1. society
2. welfare
3. healthcare
4. hospital

JUNE 2010 • CENTRAL FLORIDA EDITION
Walt Disney Pavilion
at Florida Hospital for Children
Creates the Future in Pediatric Care
with New Leading-Edge, TechnologicallyAdvanced Facilities, Specialty Care and
Innovative Family-Centered Culture
Introducing Dr. Mark Roh and the new Liver Center at M. D. Anderson — Orlando.
The diagnosis of liver cancer can be
devastating news. Time is of the essence
and patients want treatment to begin as
soon as possible. Under the guidance of
Mark Roh, MD, internationally renowned
liver cancer surgeon, the new Liver Center
at M. D. Anderson Cancer Center Orlando
was established to care for patients with
all types of liver cancer. Patients are seen
promptly and a single day evaluation
incorporates resources for the education,
diagnosis and treatment of liver cancer.
Our experienced team of physicians offers
a variety of multidisciplinary treatment
options and strives to offer hope in a
realistic and compassionate manner.
Dr. Roh has
specialized in
treating patients
with liver tumors
for 23 years and
was the former
Chief of Liver
Tumor Surgery at
M. D. Anderson
Cancer Center in
Houston, Texas.
He is certified by the American Board of
Surgery and has been recognized annually as
one of the Best Doctors in America since 1992.
According to Dr. Roh, liver cancer was once
considered a death sentence to individuals
who had the misfortune of being diagnosed
with the disease. This challenge motivated
him to specialize in treating patients with
liver disease. “Liver cancer is more common
than we think,” says Dr. Roh. “Sixty percent
of patients diagnosed with colon cancer will
develop metastatic cancer in their liver.
More patients are developing primary liver
cancer due to the increased incidence of
Hepatitis C and alcoholism.” Dr. Roh points out,
however, that because of early diagnosis and
new treatment options, the cure rate for liver
cancer is also increasing.
The Liver Center’s experienced team of physicians
strives to offer hope and total patient care in a
compassionate manner. The center offers a variety of
multidisciplinary treatment options and diagnostic
services, including:
Multimodality Diagnostic Services
• Fine needle cytopathology
• State of the Art Magnetic Resonance Imaging
with liver-specific contrast
• Triphasic Computerized Axial Tomography and
3D Reconstruction
• Nuclear Medicine functional scanning
Multidisciplinary Treatment Options
• Brachytherapy
• Chemoembolization
• Cytotoxic Chemotherapy
• Hepatic Resection
• Intraarterial Chemotherapy
• Laparoscopic Liver Resection
• Microwave Ablation
• Molecular Targeted Chemotherapy
• Percutaneous Ethanol Treatments
• Psychological Counseling
• Radiofrequency Ablation
• Selective Internal Radiation Therapy
• Stereotactic Body Radiotherapy
In addition to receiving the finest medical care,
our patients also have access to nutritionists,
support groups, social workers, genetic counseling,
educational seminars, a comprehensive medical
library and Mind/Body/Spirit programs.
Patient referrals are an easy process at M. D.
Anderson – Orlando. Patients who have the
following diagnosis should be referred to the
Liver Center:
-Newly discovered liver mass without
a histological diagnosis
-Metastatic cancer to the liver with a primary site
in the colon, rectum, breast, pancreas, stomach,
kidney or lung
-Recurrence of metastatic cancer to the liver
-Hepatocellular carcinoma
-Liver Cysts
-Gallbladder carcinoma
-Bile Duct carcinoma
-Second opinion on treatment options
To refer a patient or schedule an appointment,
please call the Liver Center at 321.841.7797.
To learn more about the Liver Center,
visit mdacco.com/livercenter or email
[email protected].
