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Popular? No Necessary?

Yes! How a colonoscopy can save your life

The Sound You Want

Ways to keep your voice in good shape

… so you’ll look and feel better NH_JulSep11_cover.indd 991

6/3/11 12:04:28 PM


CALYPSO® 4-D LOCALIZATION State-of-the-art prostate treatment system

BUT DON’T TAKE OUR WORD. TAKE THEIRS...

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Calypso® 4-Dimensional Localization Centers • Memorial Sloan-Kettering Cancer Center • University of Washington Medical Center • Duke University Medical Center • Cleveland Clinic • Hospital of the University of Pennsylvania • University of Michigan Hospitals • Fox Chase Cancer Center • Barnes Jewish Hospital/Washington University

6/3/11 12:04:45 PM


Korunda Pain Management Center “Striving to deliver the highest quality of comprehensive care for those suffering with chronic or acute pain.”

Zdenko Korunda, M.D. Board Certified in Pain Medicine, by American Board of Physical Medicine and Rehabilitation Cleveland Clinic Foundation Fellowship Trained in Pain Management Diplomate of American Board of Pain Medicine Assistant Clinical Professor at Nova Southeastern University Chairman, Pain Management Division at Physicians Regional Medical Center Patient Choice Award for 2008, 2009 and 2010

Specializing in a comprehensive approach in evaluating and treating spine, joints, headaches, fibromyalgia, neuropathies, sciatica, neck and back pain, etc. Dr. Korunda uses both invasive and noninvasive approaches in treating a variety of chronic pain. He offers a comprehensive approach in evaluating and treating spine, joints, headaches, fibromyalgia, neuropathies, sciatica, neck and back pain, shoulder, hip and knee pain, osteoarthritis, spinal stenosis, disc disease, shingles, MVA related injuries, etc. Dr. Korunda does his procedures under fluoroscopic guidance in a state-of-the-art procedure room. He has added a revolutionary, new modality of treatment, Low Intensity Laster Therapy/Cold Laser Therapy. Low Intensity Laser/Cold Laser therapy is a painless, noninvasive approach to help patients suffering from pain.

Appointments: 239-591-2803 www.korundapmc.com

Korunda Medical Institute “A comprehensive internal medicine practice that strives to exceed your healthcare expectations by providing excellence in care as your primary care provider.”

Nena Korunda M.D., F.A.C.P. Board Certified in Internal Medicine Diplomate of American Board of Internal Medicine Assistant Clinical Professor, Nova Southeastern University Patients Choice Award in 2008, 2009 and 2010 America’s Top Physician Award in 2009 and 2010

Specializing in primary care services for patients 14 and over. Dr. Korunda takes care of all primary care needs, acute and chronic. She believes in proactive, preventive approach, which helps her patients stay healthy, productive, and happy. The patients are able to receive various services in the office, including ultrasound, ECG, holter, spirometry, Coumadin Clinic, vaccinations, and massage/myofascial release. Dr. Nena has added a Medical Spa to her scope of practice offering facials, microdermabrasion, and Blue Light Treatment for actinic keratosis, acne and rejuvenation.

Acute care appointments are available within 24 business hours.

Appointments: 239-431-6464 www.korundamd.com

NEW PATIENTS WELCOME Accepting Medicare and most commercial insurance plans

NORTH NAPLES LOCATION 4513 Executive Drive Naples, FL 34119

BONITA SPRINGS LOCATION 26741 Dublin Woods Circle Bonita Springs, FL 34135

1/2 mile East of I-75 off Immokalee Road by Quail Creek/Longshore Lakes

Off U.S. 41, north of Target

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Contents

July-September 2011

F E AT U R E S

16 How to Eat Smarter

16

How to improve your judgment of food labels and ads to create a healthier lifestyle.

20 The Procedure that Saved My Life Though unpopular, colonoscopies can make a critical difference.

32 Sounds Good Keeping your voice in good shape—and how to respond if problems arise.

42 You’ll Be Targeted for Special Care New technology may help doctors treat patients’ very particular needs.

32

EVERY ISSUE

4

mber 2011 July-Septe

From the President & CEO Making strides toward a happy, healthy summer.

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Yes!

y How a colonoscop can save your life

The Sound t You Wan your

Ways to keep voice in good shape

…so you’ll look and feel better

Cover illustration by Jeff Bennett for Naples Health magazine

12 In the Spotlight A new coalition mounts initiatives to prevent child drowning incidents.

14 Ask the Experts NCH specialists answer your urgent health questions.

46 Up and Coming Information on health screens, workshops and support groups.

48 Looking Ahead What’s new and promising. 2

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Naples Health |

JULY-SEPTEMBER 2011

6/3/11 12:09:32 PM


Now Open!

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Charles Camisa, MD

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Laura Taylor, ARNP

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Celebrating 10 Years of Serving Southwest Florida Our team of skillful, caring providers offers the very latest advances in Dermatology while treating each patient like family. Whether you have a skin health concern or just want

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to look your best, trust the experts at Riverchase Dermatology and Spa Blue MD. Weâ&#x20AC;&#x2122;re Redefining Dermatology. We are now accepting new patients at all of our locations.

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1425 Viscaya Pkwy., Suite 102 Cape Coral (239) 443-1500

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6/3/11 12:10:53 PM


From the President & CEO

To a Happy,

Our Mission: Wellbeing Our Focus: You FAMILY PRACTICE Pediatrics to geriatrics, acute and chronic illnesses, preventive care, routine physicals and minor surgery

URGENT CARE

Healthy Summer As the song lyric goes, “Summertime, and the living is easy.” But in healthcare, the challenges and the changes aren’t seasonal; they’re constant. The goal of Naples Health has always been to present revealing articles about medicine and healthcare that benefit all of us. So this summertime issue features a highly personal story about the power of prevention. Our very talented lead writer for Naples Health, Janina Birtolo, had a perfect patient outcome with a not-soperfect medical situation: colon cancer. Her early detection and cure averted a calamity. Ms. Birtolo, thank you for sharing your story.

Burns, fracture care, lacerations, sprains and strains, and sudden onset of minor illness

We’ve all heard the expression, “We are what we eat.” Our von Arx Diabetes Center helped change the diet of a young person who ate not-so-healthy foods. Now our friend is eating right and teaching others as well.

OCCUPATIONAL MEDICINE

Another feature in this issue explains why our voices change at puberty, when we have a cold, after screaming at a ball game or when whispering. When you “listen” to this piece, you’ll have a new understanding of your own voice.

Worker’s compensation, FAA physicals and MRO

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The future of healthcare may just revolve around the four Ps: predictive, personalized, preventive and participatory medicine. The future will include all these Ps as technology changes the way we diagnose, treat and predict. That’s an Rx for a better prognosis. Sadly, Florida is the drowning capital of the country for preschool children. And in “Protect Your Children from Drowning,” we discuss ways to eliminate these tragedies. This feature is based on a coalition of several local organizations led by Dr. Todd Vedder and R.N. Jamie Roberts, director of the MacDonald SeaCAREium, which has formed the Collier County Water Safety Prescription Program. “Health Buzz” dives into these four topics: foods that lower your cholesterol; protecting your memory with Vitamin B12; the association between hot flashes and a lower chance of breast cancer; and 10 tips to ease restless leg syndrome. Finally, “Looking Ahead” asks whether at-home glaucoma testing will soon be available. Patients who have implantable cardiac defibrillators and resynchronization devices live longer when they are remotely monitored. Also, looking into the future, scientists are growing arteries with high levels of elastic protein. In all, another issue full of timely, informative topics. Medicine continues its rapid improvement, helping us all live easy in the summertime—and beyond.

Allen Weiss, M.D., MBA, FACP, FACR President and CEO, NCH Healthcare System 4

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Naples Health |

JULY-SEPTEMBER 2011

6/3/11 12:10:56 PM


P E R S O N A L I Z E D H E A LT H C A R E F O R G E N E R AT AT I O N S

Dr. David Scott Madwar, a fourth generation physician, offers individualized healthcare tailored to meet his clienteleâ&#x20AC;&#x2122;s unique needs. Limiting the physician-patient ratio to a fraction of the industry standard, Dr. Madwar provides emphasis on accessibility, education and quality, thereby optimizing the chances for healthy outcomes. The practice environment is designed

with ample time for your visits, fostering a more comprehensive approach to care with meticulous attention to detail and coordination of medical subspecialty services. Same-day appointments, around-the-clock access, hospital rounds and even house calls mean a seamless blend of care continuity which ensures peace of mind for you and those dearest to you.

T: 239.352.5550 F: 239.352.5545 www.drmadwar.com 1400 Gulf Shore Boulevard North, Suite 166, Naples, FL 34102

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6/3/11 12:11:02 PM


GERMAIN TOYOTA OF NAPLES IS A CERTIFIED TOYOTA MOBILITY DEALER

Germain Toyota of Naples is proud to be part of the Toyota Mobility Program. The Toyota Mobility Program supports the mobility needs of Toyota owners and/or family members with a disability. It provides financial support for new vehicle customers, offers special mobility financing and resource information. Toyota Motor Sales, U.S.A. will provide a reimbursement of up to $1,000 to each eligible, original retail customer, towards the cost they paid to purchase and install qualifying adaptive driving or passenger equipment for transporting persons with physical disabilities. This offer applies to all purchased or leased new 2010 to 2011 Toyota vehicles. Plus, when you purchase a New Toyota from Germain Toyota of Naples, you get a Free Lifetime Limited Non-Factory Warranty, good at participating dealerships, and 2 years complimentary maintenance and lifetime warranty provided by Toyota.

