WINTER 2019
Biologics in Dermatology:
DR. ANTHONY PORTER SPEAKS ON DERMATOLOGY’S LATEST TREATMENT
CLEVENS FACE & BODY SPECIALISTS
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Without a Heart, it’s just a machine. So in 1971, a little Heart built a different kind of airline—one that made sure everyone could fly. Everyone has important places to go. So we invented low-fares to help them get there. To us, you’re not 1A or 17B. You’re a person with a name, like Steve. Here, we think everyone deserves to feel special, no matter where you sit or how much you fly. And with all the places we’re going next, we’ll always put you first, because our love of People is still our most powerful fuel. Some say we do things differently. We say, why would we do things any other way? Without a Heart, it’s just a machine.
IN THIS ISSUE of HEALTH:
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FEATURE ROCKLEDGE COUNTY CLUB
4-5
FEATURES HEALTH FIRST
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FEATURE FIRST CHOICE ORTHOPAEDICS On the cover: Dr. Anthony Porter; Photography by Jason Hook
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FEATURE SUNRISE FACIAL AND ORAL SURGERY
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FEATURE LIVE LONGER MEDICAL
COVER STORY PORTER PREMIERE DERMATOLOGY PAGE 12
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PROFILES PALM BAY MEMORY CARE
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FEATURE BREVARD EYE CENTER
FEATURE PET HEALTH
FEATURE DERMATOLOGY + PLASTIC SURGERY
PROFILE FAMILY PRACTICE OF SUNTREE AND VIERA W I N TE R 2019 : 1
HEALTH
FEATURE
THE HIDDEN HEALTH BENEFITS OF GOLF: WHAT YOU GET FROM THE GREEN BY SARA SANTORA MANAGING EDITOR
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hough its biggest fans won’t be found huddled up in sports bars, wearing jerseys and face paint and yelling at the television, golf is among the top ten most popular sports in the world. Millions follow the sport and watch tournaments, and thousands descend on their local clubs to play a few rounds themselves. Though many see the sport as slow-moving – which, it is – there is still a great amount of athleticism that is required to play the game well, along with precision, focus and strategy. Golf doesn’t require you to tackle other players to the ground, or to run around a field for hours at a time; however, as Kayla Burri and Jerry Yeomans with the Rockledge Country Club explained, there are many health benefits that come with playing the game. 1.
Cardio: As previously stated, though you’re not running around, you are playing on a course that can be anywhere from 30 – 200 acres. So, you’re doing a lot of walking – two to five miles, to be exact. According to Yeomans and Burri, this amount of walking, along with carrying and swinging your clubs, can cause golfers to “burn up to 1,000 calories per game.” Of course, this just means you can enjoy a hefty meal and a drink (or two) after your game.
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Photo provided by Rockledge Country Club
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Improved mental health: Burri continued to explain that golf can be very beneficial to those with anxiety. According to Rockledge Country Club, “Studies have shown that constant exposure to green areas relaxes the body, reduce stress and can aid in alleviating anxiety.” The exposure to sunlight can also help younger golfers with their bone growth and reduce risk of depression.
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3. Improved vision: Golf requires its players to spot their golf ball from yards away. And, in order to get the ball off the tee, you must have great handeye coordination. As you continue to practice the sport, both your eyesight and your hand-eye coordination will improve over time.
reading along, Rockledge Country Club shared that, “studies have shown that a great number of business deals are closed on the golf course.” If you ask me, a day on the course sounds much better than a day at the office, right? Because this sport can be both solitary or social, there is plenty of room for a player to get what he or she needs form the game, whether that is time away from day-today stress, or time to build stronger relationships and be competitive.
4. Stronger relationships: This final point was big for Burri and Yeomans. Though not necessarily a health benefit, strong relationships do have a positive impact on a person’s overall wellbeing. Because the sport is not as competitive as others, players have the time to interact with each other on the course. For all you businessmen and women
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FEATURE
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Photos provided by Health First
Dr. Joseph McClure and Tina Goins
COUPLE’S LEGACY TO LIVE ON WITH PLANNED GIFT HELPING OTHERS RECEIVE HIGH-QUALITY CANCER CARE IN BREVARD ON OVERCOMING HER DISEASE BY SARA PAULSON HEALTH FIRST
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hen Tina’s beloved husband, Mike, died of Stage 3 multiple myeloma in 2012, she knew she needed to do something. She wanted to help her own heart heal through helping others be able to receive the cancer care they desperately need and deserve, close to home. Tina, who serves on the Health First Foundation’s Board of Trustees, feels passionately about giving back to the organization, which supports programs dedicated to improving the wellness and health of Brevard County residents. That’s why she has designated a gift to the Health First Cancer Institute as part of her estate plans. If her planned gift helps at least one person receive the cancer care they need without having to leave the familiarity of home, Tina says, “my life would be complete.” Both Tina and her husband came from hardworking families who had little, so she understands what it’s like to be financially strapped. With no children and
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other family members who are already comfortable, she’d like to be able to help others. What compelled Tina to support the Cancer Institute is not only the care and compassion Mike received, but the desire to support bringing the most high-quality, effective cancer treatment to Brevard. Tina was with Mike when he passed in January 2012 at the Health First Cancer Institute. His oncologist, Dr. Joseph McClure, rushed to be alongside him as well. After Mike’s death, Tina sought bereavement help through Hospice of Health First. Her counselor urged her to get involved with the Foundation’s Benefit Ball, which was benefitting hospice that particular year. She hasn’t stopped since. “There’s so much more to this than I knew,” Tina said of the many ways the Foundation helps Brevard. “I’m now in a position that maybe I can help.”
