WestJet Connects Canada, Gulf Coast

Toronto and Sarasota will soon be just one cheap plane ride apart. Sarasota-Bradenton International Airport officials announced Monday that Canadian airline WestJet, a low-cost carrier, will begin nonstop service between the two cities starting in December. For the tourism industry on the Gulf Coast, that means a stronger connection with the entire Canada market at a time when visitation from the Great White North has grown increasingly important.

“This is very exciting for Canadian customers traveling to our beautiful Gulf Coast communities,” said SRQ airport President and CEO Fredrick Piccolo, “and will provide additional opportunities for locals to explore Canada and other destinations worldwide.”

WestJet starting Dec. 18 will offer nonstop service on Fridays and Sundays between SRQ and Toronto Pearson International Airport (YYZ). The flights will be offered seasonally, running through April 29. Flights will be on a Boeing 737-700 with 136 seats. Morning flights are scheduled to depart Toronto at 8:05am and land in Sarasota at 11:06am, with afternoon flights departing Sarasota at 11:55am and landing in Toronto at 2:39pm.

Virginia Haley, president of Visit Sarasota County, said more visitors to Sarasota County originate from Toronto than any other international city, and the city is the seventh-most important origin city to the county. Since Oct.1, around 72,000 visitors to the county have come from Canada, compared to some 25,000 from the United Kingdom and 18,000 from Central European nations (Germany, Switzerland and Austria). She said WestJet should open access to more Canadians as well. “This is the first time a low-fare carrier comes from this market,” she said. “If ever there is a complaint from Canadian visitors, especially from Toronto, it’s that they feel they have to go to Buffalo for low-fare alternatives.” 

In Manatee County, tourism officials say Canada still trails Europe in terms of importance as far as visitors. In the first quarter of the year, for example, some 14,530 visitors originated from Europe while 14,050 came from Canada. But Elliot Falcione, director of the Bradenton Area Convention and Visitors Center, said getting the WestJet connection may be most important to the area as a means to serve seasonal residents who live in Toronto but winter in Sarasota. With the nonstop flight, Falcione said a concerted effort would be made toward boosting travel from Toronto to Manatee County. “With these additional flights in and out of Toronto, we will look at putting more advertising and public relations in that area,” he said. 


Rethink sun, sand and surf

Inbound Medical Tourism

Rethink sun, sand and surf. Medical Tourism is taking Florida by storm. If you haven't heard the news about Florida lawmakers' multi-million dollar push to bring both domestic and international patients to the Sunshine Staute -- you should. Watch the video (see links).


Tourism Patients Finding More to Florida under Sun


Like many tourists visiting Florida, she and her son went to Disney Worldbefore driving east to the beach to check out a rocket launch at Cape Canaveral. Before Amy Caterina returned to her home 2,500 miles away in Southern California, she made one last stop in Orlando again to visit a team of plastic surgeons at UF Health Cancer Center – Orlando Health.


Beyond warm sunny days at the beach or pool, Caterina now has a greater appreciation of the Sunshine State. Health and tourism officials are hoping more visitors like Caterina, who returned four months later to undergo vascular lymph node transfer at UF Health Cancer Center, will transform the state’s sun and sand into a hot spot for medical tourism.


Visit Florida, the state’s tourism arm, said that grants totaling $2.5 million will be offered to bring this goal to fruition. One will strengthen Florida’s position as a medical tourism destination of choice for both international and domestic healthcare consumers; the other will be to market related medical conferences, meetings and training programs.


"Patients around the world are no longer looking for procedures and treatments only within their own neighborhood, state or national boundaries," said Renée-Marie Stephano, President of the Medical Tourism Association®. "When these potential patients combine Florida’s attractions, and warm weather with healthcare services that are not only readily accessible, but super-specialized – like in this case, a side effect to breast cancer — Florida becomes a serious consideration for medical travel."


Fly Orlando


Few hospitals offer the type of comprehensive approach to lymphedema that Caterina found at UF Health Cancer Center, where surgeons have now performed the procedure more than 55 times including at least 7 on medical travel patients.


As many as 6.8 million Americans have lymphedema, which prevents lymph fluid from draining from body tissues. The fluid builds up, causing chronic, painful, disfiguring and even immobilizing swelling. Many patients must wear special compression garments, have daily compression massages and have the fluid drained regularly.


"More and more people are flying into Orlando for this operation," said Richard Klein, M.D., section chief of the Plastic and Reconstructive Surgery Center at the UF Health Cancer Center – Orlando Health. "In fact, we’ve been performing this surgery just over a year now, and in that time we’ve already consulted with patients from 22 different states about it. I think we’re going to become more and more known for this type of procedure and we hope that patients are going to fly in not only from around the country, but from around the world as well."


