Advanced Lenses

By Dr. Pooja Khator
Pooja Khator, MD, a glaucoma specialist and cataract surgeon, is certified by the American Board of Ophthalmology. She joined Coastal Eye Institute in 2006. 

Cataracts, or clouding of the lens of the eyes, are common as we age. Fortunately, cataract surgery is quite effective and, in fact, one of the most common surgeries performed in the United States. lenses

When ophthalmologists perform cataract surgery, they remove the eye’s old lens and replace it with an intraocular lens (IOL). Originally, a standard intraocular lens, which can certainly help patients see better but cannot correct astigmatism or presbyopia (the ability to see close up), was the only option for such a replacement. Advances in lens technology, however, have expanded our arsenal, and we now have lens options to help improve astigmatism and reading vision after surgery.

Advanced options in lenses

Astigmatism is a common vision condition that happens when a person’s cornea is not symmetrical. A normal cornea is round like a baseball. With astigmatism, the cornea curves more like a football.  With the toric intraocular lens, regular astigmatism can be corrected, allowing for crisp distance vision without glasses.

Another premium lens option is the multifocal intraocular lens. By separating the light entering the eye into zones for distance and for near vision, it can allow correction for driving and for reading at the same time. Many multifocal lenses come in several reading powers, allowing surgeons the ability to tailor the lens to fit specific visual needs. Not all patients are good candidates for this type of lens, however, and a full eye examination to exclude the presence of glaucoma or macular degeneration is necessary.

The latest arrival to eye surgery is the Technis Symfony lens. The Symfony allows correction for distance and intermediate vision. These days, much of our world is in the intermediate range of vision. If you are over the age of 40, chances are you have experienced loss of intermediate vision, making you wish you had longer arms to read your phone screen, the labels of cans on a shelf, or a recipe in a cookbook. The Symfony lens is potentially an excellent choice for those who do a lot of computer work or spend a lot of time reading on smaller devices, such as an iPad. Furthermore, the Symfony lens comes in options that correct astigmatism at the same time, as well as being a good choice for patients with mild glaucoma and macular degeneration who may not be good candidates for a multifocal lens.

How do I choose?

Your ophthalmologist can conduct certain tests to make sure you are a good candidate for a premium intraocular lens and help educate you about the benefits of these lenses following cataract surgery. These lenses take some time to get used to, so it is important to understand exactly how they work and their limitations. Although a premium intraocular lens can reduce your dependence on eyeglasses, it does not completely eliminate the need for glasses in all situations.

Coastal Eye Institute has served this community since 1964, focusing solely on comprehensive eye care and providing everything from routine check-ups to diagnosis, correction and management of complex medical eye conditions. Coastal Eye Institute has four offices to serve you. For an appointment visit CoastalEye.com or call 941.748.1818.

50, 60, 70 is the New….

by Dr. Alissa M. Shulman

Dr. Alissa M. Shulman is a board-certified plastic surgeon who founded her solo practice, Sovereign Plastic Surgery, in Sarasota, in 2009. Long before she became a cosmetic plastic surgeon, Dr. Shulman wholeheartedly pursued her passion for art. The unique combination of outstanding medical credentials and an in-depth artistic background truly sets Dr. Shulman apart from most other plastic surgeons.

Let’s face it, we are living longer, are more active, and continue to redefine what “old” is. As a plastic surgeon, I’m frequently asked “Doctor, am I too old for this procedure?” Rather than looking at the patient’s birth date, I look at their list of medications and medical conditions. This is the “age” that truly counts for elective surgery of any kind.

Now, I will also consider different factors for the “over 60” prospective surgery patient. Is the person on blood thinners? Is the surgery worth the risk of being off their medications for the necessary time before surgery? If this situation is part of the equation, I recommend the patient discuss this with their cardiologist before we proceed.

