Advances | Tampa General Hospital | Fall/Winter 2021 (West Coast)

ADVANCES THE ACADEMIC DIFFERENCE

LEADING THE INDUSTRY

IN TECHNOLOGY, CUTTING-EDGE TREATMENTS, AND COMPLEX CARE 000_COVER_TGH.indd 29

11/18/21 10:07 AM

Spread.indd 1

11/18/21 4:57 PM

Spread.indd 2

11/18/21 4:57 PM

Dress Dress - Dolce - Dolce & Gabbana & Gabbana (available (available at at Neiman Neiman Marcus) Marcus) | Sunglasses | Sunglasses - Gucci - Gucci

e u n e v a worth starts here

AKRIS • ALTONA • AMINA RUBINACCI • ANNE FONTAINE • BADGLEY MISCHKA • BRADFORD PORTRAITS CHRISTOFLE • COJIMAR PALM BEACH • EDWARD BEINER EYEWEAR • EMILIO PUCCI • GUCCI • HUBLOT • SAKS FIFTH • AKRIS � HUBLOT • PROVIDENT • SAKS LOUIS VUITTON SEEKERS INTERNATIONAL FIFTH AVENUE GUCCI � LOUIS VUITTON � NEST AVENUE � EMILIO PUCCI � PANERAI � LAUNCHJEWELRY PAD � HOUSE OF LAVANDE � HAI HOUSE • • • STARBUCKS TAMARA COMOLLI FINE JEWELRY UNSUBSCRIBED WOODY MICHLEB BEAUTY SALON GUCCI � LOUIS VUITTON � SAKS FIFTH AVENUE � EMILIO PUCCI � AKRIS � HUBLOT � LAUNCH PAD � HOUSE OF LAVANDE � HAI HOUSE WORTH AVENUE YACHTS • WYNN FINE ART 150 WORTH AVENUE | ESPLANADEPALMBEACH.COM 150 WORTH AVENUE | ESPLANADEPALMBEACH.COM

150 WORTH AVENUE | ESPLANADEPALMBEACH.COM | COMPLIMENTARY VALET PARKING

ESPLPBI0122.indd 1

11/24/21 12:00 PM

I N N O VAT I V E S E R V I C E L I N E S

MEET OUR LEADERSHIP To learn more about our institutes, visit TGH.org

TGH Children’s Hospital Patricia J. Emmanuel, MD Medical Director, TGH Children’s Hospital

Professor and Chair, Department of Pediatrics, USF Health Morsani College of Medicine

TGH Neurosciences Institute Clifton L. Gooch, MD

Medical Director, Neurology, TGH Neurosciences Institute

TGH Urology Institute Raviender Bukkapatnam, MD Medical Director, TGH Urology Institute President, Florida Urology Partners

Rafael Carrion, MD

Medical Director, TGH Urology Institute Professor and Chair, Department of Urology, USF Health Morsani College of Medicine

Vice President, Clinical & Translational Research, TGH-USF Health Joint Office of Clinical Research Professor & Chair, Department of Neurology, USF Health Morsani College of Medicine

TGH Ear, Nose & Throat Institute

Harry van Loveren, MD

Tapan A. Padhya, MD

Professor & Chair, Department of Neurosurgery and Brain Repair,

Professor & Chair, Division of Head & Neck Oncology,

USF Health Morsani College of Medicine

USF Health Morsani College of Medicine

Medical Director, Neurosurgery, TGH Neurosciences Institute

TGH Cancer Institute Abraham Schwarzberg, MD Senior Vice President, Network Development Chief of Oncology, TGH Cancer Institute Vice President, Clinical Trials & Translational Research, TGH-USF Health Joint Office of Clinical Research

Eduardo Sotomayor, MD Director, TGH Cancer Institute

Medical Director, TGH Ear, Nose & Throat Institute

TGH Women’s Institute Judette Louis, MD, MPH Medical Director, TGH Women’s Institute

Professor and Chair, Department of Obstetrics and Gynecology, USF Health Morsani College of Medicine

TGH Orthopedics Institute Roy Sanders, MD

Medical Director, TGH Orthopedics Institute President, Florida Orthopaedic Institute

TGH Transplant Institute Kiran Dhanireddy, MD, FACS

Executive Director and Liver Transplantation Surgical Director, TGH Transplant Institute

Professor & Chair, USF Health Department of Orthopaedic Surgery

TGH Global Emerging Diseases Institute Seetha Lakshmi, MD

Medical Director, TGH Global Emerging Diseases Institute Assistant Professor, Division of Infectious Disease and

TGH Heart & Vascular Institute Guilherme Oliveira, MD, MBA Executive Director, TGH Heart & Vascular Institute

Professor and Chief, Division of Cardiovascular Sciences, USF Health Morsani College of Medicine

International Medicine, USF Health Morsani College of Medicine

Radiology & Imaging Krishna Nallamshetty, MD Chief of Staff, Tampa General Hospital

Associate Professor of Radiology & Cardiology,

Community & Corporate Wellness Daron Diecidue, MD

USF Health Morsani College of Medicine President, Radiology Associates of Florida

Bruce Zwiebel, MD

Member, TGH Board of Directors

Medical Director, Community & Corporate Wellness

Professor and Vice Chair of Clinical Affairs,

CEO, TGH Urgent Care Powered by Fast Track

USF Health Morsani College of Medicine Director, Radiology Associates of Florida

Full Page.indd 1

11/18/21 11:10 AM

FA L L / W I N T E R 2 0 2 1

CONTENTS

Departments FORWARD

WELL-BEING 64 HEALTHY AT HOME Five delectable recipes to fuel your day

10 THE FUTURE OF HEALTH CARE Q&A with John Couris

70 FLORIDA FINDS Sunshine State–based products for wellness

14 ADVANCING CANCER TREATMENT Tampa General is at the forefront of personalized immunotherapy treatment and research

Features

18 INTERMITTENT FASTING: FAD OR FRUITFUL? The benefits of restricting when you eat

30 FIGHTING CURRENT AND FUTURE PANDEMICS The Global Emerging Diseases Institute is battling COVID-19 and researching new health threats

22 NATURAL HEALING Integrative medicine techniques support recuperation and wellness 24 TAMPA BAY’S NEW WORLD-CLASS MEDICAL DISTRICT Find out about downtown Tampa’s growing medical district anchored by TGH

36 ATTITUDE OF GRATITUDE Focusing on the positive and practicing gratitude can be healing 38 WHEN COVID-19 STRIKES Stuart and Karessa Lasher give back after receiving top-notch care

40 TAKING ON THE CHALLENGE Go behind the scenes of West Florida’s first successful combined heart and liver transplant 44 HIGHLY LOGICAL Futuristic advances in neurosurgery enable TGH to tackle complex challenges in brain surgery 50 WHEN PARATHYROID GLANDS MALFUNCTION Tiny glands can cause big health problems 54 PAVING THE WAY TGH is redefining orthopedic surgery with robotic tools, next-gen prostheses, and 3D printing 58 ALLIANCE ELEVATES HOSPITAL AND UNIVERSITY USF and TGH collaboration means more access to research and novel treatments

ON THE COVER: Ashley Cox, a certified surgical technologist, photographed by Daniel Wallace at Tampa General Hospital

4

ADVANCES

004_TOC2_TGH.indd 4

11/22/21 3:02 PM

The new Bentayga Speed.

The Ultimate Bentayga.

Discover more at 2801 Okeechobee Boulevard, West Palm Beach or contact Bentley Palm Beach by calling us at 561-257-4833 or visiting BramanBentleyPalmBeach.com The name ‘Bentley’ and the ‘B’ in wings device are registered trademarks. © 2021 Bentley Motors, Inc. Model shown: Flying Spur.

Full Page.indd 1

BENTLEY PALM BEACH

A Braman Motorcars dealership

10/27/21 12:07 PM

1 Tampa General Circle Tampa, FL 33606 813.844.7000 • TGH.org

John Couris, President and CEO, Tampa General Hospital

BOARD OF DIRECTORS Phillip S. Dingle, Chairman of the Board Marylou Y. Bailey Jeffrey W. Bak

Thomas L. Bernasek, M.D. Raviender Bukkapatnam, M.D. Blake J. Casper Gregory J. Celestan

Drew Graham Patricia Jurinski Les Muma Krishna Nallamshetty, M.D.

Corey Neil Kathleen Shanahan John T. Touchton, Jr. Bruce Zwiebel, M.D.

EXECUTIVE LEADERSHIP TEAM Scott Arnold, Executive Vice President & Chief Information and Innovation Officer Stacey Brandt, Executive Vice President & Chief Strategy and Marketing Officer Kelly Cullen, Executive Vice President & Chief Operations Officer Jennifer Crabtree, Administrative Chief of Staff, Office of President & CEO Robin DeLaVergne, Senior Vice President, External Affairs Peggy Duggan, M.D., Executive Vice President & Chief Medical Officer Rachel Feinman, Vice President of Innovation & Managing Director, TGH InnoVentures Qualenta Kivett, Executive Vice President, Chief People and Talent Officer Jim Kennedy, General Counsel Stepanie Kuhn, Senior Executive Assistant to the CEO Charles “Charly” J. Lockwood, M.D., Executive Vice President, Chief Academic Officer, Tampa General Hospital; Senior Vice President, USF Health, Dean, Morsani College of Medicine

Frann Richards, Senior Vice President & Chief Development Officer, TGH Foundation Mark Runyon, Executive Vice President & Chief Financial Officer Abe Schwarzberg, M.D., Chief of Oncology & Senior Vice President, Network Development Steve Short, Special Advisor to the CEO Adam Smith, Executive Vice President, Ambulatory Services

SHARED PURPOSE We heal. We teach. We innovate.

Care for everyone. Every day.

6

VISION We will become the safest and most innovative academic health system in America.

ADVANCES

006_MASTHEAD2_TGH.indd 6

11/18/21 10:18 AM

tgh_46791_01_Best_Hospital_ad_9x10p875_M.indd 1 Full Page.indd 1

11/12/21 6:00 AM 11/18/21 11:11 AM

THE ACADEMIC DIFFERENCE Publisher Terry Duffy Editorial Director Daphne Nikolopoulos Editor Cathy Chestnut Executive Editor Mary Murray Creative Director Olga M. Gustine CONTRIBUTING EDITORS Stacey Brandt, Lisa Greene, Jennifer McVan, Laurie Slater CONTRIBUTING WRITERS Eric Barton, Karen Feldman, Sandra Gurvis, Erika Klein, Michele Meyer, Dave Scheiber, Liza Grant Smith, Seth Soffian CONTRIBUTING PHOTOGRAPHERS Alyssa Dragun, Cara DeHart Lewis, Emily Panakos, Daniel Wallace DIGITAL IMAGING SPECIALIST George Davis ADVERTISING Publisher, Naples Kaleigh Grover Advertising Manager Dina Turner Associate Publisher Deidre Wade Account Managers Kathleen Beuttel, Melissa Zolin Schwartz, Meegan Wyatt Marketing Manager Christopher Link Advertising Services Coordinator Emily Hauser PRODUCTION Production Director Selene M. Ceballo Production Manager Kayla Earle Digital Pre-Press Specialist George Davis Advertising Design Coordinators Anaely J. Perez Vargas, Jeffrey Rey Web Editor Abigail Duffy

OPERATIONS Chief Operating Officer Todd Schmidt Office Manager Andrea Berumen Circulation/Subscriptions Administrator Marjorie Leiva Distribution Manager Judy Heflin Accounting Specialists Mary Beth Cook, Lourdes Linares Accounts Receivable Specialist Ana Coronel

In Memoriam Ronald J. Woods (1935-2013) HOUR MEDIA, LLC CEO Stefan Wanczyk President John Balardo PUBLISHERS OF: Palm Beach Illustrated • Naples Illustrated • Fort Lauderdale Illustrated • Orlando Illustrated Palm Beach Charity Register • Naples Charity Register • Florida Design • Florida Design Naples • Florida Design Miami • Florida Design Sourcebook Palm Beach Relocation Guide • Southwest Florida Relocation Guide • Fifth Avenue South • The Jewel of Palm Beach: The Mar-a-Lago Club Traditions: The Breakers • Palm Beach 100 • Naples 100 • Art & Culture: Cultural Council for Palm Beach County Pinnacle: Jupiter Medical Center Foundation • Waypoints: Naples Yacht Club • Naples on the Gulf: Naples Chamber of Commerce Jupiter • Stuart • Aventura • Community Foundation of Collier County Community Report • Advances: Tampa General Hospital Published by Palm Beach Media Group North P.O. Box 3344, Palm Beach, FL 33480 Telephone: 561.659.0210 • Fax: 561.659.1736 www.palmbeachmedia.com Copyright 2022 Palm Beach Media Group North Inc. All rights reserved.

