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healthy valley

® MIAMI

ISSUE 10 December 2013

Is Your TEEN Getting Enough SLEEP?

Obama’s Health Care Reform

New Year New Options

The power of MELATONIN and SLEEP

rob Novak Races Toward His Olympic Dream

HAVE YOU HAD YOUR FLU SHOT? SCAN THIS QR CODE TO VIEW ONLINE MAGAZINE

HEALTHY MIAMI

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Publisher Mauricio Portillo Editor in Chief Claudia Portillo Del Valle Marketing Director Arnaldo Del Valle Copy Editor Lora Incardona

Claudia Portillo

Editor in Chief

Website Director Healthy Media Graphic Design Healthy Media

The holiday season is finally here! I can not help but feel a giddy, almost childlike, enthusiasm for the days that are about to come. While at the same time, I feel grateful for everything that we have accomplished this year, not only as a company but as individuals; grateful for those moments, big and small that made a difference in our lives. Today we can say that we know what progress looks like, and we have succeeded as we have learned from our mistakes, which have become the stepping stones for this new year to come. This month we had the pleasure if interviewing Robert Novak. Robert “Rob” Novak is a runner who was on his way to the Olympics, until he was sidelined by a spate of injuries. Now he runs on tracks in Miami and, although he is far from Rio de Janeiro, his mind is focused on just one thing—making it to the 2016 Olympics. This is a true story of passion and determination, and I hope we can all learn from his experience. And with that I’d like to wish all of our readers an incredible holiday season—

Photography Gala Ricote Daniela Tosta Fabiola Peñaloza Contributing Writers Joseph Zebede, MD, FACC Alysa Herman, M.D. Christina Peña, M.D. Virgilio Sanchez Jr M.D. Ritu Goel, M.D. Megan Clunan, MA, LMHC, LPC Andreea Macoveiciuc Lora Incardona, M.Ed. Maria Luisa Salcines Charlotte Libov Carolina Mar tinez Rubel Shelly Steve Stanley Frankie Ruiz Social Media Director Faride Del Valle

one that you can spend with cheer and joy, love and humility and the other emotions that surround us this time of year. I know, that with all the hustle and bustle of the season, it becomes easy to forget, but it’s important to remember that this is the time of year to practice the spirit of giving. Try to practice good acts and share love and compassion for your neighbor, not because you think that you will get it back from them but because it’s what’s in your heart. Happy Hanukkah, Merry Christmas and cheers to an incredible New Year.

cportillo@healthyvalleyonline.com

hm healthy magazine is a free monthly publication. All contents are protected by copyright and may not be reproduced without written consent from the publisher. The material in this magazine is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments. healthy magazine and its contributors accept no responsibility for inaccuracies, and the advertiser is solely responsible for ad content and holds publisher harmless from any error.

Contact@HealthyMagazine.com 1430 S. Dixie Highway, Unit 315 Coral Gables, FL 33146 PH 305-395-4554 www.HealthyMagazine.com


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ISSUE 10

WHAT’S

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December 2013

INSIDE HEALTHY KIDS 8. 10.

IS YOUR TEEN GETTING ENOUGH SLEEP? HAVE YOU HAD YOUR FLU SHOT?

HEALTHY BODY, MIND & SOUL 12. 14. 16. 18. 22. 24. 26. 28.

NEW YEAR NEW OPTIONS THE POWER OF MELATONIN AND SLEEP JAIME FLORES, MD ROB NOVAK RACES TOWARD HIS OLYMPIC DREAM INFERTILITY CHRISTINA PEÑA, M.D. SYNCOPE HEART DISEASE AN EPIDEMIC THAT IS PREVENTABLE AND REVERSIBLE OBAMA’S HEALTH CARE REFORM

FITNES & BEAUTY 30. KENDALL SPORTS MEDICINE 34. GOT CELLULITE? 36. CBT COGNITIVE BEHAVIORAL THERAPY

Contact@HealthyMagazine.com | 1430 South DIxie Hwy, suite 315, Coral Gables, Fl 33146 | PH 305-395-4554 | www.HealthyMagazine.com


healthy

Kids

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8.

IS YOUR TEEN GETTING ENOUGH SLEEP?

10.

HAVE YOU HAD YOUR FLU SHOT?


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healthy kids

Is Your TEEN Getting Enough SLEEP? by Steve Stanley

Teenagers are notorious for not getting enough sleep. Young people often think that they are invincible and don’t mind burning the candle at both ends. Computer time, chatting and texting take precedence over a good night’s sleep. What they are doing is building up a “sleep deficit,” which, over time, will interfere with their ability to concentrate and study but recently has also been proven to be a contributor to obesity. Depression and other emotional problems are also part of this lack of sleep syndrome. WHY IS SLEEP SO IMPORTANT?

MAJOR CAUSES OF SLEEP LOSS IN TEENS

Sleep is required for all humans to thrive, and in fact survive. While your body rests, your brain keeps working and supervises a myriad of biological functions to ensure that all bodily systems operate at optimum levels.

If you lack the required hours of restorative sleep, you won’t be able to work, learn, create and communicate at a level even close to your true potential. You are also headed for a physical and mental breakdown. It’s not just the amount of hours you sleep; it’s how deep you sleep. The REM Deep Sleep is what you really need to have the fullest healthful effects of sleep. If your teen is getting plenty of sleep but still waking up tired, it may be that his sleep is not deep enough. WHY CAN’T I GET MY TEEN TO GO TO BED EARLIER? You may be surprised to find out that it is natural for your teen to have trouble falling asleep early. As children grow, their natural biological clock, called the circadian rhythm, keeps resetting itself. It tells your teen to fall asleep later in the evening and wake up later the next day. Research has shown that the hormone melatonin, which induces sleep, is released later in the evening in teens than it is in children and adults.

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INSOMNIA: Stress is a common causative factor of sleep loss. Other causes of insomnia are things like a lack of a comfortable sleeping situation, physical pain, family stress and noise. INVOLUNTARY LIMB MOVEMENT AND RESTLESS LEGS SYNDROME: These conditions affect teens as well as adults. The involuntary spasms are not being consciously controlled. With restless leg syndrome there are actual sensations that are felt that cause the person to move the limb to alleviate the uncomfortable feeling, which can take the form of cramping, tingling, burning or itching. Magnesium may be helpful for this condition. SLEEP APNEA CAUSED BY OBSTRUCTIONS: This can be a serious condition. If your teen has loud snoring or is very tired during the day, an evaluation should be performed by a physician. Often the cause is enlarged tonsils or adenoids. GASTROESOPHAGEAL REFLUX DISEASE: GERD can affect teens as well as adults. It is a very uncomfortable feeling when stomach acids travel in reverse up into the esophagus.

Fortunately, better sleep is close at hand and most sleep problems can be cured with some simple lifestyle changes. The idea is to calm down the mind by doing such things as turning off the cell phone or computer before bed, cutting down on caffeine and avoiding violent video games and movies at night. A form of selfhypnosis is especially helpful. Have your teen lie in bed in a comfortable position and imagine himself doing something enjoyable but also relaxing. For some, it may be lying on a blanket at the beach, breathing in that fresh ocean air. For others it may be sitting on a mountain top taking in the beautiful scenery.


