Florida Pain Institute Magazine – Oct. 2015

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A Look Inside: A Good Night’s Sleep!

5 tips on how to sleep better without relying on medications.

Four Local Offices!

Conveniently located in Titusville, Merritt Island, Pineda and Palm Bay.

New Pain Relief!

Read up on all the latest studies, treatments, and procedures.

Here’s What

You Will Find...

Contents 7

10

14

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Relief for Chronic Knee Pain

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From the Test Kitchen

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We’re Here to Stay

How Radiofrequency technology can help relieve chronic knee pain.

A light, summertime, seafood dish to treat your taste buds to.

Meet our physicians at our new Palm Bay and Titusville Locations.

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Florida Pain’s Fresh Face

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A New Path to Wellness

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Get Back to Life

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Be Part of the Future

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The Supporting Staff

Say hello to Florida Pain’s newest doctor.

Doctor Gayles explains using adult stem cells for the treatment of pain.

Treat Chronic Tendonitis and Plantar Fasciitis at the source.

A new study is available for patients who suffer from Degenerative Disc Disease.

We would not be able to provide our quality care without our experienced practitioners.

Across: 1. CASCADE, 4. HEAT, 5. THREE, 6. TENEXHEALTH, 8. KNEE, 11. HEALTHPOLICY, 12. FOUR, 13. OSTEOARTHRITIS, 14. BONEMARROW, 15. MICROTIP, 16. TWO Down: 2. CLAUSTROPHOBIA, 3. DEGENERATION, 7. DRGOLOVAC, 9. ESPOSITO, 10. HYGIENE

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Medical Studies currently being conducted: CRPS Type 1

Complex Regional Pain Syndrome Dr. Gayles For more info please refer to www.studyCRPSSnow.com

P: 321-784-8211 F: 321-394-9425 Stanley Golovac, MD Richard Gayles, MD Ashish Udeshi, MD Michael Esposito, MD

Intrathecal Hydromorphone

Safety Study – Dilaudid Intrathecal Pain Pumps Dr. Gayles, Dr. Udeshi For more info please refer to clinicaltrials.gov

Mesoblast

Lumbar Discogenic Lumbar Back Pain, Dr. Golovac For more info please refer to clinicaltrials.gov

PRIZM Registry

Prialt Pain Pump Dr. Gayles For more info please refer to clinicaltrials.gov

STEPS Trial

Lumbar Spinal Stenosis Dr. Gayles, Dr. Udeshi For more info please refer to stenosistrial.com

For more study information, please email our Clinical Research Coordinator, Kimberly Colella at: kimberlyc@ floridapaininstitute.net -or- Susan Clark, ARNP-C at: susanclarkflp@gmail.com You may also call 321-784-8211 ext. 1115

Spinal Stenosis Holding You Back?

leg when walking or standing? It may be Spinal Stenosis

Right now, doctors at you are 55 or older and think you may have Spinal Stenosis – but are not yet ready for major spine surgery – this study may be right for you.

The study is for the Totalis™ System – a minimally-invasive

the same day.

To learn more, please contact us: Kimberly Colella, Study Coordinator | 321-784-8211 ext. 1115 KimberlyC@floridapaininstitute.net Dr. Richard Gayles, Florida Pain Institute 595 N Courtenay Pkwy, Merritt Island, FL 32953 321-784-8211 | www.floridapaininstitute.net

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A New Treatment Provides Relief for 4|

Chronic Knee Pain Sufferers

Osteoarthritis, the most common form of arthritis of the knee, affects approximately 27 million Americans. It is a degenerative disease that causes a breakdown of cartilage (the tissue that covers the ends of bones where they form a joint). Healthy cartilage allows bones to glide over one another and absorbs energy from the shock of physical movement. When the cartilage breaks down, bones under the cartilage rub together, causing pain, swelling and stiffness. And bone spurs may develop, permanently changing the joint’s shape. For pain relief, patients typically take medications like aspirin or ibuprofen. When the medications fail to provide relief, over half of adults in the U.S. diagnosed with knee osteoarthritis will undergo a total knee replacement.1 Total knee replacements can be a good option for some patients, but there are some tradeoffs. Nerve injuries occur in 1–2% of patients, and more than half of patients who underwent total knee replacement continue to have pain after the procedure.2

Managing chronic pain Chronic pain is a uniquely individual, complex condition that is often difficult to manage. Because it has many causes and possible treatments, doctors who specialize in pain management tend to take a multidisciplinary approach to managing chronic pain.