B OA RD OF T R US T EES

Joseph I. Perkovich, Chair William Allyn Kenneth Bookman, M.D. Alberto M. de la Rivaherrera, M.D. Michael Feuer Thomas J. Gazdic, Secretary/Treasurer Daniel Gill Kay F. Gow, Ed.D. Joann Jenner Kim Ciccarelli Kantor Hermes Koop, M.D. John Lewis, M.D. Mariann MacDonald, First Vice Chair Admiral Paul D. Miller Robert Moses Wayne Mullican Ambassador Francis Rooney, Second Vice Chair Scot C. Schultz, M.D. Norman Thomson Jr., M.D. Allen S. Weiss, M.D. Greg Wilkerson, R.N. N C H C O RP OR AT E OFFICER S

Allen S. Weiss, M.D. President and CEO

For more information, contact:

Kevin D. Cooper

Jan Christopher

Chief of Staff/General Counsel

at (239) 592-5550 ext 289 or e-mail jchristopher@germain.com

Chief Operating OfďŹ cer

www.germaintoyota.com

Chief Medical OfďŹ cer

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With Any Service W Call (866) 296-7321 to make an appointment Valid only at Germain Toyota of Naples. Must present coupon to obtain special. Not valid with any other specials. Expires 8/30/2011.

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Chief Financial OfďŹ cer

Gary Parsons, M.D. Chief Medical OfďŹ cerâ&#x20AC;&#x201D;NCH Healthcare Group

Michael Riley

Regaining Independence Every Day!

s$AILYLIVINGSKILLSCLASSES s,OWVISIONAIDS s-AGNIlERS##46S s#OPINGWITHVISIONLOSSCLASSES s#HILDRENSPROGRAMS email: Info@lighthouseofcollier.org

Chief Strategy OfďŹ cer

Brian C.G. Settle Chief Human Resources OfďŹ cer

Michele Thoman Chief Nursing OfďŹ cer

Susan B. Wolff Chief Information OfďŹ cer

M AGA Z I N E COOR DINATOR

Mary Trupiano

239.430.EYE4 (3934) 424 Bayfront Place

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Naples Health magazine makes every effort to ensure information published is accurate and current but cannot be held responsible for any consequences resulting from omissions or errors. Opinions expressed by writers and advertisers are not necessarily the opinions of the magazine or publisher.

Naples Health |

JULY-SEPTEMBER 2011

6/3/11 2:47:12 PM


What retirement living aspires to be:

The Carlisle Naples.

Here you’ll find a sophisticated blend of comfort, style, fine dining and social opportunities, plus a calendar filled with an engaging array of activities to nurture your body, mind and soul. Socialize with friends, pursue lifelong passions and enjoy the peace of mind of knowing comprehensive care is available to meet your unique needs, now and in the future. Available on an affordable monthly fee basis, isn’t it time you discovered the full-service retirement lifestyle awaiting you at The Carlisle Naples? Call to schedule your personal tour today.

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Assisted Living Facility #9408 An SRG Senior Living Community

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6/3/11 12:11:12 PM


Daniel J. Denton President & Publisher

Highly Recommended by Physicians for Superior Quality Home Care

Diane Loveless Associate Publisher

Jessica Schultz Account Executive

David Sendler Editor in Chief

Jennifer Freihofer Managing Editor

Janina Birtolo Writer

Tessa Tilden-Smith Creative Director

Jesse Adams Art Director

s Nurse Owned & Operated, over 50 years combined experience

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s Serving Collier & Lee Counties s We Excel In Post-Operative Nursing Care For All Types of Surgery

Naples Health is a publication of Gulfshore Life. Gulfshore Media, LLC 3560 Kraft Road, Suite 301 Naples, FL 34105

239.304.2478

Phone: (239) 449-4111

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Toll-free: (800) 220-4853

Fax: (239) 449-4164 Web site: www.gulfshorelife.com E-mail: info@gulfshorelife.com

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Naples Health |

JULY-SEPTEMBER 2011

6/3/11 12:11:15 PM


Why is NDIC your best choice for Women’s Imaging? Dedicated NDIC Physicians like Radiologist Theresa D. Vensel, M.D. specialize in Women’s Imaging. Theresa Vensel, M.D., NDIC Radiologist

RESIDENCY: Obstetrics and Gynecology - 2002 Diagnostic Radiology, Shands Hospital, Gainesville, FL - 2006 CERTIFIED: American Board of Radiology - 2006 AREA OF SPECIAL INTEREST: Diagnostic Radiology, Women’s Imaging NDIC provides our community with the most comprehensive breast health programs available. We use the latest in women’s imaging technology including SonoCine‘ Screening Ultrasound, which is an additional examination for women with dense breasts or implants that finds smaller cancers earlier. This exam is used in conjunction with the digital mammogram. Our thoroughly trained staff includes a Breast Health Navigator who helps patients from diagnosis to completion of treatment. Some of our other services include:

• Breast Biopsy • Breast MRI • Mammograms • BSGI • Osteoporosis Screening With CAD: - Screening • Breast Ultrasounds - Diagnostic

Please visit our partners in the fight against breast cancer – Susan G. Komen at www.komenswfl.org and Bosom Buddies at www.bbbcsi.org

Call (239)593-4222 to schedule your appointment. Visit us online at naplesimaging.com

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6/3/11 12:11:25 PM


Health Buzz Tips to keep you feeling great Top five foods to lower cholesterol

increase in the active portion of B12 reduced risk by 2 percent.

F

Good news about hot flashes

or those who want a natural approach to lowering cholesterol, the Mayo Clinic recommends five foods that are particularly good at promoting heart health: Oatmeal (along with kidney beans, apples, pears, barley and prunes) contains soluble fiber. Five to 10 grams of fiber a day is enough to lower LDL (bad) cholesterol (one-and-a-half cups of cooked oatmeal provides six grams of fiber). The omega-3 fatty acids in fatty fish (salmon, albacore tuna, herring, sardines, mackerel) reduce blood pressure and the risk of developing blood clots. Doctors recommend two servings of fish a week. Although high in calories, walnuts, almonds and other nuts are rich in polyunsaturated fatty acids that keep blood vessels healthy. According to the FDA, a daily handful (one-and-ahalf ounces) is enough for a positive impact. The potent mix of antioxidants in olive oil lowers LDL but doesn’t affect HDL. The FDA recommends about two tablespoons a day. Margarines, orange juice and yogurt drinks with added plant sterols (which help block cholesterol absorption) are now available. At least two grams a day are recommended (equivalent to two eight-ounce servings of juice).

Hot flashes can be a severely annoying aspect of going through menopause, but a recent study suggests experiencing them may reduce a woman’s risk of developing breast cancer. Researchers at the Fred Hutchinson Cancer Research Center in Seattle asked women between 55 and 74 years old about their menopausal symptoms, including hot flashes, night sweats, insomnia, vaginal dryness, irregular or heavy periods, anxiety and depression. Surprisingly, they found that those who reported the most hot flashes were less likely to have subsequently developed breast cancer. Those with the most severe menopausal symptoms had a risk 50 percent lower than those who reported no symptoms. The researchers theorize that the more severe symptoms reflect an aggressive lowering of estrogen levels, as high estrogen levels have been linked to increased breast cancer risk. “If you have menopausal symptoms,” says Dr. Stefan Gluck, a breast cancer oncologist, “understand it’s a natural process and it might reduce the risk of breast cancer. So it is something biologically good.”

Tips to ease restless leg syndrome Vitamin B12 may protect memory A recent Finnish study indicates that vitamin B12 may help protect against memory loss in the elderly and those with Alzheimer’s. The seven-year study tracked 271 people aged 65 to 79 who did not have dementia at the start of the study. (Seventeen subjects developed Alzheimer’s during the study.) Blood samples were taken to measure their levels of homocysteine and vitamin B12. Too much homocysteine in the blood has been linked to negative brain effects, including stroke. Higher levels of B12 can lower homocysteine. The study found that an increase in homocysteine increased the risk of Alzheimer’s by 18 percent. Further, an even smaller 10

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WebMD, an online medical information site, offers 10 changes to personal habits that can help ease restless leg syndrome: • Avoid/limit alcohol, caffeine and nicotine for at least several hours before bedtime. • Take medications only as directed by your doctor. • Exercise daily. • Stretch legs at the beginning and end of every day. • Massage legs regularly. • Avoid eating heavy meals close to bedtime. • Maintain a regular sleep schedule. • Avoid daytime naps. • Use your bed only for sleeping or sex. • Try not to use bedtime as worry time. Naples Health |

JULY-SEPTEMBER 2011

6/3/11 12:11:29 PM


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In the Spotlight

Even One Inch of Water

Is Dangerous

O

ne inch of water may seem a mere puddle to adults. But for young children, one inch of water is enough for drowning. So says Jayme Roberts, assistant director of emergency and pediatric services for NCH Healthcare System. “The No. 1 reason children one to four years old in our county die is drowning,” Roberts reports. “In 2010, we had 70 emergency room visits that were water-related. Nineteen of those required admission to our pediatric ICU, and six required life support.” Fortunately, all those who made it to the hospital survived. But Collier County also saw three drowning deaths during 2010. And Collier isn’t unusual. WaterproofFL.com reports that Florida leads the country in drowning deaths for children ages one to four.

To tackle the problem of drowning incidents, the coalition has applied for a grant to give 1,000 youngsters swimming lessons.

Recognizing the need to improve those grisly statistics, NCH spearheaded the formation of the Safe & Healthy Children’s Coalition of Collier County, an umbrella organization comprised of more than 30 groups that are working together to provide a safe and healthy environment for area youngsters.