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healthy kids

• • • • • • • •

by Steve Stanley

Don’t despair if you haven’t gotten a flu shot yet. While it is best to get the shot before the flu season, which runs October through May, it can still be effective in building your immunity against the virus. The logic behind getting the flu shot early is so that your body has a better chance at building up its immunity. DOES EVERYBODY NEED TO GET A FLU SHOT? This is a common question. While it is generally recommended that everybody get a flu shot, certain groups are at higher risk for contracting the flu than others. The Centers of Disease Control (CDC), The American Academy of Family Physicians (AAFP) and the American Academy of Pediatrics (AAP) are in consensus regarding the highest risk groups:

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Children six months through four years of age Elderly people over sixty-five years old Pregnant women, including women who are contemplating becoming pregnant New mothers and mothers who are breastfeeding during the flu season People with compromised immune systems such as those with HIV infections Nursing home residents People, regardless of age, living with chronic disorders such as asthma Children or teenagers who have been taking aspirin on a regular basis because they are susceptible to developing Reye’s Syndrome if they catch the flu • People working in health care professions • Native Alaskans and Native Americans

IS THERE ANYONE WHO SHOULD NOT GET A FLU SHOT? Not everyone is a good candidate for a flu shot. Some children can be at greater risk from a flu vaccine than if they contracted the flu itself. Children under six months of age and anyone who has had an adverse reaction to a flu shot in the past should not get one as well as those individuals with Guillain-Barre Syndrome. If your child has an allergy to eggs, consider this: The nasal mist version of the flu vaccine is grown inside of eggs and could pose a problem. Also, the nasal mist is a weaker version of the flu vaccine. Consult with your doctor about which method is best for your child with an egg allergy. Do not have your children receive any flu vaccines outside of a physician’s office if they have an egg allergy. ARE THERE POTENTIAL SIDE EFFECTS? Flu shots are generally regarded as safe and effective but there have been reported side effects. It is normal to have some swelling at the site of the injection and some patients report a low-grade fever or a headache. The nasal spray version of the vaccine can also produce side effects such as a runny nose, vomiting, headache, fever and aching muscles. A STRONG IMMUNE SYSTEM IS IMPORTANT A healthy immune system can make all the difference in the world as to who comes down with the flu regardless of the flu vaccine, so live a healthy life all year long. This means eating healthy foods, taking multi-vitamins and staying well hydrated. Don’t only be concerned about getting sick during the flu season because, after all, we are at risk all year long of becoming ill from our daily encounters with pathogens.


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HEALTHY SOUL

New Year

New Options

by Rubel Shelly I like the notion of “fresh starts” and “second chances.” How about you? Did your fall semester in college or graduate school end on a low note? The spring semester that starts in a few weeks is a fresh start for you. Was last year a tough one at work? Did you lose a job? Did you have to move your family from a place everybody really liked to a new location? One way to cope is to think of what you can gain rather than what you’ve lost. Focus on what to learn from the experience to help you move forward. Make some new friends. Is an important relationship in trouble? Did someone you love die? Are you worried about the bad-attitude friends your child has made? Maybe you need to look at these things through fresh eyes and with hope. A sense of brokenness is often the mandatory first step to renewal and healing. So it isn’t a bad thing to lament our losses. But it is a bad thing to spend the rest of our lives looking over a shoulder to the past instead of lifting our eyes to the future. It can be fatal to the human spirit. As you may expect in light of all this, I see the turning of the calendar to a new year as a big deal. Doesn’t the idea of a clean slate appeal to you too? Doesn’t the chance to

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start over sound great? But I’m not necessarily suggesting that you make a long list of New Year’s Resolutions. In fact, I would advise against it. Long lists are intimidating and frustrating. Most resolutions are too vague—reduce stress, save more money, be more helpful at home. And the notion of pledging to do something for 365 days is tough on people who are honest about just how often failure visits them. Perhaps there is a better way. Remember the advice Jesus gave about just taking care of today and not biting off tomorrow’s troubles? “Each day has challenges enough of its own!” he said. Think about it and you will realize that your own experience confirms it. In the context of that statement, Jesus gave this counsel: “Strive above all else for the reign of God in your life, and the things that have been worrying you will resolve!” God’s reign requires conscious surrender, not of the entire year but of today’s trouble, a stressor or a particular loss; not of the other person but of my attitude toward her; not of yesterday’s failure so much as today’s opportunity. New Year 2013 is God’s mercy to you. With his presence a reality and in the one-day-at-a-time surrender to him, creative new things will come out of the waste-and-void chaos of the past and life will become fresh every morning.


healthy

Body Mind & Soul

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12.

NEW YEAR NEW OPTIONS

14.

THE POWER OF MELATONIN AND SLEEP

16.

JAIME FLORES, MD

18.

ROB NOVAK RACES TOWARD HIS OLYMPIC DREAM

22.

INFERTILITY CHRISTINA PEÑA, M.D.

24. SYNCOPE 26.

HEART DISEASE AN EPIDEMIC THAT IS

PREVENTABLE AND REVERSIBLE

28.

OBAMA’S HEALTH CARE REFORM


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healthy body

Maintaining a sleep schedule and getting enough rest each night ensures a healthy production of melatonin, a hormone that helps us stay slim and healthy and boosts immune function through its antioxidant effects.

The power of

MELATONIN and SLEEP by Andreea Macoveiciuc If your health has suddenly become worse than usual and there doesn’t seem to be a reasonable explanation, how about checking your sleep schedule and routine? Is skimping on sleep among your guilty habits? Do you often fall asleep with the TV or computer on or wake up only after your alarm clock does its job? Studies have shown that an altered sleep schedule can disrupt the natural production of melatonin, the substance that ignites the sleep cycle and keeps the body healthy through its powerful antioxidant effects. Able to counteract the harmful action of free radicals on most organs and systems, melatonin helps you fall asleep, but fluctuations in this hormone’s level also tell your body when to wake up. WHY MELATONIN IS IMPORTANT Perhaps you’ve heard about the circadian rhythm— it’s that “internal clock” that regulates your body’s activity and internal processes throughout the day, speeding up metabolism at certain hours, keeping you focused and alert, or slowing down all bodily functions when the body’s preparing for sleep. Normally, melatonin levels peak at night, between 11 pm and 3 am, but as we get older these values reach their highest point a little earlier. Still, the general rule that applies to all ages is that light inhibits the production of melatonin while darkness stimulates it. If you work in a room with low light but spend your evenings and nights in places that are intensely lit, you’re very likely to get your melatonin levels out of sync. But why is this so important?