This approach includes working with a team of other specialists to develop a personalized treatment plan, which often includes a progression of therapies that patients will try until they obtain sufficient relief.

Some of these therapies, such as pain medications, physical therapy and nerve blocks, may work at first but may not offer lasting pain relief.

Radiofrequency (RF) technology has been used for decades to help relieve chronic back pain. Recently, data has shown positive results in using this therapy to treat chronic knee pain.3 With the use of an RF generator, electrode and needle, a physician can create a heat lesion along the nerve pathway. This heat lesion disrupts the nerve’s ability to send pain signals to the brain. RF ablation is a minimally invasive, outpatient procedure.

“As an interventional pain physician, I strive to offer my patients the full array of treatments short of

surgery,” explains Dr. Stanley Golovac*, a Diplomat of the American Board of Anesthesiology and the Board of Pain Management. At Florida Pain Institute, “We “For me, RF ablation represents a great choice for the appropriate patient to consider when weighing other options such as more invasive surgeries or a long-term medication regimen.”

— Dr. Stanley Golovac Florida Pain Institute 595 N. Courtenay Pkwy.

Merritt Island, FL. 32953 321-784-8211

favor a conservative approach whenever feasible.

Many patients have knee pain that is severe enough, or chronic enough, to warrant more advanced interventions. For me, RF ablation represents a great choice for the appropriate patient to consider after conservative care has failed and when weighing other options such as more invasive surgeries or lifelong medication management.”

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Before the procedure Before delivering RF, a physician will typically perform a diagnostic nerve injection. This procedure involves injecting anesthetic at the site of the nerve pathway.

The physician may also inject steroids into the joint space in an attempt to alleviate the pain. If the patient experiences relief as a result of this injection, the physician can feel more confident in diagnosing the exact nerve causing the pain. Once the painful nerve has been confirmed, an RF ablation procedure will typically be scheduled.

During the procedure The procedure is performed with the patient in a supine (face up) position, with the use of local anesthetic and possibly light sedation. An RF needle is inserted through the skin and, with the use of fluoroscopy (x-ray) or ultrasound, advanced until it reaches the target treatment area. An RF electrode is inserted through the needle and testing may be used to confirm the placement of the active tip along the nerve pathway.

Once correct placement is confirmed, additional local anesthetic may be administered before the heating profile is activated. The patient may feel the heating and should alert the physician if the pain becomes too great. After the heating sequence is finished, the needle and electrode are removed and the insertion site is covered with an adhesive bandage.

After the procedure The patient is typically monitored immediately after the procedure to ensure no complications or reactions resulting from the procedure. The patient

should expect pain at the treatment site for 7–10 days following the procedure. After this initial pain (sometimes described as feeling like a sunburn), the patient should expect to feel the pain diminish progressively over the following weeks. The amount and duration of pain relief varies from patient to patient and should be closely monitored with the physician. Typically, relief can last 6–18 months. There have been cases reporting relief ranging 3–24 months.

The pain may return once the nerves begin to regrow and reconnect the neural pathways. Fortunately, RF ablation procedures can be repeated to deliver continued relief.

“The goal of RF for chronic knee pain for me is simple: decreased pain, increased functionality and improved quality of life for 6–18 months,” states Dr. Golovac.

“If we can accomplish this and minimize the need for additional surgeries or chronic medication with a short outpatient procedure, then we have met our goal.”

While many patients may be able to manage their chronic knee pain with RF ablation, not everyone responds to this therapy in the same way.

Complications are rare, but should be discussed with a physician. Only a doctor can determine whether someone is a suitable candidate for this procedure.

If you are interested in learning more about RF ablation for chronic knee pain and finding out if it is right for you, contact a pain management specialist today. To find one in your area, visit PowerOverYourPain.com**.

1. NIH Fact Sheet on OsteoArthritis.

2. Lundblad H, Kreicbergs A, Jansson KA. Prediction of persistent pain after total knee replacement for osteoarthritis. J Bone Joint Surg Br. 2008;90(2):166–71.