When they do, healthcare providers, hotels, restaurants and tourist attractions near hospitals and clinics in Florida stand to benefit from the medical tourism grants, funded by the state legislature during the 2014 session


Economic Boon


"The establishment of these grants is a tremendous first step in our strategic planning process to spotlight Florida’s world-class doctors and facilities," said Will Secombe, Visit Florida president and CEO.


Visit Florida received $5 million in state funding to promote Florida medical tourism. Each grant awarded under the new medical tourism promotional program will be matched by private funds. Stephano, who serves on the Visit Florida Medical Tourism Taskforce and the gran subcommittee, said the goal of the grant program is to promote new service lines and enhance target markets to increase existing inbound patient flow.


That’s fine with patients like Caterina, who, before the grant program, was fortunate to learn about the lymphedema opportunity at UF Health Cancer Center on social media.


"I researched it (lymphedema)," said Caterina. "Interestingly enough, I couldn’t find anything close to home, which is ironic because I live in San Diego and it’s a big city. So, I decided to come to Orlando."

Doctors Hospital Achieves Robotic Spine Surgery Milestone

Doctors Hospital of Sarasota recently completed 100 Mazor Robotics Tenaissance guidance system procedures, performed by the team of Dr. Tan Ly and Dr. Thomas Sweeney. The Mazor technology allows spine surgeons to perform minimally invasive procedures on patients who previously were not considered good surgical candidates.

SMH and Venice Regional Medical Center Win Blue Distinction for Spine Surgery & Total Knee/Hip Joint Replacement

Both Sarasota Memorial Health Care System and Venice Regional Medical Center received the highest level of distinction by Florida Blue, Florida's Blue Cross and Blue Shield company, as a high performing hospital for quality and efficiency in spine surgery and total hip/knee joint replacements. The Blue Distinction Centers for Specialty Care® program is a national designation awarded by Blue Cross and Blue Shield companies to medical facilities that have demonstrated expertise in delivering quality specialty care - and has recently been expanded to include more robust quality measures focused on improved patient health and safety as well as new cost-efficiency measures.

SMH Announces New Chief of Cardiovascular Surgery, Unveils “Hybrid” Operating Room


Sarasota Memorial Hospital (www.smh.com) named cardiothoracic surgeon Dr. Jeffrey Sell as its new Chief of Cardiovascular Surgery. Sell is a specialist in congenital heart disease, and pediatric and transplant surgery. Sarasota Memorial also unveiled a new “hybrid” operating room, which will allow surgeons, cardiologists and other specialists to collaborate in one setting, minimizing the number of invasive procedures for complex conditions. Sell will begin working at the hospital in March, and the new operating room will be ready for use in January.

The Power of 3... Robots




With its technologically advanced i-Suites, the largest and most experienced group of multi-specialty robotic surgeons in the region and the recent arrival of the latest generation da Vinci surgical robot, Sarasota Memorial Hospital is enabling more surgeons to perform more complex procedures on more patients using a minimally invasive approach. 

Sarasota Memorial's third surgical robot – the da Vinci Si boasting the latest robotic options and features – was delivered Oct. 29 and is now hard at work in the hospital's minimally invasive operating suites. Sarasota Memorial was the first to pioneer robotic surgery in southwest Florida, and now has more than 22 robotic surgeons who have performed more than 2,000 procedures in an ever-growing field of specialties– cardiovascular, thoracic, gynecology, urology, oncology and general surgery. It is the only hospital in the region with so many experienced robotic surgeons and now three robotic operating suites to ensure a comprehensive range of minimally invasive surgical options are available to patients when they need them. 

Florida Medical Retreat is proud to partner with Sarasota Memorial Hospital and bring cutting edge technology to our clients.

For more information about robotic surgery or Sarasota Memorial's robotic surgeons, call our HealthLine at (941) 917-7777 or visit our website at: www.smh.com/robotics


Sarasota Hospital part of drug chain's innovation

With the folks at Medicare putting a spotlight on the problem of re-admissions- older patients with chronic illnesses making repeat visits to the hospital when they should be getting better- all kinds of experiments are under way to mend the missed connections between hospital room and home.

One of these, a prescription drug coordination model by Walgreens called WellTransitions, has been refined recently at a handful of U.S. hospitals, including Sarasota Memorial. The idea is to make pharmacists part of the discharge process, so that patients leave the hospital with all the new meds they've been prescribed, and a better idea of what to do with them.

Medical estimates that preventable hospital readmissions cost the system some $25 million a year, and confusion over medications is a major contributor to the problem. WellTransitions- which so far has involved a pilot program of more than 180 heart failure patients as Sarasota Memorial- is designed to follow the patient home from the hospital, from bedside drug delivery to regular phone consultations with a pharmacists.