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Melatonin helps you stay fit, enhances the immune function and protects your body against free radicals, as previously stated. At the same time, the hormone delays the signs of aging, reduces the risk of diabetes, prevents mood disorders, helps in reducing the risk of Alzheimer’s disease, protects against gallbladder stones, prevents headaches and relieves symptoms of tinnitus. Also, studies suggest that the hormone is useful in treating various neurologic disorders as well as the symptoms of irritable bowel syndrome and improving the endocrine function in menopausal women. CAN MELATONIN LEVELS BE PURPOSELY INFLUENCED? As said, the intensity of light in your office and bedroom can disrupt the normal production of melatonin and an altered sleep schedule can also affect its production; however, there are a few things that can be done to increase or regulate the melatonin levels and it’s important to understand them not only for improving your sleep hygiene but also for helping your body stay healthy and strong. Obviously, the easiest way to regulate your melatonin production is to adjust your sleep schedule and allow your body to go to sleep and wake up naturally, as the internal clock dictates. Still, adjusting the light intensity in your work and sleep rooms can also be effective. Spending your day and evening in a dimly lit room isn’t recommended, as this might suppress the normal production of melatonin. Light should be intense during the day and completely turned off at night, as even the apparently harmless light coming from a computer’s display can interfere with melatonin production. Another effective solution is to add melatonin to your diet by eating more foods that provide it, such as cherries. Beer also contains melatonin but if it isn’t your drink of choice you can always take some dietary supplements. Just make sure to take them before evening so that melatonin can reach your blood stream and start exerting its effects on time. Also, make sure to take the recommended dose because increasing the intake of melatonin can have the opposite effect. Staying organized and keeping a very strict sleeping, eating and workout program can help your body maintain its internal regimen, encouraging melatonin to be released at the right moments. And last, try not to take aspirin, ibuprofen or other NSAIDs before bedtime, as these prevent the release of melatonin in proper amounts. If you usually work out in the afternoon, make sure to do your cool down stretches to prevent muscle soreness and avoid using anti-inflammatory drugs for easing pain.


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Plastic Surgeon

Jaime Flores, MD Aesthetic & Reconstructive Surgical Associates S. Miami Plastic Surgeon

Board certified in plastic surgery, Dr. Jaime Flores is a leading expert in breast reconstruction surgery. He has performed over 1,500 DIEP Flap procedures in his 10 years of practice—each within 4-6 hours. Dr. Flores’ practice expands the discipline of plastic and cosmetic surgeries, but he holds a particular interest in the art of breast reconstruction. His primary focus is on “flap” procedures, especially the DIEP Flap. He has mastered this microvascular approach to breast reconstruction by utilizing the patient’s autologous, or own, tissue. A flap of skin can be taken from a distinct area of the patient’s body, such as the back, buttocks or abdomen, and then be transplanted to the chest, along with the reconnection of blood vessels to the newly reconstructed area. Dr. Flores graduated from the University of Maryland Medical School in 1998. He then completed a residency in Otolaryngology and a fellowship in Plastic and Reconstructive Surgery at Johns Hopkins in 2005. He spent several postgraduate years as a full-time Assistant Professor at the Johns Hopkins School of Medicine, Division of Plastic and Reconstructive Surgery teaching young residents how to excel in the field of plastic surgery and is now an American Board Certified Plastic Surgeon.

Dr. Flores’ dedication to surgery and his commitment to excellence are evident every day, to his patients here and abroad, as he strives to deliver excellent care here in the United States and throughout the world. Dr. Jaime Flores is more than just your average plastic surgeon. He prides himself in changing the lives of children and adults through his generosity, compassion and service. His life’s mission is to free those who’ve been stricken with physical deformities and bodily harm all around the world.


Dr. Flores specializes in reconstructive breast surgery, which includes reconstruction surgeries such as the DIEP, SGAP, LSGAP and TUGS as well as tissue expanders, implants, reductions and lifts, all with minimal scarring. His practice is dedicated to state-of-the-art reconstruction of the breast, head and neck, as well as aesthetic surgery.

By refining the SGAP procedure, Dr. Flores helped Johns Hopkins to establish itself as one of two places in the world offering bilateral SGAP surgery for breast reconstruction. In the last two years, he has developed an alternative flap (LSGAP) that he pioneered while at Johns Hopkins, which bears his name, “Flores flap,” also known as the “Cushion flap,” which harvests tissue from the love handle area without any muscle dissection or distortion to the gluteal region. All of these microvascular flaps give patients additional options for a natural aesthetic result.

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HIGH STANDARDS In addition, Dr. Flores, along with select colleagues, founded The Healing Hands Foundation (THHF), a non-profit foundation dedicated to delivering surgical care to underprivileged people all over the world. Every year he attends four to five international medical missions where he performs surgeries for cleft lips, cleft palates, burn scars and other congenital deformities. He has been involved in missionary work since his college years and continues to devote his life and career to healing those in impoverished communities. His vision is to perform surgeries around the globe and to provide teaching seminars to medical professionals who can then perform these surgeries in their own local communities. He encourages students from high school through all professional levels to volunteer. He believes such experiences will enrich their lives and foster their future careers. His love for volunteer work originated from the time he was just an undergraduate student at the University of Maryland, where the doctor he shadowed volunteered at a local hospital every Saturday. It was there that Dr. Flores learned through the patients’ eyes the importance of volunteering. Seeing how appreciative the patients were and hearing them vocalize how much they loved the doctor for his time and help, Flores became certain that he would do the same. Through both The Healing Hands Foundation and the Pink Petals Foundation, Dr. Flores has been able to accomplish his goal.

Aesthetic & Reconstructive Surgical Associates, LLC

Ph. 786.471.4299 | Fax 305.397.1154 www.drfloresplasticsurgery.com

SERVICES OFFERED BREAST Breast Reconstruction Breast Augmentation Mastopexy (Breast Lift) Breast Reduction BODY Thigh Lift Brachioplasty (Arm Lift) Body Lift Abdominoplasty (Tummy Tuck) Liposuction Abdominal Wall Reconstruction Laser Skin Resurfacing FACE Rhinoplasty (Nose Surgery) Facelift Platysmaplasty (Neck Lift) Blepharoplasty (Eyelid Surgery) Otoplasty (Ear Surgery) Head and Neck Reconstruction Botox Treatments Chin and Cheek Implants

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Discover New Confidence


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ROB

“I told him, ‘I don’t believe college was all I had. I know I have more in me.”

Robert “Rob” Novak is a runner who was on his way to the Olympics, until he was sidelined by a spate of injuries. Now he runs on tracks in Miami and, although he is far from Rio de Janeiro, his mind is focused on just one thing—making it to the 2016 Olympics. That’s nothing new. Although he’s now 27, he’s been focused on the Olympics since his college days. As a youngster growing up in New Jersey, though, Novak did not seem destined to become a runner. Diagnosed with asthma, his doctor warned his mother to keep him away from highintensity sports. “As I was growing up through grade school, I was hospitalized for a week each year. In 6th grade, the doctor told me I had the lungs of a 65-year-old nonsmoking man and he told my mother that the only sports I should do were golf and bowling,” Novak recalls. But in high school Novak yearned to play football. “My mom always made sure I had my medicine in case I needed it,” says Novak. It turned out that not only did Novak not need the medication, he was destined to become a runner, even back there in Bordentown, N.J., where he grew up. “We were taking a physical fitness test my freshman year and I had to do push-ups and sit-ups and run a mile. I ran the mile in 4:52. My gym teacher came to me and told me, ‘You really should run cross-country because running 4:52 is really, really good.” The assistant track coach heard about it as well, says Novak, and told him, “If you did 4:52 without training, you could be really great.” Those words turned out to be an understatement. Novak joined the track team and became one of the greatest prep half-milers that New Jersey has ever seen. Word spread among recruiters and Novak ended up at Seton Hall University on a full scholarship. In college Novak established himself as one of the top 800-meter runners on the conference and national levels. But then, in his junior year, he sustained his first injury: planter fasciitis, a common runner’s problem that occurs when too much pressure is put on the planter fascia, one of the ligaments in the foot.