To tackle the problem of child drowning incidents and deaths, the coalition is mounting a multi-faceted education initiative. It developed a water safety questionnaire and video, which is distributed to families using daycare. Pediatricians have been 12

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supplied with books to give to parents to help them get swimming lessons for their children. An “April Pools Day” event at Golden Gate pool exposed four-year-olds and their families to water safety. “Project Get Alarm,” a joint venture between the Department of Children and Families, the fire department and EMS, gives door alarms to families with pools in their yards. And the coalition has applied for a grant to give 1,000 youngsters swimming lessons. While the American Academy of Pediatrics has issued new guidelines approving swim lessons for children as young as one, Roberts points out that lessons alone won’t keep kids safe. The coalition, like WaterproofFL, recommends three layers of protection. The first and most important is supervision. Leaving a child unsupervised near water for just a few minutes can result in tragedy.

The second layer is barriers to keep children from entering a pool area unaccompanied. The final layer is emergency preparedness—knowing how to administer CPR and call 911. “The philosophy about the layers of protection,” Roberts says, “is that the more education we can give to our community, the more we reduce the risk of an event occurring.” For more information, search for the Safe & Healthy Children’s Coalition of Collier County on Facebook. For a water safety checklist, visit http://doh.state.fl.us/injury. Naples Health |

JULY-SEPTEMBER 2011

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Ask the Experts

Q:

I have to go to the hospital for surgery. What should I bring with me? Lynn Olson, R.N., NCH advanced practice nurse, answers: It is important to bring a complete list of all prescription, over-the-counter and herbal medications, and their dosages you are taking on a regular basis or on occasion. Additionally, revealing a list of allergies, your past medical and surgical history, and any special needs you may have is helpful to those working with you to plan your care. Your insurance card and photo ID will allow for easier interaction with your insurance company and prevent health identity theft. Your glasses, hearing aids or dentures may be worn. Do not bring any valuables or money; they will not be needed and could get lost.

What can cause frequent urinary tract infections and how can they be treated? Betsy Brothers, M.D., answers: Urinary tract infections (UTIs) are among the most common bacterial infections in adults. Recurrent UTIs may be a result of failure to adequately treat the initial infection or may be a second, unrelated infection. Recurrent infections occur in 25 percent to 50 percent of women within the first year of their initial infection. Up to 5 percent of women will have multiple recurrences. Management should begin with a search for risk factors associated with recurrence: frequent intercourse, long-term spermicide use, diaphragm use, new sexual partner, young age at first UTI and maternal his14

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tory of UTI. Behavioral changes, such as different form of contraception, should be advised. An initial three-day course of antibiotics should be considered to clear the infection. Repeat testing two weeks later will confirm clearance. For women with frequent recurrences, continuous daily treatment has been shown to be effective for 95 percent of cases. This should be continued for six to 12 months. Also, women with recurrences associated with sexual activity may benefit from post-coital prophylaxis, a single dose after intercourse.

Should I worry about skin tags? Can I get them removed, or should I leave them alone?

and genetic predisposition have been observed in some people with skin tags. Even though skin tags are benign skin growths, other skin conditions may be mistaken for them. Most concerning, skin cancers (such as basal cell carcinoma, squamous cell carcinoma and even melanoma) can arise in or mimic a skin tag. Therefore, itâ&#x20AC;&#x2122;s not advisable for you to self diagnose and remove a skin tag. The diagnosis and removal should be delegated to a health care professional, such as a primary care physician or dermatologist, especially if the skin tag is dark in color, bleeding, or changing in size and appearance.

Srdjan Prodanovich, M.D., answers: A skin tag is a very common, soft, harmless skin lesion that hangs off the skin. It is usually skin colored and of various sizes. They are most commonly found in the areas of frequent friction, such as skin folds (neck, armpits and groin). Although the exact cause is unknown, chronic skin rubbing, type 2 diabetes mellitus, human papilloma virus Naples Health |

JULY-SEPTEMBER 2011

6/3/11 12:13:21 PM


“The Trusted Source for Hair Loss Solutions for Men & Women”

Call to set up your FREE consultation today. A $70 value, offer good until September 2011.

Dr. Greet Baestaens, DPT www.labellechique.com walk-ins welcome • 239-213-9186 619 8th Street South • Naples, FL 34102 NH_JulSep11_15-19_nutrition.indd 15

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Naples Health |

JULY-SEPTEMBER 2011

6/3/11 12:14:15 PM


How to Eat

Smarter … so you’ll look and feel better. IF AN INTELLIGENT BEING FROM ANOTHER PLANET WERE TO TUNE INTO our television commercials—particularly those aired around dinnertime— he would likely be perplexed by the messages being broadcast. Ads portraying calorie-laden fast food burgers as highly desirable are often followed by commercials touting the effectiveness of medications for indigestion relief. Those for sugary snacks are interspersed with ones promoting the latest diabetes monitoring or treatment methods. The conclusion, our alien might think, is that any ailment brought on by unhealthy eating can easily be rectified by simply taking a counteracting medicine. Unfortunately, that’s just the message that too many Americans seem to have absorbed. “There are so many diseases that we could prevent or reduce the risk of if we’d eat healthily and make lifestyle changes,” says Marjorie Kaparos, a registered dietician with the NCH von Arx Diabetes Center of Excellence and Nutritional Health. “It’s amazing to me that the drug companies can advertise the way they do. If we ate more healthfully, maybe we wouldn’t need the Tums or Rolaids. But people don’t really want to make the changes. They just prefer to pop a pill.” Sadly, that sort of mindset is having a particularly negative impact on our younger generation. Kaparos participated in a March health fair at a local middle school and talked with one young student who reported he had indigestion continually—and his wasn’t an isolated complaint. Poor eating habits are leading to adolescents who are too often overweight and even obese and who are starting to experience diseases once assumed to affect only adults. “Weight is a huge issue for people today,” Kaparos notes. “Experts have predicted that the new generation might not live as long as the last due to unhealthy eating habits.” It doesn’t have to be this way, as Kaparos well knows. Relatively simple diet and lifestyle changes can make a brighter future for adults and youngsters. The hard part is getting people to commit to making the change.

JULY-SEPTEMBER 2011

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| Naples Health

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One girl’s tale At 12 years old, Yesenia Zul tipped the scale at 196 pounds. According to her mother, Bernice, she also suffered from GERD (gastro-esophageal reflux disease), gastritis, ulcers and asthma and was borderline diabetic. At that point, her caseworker at Children’s Medical Services suggested Yesenia consult with a nutritionist at the von Arx center. Within a year, the pre-teen had lost 20 pounds. That’s not quite at her target weight of 140, but neither is it the whole story. “I feel like I have more energy, and all my clothes are looser,” Yesenia says with evident pride. “My grades have improved, and I’m able to focus better. Instead of thinking about what I can’t eat, I use my math to figure what I can eat.” Bernice adds that her daughter isn’t having as many stomach problems these days and that she may be able to stop some of her medications as she continues to lose weight. Yesenia has also managed to inspire her mother and older sister Jessie to join in a family healthy eating initiative. They now hold regular “weigh-ins,” in the mode of The Biggest Loser. “We kind of have a game to see who can lose the most,” Bernice says with a laugh. “Jessie’s winning.” As both Bernice and Yesenia concede, making the change to healthier eating hasn’t always been easy. After losing 10 pounds, Yesenia hit a plateau, and the weight refused to budge. That continued long enough that Bernice and her older daughter began to lose interest in the effort. But Yesenia managed to find renewed purpose through an adolescents’ support group offered by the von Arx Center that got the family back on track. “It wasn’t so much that we were eating more but just that the things we were eating were not good for us,” Bernice explains. “There was also the idea of economy. Buying ramen noodles was easier and cheaper, but not as healthy.”

The way we eat Such concerns often are factors in weight problems, Kaparos notes. Between work, school and activities, families can end up rushed for time, and so instead of 18

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preparing home-cooked meals, they���ll opt for fast foods or processed, pre-packaged meals. “Anything processed is going to have more sodium, flavorings and preservatives than what you cook at home,” she points out. It also pays to be a careful shopper, one who reads labels— and understands them. The front of a package of cookies may declare them to be “fat-free,” but that often comes at the expense of extra sugar. Calorie counts may look reasonable, until you look at the serving size. “Just because it says ‘only 100 calories’ doesn’t mean it’s healthy,” Kaparos says. “It may only be 100 calories because of the portion size. But portion control is good because oversized portions are what have gotten us into this state. I buy Skinny Cows [ice cream] for my husband because he likes them. But he’ll sit down and eat three of them. If you’re going to eat three, you might as well have the bowl of ice cream you wanted in the first place.” Kaparos sees a similar scenario in restaurant servings. The recommended daily allowance for lean protein is five to six ounces a day, but at a restaurant it’s not unusual to get a 10to 12-ounce steak as a single serving. Even fast food burgers have gone from being single patties to double or triple deckers. All that fat and cholesterol takes a toll on our arteries and heart. “A lot of people today take statins to lower their cholesterol, and there’s nothing wrong with that,” Kaparos says. “But then they’ll still eat steak and bacon and all these high-cholesterol foods and think it’s OK because they take medication for their cholesterol.”

A package of cookies may declare them “fat-free,” but that often comes at the expense of extra sugar.

