New Orlando Health Spine Center Elevates Patient Care With Collaborative Approach
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Patients dealing with troublesome back and neck pain can now receive attention and care faster and more efficiently through the new Orlando Health Spine Center.
The Spine Center was launched in March, bringing together the expertise of Orlando Health Jewett Orthopedic Institute and Orlando Health Neuroscience Institute to completely rethink how patients receive care.
“Bringing those two specialties together to work in unison to create a center that’s focused on spine care really is the best of both worlds,” said Dr. Michael Jablonski, president of Orlando Health Jewett Orthopedic Institute and Orlando Health Neuroscience Institute. “The top spine programs in the country are combined programs of neurosurgery and orthopedics.”
Before the center was created, Orlando Health’s orthopedic surgeons and neurosurgeons didn’t always have reasons to collaborate. And general practitioners in the region weren’t always sure where they should send their referrals.
ON THE COVER: From left to right: Dr. Robert Hirschl, Dr. Shehzad Choudry, Dr. Sheyan Armaghani
Iam pleased to bring you another issue of Florida MD. Sometimes a patient may have the opportunity to participate in a clinical trial. Sometimes a patient may need specialized treatment that is not available in Central Florida. And sometimes there’s no money for that patient to get to those places. Fortunately there is Angel Flight Southeast to get those patients where they need to go. I asked them to tell us about their organization and how you, as physicians, can help. Please join me in supporting this truly wonderful organization.
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ANGELS ON EARTH HELP PATIENTS GET TO LIFESAVING MEDICAL TREATMENT
Everyone knows angels have wings! But did you know in Florida and many parts of the nation they have engines and tails with dedicated volunteers who donate lifesaving services every day? Leesburg, Fla.-based Angel Flight Southeast is a network of approximately 650 pilots who volunteer their time, personal airplanes and fuel to help passengers get to far-from-home medical care. A member of the national Air Charity Network, Angel Flight Southeast has been flying passengers since 1993.
Almost all of its passengers are chronic-needs patients who require multiple, sometimes 25-50 treatments. Passengers may be participating in clinical trials, may require post-transplant medical attention or are getting specialized treatment that is not available near home. Each passenger is vetted to confirm medical and financial need and is often referred to Angel Flight Southeast by medical personnel and social workers.
Angel Flight Southeast “Care Traffic Controllers” arrange flights 24 hours a day, 365 days a year. In the event of a transplant procedure, the Care Traffic Controllers have precious minutes to reach out to its list of volunteer pilots who have agreed to be prepared on a moment’s notice to fly a patient to receive his or her potentially lifesaving organ.
The organization is completely funded through donations by individuals and organizations. A typical Angel Flight Southeast pilot donates $400 to $500 in services-per-trip. In fact, Angel Flight Southeast has earned the Independent Charities of America Seal of Approval as a good steward of the funds it generates from the public. Each $1 donated generates more than $10 worth of contributed services by Angel Flight Southeast.
The charity always seeks prospective passengers, volunteer pilots and donations. For additional information, please visit https://www.angelflightse.org or call 1-888-744.8263.
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New Orlando Health Spine Center Elevates Patient Care With Collaborative Approach
By Staff Writer
Patients dealing with troublesome back and neck pain can now receive attention and care faster and more efficiently through the new Orlando Health Spine Center.
The Spine Center was launched in March, bringing together the expertise of Orlando Health Jewett Orthopedic Institute and Orlando Health Neuroscience Institute to completely rethink how patients receive care.
“Bringing those two specialties together to work in unison to create a center that’s focused on spine care really is the best of both worlds,” said Dr. Michael Jablonski, president of Orlando Health Jewett Orthopedic Institute and Orlando Health Neuroscience Institute.
“The top spine programs in the country are combined programs of neurosurgery and orthopedics.”
Before the center was created, Orlando Health’s orthopedic surgeons and neurosurgeons didn’t always have reasons to collaborate. And general practitioners in the region weren’t always sure where they should send their referrals.
“At Orlando Health, we had two separate programs. We just kind of ran in parallel, and it wasn’t very efficient,” said Dr. Robert Hirschl, physician president of the Orlando Health Neuroscience Institute.
Now, the programs share resources and exchange information through regular conferences that have them working as a cohesive unit. The Spine Center, which is the only fully integrated pro-
gram in Florida to bring together orthopedic and neurosurgical physicians who specialize in spine surgery, relies on the combined expertise of both programs to help patients find the best treatment path, as quickly as possible.
Consider the plight of a patient dealing with new back or neck pain. The sheer complexity of the spine – with all of its related bones, nerves and muscles – can make diagnosis and treatment a challenge. But for patients dealing with debilitating pain, the most important thing is quickly finding the right specialist or treatment to help them get better.
Unfortunately, this wasn’t always easy under the previous approach. A patient, for example, might be referred by their general practitioner to a surgeon for a condition that ends up not requiring surgery. Or they might find it impossible to get in front of a specialist without a lengthy delay.
“Patients would wait six to eight weeks to see somebody, just for that provider to come in and tell them: ‘Oh, you’re seeing the wrong person. You need to see this person,’” said Dr. Sheyan Armaghani, an orthopedic surgeon with Orlando Health Jewett Orthopedic Institute. “And then another six to eight weeks goes by. Meanwhile the patient is in pain for three or four months.”
The Spine Center’s new approach allows patients dealing with a variety of spine issues to receive an appointment within one or two days. It also helps patients avoid being placed in front of a surgeon or health care
The Orlando Health Neuroscience Institute’s pavilion in downtown Orlando houses neurology, neurosurgery specialists, interventional pain management, and more, under one roof.
Orlando Health Jewett Orthopedic Institute, Florida’s first orthopedic hospital, is dedicated to orthopedic and spine care and is where most of the spine surgeries are performed.
professional who may not be best for them. Specialized spine navigators help ensure they are sent to the appropriate specialist, whether it be pain management or physical therapy.
The Spine Center, which has 16 locations across Central Florida, makes the referral process for primary care physicians significantly more streamlined.
“It really makes their life easier. It takes all of the thought process out,” Dr. Hirschl said. “Right now you have to think: ‘Should I send them for an MRI? Should I send them for physical therapy? Should I send them to pain management?’”
Now, instead of figuring out the answers to those questions on their own, providers can simply refer patients with any kind of back problems to the Spine Center.
“And then they’re done,” Dr. Hirschl said. “They can take care of other patients that need their services and not worry about all of these decision trees.”
CREATING THE SPINE CENTER
Orlando Health began discussing the creation of a Spine Center two years ago as a response to shifting trends in the industry.
“Traditionally, spine care has been delivered independently by either orthopedic spine surgeons or neurosurgeons,” Dr. Arma-
ghani said. “Over the last 20 years or so, a lot of those lines between orthopedic spine surgeons and neurosurgeons have been blurred.”
Orlando Health also noticed that many of the nation’s top hospitals use a combined approach where both orthopedic surgeons and neurosurgeons work collaboratively with disciplines like pain management and physical therapy to provide the best care for patients.