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NOVAK

RACES TOWARD HIS OLYMPIC DREAM by Charlotte Libov Novak wasn’t overly concerned. “When you are in professional sports and you are performing at a certain level, it is inevitable you are going to get injured,” he said. Despite the chronic pain, Novak continued to run, graduating with a Big East Championship and an IC4A Championship. He clocked a blazing 1:47.6 before graduation in 2009. After college Novak joined the New York Athletic Club and achieved new heights just his first year out of school, achieving personal bests of 1:46.8 in the 800 meter and 3:40.9 for 1500 meters. A fresh face at the front of national level races in 2010, Novak placed third at the Olympic Development Penn Relays Mile, the Ryan Shay Road Mile and the Cigna Falmouth Mile. Now focused on the Olympics, Novak continued at the New York Athletic Club. He also worked part-time at Home Depot; growing up the child of a single mom, who was raising four kids, he didn’t have the luxury of pursuing his athletic career full-time. But he knew he was at a crossroads: either give up his dream of being a professional runner or take it to the next level. So he contacted legendary coach Frank Gagliano for an evaluation. “I told him I wanted him to coach me post-college. “I told him, ‘I don’t believe college was all I had. I know I have more in me,’ and he told me, ‘Listen, from your form and your aggressiveness, I also see you have more,’” Novak recalls. It was 2011. Novak was still training with his coach and had undergone physical therapy and was now pain-free. He also had taken a bride, Viviana, a Puerto Rican native. It

was when Novak was in Trinidad and Tobago for a race that it was suggested to him that, because his wife is Puerto Rican, he would eligible to represent that country in the 2012 Summer Olympics. But that did not pan out and Novak eventually ended up in New Jersey, with a new coach, but still focused on his Olympic dream. Novak was on track to compete in the qualifying trials until one day in May 2012, when, while finishing a workout, he felt a mild pain in his hamstring. He wasn’t concerned but the next month, while competing in Olympic trials in Eugene, Ore., that injury caught up with him. “I had only 50 meters to go in an 800 meter race to qualify for the semifinals when I felt a really bad cramp in my hamstring.” Tests showed an injury. The doctor taped it and the next day, in the semi-finals, Novak, who traditionally starts in the rear of the pack, was moving up in the field of runners as usual. “I was coming through the half-way point, then I was fourth. I moved up to third, and with 100 meters to go, I tried to start sprinting, but I couldn’t lift my right leg. I had no power.” He finished 12th overall. “Basically, my season was over. I had trained with everything I had. I knew I was ready to go but this little injury had prevented me from going to the Olympics. I was devastated,” he recalls. That July, Novak’s wife received a job transfer to Miami so they headed south. Now, Novak continues to train, working with Cathy Accurso, of In Balance Physical Therapy, who helps train runners. “Robert is humble, kind and an all-around great guy. I also believe he is a promising Olympian,” she says. As for Novak, he’s now the father of an 11-month baby boy and he works full time, but he is still training, his eye on Brazil—and beyond. “When I look back at high school and I see the joy that running brought me, I don’t see it as work,” says Novak, adding, “My love of running, and of racing, is something I want to experience for the rest of my life.”

HEALTHY MIAMI

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PABLO J. ACEBAL, M.D.

BRAIN • Brain tumor • Head injuries • Cerebral bleeds • Trigeminal neuralgia CERVICAL • Neck pain • Herniated disc • Cervical stenosis • Vertebral fractures

Board Certified in Neurosurgery Doctor of Medicine Albert Einstein College of Medicine of Yeshiva University, New York, NY General Surgery Internship Montefiore Hospital Medical Center, New York, NY Neurological Surgery Residency University of Puerto Rico, San Juan, PR Spinal Neurosurgery Fellowship University of Miami/Jackson Memorial Hospital, Miami, FL 11760 SW 40th St., Suite 511 Miami, FL 33175

Ph. 305-220-2455 Fax 305-220-2448

THORACIC • Mid-back pain • Thoracic stenosis • Vertebral fractures

LUMBAR • Low-back pain, sciatica • Herniated disc • Lumbar stenosis • Vertebral fractures

www.thecnsgroup.net SERVICES • MINIMALLY INVASIVE SURGERY • MICRODISCECTOMY • LAMINECTOMY • INTERVENTIONAL PAIN MEDICINE AND PM&R • SPINE REHAB • PHYSICAL THERAPY • CRANIOTOMY (BRAIN TUMOR, HEMORRHAGE, OTHER) • CYBERKNIFE RADIOSURGERY • CARPAL TUNNEL RELEASE • PERIPHERAL NERVE SURGERY • KYPHOPLASTY (VERTEBRAL FRACTURES)

ALLAN M. JORGE, M.D.

Board Eligible in Neurosurgery Doctor of Medicine University of Chicago, Chicago, IL General Surgery Internship Northwestern University, Chicago, IL Neurosurgery Internship Northwestern University, Chicago, IL Neurosurgery Chief Resident and Instructor Northwestern University, Chicago, IL Spine Fellowship in Adult and Pediatric Degenerative Spine Northwestern University, Chicago, IL 6705 Red Road Suite 522 Coral Gables, FL 33143

Ph. 786-517-8650 Fax 786-517-8657


GEORGE C. IBARS, M.D.

LLOYD I. MALINER, M.D.

DANIEL R. MARIN, M.D.

Board Certified in Neurosurgery

Board Certified in Neurosurgery

Board Certified PM&R and Interventional Pain Medicine

Doctor of Medicine Medical College of Pennsylvania, Philadelphia, PA General Surgery Internship Abington Memorial Hospital, Abington, PA General Surgery Residency Abington Memorial Hospital, Abington, PA Neurology Residency Tulane Medical Center, New Orleans, LA Neurosurgery Residency University of Miami/Jackson Memorial Hospital, Miami, FL Hospital

Doctor of Medicine Union College in Schenectady, NY General Surgery Internship Medical College of Hampton Roads in Norfolk, VA Neurosurgery Training University of North Carolina at Chapel Hill Neurosurgery Residency Hershey Medical Center of the Penn State University in Hershey, PA

Doctor of Medicine University of Miami Miller School of Medicine, Miami, FL General Surgery Internship St. Raphael / Yale Hospital Program New Haven, Connecticut Physical Medicine & Rehabilitation Residency Emory University, Atlanta, GA Interventional Pain Medicine Fellowship Emory University, Atlanta, GA

301 NW 84th Ave., Suite 206 Plantation, FL 33324

6200 SW 72nd St., Suite 403 South Miami, FL 33143

Ph. 954-862-7099 Fax 954-862-7296

Ph. 305-370-3439 Fax 305-430-6006

6200 SW 72nd St., Suite 403 South Miami, FL 33143

Ph. 305-740-8036 Fax 305-740-8137

ANTONIO R. PRATS, M.D.

MICHAEL E. GOMEZ, M.D.

JOSEPH A. TRAINA, M.D.