3. Choi WJ, Hwang SJ, Song JG, Leem JG, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain. 2011 Mar;152(3):481–7. * Dr. Stanley Golovac has experience using St. Jude Medical radiofrequency products in your local area. ** St. Jude Medical maintains a list of physicians who have experience with St. Jude Medical products. The listing of pain management specialists is compiled as a reference tool for locating certain physicians. No physician has paid or received a fee to be listed there. St. Jude Medical does not verify or monitor the license, credentials, or qualifications of any physician listed in the database and is not responsible for the medical advice of the physicians included in this database. The decision whether, and when, to contact a physician is yours alone. When choosing a physician, we encourage you to weigh various factors, such as level of experience, educational background, personal rapport and local proximity.

Unless otherwise noted, ™ indicates that the name is a trademark of, or licensed to, St. Jude Medical or one of its subsidiaries. ST. JUDE MEDICAL and the nine-squares symbol are trademarks and service marks of St. Jude Medical, Inc. and its related companies. © 2015 St. Jude Medical, Inc. All Rights Reserved.

SJM-NET-0615-0016 | Item approved for U.S. use only.

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New Sleep Habits 6|

Dr. Udeshi’s 5 Tips for Sleeping Better with Back Pain: One of the most common complaints people with back pain have is difficulty sleeping at night. The back is a complicated structure of bones, joints, ligaments and muscles, and having proper rest can help these structures function. Proper sleep hygiene is crucial in improving pain conditions and quality of life.

Below is a list of five tips on how to get a good night sleep without relying on medications:

1. Proper Sleeping Positions SIDE SLEEPER: If you sleep on your side, draw your legs up slightly toward your chest and put a pillow between your legs.

Use a full-length body pillow if you prefer. This will align the structures of the pelvis, spine, and head/neck.

BACK SLEEPER: If you sleep on your back, place a pillow under your knees to help maintain the normal curve of your lower back. You might try a small, rolled towel under the small of your back for additional support. Also, its important to support your neck with a pillow.

STOMACH SLEEPERS: This flattens the natural curve of the spine, and puts more strain on your back muscles, and is the WORST position for you. However, if you must sleep on your stomach do the following: reduce the strain on your back by placing a pillow under your pelvis and lower abdomen. Use a pillow under your head if it doesn’t place too much strain on your back. If it does cause strain, try sleeping without a pillow under your head.

2. Proper Mattress Selections A good mattress should provide support for the natural curves and alignment of the spine. This helps you avoid muscle soreness in the morning. Unfortunately there is not much clinical data concerning mattresses,

however one study found that medium-firm mattresses usually provide more back pain relief than firm mattresses. I suggest trying different mattress to find which one fits you best.

3. Relax the BACK Heat relaxes muscles and improves blood circulation.

Consider taking a hot shower before bed, applying topical ointments, using a warm compress or TENS (Transcutaneous Electrical Nerve Stimulation) device.

These techniques can help improve blood flow and reduce pain right before bedtime.

4. Reduce Stress Emotional stress or psychological factors can make any back pain problem worse. Thus, it is extremely important to limit stressful activities around bedtime.

I recommend stop working at least 2 hours before bed (stop checking work email or text messages), and create a dark and completely cool room.

5. Avoid Late Night Snacks Avoid sugar and heavy meals at least 2 hours before sleep. Do not drink alcohol or caffeine 2 hours before bedtime. Caffeine and sugar act as stimulants making sleep difficult. While alcohol and heavy meals can affect the central nervous and gastrointestinal systems and cause sleep interruptions.

These are just a few simple tips to help with chronic low back pain and sleep. However, its extremely important you take the time to find out what is actually causing your back pain and correct the real problem.

Getting the right diagnosis and treatment can help you get long lasting relief from the pain in your lower back, develop normal sleep patterns, and enjoy quality sleep.

New Tastes Chipotle Shrimp Tacos

on Cayenne Pepper Cabbage Slaw

by Alexandra Golovac, Fitness Nutritionist - Chef

Makes: 4 Servings This great tasting light meal is great for those hot summer days.

