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NOVEMBER/DECEMBER 2024 • COVERING THE I-4 CORRIDOR

The Orlando Health Jewett Orthopedic Institute Hospital – Celebrating One Year

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NOVEMBER/ DECEMBER 2024 COVERING THE I-4 CORRIDOR

 COVER STORY

The Orlando Health Jewett Orthopedic Institute Hospital is celebrating its success and continued growth one year after opening its doors to patients in Central Florida and beyond. The Orlando Health Jewett Orthopedic Institute Downtown Complex includes the specialty hospital, which opened August 29, 2023, and adjacent medical pavilion, which opened March 27, 2023. The facility has served more than 300,000 patients to date.

“We’re proud of the hard work our team has put in to make this first year a success. Our patients have been able to receive all aspects of excellent orthopedic and sports medicine care in one location and a patient experience that is second to none,” said Orlando Health Jewett Orthopedic Institute President/CEO Michael Jablonski, MD.

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ON THE COVER Orlando Health Jewett Orthopedic Institute Downtown Complex

The Orlando Health Jewett Orthopedic Institute is currently ranked in the 99th percentile for patient experience, according to the survey administrator that reports patient assessment scores to the Centers for Medicare and Medicaid Services (CMS). While the Orlando Health Jewett Orthopedic Institute Downtown Complex provides a wide range of services like imaging, walk-in clinical care and rehabilitation, thousands of people have undergone surgery at the facility. At the Eugene Jewett, MD Surgery Center inside the medical pavilion, more than 8,500 surgeries have been completed. At the specialty hospital, that number is more than 4,600. Overall, more than 3,200 patients have received joint replacements.

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MARKETING YOUR PRACTICE FLORIDA MD - NOVEMBER/DECEMBER 2024

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COVER STORY

The Orlando Health Jewett Orthopedic Institute Hospital – Celebrating One Year

By Staff Writer The Orlando Health Jewett Orthopedic Institute Hospital is celebrating its success and continued growth one year after opening its doors to patients in Central Florida and beyond. The Orlando Health Jewett Orthopedic Institute Downtown Complex includes the specialty hospital, which opened August 29, 2023, and adjacent medical pavilion, which opened March 27, 2023.

The facility has served more than 300,000 patients to date.

“We’re proud of the hard work our team has put in to make this first year a success. Our patients have been able to receive all aspects of excellent orthopedic and sports medicine care in one location and a patient experience that is second to none,” said Orlando Health Jewett Orthopedic Institute President/CEO Michael Jablonski, MD. The Orlando Health Jewett Orthopedic Institute is currently ranked in the 99th percentile for patient experience, according to the survey administrator that reports patient assessment scores to the Centers for Medicare and Medicaid Services (CMS). While the Orlando Health Jewett Orthopedic Institute Downtown Complex provides a wide range of services like imaging, walk-in clinical care and rehabilitation, thousands of people have undergone surgery at the facility. At the Eugene Jewett, MD Surgery Center inside the medical pavilion, more than 8,500 surgeries have been completed. At the specialty hospital, that number is more than 4,600. Overall, more than 3,200 patients have received joint replacements.

patients,” said Dr. Jablonski. “Patients across the region can trust that we have some of the highest trained experts caring for them, to provide the best outcomes possible.”

The Orlando Health Jewett Orthopedic Institute currently employs 65 physicians, 75 advanced practice providers, and operates 14 outpatient clinics across Central Florida. In addition to providing excellent patient care, the Institute is also a hub for education and research. The Orlando Health Jewett Orthopedic Institute Bioskills Lab provides an innovative and advanced learning environment dedicated to providing medical professionals with hands-on surgical training. More than 100 labs for medical residents and professional development have been completed in the first year.

ORTHOPEDIC SPECIALTY HOSPITAL Patients are experiencing innovation in motion at the first and only orthopedic hospital of its kind in the Southeast. To prepare and alleviate any anxiety before surgery, the lobby of the hospital features a simulated operating room, so that patients can see the area, tools and technology that will be used during their operation.

The orthopedic specialty hospital features 10 operating rooms and 75 inpatient smart rooms. The smart rooms offer an enhanced patient experience with customization options, interactive entertainment and seamless communication with the care team. The rooms also have large screens so that patients can “By creating a great work environment, we’ve been able to review their medical information, recovery plan and watch their cruit top physicians and healthcare professionals to care for our personal entertainment through their streaming service accounts like Netflix.

Team members celebrate their first year of success at the Orlando Health Jewett Orthopedic PHOTO: PROVIDED BY ORLANDO HEALTH JEWETT ORTHOPEDIC INSTITUTE

Institute Downtown Complex.

“Sometimes, simply knowing when your next medication is coming or what type of physical therapy plan is in store can be a huge relief to patients,” said Orlando Health Jewett Orthopedic Institute Chief Operating Officer April Ernst. “We want to make sure our patients have easy access to that information with the touch of a button.”

The Orlando Health Jewett Orthopedic Institute’s Sterile Processing department is 12,000-sq.-feet. It has a best in class clean-to-dirty-to-clean flow. The process begins when the cart with dirty instruments leaves the OR using a dedicated contaminated eleva-

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COVER STORY

PHOTO: PROVIDED BY ORLANDO HEALTH JEWETT ORTHOPEDIC INSTITUTE

tor and arrives in the decontamination area. Once the items are decontaminated, they are loaded into one of six STERIS washer disinfectors, and the carts go through separate STERIS cart washers.

These are extremely high temperature machines that render the items free of microbes. On the clean side of the department, the instruments are prepped, packed, and loaded into one of five pass through steam sterilizers or V-pro peroxide plasma sterilizers. Once the process is complete, the instruments are returned to the operating room using a dedicated clean elevator that arrives directly to the sterile core of the operating room.

When patients visit or stay at the Orlando Health Jewett Orthopedic Institute, they can expect unique dining options. Many orthopedic patients are healthy and active, so the food matches that lifestyle. All food is made to order, with fresh meat and fish options.

