Florida Health News - March 2009 issue

No. 3 • March • 2009 www.floridahealthnews-online.comSERVING BROWARD, PALM BEACH COUNTIES AND SURROUNDING AREAS

Heartburn and refluxPage 3

Grand Opening of IndependentImaging, LLC and AdvancedDiagnostic Solutions Page 5

FREEFREE TAKE ONE

President Barack Obama is joined by White House Domestic Advisor Melody Barnes and firefighter TravisUlerick of Dublin, Ind., as he addresses the White House Forum on Health Reform, in the East Room at theWhite House.

The Obama Impact on Health Care

Chronic heartburn can leadto serious complications

Chronic Cough

ImmunizationGuidelines for adultpatients: Latest annualupdate

Grand OpeningCelebrationAt Palomino ParkMedical Center

Disney On Ice:Worlds of Fantasy

Also in this issue

FACTS8,000,000 Americans with type 2.Diabetes have not reached the bloodsugar level target. (By ADA, AmericanDiabetic Association).

13,000,000 diabetic people in theUSA are overweight.

Colonoscopy was strongly associatedwith fewer deaths from left sidedcolorectal cancer. Colorectal cancer isthe second most common cause ofcancer death in North America.

People increasingly use the internetfor health information and services,including the convenient purchaseand delivery of prescription drugs.Unregulated internet healthinformation and self indication viavogue internet pharmacies could bedangerous to one’s health.

Patients with diabetes should geteducation about proper foot care andregularly inspect their foot.

What is cellulitis?Cellulitis is an infection of the skinand underlying tissues. It may followa break in the skin or a surgicalwoung but may also occur whitout anobvious break in the skin.

Risk factors for cellulitis /infection of skinTrauma - lacerations, burns,abrasions, open fractures

Intravenous drug use

Animal / human bites

Predisposing conditions, that isdiabetes mellitus, peripheral arterydisease, chronic veinous,insufficiency, swelling (edema),cirrhosis of the liver.

Previous history of cellulitis

FLORIDAHEALTHNEWS-ONLINE.COM2 MARCH • 2009

Immunization Guidelines for adultpatients: Latest annual update

The full texts of the recommenda-tions for each vaccine areavailable at www.cdc.gov/vac-cines/pubs/ACIP-list.htm and thefull Adult Immunizations Scheduleis available atwww.cdc.gov/nip/recs/adult-schedule.htm. New changes arediscussed below.

Herpes ZosterNew language states that a previous episodeof shingles is not a contraindications tozoster vaccination. We lack good evidenceabout the interval between the last episodeof shingles and immunization. Most expertsrecommend at least a 12-month interval.

Human PapillomavirusOccupational exposure does not increasehealth worker’s risk for human papillo-mavirus. They should receive vaccine onlyfor a standard indication.

Pneumococcal polysaccharidevaccineThe recommendations for use of this vac-cine have undergone many versions, in-cluding the following.

AsthmaThe pneumococal polysaccharide vaccine(PPV23) is recommended for all personsage 65 years or older, as well as for youngerpersons who have certain underlying me-dical conditions. There has been uncertaintyabout whether to vaccinate patients 19 to 65years of age who have asthma (particularybecause asthma is an indication for in-fluenza vaccine). The answer now is yes.The most compelling rationale is a recentnested case-control study demonstrating thatadults with asthma experienced a signifi-cantly increased risk for invasive pneumo-coccal infection (such as bacteremia) thandid adults of similar age without asthma.

The result suggest that asthma is an inde-pendent risk factor for serious pneumococ-cal infection.Approximately 16 million adults in theUnited States have asthma. Notably, mostasthmatic adults who develop invasivepneumococcal disease already have anothercondition for which PPV23 is recom-mended–but they often do not receive it.Making asthma an indication for pneumo-coccal vaccination wil resolve previous am-biguity.

SmokersThe new guidelines also address cigarretesmoking as an indication for pneumococcalvaccination. Population based surveillancestudies consistently report that approxi-mately half of otherwise healthy adultsyounger than 65 years of age who developinvasive pneumococcal disease are smo-kers. The intensity of smoking (number ofcigarettes smoked daily) and cumulativesmoking exposure (pack-years of smoking)both progressively increase the risk for in-vasive pneumococcal disease.