Ingredients

Directions

• • • • • •

1. Clean shrimp, season with chipotle powder, a little salt and pepper.

1 red bell pepper, sliced 1 yellow bell pepper, sliced 1 green bell pepper, sliced 1 small yellow onion, sliced 1/2 purple cabbage head, sliced 1 lb (31-35 shrimp), peeled and deveined • 1 teaspoon chipotle powder • 1/2 teaspoon cayenne pepper (optional) • Salt • Pepper • Olive oil • Corn Tortillas • Limes, quartered

2. Slice all vegetables.

3. Heat olive oil over medium heat in a large saute pan. Add onions and sweat for 3 minutes with salt.

4. Add the bell peppers and saute for another 2-3 minutes, leaving the bell peppers al dente. Remove from saute pan.

5. Heat some more olive oil in the pan and add the shrimp.

6. Cook shrimp until pink and the shrimp slightly curl. Remove from saute pan.

7. Add a little more olive oil to the saute pan and add the sliced cabbage with a splash of broth or water.

8. Add the cayenne pepper, if using.

9. Saute cabbage just until al dente, about 3 minutes over medium heat.

10. Assemble the tacos and finish with a squeeze of fresh lime.

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New Facilities Now Open in 8|

Ashish Udeshi, MD

Your Palm Bay Physicians...

• B.S. degree in Biology with Honors in 2004 and a graduate of the University of Miami Miller School of Medicine in 2008.

• Residency in Anesthesiology, Fellowship for Interventional Pain Medicine, and Board Certified in Anesthesiology.

• Speaks fluent English and Spanish.

Michael Esposito, MD

• Graduated from Georgetown University School of Medicine in 2010.

• Residency in Anesthesiology and Critical Care at Chicago Hospital where he served as Chief resident.

• Interventional Pain management fellowship at Massachusetts General Hospital.

• Board certified in Anesthesiology.

New Locations, Same Dedication to You! Exit 176

Pkwy rfolk No

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Palm Bay Location:

NOW OPEN!

490 Centre Lake Drive NE Suite 200B Palm Bay, FL 32907

Palm Bay and Titusville US 1 n cisiyo PreW a

• Doctor of Medicine Degree in 1991 from the University of Michigan School of Medicine and residency in the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins in Baltimore.

• Certified for three elite boards and ABA Special Qualifications in Pain Management

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Richard Gayles, MD

Kings Hwy

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US

Dr. Richard Gayles, Your Titusville Physician.

St ood w l l Be ita St Bon ay ed WBlvd d u l Sec r Park ir Rive tthew C Ma

Titusville Location:

South Titusville Medical Center 7455 South US Highway 1 Titusville, FL 32780

How to Arrange an Appointment: • Ask your Primary Care or Treating Physician to refer you to Florida Pain Institute.

• Referrals can be faxed to 321-336-7656. * Include: referral, patient demographics, current insurance information, current office

notes, and diagnostic testing reports that pertain to the area to be treated.

• We accept the majority of area insurance plans. Please call to check coverage availability: 321-784-8211.

Call: 321-784-8211 or Visit: www.FloridaPainInstitute.net 404

N Wickham Rd

Outlook Dr

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Cloudberry Pl

Outlook Dr

Merritt Island Location 595 N Courtenay Pkwy., Ste #101 Merritt Island, FL 32953

Co Rd 509

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Pineda Causeway

Pineda Location 5545 N Wickham Rd., Ste 104 Melbourne, FL 32940

WE’RE HERE FOR YOU. With 2 Other Convenient Locations in: Merritt Island and Melbourne

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New Doctor

Dr. Michael Esposito is happy to finally call Florida home

after having spent family vacations in Melbourne Beach annually while growing up. Dr. Esposito grew up in New Jersey and received a Bachelor of Arts with Honors from the University of Pennsylvania in Philadelphia in 2006. Upon graduation Dr. Esposito attended Georgetown University School of Medicine in Washington, DC, graduating in 2010. He completed residency in Anesthesiology in the Department of Anesthesia and Critical Care at The University of Chicago Hospital in Chicago, IL where he also served as Chief Resident.

He went on to complete an Interventional Pain Medicine Fellowship

at Massachusetts General Hospital, a Harvard Medical School Teaching Hospital. While in Boston, he worked as an Anesthesiologist at Massachusetts General Hospital and at the Veterans Affairs West Roxbury Hospital.

During his education and training, Dr. Esposito received the Arnold P. Gold Foundation Humanism and Excellence in Teaching Award in 2010-2011. He was also recognized as the University of Chicago Department of Anesthesia and Critical Care Resident of the Year in 2013-2014.

Dr. Esposito has devoted his time to various local, state, national, and international organizations.