Walgreens plans to roll out the program nationwide, first to the 150 hospitals where the company has on-site pharmacies. Sarasota Memorial was selected for the pilot project because of a relationship that goes back to 2009, said Joel Wright, vice president for health systems operations at Walgreens.

"And with their success at reducing readmissions, they were a natural fit," Wright said. "They have a very clear focus on quality, and it's hard to work with a system if that is not a clear focus."

Wright acknowledged that handling a sheaf of new prescriptions, often bearing new names for generic versions of old drugs, can be daunting.

"For the general population those are very challenging words to pronounce", he said. "You almost have to be a medical professional to read a prescription."

Compounding the difficulty is a lack of coordination between health care providers for any given patient.

"There's a handful of problems that we really struggle with as a health care system",  Wright said. "Many patient use multiple pharmacies. Physicians and hospitals don't have access to the patient's medication list at the time of new program, he said aims to make those connections - even working with other drugstore companies to make sure patients get their meds.

Spence Hudon, clinical manager of Sarasota Memorial's inpatient heart failure unit, said WellTransitions has expanded Walgreen's role from bedside delivery to "participation in medication education and reconciliation, discharge phone calls, and calls to the patients later in the 30 days post-discharge."

"Right now wer'e very focused on heart failure, " Wright said, "but we're looking at what other disease states can possibly be helped."

Original Post by Barbara Peters Smith, Sarasota Herald Tribune

Dr. John Sylvester, Radiation Oncologist


Dr. John Sylvester is a board-certified Radiation Oncologist with a sub-specialty in the treatment of prostate cancer including brachytherapy / seed therapy.

In August, Dr. Sylvester  was invited and participated on the Advisory board meeting for Provenge, (immune therapy/vaccine for metastatic hormone resistant prostate cancer), ASTRO annual radiation oncology meeting in Boston.

-          On Saturday, October 28th, Dr. Sylvester participated in the Myriad advisory board regarding a new prostate cancer prognostic procedure.


      The following day he gave a talk on Space OAR with IG-IMRT for prostate cancer at the investigators meeting. Dr. Sylvester also gave a talk on Endo-rectal Balloon use for IG-IMRT for Prostate cancer.

-          In addition, Dr. Sylvester had a paper accepted regarding THINStrand radioactive seeds for prostate cancer brachytherapy.

He continues to accrue patients to 2 separate research studies:

-          SpaceOAR for IG-IMRT low-intermediate risk prostate cancer  patients

-          IGRT + Cs-131 seeds for intermediate to high risk prostate cancer patients.

       For more information or to schedule an appointment with Dr. Sylvester, contact Florida Medical Retreat.

Buyers From Across the Pond Drawn to Sarasota-Bradenton-Venice

Florida Realtors has released its “Profile of International Home Buyers in Florida 2012," which surveyed more than 1,500 Florida REALTORS on their experience with international buyers. The survey conclusions are applicable to the 12-month period ending June 2012 and revealed that of all Florida markets, Sarasota-Bradenton-Venice is ranked as the top destination for Canadian buyers, and second for U.K. and Western European buyers. The area was far less attractive to buyers from Brazil and Latin America in general.

Florida Medical Retreat is located in Sarasota and proud to be of service to our neighbors to the North with their medical needs. For a full list of services, please visit www.floridamedicalretreat.com or call (941) 552-3288 or (800) 643-0529.

To read the full report click.

Sarasota Memorial Hospital Earns EPA’s ENERGY STAR® Certification for Superior Energy Efficiency

SARASOTA (Aug. 15, 2012) – Sarasota Memorial has earned the U.S. Environmental Protection Agency’s (EPA’s) ENERGY STAR certification, which signifies that the organization performs in the top 25 percent of similar facilities nationwide for energy efficiency and meets strict energy efficiency performance levels set by the EPA.
"We are pleased to accept EPA’s ENERGY STAR certification in recognition of our energy efficiency efforts,” said Facilities Director Jim Bugyis. "Through this achievement, we have demonstrated our commitment to environmental stewardship while also lowering our energy costs.”

Sarasota Memorial is the only hospital in Southwest Florida to earn the certification.
Buildings that earn EPA’s ENERGY STAR certification use an average of 35 percent less energy than typical buildings and also release 35 percent less carbon dioxide into the atmosphere.
Sarasota Memorial improved its energy performance by managing energy strategically across the entire organization and by making cost-effective improvements to its buildings.   

“Improving the energy efficiency of our nation’s buildings is critical to protecting our environment, “ said Jean Lupinacci, Chief of the ENERGY STAR Commercial & Industrial Branch. “From the boiler room to the board room, organizations are leading the way by making their buildings more efficient and earning EPA’s ENERGY STAR certification.”