“That was the initial reasoning for us to go ahead and start to combine forces so that we can deliver care to patients in a coordinated manner,” Dr. Armaghani said. “The ultimate goal of this is to get patients seen in an efficient manner and get them treated in the quickest way possible.”
With that goal in mind, Orlando Health Jewett Orthopedic Institute and the Orlando Health Neuroscience Institute began working to make the vision a reality.
The two units started sharing ideas and research to develop new protocols for patients, combining service lines and hiring new team members, including pain management specialists and navigators.
“Watching them work together to do this to make sure the patients have the best chance at the best outcome for a very complicated problem, it’s really exciting and it’s been fascinating to watch,” Dr. Jablonski said.
SPINE CENTER IMPROVES PATIENT EXPERIENCE, OUTCOMES
A key priority of the Orlando Health Spine Center has been to make sure that patients are getting in front of the right specialists and receiving care in an efficient manner.
Members of the Orlando Health Jewett Orthopedic Institute
PHOTO: PROVIDED BY ORLANDO HEALTH
The new Orlando Health Spine Center brings together both orthopedic and neurosurgical physicians who specialize in spine surgery.
With 16 locations across Central Florida, the Orlando Health Spine Center makes the referral process for primary care physicians significantly more streamlined.
and Orlando Health Neuroscience Institute worked in tandem to come up with state-of the-art protocols for patients.
“Coming together to say: ‘How are these patients treated the best?’ And bringing those two specialties develop standardized protocols will really be great for the outcomes and patient experience,” Dr. Jablonski said.
The new protocols were also set up to make surgery a last option for most patients, instead focusing on more conservative treatments first.
“Our design of how we do things is really to push for nonoperative management for patients,” Dr. Armaghani said. “We know from our data that 90 to 95 percent of patients who have a spine-related issue are going to get better without surgery.”
And for patients who do need surgery, the Spine Center is designed to promote the best possible outcomes. This is done through new postoperative protocols and a preoptimization process that lowers the risk of complications.
Another focus of the Orlando Health Spine Center is getting patients the appointments and care they need much faster.
“We wanted to eliminate that barrier and have patients be seen quickly,” Dr. Hirschl said. “When you’re in terrible pain, the last thing you want to do is wait six weeks to be seen.”
The new center uses its spine navigators – specialists who field referrals and work closely with patients and general practitioners to make sure patients are sent to the right provider. This has reduced wait times for patients to be seen from sometimes as long as two months to just two days or less.
“If you just have neck pain or back pain or any kind of spine pain, there’s one number that you call,” Dr. Jablonski said. “A navigator will answer the phone and we’re going to get you in within 24 to 48 hours to the right provider.”
This new strategy has also played a role in freeing up surgeons, helping keep surgery as a last resort option and limiting the possibility of patients being referred to surgeons when their condition might better be handled with pain management or physical therapy.
“Patients don’t have to see a surgeon if they don’t need surgery,” Dr. Hirschl said. “And if they get better, wonderful. They don’t have to spend time with a surgeon. But if they’re not getting better, that’s when it’s more appropriate to see a surgeon and start escalating care from there.”
POSITIVE EFFECTS OF SPINE CENTER ALREADY SEEN
While the Orlando Health Spine Center is in its infancy, it hasn’t taken long for team members and patients to see the benefit of the new multidisciplinary approach to patient care and outcomes.
Among the most noticeable immediate impacts has been the speed with which new patients are making their way to a doctor, physical therapist or other specialist who can best serve their needs.
“We’ve already had patients that are extremely thankful that they’re getting into the appropriate provider within 24 to 48 hours,” Dr. Jablonski said. “In a very short period, we’ve had patients who have had tremendous responses say: ‘Thank you so much for getting me in so quickly and starting my care so I can get back to a more pain-free existence.’”
This accelerated timeline has been accomplished in part by laying out a new roadmap for patient care. Instead of starting with a surgeon, most patients with back pain begin their treatment journey with a course of physical therapy and anti-inflammatory medications.
This alleviates patient symptoms as often as 80 percent of the time. But, if the problems persist, then they can move onto imaging and continue to work their way down the treatment road.
“We have a process in which we’re able to get patients worked up and we have different exits along this highway in terms of their ultimate recovery.” Dr. Armaghani said.
An added benefit of this approach is that, by the time a patient reaches a surgeon – if needed – they’ve already received a wide range of imaging and therapies that can help make the surgeon’s job easier.
SPINE CENTER BRINGS NEW APPROACH TO STATE OF FLORIDA
When the idea of the Orlando Health Spine Center was first being discussed, members of the Orlando Health Jewett Orthopedic Institute and the Orlando Health Neuroscience Institute searched across Florida for examples of other health care organizations using a similar approach in terms of bringing together orthopedic and neurosurgical physicians who are spine surgery specialists.
“We tried to look and see if this was present anywhere else in the state,” Dr. Armaghani said. “We were really unable to see this approach being utilized in Florida, which was surprising to us as one of the most populous states in the country.”
Now, the Spine Center will fill that gap, offering access to this multidisciplinary approach to residents across Central Florida with 29 dedicated providers. Making this service readily available to the entire community was a key goal in the development of the new center.
Having more than a dozen locations around the region means easy access for the 3.5 million residents of greater Orlando. Surgeons, pain management doctors and immediate access providers are strategically placed across the region to ensure a wide net of care. A patient will not have to drive more than 15 minutes on average to get somewhere they can receive the expertise of the Spine Center.
“We’re very sensitive to patients not wanting to travel long distances to see us,” Dr. Armaghani said. “If you’re in pain when you sit down, you’re not going to spend 30 minutes on I-4 to go to one specific location to see a doctor or specialist.”
The Spine Center also plans to offer some of its options via
telehealth, so patients can be evaluated and receive the care they need from the comfort of their homes.
ORLANDO HEALTH’S COMMITMENT TO THE COMMUNITY
Orlando Health is dedicated to providing world-class care to the residents of Central Florida, with a significant investment in the Orlando Health Spine Center representing the latest example of those efforts.
Patients can now receive care using a streamlined approach that hasn’t been available in the state before now.
“It takes a lot to invest in the infrastructure that’s required to do this,” Dr. Armaghani said. “I’ve worked at other places in the past and have floated this idea and been met with a door in my face every time because of the investment that’s needed.”
Orlando Health remains focused on dedication to quality and investigating new strategies and investments that can play a role in helping patients to have the best outcomes possible.
The Orlando Health Spine Center helps to do that through a more efficient and cohesive approach that makes patient care simpler and more effective for everyone involved.
“We want to make it easy for patients and easy for primary care providers so that all they have to do is call the number, send a referral in and we will take over,” Dr. Jablonski said.
Orlando Health remains focused on dedication to quality and investigating new strategies that can help patients to have the best outcomes possible.
CONDITIONS WE TREAT
We care for a wide range of conditions and injuries affecting the spine, including:
• Herniated/ruptured discs
• Degenerative spinal conditions
• Spinal stenosis
• Compression fracture
• Myelopathy
• Radiculopathy
• Adult and adolescent scoliosis
• Spine fractures
• Neck pain
• Sciatica pain
• Spinal deformity
• Sacroiliac (SI) joint pain
• Disorders of the cervical, thoracic and lumbar spine
MINIMALLY INVASIVE AND COMPLEX SURGERY
Orlando Health Spine Center offers a comprehensive center dedicated solely to the care of disorders affecting the spinal column. From common conditions such as disc herniations to more complex issues, including spinal tumors, infections and fractures, we offer the most advanced diagnostic tools, technologies and therapies to treat a full range of conditions.
