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Expand Advanced Center
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contents
4
JANUARY 2013
CENTRAL FLORIDA EDITION
COVER STORY
Photo: PROVIDED BY ST.JOSEPH’S HOSPITALS
This month’s cover story reveals the dramatic growth of St. Joseph’s Advanced Center
for Robotic Surgery in Tampa. The Center’s roots extend back to 2002, when St. Joseph’s
Hospital became the first hospital in Florida to use the da Vinci robotic surgical system
for general surgery. Today, more than 40 different robotic procedures are offered by nearly
two dozen surgeons using two robots and caring for patients of St. Joseph’s Hospital, St.
Joseph’s Children’s Hospital and St. Joseph’s Women’s Hospital. A core team of dedicated,
experienced individuals support the surgeons as this innovative program continues to
serve patients throughout the Tampa Bay area.
Photo: PROVIDED BY ST.JOSEPH’S HOSPITALS
St. Joseph’s Advanced Center for Robotic
Surgery is led by Medical Director and
Colorectal Surgeon César Santiago, MD,
(foreground). Program coordinator Lisa
Lockhart, RN, (background) has supported
robotic surgery at St. Joseph’s Hospital
since 2002 when the hospital became the
first in Florida to use the da Vinci® robotic
surgical system for general surgery.
3 FOR YOUR ENTERTAINMENT
20 Florida Hospital
Tampa Presents
Gastroesophageal
Reflux Disease (GERD)
Perspective for 2013
24 CURRENT TOPICS
28 ADVERTISERS INDEX
DEPARTMENTS
2
FROM THE PUBLISHER
8
Behavioral Health
9 MARKETING YOUR PRACTICE
12 PHARMACY UPDATE
14 CANCER
16 DIGESTIVE AND LIVER UPDATE
19 Medical Malpractice Expert Advice
22 ORTHOPAEDIC UPDATE
FLORIDA MD - JANUARY 2013
1
FROM THE
THE PUBLISHER
PUBLISHER
FROM
II
hope your new year has started off well. I’m pleased to bring you another issue of FloridaMD and to
Iam pleased to bring you another issue of Florida MD Magazine. It’s hard to imagwelcome new readers in Pasco county. As you are all aware, because of the current economic situation,
ine
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tions on how you and your family canComing
join the UP
march
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for your
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Cardiology, Heart Disease and Stroke.
Donald B. Rauhofer, Publisher
Warm regards,
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The Assistance Fund provides financial assistance to children and adults who are critically or chronically ill, including those diagnosed
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FOR YOUR ENTERTAINMENT
The Orlando Philharmonic Presents
Voigt Sings Wagner & Strauss
The Orlando Philharmonic Orchestra presents Deborah Voigt, the unsurpassed dramatic soprano of our time, singing luminous songs
of Strauss and the sublime Love-Death from Wagner’s Tristan and Isolde, on Saturday, March 16, 8:00 p.m., at the Bob Carr Performing Arts Centre.
“Voigt Sings Wagner & Strauss” affords us the happy opportunity to experience four of Strauss’s finest songs, all originally composed
for voice and piano and later rescored for voice and orchestra. In their own way, all are masterpieces of the highest order and provide
further evidence of the greatness of this gifted and prolific composer.
Also showcased on the program is Wagner’s Tristan and Isolde, often considered the Romantic masterpiece in German opera—an
intense, impassioned, profoundly beautiful, and revolutionary music drama based on a tragic Celtic legend dating from the thirteenth
century.
Love and death commingle throughout this program as the orchestra performs excerpts from Prokofiev’s Romeo and Juliet and Mozart’s dark comedy, Don Giovanni. Maestro Christopher Wilkins conducts this unforgettable evening of classics.
Deborah Voigt is one of the world’s leading dramatic sopranos, internationally revered for her performances in the operas of Richard
Wagner and Richard Strauss. She is also noted for her portrayals of such popular Italian operatic parts as Tosca, Aida, Amelia in Un
ballo in maschera, and Leonora in La forza del destino. An active recitalist and performer of Broadway standards, Voigt has an extensive
discography, and has given many enthusiastically received master classes. Through her performances and television appearances, she is
known for the singular power and beauty of her voice, as well as for her winning personality and stage presence.
Voigt’s extensive discography includes two popular solo recordings for EMI Classics – both of which were critical successes. The Washington Post praised the “discerning eye” behind the adventurous choice of repertoire for All My Heart with pianist Brian Zeger, and noted
that it was “performed by a voice outstanding not only for tone and power but for interpretive subtlety and emotional nuance.” Voigt’s
earlier disc, Obsessions, presents scenes and arias from operas by Wagner and Strauss. Gramophone’s review of the Billboard top-five bestseller states, “The arias highlight Voigt’s extraordinary ability to soar effortlessly and luminously above the orchestra with her trademark
rich, lustrous, never hard or brittle voice.” Her recording of Strauss’s Egyptian Helen was also a Billboard bestseller, and was named one
of the best CDs of the year by Opera News. A live recording of the 2003 Vienna State Opera Tristan und Isolde, in which Voigt made
her headlining role debut, was released by Deutsche Grammophon.
Don’t miss your chance to hear one of the most renowned
sopranos of our time in a program of celebrated classics,
Saturday, March 16, 8:00 p.m., at the Bob Carr Performing Arts Centre. Tickets are priced from $17 - $70. Call the
Orlando Philharmonic Box Office at (407) 770-0071 or visit
OrlandoPhil.org to learn more or to order online. The Box
Office is open Monday – Friday, 9:30 a.m. to 5:00 p.m.
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Coming UP Next Month: The cover story
focuses on the Pepin Heart Institute at
Florida Hospital in Tampa. Editorial focuses
on Cardiology, Heart Disease and Stroke.
FLORIDA MD - JANUARY 2013
3
COVER STORY
St. Joseph’s Hospitals Expand
Advanced Center for Robotic Surgery
Offering Unsurpassed Experience and Expertise
By Lisa Patterson
The diversity of the Center is unlike any other in the country.
And ultimately, it’s the patient who benefits from the expertise of
a seasoned surgical team.
“It is unique to have so many specialties in the same place,”
said César Santiago, MD, colorectal surgeon and medical director of St. Joseph’s Advanced Center for Robotic Surgery. “We’re
very fortunate to have the most experienced OR team in the area
supporting a phenomenal team of robotic surgeons that continues to grow. Referring physicians and their patients should know
that we also require strict criteria for our surgeons, exceeding the
requirements set forth by other hospitals.”
The result is a highly-trained team of experts who offer general
robotic surgery as well as five specialties including colorectal, gynecological, gynecologic oncology, urological and pediatric urological surgeries.
Colorectal Surgery
Dr. Santiago, who was the first to perform robotic colon and
rectal surgery at St. Joseph’s Hospital, brings extensive experience
Photo: PROVIDED BY ST.JOSEPH’S HOSPITALS
A team approach has fostered the success of St. Joseph’s
Advanced Center for Robotic Surgery in Tampa. Medical Director
and Colorectal Surgeon César Santiago, MD (center) is flanked by
Shannon Kerr, ST, (left) and program coordinator Lisa Lockhart, RN,
as the team positions robotic arms in preparation for surgery.
in advanced laparoscopic surgery to
the table where he
often finds roboticassisted surgery to
be the best minimally invasive option for complex
pelvic surgeries.
Just ten years
ago, colon and rectal surgery involved
very invasive, open
procedures to access vital structures
located in the confines of the pelvis.
And while only
a small
percent
of surgeons are
César Santiago, MD, serves as Medical
trained in the latest
Director of St. Joseph’s Advanced
colorectal robotic
Center for Robotic Surgery. Dr. Santiago
is a colorectal surgeon who says this
techniques,
Dr.
technology allows him to work more
Santiago is among
effectively in confined spaces, which
those pushing the
ultimately benefits patients by improving
envelope to give
outcomes.
his patients the best
possible outcomes. Only 1-2% of rectal surgeries are being performed robotically in the United States.
“The da Vinci state-of-the-art platform offers a high-resolution
visual field and enhanced dexterity without the need for open
surgery,” Dr. Santiago said. “I can access hard-to-reach areas and
manipulate instruments in small spaces with great precision and
less manipulation of healthy tissue. This means my patients can
feel better, faster.”
Gynecological Surgery
With 12 credentialed surgeons at press time, gynecologic surgery is the largest and fastest growing specialty in St. Joseph’s Advanced Center for Robotic Surgery. Gynecological surgeons say
the majority of procedures they perform are hysterectomies, and
most occur at St. Joseph’s Women’s Hospital. Recovery time for
hysterectomies conducted via robotic surgery is usually just two
to four weeks, as opposed to a six to eight week recovery time
after an on open procedure. Some even leave the hospital the day
after their procedure.
4 FLORIDA MD - JANUARY 2013
Photo: PROVIDED BY ST.JOSEPH’S HOSPITALS
More than 10 years after launching one of the first robotic
surgery programs in the Southeastern United States, St. Joseph’s
Hospital in Tampa remains a leader in minimally invasive procedures. Today, the St. Joseph’s Advanced Center for Robotic
Surgery includes nearly two dozen physicians who together offer more than 40 different robotic procedures for patients at St.
Joseph’s Hospital, St. Joseph’s Children’s Hospital and St. Joseph’s
Women’s Hospital in Tampa.
“Any patient who needs a hysterectomy is likely to be a good
patient for robotic surgery, which is great news for women
seeking less pain, shorter recovery time and quicker return to
their normal activities,” said Catherine Roush, MD, who was
one of the first gynecologic surgeons credentialed for robotic
surgery at St. Joseph’s Women’s Hospital, which began offering robotic surgery in January 2012.
Dr. Roush said she enjoys working as a surgeon at St. Joseph’s Women’s Hospital because of the organization’s focus
exclusively on women.
“Our entire patient population is women, so as a surgeon
I’m not competing for space and time with other specialties.
The whole surgical suite is geared toward gynecological surgery, so I can be sure that the nurses, the surgical techs, the
anesthesiologists and everyone in the OR has specialized expertise geared toward women.”
Gynecologic Oncology
“Robotic surgery from a gynecologic cancer standpoint has
been revolutionary,” said Tyler Kirby, MD, a gynecological oncologist who personally has performed nearly 800 robotic procedures in addition to more than 1,000 laparoscopic cases. “Doing
things the old way, with a big open incision, we had about a 30
percent complication rate because a lot of our patients have other
medical problems like obesity, high blood pressure, diabetes, poor
blood supply, and things like this that make surgery with the old
fashioned approach very dangerous and complicated. With robotic surgery, we’ve been able to get our patients out of the hospital the next day, complication rates are minimal, patients are
back to work in two weeks, recovery times are fantastic and they
generally just do a heck of a lot better.”
Photo: PROVIDED BY ST.JOSEPH’S HOSPITALS
COVER STORY
Catherine Roush, MD, positions robotic arms before moving to the
console to direct precise movements for gynecological surgery at
St. Joseph’s Women’s Hospital.
ments are very small to allow dissection around very tiny nerves
and blood vessels, and the visualization is beyond anything possible with open surgery.
Pediatric Urological Surgery
St. Joseph’s Children’s Hospital in the only hospital in the Tampa Bay area offering robotic-assisted urologic procedures, and all
are performed by Ethan Polsky, MD. The pediatric urologist
treats many pediatric urologic conditions including ureteropelvic junction (UPJ) obstruction, kidney disease (including cancer)
and vesicoureteral reflux (a bladder abnormality that causes urine
to flow back toward the kidney).