Clinical Trials
• Unresectable Liver Cancer
• Neoadjuvant and Adjuvant Therapies
for Resectable Liver Cancer
Palliative Care
• Treatment Morbidities
• Pain Management
• End of Life Care
• Creating Treatment Strategies to be administered
by Referring Physicians
1400 S. Orange Ave., 2nd Floor • Orlando, FL 32806
321.841.7797 • mdacco.com
10ORM014
contents
JUNE 2010
CENTRAL FLORIDA EDITION
Photographer: Spencer Freeman / Florida Hospital
4
COVER STORY
The Walt Disney Pavilion at Florida Hospital for Children is committed to providing
extraordinary care to young patients, while easing the stress associated with a hospital stay.
Each floor holds a unique theme to help decrease anxiety and help promote healing. With a
devoted team of over 70 pediatric specialists, patients will receive compassionate and expert
care throughout their stay. From the Disney® themed lobby to the state-of-the-art facilities,
Florida Hospital for Children has taken compassion and clinical care to new heights.
Photographer: Spencer Freeman / Florida Hospital
11 LIABILITY CONCERN:
SCHOOL AND SPORT
PHYSICALS
21 CHOOSING A MALPRACTICE
INSURANCE COMPANY
THAT WILL VIGOROUSLY
DEFEND YOU
22 TREATMENT OF THE CHILD
WITH ALLERGIES
25 CURRENT TOPICS
DEPARTMENTS
2 FROM THE PUBLISHER
3 FOR YOUR ENTERTAINMENT
9 PHARMACY UPDATE
13 USING NUTRACEUTICALS
15 MARKETING YOUR PRACTICE
17 WEALTH MANAGEMENT
18 EXECUTIVE BENEFITS FOR PROFESSIONALS
19 ORTHOPAEDIC UPDATE
FLORIDA MD MAGAZINE - JUNE 2010
1
FROM THE PUBLISHER
I
am pleased
pleasedtotobring
bring
another
of Florida
MD magazine.
Iam
youyou
another
issue issue
of Florida
MD Magazine.
It’s hard toWhen
imag- I was
a boy,
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outside
and get
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workmy
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may she rest in peace. I guess that boy still lives on inside the man because
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nextlikes to
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like to do.toIfcreate
there’s
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you tooupthat
month is the annual March for Babies. It’s a wonderful team-building opportunity for
play hard and doesn’t mind getting a little messy, there’s an incredibly fun event
coming
up that
youyour
should
It’smarch
calledorMud
and
benefits
tions
on how
you and
familyconsider.
can join the
how toVolleyball
form a team
for ityour
the March
of Dimes.
could
be there.
better? Form a team with your friends, your
whole
practice.
I hope toWhat
see some
of you
family or your co-workers and come out August 21st for some down and dirty
Warm
regards,
fun and
good times for a great cause. For your convenience, there is a form for
you to fill out on the inside back cover. I hope to see some of you there.
Best regards,
Donald
B. Rauhofer
Publisher/Seminar Coordinator
When
Join more than a million people walking in March of Dimes, March for Babies and
Donald
B.
Rauhofer
Saturday, April 24th
raising money to help give every baby a healthy start! Invite your family and friends
7am Registration 8am Walk
to
join you in March for Babies, or even form a Family Team. You can also join with
Publisher
your practice and become a team captain. Together you’ll raise more money and share
Where
a meaningful experience.
Lake Lily
Park, Maitland
For more information on Mud Volleyball or the March of Dimes
please
call:
Steps for New Users:
1. Go to marchforbabies.org
2. Click JOIN A TEAM
3. Search for your team name in the
search box.
4. Click on your team name
5.
Some keys
to success:
your friends,
Phone:
(407)Ask
599-5077
family and
colleagues
to
support
you by
Fax: (407) 599-5870
Central Florida Division
341
N.
Maitland
reason why
people do Avenue,
not donateSuite
is that115
Maitland,
FL (don’t
32751
no one asked
them to give
be shy)!
Emailing them is an easy way to ask.
For more information on March
for Babies please call:
Phone: (407) 599-5077
Fax: (407) 599-5870
Central Florida Division
341 N. Maitland Avenue, Suite 115
Maitland, FL 32751
Check out the new Classifieds Section at www.floridamdmagazine.com!
password for future reference.