8

ADVANCES

006_MASTHEAD2_TGH.indd 8

11/19/21 9:57 AM

TAMPA GENERAL HOSPITAL LAUNCHES HISTORIC EXPANSION WITH $550 MILLION INVESTMENT One of the nation’s best hospitals and one of Florida’s leading academic medical centers, Tampa General Hospital has launched the largest expansion in its history. The expansion will deliver the transformation needed to continue providing Florida’s growing community with world-class care.

“The expansion is an investment in our patients, team members and physicians,” said John Couris, president and CEO of Tampa General Hospital. “It’s a key part of our efforts to improve the lives and health of Floridians through continued innovation, expansion and upgrades.”

Other hospitals practice medicine. We define it.

Full Page.indd 1

TGH.org/MFP

11/18/21 11:12 AM

FORWARD

THE FUTURE OF HEALTH CARE Q&A with Tampa General Hospital President and CEO JOHN COURIS

BY CATHY CHESTNUT

10

John Couris is the president and CEO of Tampa General Hospital, a nationally recognized, not-forprofit, academic, and research health system partnered with the University of South Florida.

As a visionary leader, Couris has had continued success in building health care systems throughout the country by driving innovation, operational excellence, cutting-edge patient care, and strategic collaborations. He is best known for creating an organizational culture that thrives on authenticity, kindness, vulnerability, and transparency. Couris believes that focusing on his team’s well-being drives positive experiences for health care consumers.

Since taking the helm of Tampa General in 2017, Couris has championed innovation. Under his leadership, Tampa General was the first health care provider in Florida to partner with GE Healthcare to launch CareComm, a care coordination center using artificial intelligence, predictive analytics, and industrial engineering to improve safety, quality, and cost. In 2021, Couris launched Tampa General Hospital Innoventures, a venture capital fund dedicated to driving a culture of innovation within the organization, supporting early-stage startups and direct investments. Additionally, and under Couris’ leadership, Tampa General recently opened the Global Emerging Diseases Institute, a new facility and the first of its kind in Florida devoted to clinical care, research, and education for emerging infectious diseases. Couris has led Tampa General and the community through the pandemic, collaborating with hospital systems statewide to improve health outcomes related to COVID-19.

Couris is now leading a $550 million master facilities plan, the largest in Tampa General’s history.

Before joining Tampa General, Couris was

president and CEO of Jupiter Medical Center for eight years. He began his career at Massachusetts General Hospital, one of the nation’s premier academic medical centers.

Couris is active in numerous industry, community, and philanthropic activities and organizations.

Couris is also the recipient of multiple awards, including being named to Florida Trend’s “Florida 500” list of most influential business leaders in the state and Florida Politics’ “Influence 100” list of most influential people in Florida politics.

Q. What are the greatest challenges in health care today at TGH? A. COVID. It’s not going away. What’s going to happen is that the variants are going to change beyond the Delta variant. There are several others out there circulating, and some will weaken the virus and others will be stronger. We must focus on this infectious disease that’s killing people. This is our new normal, and we are learning how to coexist with it. We need to protect the most vulnerable in our society—that’s something we’ll have to continue to do. It’s not insurmountable. We’ll get through it.

Q. How did 2020’s challenges influence 2021’s innovations in health care and how are they being implemented at Tampa General?

A. At Tampa General, we’re innovating all the time. We are doing genetic sequencing for COVID-19 cases, and very few hospitals do that. We were one of the first in Florida to vaccinate a nurse.

We have more than 75 COVID clinical trials in progress that are either active or completed. Innovation is at our core and during COVID, it is no different.

ADVANCES

010_FOB JOHN COURIS_TGH.indd 10

11/17/21 3:40 PM

Q. And you recently opened the Global Emerging Diseases Institute?

A. This is an 80,000-square-foot facility with three legs: inpatient and outpatient clinical care, academics and teaching, and global research. As many of us know, COVID-19 can be deadly, but TGH is leaning into the problem, not running.

We’re adapting and improvising.

Q. Explain your vision for expanding Tampa General’s network to Palm Beach and Martin counties?

A. We take care of rare and complex cases.

People are referred to us every day. In fact, we get 5,000 transfers on an annual basis, and our helicopters travel to 30 counties. We’re Florida’s hospital and would like to enhance what community hospitals offer. We don’t want to compete with them—we want the rare and complex cases sent to TGH, so people don’t have to leave the state.

Q. TGH is expanding its footprint and medical services in the Tampa region and on the East Coast. Do you have any other long-range plans on the drawing board?

A. We’re going to continue to expand. We just borrowed $550 million for reinvestments. We’re updating the infrastructure at our main facility, adding more beds—we will be close to 1,200— and expanding our ambulatory footprint with more convenient care. We want to provide worldclass outpatient care at lower, affordable prices for the consumer. And we’re doing it in a transparent way. You can go online to our website today and find the cost for 300 to 400 procedures with just a few clicks. Quality of care and accessibility drive better outcomes, and if you can do it at a lower cost, that’s what the consumer deserves.

010_FOB JOHN COURIS_TGH.indd 11

AT TAMPA GENERAL, WE’RE INNOVATING ALL THE TIME…WE HAVE MORE THAN 75 COVID CLINICAL TRIALS IN PROGRESS THAT ARE EITHER ACTIVE OR COMPLETED. INNOVATION IS AT OUR CORE AND DURING COVID, IT IS NO DIFFERENT.”

ADVANCES

11

11/17/21 3:40 PM

     FifthAvenueSouth.com

Full Page.indd 1

11/19/21 11:24 AM

tgh_46791_04_Onocology_ad_9x10p875_M.indd 1 Full Page.indd 1

11/12/21 6:35 AM 11/18/21 11:13 AM

FORWARD

ADVANCING CANCER TREATMENT

The Tampa General Hospital Cancer Institute is at the forefront of personalized immunotherapy treatment and research

BY SETH SOFFIAN

14

No two people are the same, so no two cancers are the same. At the esteemed Tampa General Hospital Cancer Institute, led by world-renowned oncologist Dr. Eduardo M. Sotomayor, a heavy emphasis on personalized cancer treatment includes taking advantage of the important progress in the growing field and the application of immunotherapy, which holds out more than just great promise in oncology.

Born decades ago from an elegantly simple idea—to use the body’s immune system rather than foreign substances to fight cancer— immunotherapy has achieved extraordinary results with some cancers, even those in advanced stages.

“It’s been a game changer,” said Dr. Abraham B. Schwarzberg, senior vice president and chief of Oncology and Network Development at Tampa General Hospital, recognized in the

top 10 percent in the nation for cancer care by U.S. News & World Report for 2021-22. “It’s allowed the body to fight the cancer as if it’s an infection. We have patients now where their cancers basically melt away, and very often, if it works the way it’s supposed to, they can have the cancer either not come back for years or not come back at all. It’s completely changed the conversation.”

Immunotherapy, a broad term that includes a range of treatments at the cellular level, is hardly a magic cure-all. Its success rates vary with different types of cancers. And revving up the body’s powerful immune response—through treatments delivered intravenously, orally, topically, or in other customary fashions—can have significant side effects as well. It is not yet as widely used as surgery, chemotherapy, or radiation therapy, according to the National Cancer

ADVANCES

014_FOB IMMUNOTHERAPY2_TGH.indd 14

11/18/21 1:54 PM

Dr. Abraham B. Schwarzberg

Dr. Eduardo M. Sotomayor

Institute. But Schwarzberg is among those who have seen its benefits firsthand. He was only 12 when Dr. Steven A. Rosenberg, a pioneer in the development of immunotherapies and now chief of the surgical branch at the National Cancer Institute, treated Schwarzberg’s grandmother with immunotherapy, causing her advanced kidney cancer to go into remission.

“If you can get either your body or [immunotherapy] treatments to very specifically target tumors and allow your body to recognize the tumor in a way that it’s foreign or looks foreign, you’ll be able to fight off that cancer just like you fight off a pneumonia,” said Schwarzberg, who went on to study with Rosenberg. “That principle makes a ton of sense. And it’s really hard to do.”

Schwarzberg points to extraordinary turnarounds in the treatment of melanoma. Where options once were negligible when it came to

014_FOB IMMUNOTHERAPY2_TGH.indd 15

treating those with advanced stages of the skin cancer—as low as around 5 percent, he said— patients with advanced melanoma receiving immunotherapy today have favorable outcomes as high as 75 percent.

One case at TGH involved injections into about 30 “little pebbles” of melanoma on a patient’s arm that were too small to be removed surgically. “It basically generates such a robust immune reaction that the immune system then targets those little pebbles,” said Schwarzberg, who has been recognized by Harvard Medical School and Tufts University with Excellence in Teaching Awards. “It can come and wipe out the cancer.”

TGH is constructing a Phase I clinical trial unit that may open in early 2022. This follows the recent acquisition of the Palm Beach County–based Cancer Center of South Florida,

which Schwarzberg founded in 2008, to expand services on both Florida coasts. These moves are part of TGH’s commitment to providing patients the very best in integrated, highly personalized cancer care.

A diagnostic protocol that includes a molecular analysis of a patient’s suitability for immunotherapy or participation in a clinical trial “allows us to keep pushing the treatments to be more effective,” said Schwarzberg. Best of all, these cutting-edge treatments are close to home. “All of these things make a big difference. It’s part of being integrated into an ecosystem that has that skill set, knowledge base, and infrastructure. In cancer care, you need a lot of infrastructure to take care of a patient. Cancer patients have a lot that they deal with. I’m really proud to be part of a wonderful team. It takes all of us collaborating together.”

ADVANCES

15

11/18/21 1:54 PM

SHARE IN THE SPLENDOR OF THE FLORIDA KEYS AT

Offering luxurious waterfront three-story villas and one-bedroom suites, The Islands of Islamorada is designed for those who love the beauty and bounty of the ocean. Spend meaningful time in this natural haven, and relax in privacy among family and friends who share an affinity for an active and meaningful lifestyle.

The resort features dedicated on-site concierges, a private marina, two pools, jacuzzi, pickleball courts, in-villa spa services, fitness center, large sandy beach and a plethora of water activities. The Islands of Islamorada is the perfect place to both relax and recreate, experiencing the blissful island life the Florida Keys has to offer.

82779 OLD HWY, ISLAMORADA, FL 33036 | 786.233.8572 | INFO@THEISLANDSOFISLAMORADA.COM

PROMOTION

Full Page.indd 1

10/28/21 11:33 AM

110 Y E A R S I N T H E PA L M B E AC H E S

Enjoy Our Celebrated January White Sale

L inens

for

B ed , B ath & t aBLe | G ifts | Yacht | M onoGraMMinG | B espoke

210 CLEMATIS STREET, WEST PALM BEACH, FL. | 561.655.8553 | COMPLIMENTARY PARKING | WWW.PIONEERLINENS.COM

*some exclusions may apply

PBI NEW-2.indd 2

11/22/21 5:32 PM

Full Page.indd 1

11/23/21 7:47 AM

FORWARD

INTERMITTENT FASTING:

Fad or Fruitful?

18

ADVANCES

018_FOB_FASTING_TGH.indd 18

11/17/21 3:41 PM

DOES RESTRICTING WHEN YOU EAT HELP YOU LOSE WEIGHT?

BY CATHY CHESTNUT Intermittent fasting has become one of the most popular health trends of the last five years. It may even be one of the tools in your wellness toolbox.

Proponents of this weight-loss trend claim it burns fat, reduces fat storage, and prompts other health benefits.

However, to call it intermittent fasting isn’t the most appropriate description.

Establishing an eating pattern that incorporates a span of time when food is not consumed in a 24-hour period is more accurately called time-restricted feeding, according to both Dr. Lindsay Michelle Wiles, an obesity medicine physician at Tampa General Hospital + USF Health Bariatric Center, and her colleague, Amanda L. Musin, a TGH registered and licensed dietitian nutritionist.

Intermittent fasting has been practiced for thousands of years for religious purposes—in the form of a 24-hour fast before feasting or periodic diet restrictions—before returning to a typical, daily diet. But your diet, simply put, is the food and drink you regularly consume each day.

Therefore, if you are mindfully practicing a time-restricted diet, it’s part of your daily—not annual or occasional—regimen. “It’s truly just a restriction of when you’re consuming food,” Musin said.

Time-restricted eating is popular for weight loss. It’s been proven to break down fat and reduce fat storage and caloric intake. It’s linked to other benefits including blood pressure and blood sugar control, improved energy levels, lowered triglycerides, and insulin resistance. It is also believed to promote better sleep and improve circadian function (your daily sleep and wakefulness cycle). It may even reduce inflammation throughout the body Claims of wider benefits need more scientific study— currently underway—to better understand how an established eating pattern impacts hormones and other complex internal factors, Wiles said. “There’s been a lack of evidence-based studies to fully understand the underlying

018_FOB_FASTING_TGH.indd 19

science, but I think over time, studies will show more benefit for metabolic health and inflammation,” Wiles sai Many people already practice some form of timerestricted eating without even knowing it. If you don’t snack after dinner and sleep eight hours before tackling breakfast, you already are. “It’s a healthy nutritional plan.

