10.22.20 Health Matters

Observer

Health Matters OCTOBER 2020

Heads of the Class Orange County Public Schools’ Medical Advisory Committee comprises 11 medical experts.

Together, they provide recommendations for how the district should operate in the time of COVID-19. Pages 6-7.

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OCTOBER 2020

Observer “If we are to build a better world, we must remember that the guiding principle is this — a policy of freedom for the individual is the only truly progressive policy.”

Friedrich Hayek

“Road to Serfdom,” 1944 President and CEO / Matt Walsh, mwalsh@yourobserver.com Editor and Publisher / Michael Eng, meng@OrangeObserver.com Design Editor / Jessica Eng, jeng@OrangeObserver.com Community Editor / Amy Quesinberry, amyq@OrangeObserver.com Sports Editor /Troy Herring, therring@OrangeObserver.com Associate Editor / Danielle Hendrix, dhendrix@OrangeObserver.com Multimedia Advertising Executives / Ann Carpenter, acarpenter@OrangeObserver.com Cyndi Gustafson, advertising@OrangeObserver.com Iggy Collazo, iggy@OrangeObserver.com Creative Services Lindsay Cannizzaro, lcanniazzaro@OrangeObserver.com Advertising Operations Manager / Allison Brunelle, abrunelle@OrangeObserver.com

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West Orange Orthopaedics hires Dr. Cox Jacob Cox is the third generation to join the family’s medical practice.

AMY QUESINBERRY COMMUNITY EDITOR

When folks in need of a specialist call West Orange Orthopaedics & Sports Medicine and ask for an appointment with Dr. Cox, they have to be more specific.

Jacob L. Cox is the third Dr. Cox to join the team, following in the medical footsteps of his father, Dr. W. Kevin Cox, and his grandfather, Dr. William S. Cox. He grew up in West Orange and South Lake counties, graduated from East Ridge High School in Clermont, attended college and medical school, and has returned to the area after a yearlong fellowship in Texas.

“It’s been a long time coming, but it’s nice to get home and set some roots,” Jacob Cox said.

“It’s nice to come back and reexplore the West Orange area. It’s changed.”

What hasn’t changed is the value of having family nearby. Jacob Cox said his children, ages 3 and 7, are able to spend time with their grandparents — something he was able to do growing up, as well.

Family is important to West Orange Orthopaedics, which has provided care to West Orange County residents for several generations. William Cox started in the early 1970s, and Kevin Cox began working with the practice in early 1992.

“It is a joy and a blessing to be able to work with my dad,” Jacob Cox said. “As my practice ramps up, I’m helping him do surgeries. … I really enjoy being close with my dad. He was a good influence on me becoming a doctor and … working with him in a partnership has been fun.”

Jacob Cox said he considers himself an adult joint-reconstruction surgeon. He is trained as a general orthopedist — a surgeon who treats diseases of the musculoskeletal system. His specialties are shoulder, elbow and knee.

“It gives people a chance to live their lives,” he said. “I love

Courtesy photo

Three generations of the Cox family have practiced with West Orange Orthopaedics: Drs. William Cox, seated; Kevin Cox, left, and Jacob Cox.

to help people to have a dramatic improvement in their joy of life — where somebody has been walking with a lot of pain and suddenly they do their surgery and … get back to golfing and enjoying life with their family.

“It’s an exciting time to be in orthopedics, but now with robotics and 3D scanning, it makes it even better,” he said.

He currently practices at Orlando Health — Health Central Hospital.

Growing up with surgeons in the family put Jacob Cox close to the excitement and passion of being a doctor. When he expressed an interest in studying either architecture or medicine, his father told him to enter the medical field because he wanted to and not because of his family history.

“I decided in high school,” Jacob Cox said. “I scrubbed in with my

“It is a joy and a blessing to be able to work with my dad. As my practice ramps up, I’m helping him do surgeries. … I really enjoy being close with my dad. He was a good influence on me becoming a doctor and … working with him in a partnership has been fun.”

— Dr. Jacob Cox

dad and was able to watch a total replacement.”

That was all it took; he was hooked and never gave architecture another thought.

Jacob Cox received his bachelor’s degree in biology from Eckerd College and his doctoral degree in medicine from the University of South Florida. He completed his internship and residency at the University of South Florida, Morsani College of Medicine.

He is board eligible by the American Board of Orthopaedic Surgery. His areas of specialized experience include shoulder and elbow surgery, general orthopedic surgery, sports-related injuries, trauma, joint replacements and Mako robotic surgery.