You’re done! Your personal page has been
created for you and you are ready to begin
fundraising!
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/ Florida
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MD Magazine
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Thompson, Vincenzo Giuliano, MD, David S.
Vincenzo Giuliano, M.D., D.A.B.R., Abraham
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FOR YOUR ENTERTAINMENT
The Sounds of Summer Series ~
A Ray of Musical Sunshine
The Orlando Philharmonic Orchestra presents the first, second and third concerts in its acclaimed Sounds of Summer Series during June
and July. This popular chamber music series highlights the musicians of the Philharmonic in five diverse and highly entertaining programs.
Don’t miss this series that has won the hearts of Central Floridians year after year … it’s the perfect way to spend a summer evening!
The 2010 Sounds of Summer Series
All concerts presented Mondays at 7:00 PM
Vienna Roast
June 28
Christopher Wilkins, conductor
Sir Tamas Kocsis, violin
Maestro Christopher Wilkins conducts the opening concert on the
series with a salute to the music of wine bars, cafes and coffeehouses
of nineteenth century Vienna and Budapest. Concertmster Tamas
Kocsis captures the flavor of the gypsy violin tradition on this
entertaining program.
Music includes:
Schubert: Octet; Johann Strauss, Jr.: Emperor Waltz; Kreisler:
Liebesleid and Liebesfreud; and Franz Lehar: Hungarian Fantasy
Sovereign Brass: The Creature from the Brass
Lagoon
July 12
Sovereign Brass is back with a program of fiendish fun for your
summer entertainment! The Sovereign Brass breathes fresh life into
the otherwise serious world of brass and chamber music. These six
virtuoso performers have established a reputation for leaving their
audiences both charmed and amazed.
The Sounds of Summer Series takes place in the Margeson Theater
in the Lowndes Shakespeare Center, 812 E. Rollins Street,
Orlando. All Sounds of Summer Series concerts are presented on
Mondays at 7:00 PM. Subscriptions to this five-concert series are
available in three price levels: Level 1 seating is $160 for adults,
$144 for seniors and $80 for students with valid ID. Level 2
seating is $105 for adults, $94.50 for seniors and $52.50 for
students with valid ID. Level 3 seating is $70 for adults, seniors
and students. Single tickets go on sale Monday, May 24, 2010.
Single ticket prices are: Level 1 seating: $37 for adults, $33 for
seniors and $18.50 for students with valid ID; Level 2 seating:
$26 for adults, $23 for seniors and $13 for students with valid
ID; Level 3 seating: $14 for adults, seniors and students. To
purchase subscriptions or for more information, call the Orlando
Philharmonic Orchestra Box Office at 407-770-0071, or visit the
website at www.OrlandoPhil.org. 
Announcing Michael W. Steppie, MD
as our NEW President and Medical Director
Michael W. Steppie, MD
Medical Director
President
The Strings of Passion
July 26
The Orlando Bolshoi Violin Ensemble presents a program of
beautiful and elegant music to enchant you. In the tradition of the
famous Moscow ensemble, this all-female group of eight violinists
performs music that will leave you smiling.
Tamas and Family
August 9
Concertmaster Tamas Kocsis gathers his talented musical family
for an evening of fabulous music.
YOUR SKIN CANCER
& SKIN CARE SPECIALISTS
American Academy of Dermatology states:
1 in 5 Americans will develop skin cancer
during their lifetime.
William A. Steele, MD
Founder
Visit our office for a FREE Skin Cancer Screening
(times vary by location)
LOCATIONS: Kissimmee, Davenport, St. Cloud, Celebration, Clermont,
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Michael W. Steppie, MD • William A. Steele, MD
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Michael Sino, PA-C • Deborah LeBlanc, PA-C • Cheryl Abrams, PA-C
The patient and any other person responsible for payment has a right to refuse to pay, cancel payment, or be reimbursed for payment for any
otherservice, examination, or treatment that is performed as a result of and within 72 hours of responding to the advertisement for free, discounted
fee or reduced fee service, examiation or treatment. Exisiting patients FREE only applies to those who have not been seen in 3+ years.