In Dr. Polsky’s experience, the ultimate outcome of performing
either open surgery or minimally invasive surgery is about equal.
However, there are several benefits to robotic surgery that make it
a great option for young patients.
The size and scope of St. Joseph’s Advanced Center for Robotic Surgery makes it unique and
Dr. Kirby said he likes the precision the robot gives him as a
surgeon. Any unintended movements are filtered out, the instru-
keeps team members busy working with two da Vinci robots. Physicians focused on performing
robotic gynecological surgery at St. Joseph’s Women’s Hospital include (from left to right)
Jonathan Hershberger, MD; Jennifer Russell, DO; Madelyn Butler, MD; Catherine Roush, MD;
Evelyn Serrano, MD; Kiera Irvin-Rahaim, MD; Michael Morris, DO; and Carmen Peden, MD.
“The operation is less invasive, the surgery is
more precise with less manipulation of healthy
tissues and the child feels less pain and enjoys
a shorter, easier recovery period,” Dr. Polsky
said. “Parents notice the minimal scarring.
And on a much lighter note, kids just like the
idea of having a robot in the OR.”
Photo: PROVIDED BY ST.JOSEPH’S HOSPITALS
Urological Surgery
When it comes to the delicate issue of prostate cancer, every man hopes not only for their
disease to be cured, but for nerves and continence to remain intact. According to Frank
Mastandrea, MD, these are among the reasons
why about 80 percent of prostatectomies are
done robotically all across the country.
“Robotic surgery has taken a major operation and turned it into a minor procedure
with much less surgical risk,” said Dr. Mastandrea, who has personally performed more than
FLORIDA MD - JANUARY 2013
5
COVER STORY
David Echevarria, MD, is a general
surgeon who is leading the way for
single-site robotic surgery at St. Joseph’s
Hospitals in Tampa. Dr. Echevarria has
performed robotic surgery for more than
10 years, as he was one of the first in the
state of Florida to embrace this revolutionary technology.
“The daVinci system takes my hands
and makes them into
a little 7 millimeter instrument,” Mastandrea
said. “I can get into places and operate in a much more technically precise way than we ever could open.”
Single-Site Surgery
Single-Site Instrumentation is a new operating platform attached to the da Vinci Si Surgical System that allows surgeons
Patients at St. Joseph’s Children’s Hospital benefit from the highly
specialized expertise of pediatric urologist Ethan Polsky, MD, (right)
who is the only surgeon in the Tampa Bay area to perform robotic
surgery for pediatric patients.
“With this technique, we only have
to make one incision
about two centimeters long at the navel.
Through the small
opening, we insert a
tiny robotic camera and
flexible working instruments,” Dr. Echevarria
said. “The camera provides high-definition,
three-dimensional look
inside the body, allowing me to see details
not possible with the
naked eye. The instruments, which I control
from a console near the
patient, are like miniature versions of my
own hands, but with
even greater dexterity
and steadiness. The result is a safe, effective
operation that often
leaves no scar and allows patients to quickly
get back to their usual
routine.”
Photo: PROVIDED BY ST.JOSEPH’S HOSPITALS
While prostatectomy was the first robotic urologic procedure
to be widely adopted,
surgeons also now utilize the technology for
pyeloplasty (to remove
blockage in the urinary
system) and nephrectomy (kidney removal).
to remove the gall
bladder from a single
incision in the belly
button. Single-site robotic cholecystectomy
patients are usually in
and out of the hospital
the same day.
Frank Mastandrea, MD, is known
throughout the country as a leader in
urologic robotic procedures, which can
be performed with less anesthesia,
smaller incisions, minimal post-operative
discomfort, shorter hospitalization time,
faster recovery times and reduced risk of
infection.
Photo: PROVIDED BY ST.JOSEPH’S HOSPITALS
Tyler Kirby, MD, (wearing red cap) is one
Dr. Echevarria was
of
four gynecological/oncology surgeons
part of the team that
who are part of St. Joseph’s Advanced
pioneered
robotic
Center for Robotic Surgery. Dr. Kirby persurgery at St. Joseph’s
sonally has performed nearly 800 robotic
procedures.
Hospital in 2002,
when the hospital was
the first in the Tampa Bay area to offer this technology. In addition to robotic surgery, he continues to perform advanced laparoscopic surgery, general surgery, and surgical oncology including
breast, liver and pancreatic cancers.
Forward Thinking Team
Lisa Lockhart RN, CRNFA, program coordinator for the Advanced Center for Robotic Surgery at St. Joseph’s Hospitals, has
seen the program grow from its infancy – focused mostly on urology – to a mature Center that offers a wide array of procedures
that benefit a variety of patients.
6 FLORIDA MD - JANUARY 2013
Photo: PROVIDED BY ST.JOSEPH’S HOSPITALS
Photo: PROVIDED BY ST.JOSEPH’S HOSPITALS
1,000 robotic prostatectomies. “We can preserve continence nearly
99 percent of the time
and we get men’s potency back quicker and
with a higher percentage because we can do a
much more technically
precise operation.”
COVER STORY
Robotic Surgeons
Working at St.
Joseph’s Hospitals
Photo: PROVIDED BY ST.JOSEPH’S HOSPITALS
•
General Surgery
David F. Echevarria, MD
Colorectal Surgery
César A. Santiago, MD
Gynecological Surgery
Madelyn E. Butler, MD
Jonathan Hershberger, MD
More than 40 different robotic procedures are offered by 22 surgeons using two robots – one at
St. Joseph’s Hospital that also serves patients of St. Joseph’s Children’s Hospital and one at St.
Joseph’s Women’s Hospital. The diverse team of surgeons includes those pictured here: Timothy
Weber, MD, David Hochberg, MD, Ethan Polsky, MD, Hector Arango, MD, César Santiago, MD, Tyler
Kirby, MD; Tuan Pham, MD (to be credentialed in early 2013); David Echevarria, MD; and Frank
Mastandrea, MD.
“There are some procedures for which robotic surgery has absolutely become the standard of
care,” Lockhart said. “If you consider what we had to do for the open cases, then compare it to
laparoscopy and then how we do it robotically, you see why we never would go back – especially
on a lot of critical and complex cases.”
By all accounts, robotic technology is constantly evolving and will continue to improve. St.
Joseph’s Hospital recently added a high-definition machine and launched single-site gall bladder
surgery. Surgeons and staff members are eager to learn and offer new robotic procedures as they
become available.
“We have a highly experienced and dedicated team, wonderful surgeons, and an entire organization committed to the technology and committed to going forward,” Lockhart said. “All of
those pieces make a successful program, and we have it all at St. Joseph’s Advanced Center for
Robotic Surgery.” 
Robotic Procedures Available at St. Joseph’s Hospitals
Kiera M. Irvin-Rahaim, MD
Michael Morris, DO
Carmen E. Peden, MD
Sonja Perkins, MD
Catherine N. Roush, MD
Jennifer M. Russell, DO
Evelyn B. Serrano, MD
Pamela D. Twitty, MD
Timothy Yeko, MD
Christopher Young, MD
Gynecological/Oncology
Surgery
Hector A. Arango, MD
Patricia L. Judson, MD
Tyler O. Kirby, MD
Robert M. Wenham, MD
Gynecological Robotic Procedures: • Hysterectomy • Supracervical hysterectomy • Hysterectomy
Urological Surgery
with bilateral salpingo-oophorectomy • Myomectomy • Sacrocolpopexy • Endometriosis resection •
Salpingo-oophorectomy
Gynecologic Oncology Robotic Procedures: • Hysterectomy • Abdominal hysterectomy •
Supracervical hysterectomy • Radical hysterectomy • Hysterectomy with bilateral salpingo-oophorectomy
• Hysterectomy, bilateral salpingo-oophorectomy, omentectomy, lymphadenectomy for early ovarian
cancer • Hysterectomy, bilateral salpingo-oophorectomy, lymphadenectomy for endometrial cancer •
Radial hysterectomy, lymphadenectomy for cervical cancer • Radical trachelectomy, lymphadenectomy
for fertility preservation in cervical cancer • Pelvic lymph node dissection and para-aortic lymph node
dissection • Excision of pelvic tumor • Vaginal radical trachelectomy
Urologic Robotic Procedures:• Prostatectomy • Pyeloplasty • Nephrectomy or partial nephrectomy
Pediatric Urologic Robotic Procedures: • Ureteral reimplantation • Pyeloplasty • Nephrectomy
or partial nephrectomy • Advanced reconstructive procedures
Colorectal Robotic Procedures: • Abdominal perineal resection • Colectomy (colon resection) •
Colostomy • Illeocecectomy • Illeostomy • Intersphincteric proctectomy resection • Lower anterior
resection • Proctocolectomy with ileal pouch • Rectal resection with colon pull-through • Rectopexy •
Repair of rectovaginal and colovaginal fistula • Small bowel resection • Transanal excision of rectal mass
General Robotic Procedures: • Adrenalectomy • Cholecystectomy for gallbladder disease
(single-site surgery) • Gastrectomy • Liver resection • Nissen fundoplication (Hiatal Hernia repair)•
Pancreactectomy • Splenectomy • Stomach cancer treatment
David A. Hochberg, MD
Frank Mastandrea, MD
Timothy A. Weber, MD
Pediatric Urological Surgery
Ethan G. Polsky, MD
Contact information
To refer a patient or to learn
more about St. Joseph’s
Advanced Center for
Robotic Surgery, contact
the program coordinator:
(813) 443-3080 or
visit StJosephsRobotic.org.
FLORIDA MD - JANUARY 2013
7
Behavioral Health
Behavioral Health Lessons for 2013
from Newtown
By James D. Huysman, PsyD, LCSW
Life is a lifelong, ongoing “Recovery Room”. Usually a recovery room is equipped with skilled people delivering care and lifesaving, heroic medical services. Thirty years ago, in the days of
de-institutionalization, as poor as the available services were for
the mentally ill in the communities into which they were being
discharged, they were better than they are today in 2012.
As a therapist for the last 25 years, not shying away from acute
mental health crisis or chemical dependency interventions, I only
have experienced one suicide in my entire career. It was a patient
who was like Adam Lanza - brilliant but socially beyond awkward; much more likely to be a victim of a crime than the perpetrator. He was developmentally challenged in so many ways that
to call him a complicated case would be an understatement.
In the course of his treatment, my heart went out him and
to his clearly perceived view of society as being on the outside
looking in. Whether his disorder kept him from connecting or
society, as a whole, “saw him coming” and ran away from him, I
remember he laid the blame squarely on his diagnosis of Asperger
Syndrome.
The only person in the world who remained with him was his
Mom, who was a frail woman, scared to death of her own son,
with good reason to be. He had no one else who would socially
connect with him hence she bore the brunt of his rage, wondering why she would ever bring a son in this world and subject him
to the social isolation, feeling like a misfit and an inability to connect with anyone at all.
When I started in this business, I was reminded that “Necessity Is the Mother of Invention” and that, in the 1980’s, though
mental health was an afterthought, we were much more creative
as a society in developing programs for the mentally challenged.
Who would have imagined that things would get so much worse
in terms of available psychological and social programs?
My first stop in mental healthcare was in the early 80’s. at was a
psychosocial drop-in center that offered a comprehensive support
system, run by those with the mental health challenges. It was
called Fellowship House and their program provided psychiatric
support, psychological interventions, social support and even a
residential setting. Additionally they provided a strong caregiver
outreach that would at least be available for a mother to be tethered to.
