In Conversation: Innovation In Medicine

JANUARY 2020 EDITION

IN CONVERSATION FEATURES THREE LEADING MEDICAL PROFESSIONALS IN THE REGION, EACH OF WHOM SPECIALIZE IN DIVERSE FIELDS. THEY SHARE THEIR THOUGHTS ON TODAY’S STATE-OFTHE-ART TECHNOLOGIES AND INNOVATIVE MEDICAL TRENDS BEING CATALYZED. DR. MIKE ARSENAULT, DR. JOSEPH J. ROSS AND DR. MARK WALTER DISCUSS KEY TOPICS WITHIN THEIR RESPECTIVE SPECIALTIES, SHARE IDEAS FOR QUALITY PATIENT CARE AND HOW THEY STAY AHEAD OF THE CURVE AS MEDICAL PIONEERS.

In

Conversation

DR. JOSEPH J. ROSS, MD, FACS Director and CEO

DR. MIKE ARSENAULT, MD, MBA Director of Business Innovation

DR. MARK WALTER, MD Stem Cell Orthopedic Specialist

Envision Eye Specialists 3920 Bee Ridge Rd., Building F Suite A Sarasota | 941-921-7744 envision-eye.com

Arsenault Dermatology 8926 77th Terrace E #101 Lakewood Ranch | 941-907-0222 arsenaultdermatology.com

Stem Cell Orthopedics 2068 Hawthorne St. Suite 202 Sarasota | 941-955-4325 StemCellOrthopedics.com

INNOVATION IN MEDICINE

IN C ON VERSAT I ON

ABOUT THE PARTICIPANTS DR. MIKE ARSENAULT, MD, MBA Arsenault Dermatology is one of the most complete dermatology centers in Florida, created over 15 years ago by Dr. Mike Arsenault’s wife Dr. Emily Arsenault, MD, FAAD, an award-winning dermatologist who has been involved in both research and patient care. She has presented her work numerous times at national meetings for Dermatologists and Dermatologic Surgeons. Dr. Arsenault is a Fellow of the American Academy of Dermatology and has earned the distinction of being Board Certified in Dermatology.

Her practice is entirely outpatient—offering a full range of skin care services including mole checks, skin cancer screening, skin cancer surgery and full body mole mapping. Their highly skilled dermatologists cover all aspects of general dermatology including removal of cysts, and all kinds of skin growths; treatment of warts and keloids; surgical revision of scars; mole removal; and treatment of psoriasis, skin allergies and hair loss.

The practice also offers the latest in chemical peels, microdermabrasion, the treatment of acne, photodynamic laser therapy, advanced treatments for broken blood vessels, rosacea, and facial redness, as well as Botox® for hyperhidrosis and a variety of cosmetic dermatology procedures.

Arsenault Dermatology, 8926 77th Terrace E #101, Lakewood Ranch, 941907-0222, arsenaultdermatology.com.

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WHAT ARE YOU THE MOST PROUD AND PASSIONATE IN YOUR WORKING FIELD? Dr. Mike Arsenault: I think we’re a market here for quality, but I think what we’re really trying to achieve is creating an unparalleled patient experience. When we first started, it was more of a transaction. ‘I’m sick and I’m going to give you my copay and you’re going to exchange that for wellness.’ We’ve really tuned into the patient’s experience, right from the very beginning.

Now, everything that we’ve built and designed is to really deliver a concierge-level experience, and the way we’re able to do that is through the design of the practice, the technology, and first and foremost are the people on our team.Dr. Joseph J. Ross: Along the same lines for us. We do general eye exams and everything, but the biggest thing that we have is personal care. We don’t have a mill, we don’t send people through, but don’t push them into having anything done.

But we provide all the options for them. So anything they need done, we provide the options, not tell them they have to have this or that done and are very, very personalized. We really specialize in spending time with patients, especially patients who originally went elsewhere and didn’t get the results they wanted and to try to fix their outstanding problems here. I come from a background at a teaching institute where essentially all the problem patients and all the mess ups were sent to us, so I have years of experience fixing others’ problems.

So I don’t mind those patients coming in saying, ‘I’ve been to 10 doctors that can’t come up with the answer, can you help us’? We spend the time and effort and we have the resources in the office to help them out. We have all the treatments available, from the basic eye drops to LipiFlow to

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all the different new technologies of increasing the oil glands production in the eyes, including the M22, which is an IPL laser now actually used for Dry Eye Syndrome. And so we provide the extra service for those people who couldn’t get the results they wanted elsewhere. Dr. Mark Walter: I’m going to say our primary goal is to offer people non-surgical solutions to serious orthopedic problems. My particular area of expertise is the myofascial. So what I’m really passionate about is what I would call myofascial micro tears, which commonly are missed on MRIs and ultrasounds.