FLORIDA MD MAGAZINE - JUNE 2010
3
COVER STORY
Walt Disney Pavilion at
Florida Hospital for Children
Creates the Future in Pediatric Care with New Leading-Edge,
Technologically-Advanced Facilities, Specialty Care and Innovative
Family-Centered Culture
By Jennifer Roth Miller, Staff Writer
The pioneering culture and high level of care provided to
Central Florida’s tiniest of patients at the Walt Disney Pavilion
at Florida Hospital for Children is setting the bar for pediatric
health care. There is much that can be learned from the latest
advances in technology, treatments and operations performed at
the children’s hospital right here in Central Florida.
Providing a nurturing place for kids to heal, the hospital
operates more like a theme park or resort, where every effort is
made to entertain, comfort and distract the small patients. Clinical
concierge services, music and pet therapy, Disney® characters and
comfortable family-centered rooms are only a few of the ways
Florida Hospital for Children is exceeding expectations.
The hospital is currently undergoing a $70-million dollar
addition and renovation. The renovations will further the culture
of the hospital and make it more family-friendly than ever before.
By 2011, the addition will include 200 dedicated pediatric beds
and will open featuring concepts, colors, sounds and themes
inspired by the lobby design. The entire project has been designed
with patients, their families and visitors in mind because it is the
Clifford Selsky, PhD, MD, explores the new Disney® themed lobby
with the help of a young adventurer.
The soothing new lobby features well-known and loved Disney® characters like Flounder from The Little Mermaid and Pumbaa from The Lion King in technologically-advanced, entertaining
exhibits and experiences. The attractions help take the little patients’ minds off the fact they are visiting a hospital for care. “Our
goal is to create a therapeutic environment that reflects the type
of attention and care children and their families receive during
their visit,” says Marla Silliman, administrator of Florida Hospital
for Children. “With this captivating entrance, we hope young patients overcome the apprehension of a hospital stay by engaging
them in a world of fantasy, imagination and adventure.”
Once in a private treatment room, children can continue their
journey in rooms painted in ocean, mountain and jungle scenes,
much like the environments of the different Disney® movies from
the lobby.
The mission of Florida Hospital for Children is to “extend the
healing ministry of Christ” to children and their families. This
includes looking at the family and child holistically – mind, body
and spirit. This translates to incorporating fun and play into the
hospital to balance the sterile environment and ease the child and
family’s experience.
4 FLORIDA MD MAGAZINE - JUNE 2010
Photographer: Spencer Freeman / Florida Hospital
From the moment someone arrives at the valet and enters the
new lobby of the Walt Disney Pavilion at Florida Hospital for
Children, it’s clear this isn’t an ordinary hospital. The entrance
serves as a gateway to the remainder of the children’s hospital
where the smallest patients from around the world receive superior
treatment and care from renowned physicians.
COVER STORY
Photographer: Spencer Freeman / Florida Hospital
to a magical oasis with eight themes to choose from. The
LED lights and ambient sounds give patients a feeling of
control in a time when an accident has taken all control
away from them. It helps the child and the families cope
while providing a distraction when receiving procedures
such as stitches. Doctors also find that less anesthesia is
needed when children are calmed naturally.
Pediatric Transport Team
One of eight playful environments in the pediatric emergency treatment room.
family unit that provides support to the children as they are
going through treatment and medical procedures.
Canine Companion Aids Pediatric
Patients with the Healing Process
As a child’s stay at the hospital endures, he or she will be visited
by the hospital’s special four-legged furry employee, Murray.
Murray is a two-year old, yellow Golden/Labrador Retriever
assistance dog who provides love and comfort to patients. He
graduated from the Canine Companions for Independence
program after two years of extensive training. He recognizes
more than 50 commands and works 9 a.m. to 5 p.m., Monday
through Friday each week. Murray technically works as a facility
dog, even wearing a badge, but the real work he does is providing
pet therapy and happiness to the children being cared for. He
helps take their minds off the tests and procedures required to
help them heal as quickly as possible. Murray is one of only a few
dogs that works in a children’s hospital in the United States.