I do not know if such services were available to Nancy Lanza
or if because of stigma, guilt, shame and fear she did not utilize
them, but I do know this…
8 FLORIDA MD - JANUARY 2013
We have descended into the world
of psychopharmacology, acting as
if taking only a pill could actually
make a comprehensive and qualitative difference in someone’s life. I would suggest that many of
the developmental challenges might certainly need a psychiatrist
to be one of the supports on a 3-legged clinical stool, to deal
with the biochemical elements of their lives. But make no mistake that the psycho-social leg and the support leg for the caregiver of the person with the mental health issue are equally, if not
more important to balance the individual’s continuum of care
(stool). Without these components, the clinical equation makes
no sense.
Our mental health and social service systems have been tested
and repeatedly, they have failed. If we, as Americans, do not wake
up and take action to reform the therapeutic context in which we
deal with the mentally ill, they will continue to make headlines
and we, as a society, will continue to pay the price.
Dr. James Huysman, PsyD, LCSW aka Dr. Jamie is a fierce
advocate of patient-centered healthcare and a work force
in touch with its own wellness. He is a popular conference
speaker and media guest on the topics of caregiver burnout,
compassion fatigue and addictions and healthcare reform.
Dr. Jamie blogs for Psychology Today and sat on the NASW
committee to establish national protocols for certification
and standardization of caregiving practices. Dr. Huysman
writes for Florida MD and Today’s Caregiver magazines.
He co-founded the Leeza Gibbons Memory Foundation
and created the signature programming for its psychosocial
drop-in model, Leeza’s Place, opening 8 national locations,
each with a different funding partner, in a four year period. He co-wrote the acclaimed caregiving book, Take Your
Oxygen First: Protecting Your Health and Happiness While
Caring for a Loved One with Memory Loss, with Gibbons
and Dr. Rosemary Laird. He also contributed to the Healing Project’s offerings, Voices of Caregiving and Voices of Alcoholism. He currently works as Vice President of Provider
Relations and Government Affairs for WellMed Medical
Management in Florida, a UnitedHealthcare company. 
Marketing Your Practice
Lights, Camera, Patients!
By Jennifer Thompson, President of Insight Marketing Group
Each month the world consumes 4 billion hours of YouTube
video while users upload 72 hours of video per minute to the
service. Chances are you fall into one of these categories. If you
don’t, you can sure bet your Central Florida patients do. As the
third most popular site on the Internet behind Google and Facebook, YouTube is a robust, free business tool waiting to help you
market your medical practice. The question is, are you ready for
your close-up?
Why Do You Need to Be on YouTube?
The simple fact of the matter is that patients are looking to
learn more about you before they pick up the phone to schedule
that appointment. They want to know that you’re caring with
good bedside manner, that you’re likeable but not too friendly,
and, today, they don’t want to just read about you. They want to
see you. Yes, it’s really come to that.
In the past few months alone we’ve seen video numbers for our
clients grow at an incredible rate (one of our client’s videos has
more than 20,000 hits alone in under six months!).
In the information and social media-driven world we live in
today, patients have dozens of ways to learn everything about you
before they even go to your website. Putting a few quick videos
together allows them to see the “you” that you want them to see –
plus if you’re the first to market, it can really give you a leg up on
the competition. In fact, we’ve had several patients tell us they’ve
chosen some of our clients for a surgical procedure 100 percent
because of a YouTube video they watched while researching their
potential physicians.
The cost-to-benefit ratio is also one of the best you’re going to
find today. Uploading videos is a free service because YouTube
wants as much content on their site as possible. All you have to
do is purchase the equipment, edit your clips together and you’re
done. You then have a piece of marketing material that potential
patients can watch at home and on their mobile device, share
with their friends and family and one you can use for Facebook
posts and website content.
What Do You Need to Get Started?
To get started with your own YouTube content there are a few
things you’re going to need – but don’t worry, most of them are
free.
First, you’ll have to have a Google Account. This will double
as your login information for Google and unlock many of their
free services. We suggest signing up for a Gmail account to house
all of this data. From there, once you login to YouTube you can
create a channel for your business. This serves as your video hub,
allowing you to upload videos, make
edits to titles and descriptions, choose
keywords (very important for organic
search results) and even view in-depth
analytics about each of your videos.
The next step is creating the videos. For this you’re going to
need a camera, a tripod, and the video editing software of your
choosing, although you’re probably also going to want to invest
in a decent lapel microphone to really get the best sound quality
out of your video. This should be all of your hard costs to get
started. You can get a decent setup going for under $1,000 and
be on your way to Hollywood fame (well, not really – but you’ll
at least be on your way to more patients).
Next up, once you’ve got all of your equipment and your Google
profile, you need to give some consideration to what you’re going to be saying. What content are you going to produce? For
starters, consider filming a video that just tells a bit more about
you and your practice. Then, you’ll want to focus in on a few key
procedures or treatments you offer to patients. From there, the
only thing limiting you is the space on your hard drive and the
amount of patience you have in front of a camera.
What Are Some Tips for Success?
Once you actually get everything needed and you’re ready to
record, there are a few things to keep in mind to get the best video
on the web for patient’s hungry eyes. Of course, no one expects
you to be an ace cinematographer or director with your YouTube
medical practice marketing videos, but you shouldn’t be shooting
for Blair Witch quality, either.
When deciding on the composition of your video (how the
shot will look) consider using a background that will not drown
you or your outfit out. You’ll want to choose somewhere that
looks somewhat professional (depending on the topic of your
video) and you’ll want to make sure you are the subject of the
video. That means make sure you are the focal point, and your
body takes up most of the screen space. If we can only see you
from the shoulders up but have a full view of your office library,
something is wrong.
Often overlooked is sound quality. As discussed previously,
your best bet for quality sound is a lapel microphone. Even then,
you’ll want to find a quiet hall of your office or schedule the video
before or after appointment hours with patients. The last thing
you want to hear when editing is a nearby door closing or office
staff discussing yesterday’s Orlando Magic game.
Speaking of editing, be sure to keep your videos under five
minutes in length whenever possible. No matter what you’re talking about, no one cares after five minutes – especially if it’s a static
camera angle.
FLORIDA MD - JANUARY 2013
9
Marketing Your Practice
There are a few more tips and trends to be considerate of to get the most out of your videos, especially when it relates to keywords and
descriptions, so if you don’t know where to start or if your videos aren’t getting the views you want, it’s best to contact a medical marketing group to help you gain exposure for your project.
Remember, as painful as it is to watch yourself on screen, it’s worth the time even if you just get one patient or surgery from your efforts. Lights, camera, patients!
Marketing Your Medical Practice: A Quick Reference Guide
Are you ready to finally start marketing your practice? Visit www.InsightMG.com to get your copy of “Marketing Your Medical
Practice: A Quick Reference Guide” by Jennifer Thompson and Corey Gehrold. Encapsulating their real world medical marketing
knowledge and expertise, this easy-to-read eBook gives you all the tips and tricks you’ll need to start marketing your practice today
in a fast, fun and friendly format – just like the articles in this series. To learn more, visit www.InsightMG.com.
Looking for more information? Contact Jennifer Thompson today for a free consultation and marketing overview at
321.228.9686 or e-mail her at Jennifer@InsightMG.com.
Jennifer Thompson is president of Insight Marketing Group, a full-service healthcare marketing group focused on digital
and social media administration, referral and partnership development, creative services and graphic design, online reputation management/development and promotional products. She is co-author of Marketing Your Medical Practice: A Quick Reference Guide and an avid Twitter user, regularly posting medical practice marketing tips, articles and more at www.Twitter.
com/DrMarketingTips. You can learn more about her and her company at www.InsightMG.com. 
Be sure and check out our NEW and IMPROVED website at www.floridamd.com!
Central Florida
Pulmonary Group, P.A.
Serving Central Florida Since 1982
Specializing in:








Asthma/COPD
Sleep Disorders
Pulmonary Hypertension
Pulmonary Fibrosis
Shortness of Breath
Cough
Lung Cancer
Lung Nodules
Our physicians are Board Certified in Internal Medicine,
Pulmonary Disease, Critical Care Medicine, and Sleep Medicine
Daniel Haim, M.D., F.C.C.P.
Syed Mobin, M.D., F.C.C.P.
Kevin De Boer, D.O., F.C.C.P.
Daniel T. Layish, M.D., F.A.C.P., F.C.C.P.
Eugene Go, M.D., F.C.C.P.
Andres Pelaez, M.D., F.C.C.P.
Francisco J. Calimano, M.D., F.C.C.P.
Mahmood Ali, M.D., F.C.C.P.
Pranav Patel, M.D., F.C.C.P.
Francisco J. Remy, M.D., F.C.C.P.
Steven Vu, M.D., F.C.C.P.
Jorge E. Guerrero, M.D.
Ahmed Masood, M.D., F.C.C.P.
Ruel B. Garcia, M.D., F.C.C.P.
Neveen A. Malik, D.O.
Tabarak Qureshi, M.D., F.C.CP
Downtown Orlando: 326 North Mills Avenue
East Orlando: 10916 Dylan Loren Circle Altamonte Springs: 610 Jasmine Road
407.841.1100 phone | www.cfpulmonary.com | Most Insurance Plans Accepted
10 FLORIDA MD - JANUARY 2013
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FLORIDA MD - JANUARY 2013 11
PHARMACY UPDATE
Compounding Pharmacies:
Is There a Difference?
You Had Better Believe It!
By Sam Pratt, RPh, FIACP, Jill Weinstein, RPh, Juan Lopez, PharmD
The same reason you send a patient to an accredited hospital
is the same reason that you should seek out and refer to a PCAB
accredited compounding pharmacy. This statement is supported
by the AMA.
Of the approximately 56,000 community-based pharmacies,
more than half provide some level of basic compounding services
to local patients and physicians. International Academy of Compounding Pharmacies estimates that there are 7,500 pharmacies
in the U.S. that specialize in advanced compounding services of
which approximately 3,000 provide sterile compounding. It is
estimated that 1 to 3% of all prescriptions dispensed in the U.S.
are compounded prescriptions for individual patients, i.e. most
hospital IVs.
The value of compounding to personalize medications and
meet the needs of the healthcare system has grown as pharmacists have worked with local physicians, hospitals and medical
clinics to address the ongoing shortage of critical manufactured
items. Compounding pharmacists have been able to access the
raw drug ingredients and collaborate to provide those medicines
until manufacturing supply has been revived.
Is compounding pharmacy regulated?
All compounding pharmacists and pharmacies are subject to
governmental oversight by three regulatory bodies: their individual State Boards of Pharmacy, the Food & Drug Administration (FDA) and by the Drug Enforcement Agency (DEA).
In addition to government regulation, adherence to United
States Pharmacopeia USP <797> standards for the compounding of sterile products is expected. This is a national standard for
the process, testing and verification of any medication prepared
for administration to patients. These standards are included and
required in many state regulations as well as being a professional
standard.
The Pharmacy Compounding Accreditation Board (PCAB)
provides additional level of quality assurance recognition for sterile and non-sterile compounded preparations. In 2004, leading
pharmacy associations joined with the U.S. Pharmacopeia to
form PCAB, a voluntary accreditation body whose mission is
to assure the quality of compounded medications that patients
are prescribed. Pharmacies with PCAB accreditation status have
demonstrated their policies and processes meet the highest pos12 FLORIDA MD - JANUARY 2013
sible standards. The pharmacies are tested against ten stringent
standards which encompass regulatory compliance; personnel;
facilities and equipment for sterile and non-sterile compounding; chemicals and the compounding process; beyond use-dating
and stability; packaging, labeling, delivery for administration and
dispensing; practitioner and patient education; quality assurance
and self-assessment.