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FEATURE
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YOU’RE STRONGER THAN YOU THINK YOU ARE HEALTH FIRST NURSE INSPIRED COLON CANCER PATIENT TO STAY FOCUSED ON OVERCOMING HER DISEASE BY SARA PAULSON HEALTH FIRST
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fter undergoing chemotherapy for colon cancer, Shellie admits there were moments she’d wonder if she had it in her to fight.
Debbie, who recently beat endometrial cancer, is delighted Shellie is a survivor. Connecting with her patients is what she does. It’s who she is.
“I didn’t know how I was going to get through the next month,” Shellie recalls. “There were times that I was ready to say, ‘Maybe no more.’” Photo provided by Health First But her husband would remind her: “You’re stronger than you think you are.”
“She fought hard and she beat it,” Debbie says. “And I knew she would. I just wanted her to know she would.”
Those seven words gave Shellie the emotional armor she so desperately needed. Her nurse sat beside her, held her hand, cried with her, comforted her and inspired her by whispering those seven words into her ear during one of the worst times of her life. Recently, Shellie – now in remission – was reunited with Debbie, her nurse at Health First’s Holmes Regional Medical Center. The two embraced through tears and a flood of emotions. Their Shellie and Debbie bond embodies how a nurse is so much more than a physical caretaker. A nurse is also a beacon of hope and support during patients’ darkest times. “I’ve thought of you so very much,” Shellie wept to Debbie. “You have no idea what you did for us, for me. I just thank you for everything.”
Shellie says Debbie is amazing and has been on her mind throughout her treatment. “Just seeing her reminded me of where I was a year ago, and where I’ve been,” Shellie says. “I just want to say thank you to Health First for reconnecting me with Debbie. She’ll be in my life forever.” WIMAY N TE R2019 2019: 34 :5
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FEATURE
PUTTING PATIENTS FIRST:
FIRST CHOICE ORTHOPAEDICS HAS CREATED A PATIENT-CENTRIC PRACTICE ARTICLE AND DOCTOR PHOTOS PROVIDED BY FIRST CHOICE ORTHOPAEDICS
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irst Choice Orthopaedics has built a foundation and a reputation that is highly sought after for doctors looking to make a real impact for their patients and the community. Dr. Vliegenthart of First Choice says, “We give everyone the time they need here. We don’t rush patients in and out the door. Doctors are allowed to be doctors here.” First Choice takes a different approach to how it manages its orthopaedic-focused practice. Physicians at First Choice aren’t spread thin with tasks such as accounting and scheduling; instead, their full attention is on serving their patients and practicing medicine. First Choice's vision, “Continuous Commitment to Orthopaedic Excellence and Compassionate Care,” ensures this unique approach always puts the patient first and allows doctors to do what they do best. 6 : S PAC E COA ST L IV IN G H EALT H | S PAC ECOA ST L I V ING.CO M
First Choice Orthopaedics specializes in joint replacement, hip arthroscopy, sports medicine, shoulder pain, carpal tunnel, orthopaedic surgery, foot & ankle reconstruction, as well as pain management. It also offers ancillary services like: X-ray, MRI and a highly skilled physical therapy team. First Choice Orthopaedics really is a “one-stop shop” to take care of any of your orthopaedic needs. The practice also has an outstanding physical therapy department that continues to expand into new locations for its patients' convenience. The most recent new therapy location in Barefoot Bay marks First Choice’s sixth location in Brevard, more than any other single physical therapy group in the county. This type of commitment to patient care also attracts excellent doctors who work together to make a difference in the lives of their patients.