Pediatric ER Ranked #1 in
Patient Satisfaction
The Florida Hospital for Children Pediatric Transport
Team is prepared to transport children involved in
serious accidents to this fairy-tale hospital in just a
matter of minutes. The team is on call 24 hours a day, 7
days a week. A cardiac life support (ACLS) and neonatal
resuscitation program (NRP) trained registered nurse
and respiratory therapist accompany the injured child
to the hospital and remain in constant contact with the
hospital while in transit.
In the most serious cases, Florida Hospital for Children’s Flight
Medicine Department’s Florida Flight I medical helicopter will
rapidly and safely transport critically injured children to the
hospital. The Flight Medicine Department serves a 150 mile radius
of the hospital.
Expanded Neonatal Intensive Care Unit
(NICU)
When there’s a critically ill infant in need of immediate care,
the hospital’s Neonatal Transport Team is ready to answer the call.
Once the sick or injured infant arrives, they are delivered to the
state-of-the-art Neonatal Intensive Care Unit (NICU) at Florida
Hospital for Children. The hospital recently added 20 new beds,
bringing the total number of NICU beds to 81. Families with the
sickest babies stay in this area of the hospital.
It is very emotionally draining for a family with a sick or injured
Murray, the kid-friendly canine companion, puts a smile on a young patient’s face.
Photographer: Spencer Freeman / Florida Hospital
When the unexpected happens, the Walt Disney
Pavilion at Florida Hospital for Children’s
world-class doctors are ready to provide top-notch,
cutting-edge care at its kid-friendly emergency room
(ER). Unlike most emergency rooms, which can
be very frightening to children, the ER at Florida
Hospital for Children is an environment decorated
in welcoming child-like colors and furnished with
kid sized furniture and activities.
Florida Hospital for Children has partnered with
Philips to provide a unique ambient experience in
treatment rooms. Children are able to customize
their environment by choosing the color and theme
in their room. A Philips Ambient Experience
Lighting System projector transforms the room in
FLORIDA MD MAGAZINE - JUNE 2010
5
Photographer: Spencer Freeman / Florida Hospital
COVER STORY
A specially-trained pediatric team is always ready to care for the smallest of patients in the new technologically advanced Level 3 NICU.
baby and it can be one of the hardest times for these families.
Florida Hospital for Children eases difficulties for these families by
providing the highest technology in equipment and treatment as
well as providing quiet private family-centered accommodations.
Some of the high-tech equipment utilized in this technologically-advanced Level 3 NICU includes the latest cardiac monitoring equipment to observe vital signs and the most advanced,
high-tech isolettes or warmers for the babies. They warm, rotate,
tilt, provide phototherapy and are clear so families can see their
baby while being treated. All of the equipment in the NICU is
specialized and sized specifically for the tiny babies.
Many areas of the hospital offer quiet, private rooms for patients and their families. The rooms were designed to be large
enough to host an entire family. They feature a “family zone”
with pull-out couches and wardrobes just for family members.
There is also a parent lounge with drinks, snacks and computer
access, as well as shower and laundry facilities to promote staying at the hospital. The goal is to make the stay comfortable for
all. Children are more comfortable and cooperative when their
parents are around, making it easier for the nurses and doctors to
do their jobs easily and send the healed patients home sooner.
New Pediatric Surgery Suites Arriving
As part of the hospital enhancements, new Pediatric Surgery
6 FLORIDA MD MAGAZINE - JUNE 2010
Suites will open in July. These technologically advanced facilities
will include 12 pre- and post-operative bays, four pediatric operating rooms, a large nurses’ station and a separate family waiting
room. The family waiting room was designed in the Brother Bear
theme to be kid-friendly, extending the culture of the hospital.
The Pediatric Surgery Suite will be dedicated only to children
and will house specialized equipment dedicated and created specifically for children. It is also a place where pediatric surgeons
can train and is adjacent to a robotic suite.