Quitting smoking reduces the risk for pneu-mococcal infection. The longer the absti-nence, the less the risk for invasive pneu-mococcal infecion. Thus, smoking seems tobe a strong independent risk factor in im-munocompetent adults. Although manysmokers have other risk factors that makethem eligible for PPV23, smoking status iseasy to indentify as an indication for vac-cine, and current smokers should be vacci-nated with PPV23. About one fifth of theU.S. adult population smokes cigarettes, sophysicians face a considerable challengeto provide them with protection against in-vasive pneumococcal infection.

Influenza vaccineCurrently, about 83% of the U.S. popula-tion is eligible for annual influenza immu-nization. Several new recommendationswill increase the number of people who areeligible.

ChildrenThe new recommendation is to vaccinateall children age 5 years through 18 years.This recommendation will be of particu-lar interest to internists who care for ado-lescents.

CaregiversAnother new recommendation is to vac-cinate all persons who live with or pro-vide care to persons who are at increasedrisk for influenza-related complications.the rationale is to reduce transmission ofinfluenza virus from the family memberor caregiver to the high-risk individual.Among the caregivers who should bevaccinated are health care workers. Atlast count, only 42% of health care pro-fessionals acknowledged having receivedinfluenza vaccine. The traditional “vacci-nation season”, wich extends from lateSeptember through Thanksgiving. Be-cause influenza infections peak mostcommonly in February, it is appropiate toextend the “vaccination season”, into De-cember and January and even beyond).

The challenge of AdultImmunizationThe delivery of vaccines to patients atrisk is not only part of both patient safetyand quality of care, but it is also the stan-dard of clinical care. The Adult Immu-nization initiative Physician AdvisoryBoard to theAmerican College of Physi-cians and the Infectous Diseases Societyof America have released a joint state-ment on the importance of adult immu-nization. The statement has been en-dorsed by 17 other medical societiesrepresenting various practice areas, in-cluding many subspecialties of internalmedicine. The statement proposes severalstandards: All phisicians should periodi-cally conduct an immunization reviewwith their adult patients. Its purpose is toeducate patients about the benefits of vac-cination status is concordant with reco-mmended practice.

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CCOONNTTRRIIBBUUTTIINNGG AARRTTIICCLLEESSU.S. Department of Health and Human Services,Contexto Latino, ARA Content, Hispanic PR Wire, Centers for Disease Control and Prevention,METRO Editorial Services, Family Features,

Florida Health News is a newspaper published every monthin Broward, Palm Beach, and surrounding areas. Copyright2009, all rights reserved by SEA Publications, Inc. Contentsmay not be reproduced in any form without the writtenconsent of the publisher. The publisher reserves the right torefuse advertising. The publisher accepts not responsibilityfor advertisement error beyond the cost of the portion of theadvertisement occupied by the error within theadvertisement itself. The publisher accepts no resposibilityfor submitted materials. All submitted materials are subjectto editing.

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“He's shown real leadership”, Senator Joe Liebermantold The Associated Press in an interview. "Bottom line:I think Barack Obama, president of the United States, is off to a very good start”. Billionaire Warren Bufferr,

whose Berkshire Hathaway Inc. posted its worst results ever in 2008, said the economy “has fallen off a cliff” and thatefforts to stimulate recovery may lead to inflation higher thanthe 1970s.There is division among the Democrats about the omnibusspending Bill. Appears that the world has gone topsy turvy.Everything is the opposite of what was projected and predicted.President Obama came into office with many promises, offeringhope and change to the beleaguered voters. Based on his wordand predictions, he won the popular vote. However, we have totake a wait and see attitude.Granted that President Obama came into office at a time whenthe economy was crumbling, the war in Iraq depleted ourTreasury of billions. We have national debt in trillions of dollars- yet the President Approval ratings are still high enough tosupport his plans. Every American is hoping that he or she willbe rescued out of their financial predicament. No doubt PresidentObama has the good of the nation as his first priority- but wehave to weigh all his actions, and plans to see how they reallycome into play.The rescuing of the banks, AIG and other companies, appears tobe a money pit- the more money they throw into it the more it