Jacob Cox and others in his orthopedic practice serve as team physicians at Foundation Academy, where his oldest son is a student.

“Our role is for the bigger, highrisk events, like home football games; we provide sideline care,” Jacob Cox said.

He and his wife and two children are residents of Winter Garden.

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Dr. Emilio Alonso

Orlando Health UF Health Cancer Center is adding a new liver and pancreatic surgeon to its roster of cancer specialists at the Gastrointestinal Cancer Center.

Dr. Emilio Alonso is boardcertified in general surgery and specializes in hepatobiliary and pancreatic surgery, using minimally invasive options whenever possible.

He earned his medical and bachelor’s degrees in biochemistry from the University of Florida in Gainesville. After a general surgery residency at the University of California — Riverside, Alonso completed a fellowship in hepatobiliary and pancreatic surgery at Providence Portland Cancer Institute in Oregon.

In addition to patient care, Alonso is involved in research projects involving translational tumor immunology and neoadjuvant chemotherapy and immunotherapy. He is a national and international presenter at medical conferences and has been published in peer-reviewed medical journals such as Molecular Pharmacology, Molecular Medicine and World Journal of Clinical Cases.

To schedule an appointment with Alonso, call (321) 841-1838.

AdventHealth, Rady institute launch partnership AdventHealth for Children is partnering with Rady Children’s Institute for Genomic Medicine to bring rapid and ultra-rapid whole genome sequencing to Central Florida families for the first time.

The testing will help critically

ill babies and children in intensive care with unexplained medical conditions receive appropriate care.

This diagnostic technology rapidly identifies the causes of rare genetic disorders in some of the sickest infants and children.

AdventHealth selected Rady to bring the quickest turnaround of genomic test results available in the country to patients in Central Florida. Preliminary diagnoses are typically available in fewer than three days for medically urgent cases.

“Genomics is the future of medicine,” said Dr. Rajan Wadhawan, a board-certified neonatologist and senior executive officer of AdventHealth for Children and AdventHealth for Women.

“This advanced testing can have a significant impact on how we diagnose and treat patients. Rady Children’s Institute is a leader in genomic medicine, and this partnership will help us provide the best care to some of the littlest and sickest patients in our care.”

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Caring for Your Family Like Our Family

Shepherd’s Hope will host its Mask-R-Aid fundraiser beginning at 7:30 p.m. Saturday, Oct. 24.

Because of COVID-19, the West Orange-based nonprofit has postponed its signature event, the Famous Faces Masquerade Ball, until 2021.

A blended live/virtual event, Mask-R-Aid will celebrate community health care heroes. The event will feature entertainment, interactive elements, and live and silent auctions.

Individual viewing tickets are $75; House Party tickets are $750 and include a Happy Hour Menu for up to 10 guests, two bottles of sommelier-selected wine and one Party In A Box delivered to your viewing location; and Helping Sponsor House Party packages are $2,500 and include a catered dinner for up to 10 guests, three bottles of sommelier-selected wine and one Party In A Box delivered to your viewing location. For more, visit shepherdshope.org.

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Orlando Health adds liver/ pancreatic surgeon

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OCTOBER 2020

MINDS ARE BETTER THAN ONE

Get to know the 11 members of Orange County Public Schools’ Medical Advisory Committee.

DANIELLE HENDRIX ASSOCIATE EDITOR

A

n air of uncertainty has surrounded every major decision in 2020, and the ongoing

pandemic posed myriad questions as the start of the school year crept closer. Many agreed that the face-to-face learning modality for K-12 students was ideal. However, Orange County Public Schools leaders agreed families needed to be able to choose the solution that best worked for them.

And, furthermore, determining the best practices and protocols for safely reopening schools was another story entirely.

In late July, Orange County Public Schools established a Medical Advisory Committee to assist with COVID-19 issues the district faces. The committee was tasked with advising the School Board regarding best practices for safely operating schools.

The committee comprises 11 members — including OCPS’ medical consultant — whose expertises include epidemiology, pediatrics, pulmonology, emergency medicine, psychology, infectious disease and nursing.

It will remain in place for one year, and the School Board has the power to consider annual renewal. The group establishes meeting times and dates, and it was instrumental in providing a recommendation to the School Board regarding reopening plans in August.

Members of the committee come from various health care organizations throughout Central Florida — AdventHealth, Orlando Health and Nemours Children’s Hospital, to name a few — but all share the common goal of using their expertise to help keep students, staff, parents and community members safe.

