SARASOTA
Health Matters Observer
AUGUST 2021
GREEN YOUR THUMB Gardening has blossomed during the pandemic, helping mind and body health. PAGE 2
DIGITAL WELLNESS
MIGRAINE FAQ
PHYSICIAN SPOTLIGHT
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Health apps are increasingly popular — but can be pricey.
Head pain can be frustrating but isn’t hopeless.
SMH spinal surgeon talks technological advancements.
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HEALTH MATTERS
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YourObserver.com
AUGUST 2021
GROW YOUR OWN MEAL Growing your own food can satisfy more than your stomach. It can also improve your mood. NAT KAEMMERER STAFF WRITER
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Nat Kaemmerer
Heather Rippy is a lifelong gardener and founded gardening nonprofit Global Gardens in Tulsa, Oklahoma, in 2001.
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uring a year when everyone was supposed to be inside as much as possible, some brought nature to their own backyards or apartments. Not unlike the victory gardens of World War II, pandemic gardens sprouted up everywhere. A survey from Axiom Marketing found that half who did it picked up the healthy hobby to relieve stress and get some fresh air, and it’s becoming more well known that spending time in a green space relieves tension and symptoms of depression. “I think we’re always going to feel better when we’re more connected to nature,” lifelong gardener and Driftwood Beach Home and Garden owner Heather Rippy said. “I have always gardened. … I think it used to be the thing that everybody did, and I just think it’s a really healthy thing to do.” Rippy has grown most of the produce section in the past, from strawberries, watermelons and pumpkins to herbs and greens. This year she focused on her tomatoes, but her two daughters love when the family grows green beans.
“I love that you’ll never know everything, and there’s always something to learn,” Rippy said. “I think it’s an incredible experience watching things grow and caring for things and to just be able to start with a tiny seed and make it into something that feeds your family.” There are a few rules of thumb that apply to most plants in Florida, Rippy said. For the most part, it’s best to plant in planters or pots because the sandy soil can make it tricky for edibles to thrive. Nematodes, or eelworms, are another Floridian problem. They’re parasitic and chomp through the root and stem of plants, so keep your plant babies out of the ground. Any pot you put a plant in will need drainage so the roots don’t rot, too. “No gardener knows everything,” Rippy said. “You’re always learning.”
FOR THE NEWBIE HERBS
Some herbs, such as mint, basically grow themselves. If you buy a young mint plant, keep its soil damp and give it some sun, it will grow like crazy. Herbs do very well in pots about 6 inches wide and can grow all year round. Another easy grower is rosemary, and Rippy said that it actually does plenty
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HOW FAR YOUR FOOD TRAVELS Rippy also advocates for gardening for the control it gives you over what you eat. You can grow whatever varieties you want, and the environmental impact is significant. Food grown at home has fewer pesticides and fertilizers, and it doesn’t have to travel to get to your plate. “The food that you grow really does taste so much better,” Rippy said. “Everything we buy at the grocery store, we don’t know kind of what it’s been through. If you’re not going to garden yourself, at least buy at the farmer’s market. … We really don’t need to be importing stuff.” Here’s how far it takes produce grown by brands found in Publix to get to shelves. For this, we’re heading to the Publix at 2031 Bay St. n A peach grown by Brandt Farms travels about 2,703 miles from Reedley, California. n A Sunset Grown tomato is grown in Ontario and travels about 1,257 miles. n Romaine lettuce grown by Pacific International Marketing is grown in three places. It takes 2,813 miles from Salinas, California; 2,379 from Santa Maria, California; and 2,333 from Yuma, Arizona.
well in the sandy Floridian soil. Take care not to overwater this, though — keep it to once a week at most. RADISHES
Radishes are the perfect plant for the impatient grower, Rippy said. When you plant a radish seed, you’ll have a radish in about a month. Rippy said you should grow all root vegetables, such as carrots, from seeds. Because you’ll be eating the root, if you move an already growing plant, it will disturb the growing process. Get these growing in a planter with plenty of drainage, and keep the soil evenly moist but not too wet. Don’t water it daily. GREENS
Greens, such as arugula and Swiss chard, are good to plant from seeds in September, Rippy said. They don’t like heat once their leaves are growing, but they need heat to sprout. Arugula is easy and sprouts quickly. Plant about 10 seeds in a raised bed with a mix of soil and compost, and water frequently. Once the top inch of soil feels dry, give it a hefty pour. Leafy greens (as opposed to head lettuce) are great because they’re “cut and come again” plants, meaning you can snip leaves from a couple plants and leave some for your next salad.