The American Medical Association:
1. recognizes that compounding pharmacies must comply with
current United States Pharmacopeia and National Formulary
(USP-NF) compounding monographs, when available, and
recommends that they be required to conform with USP-NF
General Chapters on pharmaceutical compounding to ensure
the uniformity, quality, and safety of compounded medications;
2. only recognizes the accreditation program of the Pharmacy
Compounding Accreditation Board (PCAB™) and the PCAB™
Seal of Accreditation as a means to identify compounding
pharmacies that adhere to quality and practice standards, including those set forth in the USP-NF, for the preparation of
individualized medications for specific patients;
3. encourages all state boards of pharmacy to require compounding pharmacies in their states to obtain the PCAB™ Seal of
Accreditation or, alternatively, to satisfy comparable standards
that have been promulgated by the state in its laws and regulations governing pharmacy practice; and
4. encourages state boards of pharmacy and the National Association of Boards of Pharmacy (NABP), the umbrella organization for state boards of pharmacy, to work with the United
States Food and Drug Administration (FDA) to identify and
take appropriate enforcement action against entities that are
illegally manufacturing medications under the guise of pharmacy compounding. (BOT Action in response to referred for
decision Res. 521, A-06)
Who is Pharmacy Specialists?
• State licensed pharmacy serving personalized patient’s needs
for the past 14 years
• State licensed and registered pharmacists and technicians
• PCAB accredited for sterile and non-sterile compounding
PHARMACY UPDATE
• State P&E license for sterile compounding
• NATIONALLY VALIDATED as compliant with USP <795> and <797> regulations
• Currently Pharmacy Specialists is the ONLY PCAB pharmacy in Central Florida and
one of less than 200 nationwide
• A founding member of International Academy of Compounding Pharmacists (IACP)
Validated Quality
• Owner, Sam Pratt is a Full Fellow of the IACP, one of only 53 in the world
• He is on the Board of Directors for IACP, elected by peers to represent our region
Central Flo
PCAB-Ac
Compoundin
• Pharmacy Specialists requires the use of only pure chemicals from FDA licensed suppliers that provide certificates of analysis and pedigrees to guarantee purity and trace the vendors chemical source to the FDA registered
facility
• Pharmacy Specialists has a QA testing program for process evaluation
• Clinical Pharmacists do patient consultations and physician collaborations for your practice
Who are you compounding with? Your personalized outcomes will only be as good as the consistent quality and integrity of the pharmacy that you choose to collaborate with.
We desire to work with your practice in a collaborative manner to help solve your toughest patient or medication challenge. We are
your community, clinical pharmacy resource.
Please contact Pharmacy Specialists at (407)260-7002 to consult with one of our Clinical Pharmacists or to schedule a patient for a
clinical pharmacy consultation. How may we serve your practice?
References available upon request.
Juan Lopez, PharmD, graduated from Mercer University
College of Pharmacy and is proud to be the newest addition
to Pharmacy Specialists’ compounding pharmacist staff.
Jill Weinstein, RPh, graduated from University of Florida
and is the clinical pharmacist who does hormone, nutrition and weight loss consultations at Pharmacy Specialists.
Pharmacy Specialists is proud to be the only pharmacy in
all of Central Florida and one of only 129 pharmacies in the
country that are accredited by the Pharmacy Compounding
Accreditation Board (PCAB). We meet or exceed ALL standards for sterile as well as non-sterile compounding and we
are the only USP 797 and USP 795 validated compliant
pharmacy in all of central Florida. Currently, Sam Pratt,
RPh at Pharmacy Specialists is the only Full Fellow of the
International Academy of Compounding Pharmacists in the
Central Florida area. Call Pharmacy Specialists to check
with a clinical pharmacist for suggestions and recommendations. For additional information please call (407)2607002, FAX (407) 260-7044, Phone (800) 224-7711, FAX
(800) 224-0665. 
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FLORIDA MD - JANUARY 2013 13
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8/3/2012 3:32:27 PM
CANCER
Marketing
Your Practice
Advanced Gastrointestinal
Endoscopy
Improves Options for Cancer
Diagnosis, Staging, Targeting, and
Even Treatment for Early Lesions
By Cynthia Harris, MD
Technological advances have ushered in a new era in advanced
gastrointestinal endoscopy. With the incorporation of endoscopic
ultrasound (EUS) into the diagnostic armamentarium, staging
of esophageal, gastric, pancreatic, and rectal cancers now yields
important information about the primary tumor size and lymph
node status at diagnosis. Since neoadjuvant therapies have an
important role in the initial management of locally advanced
tumors, having EUS available clarifies individualized treatment
selection. At Moffitt Cancer Center, gastrointestinal endoscopic
oncologists evaluate patients in multidisciplinary clinics with surgeons, medical oncologists, and radiation oncologists as well as
participating in weekly tumor board. This close collaboration fosters consideration of all endoscopic modalities, both for diagnosis
and for treatment, early in the treatment process.
One such area where EUS is critical to individualize patient
selection is in pancreatic cancer. In the past, patients would often
be advised to undergo major exploratory surgery when presenting
with a pancreatic mass to determine whether a tumor is resectable.
Now, with EUS, a fine needle aspirate (FNA) can be obtained
first to determine the histology. This is extremely helpful to confirm a pancreatic primary adenocarcinoma vs. a neuroendocrine
carcinoma vs. a potentially benign lesion such as autoimmune
pancreatitis which would warrant medical management rather
than surgical resection. Once a primary pancreas cancer is confirmed by needle aspirate, in conjunction with a thin cut pancreas
protocol cat scan (CT), EUS can then refine the relationship of
the tumor to major blood vessels, a necessary step in determining resectability. At our institution, we follow the National Comprehensive Cancer Network (NCCN) definition of resectable,
borderline resectable, and unresectable status. We have our own
programmatic pathway of neoadjuvant multiagent chemotherapy
followed by stereotactic body radiation therapy (SBRT) in the
treatment of borderline resectable tumors to enhance conversion
to margin negative surgery.
To aid the radiation oncologists with SBRT, our group endoscopically places small radio-opaque markers termed fiducial
markers into the pancreas tumor prior to radiation. SBRT relies
on image-guided radiation therapy (IGRT), permitting escalation
of radiation dose to tumors while minimizing dose to normal tissues. In fact, our radiation group uses them to guide respiratory
gated treatment such that the markers are viewed fluoroscopically
on the treatment table. When the marker reaches the maximum
exhalation position, the linear accelerator beams “on” to deliver a
high dose fraction. At our institution, this multidisciplinary team
approach has not only successfully led to the majority of border14 FLORIDA MD - JANUARY 2013
line patients undergoing margin negative resection but also has
been associated with significant tumor and nodal downstaging;
in fact, we have patients who have had pathologic complete responses as well as minimal microscopic disease remaining.
In addition, EUS offers therapeutic intervention including celiac plexus neurolysis for relief of chronic pain caused by unresectable pancreatic tumors, pain that is not readily relieved with
narcotic medications. In the near future, EUS will likely offer
other modalities for treatment and local control of unresectable
tumors including brachytherapy and cryoablation. Furthermore,
EUS-guided fine-needle injection (EUS-FNI) is an attractive
minimally invasive delivery system with potential applications in
local and combination therapy against pancreatic cancers. The
evidence of the feasibility of EUS-FNI of antitumor agents as
well as brachytherapy and cryoablation has been expanding with
promising results.
At our institution, we also use endoscopically implanted fiducial markers to guide radiation therapy in other sites. Our group
implants these markers at the superior and inferior aspect of the
tumor in the esophagus and rectum. In the esophagus, there
is significant respiratory associated tumor motion that can be
quantified with the markers and appropriate shifts can be made
to ensure the proper treatment alignment. Moreover, with the
echoendoscope, we are also able to image the most medial extent
of the liver, which is helpful when an FNA is necessary to confirm
histology or when fiducial markers are needed to guide radiation
therapy for primary tumors and oligo-metastasis.
Patients with Barrett esophagus with high grade dysplasia
or early esophageal cancers that do not invade the submucosa
(uT1a) may also be candidates for minimally invasive therapeutic
endoscopic procedures. These procedures consist of endoscopic
mucosal resection (EMR) or endoscopic ablation including
cryoablation, radiofrequency ablation (RFA), or photodynamic
therapy (PDT). EMR is not only beneficial in obtaining a pathological stage of the tumor, but can essentially be curative for T1a
lesions. RFA has a proven track record of excellent results in
the treatment of flat high grade dysplasia and even flat intramucosal carcinoma. Those patients with locally advanced esophageal
cancer not deemed to be candidates for surgical resection may
particularly benefit from cryoablation of the residual persistent
dysplastic Barrett esophagus after definitive chemoradiation. Our
GI group has previously reported an 88% rate of persistent Barrett esophagus in patients achieving a complete clinical response
after definitive chemoradiation for invasive esophageal adenocarcinoma. Residual Barrett esophagus that is untreated may in-
CANCER
crease the risk of de novo adenocarcinoma. This has led to our approach of ensuring that patients who do not undergo surgery status post
chemoradiation are referred back for endoscopic evaluation. If residual Barrett esophagus persists, the patients are offered cryoablation.
We have previously shown that this modality is safe and effective in those patients who have received radiation as part of their treatment
algorithm. Currently, the other ablative methods have not been evaluated in this patient population.
Finally, gastrointestinal therapeutic endoscopy offers patients with locally advanced esophageal cancer more options for palliation of
dysphagia. Newer, more flexible and smaller caliber fully covered self-expanding metal stents are associated with better patient tolerability
and less pain without increased risk for migration or tumor ingrowth and are easily removable. These stents allow for the patient to maintain adequate nutrition by continuing regular per os intake, while receiving therapy, an issue as important clinically as it is emotionally
and mentally. These stents have been proven safe while the patient is receiving radiation and most are deemed MRI compatible.
All of these techniques are rapidly expanding options for the cancer patient with involvement of the gastrointestinal tract. Optimal
incorporation of these tools may allow us to better personalize treatment.
Dr. Cynthia Harris is a gastroenterologist in the Division of Endoscopic Oncology in the Gastrointestinal Oncology Program at Moffitt Cancer Center. Dr. Harris is an assistant member at Moffitt Cancer Center and an assistant professor at the
University of South Florida College of Medicine’s Department of Oncologic Sciences. Dr. Harris received her medical degree
from the University of Tennessee College of Medicine and completed a surgical internship at Greenville Memorial Hospital in
Greenville, SC, followed by completion of an internal medicine residency at University of Miami/Jackson Memorial Hospital
in Miami, FL. She pursued additional fellowship training in gastroenterology at the University of Kentucky where she was
chief fellow, and an advanced endoscopic fellowship at Moffitt Cancer Center/University of South Florida.
Before coming to Moffitt she served as an assistant professor of gastroenterology at the University of Kentucky and Indiana
University. She also worked for the Miami Veterans’ Affairs Healthcare System and Homestead Air Force Base in Homestead,
FL and spent two years in private practice in St. Petersburg, FL. In 2011, Dr. Harris received the American Society for Gastrointestinal Endoscopy Unit Recognition for Quality and Safety Program award for Moffitt.
Dr. Harris’ research and clinical interests include endoscopic ultrasound-guided (EUS) fine needle aspiration for mediastinal and gastrointestinal neoplasms, including pancreatic cysts and tumors; endoscopic retrograde cholangiopancreatography
(ERCP) for biliary and pancreatic cancer; enteral stenting; EUS-guided celiac plexus neurolysis; endoscopic mucosal resection
(EMR); cryoablation and radiofrequency ablation for Barrett’s esophagus. 