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Dr. Donald Vliegenthart
MEET THE DOCTORS
Dr. Donald Vliegenthart’s difficult upbringing has driven him to care for his patients and community at a very high level. He comes from a family of two Dutch immigrants who were victims of the Holocaust and under Nazi rule for four years until freed by America. His father immigrated to America to join the Army as repayment for saving his family and later went on the be an engineer for the Saturn V rocket that put the first man on the moon. Dr. Vliegenthart was given an incredible opportunity to not only be in America, but also be a part of the rise of the Space Coast. Dr. Vliegenthart’s mother was a severe diabetic who ended up losing both of her legs to the disease, later passing away from a heart attack. This tragedy drove Dr. Vliegenthart to pursue Medicine as a career path. After skipping eighth grade, a year in undergrad and another year in Med School, Dr. Vliegenthart graduated at just 22 years old as a medical doctor. He then completed five years of orthopaedic surgery residency and went on to perform thousands of surgeries in the following decades, developing an extensive background in orthopaedic surgery and pioneering spinal microsurgery right Dr. Allison Wade here in Brevard. Due to a partial vision loss from a failed dental procedure he underwent at age 39, Dr. Vliegenthart is unable to perform surgeries. This gives him a unique perspective when working with patients, allowing him to, without bias, provide nonoperative solutions to patients who don’t necessarily require surgery. As First Choice continues to attract a high caliber of doctors and surgeons, it’s no surprise that Dr. Allison Wade
also brings her incredible expertise to the team. She is an orthopaedic surgeon who is fellowship trained in foot and ankle surgery. Dr. Wade says that when she was looking for the right career opportunity, it was important that she found a place that felt like family. She says First Choice has proved to be just that for her. Dr. Wade prides herself in educating her patients. She provides her patients with all the information they need to succeed and recover well. One of her most impressive achievements was performing a total ankle replacement on a ballroom dancer. After recovery, Dr. Wade was able to go watch her patient get back on the dance floor with her new ankle! The newest addition Dr. Brian Hamzavi to the First Choice family is Dr. Brian Hamzavi. He practiced in Tampa while he finished his fellowship in sports medicine. Dr. Hamzavi completed his orthopaedic surgery residency at Mt. Sinai Hospital and St. Luke’sRoosevelt Hospital in New York and graduated with his MD from Drexel University College of Medicine in Pennsylvania. Newly minted surgeons have the opportunity to go anywhere they please, and Dr. Hamzavi was no different in that regard. He had several opportunities across the U.S. but found that First Choice in Melbourne, FL was the best option for him. Dr. Hamzavi fits right in with the physician team at First Choice and subscribes to the same patient centric philosophy already prevalent at the practice. He says, “I will stick by the patient through the whole process.” He knows the process of recovery can be a bit daunting but assures he will be there for the patient through every single step. He wants Brevard to know that he’s “looking forward to meeting and growing with the community.” First Choice Orthopaedics clearly brings a level of care and authenticity that is attracting a like-minded team to our beloved community that just want to “be doctors.” Who doesn’t want that in their doctor? With those ethics powering the company, First Choice Orthopaedics is actively expanding and thriving throughout the Space Coast. W I N TE R 2019 : 7
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FEATURE
Dr. King Km Photography by Jason Hook
A WEALTH OF EXPERIENCE:
SUNRISE FACIAL AND ORAL SURGERY PUTS THE “CARE” BACK IN “MEDICAL CARE” BY CASSIDY SHAW WRITER
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inding a new doctor can too often be difficult. You ask friends, family, other doctors, anyone for their suggestions. You look up countless practices, stare at so many doctor headshots and pick one based on feelings or try to determine who has the best reviews online. Finding the right doctor is worse than online dating. Thankfully, that’s where Sunrise Facial and Oral Surgery comes in. The practice covers everything from facial cosmetic surgery and corrective jaw surgery, to TMJ conditions and wisdom teeth removal. It is your go-to place for any issues in the face, jaw, mouth, or neck region with a staff dedicated to giving you the best service. The practice also offers many services that other practices may not be able to, because of their unique three-doctor practice. While many practices are a solo job, Drs. Kim, Schmid and Kossak have decided to cover more areas together and provide an all-encompassing service to their patients. “We love what we do here, and we really take pride in our work,” said Dr. Kim.
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When speaking to Dr. Kim, one of the three doctors on staff at Sunrise Facial and Oral Surgery, it was evident that his focus was on one thing: his patients. Each of the doctors of this practice know what it’s like to be on the other side of the doctor’s office and have made it a priority to create a welcoming environment for their patients to get the help they need. “The minute you walk in the door, you don’t feel threatened. We try to make it as comfortable as possible…to help [patients] relax in a stressful situation.” Originally from Beaverton, Oregon, Dr. King Kim is dual board certified in oral and maxillofacial surgery and facial cosmetic surgery. He trained in Pittsburgh, Fort Lauderdale and Mississippi before landing in Melbourne where he’s now been for 10 years. In that time, he’s cowritten a book on facial cosmetic surgery, published numerous articles and has been a guest speaker both nationally and internationally. Currently, he is both a board examiner for the American Board of Oral and Maxillofacial Surgery and a part time professor of facial cosmetic surgery at Nova Southeastern University.
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Dr. Schmid and Dr. Kossak, who are both from Michigan, also offer an amazing list of experiences to the practice. Dr. Schmid has been practicing oral and maxillofacial surgery in Melbourne, FL for over 30 years, even after starting off his career with a focus in orthodontics and four years in general dentistry. Since then, he has gained incredible experience in emergency room facial trauma and complex oral surgery, making him a perfect fit for Sunrise’s diverse field of expertise.
performing a surgery and then later have a consultation at the
Dr. Kossak gained his love for the specialty from his father, who is an oral and maxillofacial surgeon. After dental school, Kossak went on to learn a wide variety of procedures through his residency with St. John Health Oral and Maxillofacial Surgery program.
help a stressful situation become that much more comfortable.
Dr. Kim and Dr. Schmid have also dedicated much of their time outside of the office to continually help the people in their community. Whether it’s through volunteering their services at no charge for the Brevard Health Alliance and Space Coast Volunteers or going on mission trips to South America to provide oral examinations and assistance, they have made a point to use their skills for more than routine office visits. It seems staying still has never been much of a focus for Dr. Kim, from his constant volunteer and extracurricular work to his love of working between the office and the hospital. No two days are the same for Dr. Kim with his span of expertise. It’s his favorite part of the job, and why he’s stayed here for as long as he has. Depending on the day, he could be in the hospital
office. He loves both the calm office environment and the busy, fast-paced hospital setting. It’s also not something a lot of other practices can brag about. When Dr. Kim’s patients need to be transferred to the hospital, he will be the one at the hospital performing the procedure or surgery for them. It’s those small things, like being able to work with someone you trust, that can
Sunrise Facial and Oral Surgery has two locations, Melbourne and Rockledge, to service the Space Coast community. For more information, be sure to go to the practice's website to see more about the specific procedures it provides as well as before/after examples. You can also follow Sunrise on Facebook or Instagram (@SunriseOMS). Lastly, just give the office a call and talk to their staff. As Dr. Kim pointed out, “We’re an office that cares. Call us, we will respond.”
