hospital forward in continuing to ensure compliance.” Gruitza is a member of the American Health Lawyers Association and has served as a
SURVIVORSHIP CLINIC UPDATE
Since opening the survivorship clinic in October 2012, we have seen an increase in growth and enthusiasm within the clinic. In addition to classes like yoga, Tai chi, massage, cooking demonstrations and nutrition classes, I have seen many patients and am assisting them in navigating their treatment and disease process. For many patients it is the education and understanding of their disease that is the most
important piece for them. How many times do you go to the doctor’s office and forget your questions or even forget what they told you. It is so common and can be very frustrating. Here at the clinic, I go over all of your records and explain everything in layman’s terms so you can understand. I have found, in my 30 years of experience that if a patient knows the “why” of what they are being asked to do then they are much more likely to actually do it. It then makes sense to them.
volunteer author, contributing summaries on regulatory developments for the Health Reform Educational Taskforce website. Gruitza is also affiliated with the Drexel Health Law Society. Prior to graduating from Drexel University’s Earle Mack School of Law with a Juris Doctorate concentration in health law, he assisted the Office of General Counsel at the University Of Pennsylvania & Penn Medicine. While at Penn, Gruitza’s focus was healthcare compliance and financial conflicts of interest pertaining to clinical research. Gruitza also served as a summer clerk for the Honorable Anne E. Lazarus at The Superior Court of Pennsylvania and as a legal extern with the Pennsylvania Department of Insurance’s Medical Care Availability and Reduction of Error Fund.
Our grand opening that was on Feb 23, 2013 was a success with many patients, family and friends coming to see what we are all about. It was SFRO survivorship’s clinic opportunity to reach out to the community and help them understand what we do. We want to give the cancer patient and family the tools to get through their treatment with the minimal amount of side effects possible and to assist them through their cancer journey and making sure they don’t get stuck in the cancer phase of the journey. We want to assist them to the happier healthier life we know they can have.
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March 2013
HEALTH & WELLNESS
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Health, Safety and Wellness within an Acute Care Hospital There are numerous checks and balances implemented within an acute care hospital in order to limit and prevent an unsafe and unhealthy environment. A few of the staples within the acute environment include, but are not limited to, the treatment of bloodborne pathogens, post exposure protocols, needle stick protocol, universal precautions and handling latex allergies.
Mike Corvaia has been in healthcare administration for over ten years and is currently the Director of Business Development for Select Specialty Hospital in Palm Beach. He holds a Bachelor’s degree from the University of Florida and is completing his Master’s Degree this year in Business Administration, with an emphasis on Healthcare Administration.
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Please feel free to send any healthcare related questions to mcorvaia@selectmedical.com
By Mike Corvaia
n acute care hospital deals with a multitude of regulations and laws that are strictly enforced by various levels of administration. Some of these enforcement agencies are state and federal inspectors as well as not for profit outside sources such as the Joint Commission on Accreditation of Healthcare Organizations or JCAHO. Redundancy and multiple layers are built into healthcare to assist in every way possible to avoid accidents, promote health and wellness, in addition to providing the highest quality care to those in need. Within an acute care hospital, all of these factors are magnified to the highest degree in order to limit the amount of mistakes that can happen on medically complex, compromised individuals / patients.
Bloodborne Pathogens and Universal Precautions
Bloodborne Pathogens means pathogenic microorganisms that are present in human blood and can cause disease in humans. These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV). According to OSHA (1970) “Other Potentially Infectious Materials means (1) The following human body fluids: cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; (2) Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and (3) HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.” (OSHA, sec. 1910.1030b)
Bloodborne pathogens are perhaps the most stressed and educated piece of material given to healthcare professionals for obvious reasons. Many ill patients are coming in contact with other critical patients who are being taken care of by essentially a very healthy
professional. All of these people are prone to infection and are considered carriers of bloodborne pathogens if exposed to them for whatever reason. It is one of the most common talking points within a hospital because it happens every day and there is a very specific protocol to follow when someone is exposed. Universal precautions are directly tied to bloodborne pathogens and used when someone is exposed to the aforementioned fluids. According to the Bloodborne Pathogens standard, "Universal precautions is an approach to infection control. According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens." (29 CFR 1910.1030(b). This requires that universal precautions be observed to prevent contact with blood or other potentially infectious materials. The safety of the healthcare provider and of the compromised patients they care for are of the utmost importance and numerous education sessions are done to ensure the safety and well being of everyone involved. Post Exposure, Needle stick and Latex Allergies
Exposure Incident means a specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that result from the performance of an employee's duties. When this arises, a series of set protocols must be followed.