CUCUMBERS
This vine can be tough to get started and fruited, but it’s well worth it, Rippy said. Cucumbers love water and need a pot about a foot deep. Put in some sticks to act as a trellis, and gently tie the plants to them as they grow. TOMATOES
They can be tricky, but Rippy said nothing tastes better than a homegrown tomato. She does hers every year, started from seeds. Plant the seeds in a pot, and give them about six hours of full sun a day. They need about 1-2 inches of water per week; just check if the soil is dry about an inch deep, and give them a drink if it is.
FOR THE DETERMINED GROWER CAULIFLOWER
Cauliflower can be frustrating, so arm yourse lf w i t h patience and the knowledge that it’s OK to fail in the garden. Start from seeds as soon as possible because they need heat to sprout. Space your seeds about a foot to 18 inches apart in moist soil. Once they’ve sprouted, give them a good soak once a week.
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COMPOST One way to get your home garden producing is to add a little compost. No matter the space, you can compost at home — with a little know-how. Tracie Troxler from Sunshine Community Compost suggests that newbies get a small, premade bin. It’s difficult for scavengers (such as bugs if it’s indoors or animals if it’s outdoors) to get into and for smells to get out of. Sunshine Community Compost also offers kitchen scrap containers where people can store kitchen scraps and bring them in every week to add to the organization’s compost pile. “Let’s say the average (home bin) is a gallon and a half to two gallons,” Troxler said. “You must have a lid to keep fruit flies out of your house. People tend to put their little kitchen scraps under their sink, in their fridge, on their back patio or in a pantry, depending on what your space size is. … There shouldn’t be a smell if you go to your compost bin at least weekly. “We just try to keep coming up with little tweaks that make it easy and user-friendly.” To put it simply, most things that were once alive can be composted, including fruit and veggie scraps, grain-based foods, coffee grinds and eggshells. Troxler said eggshells are the only animal product they’ll accept because flesh, bones and lard will smother the microbes that create compost. It’s important to start with some carbon, such as paper or cardboard, to kick-start the decomposition. Once you can no longer recognize the original materials, the compost is ready to go, Troxler said. Sunshine Community Compost sifts out the pieces that haven’t broken down already and mixes the compost in with the soil. For new planting, try a 1-to-1 soil-to-compost ratio. If you’ve already planted, you can still massage it into the topsoil around plants. It’s also great for feeding fruit trees.
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YourObserver.com
AUGUST 2021
The cost of digital health Are subscription weight-loss and wellness applications worth the sometimes-hefty cost? RYAN KOHN STAFF WRITER
The health services world becomes more digital each year — but are any of the most popular services actually worth the cost? There are loads of options, including Noom and WW, formerly known as Weight Watchers. Noom is about “tricking” your body into better habits while WW focuses on the company’s SmartPoints system of determining healthy foods to eat. Every service offers something unique, and some of them can work — but they can also be expensive. Noom can run users up to $60 per month. For people with less disposable income, that can be a tall barrier. According to Bonni London, a Sarasota-based dietitian and wellness expert, there is no general answer to whether a service is worth the money. It all depends on what a user is looking for. London said she sees many clients who try such apps as WW, lose a lot of weight initially and then gain it all back. She said it is difficult to keep up strict programs like that for the long term. Apps also tend to be less personalized. In an age where people’s diets should be more personal than ever, with knowledge about gluten and dairy sensitivity, etc., that’s a disadvantage. Even an app like Noom, which
WEIGHT LOSS AND WELLNESS APP OPTIONS Noom: A subscription service that asks users to make behavioral changes in order to live healthier. “Once you determine the things you’re ready to work on, your mindset will help you form new neural connections over time to change your habits,” Noom tells users. This approach involves lots of psychological quizzes, calorie budgeting and personal responsibility to follow through on its teachings. The app can cost up to $60 a month after a oneweek free trial, but because pricing takes into account a person’s weight-loss goals and the time it will take to achieve them, personalized plans might be discounted. MyFitnessPal: A less comprehensive app than Noom, MyFitnessPal helps users count calories and nutrients from all the foods they ingest during a given day, providing a breakdown of fat, carbohydrate and protein consumption. A barcode scanner in the app makes keeping track of foods simple. There is also a message board where users can trade helpful tips. The app has a free version; the premium version costs $10 a month or $50 for a year.