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FEATURE
Live Longer Medical team Photography by Jason Hook
LIVE LONGER MEDICAL: IT’S A LIFESTYLE BY MATTHEW WEINSTEIN WRITER
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ealth, wellness and longevity continue to be prominent factors in many peoples’ everyday lives. We continuously see advertisement and celebrity endorsements on how a single pill, or a “magic” treatment can change your body and your mind for the better. The necessity to maintain and even enhance your nutrition, lifestyle and health is of the highest order; however, there’s no magic pill that does it all. What it takes is the education on numerous advanced practices and the knowledge of individual biochemistry. That is what provides the benefits that we all desire. And that’s exactly what you’ll find at Live Longer Medical. Located in Indialantic, Owner and CEO of Live Longer Medical, Lisa Guyer, chose to settle on the Space Coast after exploring many locations and opportunities in Florida. 10 : S PAC E COA ST L IV IN G HEALT H | S PAC ECOA ST L I VING.CO M
“I liked this clinic because of its location in the middle of multiple major hubs,” said Guyer. As she continued, Guyer commented on the continuous demand around the nation for cutting edge, integrated treatments and therapies for people from all walks of life. Upon her arrival to the Space Coast, Guyer noted how special the area felt to her. The nature of the people and the communities around her have welcomed her with open arms, showing Guyer that she can provide her knowledge and share her expertise. The team at Live Longer Medical faces illness and medicine head on with a multidisciplinary approach, allowing them to provide integrative paths to treat their patients. “We provide insurance-based, family practice medicine, but we are not limited by insurance mandated detail. In other words, we take a little more time and dig a little deeper to
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find the needle in the haystack. We look for the root cause of an illness or a disease and we focus on practices that are scientifically based in order to help treat our patients,” says Guyer.
sets us apart is that we’ve stepped out of the box. We’re
“We give traditional a different twist. We’ve stepped out of the box and we’re giving medicine a higher look and a higher response.”
volunteers her time to speak to many community groups.
Live Longer Medical provides cutting edge technology, practices and knowledge to help you restore your health, vitality and to increase your longevity. Nutritional medicine, weight loss programs, anti-aging medicine, adjunctive cancer treatments, IV vitamin therapies, and even “Smart Photography Arrogant Watcher Drugs” which help improve your memory and IQbyare some of the many available options. Not to mention the numerous other fantastic treatments and options that Guyer and her team provide! “We like to be very in the know as far as what’s out there and what’s new.” Guyer’s practice provides both insurance and cash-based visit methods, giving patients even more options to fit their needs and capabilities.
“We don’t believe in one size fits all. We really take the time to listen to our patients”
focusing more intently on our individual patients and their unique needs.” Integrating herself even more in the community, Guyer She has personally spoken to members of the American Business Women’s Association, The Rotary Club and numerous other community support groups, with more to come. Within the next five years, Guyer plans to expand on her Indialantic location to open up several other practices around the area. She and her team also expect to continue searching for alternative treatments that can help people be their best selves. If you’re the kind of person who is looking for a premier, comprehensive care provider, then Lisa Guyer is ready to accept you with open arms.
FOR MORE INFORMATION • 102 5th Ave, Indiatlantic, FL 32903 • (321) 327-2980 • livelongermedical.com Lisa Guyer, CEO/Health Coach
Guyer is very passionate about what she does. You can hear the passion in her voice when she speaks about helping others in her community. She genuinely wants to know you personally and find out what you want and need with regards to your health, wellness and body. “We don’t want to be a ‘Band-Aid’ caretaker. We want to get to the root of that illness to treat our patients.” By promoting lifestyle changes, Guyer is able to help patients restore their vitality and increase their longevity in numerous ways. To maintain and expand on their experience and knowledge base, Guyer and her team attend multiple different training sessions throughout the year, always looking to pick up on a new skill or practice. “We want to continuously improve our knowledge base and our services. The newest, the latest, the greatest! We want to be the best in our area,” says Guyer. Guyer also attends at least three major conferences a year in addition to the online courses that she and her team take as refreshers and continuous improvement practices. If that isn’t enough, Guyer comes to the Space Coast with over 20 years of experience in the medical field, treating over 200,000 patients. Those numbers attest to her knowledge and her ability to help our communities. Guyer has also treated professionals ranging from numerous athletic backgrounds to performers and to communities around the country. Guyer’s last practice, The Guyer Clinic in Indiana, even had a year-long wait time to be seen. “What WI N TE R 2019 : 11
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BIOLOGICS IN DERMATOLOGY
Porter Premiere Dermatology team Article photography by Jason Hook
INTRODUCTION BY HEATHER MOTRO JUNIOR ASSISTANT EDITOR MAIN ARTICLE BY DR. ANTHONY PORTER PORTER PREMIERE DERMATOLOGY
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r. Anthony Porter has long held a passion for innovation and progress. First earning a B.S. in Engineering from the University of South Carolina, Dr. Porter worked as a nuclear engineer for seven years before choosing to return to school to study medicine. When he finished his Residency in Dermatology at the Medical University of South Carolina in 2002, he held both a doctorate in medicine and membership in Alpha Omega Alpha Medical honor society. After gaining experience in the field, Dr. Porter opened his own practice, Porter Premiere Dermatology and Surgery Center, on Nasa Boulevard in 2010. Porter Premiere Dermatology offers general, surgical and, at its brand-new second location on Suntree, cosmetic services. The new office is twofold, with separate waiting and procedure rooms for both sides: One wing is devoted to clinical dermatology and is staffed by experienced medical 33: : SPAC 12 SPACEECOA COAST L IV IN G HEALT H | S PAC ECOA ST L I V ING.CO M
professionals, while the other wing is Premiere Medical Aesthetics, a spa-style cosmetics center with professional aestheticians. The office also has a nurse practitioner onsite, who does about 95% of the injections for botox and fillers for the whole practice. Unlike most dermatology practices, Porter Premiere offers services to anyone regardless of age. You won't find another practice to offer full-body phototherapy nor another dermatology office with Ultrasound-guided superficial radiotherapy for non-melanoma skin cancers in the area. With this kind of forward-thinking, it's no surprise that Dr. Porter is an expert on dermatology’s latest development, a life-changing form of treatment known as biologics.