For instance, it is posted in numerous places throughout the hospital, “If you are stuck by a needle or other sharp object or get blood or other potentially infectious materials in your eyes,
nose, mouth, or on broken skin, immediately flood the exposed area with water and clean any wound with soap and water or a skin disinfectant if available.
must be given to that employee for use during working hours. Examples of these include lowprotein, powder-free and synthetic gloves.
Latex allergies, may appear to be harmless at first compared to bloodborne illnesses, but could in fact lead to a life threatening reaction. According to OSHA's website, “8 percent to 12 percent of health care workers may have or will develop an allergy to latex while working in a hospital.” These allergies can range from minor irritations to more debilitating conditions that can lead to life-threatening situations. Testing within the hospital environment is made available to those who suspect a latex allergy and, if found to be positive, the appropriate gloves
Select Specialty Hospital of Palm Beach boasts numerous accolades pertaining to the exceptional infection control statistics and positive patient experiences from our hospital. Some of those include a Central Line associated blood stream infection rate less than 1%, catheter associated UTI is 1.1% (National Average is 2.16%) Vent acquired pneumonia in 0%. Select Specialty Hospital also had zero deficiencies from our recent JCAHO survey in relation to our infection control within the facility. These impressive statistics are made possible due to the dedicated staff and administration teams that have been working together for years providing consistently positive outcomes and unparallel continuity for our patients.
Report this immediately to your employer and seek immediate medical attention” (OSHA 1970) According to the Centers for Disease Control (2001), “Nurses are among the largest group of hospital workers injured by needle sticks each year... Studies show that nurses sustain the most needle stick injuries and that as many as one-third of all sharps injuries occur during disposal.” The Centers for Disease Control and Prevention (CDC) estimates that 62 to 88 percent of sharps injuries can be prevented simply by using safer medical devices. In order to prevent these unnecessary injuries, workers must be made aware of their hospital's specific protocols. These are the methods by which needle sticks and all other materials that could have been exposed to bloodborne pathogens are removed safely from the hospital. Self-sheathing needles, disposal containers and needless systems are all ways that hospital workers can be protected against possible exposure to needle sticks and blood borne pathogens.
While a hospital environment can be the most infected environment one can be exposed to, there are hundreds of different protocols and regulations to follow to assist in limiting the exposure to harmful diseases and dangerous situations. While evaluating this particular acute care hospital, I would only recommend more of what is already being done. Every facet of safety and health is promoted from every level of leadership, including both clinical and nonclinical personnel. Working within such a volatile environment for spreading disease, every person must practice and enforce the standards OSHA regulates as well as their own approach to ensuring safety, health and wellness is ensured for every person working within the hospital environment and for every patient that is admitted.
Your sleeping position says much about you Just like our waking posture and position can influence our emotions, our sleeping position is thought to influence our emotions or represent our personality, said Dr Mark Kohler from the University of South Australia's Centre for Sleep Research. Most people sleep on their side or in the foetal position, according to the British Sleep Assessment and Advisory Service. And Kohler believes people who sleep on their sides are likely to be balanced or well adjusted, News.com.au reported. "People who sleep in the foetal position, as well as those who
go to sleep face down (prone), are more likely to be anxious. Those who sleep on their back (the 'royal' position) have higher self-confidence," the website quoted him as saying. Additionally, people who go to sleep on their stomachs [face down] were found to be more anxious and less self-confident, Kohler said. By observing a couple and their sleeping pattern, body language gurus Allan and Barbara Pease can also reveal a lot about the current state of their relationship. Sleeping in each other's arms: According to Allan, very few couples continue sleeping like this beyond nine months together.