Sarasota Memorial reduced total energy costs by nearly $300,000 a year through a variety of initiatives, including replacing more than 10,000 bulbs with efficient fluorescent lighting (old bulbs are recycled) and upgrading corridor lights to LED lights, which use less electricity and last longer. Earlier this year, SMH also installed 40 solar panels atop the Waldemere Tower, a pilot project designed to produce 1,000,000 BTUs of heated water per day to supplement the hospital’s air conditioning and heating systems’ boilers.
“The savings from our energy efficiency initiatives not only reduce the hospital's carbon footprint, but also help provide additional funds for critical medical services,” said Bugyis.

By:  Sarasota Memorial Hospital

Controversial USPSTF Decision on PSA Screening Worries Patients and Physicians by Dr. John Sylvester

By Dr. John Sylvester

There has been a great deal of attention in the media recently about PSA screening. A few months ago, the United States Preventative Services Task Force (USPSTF) came out with preliminary recommendations that PSA screening should not be done. They have now decided to make this decision final. They recommend no routine PSA blood tests for prostate cancer screening. These recommendations may lead Medicare and private insurance companies to refuse to pay for PSA tests.

Many prostate cancer experts were surprised and frankly upset by the USPSTF recommendations. We feel the USPSTF made some major errors. They made these recommendations after reviewing several articles published in the medical literature. They primarily based their decision on one article published in the New England Journal of Medicine (NEJM) in 2009 "Mortality Results from a Randomized Prostate-Cancer Screening Trial" (the PLCO trial). This paper evaluated whether patients randomized to PSA screening versus "usual care" experienced a reduced risk of death from prostate cancer. It was a poorly run study with major flaws and should not have been used to make any recommendations.

Problems with PLCO Article:

-Only 85% of men in PSA screening are actually got PSA tests

-At least 52% of men in non-screening arm received PSA screening

- Length of follow-up was too short to show a survival advantage

- PSA cut-off was too high to detect many cancers when they are most curable

Why the USPSTF chose to ignore these major problems was not explained. Moreover, the USPSTF chose to ignore the positive findings in the PLCO study. The "healthy" men who participated in the PLCO were 44% less likely to die of prostate cancer with screening. The 10% of men in the study that had 1-2 PSA checks prior to entering the PLCO trial had a 25% reduction in prostate cancer deaths.

Positive Studies

Other, cleaner randomized studies have been published on PSA screening. The European randomized study from the same issue of the NEJM as the PLCO study was much larger, had less contamination and showed a 20% reduction in prostate cancer deaths initially, and will longer follow-up now shows a 31% reduction in prostate deaths with PSA screening. The smaller but even better run Goteborg randomized trial showed a 44% reduction in prostate cancer deaths with PSA screening (Lancet 2010). Why the USPSTF chose to de-emphasize these positive studies was, again, not explained.

During the PSA era, prostate cancer mortality in the USA had dropped ~40% and the percentage of men being diagnosed with metastatic (incurable disease) has dropped ~75%. The USPSTF suggests evaluation and biopsies be considered when men develop symptoms of prostate cancer. Every cancer doctor knows it is usually incurable at that point.  But, the USPTF had no cancer doctors on the panel.

PSA Blood Test

The PSA blood test is simply another piece of information a doctor can discuss with his/her patient. Having a rise in PSA does not necessarily mean you need a biopsy A short course of antibiotic may make the PSA fall, in which case a biopsy may not be needed.

Even if a biopsy is done and found to be positive for cancer, many options are available to the individual patient. These options include  active surveillance, Radical Prostatectomy, Image Guided Intensity Modulate Radiation Therapy (IG-IMRT), Radioactive seend implantation (brachytherapy), hormonal manipulation, Cyrotherapy, etc.  If a relatively healthy man is found to have an aggressive cancer, treatment is indicated. If an older less healthy man is found to have a low volume low risk cancer, active surveillance may be the best option.  These treatment decisions are best decided by the patient and his physician, not by some government panel that did not even include any prostate cancer doctors.

If you would like more information on Dr. Sylvester, please contact Florida Medical Retreat.


Sarasota Memorial Hospital Listed Among Nation’s Top Two Hospitals for heart attack, heart failure, pneumonia care

Florida Medical Retreat is thrilled to share this exciting news from our hospital member, Sarasota Memorial Hospital!

Sarasota Memorial Hospital was one of just two hospitals – out of more than 4,000 nationwide – singled out for demonstrating the lowest (best) readmission rates in the nation for heart attack, heart failure and pneumonia patients.