How long will the actual surgery take? After two or three hours of general anesthesia, the after-effects start building up. I think older patients do better with multiple shorter procedures — well-spaced. Virtually all surgeries for patients over 50 require a request be sent to their primary doctor for “surgical clearance.” As a surgeon, I also want to make sure that the doctor handling their overall health is kept in the loop.

Another (often ignored) factor to consider is help at home. Many older patients are living alone and do not want to bother their friends, thinking that they will be fine the next day. I try to make sure we have addressed this assumption thoroughly before surgery; I prefer someone stay with them at least a day after surgery. If there is truly no one available, my office can help connect the patient with one of the many wonderful nursing services in our area.

While I consider these factors with all my patients, it is doubly important for the more mature ones. Every potential surgery patient needs to ask themselves:  Is the risk of surgery worth the potential reward? Are the expected scars worth the risk? Are my expectations realistic?

I often meet two or more times with the patient to talk about the surgery plan. I have been known to change the plan after further consideration, and always want the patient to understand that there are many ways to address the same issue. This is not a simple mathematical formula with one solution; the initial consult is only the beginning.

Some of the most common procedures for my mature patients are breast lifts (mastopexy), old implant removal (+/- lift), abdominoplasty, and liposuction. Liposuction is the one I tend to be most cautious of, as the skin does not spring back very well after the age of 50. These patients need to expect excess skin (which could be removed with a separate surgery). Each of these surgeries is less than three hours.

Suffice it to say, age is more than just a number!

Sovereign Plastic Surgery is located at 1950 Arlington Street, Suite 112 in Sarasota. For an appointment, visit SovereignPS.com or call 941.366.LIPO (5476).

Shoulder Injuries in Golf

by Dr. Steven Page

Steven Page, MD is an Orthopedic Surgeon with a specialty in Sports Medicine at Sarasota Orthopedic Associates. He is Fellowship Trained and Board Certified. Dr. Page serves as a Team Physician for the Mustang football team at Lakewood Ranch High School.

Shoulder injuries are common in golfers. Stresses on the shoulder are different from other sports because each shoulder is in opposition when swinging the club. The forward shoulder stretches across the body with the trailing shoulder raised and rotated. This leads to different complications in each shoulder.

In addition, the rotator cuff muscles are placed under stress, as they are a major force in providing power and control of the swing. The leading, non-dominant shoulder is most commonly injured. It is placed into an extreme position during the backswing, causing impingement or pinching of the rotator cuff. This condition causes inflammation and rotator cuff tears. The placement may also put stress on the shoulder joint and cause tears of the labrum (a stabilizing structure in the shoulder).

Pain may be felt in the shoulder or upper arm at various phases of the golf swing or following play, often when the arms are overhead or at night. Injuries to the shoulder may be sustained from a poor golf swing, a mis-hit, or from overuse. Golfers can develop tendinitis and tears in the rotator cuff from a combination of poor mechanics and the repetitive motion of the golf swing.

Prevention

While many golf injuries occur due to a combination of overuse and poor technique, a lack of conditioning and flexibility also contribute to injuries and pain.  Following these tips could greatly reduce the chance of injury:

• Rest between playing to prevent overuse injury.

• When in discomfort, decrease the amount of time you play.

• Shorten your backswing and turn more through the hips & waist.

• Refine your swing to decrease force on the shoulder joint (pro lessons will help).

• Exercise when not on the course to improve flexibility.

• Warm up with brief cardio and stretching.

In the event of injury, the following at-home

treatments may be effective at relieving pain:

• Shoulder pain should be treated initially with rest or decreased playing time.

• It’s best to completely avoid playing until pain is resolved.

• Nonsteroidal anti-inflammatory drugs may be helpful short-term.

• Icing over 24-48 hours may support relief.

• Range of motion exercises can improve flexibility.

• If pain persists beyond 7-10 days, consult your physician.

A sports medicine physician can examine the shoulder and obtain x-rays or an MRI to determine the cause of injury. Most injuries are treated with rest, anti-inflammatories, and/or physical therapy. Bursitis and tendinitis may be treated with a cortisone injection.  For pain that persists despite treatment, surgery is an option to consider. Recent advances in arthroscopic surgery allow repair of most injuries through minimally invasive techniques, enabling quick return to your game and minimizing downtime.