INTERVENTIONAL SPINE AND PAIN MANAGEMENT
We understand the challenges of living with chronic pain. Our goal is to deliver the best treatment for your underlying condition and its painful symptoms, so you can get back to living the life you love. Our team of award-winning pain specialists focus on the latest minimally invasive treatments for a broad range of chronic conditions. We will evaluate and diagnose the cause of your pain and work with you to create a unique care plan to relieve your symptoms.
PHYSICAL THERAPY
We deliver advanced care using a patient-centered approach. Our team of highly specialized clinicians works with both the patient and family to establish rehabilitation goals that promote the highest level of function and independence possible, while improving overall quality of life - physically, emotionally and socially.
The $8500 Tube of Cream
By John “Lucky” Meisenheimer, MD and John Meisenheimer, VII, MD
Several years ago, a patient came back to my office for a return visit. She had been seen earlier that week for a small amount of intertrigo underneath her breasts. Intertrigo is a common inflammatory condition of the skin folds, and it is aggravated by heat, moisture, and friction. Occasionally a patient might get a minor secondary yeast infection in the area as well. The treatment is keeping the area dry and using a topical cream to clear the yeast and decrease the inflammation.
The patient said, “doctor, I am worse.” I asked how she was using the cream, and she responded that she had not filled her prescription. Now I have lived through this scenario before with other patients. I am always amazed when people seem surprised that their condition has not improved when they have either not filled their prescription or filled the prescription and never used the medicine.
Now, if they filled the prescription and didn’t use the medicine, I am flummoxed as I am not sure how to respond. So, I usually say “oh” and stop talking, leaving a long moment of uncomfortable silence that eventually forces the patient to speak. Then the response comes, “so you think I should use the medicine you prescribed?” I reply, “Well, yes, as we have tried not using the medicine, and that plan is not working so good.” Amazingly, the patient seems okay with this response and goes happily on his or her way. Yes, this very conversation has happened on more than one occasion.
Now, in this case, since this patient had not filled her prescription, I wanted to know why. In the past, the cream I prescribed called Alcortin sold for about $35 a tube, so I didn’t think the cost was a concern. She then told me that the pharmacist wanted to charge her $8500.00 for a tube of the cream. I laughed out loud because I knew there had been some gross misunderstanding regarding the cost, and I said there must have been a decimal put in the wrong place. I was confident she didn’t understand the pharmacist correctly.
and it wasn’t for a flatbed truck loaded with cream; it was for one lousy 60gram tube. At the time, that cream was selling for four times its weight in gold! The pharmacist had no explanation for why the medicine went up so much in price; all he knew was that was the price.
Since that bit of medical-cultural shock, other medicine prices have skyrocketed as well as everyone reading this knows. Nobody seems to know why, but I suspect this is due to our government meddling with the free market system. When the
Intertrigo - Would you spend $8500.00 on a tube of cream to treat this eruption?
last big round of Medicare laws changed the way Medicare buys drugs, and this had bipartisan support I might add, this is when the chaos started. Drug companies loved the clause that they could name their price without any negotiation on price, and we are all now living the outcome.
The patient was very adamant that she had spoken with the pharmacist in person, and there was no question that the price was $8500.00. I asked her for her pharmacy, and I contacted the pharmacist myself. I started by saying, “well, I am just clearing up a misunderstanding. There is a patient here that is trying to tell me that Alcortin is $8500.00 a tube. I am sure the decimal point has been put in the wrong place, or you mistakenly thought I ordered a tractor-trailer full of the cream. There was a long pause, and the pharmacist said, “no, $8500 is correct,”
Just recently, a study showed that worldwide, when several first world countries were compared for the average cost spent on nineteen different conventional medicines, the United States was paying 300% more than the average price paid by other countries. Iceland, for example, was paying approximately 50% the average cost, which means that we are spending six times as much as the Icelanders for the same medication. So why don’t we go to Iceland and buy all our medicines straight from Iceland? The answer is the drug companies have convinced the government that reimportation should be illegal. Therefore, it is un-
Continued on page 15
PHOTO:
JOHN MEISENHEIMER,
VII, MD
Is Your Online Reputation Costing You Patients?
By Sonda Eunus, MHA, CMPE
What does your online reputation say about your practice? If you have a negative online reputation, you are missing out on new patients every day. Most medical practices now get the majority of their new patients through Google and other search engine queries, such as “Pediatrician in Orlando”. If your practice appears in these searches, the most common next step for a potential new patient would be to check out your reviews – what are other patients saying about your practice? It has been reported that 90% of consumers read online reviews before visiting a business and that online reviews influence 67% of purchasing decisions (Bright Local). For this reason, it is incredibly important to pay attention to the rating and reviews that your practice has on search engines, social media platforms, and local online business directories.
However, despite the importance of cultivating a positive online reputation, only 33% of businesses report actively collecting and asking for reviews (1). One great process to set in place at your practice is asking for patient reviews after each patient visit. It can be as simple as training your front office staff to ask each patient how their visit went while checking them out, and if they receive favorable feedback then they can ask the patient to please leave a review on Google or Facebook about their experience. If they receive negative feedback, this feedback should be taken very seriously, and management should be notified as soon as possible so that the issue can be mitigated before the patient decides to post a negative review.
Setting up an automated text or email campaign that asks each patient for their feedback after their appointment is also a great way to improve your online reputation as well as to correct any issues that may be occurring at your practice. When you receive feedback from patients, you are then able to prompt them to leave a public review on Facebook, Google, Yelp, Healthgrades, or other applicable review platforms. However, you must be aware that legally, you are not allowed to only direct people with favorable feedback to leave reviews, which is known as review-gating – so if you are implementing an automated system like this, just make sure that you are aware of this limitation. There are online reputation management platforms which allow you to customize the messages that people see when they leave negative feedback as opposed to positive feedback, but both of those messages must still offer the option to leave a public review. However, if you create your message in such a way as to communicate to the patient who may leave negative feedback that you are working hard on resolving the issue and that someone will be in touch shortly, that may prevent them from leaving a public negative review.
When you receive a public review on Google, Facebook, or other review sites, make sure that you respond to it – either by thanking them for a good review or by asking them to contact you to discuss how you can improve their experience. Do not argue or try to defend yourself online – try to speak about it with them privately, fix the issue, and ask them to remove the review if possible. When you receive great reviews, make sure to cross-share them on your various social media platforms. You should also create a “Reviews” page on your website and add all great reviews to this page. This instantly adds credibility to your website.
Finally, make sure that when you look over the feedback and reviews that you receive, you are paying attention to what the negative reviews are saying – this is a great opportunity to identify current process challenges and improve your patients’ experience at your practice. Need help managing your practice’s online reputation? Visit www.lms-plus.com to see how Leading Marketing Solutions can help.