I think we all benefit from fasting overnight for 12 hours,” said Wiles. “As our day goes longer and longer, we graze throughout the day, and eat later and later.”

The most common approach to a time-restricted diet is a 12- or 16-hour period of fasting and a 12- or 8-hour window for eating each day. Obese patients who are mindfully attempting a time-restricted diet for the first time may fast for only six hours. “My patients are specifically trying to lose weight. We start where they are at,” said Wiles. “If we hit a plateau, adjusting the fasting time is a good way to change it up.”

Timing and duration matter. “The smaller the window for eating, the less sustainable,” Wiles explained. “I tell my patients if they are choosing a six- or eight-hour time frame for eating, it will be more beneficial if they do it earlier in the day. And be sure you are consuming fluids—at least 64 ounces in a 24-hour period. That’s important.”

No matter how it’s structured, intentionally timing meals teaches people to focus on the quality of the sustenance they are fueling up on. It also helps regulate the daily circadian cycle because calories are being used to provide energy when you’re active during the day, rather being stored, unused, at night, Musin noted.

“Most people have almost constant access to food. Even in food deserts [areas where healthy food options are sparse], there’s fast food on every corner,” said Musin. “It is interesting to see how our bodies are metabolically responding. We’re living in this world of excess and the body doesn’t know how to work with that. We need to eat less and move more.”

ADVANCES

19

11/17/21 3:41 PM

VISIONARY DESIGN | EXPANSIVE RESIDENCES | IMPECCABLE STYLE

NEW DIMENSIONS IN PALM BEACH LIVING 24 Floors Featuring Half- and Full-Floor Luxury Residences From $6.7 Million

SALES PRESENTATIONS BY APPOINTMENT 1217 SOUTH FLAGLER DRIVE | WEST PALM BEACH, FL 33401 FORTEWPB.COM | 561.903.4702

ORAL REPRESENTATIONS CANNOT BE RELIED UPON AS CORRECTLY STATING REPRESENTATIONS OF THE SELLER. FOR CORRECT REPRESENTATIONS, MAKE REFERENCE TO THE DOCUMENTS REQUIRED BY SECTION 718.503, FLORIDA STATUTES, TO BE FURNISHED BY A SELLER TO A BUYER OR LESSEE.

This project is being developed by Flagler Residential LLC, a Delaware limited liability company, which was formed solely for such purpose. Two Roads Development LLC, a Florida limited liability company (“Two Roads”), is affiliated with this entity, but is not the developer of this project. This condominium is being developed by Flagler Residential LLC, a Delaware limited liability company (“Developer”), which has a limited right to use the trademarked names and logos of Two Roads pursuant to a license and marketing agreement with Two Roads. Any and all statements, disclosures, and/or representations shall be deemed made by Developer and not by Two Roads and you agree to look solely to Developer (and not to Two Roads and/or any of its affiliates) with respect to any and all matters relating to the marketing and/or development of the Condominium and with respect to the sales of units in the Condominium.

Full Page.indd 1

11/23/21 7:52 AM

Full Page.indd 1

11/18/21 11:16 AM

FORWARD

Natural

Healing Mindfulness, music, and other integrative medicine techniques support recuperation and general wellness

BY ERIKA KLEIN

Dr. Tanuja Sharma, medical director of the Integrative Medicine and Arts Program at Tampa General Hospital, demonstrates how to perform acupuncture.

A

young woman with Crohn’s disease and abdominal pain was healing after a recent surgery at Tampa General Hospital, but constant pain prevented her from going home.

“The patient’s medical issues and surgery had already been completed and managed.

There was nothing else keeping her in the hospital except her uncontrolled pain,” recalled Dr. Tanuja Sharma, a family medicine physician and medical director of the Integrative Medicine and Arts Program at Tampa General Hospital. “The medical team was just trying to get her pain under control.”

After the patient went weeks without im-

22

provement, Sharma was consulted to attempt an integrative medicine approach to improve the patient’s pain, which was not being well controlled through medication. When she arrived, the woman’s pain was a 10 out of 10.

Sharma walked her through a mindfulness exercise combined with guided imagery and aromatherapy to help calm her. By the end of the half-hour session, the woman had fallen asleep. That evening, her pain had improved so much she declined her scheduled pain medications and was able to be discharged from the hospital the very next day.

“In order to get the best outcomes, it is important to get to the root of the problem and

address the whole person—mind, body, and spirit,” she said. “If not, things may be missed, or patients may be placed on medications or treatments that are not effective or which may even cause unwanted side effects.”

This is the core of integrative medicine. It cares for the whole person as informed by scientific evidence. It focuses on prevention, optimizing health and wellness, and lifestyle medicine and uses the most natural and safest remedies first. It takes a team-based approach that includes the traditional medical team.

“We can’t put every single person in a cookiecutter box because we all have our own unique makeup and don’t always respond to treatments

ADVANCES

022_INTEGRATIVE MEDICINE2_TGH.indd 22

11/17/21 3:42 PM

Danielle Goodwin and Anthony Goodwin, members of the Integrative Medicine and Arts Program team, visit with a patient.

in the same way,” she said.

Integrative medicine, which is available at no cost to patients admitted to TGH, comes in a full-spectrum menu of approaches: mindfulness, meditation, yoga, aromatherapy, music therapy, touch therapy, and art, with acupuncture an upcoming addition to the hospital’s program. “We really try to offer something for all the senses, so patients have a variety of modalities to choose from,” Sharma explained.

In many cases, integrative medicine specialists may tailor their treatments based on scientific evidence for the patient’s specifi condition. Studies in this field of medicine may include thousands of participants completing randomized, controlled trials to offer strong support for integrative treatments.

For instance, a 2020 study published in Holistic Nursing Practice found that guided imagery and breathing-based exercises significantly improved sleep quality in elderly patients both before and after abdominal surgery.

A 2016 study published in the Global Journal

022_INTEGRATIVE MEDICINE2_TGH.indd 23

of Health Science found that chronic headache patients using mindfulness exercises to reduce stress experienced less pain and an improved quality of life than patients who did not use these techniques. Research reviews also support the benefits of integrative medicine, with a 2019 meta-analysis in Mayo Clinic Proceedings finding that yoga, particularly when combined with breathing techniques, helped reduce blood pressure in people with hypertension.

Sharma finds it fulfilling to see the benefit of integrative medicine firsthand in acutely sick patients in the hospital. “Frequently after a session, patients feel very relaxed, calm, and uplifted,” she said. “Their mind shifts in a more positive way, allowing them to cope with their symptoms and hospitalization better. They are also sometimes more receptive and responsive to treatments. Patients also may require less pain and anxiety medication, which can even result in them going home sooner.”

Before her patients leave the hospital, Sharma teaches self-care mindfulness techniques that

they can practice on their own at home, such as deep-breathing exercises and meditation. She emphasizes that anyone can use, and benefi from, these methods.

“Sometimes I hear from patients, ‘It’s too hard to meditate,’” Sharma said. “I explain to them that simply centering yourself and focusing on your breath—taking a few deep breaths in and out—is a form of meditation.”

Integrative medicine has been shown to improve pain, anxiety, and several other symptoms without always having to rely on pharmaceuticals such as opioids and benzodiazepines alone, Sharma said. This helps to save costs as well as avoid potential side effects and the possibility of addiction.

“Even if a patient is skeptical, I explain that it is always worth a try,” Sharma said. Integrative medicine techniques have no risk—and the benefits can be bountiful. “There’s no real negative aspect in using an integrative medicine technique in a treatment regimen. It is inexpensive, it’s effective, and it’s safe.”

ADVANCES

23

11/17/21 3:42 PM

FORWARD

TAMPA BAY’S NEW WORLD-CLASS

Medical District

With Tampa General Hospital and the USF Health Morsani College of Medicine as its anchors, downtown Tampa will have a medical district that rivals those in the biggest cities

24

ADVANCES

024_FOB_MEDICAL DISTRICT2_TGH.indd 24

11/17/21 4:52 PM

BY ERIC BARTON

Tampa General Hospital’s main campus address on the edge of downtown is the ideal location to anchor the downtown medical district.

024_FOB_MEDICAL DISTRICT2_TGH.indd 25

If you’ve been to Chicago, Houston, or Boston, perhaps you’ve seen them: sections of the city that serve as medical districts, where hospitals, universities, and all kinds of clinics and doctors’ offices cluster together and patients can find experts across a wide range of fields In Florida, we’ve never had this kind of expansive medical district. But Tampa General Hospital now headlines a growing medical district that includes a brand-new, state-of-the-art location for the USF Health Morsani College of Medicine and several health care providers in downtown Tampa.

The idea was inspired by the century-old Longwood Medical and Academic Area in Boston and the Texas Medical Center district in Houston, which formed in 1945, said TGH President and CEO John Couris.

“While we are learning from what has been done in other states, we are really creating a new model of care—something that doesn’t exist in the state of Florida,” Couris said. “We’re an institution that, for almost 100 years, has enjoyed an excellent reputation overall. Because of our team, new strategic plan, vision, focus, and collaboration with USF Health, we are in a renaissance period for TGH. We are investing in the future.”

Tampa’s medical district began organically, starting with TGH and its 1,041-bed campus. In 2017, TGH had 17 locations in the community. It now has more than 80, including imaging, primary care, subspecialty clinics, convenient care, and others.

“We’re expanding our footprint from Hillsborough to all of West Central Florida and even across ADVANCES

25

11/17/21 4:52 PM

TGH is investing more than $550 million in building a new physical plant, modernizing infrastructure, and adding more capacity.

the state in a very cost-effective way. We want to then pass this value on to the consumer,” Couris said.

TGH also is expanding and modernizing its existing facilities. Over the next three years, TGH will invest more than $550 million in building a new physical plant, modernizing infrastructure, and adding more capacity. These changes will include adding more than 100 hospital beds and 12 operating rooms, building a freestanding emergency department just west of downtown Tampa, and renovating several areas of the hospital.

A Medical Ecosystem “The whole idea behind it is that if you build an ecosystem centered around world-class clinical care and research, then talent and ven-

26

ture capital for investment in further innovation follows,” Couris said. “What we are building inside the city will create economic prosperity for people in the form of new jobs, thriving industries, and ultimately a healthier population, which will drive down health care costs.”

The anchor of the medical district, TGH is one of the largest freestanding academic research institutions in the state and the country, with three million square feet on 25 acres. Nearby is the University of Tampa, with its nursing and allied health programs. Two years ago, the University of South Florida opened a new location for its Morsani College of Medicine nearby. The groupings of these three organizations created a natural synergy of health care services that is evolving into this downtown medical district, said TGH Executive Vice President and Chief

Strategy and Marketing Officer Stacey Brandt.

“Predominantly, you see them in large cities,” Brandt said. “It’s a cross-section of health care delivery, research, and education—and it’s really meant to become the destination for all of those things.”

Expanding Footprint, Services In addition to the three signature health care institutions already in downtown Tampa, many other related offices and clinics have opened or are planned nearby. At TGH, several new and existing buildings will help link the medical district.

TGH is leasing a 25,000-square-foot space inside the medical school’s new downtown building and is opening a 200-bed acute care rehabilitation center near the University of Tampa

ADVANCES

024_FOB_MEDICAL DISTRICT2_TGH.indd 26

11/17/21 4:52 PM

The USF Health Center for Advanced Medical Learning and Simulation, located in the heart of the Tampa medical district

IF YOU BUILD A CONCENTRATION OF GREAT, WORLD-CLASS CLINICAL CARE, YOU ATTRACT WORLD-CLASS CLINICIANS AND RESEARCHERS, AND VENTURE CAPITAL FOR INVESTMENT IN INNOVATION FOLLOWS.” — John Couris to connect to its future freestanding emergency department on Kennedy Boulevard. TGH has opened a dozen TGH Urgent Care powered

by Fast Track locations in Tampa Bay. The USF Health Center for Advanced Medical Learning and Simulation is also downtown.

024_FOB_MEDICAL DISTRICT2_TGH.indd 27

Many of the pieces of the medical district are already in place, but now it’s about filling in the gaps between the campuses and companies to help create new synergies and alliances, elevating Tampa’s national health hub. “We have a really great foundation already,” Brandt said.

This cluster, or concentration of compatible services and resources, will create a center for health and science research—a medical research biotech ecosystem—that is expected to spur more growth as other medical-related companies and research groups become established nearby, Brandt said.

However, not all the companies and facilities drawn to the district will be directly involved with health care, Brandt noted. TGH would like to see a hotel built near its campus to provide accommodations for family members of the many patients who arrive from elsewhere to receive care at the hospital. It could also accommodate visiting researchers and academicians.

For the community, this means first and foremost that patients will have access to a wide breadth of health care facilities, Brandt said.