Making changes in their diets could help alleviate the need for the drugs. Eating more fruits and vegetables and foods high in fiber, replacing meat at a couple of meals a week with beans, filling your plate halfway with vegetables, and allotting only a quarter of the space to protein and carbohydrates—such choices lower cholesterol naturally. Kaparos has one friend who lowered his cholesterol 30 points just by eating oatmeal every day. Yesenia’s dietician, Audrey McKernan, made similar Naples Health |

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Simple steps for a healthier life Dr. T. Colin Campbell, author of The China Study (the diet used by former President Bill Clinton to lose weight and reduce his cholesterol level), is a strong proponent of using diet as a means to remaining healthy. Discussing this idea in the Huffington Post, Dr. Campbell wrote, “When done right, advanced heart disease can be cured, type 2 diabetes stopped and reversed, cancer can be prevented and, with some newer evidence, controlled after it appears. The range of diseases that can be prevented is more than impressive. … The totality of these health effects are far more than almost anyone knows.” Those are heady claims, but, as Marjorie Kaparos, a registered dietician with the NCH von Arx Diabetes Center of Excellence and Nutritional Health, reports, the evidence indicates the combination of diet and exercise is a potent one. And the guidelines are relatively simple:

Watch your fat intake. Eat moderate portions. Fill at least half your plate with vegetables and only a quarter each for protein and carbs. Maintain a moderate weight. Eat on a regular basis (don’t skip meals). Exercise daily.

“Walking 30 minutes a day can lower the risk of stroke dramatically,” Kaparos adds. “Hypertension can be managed much better with a healthy diet and exercise, and sometimes medicine is necessary. Never go against your doctor’s orders, but it is important to inquire about the role of diet and exercise as part of treatment.” You can eat most foods that you enjoy if you do so in moderation and watch portion size. “But,” she adds, “you have to want to make the changes.”

recommendations. “She talks to me about what I should have instead of what I used to eat—turkey burgers, not regular burgers; fruit instead of candy,” she reports. “I drink nothing but water, and I eat sugar-free. It was hard at first, but you get used to it.” As for finding those fruits and vegetables to eat instead, the produce section isn’t the only place to look. Kaparos points out that frozen fruits and vegetables are just as nutritionally sound as fresh—and are often more moderately priced and last longer. “And canned vegetables are fine,” she adds. “They may have more sodium, but you can rinse them off. And their shelf life is great.” JULY-SEPTEMBER 2011

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| Naples Health

A little help from friends When Yesenia hit her weight-loss plateau, McKernan suggested she start attending a free, monthly support group the von Arx Center offers for adolescents and their families. That proved to be just the boost she needed. When her friends saw how well she was doing, they asked to attend the meetings with her. “We have lots of age-appropriate games about food, to help the kids learn where food comes from,” explains Mary McElligott, diabetes program coordinator at the von Arx Center. “Do you know that book, Food Rules, by Michael Pollan? His number one rule is ‘eat food,’ not the processed stuff. We want to help kids identify what is real food.” At the group meetings, the kids (and their parents) can share the challenges they’ve been facing and also get the most up-to-date nutritional information available. McElligott notes, for example, that sodium consumption guidelines recently changed to include children as young as three. “The guidelines used to be only for adults,” she says. “The old guideline was 2,300 milligrams a day. Now it’s 1,500 milligrams a day. Some of these teen boys have been consuming something like 18,000 milligrams a day!” All that sodium, Kaparos points out, can have a negative impact on blood pressure and lead to the development of hypertension. The von Arx Center has been notifying area schools and pediatricians about the meetings and plans to spin off different age groups as the number of participants grows. The center also holds a free monthly group for adults that is open to anyone who is having weight management issues or simply has questions about nutrition. “Nutritional science has been a little crazy with recommendations over the years,” McElligott acknowledges. “Eggs are no good one year, then fine the next … things like that. It’s nice to be in a group where you can sort out the fact from the fiction.” Being exposed to the information—and seeing and feeling the difference eating healthily has made for her—have convinced Yesenia that her new lifestyle is one worth keeping. “It’s better to be healthy than to be overweight,” she states firmly. “I had a great grandma who had diabetes. I don’t want to go through that. So I’m going to stay with it and try other things.” Bernice, her mother, marvels at her daughter’s level of commitment and at the knowledge she’s already amassed. It’s a long, tough road, she admits, because food (and food advertising) is everywhere. But she draws inspiration from her child. “We’re a work in progress,” Bernice says. And that’s the sort of attitude that can change and maybe even save a life. 19

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Colonoscopies may not be popular but—as the author discovered—they can make a critical difference. by JANINA BARTOLO photography by ERIK KELLAR

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Naples Health |

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N

O ONE REALLY looks forward to a colonoscopy. Even though they are painless and relatively straightforward, the day-before preparation of liquid diet and powerful laxatives combined with the general yuck factor at the thought of the procedure is enough to prompt many people to procrastination. I should know. I was one of those people for several years, until blood showed up in a stool sample at my annual physical. So last July, I finally stopped putting it off and went for my first colonoscopy. Boy, am I glad I did! I am now a colon cancer survivor. And since the colonoscopy revealed the cancer at a very early stage, my prognosis is good—a 95 percent chance I’ll still be alive in five years. I was lucky. According to the American Cancer Society, colorectal cancer is the third most common cancer diagnosed in the United States and the second-leading cause of cancer-related deaths among men and women in the country. The overall lifetime risk of developing colorectal cancer is 1 in 20, and the cancer society expects the disease to cause nearly 50,000 deaths in 2011. As sobering as those statistics are, the good news is that the death rate from colorectal cancer has been dropping for more than 20 years. The reason? The biggest factor is that more people are following their physicians’ advice and having colonoscopies on a recommended schedule. Advances in screening technology are also helping. When caught early—as mine was—colon cancer is one of the most easily and successfully treated. The cancer society estimates there are now more than one million survivors of the disease.

My journey begins Despite my reluctance to have a colonoscopy, I’ve always been very good about having my annual gynecological JULY-SEPTEMBER 2011

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| Naples Health

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exam. In April of 2010, that exam gave me a clean bill of healthâ&#x20AC;&#x201D;and a Hemocult stool screening to perform at home. The results of that screening indicated the presence of some blood.

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As I have hemorrhoids, I wasnâ&#x20AC;&#x2122;t terribly concerned about the blood. But a colonoscopy was the only way to be sure there was nothing else wrong. Still, I put off the procedure for a few months. After all, it was still season here, and I was busy. Finally, I realized that I couldnâ&#x20AC;&#x2122;t procrastinate any longer, and I made an appointment with Susan Liberski, M.D., a gastroenterologist with Gastroenterology Group of Naples.

The overall lifetime risk of developing colorectal cancer is 1 in 20. standing: Holly Miller, M.D.; Jeffrey Heitman, M.D.; Cristina Tzilinis, D.O. sitting: Su Parker, M.D.; Michon Floreani, M.D.

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Dr. Liberski was great, very straightforward and clear in her explanations. She outlined the preparation I would need to undergo and the procedure, including the risks and benefits. The colonoscope, she explained, is a long, flexible tube fitted with optical lenses. The images captured by the lenses are fed to a video screen, allowing the physician to see the inside of the colon. Little channels allow the physician to fit the scope with instruments to excise any polyps found and cauterize the incisions. I made an appointment to have the procedure a couple of weeks later. As Dr. Liberski had warned, the preparation day was the worst. Sticking to a liquid diet wasnâ&#x20AC;&#x2122;t so bad, but the TriLyte solution I had to drink (four liters, consumed in eight-ounce portions every 15 minutes) was, quite honestly, dreadful. The taste wasnâ&#x20AC;&#x2122;t pleasant, but mostly I just had trouble drinking that much that quickly. Naples Health |

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Dr. Liberski Some colonoscopies are done under partial anesthesia. The patient is awake but relaxed enough not to feel any pain or even intrusion. I was given propofol and put under completely. Before I knew it, I was waking up and amazed that the whole thing was over.

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Not the best news Only it wasn’t quite. What followed next was a rollercoaster of emotion. Dr. Liberski met with my husband and me immediately after the procedure and informed us she had found and removed a polyp in the lower part of my colon. It was small and looked fairly regular, so there was a good chance it was benign. Several days later, the pathology report revealed that it wasn’t. The polyp showed signs of cancer—but only at its base, where it attached to the colon wall. Still, because of the presence of cancer cells, I would need a rectal ultrasound (to show how deep the growth extended into the colon wall and the presence of any enlarged lymph nodes), followed by surgery. The ultrasound wasn’t as trying in terms of preparation. I could eat normally the day before and prepared only by administering two Fleet enemas. Once again, I was fully anesthetized. And there was good news after this

Before I knew it, I was waking up and amazed that the whole thing was over. procedure—the ultrasound didn’t show any abnormalities. From there I met with Jacob Jordan, M.D., a surgeon with Surgical Group of Naples. Like Dr. Liberski, he was wonderful, patient and calmly reassuring. And the preparation for the surgery wasn’t as bad—the same liquid diet but, rather than the TriLyte, I had to drink two 10-ounce bottles of magnesium citrate, each followed by eight ounces of water. I found the lesser volume much easier to bear, but Dr. Jordan told me the magnesium citrate provokes cramps in some people. Dr. Jordan had explained that he would perform the surgery through my anus, using long instruments to slice off a portion of the colon wall where the polyp had been found. The sample would immediately be sent to pathology. If no evidence of further cancer was found, that would be it. If, however, pathology indicated the cancer had grown through Naples Health |

JULY-SEPTEMBER 2011

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7KLVLVP\ KRVSLWDO -Lillian Love, MD, Oncologist practicing at NCH for 32 years.

