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SEPTEMBER 2012 • COVERING THE I-4 CORRIDOR
Nemours Children’s Hospital
Opens Doors to Advanced
Pediatric Care
Local Care Designed
‘FOR Families, BY Families’
Experts at providing
big hope for the
tiniest hearts.
The last words a new parent wants to hear are “life-threatening heart condition.” No one understands this
emotional rollercoaster more than Florida Hospital for Children. Our full cardiac program is led by a team
of experts including our medical director Constantine Mavroudis, MD, one of the nation’s leaders in cardiac
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journey for your child begins right here at Florida Hospital for Children.
FloridaHospitalForChildren.com/Heart | (407) 303-KIDS (5437)
contents
4
SEPTEMBER 2012
CENTRAL FLORIDA EDITION
 COVER STORY
Coming to Orlando in October: Nemours Children’s Hospital and
Health Campus
Photo: mage courtesy of Skanska USA
Nemours Children’s Hospital will be home to some of the top pediatric specialists
in the country and will offer specialized care that is not currently available in Central
Florida. The 60-acre pediatric health campus has been designed FOR families BY families and will offer family-centered specialty care, education and state-of-the-art hospital
services. The pediatric team at Nemours will provide expert care to children of Central
Florida and beyond. They are actively working to bring the latest advances in research
and treatment to all children.
Nemours Children’s Hospital
19
Photo: PROVIDED BY HEART OF FLORIDA REGIONAL MEDICAL CENTER
SPECIAL FEATURE 
Heart of Florida Regional Medical Center is celebrating 15 years of providing quality care at its current location on Highway
27 in Davenport. After a six-month development phase, Heart of Florida recently
unveiled its $9.5 million expansion into the
fifth floor. Open since June 24th, all 31,000
square feet of the new floor is dedicated to
the Center for Women’s Health, offering 10
large birthing suites, 20 post-partum beds,
an expanded nursery and two dedicated
operating rooms. With space freed up elsewhere in the hospital, the Pediatrics Department is growing, too, expanding care for
women and children at Heart of Florida.
DEPARTMENTS
3 FOR YOUR ENTERTAINMENT
30 First Pediatric Bone
Marrow Transplant Unit
Opens in Central Florida
31 Powerball & Real Estate
Offer Similar Choices!
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FROM THE PUBLISHER
10 MARKETING YOUR PRACTICE
12 PULMONARY AND SLEEP DISORDERS
14 PHARMACY UPDATE
16 Behavioral Health
33 CURRENT TOPICS
18 Medical Malpractice Expert Advice
36 ADVERTISERS INDEX
23 ORTHOPAEDIC UPDATE
25 DIGESTIVE AND LIVER UPDATE
28 CANCER
FLORIDA MD - SEPTEMBER 2012
1
FROM THE
THE PUBLISHER
PUBLISHER
FROM
II
am pleased to bring you another issue of Florida MD. Cancer in all its forms touches millions of lives.
Iam pleased to bring you another issue of Florida MD Magazine. It’s hard to imagThe disease is particularly devastating when the victim is a child. The family dynamic is strained.
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profit organization that provides direct support and assistance to the children and families in the Central
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you have a patient or
always reinventing
to create
newusprograms
and services.
Coming upIf next
know a family that could benefit from their services please pass along the information below. Please join
month is the annual March for Babies. It’s a wonderful team-building opportunity for
me in supporting the Runway To Hope and the fine work they do.
Best regards,
tions on how you and your family can join the march or how to form a team for your
whole practice. I hope to see some of you there.
Donald B. Rauhofer
Warm regards,
Publisher
Runway To Hope is a non-profit organization founded in September 2010 by Mark and Josie NeJame. Runway To Hope’s mission
is to serve and provide direct support to the children and families in the Central Florida community who have been impacted by
Donald B. Rauhofer
pediatric cancer. Assistance includes but is not limited to research, education, technology and family assistance.
Publisher/Seminar Coordinator
The organization aids these children and their families by partnering with Arnold Palmer Hospital for Children, Florida Hospital
for Children, corporations, local businesses and philanthropists to raise funds and awareness so that progress made locally will
benefit
children
with cancer,
worldwide.
When
Join
moreallthan
a million
people nationally
walking inand
March
of Dimes, March for Babies and
Saturday,
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24this a special fashion
raising
money to
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family
and friends
It’s signature
charity
eventevery
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Hope
Spring
Fashion
Soiree. The highlight
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7am Registration
8am
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featuring
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incredible
and
brave
children,
ages
2
to
18,
all
who
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currently
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to join you in March for Babies, or even form a Family Team. You can also join with
cancer.
Modeling
much
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than
clothing,
these
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show
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the
truest
beauty
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your practice and become a team captain. Together you’ll raise more money and share
Where
The Runway To Hope Spring Fashion Soiree is a celebration of these children and their incomparable strength and courage.
a meaningful experience.
Lake Lily Park, Maitland
Runway To Hope relies heavily on the pediatric oncologists at both Arnold Palmer Hospital for Children and the Florida Hospital
for Children,
as they are our strongest connection
to thetochildren
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to Runway Toon
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of assistance
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events
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the
Runway
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Hope
Spring
colleagues to support you by
for Babies please call:
1.Fashion
Go toSoiree,
marchforbabies.org
Beauty Bash, Boys Bash and the other events of which we are so lucky to have
them
be
a
part.
Phone: (407) 599-5077
2. Click JOIN A TEAM
Fax:us
(407)
599-5870
To learn more about Runway To Hope please visit www.runwaytohope.org email
at info@runwaytohope.org.
3.Phone
Search for your team name in the
reason
why
people
do
not
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is
that
Central
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Division
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407-802-1544, 189 S. Orange Avenue, Orlando, Florida 32801.
no one asked them to give (don’t be shy)!
search box.
341 N. Maitland Avenue, Suite 115
Emailing them is an easy way to ask.
Maitland, FL 32751
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5.Coming UP Next Month: The cover You’re
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surgeon
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Olga Ivanov at the Comprehensive Breast
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created
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FOR YOUR ENTERTAINMENT
The Orlando Philharmonic Opens the
Pops Series with “Wicked Divas”
The Orlando Philharmonic Orchestra celebrates its 20th anniversary this season. Music Director Christopher Wilkins sums up the
programming for this special period in the orchestra’s history. “This milestone year brings a sense of occasion to every concert. It is a
season of great repertoire, star appearances, and community connection. We are especially pleased to offer works like Prokofiev’s Romeo
and Juliet and Elgar’s Enigma Variations that display so brilliantly the virtuosity of our musicians.”
Nowhere is this sense of occasion more apparent than in the Pops Series. “The Pops Series,” explains Wilkins, “is filled with joy and
spectacle, offering Central Florida’s diverse community a range of musical styles and experiences to choose from. Broadway (Wicked
Divas), Family Entertainment (Home for the Holidays) and the Great American Songbook (Michael Andrew’s My Funny Valentine)
inspire programs that are attractive, diverse, and attention grabbing. The year is capped by a full production of Frank Loesser’s Pulitzer
Prize-winning musical, How to Succeed in Business Without Really Trying.”
The 5-concert Pops Series opens on Saturday, October 13 with wicked good fun! The first program is titled Wicked Divas. It’s a concert
of diva showstoppers from Broadway, opera and popular music and is highlighted by selections from the Tony Award-winning musical
Wicked. This program features the Elphaba (Nicole Parker) and Glinda (Alli Mauzey) from the Broadway production of Wicked and
will showcase the breadth of their high-flying talents. In addition, favorites from the “untold tale of the witches of Oz,” the program also
includes favorites from Gypsy, Ragtime, Titanic and opera selections from George Bizet’s Carmen.
Andrew Lane returns to the Philharmonic stage to conduct this concert. In 2010, Maestro Lane concluded seventeen years as Resident
Conductor and Principal Pops Conductor of the Orlando Philharmonic Orchestra. Under his leadership, the orchestra expanded its
concert offerings to include pops, community concerts, family concerts, and educational concerts, which reached over 60,000 people
each season.
A dynamic and popular pops conductor, Maestro Lane serves as Pops Conductor of the Sarasota Orchestra and will lead that ensemble
for all their subscription pops concerts for the 2012-2013 season. His pops concerts have included Banford Marsalis, Deborah Gibson,
Peter Schickele, Arturo Sandoval, Roy Scheider, Doc Severinsen, Broadway star Davis Gaines, and many other renowned artists. He has
been featured as conductor in 25 CD recordings produced by Madacy Entertainment Group of Quebec, Canada. Mr. Lane has also been
a featured guest conductor with the Florida Orchestra, The Naples Philharmonic, Rochester Philharmonic, Asheville Symphony and San
Antonio Symphony. In October of 2010, he was chosen by Bank of America as a “Local Hero” for his commitment to music education
in Central Florida. United Arts of Central Florida named Andrew Lane “Music Educator of the Year” in 2012.
All concerts in the Pops Series are offered on Saturdays at 2:00 p.m. and 8:00 p.m., at the Bob Carr Performing Arts Centre, located
in downtown Orlando. Tickets are priced at $17, $29, $39, $55 and $70.
The Pops Series schedule includes:
OCT 13 – Wicked Divas
NOV 24 – Home for the Holidays
FEB 9 – My Funny Valentine
MARCH 30 – Cirque de la Symphonie
MAY 11 – How to Succeed in Business Without Really Trying
To purchase tickets or to learn more about this series or the Classics, Focus and Opera Series, call the Box Office at (407)
770-0071 or visit www.OrlandoPhil.org. 
FLORIDA MD - SEPTEMBER 2012
3
COVER STORY
Nemours Children’s Hospital Opens Doors
to Advanced Pediatric Care
Local Care Designed ‘FOR Families, BY Families’
By Nancy DeVault, Staff Writer
Just over three years after breaking ground on Nemours Children’s Hospital, the facility will open its doors to its first patient
on Oct. 22, 2012 in what is known as Lake Nona Medical City.
The historic achievement will grant Central Florida families and
statewide residents alike access to long awaited, much demanded
pediatric specialty care. With just 50 freestanding pediatric hospitals in the nation, Nemours Children’s Hospital will be the region’s only entity solely offering exceptional pediatric medicine
including emergency treatment, prevention programs, and most
importantly, a wide range of medical services, including specialties that are not currently available in Central Florida, which will
provide intensive and acute inpatient care, in addition to outpatient services covering more than 40 disciplines.
Since the conception of the Nemours Foundation in 1936, this
large pediatric health system has operated with a “for families,
by families” mission. Today, the Nemours health system directly
impacts care for 250,000 children annually through personalized
treatment plans offered throughout 28 clinic and hospital facilities located in Delaware, Florida, New Jersey, and Pennsylvania.
Nemours will have great influence in advancing pediatric medicine and research, in addition to economic stimulus, in Orlando.
In fact, thus far, Nemours Children’s Hospital has hired more
than 750 associates comprised of more than 200 trained nurses,
50 skilled physicians and surgeons, an experienced visionary ad-
ministration team, and hundreds of other accomplished clinical
and organizational staff positions.
“This hospital will represent how the Nemours Foundation
believes care ought to be given to children in the 21st century,”
stated David Bailey, MD, MBA, president and chief executive
officer of The Nemours Foundation. “It’s all about providing care
and support to children and the entire family unit, while effectively allowing health care professionals to implement superior,
quality care.” That goal has remained a driving force during the
formation process, and will finally take effect on a grand scale
next month. Parents also will continue to have access to Nemours
Children’s Clinics located throughout the state including Destin,
Jacksonville, Lake Mary, Orange Park, downtown Orlando, Pensacola, and Viera.
Decision Making is a Family Affair
Barbara Meeks, RN, MSN, MBA, chief nurse executive for
Nemours Children’s Hospital, explains that pediatric medicine is
a personal family affair, and therefore, Nemours Children’s Hospital embodies a patient-family centered model of care. “When
you are taking care of a sick child, you’re truly taking care of the
whole family. It’s definitely not exclusive to one or the other – it’s
both.” Meeks, who offers 35 years of pediatric health care experience, explains that though Nemours physicians may spearhead
Photo: Image courtesy of Skanska USA
Nemours Children’s Hospital will open to patients on October 22, 2012 in Lake Nona’s Medical City, near the Orlando International Airport.
Patients will have a chance to control the color of the overhead lighting in the rooms, making NCH a colorful place at night and giving
patients a sense of control over their environment.
4 FLORIDA MD - SEPTEMBER 2012
Paul and the other members have participated in
monthly Family Advisory Council discussion and
planning sessions, plus focused subcommittees. Results are integrated throughout the hospital, including details like the surface over patient beds. When
one parent realized the reflective surface could scare
a child to see himself with tubes in the arms and
nose, the Family Advisory Council had the surface be made non-reflective. “As ‘frequent-users’
of healthcare and medical facilities, we know what
our kids need and want more than hospital ‘traditional builders’. For example, while most might
expect food services to only provide ‘healthy’ meal
plans, my son actually requires a higher caloric intake including high fat, high sodium foods because
his body’s ability to absorb and process nutrients is
different,” Paul explains. She adds that the diverNemours Children’s Hospital is a hospital designed FOR families BY families. The
sity among the Family Advisory Council members
Nemours Family Advisory Council is made up of a group of local moms and dads who
(referring specifically to the variety of medical conhave been there every step of the way, meeting regularly with the hospital architect
and other executives to provide feedback on the design and policies of the hospital.
ditions) is what will make the unique qualities of
The Nemours Family Advisory Council is made up of members of the community,
Nemours Children’s Hospital best set to serve the
many of whom have children with health issues.
needs of all families. “A fellow member utilizes a
large motorized wheelchair for her daughter and
treatment plans, parents know their child best and thus, their
was able to communicate her concern of space, such as handicap
knowledge and insight must count. “Parents, and of course our
parking lot accessibility and size to room functionality.” Paul says
children, are the end-users of what we do. Their direction for our
that parents also were ‘testers’ for furniture such as desks, beds,
new facility and service lines has been essential in establishing the
best quality of care that fits their treatments needs.”