BIOSKILLS LAB

The Orlando Health Jewett Orthopedic Institute specialty hospital features 75 private inpatient rooms with smart-room technology.

A research and innovation center on the seventh floor provides a hands-on learning environment for orthopedic surgery residents. It includes a 10-station cadaver lab, 3D printer and 116-seat auditorium.

“We know we have physician shortages throughout the United States. If physicians could be educated at a facility of this caliber, that puts people out in the community that have access to the latest technology and the best training you can get in the Southeast,” said Dr. George Haidukewych, Orlando Health Jewett Orthopedic Institute Academic Chairman.

An institute is defined by excellence in patient care, education, and research. The Orlando Health Jewett Orthopedic Institute’s world-renowned surgeons have published hundreds of research studies, book chapters and instructional videos. They are highly sought after speakers at national and international orthopedic meetings, and many are involved in new implant development and design. This ensures that patients have unique access to cutting-edge technologies and techniques.

Orlando Health offers a comprehensive, hands-on orthopedic surgery residency program that allows each resident to gain experience in the full range of orthopedic care, from hand and upper extremity, foot, ankle and hip subspecialties, to pediatric orthopedics, spine care and sports medicine. Orlando Health’s fellowship programs in trauma, pediatric orthopedics, surgical sports medicine and primary care sports medicine allow fellows to participate in diagnosis and treatment within their area of focus. Orlando Health also offers an orthopedic physician’s assistant and nurse practitioner fellowship.

IMAGING Phase I of the Orlando Health Jewett Orthopedic Institute Downtown Complex was completed in March of 2023. Every detail of the institute was designed to ensure the best experience for patients. For many, this begins with imaging.

Orlando Health is the first health system in Florida to receive MRI technology that significantly accelerates scans and provides new entertainment options. According to Siemens, some knee exams can be completed in less than two minutes. “Most orthopedic patients are used to spending 30 to 40 minutes inside an MRI machine,” said Orlando Health Jewett Orthopedic Institute musculoskeletal radiologist Dr. Jonathan Kazam. “By significantly reducing scan time, we expect that patient comfort inside the MRI machine will be greatly enhanced, which will result in less motion and higher quality images.”

ORTHOPEDIC CLINIC The orthopedic clinic includes 62 exam rooms, three procedure rooms, seven x-ray suites and two casting rooms. On average, 12 providers staff the clinic daily, offering expertise in traumatology, spine, foot and ankle, hand, joint replacements, sports surgery, non-operative sports medicine, concussion management and pediatric sports medicine. The Orlando Health Jewett Orthopedic Institute employs highly-trained orthopedic and sports medicine physicians, many of whom completed sub-specialty fellowships in their areas of focus. They are trusted to care for Central Florida’s elite athletes, as the official medical provider for Orlando City and Orlando Pride soccer, University of Central Florida and Orlando Ballet. They provide that same level of care to all patients.

Same day appointments are available in the Orlando Health Jewett Orthopedic Institute’s walk-in center at the downtown complex.

“We’re really excited to offer walk-in orthopedic care at the downtown complex,” said Orlando Health Jewett Orthopedic Institute assistant vice president Kelsey Kiser. “This is a convenient alternative to an emergency room visit and can save patients time and money.”

Providers in the clinic are trained to assess and diagnose orthoFLORIDA MD - NOVEMBER/DECEMBER 2024

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COVER STORY tients back to their functional levels, from office workers to professional athletes, and everyone in between.

The Eugene Jewett, MD Surgery Center is one of the largest ambulatory surgery centers in Florida with 12 operating rooms and three minor procedure rooms.

The ORs are only used for orthopedic and spine surgeries. Due to the specialized use, the lay out is specifically designed to prevent infection.

The surgery center is embedded within the medical pavilion, a unique feature that provides all types of orthopedic services in one location. Not only do patients have easy access to the ASC with a dedicated parking garage and valet, they may also receive pre-admission testing, imaging services, pharmacy services and outpatient rehabilitation at the Orlando Health Jewett Orthopedic Institute Downtown Complex.

Physicians helped configure the operating rooms to create the safest space for patients. A clean suite operating room ceiling system uses high-performance diffuser The Orlando Health Jewett Orthopedic Institute offers walk-in care convenience grilles to turn turbulent air flow into laminar flow, diwhere patients can see an orthopedic or sports medicine specialist same-day recting airborne particles and contaminants away from for a wide range of conditions. the patient and OR staff while encompassing the room pedic injuries and concerns. Some patients may be able to leave in HEPA-filtered air. The operating rooms are equipped to live the same day with a treatment plan and all follow-up appointstream surgeries so residents and fellows can further their learning ments scheduled. In addition, Orlando Health Jewett Orthopedic opportunities at the Orlando Health Jewett Orthopedic Institute.

Institute clinic locations across Central Florida will remain open Physicians worldwide can access the streams for additional learnwith 24/7 access to scheduling online or through a call center. ing and collaboration opportunities.

REHABILITATION

The integration of video technology also provides a direct route Orlando Health’s rehabilitation team has extensive experience, for all intra-operative imaging to be uploaded into the patient’s numerous board certifications and top-quality scores in A team of fellowship-trained musculoskeletal radiologists and orthopedic docchange in function and efficiency. These expert therapists tors bring extensive expertise to the treatment of diseases and injuries of the will collaborate with physicians daily to optimize care joints, bones, muscles and spine. plans for patients.

The therapists use a variety of techniques. For example, many therapists are certified in dry needling, which is the specialized use of micro needles to release muscular trigger points. This can often relieve pain within a day.