Board Certified in Neurosurgery

Board Eligible in Neurosurgery

Board Certified in Neurosurgery

Doctor of Medicine University of Miami, Miami, FL General Surgery Residency Emory University, Atlanta, GA Cerebrovascular Fellowship Emory University, Atlanta, GA Neurosurgery Chief Resident Emory University, Atlanta, GA

Doctor of Medicine Tulane University School of Medicine University of Miami Bachelor of Science in Chemistry, minor in Biology and Art HistoryCum Laude General Surgery Internship Parkland Hospital/University of Texas Southwestern Department of General Surgery Neurosurgery Residency Parkland Hospital/University of Texas Southwestern Department of Neurological Surgery

Doctor of Medicine University of Miami, Miami, FL General Surgery Internship West Virginia University, Morgantown, WV General Surgery Residency West Virginia University, Morgantown, WV Neurosurgery Fellowship University of Vienna, Vienna, Austria

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Ph. 305-740-8036 Fax 305-740-8137


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HEALTHY BODY

“Women are beautiful, no matter what their size or shape. If they feel this way, they will project this belief in themselves...and this confidence is what really makes a woman beautiful.”

INFERTILITY CHRISTINA PEÑA, M.D.

In this holiday season, we have much to celebrate. Naturally, it is also a time where many find themselves mourning the loss of a loved one unable to share in these celebrations. And even others mourn the inability to have children and create these memories and traditions of their own. Many couples begin their journey to have children full of excitement. But as time goes by some meet challenges they did not see coming. Doubt, worry, and stress set in. Why can’t they get pregnant? There are many factors that go into a successful pregnancy. Here are just some to consider: 1. Are you ovulating? 2. Do you have enough eggs in your ovaries? 3. Are you producing enough hormones required to hold the pregnancy if you did get pregnant? 4. Is there a blockage in the cervix, the uterus or fallopian tubes which doesn’t let the sperm make it to the egg? 5. Is there enough normal sperm? 6. Are there genetic abnormalities that you or your partner may have, or don’t even know you have? Today’s article will focus on couples who are not able to get pregnant. On a future article, I will go into other forms of infertility which include couples who do get pregnant, but repeatedly miscarry. The first thing is to realize that in a normal menstrual cycle, there are only about 3 days in the month where it is even

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possible to conceive. When that window of time exists, depends on how long your cycle lasts. To calculate this, first go to a calendar and document the first day of each of your menstrual cycles. You are going to want to count how many days pass from the first day of one cycle to the first day of the following cycle. Then do that for several months to see if your cycle is regular. Do 28 days, 30 days, 35 days consistently pass from day 1 of one cycle to day 1 of the next? If it is consistent, no matter what the number is, then your cycles are regular and you are likely ovulating. WHAT IS OVULATION? Ovulation is when the egg comes out of the ovary and is sent to the fallopian tube. It lives there for a maximum of three days waiting for a sperm to reach it. If the sperm does not reach it within those 3 days, the egg will dissolve. Your next chance to try again is next month’s ovulatory window. The sperm lives for approximately two days, and in those 2 days it needs to travel through the channel of the cervix into the cavity of the uterus and into the fallopian tube where the egg is waiting. Keep in mind that women don’t typically ovulate from both ovaries every month. You may ovulate from one ovary on one month, and the other ovary the next. You may ovulate from one ovary more months of the year than the other as well. The sperm will typically go to the right and left tubes randomly. The sperm don’t know which tube is holding the egg. Even if all goes right, you only have a 20% chance of conceiving with each try.


Women don’t always ovulate every month either. You can see a period and not have ovulated in that month. But if you did ovulate, you always will have your period 14 days after ovulation happened. If you calculated your menstrual cycle is every 28 days, then it’s easy…14 days into the month you ovulate and 14 days later you will see your period. If you have a period every 30 days, then 16 days into that month is when you will ovulate. 14 days later you will get your period. I have spent a lot of time on this topic because the first thing you want to make sure is that you are trying to conceive during the ovulation time. Start trying to conceive from a few days before to a few days after you calculated you were ovulating. As an example, if you try to conceive two days before you even ovulate, and the egg can live up to 3 days, it is possible that by the time the sperm swim up to the egg, a few days have passed. Once it reaches the fallopian tube, the egg may have just arrived to meet it. NOW DO YOU HAVE ENOUGH EGGS IN THE FIRST PLACE? We have all heard of the saying ‘her clock is ticking’. This is because women are born with all the eggs they will ever have in their lifetime. Every day, they undergo a process of dying which we call cell atresia. When a woman was still in her mother’s womb, at about 32 weeks of the pregnancy, she had about 7 million eggs present. By the time of her birth, she was down to about 2 million. By the time she grew up to have her first period, she was down to 500,000. The eggs continue to die off after that. It is just about the complete opposite that occurs with men who make new sperm almost daily. As you can see, the process that takes place in order for pregnancy to occur is very complex and intricate. There are many steps that couples can take to help reach a normal pregnancy, but there are many factors that are far beyond our control. In short, pregnancy IS a miracle. Not ovulating is the most common reason couples are infertile. For this a gynecologist can assess a patient’s hormone levels at specific times in the menstrual cycle to answer the question of ‘are you ovulating’ and ‘do you have enough eggs?’ An ultrasound to see the developing egg is also important to have the full picture of that process. The second most common problem is with the sperm. A semen analysis is important.

I recommend for this to be done at least two different times in order to have a better idea if the results reflect what is consistently happening. There’s a long list of smaller probabilities but yet significant causes of infertility. Among the risk factors we screen for are if they have or have had any of the following: 1. A sexually transmitted disease or pelvic inflammatory disease 2. Endometriosis 3. Fibroids 4. Polycystic ovarian syndrome 5. Nicotine smoker for either partner 6. Certain medical conditions or medications for either partner 7. If either have or are carriers of a genetic mutation. The answers to these types of questions guide the testing that needs to be done. For example, if the answer is “Yes” to the first on this list, it can mean that there is a blockage in the path of the sperm before it meets the egg. The uterus and ovaries can be evaluated by ultrasound. The fallopian tubes can be evaluated by a special X-ray test. And a hysteroscopy can be done for direct evaluation of the inside of the uterus where a baby would grow. Hysteroscopy is where a small camera is passed via the vagina and through the cervix to evaluate if there is any irregularity or blockage in the uterus for the implantation of a baby. Just this month, I helped several patients who were having trouble conceiving using this tool. One was found to have scar tissue in her uterus caused by a sexually transmitted disease. Through the same camera used to visualize the inside of the uterus I was able to remove the scars, thereby significantly improving her chance for implantation. Another example is a patient who developed a golf ball sized fibroid in the inside of her uterus that was preventing implantation from taking place. Using the same camera and some specialized instruments, I was able to remove the fibroid and she is now resuming her attempts at conception. There are exceptions to every rule but if you are younger than 35 without any other risk factors, it is normal to take up to a year to get pregnant. Whether you have been trying to conceive or are planning to do so, it is important that you see your gynecologist for a consultation. We may help identify and correct factors to help you not only get pregnant, but have a healthy baby. For those of you out there trying to conceive, I wish you a healthy pregnancy this coming year.