The commitment of Sarasota Orthopedic Associates is to get our patients back on their feet, back to work, back in the game, and back to life. For an appointment, go to our website at www.SOA.md or call 941-951-2663.

Atrial Fibrillation

by Dr. Kenneth D. Henson

Kenneth D. Henson, MD, FACC  is certified by the American Board of Internal Medicine in Cardiovascular Disease (2013) as well as Internal Medicine (2014). He began medical practice in Sarasota in 1995 and is a former Chief of Cardiology at Sarasota Memorial Hospital. 

Atrial fibrillation is one of the most common heart problems that cardiologists see in daily practice. Increasing age, high blood pressure, coronary artery disease, valve problems and an overactive thyroid may increase the risk of atrial fibrillation.

Atrial fibrillation is an irregular rhythm that starts in the upper chamber of the heart, known as the atrium. In a normal heart, the atrium collects blood returning to the heart and then pumps it through a valve to the lower chamber, known as the ventricle, which then pumps the blood back out to the body. When the heart is in a normal rhythm, the upper and lower chambers are synchronized and blood flows briskly. In a normal heart the rhythm is perfectly regular, like a clock or metronome. With atrial fibrillation, the atrium no longer beats regularly; instead, it quivers (fibrillates). The ventricle does not get its regular signal to contract and therefore beats in an irregular or chaotic pattern. Most importantly, atrial fibrillation causes the blood to stagnate in the atrium. This stagnation can lead to clot formation and increase the risk of stroke. Strokes from atrial fibrillation are often fatal.

There are many options for treating atrial fibrillation, but the most important initial treatment is anticoagulation with blood thinners. Cardiologists use a simple formula known as a CHADS2 score to estimate the risk of stroke. With a score of zero, aspirin is adequate. Higher scores may require more potent blood thinners. For many years, Coumadin was the only oral blood thinner available. While Coumadin is effective, it has drawbacks, including the need for frequent blood draws and multiple interactions with drugs and foods. On a positive note, Coumadin is rapidly reversible in the event of bleeding. Newer blood thinners like Apixaban and Rivaroxaban do not require frequent blood monitoring. Both are effective at preventing clots and reducing stroke risk, but they are not rapidly reversible. Dabigatran, a similar drug, is now reversible. In selected patients, a device known as a Watchman may be implanted using a minimally invasive technique to prevent clots and reduce the need for blood thinners.

Many patients with atrial fibrillation are asymptomatic. In these individuals, protection with blood thinners and simple medications to slow the heart rate may be the only treatment needed. Symptomatic patients may benefit from restoration of a normal rhythm, which may involve rhythm-regulating medications. Antiarrhythmic medications may require a hospital stay for safe initiation. In some cases, an electrical shock, known as a cardioversion, may be used to return the heart to a normal rhythm.

For patients who cannot tolerate medication or who return to atrial fibrillation despite medical treatment, a minimally invasive, non-surgical procedure known as ablation or pulmonary vein isolation may help restore rhythm. The procedure uses either a radiofrequency or cryogenic probe to “burn” or ablate the area in the heart that causes atrial fibrillation. When successful, ablation is a cure and eliminates the need for ongoing medical treatment in many patients.

Atrial fibrillation is a complex problem with many treatment options. Choosing the right treatment for an individual patient requires a thorough knowledge of their medical history, diagnostic studies, lifestyle and personal preferences.

Culp-Henson Private Cardiology and Internal Medicine is located at 1250 South Tamiami Trail, Suite 201 in Sarasota. For an appointment, visit culphenson.com or call 941.929.1039.

Coastal Orthopedics Specialist Improves Fracture Treatment Methods

Innovative fracture-treatment device secures U.S. patent

Orthopedic shoulder and elbow specialist Dr. Avi G. Kumar, with Coastal Orthopedics Sports Medicine & Pain Management, is at the forefront of an innovative shift in the way physicians can stabilize proximal humerus fractures during surgery.