The rehabilitation space is filled with the latest technology. For injured athletes, a simulator for golf and soccer helps track progress and guide treatment. This is the same simulator that the pros use on the PGA tour. Another game changer is the AlterG anti-gravity treadmill. Only about 10 percent of clinics have this technology, which allows patients to walk and run much earlier in their recovery, with up to 80 percent of weight removed from their bodies. The expert therapists use motion analysis cameras and force plates, which helps provide data on movement and balance. To better assess when an athlete is ready to return to the field or court, Orlando Health has installed turf and hardwood surfaces in the physical therapy space, to match those surfaces used in sports.

The entire clinic was designed around returning pa6 FLORIDA MD - NOVEMBER/DECEMBER 2024

PHOTO: PROVIDED BY ORLANDO HEALTH JEWETT ORTHOPEDIC INSTITUTE

PHOTO: PROVIDED BY ORLANDO HEALTH JEWETT ORTHOPEDIC INSTITUTE

EUGENE JEWETT, MD SURGERY CENTER

electronic medical record. This allows the post-operative care team, such as physical and occupational therapists, the ability to review the anatomy and repair. That information helps customize post-operative therapy to achieve the most successful outcomes.

In the Eugene Jewett, MD Surgery Center nano-suites, the state-of-the-art NanoScope operative arthroscopy system uses high definition, chip-on-tip image sensor technology to provide surgeons with a needle-sized, single-use camera system. The portability of the imaging system allows the surgeon to perform minimally invasive arthroscopy without the need for anesthesia.

Pre-planning and post-operative care reThe 375,000-square-foot Orlando Health Jewett Orthopedic Institute Downtown Complex is main at the center of positive outcomes for located at the corner of Columbia St. and Lucerne Terrace in Orlando. Phase 1 of the building all same-day surgeries. Patients can access opened March 27, 2023 Phase 2, which includes an orthopedic specialty hospital, opened in August 2-23. total joint replacement education classes to prepare for their surgery and classes that foin the region. Orlando Health has pioneered life-changing medicus on the recovery work needed after surgery. cal research and its Graduate Medical Education program hosts more than 350 residents and fellows.  OUR HISTORY Orlando Health acquired Jewett Orthopaedic Clinic in 2019 to begin work on the Orlando Health Jewett Orthopedic Institute – named to honor Dr. Eugene Jewett.

Dr. Eugene Jewett was a Central Florida orthopedic surgeon, and founder of the Jewett Orthopaedic Clinic, whose dedication to the specialty saved hundreds of thousands of lives. When injured and bedridden patients couldn’t access orthopedic care in the 1930’s, he would bring the care to their homes. Known to drive around with an x-ray machine and a nurse, his reputation became well-known. Soon, hospitals were asking him to visit.

They assembled rooms full of orthopedic patients for Dr. Jewett to examine and treat.

His inventions include the Jewett Hip Nail and the Jewett Hyperextension Back Brace. Both devices significantly improved the outcome for orthopedic patients. The earnings he received from the pioneering devices were poured back into medicine and education for others.

Orlando Health was founded in 1918 on the heels of World War I, in the midst of the Spanish Flu epidemic that raged across the world. Orange General Hospital, as it was known then, was supported financially by community members and a dedicated group of physicians. More than 100 years later, the healthcare system is recognized around the world for Central Florida’s only pediatric and adult Level I Trauma program as well as the only state-accredited Level II Adult Trauma Center in Pinellas County.

It is the home of the nation’s largest neonatal intensive care unit under one roof, the only system in the southeast to offer open fetal surgery to repair the most severe forms of spina bifida, the site of an Olympic athlete training facility and operator of one of the largest and highest performing clinically integrated networks

OUR SPECIALTY ORTHOPEDIC CENTERS Our doctors specialize in the full range of orthopedic care, including: • Bone Health • Elbow • Hip • Hand and Wrist • Shoulder • Spine • Sports Medicine • EMG/NCV • Knee • Foot and Ankle • Head (Concussion) • Trauma • Upper Extremity Program

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PHOTO: PROVIDED BY ORLANDO HEALTH JEWETT ORTHOPEDIC INSTITUTE

COVER STORY

DERMATOLOGY

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.

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 Alcor: Intertrigo - Would you spend $8500.00 on a tube of cream to tin sold for about $35 a tube, so I didn’t think the cost was a concern. treat this eruption?

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.

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,” and it wasn’t for a flatbed truck loaded with cream; it was for one lousy 60-gram 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 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.

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 unlawful 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.  8 FLORIDA MD - NOVEMBER/DECEMBER 2024

PHOTO: JOHN MEISENHEIMER, VII, MD

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.

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PULMONARY AND SLEEP DISORDERS

Pulmonary Rehabilitation

By Daniel T. Layish, MD, FACP, FCCP, FAASM Pulmonary rehabilitation can benefit patients with a wide variety of lung diseases including COPD, pulmonary fibrosis, cystic fibrosis, and sarcoidosis (among other chronic respiratory illnesses). Pulmonary rehabilitation does not replace standard medical and/or surgical treatments for these lung diseases. Rather, it supplements and complements standard therapy.

Patients with COPD (and other chronic lung diseases) develop shortness of breath with activity. This leads to the tendency to avoid activity, which in turn leads to deconditioning. It is felt that one of the main benefits of pulmonary rehabilitation is to break the cycle of deconditioning. Pulmonary rehabilitation programs typically include two or three outpatient sessions per week for 10 to 12 weeks. Typically, a pulmonary rehab program will include aerobic exercise, strength training, patient education in management of lung disease - including nutrition, energy conservation, medication compliance, bronchial hygiene, and breathing strategies. The component of group support is also felt to be a significant contributor to the success of these programs. The group support motivates the patient to attend the pulmonary rehab sessions. It also allows the patient to realize that there are other people suffering from chronic respiratory illness and to see how they are able to overcome these obstacles. Pulmonary rehabilitation is considered to be critical both before and after lung transplantation. Occasionally, a patient will have such a significant functional and symptomatic improvement after pulmonary rehab that transplant can be delayed.