Sonda Eunus is the CEO of Leading Marketing Solutions, a Marketing Agency working with Medical Practices and other Businesses to help them identify the best marketing strategies for their business, create a strong online presence, and automate their marketing processes for a better return on their Marketing budget. Learn more about Leading Marketing Solutions at www.lms-plus.com.
Halotherapy
By Daniel T. Layish, MD, FACP, FCCP, FAASM
The word Halotherapy comes from the Greek word “halos” meaning salt. While the potential benefits and therapeutic nature of salt has been known for centuries, it was not until the early 1800’s that the underground salt mines throughout Eastern Europe were noted to benefit various respiratory conditions. As the workers were mining the salt in these climate-enriched chambers, dry salt particles would be inhaled into the respiratory system. The dry salt was discovered to be super absorbent, anti-bacterial and anti-inflammatory. Soon people with various conditions were spending time in these salt mines. In the mid-1900’s the Russians began working on a technology to replicate the dry salt particles in the air and developed the first halogenerator, a device that grinds pure sodium chloride into precise particles (several microns in diameter) and disperses the dry salt into a climate controlled room or chamber. This was the start of modern Halotherapy, which has been utilized for several decades throughout Eastern Europe and has begun to expand into many other countries including the United States and Canada. The small particle size is felt to be important to allow penetration deep into the lungs, since larger particles will simply be deposited in the nose, throat or large airways. The air in a halotherapy chamber is also filtered to remove contaminants and the temperature and humidity are well controlled.
As a pulmonologist, I initially became familiar with halotherapy through my care of individuals with Cystic Fibrosis. Cystic Fibrosis is a genetic disorder characterized by dehydration of the respiratory epithelial surface, resulting in impaired mucociliary clearance. In this disorder, thick tenacious secretions obstruct the lower airway and sinuses and provide an environment for chronic infection. Nebulized hypertonic saline has been shown (in well done randomized clinical trials) to improve pulmonary function and respiratory symptoms as well as reduce pulmonary exacerbation rate in individuals with cystic fibrosis. This may be referred to as “wet” salt therapy as opposed to halotherapy which is “dry” salt therapy. Nebulized hypertonic saline can sometimes cause bronchospasm, and not all patients can tolerate this therapy even when premedicated with a bronchodilator. In cystic fibrosis, halotherapy has some theoretical advantages over nebulized hypertonic saline. The prolonged duration of therapy (typically a 45-minute session) appears to be associated with a much lower incidence of bronchospasm then is seen in the setting of nebulized hypertonic saline. In addition, in the halotherapy mode of administration the salt particles are delivered to both the sinuses and the lower respiratory tract. After seeing anecdotal benefit in our patients with cystic fibrosis, we performed a clinical study, which confirmed that this therapy was well tolerated and the patients derived symptomatic benefit in terms of their sinus complaints. Other studies are planned to study this therapy further in individuals with cystic fibrosis.
The fundamental defect in cystic fibrosis is related to chloride transport and therefore there is a strong rationale for halotherapy in this particular disease. Anecdotally, I have seen patients with other respiratory diseases derive significant benefit from Halo-
therapy including bronchiectasis, chronic bronchitis, chronic sinusitis and allergic rhinitis. The hypothesis is that Halotherapy may help with respiratory illnesses by liquefaction of airway secretions thereby enhancing expectoration. There seems to be very little risk to this therapy other than the financial and time investment. There is certainly a theoretical basis for the possible benefit of halotherapy, given the known antiinflammatory and anti-infective properties of salt. Currently, halotherapy is not covered by medical insurance companies. However, it is hoped that this may change as research is planned to try to prove the benefits that many patients have reported. Many halotherapy institutions offer a monthly pass that can make therapy more affordable than purchasing individual sessions. There is also an effort to develop systems that can deliver halotherapy in the home setting, avoiding the need to travel to a salt room. This is important since many people do not live close to a halotherapy center. It is worth noting that many patients have also noticed benefits in non-respiratory conditions, particularly dermatalogic conditions such as acne and psoriasis and research is planned in this area as well.
References available upon request. I would like to thank Leo Tonkin and Ulle Pukk for reviewing this manuscript.
Daniel Layish, MD, graduated magna cum laude from Boston University Medical School in 1990. He then completed an Internal Medicine Residency at Barnes Hospital (Washington University) in St.Louis, Missouri and a Pulmonary/Critical Care/Sleep Medicine Fellowship at Duke University in Durham, North Carolina. Since 1997, he has been a member of the Central Florida Pulmonary Group in Orlando. He serves as Co-director of the Adult Cystic Fibrosis Program in Orlando. Dr. Layish serves as the medical advisor for the Just Breathe Salt Therapy Wellness Spa and also sits on the board of the Salt Therapy Association. He may be contacted at 407-841-1100 or by visiting www.cfpulmonary.com.
Changing the Trajectory: Haley’s Story
Lifechanging Spine Care at Nemours Children’s Center for Orthopedics & Sports Medicine
By Staff Writer
As a high school senior, Haley is already a seasoned competitor on the golf course, but her path to success hasn’t been without challenges. Diagnosed with adolescent idiopathic scoliosis at age 12, Haley’s journey took her to Nemours Children’s Health, where she found the care and support she needed to thrive.
It all started in 6th grade when Haley’s trainer noticed that one side of her back was higher than the other during a routine assessment at a sports-specific gym. A visit to her pediatrician and an X-ray confirmed a 34-degree curve in her spine. Initially, treatment included wearing a nighttime back brace from 6th to 9th grade, but the curve progressed to 52 degrees over the next two years, requiring spinal fusion surgery.
By the time she started high school, Haley started experiencing back pain, which impacted her sleep and daily life—and, more importantly, her golf game. “The progression of my scoliosis created back pain starting my freshman year,” Haley explained. “I also began having breathing issues a few months prior to surgery. This pain began to affect how I competed.”
When it came time to find a pediatric orthopedic surgeon, Haley’s family turned to a trusted source—her uncle, who works in healthcare, specifically in a spine and biologics division. His research led them to Dr. Alec Stall at Nemours Children’s, who became the clear choice for her care.
The surgery, which involved fusing her spine from T4 to L1, was a turning point. Recovery wasn’t easy, but Haley approached it with determination. “It was a long, tough recovery, but it was all worth it,” she shared. Just two months post-surgery, Haley
was back to hitting golf balls. Eight months later, she was competing again, better than ever.
“This surgery allows me to play golf pain-free, and I’ve become a better player than before,” Haley says. “It opened so many doors for me, and I will forever be thankful to Dr. Stall and every person at Nemours Children’s Hospital and the clinic in Winter Garden. This surgery has truly changed my life.”
Today, Haley’s hard work and resilience have paid off. She is an accomplished golfer with an impressive list of achievements, including winning an AJGA Championship, a Florida State Championship, and qualifying three times for the USGA Women’s Four-Ball. Next year, she’ll take her talent to Florida State University, where she’s signed to play collegiate golf.
For others facing scoliosis and its challenges, Haley offers simple but powerful advice, “Trust the process. It is a tough recovery but getting up every day with a goal you are working toward will help you. Pain is only temporary, and better days are coming.”