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SURGICAL PROCEDURES 1. Robotic surgery for the treatment of endometriosis or infertility; removal of the uterus, fibroids, ovaries, cysts and/or scar tissue 2. The benefits of robotic surgery include minimal scarring, minimal blood loss, lower risks of infection or injury, and a minimal recovery period. 3. Laparoscopic surgery for tubal ligation, ectopic pregnancy or other minor conditions and indications 4. Essure: a procedure for permanent sterilization without any incision or recovery period 5. Hysteroscopy: evaluation of the uterine cavity for treatment of infertility, polyps, heavy bleeding or removal of intrauterine contraceptive device 6. Prevention and treatment of cervical precancerous cells and genital warts 7. Insertion or removal of Mirena, Paraguard, Nexplanon birth control methods COSMETIC PROCEDURES 1. Labialplasty 2. Vaginal tightening 3. Scar revision, both surgical and noninvasive methods 4. Removal of skin tags, lipomas or other unwanted skin abnormalities MEDICAL TREATMENTS 1. Treatment of heavy or irregular periods 2. Bio-identical hormone replacement therapy for symptoms of menopause 3. Infertility workup and treatment 4. STD testing and treatment 5. Birth control 6. Low and high risk pregnancy care Exclusive concierge 24/7 access

CHRISTINA PEÑA, M.D. South Florida

OB-GYN SPECIALIST

PH. 305-227-8727. 7400 N Kendall Drive, Ste 507, Miami FL 33156

HEALTHY MIAMI

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healthy body

Syncope by Joseph Zebede, MD, FACC

What makes a young maiden faint at the sight of her prince charming? And what makes her valiant prince lose consciousness years later, long after sustaining a fall from his white stallion? Syncope, or fainting, is one of the most common conditions evaluated by medical personnel. It accounts for approximately 3% of visits to emergency rooms. Despite its frequent occurrence, however, it is relatively poorly understood. The definitive diagnosis of the cause of syncope oftentimes remains elusive. The difficulty in establishing a precise diagnosis rests in part in the fact that syncope may have a myriad of causes from simple, so-called “vagal� spells, which may occur because of pain or nausea, to complex cardiac arrhythmia or neurologic (brain) disease. When a person loses consciousness, it is essentially because of one of two reasons: either there is not enough blood supply to the brain or the brain function itself is altered. Thus, someone may lose consciousness because low blood pressure is reducing the amount of blood reaching the brain or because of the brain having a seizure as a primary event.

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Reasons for a low blood pressure include changes in body position and dehydration, as well as obstruction to the flow of blood as may be seen with certain cardiac valve abnormalities (e.g., aortic stenosis). A drop in blood flow may also happen because either the heartbeat is too slow or has stopped altogether, thus reducing the amount of blood pumping to the brain, or because the heart rate is so rapid that, in effect, the heart cannot pump the blood appropriately. The key to the diagnosis of syncope is a detailed history and a basic evaluation. A physical examination is performed, which may suggest disease of the arteries, abnormalities of the heart valves or nervous system problems. Typically, testing for fainting may involve an ECG (electrocardiograph), an ultrasound of the heart (echocardiogram) and one or more types of cardiac monitoring. Examples include 24-hour monitoring (Holter monitor) and long-term monitoring for one or more weeks (loop or event monitors). Further testing may involve measurement of blood pressure for 15-40 minutes while standing (tilt test) in order to detect the propensity to drops in blood pressure under certain circumstances.


An electrophysiology study is a form of cardiac catheterization in which small electrode wires are threaded from the leg veins into the heart. Electrical measurements are made that, in turn, may shed light on the origin of the condition. For instance, problems with the conduction of the electrical impulse in the heart leading to slow heartbeats can be diagnosed. In addition, abnormal “electrical circuits” that can lead to very rapid heartbeats (tachycardia) may be found. Oftentimes these can be corrected at the same time by a procedure called catheter ablation. Other testing may include evaluation of the arteries that irrigate the brain (carotids, vertebral) as well as brain scans (CT or MRI). Testing for seizures may involve a brain wave test called electroencephalogram (EEG), which generally takes a few hours. Rarely an ambulatory EEG, lasting for 24 hours or more, may be indicated. Another cause of syncope and seizures may be markedly abnormal blood sugar levels. This can be evaluated by blood tests and/or a glucose tolerance test, which is a series of blood sugar levels taken at multiple intervals after a fixed dose of glucose is ingested. In cases where fainting events are very infrequent and far apart in time from each other, and when the evaluation has been unremarkable, a small monitor may be implanted. This acts as a computerized “chip” that records abnormal heartbeats automatically or when the patient activates it immediately after an event. Readings are obtained via a programming wand and a computer. Clearly, the treatment for syncope will depend on its cause. It may range from increasing hydration and posture exercises to medication for seizures or implantation of a cardiac pacemaker or defibrillator. If significant cardiac valve disease is present, a valve may need to be fixed or replaced. If carotid arteries are significantly obstructed, they may need surgery to clear the obstruction, or a stent (a scaffolding inside the artery) deployed in order to keep an artery open. Now that we have a clearer understanding of the mechanisms, we may propose that the princess fainted because of a reflex that lowered her blood pressure (A tilt test would have helped in the diagnosis.) and she needs better hydration. The prince, however, is likely having seizures as a result of head trauma upon falling from his steed (He will likely need medications.). In summary, syncope is a common condition with multiple potential origins. One must investigate the cause of the symptoms thoroughly in order to prescribe targeted, effective therapy.

JOSEPH ZEBEDE, MD, FACC Mount Sinai Medical Center 4308 Alton Road, Suite 980 Miami Beach, FL 33140 Aventura Hospital Campus 21000 NE 28th Avenue, Suite 203 Aventura, FL 33180 PH. 305.674.6770 | info@epconsult .net

HEALTHY MIAMI

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HEALTHY BODY

Heart disease is our nation’s number one killer, accounting for 1 out of every 4 deaths each year!

HEART DISEASE

An Epidemic that is Preventable and Reversible The primary cause of heart attacks and strokes is the gradual clogging, hardening and damage done to the inside walls of our blood vessels. Heart attacks major warning signs and symptoms may include: • • • • •

Chest pain or discomfort. Upper body pain or discomfort in the arms, back, neck, jaw, or upper stomach. Shortness of breath. Nausea,lightheadedness, or cold sweats

YOU CAN PREVENT AND EVEN REVERSE HEART DISEASE BY FOLLOWING A HEART-HEALTHY LIFESTYLE Here are 10 strategies to help you protect your heart: 1.

2. 3.

EAT A HEALTHY WHOLEFOOD DIET - Eat at Least 8 to 10 servings of colorful fruits and vegetables a day, which contain important disease fighting micronutrients. Also eat lots of beans and legumes, raw nuts, seeds, avocados, whole grains and some lean meats. Reduce or avoid processed foods. These usually contain high amounts of sugar, salt, harmful trans-fats and artificial chemicals. AVOID TOO MUCH SUGAR - which can raise your blood pressure and damage your arteries-maintain a fasting blood sugar between 70- 85 mg/dl. GET MOVING -avoid a sedentary lifestyle. Regular physical activity is a must for having a healthy heart. Exercise helps you maintain normal weight. Excess weight is a risk factor for heart disease, diabetes, and high blood pressure.

4. DON’T SMOKE OR USE TOBACCO - Smoking or using tobacco is one of the most significant risk factors for developing heart disease. 5. TAKE TIME TO RELAX -We live in a fast-paced hectic world that’s often stressful Take some time daily to meditate. Sit quietly for 10-15 minutes, take slow, deep breaths and think peaceful thoughts. 6. TAKE CARE OF YOUR TEETH -people with periodontal disease are more likely to have heart disease and suffer a heart attack than those with healthy gums. Floss daily! 7. CHECK YOUR CHOLESTEROL -Your total cholesterol should be under 200, and your LDL should be ideally under 80. But more importantly, your ratio of HDL to total cholesterol should be more than 24%. Your ratio of triglycerides to HDL should be below 2. 8. KNOW YOUR BLOOD PRESSURE - Optimal blood pressure is less than 120/80 millimeters of mercury. 9. LIMIT ALCOHOL -In addition to raising blood pressure, too much alcohol can add unneeded calories to your diet. If you drink alcoholic beverages, have only a moderate amount- one drink a day for women, two drinks a day for men. 10. GET REGULAR HEALTH SCREENINGS - Regular screening can tell you what your risks are and whether you need to take action. Make sure to consult your healthcare professional for any questions concerning your heart health or when to begin any exercise regimen.