Pulmonary rehabilitation programs are typically multidisciplinary in nature and may include a respiratory therapist, registered nurse, exercise physiologist, nutritionist, physical and/ or occupational therapists. The staff is trained to encourage the patient’s self management and coach them to adopt healthier habits through lifestyle modification. To enroll in a pulmonary rehabilitation program requires a medical referral. Pulmonary rehabilitation is covered by most third party payors. Pulmonary rehabilitation is appropriate for any stable patient with a chronic lung disease who is disabled by respiratory symptoms.

The pulmonary rehab program should involve assessment of the patient’s individual needs and creation of a treatment plan that incorporates realistic goals tailored to each patient. Evidence based analysis consistently reveals improvement in health related quality of life after pulmonary rehabilitation as well as improved exercise tolerance. Pulmonary rehabilitation has been shown to improve the symptom of dyspnea and increase the ability to perform activities of daily living. Pulmonary rehabilitation has also been shown to reduce health care utilization (including frequency of hospitalization) and decreases length of stay (when hospitalization is required). Pulmonary rehabilitation has not been demonstrated to improve survival.

The benefit from a pulmonary rehabilitation program may decline over time if the individual does not maintain their con10 FLORIDA MD - NOVEMBER/DECEMBER 2024

ditioning. Some pulmonary rehabilitation programs will therefore include a “graduate” or maintenance program after the patient finishes the initial program.

Patients who develop shortness of breath often become anxious which in turn exacerbates the sensation of dyspnea and this can become a vicious cycle. Pulmonary rehabilitation can be very helpful in addressing this problem. Sometimes pulmonary rehabilitation will require supplemental oxygen with exercise.

Although the strongest evidence regarding pulmonary rehabilitation programs is in the setting of COPD, it has been shown to be beneficial in a variety of disease states. Pulmonary rehabilitation has been shown to be a cost effective tool in the fight against chronic lung disease. It is currently felt to be underutilized.

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. He may be contacted at 407-841-1100 or by visiting www.cfpulmonary.com. 

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PEDIATRICS

Nemours Children’s Hospital, Florida Continues to Grow Neurosurgical Capabilities – One Patient’s

Journey to a Seizure-Free Life

By Satyanarayana Gedela, MD and Gregory Olavarria, MD At Nemours Children’s, our method for treating children with epilepsy is a careful, deliberate, two-phased approach. The focus is as much on precisely pinpointing the source of seizures as it is on effectively treating them. This leads to a higher rate of success in not only helping to stop the seizures, but also in reducing the likelihood of them returning in the future.

UNDERSTANDING EPILEPSY Nearly 3.5 million Americans have been diagnosed with epilepsy, a brain disorder that causes repeated seizures in those affected. It’s often assumed that someone having a seizure will begin to shake or lose control of their body, but the signs could be as subtle as a person seeming confused or being unable to speak or answer questions clearly.

It’s not always immediately apparent what causes epilepsy.

However, if tests show that the seizures are originating from a specific part of the brain and medicines are unsuccessful, surgical intervention may be required. Many children with seizures go many years without the opportunity for surgical intervention that can potentially be curative. Early referral to a specialized epilepsy surgery program, such as the one at Nemours Children’s Hospital, Florida is critical.

MEET KAYLEE Earlier this year, we were introduced to Kaylee, a 12-year-old girl from Orlando who had been diagnosed with epilepsy after scans revealed a lesion on her temporal lobe, the part of the brain near the left ear. She was prescribed medicine to help conKaylee with Dr’s. Olavarria and Gedela

trol her seizures, but her episodes continued and the side effects from the medication (including fatigue and difficulty concentrating) further complicated her daily life. After a second medicine also failed to prevent her seizures, we knew that Kaylee was dealing with drug-resistant epilepsy and that surgery would be the next step.

We immediately began working on our plan for treatment. The lesion was present in her left temporal lobe, near the area of the brain where memory is stored, so we knew that precision was going to be especially critical in Kaylee’s case.

Satyanarayana Gedela, MD

Gregory Olavarria, MD

PHASE ONE: STEREOTACTIC EEG OR ELECTRODE INSERTION The first phase of our approach involved a stereo electroencephalography (SEEG). In this minimally invasive operation, we placed intracranial electrodes in Kaylee’s brain in order to recreate the episodes she was having and identify the exact origination point of the seizures. Placing electrodes on the brain is a delicate and difficult task, but the neurological capabilities at Nemours Children’s now include ROSA One Brain robotic technology, a system that enabled us to precisely place the electrodes within 1mm of our target area on Kaylee’s brain.

Once the electrodes were in place, our testing showed that Kaylee’s seizures were actually coming from the hippocampus an area near the lesion seen on MRI. Fortunately, we also learned that her memory had moved to the right side of her brain; this made us confident that we’d be able to surgically remove the affected area with minimal risk of memory loss. Her resection would have to be very precise, because even though her memory may not be affected, sensitive language functions resided very close to the area of concern.

PHASE TWO: RESECTION We then moved to the second phase of our plan—resective surgery to remove Kaylee’s hip12 FLORIDA MD - NOVEMBER/DECEMBER 2024

PEDIATRICS pocampus, along with the lesion. If this type of operation is performed without first completing a SEEG, or the SEEG is performed without the precision of advanced technology like our ROSA system, a lesion can still be removed; however, there is a higher likelihood of the seizures returning if they were originating from somewhere beyond the lesion, as was Kaylee’s case.

Surgery to remove a part of the brain, it can be a very stressful and traumatic time for both the child and their family. But we’ll never forget the relief and excitement from Kaylee’s mother when she saw her daughter wake up after surgery, speaking clearly and with her memory intact.

THE PATH TO A SEIZURE-FREE LIFE We’re proud to say that Kaylee has been seizure-free since she has completed treatment. We will continue to work with her in the coming years—generally, we’ll check-in at the one-year, five-year and ten-year mark. Once a patient has gone a decade without a seizure, we’re able to confidently say they are no longer living with epilepsy. We have every reason to believe that Kaylee will get there based on the results we’ve seen so far. In the meantime, she’s turned into an ambassador of sorts for Nemours Children’s, meeting with other children and families who are about to go through the same surgeries to share her story.