“The goal is to create a natural healing response.” – Dr. Avi Kumar, Coastal Orthopedics

Fractures of the upper part of the humerus are the third most common type of fracture that orthopedic surgeons treat, after hip and wrist fractures, but they are also among the most complicated. In December, Dr. Kumar secured a U.S. patent for an anatomic humeral fracture plate, an implanted medical device that is contoured for the shoulder and designed to provide better fixation for the different fracture patterns. Specialized screws are mated to the plate to stimulate a callous healing.

Custom Design

Dr. Kumar plans to name the Gaudi plate after Spanish Catalan architect Antoni Gaudi, from whom he drew inspiration. The plate allows the shoulder tuberosities, which is bumps on the top and front of the upper part of the humerus that attach to tendons and ligaments, to be set in their normal position and internally fixed. The device has specific cutouts for suture needles, allowing them to pass through the plate even after it has been applied to the actual bone.

“The goal is to create a natural healing response,” Dr. Kumar said. “It allows physicians to not only fix the fracture but to also reduce the time it takes to heal.”

Multi-use

The device is also designed to help incorporate the rotator cuff in the plate itself, allowing physicians to successfully repair soft tissue as well as fractures. Dr. Kumar’s plate can be used to support bone grafts into the fracture site, which will be particularly beneficial for elderly patients with osteoporosis who have experienced bone loss.

A New Approach

Having spent the past 15 years as a shoulder and elbow specialist, Dr. Kumar noticed numerous problems with the current technology while following his patients’ progress after surgery. Currently, only about 40 percent of proximal humerus fractures are fixed anatomically.

“It’s difficult to fix these fracture because often the shoulder muscles tend to shift or move the bone fragments out of position,” Dr. Kumar said.

“I wanted to design a device that would provide physicians with more options to stabilize and maintain the fracture position during surgery.”

Dr. Kumar began working on different iterations of the project a little more than 10 years ago before filing a patent in 2014. On December 27, 2016, Dr. Kumar secured the patent for both the system and the method that provides better fixation for humerus fractures.

A large step forward

With the new medical device and method, Dr. Kumar is hoping to increase the anatomic fixation rate of proximal humerus fractures to 75 to 80 percent. Through his patented process, Dr. Kumar believes he will be able to achieve anatomic fixation, maintain reduction and stimulate fracture healing.

“I wanted to be able to help more of my patients and anyone who has suffered these types of fractures,” Dr. Kumar said. “Now we will have a medical device that can address the issues we have had in the past such loss of fixation of bone and soft tissue. The hope is that our patients can regain their independence and return to their normal lives as quick as possible.”

But first, testing

Traditional plate-stabilizing methods take longer to heal and have a high risk of separation.

He plans on hiring a manufacturing company to test the prototypes in an approved Food and Drug Administration lab over the next several months. The company will have to conduct different tests to make sure the plate is biocompatible with the human body and is mechanically strong enough.

 

 

 

“Fortunately, I was able to get the patent issued,” Dr.  Kumar added. “It truly is novel. There is nothing  similar in the marketplace.”

 

Once he receives the results of the testing, Dr. Kumar will have to file with the FDA to apply for approval to market the medical device. Dr. Kumar believes it will be another year or two before the device is available in the marketplace.  -Bobbilynn Hollifield

 

Dr. Avi Kumar is a board certified orthopedic shoulder and elbow specialist. He specializes in traumatic, acute and chronic injuries of the shoulder and elbow. Dr. Kumar is one of only a few physicians in the state of Florida who performs the Reverse Total Shoulder Replacement and is the only fellowship-trained orthopedic shoulder and elbow expert along the southern gulf coast of Florida. Dr. Kumar is actively involved with outcome based studies and clinical research. He is a reviewer for the Journal of Shoulder and Elbow Surgery.