He said though the position restricts blood flow to arms, psychologically, it's a sign they're still new to each other. This is a honeymoon position, he added.
Sleeping spooning and cuddling: Here both partners lie
on the same side facing the same direction, one behind the other, like a set of spoons.
When men are the ones who do the wrapping, they tend to show they are in control, while women do it to show their nurturing nature, Barbara said.
Sleeping with your bottoms touching: When you are sleeping separately and letting your bottoms touch, it shows you probably give each other space in your relationship, without fear that you will lose one another, said Barbara. Since bottom is an intimate part of the body to touch one another with, it really does suggest that you are very close, Barbara said. Distant sleepers: Sleeping apart may not necessarily mean your relationship has come to an end - as long as you snuggled up first or had a warm kiss good night, before moving into your own space, said Allan
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March 2013
HEALTH & BEAUTY
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Walk Multiple Sclerosis Society n Sunday, February 24, the National MS Society held their walk to raise funds for multiple sclerosis in downtown West Palm Beach. Since the walk began in 1988, Walk MS has raised over $10 million dollars that has helped to support people living with multiple sclerosis.
If you would like to get involved in one of the programs that the National MS Society has to offer, you can visit their website at www.nationalmssociety.org.
Avastin Recalled Over Eye Infections By Kelly Young
Avastin (bevacizumab) unit dose syringes have been recalled after five intraocular infections were reported to the manufacturer. The cancer drug was used off-label to treat macular degeneration.
The syringes were sent to physicians' offices in Georgia, Louisiana, South Carolina, and Indiana beginning December 18, 2012.
Federal Commission Advises Waiting on Testing Anthrax Vaccine in Kids By Kelly Young
Several steps need to be taken before the government could ethically embark on anthrax vaccine trials in children, concludes a report from the Presidential Commission for the Study of Bioethical Issues.
The commission found that children would not directly benefit from participating in studies before a bioterror attack. They concluded that research with children is ethical only if it poses "no more than minimal risk," such as that faced by a healthy child in daily life or at a physician visit. Further testing in young adults should occur before children undergo vaccine trials. Young Adults Who Experience Stroke Face Increased Mortality Risk Decades Later By Amy Orciari Herman Patients who suffer a first stroke relatively early in adulthood have a higher mortality risk than their peers even 20 years later, according to a JAMA study.
Researchers in the Netherlands enrolled some 959 adults who suffered a first transient ischemic attack, ischemic stroke, or hemorrhagic stroke between ages 18 and 50; mortality was assessed among the 916 who survived 30 days post-stroke.
Estimated 20-year mortality was increased with each stroke type relative to that observed in the general population. The excess risk was highest and most consistent for patients with ischemic stroke or TIA, while those with hemorrhagic stroke eventually saw a leveling off of risk. Causes of death were most frequently cardiovascular.
An editorialist says clinicians must recognize that young stroke survivors face a considerably higher mortality risk for 10 to 20 years. He then offers advice for minimizing that risk, including aggressive management of the underlying cause of the stroke.
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Despite free treatment, Britain lags others on health
ears of universal healthcare, rising health spending, cancer screening, immunization and anti-smoking laws have failed to stop Britain falling behind its peers in reducing early death and disease.
Researchers who compared Britain's health performance since 1990 with 14 European Union countries plus Australia, Canada, Norway and the United States said its pace of decline in premature death was "persistently and significantly" behind the average - a finding they described as "startling".
Chris Murray, who led the work at the University of Washington, said Britain's poor performance
was partly due to dramatic increases in Alzheimer's disease and in drug and alcohol abuse problems, and to a failure to tackle leading killers such as heart disease, strokes and lung diseases.
"Concerted action is urgently needed," said Murray, director of the university's Institute for Health Metrics and Evaluation, whose study was published in the medical journal The Lancet.
Featured in Journal Watch: Can We Use the Diagnosis to Determine Whether an ED Visit Was Necessary? By The Journal Watch Editors
Emergency-department presenting complaints are similar for patients with serious and nonserious discharge diagnoses, according to an analysis of data from U.S. ED visits, published in JAMA.