START WEIGHT SEPT. 2010: 207 LBS. • END WEIGHT DEC. 2010: 166 LBS.
Pathology Lab Results — Patient: SP Age: 63 Sex: Male
Before Diet
Lipid Panel
Result 08/28/2009
Ref Range Result
Cholesterol
H 278
(80-199)mg/dL
Triglycerides
H 199
(30-150)mg/dL
HDL Cholesterol
51
(40-110)mg/dL
LDL Cholesterol
H 187
(30-130)mg/dL
VLDL Cholesterol
40
(10-60)mg/dL
Risk Ratio(CHOL/HDL)
H 5.5
(0.0-5.0)Ratio
8/26/10:
9/24/10:
Tissue Fat %
26.3%
21.1%
Body Scan Results
Tissue (g)
83,019
78,045
Fat (g)
21,864
16,449
After Diet
09/20/2010
180
82
55
109
16
3.3
Lean Muscle (g)
61,155
61,596
Please Note: Gain of 441g of muscle and a fat loss of 5,415g in 30 days! Individual results may vary.
For information call 407-260-7002 or email Sam@makerx.com.
FLORIDA MD - JANUARY 2013 15
Digestive and Liver Update
Pancreatic Cancer and Recent
Advances
By Harinath Sheela, MD
Pancreatic cancer is the growth of cancer cells in the pancreas.
The pancreas is a long, flattened pear-shaped organ in the abdomen. It makes exocrine and endocrine enzymes and hormones
including Insulin and Glucogon. It makes and releases enzymes
that help the body absorb foods, especially fats. These hormones
help your body control blood sugar levels.
The Pancreas
Spleen
Liver
Stomach
(cut)
Colon
Pancreas underlying stomach
Cancer occurs when cells in the body divide without control
or order. If cells keep dividing uncontrollably, a mass of tissue
forms. This is called a growth or tumor. The term cancer refers to
malignant tumors. They can invade nearby tissue and spread to
other parts of the body.
Etiology:
The exact etiology of pancreatic cancer is unknown. There is a
small genetic correlation with family history. A role for familial
aggregation and/or genetic factors is suggested by the fact that 5
to 10 percent of patients with exocrine pancreatic cancer have a
first degree relative with the disease. Only about 3 of every 100
patients with pancreatic cancer have the “familial form”. In the
United States, approximately 43,140 patients are diagnosed with
cancer of the exocrine pancreas annually, and unfortunately almost all are expected to die from the disease. Pancreatic cancer
is the fourth leading cause of cancer-related death in the United
States among both men and women. The majority of these tumors (85 percent) are adenocarcinomas arising from the ductal
epithelium.
The disease is rare before the age of 45, but the incidence rises
sharply thereafter. The incidence is greater in males than females
(male-to-female ratio 1.3:1) and in blacks (14.8 per 100,000 in
black males compared to 8.8 per 100,000 in the general population).
16 FLORIDA MD - JANUARY 2013
RISK FACTORS
Pancreatic cancer is more common in smokers and people who
are obese. The risk increases with age. Other risk factors include:
Diabetes, chronic pancreatitis, hereditary pancreatitis, family
nonpolyposis colon cancer syndrome, family or personal history
of certain types of colon polyps or colon cancer, family history
of pancreatic cancer (especially in Ashkenazi Jews with BRCA2
[breast cancer associated]) gene, and high fat diet. A two- to fivefold increased risk of developing pancreatic cancer 15 to 20 years
after partial gastrectomy has been described. An increased incidence has also been observed in patients who underwent cholecystectomy.
Symptoms:
Majority of times at the time of diagnosing pancreatic cancer,
the patient presents with advanced stages. Pancreatic cancer does
not cause symptoms in its early stages. The cancer may grow
for some time before it causes symptoms. When symptoms do
appear, they may be very vague. In many cases, the cancer has
spread outside the pancreas by the time it is discovered.
Symptoms include:
• Nausea
• Loss of appetite
• Unexplained weight loss
• Pain—in the upper abdomen, sometimes spreading to the
back (a result of the cancer growing and spreading)
• Jaundice —yellowness of skin and whites of the eyes; dark
urine (if the tumor blocks the common bile duct); tan stool or
stool that floats to the top of the bowl.
• Weakness, dizziness, chills, muscle spasms, diarrhea (especially
if the cancer involves the islet cells that make insulin and other
hormones)
• Back pain
• Blood clots due to hypercoagulable states
• Depression
• Diarrhea
• Indigestion
Diagnosis:
Initial laboratory evaluation include complete blood count,
complete metabolic panel, PT/INR. Routine laboratory tests
may reveal a rise in the serum bilirubin concentration and alkaline phosphatase activity, and the presence of mild anemia. Several serum markers for pancreatic cancer have been evaluated, the
most useful of which is cancer associated antigen 19-9 (CA 19-9).
The reported sensitivity and specificity for pancreatic cancer are
80 to 90 percent, respectively.
Digestive and Liver Update
Radiologic Investigations:
A variety of diagnostic studies are available for the diagnosis
and staging of pancreatic cancer. The diagnosis of pancreatic cancer is typically made radiographically by the finding of a mass
within the pancreas, which often obstructs the pancreatic duct or
biliary tree. Contrast-enhanced multislice (multidetector) helical
computed tomography (MDCT) scanning with three dimensional reconstruction is the preferred method to diagnose and
stage pancreatic cancer. Other imaging studies that may be helpful in the diagnostic evaluation include transcutaneous or endoscopic ultrasound (US or EUS); endoscopic retrograde cholangiopancreatography (ERCP); magnetic resonance imaging (MRI),
and MR cholangiopancreatography (MRCP). The utility of PET
in the diagnostic and staging evaluation of suspected pancreatic
cancer is uncertain.
Treatment:
Because pancreatic cancer is often advanced when it is first
found, very few pancreatic tumors can be removed by surgery.
The standard procedure is called a pancreaticoduodenectomy
(Whipple procedure). Removal of the cancerous tumor and nearby tissue may be done. Nearby lymph nodes may also need to be
removed. In pancreatic cancer, surgery may also be performed
to relieve symptoms. Surgeries include: Whipple procedure, total
pancreatectomy and distal pancreatectomy.
Surgery should be done at centers that perform the procedure
frequently. When the tumor has not spread out of the pancreas
but cannot be removed, radiation therapy and chemotherapy together may be recommended.
When the tumor has metastasized to other organs such as the
liver, chemotherapy alone is usually used. The standard chemotherapy drug is gemcitabine, but other drugs may be used. Gemcitabine can help approximately 25% of patients.
Patients whose tumor cannot be totally removed, but who have
a blockage of the tubes that transport bile (biliary obstruction)
must have that blockage relieved. There are generally two approaches to this:
• Surgery
• Placement of a tiny metal tube (biliary stent) during ERCP
Management of pain and other symptoms is an important part
of treating advanced pancreatic cancer.
The best treatment for pancreatic cancer depends on how far
it has spread, or its stage. The stages of pancreatic cancer are easy
to understand. What is difficult is attempting to stage pancreatic
cancer without resorting to major surgery. In practice, doctors
choose pancreatic cancer treatments based upon imaging studies ,
surgical findings, and an individual’s general state of well being.
Understanding Pancreatic Cancer
Stages of Pancreatic Cancer
Stage is a term used in cancer treatment to describe the extent
of spread of the cancer. The stages of pancreatic cancer are used
to guide treatment and to classify patients for clinical trials. The
stages of pancreatic cancer are:
• Stage 0: No spread. Pancreatic cancer is limited to a single layer
of cells in the pancreas. The pancreatic cancer is not visible on
imaging tests or even to the naked eye.
• Stage I: Local growth. Pancreatic cancer is limited to the pancreas, but has grown to less than 2 centimeters across (stage IA)
or greater than 2 centimeters (stage IB).
• Stage II: Local spread. Pancreatic cancer has grown outside the
pancreas, or has spread to nearby lymph nodes.
• Stage III: Wider spread. The tumor has expanded into nearby
major blood vessels or nerves but has not metastasized.
• Stage IV: Confirmed spread. Pancreatic cancer has spread to
distant organs.
Determining pancreatic cancer’s stage is often tricky. Imaging
tests like CT scans and ultrasound provide some information,
but knowing exactly how far pancreatic cancer has spread usually
requires surgery.
Since surgery has risks, doctors first determine whether pancreatic cancer appears to be removable by surgery (resectable).
Pancreatic cancer is then described as follows:
• Resectable: On imaging tests, pancreatic cancer hasn’t spread
(or at least not far), and a surgeon feels it might all be removable. About 10% of pancreatic cancers are considered resectable when first diagnosed.
• Locally advanced (unresectable): Pancreatic cancer has grown
into major blood vessels on imaging tests, so the tumor can’t
safely be removed by surgery.
• Metastatic: Pancreatic cancer has clearly spread to other organs, so surgery cannot remove the cancer.
If pancreatic cancer is resectable, surgery followed by chemotherapy or radiation or both may extend survival.
Treating Resectable Pancreatic Cancer
People whose pancreatic cancer is considered resectable may
undergo one of three surgeries:
Whipple procedure (pancreaticoduodenectomy): A surgeon
removes the head of the pancreas, parts of the stomach and small
intestine, some lymph nodes, the gallbladder, and the common
bile duct. The remaining organs are reconnected in a new way to
allow digestion. The Whipple procedure is a difficult and complicated surgery. Surgeons and hospitals that do the most operations
have the best results.
About half the time, once a surgeon sees inside the abdomen,
pancreatic cancer that was thought to be resectable turns out to
have spread, and thus be unresectable. The Whipple procedure is
not completed in these cases.
What is the Prognosis?
Minority of patients with Pancreatic Cancer who presents at
FLORIDA MD - JANUARY 2013 17
Digestive and Liver Update
early stages can have surgical resection and can be curative. However, in more than 80% of patients the tumor has already spread and
cannot be completely removed at the time of diagnosis.
Is screening for pancreatic cancer helpful?
Although imaging surveillance of high-risk family cohorts is pursued at some centers, it has not yet been shown to improve survival
and this practice has been considered by some to be investigational.
Harinath Sheela, MD moved to Orlando, Florida after finishing his fellowship in gastroenterology at Yale University School
of Medicine, one of the finest programs in the country. During his training he spent significant amount of time in basic and
clinical research and has published articles in gastroenterology literature.
His interests include Inflammatory Bowel Diseases (IBD), Irritable Bowel Syndrome (IBS), Hepatitis B, Hepatitis C, Metabolic and other liver disorders. He is a member of the American Gastroenterological Association (AGA), the American Society
for Gastrointestinal Endoscopy (ASGE) and the American Association for the Study of Liver Diseases (AASLD) and Crohn’s
Colitis foundation (CCF). Dr. Sheela is a Clinical Assistant Professor at the University of Central Florida School of Medicine.
He is also a teaching attending physician at Florida Hospital Internal Medcine Residency and Family Practice Residence (MD
and DO) programs. 
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18 FLORIDA MD - JANUARY 2013
1/4/13 1:10 PM
PULMONARY AND SLEEP DISORDERS
Medical Malpractice Expert Advice
401K Plan Liabilities Increasing
Significantly for Employers
By Wes Caldwell
Most medical practices don’t know about the significant liability they have regarding their 401k plans and,
even worse, almost none know how the government is dramatically increasing its enforcement actions. I
have talked with many medical practices who think that the service provider or plan administrator has the
fiduciary responsibility for their 401K or profit-sharing plan. Most employers are often quite surprised to find out that they are the plan
sponsor and primary fiduciary since they are the ones who sign the form 5500. They are also very surprised to find out what they must
do under the new ERISA fee-disclosure requirements.