ADVANCED NEUROLOGICAL CARE While Kaylee was the first patient to receive a SEEG procedure at Nemours Children’s, it’s not a new surgery. There aren’t many other children’s hospitals in the world that can offer the full suite of pediatric epilepsy care, with multiple tailored surgical interventions and with the technology that we have, to provide end-to-end treatment all in one place. We’re excited to now be offering SEEG surgery right here at our hospital in Orlando. We have one of the fastest growing neurosurgery programs in the country, and we look forward to continuing to improve health outcomes for children in Central Florida with our state-of-the-art care.

Dr. Gedela is an epileptologist at Nemours Children’s Hospital, Florida with extensive experience in STEEG procedures. He completed his pediatric neurophysiology fellowship at the Children’s Hospital of Pittsburgh of UPMC and is certified in epilepsy and child neurology by the American Board of Psychiatry & Neurology.

Dr. Olavarria is a highly skilled neurosurgeon at Nemours Children’s Hospital, Florida. He received his MD from the University of California and completed his fellowship in pediatric neurosurgery at Children’s Memorial Hospital in Chicago. He’s certified by the American Board of Neurological Surgery.

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Call 407.650.7715 or visits Nemours.org for more information about the pediatric neuroscience program at Nemours or to refer a patient. 

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FLORIDA MD - NOVEMBER/DECEMBER 2024 13

Multimodal Pain Management with Opioid Minimization

By Luke Elms, MD In 2016, overdoses accounted for more than 42,000 deaths in the United States according to data from Health and Human Services (HHS). While many of these deaths are multifactorial, a majority reportedly involved opioids. Despite HHS declaring a nationwide public health emergency regarding the opioid crisis in October 2017, the numbers have continued to rise, which many experts believe is being driven by counterfeit pills containing illicit fentalogues. Recently, the government released provisional numbers reporting more than 100,000 overdose deaths for the 12-month period ending April 2021. Although there is debate whether the number of overdose deaths attributable to legal prescription opioids is being overestimated, opioids and the overdose crisis has become a frequent topic of public discourse and raised concerns regarding opioid exposure in some patients.

As the opioid crisis was gaining national attention, I was involved in Orlando Health’s Right Care Initiative for the ERAS (Enhanced Recovery After Surgery) protocol. The ERAS protocol has multiple tenants, and one of the main tenants was the utilization of multimodal pain management. This area really sparked my interest, as alleviating the suffering of postoperative pain is always a battle I’m willing to fight. So, along with my colleague Dr. Bobby Gibbons, we began implementing the protocol in our practice. Through a gradual process over the next few years, we made modifications to the ERAS protocol’s multimodal pain regimen and settled on our own multimodal pain control protocol.

We now utilize this protocol in all our surgical patients without a contraindication, most of who undergo minimally invasive or robotic procedures. When we implemented the multimodal pain control, our patients started reporting much less use of the opioids we were prescribing and some even reported eliminating their use altogether. In response, we were able to transition from oxycodone to tramadol, which is a less powerful schedule IV drug compared to the schedule II status of oxycodone. After finding success with this change, we started decreasing the quantity of opioid pills we were prescribing. Now, with some smaller procedures we can achieve good pain control with no opioids, but most patients still get a one-day supply of 50 mg tramadol to ensure they have a rescue medication to add if non-opioid medications alone are not sufficient. Many patients do not fill the tramadol prescription or only take 1-2 pills and still report great pain control at their follow-up. With better pain control and reduction of the uncomfortable side effects of the opioids like nausea and constipation, our patient satisfaction increased.

In 2018, I realized that most patients who had poor pain control while using the protocol were unintentionally noncompliant with the instructions. This was addressed with more purposeful 14 FLORIDA MD - NOVEMBER/DECEMBER 2024

patient education prior to surgery and the creation of patient education handouts that were created and modified in response to patient feedback. Proper patient education includes explaining the benefits of opioid minimizing multimodal pain control, setting proper expectations so patients understand that surgery does cause pain, and that while they can expect to experience pain, it will be managed with the addition of an opioid is necessary. It is vitally important to have these conversations up front, because when patients are properly prepared and understand the reasoning, they are much more comfortable and willing to attempt opioid-minimizing analgesia. Now, with our updated education, we have found the need to prescribe oxycodone or refill their tramadol prescriptions to be less than 5 percent for most of our operations.

One underestimated opportunity is the use of multimodal pain control in the nonsurgical realm. There are people all over the country who had their first exposure to an opiate from accessing routine medical care. These people were in pain and needed intervention, but were opioids always necessary to provide adequate pain control? We have an opportunity for a paradigm shift in the way we think about postoperative pain management in the United States. Historically, in the United States, 90 percent of major or minor medical procedures were prescribed an opiate. After using opioids post-surgery to maintain adequate pain control during recovery, there are 3.3 billion opioid pills left over every year in the United States. With all this considered, there is an opportunity to shift our prescribing practices to opioids not as first-line treatment for acute pain, but as an adjunct when non-opioid alternatives are not sufficient to provide adequate pain relief. It is possible to drastically reduce that number while still providing compassionate pain control with opioids to those who need it.