The committee members are Dr. Akinyemi Ajayi, Dr. Adriana Cadilla, Dr. Brian Harris, Dr. Vincent Hsu, Dr. Omayra Mansfield, Dr. Michael Muszynski, Dr. Annette Nielsen, Dr. George Ralls, Darcy Ravndal, Dr. Mercedes Rodriguez and Dr. Regan Schwartz.

EXPERTISE EMBODIED

Each member of the OCPS Medical Advisory Committee brings something unique to the group.

Ajayi’s passion lies in providing pulmonary and sleep medicine care to children throughout much of the state. He finds joy in working with parents and their children.

“With over 25 years as a physician, he is an excellent diagnostician and takes pleasure in attempting to solve every medical mystery that comes before him,” OCPS officials said.

Cadilla serves as a physician with the infectious disease team at Nemours Children’s Hospital.

Harris works with Orlando Health, caring for children with social, behavioral and functional issues

tivation to make sure they

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that could indicate the possibility of neurodevelopmental conditions such as attention deficit hyperactivity disorder, autism spectrum disorder, communication concerns, learning difficulties and more.

Hsu — also the committee chair — has trained at the Centers for Disease Control and Prevention as an epidemic intelligence officer studying outbreaks caused by respiratory and enteric viruses. He even participated in investigations into the 2001 anthrax attacks and 2003 SARS epidemic.

Mansfield is a board-certified emergency medicine physician who is focused on the providerpatient experience.

“Her primary areas of interest are improving the physician and patient experience as it relates to improving provider well-being, patient adherence to care and clinical outcomes, and she has lectured extensively on these topics,” according to OCPS. Muszynski is an expert in pediatric infectious diseases, Nielsen’s heart lies with pediatrics, and Schwartz chairs AdventHealth’s emergency department.

Ralls serves Orlando Health as the senior physician leader responsible for clinical quality, clinical-care delivery systems and outcomes. His job is to ensure Orlando Health provides highquality, efficient care.

“As a physician with a background in public health and safety, it’s rewarding to do my part to assist the staff, students and families of Orange County Public Schools in navigating the challenges of this unprecedented pandemic,” Ralls said.

Ravndal is the Edgewater High School Student Health Center’s primary clinician. During her time at the USF Center for Biological Defense, she was part of the team that developed protocols for sample collection of suspected agents of biological terrorism for first responders.

Rodriguez has been with OCPS since 2004 as a part-time medical consultant for the school system.

“In this unique position, she has also had the opportunity to

different in that many

COMPASSION

join the school nurses in developing coordination and communication systems with local primary and specialty-care providers to ensure continuity of care for OCPS students, particularly fragile students,” according to OCPS. Members of the Medical Advisory Committee advocate on behalf of Orange County’s staff, students and families to ensure that schools are equipped to operate in a safe environment.

“We come from a wide spectrum of roles … and subspecialties … which lends itself to a diverse array of expertise to weigh in on critical issues,” Harris said. “As a group, we review the evidence set forth by national guidelines and peer-reviewed publications which guide our discussion. Ultimately, we address stakeholder questions and provide guidance that is individualized to our community in Central Florida.”

Ultimately, Harris said, safety is the No. 1 goal and priority of all stakeholders involved — from families and staff to district officials and health care providers. It’s why he and other providers advocate for following safety protocols to help minimize the spread of the virus.

“Appropriate safety protocols including social distancing, wearing masks, hand-washing and working closely with the Florida Department of Health to identify cases (and) quarantine if necessary,” Harris said. “Contract tracing is integral to ensuring staff, students and families are as safe as possible.”

Schwartz said although the committee members are not the decision-makers regarding opening schools, their role as health care leaders is to support the community. He echoed Harris’ sentiments regarding mask-wearing and social distancing to stop the spread of COVID-19.

“The school system is different in that many students access services beyond what they’re learning in the classroom while they’re in school, which adds an extra layer of motivation to make sure they can open safely,” Schwartz said.

“Among the recommendations we’ve made is to continue to work with us to understand hospital capacity and community-infection rates and how they impact the safety of schools; be transparent on infections in schools; ensure students stay 6 feet apart at all times; and protect teachers with adequate PPE.” One of the largest tasks thus far in which each member was called upon for insight was coming up with a recommendation on timing and conditions for face-to-face instruction.

“We’re learning new things about the COVID-19 virus all the time, and I think, like the health care community, schools should learn and adapt as the science evolves,” Schwartz said.