What is ERISA section 408(b)(2)?
A new regulation from the Department of Labor requires “covered service providers” to disclose all fees received directly and indirectly
from the plan, effective July 1, 2012. These disclosures are then to be distributed to all participants by you, the plan sponsor, but most
of you have not even been told that you are the plan sponsor and must comply!
What does this mean to me?
As the plan sponsor, your fiduciary obligations with respect to service providers that submit fee disclosures are the following:
•Review the disclosed fee information and assess the overall reasonableness of the fees in the context of the services being performed.
•Review the disclosed information about conflicts of interest among service providers, their related parties, and/or third parties.
•Based on the above, prudently determine whether to continue, terminate, or modify contracts and arrangements with each of the
plan’s service providers.
If these steps are not carried out and well documented, the liability rests on you, the plan sponsor, and you can now expect some serious consequences doled out by the government.
Can I shift the responsibility to a third party?
Yes, many of our medical-practice clients are taking advantage of a program design wherein they are almost completely relieved of their
fiduciary liability. The program becomes the plan sponsor and assumes responsibility for all reporting and 408(b)(2) fiduciary obligations. Because of their economies of scale, these programs can generally provide significant administrative cost savings to your plan, as
well.
Conclusion
The significant new fiduciary liabilities associated with 401K plans are causing medical professionals to reassess how they approach the
administration and management. We can provide liability relief and cost savings, so call us to discuss.
Wes Caldwell heads up Danna-Gracey’s Physician and Employee Benefits Division. He is a 27-year veteran of the financialservices industry and brings a wealth of knowledge to serve the medical community. Wes@dannagracey.com / 800-966-2120. 
FEBRUARY 2013 ISSUE
Coming UP Next Month: The cover story focuses on
the Pepin Heart Institute at Florida Hospital in Tampa. Editorial focuses on Cardiology, Heart Disease and Stroke.
FLORIDA MD - JANUARY 2013 19
Florida Hospital Tampa Presents
Gastroesophageal Reflux Disease (GERD)
Perspective for 2013
By Alexander Rosemurgy, MD & Sharona Ross, MD
Gastroesophageal reflux disease (GERD) affects approximately
19 million Americans, including infants, teens and adults. Symptoms vary –patients who have symptoms relating to the esophagus suffer from heartburn or chest pain, while patients who have
symptoms not related to the esophagus experience coughing and
asthma.
GERD primarily happens because of the following three reasons: the esophagus normal defenses are overwhelmed by the
acid content of the stomach, the contents of the stomach are too
acidic, or the food is not cleared from the esophagus fast enough.
When “refluxed” stomach acid touches the lining of the esophagus, it causes a burning sensation in the chest or throat called
heartburn. The fluid can even reach the back of the mouth, and
this is called acid indigestion. Heartburn is common but does not
necessarily mean you are suffering from GERD. Heartburn that
happens more than twice a week may be considered GERD, and
it can eventually lead to more serious health problems.
It is common for patients to be placed on acid-suppression
medication as initial therapy for GERD. These drugs are sold as
generic and brand names and they are divided into two groups:
H-2 blockers, such as Zantac and Tagament, or proton pump
inhibitors (PPI’s) such as Prevacid. PPI drugs are more effective
than the H-2 blockers, but they do have significant consequences
which cannot be understated:
1. Patients continue to have reflux since these drugs don’t technically stop reflux; they just inhibit stomach acid production
and secretion. While the reduction in acidity is a good outcome of the PPI, it’s insufficient therapy because the reduction
in acid without cessation of reflux results in unopposed bile
reflux.
2. Unopposed bile reflux is bile rich fluid in the esophagus,
which is also a potent carcinogen. Twenty years ago, cancer
of the esophagus was unusual, but with the widespread use
of PPI’s and H-2 blockers, cancer of the esophagus is now an
epidemic in the United States.
3. Drug therapy inactivation Acid suppression can cause calcium
malabsorption resulting in decreased bone strength leading to
osteoporosis. This is true especially in men over 50 years of
age and women after menopause, a group already prone to osteoporosis and its complications. Acid suppression also causes
malabsorption or inhibition of other drugs such as Plavix, a
commonly prescribed antiplatelet drug given to cardiac and
carotid stent patients.
20 FLORIDA MD - JANUARY 2013
Dr. Sharona Ross & Dr. Alexander Rosemurgy, Directors of The
Southeastern Center for Digestive Disorders & Pancreatic Cancer
located at Florida Hospital Tampa.
4. PPI drugs are expensive! Regardless of patient’s insurance coverage to pay for these drugs, collectively, we all pay billions for
them every year.
H-2 blockers and PPI’s are not definitive therapies for GERD,
as they should only be prescribed for well-defined and finite periods of time. More definite solutions are available for GERD
patients including endoscopic (through the mouth) procedures
and laparoscopic procedures which can be done using robotics
and/or a “scarless” approach which is dependent upon the diagnosis of GERD.
The diagnosis of GERD requires measurement of movement
of fluid or solids from the stomach back into the esophagus. The
diagnosis can be made using minimally invasive modalities including ambulatory ph measurement using a “chip” to measure
reflux episodes (Bravo ph measurement), or an impedance measurement. It is important to note that upper gastrointestinal contrast x-ray studies are not a good measure of reflux and should
not be used to diagnose excessive reflux; however these studies are
useful for evaluating how food moves down the esophagus.
We have developed techniques to undertake endoscopy and
Bravo ph probe placement in the office without sedation. This
means patients do not lose control and they are able to drive and
return to work immediately after the procedure. It also shortens the overall evaluation period to determine if an operation is
needed. There are many interventions for GERD that include
endoscopic therapy, laparoscopic surgery, and robotic and laparoscopic anti-reflux surgery. These options depend on the patient… it’s a case by case decision. As would be expected with
any new therapy, long-term follow-up is not yet available for the
endoscopic therapy. This definitive therapy can be undertaken
using instrumentation introduced by the mouth. This is often
called “Transoral Incisionless Fundoplication” (TIF). We use TIF
selectively in patients that are not particularly good candidates
for laparoscopic surgery, due to the lack of long-term data. We
also use endoscopic therapy for patients with a notable history of
abdominal surgery.
Results with the laparoscopic surgery approach are well documented from multiple centers across the United States and are
very encouraging. We have undertaken more than 1,200 of these
operations and have been very pleased by the efficacy and durability and complications are few. Confinement is limited and patients quickly return to their normal lifestyle. Robotics has been
applied to antireflux surgery in the same way that laparoscopy has
been used. The use of a robot allows surgeons with limited laparoscopic skills to safely undertake antireflux surgery. This approach
utilizes 4 to 5 incisions much like laparoscopy. We have utilized
this approach for patients best served by laparoscopy and in need
of the special abilities offered by robotics.
Dr. Sharona Ross & Dr. Alexander Rosemurgy performing Advanced
Minimally Invasive & Robotic Surgery
Finally, laparoscopic anti-reflux surgery can be undertaken in a “scarless” manner using a single 12mm incision at the umbilicus.
This is called Laparo-Endoscopic Single Site (LESS) surgery. This approach has been well received and results in less pain and a quicker
recovery. “Scarless” antireflux surgery is possible only through this approach. We embraced this approach very early and have undertaken more antireflux operations using this approach than any other center in the United States. As experts in this surgical approach,
we remain excited about the expected benefits with outstanding cosmetic outcomes. believe that, in general, the LESS approach is the
optimal approach in 2013 because it is “scarless” and less painful compared to laparoscopy while being as efficacious.
In summary, these are exciting times in the treatment of gastroesophageal reflux!
LESS surgery is an evolving advancement in the treatment of GERD, one that we have labored relentlessly to develop and establish.
Robotic utilization continues to find its specific role, a process we are leading. Transoral endoscopic therapy continues to build and we
continue to apply it to patients who are best positioned to receive it. Therapy for gastroesophageal reflux in 2013 is much more advanced
and less invasive than just a few years ago. It will continue to evolve and advance to provide the best outcomes with ever decreasing
invasiveness. If you are looking for minimally invasive no-scar surgery in the greater Tampa area, please contact us at The Southeastern
Center for Digestive Disorders & Pancreatic Cancer, Advanced Minimally Invasive & Robotic Surgery at (813) 615-7030 or visit us at
www.SoutheastMinimallyInvasive.com.
Alexander Rosemurgy, MD, joined the faculty of the University of South Florida in 1984 after completing his residency in
Surgery at the University of Chicago. He was a Professor of Surgery and Medicine at USF from 1995 through 2011. He was
awarded The Vivian Clark Reeves / Joy McCann Culverhouse Endowed Chair in Pancreatic Cancer and Digestive Disorders.
In 2011, he joined the Tampa General Medical Group. Prior to relocating to Florida Hospital Tampa, Dr. Rosemurgy served
as Chief of General Surgery at Tampa General Hospital for more than 20 years and he was the Director of the Tampa General
Hospital JCAHO approved Centers of Excellence in Hepatopancreaticobiliary Disorders and Esophagogastric Disorders. For
more than a decade he has been the Director of a Hepatopancreaticobiliary Fellowship, one of the select few in North America.
Dr. Rosemurgy is currently serving as the President of the Southeastern Surgical Congress. He has undertaken more than
1,000 pancreatic resections, has been a lead investigator in over 40 pancreatic cancer trials, has undertaken more than 1,000
antireflux operations, and has more than 300 clinical and scientific publications.
Sharona Ross, MD, was born and raised in the State of Israel. After two years of military service in the Israel Defense Forces,
she moved to the United States, where she graduated Phi Beta Kappa and Summa Cum Laude from the American University
in Washington, DC. She graduated Alpha Omega Alpha from the George Washington University School of Medicine and
Health Sciences in Washington, DC. Dr. Ross completed her residency in General Surgery with the Department of Surgery,
University of South Florida College of Medicine. She was awarded the prestigious Advanced Gastrointestinal Surgery, Hepatopancreaticobiliary (HPB), and Minimally Invasive Surgery (MIS) Fellowship at the USF College of Medicine and Tampa
General Hospital. She then completed a Gastroenterology Fellowship with the Division of Digestive Disorders & Nutrition,
Department of Medicine, USF College of Medicine. Prior to relocating to Florida Hospital Tampa, Dr. Ross was the Director
of Minimally Invasive Surgery and the Director of Surgical Endoscopy in the Department of Surgery at the USF College of
Medicine. She is the Program Director/Chair of the Annual International Women in Surgery Career Symposium, now entering its fourth year. Dr. Ross was one of the first surgeons in the United States to undertake Laparo-Endoscopic Single Site
(LESS) surgery, and continues to develop new techniques and instrumentation to improve its safety and application. 
FLORIDA MD - JANUARY 2013 21
ORTHOPAEDIC UPDATE
iFuse Implant System Revolutionizing
Sacroiliac Joint Fusion Surgery
By Corey Gehrold
The iFuse Implant System is a new, minimally invasive approach for sacroiliac (SI) joint fusion surgery to treat conditions
including sacroiliac joint disruptions and degenerative sacroiliitis. The procedure utilizes a smaller incision and a guide pin to
provide stability to the SI joint, which results in less pain and a
quicker recovery time for patients.
Why Would a Patient Need SI Joint
Fusion Surgery?