In Journal Watch Emergency Medicine, Daniel J. Pallin writes: "This study invalidates any strategy that uses diagnoses derived from administrative data to identify inappropriate emergency department visits." He adds: "Instead of penalizing patients for using the ED, wouldn't it be better to figure out what features of the ED are attractive to them, and incorporate such features in the medical home?"
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March 2013
PRACTICE TRENDS
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Appearances Can Be Deceptive! medicines for me to look at saying he has been experiencing chest pains for the past several weeks. Upon much questioning of the patient, I find out that the chest pains are associated with shortness of breath and sweats and this was something that I could only get out of him after direct questioning. Since the patient initially did not give me much of his history, I have to kind of dig and delve to extract the information and therefore, come to the proper conclusion. What do you think he has?
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Shekhar V. Sharma, M.D. Board Certified in Internal Medicine
wanted to give you another brief look into what goes through my mind and what I do in my office on a daily basis. Therefore, this article is your looking glass into my practice.
Answer: After much workup and investigation into this gentleman’s complaints, I found that he has underlying heart disease, which he did not know about and it is not unusual in a man of this age. This is one of my simpler cases to diagnose.
Answer: After ruling out heart disease, I diagnosed the patient with a condition called GERD, which means gastroesophageal reflux disease which means a reflux of acid from the stomach to your food pipe also called the esophagus. This can mimic a heart attack at times and I would definitely seek medical attention for something as innocuous as this because it can sometimes be more dangerous than what one would assume.
Answer: At this time, I was on-call in the emergency room at a local hospital and guess what I found after doing a chest x-ray? This unfortunate lady had a very dangerous condition called acute dissection of the thoracic aorta, which is the large artery coming out of the heart. This condition is lifethreatening and also can lead to death if not diagnosed and treated immediately.
Answer: Well, this patient ended up with having cardiac catheterization diagnosed by a cardiologist, which showed severe primary pulmonary hypertension. This is a dangerous condition to have. But at the same time, it is also a rare condition.
Case #2: A 70 year-old lady comes into the emergency room complaining of severe crushing chest pains with shortness of breath and sweats. What do you think is going on?
I would like to take this opportunity to describe a few case histories that I have encountered in my many years of practice. Some of them are quite interesting, challenging and at the same time, time consuming. Patient problems and complaints can be quite innocuous at times and quite misleading, so much so, that if my mind is not completely focused during a busy and hectic day, I could miss the boat. I have written articles regarding different patient scenarios in the past that I have faced in my years of private practice of internal medicine. Below, you will find a few more challenges that I would like for you to help me with the diagnoses:
Many of you may recall the actor, John Ritter. He fell ill on set complaining of chest pains and vomiting, he later died at the hospital of this very condition. It often goes undiagnosed and there is little time to react.
Case #1: A 70 year-old pleasant gentleman comes in with a bag of
Case #3: A 70 year-old gentleman comes into the office today complaining of having chest pains and sweats. Since this patient is not a good historian, I had asked him some direct questions. He has kind of a stoic personality, so it took me some time to get a good history from him. He also has heartburn. What do you think is going on with him?
Case #4: A 40 year-old lady has been experiencing chest pains and shortness of breath on and off for several months with a normal stress test, which means essentially coronary artery disease of the heart was ruled out. This person had no heartburn related to acid reflux disease. So what could she be experiencing?
Case #5: A young gentleman was experiencing chest pains on and off for the past several months accompanied with some shortness of breath. At times, he has also experienced a fever. What do you think the patient could be having?