offers daily messages from one of the company’s behavior-change specialists, is not as personalized as talking to an expert in person. That doesn’t necessarily mean the apps are ineffective. According to a report from WebMD, 78% of Noom users lost weight using the app, and 23% lost more than 10% of their body fat. But, as London said, the challenge also about keeping the weight off. There is a lot of work that goes into that. Noom users get food guides advising them what to eat but still have to do the shopping and cooking for themselves. They are also advised to exercise and log their routines in the app to track their progress. It’s easier to lie about behavioral changes to a digital screen than it is to an in-person professional, meaning
there is less accountability. Some users’ gripes have nothing to do with the content and everything to do with its delivery system. For example, Noom sends users work to do every day, either of tips to memorize or quizzes to reinforce those tips. If that sounds like an annoyance, the app might not be for you. “The No. 1 recommendation I make to everyone is setting their environment up for success,” London said. “That could be the people around them that influence them. It could be the stuff in their cabinets. You basically want to take the brains out of this stuff as much as possible. … Whatever it is for you, the less you have to think about it, the more likely you are to sustain the changes into the future.”
WW: Formerly known as Weight Watchers, this app uses a SmartPoints system to assign values to different foods to promote fat loss. Like MyFitnessPal, WW includes a barcode scanner to easily track the foods you eat. The app also includes more than 8,000 healthy recipes for users to try, and a deluxe version of the app includes digital coaching from someone on the WW team. WW’s basic version costs $3.38 per week while the premium version with coaching costs $4.61 per week. Headspace: Although not directly focusing on weight loss, mental health app Headspace does help regulate users’ sleep habits, stop cravings and promote healthy behaviors, which can have a secondary effect of helping people in their weight-loss journey. The premium version, Headspace Plus, also includes access to mindfulness workouts and meditations designed to help users get through intense experiences. A Headspace Plus subscription costs $13 per month or $70 for one year.
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Migraine Matters HARRY SAYER STAFF WRITER
T
Courtesy photo
Physician Assistant Yiliam Clavelo knows plenty about head pain.
experiencing changes in the body. What those triggers are, though, can vary wildly from person to person. “It can be weather changes — a lot of our patients come in with barometric pressure changes,” Clavelo said. “For others it can be food or red wine. For others it can be preservatives or nitrites in cheeses. It can even be exposure to bright lights.”
What are migraines? Clavelo said migraines are moderate to severe headaches that are often felt on one side with a constant, throbbing pain. They typically last for four hours at the least, but Clavelo has seen some that have lasted for three days. She also said that around 90% of migraines are due to genetics and
Who gets them? Migraines typically first manifest in children experiencing puberty up to adults in their late 40s and early 50s. They’re more commonly seen in women, though Clavelo noted that there’s not a clear consensus on why.
Are there different types of migraines? There are a number of different types of migraines that are accompanied by physical and visual factors. Ocular migraines are a subdivision where the migraine and pain is usually preceded by an aura — some kind of visual deviation like flashes of light, odd shapes and other effects in the eye. Many of those auras are strictly visual and aren’t painful in and of themselves. But other auras have more physical effects including dizziness, nausea, motion intolerance and even the loss of motor function. What’s the best way to reduce the frequency and intensity of migraines? The first step to bringing down the number of migraines is to figure out what caused them in the
Topical Medications for Foot Pain Relief Here in Florida, tile and hardwood floors are practical for their ease of cleaning and cooler surfaces but they can also cause painful foot conditions, especially among older people. We lose fat on the soles of our feet as we age and walking on harder surfaces increases the likelihood of nerve problems in the feet. Among these are Morton’s neuroma, which causes sharp, burning sensations in the ball of the foot; peripheral neuropathy, weakness and
pain caused by nerve damage that affects 3 to 4 percent of adults over 55; and tarsal tunnel syndrome, when a compressed nerve around the ankle creates pain or numbness in the sole or base of the foot. Dr. Jemaar Graham, a podiatrist at 360 Orthopedics, says he often prescribes compounded topical medications, usually a cream or an ointment, to treat his patients who have these conditions. He cites two main reasons for preferring topical medications.