Looking back, Haley reflects on her journey with gratitude and perspective. “This surgery changed my life and I 100% guarantee it will change someone else’s. There were moments that I thought all my dreams of playing college golf were over, however, this sur-
Alec Stall, MD,MPH
PHOTO: PROVIDED BY NEMORS
gery not only fixed my back, but changed the trajectory of my golf career for the better. Everything happens for a reason, and I am so grateful to be on the other side of this journey!”
As Haley prepares to tee off at Florida State, her story will undoubtedly inspire others to rise above challenges and pursue their dreams.
Alec Stall, MD, MPH, is a pediatric orthopedic surgeon at Nemours Children’s. Prior to joining Nemours in September 2018, Dr. Stall cared for pediatric patients and served as chief of pediatric orthopedic surgery and medical director for The STTAR Center (spinal and thoracic treatment and research) at The Children’s Hospital of San Antonio. He earned his medical degree and a master’s degree in public health in a combined program at Tulane University, then completed a residency in orthopedic surgery at the University of Maryland School of Medicine in Baltimore. Dr. Stall specialized in pediatric orthopedic surgery and scoliosis with a fellowship at the Texas Scottish Rite Hospital for Children in Dallas.
Many Floridians Suffer From Arthrofibrotic Knees That Can Be Treated Successfully With Minimally Invasive Surgery
By Bruce Levy, MD
Since arriving at Orlando Health Jewett Orthopedic Institute, I have seen numerous patients referred to us who are dealing with a relatively uncommon condition: arthrofibrosis of the knee. This debilitating condition can be seen following knee ligament reconstruction, trauma fracture surgery and after knee replacements to name a few. This condition can cause significant functional limitations to a patient, resulting in extreme stiffness in the joint, decreased range of motion, and even chronic pain. Surgical treatment in the form of arthroscopic releases and removal of scar tissue can offer patients a minimally invasive approach with published successful patient reported outcomes.
The causes of arthrofibrosis vary and the susceptibility of some patients over others is not fully understood. Usually, it develops following a traumatic insult to the joint, an infection, or with surgery; for example, following anterior cruciate ligament (ACL) surgery. ACL reconstruction is one of the most common orthopedic surgeries in the United States; by some estimates there are more than 250,000 such procedures performed every year. Although complications following ACL surgery are rare, at this volume, even a small percentage can mean a significant number.
Once arthrofibrosis begins, it can initiate a cascade of proinflammatory mediators which then drives the proliferation of fibroblasts. These fibroblasts secrete Transforming Growth Factor Beta (TGF-β), a crucial cytokine, that begins a positive feedback loop that generates more fibroblasts, which then generates more TGF- β, and so on. This in turn forms an extra-cellular matrix, causing more adhesions to form inside the joint, which in turn causes bursa (the little pouches and fluid pockets in the knee) to contract. The results are pain, stiffness and decreased range of motion.
During my time at the Mayo Clinic, along with my colleagues Abhinav Lamba BS, Charles L. Holliday MD, Erick M. Marigi MD, Anna K. Reinholz MD, Ryan R. Wilbur MD, Bryant M. Song MD, Mario Hevesi MD, PhD, Aaron J. Krych MD, and Michael J. Stuart MD, we published “Arthroscopic Lysis of Adhesions for Arthrofibrosis After Anterior Cruciate Ligament Reconstruction” (https://journals.sagepub.com/doi/abs/10.1177 /03635465231195366).
We showed that with a minimally invasive arthroscopic approach combined with medications to inhibit TGF- β and physical therapy, people can have very successful outcomes with regards to pain relief, improvement to range of motion, and overall improvement of function. We had a mean follow-up of 10 years, so this was a long-term study. The protocols we developed were the result of a lot of dedicated work and study by medical students, research fellows, and lead by my orthopedic partners at Mayo Dr. Matthew Abdel and Dr. Mark Morrey. These protocols
have been shown to be effective in reducing the recurrence, at least, in people who are being treated for this disease.
The article was published in the American Journal of Sports Medicine (AJSM) and the AJSM editors followed it with an extensive podcast.
Because we saw a large number of referrals at Mayo and now at Orlando Health Jewett Orthopedic Institute, our techniques have continued to evolve. With these advancements we are now able to reach even the posterior aspects of the knee (back of the knee) joint and release the scar tissue trapped there.
Although we are encouraged by the results of these techniques, this surgery presents a number of significant risk factors, such as the potential for neurovascular injury in particular when in these posterior recesses of the knee joint. The joint spaces behind the knee in which we are making incisions to release the scar tissue tend to be very contracted and very narrow. The popliteal neurovascular structures are sometimes within millimeters of where we are operating.
To help mitigate these risks, in addition to the techniques we’ve developed, we need a team of other specialists. Earlier this spring, I took care of a young man from Pittsburgh who had already had several operations to help with his arthrofibrosis. Unfortunately, even after months of therapy he was unable to straighten his knee and walked with his knee bent the whole time. He was so scarred in the back of the knee that the popliteal artery (the main artery giving blood supply to the lower leg) was within millimeters from where we needed to work. After thoroughly discussing the risks with the patient and his family, we developed a plan that included having a vascular surgeon from Orlando Health on standby and all their necessary equipment ready to go in the operating room. It is imperative to be prepared for as many potential complications as possible.
And, of course, this is one of the advantages of having a dedicated orthopedic institute that is directly adjoined to a leading multi-disciplinary healthcare system like Orlando Health. Throughout the patient’s treatment, we are able to align a team of all of the specialists and care providers who are within steps of each other: orthopedic, vascular, neurological, anesthesia, radiology, physical therapy, and all of the support staff. Fortunately, we were able to remove all the scar tissue in his knee through our minimally invasive techniques and he is now able to fully straighten his knee and walk with a completely normal gait.
The most important thing for prospective patients to know is that there is help available. The decision to have surgery is certainly not one to be made lightly. You want to begin with all of the non-surgical modalities first. And then only consider surgery as a last resort. That said, we have clearly shown with data from several published studies that people with arthrofibrosis after knee surgery can be successfully helped with these minimally invasive techniques, and the results appear to be sustainable overtime.
Seven of our most recent published studies on arthrofibrosis are collected by the National Library of Medicine at this link: https:// pubmed.ncbi.nlm.nih.gov/?term=levy+ba+arthrofibrosis.
Our podcast on arthroscopic lysis of adhesions for arthrofibrosis is available at this link: https://sageorthopaedics.libsyn.com/ajsmoctober-podcast-arthroscopic-lysis-of-adhesions-for-arthrofibrosis-after-anterior-cruciate-ligament-reconstruction
Bruce Levy, MD, is a board-certified orthopedic and sports medicine surgeon with Orlando Health Jewett Orthopedic Institute. He also serves as the academic chief of sports medicine and the director of the Sports Medicine Surgical Fellowship program. Previously he was a professor of orthopedics and surgeon at the Mayo Clinic in Rochester, Minnesota. He is an editorial board member for numerous medical journals and has published more than 300 scientific papers.