If you think that you or someone you know is having a heart attack, you should mil 911 immediately.

>

Call MCCI We’ll send you an information package and arrange a private tour of your nearest MCCI location

1-888-670-MCCI (6224) by Virgilio Sanchez Jr M.D.

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DECEMBER 2013

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healthy body

Obama’s Health Care Reform by Dr. Ritu Goel

HEALTH CARE REFORM 101 Highlight:Much change will be seen to health care and health care plans over the next year as key portions of the Patient Protection and Affordable Care Act, commonly called ACA and Obamacare, went into effect October 1, 2013. Under this health care reform each individual must have a health care plan or pay a penalty.

The ACA actually became law on March 23, 2010, and changes to health care and health care plans will be seen over the next 12 months now that key parts are now in effect. There is so much information available on the health care reform that it can become overwhelming. The new rules under the ACA primarily affect those who either don’t currently have an insurance plan and those who purchase their own plans because they do not get insurance coverage through their employers. Here is a broad overview of the Health Care Reform, which is also called Reform 101. HOW MUCH IT AFFECTS YOU? This depends on the type of health insurance you have. For instance, if you have Medicare, you will not see much change; likewise, if you are covered under group insurance, you will see some new benefits but there are no major changes for you. If you have insurance coverage through a large employer, then your employer has to offer you coverage or pay a penalty. If you have an individual policy or you are not insured, then you will experience the majority of the changes according to the health care reform. Starting in 2014, each individual will need to be covered by a health care policy. In the case that your employer does not provide insurance coverage, you must purchase your own policy or pay a penalty.

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WHAT ARE THE CHANGES TO INDIVIDUAL INSURANCE IN HEALTH CARE REFORM? There are five major changes for individuals. •

BENEFIT CHANGES: All insurance plans will now have to cover a collection of benefits known as EHB, or Essential Health Benefits. These essential health benefits are grouped into four main types of benefits to make it easy to compare the different types of benefits: Platinum, Gold, Silver and Bronze. RATING CHANGES: According to the ACA, insurance companies are not able to decide their rates based on your level of health, your gender or if you have a preexisting condition; instead, the rates will be based on your age, where you live and whether or not you smoke. INDIVIDUAL MANDATE: One of the ways to keep costs down is to make everybody purchase insurance coverage; hence, beginning January 1, 2014, most Americans need to have qualified health insurance. In the case that you don’t have insurance, you will be required to pay a penalty. SUBSIDIES OR TAX CREDITS: Purchasing health insurance can be expensive and not all individuals can afford it, so the government plans to give financial assistance to qualified individuals in the form of subsidies or tax credits. HEALTH INSURANCE MARKET PLACE: Shopping online allows you to compare plans and prices from different insurance companies. When you find the plan that suits your needs, you can enroll in that plan.

WHAT IS THE AMOUNT OF THE PENALTY? In 2014, individuals who do not have health insurance could be penalized either $95 or 1% of their total income reported their 2014 income tax return, whichever is greater, with the penalty rising each year. References: https://www.lifewisewa.com/visitor/health-plan-basics/affordable-care-act/changesfor-healthcare-coverage/ http://www.youtube.com/watch?v=oNUXCKIF0Bc


FITNESS &

Beauty

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KENDALL SPORTS MEDICINE

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GOT CELLULITE?

36. CBT COGNITIVE BEHAVIORAL THERAPY


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Kendall Sports Medicine

“Train like an athlete and, though you may not look like one now, you will become one.” (Chalene Johnson)

By Andreea Macoveiciuc At the junction of medicine and sports lies sports medicine, an interdisciplinary subspecialty that focuses on preventing injuries and offering treatment to athletes, amateurs and professionals. Founded in the early 1980s, Kendall Sports Medicine specializes in all aspects of lower extremity medical care including podiatric sports medicine, trauma, orthopedics, foot and ankle surgery, pediatrics and custom made orthotics. We know that an injury affecting one athlete actually affects the entire team and we understand how frustrating it can be for an athlete to miss a competition due to a temporary disability, so we put all our dedication, knowledge and professional experience at your service, in order to offer you the best care possible. Our goal is to provide the highest level of individualized treatment and to address most of the common health care concerns appearing in this field. We do our best to accommodate your needs and schedule, as we are committed to helping you get back into shape and return to action in the shortest time possible, fully recovered. Our programs are not only curative and rehabilitative but also preventative and we use state-of-the-art technology in order to offer you a treatment plan tailored to your individual needs. The multi-disciplinary team of physicians at Kendall Sports Medicine works collaboratively to find the best personalized solution for your injury. So whether you’re dealing with tendonitis, shoulder instability, ligament tear or lesions of the ankle cartilage, you’ll always receive the best care in our office. After evaluating your condition, our team will recommend the most effective treatment plan based on the severity of your injury as well as on your overall health state and physical shape. We utilize cutting-edge technology and procedures to make sure you’ll progress to your functional and sport goals in a safe and efficient way, not just by recovering from the injury but also by improving your coordination, balance, endurance and strength after dealing with a sport injury.

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Although we put emphasis on non-surgical interventions, we have highly skilled professionals who are always ready to perform complex surgical procedures if your condition asks for them. In our office you can benefit from a full range of progressive treatment options, including: • orthopedic evaluation procedures • bone density tests • computed scans • physical therapy solutions • reconstructive procedures • minimally invasive surgery • complex surgery We perform reconstruction and replacement procedures, arthroscopies, cartilage repairing procedures, ligament reconstructions, osteotomies, instability repairing procedures, transplantations, nerve decompression, tear repairing, tendon transfer procedures, resurfacing procedures and many other treatments meant to help you recover and get back into shape. So if you’re dealing with a sports injury, don’t hesitate to give us a call or drop by Kendal Sports Medicine’s office and schedule an appointment. We’ll be glad to help you!