On October 6, 2012 Nemours will host a Community Open House.
To deliver this collaborative approach, Nemours Children’s
Hospital established a Family Advisory Council to learn precisely
what families desired for Orlando’s new pediatric medical facility.
The council is made up of members of the community, many
of whom have children with health issues. Under the executive
ambassadorship of Meeks, roughly 25 local families, who have accessed the Nemours health system, were called to offer their consultative ‘expertise’ aimed to achieve a unique vision: “for families, by families.” Many of the passionate members are parents of
children who have varying diagnoses and alignments, reflective of
potential patient populations. Their personal feedback has guided
aspects of facility and services development including planning,
designing and building phases. “Sometimes children and their
families spend days, weeks, or even longer in the hospital setting. Their comfort level – both physically and emotionally – is a
key content to our healing environment. We gauged their hopes,
wants and treatment frustrations,” adds Meeks.
A public open house event for community families, patient families and
Associate families. A great opportunity to tour the brand new hospital.
The Family Advisory Council offered the direct perspective of
parents like Lori Paul, an Orlando full-time mother to 8-year-old
Max who received a diagnosis of cystic fibrosis at 13 months of
age. Paul credits a Nemours physician with identifying her son’s
rare symptoms that had previously been overlooked. “The caring
team at Nemours has always felt like a family to us, truly invested
in Max’s well-being. To be offered the chance to participate in the
Family Advisory Council is simply the ultimate display of Nemours’ desire to foster genuine patient-family care. It’s unheard of
in medicine and amazing!”
Photo: Image courtesy of Nemours
Photo: Image courtesy of Preston Mack
COVER STORY
FLORIDA MD - SEPTEMBER 2012
5
COVER STORY
Photo: Image courtesy of Nemours
perinatal guidelines for a low nurse to patient ratio
(1:4 pediatrics and 1:3 intensive care unit), will also
take a collaborative approach to leadership. “We’ve
established a physician-nurse partnership to oversee
the emergency department. It’s a joint responsibility
for all aspects including financials, quality of care,
patient satisfaction, staffing and so on. This strategy
will ultimately eliminate silos among roles and create
uniformity,” describes Meeks.
Nemours fully understands the important role nature plays in the healing process
and has incorporated natural settings into the facility’s design - both inside and out.
The 10-thousand square foot garden on the fourth floor was designed with the help
of occupational and physical therapists who will use the space as part of a patient’s
rehabilitation. On the second floor, a seven thousand square foot balcony garden will
offer a distraction to families while a child is in surgery. The balcony is just off the
surgical commons area where families gather. It will also provide a quiet refuge for
staff. Nemours Children’s Hospital’s one acre Discovery Garden will bring together
nature and art by featuring five interactive areas devoted to the five senses.
couches, electronic capabilities, and other items that parents will
utilize in private patient rooms and/or waiting lounges.
This patient-family centered influence stems back to Nemours
Children’s Hospital’s objective to simply offer parents more choices. “It’s more than just physical design input. We’re expanding
upon parent choices from comfortable, 24-hour access to be with
your child to the ability to be present when the anesthesiologist
puts your child to sleep before a procedure. We are listening to
our parents and they see that in turn, the Nemours team is doing
whatever we can to save the life of their child,” said Meeks.
Lori Paul says she is especially looking forward
to the ‘one-stop shop’ quality care experience that
Nemours Children’s Hospital will provide to her son
Max. The 60-acre, fully integrated health campus is
split into two complimentary halves. One side of the
facility is clinic-based, housing specialty pediatric
practices; while the other is an advanced 95-bed hospital inclusive of a pediatric emergency department.
“We won’t have to shuffle around town (or even to
another city) to different doctor’s offices because all
of Max’s specialty physicians - pulmonologist, nutritionist, gastroenterologist, social worker and other
providers - will be here at one centralized location,”
says Paul.
By the end of the year, more than 750 people will be working at
Nemours Children’s Hospital in Orlando. The medical staff has been
training in the brand new, state-of-the art building in preparation for
the specialized care they will provide Central Florida’s children on
opening day, October 22, 2012.
The nursing team of the system’s other children’s hospital, the
Nemours/Alfred I. duPont Hospital for Children in Delaware
was equally as vital in contributing design direction for functionality of private patient rooms. With an understanding that
the nursing staff likely navigates patient rooms most frequently,
their experience offered knowledge surrounding flow of care
and space requirements affecting the ease of equipment’s mobility. Ultimately, such insightful planning on the front end for
Nemours Children’s Hospital will allow staff to work more efficiently, resulting in cost savings. Nemours nurses, who follow
6 FLORIDA MD - SEPTEMBER 2012
Photo: Image courtesy of Nemours
More than a dozen members of the Family Advisory Council
are trained to interview finalists for positions at Nemours, including involvement in the hiring of top executive level positions.
“The opinions of our Family Advisory Council truly were deciding factors in determining our leadership roles. For example, these
members took part in the interview and hiring process of Randall
W. Hartley who was ultimately hired as Chief Administrative Officer (CAO) for Nemours Children’s Hospital,” says Meeks.
Unique features generated with the support of the
Family Advisory Council are prevalent throughout all
hospital floors. Embracing the power of nature, natural
light fills the hospital. Outpatient surgery and surgical
clinics are housed on the second floor, under the third
floor neonatal and pediatric intensive care units. The
fourth floor houses infusion departments and pediatric specialists, with the rehabilitation and neuro units
comprising the fifth floor.
Specializing in Pediatric
Specialties
Photo: Image courtesy of Nemours
The Nemours health system utilizes HIMSS Analytics™ Database, an electronic records system which
grades progress in effectively completing eight stages
(0-7) of electronic technology. In 2011, Nemours
Members of the Family Advisory Council have strong opinions about what a hospital
should and should not include. They looked at the designs and made plenty of
achieved Stage 7, this top level has only been accomchanges. Not only have they helped shape the hospital design but they are helping
plished by 5 percent of hospitals nationwide. With a
select the staff who will work there by interviewing candidates who want to become a
comprehensive environment embodying numerous
physician or a leader at Nemours.
specialties, this high standard of metric tracking ensures patient safety and quality of care. “Medical personnel can
ida, University of Florida (Pharmacy), the Orlando VA Medical
easily access up-to-date medical records at the bedside of a paCenter and even Holmes Regional Medical Center. Dr. Finkel, is
tient,” explains Terri Finkel, MD, PHD, chair of pediatrics and
also an example of one of the rare specialists recruited by Nemchief scientific officer for Nemours Children’s Hospital.
ours. She is one of just 250 pediatric rheumatologists practicing
in the nation and earned a top distinction by U.S. News & World
Dr. Finkel is charged with establishing cutting-edge pediatric
Report. Prior to her arrival in Orlando, no one with this specialty
research programs. She says Lake Nona Medical City offers rewas based in Orlando. “The U.S. Department of Health and Husearch synergy through collaborations and partnerships from the
man Services estimates that the specialty field of pediatric rheuSanford-Burnham Research Institute, University of Central Flormatology actually requires at least 700 more trained physicians
throughout the country. Our community is delivering
Doctors at Nemours Children’s Hospital are not only treating children but
that demand for care. This unique specialty will impact
they are also looking for ways to cure them. Nemours’ location in Lake Nona
many families who previously had no choice but to
Medical City and its proximity to Sanford-Burnham has been enormously
travel at least 50 miles outside of the area for rheumatic
helpful in recruiting world-class physician-researchers. Nemours has partnered
diseases such as childhood arthritis or autoimmune diswith Sanford-Burnham to house the lab space physicians need to search for
new treatments and cures for childhood illnesses.
eases,” says Dr. Finkel.
Dr. Finkel says that while ‘Dr. House’ may be the fictional lead character on the FOX network’s hit television
program, sometimes children’s health symptoms often
do require ‘detective’ medicine. In addition to pediatric
rheumatology, Dr. Finkel says Nemours Children’s Hospital will offer other specialties new to the Central Florida
area and advancements to other specialties already present. Some new disciplines include, among other areas,
chronic pain, pediatric rehabilitation, gastroenterology,
behavioral health, fetal surgery, interventional radiology
and muscular dystrophy – a specialty area for her husband and fellow researcher, Richard Finkel, MD. “Like
many aligned with Nemours Children’s Hospital, we’re
looking for cures, not just methods of treatments.”
Dr. Finkel’s research is still needed to answer very basic questions stumping medical scientists: Why is this
specific condition developing? How does the condition
occur (in children)? What is the genetic makeup? She
FLORIDA MD - SEPTEMBER 2012
7
Photo: Image courtesy of Preston Mack
COVER STORY
is now working to find solutions in her laboratory,
located at the Sanford-Burnham Institute, regarding
pediatric immune system diseases. Dr. Finkel says it’s
important for parents to know that physicians at Nemours Children’s Hospital are leading the charge with
pediatric research. “Patients will gain a sense of security and hope knowing their physician is a researcher.
Research physicians are accustomed to asking questions and digging down for a precise, accurate conclusion. Therefore, we’re not going to accept the obvious
and possibly flawed medical diagnosis and treatment
approach when caring for pediatric patients. We can
do better…we can save lives. That’s why our motto remains Your Child. Our Promise.” 
NEMOURS CHILDREN’S HOSPITAL:
Photo: Image courtesy of Nemours
COVER STORY
Fred Hames, right, Executive Vice President and General Manager of Skanska
Florida, turned over the ‘key’ to Nemours Children’s Hospital to CEO, Roger
Oxendale. The first wave of new associates were then welcomed into the building
for the very first time.
Adolescent
Cardiology
Critical Care Medicine
Endocrinology
Hematology/Oncology
Hospitalist Services
Infectious Disease
Gastroenterology
General Pediatrics
Genetics
Neonatology
Nephrology
Neurology
Physical Medicine & Rehabilitation
Pulmonology
Rheumatology
Behavioral Health
Surgical Specialties
Craniofacial
Dental
ENT
General Surgery & Thoracic
Interventional Radiology
Neurosurgery
Orthopedics
Urology
Ancillary Services
Radiology
Anesthesia
Pathology
8 FLORIDA MD - SEPTEMBER 2012
Photo: Image courtesy of Nemours
Medical Subspecialties
Nemours Children’s Hospital’s has a modern aesthetic design that is fresh,
progressive, and playful for children of all ages. Designed with the child of the
information age in mind, technology was incorporated in creative ways.
Nemours Children’s Hospital
13535 Nemours Parkway
Orlando, FL 32827
Phone: (407) 567-4000
Nemours.org
Get Connected to
Nemours Children’s Hospital
Facebook.com/Nemours
Facebook.com/NemoursChildrens
Twitter.com/Nemours
YouTube Channels:
• NemoursUpdates • YourchildOurpromise
Flickr.com/Nemours
Interventional Radiology Services
now available at Dr. P. Phillips Hospital
Every Tuesday, Dr. P. Phillips Hospital Interventional Radiology is now offering Interventional Outpatient
Imaging procedures. Procedures include:
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To schedule a patient appointment, please
contact Karen Bolton, Interventional
Radiology Coordinator:
Phone: 321.842.7611
Fax: 407.351.1949
Email: Karen.Bolton@orlandohealth.com
Sunrise via SMS Messaging at: Karen B’s DPHIR.
FLORIDA MD - SEPTEMBER 2012
9
Marketing Your Practice
Found Dead on Arrival: Public Relations
By Jennifer Thompson, President of Insight Marketing Group
Some people out there will argue that traditional public relations as it was once known is dead (or, rather, dying a slow
death). Others will say that traditional public relations has simply
evolved – that the message is the same but the delivery of the message is what has changed significantly. Either way, if you’re over
40 and aren’t an early adopter you may very well be looking at a
career change if you’re in the public relations field. If you haven’t
evolved the way your office delivers its public relations announcements, your efforts could be dead the second they arrive in the
news editor’s inbox.
Today, there are two types of public relations and then there’s a
whole bunch of stuff in between.
Proactive Public Relations – has an inbound marketing strategy
at its core, and contains a strong content creation program and
social media strategy which including news releases, timely story
pitches and media alerts for media-friendly events.
Reactive Public Relations – includes managing your reputation and responding to what’s being said about you, your medical
practice (or any type of business for that matter) and your specialty across the internet and in the real world.
Why Your Business Needs to be
Proactive:
If your practice is strictly reactive, you’re missing out on all
sorts of free media attention and opportunity. The trick is knowing the proper ways to deliver the message so it’s most effective in
garnering attention for your practice.
Here are some stat’s that help illustrate why proactive public
relations are so important:
• 84% of all marketers agree that building consumer trust will
become marketing’s primary objective in the near future.