DERMATOLOGY Continued from page 8
lawful to reimport medicines (a bill has been passed in Florida to allow reimportation, but it still faces an uphill battle for implementation). In other words, the United States is subsidizing the healthcare of the rest of the world by paying outrageous prices, allowing other countries to continue paying bargain-basement prices. Yet, we wonder why our healthcare costs so much here in America.
So how did I resolve the problem of the $8500 cream? Well, we sent the prescription to the local compounding pharmacy and had virtually the same medicine compounded up for $75. The patient did well and saved $8425 along the way. And what happened to the company that made Alcortin and raised the price thousands of dollars? Well, they went bankrupt. What goes around comes around.
Lucky Meisenheimer, M.D. is a board-certified dermatologist specializing in Mohs Surgery. He is the director of the Meisenheimer Clinic – Dermatology and Mohs Surgery. John Meisenheimer, VII is an MD practicing in Orlando.
A New Era in Severe Obstructive Sleep Apnea Treatment: FDA Clears Innovative Oral Medical Devices
By Tara M. Griffin, DMD, DBDSM, DASBA
At Sleep Solution Centers, we are here to provide safe, effective alternative treatment solutions to chronic sleep breathing disorders such as obstructive sleep apnea (OSA), and other related conditions. These options are ideal for patients who can’t tolerate traditional treatment methods such as a CPAP machine with low compliance and fear of having to endure a lifetime of wearing a mask while sleeping, or those not keen on invasive surgeries such as tonsil and adenoid removal or neurostimulation implant devices. Our goal is to bring a new dawn in treatment for such disorders that is safe, convenient, and non-invasive.
The recent FDA granting of the first-ever 510(k) clearance permitting the use of unique oral medical devices for the treatment of Severe OSA reflects an exceptional moment in the field of dentistry and medicine. It marks a grand stride towards a more integrative approach between the medical and dental communities, aiming to effectively and holistically treat OSA in patients across all severity levels.
For over 40 years, professionals in both the medical and dental industries have eagerly envisaged this momentous development. The recent FDA clearance implies that advanced oral medical devices, such as Vivos CARE devices, can cater to OSA patients with ground-breaking success rates—a blend of innovation and convenience that perfectly aligns with our philosophy at Sleep Solution Centers.
A study published in the esteemed Journal of Sleep Medicine substantiates the impressive efficacy of such oral medical devices. In the study, Vivos CARE demonstrated substantial reduction in apnea hypnopnea index (AHI) scores in a majority of OSA patients. Remarkably, 61% of the patients saw significant improvements in their OSA, with a full 26% experiencing complete resolution of their OSA symptoms and diagnosis–an unprecedented
breakthrough in OSA treatment! The resolution of OSA occurred when a sleep test was taken without any oral device in the patient’s mouth and the patient had an AHI < 5 with no diagnosis of OSA after treatment.
As the medical community scales up its understanding of the complex nature of OSA, the structure and functionality of the oral vault have emerged as paramount factors to this condition. This realization helps establish why collaboration with Sleep Solution Centers and airway-centered dentistry approaches like Vivos, is evolving as a unique game-changer providing transformative therapeutic alternatives for this condition that transcends traditional CPAP treatment.
The FDA’s decision to corroborate the application of oral medical devices for the treatment of mild to severe obstructive sleep apnea is surely a beacon of progress in the realm of patient care. Besides chronic OSA sufferers who have struggled to attain relief through traditional treatment methods, patients who prefer non-invasive treatments stand to benefit immensely from this development.
In light of this significant advancement, we urge physicians to consider these alternative treatment solutions to traditional CPAP, particularly for patients who are averse to a lifetime of continuous treatment or invasive surgeries. By referring them to specialized facilities such as Sleep Solution Centers, equipped with state-of-the-art advancements in oral appliance therapy as well as non-invasive adjunctive therapies, we can collectively contribute to a revolution in holistic and sustainable OSA management and/or resolution.
The FDA’s clearance of breakthrough oral medical devices for the treatment of mild to severe OSA marks the onset of a new
Continued on page 20
The Vivos mRNA appliance
Sleep Solution Centers
Social Media – Five Things Physicians Should Never Post
By Julie A. Tyk, JD
Last year, Alaska dentist, Seth Lookhart, made national headlines for filming a video of himself riding a hoverboard while extracting a patient’s tooth. Dr. Lookhart filmed the procedure on a sedated patient without authorization and forwarded the video to several people. A lawsuit was filed by the State of Alaska in 2017 charging Dr. Lookhart with “unlawful dental acts”, saying his patient care did not meet professional standards. The lawsuit goes on to further allege Dr. Lookhart joked that performing oral surgery on a hoverboard was a “new standard of care,” citing phone records that were obtained. Dr. Lookhart has also been charged with medical assistance fraud for billing Medicaid for procedures that were not justified, unnecessary, and theft of $25,000 or more by diverting funds from Alaska Dental Arts. On Friday, January 17, 2020, Dr. Lookhart was convicted on 46 counts of felony medical assistance fraud, scheming to defraud, misdemeanor counts of illegally practicing dentistry and reckless endangerment. Dr. Lookhart is expected to be sentenced on April 30, 2020. He faces the possibility of up to 10 years in prison.
A doctor in Rhode Island was fired from a hospital and reprimanded by the state medical board. The hospital took away her privileges to work in the emergency room for posting information online about a trauma patient. The doctor’s post did not include the patient’s name, but she wrote enough that others in the community could identify the patient, according to a board filing.
The popularity of social media has exploded in recent years. According to a recent PEW report, 70% of Americans use social media. Before jumping on the bandwagon, healthcare professionals are advised to be mindful of the possible ramifications of posting information on social media sites. There are numerous legal issues that can arise when healthcare providers use social media, including issues related to patient privacy, fraud and abuse, tax-exempt status, and physician licensing. The Federation of State Medical Boards has issued the Model Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice, which contains the “industry standards” for cyber security, online behavior, and patient privacy. Physicians should familiarize themselves with these guidelines.
Five things which physicians should never post to social media.
1. Inaccurate Medical Information: Medical professionals should avoid republishing, sharing, “liking,” or “retweeting” news stories about medical treatments unless they have completely read the story and have verified its accuracy. If a user finds inaccurate medical information through your social media channel, it can reflect very poorly upon you and your practice. Healthcare professionals also need to be careful about providing medical advice to patients using social media. If a patient receiving the medical advice from a doctor through social media is located in a state in which the doctor is not licensed, the doctor giving the advice risks liability under state licensing laws.
2. Do Not Post Anything that Violates Patient Confidentiality: Friending patients on social media sites may pose risks under Health Insurance Portability and Accountability Act (HIPAA) and state privacy laws. The fact that an individual is a patient of a healthcare provider falls within the types of health information that these laws
are designed to protect. As a rule, healthcare providers should not use social media to share any health information that could be linked to an individual patient, such as names, pictures, and physical descriptions, without the patient’s consent. The American College of Physicians recommends that doctors be especially aware of the implications for patient confidentiality when using social media. There have been cases of physicians losing their medical license after posting an image on social media that violated patient confidentiality. Always obtain permission from the patient in writing if you intend to use an image featuring any body part. Avoid talking about specific patients at all on social media unless you have permission to do so. Even if there is no chance that a patient could be identified by what you write on social media, it is considered unprofessional to discuss the specifics of their condition. Also be careful when taking photographs of yourself while in your practice. There have been cases where medical professionals have accidentally included the image of the patient behind them while taking a ‘selfie’. Make sure there are no patient health records on display when taking photos in the medical practice and no patients are included in photographs unless they want to be.