On Aug. 14, Hsu wrote to School Board members that the committee took into consideration multiple factors, from community prevalence of COVID-19 in Orange County to students’ socioeconomic and learning needs, along with data on age-related infectivity and transmission.

While the committee recommended a staggered face-to-face start date for different age groups, the School Board ultimately voted to keep the start date of Aug. 21 as planned.

“The school system is

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can open safely.”

— Dr. Regan Schwartz

As part of the committee, each member draws on his or her own specialty to provide insight and

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round out the conversation on health and safety.

For Harris, it means he thinks from the perspective of his role as a developmental/behavioral pediatrician. Many of Harris’ patients and families have health care and/ or educational needs that require special-education services or classroom accommodations, like Individualized Education Program or 504 plans. To help children manage this stressful time, Harris recommends that parents work on setting up structure and routine.

“For families that have elected for virtual learning, there have been many challenges for both families and schools to access these necessary services such as speech therapy, occupational therapy or physical therapy,” Harris said. “These students are at high risk for regression and require strong advocacy to ensure that their educational rights are being protected. Many parents have been thrust into new, unfamiliar roles as teachers and therapists for their children.

“We have encouraged families to be proactive and open lines of communication with their child’s school team to discuss strategies to implement their IEP services, and to brainstorm ways to generalize any accommodations that are made in the classroom to the home setting,” he said.

He added that some students may benefit from using different modalities — such as visual, verbal and auditory — for presentation of learning materials. For example, some children might benefit from using a visual or picture schedule.

It’s also important, he said, for everyone — not just children — to take time for self care.

“Throughout this time, parents and staff members are also encouraged to be mindful of their own stress/anxiety levels and communicate with their team,” Harris said. “It might be a good idea to ‘tag-in’ with another caregiver or staff member when feeling overwhelmed or needing to take a break.”

Schwartz added that every child is different, and parents should keep an eye on their children for physical and emotional symptoms that the change in environment has on them. It’s important, he said, to get help when they need it.

“Parents should keep a close eye on their children for any significant behavioral or health changes,” Schwartz said. “But they should also keep an open dialogue with their kids about how things are going and let them know that it’s OK to not be OK right now, and that there is help available to them to cope with what’s going on.”

MEET THE COMMITTEE n DR. AKINYEMI AJAYI POSITION: Director for pediatric pulmonary services, AdventHealth for Children; medical director, Florida Pediatric Research Institute CREDENTIALS: Ajayi received his subspecialty training in pediatric pulmonology and sleep medicine at The Children’s Hospital of Philadelphia and is board-certified in pediatric pulmonology and in sleep medicine. He also is a diplomate of the American Board of Sleep Medicine. n DR. ADRIANA CADILLA POSITION: Pediatric infectious disease specialist, Nemours Children’s Hospital CREDENTIALS: Cadilla earned her medical degree at Ponce Health Science University in Puerto Rico and completed a residency in pediatrics at Nicklaus Children’s Hospital, followed by a fellowship in pediatric infectious diseases at the University of Chicago. Cadilla is certified by the American Board of Pediatrics with subspecialty certification in pediatric infectious diseases. She has served as an urgent-care physician in Miami, a pediatric infectious disease physician at Lee Memorial Hospital in Fort Myers, and a pediatric hospitalist at Little Company of Mary Hospital in Chicago and at Chris Evert Children’s Hospital in Ft. Lauderdale. Prior to joining Nemours, Cadilla was the pediatric clerkship assistant director for Florida International University and Nicklaus Children’s Hospital. n DR. BRIAN HARRIS

POSITION: Developmental-

behavioral pediatrician, Orlando Health Arnold Palmer Hospital Pediatric Behavioral Health and Developmental Center CREDENTIALS: Harris earned his medical degree from George Washington University, a master’s degree in physiology and biophysics from Georgetown University in Washington, D.C., and a bachelor’s degree in psychological and brain sciences from Johns Hopkins University in Baltimore.

He completed a residency in pediatrics at Children’s National Health System in Washington, D.C., and a fellowship in developmental and behavioral pediatrics at Boston Children’s Hospital. n DR. VINCENT HSU POSITION: Hospital epidemiologist and executive director for infection prevention, AdventHealth Orlando; assistant director, AdventHealth Internal Medicine Residency Program CREDENTIALS: Hsu graduated from Loma Linda University School of Medicine and holds a master’s degree in public health from UCLA. He completed his internal medicine residency at Legacy Health in Portland, Oregon, and an infectious disease fellowship at USC. He has board certifications in infectious disease and preventive medicine.

n DR. OMAYRA MANSFIELD POSITION: Vice president and chief medical officer, AdventHealth Apopka and AdventHealth Winter Garden CREDENTIALS: Mansfield earned her medical and master’s degrees in health care administration at the University of Florida and completed her residency at Carolinas Medical Center. She is a fellow with the American College of Emergency Physicians.