• More than 92% of buyers regularly check reviews online before making a purchase or service decision.
• 78% of consumers trust peer recommendation while only
14% trust advertisements.
• 4 out of 5 people say they have received advice via social media regarding what product or service to purchase.
A recent study by Hubspot says that businesses that practice
inbound marketing (where customers find you and CONTENT
IS KING) increase leads an average of 4.2 times within a few
months. It was also reported that 70% of customers (patients)
prefer getting to know a company (your medical practice) via articles rather than advertisements.
If you want potential customers to find you, then you need to
10 FLORIDA MD - SEPTEMBER 2012
put stuff out there for them to find
(such as videos, articles, announcements, photos, presentations, etc.)
and you need to do it consistently.
You also need to post these efforts
and push them through your own
channels, rather than just relying on
the traditional means of sending news releases and pitch letters.
Do those still work? Sometimes. But having all of your bases covered and making sure your inbound internet presence is strong is
part of the evolutionary process.
When well executed, an effective content management plan
will increase your organic search listings, protect your online reputation and drive traffic to your website. I would argue that if you
are thinking about hiring a public relations firm to increase your
visibility in the marketplace, consider hiring an inbound marketing firm that specializes in content development, social media
and online reputation management in lieu of or in addition to a
traditional PR team.
They should have a clear understanding of the do’s and don’ts
in public relations but also a clear understanding and ability to
get your messaging out there in the non-traditional outlets. Long
gone are the days where the only way to get noticed was to get
picked up in your local newspaper or television station. Today,
the internet (including social media and blogging) has afforded us
the opportunity to bypass the traditional media outlets altogether
and deliver our messages directly to patients. Public relations today has become more about search engine optimization (SEO)
and getting your news indexed on the first page of Google than
about getting your story covered on the evening news.
If you are looking to get picked up in the traditional sense,
one thing that certainly hasn’t changed in the realm of public
relations is the need to make your business relevant to the news
cycle. Making yourself relevant will increase your odds of getting
picked up tenfold.
Being relevant to the current news cycle is a great way to get
your business and brand some good publicity and a nice way to
help improve your online reputation at the same time (this means
you are practicing both proactive and reactive public relations).
For example, the Florida State Legislature recently passed a
new youth concussion law requiring that all high-school athletes
receive clearance from a physician following a suspected concussion-related injury on the field in practice or during a game. We
saw this as an opportunity to get one of our clients positioned
with the local television news as an expert on youth athletic injuries and overuse injuries. We also saw this as the right time to an-
Marketing Your Practice
nounce our client’s new baseline testing concussion program for area high schools. Not only were they able to create some great content
for their website, which will go a long way for their online reputation management, but they have received a good deal of traction with
the news program as well.
It’s this combination of traditional, nontraditional, inbound, outbound, proactive and reactive public relations that comes together
to create the desired results and put more patients in your medical office’s lobby. And at the end of the day, after all the buzz words and
trends, jockeying for position on Google, edits and rewrites, submissions and rejections, that’s what it’s all about. When evolution is put
into practice and PR lives to fight another day, we know we accomplished our goal.
Marketing Your Medical Practice: A Quick Reference Guide
Are you ready to finally start marketing your practice? Visit www.InsightMG.com to learn how you can order your copy of
“Marketing Your Medical Practice: A Quick Reference Guide” by Jennifer Thompson and Corey Gehrold on Amazon. Encapsulating their real world medical marketing knowledge and expertise, this easy-to-read book gives you all the tips and tricks you’ll
need to start marketing your practice today in a fast, fun and friendly format – just like the articles in this series. To learn more,
visit www.InsightMG.com.
Looking for more information? Contact Jennifer Thompson today for a free consultation and marketing overview
at 321.228.9686 or e-mail her at Jennifer@InsightMG.com.
Jennifer Thompson is president of Insight Marketing Group, a full-service healthcare marketing group focused on digital
and social media administration, referral and partnership development, creative services and graphic design, online reputation management/development and promotional products. She is co-author of Marketing Your Medical Practice: A Quick Reference Guide and an avid Twitter user, regularly posting medical practice marketing tips, articles and more at www.Twitter.
com/DrMarketingTips. You can learn more about her and her company at www.InsightMG.com. 
Central Florida
Pulmonary Group, P.A.
Serving Central Florida Since 1982
Specializing in:
x
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Asthma/COPD
Sleep Disorders
Pulmonary Hypertension
Pulmonary Fibrosis
Shortness of Breath
Cough
Lung Cancer
Lung Nodules
Our physicians are Board Certified in Internal Medicine,
Pulmonary Disease, Critical Care Medicine, and Sleep Medicine
Daniel Haim, M.D., F.C.C.P.
Syed Mobin, M.D., F.C.C.P.
Tabarak Qureshi, M.D., F.C.C.P.
Daniel T. Layish, M.D., F.A.C.P., F.C.C.P.
Eugene Go, M.D., F.C.C.P.
Kevin De Boer, D.O., F.C.C.P.
Francisco J. Calimano, M.D., F.C.C.P.
Mahmood Ali, M.D., F.C.C.P.
Andres Pelaez, M.D.
Francisco J. Remy, M.D., F.C.C.P.
Steven Vu, M.D., F.C.C.P.
Pranav Patel, M.D., F.C.C.P.
Ahmed Masood, M.D., F.C.C.P.
Ruel B. Garcia, M.D., F.C.C.P.
Downtown Orlando: 326 North Mills Avenue
East Orlando: 10916 Dylan Loren Circle Altamonte Springs: 610 Jasmine Road
407.841.1100 phone | www.cfpulmonary.com | Most Insurance Plans Accepted
FLORIDA MD - SEPTEMBER 2012 11
PULMONARY AND SLEEP DISORDERS
State of the Art: Medical Thoracoscopy
By Jorge Guerrero, MD
WHAT IS MEDICAL THORACOSCOPY?
Medical Thoracoscopy is a minimally invasive procedure that
involves the use of a high definition endoscopic camera that is
introduced percutaneously (via the patient’s chest) in order to
access the pleural space. This allows for a remarkable exposure
to the pleura and the lung itself, therefore allowing the operator
to perform both diagnostic and therapeutic interventions with
pinpoint precision. Unlike Video-Assisted Thoracoscopic Surgery (VATS) used by thoracic surgeons, Medical Thoracoscopy
is performed by an interventional pulmonologist trained in this
procedure. While VATS requires endotracheal intubation, general anesthesia and a hospital stay after the procedure, medical
thoracoscopy is done under conscious sedation and patients may
be discharged home the same day of the procedure to resume
their normal daily activities with no restrictions.
INDICATIONS
The procedure is indicated for the diagnosis and treatment
of patients with recurrent pleural effusions of unknown etiology, suspected tuberculous pleural effusions, chylothorax and
for those that have malignant pleural effusions (regardless of cell
type), including malignant mesothelioma. Furthermore, in lung
cancer, it is used not only as a diagnostic procedure, but also for
staging purposes in order to guide oncologic therapy.
Medical Thoracoscopy is also indicated for those patients with
benign, recurrent pleural effusions (such as may occur with connective tissue disease, post-cardiac surgery and diuretic or dialysis
resistant pleural effusions due to congestive heart failure or renal
failure). The procedure not only allows for sizable tissue biopsies
of the pleura and intrathoracic tumors, but it also permits definitive treatment of the pleural effusion with a single procedure.
Another application involves the treatment of a persistent
pneumothorax in patients who are not candidates for general anesthesia and VATS pleurodesis. In these patients, medical talc can
be instilled via the medical thoracoscope into the pleural space in
order to treat the persistent pneumothorax.
DIAGNOSTIC YIELD AND THERAPEUTIC OUTCOMES
The yield of Medical Thoracoscopy in the diagnosis of malignant pleural effusion is 95%, regardless of cancer cell type. This
surpasses the diagnostic yield of repeated thoracentesis, where the
yield plateaus at around 60%.
Dr. Guerrero obtains pleural
The yield of thoracentesis is
biopsies using Medical
even lower in patient with pleuThoracoscopy (actual patient).
ral effusions due to lymphoma
or mesothelioma.
Tuberculosis currently is the
cause of only 10% of all pleural effusion in the United States.
However, the ramifications of
missing a diagnosis of pleural
tuberculosis (or the side effects
of the anti-tuberculosis medica12 FLORIDA MD - SEPTEMBER 2012
tions if forced to treat based on incomplete data) are significant. Medical
Thoracoscopy has a yield of 95-98%
for the diagnosis of tuberculous pleural effusions, significantly higher than
the expected yield for thoracentesis (10-35%) Or closed pleural
biopsy (36-86%).
Therapeutic outcomes are viewed in terms of resolution of the
pleural effusion. Available data from prospective evaluation of patients have been published with a follow up of up to 6 months,
showing complete control of the pleural effusion in 83% of the
patients. However, non-published observational data suggests
that it actually results in permanent control of the pleural effusion. State of the art protocols combining mechanical pleurodesis
with talc pleurodesis can achieved
Dr. Guerrero insufflates
complete control in at least 90% medical talc guided by Medical
of the cases.
Thoracoscopy in order to treat
a recurrent malignant pleural
Complications are rare with
effusion (actual patient).
this procedure with a mortality
risk of 0.09% and major complication rate of only 1.9% (which
include prolonged air leaks, empyema, acute lung injury and
bleeding). Contraindications to
this procedure include uncorrectable coagulopathy, severe thrombocytopenia and severe hypoxemia. When comparing Medical
Thoracoscopy with other modalities used to diagnose and treat
patients with pleural disease, the advantages of the former are
substantial. Overall, this is a safe and efficacious procedure that is
minimally invasive, avoids hospital admission and provides long
lasting results to the patient.
Dr. Jorge Guerrero, MD, graduated from Universidad
Javeriana School of Medicine in 2002. He then completed
a fellowship at Harvard Medical School in Boston, Massachusetts in Adult Tracheobronchomalacia Novel Clinical Research. Next, Dr. Guerrero completed an Internal
Medicine Residency at Tufts University School of Medicine
in Boston, Massachusetts and a Pulmonary and Critical
Care fellowship at Georgetown University School of Medicine. Dr. Guerrero went on to complete another fellowship at Harvard Medical School – Beth Israel Deaconess
Medical Center in Boston, Massachusetts in the Division
of Interventional Pulmonology. Since finishing his third
fellowship, Dr. Guerrero became a member of Central
Florida Pulmonary Group in Orlando as of August 2012.
Dr. Guerrero may be contacted at 407.841.1100 or by visiting www.cfpulmonary.com. 
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FLORIDA MD - SEPTEMBER 2012 13
PHARMACY UPDATE
Compounding for Autism
By Jill Weinstein, RPh and Farah R. Kablaoui, PharmD Candidate
“I love compounding pharmacists because only they can prepare what I want to prescribe:
pure formulations without dyes, filler, and additives at whichever dose and concentration the
patient needs and in whichever form the patient will best accept.” — Dr. James A. Neubrander,
owner and director of the Autism Clinical Research Center of New Jersey, who specializes in the use of subcutaneously
injected methyl-B12 to treat autism.
Do you treat any patients with autism? Chances are that you do
as the Centers for Disease Control and Prevention reports that 1
in 88 children suffer from this disorder. Autism was defined as a
lifelong neurobiological disorder but some physicians have found
that it may be treatable. Autistic patients exhibit a variety of symptoms including behavioral problems, poor attention and concentration, and depression. It is important to, if not cure the patient,
alleviate some of the symptoms. Serotonin reuptake inhibitors
can be used to treat depression, anxiety and obsessive-compulsive
disorder. Amitriptyline, diazepam, lorazepam, and bupropion
have also been used for anxiety and behavioral problems. Antipsychotics such as risperidone or olanzapine can help stabilize patients that experience hyperactivity or aggression. Compounding
pharmacists can dispense commonly used medications for autism
in different drug delivery vehicles and at various strengths for specific patient needs. Antifungals, antibiotics, transdermal chelation
agents and nutritional supplements can also be formulated.
There can be many contributing factors leading to a lack of
compliance to medications in autistic patients. These patients may
experience symptoms of being overly sensitive to sight, sound,
touch, smell, or taste. Medications can taste too bitter or feel
gritty, topical creams may feel abnormal on their skin or a capsule
may be tough to swallow resulting in noncompliance. Sulfation,
methylation and immune system function appears to be impaired
in autistic patients resulting in dysfunctional metabolism, biochemical function and systemic detoxification. Glutathione and
methionine are peptides responsible for protecting cells from
damage. Low levels of these peptides have been observed to correlate with elevated levels of heavy metals and the body’s oxidative
stress. Sulfation abnormalities result in difficulties in concentration, attention and cognition. Methylation abnormalities result
in hyperactivity and poor concentration. These abnormalities are
also linked to allergies and intestinal tract inflammation. Recent
clinical studies have revealed a high occurrence of gastrointestinal symptoms, inflammation, and dysfunction in children with
autism.