Newly-released data from the U.S. Centers for Medicare and Medicaid Services (CMS) posted on the government’s Hospital Compare website reveals mortality and re-admission rates for more than 4,600 hospitals nationwide. The data shows how often patients died or were readmitted within 30 days of discharge from a previous hospital stay for heart attack, heart failure, or pneumonia.
Sarasota Memorial was one of only two hospitals in the nation to perform well-above the national average in all three readmission categories studied. The data, which covers a three-year period from July 2008 to June 2011, was posted this month on CMS’ Hospital Compare website; an analysis this week by Kaiser Health News spotlighted Sarasota Memorial and Citrus Memorial Hospital (Inverness, FL) as the only two hospitals in the nation that had better than average readmission rates for all three conditions.
According to the Kaiser study, only 1 percent of hospitals were labeled as better than average in heart attack (30 hospitals) or pneumonia cases (33 hospitals) and only 2 percent (94 hospitals) were labeled as better than average in heart failure.

The study, based on the most recent Medicare data available, showed that:
• 19.7 percent of heart attack patients were readmitted within 30 days of discharge
• 24.7 percent of heart failure patients were readmitted • 18.5 percent of pneumonia patients were readmitted
In comparison, readmission rates at Sarasota Memorial were 16.2 percent for heart attacks, 19.7 percent for heart failure and 15.6 percent for pneumonia. Sarasota Memorial also scored well on mortality rates for each of the three conditions.

The rates are all “risk-adjusted” — which means they take into account how sick patients were, to make sure hospitals of different sizes and with different patient populations can be compared fairly.

“Of all the achievements Sarasota Memorial has earned in recent years, we’re particularly proud of our low readmission rates,” said Sarasota Memorial CEO Gwen MacKenzie. “We have many quality goals, but among the most critical are reducing readmissions, complications and mortality.

“Achieving such low readmission rates is a tribute to everyone on our health care team and the continuum of care they provide. It means that we’re following up and communicating well with our patients, their families and each other to make sure everyone is on the same page, that everyone understands our patients’ diagnoses, their medications, their plans of care and how to care for themselves once they leave the hospital.”

Center For Sight First in Nation to Launch LensAR Laser for Cataract Surgery

Cataract surgery is about to undergo a revolutionary advance—shifting from the conventional hand-held blade—to an ultramodern blade-free, femtosecond laser procedure which can treat even the hardest cataracts in mere minutes. Not since the “no-stitch” cataract procedure has the ophthalmology profession experienced such a seismic shift in eye surgery; and it’s now in Sarasota.

For nearly two years Center For Sight founder and CEO, David Shoemaker, M.D., has been cautiously monitoring developments related to the use of femtosecond lasers in cataract surgery with a keen interest in the technology offered through the LensAR Laser System designed by LensAR, Inc., an Orlando-based company. He was among a select group of 18 ophthalmologists from the U.S. and abroad who recently traveled to Lima, Peru to help deploy the technology in that country. While there, he performed laser cataract surgery on 20 patients with very dense cataracts and was amazed with the flawless execution of this amazing technology. He will perform the first LensAR Laser Cataract procedure in the United States on August 1st.

“There is no doubt the LensAR Laser System will result in safer and more predictable outcomes for patients throughout the world,” says Dr. Shoemaker. “It is rare to experience a true ‘Wow!’ moment in medicine, and that is exactly what this laser does. We couldn’t be more excited to bring this technology to Sarasota.”

With Laser Cataract Surgery, the hand-held blade will be limited to a supporting role. The LensAR Laser System uses the most advanced scanning beam technology ever offered to surgeons. The system employs a proprietary, high resolution 3D-CSI measurement device combined with an advanced femtosecond laser designed to deliver laser pulse placement and surgical incisions with unsurpassed precision.

“LensAR Laser System has been successfully used outside the U.S. with excellent clinical success and reliability,” says Dr. Shoemaker. “It’s a privilege to be the first in country to offer the genius of this laser technology to our patients.”

For more information, please contact Florida Medical Retreat.

New Valve Clinic at Sarasota Memorial Hospital Helps Patients with Severe Aortic Stenosis

With people living longer, more are becoming susceptible to aortic stenosis (narrowing of the heart vales), but many patients - because of age or other health issues - cannot tolerate open hear surgery to treat it.

Now, a breakthrough procedure that allows doctors to replace the diseased valve without surgery is providing new hope to the estimated 40 percent of people living with the potentially deadly condition.

Bolstered by its collaboration with New York's Columbia University Medical Center, Sarasota Memorial opened a new Heart Valve Clinic in June and is now evaluating patients with valve disorders to identify those who could benefit from a new minimally invasive procedure - Transcatheter Aortic Valve Replacement (TAVR). FDA approved, TAVR is the only catheter-based treatment option for people with severe aortic valve disease who are not eligible for surgery.