He has served on two hospital Graduate Medical Education Committees which oversee resident and fellow education. He has also served as an instructor for conference workshops, teaching physicians from all over ultrasound guided procedures. He developed an educational web-based lecture series and helped implement annual conference educational programs while serving as the Resident Section Chair for the Society for Ambulatory Anesthesia. Dr. Esposito has also spent some time in our nation’s capital, discussing health policy with U.S. Congressmen and advocating for patient safety while working with the American

Society of Anesthesiologists’ Advocacy Division.

He has presented at numerous national Anesthesia and Pain Medicine conferences. Dr. Esposito has been affiliated with the American Society of Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine, American Academy of Pain Medicine, American Society of Interventional Pain Physicians, American Pain Society, North American Neuromodulation Society, and the Society for Ambulatory Anesthesia.

Dr. Esposito is extremely thrilled to be part of the Florida Pain Family. He is a Board Certified Anesthesiologist (Diplomate of the American Board of Anesthesiology) and will sit for the Pain Medicine Boards in September 2015.

• Graduated from Georgetown University School of Medicine in 2010.

• Residency in Anesthesiology and Critical Care at Chicago Hospital where he served as Chief resident.

• Interventional Pain management fellowship at Massachusetts General Hospital.

• Board certified in Anesthesiology.

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Adult Stem Cells For The Treatm 12 |

Discovering A New Path To Wellness REGENERATIVE MEDICINE Through regenerative medicine, a person can take advantage of their body’s ability to heal itself by using the healthy adult stem cells that can be found throughout the body. Laboratory and clinical research has shown that it is possible to use adult stem cells to restore lost, damaged or aging cells and effectively regenerate tissue in the body. Regenerative therapies are showing promise in the treatment of pain.

Adult stem cells were discovered over 40 years ago when researchers found that cells derived from bone marrow had the ability to form various tissues.

Adult stem cells are early stage cells and under the right conditions, are capable of developing into other types of cells with the potential to regenerate damaged tissue.

Adult stem cells are being used to treat many types of chronic pain and degeneration. Currently doctors are treating shoulder, knee, hip, and spine degeneration, in addition to soft tissue (muscle, tendon, ligament) and other bone related injuries.

FREQUENTLY ASKED QUESTIONS Where Do Adult Stem Cells Come From?

In adults, stem cells are present within variety of tissues and organs, the most common sources being bone marrow and fat (or adipose) tissues.

How Do Adult Stem Cells Know What Type of Tissue to Develop Into?

The differentiation of adult stem cells is dependent on many factors, including cell signaling and microenvironmental signals. For example, adult stem cells delivered to damaged bone can develop into bone cells to aid in tissue repair.

What is the Difference Between Adult Stem Cells and Embryonic Cells?

Adult stem cells are found in mature adult tissues including bone marrow and fat, while embryonic cells are not found in the adult human body.

Embryonic cells are obtained from donated in vitro fertilizations which raises many ethical concerns.

ment Of Pain How Are Adult Stem Cells Obtained, Prepared, and Delivered?

One of the richest sources of adult stem cells is bone marrow, and the hip (pelvis) is one of the best and most convenient locations for obtaining bone marrow. In the harvesting procedure, the doctor typically removes (or aspirates) from the pelvis. A trained nurse or technician then uses specifically designed equipment to concentrate the adult stem cells in the bone marrow and provides the cells back to the physician for implantation at the site of injury at point-of-care.

POTENTIAL APPLICATIONS There are many potential applications where stem cell treatments can be very effective. The following are the most common:

Will My Body Reject the Adult Stem Cells?

No, since they are cells collected from your own tissue, there is little threat of rejection.

Who is a Good Candidate for a Stem Cell Procedure?

The ideal candidate for a stem cell procedure is a patient that wants to use their body’s own regenerative potential as an option to possibly delay or avoid invasive surgery.

ABOUT DR. RICHARD GAYLES • Doctor of Medicine Degree in 1991 from the Michigan School of Medicine and residency in the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins in Baltimore. Fellowship completed at the Cleveland Clinic in Ohio.

Knee

Shoulder

Osteoarthritis Partial ligament tears Partial meniscal tears Augmented ACL or PCL reconstruction

Partial rotator cuff tears Labral tears Mild to moderate osteoarthritis

Foot and Ankle

Osteoarthritis Labral tears Articular cartilage injuries Congenital deformities

Mild to moderate osteoarthritis Tendon inflammation Partial Achilles

Hip

• American Board Certified in Anesthesiology with qualifications in Chronic Pain Management.