FROM THE DR. Approximately 3% of the world’s population suffers from psoriasis. Caused by a hyperactive immune system, it is systemic (effecting the full body) and presents as round, red, scaly plaques on the skin and characteristic changes in the nails. One-third of patients with psoriasis eventually develop psoriatic arthritis, which can lead to deformity and destruction of joints. While mild, isolated forms of psoriasis typically respond to topical steroid ointments or creams or phototherapy, moderate to severe cases may require a treatment that affects the whole body. In 2003, a new class of medication called biologics, which are antibodies and
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proteins engineered to prevent the psoriatic inflammation, were developed to treat more aggressive psoriasis. Before biologics, systemic treatments for psoriasis involved the use of strong medications like methotrexate and cyclosporine that suppress the immune system. These drugs are effective; however, their use can lead to kidney and liver disease and, due to their immunosuppression, greatly increase a patient's risk of developing an infection. Biologics provide a more targeted, nuanced approach, inhibiting only portions of the chain of inflammation, called the inflammatory cascade, that causes psoriasis, thereby resulting in more effective, safer treatments with much less immunosuppression. The efficacy of these biologics is remarkable: Most patients achieve clear or almost clear results. Not only do biologics improve the psoriasis of the skin and nails, but they greatly diminish the painful and destructive inflammation that leads to arthritis. The improvement in the quality of life is life-changing, as most patients can achieve these impressive results without the need for creams, ointments or phototherapy. Currently, 12 FDA-approved biologics for psoriasis are available. Eleven of the 12 are administered by injection, with only one, Infliximab, requiring intravenous infusion. There is no ideal or first-line biologic. Instead, the physician chooses which biologic to use in consultation with the patient, giving consideration to frequency of dosing, patient weight, involvement of joints, body parts affected and drug cost. The biologics currently fit into three main categories based on which specific portion of the immune system inflammatory cascade they target: Tumor Necrosis Factor inhibitors such
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as Adalimumab (HUMIRA) and Etanercept (ENBREL), Interleukin-17 inhibitors such as Secukinumab (COSENTYX) and Ixekizumab (TALTZ) and Interleukin 23 inhibitors such as Guselkumab (TREMFYA) and Risankizumab (SKYRIZI). We teach patients how to self-administer these products by an injection just under the skin of the abdomen or upper thigh using a small, user-friendly syringe or an auto injector pen. Most of these products are approved for adults 18 years of age and older, but a few are also FDA-approved for teens and adolescents. The safety profile of these biologics continues to improve as newer agents get approved. Before starting biologics, all patients must be screened for active tuberculosis. In addition, I obtain comprehensive blood tests, including tests for Hepatitis B and C. The patient must also be free of any active infection. Patients with minimally active human immunodeficiency virus (HIV) but otherwise average health have been successfully treated with the IL-23 biologics. The TNF class agents carry a very small risk of organ cancers and skin cancers. Likewise, the IL-23 agents must be used with caution in patients with inflammatory bowel disease. Certolizumab (CIMZIA) is the only agent that has been shown to be safe in pregnancy and breast-feeding. Patients are encouraged to get all required vaccinations prior to
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starting a biologic, especially as live vaccines cannot be given during biologic therapy. The most commonly used live vaccine on the market is the shingles vaccine, but there is now a new attenuated (inactive) shingles vaccine available for use. Access to biologics has been a challenge for some patients due to a variety of reasons. An important element is the relatively low number of dermatologists who are willing to prescribe these products. Dermatologists have traditionally been quite cautious about recommending medications that suppress the immune system, and thus have not been very aggressive about prescribing biologics. Fortunately, over the past several years this trend has changed as more dermatologists are recognizing the incredible effectiveness of these products along with the relatively clean safety profile. I have been a long-term advocate for and prescriber of biologic therapy for patients with psoriasis over the past 16 years. Another critical factor is the incredible costs of these drugs. Unfortunately, these products can range in cost from $30,000 - $40,000 per year. Commercial insurers and certain Medicaid providers play a critical role in helping patients gain access to these agents by covering most costs for the patient. The pharmaceutical industry has also helped with access by establishing foundations and co-pay
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assistance programs that help to expand availability to these valuable medications. Patients over the age of 65 who rely solely on Medicare also have difficulty accessing these drugs due to the exorbitant cost. Another product for psoriasis that is FDA-approved and worth mentioning is apremilast (OTEZLA). This drug also inhibits certain inflammatory proteins, but it is not immunosuppressive and has therefore gained popularity with patients who may be concerned about suppression of their immune system. Though not considered a biologic, this product, which is administered in tablet form, has delivered reasonably good results in the treatment of psoriasis. The American Academy of Dermatology and the National Psoriasis Foundation are great sources of information about treatments for psoriasis. Atopic dermatitis (eczema) is another systemic, immune-related disorder that is characterized by inflamed, scaly red patches and plaques on various parts of the skin. The condition can be associated with asthma, seasonal allergies, sinusitis and/or hay fever. Patients can have only a few isolated lesions, or, have almost their entire skin surface affected by this disorder. The lesions are intensely itchy leading to constant picking and scratching of the skin that severely decreases the patient’s quality of life. Most cases are mild and typically respond to lotions, topical steroid creams and Dr. Anthony Porter antihistamines. However, severe cases of atopic dermatitis require more aggressive treatment. The first biologic developed to target the specific inflammatory process that leads to atopic dermatitis was FDA-approved and launched in 2017. This product, Dupilumab (DUPIXENT) has revolutionized the way I treat atopic dermatitis and has drastically improved the lives of patients suffering from this debilitating condition. This agent modulates the immune system by inhibiting specific inflammatory proteins but does not suppress the whole immune system. DUPIXENT is now approved for