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Fitness & beauty

Got

CELLULITE? by Andreea Macoveiciuc

Although not a serious medical condition, cellulite is one of the most disturbing and difficult to handle skin problems, affecting mostly women and occurring, usually, after puberty. Scientifically called adiposis edematosa, cellulite is not the same as cellulitis, the inflammation of the skin that can lead to severe complications. WHAT IS CELLULITE? The easiest way to define it is “orange peel skin,” as cellulite makes skin look lumpy and dimpled. Affecting the areas where the underlying fat deposits are more pronounced, the condition is thought to be the result of a series of factors, although the main cause is still unknown. Most noticeable on thighs, buttocks and abs, cellulite forms when fat cells accumulate underneath the skin or enlarge and push against the dermis. The connective tissue cords that tether the skin to muscles maintain a relatively constant length, pulling the skin down, so when the volume of fat tissue lying between the dermis and muscles increases, the uneven appearance occurs. CAN CELLULITE BE REMOVED? Over 80% of all women develop cellulite at a certain point in their lives, so it’s only logical for the condition to be seriously investigated by companies producing skin care products or offering skin care treatments. However, despite the large number of solutions available and despite the remarkable results claimed and advertised by these treatments, few are actually able to reduce the uneven aspect and restore the healthy skin appearance. Still, this doesn’t mean that cellulite is untreatable. A complex approach to this problem can be effective, as long as it takes into consideration its potential causes. Given that cellulite is triggered by a combination of factors, including hormone levels, fat accumulation, impaired blood and lymph circulation, sedentariness and inadequate eating habits, any treatment that claims to remove cellulite or to diminish the orange peel aspect should target a wide range of causes. Unfortunately, creams, gels and other topical products are rarely effective, as even if they could improve cell function in the superficial skin layers and enhance circulation and the removal of toxins and excess water from these cells, they’re unable to work in the deeper layers. In fact, fat cells are distributed in several layers, so applying a treatment that targets just the skin’s surface is rarely efficient. A better approach is to use a combination of lifestyle changes, internal and external treatments. Switching to a healthier diet of minimal processed foods, unhealthy carbs and fats; being more active in order to drop excess fat and enhance circulation; and getting cellulite massages can all help in smoothening the skin, but more advanced therapeutic options are more likely to bring better results. Such options include heat therapy, radio frequency therapy, ultrasound therapy, magnetic therapy, endermology, radial waves therapy and electrical stimulation. Drugs that target the fat tissue underneath skin can also be used, alternatives being numerous: methylxanthines (such as caffeine, beta-agonists, adrenaline), pentoxifylline, alpha-antagonists, rutin, ginkgo biloba and amino acids. Also, according to recent studies, a combination of bipolar radiofrequency, infrared heat and pulsatile suction therapy provides a beneficial effect on improving the skin’s aspect and reducing the circumference of the thighs and abdominal area by smoothening the tissue affected by cellulite.

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healthy body FITNESS & BEAUTY

So what do we do? Surrender to the off-balance, overspending and under-sleeping lifestyle? Or choose balance and, therefore, sanity? Too often my client case load unnecessarily increases during the holiday months. Clients present with stress, anxiety and depression as results of allowing the holidays to negatively control their daily lives. In the clinical counseling world, there is a therapy called Cognitive Behavioral Therapy (CBT). CBT’s foundation is: What we think (cognition) directly impacts the way we feel and, therefore, the way we behave. If we can change the way we think, even if surrounding circumstances do not change (e.g., Thanksgiving is still coming!), we can change the way we feel (e.g., stressed) and, therefore, change the way we mentally and physically respond. By consciously changing our thinking we regain control of our emotions and behaviors and thereby regain control of our days (or holidays). CBT rests upon the evaluation of thoughts in terms of validity and utility. • Is what you are thinking valid? • If so, is what you are thinking useful?

CBT COGNITIVE

BEHAVIORAL THERAPY by Megan Clunan, MA, LMHC, LPC

Let’s face it, the holiday season is upon us—with holiday parties causing us to stay out later than usual, gifts for loved ones causing us to spend more than usual, rich foods abundantly available causing us to eat more than usual and, sometimes, unwanted guests staying longer than usual! From October 31st through January 1st, the average person can expect to be in a fight for his sanity. 36

DECEMBER 2013

If either question is answered with “no,” then the thought is considered dysfunctional. Dysfunctional thoughts cause us to think in distorted ways, therefore creating in us an unnecessary negative emotion (e.g. stress, anxiety, anger), which likely leads to unnecessary negative responses (e.g. migraines, yelling at loved ones, not sleeping well). An example: Let’s say you receive a phone call from your adult daughter telling you that she cannot come home for the holidays this year. Immediately you begin to feel depressed. A thought fueling this emotion may be, “The holidays aren’t going to be the same this year.” Taking the CBT approach you ask yourself, “Is this thought valid and useful, or simply causing an unnecessary negative imbalance?” This thought is valid, but is it useful? No. What would make it useful would be to finish it with, “The holidays aren’t going to be the same this year but we will find new ways to celebrate with one another and create new traditions.” Utilizing CBT, in this instance, does not necessarily take away the sadness of a child not coming home for the holidays; however, it does allow for greater balance between the negative and positive emotions, empowering intrapersonal control, rather than allowing dysfunctional thoughts to control and, therefore, ruin this season. So, again the question: Is sanity amidst the holiday season even possible? YES. Sanity begins and ends with the way we are thinking. Instead of being washed by the negative emotions that come our way, we must attempt to identify the thought fueling our emotions and ask ourselves if the thought is valid and useful. If we cannot answer yes to both questions, the thought must be replaced with balanced thinking. Balanced thinking leads to healthy living and healthy living enables us to fully embrace the joys that this holiday season may bring!


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COMMUNITY EVENTS DECEMBER 5

DECEMBER 19

Health Talk on Senior’s Health 6:00pm – 7:00pm Cleveland Clinic, Jagelman Conference Center 2950 Cleveland Clinic Blvd., Weston For more information, call 305-673-7300.

Herbert Kay Parkinson’s Support Group Meeting 10:30am - 12:30pm Michael Ann Russell Jcc North Miami Beach, FL For more information, call 305 932-1870

DECEMBER 12

DECEMBER 26

Parents Seminar: Identifying Giftedness and Developmental Delays 9:00am – 10:00am Beth David Congregation 2625 SW Third Ave., Miami For more information, call 305-854-3911, ext. 201.

Alzheimer’s Support Group Coral Gables 12:30pm City of Coral Gables Parks & Rec. Dept., Youth Rm. 405 University Dr., Coral Gables For more information, call 305-674-2121, ext. 54461.

DECEMBER 14

Dance for Parkinson’s Disease 1:00 pm-2:00 pm St. Matthews 7410 Sunset Dr., Miami 33143. For more information, call 305 243-1061

Family Fun-Healthy Living 1:00pm – 4:00pm History Miami 101 W. Flagler St., Miami For more information, call 305-375-1492. DECEMBER 17 Bootcamp In The Park with Downtown Athletic Club 7:00am - 8:00am Bayfront Park - Tina Hills Pavilion For more information call 305 358-9988 DECEMBER 18 Memory Screening for 55+ 1:00pm – 3:30pm Miami Jewish Health Systems 5200 NE Second Ave., Miami For more information, call Gloria Orlandi at 800-272-3900. Alzheimer’s Support Group - Mount Sinai Aventura 12:30 pm- 2:00pm Mount Sinai Medical Center 2845 Aventura Blvd, Aventura, FL 33180 For more information, call Tatiana Vallejo‐Luces, call 305-674-2121, ext. 54461.

DECEMBER 27

WEDNESDAYS Youth & Recovery with Nar-Ateen 7:00pm Kendall Community Church of God 8795 SW 112th St., Miami For more information, call 305-256-4247. Free Amplified Phones for Senior Citizens 10:30am – 11:30am Deaf Service Center of Palm Beach County 3111 S. Dixie Hwy., Ste. 237, West Palm Beach For more information, call 561-802-3353. THURSDAYS Weekly Farmers Market 8:00 am – 3:00pm Cleveland Clinic, Jagelman Conference Center 2950 Cleveland Clinic Blvd., Weston For more information, call 954-659-5000.


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