Mansfield is immediate past chief of staff of AdventHealth Celebration and a graduate of the AdventHealth Physician Leadership and REACH Leadership courses. n DR. MICHAEL MUSZYNSKI POSITION: Professor emeritus of clinical sciences, Florida State University College of Medicine CREDENTIALS: Muszynski is a graduate of the Ohio State University College of Medicine and completed his pediatric residency plus a chief residency year at Nationwide (Columbus) Children’s Hospital, as well as his pediatric infectious diseases fellowship at the University of Oklahoma Health Sciences Center and the Children’s Hospital of Oklahoma. Previously, he was the Orlando regional campus dean for FSU’s college of medicine, associate dean for clinical research for the entire university, and founder of the College of Medicine’s Network for Clinical Research and Training. He founded the pediatric infectious disease division and research laboratories at the Arnold Palmer Hospital for Children, where he was founding division chief of pediatric infectious diseases from 1986 to 2004. He served in the same capacity at Nemours Children’s Clinic from 1996 to 2004. n DR. ANNETTE NIELSEN POSITION: Owner, Tree House Pediatrics in Lake Nona CREDENTIALS: Nielsen attended the University of Alabama at Birmingham for her undergraduate degree in biology and attended the University of Alabama School of Medicine. She completed her pediatric residency at Arnold Palmer Hospital for Children and has worked at Vanderbilt University Monroe Carroll Children’s Hospital and Community Health Centers of Central Florida. n DR. GEORGE RALLS POSITION: Chief medical officer, Orlando Health CREDENTIALS: Ralls earned his medical degree at the University of Miami School of Medicine and completed his residency in emergency medicine at Orlando Regional Medical Center. He previously served as Orange County’s director of health and public safety. Ralls joined Orlando Health as the chief quality officer for Orlando Regional Medical Center and most recently served as the system chief quality officer. He has been on Orlando Health’s medical staff since 2001.

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n DARCY RAVNDAL POSITION: Primary clinician, Edgewater High School Student Health Center CREDENTIALS:

Ravndal completed her bachelor’s and master’s degrees in nursing at Johns Hopkins University, as well as a master’s degree in public health from the University of South Florida. She is nationally accredited by the Pediatric Nursing Certification Board and is an active member of the National Association of Pediatric Nurse Practitioners and of the American Public Health Association. She previously served as a science teacher and as director of education and training at USF Center for Biological Defense. n DR. MERCEDES RODRIGUEZ POSITION: Physician consultant, Orange County Public Schools CREDENTIALS: Rodriguez completed training in pediatrics at Orlando Regional Medical Center and has previously served as medical executive director at both Orange and Osceola counties’ health departments. She retired from HCA/Osceola Regional Medical Center in February. n DR. REGAN SCHWARTZ POSITION: Boardcertified emergency medicine physician, AdventHealth CREDENTIALS:

Schwartz received his medical degree from the State University of New York at Stony Brook. He also completed an internship at Emory University/Grady Memorial Hospital in Atlanta, as well as his emergency medicine residency training at the Albert Einstein/Long Island Jewish Medical Center in New York City. He has served as the chairman of the emergency department for the past 12 years and has clinical oversight of all the emergency departments in AdventHealth’s Central Florida South division.

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FLU SEASON DURING COVID-19?

What does it mean for you and your family?

This season, doctors will need to pay careful attention to symptoms and their timelines to discern between COVID-19, the flu and even the common cold.

TROY HERRING SPORTS EDITOR

Throughout the year, most questions being asked by medical professionals are largely related to the ongoing COVID-19 pandemic.

But now, as the winter months approach, those questions give way to more questions about the season of the year known for the spread of another virus: Influenza.

Two weeks ago, Dr. Gary Visser — of PremierMed Family & Sport Medicine in Ocoee — saw the first case of the flu appear in the practice. Flu season normally starts slowly in October and can last until about May — though it usually peaks between November and February, Visser said.

And although the flu tends to keep to the winter months, COVID-19 doesn’t really seem to have a specific season, because it has survived throughout the year — including during the summer months, which some believed would slow it down because of the heat. Now, the medical field is preparing for both, and it’s changing how many get ready for the flu season.