When Dr. Kumar is not treating patients, he enjoys spending time with his wife and two children. He also likes to stay active by participating in sprint triathlons and other competitive sporting competitions.

 

Source: Coastal Orthopedics, via ThreeSixOh PR

An Interview with Dr. Burr Bakke & Dr. Jill Morris

THE JOY OF AN UNINHIBITED SMILE AND EATING ALL THE FOODS YOU LOVE AGAIN

As a married couple, Dr. Morris and Dr. Bakke combine their talents and passion for dentistry to create innovative and ever-evolving techniques. They want their patients to be able to smile and enjoy the foods they love. With more than 60 years of combined dental experience, they created World Class Dentistry in Sarasota, and continue to utilize the latest advances to innovate and evolve, changing the way we think of dentistry.

Dr. Bakke, what innovative dental implant techniques are you using?

The All on 4® (also known as Teeth in a Day®) was developed to eliminate the need and high cost of bone and sinus grafting requirements. As a leading expert in the All on 4® technique, I have over 10 years of experience with this specific implant procedure, which was developed due to patients’ concerns with high costs and time required for traditional bone and tissue grafting, as well as implant healing. Computer-generated technology allows me to accurately place the implants and attach the restorations to the implants during the same visit. This increased efficiency reduces cost and healing time for the new smile. All phases of treatment are completed in-office. Our laboratory is part of our facility, so our dental technician is on hand at all times. In addition to surgery, I have taught cosmetic dentistry and bite correction; therefore, I can completely manage all phases of the treatment. We have a complete protocol our hygienists use to help patients care for and maintain their new smiles for a lifetime.

Dr. Morris, what advances do you see in the area of cosmetic dentistry?

I have placed over 10,000 cosmetic restorations in my 30-year career, taught cosmetic and full-mouth reconstruction to hundreds of dentists on their own patients, and still find that today is the most exciting time in the field of cosmetic dentistry. One concern that patients express to me is the altering of the natural tooth structure in order to place porcelain veneers to create the smile. This led to weak attachment to the tooth, sensitive teeth, and permanently altered teeth. With our robotics and stronger, thinner porcelains, I can now create stunning smiles without drilling the natural tooth. This results in minimal to no sensitivity, veneers that adhere better to the teeth, and stronger restorations that hold up over the years. Imagine receiving a beautiful new smile without drilling on the teeth. It is a dream come true.

Drs. Morris and Bakke shared how important it is for them to get to know the individual needs of each patient so they can customize a plan for lifetime dental health. They believe that being patient-centric is paramount to successful outcomes. Having a complete on-site dental lab with all the latest equipment enables them to take a complete approach to dental care, which is key to providing a much more satisfactory experience and pleasing result for implants and cosmetic dentistry.

SarasotaDentist.com | 941-923-6363

Dr. David L. Mobley On Replacing Older Saline Implants

Recent innovations in breast augmentation and breast lift surgery make replacement of old saline-filled breast implants an extremely attractive option for a generation of women whose implants are aging. Saline implants were used to enlarge the breasts of millions of women during a 14-year FDA ban on gel implants, which ended in 2006 after they were proven to be safe. It is not uncommon for old saline implants to need replacement because of deflation or increased visibility and rippling. In addition, women often prefer the softer and more natural appearance of the new cohesive silicone gel breast implants.

A new 4th and 5th generation of increasingly cohesive (thicker, more substantial) silicone gel breast implants are now available. Consensus is that they are safer and more effective than any previous version that came before them. These implants, nicknamed “gummy bear” implants, help produce a better breast shape and feel much more like a natural breast. They also come in a range of profiles, including an anatomically realistic “tear-drop” shape for an ultra-natural result. By modifying VECTRA 3-dimensional images of a patient’s own breasts, we can now show specifically how each implant would look after the procedure. This ability to preview results helps to greatly improve decision making and communication between the doctor and patient concerning the desired shape and size.