Answer: Again, another case history from my practice and as routine protocol warrants, I did a chest x-ray of which I always order for anyone that is experiencing chest pains and shortness of breath. I found this person to have lymphoma of the lungs which caused the above symptoms and it had nothing to do with his heart. Case #6: The patient came in with tightness in the chest, shortness of breath and feeling tired. They have been experiencing these symptoms on and off for several months and was getting tired on walking up stairs. What is going on here? Answer: Upon examining the patient, I found him to be wheezing, was a known cigarette smoker and later on, he also mentioned, “Yes, I had asthma when I was a kid, but I do smoke cigarettes too.” Well, this one was easy to diagnose and I’m sure you must have guessed correctly by now. The answer is bronchial asthma. He should stop smoking cigarettes immediately and his condition should improve. Although this person may require medications to treat this condition for life, but if he is careful and does the right thing, he could live a long life free of asthma attacks. Case #7: A young lady came into my office with chest pains, shortness of breath, palpitations and sweats. Again, what is going on with her?
Answer: She has a condition called, mitral valve prolapse which is a valvular disease of the mitral valve of the heart which she has had since childhood and could cause the symptoms above. Again, this was diagnosed by doing an echocardiogram of the heart.
Case #8: Another young lady had been experiencing shortness of breath, sweats, and on and off again palpitations for the past several years comes into my office. She also has a very stressful job and personal family issues to go along with it. Again, what do you think the problem is? Answer: After much workup and ruling out cardiac and pulmonary disease, I found she was having anxiety and panic attacks all along and nothing more. She was otherwise healthy.
So folks, you now know what goes on in my mind when you come into my office with chest pains. I have to think through all the possibilities when you come into my office. Sometimes, it is not easy to do a good job in a short period of time and that is why I take a little longer with my patients. One may think that if I only have a slight pain in my chest that I am sure my doctor can look at me in 15-20 minutes and I can go back to my job or performing my daily duties. Wait, it’s not that easy! I will reiterate again and again, please remember that all of the above scenarios are real and I have encountered all of them. In my many years of practice, I have been fortunate in the above scenarios as I was able to hit the nail on the head and properly diagnose what ails them. One thing that I would stress, is when you are making your appointment with your physician, please let them know all of the symptoms that you are experiencing. This will help for them to allow enough time between patients and your wait will be a pleasant one.
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March 2013
WOMEN’S HEALTHCARE
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What Do Those COPD Medications Actually Do? breathing difficulties. Many of these medications do not work immediately to relieve symptoms and must be taken on a regularly scheduled basis to work effectively. But, there seem to be so many! So, what are they exactly and why are they necessary?
Sheryl Gilman has been practicing respiratory care for 14 years in Palm Beach County. For the last 5 years she has been the Clinical Supervisor of the Cardiopulmonary Department at Lakeside Medical Center, the hospital in Belle Glade serving the residents of the Western Communities. She has specialty certifications in Neonatal and Pediatric care, Pulmonary Function Testing, and is a Certified Tobacco Cessation Specialist as well as having a Bachelor degree in Health Care Services Management.
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By Sheryl Gilman
he physician has diagnosed you or a loved one with COPD and prescribed several medications to improve breathing ability. Although COPD can be a life altering disease process, there are medications either alone or combined that can greatly improve quality of life and limit acute episodes of
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Anticholinergics This long word indicates the action of these medications. In your nervous system, they block off the way choline gets into the nerves. Choline helps your body to maintain a basic tone or support in the bronchial tubes of the lungs. When this type of medication is used, it decreases that tone (or tightness) of the airways allowing the bronchial tubes to relax and create a larger space inside for air to flow. These medications have proved to be especially helpful in improving symptom control in COPD. They work for a long time in the body and therefore are not needed as often as other inhaled medications. Spiriva (tiotropium) has recently shown to be particularly helpful in preventing acute respiratory episodes. In one study, rescue inhaler use was decreased by four uses a week when the patient used Spiriva properly. Another such medication is Atrovent (ipratropium), a medication that has been on the scene for many years. Beta2 Agonists This class of medications is one
moderate or severe COPD. This medication is absolutely not used as rescue medicine in an acute, emergency situation. It must be used regularly and consistently to be effective.