In previous years, the Ocoee practice began to administer flu

shots in October, but this year’s pandemic has changed that.

“We actually started end of September,” Visser said. “We were like, ‘Oh, we don’t want you to get the flu and COVID, so let’s get everybody set earlier,’ so we started a little bit earlier with the flu vaccines.”

DIFFERENTIATING BETWEEN VIRUSES

The biggest challenge that faces doctors now — besides treating a virus that currently has no cure — is that the symptoms of the flu and COVID-19 almost overlap entirely.

Ailments such as fatigue, fever, body aches and respiratory issues area just a few of the commonalities between the flu and COVID, but there are some small ways they differ, Visser said.

“It’s almost impossible to distinguish the two,” Visser said. “If you draw a big circle and you said, ‘OK, these are all COVID symptoms,’ and then you drew a smaller circle inside of the COVID circle, those are all of your flu symptoms.

So pretty much everything you get with the flu, you can get with COVID. “But COVID has the extra loss

of smell and loss of taste we don’t normally see with the flu,” he said.

“And it also has the blood clots that we don’t see with the flu — people are getting a lot of pulmonary blood clots … and that is mostly from inflammation in the arteries from the virus.”

Another aspect Visser has noticed is that the flu tends to make its presence known much more quickly. Often, the side effects of the flu happen within a day or two; COVID may take up to several days to present symptoms.

During a morning briefing at

AdventHealth in September, Dr. Tim Hendrix — medical director at AdventHelath Centra Care — addressed a point that flu often strikes hard and with fury.

“Typically, flu is very distinctive — you’ll wake up in the morning and you’ll feel fine, and then by that evening, you have a fever, and you’re crawling into bed, and you just feel like you’ve been run over,” Hendrix said. “I joke during flu season that I can walk into a Centra Care lobby and I can look into the eye of every person (who) has a flu and diagnose them. I

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“I’m hoping — fingers crossed — with our masks and social isolation, and just being more cognizant about washing our hands and not being in close quarters with people, that it is probably going to reduce the severity of the flu this year.”

— Dr. Gary Visser, PremierMed Family & Sport Medicine

don’t really do it that way … but you can tell.”

Another difference is how the two viruses affect children.

“The flu is worse in kids, whereas with COVID, it doesn’t seem to affect them as much,” Visser said.

“Mostly young kids — newborns, 2-, 3- and 4-year-olds — are going to be more affected by the flu than what I have seen with COVID.” The confusion when diagnosing a patient is further compounded with the common cold and allergies. Hendrix said those normally come with a scratchy throat, itchy eyes/nose and sneezing. And often with a cold or allergies, symptoms begin to dissipate in about four days, which is why Visser tells patients to wait a couple days before being tested for COVID. If things quickly worsen — a sign of flu — then he suggests being seen immediately so medication can be given to curb the flu.

At PremierMed, Visser and the

other physicians perform a double-check with patients — testing them for both COVID-19 and the flu as a way to figure out what exactly is happening.

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CO-INFECTION, FLU SHOTS

Another concern of medical professionals is the chance of coinfection — someone having both COVID-19 and the flu.

“Co-infection … happens,” Hendrix said. “We were in the middle of flu season when COVID-19 started — so back in February — and I didn’t think it did, but then we started seeing it happen where we were actually seeing people with COVID-19 and influenza.

“Those people got through it OK, but having two different viruses is never a good thing,” he said. “We look at co-infections when people get the flu and they have pneumonia … those are people that end up in the hospital, so the risk of complications is higher with co-infection like that.”

It’s because of this possibility of a co-infection that Hendrix stressed the importance of getting the flu shot this year while also abiding by all of the guidelines put forth by the Centers for Disease Control and Prevention.

There’s even hope there may be a quieter flu season because of all the precautions taken for COVID-19.

“I’m hoping — fingers crossed — with our masks and social isolation, and just being more cognizant about washing our hands and not being in close quarters with people, that it is probably going to reduce the severity of the flu this year,” Visser said. “But schools are open, so it is definitely going to be spread. I’m just hoping that number will come down this year.”

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OCTOBER 2020

OPEN ENROLLMENT:

Knowledge is power It’s important to know your options before making a decision on your health insurance.

AMY QUESINBERRY COMMUNITY EDITOR

It’s that time of year, when the air is cooler at night and the sounds of fall sports echo throughout the community.

That also means it’s time for health care open enrollment.