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first place. A measured but productive approach is to make a headache journal of what you ate, drank and experienced the day you had head pain and to start avoiding those substances and experiences to see if it helps reduce the number of headaches. There are also basic over-thecounter medicines, such as ibuprofen, that if taken regularly during the week can help with the amount of pain. Clavelo recommends even having caffeine, such as in coffee or soda, to help. When is it time to go to the hospital? There are medicines and lifestyle changes that can help with migraines, but some people still have dayslong, debilitating headaches that require more drastic action. When someone is experiencing
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around four or more prolonged migraine attacks a month, Clavelo recommends going to the hospital for preventative medication to help reduce pain and frequency. Many medications already used to treat other conditions, such as hypertension, epilepsy and depression, were noted by patients to help treat their migraines as well. Clavelo said there has been a development since 2018 of a surge of injection-based therapies designed to reduce migraine frequency and pain. There are more common and immediate medications and agents to help with migraines first, but it’s promising to see new therapies be developed, she said. “These (injections) have good evidence of reduction of migraine frequency,” Clavelo said. “People also report improvement with intensity of attacks.” What can be done at home to reduce pain? Clavelo stresses that if you are feeling intense head pain and haven’t experienced it before, it’s imperative to get checked out at a doctor’s office or hospital to be sure it’s not more serious. “If there’s an intense migraine coming on all of a sudden, it can be a sign of something scarier going on,” Clavelo said. But if people have seen a doctor and are certain it’s just a headache, Clavelo recommends working through it by staying in a dark, quiet room and having a cool ice pack on their head and over-thecounter medicine nearby. Ultimately, though, the biggest help can be sleep. “People tell me all the time that they sleep it off and wake up and feel a lot better,” Clavelo said.
Dr. Jemaar L. Graham, DPM Jemaar L. Graham, DPM, is a double boardcertified foot and ankle surgeon at 360 Orthopedics in Sarasota, Venice, and Lakewood Ranch, Florida. Dr. Graham originates from Lakeland, Florida. As a Podiatrist, he is trained to treat all problems related to the foot and ankle with both surgical and conservative modalities. www.360-orthopedics.com
Many of his older patients are taking many other prescriptions daily, so avoiding potential counterindications can be challenging. This is not a concern with topical medications. They’re not ingested so they don’t have the drug interaction concerns of oral medications. Additionally, there aren’t side effects that often come along with oral medications. Dr. Graham says another advantage of compounded topical medications is the ability to mix several medications into one treatment. Neuropathic topical treatment can combine an anti-inflammatory, an anesthetic and gabapentin, a nerve pain medication. In order to have all these benefits in oral medication, patients would have to swallow three separate pills every day. Dr. Graham believes there would likely be an issue of lack of compliance on the patient’s part if there were that many different pills to take. When all the medications
are together in a topical cream, the patient is more likely to be consistent with the prescribed treatment plan. He has also observed that other commonly prescribed treatments are not as effective for many of his patients as compounded topical medications. “I’ve had patients who’ve had chronic nerve pain that didn’t get better with injections or orthotics,” says Dr. Graham, “but they were able to try topical medication that calmed symptoms down.” With the help of topical medications, his patients are able to resume their usual activities without feeling restricted.
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h e re ’s something uniquely irritating about a bad headache. The constant pressure, the pounding at the temples, the vague but ever-present dread that it’s going to be hurting like that for some time. Most headaches can be traced to obvious culprits — overexertion, lack of food, dehydration — but some head pain can’t be explained away or cease its intensity quite as easily. Migraines are a more severe type of headache that can have a variety of triggers. Yiliam Clavelo, a physician assistant with the First Physicians Group of Sarasota, has worked in the neurology department for the past three years and is well versed in migraine matters. She lent insight on what causes them and what to do if you’re feeling one.