Multidisciplinary Clinics
The Walt Disney Pavilion at Florida Hospital for Children
also houses several specialty clinics such as the Neurofibromatosis,
Pediatric Cleft Palate and Craniofacial Clinics. Renowned doctors specialized in these serious conditions provide compassionate, friendly and professional care. The doctors are early adopters
and often times pioneers of advanced treatments using leadingedge equipment, care and techniques. These specialty clinics are
some of the only in the region and have led to new specialty areas
such as the Nicholson Center for Surgical Advancement, an internationally recognized center in the field. These specialty clinics
lead the way in clinical trials that may some day find a cure or
new therapy for complex diseases such as neurofibromatosis.
Dedicated to medical research and eduction, Florida Hospital
COVER STORY
Photographer: Spencer Freeman / Florida Hospital
The program, directed by Dr. Angela Fals, is comprised of
a team of professionals including a physician, nutritionist,
exercise physiologist, psychologist and support staff. The team is
a resource to the community with a goal of working with local
physicians to help obese children and teens. Local physicians have
the opportunity to refer patients between the ages of six and 17
that are above the 85th percentile for weight to receive low-cost
services designed to help them beat obesity.
The program was named Healthy 100 Kids because it aids obese
children and teens in learn habits of a healthier lifestyle that will
allow them to live to 100 years. The program helps prevent high
blood pressure, high cholesterol, diabetes, asthma, heart disease
and low self-esteem in this population.
Pediatric minimally invasive surgical specialists Christopher Anderson,
MD, and W. Raleigh Thompson, MD.
for Children hosted a course in May lead by course director, Dr.
Thompson, on advanced neonatal endoscopic techniques for the
American Pediatric Surgical Association and International Pediatric Endosurgery Group. During the continued medical education (CME) course, pediatric robotic surgery was featured to the
twenty-two attending surgeons from throughout north and south
America.
Healthy 100 Kids
The core team of specialists assesses each child that enters the
program and tailors a custom treatment program for him or her.
The specialists work with the children and with their families to
promote eating right, exercising, positive body image, rest and
relaxation. Dr. Fals says, “We show them how to exercise and
make good food choices. It’s our goal to be in the community
working with these families, and to be right there with them
because obesity is a difficult challenge for all involved. We all
pitch in together for the sake of the kids.” To learn more about
Healthy 100 Kids go to www.healthy100kids.org.
Angela Fals, MD, Healthy100 Kids program director.
Florida Hospital for Children not only leads the way in treating
pediatric illnesses and injuries, but it is also proactive in prevention.
For example, the hospital hosts a program, Healthy 100 Kids,
which seeks to lower the incidence of childhood and teen obesity.
Obesity has become not only an epidemic but also a threat to
the health of the next generation. According to figures shared at
the White House Childhood Obesity Summit in April, current
obesity costs are $150 billion per year and in the next decade the
cost of obesity is projected to double, being responsible for one
fifth of overall healthcare costs.
Photographer: Spencer Freeman / Florida Hospital
Photographer: Spencer Freeman / Florida Hospital
Frank Stieg, MD, provides compassionate care for children at the
Craniofacial Clinic.
FLORIDA MD MAGAZINE - JUNE 2010
7
COVER STORY
Ben Guedes, MD, pediatric intensivist at the Walt Disney Pavilion
at Florida Hospital for Children
Photographer: Spencer Freeman / Florida Hospital
Florida Hospital for Children is setting the bar for the future of
pediatric care with its innovative culture, technology and top-notch
level of care. The hospital ready to respond to current illnesses and
injuries, and is proactive in prevention and clinical trials searching
for cures and new therapies. This world-class institution is setting
the pace for pediatric health.
The Walt Disney Pavilion at Florida Hospital for Children
welcomes questions you may have about our services, specialties
and programs. Please contact one of our Care Coordinators at
(407) 303-KIDS (5437) or visit us online at www.FloridaHospitalForChildren.com. They are your clinical concierge, assisting
you in scheduling appointments, consultations and procedures,
as well as providing you with information about diseases and
the availability of clinical trials. 