For patients who also need a breast lift, the use of Vertical Mastopexy has greatly reduced the occurrence of scarring and improved the shape and longevity of the breast lift. In addition, Galaflex Mesh, a transient scaffold which supports the tissue after a breast lift, appears to solve the age-old problem of “gravity wins.”   Using Galaflex Mesh is like wearing an internal demi-bra, which helps support the newly-lifted breast for two years. Even after the mesh is absorbed, it leaves behind a layer of supportive living tissue, which is 3-5 times stronger than the original tissue. It truly is the gift that keeps on giving, as far as helping to keep the breast lifted and maintaining perkiness.

In combination, the latest gel implants, vertical mastopexy and Galaflex mesh support can produce truly natural-looking breasts with the perkiness that many women desire. With access to much better, safer implants and so many options as far as profile and shape, replacing your old saline implants is highly advantageous. The new technology gives patients a soft, lifelike breast with better shape and less chance of developing excess firmness or leakage. Breast lifts have also greatly improved using vertical mastopexy, which greatly reduces the scarring (usually leaving only a lollipop-shaped scar, rather than the anchor scars of the past). Galaflex mesh practically eliminates the drooping that used to occur frequently after breast lift surgery and helps maintain the coveted fullness in the upper breast.

For women with aging saline-filled implants who desire replacement and women who need a breast lift, a youthful, life-like breast with fullness in the upper breast is now possible. With 4th and 5th generation silicone implants in both shaped and higher profiles, Galaflex mesh for support of breast lifts and vertical breast lifts with limited scarring, plastic surgeons have the tools and technology to offer patients a truly youthful appearance.

Sarasota Plastic Surgery Center

941-203-1303

sarasotaplasticsurgery.com

Coastal Orthopedics Doctor a Leader for New Spinal Cord Study

Interventional pain management specialist Dr. Richard H. Bundschu (of Coastal Orthopedics Sports Medicine & Pain Management) is at the forefront of a new way physicians can help their patients manage chronic neck and arm pain.

Dr. Bundschu is the principal investigator for the Nevro study — a landmark clinical trial to test the company’s spinal cord stimulators in treating ongoing neck and upper extremity body pain. Spinal cord stimulators have been used in the past to treat chronic pain in the lower back, torso and legs when pain medications, injections and physical therapy are ineffective.

“The whole idea is that this is not the first line of therapy,” Dr. Bundschu said. “It’s a very high-tech option for those people who have failed with other routes or treatments.”

Coastal Orthopedics was one of six locations nationwide selected to participate in the Nevro study, which began in June 2016. Bayshore Gardens resident Mike Daughtrey is participating in this trial and has experienced life-changing results.

After living with a chronic stiff neck for the past nine years, Daughtrey, 70, learned about the Nevro study while his wife, Donna, was being evaluated for a low back stimulator. He participated in a nine-day trial in September 2016 before receiving a permanent stimulator in October.

“I’m 85 to 90 percent better.” – Mike Daughtrey, pain patient

Within 36 hours, Daughtrey’s nightly headaches disappeared, and he was able to turn his head left and right without pain. Prior to receiving the stimulator, Daughtrey couldn’t look up at the stars, drive without turning his whole body or drink a can of soda without using a straw.

“It was truly like an angel reached down and touched my neck and made it better,” Daughtrey said. “If I had to give it a percentage, I would say I’m 85 to 90 percent better.”

Four months later, Daughtrey is once again able to work a part-time job. He can ride the motorcycle that had been parked for nearly a year because he didn’t feel safe. And he can tilt his head back to drink a can of soda.

“It’s the things you don’t think of,” Daughtrey said. “It doesn’t wake me up at night. It’s been a miracle. I don’t know anyone who wouldn’t want to have it done.”

The neck stimulator resembles a pacemaker. A battery is installed above the hip and below the rib cage, in the area typically referred to as a “love handle,” while the electrodes are placed in the neck. An electric current is applied to the spinal nerves, which disrupts the flow of pain signals that travel to the brain. Patients are given a remote control where they can select a series of programs, ranging from one to five, depending on their level of pain.