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NCH wants to be your hospital. Call us at 436-5430. www.NCHmd.org

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Dial-a-NurseÂŽ

the layers of the colon, Dr. Jordan would have to make an abdominal incision to remove a cross-section of my colon. Fortunately, the pathology report came back clear. But everything wasnâ&#x20AC;&#x2122;t cut and dried. When Dr. Liberski had removed the polyp, she had marked the area with an India ink tattoo. By the time I had the surgery, the tattoo had disappeared and Dr. Jordan had to call Dr. Liberski from the operating room to double-check the location. â&#x20AC;&#x153;There was not much dye left, but there was a little scar,â&#x20AC;? Dr. Jordan reports. â&#x20AC;&#x153;The polyp appeared to be completely excised, but we werenâ&#x20AC;&#x2122;t completely satis-

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fied because the dye was gone. Usually, the dye will be there even two months later. But you have to get a specific layer for it to stay, and some people expel it more easily.â&#x20AC;? Because of the uncertainty, Drs. Jordan and Liberski suggested I undergo a flexible sigmoidoscopy (similar to a colonoscopy but only looking at the lower colon) in four to five months. I had that done just before Christmas, and the results were disheartening. My polyp had started to grow back. The general consensus was that, because of the missing tattoo, Dr. Jordan hadnâ&#x20AC;&#x2122;t been able to get exactly the right spot

The Katie Couric Effect Ten years ago, Katie Couric televised her own colonoscopy on the Today show. The program drew millions of viewersâ&#x20AC;&#x201D;and prompted a very interesting effect. In the year following the broadcast, 20 percent more Americans underwent colonoscopies. Researchers at the University of Michigan who tracked the numbers called it â&#x20AC;&#x153;the Couric effect,â&#x20AC;? and it was just the sort of result Couric had hoped for. Her husband, Jay Monahan, died of colon cancer in 1998 at the age of 42. He had been diagnosed just a year earlier. Even though he had had no symptoms, his cancer was so advanced that it took his life. Couric decided afterward that she needed to do something to help convince people to get tested early for this silent killer. Hence, her televised colonoscopy. That trend continued last year when Dr. Mehmet Oz, the health guru favored by Oprah Winfrey, decided that, since he was turning 50, he should walk the walk and have a screening colonoscopy. Dr. Oz is very much the poster guy for healthy living. Heâ&#x20AC;&#x2122;s physically fit, doesnâ&#x20AC;&#x2122;t smoke and eats a healthy diet. He also has no family history of colorectal cancer. Yet his colonoscopy revealed the presence of a pre-cancerous polyp.

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Dr. Oz was stunnedâ&#x20AC;&#x201D;but he decided to publicize his story widely, in hopes of creating a â&#x20AC;&#x153;Dr. Oz effectâ&#x20AC;? and convincing others to get screened. Heâ&#x20AC;&#x2122;s told his story in Time magazine, in the Huffington Post and to various other news organizations. Even Oprah responded that she was going to schedule her own colonoscopy because of his results. Celebrities often dominate the headlines with frivolous pursuits. Hereâ&#x20AC;&#x2122;s hoping that this trend toward celebrity colonoscopies serves a better purpose by raising awareness. The American Cancer Society estimates that only half of the Americans over 50 have had any colorectal cancer screening. This is a case where it pays to emulate the stars. Naples Health |

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6/3/11 12:25:46 PM


the first time. This time, the tattoo was clearly evident, so there was no doubt. And the pathology report showed that he had gotten all of the cancer and that it was still in situ (affecting only the topmost layers of cells).

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â&#x20AC;&#x153;Once a person turns 50, everyone should have a colonoscopy,â&#x20AC;? Dr. Jordan says. â&#x20AC;&#x153;Colon cancer is that prevalent. I do at least two colon surgeries every week, sometimes four or five a week in season. Colonoscopies are the most important screening tool. People are scared [of them] so they donâ&#x20AC;&#x2122;t get them. I see people all the time whose doctors have been trying to get them to have colonoscopies for years. When they finally do, they find they have advanced cancer. I see at least one case a month like that.â&#x20AC;?

A word to the wise Advanced colon cancer is something no one would choose to face. As Dr. Liberski points out, the five-year survival rate for early colon cancer is 95 percent. Once the cancer has metastasized to distant organs at the time of discovery, the five-year survival rate is only 5 percent. And the follow-up treatment for advanced cases is daunting. â&#x20AC;&#x153;It depends on the depth of penetration of the tumor,â&#x20AC;? Dr. Liberski says. â&#x20AC;&#x153;If the cancer has gone into the lymph nodes or surrounding area, thereâ&#x20AC;&#x2122;s definitely a need for more treatment. Sometimes, patients will need chemotherapy and radiation first, before surgery, to shrink the tumor.â&#x20AC;? If too large an area is affected, removal of the colon or small intestine may be necessary, and the patient will have to have a colostomy or ileostomy (attaching the colon or small intestine to an opening in the abdomen and adding a bag to collect wastes). Often the colostomy/ileostomy can be reversed once the patient has healed and regained strength, but sometimes they are permanent. There are no surefire ways to prevent colon cancer. Genetics appears to play Naples Health |

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We are proud to announce the NCH family has expanded. Introducing

It’s the same great care you’ve come to expect under a familiar name you’ve come to trust. Allergy & Immunology Steven A. Nguyen, MD Cardiology - Naples Heart Institute David Axline, MD, FACC Francis C. Boucek, MD, FACC Michael S. Flynn, MD, FACC, FSCAI Adam J. Frank, MD, FACC George A. Gamouras, MD, FACC Bruce A. Gelinas, MD, FACC Ronald L. Levine, MD, MS, FACC Tracey Roth, MD, FACC Alberto Rotsztain, MD, FACC Carlo Santos-Ocampo, MD, FACC Herman Spilker, MD, FACC David A. Stone, MD, FACC Silvio C. Travalia, MD, FACC Shona Velamakanni, MD, FACC James Venable III, MD, FACC Linda Cifani, ARNP Susan Gill, PA Daniel M. Moore, PA-C Annmarie Morrisseau, ARNP Bonnie Sealey, ARNP Family Medicine Cynthia S. Bell, MD Andrew M. Bernstein, DO Christian O. Beskow, MD Jennifer A. DiRocco, DO Richard S. Gould, MD Robert E. Hanson, MD Jesse H. Haven, MD Mark E. Josephson, MD Thomas Linberg, MD Ashley L. Tunkle, MD, FAAFP Jennifer Canmeld, ARNP-BC, MSN Jill M. Hefti, ARNP Angela B. Morales, PA-C Kearston Perfetto, ARNP

Gastroenterology & Hepatology Jan M. Barrios, MD Guy R. Winzenried, MD Beth Diamond, ARNP Geriatric Medicine Angel H. Herrera, MD Obayedur R. Khan, MD, FACP, CMD Courtney Chumbley, ARNP Hospitalist Medicine Carlos B. Quintero, MD Vladimira “Vladi” Valova, ARNP Infectious Diseases Gary A. Bergen, MD, FACP Vato Bochorishvili, MD Mark A. Brown, MD Internal Medicine George T. Crabb, DO, FACOI Mark R. Goldstein, MD, FACP Karen Henrichsen, DO Fritz F. Lemoine Jr., MD Mary Ann M. LoMonaco, MD Gary A. Parsons, MD David I. Sommerfeld, MD David C. White, MD, FACP Doreen Cassarino, ARNP Kelly Fennemore, ARNP Melanie Makar, ARNP Victoria Wadsworth, ARNP Orthopedic Surgery Jon S. Dounchis, MD Howard J. Kapp, MD Erik Benson, PA Gerard Fischer, PA

New patient appointments please call 436-2855

Pediatrics Reisha F. Brown, MD, FAAP Dulce V. Dudley, MD, FAAP Andrew P. Podos, MD, FAAP Gloria Ribas-Schultz, MD, FAAP Debra G. Shepard, MD, FAAP Todd Vedder, MD, FAAP Anne M. Bentley, ARNP-BC Physical Medicine & Rehabilitation Jackie Kawiecki, MD, MHA E. Sean Kelley, MD Pulmonary, Critical Care & Sleep Medicine Lawrence H. Albert, MD, FCCP Kenneth Bookman, MD, FCCP Howard L. Cohen, MD, FCCP Douglas Harrington, MD, FCCP Barry C. Hertz, MD, FCCP David H. Lindner, DO, FCCP Ismael Martin, DO, FCCP Christopher A. Mendello, MD, FCCP Bruce G. Roy, MD, FCCP, DASM Maria Ciferni, DNP, ACNP-BC Pamela Sans, ARNP Radiology Adam Fueredi, MD, FACR Daniel V. Tufariello, MD Stephen V. Veigh, DO Rheumatology Eric J. Hochman, MD Jay Bombero, PA Urgent Care Richard S. Gould, MD Karl Korri, MD Steven A. West, MD, FACEP Barbara Hulser, PA Lori Oswald, PA-C Michael Tanner, PA

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a role, as black people and Eastern European Jews both have higher incidences of the disease than the general population (although no one really knows why). A family history of colon cancer and inflammatory bowel disease also increase the risk. Smoking, excessive alcohol use, and eating too many red meats and processed meats and too little fiber may play a role, although those links aren’t certain. What is clear is that about one-third of Americans will develop polyps at some point, and the incidence increases substantially with age, starting at about 50. And the best way to find and treat

polyps and colon cancer is through regular colonoscopies. Because of my situation, Dr. Liberski is recommending I have a colonoscopy every year until I have a number of years with no further polyps. For those people of average risk with no polyps or cancers found at the initial colonoscopy, the recommended follow-up colonoscopy exams are every 10 years. This month, I’m due for my follow-up. I will, I’m sure, grumble and complain throughout my day of preparation. But I realize that’s a small price to pay to remain cancer-free. So don’t put off that colonoscopy. It could save your life. It did mine.