Aortic stenosis reduces the valve's ability to open and close completely and can cause severe shortness of breath, chest pain and weakness, said David Patterson, executive director of Sarasota Memorial's Heart & Vascular Services. The condition can result from a birth defect, heart attachk, hypertension, aortic aneurysm or infection; however, some causes are unknown. Left untreated, heart valve disease can result in heart failure, severe infection and sudden death.

"Basically, TAVR allows us to replace the valve through a small opening near the groin, rather than open heart surgery," Patterson said. While there is an increase chance of stroke with TAVR, studies show that for the inoperable, the benefits greatly outweigh the risks.

Original Post: Sarasota Memorial Health Care System, Summer 2012 newsletter

For additional information on Sarasota Memorial Hospital contact Florida Medical Retreat.

US News Ranks Sarasota Memorial Hospital among Best Hospitals

Sarasota Memorial Hospital is the only local hospital on U.S. News & World Report's 2012 "Best Hospitals" list, ranking #47 for excellence in gynecological care. It also ranked #1 again for overall care in the Sarasota-Venice-North Port region, and this year earned a spot on Florida's top 10 hospitals list. Sarasota Memorial was among just 3 percent of the nation's hospitals to earn its spot on the list of 50 Best Hospitals. In U.S. News' 2012 Best Hospitals study, fewer than 150 of roughly 5,000 U.S. hospitals evaluated earned a national ranking in at least one of 16 medical specialties.

Florida Medical Retreat is proud to partner with SMH and congratulate the entire staff on this achievement!

Relief for joints besieged by arthritis

If you live long enough – that is, beyond 50 or 60 – chances are one or more of your joints, probably your knees or hips, will become arthritic. And if pain or stiffness begin to seriously limit your ability to enjoy life and perform routine tasks, chances are you’ll consider replacing the troublesome joint.

“People with osteoarthritis are relying more and more heavily on surgery,” Dr. David T. Felson, a rheumatologist and epidemiologist at Boston University School of Medicine, told me. “The rate of knee replacement is just skyrocketing, out of proportion to increases in arthritic changes seen on X-rays, and replacement surgery is contributing greatly to the rising costs of Medicare.”

Between 1979 and 2002, knee replacement surgery rose 800 percent among people 65 and older. Although Dr. Felson described hip replacement as “dynamite” — highly effective in relieving pain and restoring function — knee replacement may be far less helpful.

“For 10 to 30 percent of patients, the improvement never comes,” Dr. Felson said.

How the Trouble Starts

Osteoarthritis results from wear and tear on the joints. (Rheumatoid arthritis, on the other hand, is an autoimmune disorder.) Some 27 million Americans have life-limiting osteoarthritis, and the numbers are rising as the population gets older and fatter.

“With every step, the force exerted on weight-bearing joints is one and a half times body weight,” said Dr. Glen Johnson, who reported on arthritis prevention and treatment at the annual meeting of the National Athletic Trainers’ Association in June. “With jogging, the force is increased seven or eight times. Thus, the most effective way to prevent arthritis in knees and hips is to lose weight if you’re overweight and to pursue non-impact activities for recreation.”

While most people think of osteoarthritis as a breakdown of the cartilage that keeps bones from rubbing together, recent studies have shown it is a far more complicated disease that also involves tissues in and around joints, including bone and marrow. Inflammation can be a contributing factor, and genetics play a role. Three genes have been identified thus far that accelerate the development of arthritis in people who carry them.

Any kind of joint injury or surgery, even if performed arthroscopically, raises the risk that a joint will become arthritic. That is why so many professional and recreational athletes develop arthritis at younger ages.

Still, there are many potential remedies short of surgery to relieve arthritic pain and to preserve — and perhaps restore — normal joint function. Even if surgery is needed, it can be postponed for many years with treatments proven to help in well-designed clinical trials.

Artificial joints usually last 10 to 15 years. Delaying surgery is helpful because the earlier in life a joint is replaced, the more likely a subsequent replacement will be needed. And both devices and surgical techniques are constantly being improved; by delaying a joint replacement, you may end up with a simpler operation or more durable device.

Take it from someone who has been there: Joint replacement, especially of the knee, is not a walk in the park. Arduous physical therapy is essential, and recovery can be long and painful. There are limitations after recovery, too, because artificial joints are not as flexible as the ones you were born with.

What Works, What Doesn’t

First things first: If you weigh more than you should, do your best to shed those extra pounds. Even a loss of 10 to 15 percent of body weight can make a big difference to weight-bearing joints.

“I can’t stress enough how important body weight is,” Dr. Johnson said. “With our national crisis of obesity, we’ll see more and more arthritis of the knees, ankles, hips and spine.”

Stephen Messier, a professor of health and exercise science at Wake Forest University, has shown in a trial among 450 men and women with osteoarthritis that a weight-loss diet combined with a well-designed exercise program can significantly reduce knee pain.