Evidence has recommended that vitamins, minerals and supplements should be given to support the oxidative stress the body
is exhibiting. Methylation is important for a variety of fundamental physiological effects including proper sequencing and production of brain chemicals, such as dopamine and serotonin, which is
utilized in motor coordination, mood and focusing. Methylation
enhances the production of glutathione which is needed to protect cells against heavy metals and chemicals. Methylcobolamin,
a methylated form of vitamin B-12, is a supplement used for the
deficiencies caused by abnormal methylation. The best method for
administering methylated B-12 is subcutaneously. Compounding pharmacies can compound methylated B-12 for patients in a
preservative-free formulation to reduce pain to the area.
Pharmacy Specialists Compounding Pharmacy can customize prescriptions to be delivered in an innovative dosing form to
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14 FLORIDA MD - SEPTEMBER 2012
escf_6.11.indd 1
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PHARMACY UPDATE
tions. Common ingredients omitted in formulations due to food or drug allergies include sugar, dye, wheat, casein, gluten, and yeast. As
taste can be a concern, especially in children, the compounding pharmacy staff will work with parents and the patient to determine what
flavor will be best for patient adherence. The possibilities are endless!
Why not cater to the needs of autistic patients with a formula and delivery form that is created especially for them? Call Pharmacy
Specialists today at (407) 260-7002 or visit us online at www.makerx.com to get the answers for your questions today!
References available upon request.
Validated Quality
Coming UP Next Month: The cover story focuses on breast surgeon Dr.
Olga Ivanov at the Comprehensive Breast Health Center at Florida Hospital
Celebration Health. Editorial focuses on Cancer and Dermatology.
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FLORIDA MD - SEPTEMBER 2012 15
Behavioral Health
What Does the Affordable Care
Act mean for Family Caregivers?
By James D. Huysman, Psy.D., LCSW
What does the Affordable Care Act (ACA) mean for caregivers? That seems to be the question on a lot of minds since the
Supreme Court upheld the legislation.
As we trudge the road less taken to find our place in the new
order of healthcare made possible by the ACA, there are surely
more questions than answers at this point. So, let’s concentrate
on what we know about it.
The Affordable Care Act is a federal statute signed into law
in March 2010 as a part of the healthcare reform agenda of the
Obama administration. Minus the political dramas and traumas
around it, it was designed to address the three-legged dilemma
we see in healthcare today: cost, access and quality. It means that
healthcare delivery is going where it has not gone before.
That means that healthcare delivery is going where it has not
gone before. I know what you are thinking. “Beam me up, Scotty.
Let’s do this!” Right? Great, you’re on board, but are you prepared?
One of the ACA’s best features is that it makes a patient-centered approach to health and wellness possible. This makes each
individual a partner in their own health and wellness. In addition,
it focuses on the concept of prevention and even allows what have
been categorized as “alternative” modalities to be integrated into
the mainstream of 21st century medicine, opening the door to
embracing palliative care as a process that includes the caregiver,
and so much more.
It will not be easy; change never is. Progress may be chaotic
and slow. So it’s even more important to take a collective deep
cleansing breath and get in touch with ourselves – Yes, I said it. A
mu book is titles…Take YOUR Oxygen First. As a caregiver, you
are part of the transitional process. You must also understand that
to be dedicated and empowered you just take care of your mental
health. Anxiety, panic, depression and a host of other treatable
behaviors are at their highest level of activity. If the ACA is about
prevention and wellness for the patient, it is as important to practice wellness and prevention as a family caregiver. Start by taking
care of your health and wellness medically and seek strong mental
health to avoid burnout by identifying a therapist, joining a self
help support group or simply developing a program for yourself
that allows for you to stay balanced and on two sturdy legs.
Now is the time to re-evaluate your caregiving goals. How can I
be included in the process? What do I need that is not being provided? How can I be a better partner in my own wellness and that
16 FLORIDA MD - SEPTEMBER 2012
of the one I care for? Imagine the
healing power for someone in the
grips of a chronic illness to know
that their medical team is in touch with its own wellness.
The French dramatist Eugene Ionesco said, “Art requires that
one place everything in doubt all over again”. What an appropriate metaphor for finding the positive in accepting and molding
the impact of the ACA. The ACA is not perfect but it can be a
process that, if we are up to the challenge, can direct us, as caregivers, to becoming real partners in the continuum of care.
Perhaps the most important question of all is for each of us to
ask ourselves, “What kind of healthcare delivery and support system do I want in this country for myself, my kids and my grandkids? As we ask these questions as a family caregiver, remember
that “let peace (& wellness) begin with me.
Our loved ones will learn an important from us and can take
that lesson to navigate the future for themselves, as well. Now
that’s something to think about!
Dr. James D. (Jamie) Huysman, Psy.D., LCSW began his
career serving in vice presidential roles at freestanding psychiatric and chemical dependency treatment centers. Subsequently he was called upon to integrate behavioral healthcare with medical services in the same capacity at several
national medical surgical hospital groups. Today, he is part
of the WellMed Medical Management team that advocates
for and integrates behavioral health into primary clinic settings to create better qualitative outcomes and care efficiencies.
He received his Masters in Social Work from Barry University and Psy.D. from California Southern University. He
is also certified as an addictions professional and compassion fatigue therapist.
A popular and engaging speaker, Dr. Huysman keeps an
active schedule presenting on a variety of relevant topics for
professional caregivers and service providers around the
country. He can be reached at drj@drjamie.com or through
his website www.drjamie.com. 
WelcomING
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The Center for Specialized Surgery proudly welcomes board-certified surgeons
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J. Pablo Arnoletti, MD, FACS
Sebastian de la Fuente, MD
t Board Certified, General Surgery
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t Fellowship, Surgical Oncology, Fox
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t Fellowship, Surgical Oncology, H. Lee
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FLORIDA MD - SEPTEMBER 2012 17
Medical Malpractice Expert Advice
Focusing On Patient Safety vs. Tort Reforms
By Matt Gracey of Danna-Gracey – The Malpractice Insurance Experts
Often in medicine’s tort-reform efforts, we get so focused on the politics of changing unfair laws that we lose
sight of the low-hanging fruit. How many dollars have gone into trying to convince the politicians to limit the
number of lawsuits against doctors and hospitals? How much progress have we really made, given that a bunch
of states in the last year or two have overturned their caps on non-economic damages? How many years have
some great medical leaders spent rallying their peers to contribute money and time to their political action
committees focused on changing our oftentimes-ridiculous court systems as it relates to complex medical cases?
Maybe it is time that we weigh these efforts against the results and against using those efforts toward other options for change, since obviously this “top down” approach is not working as well as we had hoped.
The bottom-up approach is to focus on patient safety. Maybe we should focus on the findings of the 2006 Health Grades Study
showing that 54.9% of patients received the recommended care. Maybe we should focus on the studies comparing a number of our
medical-results measures to those in other parts of the world. We just might find that serious efforts like those under way on so many
fronts, such as those of the National Patient Safety Foundation, will prove more fruitful for lowering malpractice-insurance lawsuits in
the future. Certainly, doctors and hospitals working with doctors and hospitals toward change will probably be much more productive,
more rewarding, saner, and maybe even more fun than doctors and hospitals continuing to work with politicians and expecting different
results.
Matt Gracey, Jr. is a medical malpractice insurance specialist with Danna-Gracey, an independent insurance agency based in
downtown Delray Beach with a statewide team of specialists dedicated solely to insurance coverage placement for Florida’s doctors.
To contact him call (800) 966-2120, or email: matt@dannagracey.com. 
START WEIGHT SEPT. 2010: 207 LBS. • END WEIGHT DEC. 2010: 166 LBS.
Pathology Lab Results — Patient: SP Age: 63 Sex: Male
Before Diet
Lipid Panel
Result 08/28/2009
Ref Range Result
Cholesterol
H 278
(80-199)mg/dL
Triglycerides
H 199
(30-150)mg/dL
HDL Cholesterol
51
(40-110)mg/dL
LDL Cholesterol
H 187
(30-130)mg/dL
VLDL Cholesterol
40
(10-60)mg/dL
Risk Ratio(CHOL/HDL)
H 5.5
(0.0-5.0)Ratio
8/26/10:
9/24/10:
Tissue Fat %
26.3%
21.1%
Body Scan Results
Tissue (g)
83,019
78,045
Fat (g)
21,864
16,449
After Diet
09/20/2010
180
82
55
109
16
3.3
Lean Muscle (g)
61,155
61,596
Please Note: Gain of 441g of muscle and a fat loss of 5,415g in 30 days! Individual results may vary.
For information call 407-260-7002 or email Sam@makerx.com.
18 FLORIDA MD - SEPTEMBER 2012
SEPTEMBER 2012 • COVERING THE I-4 CORRIDOR • SPECIAL FEATURE
Heart of Florida
Regional Medical Center
Women’s and Children’s
Services Expansion Aids
Expanding Families
FLORIDA MD - SEPTEMBER 2012
3
SPECIAL FEATURE
Heart of Florida Regional Medical Center
Women’s and Children’s Services Expansion Aids Expanding Families
By Nancy DeVault, Staff Writer
Heart of Florida Regional Medical Center is celebrating its
15th anniversary of providing quality care for Polk County residents and area tourists alike at its current location on Highway 27.
Operated by Health Management Associates, Inc. (HMA), which
has seventy hospitals in non-urban locations across multiple states,
Heart of Florida has evolved from a 51-bed facility to a 193-bed
facility complete with comprehensive health care services. Priority service lines and specialty sites include bariatric surgery, cardiac
services, Center For Day Surgery, clinical laboratory services, da
Vinci® robotic surgery, diagnostic imaging, emergency department,
Orthopedic and Joint Replacement Center, Designated Stroke
Center, therapy and rehabilitation center, pediatrics and Center for
Women’s Health..
“Heart of Florida Regional Medical Center has grown considerably to meet the demands of our community, covering Polk
County and the four corners area. Advancements in technology
aid our medical teams in offering a magnitude of care options for
patients,” said Don Breeding, Chief Executive Officer. “Last year,
we treated 81,000 patients including approximately 50,000 emergency room visits.”
Breeding joined the executive leadership team at Heart of Florida in 2008 as the Chief Nursing Officer, offering more than thirty
years of hospital-based nursing and administrative expertise. After
being named CEO in 2011, Breeding’s leadership paired well with
the talent of the hospital’s nearly 200 physicians and hundreds of
other clinical and staff positions. Recent performance awards validate this superior partnership and the collaborative commitment
to provide high quality, compassionate healthcare services.
20 FLORIDA MD - SEPTEMBER 2012
Center for Women’s Health
Following a six-month development phase, Heart of Florida Regional Medical Center recently unveiled its $9.5 million expansion
into the fifth floor which added 35 new hospital rooms and equipment upgrades. Open since June 24th, all 31,000 square feet of the
new fifth floor is dedicated to the Center for Women’s Health. The
space includes 10 large birthing suites, 20 post-partum beds, an
expanded nursery (triple the previous space), two dedicated operating rooms, and a unique HUGS® security system.
“We’ve created our niche for women’s health care to offer preventive services, diagnostic testing and treatment for health issues
at all ages and all stages of life,” explains Breeding.
The Center for Women’s Health provides obstetrics care with a
unique feminine touch catering to all needs of mommy and baby.
Plus, the facility offers a broad range of gynecology services including da Vinci® robotics-assisted surgery, hormone therapy and
menopausal care, incontinence and urogynecology, family planning, infertility treatments, and breast health, including digital
mammograms, MRI, ultrasound and stereotactic needle biopsies,
and bone density screenings.
“We are fortunate to have state-of-the-art equipment in our innovative Center for Women’s Health to benefit work flow and of
course patient care,” explains Lisa Bishop, RNC, BSN, Director of
Women’s and Children’s Services, adding that building architects
accounted for extra space to accommodate usage and storage of
Heart of Florida Regional Medical Center is positioned on Highway 27 in Haines City, four
miles south of I-4.
Photo: PROVIDED BY HEART OF FLORIDA REGIONAL MEDICAL CENTER (HOFRMC)
“Of Polk County’s five hospitals, Heart
of Florida Regional Medical Center was
named as the top-ranking hospital in the
Lakeland/Winter Haven metropolitan area
in U.S. News & World Report’s 2011-2012
Best Hospitals rankings,” said Breeding.
Then, earlier this year, Heart of Florida Regional Medical Center was highlighted as
the sole Polk County hospital to receive an
A grade delivered by The Leapfrog Group on
its Hospital Safety Score report. “The Leapfrog distinction helped authenticate that we
are hitting on all cylinders for our patients
and their families, ensuring not only their
safety but proper and effective treatment
plans. Overall, we aspire to be servant leaders providing compassionate and quality
care.” Breeding says among the many service
lines, he sees great potential for growth in a
number of programs, including: cardiology
(which recently added a third cath lab), joint
replacement, pediatric unit (lead by a skilled pediatric hospitalist),
and the recently expanded Center for Women’s Health.
the help of the OB/GYN practice co-founder Mark Alkass,
M.D., an obstetrician with residency training from the University of Maryland in Baltimore. This team has grown to
include five OB/GYN physicians, two midwives, and a nursing staff with three office locations in Davenport, Lake Wales
and Winter Haven. At that time, Dr. Alkass says he and his
associates delivered just 100 babies annually and now deliver
well over 1,000 newborns annually.