Patients will also benefit from the research and advances that will develop out of the centers and labs that call the district home. Tampa Bay will also see a benefit in keeping and attracting talented employees in health and other industries who may otherwise have sought out a medical district in another city. Talented new graduates also will be more likely to stay in the area because of increased opportunities.

As the district grows and becomes at least as sprawling as those in other cities, Brandt said it will help Tampa Bay grow as a destination. “It’s exciting to look at this and imagine what the future will be,” Brandt said. “This district will be an economic engine for the market and attract talent that will bring in new professionals to the city and create a spark that will continue to drive innovation.”

ADVANCES

27

11/18/21 2:08 PM

Full Page.indd 1

10/27/21 12:37 PM

YOUR DEDICATION IS INSPIRING. YOUR CARE IS LIFESAVING. Tampa General Hospital proudly recognizes our dedicated team of health care professionals for their unwavering commitment and care.

Every day is a test of your strength and your resilience. And every day you heroically rise to the occasion. This pandemic has tested us all. For far too long. Yet through it all, you continue to care for your community with a level of professionalism, compassion and care that is second to none.

We are so proud, and so humbled, by the dedication you demonstrate each and every day. #WeAreTGH

Other hospitals practice medicine. We define it.

tgh_46791_03_Dedication_ad_9x10p875_M.indd 1 Full Page.indd 1

TGH.org

11/18/21 11:20 AM 11/18/21 11:42 AM

Fighting Current and Future

PANDEMICS 30

ADVANCES

030_GLOBAL EMERGING4_TGH.indd 30

11/17/21 3:48 PM

Nurse practitioner Tiffany Vasey prepares to enter an isolation room in the monoclonal antibody treatment infusion center.

The Global Emerging Diseases Institute is battling COVID-19 while keeping an eye out for new health threats

BY KAREN FELDMAN The swift and vicious rise of the COVID-19 pandemic has delivered a powerful lesson in just how critical research into infectious diseases is, and how urgent the need is to prepare the next generation of infectious diseases physicians. With the World Health Organization reporting more than 5.1 million deaths worldwide from the novel coronavirus by mid-November 2021, and the emergence of viral variants that threaten to undercut the effectiveness of vaccines designed to combat it, expanded research and treatment are vital.

That’s what the Global Emerging Diseases Institute (GEDI) was established to do in late 2020. A collaborative effort between Tampa General Hospital and the USF Health Morsani College of Medicine, the institute is dedicated to conducting groundbreaking research, treating patients with diseases from emerging pathogens, and training a new generation of infectious diseases specialists in medicine, nursing and ancillary support services.

As a leading academic medical center, TGH and the College of Medicine are dedicating valuable resources to the fight against COVID-19, both in research and patient care. Since March 2020, the hospital has admitted more than 5,240 COVID patients, treated more than 3,600 patients with monoclonal antibodies, administered more than 257,500 COVID tests, and is currently conducting more than 58 clinical trials.

030_GLOBAL EMERGING4_TGH.indd 31

ADVANCES

31

11/18/21 2:09 PM

Dr. Andrew Myers makes multidisciplinary rounds in a COVID-19 unit with TGH team members and University of South Florida infectious diseases doctors.

Joe Kimmins, a TGH respiratory therapist, writes information about ventilator settings on the window glass of a patient’s room in a TGH COVID unit.

32

ADVANCES

030_GLOBAL EMERGING4_TGH.indd 32

11/17/21 3:48 PM

Leading the Way A pioneer in teaching, research, and clinical care, TGH was the first hospital in Florida to offer monoclonal antibody treatments to COVID-19 patients, a therapy that is now used broadly to help reduce the virus’s effects. Monoclonal antibodies are molecules that can restore, enhance, or mimic the immune system’s attack on cells. In treating COVID-19, they may block the virus from attaching to cells, making it more difficult for the virus to reproduce and cause harm. They may also neutralize the virus and are most effective when administered within a week of infection.

Dr. Seetha Lakshmi is the medical director of the GEDI and TGH’s associate epidemiologist; she has worked with her team on the front lines since the beginning of the pandemic. She is also an assistant professor in the Division of Infectious Disease and International Medicine at the Morsani College of Medicine.

“Historically, infectious disease is part and parcel of every health care system,” Lakshmi said. “Our specialty pertains to protecting patients and health care workers from infections.”

Infectious diseases specialists work diligently to treat their patients with infections whether they contract it in the community or become susceptible to them when they are in the hospital. However, when COVID-19 was added to the equation, Lakshmi said, a “whole new branch of pandemic preparation and response became highlighted, a specialty on its own,” requiring even more stringent measures to ensure the highly contagious viruses doesn’t spread through the hospital.

The GEDI’s post-COVID focus will be on contagious pathogens and sepsis, the leading cause of mortality in hospitals, according to Lakshmi.

“As long as humans interact with the environment and have 100 trillion bacteria normally living in their guts, they will always be susceptible to sepsis,” she said. “In terms of getting better at controlling it, there are very few new antibiotics. We don’t have new ways to fight it.”

What the GEDI staff does have is the ability to act swiftly, as evidenced by their implementation of monoclonal antibody treatment just three days after the U.S. Food and Drug Administra-

tion approved it for use against COVID-19.

Their use has resulted in a dramatic reduction in hospitalization, Lakshmi said, but the surge in new cases from the Delta variant that began this summer again strained hospital staff and resources—and many of the serious illnesses could have been prevented with higher vaccination rates.

“More than 90 percent of COVID hospitalizations and deaths could have been prevented from vaccinations,” Lakshmi noted. The medical teams continue to strive to help ease patients’ suffering and get them home to their loved ones to the best of the teams’ abilities, regardless of patients’ vaccination status. “Our goal as health care providers is to help our patients through sickness and harm regardless of what led to it,” said Lakshmi.

While treating an avalanche of very ill COVID patients, the Institute’s researchers continue to delve into the mysteries of how such viruses cross from one species into another, which is the prevailing theory of how COVID-19 made its way into the human population.

“We hope to give future generations a better chance at controlling pandemics,” Lakshmi said. ”It’s our No. 1 goal.

We strive to provide patient-centered, team-based infectious diseases care for everyone, every day.”

The Long Haul Once renovations to what was previously a rehabilitation center are complete, the GEDI will have 28 private beds and will operate in a stand-alone building on the TGH campus, so it’s close to all the hospital’s resources but self-contained. It also operates an outpatient clinic to provide follow-up care for those who have been hospitalized and are on the road to recovery, as well as to provide monoclonal antibodies, COVID long-hauler treatment, and a travel vaccination clinic.

The GEDI team also is working to treat what’s known as “longhauler syndrome,” in which people who no longer have active coronavirus continue to experience a puzzling range of symptoms.

Dr. Lucy Guerra is the division director of Internal Medicine and professor of general internal medicine at the Morsani College

a

Nurse Scherika David

030_GLOBAL EMERGING4_TGH.indd 33

ADVANCES

33

11/17/21 3:48 PM

Tampa General Hospital nurse Vanessa Arroyo, who works with COVID-19 patients, becomes the first nurse in Florida to receive a COVID vaccine when this shot is administered by nurse Rafael Martinez on Dec. 14, 2020. Florida Governor Ron DeSantis was on hand to see the vaccines arrive.

of Medicine as well as a member of the GEDI COVID Clinic staff. In August, the clinic was receiving 40 to 50 calls a day from people experiencing long-haul symptoms, and it already had 80 patients with such symptoms.

Many of these patients, she noted, are younger people.

She cited the case of a young woman in her late 20s who is a graduate school student and ran in a 5K race a year ago. She contracted COVID in April 2020—prior to the availability of vaccines—at a funeral where 12 others came down with it as well. Three family members have since died.

“She was hospitalized in the ICU for 12 weeks and was on a ventilator for four weeks,” Guerra recalled. “It was pretty horrific, and she had no underlying conditions.” Today the young woman must carry an oxygen tank with her to her classes. She also has pulmonary fibrosis and has been referred to a lung transplant clinic.

In another case, an attorney in her 40s with mild asthma contracted COVID in the summer of 2020 at an outdoor barbecue. After a month’s hospitalization, she recovered, but her memory did not. Her brain fog was so bad she had to take a leave of absence while working to improve the condition.

“Symptoms fall into several buckets,” Guerra explained.

“The vast majority will have pulmonary symptoms: shortness of breath, chest pain, or feel like their endurance for walking or running is significantly decreased. Second are heart-related: tachycardia (palpitations), a tightness in their chest, and they can have pulmonary symptoms. And the third variety, the most common, are neurological symptoms—they don’t feel as sharp as they were before. They have trouble recalling people’s names or words they

34

use all the time. It also takes longer to do their jobs.” One overriding symptom, Guerra added, is an inability to recover from “tremendous fatigue.”

The medical team is finding that this brain fog generally improves with time, as does the loss in ability to taste or smell. Using National Institutes of Health guidelines, the GEDI team assesses these patients to determine their symptoms, then conducts whatever tests or scans they deem necessary to ensure they have the full picture.

That may involve echocardiograms for heart issues, or perhaps an MRI (magnetic resonance imaging) or PET (positron emission tomography) scan to explore organs in greater detail than can be seen with an X-ray or CT (computerized tomography) scan.

Patients complaining of brain fog might try physical therapy or occupational therapy to improve their endurance and cognition in much the same way physicians treat patients with traumatic brain injuries or concussions.

Guerra is also a principal investigator in a study of a medication being tested on those with lung impairment. Results of that study are not yet available.

Although Guerra said many long-haulers may not fully recover, most do see improvement with treatment. “Longhauler patients require a lot of intense treatment,” she said.

“They see you frequently and require close follow-up.

The worst thing you can say to any COVID long-hauler is that there is nothing we can do. That is not true.”

But the best advice both Lakshmi and Guerra can offer is simple: Get vaccinated, use masks, and practice physical distancing when in public.

Although the institute’s primary focus has been on COVID, its researchers and medical staff remain vigilant to combat any new diseases that may emerge to prevent another such pandemic from occurring.

ADVANCES

030_GLOBAL EMERGING4_TGH.indd 34

11/17/21 3:48 PM

The TGH Global Emerging Diseases Institute, established in late 2020, was the first in Florida to administer monoclonal antibody treatments to COVID-19 patients.

Infectious diseases physician leaders of the USF Health Morsani College of Medicine stand in front of origami birds that are symbols of hope and loss in the fight against COVID-19. From left to right: Dr. Kami Kim, Dr. John Sinnott, and Dr. Seetha Lakshmi.

For more information on the Global Emerging Diseases Institute, visit tgh.org/institutes-and-services/ global-emerging-diseases-institute or call 813-844-4715.

The team members on the front lines of Tampa General’s COVID units are fueled by dedication and persistence.

030_GLOBAL EMERGING4_TGH.indd 35

11/18/21 2:10 PM

Attitude of Gratitude

FOCUSING ON THE POSITIVE AND PRACTICING GRATITUDE IS HEALING

By Dave Scheiber

Healing has its roots in more than medicine and myriad health care strategies. It can also grow from the simple human emotion of gratitude—and ultimately result in thankful patients becoming dedicated donors.

“The power of expressing gratitude is becoming a well-researched and much more understood concept,” said Seema Weinstein, Ph.D., manager of Psychology and Neuropsychology at Tampa General Hospital.

Weinstein, who has been a Tampa General psychologist for more than 30 years, said that recognizing gratitude as a healing agent can be found in the positive psychology movement of the late 1990s. Instead of the traditional approach of identifying abnormal behavior, positive psychology focuses on what’s right with

36

people—and on ways they can feel worthwhile and experience joy.

“One of the things we know is that people who engage in active gratitude exercises actually experience lower levels of depression and anxiety in a measurable way than they did prior to engaging in gratitude exercises,” she said.

“Gratitude isn’t just about saying thank you or appreciating something. One of the core concepts is that you’re affirming that the source of goodness in the world is outside of yourself.

And that’s probably the key for people who are grateful patients and grateful givers.”

Weinstein advocates adopting a practice to reinforce feelings of gratitude—a simple technique called the “Three Good Things Exercise.” The idea is to increase a sense of

personal well-being by redirecting a negative thought to a positive one.

“For example, if I’m starting to get aggravated in traffic, I would stop and ask, ‘Okay, what are three things I’m grateful for?’ They can be simple things, such as, ‘I’m happy people are observing the speed limit today.’

Just recognize the little things you appreciate—it’s a mindset that allows you to be in a different place.”

Neuroscience studies show neurotransmitters are released when people are engaged in a gratitude exercise, Weinstein explained.

“Gratitude creates more dopamine and serotonin,” she said. “Those are transmitters that make you feel better.”

Humans are wired to see things through

ADVANCES

036_GRATITUDE_TGH.indd 36

11/17/21 3:51 PM

Top and below: Amid the pandemic, inspirational messages of hope and gratitude greet TGH employees.

Right: Seema Weinstein, Ph.D.

a negative lens, Weinstein explained, which is embedded in our DNA as a way of identifying threats. As a result, it takes extra work to see the positive in challenging situations.