patients with atopic dermatitis as young as 12 years old. The new age of biologics is incredibly exciting as the medical industry continues to develop targeted, safer, more effective therapies. Cosmetic dermatology is an everexpanding field as patients seek aesthetic procedures to approve their appearance. However, biologics have breathed new life into the field of general dermatology for physicians like me who have a passion for treating inflammatory diseases. WI N TE R 2019 : 15
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FEATURE
SEEING AGING EYES IN A DIFFERENT LIGHT
HOW LIFESTYLE CHANGES AND SUPPLEMENTAL NUTRITION CAN MAKE A DIFFERENCE IN MACULAR DEGENERATION BY CARRIE STEVENSON WRITER
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long lifespan is a nearly universal goal. But the more birthdays you celebrate, the more health issues you may face, especially when it comes to the most vulnerable parts of the body – the skin and eyes. While we cannot entirely prevent the cellular breakdown that occurs to our eyes over the years, we can take steps to delay the onset and drastically reduce the severity. And according to Rafael Trespalacios, MD, Lead Surgeon and Medical Director of Brevard Eye Center, it all starts with limiting our exposure to damaging factors and taking supplemental steps to buffer our biological defenses. When it comes to aging diseases of the eye, Macular Degeneration looms large. According to the American Macular Degeneration Foundation, “Macular Degeneration is the leading cause of vision loss and affects more than 10 million Americans – more than cataracts and glaucoma combined.” Caused by the deterioration of the center of the retina, Macular Degeneration involves the loss of central vison in the eye, which impacts the ability to drive, read or recognize faces. Those affected by advanced Macular Degeneration are considered legally blind, although they maintain peripheral vision. There is currently no cure for Macular Degeneration. “The truth is, if we live long enough, we will all be affected by Macular Degeneration,” explains Dr. Tres. “It’s an aging disease, and there are things about aging that are inevitable – tissue gets thinner and more fragile, things break down. But there are choices we make before we reach old age that have a huge impact on when our macula (the center of the retina) begins to degenerate and how quickly it progresses.”
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Top: normal eye Bottom: Eye with Macular Degeneration
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The eye is a complex and amazing organ that ages similarly to our skin. Just as our skin gets thinner as we grow older, with some thicker patches and uneven tone, our eyes atrophy with
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age. The steps to slow this process down include quitting smoking, eating an abundance of leafy green vegetables and reducing our exposure to “blue light,” the light emitted by electronics. “The idea is to address modifiable risk factors,” Dr. Tres says. “Smoking breaks down collagen, which weakens the integrity of the retina. It’s one of the most crucial risk factors for Macular Degeneration. Eating a lot of leafy greens buffers the biologically active tissue in the back of the eye, so it doesn’t degenerate as quickly.” “And there is more and more evidence that the blue light from our cell phones, laptops, and other electronics plays a role in this disease,” continued Dr. Tres. “So, change the setting on your devices to ‘night mode’ and get blue-blocking film on your glasses. It’s simple lifestyle changes like these that can delay the onset or lessen the severity of Macular Degeneration.” As an additional protective step, carotenoids – pigments that provide color in many fruits and vegetables – can be taken as supplements that, along with a healthy diet, can protect eyes from the damaging effects of blue light and reduce the risk of developing Macular Degeneration. Brevard Eye Center
. u o Y r o F e r e ys H a w l A e 'r e W
was the first ophthalmologist practice in Florida and remains the only one in Brevard County that can measure the level of carotenoids and macular pigment in your eyes to establish a baseline reading, provide carotenoid supplements to improve the pigment’s thickness and then retest your level to measure improvement. “Carotenoid supplements can actually improve the performance of your eyes – professional baseball players utilize them to lessen their reaction time,” says Dr. Tres. “There are vitamins specifically made for children’s eyes, because the earlier you strengthen pigment level, the better. It’s one more layer of care to delay the onset of Macular Degeneration.” Brevard Eye Center team Photography by Jason Hook
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HEALTH
FEATURE
THANKSGIVING AND YOUR PETS:
HOW TO KEEP THEM SAFE AND WELL THIS HOLIDAY SEASON BY CHLOE EVETTS WILLIAMS, DVM CONTRIBUTOR
KEEP THE FOOD ON THE TABLE What to avoid:
T
he weather is cooling down, stores are showcasing their fall decorations and Pumpkin Spice Lattes are available at every coffee shop. That can only mean one thing: Thanksgiving is on the way! The holiday season brings lots of joy and excitement, but it’s important we consider our furry friends who share our homes with us while we are busy cooking, decorating and preparing for the holiday. Some holiday foods can be toxic to pets, and although traveling to see family and friends is great for us, this can sometimes cause some stress to our pets. Below are some ways to help keep our pets as safe as possible during this festive time of year. 18 : SPAC E COA ST L IV IN G HEALT H | S PAC ECOA ST L I VING.CO M
1.