So people come in with, let’s say, back pain, or complex cases and no one seems to be able to help them, or they have an abnormal MRI, and there’s discopathy but they might be misdiagnosed as a discopathy that may not be the primary pain generator. So that’s my expertise, to find out what’s the root cause of the pain? And is there a nonsurgical way for us to fix it? Is STEM cells appropriate in this case? And when I say STEM cells, I’m usually using STEM cells from fat. We find they’re far more potent than from bone marrow. But that’s another option. And we usually mix it with PRP. Those are your growth factors in your blood.

Ross: We don’t use STEM cells in our industry yet, so it’s exciting to hear how mainstream it’s becoming because even before it was research level, it didn’t really feel like it was part of ongoing practices. Walter: So there’s two different approaches. You know the macro thing, which is the surgeons trying to put things back together and change things and do stuff. And then there’s the cellular level. We’re trying to regenerate things at a cellular level with the STEM cells and of course the best mix, the best solution will be sometimes you

have to mix these two things and use them optimally. Sometimes cellular regeneration is what you really need at a microscopic level and sometimes these are macro things—like we have a ligament or tendon tear that’s avulsed that needs to be reattached.

WHAT TECHNOLOGICAL INNOVATIONS ARE TRENDING SPECIFICALLY IN YOUR FIELD? Ross: The technology is just booming. Ophthalmology and eye plastics is really generally about new machinery and new technology, so new stuff is coming out every year—mainly to treat things earlier so you prevent things from going bad like macular degeneration in the retina, so helping to prevent it from advancing to the point where the person loses their vision and they we have to try to restore it. You can prevent it with the newer supplements and vitamins and things that have now been technologically proven to help preempt macular degeneration. For example, there are 10% of people who have macular degeneration that actually zinc vitamins make their macula worse. So now, there is a test that is approved by the FDA that you can have genetic DNA tests and it’ll tell you your optimal vitamins to take for macular degeneration. Then you can formulate those, instead of giving somebody an over-thecounter vitamin that has a high dose of zinc, which helps 90% of people but they may be that 10% that it actually is making their eyes worse. So a lot of things go towards DNA testing, both for retina diseases, the STEM cell technology, which is the newest in the field and just the machinery available now to pick up things earlier on a microscopic level that we didn’t have before.

Arsenault: I’m a little less ap-

IN C ON VERSAT I ON

ABOUT THE PARTICIPANTS DR. JOSEPH J. ROSS, MD, FACS Dr. Joseph Ross specializes in eye and maxillofacial cosmetics, reconstructive plastic surgery, hair restoration surgery and scalp alopecia reduction.

He graduated from the prestigious Case Western Reserve University and received his fellowship from the University of Arizona College of Medicine. A"er receiving numerous medical awards for the best surgeon in Florida and with over 35 years of practice, he is considered a worldwide leader among the elite board-certified ophthalmologists and plastic surgeons. At Envision Eye Specialists, Dr. Ross currently provides highly recommended cataract refractive surgery as well as surgical care for patients with any kind and any stage of eye-related disease or eye malfunction. He has a license to practice in multiple states including Florida, Ohio, Arizona and Michigan and is part of an extensive list of professional societies including American Medical Association, American Society of Ophthalmic Plastic & Reconstructive Surgeons, American Academy of Ophthalmology, International Society of Hair Restoration Surgery and more. Envision Eye Specialists, 3920 Bee Ridge Rd., Building F Suite A, Sarasota, 941921-7744, envision-eye. com.

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plied and more on the innovative side of operational efficiencies.

The innovation that I’m involved in is not very patient-facing directly. It’s not like, ‘Oh, we have this brand new laser.’ It’s more under-the-hood kind of stuff. And then eventually turns into the experience that they get from our provider. Because we see a huge volume of patients, and give every single one of them a concierge-level experience, it requires a huge amount of infrastructure. So what it is really starting to trend toward, and I think we’re one of the more early adopters of it, is the application of big data. Probably the biggest innovation in our field in the last 10 years is actually electronic medical record-keeping. We’ve moved away from paper charts and everything’s being held on the computers. We use two totally different systems because one’s great in the rooms and one’s great to operate the practice. The one that’s great to operate the practice, we’ve actually tethered that to a national level—kind of like a super computer of big data.