Diplomate American Board of Pain Management.

• Certified for three elite boards and ABA Special Qualifications in Pain Management

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New Pain Relief 14 |

Tenex Health TX Treats Chronic Tendonitis and Plantar Fasciitis at the Source.

You. Are. In. Pain.

It’s in your shoulder, elbow, knee, ankle or foot.

It’s with you always and takes a toll on the activities you love and need to do.

You’ve tried everything: over-the-counter pain medication, rest, ice, compression, elevation, physical therapy, even cortisone injections—and nothing works. Nothing. It’s been at least 3 months now and you don’t know what else to do.

YOU are one of the millions of people suffering from chronic tendon pain.

How did this happen? Chronic tendon pain comes from performing activities over and over and over again. Repetitive motions, no matter how ordinary, are causing you injury.

Maybe it feels like burning, cutting, or stabbing. However you describe it—it hurts when you perform even the simplest tasks and that pain is interfering with your life.

Sound like you?

You may be a candidate for a minimally invasive procedure, using Tenex Health TX™ technology, that may provide relief for your chronic tendon pain with a one-time ultrasonic treatment.

With Tenex Health TX™, you could return to doing what matters most to you quickly without surgery, stitches or physical therapy. Just one simple procedure.

Tenex Health TX is designed to use precise ultrasonic energy to end your frustration with chronic tendon pain that has lasted 3 months or longer despite trying rest, injections, or medications.

Unlike these treatment options, Tenex Health TX removes the source of your pain, the damaged tissue, and in so doing stimulates a healing response.

Using ultrasound imaging technology, the same kind used to see babies in the womb, your doctor identifies the specific location of your damaged tissue. He or she then creates a microincision and inserts the TX MicroTip through this microincision.

The TX Micro Tip uses ultrasonic energy to precisely remove only your damaged tissue, breaking it down; without removing or hurting any healthy tissue. With this accuracy, Tenex Health TX accelerates your pain relief allowing you a rapid return to the things you love.

There is no general anesthesia, you are awake the entire time, and, most people feel nothing once the area is numbed, possibly a slight pressure.

Get Back: To Quality Time

| 15| 15

Using ultrasound imaging technology, the same In most cases, you should be back to your kind used to see babies in the womb, your doctor normal everyday activities within a few identifies the specific location of your damaged weeks.

There nothen need for any additional and tissue. He or is she creates a microincision treatment like Though inserts the TXphysical MicroTip therapy. through this microincision. recovery is rapid, those with extensive tendon The TXmay MicroTip ultrasonic energy to precisely damage takeuses slightly longer to heal and remove only your damaged tissue, breaking it results will vary.

For 3 days after the procedure, you should take

Ask about Tenex Health TX today!

In most cases, you should be back to your normal everyday activities within a few weeks.

There is no need for any additional treatment like physical therapy. Though recovery is rapid, those with extensive tendon damage may take slightly longer to heal and results will vary.

down; without removing or hurting any healthy tissue. With this accuracy, the Tenex Health TX™ procedure accelerates your pain relief allowing you a rapid return to the things you love.

Is Tenex Health TX™ Right for You?

• Do you have pain in your shoulder, There is no general anesthesia, you are awake the elbow, knee, ankle or foot?

entire time, and, most people feel nothing once the area is numbed, possibly a slight pressure.

• Have you been in pain for 3 months or longer?

005_Tenex_PodiatryBrochure_05072014.indd 6-8

Desc Rest or R.I.C.E

of the yes area.to any of these questions, Ifextra you care answered Tenex Health TX could be the answer to your For 2 weeks after the procedure, you should not tendon painany problems. perform weight bearing exercise or activities.

Medication

For 2 weeks after the procedure, you should not perform any weight bearing exercise or activities.

• Would you prefer a relatively painless procedure versus the well known challenges of traditional surgery?

Physical Therapy (PT)

For 3 days after the procedure, you should take extra care of the area.

• Have you already tried to manage your discomfort with rest, ice, medicine and/or cortisone shots?

Open surgical procedure

After your procedure, you can simply go home.

Really. You may even drive yourself if your doctor approves. There are none of the stitches or general anesthesia you would need with open surgery, so there isGet minimal downtime. Best of all, the pain Back: relief can be nearly instant. So you can get back to To Giggles the things you miss significantly faster than with open surgery. Your individual results may vary.