that people with breathing difficulties are most familiar. Albuterol (Ventolin, ProAir), salmeterol (Serevent), formoterol (Foradil), aformoterol (Brovana), and indacaterol (Arcapta) are all in this group. By directly affecting the smooth muscle around the airways in your lung, the inside of the airway increases allowing greater airflow and, of course, decreases the wheezing resulting from “tight” airways. This is where the rescue inhaler albuterol is found. Because, it does work so fast (5-15 minutes), it is used when immediate relief is needed. However, other medications found here, although they do not work as quickly, last much longer and should be taken on a daily basis for long-term
Energy drinks may cause high blood pressure, warn researchers ad news for anyone who likes chugging energy drinks. According to the American Heart Association, energy drinks may cause high blood pressure and irregular cardiac rhythms. These findings were recently discussed at the AHA’s Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2013 Scientific Sessions. According to a news release from the AHA, researchers looked at data from seven previously published studies to figure out how imbibing energy drinks might affect heart health. Their findings were not encouraging for frequent consumers of energy drinks.
The researchers analyzed the QT interval of 93 people who had just drank one to three cans of energy drinks. They discovered that the QT interval was 10 milliseconds longer for the people who had just downed the energy drinks.
According to Dr. Dennis Clements, the QT interval “is a measurement made from the ECG of the time from the onset of the electrical wave in the heart to when the entire heart has reset and is ready for the next beat.”
Researchers noted that prolonged QT intervals can cause sudden cardiac death.
According to lead author Sachin A. Shah, an assistant professor at the University of the Pacific, doctors are usually worried if patients experience an additional 30 milliseconds in their QT interval from baseline.
Co-author Ian Riddock, director of preventive cardiology at the David Grant Medical Center, said the discovery that energy drinks could prolong the QT interval is worthy of additional study given recent reports of sudden cardiac death.
Researchers also learned that the systolic blood pressure rose by an average of 3.5 in a group of
132 participants. Shah called the correlation between energy drinks and increased systolic blood pressured both “convincing and concerning,” adding that patients with high blood pressures or long QT syndrome should avoid energy drinks. The potentially adverse health effects of energy drinks on children, adolescents and young adults have already been described by researchers in the journal Pediatrics.
“The known and unknown pharmacology of agents included in such drinks, combined with reports of toxicity, raises concern for potentially serious adverse effects in association with energy drink use,” wrote the authors.
control of bronchospasm (wheezing from tightened airways).
Corticosteroids This group of medications helps to reduce inflammation in the lungs. Inflammation is not so much an event as a process with many steps. Inhaled corticosteroids such as fluticasone (Flovent), budesonide (Pulmicort), and triamcinolone (Azmacort) interrupt this process thereby reducing inflamed lung tissue to allow greater air flow through the bronchial tubes with fewer side effects than oral medication such as prednisone. Although, more effectively used in the treatment of Asthma, it can be helpful in controlling acute episodes in
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Other Medications Another medication on the market used in the management of severe COPD is roflumilast (Daliresp). This drug decreases airway inflammation and relaxes the airway to allow greater airflow. Various other medications may be added temporarily as needed when COPD flares up, but are not necessarily used on a daily basis. This includes mucolytics such as n-acetylcysteine to break up extremely thick mucus allowing it to be coughed up more easily. Supplemental oxygen, considered a drug and regulated as such, can be quite helpful both during an acute attack requiring hospitalization and on a more long-term basis in the home.
COPD is a treatable lung disease, but often requires a combination of medications to control. The patient’s best efforts at following a treatment regimen are required to maintain a positive quality of life. Whenever a new medication is prescribed, ask questions and understand the importance of its use. Any respiratory therapist, nurse, or physician will be happy to provide information and answer your questions.
Excess Salt a Factor in 2.3 Million Deaths Annually Worldwide verabundant salt intake was a factor in nearly 2.3 million deaths from heart attacks, strokes and other heartrelated causes that occurred worldwide in 2010, according to a new study.
That number represents 15 percent of all heart-related deaths that year, the researchers said. Nearly 1 million deaths (40 percent) caused by eating too much salt were considered premature, occurring in people aged 69 and younger, the study found. Sixty percent of the deaths were in men. The United States ranked 19th out of the 30 largest countries, with 429 deaths per million adults caused by eating too much salt. That works out to one in 10 of all heart-related deaths in the United States, the study authors noted.