I can bring down chunks of data to my desktop and try out ideas and start to explore the data.

Now that this data is flowing in, it’s getting us a very granular look at the operation and it’s allowing us to counterbalance the schedule and to give feedback to the providers so that they can dial in what they’re doing too. Ross: Do those programs reach out to the patient’s home? Because a lot of things are going to begin messaging at the home level.

They type it in from their home computers into your system and communicate with you that way.

Arsenault: We don’t do that yet, but the concept of extending care somehow outside of the office environment, we’re looking at that right now. Everyone has a miniature computer in

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their pocket and there’s a lot of different groups throughout the country that are trying different models to teledermatology. This is something that we’re in beta with right now. We’re pretty excited about this idea of patients being able to send us in a selfie of their concerns. We’re kind of like an observational science, maybe more akin to radiology, where a lot of it’s very visual and I think the fact that it is and you don’t have to palpate, that starts to open doors for allowing technology to bridge the physical gap, a geographic distance. Sometimes we won’t be able to say without a biopsy, but they generally want to know, ‘Do you think this is something I should come in and be seen for?’ We’re in beta right now where we’ve built the whole platform so folks can do this completely on their smartphones so they can take the picture and they can send it in a secure way to our system and then we have a huge level of infrastructure so we’re able to process and move that request right up to the provider within basically seconds.

Then the provider can give that answer, ‘Yes, I think you should come in’ or ‘No, you’re fine to wait till your next appointment’.

I think that a lot of medicines are going that way—both initiated by the patient, because they want the convenience of being home or using their cell phone to get that information. And insurance companies, they see it as a cost-saving event. Ross: Exactly. And they’re doing a little bit along those lines in Ophthalmology too. At our center in Largo, we do some telemedicine for retina because there’s a lot of areas we tap into in Florida where patients just don’t have access to come in, especially with diabetics. So we have machines out there—again, back to the new technology that will actually analyze. The patient

goes in, they take a photo of tests, there are about six different tests on the patients just looking into these machines. It’s all sent to the office by computer. And then the computer programs will actually alert us that this patient has diabetic retinopathy or this patient has mac degeneration. Walter: For us, it’s simple—if it hurts, you should come in so we can check it out. In terms of technology, I am the applied science side. I’m taking what these guys do and then say, ‘Okay, how are we going to use it?’ My particular expertise is myofascial and that’s often a palpation exam, because like I said, a lot of these micro-tears don’t show up on MRIs or ultrasounds.

So you’ve got to become very adept at palpating and finding, where’s the root cause of this pain? Where’s the jump sign in this patient? And if you push on a ligament or tendon attachment or a myofascial attachment that’s tender, that’s telling me that it’s weak. And so there’s science, but it’s the art of finding the thing and putting STEM cells and PRP in the exact right spot, peppering it so you can stimulate the body to heal it. Myofascial pain is probably 80% of musculoskeletal pain. So it isn’t just bones and cartilage and nerves—the ligaments and tendons and myofunctional attachments are usually important pain generators.

HOW DOES YOUR PRACTICE AND THE INNOVATIONS THAT YOU DO IMPROVE THE LIVES OF YOUR PATIENTS? Arsenault: A lot of folks see us as a visual science, but very frequently we need to do a biopsy so that that sample can be made into a microscopic slide. Then there’s another physician dermatopathologist who will then zoom in at the cellular level to tell you if you have cancer or not. The industry standard, and it’s been

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ABOUT THE PARTICIPANTS DR. MARK WALTER, MD, Dr. Walter is a pioneer in the field of Stem Cell Orthopedics and one of Florida’s top Regenerative Orthopedic specialists, and has even appeared as a guest on NBC’s Daytime, as well as ABC’s Suncoast View.

He is a member of the American Academy of Orthopedic Medicine and has wri!en and lectured extensively on the field of Regenerative Orthopedics and Stem Cell Orthopedics. Dr. Walter received his M.D. degree from McGill University and is board certified in Family Practice (C.C.F.P.).

He trained and worked with the top Regenerative Orthopedic teachers in the world and has specialized in regenerative orthopedic injections for the last 15 years and treated thousands of patients with this approach. By combining this extensive Regenerative Injection experience and skill with leading-edge stem cell technology, he is able to offer his patients some of the most advanced approaches in Regenerative Orthopedics available to fix joints, back and neck pain non-surgically. Dr. Walter is the founder of ProloMD and Advanced Orthopedic Stem Cell.