“By engaging in positive gratitude exercises, it allows you to make a shift in perspective,” she said. “In medicine, we always have to look for what’s wrong with people. That’s our job. But by embracing this shift, and looking for what’s right, it can help you be healthier as a provider, too.”

Weinstein said that health care providers should be open to expressions of gratitude from patients: “As caregivers, we don’t do as well as we could in accepting compliments from patients because we feel like we’re just doing our job. But it’s much more than that to them. It can be something really small that makes people feel like they’re being cared for well.”

She believes “there is a shift culturally with more people talking about this. What makes people resilient? This is one of those things. Having an attitude of gratitude can help you be more resilient, even when faced with a challenge.”

036_GRATITUDE_TGH.indd 37

ADVANCES

37

11/17/21 3:51 PM

WHEN COVID-19

STRIKES A GRATEFUL COUPLE GIVES BACK AFTER RECEIVING

MONOCLONAL ANTIBODIES TREATMENT AND TOP-NOTCH CARE

By Dave Scheiber | Photography by Cara DeHart Lewis Until you hear Stuart and Karessa Lasher reflect on the last year, you would never imagine the ordeal that is still fresh in their minds. They look like the picture of health on the screen of a morning Zoom call, their words punctuated by laughter and energy. But their message is unmistakably serious: one of deep gratitude to Tampa General Hospital for getting them through their frightening bouts of COVID-19.

The Lashers had done everything right from the start.

They followed all the social distance and mask protocols after the pandemic hit in March 2020. They quickly transitioned their family-owned business, Quantum Capital Partners, Inc., into a remote operation to protect employees and their families. And they left the house only for shopping or essential trips, always adhering to safety guidelines.

But through sheer bad luck of the COVID draw, Stuart and Karessa were exposed to the virus by a family member. An initial test came up negative, but soon after each of them began feeling ill—Karessa with a fever and chills, Stuart with headaches and gastrological symptoms. A few days later, both of them tested positive.

“The uncertainty is very scary,” Stuart said. “You don’t know if you’ll be one of those on a bad track, in the middle, or mild.”

The couple immediately turned to TGH and received care from Dr. John Sinnott, chief epidemiologist at TGH and chair of Internal Medicine at the USF Health Morsani College of Medicine. “Dr. Sinnott was so reassuring,” Karessa said. “We feel very blessed by the care—both emotional and medical—he provided.”

At Sinnott’s recommendation, both Stuart and Karessa received an infusion of monoclonal antibodies at Tampa General’s new Global Emerging Diseases Institute. In November 2020, Tampa General became the

38

first hospital in Florida to offer this treatment, which is used to lower the risk of contracting more severe symptoms.

Once they received antibodies, the Lashers were able to return home while staying connected to TGH through Sinnott and the hospital’s COVID telehealth program. They called in their temperature and oxygen levels twice a day, and TGH clinicians remained in constant contact.

“We were very impressed with the ‘culture of care’ at TGH,” Stuart said. “Every employee who we came into contact with at TGH provided five-star customer service.”

Fast-forward several months and the Lashers are doing great—and feeling grateful for the care they received and witnessed others receiving. Always philanthropic in nature, they have already supported other TGH programs in the past. Now they’re talking with Sinnott about new ways to support TGH, especially in the research of infectious diseases.

For the Lashers, giving back to a place that has given so much to them is an uplifting part of the healing process. The role of gratitude in healing is a force that’s actually receiving more scientific study “The power of expressing gratitude is becoming a well-researched and much more understood concept,” said Seema Weinstein, Ph.D., manager of TGH Psychology and Neuropsychology. “One of the core concepts is that you’re affirming that the source of goodness in the world is outside of yourself. I think that’s the key for benefactors who are grateful patients and grateful givers.”

For the Lashers, it’s just part of who they are and how they live. “We feel so fortunate to have TGH in our community,” Stuart said, “and we love being able to give back in any way we can.”

ADVANCES

038_DONOR PROFILE_TGH.indd 38

11/18/21 2:11 PM

WE WERE VERY IMPRESSED WITH THE ‘CULTURE OF CARE’ AT TGH. EVERY EMPLOYEE WHO WE CAME INTO CONTACT WITH AT TGH PROVIDED FIVE-STAR CUSTOMER SERVICE.” —Stuart Lasher

038_DONOR PROFILE_TGH.indd 39

ADVANCES

39

11/17/21 3:53 PM

TAKING ON THE

Dr. Kiran Dhanireddy, Dr. Vijay Subramanian, and Dr. Lucian Lozonschi work together on the first combined heart and liver transplant at Tampa General Hospital, performed on March 10, 2021.

40

ADVANCES

040_DOUBLE TRANSPLANT2_TGH.indd 40

11/18/21 10:05 AM

CHALLENGE

Tampa General Hospital Transplant Institute performs West Florida’s first successful combined heart and liver transplant

W

By Sandra Gurvis

hat do you do when your patient has two unrelated yet life-threatening conditions?

You put together a multidisciplinary team ready to execute precise timing for a 12-hour operation.

That’s what Dr. Kiran Dhanireddy, executive director of the Tampa General Hospital Transplant Institute, and teams from the heart and liver transplant programs, anesthesia, and other specialists did in March 2021 as they prepared to perform a combined heart and liver transplant on 56-year-old Justine Gant.

“Mr. Gant’s case is unique because his heart and liver disease are not related,” said Dr. Debbie Rinde-Hoffman, a Tampa General Hospital cardiologist and medical director of advanced heart failure, who oversaw Gant’s pre-surgery care. “Typically, the heart impacts the liver, or the liver disease impacts the heart, but he had two separate conditions.”

Although this made Gant a good candidate for the combined transplant—a groundbreaking procedure and the first successful one of its kind in West Florida—it required a high degree of coordination between the heart, liver, and other teams, Dhanireddy noted. The complex surgery took 12 hours from start to finish

040_DOUBLE TRANSPLANT2_TGH.indd 41

ADVANCES

41

11/18/21 10:05 AM

“Each organ transplant has a highly specialized process that is all its own,” Dhanireddy explained. “The timing had to be such that the heart transplant needed to proceed smoothly, and then the liver would follow and be implanted shortly after. Both organs needed to start working immediately, and they did.”

Step-by-step details were carefully planned.

“Our multidisciplinary team met several times to plan all aspects of the surgery, from presurgery care to Mr. Gant’s recovery,” Dhanireddy said. “When the organs did become available, it was fully scripted out.”

Tampa General is one of only four hospitals in Florida to have accomplished a combined heart and liver transplant. The Tampa General Hospital Transplant Institute has performed more than 11,000 transplants since the program began in 1974 and is now one of the top 10 transplant centers in the nation. The academic medical center has continued to perform a large number of transplants through the pandemic—performing a record 611 transplants in 2020.

Dhanireddy and Dr. Vijay Subramanian, a liver transplant surgeon on staff at TGH, were responsible for the liver transplant portion.

Cardiothoracic surgeon Dr. Lucian Lozonschi performed the heart transplant.

“Mr. Gant’s heart condition was so severe that he could not be considered a candidate for liver transplant surgery unless his heart condition was addressed,” said Lozonschi, who is also a professor and chief of the Division of Cardiothoracic and Transplantation Surgery at the USF Health Morsani College of Medicine and associate director of the Tampa General Hospital Heart & Vascular Institute. “His liver condition was also serious, and he really needed to have both surgeries at the same time.”

Dr. Guilherme Oliveira is executive director of Tampa General Hospital’s Heart & Vascular Institute and professor and chief of the Division of Cardiovascular Sciences at USF Health Morsani College of Medicine.

Because the health care team had to remain heavily masked due to pandemic precautions, Gant, who is deaf, could not read lips and used a sign interpreter to help communicate needs and questions—and he also enjoyed teaching sign language to the TGH team, Dhanireddy

42

Dr. Debbie Rinde-Hoffman speaks through a signlanguage interpreter to double-transplant patient Justine Gant.

Dr. Kiran Dhanireddy

Dr. Debbie Rinde-Hoffman

Dr. Guilherme Oliveira

In 2020, the Tampa General Hospital Transplant Institute performed a record 611 transplants. said. The team’s ability to communicate clearly and accurately, as well as Gant’s positive attitude, greatly contributed to his recovery.

“Although he had two serious conditions, Mr. Gant has a very positive outlook and that will play a big role in his recovery,” said Dr. Benjamin Mackie, medical director of TGH’s heart transplant program.

A History of Innovation Tampa General has a long history of firsts in the transplant field, including performing the first successful heart transplant in Florida in

1985; it has since performed more than 1,400 heart transplants. TGH performed its first liver transplant in 1987 and has since performed more than 2,000.

Tampa General has continued being an innovator in the transplant field. It is one of about 40 transplant centers nationwide using the Paragonix SherpaPak® Cardiac Transport System to transport donor hearts to the hospital. “This device cools the donor heart to the right temperature and keeps it at the right temperature,” said Dhanireddy.

Studies show that hearts transported in the

ADVANCES

040_DOUBLE TRANSPLANT2_TGH.indd 42

11/18/21 2:20 PM

SherpaPak—which controls the cooling of the heart more precisely than the traditional method of packing it in ice—are more likely to be transplanted successfully.

Tampa General also is known as a national leader in using mechanical devices that can help diseased hearts function better. Called mechanical circulatory support or ventricular assist devices, these devices can be implanted to help patients survive until their transplant, recover from a cardiac event, or be used as an alternative to a transplant.

Along with these new heart technologies,

040_DOUBLE TRANSPLANT2_TGH.indd 43

the Tampa General Hospital Transplant Institute is creating strategies to utilize more living donations for the kidney and soon for the liver. “We are adding to and developing a highly expert team, one that can perform complex operations for all types of donors and recipients,” Dhanireddy said.

Another goal of both the Tampa General Hospital Transplant Institute and TGH is the expansion of programs to help underserved populations. “Historically, minority populations have been disadvantaged,” Dhanireddy said. “Part of our mission is to serve every per-

son in the community, so they have access to the best medical care. We are working on a specialized approach geared toward their cultural, linguistic, and socioeconomic needs.”

But as always, the proof is with the patient.

“The thing I’m looking forward to the most is playing with my grandkids and playing basketball,” Gant signed through an interpreter after the surgery. “Those are the things I love to do most, and I haven’t been able to do them for such a long time. Before my surgery, I was always just so tired. I’m so excited to be able to do them again.”

ADVANCES

43

11/18/21 10:05 AM

HIGHLY

Futuristic advances in neurosurgery enable Tampa General Hospital to tackle the most complex challenges in brain surgery

LOGICAL

044_NUEROSURGERY2_TGH.indd 44

11/17/21 3:55 PM

BY SANDRA GURVIS

T

The neurological team at Tampa General Hospital performs a wide variety of innovative procedures.

044_NUEROSURGERY2_TGH.indd 45

wo innovations in neurosurgery at Tampa General Hospital seem to have come straight out of Star Trek. But unlike phasers and warp drive, these technological advances are more than science fiction The first, a medical device called laser interstitial thermal therapy (LITT), utilizes MRI-guided laser ablation (removal) technology and “is minimally invasive, requiring only a 2-millimeter incision in the scalp,” said Dr. Harry van Loveren, co-medical director of the TGH Neurosciences Institute and chair of neurosurgery for the USF Health Morsani College of Medicine. Tampa General was one of the first hospitals in Florida and the first in the region to offer LITT. It is also one of the few hospitals in the state with Visualase—one of most advanced LITT laser technologies currently available.

ADVANCES

45

11/17/21 3:55 PM

Because LITT targets a precise area deep inside the brain, it can reach places that might otherwise be considered inoperable.”

—Dr. Harry van Loveren 46

ADVANCES

044_NUEROSURGERY2_TGH.indd 46

11/17/21 3:55 PM

Right: Dr. Harry van Loveren Left: TGH is using innovative technologies that demand the neurosciences team to perform with a high degree of expertise and accuracy.

LITT is safe, effective, and, in some cases, can go where no neurosurgeon has gone before. “Because LITT targets a precise area deep inside the brain, it can reach places that might otherwise be considered inoperable,” van Loveren said.

The technology is used to treat primary and metastatic brain tumors, including those that frequently recur, as well as lesions responsible for epileptic seizures. LITT can also benefit people with health conditions such as heart disease or cancer that render them too high-risk for traditional brain surgery.

LITT has other advantages as well. Because no ionizing radiation is involved, van Loveren said, “LITT is especially beneficial for patients with radiation necrosis”—loss or damage to healthy tissue resulting from radiation therapy that can sometimes occur even after treatment has ended. Another bonus of no radiation: “LITT can be repeated multiple times with no need for a bone flap.” In a traditional craniotomy, a bony section of the skull is removed to access the brain underneath, and it may require a longer recovery time, resulting in possible surgical complications and/or changes within the brain itself.