wants. Almost like feeding a beast with an unlimited appetite.As some scholars write- it may be better to let some banks andinstitutions fail, regroup and get back up in a newtransformative manner.Money should instead be leveraged into resolving problems.The crumbling infrastructure of our highways and bridgesneed added attention. Infusing money into universities andhigher centers of learning is necessary so that the cost ofeducation goes down, and more young people can affordcollege education.The housing market has tumbled and is being rescued-however this is causing tremendous resentment among thosewho have planned their budgets and spending so that theywould be in over their heads- the rescue has to be planned anddirected at homeowners who were genuinely misled by thegreedy banks and mortgage companies. This will take a lot ofwork- but is well worth the investment.As for healthcare- giant reforms are being planned. The ideaand vision is good, but a lot must be put into place before thismust happen. Medicare may have to be overhauled - allaspects must be reviewed to excise fraud, and over charging.Medical costs can come down if doctors did not have to paysuch high costs for malpractice, and if insurance companieswould be rational with their pay outs for claims.There is a lot on the President’s plate- let’s hope that thecountry does not get indigestion instead.

The Obama Impact on Health CareBy Lauren Armstrong

FLORIDAHEALTHNEWS-ONLINE.COM MARCH • 2009 3

About 15 million Americansexperience heartburn every day. Itoccurs when muscles in the lowerend of the esophagus abnormallyweaken or relax.

This allows stomach acid to backup and cause:• A burning sensation behind the breastbone• A sour taste in the mouth• The sensation of food re-entering themouth

Chronic heartburn can lead toserious complicationsLeft untreated, chronic heartburn can resultin gastroesophageal reflux disease (GERD).In addition to heartburn, GERD causes chestpain, difficulty swallowing, coughing, ane-mia, ulcers and regurgitation of food or sourliquid. Over a period of years, GERD canlead to Barrett’s esophagus, a condition thatincreases the risk of esophageal cancer.

Complications of refluxIn some people, acid in the lower esophagusactually causes tissue damage. Certain com-plications can then result:• Chronic bleeding and anemia.• Scar information and narrowing of thelower esophagus. This is called a stricture.It usually is treated by dilatation, a proce-dure to widen the area.

• Barret’s esophagus can occur when refluxirritates the lower esophagus over a longperiod of time. The stomach lining thenactually grows into the esophagus. In thesecases, there is a slight, but definite, risk ocancer developing.

• Lung problems can develop when reflux

results in stomach fluid tricklin into thebreathing tubes. It often occurs at night whena patient is lying down. This causes wheez-ing, bronchitis, and even pneumonia.

Treatment of refluxThere are general measures the patient cantake to reduce reflux:• Eat smaller and more frequent meals.• Do not lie down immediately after eating,and avoid eating for several hours beforegoing to bed.• Excessive bending, lifting abdominal ex-cersises, girdles, and tight belts all increaseabdominal pressure and provoke reflux.

• If overweight, lose weight. Being over-weight promotes reflux.

• Stop using all tobacco; nicotine weakensthe LES.

• Avoid fatty foods, alcohol, coffee, choco-late, and peppermint.

• Elevate the head of the bed 8” to 10” sogravity keeps stomach juices out of theesophagus while the patient sleeps. Extrapillows, by themselves, are usually nothelpful.

• Certain prescription or over the countermedications can weaken the LES or aggra-vate reflux. Review all medications youare taking with the physician.

Treatments tailored to you specialneedsIf needed, we’ll identify when your heart-burn occurs and how much acid is involvedthrough a test known as pH monitoring.The test checks the acid levels in youresophagus over 24 hours or longer, It isbased on a disposable pH capsule that trans-mits data from your esophagus to a small re-ceiver worn on your belt. Using this infor-mation, we’ll design a personalizedtreatment plan just for you.

Defeat GERD with endo-suturingAlthough hearthburn and GERD are oftentreated with long-term medications or sur-geries, we offer a simpler solution known asendo-suturing. During this painless oupa-tient procedure, we’ll tighten your loweresophagus to prevent acid from flowing outof the stomach and into the esophagus. Theprocedure requires only local anesthesia,and most people return to normal activitiesthe next day… without needing to continuetaking heartburn medications. As pioneersin this area, we have performed more than1,000 of these procedures, letting people

who were once troubled with GERD enjoythe pleasures of a good meal.