“It’s electrical. It’s not chemical and the patient has control,” Dr. Bundschu said. “They are independent now.”

Enrollment in this trial is closed. Now, Dr. Bundschu will spend the remainder of the trial collecting data. He will meet with each of his patient’s every three months for the first year following implantation and possibly the second as well.

Dr. Bundschu worked with Nevro on two prior studies, including a low back study, which helped the company’s groundbreaking products earn U.S. Food and Drug Administration approval.

Last month, during a conference with 2,500 doctors, Dr. Bundschu learned the national study’s initial results. Although specific findings cannot be cited in an ongoing trial, the preliminary results showed a decrease in pain.

“I knew we had good results, but I didn’t know the results were that good nationwide,” Dr. Bundschu said. “The results of this neck and arm study are even better than the low back study.”

coastalorthopedics.com

Source: Candice McElyea, ThreeSixOh PR

Stem Cell Orthopedics: A New way to fix Joint Problems

by M. Walter M.D.

BREAKTHROUGH TECHNOLOGY
We now have the technology to use a patient’s own stem cells and blood products (growth factors) to regenerate almost any tissue or structure in the body. Stem cells are a game-changer, and will soon revolutionize almost every branch of medicine. In the orthopedic field, we have about an 80% success rate* with common problems such as osteoarthritis of the knee or hip (even bone-on-bone), rotator cuff, back or neck pain, sports or other types of injuries and many other conditions. Once successful, the improvements tend to be long-term because we have rebuilt and corrected the underlying structural problem and therefore addressed the root cause of the pain.
*success rate is defined as 50% or better improvement in pain and disability at the 6-week mark

LIPOSCULPTING
The stem cell procedure, typically performed in about 4 hours, is minimally invasive and considered very safe. Using a gentle technique called Liposculpting, we harvest 60 to 120 ccs (2 – 4 ounces) of fat from the patient’s belly or flank. We then isolate the stem cells, then mix them with growth factors from the patient’s own blood (Platelet Rich Plasma) to activate and stimulate the growth of the stem cells.

RECOVERY
One important advantage of the stem cell approach is the minimal downtime – patients can return to basic activity in 1 – 2 days. Active rehab is recommended with an early return to activity to help stimulate the blood flow to joints and help them heal properly. “Movement without load” is the guiding principle. Since stem cells address the root cause of joint problems and rebuild damaged tissues at the cellular level, once a patient improves, the results tend to be long-lasting.

REGENERATION
Since stem cell regeneration is a healing process, it is impossible to predict how quickly patients will notice improvement. Some patients feel significant improvement within days, while others don’t see any benefit until after the first month has passed. If patients have not improved substantially by the six-week mark, we can assume that the stem cells (which remain alive and active for about 6 months) are sluggish and recommend a booster session of growth factors to reignite the stem cell healing process.

COST & BENEFIT
Unfortunately, stem cell procedures are not yet covered by medical insurance programs. The cost for the procedure depends on how many joints and areas are involved, but typically, the all-in cost varies between $7,000 and $12,000. However, for many, the benefits of stem cells are well worth the cost. Although stem cells cannot fix all problems, I consider that for many cases, stem cells are the treatment of choice. This option should be carefully considered before a patient chooses to undergo surgery. Stem cells are powerful regenerative dynamos that can fix many orthopedic problems in a most elegant and amazing manner. This is truly the medicine of the future!

About Dr. Mark Walter, M.D.
Stem Cell Orthopedic Specialist
As a pioneer in the field of stem cell orthopedics, Mark Walter, M.D. is one of Florida’s top regenerative orthopedic specialists. He has trained and worked with the top regenerative orthopedic
teachers in the world and written and lectured extensively on subjects in the field. Dr. Walter received his M.D. from McGill University (1980), is board-certified in Family Practice (C.C.F.P.) and is a member of the American Academy of Orthopedic Medicine. He has been dedicated to the specialty of regenerative orthopedics for sixteen years and has treated over 10,000 patients with this approach.