Turkey meat and turkey skin can be quite harmful to pets, due to its high fat content. This can result in nausea, vomiting, diarrhea and even severe illnesses such as pancreatitis (inflammation of pancreas).
2.
Certain foods like grapes and raisins, which may be dropped on the ground while cooking, are actually toxic to our pets and can sometimes result in kidney failure.
3.
Onions and garlic are two other common ingredients that make an appearance when cooking. Excessive ingestion of these items by our pets can result in toxicity.
However, some safe snacks to share with your pooch are pureed plain pumpkin (not sugar-filled pumpkin pie filling) and uncooked green beans and carrots. If you are concerned your dog or cat may have ingested something toxic, the best action is to call your local veterinarian or the ASPCA Pet Poison Hotline.
4.
Not all pets love car rides. If your pet is one who finds this experience stressful, there are a few different medications that may be tried to help either sooth anxiety or ease motion sickness. Your vet will be able to help determine if they are a candidate for such therapy.
5.
Sometimes the safest place for your pet to be while traveling is in a trusted boarding facility. Many facilities require certain vaccines such as the canine flu vaccine or the Bordetella vaccine (also referred to as the “Kennel Cough” vaccine). Ensure your pet is up to date on all their required vaccines many weeks prior to leaving for your trip to avoid any last-minute hiccups or delays. Contact your boarding facility to see what is required, and then contact your veterinarian to see what vaccines your pet may be due for.
Thanksgiving is a time to reflect back on our lives and everything we are grateful for including our dogs, cats and other furry family members. Hopefully the provided tips will help everyone enjoy the upcoming holiday as stress-free as possible. Happy Thanksgiving!
TRAVELING TIPS 1.
If you are traveling with your pets, keep them safely restrained in vehicles, either in a crate or via a seatbelt compatible harness. 2. Never leave your pet in your vehicle alone. Even though temperatures have begun to cool down, heat stroke can happen in a matter of minutes if pets are left in cars unattended. 3. Proper identification is important should your pet somehow get lost or separated from you on your trip. Make sure they are fitted with a collar with identification, whether that is embroidered onto the collar or on a separate tag. Discuss with your vet about whether your pet is micro-chipped, and if not, you may want to consider getting them micro-chipped before leaving for travel.
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Celebrating Life at Palm Bay As neighbors, family members and friends, we share the emotional connection that inspires a sense of community. Our comprehensive memory care program is specifically designed to engage the senses, expand the mind and enhance the emotions of our residents.
Call today for information or to schedule a visit! (321) 574-6290 Palm Bay Memory Care 350 Malabar Rd, Palm Bay, FL 32907 www.palmbaymemorycare.com Assisted Living Facility #12617
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J James Brassard MBA, CDP Community Relations Director
ames Brassard is a combat veteran who served in both Afghanistan and Iraq. After exiting the military, he continued his education, which culminated with his MBA from Florida Gulf Coast University. Throughout his career
350 Malabar Rd. SW Palm Bay, FL 32907 (321) 574-6290 palmbaymemorycare.com mlyon@palmbaymc.com
M
ichele returned back to school in 2010 to complete her degree.
During her internship, she was fortunate to be placed with the most amazing mentor, Charlotte Willis,
Michele Lyon, CDP Executive Director
PH.D., LCSW, FAACS. As mentors go, Charlotte was the best. She taught Michele that the most important thing
HIGHLIGHTS
in Senior Living, James has been responsible for two successful startup communities, one which he not only helped open but has also recently helped with its transition from Inspired Living to Palm Bay Memory Care. As the Community Relations Director, he serves the aging population with knowledge, experience, understanding and integrity. In his free time, he enjoys traveling with his family, and also gives back to our younger generation as a College Professor. He has also started a non-profit organization that hosts golf tournaments to raise money and awareness for those with dementia in Brevard County. James makes himself available 24 hours a day and has a deep passion and desire to help those with whom he comes in contact.
was to always keep learning, surround yourself with people who want the best for others, and most important, to be relatable. One of things Charlotte stressed was that if you were perfect, people would be hesitant to share their stories or be vulnerable or ask for help, whereas if they could see you were just a person like them, then you could create an actual connection and make a difference. Michele has the outlook of mistakes create opportunity. As long as you are learning and growing from your mistakes, then there was a reason those mistakes happened. During her career, Michele has grown through the ranks in senior living. She started as a program assistant and is now working as the executive director. Michele feels that the most important part of her job is to create relationships with the residents, families and staff members that choose to make her community home.