A virtual colonoscopy Those who have trouble getting past the thought of a colonoscopy can now opt for a “virtual colonoscopy.” This is a non-invasive computerized tomography (CT) scan that takes a series of detailed X-rays of the soft tissue in and around the colon. I ended up having a similar scan before my second surgery, to make sure that the re-growth of my polyp wasn’t caused by some underlying cancer. I had to refrain from eating that day and could only drink the two containers of contrasting liquid I had been given. Once I was at the lab, I had an IV inserted so more contrast could be pumped through my veins during the scan. I didn’t have to disrobe because clothing doesn’t get in the way, but I had to make sure I hadn’t worn pants with any metal zippers or buttons. The CT machine is like an abbreviated MRI, a short tube that the platform I was on slid in and out of. It was a pain-free experience but a bit uncomfortable. For me, the news was “virtual colonoscopy” good. The CT revealed no sample image suspicious masses or tumors in my colon and other organs. But the virtual colonoscopy isn’t always the best route to take.

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“It’s not a bad screening if you’re asymptomatic,” says Dr. Susan Liberski of Gastroenterology Group of Naples. “It’s good at finding bigger things but not so good at finding littler things. And you still need to do the [previous day] preparation, and you can’t remove any polyps that are found.” The news that the presence of a polyp found through a virtual colonoscopy would necessitate another round of preparation and a regular colonoscopy was enough to convince me to go straight to the standard procedure. But if the non-invasive version makes the difference between having or not having any procedure, opt for this one. It’s too important a matter to choose to do nothing. Naples Health |

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SOUNDS GOOD How to keep your voice in good shapeâ&#x20AC;&#x201D;and what to do if problems develop. Photograph by Erik Kellar

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Think about your voice. In following that instruction, chances are you’ll consider what your voice sounds like—its volume and clarity, whether it’s high, low or in between. But pondering beyond your voice’s individual characteristics can lead to a new level of appreciation for this ability that is so often taken for granted. That we can even make clear and sometimes beautiful sounds is a marvel. Speaking, singing, shouting, whispering—all these are possible only because of a wonderfully engineered biological system. That we value our vocal abilities is evident by how references to the voice have rooted firmly in our language: We voice our opinions and feelings; we elect politicians to represent the voice of the people. To give voice to those who are oppressed is to give them the first steps to freedom. And yet most of us rarely think about the wonder of our voices until a problem develops. When it comes to the human voice, we often don’t know what a good thing we have until it’s gone.

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“The voice is produced by the vocal folds, also called the vocal chords,” explains Susan O’Neill, a speech/language pathologist who serves as director of the speech therapy program at NCH Healthcare System. “The folds are pliable shelves of tissue that stretch along the throat, right behind the Adam’s apple. When they’re lightly touched [by air], they vibrate. The frequency of the vibration determines the pitch of the voice.”

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The process is similar to the way a reed instrument works. In a clarinet, air blown through the mouthpiece causes the reed to vibrate, resulting in a sound. Naples Health |

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The same thing happens when we force air through the larynx while simultaneously using the muscles in our throat and mouth to form words. In children, the larynx is small, and the vocal chords tend to be tighter. That means a smaller range of vibration and a higher voice. When we reach puberty, hormonal changes combine with physical growth to alter the size in the larynx and chords, and the voice becomes lower. The change is especially dramatic in boys, because their larynx usually grows larger than it does in girls. “Sometimes they [the boys] can’t keep up with how to use the longer muscles there, and that leads to their voices cracking,” O’Neill says. “But everyone typically adapts over time.”

The key is using the breath correctly— speaking from the diaphragm (as singers are taught) rather than from the throat. Voices usually remain relatively stable after puberty until we reach the “golden years,” when the vocal chords and surrounding muscles may start to change again. “As we get older, the muscles within a chord and on each side can get thinner,” says William Laskowski, M.D., an otolaryngologist with Naples Medical Center. “The muscles will get a little floppier, and you can get more of a space between them, in the middle of the larynx.” “The volume of the voice can decrease in both sexes,” adds O’Neill, “and some people will develop a little tremor. Even though that’s normal, there are ways to keep your voice in better shape 36

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if you’re unhappy with it or if it’s affecting your quality of life. You can go into a speech fitness program. The voice muscles will respond to exercise, just like any other muscles.” Such a program, O’Neill explains, entails meeting with a speech/language pathologist once to learn proper voice support and then continuing exercises (including such simple activities as singing or reading out loud) at home. The underlying key is using the breath correctly—speaking from the diaphragm (as actors and singers are taught to do) rather than from the throat. When done correctly, that pushes the breath from lower in the lungs, so volume can be increased without straining the voice box or vocal chords.

When things go wrong A year ago, National Public Radio broadcast the story of Julie Treible, who had lost her ability to speak following a cold that turned into bronchitis. Although Treible recovered from the bronchitis, her voice did not return. A series of throat scopes, CT scans, an MRI and visits to various specialists provided few clues and no relief. Finally, Treible consulted Claudio Milstein, a voice specialist, who massaged the muscles around her voice box while giving her simple sounds to repeat. Within a few minutes, Treible’s voice began to come back. Treible was diagnosed with functional dysphonia, a condition that occurs when the muscles controlling the vocal chords tighten up and lock. In her case, the muscles had effectively frozen the chords in an open position, so that air could get through but the chords couldn’t vibrate. “Functional dysphonia means there is no underlying abnormality,” Dr. Laskowski explains. “The cause could be stress or any number of things. There is also spasmodic dysphonia, which is more of a neurological problem. It’s a failure of the chords to relax. We use JULY-SEPTEMBER 2011

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The story of castrati

I

n 16th century Italy, a new type of singing voice became celebrated—that of the castrati. These were men who had been castrated before puberty, retaining their childish voices throughout their lives. By the 18th century, the fame of the castrati had spread throughout Europe, and they were highly regarded in the world of opera, even prompting the writing of specific pieces to show off their remarkable vocal talents.

have a range of three-and-a-half octaves and to be able to produce 250 notes in a single breath. He was able to hold notes for so long that many people believed he must have a special instrument hidden under his clothing. According to Wikipedia, more than 4,000 boys were castrated annually during the 1720s and 1730s, the height of castrati popularity. Only a handful developed into successful singers. Yet many poor parents would castrate their sons in hopes that his subsequent singing career would lift the family out of poverty.

Because of the castration, the boys’ voice boxes never enlarged. The lack of testosterone also meant that their bone joints didn’t harden in the normal manner, and their limbs and ribs often grew unusually long. Coupled with years of rigorous training, their physical characteristics allowed them exceptional lung power and a vocal range that could encompass a high male tenor and a female soprano. The sound of the castrati was much different than that of the falsettists, who merely sang in a stressed high voice.

The castrati—and the practice of creating them—began to fall from favor toward the end of the 18th century. But there are natural “castrati” singing today. Javier Medina, born in 1970 in Mexico City, suffered leukemia when he was eight. The disease and/or treatment disrupted the normal development of his larynx, leaving him with a voice that is pure and abnormally high. Similarly, the larynx of Jorge Cano from Bogota, Columbia, didn’t grow and mature as he passed through puberty.

One of the most famous castrati was Carlo Broschi (known as Farinelli), who lived from 1705–1782. He was reported to

Both men perform throughout the world, reviving interest in this forgotten art form.

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Botox to treat that, but the treatment only lasts three to four months.” In the NPR interview, Treible reported that not being able to speak took a definite toll on her. She had to give up her job at a local grocery store because customers couldn’t understand her, she had to communicate with her family by using a whiteboard, and she felt increasingly isolated from the society around her. That’s a scenario well appreciated by Brenda Charett Jensen, whose story was widely reported in the fall of 2010. Jensen had been speechless since 1999, when a breathing tube inserted during surgery permanently damaged her larynx. In October 2010, she received a larynx transplant—and recovered her ability to speak. Needless to say, she was thrilled to have her voice back. Jensen is the second person in the United States to receive such a transplant. The first was Tim Heidler, who injured his neck in a 1978 motorcycle accident. He received his larynx trans-

plant in 1998 and feels it is well worth having to take immune-suppressing (anti-rejection) medication for the rest of his life. “Try walking around for an hour and tape your mouth shut,” Heidler told CNN. “You’d be frustrated in 15 minutes. You can’t imagine it till it happens to you. You take your voice for granted, your life for granted.”

“When you’re screaming, you can slam your vocal chords together so hard that they get bruised.”