Florida Hospital for Children Pediatric Specialists
Allergy and Immunology
Denise Gonzalez, MD
Carlos Jacinto, MD
Santiago Martinez, MD
Steven Rosenberg, MD
Anesthesiology
Ann Holt, MD
Eric Kunichika, MD
Timothy Roedig, MD
Kevin de la Roza, MD
H. Kenneth Spalding, MD
Robert E. Tainsh, Jr., MD,
MPH
Shakuntala Janwadkar, MD
Endocrinology
Jorge Daaboul, MD
Naznin Dixit, MD
Gastroenterology
Sangeeta Bhargava, MD
Sanjay Khubchandani, MD
Hematology/Oncology
Fouad Hajjar, MD
Clifford Selsky, PhD, MD
Hospitalists
Vijay Reddy, MD
Vivek Desai, MD
Ayodeji Otegbeye, MD
Oludapo Soremi, MD
Cardiology
Infectious Diseases
Scott Appleton, MD
Thomas Carson, MD
Jorge Garcia, MD
Agustin Ramos, MD
Sumbal Sattar, MD
Cathy Lamprecht, MD
Dawn Sokol, MD
Bone Marrow Transplant
Childhood Development
Sandra Cely, MD
Dental Surgery
Afsoon Elmore, DDS
Emergency Medicine
Audrey Bowen, MD
Dennis Hernandez, MD
Intensive Care/
Hospitalists
Aaron Godshall, MD
Ben Guedes, MD
Paul Halczenko, MD
Heidi Herrera, MD
Boaz Ovadia, MD
Neonatology
Carlos Alana, MD
Hilton Bernstein, MD
Winslade A. Bowen, MD
8 FLORIDA MD MAGAZINE - JUNE 2010
Neal Goldberg, MD
Eduardo J. Lugo, MD
Lewis Otero, MD
D. Jim Rawlings, MD
Thomas Wiswell, MD
Nephrology
William Zink, MD
Otolaryngology
Cheryl Cotter, MD
Izak Kielmovitch, MD
James Kosko, MD
Mehul Dixit, MD
Robert Mathias, MD
Plastic Surgery
Neurology
Pulmonology and Sleep
Disorders
Karen Baker, MD
Carl Barr, DO
Dina Dahan, MD
Ashraf El-Bohy, MD
Jasna Kojic, MD
Ananthi Rathinam, MD
Neuropsychology
Michelle Dolske, PhD
Patrick Gorman, PsyD
Michael Westerveld, PhD
Neurosurgery
Eric Trumble, MD
Ophthalmology
Louis C. Blumenfeld, MD
Robert S. Gold, MD
Jamie Ikeda, MD
Frank Stieg, MD
Akinyemi Ajayi, MD
Kimberly Justice, PhD
Shivani Verma, MD
Radiology
Jane Cook, DO
Gregory Logsdon, MD
Peter Salazar, MD
Laura Varich, MD
Surgery
Christopher Anderson, MD
Mark Chaet, MD
W. Raleigh Thompson, MD
Urology
Michael Keating, MD
Orthopedic Surgery
Weight Management
(Healthy 100 Kids)
Adam Fenichel, MD
Angela Fals, MD
PHARMACY UPDATE
The ALCAT – A Step Towards Personalized Nutrition
By Jill Weinstein, R.Ph. and Melissa Page Crow, PharmD Candidate, University of Florida
For those who suffer from such ailments as migraines, irritable
bowel syndrome (IBS), and other digestive disorders, it comes
as no surprise that certain foods can trigger episodes of these
diseases. It is also prevalent in today’s society to read of people
– especially children – whose documented food allergies are so
severe that merely touching a peanut or eating an apple can put
their lives in danger. In such cases as these those who suffer can at
least take means to avoid their trigger substances.
A new theory being explored by both doctors and pharmacists
asks about the possible detriment caused by hidden food allergies.