“It’s exciting to see our comprehensive obstetrics and gynecological services expand and encompass a fully dedicated
floor for our female patients,” said Dr. Alkass, who personally treats over 5,000 gynecological cases each year. He says
that gynecologic surgery using da Vinci® robotics has been
a welcome advancement to better serve both patient and
physician. “It’s not a ‘one tool fits all’ for patients, yet the
majority of our patients do receive improved outcomes with
Mark Alkass, M.D.,OB/GYN
Natalia Wetterer, M.D., Pediatrics
fewer risks or complications by opting for robotics assisted
treatments,” says Dr. Alkass, a certified da Vinci® trained surgeon
large medical robotic devices. “We have spacious, private patient
who has completed over 100 da Vinci® robotic surgeries. “As a phyrooms, as well as private waiting areas. These details are apprecisician, the robotics assistance has great impact on level of fatigue
ated by patients and families and accommodate the diverse patient
during surgery.”
populations visiting our hospital. There is a great difference between families waiting for a baby’s arrival to those awaiting surgery
Some robotic assisted procedures performed by Dr. Alkass have
completions from other gynecological procedures.”
included hysterectomy, myomectomy, endometriosis resection, and
sacrocolpopexy. According to Dr. Alkass, the da Vinci® tool delivers
The Center for Women’s Health offers pregnancy services inprecision and control thanks to three robotic arms, a camera, and
cluding Childbirth Education Classes and the CuddleBugs® mater3D magnifier. Depending on the procedure, the technique shortnity program, a free platform designed to provide answers for new
ens hospital stays to usually allow next-day discharge for patients
and expectant moms from the earliest stages of pregnancy through
(and in some cases day of surgery release).
post-delivery, and guidance on newborn care. Bishop says the hospital delivers approximately 90 to 100 babies per month.
The Center for Women’s Health is committed to providing
complete health care options for patients of all ages, and in all
“We recently rolled out a new VIP Package to enhance the
stages of life.
memorable delivery experience. It’s simply a little something special to reward and pamper new mommies and daddies during their
Pediatrics Growth
hospital stay,” said Bishop. The optional $200 plan provides new
With the Center for Women’s Health physically transitioned
parents with a welcome basket, robe and slipper socks, scrubs for
completely to the fifth floor of Heart of Florida Regional Medical
the birthing coach, upgraded bath products and linens, celebration
Center, space has freed up to expand other departments including
dinner for two on day of delivery, candlelight dinner the day of
the pediatric unit which provides care for children birth through
discharge, memento blanket and infant onesie, luggage tag/diaper
age 21.
bag tag, refrigerator in each suite, free baby photo package, and
concierge support to schedule OB/Pediatric appointments. “The
“We’ve grown into a 14-room pediatric unit,” said Natalia M.
satisfaction of the birthing experience is surely improving here at
Spacious rooms and state-of-the-art equipment combine with
our maternity ward.”
In addition to the emotional support and instruction of the
licensed lactation consultant, parents truly value the added security
– both physically and emotionally – of the special Hugs® security
system. “This safety component is a lightweight bracelet worn by
the baby during the duration of their hospital stay. It monitors
skin contact on the newborn; therefore it won’t be prematurely removed. Plus, it causes the hospital doors to close and lock if the
child is carried too close to an exit,” describes Breeding.
Partnering Care
Heart of Florida Regional Medical Center partners with the
skilled providers from Heart of Florida OB/GYN Associates on
many basic woman care services available through the Center for
Women’s Health. In fact, the Heart of Florida women’s program
was reintroduced to the community almost fifteen years ago with
excellent medical care to provide a memorable experience for new
families at Heart of Florida.
Photo: PROVIDED BY HOFRMC
PhotoS: PROVIDED BY HOFRMC
SPECIAL FEATURE
FLORIDA MD - SEPTEMBER 2012 21
SPECIAL FEATURE
Dr. Wetterer says she has been charged with establishing partnerships with referring physicians and conducts
speaking engagements. However, her main role is to serve
as the primary care taker of all pediatrics patients. “I am
the first and often the main point of contact for families
upon arrival and throughout their child’s treatment stay.
That typically means identifying the appropriate hospital
specialists if needed, and serving as the communications
channel for both our medical teams and patient families.”
The da Vinci® robotics-assisted
procedures are allowing physicians to
provide surgical options to women that
involve shorter recovery times with
minimal scarring and blood loss.
Photo: PROVIDED BY HOFRMC
Wetterer, M.D., who has served as the pediatric hospitalist
at Heart of Florida for two years, following her residency
at St. Vincent’s Medical Center of Richmond in Staten Island, New York. “We typically average six to eight pediatric patients per day, but often reach ten pediatric patients
daily.” Dr. Wetterer said that word-of-mouth satisfaction
has truly been the (most effective) unsolicited grassroots
marketing tool to increase the quantity of pediatric visits, and thus, expansion was a necessity of this welcomed
growth. “We treat a variety of pediatric ailments such as
asthma, gastroenteritis, orthopedics, ENT, and so on.”
All of the equipment in the nursery of the new Center for Women’s Health
meets 2012 NRP guidelines.
Dr. Wetterer says the hospital is
bringing a fresh, kid-friendly look
to the pediatrics unit. “This detail
may seem secondary, but with pediatric patients typically staying one to
three days to complete treatments,
we need a welcoming environment
for their comfort.”
Photo: PROVIDED BY HOFRMC
“Heart of Florida Regional Medical Center is just the right size, giving patients extra space for comfort
with great personalized services,”
said Lisa Bishop. “Polk County is a
huge region but our geographic location provides convenient access
for the community. It’s a hometown
feel.” 
The Center for Women’s Health includes two dedicated operating rooms for
women’s surgical needs.
Contact Information
40100 Highway 27
Davenport, FL 33837
Phone: (863) 422-4971
www.HeartOfFlorida.com
Phone: (863) 419-BABY
Email: WomensHealth@hma.com
www.WomensHealthAtHOF.com
Explore Online Services
Visit www.HeartOfFlorida.com for unique
and convenient features such as:
• Upcoming events
•Online nursery
•Patient e-cards
• Bill pay services
•Link to Cuddlebugs®
Photo: PROVIDED BY HOFRMC
See www.WomensHealthAtHOF.com for
additional options, including:
•Pregnancy calculator
•Health library
•Provider biographies
•Center for Women’s Health services
22 FLORIDA MD - SEPTEMBER 2012
ORTHOPAEDIC UPDATE
Ulnar Collateral Ligament
Reconstruction (Tommy John
Surgery) in the Throwing Athlete
By Corey Gehrold
You may not know who Tommy John is, but if you’re involved
in the world of sports medicine, odds are you’ve heard the name
before. Ulnar collateral ligament (UCL) reconstruction is performed on athletes, most commonly baseball pitchers, when they
tear this important stabilizing ligament in their throwing elbow
and the nonsurgical treatment options have failed.
Named Tommy John surgery outside of the medical field, this
procedure was first performed in 1974 by Dr. Frank Jobe on Major League Baseball pitcher Tommy John. At the time of the original Tommy John surgery, Dr. Jobe put his chances of recovering
from the ligament injury at one in 100. Today, literature says that
number is closer to the 90 percent mark thanks to advances in
technology and modern medicine.
“When the ulnar collateral ligament sustains a tear, the throwing athlete often complains of pain on the inside, or medial, part
of the elbow as well as a loss of velocity and control on their pitch,”
says Randy S. Schwartzberg, M.D., a board certified sports medicine specialist at Orlando Orthopaedic Center. “If non-surgical
treatment fails for the UCL tear, the surgical treatment involves
replacing the ligament with a tendon graft.” To ensure that the UCL can return to functioning as the stabilizing structure of the elbow, a complete replacement is necessary. Although it can heal, it often heals in a lengthened position,
resulting in a loose condition that can hinder the throwing athlete
from ever returning to the type of play they were accustomed to
prior to ligament injury. “Damage to the ulnar collateral ligament can occur suddenly or gradually after continued stress on
the throwing athlete’s elbow,” says Dr. Schwartzberg.
Before discussing Tommy John surgery in-depth, the following
is background on ulnar collateral ligament tears.
Risk Factors
Risk factors for tearing the UCL involve excessive use or repeated stress being placed on the ligament. In day-to-day activities, it’s very rare to injure the ligament. Most injuries occur in
baseball because of the intense overhead motion and force used
when winding up and releasing hundreds of pitches. Ultimately,
the ligament becomes compromised and tears.
“Other risk factors may include contact sports where one may
fall on an outstretched hand, ultimately dislocating their elbow,”
says Bradd G. Burkhart, M.D., a board certified sports medicine
specialist and colleague of Dr. Schwartzberg’s at Orlando Orthopaedic Center. “We also see UCL ligament tears in other overhead
athletes, such as volleyball and tennis players as well. Throwing
mechanics and form also contribute
to risk factors of the injury.”
Symptoms
Symptoms of the ligament injury
that may ultimately lead to Tommy
John surgery and a complete ligament reconstruction include pain
on the inner side of the elbow.
Many athletes also note a “pop” or
“tearing” sensation at the site of the
injury, according to Dr. Schwartzberg.
“Then swelling and bruising may
be noticeable after roughly 24 hours
post injury,” he says. “Athletes will
also notice newfound elbow stiffness
and they may feel a slight numbness
or tingling in the small and ring fingers of the injured arm.”
Non-Surgical
Treatment
Randy S. Schwartzberg, MD
Board Certified in
Orthopaedic Surgery
Board Certified in Sports
Medicine
Bradd G. Burkhart, MD
Board Certified in
Orthopaedic Surgery
Specializing in Sports
Medicine,
Knee & Shoulder Surger
A mild tear to the ulnar collateral ligament may heal on its
own. Non-surgical treatment for the ligament tear consists of
medications, ice and rest to relieve pain and swelling. Functional
rehabilitation supervised by a skilled sports medicine athletic
trainer or physical therapist is the most important component of
non-surgical management.
Surgical Treatment (Tommy John Surgery)
Tommy John surgery is recommended to those that have sustained an acute rupture or partial tear of the UCL ligament and
have failed non-surgical treatment.
The procedure is performed under general anesthesia by a
trained orthopaedic surgeon. Ligament reconstruction begins
with an incision on the inner part of the elbow where the damaged ligament is removed. From there, holes are drilled to accommodate the new tendon grafts, often taken from the palmaris
longus tendon found in the forearm or the gracilis tendon in the
leg, according to Dr. Schwartzberg. These holes are drilled in the
ulna and humerus bones of the elbow precisely where the ulnar
collateral ligament attaches.
“Then we place the new tendon into the sockets created in the
ulna and humerus. The graft is then secured with fixation devices
FLORIDA MD - SEPTEMBER 2012 23
ORTHOPAEDIC UPDATE
to allow an accelerated rehabilitation approach,” says Dr. Schwartzberg. “After one week in a splint, the throwing athlete is placed into a
hinged elbow brace with no range of motion restrictions. Rehabilitation commences with progressive functional activities leading up to
an interval throwing program at the four month postoperative mark.”
Potential complications of the surgery include infection, elbow range of motion loss and ulnar nerve issues. However, the rate of these
complications is very small following the procedure.
Recovery
“Typically we see a return to the sport of choice following surgery within 6-9 months,” says Dr. Burkhart. “Rehab can be carried out
at home, but at Orlando Orthopaedic Center we recommend patients see our physical therapists to help guide their road to recovery.”
Because the graft is very strong and fixation is so secure, early range of motion and rehabilitation is safe. Physical therapy is necessary
to regain strength and range of motion in the elbow following Tommy John surgery and may begin following the first several weeks of
recovery.
“Although range of motion and strength about the elbow returns within a couple of months of the surgery, the throwing athlete still
has a large amount of work to ready the elbow for throwing,” says Dr. Schwartzberg. “Emphasis on the entire kinetic chain during rehabilitation is critical. The throwing motion begins with the legs, involves the trunk and then the shoulder, elbow and wrist. Core strengthening is very important and a hard working and patient athlete can end up becoming a stronger, healthier throwing athlete.”
Most patients make a complete recovery and return to normal activities with little to no change in their routine once fully healed.
Want to Learn More About a UCL Reconstruction?
Check out the “Latest News” section of www.OrlandoOrtho.com to watch Dr. Schwartzberg take you step-by-step through
a UCL Reconstruction surgery. 
Has Your Student-Athlete Patient Sustained a Concussion?
We Can Evaluate and Clear Them to Return to Play.
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24 FLORIDA MD - SEPTEMBER 2012
Digestive and Liver Update
Update in GI and Hepatology
By Harinath Sheela, MD
CONSTIPATION
Sodium phosphate enemas — Sodium phosphate enemas
are used in the treatment of constipation and for preparation for
flexible sigmoidoscopy. A retrospective series found that sodium
phosphate enema use in older adults (mean age 80 years, range
61 to 89 years) was associated with complications including hypotension and volume depletion, hyperphosphatemia, hypo- or
hyperkalemia, metabolic acidosis, severe hypocalcemia, renal failure, and EKG changes (prolonged QT interval). In patients over
the age of 70 years, we suggest that warm water enemas rather
than sodium phosphate enemas be used for the treatment of constipation.