Open enrollment is the yearly period when people can enroll in a health insurance plan for the upcoming year. They are eligible if they have certain life events, such as getting married, having a baby or losing other health coverage. Job-based plans might have different open-enrollment periods.

Enrollment plans are crucial to discourage adverse selection, which happens when sick people sign up for health insurance but healthy people don’t.

Open enrollment for 2021 runs Sunday, Nov. 1, through Tuesday, Dec. 15. Starting Nov. 1, people

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ENROLLMENT CHECKLIST

can log in to HealthCare.gov, fill out an application and enroll in a 2021 Marketplace health plan.

Coverage starts Jan. 1, 2021. The new plans and prices will be available to preview just before Nov. 1.

Looking for the right coverage for you or your family can be daunting, but Jessie Nelson, corporate director of benefits for Orlando Health Human Resources, provided tips on navigating the often-confusing world of health insurance. She said it’s important to review all the available options — through one’s employer, a spouse or parent’s plan, and Marketplace.

“Generally speaking, an employer plan is generally better than anything you could purchase independently,” Nelson said. “Employers usually subsidize part of the plan … versus if you go and buy something on the open market. … You can’t negotiate because you are one.”

“Look at your payroll deductions. Some folks will say, ‘I want the best plan,’ (but) that varies with each person. They might say, ‘I want the least deductible,’ but (that) might not be it here.”

— Jessie Nelson, Orlando Health Human Resources

Plans sometimes change from one year to the next, and people need to know whether the plan is active or passive, whether the coverage is broad or narrow, and whether the right doctors for them are included.

“Look at your payroll deductions,” Nelson said. “Some folks will say, ‘I want the best plan,’ (but) that varies with each person.

They might say, ‘I want the least deductible,’ but (that) might not be it here.”

Another important factor for people making insurance decisions is knowing the maximum amount of money they would be responsible for, she said.

“Within PPO or HMO plans, every individual on the plan has their own out-of-pocket and deductible,” Nelson said. “In some high-deductible plans, all of the family’s expenses count together toward that maximum deductible.”

Knowing the drug coverage is important, too, she said.

There is a difference between flexible savings accounts and health savings accounts, too, Nelson said. Both are tax-advantaged savings accounts that allow the insured to pay for qualified medical expenses with pretax funds, but they differ in who is eligible to enroll and when savings expire.

Many employers will offer dental, vision, disability coverage and discounts on things such as cell phones or pet or auto insurance.

To apply for or re-enroll in Marketplace coverage, visit HealthCare.gov or call the Marketplace Call Center at (800) 318-2596. This is the information needed to proceed: n Your information n Information about your household n Home and/or mailing addresses for everyone applying for coverage n Information about everyone applying for coverage n Social Security numbers for everyone on the application n Information about the professional helping you apply, if any n Immigration document information n Information on how you’ll file your taxes n Employer and income information for everyone in your household n Best estimate of your household income n Health coverage information if anyone in your household currently has a health plan n Employer information for everyone in your household n A completed “Employer Coverage Tool” for anyone who has or is eligible for coverage through their employer n Health Reimbursement Arrangement notice if anyone in your household is offered an HRA through their employer SOURCE: Healthcare.gov

“Folks miss those,” Nelson said.

“People don’t realize those fun little perks or little extra benefits are available, and they can give you more take-home pay.”

She said it’s important to review one’s life insurance policy annually — making any necessary updates to beneficiaries — and looking over his or her retirement plan.

“You’ll want to know where your retirement is going to,” she said. “And look for an employer match; make sure there’s nothing left on the table.”

THE YEAR OF COVID

Nelson said rates are increasing an average of 4.4% next year.

“Employers are looking at the impact we’re seeing from COVID,” she said. “Employers are seeing an increase in COVID claims.”

At the same time, other claims have decreased this year, she said.

When the coronavirus reached the United States in the spring, people scaled back on scheduling as many elective surgeries or using other discretionary services.

All of this has an impact on health insurance in 2021.

Nelson said she is starting to see the number of claims nearing pre-COVID-19 levels.

The government has passed legislation regarding the coronavirus, so employers are seeing those changes — including COVID-19 testing at no cost —in insurance options, as well.

It’s up to each employer to determine what he or she feels is in the best interest of their employees.

People also have options when it comes to shopping around and comparing insurance plans to make sure they are getting what’s best for them and their family.

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HEALTH MATTERS

PHYSICIAN’S SPOTLIGHT

OrangeObserver.com

Dr. Alexander Schroeder Dr. Alexander Schroeder joined Mid-Florida Surgical Associates in July and specializes in surgery using high-tech robotics.