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HEALTH MATTERS
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YourObserver.com
AUGUST 2021
Floating away your fears Our reporter tests out a sensory deprivation float tank to examine the treatment’s health benefits. BRYNN MECHEM STAFF WRITER
H
ave you ever felt like you’ve been swallowed by a beluga whale and are just floating around in a dark abyss? No? I’d like to say “me too,” but then I’d be a liar. I wasn’t actually swallowed by a whale, or anything for that matter. I simply voluntarily stripped to the buff, put in earplugs and stepped into a pitch-black, fully enclosed tank of saltwater. I know, this sounds like the beginning of a horror movie, but the experience is actually part of a spa treatment designed to help people relax. MindSpa Integrative Wellness Center, at 5632 Bee Ridge Road, offers sensory deprivation flotation tanks where clients float in individual pods filled with 10 inches of water and 850 pounds of dissolved magnesium-enriched Epsom salt. The service costs $60 for an hour in the tank. After a person enters the tank, the lid is closed to create total darkness. The idea is to reduce stimuli and create a relaxing atmosphere through water that rests at about 95 degrees, a com-
pletely quiet setting (hello, earplugs), total darkness and a zerogravity environment. The treatment, which has been around commercially since 1972, is said to reduce symptoms of stress, anxiety, depression, chronic fatigue, fibromyalgia, arthritis, insomnia, sports injuries and PTSD. It can also help with high blood pressure, migraines and premenstrual tension. A 2018 study by the National Institutes of Health found that a one-hour session can lead to significant reduction in anxiety and improvement of mood. Because the salt contains an abundance of magnesium, other benefits include detoxification of the body, strengthening of the immune system and heightened endorphins release. However, MindSpa Manager Angela Chittum said the best benefits are those in the brain. According to several studies, chronic stress can impact the brain’s function by killing brain cells, disrupting synapse regulation and reducing the size of the brain. It also can reduce the prefrontal cortex, which is responsible for memory and learning. Although researchers have reported limited risks, some people have experienced hallucinations within the tank that are often described as psychosislike. After ensuring I didn’t have disqualifying circumstances — such as epilepsy, being under the influence of alcohol or drugs, or having open skin wounds — I
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Photos by Brynn Mechem
Top: MindSpa’s Angela Chittum and Jessica Childs say the floatation tanks relax the mind and body. Above: The individual tanks are filled with 850 pounds of Epsom salt dissolved into 10 inches of water.
was asked to take a quick shower before getting into the pod. As someone who usually floats like a boat, it was not difficult to get comfortable. For those who are, shall we say, not so buoyant, no need to worry. The large salt quantity means it’s as easy to float as if you were in the Dead Sea. However, after flipping off the lights, it took me awhile to relax. As someone with anxiety, I couldn’t stop my mind from wandering. Did I ever call that source back?
How am I going to have time to make dinner before a school board meeting? Are those the lyrics to “Sleigh Ride”? Am I doing this wrong? How much time is left? God, why did I open my eyes?! Chittum said first-time floaters often have the same experience I did, so I decided to give a second float a try, and I’m glad I did. It was euphoria. I have tried many activities to relax — meditation, massages and even an infrared sauna — but nothing worked as well as the floatation tank. And I’m not alone. Jessica Childs, a licensed massage therapist at MindSpa, also uses the flotation tanks, often pairing them with a massage. “It’s amazing. You just hit a new level of relaxation,” Childs said. “You relax your muscles and then move all the toxins out of your body with the Epsom salt. It’s like a total body relaxer.” Aside from the immediate relaxation, I felt fewer aches and pains in my body, I focused more on work, and I slept well the week following. Although this therapy might not be for everyone, I would recommend giving it a try. Just remember one thing: Always keep your eyes closed.
I’m claustrophobic. Will I die? You will have complete control of your session, so you can open or close the lid at any time. The tank is not airtight, and fresh air is constantly circulated through the system. What should I do to prepare? It is best eat a small meal and drink plenty of water about two hours prior to your appointment. Avoid caffeine, which can be distracting to a relaxing environment. Do not shave prior to your visit, and cover any fresh wounds that could be irritated by the salt. Do I have to be in complete darkness? You can choose whether to have the lights on or off with a light switch located in the pod. You can start with them on and ease your way into darkness. You also can choose whether to have music in the pod. For the complete experience, it is best to have total silence and complete darkness. What do I wear? You can wear a swimsuit, but it is recommended to float in the nude to reduce any and all distractions, including the sensation of touching clothing.