WI N TE R 2019 : 21
HEALTH
FEATURE
EVENT READINESS TIMELINE:
HOW TO LOOK YOUR BEST ON YOUR MOST IMPORTANT DAYS ARTICLE AND PHOTOS PROVIDED BY DRS. ANITA SALUJA AND REBECCA NOVO
A
t Dermatology + Plastic Surgery, we often meet with patients who are getting ready for a huge life event: weddings, reunions, holidays, birthday milestones or photoshoots. The common feeling among all these patients is that the timeline to prepare is shorter than ideal. So we developed a timeline tool to put things in perspective for patients to better prepare and plan, so that we have a strategic approach and can obtain optimal results for our patients. If time is limited, there are always things we can do to enhance or improve skin quality and facial features, but we will present the ideal timeline for major life event readiness. When patients are considering a more major change involving healing or recovery time, a consultation should take place four to six months prior to event. This allows appropriate evaluation and planning to coordinate time that may be needed to be off work or arrange special support through recovery. Typically, from the time of consultation, procedures or surgery can be done within one to two months, and recovery is normally four to six weeks. Popular procedures are eyelid surgery, breast augmentation and body contouring. We encourage starting a medical grade skin care regimen four months prior to an event. Every six weeks the skin goes through a complete regenerative cycle, and this gives time to optimize any skin care regimen to achieve goals such as removing aging brown spots or discoloration, improving texture and reducing fine lines. Our core steps to any regimen can be simplified to:
1. Cleanse 2. ProteCt 3. renew
Graphic from yourbestself.com
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We need to remove daily oil and debris so that our products can penetrate the skin and take effect. We must protect with a mineral SPF 30 or greater to reduce and repair damage caused by the sun and our environment. And we must renew with retinol/tretinoin and antioxidants to slow and actually reverse the aging process that is ongoing.
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Between two and three months leading to event, we recommend treatments such as liquid lifts, and Dr. Saluja’s Y-Lift using fillers to re-volumize and optimize facial shape. We often do these treatments in combination with wrinkle relaxers such as botox, dysport, or jeuveau to synergistically enhance facial appearance. Wrinkle relaxers will last up to three to four months, and typically hyaluronic fillers will last six to 12 months, allowing time for refinement or addition of product prior to any event if needed.
from the skin surface and infused customizable options such as hydration or antioxidants back into the skin. Both treatments enhance your skin care products penetration so that they work better, and both treatments leave you with an irresistible albeit addictive event ready glow. And here you are – event ready!
Other non-invasive treatments to consider during this time are radiofrequency body contouring with Trusculpt 3D. We have found this treatment to be as or more effective than Coolsculpting with less discomfort. Also, in this timeframe is when we introduce lasers for complexion or resurfacing to further enhance skin quality and appearance and visibly reduce signs of aging. When the event is one to two months away, we encourage light chemical peels to remove dulling dead skin layers and improve the appearance of your complexion. As the event day approaches within one to two weeks, we recommend our patients to experience a dermaplaning or a hydrafacial. Dermaplaning uses a surgical scalpel to very gently scrape away all the peach fuzz, debris and dead skin cells from the skin’s surface without any recovery. The hydrafacial is an innovative suction/extraction/infusion system that clarifies all pores and removes dead skin cells and debris
Before
after
Dermatology + Plastic Surgery team
WI N TE R 2019 : 23
EXECUTIVE
HIGHLIGHT
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Frank G. Ditz, MD Medical Director/Owner
2 Suntree Place Melbourne, FL 32940-7689 (321) 253-3944 familypracticesuntreeviera.com familypracticeofsuntree@gmail.com
F
rank G. Ditz, MD, is a board-certified family practice physician with more than 20 years of experience. He has won many physician and patient choice awards as well as the Physician of the Year for the National Republican Congressional Committee™. Dr. Ditz has expertise in multiple fields and is both a local and a national lecturer in many subjects including insomnia, osteoporosis, hypertension, depression, asthma, diabetes mellitus and antibiotic therapies Dr. Ditz states his most impactful mentor during his career journey is the same person that made him grow into his profession: his mother, Nancy Ditz. His deep love and respect for others, along with his need to help improve and maximize the length and quality of life, came from the love she had for her family and her selfless devotion to
24 : SPAC E COA ST L IV IN G HEALT H | S PAC ECOA ST L I VING.CO M
others. While witnessing her face a life-threatening experience, he made a simple “deal with God:” He promised if he got his mother back, in return, he would do everything he could to help others get their lives and family members back from any medically related danger. That promise is as strong at age 55 as it was at age five and is what powers his entire practice and has led him to practice medicine from Washington D.C. to Okinawa, Japan to Saudi Arabia in both wartime and peacetime, military and civilian practice. The real world has often let him down but his medical sense of always looking at the big picture and how everything works and fits together allows him to catch things both in medicine and business before too late and has allowed him to become successful in the position he now holds.
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