Get the expert compassionate careyou deserveThe board-certified gastroenterologists atPalm Beach Gastroenterology Consultantshave the training, experience and resourcesto diagnose and treat heartburn, GERD andother digestive disordes. And we do it allfrom one central location. Our in-house endoscopy center is staffedby nurses, anesthesiologists and other care-givers and equipped with the latest medicaltechnology. We also offer advanced proce-dures not available at other area practices,and we’re dedicated to uncovering and co-rrecting the underlying cause of your heart-burn, not just treating the symptoms.

Don’t let chronic heartburn undermine yourhealth and lifestyle. Call (561) 795-3330today to schedule a convenient appointment.

Heartburn and reflux

Krishna Tripuraneni, M.D., MBA

Krishna Tripuraneni, M.D., M.B.A.Thomas J. Flannery, M.D., M.B.A.

Maria Valdes, M.D.

1157 South Rd. 7-US 441Wellington, FL 33414Phone: (561) 795-3330Fax: (561) 795-1030

1200 S. Main Street, Suite 102Belle Glade, FL 33430Phone: (561) 996-5600

Fax: (561) 996-6498www.gi-trip.com

PALM BEACH PRIMARY CARE ASSOCIATES, INC.

FLORIDAHEALTHNEWS-ONLINE.COMHEALTH4 MARCH • 2009

Chronic CoughOne can have chronic coughdue to various reasons.Chronic cough due to chronicbronchitis is defined ascough for at least threeconsecutive months in a yearfor three years.

Chronic bronchitis can becaused by cigarettesmoking and alsooccupaciontal exposure

to chemicals, fumes and sometimessecond hand cigarette smoke.

I have seen patients in my practicewho have had chronic cough andwere diagnosed to have chronic

bronchitis, but in few instances Ihave found that these patientsactually have chronic post nasaldrip which was the prime cause oftheir malady, in some instances, Ihave seen chronic cough caused byreflux of acid from the stomach oreven food contents aspirate into thelungs causing sleepless nights, inother words known as insomnia.These conditions can be easilyhandled in an effective manner, ifdiagnosed by a cognizantphysician.Some antihypertensive medicinescan cause cough: Treatments forchronic cough could be varieddepending on the etiologicalfactors.

Last but not least, I have toreiterate that chronic cough, if leftuntreated, can be quite disablingand people must be aware that inmost instances chronic cough canbe either contained or treated.Dr. Sharma is Board Certified inInternal Medicine and has beenpracticing in the WesternCommunities for the past 19 years.

His offices are located inWellington at 3347 State Road 7,Suite 200, Wellington, FL 33449 •Tel: (561) 795-9087 • Fax: (561)753-8730. In Belle Glade at 425SE 2nd Street, Belle Glade, FL 33430 • Tel: (561) 996-7742 • Fax: (561) 753-8730

Shekar V. Sharma M.D.Board Certified in Internal Medicine

3347 State Road 7 Suite 200 Wellington, FL 33449Tel: (561) 795-9087 • Fax: (561) 753-8730

425 SE 2nd Street, Belle Glade, FL 33430Tel: (561) 996-7742 • Fax: (561) 753-8730

State of the Art Office Building with Imaging Center,

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FLORIDAHEALTHNEWS-ONLINE.COM MARCH • 2009 5

GET BACK ON YOUR FEET!LA PODIATRY GROUP, LLC

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Independent Imaging, LLC andAdvanced Diagnostic Solutionsannounced the Grand Opening oftheir state of the art facilitylocated at The PalominoProfessional Park at 3347 StateRoad 7 – Suite #100 in Wellington,Florida with a Grand OpeningCelebration at the facility.