Stem Cell Orthopedics, 2068 Hawthorne St. Suite 202, Sarasota, 941-955-4325, StemCellOrthopedics.com.

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this way ever since we started 16 years ago, is it’s a 10- to 14-day process between your visit and when someone on the team calls you to tell you what your results are and what the next step is.

That’s a long time to wait, wondering, ‘Do I have cancer?’ And the first thing that we identified is trying to get people on the telephone is tremendously inefficient and actually just builds the anxiety. Every time you keep having a near-miss, they get more anxious. If you miss someone on the phone on a Friday afternoon, we’re not going to talk to them till Monday. Boy, by Monday they’re really not feeling great about it. So we’ve really leaned into texting patients—from initial contact to delivering test results.

We took the technology that we have internally and we applied a little creativity and we have a new platform that has been running for about four months and is wildly popular. We took the return time from two weeks down to two days for the vast majority of our patients. And that has really delivered a level of service that is so new to patients. That’s where they see the technology really play. My wife, Dr. Emily Arsenault, recorded a series of videos and these videos are made into 70 different configurations so that you get texted, ‘Hey, results are ready’. We do the HIPAA handshake, make sure that everything is secure, and then for each one of your biopsies, you get a custom-created video that’s specific to your diagnosis and your treatment plan. The patients love it too, because usually when you’re getting these results in person, your mind is going a million different places and you’re not really paying attention. They’ve done studies about how little people retain after a visit. So the beautiful thing about this is patients can watch it as many times as they want on their

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phone. Ross: That’s pretty neat.

Probably the biggest things that I see are patients that come in and we can actually help them to see a lot better and look a lot better.

Over time, patient’s eyelids just start to droop down and they don’t realize how much it’s really blocking their vision and they’re out here driving in Florida, which is crazy to drive in. And you do their eyelid surgery, which most of the time is covered by the insurance, to get them to see better. And they come in and say, “Wow, I can see better, my eyes aren’t tired and I can lift my eyelids by the end of the day I can finally see cars on the side.” So many people, they’re so ecstatic toward us, how they could come in and see better, interact better and drive easier, which is a big thing. Some cases are just from routine aging but there are other people too that have neurological problems. We have had to actually make an eyelid that has no function to it. So I’ll have to use different muscles to move around and get them to have eyelids that open, or the person that’s been in a bad accident or has a neurofibromatosis a really bad disorder. I can reconstruct their whole lids back to normal for them. We’re also known for hair transplants. I’ve had kids come in in their thirties who have never been out on a date because they’re so self-conscious that they have no hair. One guy came in and he had two sessions of transplants and now has a full head of hair. He constantly calls me up to thank me and say how happy he is now. He’s dating again, he’s going out, he’s got a better job—their self-esteem and their feelings about themselves is tremendously boosted by that. Walter: We commonly see patients with back pain—a huge problem in North America. They come in with an MRI that shows ‘Hey, I have a disc problem’ and

then they’re wondering what to do. And I think in many cases STEM Cell Orthopedics might be ideal for these patients because the true pain generator may actually be in the pelvis and not the discopathy. So we kind of bucked the trend there a little bit. You may or may not know it, but back surgery doesn’t have a terrific track record. In my view, they’re misdiagnosing the primary pain generators. So if we can give patients an option and, to me, a better diagnosis,I think we have an 80 to 85 percent chance of fixing it, I think we’ve done a good thing. Because otherwise, that patient, if the discopathy is not the cause of the pain and they have surgery, it can be not a great outcome. Unfortunately, I often see patients at the end of the line—they come to me as the last resort. We’d love to see them as a first resort. If you have a significant orthopedic problem, please come in because we may be able to fix it fairly simply without surgical intervention. The good thing about STEM cells is that you’d never be worse off—there’s no adverse effects, where as with surgery you could end up worse off. It’s a very safe treatment.

You’re using your own STEM cells and injecting them. As long as you inject them correctly, this is a very safe treatment. The only risk, or downside, is it may not work. Because in the end, you’re depending on the patient’s healing and you can’t predict that. But roughly, we have an 80% success rate with most orthopedic problems, and in some cases, I think we have a far superior outcome than the person might have had with surgery, with a fraction of the risk. SRQ The In Conversation program is produced by the BrandStory Division of SRQ MEDIA.