More typical problems Dr. Laskowski notes that larynx transplants are still a science very much in its infancy. But there are numerous other vocal problems that he and O’Neill encounter on a daily basis. “One of the most common ways to harm the voice is through overuse—screaming, shouting, that sort of thing,” he says. “That can lead to the development of nodules, callus-like growths.” Dr. Laskowski uses a video stroboscope to look at nodules. The instrument makes the chords appear to move in slow motion, so he can get an accurate picture of what’s happening. “The best treatment is therapy,” O’Neill adds. “You want to get all the muscles in balance and working together. It’s just like teaching someone to lift properly. Acute laryngitis is usually from a virus, but it can be caused by overuse, so you want to rest the chords. When you’re screaming, you can slam your vocal

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chords together so hard that they get bruised. Screaming can even cause a hemorrhage in the chords.” Whispering is no better than screaming. “It’s actually harder on the throat, because everything gets tighter,” Dr. Laskowski says. Surgery is not typically recommended for the treatment of nodules and can, in fact, lead to the development of scar tissue and subsequent problems. But surgery is sometimes necessary, particularly in cases of throat cancer or when polyps are found. “Women who smoke sometimes get polyps on their vocal chords,” Dr. Laskowski reports. “Those we sometimes remove. With throat cancer, if it’s found early enough we can remove it with a laser and radiation. And we can now pick up tiny, tiny cancers—as little as one millimeter across.” Acid reflux disease can also cause hoarseness problems, as can low-grade infections and viruses. In those cases, treatment begins by addressing the underlying illness. “When you get a virus, it can cause the tissues in the voice box to swell,” O’Neill explains. “You want to see a doctor if it’s a chronic condition, anything lasting three weeks for sure.” Continually clearing your throat takes a toll as well, because it slams the vocal chords together repeatedly. Smoking and fumes from strong cleaning products can also irritate the larynx and vocal chords. Irritants, acid reflux, stroke, aging and JULY-SEPTEMBER 2011

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“The esophagus can get less efficient at squeezing food down as we age. But therapy can help in as little as six weeks.” bad habits can sometimes lead to the development of swallowing problems. O’Neill estimates that 98 percent of her current practice concerns dealing with changes in swallowing. “That can be from a weakness in the throat muscles or the patient can become more prone to things going down the wrong way,” she says. “The esophagus can get less efficient at squeezing food down as we age. But if you’re cognitively intact and motivated, therapy can help really quickly—maybe in as little as six weeks.” The recommendations to keep your voice strong and functioning properly are fairly simple and straightforward. “Stop smoking. That solves a lot of problems,” Dr. Laskowski advises. “Treat any acid reflux. Don’t misuse your voice. If you have any change of voice for a couple of weeks, you should see someone. Have your larynx checked—and that doesn’t mean just looking at your throat. The doctor should use mirrors or small scopes.”

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Preddicting the future is allways a tricky businesss. Baby boom mers, for instannce, are sttill waiting for those individualized rockkett cars foretold in their youth. Yet sincee those baby boomers started being born,, we have admittedly seen advances harrdly imagined—tthe Interneet, cell phones able to play movies, sppacce shuttles maaking routine missions and minimally invasive lapparoscopic surgerry, to name just a few. So it’ss obvious thatt change does happen, offten in surprising, exponential ways. But when it comes to detailing the shape off that change, the crystal ball is often cloudy.

Thanks to new technology, doctors are learning to treat patients’ very particular needs.

That holds true in the world of medicine and healthcare, too. Advances in technology have been truly incredible over the past 50 years. MRIs and CT scans allow us to see inside the body and brain without making an incision. Diseases that once carried a death sentence can be kept in remission or even beaten. Diagnoses are more accurate and often made earlier, when treatment can be simpler and more effective. But have we reached the stage where medicine can be tailored to individual needs, as was predicted with the mapping of the human genome in 2001? “The future is here,” says Allen Weiss, CEO and president of NCH Healthcare System, “but it’s not evenly distributed. I think we may be in a time similar to when the Gutenberg printing press was just getting created.” The success of the Human Genome Project prompted grand visions for change and development in 21st century medicine. There was talk of being able to use the mapping of an individual’s genome to predict, in childhood or even in utero, what diseases that person was likely to develop later in life and how he/she would respond to specific drug treatments. One of the strongest voices for this changing face of healthcare has been Leroy Hood, a research biologist who

assisted in mapping the genome and who invented both an automatic DNA sequencer and an automated system for synthesizing DNA. Hood calls his new vision for healthcare “P4 medicine,” medicine that is predictive, personalized, preventive and participatory. “What’s driving this change are powerful new measurement technologies and the so-called systems approach to medicine,” Hood wrote in a 2009 Newsweek essay. “Whereas medical researchers in the past studied disease by analyzing the effects of one gene at a time, the systems approach will give them the ability to analyze all your genes at once.” That overall analysis is the predictive part of P4. The idea is that people who have genetic markers for the development of such diseases as type 1 diabetes or breast cancer could find out before any symptoms appeared and modify their behavior and environment to help keep that gene from turning on and triggering the disease. As more individuals have their genomes mapped, computer analysis of the collected data will allow physicians to see the molecular patterns for both healthy and ill states and spot potential problems in each patient (the personalized aspect). The amassed data will also allow the development of therapies to stop or even reverse disease and to assess how each patient will react to any 43

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drug (preventive). Finally, because of the highly individualized approach, patients will be transformed from passive recipients to active participants in maintaining their health (participatory). That’s the promise of P4 medicine. But, as Dr. Weiss points out, we’re not quite there yet. “We have to get the whole species mapped so that every gene is known, as is every variability,” he explains. “We’re not making as much progress as we thought we would. We’re still probably decades away from understanding how to do this.” Part of the problem is cost. Currently, it costs about $50,000 to map an individual genome completely. That cost is expected to fall as technology develops further—something we’ve all witnessed with computers and televisions. But as two geneticists from the Stanford University School of Medicine noted in a November 2010 article in Modern Healthcare, even if individual genomes

could be mapped for as little as $1,000, several more thousands of dollars would be needed for interpretation of the information. According to Craig Venter, who spearheaded the Human Genome Project, we also don’t yet have the computational infrastructure to compare the vast database of genomic information needed to make the information clinically useful. And then there is the issue of privacy: How would insurance companies or employers react to genetic information? What about the concerns of relatives of someone who agrees to undergo genetic testing? “This whole idea raises important ethical questions,” Dr. Weiss agrees. Still, there are advances that are happening around the periphery of P4 medicine that are improving healthcare for numbers of patients. Discovering (at least partially) the role of genes in cancer, for example, has led to a greater understanding of that disease.

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is a growth in the body, a tumor. But there are a lot of different things underlying the growth because of different gene types. The hope is that will lead to different treatments and treatments that are not as toxic.” Dr. Weiss points to the treatment of prostate cancer as one example. Years ago, surgical intervention or broad-range radiation were the only options, but both often left patients with incontinence and other problems. Nowadays, doctors can implant fiducial markers that allow for pinpoint radiation treatment, which carries a lesser risk of side effects or collateral damage. The hope is that similar types of targeted treatments can eventually take the place of such broad-based approaches as chemotherapy. “Chemotherapy is like using a machine gun to kill a mouse,” Dr. Weiss notes. “It works, but there’s a lot of damage all around. Changing a gene to halt the growth of a tumor would be like using a

high-powered rifle instead. Some chemotherapy is already disease-specific now, but that’s just the tip of the iceberg.” Technological advances can also be seen in the hospital rooms planned for NCH’s North Naples Hospital. These new “smart” rooms come equipped with flat-screen TVs that flash a picture, name and identification whenever a caregiver enters the room. They can also show educational videos pertinent to a patient’s condition (e.g. videos on diet for diabetes patients, ones on breast feeding for new mothers, etc.), as well as regular television programming. A second flat screen above the patient’s bed allows caregivers to access clinical data, including continuously downloaded information from intravenous smart pumps and vital sign monitors. Doctors and nurses will also be able to access the patient’s medical records in a secure manner, even when not on site. Meanwhile, Leroy Hood and his colleagues continue down the path to fully

integrated P4 medicine. In May 2010, his Institute for Systems Biology (ISB) entered into a two-year collaboration with Ohio State University. The university is providing a group of 55,000 insured employees and family members who can choose to enroll in clinical trials. ISB is contributing genetic and protein analysis of samples from those who participate. This “demonstration project” is being handled by the nonprofit P4 Medicine Institute Hood helped launch in 2009. Hood hopes that the partnership with OSU will be the tipping point that leads to the paradigm shift he calls P4. And while the future is always hard to describe while we’re still in the present, it’s safe to say that healthcare will change in myriad ways in the coming years. “Science fiction becomes reality,” Dr. Weiss notes. “We got off to a slower start than we thought in 2001. But now we may be underestimating what will happen in the next 50 years.”

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WELLNESS CENTER

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COMMUNITY BLOOD CENTER BLOOD DRIVES Donors can visit www.givebloodcbc.org or call 436-5455. For the most comprehensive and up-to-date information on fitness classes, call Briggs Wellness Center, Downtown, 436-6770; or Whitaker Wellness Center, North Naples, 596-9200; for more information and fees. www.nchmd.org/wellness

WOMEN’S AND CHILDREN’S EDUCATIONAL OFFERINGS

July 1–3; 11 a.m. to 6 p.m.† Hollywood 20 Cinemas, 6006 Hollywood Blvd., Naples July 6; 8:30 to 10:30 a.m. NCH Support Services, Central Campus, 2157 Pine Ridge Road, Naples • noon to 4 p.m. NCH North Naples Hospital, 11190 Healthpark Blvd., Naples • noon to 3 p.m.‡ NCH Downtown Hospital (Bloodmobile near Telford Center) 350 Seventh St. N., Naples July 7; 8:30 a.m. to 4:30 p.m. Marco Healthcare Center, 40 Heathwood Blvd., Marco Island ‡

July 9; 1 to 6 p.m.† Hollywood Theatres Coconut Point 16, 8021 Cinemas Way, Estero July 27; 8 to 11 a.m.‡ HMA Corporate Office, 5811 Pelican Bay Blvd., Naples

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July 23–24, 30–31; 11 a.m. to 6 p.m.† Hollywood 20 Cinemas, 6006 Hollywood Blvd., Naples †