Even Dr. Leonard “Bones” McCoy, who was often suspicious of new technology in the original Star Trek, might be impressed with LITT’s machinations. “Surgeons use the MRI to guide a microscopic laser catheter through the surgical incision hole to the brain,” explained van Loveren. Using real-time information shown on the MRI monitor, “they then place cursors around the tumor or lesion on the monitor to specify where the heat should go.”

Van Loveren likens this thermographic imaging to the GPS mapping system used in a phone or car. “The equipment automatically recalibrates so that you can precisely locate, then destroy, the tumor or lesion. It also protects healthy tissue.”

As the laser light is delivered, temperature in the targeted area rises, “creating a color-coded heat map that

044_NUEROSURGERY2_TGH.indd 47

ADVANCES

47

11/17/21 3:55 PM

shows the targeted tissue turning from blue [cold] to red [hot],” said Dr. Yarema Bezchlibnyk, co-director of TGH’s Comprehensive Epilepsy Program and Movement Disorders Neuromodulation Center. “At the same time, we can make sure that healthy brain tissue stays cool.”

With three different components and technologies, LITT is definitely Starship Enterpriseready.

As Bezchlibnyk explained, the LITT procedure at TGH includes the IMRIS magnet (part of the iMRI Suite), the ClearPoint targeting system (or sometimes the Vertek arm or ROSA ro-

48

bot), and the Visualase laser. “Each provides a unique function during the procedure to make it as safe and effective as possible,” he noted.

Not only is there little to no pain, less scarring—only one stitch is generally required— and minimal hair removal, LITT patients are usually released after a single night’s hospital stay and have few, if any, complications.

A second TGH innovation, focused ultrasound (FUS)—also known as high-intensity focused ultrasound (HIFU)—is somewhat different, although it too ventures into Star Trek territory. Initially approved by the Food and Drug Administration in 2016 and scheduled

for implementation at TGH in early 2022, the ExAblate Neuro FUS focuses many beams of ultrasound on a single target to heat up and destroy the tiny section deep inside the brain that controls tremor. Also known as familial, idiopathic, or benign tremor, essential tremor causes uncontrollable shaking that can greatly hinder quality of life. Focused ultrasound “represents a breakthrough for patients with Parkinson’s or other conditions that have not responded to medication,” Bezchlibnyk said.

Unlike LITT, the patient’s head is completely shaved before the two-and-a-half-hour procedure. According to the ExAblate website, a local

ADVANCES

044_NUEROSURGERY2_TGH.indd 48

11/18/21 2:12 PM

Some of TGH’s devices and equipment allow neurosurgeons to reach places that might otherwise be considered inoperable.

anesthetic is used while a standard, stereotactic head frame (a halo fixation device) is applied.

The patient then lies down in the MRI machine with his or her head in the ExAblate Neuro helmet and cold water is circulated around the scalp to keep the patient’s head cool. Except for the attachment of the halo, FUS is completely noninvasive. Bezchlibnyk added that, in most instances, the patient should be awake so that the physician can get immediate feedback as to how the treatment is progressing.

The targeted area, known as the ventral intermediate nucleus of the thalamus, is first subjected to low energy. This results in temporary tremor improvement, enabling the physician to identify any potential side effects and adjust the target accordingly. The physician then proceeds to dispatch multiple high-energy beams, leaving healthy tissue undisturbed. After each one, the patient will perform tasks, such as touching his or her nose, allowing the physician to evaluate the tremor improvement until the targeted area is completely ablated. Results are immediate and long-lasting.

There are similarities between FUS and LITT. Both use an MRI, which automatically adjusts to

pinpoint targeted areas; have minimum recovery time and side effects; and are safe and effective. “Focused ultrasound is a treatment for a specific condition, whereas LITT is a medical device and has several uses,” Bezchlibnyk said.

Both require high levels of expertise and accuracy. “We are essentially learning a new technology,” van Loveren said. “With traditional surgery, we relied on what we could see with the naked eye. Now, not only are we getting a great deal more data from the MRI screen, it is far more precise than even looking through a microscope—the information is at the micromicroscopic level.”

Introducing such technology not only requires a financial commitment, he noted, “but a willingness to invest in human capital and recruit the best and the brightest” neuroscience professionals who can provide top-tier care. “If you’re going to bring in the most complicated brain surgery patients, then you’re going to need an equally highly trained neurocritical care specialist team,” van Loveren said.

This ecosystem, he concludes, needs to blend almost seamlessly—not unlike the crew of the Enterprise.

Dr. Harry van Loveren shows off the TGH intraoperative MRI.

If you’re going to bring in the most complicated brain surgery patients, then you’re going to need an equally highly trained neurocritical care specialist team.”

—Dr. Harry van Loveren

044_NUEROSURGERY2_TGH.indd 49

ADVANCES

49

11/17/21 3:55 PM

When Parathyroid Glands

MALFUNCTION Tiny glands can cause a host of big health problems that TGH parathyroid gland surgeons excel at treating

BY KAREN FELDMAN Two pairs of rice-sized glands pack a big punch when it comes to keeping our bodies in good working order.

Most people haven’t even heard of parathyroid glands, but these four tiny organs tucked behind the thyroid gland in our necks produce a hormone that regulates calcium in the blood. When they malfunction, calcium blood levels become unbalanced, causing a wide range of unwelcome symp-

50

toms, such as chronic fatigue, insomnia, memory loss, kidney stones, cardiac arrhythmias, chronic kidney disease, and osteoporosis.

The good news is that this condition, referred to as hyperparathyroidism, is most often caused by a benign tumor in the glands. The tumor—or the gland in which it is situated—can be surgically removed in a simple outpatient procedure, solving the problem. (A less common condition, known

Dr. Doug Politz and Dr. Jose Lopez perform parathyroid surgery.

ADVANCES

050_PARATHYROID_TGH.indd 50

12/10/21 10:15 AM

050_PARATHYROID_TGH.indd 51

ADVANCES

51

12/10/21 9:57 AM

IT’S A CURABLE DISEASE. NOT MANY SURGEONS GET MUCH EXPERIENCE TREATING IT. IF YOU GET A LOT OF EXPERIENCE WITH THIS ONE RELATIVELY UNCOMMON ORGAN, YOU ARE ON TRACK TO BECOME AN EXPERT AT IT.” —Dr. Doug Politz as secondary hyperthyroidism, is caused by deficiencies of calcium or vitamin D in the diet or, in some cases, chronic kidney failure.)

Tampa General Hospital’s Parathyroid & Thyroid Institute has the distinction of performing more parathyroid operations than any other hospital in the world over the past decade. The institute is led by two surgeons who have devoted their lives to diagnosing and treating this condition.

Meet the Experts Dr. Doug Politz and Dr. Jose Lopez are general surgeons who have focused their practices on treating patients with parathyroid problems. “Patients get tumors that are almost never cancerous but do cause a lot of harm,” Politz said. “We’ve seen just about everything this disease can throw at you.”

Dr. Doug Politz Politz developed an interest in parathyroid conditions when he did a rotation in the endocrine surgical department as a surgical resident. “I took to it very quickly,” he said. “It’s a curable disease.

Not many surgeons get much experience treating it. If you get a lot of experience with this one relatively uncommon organ, you are on track to become an expert at it.

Dr. Jose Lopez That did appeal to me.”

He added: “Waiting rooms are filled with patients with diseases you can’t cure—diabetes, heart disease, asthma. With this, you can cure the patient. To me, that’s very appealing.”

And now, having examined some 25,000 glands and performed over 8,000 parathyroidectomies, he is that expert who can remove even the tiniest of tumors or the miniscule organs altogether, providing a cure for the patient.

Lopez was performing colorectal surgery at TGH and was considering going into private practice when a vacancy opened for a surgeon to treat parathyroid disease. “If I concentrate on one organ, I bet I’d be really good,” he reasoned. “I really enjoy the operations and how challenging they are. I’m still learning despite doing thousands and thousands. People will travel to see us, and that makes us feel very proud of what we’re doing here. There’s not a single day when I leave the hospital when I don’t feel proud of what I did in the operating room.”

Lopez and Politz are great friends and colleagues, winning praise from patients and accolades such as “Compassionate

52

Doctor,” “Patient’s Choice,” and “On-Time Physician” awards.

Best of all, they love what they do and working together.

“Surgery is really the only treatment for this,” Politz said. “The nice thing is it is a pretty quick procedure. You make a small incision in the neck. Locate the glands, find the tumors, confir the number—70 to 75 percent of the time it’s just one tumor, although there can be two or three or four—and remove them.”

Symptoms and Treatment How can you tell if you have parathyroid disease? Politz recommends keeping an eye on the calcium levels in your routine blood tests, particularly if you are older than 35. If the level is above 10, there’s cause for concern and it may be time to consult a specialist. It is a well-known cause of osteoporosis and kidney stones.

“What most people complain of are the other problems—neurocognitive problems,” Politz explained.

“They are tired, depressed, and achy.

SYMPTOMS OF They can’t sleep, can’t concentrate, PARATHYROID GLAND can’t remember things. Only 20 to 25 MALFUNCTION percent ever get a kidney stone. Fewer get osteoporosis, but they describe themselves as meaner and nastier and FATIGUE say, ‘I’m tired all the time.’ ” MEMORY LOSS In addition to assessing the state of BODY ACHES the parathyroid glands, the surgeons routinely examine their patients’ thyroid at the same time. In about 25 percent of the cases, Lopez said, they may have a thyroid tumor as well. If that’s the case, the physicians discuss treating the thyroid at the same time as the parathyroid glands.

In some cases, the parathyroid glands can be located inside the thyroid, making it necessary to remove a portion of the thyroid to get to the parathyroid tumors. The good news is that only a portion of one gland is required to produce the hormone needed to regulate calcium in the blood, Politz said.

So why do we have four—or in rare cases, five—parathyroid glands? Think of them as a security system.

INABILITY TO CONCENTRATE BONE PAIN DIFFICULTY SLEEPING DECREASED LIBIDO (MORE COMMON IN WOMEN) HEART PALPITATIONS HIGH BLOOD PRESSURE EXCESSIVE URINATION KIDNEY STONES NAUSEA CONSTIPATION LOSS OF APPETITE

ADVANCES

050_PARATHYROID_TGH.indd 52

12/10/21 9:57 AM

“We have two kidneys, two lungs, in case one goes bad,” Lopez said.

“The body needs very tight calcium control. It doesn’t like a fluctuatin level. The more thermostats, the more sensors, the faster the thermostat can adjust. When four are working, the first one senses the calcium is low.”

Calcium plays a crucial role as a facilitator of communication among cells. “Muscles contract because of calcium,” Lopez said. “Nerves communicate because of calcium. So, calcium is being constantly monitored.

High calcium is bad. Low calcium is bad. That’s why there are four parathyroid glands making sure the calcium is at a good range.”

Among the unique features of the Parathyroid & Thyroid Institute is that patients do not require imaging studies prior to surgery. On the day of surgery, each patient receives a sestamibi scan, in which a small dose

050_PARATHYROID_TGH.indd 53

Tampa General Hospital Parathyroid & Thyroid Institute Phone: 813-844-8335 Website: tgh.org/parathyroid

of a radioactive compound is administered intravenously. It adheres to the parathyroid gland, allowing the surgeons to detect any growths.

A thyroid ultrasound is also conducted to evaluate the thyroid for suspicious nodules. These procedures result in precise diagnoses and reduce the number of visits and tests most patients must undergo before surgery to remove the growth and the problem.

It’s a practice that gives Politz and Lopez great satisfaction. “The best part of my day is knowing that I’ve been able to do something every day that our patients are going to benefit from,” Politz said. “They are going to walk away and be better than when they arrived.”

ADVANCES

53

12/10/21 9:57 AM

PA VI N G

ROBOTIC TOOLS, NEXT-GEN PROSTHESES, AND 3D PRINTING ARE REDEFINING ORTHOPEDIC SURGERY AT TAMPA GENERAL HOSPITAL

E

H T 54

BY SETH SOFFIAN

Y A W V

alrico residents Roger and Gloria Chambers loved traveling to archaeological sites around the world—until one of Roger’s ailing knees gave out as they were walking through a long terminal at London Gatwick Airport several years ago and he had to be pushed along in a cart. Before long, Chambers ended up in the office of Dr. Michael Miranda, an orthopedic surgeon at Tampa General Hospital and Florida Orthopaedic Institute.

It was more than Miranda’s sterling reputation that drew Roger and Gloria, whose own arthritic knees needed attention as well. Retired educa-

tors, they’d also read of Miranda’s use of roboticassisted surgery in conjunction with both TGH and the Institute, and they wanted to benefit from the greater precision and improved patient outcomes, including quicker recoveries and less pain.

“This is the only way to go,” said Roger, who underwent a total knee replacement two months after his wife in the fall of 2019. “It really worked well. He is really outstanding.”

TGH is accustomed to superior outcomes.