The vitally important point is that medically indicated prescription opioid pain medications are not the enemy, and neither are the patients who rely on them. Prescription opioids are a vital tool in our battle to alleviate the suffering of pain. Opioids responsibly prescribed and utilized are both safe and necessary for many of our fellow Americans who suffer from chronic pain, palliative conditions and other causes of uncontrolled pain. The opportunity for discussion and change lies in the portion of our patients we have historically treated with an opioid as a first-line pain control method when non-opioids could provide high quality, compassionate pain control. Eliminating the use of opioids while leaving our patients in uncontrolled pain is not a compassionate, or ethical, solution. That practice runs afoul of many of the tenants that

we are called to uphold as medical providers. It should not be considered a victory if going “opioid-free” means leaving people in uncontrolled pain. Instead, when possible, we must replace the prescription opioids with a viable, effective alternative, and non-opioid multimodal pain control can fill that role. What multimodal pain control protocols have demonstrated is that significant opioid minimization while maintaining adequate pain control is possible in many cases. The broader application of opioid-minimizing multimodal pain control presents the opportunity for a muchneeded discussion regarding how we approach acute pain control in a compassionate, safe manner, not just within our own practice, but throughout the entire healthcare system.

Luke Elms, MD, is a board-certified general surgeon with Orlando Health Medical Group at Orlando Health Dr. P. Phillips Hospital. He also has certification in robotic surgery and serves as teaching faculty for the general surgery residency program at Orlando Health. After earning his medical degree

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from the University of Oklahoma College of Medicine, Dr. Elms completed his general surgery residency at Orlando Health. Over his years in practice, Dr. Elms has developed both a professional and personal passion in the opioid epidemic. This passion has led to a focus on minimally invasive and robotic surgery techniques with postoperative opioid-minimizing multimodal pain control.

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Oviedo Medical Center Announces the Opening of Two New For Information Please Operating Suites and New Post-Anesthesia Unit Email:Care info@floridamd.com

In response to the growing healthcare demands of Oviedo and East Orlando, Oviedo MedicalText Center,or ancall affiliate of HCA Florida Health407.417.7400 care, recently opened two new state-of-the-art operating suites. Two more new operating suites are scheduled to open in early 2025. Additionally, a new 14,000-square-foot surgery recovery Post-Anesthesia Care Unit, with 14 beds, will open later this month. This $18 million expansion will serve as a vital resource for patients, offering an advanced surgical Oviedo Medical Center CEO KC Donahey and care team environment for a wide range of procedures, from routine to highly complex. members cut the ribbon on one of two new operating suites.

“The addition of these new operating suites and Post-Anesthesia Care Unit is great news for our colleagues, surgeons, and most importantly, our patients,” said Joseph Everette, chief nursing officer at Oviedo Medical Center. “These additional suites will enable us to reduce wait times and enhance our capacity to serve the community more efficiently.”

KC Donahey, chief executive officer of Oviedo Medical Center, added, “The expansion of our operating rooms and Post-Anesthesia Care Unit will have a significant positive impact on patient care. This is a tremendous step forward in our commitment to the care and improvement of human life.”

When the expansion is complete, Oviedo Medical Center will have a total of nine operating suites, designed to meet the increasing demand for surgical services in the community. These new suites will also improve workflow efficiency for surgeons, surgical staff, and patients.

“The additional space will create greater efficiencies for both surgeons and surgical staff, enhancing our ability to schedule surgeries and meet the healthcare needs of our community,” said Dr. Chris Bryant, gynecologic oncology surgeon. “The leadership at Oviedo Medical Center is dedicated to supporting our community and medical professionals, and this expansion will significantly improve access to advanced surgical care.”  FLORIDA MD - NOVEMBER/DECEMBER 2024 15

Healing Eczema: Beyond Skin Deep

By Joseph Cannizzaro, MD Oftentimes the children we treat in our practice suffer from asthma, allergies, eczema and other comorbid conditions, which create a persistent inflammatory state in the body. In these cases, we apply a synergistic mix of healing factors: nutrition with dietary modifications, supplements, enhanced detoxification, and medications when necessary. We determine food intolerances, look for nutritional deficiencies, and analyze chemical exposures.

Additionally, salt therapy has proven to be a safe and effective healing modality that helps clear eczema completely.

HOW DOES SALT THERAPY HELP HEAL ECZEMA? In January 2018, our pediatric center became the newest location for The Salt Room® in Central Florida. Salt therapy is performed in this special spa-like room with salt-coated walls and floor, called a halochamber. Pharmaceutical-grade salt is pulverized into microscopic particles and pushed into the room by a halogenerator.

Salt therapy involves lounging in this cozy room and passively breathing in the particles while listening to soothing music, reading, or just relaxing in a zero-gravity chair. Toys are provided so children can play with the salt in the room, much like sand at the beach.

The salt particles enter the lungs and nasal passages, accelerating mucus clearance and improving lung function while killing harmful bacteria and soothing the respiratory system. The antibacterial, anti-fungal, and anti-inflammatory properties of salt have been documented to help with symptoms of both respiratory and skin conditions.

HOW SALT THERAPY PROVIDES RELIEF FOR ECZEMA: • Fortifies the skin’s protective barrier • Stimulates microcirculation • Reduces inflammation, redness and irritation • Has anti-bacterial and anti-fungal effects • Reduces IgE levels • Helps normalize the skin’s pH balance • Promotes healthy tissue regeneration • Facilitates deeper penetration of skin care products • Increases skin elasticity • Cleans impacted follicles • Promotes gentle exfoliation (cell turnover) For those suffering from eczema, salt therapy works by activating multiple physiological processes in the body. On the outside of the body, the salt particles kill bacteria and fungi, reduce inflammation on the skin, and improve circulation on the skin surface. Salt calms the itchy rash and heals cracks, which restores 16 FLORIDA MD - NOVEMBER/DECEMBER 2024

the skin’s barrier against infections and allergens. The skin and respiratory tract are cleansed of allergens like pollen, dust, or smoke. Salt therapy also reduces stress and strengthens the body’s defense system. Salt therapy is a clinically-proven, natural, safe, and beneficial method of treatment for every age group.

Taking a holistic approach to eczema—identifying the underlying cause(s), applying the appropriate integrative protocol, and incorporating salt therapy—has yielded successful outcomes for our patients. This “beyond the surface” approach to a skin condition has proven to shorten the journey to lasting relief—with a side effect of smiles.