COLORECTAL CANCER SCREENING
Flexible sigmoidoscopy for colorectal cancer screening —
Results of the flexible sigmoidoscopy arm of the Prostate Lung
Colorectal and Ovarian (PLCO) Screening Trial have been reported . A total of 154,900 men and women aged 55 to 74 were
randomly assigned to screening with flexible sigmoidoscopy or
to usual care, with median follow-up of 11.9 years. There was
a 21 percent reduction in the relative risk of colorectal cancer
(CRC) and a 26 percent reduction in the relative risk of death
from colorectal cancer, comparing the screening arm with usual
care. Although the incidence of both proximal and distal CRC
significantly decreased, a reduction in mortality was seen only for
distal cancer. There was significant contamination in the usual
care group (among whom 47 percent underwent either sigmoidoscopy or colonoscopy), suggesting that the impact of sigmoidoscopy compared to no screening might be even greater than
was seen in this trial.
Mortality benefit for screening colonoscopy — Long-term
follow-up of the National Polyp Study (NPS) population found
that, at an average follow-up of 16 years, there was a 53 percent
reduction in colorectal cancer (CRC) mortality in patients who
had adenomas removed compared to the expected CRC mortality
rate in the general population (based on data from the SEER program) . CRC mortality in the NPS for the first 10 years following
polypectomy was the same for patients found to have adenomatous or nonadenomatous polyps. Although not a randomized
trial, this is the first study to strongly indicate a CRC mortality benefit for colonoscopy. The magnitude of the results of this
study may not be generalizable to community practice, because
NPS colonoscopies were performed by a small number of trained
endoscopists and reported rates of CRC following polypectomy
were lower for the NPS than reported in other studies. Rates of
postpolypectomy surveillance colonoscopies (81 percent in the
NPS) may also be higher than is common in the community.
Glucocorticoid therapy for eosinophilic esophagitis — Two
small trials investigated the use of topical glucocorticoids for the treatment of
eosinophilic esophagitis in adults, and both found improvement
in histologic eosinophil counts. One trial randomly assigned 42
patients to swallow aerosolized fluticasone (880 mcg/day in two
divided doses) or placebo for six weeks. Fluticasone was associated with a histologic response (>90 percent decrease in mean eosinophil count) but no significant improvement in dysphagia. In
another trial, budesonide was administered to 25 patients either
by nebulizer, with patients instructed to swallow the accumulated
liquid, or by viscous slurry. Although patients who received the
viscous slurry had a higher duration of mucosal contact with
budesonide and lower eosinophil count, there was no significant
difference in dysphagia symptom scores which improved in both
groups.
Dietary therapy for eosinophilic esophagitis in children
— Dietary therapy is an effective treatment for eosinophilic
esophagitis in children. An observational study compared outcomes in 98 children with eosinophilic esophagitis who had been
treated with one of three diets: an elemental diet; a diet in which
six foods associated with allergy were eliminated (ie, cow-milk
protein, soy, wheat, egg, peanut, and seafood); or a skin prick
allergy testing-directed elimination diet . Histologic remission
occurred in children on all three diets (96, 81, and 65 percent,
respectively). However, the odds of histologic remission were significantly higher in children on elemental diets compared with
directed diets.
Dietary therapy for eosinophilic esophagitis in adults — In
an observational study of 50 adults with eosinophilic esophagitis,
patients were treated with a six-food elimination diet for six weeks
. A clinical response (decreased dysphagia) was seen in 94 percent,
although the endoscopic appearance improved in 78 percent and
only 74 percent had a reduction in the eosinophil count to less
than 15 eosinophils/hpf on esophageal biopsy. A specific food
was implicated in the 20 patients in whom follow-up data were
available after gradual reintroduction of food groups. Skin prick
allergy testing identified only 13 percent of the food triggers. This
study suggests that food elimination diets may be an option for
motivated adults. However, successful implementation of such
diets requires a dedicated and informed nutritionist and willingness of the patient to make substantial lifestyle changes and to
undergo multiple endoscopies to determine which food group is
the trigger.
ENDOSCOPY
Sodium phosphate for flexible sigmoidoscopy — The preparation for flexible sigmoidoscopy typically involves two sodium
phosphate enemas given the morning of the examination. HowFLORIDA MD - SEPTEMBER 2012 25
Digestive and Liver Update
ever, sodium phosphate enemas have been associated with complications, particularly in older adults. A retrospective series found
that sodium phosphate enema use in older adults (mean age 80
years, range 61 to 89 years) was associated with complications including hypotension and volume depletion, hyperphosphatemia,
hypo- or hyperkalemia, metabolic acidosis, severe hypocalcemia,
renal failure, and changes on the electrocardiogram (prolonged
QT interval). As a result, in patients over the age of 70 years,
the risks of oral preparations (eg, polyethylene glycol lavage or
magnesium citrate) and sodium phosphate enemas need to be
weighed for each individual patient before deciding upon an appropriate preparation.
HEPATITIS B VIRUS INFECTION
Vaccination of patients with diabetes
mellitus — The Advisory Committee on
Immunization Practices recommends that
hepatitis B virus (HBV) vaccination be
given to unvaccinated adults with diabetes
mellitus who are ages 19 to 59 ]. For older
patients with diabetes, vaccination can be
administered at the discretion of the treating clinician based on the risk of acquiring
HBV and the likelihood of an adequate
immune response to vaccination.
HEPATITIS C VIRUS INFECTION
Treatment without peginterferon or
ribavirin — Standard treatment regimens for hepatitis C virus (HCV) contain
peginterferon and ribavirin, but a substantial number of patients cannot receive one
or both drugs due to known intolerances or
contraindications. Treatment regimens are
being studied that do not use peginterferon
or ribavirin. Two small studies (21 patients
total) tested such regimens in patients with
HCV genotype 1. Patients received 24
weeks of treatment with a combination
of daclatasvir and asunaprevir, two experimental direct-acting antiviral agents. Viral
loads 24 weeks after stopping treatment
were undetectable in 14 of the patients (67
percent), including one patient who was
only treated for two weeks. These preliminary studies suggest that HCV treatment
without peginterferon and ribavirin may
be possible.
Drug interactions with boceprevir
in patients with HIV — Boceprevir is a
protease inhibitor used in the treatment of
patients with HCV genotype 1 infection.
If boceprevir is used in combination with
certain ritonavir-boosted HIV protease inhibitors (eg, atazanavir, lopinavir, darunavir), the effectiveness of boceprevir as well
26 FLORIDA MD - SEPTEMBER 2012
as the ritonavir-boosted medications may be decreased. The US
Food and Drug Administration recommends that patients taking
boceprevir along with one of the listed ritonavir-boosted protease
inhibitors should be closely monitored for potential HCV and
HIV virologic rebound.
HEPATOTOXICITY
Flavocoxid — Flavocoxid is a prescription dietary supplement
that is used to treat osteoarthritis. In a prospective study of 877
patients, four patients (0.4 percent) developed liver injury. In all
four cases, liver tests returned to normal within 3 to 12 weeks
of discontinuing the flavocoxid. Flavocoxid should be avoided
in patients with known liver disease and should be considered
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Digestive and Liver Update
as a possible etiology in patients with clinical manifestations of
liver injury.
HEREDITARY COLORECTAL CANCER
Aspirin for chemoprevention in patients with Lynch syndrome — Individuals with Lynch syndrome have an 80 percent
risk of developing colorectal cancer in their lifetime. While an
earlier placebo-controlled trial (CAPP2) did not find a benefit
for aspirin for adenoma or colon cancer prevention in patients
with Lynch syndrome after a mean of 29 months of follow-up,
a subsequent analysis found a marginally significant reduction in
colorectal cancer incidence in the subset of patients treated with
600 mg aspirin per day for more than two years. A secondary
analysis found a decreased rate of overall Lynch cancers in the
aspirin-treated group. Further studies are needed to validate this
potentially important result and determine if the benefits associated with aspirin outweigh the risks.
NUTRITION
Initiation of enteral nutrition in critically ill patients —
Two strategies have been used to initiate enteral nutrition: incrementally increasing the infusion rate until the target maintenance
rate is achieved or initiating the infusion at the target maintenance rate. The EDEN trial was a multicenter open-labelled trial
that compared these approaches by randomly assigning 1000
mechanically ventilated patients with acute lung injury to receive either full enteral feeding or low-volume enteral feeding for
six days, after which both groups received full enteral feeding.
The trial found no differences in the number of ventilator-free
days, 60-day mortality, or the frequency of infectious complications. However, the low-volume feeding group had less vomiting, smaller gastric residual volumes, lower mean plasma glucose
levels, and less constipation. These data suggest that initial lowvolume enteral feeding has fewer undesirable effects than initial
feeding at the target rate.
esomeprazole, and pantoprazole, with methotrexate (primarily at
high dose), may elevate serum levels and prolong the half-life of
methotrexate and/or its metabolite hydroxymethotrexate, possibly leading to methotrexate toxicities.
Harinath Sheela, MD moved to Orlando, Florida after
finishing his fellowship in gastroenterology at Yale University School of Medicine, one of the finest programs in the
country. During his training he spent significant amount
of time in basic and clinical research and has published
articles in gastroenterology literature.
His interests include Inflammatory Bowel Diseases
(IBD), Irritable Bowel Syndrome (IBS), Hepatitis B,
Hepatitis C, Metabolic and other liver disorders. He is a
member of the American Gastroenterological Association
(AGA), the American Society for Gastrointestinal Endoscopy (ASGE) and the American Association for the Study
of Liver Diseases (AASLD) and Crohn’s Colitis foundation (CCF). Dr. Sheela is a Clinical Assistant Professor at
the University of Central Florida School of Medicine. He
is also a teaching attending physician at Florida Hospital
Internal Medcine Residency and Family Practice Residence (MD and DO) programs. 
PROTON PUMP INHIBITORS
C. difficile and proton pump inhibitors — Proton pump
inhibitors (PPIs) may be associated with an increased risk of C.
difficile-associated diarrhea (CDAD). The US Food and Drug
Administration (FDA) issued a drug safety communication in
February 2012 following a review of published literature. Most
studies reviewed found that the risk of C. difficile infection or
disease, including CDAD, ranged from 1.4 to 2.75 times higher
among patients with PPI exposure compared to those without
PPI exposure. The relationship between the risk of C. difficile infection and PPI dose and duration of use is uncertain. Given the
potential risk of CDAD, the FDA has also recommended that
providers prescribe the lowest dose and shortest duration of PPI
therapy appropriate to the condition being treated.
Proton pump inhibitors in patients receiving high-dose
methotrexate — The US Food and Drug Administration has
issued a warning about use of proton pump inhibitors (PPIs) in
patients receiving methotrexate, particularly high-dose methotrexate . Case reports and published population pharmacokinetic
studies suggest that concomitant use of PPIs, such as omeprazole,
FLORIDA MD - SEPTEMBER 2012 27
CANCER
Marketing Your Practice
Lung Cancer Screening:
A New Standard of Care?
By Jacques P. Fontaine MD, FACS
Lung cancer is not the most common cancer in men, prostate
cancer is. Lung cancer is not the most common cancer in women,
breast cancer is. However, lung cancer kills more American men
than prostate cancer. Lung cancer kills more American women
than breast cancer, colon cancer and cervical cancer combined.
Lung cancer is the leading cause of cancer related deaths in the
United States. Although the incidence of smoking is slowly decreasing, the incidence of lung cancer continues to rise.
The 5-year overall survival for lung cancer is 16% as compared
to 97% with prostate cancer and 84% with breast cancer. There
are two reasons for this. First, the tumor biology is very aggressive. Second, most lung cancers are diagnosed in advanced stages
where prognosis is very poor. The great majority of early stage
lung cancers are asymptomatic and discovered incidentally. The
prognosis of very early stage, asymptomatic, lung cancers is comparable to that of prostate, breast and colon cancers. Certainly,
smoking cessation and prevention programs aimed at adolescents
and young adults is the best long term method to decrease the
impact of this cancer on our society. However, the most practical
and immediate method to improve the prognosis of our lung
cancer patients is to diagnose them earlier when the chance of a
cure is much better. Renewed interest has thus emerged in the
significance of lung cancer screening programs.
Successful, government funded, screening programs for prostate cancer, breast cancer, colon cancer and cervical cancer have
been in place for years. Until recently, there were no screening
programs for lung cancer, the number one cancer killer in America.
Previous lung cancer screening programs using chest x-rays
were ineffective. To determine whether CT scans were more
sensitive and could be an effective screening tool, the National
Cancer Institute (NCI) funded a large multicenter, prospective randomized trial which enrolled 53 456 patients between
2002 and 2004. The fact that so many patients were enrolled so
quickly is a testament of patients’ willingness to enroll in lung
cancer screening programs. Patients enrolled in this study were
considered at high risk for developing lung cancer and consisted
of asymptomatic men and women between the ages of 55 and 74
who had a 30 pack-year history of smoking. The patients were
randomized to an annual CXR or to an annual CT Scan.
A “positive” screen was a CT Scan demonstrating a 4mm noncalcified nodule. An astounding 24% of patients were found to
have a “positive” CT Scan. Various investigational algorithms for
these pulmonary nodules were used to determine which nodules
28 FLORIDA MD - SEPTEMBER 2012
were suspicious enough to warrant a
biopsy. These “work-up” algorithms
which included the use of PET Scans and repeat interval CT
Scans were not standardized and therefore more realistic of generalized medical practice. Using proper “work-up” algorithms,
only 8% of patients found to have pulmonary nodules were
deemed suspicious enough to warrant a biopsy. This represented
less than 2% of the screened population. Of the patients who
did undergo a biopsy, 53% were found to have a lung cancer
and the majority of the time (63%) it was an early Stage I cancer.