For 2021-22, it ranks as the top hospital in Florida and No. 23 in the nation in orthopedics by U.S. News & World Report. The all-fellowship-

ADVANCES

054_JOINT TRANSPLANTS2_TGH.indd 54

11/17/21 4:33 PM

Tampa General Hospital is ranked as the best hospital in Florida and No. 23 in the nation for orthopedics by U.S. News & World Report for 2021-22.

trained surgeons of Florida Orthopaedic Institute, the largest orthopedic group in Florida, lead research into, and the development of, the latest surgical practices and technological advances to help keep TGH at the forefront of world-class care.

“There is not a place in the area that has surgeons who do development and design like we do,” said Miranda, who also serves as an affiliate assistant professor at the USF Health Morsani College of Medicine. “It’s unmatched certainly in the area and maybe even as far as the Southeast.”

054_JOINT TRANSPLANTS2_TGH.indd 55

Surgical Advancements Leading technologies at TGH include the use of the MAKO RIO™ Robotic Arm Interactive Orthopedic System in hip replacements and total and partial knee replacements. Controlled by surgeons using tactile, acoustical, and visual feedback, the robotic arm provides greater precision and consistency for bone preparation and customized implant positioning.

“It can cut to less than half a millimeter accuracy—that’s pretty accurate,” said Miranda, who specializes in knees and hips. “The precision is unmatched by the human hand or eye.”

TGH’s continued improvements in preoperative planning in recent years through 3Dprinted modeling is critical to achieving the best possible outcomes, too. Printed based on patient CT (computerized tomography) scans, the models allow surgeons to precisely size, rotate, and position implants customized to a patient’s joint. This can cut down on surgical times and result in greater patient mobility and function, as well as implant longevity.

“The thing I’ve been amazed about is the accuracy,” Miranda emphasized. “The preoperative plan and what you’ve executed match ADVANCES

55

11/17/21 4:33 PM

The surgeons of Florida Orthopaedic Institute practicing at Tampa General Hospital are all fellowship trained.

The results are proven. Patients have less pain and get back to their normal activities more quickly.”

—Dr. Michael Miranda

56

perfectly. Patients are up and moving and out of the hospital quickly and back to their activity level in four to six weeks. You can’t argue with that kind of result.”

Some of the newer, more advanced orthopedic procedures being conducted at TGH include a direct anterior approach to hip replacement, conducted through a small incision at the front of the hip rather than the more traditional posterior approach. The less-invasive direct anterior approach is deemed more technically demanding and is not universally practiced. But it avoids the need for a considerably larger incision, and more importantly reduces the need to cut—and later repair—muscles and tendons to reach the damaged joint, as with most posterior approaches.

“The results are proven,” said Miranda, an early pioneer of the direct anterior approach. “Patients have less pain and get back to their normal activities more quickly.”

Tampa General also has been at the forefront of major developments in an option that once didn’t exist for

people with long-standing ankle arthritis or trauma to the joint: a replacement. Dr. Roy Sanders, chief of Orthopedic Surgery at TGH, chair of Orthopaedic Surgery at the USF Health Morsani College of Medicine, and president of Florida Orthopaedic Institute, helped design the secondgeneration ankle prosthesis and was the third surgeon in the U.S. to perform routine ankle replacement surgery.

Third-generation implants now in use have greater longevity, thanks to advances in 3D-printed modeling.

Until the mid-1990s, the only option was to fuse the bones in the ankle. Those include the larger lower leg bone (the tibia) and ankle bone (the talus). “This technology is amazing,” said Sanders, leader of the TGH team that has performed hundreds of ankle replacements— more than any other center in Florida. “A completely custom, mirror image of the anterior tibia and talus can be created to perfectly position the reference wires, which then allow an anatomically correct placement of the implants. This makes it possible for us to make the most precise cuts, and the outcomes are much better.”

ADVANCES

054_JOINT TRANSPLANTS2_TGH.indd 56

11/17/21 4:33 PM

Tampa General Hospital’s commitment to innovative technologies is critical to achieving the best possible outcomes.

More to Come For knee replacement recipients Roger and Gloria Chambers, surgery was so successful that both are scheduled to have their other knees—the left for both—replaced by Miranda. “This all went off a lot smoother than I really thought it might. I was very pleased,” said Gloria, praising the pain management, physical therapy, and overall outcome she experienced. “Friends of mine who came to visit were astonished I was as mobile as I was” about six weeks after surgery, she recalled. “I was far more recovered than they thought I would be at that point.”

As pleased with the outcomes as most patients are, Miranda noted that continued technological advancements in orthopedics at Tampa General will be important in further reducing the rate of the small sample of patients who aren’t satisfied with their results. Those include more advancements in robotics and 3D modeling, as well as developments in the next generation of orthopedic technology, such

054_JOINT TRANSPLANTS2_TGH.indd 57

as augmented reality for training and simulations.

“I think that’s the next step after robotics,” Miranda said. “That’s pretty exciting.”

In terms of robotic technology, Miranda is part of a design team working on pressure sensors that can help with the measurement and balancing of ligaments on both sides of the knee, “so the patient doesn’t even feel like they have a knee replacement,” he said. “Robotic technology is not just a cutting tool.

It can give the surgeon a lot more information and feedback, such as component sizing and ligament balancing throughout the procedure.”

Industry-wide, studies show as many as 10 percent of orthopedic patients aren’t satisfied with their care.

But Miranda believes that continued technological progress can improve outcomes for everyone.

“We’re perfectionists,” he said. “We want to make sure that everybody has a good result. That’s why we get on these design teams. That’s part of the drive to get everything right. Always.”

Dr. Roy Sanders

Dr. Michael Miranda

ADVANCES

57

11/17/21 4:33 PM

ALLIANCE

Elevates Hospital and University Increased collaboration between USF and TGH means more access to research and novel treatments In the midst of the COVID-19 pandemic in 2020, a 34-year-old woman was flown to Tampa General Hospital from the community hospital where she had just delivered her second child. The baby girl was healthy, but COVID was trying to kill the mother. Her lungs were so fille with fluid that she had to go on advanced life support to survive the flight It took health experts from at least 10 medical specialties, many of them faculty members of the USF Health Morsani College of Medicine, to prepare treatments based on the latest COVID-19 research and provide around-the-clock, worldclass care to save her.

She survived.

Tampa General and the USF Health Morsani College of Medicine leverage these kinds of resources and expertise every day to save lives, a nd that is why they are the leading academic medical center on the West Coast of Florida, providing a level of complex care that simply isn’t available at many other hospitals.

Now TGH and USF Health are moving ahead with an enhanced affiliation agreement, forming the closest relationship in

58

the history of the two organizations.

That’s good news for the health of residents in Tampa Bay and the state of Florida, as strengthening the bond between the two will provide more opportunities for the kind of advanced, complex care that saved that COVID patient’s life, as well as expanded health research and better learning opportunities for the health care leaders of tomorrow.

Tampa General has served as the primary teaching hospital for USF’s College of Medicine since the 1970s, and many of the physicians already on the hospital’s medical staff are USF Health faculty members. But now, the two organizations have created USF Tampa General Physicians, a combined physician practice that will provide a unified management and support structure for physicians employed by both USF Health and Tampa General Medical Group, allowing for more coordinated care and increased patient access to the kind of world-class, specialized care typically found only at academic medical centers. The new group will be one of the largest academic physician groups in Florida.

The new USF Health Morsani College of Medicine and Heart Institute building on Channelside Drive, part of the Water Street development

ADVANCES

058_USF PARTNERSHIP4_TGH.indd 58

11/18/21 2:14 PM

058_USF PARTNERSHIP4_TGH.indd 59

ADVANCES

59

11/18/21 2:14 PM

Above: TGH President and CEO John Couris, Gov. Ron DeSantis, and Dr. Charles “Charly” J. Lockwood prepare for a COVID-19 press conference. Right: The GenshaftGreenbaum Student Center in the new USF Health Morsani College of Medicine and Heart Institute building

The new organization also promotes coordinated and strategic planning, investment, and joint accountability across both organizations related to shared clinical, research, and teaching efforts.

“Patients will experience the best of both worlds as we come together as one united physicians’ group,” said John Couris, Tampa General president and CEO. “TGH, USF, and our private practice physicians have always had the most success when working together to improve health in Tampa Bay. Now that we are more closely strategically aligned, we can create a powerhouse that delivers world-class health care on the West Coast of Florida.”

The alliance will benefit patients by elevating and enhancing the growth of West Florida’s leading academic medical center. Academic medical centers such as USF and Tampa General provide cutting-edge, specialized care for the most complex and challenging illnesses and conditions, while providing patients with access to innovative research and clinical trials, and training the next generation of health care professionals.

“This enhanced affiliation will have a lasting impact on Tampa Bay, bringing the highest-quality care to our region,” said Dr. Charles “Charly” J. Lockwood, senior vice

60

president of USF Health and dean of the USF Health Morsani College of Medicine. “USF Health and Tampa General Hospital have enjoyed a longstanding and fruitful relationship, and as the only academic medical center on the West Coast of Florida, we provide cutting-edge treatments and pioneer lifechanging research discoveries. Our worldclass resources and providers will allow this new medical group to deliver unrivaled advanced care to patients and families across the state.”

The enhanced alliance will also help the organization expand its research efforts, said Dr. Clifton Gooch, chair of USF Neurology and TGH Endowed Chair of Neurology and co-medical director of the TGH Neurosciences Institute. “There’s a direct advantage to the patients,” Gooch said. “We have researchers blazing new paths in science that are going to benefit the patients who come into this type of system.”

Along with the enhanced alliance, TGH and USF collaborated to create the new joint TGH-USF Office of Clinical Research. Gooch is now co-vice president of Clinical Trials and Translational Research for the office. The new office was formed to strengthen and expand current, jointly conducted clinical trials,

Thanks in part to its enhanced alliance with USF, TGH became the first hospital locally, and only the third in the United States, to administer monoclonal antibodies.”

—Dr. Clifton Gooch

ADVANCES

058_USF PARTNERSHIP4_TGH.indd 60

11/18/21 2:14 PM

including translational studies that bridge laboratory discoveries and benefit patient care.

The restructuring allows TGH and USF Health to combine resources and work together more seamlessly to initiate, operate, and coordinate clinical trials looking at new ways to prevent, detect, and treat disease, said Dr. Abraham B. Schwarzberg, chief of Oncology and senior vice president of Network Development at Tampa General. Schwarzberg also is co-vice president of Clinical Trials and Translational Research for the new research office

058_USF PARTNERSHIP4_TGH.indd 61

11/18/21 2:14 PM

Above: University of Panama instructors and students tour TGH. Bottom left: Dr. Charles “Charly” J. Lockwood talks with students at the grand opening of the USF Health Morsani College of Medicine and Heart Institute building on Channelside Drive.

“The synergy between the basic science and translational work being done at USF will enhance and broaden the ability at TGH for its clinicians to offer patients in our community early-phase clinical trials, expanded access to new drugs, and a greater ability to innovate and provide world-class care throughout our region,” Schwarzberg said.

Developing New Therapies, Attracting Top Talent, Participating in National Trials Through Enhanced Alliance Over the past few years, USF has seen the fastest ever rise in its ranking as a research institution.

“Dean Lockwood’s leadership has really been

62

ADVANCES

058_USF PARTNERSHIP4_TGH.indd 62

11/18/21 2:14 PM

Patient Milenko Rivera, 11, receives care at Tampa General Hospital’s Pediatric Center at Healthpark from Dr. Jennifer Takagishi, a professor of pediatrics and division chief of General Academic Pediatrics at the USF Health Morsani College of Medicine.

Tampa Mayor Jane Castor speaks at USF Health Heart Institute ribbon-cutting.

058_USF PARTNERSHIP4_TGH.indd 63

transformational,” Gooch said. “His goal was to make USF a world-class medical research institution, and his goal has been realized.”

There are many examples of how the alliance has benefitted patients, but Gooch said one of the most visible occurred in late 2020, during the COVID-19 pandemic. At the time, administrators and physicians who were starting in new roles as part of the alliance “had just taken our seats,” Gooch said, but they also recognized the importance of the coming research. When the federal government fast-tracked clinical trials, TGH and USF team members made a lightningfast, 72-hour pivot to begin the work. Gooch said they were well-positioned to participate, thanks to a breadth of knowledge from infectious diseases specialists and from their lab expertise for administering the vaccines.

“Obviously, speed was of the essence, and we said yes, and we went full-speed ahead,” Gooch said. “We had to turbocharge it literally within weeks of just taking our positions.”

Thanks in part to its enhanced alliance with USF, TGH became the first hospital in the re-

gion, and only the third in the United States, to administer monoclonal antibodies. “This unquestionably saved the lives of many people in Florida,” Gooch said.

The next challenge, Gooch said, may be in administering a new treatment in other arenas, such as heart disease, transplant medicine, or Parkinson’s. This type of work builds the international reputation of USF and TGH, which puts the organizations on the radar of funding for future projects and helps to attract talented professionals who want to be a part of organizations with these types of alliances.