TROY HERRING SPORTS EDITOR

The world of medicine is constantly changing, and thanks to the development of robotics, there are some practices where work is done almost exclusively through the use of robotic technology.

One such place is Mid-Florida Surgical Associates — which has locations in Ocoee and Clermont. The practice also performs surgical work for Orlando Health’s South Lake Hospital, Orlando Health — Health Central Hospital and the new Horizon West hospital.

The practice’s use of technology is what brought Dr. Alexander Schroeder aboard in July after he graduated from Creighton University.

“They are heavy into robotics,” Schroeder said. “Basically, the surgeons working in that practice sort of pioneered robotics in this area. They started out when the first robotics systems came on the market, and really, the senior partners trained all of the other surgeons in the midFlorida area on the robot.”

Schroeder was inspired to go into medicine by his father, a surgeon in his home country of Germany. And although he’s had his fair share of medical education — Schroeder studied at the

University of Hamburg before doing a five-year residency at the Creighton University School of Medicine — it was only about three or four years ago when he discovered the wonders of robotic surgery during a meeting in Germany.

During that event, Schroeder watched videos that showcased how one doctor — Dr. Conrad Ballecer — utilized robotics with hernia surgeries. Schroeder, who performs general surgery but specializes in hernia surgery, was fascinated.

“What really amazed me was that there are a lot of procedures that can be done laparoscopically without the robot — through small incisions — with long instruments and a camera, but your hand is at the end of the instrument, versus the robot where you also use a long instrument but then you have the robot interface in between,” Schroeder said. “I always thought, ‘What is the true advantage?’

“In the field of hernia surgery, the robot basically allowed for the development of completely new techniques,” he said. “So, instead of putting mesh inside of the abdomen — where it has contact potentially to bowels and can form adhesions and scar tissue — the robot allowed for new techniques to put it into the layers of the abdominal wall, so

Courtesy photo

Dr. Alexander Schroeder has found a home for himself with Mid-Florida Surgical Associates.

DR. ALEXANDER D. SCHROEDER MID-FLORIDA SURGICAL ASSOCIATES 10000 W. Colonial Drive, Suite 288, Ocoee; 1804 Oakley Seaver Drive, Suite A, Clermont PHONE: (407) 521-3600 (Ocoee and Horizon West); (352) 243-2622 (Clermont) WEBSITE: midfloridasurgical.com

it allows for ... precise dissection of spaces where we fix the hernia and put the mesh.”

Toward the end of his training, Schroeder connected with Ballecer — who was practicing in Phoenix — and asked about

possibly working alongside him.

Ballecer agreed, and Schroeder received approval from Creighton to start an externship.

Schroeder had performed simulation after simulation with what it would be like to use robotics for surgery, so by the time he got to Phoenix, he was both excited and prepared.

Being comfortable helped, but more than anything, it was having someone as experienced as Ballecer by his side that really helped him succeed.

“You can’t just sit down and say, ‘Hey, I’m going to use the robot now.’ You have to go and find a surgeon or mentor who is willing to share with you what he knows and shows you how he does things successfully,” Schroeder said. “That’s the only way to do it safely.”

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OCTOBER 2020

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The machine itself — called a da Vinci Surgical System — is like something straight out of a science-fiction film.

The machine has four arms with tools at the end of each, and it is controlled by a surgeon via a console that has a monitor and controls. It’s high-tech, and South Lake, Health Central and the new Horizon West hospital each utilize the device — the machine at South Lake actually has a unique da Vinci Surgical System.

“Right now at South Lake Hospital, we have two consoles that are connected with the actual robot, so you can actually do cases with another surgeon,” Schroeder said. “You can pass instruments digitally back and forth — your proctor can take over for you or you can give it to someone you proctor yourself.

“That’s something I really think is a really cool thing — you can learn new techniques, you can make sure you’re as efficient as you can be, and you can invite a colleague and say, ‘Hey, do you want to do this case with me together and kind of see how I do things?’ So it allows for constant learning and improvement.”

It’s that ability to constantly improve and a desire to help people that led Schroeder to MidFlorida Surgical Associates.

“The reward is when things go well, you see your patient afterwards in your clinic and they’re happy, and you’re happy that everything went well — you actually helped somebody … it’s immediate gratification,” Schroeder said. “And the second thing is obviously getting better at what you’re doing — that’s gratifying, too.”

HEALTH MATTERS

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OCTOBER 2020

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