The most helpful exercises are those that strengthen the quadriceps (muscles in the front of the thighs), like leg presses, mini-squats and wall squats, and flexion and extension exercises that restore and preserve range of motion, Dr. Johnson said. Several visits to a physical therapist can help assure that you are doing the exercises correctly.

“The severity of pain is directly correlated with the degree of muscle weakness,” Dr. Felson wrote in The New England Journal of Medicine. (If the knee hurts during exercise, he added, then it should be avoided.)

Wearing the right shoes with certain adjustments to the sole and heel, if needed, can help too. Get fitted in a store with expertise in evaluating feet and gait. Are your arches flat? Are you bow-legged or knock-kneed? Wedges specifically designed for you can help take stress off arthritic knees and hips.

Though most experts endorse walking for exercise for its ease, accessibility and low cost, Dr. Johnson instead recommends such non-impact activities as stationary or outdoor cycling, swimming, or working out on an elliptical or rowing machine for cardiovascular fitness. Those who choose to walk, he said, may benefit from runners’ shoes designed to dissipate the force on joints.

Bracing an arthritic knee can help, too, especially with an unloader brace that shifts the stress away from the damaged part of the joint. Most patients are unlikely to wear such a brace all the time, Dr. Felson said. Still, knee braces can help arthritis sufferers continue to participate in physical activities, reduce the use of pain medication and postpone the need for surgery.

Pain relievers usually bring only temporary relief, if any. Daily dosing with acetaminophen (the ingredient in Tylenol) should be tried first, experts say, because it is significantly safer than ibuprofen and other nonsteroidal anti-inflammatory drugs, especially for older people.

Well-designed clinical studies have shown no significant relief of arthritic knee pain from supplements of glucosamine and chondroitin sulfate, taken alone or in combination, though Dr. Felson said that if people feel better taking them, he does not discourage the practice.

Nor is there good evidence of benefit from methylsulfonylmethane, SAM-e or acupuncture. Some evidence suggests that osteoporosis drugs may be helpful, though they have not yet been tested for arthritis relief in a randomized clinical trial, Dr. Felson said.

There are also hints of benefit from vitamin K, an essential nutrient found in cruciferous vegetables (broccoli, kale, cabbage and the like), which are good for health in general (unless you take blood thinners).

Doctor-administered treatments include steroid injections every three or four months to control pain and buy time, and injections of a synovial fluid replacement like Synvisc twice a year. In general, though, these are not very effective when arthritis has reached the bone-on-bone stage, Dr. Johnson said.

Original Post by Jane Brody Herald Tribune

3D Photographic Simulation Brings a New Dimension to Plastic Surgery at Sarasota Plastic Surgery Center

If you are one the thousands of people each year considering aesthetic plastic surgery, Sarasota Plastic Surgery Center has some good news for you. Recent advances in three dimensional (3D) photography combined with revolutionary new software allow prospective patients to preview what they will look like as the result of breast augmentation, facial procedures, and more, well in advance of any surgery.
Both the VECTRA® 3D camera and Sculptor software which make this possible were developed by Canfield Imaging Systems of Fairfield, NJ, the world’s leading provider of medical photography systems. The process starts with a VECTRA 3D session which produces a three-dimensional photograph of the patient. Then, using Sculptor software, the surgeon is able to simulate the expected results of a variety of aesthetic procedures.
“We are truly excited about using this new technology to help our patients,” said Dr. Scott Engel “For the first time, they’re able to see a 3D picture of themselves while we rotate their picture to any viewpoint and examine the desired result. We can make changes and agree on a final look in advance. This significantly helps them make a decision. In addition, we can review their postoperative pictures and analyze their dramatic improvement”.

For more information, contact Florida Medical Retreat.

Sarasota’s First ACR Breast Imaging Center of Excellence is at Doctors Hospital of Sarasota

Doctors Hospital of Sarasota has been designated as Sarasota’s first Breast Imaging Center of Excellence (BICOE) by the American College of Radiology (ACR).

By awarding Doctors Hospital the status of a Breast Imaging Center of Excellence, the ACR recognizes our Breast Care Center as having earned accreditation in mammography, stereotactic breast biopsy, and breast ultrasound (including ultrasound-guided breast biopsy).

“Achieving BICOE status shows the level of commitment our hospital has to fighting breast disease, a social cause and movement that has grown significantly, says Alberto Righi, MD. “It demonstrates that we are performing at a high level and that we are doing our best for the benefit of our patients.”

“Our team of clinical professionals is dedicated to providing each patient with high quality, compassionate care,” says Kay Adkins, Director of the Breast Care Center. “It is exciting to be the first in our area to be recognized as a Center of Excellence, but it is truly rewarding to know that we are consistently doing what is right for our community,”

Peer-review evaluations, conducted in each breast imaging modality by board-certified physicians and medical physicists who are experts in the field, have determined that we have achieved high practice standards in image quality, personnel qualifications, facility equipment, quality control procedures, and quality assurance programs.