Attracting new talent, Gooch said, means improving the research being done locally, paving the way for new therapies, and participating in national studies in Tampa. “Tampa General will ultimately be able to develop new therapies that can benefit the world,” he said.

In the meantime, Tampa General and USF have already proven their value to that one COVID mother. Last summer, she left Tampa General—and returned home to her husband and two young daughters.

ADVANCES

63

11/18/21 2:14 PM

WELL-BEING

A

Healthy AT HOME

TREATING YOURSELF WELL includes eating fresh, wholesome meals that boost your energy, maintain your weight, and prevent disease, all of which adds up to better health. Preparing a meal at home allows you to have more control over the ingredients.

Try these recipes and develop your culinary talents as you connect with family and friends.

PHOTOGRAPHY BY ALISSA DRAGUN

Brighten Your Day Breakfast POACHED EGGS, AVOCADO, & SMOKED SALMON TOAST (Serves 2) 4 free-range eggs 1 Hass avocado 4 slices, toasted, rustic multigrain bread 4 slices, smoked salmon 1 tbsp. of white vinegar

CHEF LARRY LAVALLEY, Urgo Hotels & Resorts corporate director of food and beverage, shares recipes packed with nutrients that supercharge your day and satiate your hunger. LaValley urges home cooks to use organic ingredients, including herbs, whenever possible.

64

TOMATO RELISH INGREDIENTS (Makes 1/2 cup) 2 seeded, diced plum tomatoes 3 tbsp. minced red onion 1 freshly juiced lime 1 tbsp. extra virgin olive oil 1 tbsp. chopped cilantro 1 tsp. minced jalapeño (optional)

.

Procedure: Prepare the tomato relish by combining all ingredients in a small mixing bowl. Season with salt, pepper, and lime juice to taste. In a separate small bowl, smash the avocado with a spoon and mix with 1 tbsp. of tomato relish. Add lime juice, salt, and pepper to taste.

Toast multigrain bread to desired darkness.

Poach eggs: In a sauce pot, add water, white vinegar, and salt. Bring to a boil. When bubbles form on the bottom of the sauce pot, crack eggs and gently drop into the water. Cook to desired doneness and drain on a paper towel with a slotted spoon.

Assemble and serve: Spread avocado on toast. Add a slice of salmon. Place 2 eggs on top. Add dollop of tomato relish. Garnish with olive oil and cilantro. Serve immediately.

Shot on location at Palm Beach Marriott Singer Island Beach Resort & Spa with executive chef Jeffrey Armusik

ADVANCES

064_BOB FOOD_TGH.indd 64

11/17/21 4:43 PM

064_BOB FOOD_TGH.indd 65

ADVANCES

65

11/17/21 4:42 PM

66

ADVANCES

064_BOB FOOD_TGH.indd 66

11/17/21 4:42 PM

Power Lunch Bowl LEMON-GARLIC GRILLED CHICKEN & MUSHROOM FARRO (Serves 2) 2 free-range, organic chicken breasts, 6 oz. each 2 freshly juiced lemons 2 tbsp. chopped, fresh garlic 1 tbsp. chopped rosemary 1 tbsp. chopped thyme 1/2 cup extra virgin olive oil 2 cups boiled farro 2 tbsp. minced shallots 1 cup mixed variety of mushrooms 1/2 cup halved, baby heirloom tomatoes 1/2 cup cooked cannellini beans 1 cup chicken stock 1/4 cup shaved ricotta salata 2 cups baby arugula Procedure: Marinate chicken breasts with fresh lemon juice, 1 tbsp. chopped garlic, 1 tsp. chopped rosemary, 1 tsp. chopped thyme, and 3 tbsp. of olive oil for at least 1 hour. (Reserve 1 tbsp. of lemon juice for the arugula.) Boil the farro until tender in salted water.

Drain and hold.

ARUGULA PESTO INGREDIENTS (Makes 1/4 cup) 2 cups baby arugula 4-6 medium leaves fresh basil 1 tbsp. toasted pine nuts 1/8 cup grated Parmigiano-Reggiano Procedure: In a food processor, add arugula, basil leaves, toasted pine nuts, and 2 tbsp. of Parmigiano-Reggiano. Pulse and add a touch of olive oil to make a paste. Reserve and chill.

SUN-DRIED TOMATO PESTO INGREDIENTS (Makes 1/4 cup) 1 cup plump sun-dried tomatoes 4-6 medium leaves fresh basil 1 tbsp. toasted pine nuts 1/8 cup grated Parmigiano-Reggiano Procedure: Steep 1/2 cup of sun-dried tomatoes in hot water to soften, then let cool. In a food processor, add sun-dried tomatoes, basil leaves, pine nuts, and 2 tbsp. of Parmigiano-Reggiano. Pulse and add a touch of olive oil to make a paste. Reserve and chill.

Assemble and serve: Grill chicken breasts (165 degrees internal temperature) and allow to rest before slicing. Drizzle olive oil into a medium sauté pan and coat pan on medium heat. Add the shallots and the remainder of the chopped garlic. Sauté until fragrant. Add mushrooms, rosemary, and thyme, and cook until caramelized. Add 1/2 of the baby heirloom tomatoes and continue to cook. Add the chicken stock, beans, and farro. Allow the farro to absorb the stock.

Spoon into serving bowls and sprinkle with the remainder of the Parmigiano-Reggiano. Slice the warm chicken breasts and add to the plate. Drizzle with the pestos. In a mixing bowl, add remainder of arugula, lemon juice, tomatoes, olive oil, salt, and pepper, and toss.

Top the dish with the salad and shaved ricotta salata.

064_BOB FOOD_TGH.indd 67

ADVANCES

67

11/17/21 4:42 PM

68

ADVANCES

064_BOB FOOD_TGH.indd 68

11/17/21 4:42 PM

End of the Day Gourmet PAN-ROASTED SCALLOPS (Serves 2) 8 sea scallops (U-10 size) 1/4 cup clarified butter 2 tbsp. olive oil 2 tbsp. minced shallots 2 cups spinach Salt and pepper, to taste BUTTERNUT SQUASH AND APPLE HASH INGREDIENTS (Makes 2 cups) 1 1/2 cups roasted, diced butternut squash 1/2 cup diced apple (hold in water sprinkled with lemon juice) 1/4 cup minced red onion 1/4 cup diced red bell pepper 1 tsp. picked thyme Scallops: Preheat oven to 350 degrees. Spread scallops out on a paper towel to absorb excess moisture. Season with salt and pepper.

Warm a large sauté pan with clarified butter over high heat. When the pan is almost smoking hot, add the scallops to the pan, arranging them so as not to touch one another nor the sides of the pan. (You can repeat the process in batches if your sauté pan is too small.) Allow the scallops to sear on the first side (do not disturb them) for 1-2 minutes. Carefully turn the scallops over, then transfer the pan to the oven for about 5 minutes to allow the scallops to finish cooking.

Procedure: Caramelize the onions and peppers with clarified butter in a sauté pan. Add the apples and when they turn brown, add the butternut squash. Place the butternut squash and apple hash in an oven-proof casserole dish. Keep heated in the oven for about 5 minutes while the scallops finish cooking. Once the scallops are finished, remove the hash and scallops from the oven and allow to rest for a few minutes.

Simultaneously, warm the olive oil in a sauté pan over medium heat. Add minced shallots to the pan until they become translucent.

Add the spinach and wilt until slightly soften. Season to taste with salt and pepper.

CIDER GASTRIQUE INGREDIENTS (Makes 1/4 cup) 1/2 cup sugar 1/2 cup water 1 cup apple cider 1/2 cup apple cider vinegar 1 cup chicken stock Procedure: Combine water and sugar, and cook until it is a light caramel color. Add the remainder of the ingredients and reduce to nappe (thickened). Keep warm.

Assemble and serve: Spoon a 1/2 cup of the hash into the center of each of plate (preferably warmed). Top with wilted spinach. Arrange 4 scallops across the spinach and hash. Drizzle about 3 tbsp. of gastrique onto and around the scallops.

064_BOB FOOD_TGH.indd 69

ADVANCES

69

11/17/21 4:42 PM

WELL-BEING

Florida Finds Add these HOT PRODUCTS from Sunshine State–based companies to your health and wellness arsenal

BY LIZA GRANT SMITH

Cold Snap Looking for a way to keep your cool? Engineers at The Coldest Water have spent the past seven years creating products (everything from coolers to pillows to dog bowls) proven to deliver icy results. Their durable, lightweight, 40-ounce sports bottle ($42) keeps liquids cold for at least 36 hours, offers no-sweat technology, and floats in the pool and ocean so you never lose it. Stay hydrated and reduce your plastic waste with this reusable phenom. The Coldest Water, Naples (thecoldestwater.com)

Masked Crusader With organic, vegan ingredients and nothing artificial, Teami’s Mask Essentials set ($76) is a stunning way to unleash your natural beauty. The company says the matcha green tea, lemongrass, and bentonite clay of the green tea detox mask will help rid pores of impurities and replenish skin, while it says the beauty mask with butterfly flower, zinc oxide, and kaolin clay works to reveal skin that appears smoother, hydrated, and more supple. Teami, Seminole (teamiblends.com)

Worth Your Salt There’s no need to book a spa appointment to reap the storied benefits of Himalayan crystal salt.

Simply add Saltability’s Himalayan salt detox bath ($22) to your bath and soak for a minimum of 20 minutes and it promises to detoxify your body and boost your energy field. It claims to release toxins and negative energy, while the salt’s minerals are absorbed through the skin. Saltability, Boca Raton (saltability. com)

Protective Instinct This is sun protection with soul. Every purchase of a Mang product plants a mangrove in your name to help restore coastal ecosystems. Plus, 10 percent of the purchase price of this supremely breathable UPF 50 Eco Snook hoodie ($55), which says it blocks 98 percent of harmful UVA and UVB rays, directly funds Tampa Bay Watch projects. Mang, West Palm Beach (manggear.com)

70

Swing of Things After discovering the fun sport of frescobol on a beach in Brazil, the founders of Vero Frescobol brought the addictive diversion to America. Choose from classic wood paddles or handcrafted fiberglass picks with fun prints like this tropical leaf.

All sets ($130) come with two paddles, one official ball, and a tote bag for easy carrying.

Vero Frescobol, Winter Garden (frescobol.com)

Take it to the Mat Created by yogis for yogis, Clever Yoga’s mats are the perfect way to level up your yoga efforts. The LiquidBalance extralong non-slip yoga mat ($135) offers an ideal combination of a cushioned base layer and an ecopolyurethane (which is PVC- and latex-free) top layer to provide superior grip whenever you are ready to salute the sun or adopt a warrior pose. Clever Yoga, Tampa (cleveryoga.com)

ADVANCES

070_BOB HOT ITEMS_TGH.indd 70

11/17/21 4:44 PM

DREAM WEDDINGS | BESPOKE EVENTS | WORLD CLASS DESIGN 561.686.7757 | WWW.SPECIALEVENTRESOURCE.COM | BY APPOINTMENT

Full Page.indd 1

7/29/21 4:26 PM

SETTING THE STANDARD

Palm Beach Media Group is a renowned publishing company with print publications representing a mix of proprietary titles and custom magazines, along with digital solutions, serving the entire state of Florida and more.

PALM B E AC H M E DI A. C OM

PUBLISHER OF: Naples Illustrated Orlando Illustrated Palm Beach Illustrated Naples Charity Register Palm Beach Charity Register Southwest Florida Relocation Guide Waypoints: Naples Yacht Club Palm Beach Relocation Guide Traditions: The Breakers The Jewel of Palm Beach: The Mar-a-Lago Club Jupiter Magazine South Florida Baby and Beyond Magazine Stuart Magazine Fort Lauderdale Illustrated Aventura Magazine Naples 100 5th Avenue South: 5th Avenue South Business Improvement District Palm Beach 100 Go561 Community Report: Community Foundation of Collier County Pinnacle: Jupiter Medical Center Foundation art&culture: Cultural Council for Palm Beach County Florida Design Florida Design Naples Edition Florida Design Miami Edition Florida Design Annual Sourcebook Naples on the Gulf: Greater Naples Chamber

PBI_Full Page.indd 1

12/10/21 9:14 AM

L I V E

L I F E

G R A N D E

The Gulf Coast’s most exciting beachside destination on miles of unspoiled sugar-sand beach.

Exclusive access to one of Naples’ top courses - the Naples Grande Golf Club, three swimming pools, and fifteen tournament quality tennis courts.

Our Naples community neighbors are welcome to experience our pristine beaches, full-service luxury organic Spa, and decadent restaurants.

4 7 5

S e a g a t e

D r i v e ,

N a p l e s ,

F L

3 4 1 0 9

n a p l e s g r a n d e . c o m

NAPGNPI0122.indd 1

11/24/21 11:04 AM

Full Page.indd 1

11/19/21 9:45 AM