The facility offers a wide array ofdiagnostic testing with the mostadvanced equipment in the in-dustry. The new GE Signa EX-

CITE 11.0 MRI Scanner operates at ahigher field strength allowing clearermore detailed scans which improves infor-mation used by physicians for diagnosis.Not only does this technology improveclinical productivity and image quality, ithas unprecedented scanning speed. In anMRA study of the brain, scanning timewas reduced by 50%. It also offers dedi-cated applications for Breast MRI’s andFunctional MRI’s.The Aquillion 64 Slice CT Scanner offers

the most advanced multislice technologieson the market. It produces high speed, highresolution imaging with the best low con-trast resolution at the lowest dose. It is de-signed to improve patient comfort andsafety while offering uncompromised per-formance. In addition, it features specialcapabilities for cardiac coronary scans, vir-tual colonoscopy, and 3D reconstruction.One of the most exciting areas of this ad-vanced facility is The Women’s Center atIndependent Imaging/Advanced DiagnosticSolutions. It offers women the latest in Di-gital Mammography, DEXA Bone Density,Breast MRI, Breast Biopsy and ObstetricUltrasound in a comfortable, qualified, tran-quil setting.The center also offers physicians and pa-tients Digital XRay, Nuclear Medicine, Car-diac Stress Tests, MRA and Ultrasound.The premiere radiologists at this facilityare Dr. Jonathan S. Huber, Dr. Eric M.Baumel, Dr. Thomas M. Kirchner, Dr. EricS. Grimm, Dr. Adam S. Mandel, Dr. KyleR. Gormezano, and Dr. Scott D.Ruehrmund.For further information on this facility, pleasecontact Independent Imaging/Advanced Diagnostic Solutions at 561.795.5558.

Grand Opening of Independent Imaging, LLCand Advanced Diagnostic Solutions

DEXA Bone Density examination.

The Aquillion 64 Slice CT Scanner.

Independent Imaging/Advanced Diagnostic Solutionsare proud to announce the Grand Opening of our State of the Art Diagnostic Center at 3347 State Road 7 in Wellington, Florida.

• High Field MRI• 64 Slice CT Scans• Digital XRay• Nuclear Medicine• Cardiac Stress Tests• MRA• Ultrasound

...and announcing "The Women's Center at IndependentImaging/Advanced Diagnostic Solutions" offering DigitalMammography,DEXA Bone Density, Breast MRI, andObstetric and Breast Ultrasound in a private and relaxedsetting...

Please call 561.795.5558 to schedule an appointment or speak to one of our associates

Secreening Guidelines for theEarly Detection of Prostate CancerThe prostate-specific antigen(PSA) test and the digital rectalexamination (DRE) should beoffered annually, beginning at age50, to men who have a lifeexpectancy of at least 10 years.

Men at high risk (African-American men and men witha strong familiy history of oneor more first-degree relatives

diagnosed with prostate cancer at an earlyage) should begin testing at ate 45.

For men at average risk and high risk, infor-mation should be provided about what isknown and what is uncertain about the bene-fits and limiations of early detection andtreatment of prostate cancer so that they canmake an informed decision about testing.

• Yearly mammograms are recommendstarting at age 40.

• A clinical breast exam should be part of aperiodic health exam, about every threeyears for women in their 20s and 30s, andevery year for women 40 and older.

• Women should know how their breastsnormally feel and report any breast changespromptly to their health care providers.Breast self-exam is an option for womenstarting in their 20s.

• Women at increased risk (e.g., family his-tory, genetic tendency, past breast cancer)should talk with their doctors about the be-

nefits and limitations of starting mammo-graphy screening earleir, having additionaltests (i.e., breast ultrasound and MRI), orhaving more frequent exams.

Beginning at 50, men and women shouldfollow one of the following examinationschedules:

• A fecal occult blood test (FOBT) everyyear

• A flexible sigmoidoscopy (FSIG) everyfive years.

• Annual fecal occult blood test and flexiblesigmoidoscopu every five years*

• A double-contrast barium enema everyfive years

• A colonoscopy ever ten years

* Combined testing is preferred over eitherannual FOBT of FISG every 5 years alone.

People who are at moderade or high risk forcolorectal cancer should talk with a doctorabout a different testing schedule

By Staci Martin, contributing writer.

FLORIDAHEALTHNEWS-ONLINE.COM6 MARCH • 2009 &

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Grand Opening CelebrationAt Palomino Park Medical Center

FLORIDAHEALTHNEWS-ONLINE.COM MARCH • 2009 7&

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