Dr. Walter is founder of the Stem Cell Orthopedic Institute located at 1250 Tamiami Trail in Sarasota, Florida. To sign up for a free seminar (offered monthly) or for more information please call (941) 955-4325. For additional details, please visit StemCellOrthopedics.com or Regenortho.com.

CoQ10: Often Overlooked in Cardiovascular Health

by Christopher Davis, MD, FACC

Coenzyme Q10, also known as CoQ10, has become one of the most popular dietary supplements in the United States, yet many medical professionals still overlook its importance in the maintenance of cardiovascular wellness.

What is CoQ10?
CoQ10 is a vitamin-like compound found throughout our bodies that plays a critical role in how we produce energy. Small amounts of CoQ10 are naturally found in some foods; however, most CoQ10 is synthesized by tissues in our body. As we age, our bodies produce less CoQ10, resulting in less efficient energy production. Studies have shown vast benefits with CoQ10 supplementation in patients with coronary artery disease, heart failure, high cholesterol and high blood pressure.

CoQ10 & Lowering Cholesterol
According to the American Heart Association, more than 30 million Americans are taking cholesterol-lowering drugs known as “statins.” Evidence shows that the level of LDL, or “bad” cholesterol, in our body may not be what causes atherosclerosis – artery clogging plaque. Rather, it is actually the oxidation of LDL, a chemical change in the LDL molecule that promotes atherosclerosis.

Studies have shown CoQ10 supplementation enhances the cholesterol lowering benefits of statins by reducing LDL oxidation.

Unfortunately, statins interfere with the body’s natural production of CoQ10. Statins work by blocking the cholesterol-producing pathway – which is also the same pathway by which CoQ10 is produced. Therefore, the loss of CoQ10 leads to loss of cellular energy and increased amounts of free radicals in your body generated by LDL oxidation. As the body becomes more depleted in CoQ10 levels, people often complain of fatigue, muscle weakness and soreness – well-known side effects of cholesterol-lowering medications.

CoQ10, Heart Failure & Lowering Blood Pressure
Recent studies have shown improvement in heart failure symptoms with daily CoQ10 supplementation. About 5.7 million adults in the United States have heart failure. Unfortunately, about half of people who develop heart failure die within 5 years of diagnosis. Heart failure is caused by many conditions – such as coronary artery disease, vitamin deficiencies, metabolic derangements (such as thyroid disorders), and high blood pressure. In multiple studies, heart failure patients have been shown to have significantly lower levels of CoQ10. In 2013, the European Journal of Heart Failure published data from one of the most robust 10-year CoQ10 studies to date showing that CoQ10 supplementation significantly improves survival for even the most severe heart failure patients, while radically reducing incidences of hospitalization and improving quality of life.

There is also growing data showing CoQ10 may also be beneficial in regulating blood pressure in hypertensive individuals. Most of this data is derived from fairly small studies but shows consistent blood pressure reduction with CoQ10 supplementation.

Using CoQ10
CoQ10 is available in two interchangeable chemical forms – ubiquinone and ubiquinol. Ubiquinol is the reduced form of CoQ10 that is better absorbed in the intestinal tract and therefore it is considered to be more bioavailable than conventional CoQ10, ubiquinone.
There is no official daily intake recommendation, but most cardiologists suggest at least 200mg daily for any adult taking statin medications and also for those who have a past medical history of cardiovascular disease. Higher doses are often recommended for patients with severe heart failure.

If you have any history of cardiovascular disease, ask your physician about the benefits of CoQ10 supplementation.

Dr. Christopher Davis is a board-certified interventional cardiologist with an interest in integrative cardiology incorporating nutritional metabolic support in the treatment of many of his cardiovascular patients. Dr. Davis is also passionate about the prevention of underlying heart and vascular disease, and strives to develop a relationship with each patient in order to provide the best customized treatments. manateecardio.com