3. Your Personal Information: The American College of Physicians (ACP) and the Federation of State Medical Boards (FSMB) recommend that doctors create separate social media accounts for their professional and personal lives. They also suggest that the professional profile be more visible than any personal one.
4. Opinions on Controversial Issues: Any controversial topic or “hot button” topic should be avoided as much as possible, including anything to do with religion, politics, racism, abortion, and gun control. Moreover, healthcare providers that are exempt from taxation under Section 501(c)(3) of the Internal Revenue Code are prohibited from intervening in political campaigns and from seeking to influence legislation as a substantial part of their activities. This restriction may extend to advertising on or sponsoring social media sites that support a political candidate or particular pieces of legislation.
5. Complaints or Rants: It is unprofessional to use social media platforms to complain or rant about your professional situation. Everything you write on social media may one day come back to haunt you. A patient might realize that you were complaining about them on social media.
A medical malpractice claim can have far reaching implications. The Health Care Practice Group at Pearson Doyle Mohre and Pastis, LLP, is committed to assisting Clients in navigating and defending medical malpractice claims. For more information and assistance, please contact David Doyle and Julie Tyk at Pearson Doyle Mohre & Pastis, LLP.
Julie A. Tyk, JD, is a Partner with Pearson Doyle Mohre & Pastis, LLP. Julie concentrates her practice in medical practice defense litigation, insurance defense litigation and health care law. She has represented physicians, hospitals, ambulatory surgical centers, nurses and other health care providers across the state of Florida, and may be contacted by calling (407) 951-8523; jtyk@pdmplaw.com.
Why Debunking the Myths Around Epilepsy is Crucial for Our Patients –and Considerations For Women With the Condition
By Dipali Nemade, MD
For years, we as neurologists and physicians have seen discouragingly consistent reporting on widespread misperceptions, misunderstandings, and complete myths when it comes to epilepsy. These misconceptions impede our ability to offer all the three million Americans who suffer from some form of seizure disorder the help they need to lead their best lives.
A recent survey conducted by Orlando Health found that seizure misperceptions are widespread and that many people don’t recognize the lesser-known signs of seizures. Even though it is, as we know, a relatively common condition that can afflict anyone, we continue to see a social stigma and lack of basic understanding about it.
Let’s take a look at some of the most common misconceptions surrounding epilepsy and seizures that perhaps our patients and their families have brought to us:
1. People with epilepsy have lower-than-average IQs.
2. Epilepsy can be contagious.
3. Women with epilepsy should not become pregnant.
4. Flashing or strobing lights are a very common trigger of seizures in people with epilepsy.
5. If someone is having an epileptic seizure, there is nothing you can do.
6. Epilepsy is incurable.
These misperceptions are largely responsible for the stigmatization that surrounds the disease, and they sometimes interfere with patients getting the treatment they need and even assistance from bystanders when they are experiencing a seizure.
In light of this, I believe we as physicians need to conduct a more concerted effort to educate the public about epilepsy and seizure disorders so our patients can get the treatment they need and also decrease sudden unexpected deaths in epilepsy, or SUDEP, which claims about 3,000 lives in the U.S. each year.
Epilepsy is the fourth most common neurological disease after migraines, stroke, and Alzheimer’s. According to a 2021 National Health Interview Survey (NHIS), it affects about 3.4 million Americans, with about 150,000 Americans diagnosed each year. Over a lifetime, 1 in 26 people in the United States will be diagnosed with epilepsy.
Popular movies and television programs often show what I call “cinema seizures” when depicting epilepsy – people experiencing severe convulsions, foaming at the mouth, and other dramatic displays. Many television programs carry warnings that they contain flashing light sequences that may affect some people, but we know flashing lights trigger seizures in only about three percent of people with epilepsy.
EPILEPSY IN WOMEN
As a specialist in women with epilepsy, there is a misconception I frequently come across – and that is that people believe women with epilepsy shouldn’t become pregnant.
Although we know epilepsy does not discriminate by age or sex, there are some special considerations for women. Half of our total epilepsy patients – around 1.5 million – are women.
We should encourage all women in the reproductive age group who have epilepsy to see a neurologist or epileptologist before they plan to become pregnant so that a proper pathway can be laid to ensure the safety of the mother and baby during and after the pregnancy.
We need to have conversations with women of reproductive age groups and pregnant patients about what having epilepsy means for them during and after pregnancy. I emphasize the importance of taking anti-seizure medication before, during, and after the pregnancy for the safety of the mother and baby. With the whirlwind that comes along with being pregnant and having a baby (preparation, sleep deprivation, newborn care, etc.), I encourage my patients who are expecting to put measures in place that will ensure they do not forget to take their anti-seizure medication. One way I tell them to do this is to set a reminder or alarm on their phones to take it so it’s one less thing they have to remember on their own. I also advise them to make their obstetrician and prenatal care team aware of their epilepsy.
Another concern I hear from pregnant patients is about passing epilepsy to their children. After I evaluate the patient, I refer the patient to genetics testing and counseling if the genetic cause is suspected as we know certain types of epilepsy can be transmitted to children.
EDUCATING OUR PATIENTS ON HOW PEOPLE CAN HELP THEM
When someone appears to be having a heart attack or stroke, people around them are often quite good about rushing to help them. It should be no different with epilepsy. If our patients are having a seizure, people can help them.
Educating my patients on how to speak about their condition and inform their family, friends, coworkers, and neighbors about how to help them is a critical step in my care. This is another reason why working to debunk the myths around epilepsy and spread awareness about the symptoms is so vital in helping our patients and preventing SUDEP.
WHY WE FOCUS ON COLLABORATIVE CARE
Our new Orlando Health Neuroscience Institute facility is adjacent to Orlando Health Orlando Regional Medical Center, which for over 100 years has provided the most advanced options available for surgical, medical, rehabilitative, and emergency care, including serving as Central Florida’s only Level 1 Trauma Center. Our multidisciplinary team at the Orlando Health Neuroscience Institute includes more than 45 physicians and more than 20 advanced care providers who offer next-level treatments and technology tailored to patients’ unique needs. At our institute, we are focused on collaborative care among our specialists, particularly our epileptologists.
With a new medical office building in the heart of downtown Orlando, our neurologists, neurosurgeons, and interventional spine and pain management specialists now work under one roof. This makes it easy for us to consult with each other, and for example in cases of epilepsy when neurosurgery may be needed, we can come together to determine the best course of action for our patients.