Due to the fact so many of these lung cancers were detected at
an early stage, this translated in a 20% reduction in mortality.
The cost of having lung cancer screening covered by commercial
healthcare insurance plans would be less than $1 per month for
policy holders, far cheaper than breast cancer screening at about
$3 a month. In terms of cost effectiveness, the cost per life-year
saved would be below $19 000. This compares favorably to cost
per life-year saved in breast ($31 000 - $52 000), colon ($19 000
- $29 000), and cervical cancers ($50 000 - $75 000).
On the other hand, these results also highlight the fact that
47% of patients who underwent a biopsy did not end up having
a lung cancer and therefore underwent an “unnecessary” biopsy.
We can be reassured, however, that patients with pulmonary
nodules deemed suspicious enough to require a biopsy were at
very low risk of being harmed by a “negative” biopsy since the
complication rate was extremely low at 0.05% due to the minimally invasive techniques used: bronchoscopy, percutaneous
needle or thoracoscopy. Avoiding unnecessary scans or biopsies
is of the highest priority to multi-disciplinary teams that specialize in lung cancer and use rigorous algorithms. With proper
use of algorithms, 92% of patients found to have a pulmonary
nodule on CT screening avoided a biopsy and none developed a
lung cancer from a false negative screen.
CT Scan screening for lung cancer not only impacts the survival from the disease but also the way we treat it. Surgical resection remains the best treatment modality with the highest cure
rate for early stage lung cancer. Because lung cancers are typically
diagnosed in advanced stages, however, even for those patients
where lung resection is an option, often the cancers are too large
to be amenable to minimally invasive, lung sparing, surgical
techniques. Thus, another major advantage derived from CT
Scan screening for lung cancer is the fact that the majority of
these lung cancers are discovered at an early stage when they
measure less than 2cm. These small tumors are ideally resected
using minimally invasive techniques of thoracoscopy (VATS) or
CANCER
robotic surgery rather than using a more
traditional, invasive thoracotomy.
The costs of lung cancer screening is
already covered by medical insurance carriers in Japan and some third-party insurance carriers in the United States are in
the process of approving coverage for this
screening modality. Nonetheless, lung
cancer screening programs are already being offered throughout the country with
an out-of-pocket patient cost of up to
$350. The radiation dose from a screening CT is similar to that of a screening
mammogram and 10 times lower than a
regular diagnostic CT scan of the chest.
Be sure and check out
Coming UP Next Month:
The cover story focuses
on breast surgeon Dr. Olga
Ivanov at the Comprehensive
Breast Health Center at
Florida Hospital Celebration
Health. Editorial focuses on
Cancer and Dermatology.
our NEW and
IMPROVED
website at
www.floridamd.com!

The H. Lee Moffitt Cancer Center in
Tampa, Florida offers lung cancer screening, which includes a consultation with
our specialized multidisciplinary team.
Appointments can be made by calling
1-888-MOFFITT. Our team treats more
lung cancer patients than any other institution in Florida. Over 70% of our lung
cancer resections are performed using
minimally-invasive techniques including
robotic, lung sparing surgery with results
superior to the national average. Our
surgical team has performed the most robotic lung surgery in the state of Florida
as well.
Jacques P. Fontaine, MD is a
thoracic surgeon at H. Lee Moffitt
Cancer Center in Florida who specializes in robotic lung surgery. He
was chief resident in thoracic surgery at Brigham & Women’s Hospital – Harvard Medical School.
Prior to joining the staff at Moffitt,
he worked for the Department of
Thoracic Surgery associated with
Brown Medical School in Providence, RI. He has a special interest in lung and esophageal cancers
as well as thymoma and mesothelioma. He is accepting new patients
at Moffitt Cancer Center; appointments can be scheduled at (813)
745-2733. 
"Jewett made my family
feel like we were part
of their family."
Go to www.jewettortho.com
and see the O’Lenick’s full story
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
No appointment necessary!
Monday - Thursday: 7:30am - 8:00pm
Friday: 7:30am - 4:00pm
Saturday: 9:00am - 3:00pm
Stirling Center
701 Platinum Point
On Rinehart Road
Lake Mary, FL 32746
407.206.4500

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FLORIDA MD - SEPTEMBER 2012 29
First Pediatric Bone Marrow Transplant
Unit Opens in Central Florida
By Paul Gordon, MD
On Thursday, August 16th, 2012, Florida Hospital for Children opened the first and only pediatric stem cell transplant
unit in Central Florida. Stem cell transplantation (SCT) is a
well established treatment for many otherwise fatal pediatric
conditions. Allogeneic SCT involves the complete ablation of
a child’s bone marrow with chemotherapy and/or radiation and
replacement with donor stem cells from a volunteer bone marrow donor or umbilical cord blood (UCB) collected at the time
of delivery. Autologous SCT involves the use of a patient’s own
stem cells to replace the bone marrow after ablation with chemotherapy/radiation. Pediatric conditions cured with SCT include
Leukemia, myelodysplastic syndromes (MDS), bone marrow
failure syndromes such as Fanconi anemia, hemoglobinopathies
such as sickle cell disease (SCD), metabolic conditions such as
adrenoleukodystrophies and, immunodeficiencies. Many non
malignant congenital conditions in pediatrics can be cured with
SCT.
We performed our first SCT June
23, 2011, and have performed 15
transplants so far. A passion of mine
is sickle cell disease and we have successfully transplanted and cured three
patients with sickle cell disease to date. Our new pediatric SCT
unit is a beautiful 8 bed unit. The entire unit has a high efficiency (HEPA) air filtration system with positive pressure controlled
rooms relative to the corridors and the outside to protect our patients. All the rooms are private, large and beautiful. We have age
appropriate amenities patients and a family room for parents.
Approximately 1100 pediatric allogeniec transplants are performed in the USA annually and about 100-120 of these occur
here in Florida. About 50% of pediatric allogeneic transplants
use UBC as the stem cell source and 50% bone marrow. There
are three pediatric hematology/oncology practices in Central
Florida and we were referring out 20-40 transplant patients per
year to other facilities.
Kids Beating Cancer (KBC) is an incorporated philanthropic
group whose objective is to be the resource so that no child diagnosed with cancer, or related life threatening diseases will ever be
denied treatment. KBC’s CEO and founder Margarette Geddes
was one such Orlando parent whose son was diagnosed with a
life threatening illness (MDS), needed a stem cell transplant and
had to be transferred out of state. Her extremely difficult journey and subsequent loss of her son is a powerful testament that
a SCT unit was needed in central Florida. The partnership of a
grieving mother with a mission and a hospital with a vision and
commitment to the children of Central Florida led us to where
we are today and the opening of the new unit; “The Kids Beating
Cancer Pediatric Transplant Unit”
I received my stem cell transplantation training at St Jude
Children’s Research hospital. I joined the team at FH to head
the pediatric stem cell transplantation program about 18 months
ago. I have a deep passion for families like Margaret. I have personally lost a close family member to cancer and really want to
be the torch bearer of hope for families that have either failed
standard therapies or require SCT for cure. I was immediately
drawn to Margaret’s journey and story. I am committed that no
child should have to leave home and travel far away for a SCT.
30 FLORIDA MD - SEPTEMBER 2012
Dr. Paul Gordon performing a bone marrow transplant procedure.
We have put together a world class team of nurses and support
staff. Child life, psychology and social work. We are part of the
Florida Hospital for Children and all the support physician services such as ICU, Pulmonology, radiology, surgery etc. are available to us. We have partnered with University of Chicago for
nurse training and with Joanne Kurtzberg from Duke University
for clinical consultation and patient care. We are off to a superb
start and feel truly blessed that Florida Hospital has committed
the resources and support to build this unit. It is a very exciting
time here at Florida Hospital for Children and I am looking
forward to increased patient referrals for consultation.
Dr. Paul Gordon is medical director of pediatric bone
marrow transplant at Florida Hospital for Children. 
Be sure and check out our
NEW and IMPROVED website
at www.floridamd.com!
Powerball & Real Estate Offer Similar
Choices! 39 Years or Lump Sums?
By Frank Ricci
If you won $3.9 million dollars in a lottery, would you take
$100,000/year for 39 years or a lump sum payout?
The IRS offers you a similar choice when it comes to real estate
you own or lease? You see, the IRS allows you an opportunity to
front load your depreciation deductions to significantly reduce
your taxable income during the first few years of ownership.
The IRS provision that allows you to take your money now is
based upon the concept called Cost Segregation and it can save
you money in 4 ways:
1.Whether buying or building a new facility, a CSS allows you to
itemize building components into classes, thereby maximizing
your depreciation deductions
2.You can deduct equipment costs, replacements or structural
failures
3.You can depreciate leasehold improvements
4.You can deduct as a loss, leasehold improvements upon vacating the premises
First, let’s define Cost Segregation (CS)?
Real estate, as defined by the IRS, is comprised of four elements:
1.Raw Land (not depreciable)
2.Land Improvements (sidewalks, parking areas, etc. depreciable
over 15 years)
3.The Building Structure (roof, walls etc. depreciable over 39
years)
4.Personal Property (cabinetry, special electrical, etc. depreciable
over 5 or 7 years)
Cost Segregation (CS) is a strategy where a dollar value is assigned to each component of a building by a group of experts so
that it can be depreciated correctly. For example, a commercial
building has an expected life (for IRS purposes) of 39 years while
carpeting has an expected life of 5 years. The IRS allows you to
depreciate your carpeting and other personal property over 5 years
instead of 39 years, thereby lowering your taxable income and
saving you money – oftentimes a significant amount of money.
How does CSS minimize my taxes?
Let’s assume you are constructing a new $5,000,000 facility
with the following costs and assumptions:
• $1,100,000 - Land Value (LV)
• $3,900,000 - Building Value (BV)
• 39 years– Standard Building Depreciation Schedule w/o CSS
• 35% - Annual Federal Tax rate
Under the most commonly used
method, your annual depreciation deduction is determined by dividing the
Building Value by the Depreciation
Rate to get the annual tax deductible
expense. ($3,900,000 BV / 39 years = $100,000 annual tax deduction.
Multiply the deduction by your tax rate to show the tax benefit
or increase in cash flow.
$100,000 deduction x 35% tax rate = $35,000 cash benefit
Now, let’s evaluate the same property based upon the results
of a Cost Segregation Study. The total land value of $1,100,000
is comprised of the cost of raw land ($725,000) plus the cost
of land improvements ($375,000) such as utilities, paving and
landscaping. The cost of raw land is NOT depreciable while land
improvements are depreciated over 15 years.
The total building value of $3,900,000 is comprised of the
building structure (walls, roofs and mechanical systems) valued
at $2,715,000 depreciated over 39 years plus the value of personal property such as cabinetry, flooring, wall coverings, special
plumbing and electrical fixtures valued at $1,185,000 depreciated over 5 or 7 years.
Divide each asset cost by their depreciation rate to determine
the allowable annual deductions for each.
Land Improvements:
$375,000 / 15 years = $25,000
Building Value:
$2,715,000 / 39 years = $69,615
Personal Property:
$1,185,000 / 5 years = $237,000
Total tax deduction after Cost Segregation = $331,615
Multiple by the tax rate to get the annual after tax cash benefit.
$331,615 deduction x 35% tax rate = $116,065 cash benefit.
By using a CSS in the example above, the property owner is
able to increase his cash flow by $81,065 per year for the first
five years.
Deduct as losses equipment failures
or replacements!
A tremendous benefit of Cost Segregation relates to equipment
failures or component replacements. Suppose you purchased or
constructed a building last year and the air conditioner fails and
must be replaced at it’s original cost of $39,000.
• Without a CSS, you would receive no current benefit as A/C is
integral to the building
FLORIDA MD - SEPTEMBER 2012 31
• With a CSS, you would calculate your basis in that A/C as total cost ($39,000) minus depreciation taken ($39,000/39 years
=$1,000) for a tax basis of $38,000. You would then write off
$38,000 on your taxes.
Depreciate Leasehold Improvements?
Leasehold improvements can also be depreciated through the
use of a CSS but there are important considerations. The most
important is that you MUST itemize which party - landlord or
tenant, paid for which improvements and identify their respective
costs. This must be identified in the lease or an addendum and the
lease must provide the tenant the right to depreciate these items.
An allowance is NOT sufficient. To protect yourself, you should
hire an experienced medical facility broker to
ensure this issue is properly addressed at the
very beginning of lease negotiations.
Can my accountant offer this service?
The IRS requires very strict guidelines in the performance of
these studies. Since CS studies require specific knowledge of design & construction, construction costs, approved estimating procedures & cost databases and the relevant tax code, very few accounting firms have the expertise to offer this service in-house.
Frank Ricci is Director of Real Estate at Healthcare Realty
& Development Services 300 N. New York Avenue, Winter
Park, FL 32790-28022. He has over twenty years of medical
real estate and development experience. For more information or questions, please feel free to contact Frank at (407)
947-5074 or HealthCareRealtyServices@Gmail.com. 
A rarely used added benefit
for Leasehold Improvements
At the end of your lease, if you have had
a CSS performed and kept careful records,
you may write off as a loss, all improvements
you paid for which you are leaving at the
premises. For example: if you paid $10,000
for a new A/C unit and you have depreciated
only $2,000 – you can deduct the remaining
$8,000 as a loss on your taxes.