Joseph Cannizzaro, MD has been practicing pediatrics in Central Florida for over 40 years and is the author of “Answers for the 4-A Epidemic: Healing for Kids with Autism, ADHD, Asthma and Allergies.” As a classicallytrained primary care physician who practices functional integrative medicine, Dr. Cannizzaro believes that integrative medicine can bring conventional and complementary healing modalities together, creating a highly personalized and high-touch healing environment. Call the Cannizzaro Integrative Pediatric Center at 321-2805867 for a meet and greet or to book a session at The Salt Room® Longwood. www.MyCIPC.com. 

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.

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.

Sleep Solution Centers

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 The Vivos mRNA appliance

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 18 FLORIDA MD - NOVEMBER/DECEMBER 2024 17

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

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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

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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 

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ORTHOPEDICS

Early Recognition Can Save Patients’ Hips By Andrew Carbone, MD It’s easy for us to imagine the scene. A young adult athlete, such as a hockey goalie or a ballerina, sits with their physician in the examination room reviewing several X-rays on a screen that show an apparently healthy hip.

The physician tells the patient that they have sustained an injury to the joint. The soft tissues will heal with time and the pain can be managed, but arthritis could possibly develop in the future.

While just two decades ago, this may have been the end of the conversation, young adults should no longer accept that arthritis and a deteriorating joint is the inevitable result of a hip injury. Fortunately, a major paradigm shift is underway. Supported by extensive data and increasingly effective arthroscopic techniques, we can recognize the underlying pathologies resulting from hip injuries and treat them now. Such early intervention may possibly delay or obviate the need for total hip replacement in the future and might even prevent the joints from developing arthritis altogether.

THE CHALLENGE –Traditionally, arthritis has been divided into two categories: primary and secondary. Primary arthritis basically means arthritis with no known origin. Secondary arthritis includes arthritic conditions of known medical origin, such as rheumatoid or inflammatory arthritis and infectious or septic arthritis. In the 1970s, 80s and even the 90s, we lacked the diagnostic tools to be more precise than this. But today, with increased awareness, improvements in advanced imaging, better understanding of synovial biomarkers, and other technology available, we can invest greater effort in determining the precise causes of the pre-arthritic condition and treat the underlying pathology.

These pathologies may include femoroacetabular impingement, acetabular labral tears, excessive femoral or acetabular anteversion or retroversion, inadequate femoral head coverage (Acetabular Dysplasia), or hip microinstabiltiy. In some cases, the injury that brings the patient to the physician’s office may reveal another pathology such as generalized ligamentous laxity, or even some connective tissue disorders like Ehlers-Danlos Syndrome.

These conditions may result in an earlier than normal onset of arthritis of the hip if left untreated. Ultimately, the goal is to change the mindset of both patients and providers alike – that osteoarthritis is not a disease, but rather a symptom or side effect of an untreated predisposing hip condition.

THE PARADIGM SHIFT – The focus of hip preservation

is the idea that we don’t treat hip pain patients like pre-arthritic patients; we treat them like they have actual pathologies that need to be treated. A growing body of evidence shows us that early intervention can improve hip function, reduce pain, and possibly delay or even prevent the onset of arthritis.

But as with many advances that result in a paradigm shift, 20 FLORIDA MD - NOVEMBER/DECEMBER 2024

there has been skepticism and resistance in some quarters. I compare this to how arthroscopic surgery was viewed many years ago.

For a long time, some physicians Dr. Andrew Carbone is a considered shoulder arthroscopy to dual fellowship-trained orthopedic surgeon be “an instrument of the devil” by and sports medicine very prominent shoulder surgeons. physician at the Orlando For example, if you were doing a Health Jewett Orthopedic labral repair arthroscopically, some Institute. argued that you were doing harm to the patient and that of course would be a terrible thing. But then our arthroscopy techniques steadily improved. The result has been a total shift away from open surgical labral repairs for shoulder instability. In fact, the role for open shoulder labral repairs is so limited today that the technique is not often taught in surgical residency or fellowship anymore.

With hip surgery, it’s similar. Early articles were published with nearly the same headlines, comparing hip arthroscopy to the “devil’s tool.” Open surgery on the hip for dysplasia, for example, has been around for some time. Whereas hip arthroscopy has been around only since the early 2000s. But now that paradigm has started to change. Now, we are able to combine open surgery with arthroscopic techniques. The results are promising, but they have taken time to gather. Part of this is due to the nature of hip preservation. Unlike surgery to the shoulder or the knee, for example, in hip surgery, the benefits for the patient may not always be immediately clear. Instead, we are trying not only to improve function and reduce pain now, but potentially prevent a disease that’s possible to happen 10 to 20 years from now. Now that we have been doing this work for nearly 20 years, longer term data has begun to demonstrate that hip arthroscopy improves a patient’s pain and function. And while it is likely too early to truly know hip arthroscopy’s effect long term, as we continue to improve our techniques and study our patients, I am confident we will start to see stronger evidence for delayed and possibly reduced rates of hip osteoarthritis.

UNDERDIAGNOSED – Education is key in hip arthroscopy because many times the underlying pathology goes undiagnosed.

For example, often a patient will present with vague groin pain or maybe a tightness they experience when they are trying to stretch out. Sometimes this pain radiates to other areas, such as the buttocks, or the hip. Then it often gets written off as a muscle pull or lower back pain. But unlike those conditions, it never really goes away. The patient gets X-rayed, but the X-ray looks healthy. Eventually, the patient gets frustrated and that’s typically when we are consulted; because, if you are 21 years old, you should not be experiencing hip pain. And if you do, that’s something that needs to be addressed.