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Aug. 4; 8:30 a.m. to 4:30 p.m.‡ Marco Healthcare Center, 40 Heathwood Blvd., Marco Island Aug. 11; 7:30 to 11 a.m. Collier County Development Services, 2800 Horseshoe Drive N., Naples • 7:30 a.m. to noon. Collier County Government Center, 3301 Tamiami

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september Childhood Cancer Month Leukemia & Lymphoma Awareness Month

COMMUNITY BLOOD CENTER BLOOD DRIVES Donors can visit www.givebloodcbc.org or call 436-5455. Sept. 1; 8:30 a.m. to 4:30 p.m.‡ Marco Healthcare Center, 40 Heathwood Blvd., Marco Island Sept. 2–5; 11 a.m. to 4 p.m.† Hollywood 20 Cinemas, 6006 Hollywood Blvd., Naples Sept. 6; 8:30 to 10:30 a.m. NCH Support Services, Central Campus, 2157 Pine Ridge Road, Naples • 3 to 7 p.m. NCH North Naples Hospital, 11190 Healthpark Blvd., Naples • 3 to 7 p.m.‡ NCH Downtown Hospital (Bloodmobile near Telford Center), 350 Seventh St. N., Naples Sept. 10; 1 to 6 p.m.† Hollywood Theatres Coconut Point 16, 8021 Cinemas Way, Estero Sept. 11; 10 a.m. to 3 p.m.‡ Waterside Shops (Bloodmobile adjacent to Barnes & Noble Booksellers), Pine Ridge Road and U.S. 41 Sept. 21; 8 to 11 a.m.‡ HMA Corporate Office, 5811 Pelican Bay Blvd., Naples

Naples Health |

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Up & Coming Sept. 24–25; 11 a.m. to 6 p.m.† Hollywood 20 Cinemas, 6006 Hollywood Blvd., Naples †

Indicates free movie ticket gift with successful donation. ‡

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days, 5 to 6 p.m. No meetings in July, August or December. Joan McInerney, 436-5000, ext. 2358 SPOHNC (support group for people with oral, head and neck cancer) Meets the first Wednesday of every month, 3 to 4:30 p.m., Briggs Rehab Conference Room 2. Karen Moss, 436-6712

every month DIABETES PROGRAMS

The Stroke Club Meets the second Tuesday of every month, 2 to 3:30 p.m., Telford Education Building. Rebeka DiMaria, 436-6361 Survivors & Friends Cancer Support Group Meets Tuesdays, 3 to 4 p.m., North Naples Hospital, Brookdale Center for Healthy Aging, Conference Room C. Therese Richmond, 552-7203

BE SURE NOT TO MISS…

Pre-Diabetes Seminar What is it, and could you be at risk? Join us for this free informational seminar on diabetes prevention at the von Arx Diabetes Center of Excellence. Registration required, 436-6755. Diabetes Self-Management Classes Call 436-6755 for available dates and times. Free 30-day Wellness membership and glucometer instruction. Fee covered by Medicare and most insurance plans.

NUTRITIONAL PROGRAM Lose to Win Weight Management Program Call 436-6755 for more information. Unique weekly group counseling sessions for achieving weight control. Weekly weigh-in. Weekly prize incentives.

NCH Hospital Ball 2011; Saturday, Oct. 29 at The Ritz-Carlton, Naples. Proceeds will fund the creation of 64 “smart rooms” at the North Naples campus. This investment in the future merges wireless technology and medical software to create a room designed for improving safety and efficiency in patient care. For more information, call 239-439-4511 or email foundation@nchmd.org.

SUPPORT GROUPS Amputee Support Program Meets the second Wednesday of every month, 2 to 3 p.m., Telford Building. Jennifer Shover, 436-6065 Healthy Lifestyles Support Learn how to improve your health and lifestyle at vonArx Diabetes and Nutrition Center. Different health topics each month. Call 436-6755. Healthy Lifestyle Adolescent Support Group Meets the second Tuesday of every month, 5 p.m., the von Arx Diabetes and Nutrition Center. Call 436-6755. Mended Hearts Group Meets the third Wednesday of every month, 4 to 5:30 p.m., Telford Building. No meetings in July or August. Orland Smith, 5911148 Naples SpeakEasy Aphasia Support Group Meets the first and third Thursday of every month from 3 to 4:30 p.m. at North Naples Methodist Church. Anne Loughridge, 436-6712 Ostomy Support Group Meets WednesJULY-SEPTEMBER 2011

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| Naples Health

NCH Spirit of Women: Girls Night Out; coming October 2011. Watch for details.

For a complimentary subscription, log on to www.nchmd.org/napleshealth.

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Looking Ahead What’s new and promising An at-home glaucoma test

T

wo million Americans, most over age 40, have glaucoma, an optic nerve disease that causes a gradual loss of peripheral or central vision. Usually related to unhealthy pressure inside the eye, the disease has such subtle early symptoms that people don’t realize they have it until they begin to lose their vision. Once they have been diagnosed, the progress of the disease is typically tracked through a two-second test administered by ophthalmologists three times a year. That could soon change with the development of a home glaucoma test that would allow patients to check their intraocular pressure several times a day, similar to how diabetics can test blood sugar levels on their own. As with diabetes, the increased testing would lead to better management of the disease. The home glaucoma test is a simpler, experimental version of one already in clinical use. Duke Eye Center patients have used the device successfully to check fluctuations in their glaucoma over an extended period, and researchers hope the test will soon be available to all glaucoma patients.

cardiologist) were about half as likely to die as patients who had only intermittent in-person assessments.

Re-growing “elastic” arteries University of Pittsburgh scientists made a giant leap forward in the quest to create living tissue replacements for damaged arteries by growing arteries with the highest level of elasticity yet reported. The scientists used smooth muscle cells from adult baboons to produce the first arteries grown outside the body that contain a substantial amount of the pliant protein elastin, which allows blood vessels to expand and contract. The muscle cells were seeded into rubber tubes chambered like honeycombs and then transferred to a bioreactor that pumped a nutrient solution. The process mimicked the human circulatory system. As the cells grew, they produced proteins that fused to form a vessel.

Implanted cardiac devices prove their “real world” worth An analysis of patients who had devices implanted to control heart rhythm and prevent sudden death shows the implants work well even outside the confines of a scientific study. The analysts looked at the outcomes of 186,000 patients who had received either an implantable cardioverter defibrillator (ICD), a cardiac resynchronization therapy device (CRT) or a defibrillator combined with CRT (CRT-D). Researchers determined that 92 percent of ICD patients survived one year after implantation, as did 88 percent of CRT-D patients. Five-year survival rates slipped to 68 percent and 54 percent, respectively. Those with CRT devices had a oneyear survival rate of 82 percent and a five-year survival of 48 percent, but the investigators attributed the poorer numbers to the patients’ older average age. The team also found that those whose implants were remotely monitored (a typically free service if recommended by the 48

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Subsequent tests showed the grown artery could withstand a pressure burst between 200 and 300 millimeters of mercury (mmHg). (Healthy human blood pressure is below 120 mmHg.) The next steps are to design a vessel that fully mimics the three-layer structure of a human artery, but the scientists are hopeful that someday soon the process can be used in humans to re-grow damaged blood vessels. Naples Health |

JULY-SEPTEMBER 2011

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Internationally Recognized Expert In

UROLOGIC CANCER AND ROBOTIC SURGERY “Our goal is to use technology, when appropriate, to help provide the best possible care, and to do so in a thoughtful and compassionate manner.”

David K. Ornstein, M.D. “Best Doctors in America” 2005-2010 Top Urologist by Consumer Research Council of America Decade of clinical and leadership experience at top ranked academic medical centers. TRAINING (COMPLETED IN 2000) t Harvard School of Public Health – Leadership Development for Physicians in Academic Health Centers t National Cancer Institute – Urologic Oncology Fellowship t American Cancer Society Clinical Oncology Fellowship t Washington University in St. Louis – Medical School & Urology Residency t University of Pennsylvania – Bachelor of Science CLINICAL EXPERIENCE t Pioneer in Robotic Surgery t Successfully completed over 700 robotic surgical procedures including radical prostatectomy, radical cystectomy with urinary diversion, total and partial nephrectomy, pelvic lymphadenectomy and ureteral reimplantation t Chief Division of Urologic Oncology, The University of California, Irvine t Medical Director Urologic Oncology and Robotic Surgery at Long Beach Memorial Medical Center t Assistant Professor, Dept. of Surgery, University of North Carolina, Chapel Hill t Published more than 75 medical and scientific articles on prostate cancer and robotic surgery t Lectured extensively and trained multiple surgeons in robotics nationally and internationally ACCEPTING NEW PATIENTS Offering care of urologic conditions with expertise in the following: t All urologic cancers including prostate, bladder, kidney ureteral and testicular cancer t Elevated PSA t All benign prostate problems including BPH and prostatitis t Hematuria t Renal mass t Hydronephrosis

Offices in Naples and Bonita Springs (239) 403-9503

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Your Husband? Your Dad? Your Brother? Your Experts. Our Team. It has been written by some in the medical field that 30â&#x20AC;&#x201C;50% of prostate cancers may be insignificant. This is easy to say when it is not you or one of your loved ones. Knowing which 30â&#x20AC;&#x201C;50% this applies to is not necessarily simple when we still lose nearly 40,000 men each year to this disease. The board certified physicians at Specialists in Urology have diagnosed and treated tens of thousands of cases of prostate cancer. Whether it is watchful waiting with close follow-up or one of many different treatment options, our team is equipped with the experience, technology and vision to treat each patient as though he is one of our own family members. Simply put, our team members are your experts.

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(239) 434-6300

www.SpecialistsInUrology.com

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Naples Health