How does it work?
A firm with a team of experts in tax and
building design and construction will review all of the information available for your
property and create a report which will detail
costs for every component of your building
or suite. Based upon the cost of each component, a detailed depreciation schedule will
be created with a breakdown of each year’s
depreciation. This will be forwarded to your
tax accountant for inclusion in current and
future tax filings. If your property is several
years old, there is a catch up provision in the
IRS code allowing you to capture deductions
you have missed.
The cost and amount of time required to
prepare this report depends upon the size
and complexity of the project and the documentation that exists. Most reports cost between $5,000 and $12,000 (tax deductible)
and take approximately 30 days.
The best time to hire a CS team is during
the design and construction phase, followed
by recently completed projects with budgets
and cost data. The most challenging project
is an existing building where the entire set of
design documents and costs must be reconstructed using cost databases and city code
multipliers.
32 FLORIDA MD - SEPTEMBER 2012
nursing
excellence
Saturday, November 10, 2012
Walt Disney Swan and Dolphin Resort
March of Dimes Nurse of the Year will honor the contributions
of nurses working in Orange, Seminole and Osceola counties
during an evening celebration at the Walt Disney World
Sponsorship Opportunties Available
For more information call 321-274-8619,
email, estuart@marchofdimes.com
or visit marchofdimes.com/florida
Table: $1,500 | Ticket: $150
Media Sponsors
working together for stronger, healthier babies
CURRENT TOPICS
Florida Hospital and Mimic Technologies Use
Simulator to Improve Surgical Training
The Device Mimics the da Vinci® Robot and Will Allow More Doctors to Perfect
Techniques Before Surgery
There is no wireless controller or game console, but surgeons are now able to use video game
technology to practice their robotic surgery skills before going into the operating room. At the
Florida Hospital Nicholson Center, through a new strategic alliance partnership with Mimic
Technologies, robotic surgeons will be perfecting new techniques by doing virtual surgery.
Each year, the Nicholson Center provides training for more than 10,000 physicians. Now
with the Mimic simulator added to the robotic surgery curriculum, doctors will be able to train
in a new simulation center inside the Nicholson Center. Video game and, in the near future,
virtual reality simulation training is rapidly being adopted as hospitals seek to minimize the
learning curve associated with robotic surgery. Mimic Technologies, the company responsible
for da Vinci® robot simulation, has provided the latest simulation technology to Florida Hospital to help meet the demand for better training.
Dr. Monica Reed, Florida Hospital Celebration
Health administrator and Jeff Berkley, founder
and CEO of Mimic Technologies
“Robotic surgery offers several benefits to patients. It is minimally invasive so there is less scaring and patients generally experience
quicker recovery time,” said Dr. Arnold Advincula, medical director of the benign gynecologic surgery program at Florida Hospital Celebration Health. The more physicians we can train to use this technology appropriately, the more patients will be able to benefit. Incorporating the Mimic simulator into training courses gives the doctor and patient additional confidence when entering the operating room.”
Mimic will collaborate with the Nicholson Center to develop simulation-based curricula as part of the strategic alliance partnership.
The new jointly developed curricula will accelerate the adoption of the latest robotic technologies and techniques and surgeon skill expertise.
Today, there are more than 2,000 da Vinci Systems installed in over 1,500 hospitals worldwide. The da Vinci System has been used
in nearly 300,000 surgeries to date. However, there are major challenges to providing adequate training for surgeons new to this complex robotic system. Florida Hospital Nicholson Center has created
a facility that will utilize the latest technology in robotic simulation
training in an effort to set the standard for academic medical centers and professional organizations.
Does your Hospitalist Partner
Help Your Practice Grow?
“This new partnership focuses on educating surgeons at Florida
Hospital and beyond about the importance of effective training, in
order to save lives and improve cost and quality,” says Jeff Berkley,
founder and CEO of Mimic Technologies. “It is our hope that access to quality simulation training will move surgeons more rapidly
up the learning curve.”
The new simulator technology will also reduce training time
spent on the actual da Vinci device, freeing up the surgical robot
for elective patient surgeries. Robotic simulation training also reduces costs, as simulation training does not consume disposable
instruments or surgical materials. There is also the potential for
improving the efficiency of novice surgeons when performing their
first robotic cases.
This strategic alliance partnership, created by the Florida Hospital Strategic Venture Group, includes joint research and development of advanced technology for training robotic surgeons and to
extend this technology to remote telesurgery operations. Mimic’s
simulator is a powerful platform for measuring the changes in the
skills of robotic surgeons as they receive different types of training. This opens the door for a wide variety of research experiments
that will improve the methods of training and certifying robotic
surgeons. 
Expedited Care & Rapid Response
Time for Improved Patient Outcomes
CFIM’s on-site presence at multiple hospitals and skilled
nursing facilities allow our 40 physicians and 10 Nurse
Practitioners to manage a patient’s care 24 hours a day.
Extraordinary Control,
Convenience & Communication
iTrack each of your patients in the hospital or SNF
and view diagnosis, labs, medication lists, diagnostic
test results, and discharge summaries in real time
iConveniently admit patients through the “Direct
Admit” functionality
iRequest additional communication and initiate a
page to our physicians from the system
iRely on CFIM’s dedicated office team of 15
professionals with extended office hours and aroundthe-clock electronic access to serve you and your staff
Appreciation of Your Medicare
Advantage Challenges
CFIM has a dedicated team of Patient Advocates to
communicate with your Medicare patients to ensure
our entire practice is attuned to patient satisfaction
and improving quality measures.
To receive more information on CFIM and our
Physicians, contact Jim DeFalco @ (407) 647-2346
+%&'"-$0!$'-*.$0.t888$'-*.$0.
FLORIDA MD - SEPTEMBER 2012 33
CURRENT TOPICS
First Patient in Eastern U.S. Enrolls in Metastatic
Melanoma Clinical Trial at Lakeland
Regional Cancer Center
Lakeland Regional Cancer Center (LRCC) is proud to have been
initiated as the only enrolling site in the eastern United States for
a metastatic melanoma clinical trial, and one patient, in particular,
is filled with hope because this ground-breaking option is offered
within driving distance from his home in St. Petersburg.
Military Veteran Carl Hall, 79 years, was diagnosed with melanoma six years ago, after inquiring about a shiny mole he discovered on his chest. The cancer was removed in its entirety, along
with multiple lymph nodes which all came back clear. Hall was
cancer free and bound and determined to enjoy every moment of
his life.
Three years later, Hall learned the melanoma had returned. He
was referred to Lakeland Regional’s Helen Chan, M.D., a boardcertified surgical oncology specialist, who joined him in the fight
of his life.
“It meant the world to me to have a specialist on my side who
wanted what I wanted,” said Hall. “She has a personality that sets
you at ease. She listened to what I wanted and presented every
option.”
In 2012, his list of options grew when he learned about LRCC’s
new clinical trial, in which cancerous tumors are treated with a
potential breakthrough therapy to include a new medication and
a mild electrical current. Hall, who is known for doing his homework and asking for second opinions, liked what he learned about
the trial – especially since early data revealed the treatment
may help destroy cancer while
leaving healthy cells intact.
Now just a week into the
trial treatment, Hall says he is
filled with hope since he has
already seen the tumors in his
neck shrink in size.
“To already see positive reDr. Helen Chan with Carl Hall, the
sults without the harsh treatfirst patient to enroll in a potential
ments and side effects I’ve exbreakthrough melanoma clinical trial
perienced in the past is what
at LRCC.
means the most to me, said
Hall. “I am fighting this cancer, while still living life to the fullest.”
Hall says another reason he wanted to take part in the clinical trial is because it had the potential to help many others facing
cancer.
“Now that I’m in the midst of it, I want others in my situation
to know what this treatment has the potential to do for them – to
offer a cure, of sorts, not just remission.”
To learn more about LRCC and its clinical trials program please
call 863-904-1900 or visit www.LRMC.com/cancer-center. 
Arnold Palmer Hospital Opens Feeding Difficulties Center
Florida’s First Center for Children Unable to Eat by Mouth
Arnold Palmer Hospital for Children is opening Florida’s first outpatient intensive feeding center dedicated to treating children with
feeding difficulties.
The new Feeding Difficulties Center will be located on the seventh floor of the hospital and will work with families to treat young patients
with a variety of feeding difficulties due to:
•
Sensory/aversion disorders
•
Swallowing disorders
•
Oral-motor problems
•
Behavior-related food refusal
Children at the Feeding Difficulties Center will be cared for by a multi-disciplinary team of medical professionals, including gastroenterologists, occupational therapists, speech-language pathologists, registered dietitians, clinical social workers, and others. The center will treat
children up to age 12.
Once referred to the center, patients will be enrolled in a four-week program. Each patient will receive a full day of treatment five days a
week. Up to four children can be treated in the center at once.
The Feeding Difficulties Center features four patient observation rooms equipped with video recording/monitoring, a private consultation room, an observation room for parents, and a patient gym designated for sensory integration activities.
“The Feeding Difficulties Center is fulfilling a real need in Central Florida,” stated Devendra Mehta, M.D., pediatric gastroenterologist
at Arnold Palmer Hospital. “We’re seeing many children not physically growing because they are unable to eat. This center is the next step
in treating these children and helping them thrive.” 
34 FLORIDA MD - SEPTEMBER 2012
CURRENT TOPICS
Florida Hospital DeLand Wins the TransLife Award of
Excellence: Hospital Reaches a 100 Percent Organ Donation R0ate in 2011
TransLife recently presented Florida Hospital DeLand the TransLife Award of Excellence.
TransLife is a federally-designated organ procurement organization for 10 counties in east Central Florida, responsible for the recovery,
preservation and distribution of donated organs to critically ill patients.
The award is in recognition of exceptional hospital clinical and quality performance practices contributing to high rates of lifesaving organ
donations meeting or exceeding national goals. The TransLife Award of Excellence recognizes a 100 percent organ donation rate for Florida
Hospital DeLand in 2011.
The award is a testament to the quality of the entire clinical team at Florida Hospital DeLand, especially nurses, who are responsible for
notifying TransLife of every death and imminent death, should there be potential for donation.
Due to the generosity of organ donors and their families, more than three lives were saved through transplantation in 2011.

DR. REUSS WINS 2012 INJURED
WORKERS INSPIRATION AWARD
Given at the 67th Annual Workers’ Compensation
Educational Conference in Orlando
Orlando Orthopaedic Center’s Bryan L. Reuss, M.D., was presented with the 2012 Injured Workers Inspiration Award at the
67th Annual Workers’ Compensation Educational Conference for
his work with a workers’ compensation
patient who sustained an acetabular labral
tear (damage to cartilage and tissue in the
hip socket) and subsequently required hip
arthroscopy surgery.
The patient, a stuntman at Disney’s Hollywood Studios theme park in Orlando,
Fla., fell off of his motorcycle during a show
and slid hundreds of feet on his hip before
coming to a stop. After failing to recover
from the injury during weeks of extensive
conservative therapy, the hip arthroscopy
procedure was performed by Dr. Reuss.
After 10 weeks of rehabilitation following surgery, the patient is back on his
motorcycle, working full duty as one of the
main stuntmen in the popular theme park
attraction.
“I think I speak for the entire Orlando
Orthopaedic Center team when I say it’s
an honor to help anyone who chose our
practice for treatment return to work or
get back to their day-to-day activities without pain, as tame or as dangerous as those
activities may be,” says Dr. Reuss. “The
award is recognition for the effort we put
forth every day with every patient in our
offices.” 
Bryan L. Reuss, M.D.
Board Certified in Orthopaedic Surgery,
Board Certified in Sports Medicine;
Specializing in Sports Medicine, Knee
and Shoulder Surgery
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FLORIDA MD - SEPTEMBER 2012 35
CURRENT TOPICS
Orlando Health Now
Providing Cancer Services
at Health Central
Cancer patients living in west Orange County now have more options
right in their own backyard when it comes to receiving cancer care. Orlando
Health is now offering full-time radiation oncology and medical oncology
services at Health Central Hospital located in Ocoee. Services include raOrlando Health’s new cancer treatment facility houses a Varian
TrueBeam™ medical linear accelerator machine, making it one
diation treatments, infusion treatments and chemotherapy. The new cancer
of only two locations in Central Florida offering this advanced
treatment facility, a 16,500 square foot building located across the street from
radiation technology.
Health Central, also houses a Varian TrueBeam™ medical linear accelerator
machine. This is one of only two locations in Central Florida offering this advanced radiaADVERTISERS INDEX
tion technology which treats breast, lung and prostate cancer patients. “We are thrilled to
be able to bring cancer services right to west Orange County,” said Greg Ohe, President,
Health Central Hospital. “We continue to see the number of men and women diagnosed
Center for
with cancer climbing and by having these services at Health Central, cancer patients can
Specialized Surgery. . . . . . . . . . . 17
now receive the best care available right in their own neighborhoods.”
The opening of the cancer facility comes following Orlando Health’s acquisition of
Health Central this past April. The new cancer facility initially brought 20 new jobs to the
area with more jobs expected as its cancer services expand. 
Be sure and check out our NEW and IMPROVED
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36 FLORIDA MD - SEPTEMBER 2012
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