“A patient would be recommended for SI surgery when they
exhibit symptoms of chronic sacroiliac inflammation and degeneration, and when conservative methods of treatment – such as
medication, therapy and injections – have failed,” says G. Grady
McBride, M.D., a board certified orthopaedic surgeon specializing in cervical and lumbar spinal surgery at Orlando Orthopaedic Center. “SI joint dysfunction, when the sacral bone joins
the pelvis bone, may lead to pain in the lower back or upper
buttock area. The pain is fairly common and frequency does increase with age.”
New Vs. Old Methods of SI Joint Fusion
Surgery
The traditional SI joint fusion surgery involved open surgery
that could last up to several hours, required a large incision and a
prolonged hospital stay and recovery. The surgeon would remove
cartilage tissue from the joint and use bone grafts from another
part of the body to help fuse the SI joint.
But with the iFuse Implant System, patients no longer have to
endure much of the discomfort and inconvenience experienced
with the traditional procedure.
The iFuse Implant System requires a very small incision and
uses a special guide pin to place rigid titanium implants specifically made to stabilize and fuse the heavily loaded SI joint. These
small implants are designed to stabilize the SI joint and allow
healing through minimization of micromotion.
“The advantages to the patients are that, as a minimally invasive procedure, the recovery is quite rapid and you’re out of
the hospital the next day with minimal down time,” says Dr.
McBride. “Patients can be up walking the evening of surgery
with a walker and they will only need to limit weight-bearing for
approximately three weeks.”
SI joint dysfunction is quite common in patients who have undergone lumbar fusions. In fact, some studies have indicated up
to 50 percent of patients having lumbar fusions or lumbosacral
22 FLORIDA MD - JANUARY 2013
fusions develop degeneration in the
adjacent sacroiliac joints. With the
iFuse system there are no conflicts
with lumbar fusion devices, meaning if a patient previously had spinal surgery they may still be a candidate for the new procedure.
G. Grady McBride, MD,
Orlando Orthopaedic Center
Spine Specialist.
“From a surgeon’s standpoint, the iFuse System is relatively
simple and offers special targeting guides to insert the stabilizing pins which are directed under x-ray or fluoroscopic control,”
says Dr. McBride. “This limits the size of the incision needed to
insert these pins, which really is a benefit for both the patient
and surgeon.”
The Surgery Process: Before, During
and After
The road to an iFuse Implant System starts at the initial exam.
If a patient is experiencing lower back symptoms predominately
below the L5 vertebra and the physician is able to determine
pain originates in the SI joint, the doctor will request X-rays or a
CT scan to look for signs of degeneration of the joint.
“A common test to determine whether a patient may be a candidate for SI surgery is to do a selective injection of Lidocaine or
an anesthetic agent in the sacroiliac joint,” says Dr. McBride. “If
the sacroiliac pain is completely relieved for several hours then
that would indicate the source of the pain and suggest they may
benefit from the iFuse Implant System.”
But first, before surgery is considered, all conservative measures of treatment (such as the aforementioned injections and
physical therapy) are attempted. Only after these measures have
failed will a patient be considered for surgery.
If the patient chooses to undergo the iFuse surgery to stabilize
their SI joint, the patient will be contacted by the physician’s office and a surgery will be scheduled. On the day of surgery, the
patient will be admitted and administered a general anesthetic.
They will then be placed lying face down on the surgical table
while the surgeon uses the specially designed iFuse system to
guide the instruments that prepare the bone and insert the implants. The entire procedure is performed through a small incision (approximately 2-3cm long), along the side of the buttock.
During the procedure, X-ray guidance provides the surgeon with
live imaging to facilitate proper placement of the implants. Typically three implants are placed, depending on the patient’s size.
Surgery is usually completed in less than 40 minutes and the
ORTHOPAEDIC UPDATE
patient is returned to their room and instructed to start limited weight-bearing activities shortly after surgery.
“Following surgery with the iFuse Implant System, the patient only needs to limit weight-bearing for approximately three weeks and
recovery is quite rapid with full healing in the six to eight week timeframe,” says Dr. McBride.
Patients will return to their physician’s office between one and two weeks following surgery for a follow-up appointment to assess the
incision and for follow-up X-rays. Based upon the physician’s recommendation, patients will also have to come back to the office 12
weeks post-surgery for more X-rays and to determine whether they may resume full weight-bearing activities.
iFuse Implant System Results
“Overall this system has had a very high success rate with very few failures,” says Dr. McBride. “Healing is usually complete by the six
to eight week timeframe, but I usually will limit my patients from doing anything strenuous for a three to four month period. Hopefully by that time the patient has made a full recovery and their sacroiliac pain has resolved.”
Check out www.OrlandoOrtho.
com to learn more about the iFuse
Implant System and how it can
help your patients. 
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out our NEW
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FLORIDA MD - JANUARY 2013 23
CURRENT TOPICS
South Florida Baptist Hospital Brings Robotic Surgery to Plant City
As interest in robotic surgery expands, so has the family of robots that began with the first $1 million investment for a daVinci Surgical
System at St. Joseph’s Hospital in 2002. In addition to treating patients of St. Joseph’s Hospital, St. Joseph’s Children’s Hospital and St.
Joseph’s Women’s Hospital in Tampa, surgeons now can perform robotic surgery at South Florida Baptist Hospital in Plant City.
South Florida Baptist Hospital welcomed a daVinci robot to its surgical suite in late 2011. Now, local patients seeking a robotic procedure
for general surgery, urologic surgery, gynecological surgery or colorectal surgery can be treated close to home at their community hospital.
Specifically, robotic surgeons practicing at South Florida Baptist Hospital offer cholecystectomy for gallbladder disease, as well as colorectal robotic surgery to treat a number of conditions including diverticular disease, colon cancer and stomach cancer. Additional robotic procedures include lower anterior resection, colectomy and gastrectomy for stomach cancer. Robotic esophageal surgery includes a fundoplication
procedure for achalasia, in which the surgeon folds the top part of the stomach and sews it around the muscular valve at the bottom of the
esophagus to treat complaints of stomach acid and reflux.
In addition, patients with prostate cancer, ureteropelvic junction (UPJ) obstruction, bladder cancer, kidney cancer, or vesicoureteral may
be candidates for urologic robotic surgery at South Florida Baptist Hospital. The robot is an effective tool for minimally invasive prostatectomy, pyeloplasty and nephrectomy.
And more good news for women! Patients not wishing to travel to Tampa for gynecological robotic procedures at St. Joseph’s Women’s
Hospital can now receive treatment in Plant City. Whether they need a hysterectomy, hysterectomy with bilateral salpingo-oophorectomy,
endometriosis resection or salpingo-oophorectomy – all are now performed at South Florida Baptist Hospital.
Currently, four physicians can perform robotic surgery at South Florida Baptist Hospital in Plant City. They are Stephen Butler, MD
and Clinton Hall, MD for general and colorectal surgery; Carlos Lamoutte, MD for gynecological surgery; and Jamil Rehman, MD for
urological surgery. 
Dr. P. Phillips Hospital Receives Full Heart Failure Accreditation Status
Dr. P. Phillips Hospital Heart Failure Program has been awarded full Heart Failure Accreditation status from the Society of Cardiovascular Patient Care (SCPC), making it a leader in cardiac care in Central Florida.
Dr. P. Phillips Hospital has been awarded this distinction – the SCPC Heart Failure Cycle I Accreditation – which indicates that Dr. P.
Phillips Hospital meets the highest level of
expertise in heart failure diagnosis and treatment of patients presenting with heart failure
in the emergency department and during
hospital stays. Dr. P. Phillips Hospital demonstrated its expertise and commitment to
quality patient care by meeting or exceeding
a wide set of stringent criteria and undergoing an onsite review by a team of SCPC’s
accreditation review specialists. The efforts
towards full accreditation were led by Joel R.
Garcia, MD, FACC- Heart Failure Program
Director; Ellen Probst, MSN, ARNP, RNBC, NP-C, CHFN – Heart Failure Program
Coordinator for Orlando Health Heart Institute; and the Dr. P. Phillips Hospital Heart
Failure Collaborative Practice Group. The
accreditation process was an Orlando Health
and Orlando Health Heart Institute network
wide collaboration.
Heart failure is a leading cause of morbidity and mortality in the United States.
Approximately five million patients in the
United States have heart failure. In addition,
heart failure patients are responsible for 12
to 15 million physician office visits per year
and 6.5 million hospital days. SCPC’s goal
is to help facilities manage the heart failure
patients more efficiently and improve patient
outcomes. 
24 FLORIDA MD - JANUARY 2013
CURRENT TOPICS
Florida Hospital Awarded as Central Florida’s First and
Only NAPBC Accredited Breast Program
National Accreditation Notes Center of Excellence to Patients Looking for Breast Care
Florida Hospital now offers the first and only breast care program in Central Florida to be granted the American College of Surgeon’s
National Accreditation Program for Breast Centers. This accreditation spans the entire breast care spectrum, including Florida Radiology
Imaging (FRi), Florida Hospital Outpatient Imaging Services and the Florida Hospital Cancer Institute (FHCI). Granted only to programs
that have committed to providing the best in breast care, the accreditation means the program streamlines the process from diagnosis to
treatment for patients. To receive this award, Florida Hospital met all 28 program standards and 17 program components for areas like
imaging, pathology, radiation oncology and many more.
As an accredited program, Florida Hospital Cancer Institute can now participate
in the National Breast Disease Database to
report patterns in care and ultimately effect quality improvement. The program will
also have access to breast center comparison
benchmark reports to compare outcomes to
national norms and standards.
To contact the Florida Hospital Cancer Institute, please call 407-303-5999. To schedule an appointment with Florida Radiology
Imaging, contact 407-303-9887. 
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improvement of the quality of care and the
monitoring of outcomes for patients with
diseases of the breast. The application and
survey process requires NAPBC to monitor
prevention, diagnosis, optimal treatment,
support services and much more, looking for
efficient and contemporary care available for
patients.
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“We are thrilled to have been recognized
for extraordinary service within our breast
care program,” said Dr. David Decker, medical director at the Florida Hospital Cancer
Institute. “There are many questions to be
answered when seeking services, and this accreditation points patients in the direction of
quality care.”
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FLORIDA MD - JANUARY 2013 25
CURRENT TOPICS
In-Office, Minimally Invasive Balloon Sinuplasty Procedure
Offers Sinus Relief for Central Florida Residents
Balloon sinuplasty is one of the newest, least invasive alternatives
to traditional sinus surgery to open blocked sinus passageways and
restore normal sinus drainage; and it’s available now as an in-office
procedure at The Ear, Nose, Throat and Plastic Surgery Associates.
Sinusitis affects more than 37 million people each year, making it one of the most common health problems in the U.S. The
breakthrough FDA-approved balloon sinuplasty procedure utilizes
a small, flexible balloon to open and restructure nasal passageways
which may alleviate sinus headaches, fatigue and congestion for affected individuals. The balloon catheter is gently inserted into the
problem region and inflated, restricting and widening the walls of
the sinus passageway without requiring the removal of bone and
tissue, as was the case with previous sinus surgery techniques.
“By preserving the normal anatomy of the sinuses and mucosal
tissue, we are able to perform the minimally invasive procedure in
our Orlando area offices under local anesthesia in about 45 minutes
in most circumstances,” says Hao “Mimi” Tran, M.D., F.A.C.S., of
The Ear, Nose, Throat and Plastic Surgery Associates. “For patients,
there is less discomfort, a faster recovery time and minimal bleeding involved with the balloon sinuplasty procedure. In fact, some
patients report feeling relief after just several hours following the
procedure.”
According to Acclarent, the official developer of the balloon
sinuplasty procedure, more than 150,000 patients have undergone
the procedure since its inception in 2005. Of those patients who’ve
undergone the procedure, more than 95 percent of them say they
would have it again if needed.