Most importantly for us, we are a level 4 epilepsy center. That means we provide more complex forms of intensive neurodiagnostic monitoring, as well as more extensive medical, neuropsychological, and psychosocial treatment. We also offer a complete evaluation for epilepsy surgery, including intracranial electrodes, cortical mapping/functional mapping, and a broad range of surgical procedures for epilepsy (resection, ablation (LITT), and neuromodu-
lation (RNS, DBS, and VNS), etc. Orlando Health ORMC houses our Epilepsy Monitoring Unit (neurodiagnostic monitoring unit), where we work with our team to observe patients’ brain activity (EEG) and record what happens before, during, and after a seizure. This greatly helps us determine the most effective treatment plan as efficiently as possible as noted before.
Dr. Dipali Nemade is a board-certified epileptologist and neurologist at the Orlando Health Neuroscience Institute.
Dr. Nemade believes in providing high-quality and individualized care with the latest advanced epilepsy treatments. Her comprehensive approach toward epilepsy management includes EEG, sEEG, and brain mapping, diagnostic neuroimaging, and collaboration with neurosurgeons, neuropsychologists, and neuroradiologists.
76 W. Underwood St., 2nd Floor • Orlando, FL 32806
Call: (321) 841-2800
Fax: (321) 843-8777
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era in OSA therapy. Our obligation is to ensure patients enjoy access to these transformative treatments and advance a sustainable and cross-disciplinary treatment outcome that holistically caters to OSA. This innovative approach bridges science and patient comfort to offer relief to patients in their long-standing battle against obstructive sleep apnea. Together, we can write a new chapter in the narrative of OSA treatment.
Sleep Solution Centers located in the heart of Medical City, Lake Nona, was co-founded by Dr’s Rupal Thakkar DMD and Tara M. Griffin DMD in March, 2024. We are both dentists by trade that have focused on treating sleep breathing disorders for the past 14 years of practice. The recent grand opening of Sleep Solution Centers marks our flagship medical center that solely treats the root cause of sleep breathing disorders and TMJ disorders for children and adults. With direct collaboration with our medical community, we aim to help revolutionize healthcare through early detection, prevention and treatment ensuring good quality sleep for a lifetime!
If you are interested in learning more about our practice, contact us at 407-502-0110 www.sleepsolutioncenters.com or info@sscln. com. References available upon request.
Tara M. Griffin, DMD, DBDSM, DASBA, graduated from Nova Southeastern University in 2006, with a doctorate in Dental Medicine. She became passionate about helping her patients breathe and sleep better and completed her Diplomate with the American Academy of Dental Sleep Medicine in 2011. In 2015, she completed her Diplomate with American Sleep and Breathing Academy. In 2016, she became a Clinical Advisor with Vivos Therapeutics to help educate and mentor doctors interested in the treatment of OSA with oral medical devices. She owned a private practice focused on sleep, TMD and general dentistry in the panhandle of Florida for 17 years before becoming the co-founder of Sleep Solution Centers in Medical City, Orlando in 2024. She may be contacted at 407-502-0110 or by visiting www.sleepsolutioncenters.com
A B O U T U S
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R e f r e s h P a c k a g e
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F l o o r i n g r e p l a c e m e n t ( c a r p e t , v i n y l , o r t i l e )
W a l l r e p a i r a n d t o u c h - u p s ( e . g . , p a t c h i n g h o l e s , s m o o t h i n g s u r f a c e s )
M i n o r l i g h t i n g u p g r a d e s ( e . g . , r e p l a c i n g o u t d a t e d f i x t u r e s )
R e n e w a l P a c k a g e ( i n c l u d e s R e f r e s h P a c k a g e )
R e f r e s h P a c k a g e p l u s :
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L a n d s c a p i n g r e f r e s h ( m u l c h i n g , p r u n i n g , n e w p l a n t i n g s )
S i g n a g e D e s i g n a n d I n s t a l l a t i o n ( e x t e r i o r b r a n d i n g , d i r e c t i o n a l s i g n s , o r
A D A - c o m p l i a n t w a y f i n d i n g )
P a r k i n g L o t R e s u r f a c i n g a n d M a i n t e n a n c e ( f i x i n g p o t h o l e s , s e a l i n g c r a c k s ,
a n d r e s t r i p i n g s p a c e s )
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N e w w a l l s , c e i l i n g s , i n s u l a t i o n , e l e c t r i c a l , p l u m b i n g , H V A C , b u i l d i n g s e r v i c e s
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D o o r a n d H a r d w a r e U p d a t e s
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E m e r g e n c y P r e p a r e d n e s s U p d a t e s ( b a c k u p g e n e r a t o r s , e v a c u a t i o n p l a n s , f i r e s u p p r e s s i o n , e t c . )
A r t w o r k a n d f u r n i s h i n g s s e l e c t i o n
C a l l F r a n k R i c c i t o d a y f o r y o u r f r e e e v a l u a t i o n
Orlando Health Doctors & UCF Students Team Up to Invent AI Technology for Surgeries
On May 13th, Orlando Health and UCF unveiled a new AI project developed by doctors, students and faculty. Orlando Health surgeons teamed up with undergraduate UCF engineering and computer science students to develop AI software to assist during surgeries.
“It’s very fulfilling and rewarding to help people through our work,” said Rachel Leiner, recent graduate from UCF’s College of Engineering and Computer Science.
The project is called the AIMS system (Artificial Intelligence for Medical Surgery system). This past Spring, Dr. Alexis Sanchez, Director of Robotic Surgery at Orlando Health, and Laura Brattain, UCF biomedical engineer, put their heads together in the operating room (OR). While observing a robotic surgery, the pair came up with an idea to track surgical tools in ORs. Through the new partnership, UCF students developed the idea into reality.
“This collaboration is so important. It brings the best minds together: academic innovation paired with clinical experience for the ultimate goal of improving patient care,” said Dr. Alexis Sanchez, Director of Robotic Surgery at Orlando Health.
The AIMS system links a camera feed to a computer in the operating room. During surgery, the innovative AI software helps track the use of surgical staples to improve efficiency and sustainability, with the potential to be trained to track additional items, further expanding its utility. Laura Brattain's research focus is developing AI solutions to improve healthcare.
“This is really a great example of how an integrated team working together makes an impact. This is only the starting point,” said Laura Brattain, UCF biomedical engineer and College of Medicine Associate Professor. “What’s important is to build translational technology so we can see that technology making an impact. We don’t want technology to be developed and then collecting dust on the shelf.”
Rachel Leiner, recent graduate from UCF’s College of Engineering and Computer Science, was one of the six students who developed the AI software.
The goal is to align scientists from each organization, creating an intersection of knowledge and practice where innovation is embraced. Working together creates synergy and provides advances in the science of medicine in Central Florida.
“The relationship between Orlando Health and UCF has helped support collaborative projects like this one that Dr. Sanchez, Dr. Brattain and the students accomplished,” said Daleen Penoyer, Senior Director of Corporate Research Partnerships, Orlando Health Strategic Innovations. “We expect more projects like this to be developed between UCF and Orlando Health in the future and we’re excited for what’s to come.”
In addition, Orlando Health is also a UCF Pegasus Partner, a program that offers opportunities for select partners to engage across the university in ways that create meaningful value for both organizations. That engagement includes talent development and recruitment, shared research projects, joint ventures and collaborations, and strategic philanthropy.
JANUARY – Digestive Disorders
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2025
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