Don’t let wait and see turn into wait and suffer

Diseased Achilles tendon

Icing, h avoiding

Anti-infla Cortison

Usually with rest or s

Remove tissue w (k

Healthy Achilles tendon

Before your procedure, your doctor can visualize the

Before your procedure, your ultrasound doctor canimaging. visualizeAfter the damaged tendon tissue using the procedure, you can see the damaged areas are gone damaged tendon tissue using ultrasound imaging. leaving healthy tendon tissue.

After the procedure, you can see the damaged areas are gone leaving health tendon tissue.

Tenex Health TX

Get Back: To Giggles

Remove tissue wi en

Treatment options

New Study 16 |

Be Part of the Future of Degenerative Disc Disease Research If you are an adult with degenerative disc disease, you may be eligible to take part in a clinical research study.

The CASCADE Study is looking at the impact of an investigational product for people experiencing chronic low back pain caused by degenerative disc disease. The investigational product aims to potentially reduce pain and improve disability that results from the disease. You may be eligible to participate in this study, if you:

• are 18 years of age or older • have a diagnosis of degenerative disc disease • have had chronic low back pain for at least 6 months • are still experiencing low back pain, despite trying other treatments for at least 3 months.

ABOUT DR. STANLEY GOLOVAC • Medical degree from UTESA University in 1985 and residency in the Department of Anesthesiology at Jackson Memorial in Miami.

• American Board Certified in Anesthesia with an emphasis in Pain Management.

• Speaks fluent English, Spanish, and Portuguese.

CASCADE If you decide to take part in the CASCADE Study, your participation will last approximately 1 year. You will be required to attend the study center a number of times so that the study doctor can assess your degenerative disc disease and overall health. After the start of the study when you receive the investigational product, you will be required to visit every 3 months.

The CASCADE Study is looking at a potential new treatment (an investigational product) for people with degenerative disc disease. The investigational product is made from a certain type of adult stem cell. Stem cells are immature cells produced by the human body that have the ability to develop into many different types of cells.

The stem cells being looked at in this study are called mesenchymal precursor cells. The cells being used in the study have been carefully collected from bone marrow samples from healthy human adult donors and grown in a laboratory under strict conditions.

The CASCADE Study will involve approximately 330 adults with degenerative disc disease. The main study will last about 1 year; however, study participants will be asked to be followed up for a total of 3 years.

Everyone who takes part in the study will receive a single injection into their painful disc of either: the investigational product the investigational product combined with a carrier material called hyaluronic acid, or a saline solution, which looks like the investigational medication but contains no active ingredient.

There is a two in three chance of receiving the investigational product and a one in three chance of receiving a saline solution. The injections will be assigned randomly (like flipping a coin) and neither the study participant nor study doctors performing the follow-up assessments will know who is receiving what.

Meet Your Practitioners | 17

Susan Clark, ARNP,

Eric Cole, PA-C,

Patricia (Tricia) Dunn, DNP, ARNP-BC,

is Board Certified as an Adult Nurse Practitioner as well as Acute Care Nurse Practitioner. Her professional memberships include American Nurses Association, Florida Nurses Association, American Academy of Nurse Practitioners, Association of Clinical Research Professionals, Space Coast Clinicians, North American Spine Society and American Academy of Pain Management. She is also a Certified Research Coordinator.

began his career as a Medical Technologist while in the Army and decided that becoming a Physician Assistant was his calling. After graduating in 1992 Eric spent the bulk of his career in surgery and in 2008 he began working in Pain Management.

Beth Holtham, PA-C,

Michael Thomas, PA-C,

John Welch, PA-C,

obtained initial certification by the National Commission of Certification of Physician Assistants in 1998 and has maintained certification. She is a member of The Florida Academy of Physician Assistants, The American Academy of Physician Assistants, and Space Coast Clinicians Group.

began his training as an US Navy Hospital Corpsman. He is currently a Board Certified member of the Florida Academy of Physician Assistants as well as the American Academy of Physician Assistants. He is also the President of Space Coast Clinicians educational and networking group.

is Board Certified through the American Nurses Credential Center as an Adult Nurse Practitioner. His professional memberships include American Nurses Association, Florida Nurses Association, and Space Coast Clinicians. His focus is on Primary Care, Urgent Care, Physical Medicine, Cosmetics, and Interventional Pain Management.

is Board Certified by the America Nurse Credential Center as an Advanced Registered Nurse Practitioner- Family Nurse Practitioner.