ORTHOPEDICS At the Orlando Health Jewett Orthopedic Institute, we are seeking to raise awareness among young adult athletes that hip-related pain is not normal and the cause of it should be carefully investigated and identified. And if it is determined not to be a temporary condition, such as a muscle strain, we should review the possible treatment options, which may include arthroscopy. Orlando Health Jewett Orthopedic Institute is the first orthopedic specialty hospital in Florida, and we’ve assembled a team of distinguished experts to address these kinds of cases. When a patient comes here, they aren’t seeing just one doctor and getting just one opinion, they are seeing several doctors and getting several perspectives at once. We form a kind of collective in which we can share our views and challenge each other. In addition to this, we are part of the Academic Network of Conservational Hip Outcomes Research group (ANCHOR).

ANCHOR is a multicenter, clinical research group of physicians and scientists who are investigating adolescent and adult hip disorders.

We are focused on improving patient care through research, education and mentorship. This collaboration enables us to learn from thousands of data points and patient outcomes.

BOTTOM LINE – If you have a young adult patient who has experienced an injury to their hip or is presenting with unusual

pain, don’t dismiss it, investigate it. Find out why this is happening, and let’s get it treated. It might save that patient a lot of pain and difficulty not just now, but many years from now.

Dr. Andrew Carbone is a dual fellowship-trained orthopedic surgeon and sports medicine physician at the Orlando Health Jewett Orthopedic Institute. His expertise is in sports medicine, and he frequently collaborates with athletes across many sports. This includes enthusiasts who play sports in their leisure time as part of an active lifestyle. Dr. Carbone is proficient in a wide array of procedures including: • Arthroscopic hip labral repair for treatment of femoroacetabular impingement • Complex primary and revision hip arthroscopy including labral reconstruction for treatment of recurrent labral tears • Shoulder arthroscopy for rotator cuff tears, shoulder instability and biceps injuries • Knee arthroscopy for treatment of meniscal and cartilage injuries • Ligament reconstruction for knee injuries • Minimally invasive robotic hip replacement • Minimally invasive treatment of gluteal and hamstring tears Dr. Carbone stays informed on the latest medical research and science so he can offer his patients the most comprehensive information and care. He takes time to answer all of their questions so they feel comfortable about their treatment options.

DR. CARBONE’S TRAINING

He earned a bachelor’s degree in neuroscience and behavioral biology from Emory University in Atlanta. Dr. Carbone received his medical degree from New York Medical College in Valhalla, where he was inducted into the Alpha Omega Alpha national medical honor society. He then stayed in New York for an orthopedic surgery residency at The Mount Sinai Hospital.

He completed a sports medicine fellowship at the Cedars-Sinai Kerlan-Jobe Institute in Los Angeles and another fellowship in hip preservation at the American Hip Institute & Orthopedic Specialists in Des Plaines, Illinois. He received specialized training in open and arthroscopic hip preservation techniques, treatment of gluteal and hamstring injuries, and minimally invasive robotic hip replacement procedures.

ABOUT DR. CARBONE Dr. Carbone is a member of the American Orthopaedic Society for Sports Medicine, American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America and International Society of Hip Preservation. He is also a peer reviewer for The American Journal of Sports Medicine.

His research has been published on topics including arthroscopic capsular repair, batter’s shoulder, shoulder arthroplasty and femoroacetabular impingement syndrome, a condition in which the bones at the hip joint rub together due to one or both bones being irregularly shaped.

He has a particular interest in the arthroscopic treatment of sports-related injuries of the hip, knee and shoulder. During his medical studies, he spent a year researching the biologic and mechanical pathways involved in tendon to bone healing and how sports-related injuries affect cartilage health and contribute to the development of osteoarthritis.

He constantly reviews the latest research, allowing him to extend to his patients the most comprehensive information and care available to ensure they are comfortable with their treatment options.

An avid sports fan, Dr. Carbone previously served as the assistant team physician for the Los Angeles Dodgers and Los Angeles Angels. He served as the associate team physician for the Anaheim Ducks, Los Angeles Galaxy, Los Angeles Sparks, Pepperdine University and West LA College.

Outside of work, he enjoys spending quality time with his wife and children, playing golf, and exploring new places through travel.  FLORIDA MD - NOVEMBER/DECEMBER 2024 21

MARKETING YOUR PRACTICE

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.

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2025

EDITORIAL CALENDAR

Florida MD is a monthly medical/business digital magazine for physicians..

Florida MD is emailed directly to healthcare providers in Orange, Seminole, Flagler, Volusia, Osceola, Polk, Brevard, Lake and Indian River counties. Cover stories spotlight extraordinary physicians affiliated with local clinics and hospitals. Special feature stories focus on new hospital programs or facilities, and other professional and healthcare related business topics. Local physician specialists and other professionals, affiliated with local businesses and organizations, write all other columns or articles about their respective specialty or profession. This local informative and interesting format is the main reason physicians take the time to read Florida MD. It is hard to be aware of everything happening in the rapidly changing medical profession and doctors want to know more about new medical developments and technology, procedures, techniques, case studies, research, etc. in the different specialties. Especially when the information comes from a local physician specialist who they can call and discuss the column with or refer a patient. They also want to read about wealth management, financial issues, healthcare law, insurance issues and real estate opportunities. Again, they prefer it when that information comes from a local professional they can call and do business with. All advertisers have the opportunity to have a column or article related to their specialty or profession.

JANUARY –

Digestive Disorders Diabetes

FEBRUARY –

Cardiology Heart Disease & Stroke

MARCH –

Orthopaedics Men’s Health

APRIL –

Surgery Scoliosis

MAY –

Women’s Health Advances in Cosmetic Surgery

JUNE –

Allergies Pulmonary & Sleep Disorders

JULY –

Neurology / Neuroscience Advances in Rehabilitation

AUGUST –

Sports Medicine Robotic Surgery

SEPTEMBER – Pediatrics & Advances in NICUs Autism OCTOBER –

Cancer Dermatology

NOVEMBER – Urology Geriatric Medicine / Glaucoma DECEMBER – Pain Management Occupational Therapy

Please call 407.417.7400 for additional materials or information.

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