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Photo courtesy of Sarasota Memorial Hospital
Dr. Ashvin Patel is studying the use of a two-level disk replacement through a disk implant that could be done instead of spinal fusion.
Dr. Ashvin Patel BRENDAN LAVELL STAFF WRITER
S
arasota resident Dr. Ashvin Patel is a spine surgeon at Sarasota Memorial Hospital. He is leading studies at the hospital that aim to create
new and improved techniques for spinal surgery to reduce pain.
How did you decide that you wanted to become a surgeon? I like that you can have immediate results. In a surgical field, you have a problem, and when you address it, usually the result is fairly evident. I like the cerebral part of figuring things out but also the mechanical part of the job. It gives you a chance to use your brains as well as your hands and your skills. You can’t be a good surgeon if you’re not a good clinician or diagnostician. I wanted to do spine surgery, specifically, because it’s more pensive. It’s more analytical. You have to figure out which nerve is causing the patient’s symptoms. You have to know a lot of different disciplines. Also, I think I chose spine surgery above all the other subspecialties in orthopedics because when I was in my training, they did not have their revolution of new, successful operations. They were just starting to scratch the surface. I figured that during my lifetime, I would see tremendous changes in the field, and I would be able to stay interested in the field because there are so many changes coming. I would be able to offer better treatments than my mentors or predecessors had. Did you have a role model or someone who influenced you to become a surgeon? I have a lot of doctors in my family. My father is a physician, and he certainly had an impact on my choice. The orthopedic surgeons I worked with were generally happy in their field. A lot of surgeons
you meet are so stressed. When I did my fellowship, there were a couple of surgeons that inspired me to pursue newer technology and disc replacements, for example. What should people know about your research in nonfusion technologies? The benefits of fusion are obvious. You have an unstable spine, and you stabilize it, and the person’s pain relief is generally predictable. The problem with fusion is it affects the level above and below where you perform the fusion. If you fuse one vertebrae at one level in the lumbar spine, the level above and below now have to compensate by doing more work. That puts them at higher risk for getting adjacent segment disease or early arthritis. The two studies I’m doing, one is for the cervical spine, which is a two-level disk replacement study where instead of fusing the two levels, we replace them with a disk. The second study is where we replace the facet with an implant that allows motion. A facet is a joint in the back of your spinal column. Are there any other advancements in your field that you’re looking forward to or hoping might come soon? We’re starting to use robotics for placement of implants and screws. We’re also getting better at biologics. When we try to fuse somebody, instead of harvesting bone from their pelvis, we are using biologic materials that are made in the laboratory to try to get bones to fuse.
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What is the most rewarding part of your job? When the patient comes back and tells you their arm or leg or back or neck pain is gone. The most rewarding part is seeing the patient walk again and do their activities of daily living and be more active, which in itself is a requirement if you’re going to live the long life that most of us are now going to live because of improvements in our diet and health care. When someone is able to remain active, they don’t get as many chronic diseases. When you’re not working, what do you enjoy doing? I like hiking, biking, skiing. I try to play tennis twice a week. I try to swim about four times a week. I like traveling. I’m a product of an immigrant family, so I’ve come from another part of the world. My family traveled a lot when I was younger. I like seeing different parts of the world and meeting different kinds of people, trying out different food, learning about cultural differences and so on. Where is your favorite place that you’ve traveled to? In the U.S., I travel to Colorado because I like the recreational activities that you can do there: skiing, hiking, biking. Overseas, I like traveling to Africa because it’s so different from the rest of the world. The geography, the wildlife, the people, and there’s a lot of diversity. I like traveling to my homeland, India, to see my relatives. It’s really special for me to talk to a street vendor or go to a restaurant and be able to speak the language.
Experience the Millennium Difference Welcome Our New Healthcare Providers Now
Accepting New Patients for Primary Care!
Santosh Kamath, M.D.
Gnanambal Manivel, M.D.
(941) 933-8103
(941) 552-8808
Internal Medicine, Sarasota
358824-1
Geriatrics & Internal Medicine, Palmetto
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