Heart attacks caused 42 percent of the deaths worldwide, while strokes caused 41 percent. The rest of the deaths were caused by other types of cardiovascular disease. Eighty-four percent of the deaths were in low- and middle-income countries. (The United States is considered a high-income nation.)
Among the 30 largest countries, those with the highest death rates due to excess salt consumption per million adults were: Ukraine, 2,109; Russia, 1,803; and Egypt, 836.
Among all countries, those with the lowest death rates related to salt consumption per million adults were: Qatar, 73; Kenya, 78; and United Arab Emirates, 134. The study was scheduled for presentation at an American Heart Association (AHA) meeting in New Orleans. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.
"National and global public health measures, such as comprehensive sodium reduction programs, could potentially save millions of lives," lead author Dr. Dariush Mozaffarian, an associate professor of medicine and epidemiology at Harvard Medical School and the Harvard School of Public Health, said in an AHA news release. Although the study found an association between high salt intake and higher risk of death, it did not prove a cause-and-effect relationship.
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March 2013
UPCOMING EVENTS
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Upcoming Charity and Medical Fundraising Events March 20 – April 30, 2013 March 21
Red Cross. 3rd Annual Honoring the Hero in All of Us. Ruth’s Chris Steakhouse, Boca Raton. Tickets are $150.00 per person. For additional information, contact Jennifer Durrant at 561-650-9105 or e-mail Jennifer.durrant@redcross.org. Or, visit their website at www.pbtcredcross.org.
March 23
WPBF 25’s Health & Wellness Festival with Dr. Oz. The Gardens Mall, Palm Beach Gardens. For additional information, visit their website at www.thegardensmall.com.
April 3
Palms West Community Foundation. 2013 Women of the Year Stiletto Luncheon. Breakers West Country Club, West Palm Beach. Tickets are $30.00 for members and $35.00 for nonmembers. For additional information, contact Mariela Castillo at 561-790-6200 or at mariela@cpbchamber.com. You can also visit their website at www.cpbchamber.com.
April 6
Boys & Girls Clubs of Palm Beach County. Barefoot on the Beach. The Breaker’s Beach Club, West Palm Beach. Tickets are $300.00. For additional information, please contact 561-683-3287.
April 26
Central Palm Beach County Chamber Installation Gala. International Polo Club, Wellington. Tickets for members are $125.00 and future chamber members are $175.00. For additional information, contact Jaene Miranda at 561-578-4816 or e-mail her at jaene@pbcchamber.com. You can also visit their website at www.cpbchamber.com.
Antibiotic resistance a "catastrophic threat" -UK medical chief Antibiotic resistance poses a catastrophic threat to medicine and could mean patients having minor surgery risk dying from infections that can no longer be treated, Britain's top health official said on Monday.
Sally Davies, the chief medical officer for England, said global action is needed to fight antibiotic, or antimicrobial, resistance and fill a drug "discovery void" by researching and developing new medicines to treat emerging, mutating infections.
Only a handful of new antibiotics have been developed and brought to market in the past few decades, and it is a race against time to find more, as bacterial infections increasingly evolve into "superbugs" resistant to existing drugs. "Antimicrobial resistance poses a catastrophic threat. If we don't act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can't be treated by antibiotics," Davies told reporters as she published a report on infectious disease.
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March 2013
COMMUNITY EVENTS
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Palm Beach County Medical Society Services Recognizes Outstanding Leaders
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alm Beach County Medical Society Services paid tribute to outstanding community partners and physician leaders at the Annual Meeting on March 14, 2013 at the Atlantis Country Club. The following individuals and organizations were recognized. PBCMS Services Leadership Award: Dr. Michael Dennis
Project Access Awards: Medical Physician of the Year: Dr. Marypat Lynch Clements Surgical Physician of the Year: Dr. David Weinstein Hospital of the Year: West Palm Hospital Medical Provider of the Year: Laser & Surgery Center of the Palm Beaches
Julie Quattlebaum, Greg Quattlebaum, K. Andrew Larson, MD, Ivy Larson.