She is a member of the American Association of Nurse Practitioners, The American Association of Heart Failure Nurses, Florida Nurse Practitioner Network, American Academy of Pain Management, and Space Coast Clinicians.

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3T MRI • OPEN MRI • CT ULTRASOUND • X-RAY Serving All of Central Florida with 3 Convenient Locations NSI of Melbourne 2222 S. Harbor City Blvd Suite 520 Melbourne, FL 32901

(321) 409-9990 • Fax (321) 409-9989

NSI of Merritt Island 255 N. Sykes Creek Parkway Suite 102 Merritt Island, FL 32953

(321) 454-6335 • Fax (321) 454-4897

NSI Orlando 1315 S. Orange Avenue Suite 1B Orlando, FL 32806

(407) 999-9977 • Fax (407) 999-9988

New Knowledge Test to see how much you’ve learned.

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Across 1. What study is looking at the impact of an investigational product for people experiencing chronic low back pain caused by degenerative disc disease.

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15. The TX ______ ____ uses ultrasonic energy to precisely remove only your damaged tissue; without removing or hurting any healthy tissue.

16. How many hours before sleep should you avoid sugar and heavy meals?

4. What relaxes muscles and improves blood circulation?

5. NSI is serving all of Central Florida with ___ convenient locations.

7. ______ _______ TX Treats chronic Tendonitis and plantar fasciitis at the source.

8. The St. Jude article discusses the benefits of using Radiofrequency Ablation to relieve chronic _____ pain.

11. Dr. Esposito spent time in our nations capital, discussing _____ ______ with U.S. Congressman and advocating for patient safety.

12. How many locations does Florida Pain currently have?

13. What is the most common form of arthritis in the knee?

DOWN 2. NSI offers highfield open MRI’s for ____________ .

3. Adult stem cells are being used to treat many types of chronic pain and ________ .

6. Which Florida Pain Physician is currently enrolling patients in the Cascade study?

9. The newest Physician to join Florida Pain Institute is Dr. ________ .

10. Proper sleep ______ is crucial in improving pain conditions and quality of life.

14. In adults, stem cells are present within a variety of tissues and organs, the most common being _____ _______ and fat(or adipose) tissues.

See page 2 for answers.

BREVARD COUNTY’S LEADING INTERVENTIONAL PAIN MANAGEMENT GROUP | 20

Dr. Stanley Golovac

•

Dr. Ashish Udeshi

•

Dr. Richard Gayles

Dr. Michael Esposito

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Specializing in Neck, Back, & Cancer Pain FLORIDA PAIN INSTITUTE is a multi-service facility that offers interventional pain management for acute and chronic pain. Florida Pain Institute has offices in Merritt Island, Pineda, Palm Bay, and Titusville.

Merritt Island Location 595 N Courtenay Pkwy., Ste 101 Merritt Island, FL 32953 Fax: (321) 394-9425

Pineda Location 5545 N Wickham Rd., Ste 104 Melbourne, FL 32940 Fax: (321) 775-0535 404

Outlook Dr

Dr

Cloudber ry Pl

N Wickham Rd

Hoofprint Dr

Co Rd 509

s ke La er De

High Pasture Way

Needle Blvd

Hoofprint Dr

Outlook Dr

US 1

Exit 176

Pkwy rfolk No

n cisiyo PreW a

5

I-9

Merritt Island Pineda Palm Bay Titusville

Hurtwood Ave

Aster Ct

Serving all of Brevard with 4 Convenient Locations in:

N Courtenay Pkwy

Kurek Ct

Minna Ln

404

Pineda Causeway

Palm Bay Rd NE

d St woo Bell ita St Bon ay dW lude rk Blvd c e S ir r Pa Rive tthew C Ma

76

it 1

Ex 5

I-9

1

Palm Bay Location 490 Centre Lake Drive NE, Ste 200B Palm Bay, FL 32907 Fax: (321) 265-5120

US

Culver Dr NE

Kings Hwy Centre Lake Dr NE

Titusville Location 7455 South US Highway 1 Titusville, FL 32780 Fax: (321) 394-9425