The ACR is a national professional organization serving more than 34,000 diagnostic/interventional radiologists, radiation oncologists, nuclear medicine physicians, and medical physicists with programs focusing on the practice of medical imaging and radiation oncology and the delivery of comprehensive health care services.

 For more information on the Breast Care Center at Doctors Hospital of Sarasota, please contact Melissa Morgan at 941-342-1012 or 941-809-9130.

Sarasota Memorial Ranks Among Nation’s Top 5% of Hospitals for Women’s Health and Maternity Care – 10 years in a row

HealthGrades study: If all U.S. hospitals had performed at the level of Sarasota Memorial, about 39,450 women could have potentially survived their hospitalization and 19,062 could have potentially avoided a major in-hospital complication

Sarasota Memorial Hospital ranks among the top 5% in the nation for excellence in women’s health and maternity care, according to a new report released today by HealthGrades, the leading provider of information to help consumers make an informed decision about a physician or hospital.

Sarasota Memorial is the only hospital in the region to receive both the Maternity Care and Women’s Health Excellence Awards since their inception – and the only one to rank in the top 5% in the country in both areas 10 years in a row.

Participation in the study was not voluntary; all 4,783 of the nation’s acute care hospitals were evaluated by HealthGrades as part of its 2012 Trends in Women’s Health in American Hospitals report.

In its Women’s Health study, HealthGrades evaluated 16 women’s medicine, cardiovascular, and bone and joint health treatments and procedures over the years 2008, 2009 and 2010 using data from the federal Medicare program. Sarasota Memorial and the 175 other recipients of the HealthGrades Women’s Health Excellence Award had, on average, women’s mortality rates that were 42 percent lower than the poorest performers across nine diagnoses and procedures, and complication rates were, on average, 14 percent lower than the poorest performing hospitals across seven procedures.

To evaluate maternity care, the 224 hospitals that received the 5-Star rating were evaluated on vaginal delivery maternal complications for single live deliveries; c-section delivery maternal complication rates for single live deliveries; overall volume and volume of low birth weight deliveries; and risk-adjusted infant mortality rates for single live deliveries. The study found that women who give birth at 5-Star rated hospitals experience 62 percent fewer complications than lower-performing hospitals.



SMNeNews Release Page 2 – HealthGrades Women’s Health/Maternity Care Excellence Awards

“In our study, HealthGrades noted the rate of surgical intervention for women suffering a heart attack has increased over the years. This is good news, especially for patients who choose care at hospitals that are top performers in women’s healthcare,” said Divya Cantor, MD, MBA, HealthGrades Senior Physician Consultant and author of the study. “Our goal is to provide current, independent data on clinical outcomes to help prospective patients make informed decisions about their providers while also identifying hospitals that are setting national benchmarks to which other hospitals can aspire.”

If all of the nation’s hospitals had patient outcomes among women that at the level of those receiving the HealthGrades award, 39,450 women could have potentially survived their hospitalization and 19,062 women could have potentially avoided a major in-hospital complication.

The HealthGrades study examined hospitalization records from the MedPAR database in all 50 states, for the years 2008 through 2010. The following procedures and treatments were analyzed: heart attack, congestive heart failure, pneumonia, chronic obstructive pulmonary disease, stroke, coronary bypass surgery, peripheral vascular bypass, coronary interventional procedures, resection/replacement of abdominal aorta, carotid surgery, and valve replacement; total knee and total hip replacement surgeries, spinal surgeries, and hip fracture repair.

To be eligible for the HealthGrades award, hospitals must have met volume requirements in stroke and either coronary bypass or valve replacements; met the volume requirements in at least six additional cohorts of the 16 evaluated; and have transferred out less than 10 percent of stroke patients. Volume requirements are a minimum of 30 female discharges over the three years, with at least five in the most recent year for the cohort.

The Women’s Health and Maternity Care Excellence Awards are the latest in a series that Sarasota Memorial has received from HealthGrades so far this year. In February, Sarasota Memorial earned the elite “America’s 50 Best Hospitals” designation, placing Sarasota Memorial in the top 1% of hospitals for consistently superior clinical outcomes. Indeed, Sarasota Memorial is one of just five hospitals in the nation to receive the organization’s two top awards six years in a row.

In 2012, Sarasota Memorial also received HealthGrades’ “Distinguished Hospitals for Clinical Excellence,” Emergency Medicine Excellence award, with five-star ratings in 23 specialty areas.

The HealthGrades 2012 Trends in Women’s Health in American Hospitals report, including the methodology, and other reports, can be found at http://www.healthgrades.com.


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