HERC and MRC Awards: HERC Leadership Award: Brenda Atkins HERC Member of the Year: Mary Russell, RN MRC Member of the Year: Edward Knuckles
Brent Schillinger MD was recognized for his service as President. The following individuals were installed as members of the 2013 Board of Directors: Douglas Dedo, MD – President Michael Dennis, MD – Vice President Ivy Faske, MD – Secretary Don Chester – Treasurer Brent Schillinger, MD – Immediate Past President William Adkins, MD Brenda Atkins Cynthia Clayton, MD Tammy Clarke Ronald Davis, PhD Bradley Feuer, DO, JD Marsha Fishbane, MD Judy Goodman, Esq. Matt Gracey Daniel Higgins, MD Robert Hill Stuart Himmelstein, MD James T. Howell, MD Heather Siegel Miller, Esq. Alan B. Pillersdorf, MD Greg Quattlebaum Andrea Stephenson Jim Sugarman Kimberly Warth
DEAR DEBORAH: My boyfriend of two years is a motivational speaker for one of those glorified pyramid companies. He earns a lot of money and maintains an extravagant lifestyle. He also travels all over the world for various events and functions. I have seen photos from these events, not because he has shown me, but because I know where to look to view them. I have been heartbroken many times. Several of those photos show him with the same woman. Although he denies cheating, he never invites me to these work events. We recently had another blowup because he has a work-related cruise next month and hasn’t invited me. When he does travel and I reach out to him, he’ll respond with “I have business meetings all day and night and don’t have time to talk.” Really? I resorted to
stealing his old cellular phone and went through his old emails and text messages. From what I could see, he met with about 50 women from the same dating site where we met, slept with them and dismissed them. There is so much more, but I just wanted to ask your opinion on this issue. He tells me that he loves me, but he really doesn’t show much emotion or do anything to prove that. - Cause for Concern?
Dear Cause for Concern: You certainly do have a lot going on in your relationship. Would I view this as cause for concern... absolutely! He shows a pattern of deceptive behavior. Is he the only man available in your area? What is it that you are getting from this relationship – other than heartache? I personally would run, not walk away from this man. He seems to be selfabsorbed and shows a lack of
Jose Arrascue, MD, Tenna Wiles, Palm Beach County Medical Society CEO, Douglas Dedo, MD, and Ivy Faske, MD.
Ivy Faske, MD, Alan Pillersdorf, MD, Stefan Pasternack, MD, Brent Schillinger, MD, and Jeff Berman, MD.
compassion, empathy and emotion for other women. You were wrong to take his old phone, however after finding all the women that he had been with from that phone alone, why and how could you excuse such behavior? You need to dig deep within yourself to determine if you really care for this man and if so, WHY? Perhaps it’s his status or money that keeps you there. You should ultimately be concerned about yourself. Take a long hard look at what it is you are looking for in a partner. If you like drama and deception, then he’s your man. If you are looking for stability, honesty, loyalty, love, support, communication and understanding – look elsewhere.
DEAR DEBORAH: I know that you have mentioned how to respond to a man or woman in online dating. However, I want to know what to
Dear Deborah
put in my profile that will attract someone. Are there any suggestions that you can offer? - How to Attract Someone?
Dear How to Attract Someone: I would love to offer some helpful hints. Before you begin, put your optimistic hat on. Think about all the wonderful and positive ways that you can describe yourself. Now, create some interesting, exciting and creative text that can incorporate all of those great qualities and sell it. Be original and avoid simple statements. For example, “I love life” is such a generic statement and yet, people use it. It’s great that you love life, but who doesn’t? Instead, try to add your own flair as to why you love life. You do not want to put your life story in print. Keep your negative qualities out of your profile. For example, you
do not want to say, “You cannot talk with me until I have had my morning coffee.” Instead, you can write, “There is nothing like the smell of fresh coffee brewing that really gets me going in the morning.” You spun the negative into the positive. Remember, you are simply trying to get your foot in the door. Let your potential partner feel your energy through your words and want to be around you. Again, be creative, have fun, and simply leave them wanting to learn more about you. If you would like for me to review and offer suggestions, please feel free to send me your online profile.
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.