To learn more about balloon sinuplasty and to watch a balloon
sinuplasty patient testimonial for Dr. Tran, visit www.ENTorlando.
com.
About The Ear, Nose, Throat & Plastic
Surgery Associates
Since 1958 The Ear, Nose, Throat & Plastic Surgery Associates,
has combined quality patient care with state-of-the-art innovation.
The office has four locations and 12 physicians available to treat a
myriad of adult and pediatric otolaryngology issues in addition to
providing facial plastic and reconstructive surgery options, hearing
device dispensing, individualized allergy care, voice care and hearing & balance treatment. To learn more, visit www.ENTorlando.
com. 
Regional Medical Center Bayonet Point Awarded an “A”
for Patient Safety by Hospital Safety Score
Hudson, Florida (December 5, 2012) – Regional Medical Center Bayonet Point was honored with an “A” Hospital Safety Score by The
Leapfrog Group, an independent national nonprofit run by employers and other large purchasers of health benefits. The A score was awarded
in the latest update to the Hospital Safety ScoreSM, the A, B, C, D or F scores assigned to U.S. hospitals based on preventable medical errors,
injuries accidents, and infections. The Hospital Safety Score was compiled under the guidance of the nation’s leading experts on patient safety
and is designed to give the public information they can use to protect themselves and their families.
“This ‘A’ rating has a very special meaning for us,” said Shayne George, CEO of Regional Medical Center Bayonet Point. “It is recognition
of our entire staff’s effort to ensure our service area of the safest hospital experience possible. Additionally, this is another objective third party
measurement showing that RMCBP meets the highest industry standards and has again earned the top score awarded by the rating organization,” he added.
“Hospitals like this that earn an A have demonstrated their commitment to their patients and their community,” said Leah Binder, president and CEO of The Leapfrog Group. “I congratulate Regional Medical Center Bayonet Point for its safety excellence, and look forward to
the day when all hospitals will match this standard.”
To see Regional Medical Center Bayonet Point’s scores as they compare nationally and locally, visit the Hospital Safety Score website at
www.hospitalsafetyscore.org, which also provides information on how the public can protect themselves and loved ones during a hospital stay.
People can also check their local hospital’s score on the free mobile app, available at www.hospitalsafetyscore.org.
Calculated under the guidance of The Leapfrog Group’s nine-member Blue Ribbon Expert Panel, the Hospital Safety Score uses 26 measures of publicly available hospital safety data to produce a single score representing a hospital’s overall capacity to keep patients safe from
infections, injuries, and medical and medication errors. The panel includes: John Birkmeyer (University of Michigan), Ashish Jha (Harvard
University), Lucian Leape (Harvard University), Arnold Millstein (Stanford University), Peter Pronovost (Johns Hopkins University), Patrick
Romano (University of California, Davis), Sara Singer (Harvard University), Tim Vogus (Vanderbilt University), and Robert Wachter (University of California, San Francisco).
About The Leapfrog Group
The Leapfrog Group (www.leapfroggroup.org) is a national nonprofit organization using the collective leverage of large purchasers of health
care to initiate breakthrough improvements in the safety, quality, and affordability of health care for Americans. The flagship Leapfrog Hospital Survey allows purchasers to structure their contracts and purchasing to reward the highest performing hospitals. The Leapfrog Group
was founded in November 2000 with support from the Business Roundtable and national funders, and is now independently operated with
support from its purchaser and other members.
Continued on page 27
26 FLORIDA MD - JANUARY 2013
CURRENT TOPICS
About Regional Medical Center Bayonet Point
Regional Medical Center Bayonet has been serving the community since 1981. We are a 290-bed acute care hospital located in Hudson,
FL and home of the nationally acclaimed Heart Institute. We have more than 350 physicians, 900 employees and 500 volunteers on our
integrated healthcare delivery team.
RMCBP has been approved by the Florida Department of Health, Office of Trauma, as a Provisional Level 2 Trauma Center. This designation means critically injured patients may have access to treatment in the “golden hour.” This is the first hour after a serious injury in which
there is the highest likelihood that prompt medical attention will prevent death. Through an affiliation with the University of South Florida
Health, RMCBP has the support of a major academic university and medical school. A Trauma Center in our community means faster treatment to improve patient outcomes and keep patients close to home and their loved ones.
Regional Medical Center Bayonet Point has achieved distinction in the following areas:
• Recipient of the 2012 American Heart Association (AHA)/American Stroke Association’s Get With The Guidelines® Gold Plus Performance Achievement Award in both heart failure and stroke.
• Recipient of the AHA’s Mission: Lifeline Bronze Quality Achievement Award for implementing a higher standard of heart attack care that
improves the survival and outcomes for STEMI (ST Elevation Myocardial Infarction) patients.
• Top Performing Hospital, the Joint Commission - recognized as one of the nation’s top performing hospitals in quality measurements for
heart attack, heart failure, pneumonia, and surgical care.
• Certified Advance Primary Stroke Center - Joint Commission
• Accredited Chest Pain Center, with PCI - Society of Chest Pain Centers for Cycle I, II and III
• Heart & Stroke Champions Award Winner 1998 – 2011
• MRI, CT, Ultrasound, and Nuclear Medicine Accredited - American College of Radiology
• Approved, with Commendation, Community Cancer Program - American College of Surgeons.
• 10 Joint Commission Disease-Specific Certifications: primary stroke center, acute myocardial infarction, chronic obstructive pulmonary
disease (COPD), coronary artery bypass graft, heart failure, joint replacement hip, joint replacement knee, lung cancer, pneumonia,
wound care!
Regional Medical Center Bayonet Point is located at14000 Fivay Road, Hudson, FL. 34667. For additional information on Regional Medical Center Bayonet Point visit RMCHealth.com or HeartofTampa.com. Or visit us on Facebook. 
Nemours Children’s
Hospital Awarded
Accreditation from
the Joint Commission
Nemours Children’s Hospital has earned
The Joint Commission’s Gold Seal of Approval® for accreditation by demonstrating
compliance with their national standards for
health care quality and safety in hospitals.
The accreditation award recognizes Nemours
Children’s Hospital’s dedication to continuous compliance with The Joint Commission’s
state-of-the-art standards.
Nemours Children’s Hospital underwent
a rigorous unannounced on-site survey on
Nov. 19 and 20. During the two-day survey,
a team of Joint Commission experts evaluated Nemours for compliance with standards
of care specific to the needs of patients, including infection prevention and control,
leadership and medication management.
“In achieving Joint Commission accreditation, Nemours Children’s Hospital has demonstrated its commitment to the highest level
of care for its patients,” says Mark Pelletier,
R.N., M.S., executive director, Hospital ProContinued on page 28
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FLORIDA MD - JANUARY 2013 27
CURRENT TOPICS
grams, Accreditation and Certification Services, The Joint Commission. “Accreditation is a voluntary process and I commend Nemours Children’s Hospital for successfully undertaking this challenge to elevate its standard of care and instill confidence in the community it serves.”
“It took the efforts of hundreds of people over many years to get us to this day,” said Roger Oxendale, CEO of Nemours Children’s Hospital. “In addition to our team in Central Florida who performed so well during the survey, I would like to offer our sincere thanks to the
many Nemours Associates – in both Florida and the Delaware Valley - who have shared their time, talents and expertise so generously with
us. That collaborative effort is the reason we are able to celebrate this incredible accomplishment.”
The Joint Commission’s hospital standards address important functions relating to the care of patients and the management of hospitals.
The standards are developed in consultation with health care experts, providers, measurement experts and patients.
About The Joint Commission
Founded in 1951, The Joint Commission seeks to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.
The Joint Commission evaluates and accredits more than 19,000 health care organizations and programs in the United States, including
jewett-florida-md_Layout 1 11/30/12 3:55 PM Page 1
more than 10,300 hospitals and home care organizations, and more than 6,500 other health care organizations that provide long term care,
behavioral health care, laboratory and ambulatory care services. The Joint Commission
currently certifies more than 2,000 diseasespecific care programs, focused on the care of
patients with chronic illnesses such as stroke,
joint replacement, stroke rehabilitation, heart
failure and many others. The Joint Commission also provides health care staffing services
certification for more than 750 staffing offices.
An independent, not-for-profit organization,
The Joint Commission is the nation’s oldest
and largest standards-setting and accrediting
body in health care. Learn more about The
Joint Commission at www.jointcommission.
org. 
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Florida MD 2013 Editorial
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St. Joseph’s Hospital
Robotics . . . . . . . . . . . . Back Cover
Tom Winters, MD. . . . . . . . . . . . . 24
2013
EDITORIAL
CALENDAR
Florida MD is a four-color monthly
medical/business magazine for physicians in
the Central Florida market.
Florida MD goes to physicians at their offices, in the
thirteen-county area of Orange, Seminole, Volusia,
Osceola, Polk, Flagler, Lake, Marion, Sumter, Hardee,
Highlands, Hillsborough and Pasco counties. Cover
stories spotlight extraordinary physicians affiliated
with local clinics and hospitals. Special feature stories
focus on new hospital programs or facilities, and other
professional and healthcare related business topics.
Local physician specialists and other professionals,
affiliated with local businesses and organizations, write
all other columns or articles about their respective
specialty or profession. This local informative and
interesting format is the main reason physicians take
the time to read Florida MD.
It is hard to be aware of everything happening in the
rapidly changing medical profession and doctors want
to know more about new medical developments and
technology, procedures, techniques, case studies,
research, etc. in the different specialties. Especially
when the information comes from a local physician
specialist who they can call and discuss the column with
or refer a patient. They also want to read about wealth
management, financial issues, healthcare law, insurance
issues and real estate opportunities. Again, they prefer
it when that information comes from a local professional
they can call and do business with. All advertisers have
the opportunity to have a column or article related to
their specialty or profession.
JANUARY –
Digestive Disorders
Diabetes
FEBRUARY –
Cardiology
Heart Disease & Stroke
MARCH –
Orthopaedics
Men’s Health
APRIL –
Surgery
Scoliosis
MAY –
Women’s Health
Advances in Cosmetic Surgery
JUNE –
Allergies
Sleep Disorders
JULY –
Imaging Technologies
Interventional Radiology
AUGUST –
Sports Medicine
Robotic Surgery
SEPTEMBER – Pediatrics & Advances in NICU’s
Autism
OCTOBER –
Cancer
Dermatology
NOVEMBER – Urology
Geriatric Medicine / Glaucoma
DECEMBER – Pain Management
Occupational Therapy
Please call 407.417.7400 for additional materials or information.
“Within 48 hours I was
back to my old self ...
Better actually.”
Nora M., a real patient of St. Joseph’s Hospitals
Discover Robotic Surgery
Many patients like Nora are discovering the positive outcomes of robotic
surgery. They trust the Advanced Center for Robotic Surgery at St. Joseph’s
Hospital, to deliver their care. The highly trained robotic surgeons bring
expertise to general surgery as well as specialties including colorectal,
gynecology, gynecologic oncology, urology and pediatric urology.
St. Joseph’s continues to blaze a trail by providing unique robotic services
including:
To refer a patient or to learn more,
contact the program coordinator:
����� �������� or
StJosephsRobotic.org
rSingle site cholecystectomy
rRobotic-assisted urologic procedures for children including pediatric
pyeloplasty, nephrectomy and advanced reconstructive procedures
rColorectal procedures performed by a colorectal surgeon
r40 different procedures offered by 20 surgeons
For additional information about the surgeons and procedures offered by
the Advanced Center for Robotic Surgery, visit StJosephsRobotic.org.
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