In these cases, a patient allergic to any common food substance
(e.g. wheat, gluten, rice, corn, anchovy, to name a few) would
have minimal if any outer manifestations of an allergic reaction.
Instead, ingestion of these substances would activate their
immune system, causing a cascade of reactions that would lead
to inflammation of the digestive tract, especially the intestines.
This in turn would lead to poor nutritional acquisition and the
problems that arise from lack of the proper amounts of vitamins
and minerals.
Recently a test has been developed to identify foods as well
as factors that induce immune system activation. Called the
ALCAT Test, it is a simple blood test that can measure the body’s
response to up to 200 foods, 50 functional foods and herbs, 10
food additives, 20 molds and 10 environmental chemicals.
To perform the test, blood is drawn from the patient. Based
on the panel chosen by the patient, their blood is placed in
contact with the ‘challenged’ materials. Response is measured
by analyzing the change in the size and volume of white blood
cells (leukocytes). A histogram for each substance is recorded and
the substances tested against the patient’s blood are then placed
into four categories based on the results. Red-level foods are those
that generated the most response and should be avoided; orange
level foods caused moderate stimulation of the immune system.
Yellow foods are mildly irritating and should only be enjoyed in
moderation. Green level foods are acceptable to the patient and
can be freely consumed.
The ALCAT Test is considered by certain practitioners to be
a more complete test in that it tests the actual white blood cells’
response to a challenge substance. Traditional allergy tests (skin
testing or RAST) use the release of histamine from mast cells and
allergen-specific Immunoglobulin E (IgE) molecules to measure
an allergic response. While both are components of the immune
system, histamine release and the presence of IgE are more
indicative of the immediate mechanisms of immune response to
an allergen. The ALCAT Test not only measures histamine release
and IgE, but also several other factors that together compose an
immune system response to an allergen.
Immunoglobulin M (IgM) and immunoglobulin D (IgD)
work in concert together to alert the immune system to the
presence of antigens. IgM also helps to activate the complement
system, an immune pathway triggered by direct exposure to
antigens, and is a major component of rheumatoid factors
(autoantibodies). Immunoglobulin A (IgA) is present both in
serum and as a secretion released by cells. This ‘secretory’ IgA is
present in colostrum, intestinal secretions, tears and saliva and
provides localized immunity. Immunoglobulin G (IgG) is a major
component in the delayed immune response. Composing 85% of
the total immunoglobulins in adults, IgG has a great ability to
bind antigens and stimulate the removal of offending materials
from the body through phagocytosis. By measuring these various
factors, the ALCAT Test takes into account both immediate and
delayed immune response.
Patients who undergo food sensitivity testing receive a list of
red, yellow, orange and green- level foods so that they can customize
their diet to avoid any immune system triggers. Patients can also
add panels that include functional foods and medicinal herbs,
molds, food additives and environmental chemicals in order to
obtain a more comprehensive list of items to avoid. Test results
also include a booklet that explains to you your test results, a
customized 4-Dat Rotation Diet and a wallet-sized results card.
Pharmacy Specialists of Central Florida is pleased to
announce that they will start providing the ALCAT Test this
summer. Testing packages are available as both individual and
comprehensive panels, allowing for the patient to create their
own customized package. Since the ALCAT Tests only requires a
simple blood draw, patients 3 and younger can be tested. Patients
who are interested in finding out more about the ALCAT Test
are encouraged to go to www.alcat.com to read more about this
exciting new tool in personalized nutrition.
For those who suffer from such ailments as migraines, irritable
bowel syndrome (IBS), and other digestive disorders, it comes
as no surprise that certain foods can trigger episodes of these
diseases. It is also prevalent in today’s society to read of people
– especially children – whose documented food allergies are so
severe that merely touching a peanut or eating an apple can put
their lives in danger. In such cases as these those who suffer can at
least take means to avoid their trigger substances.
A new theory being explored by both doctors and pharmacists
asks about the possible detriment caused by hidden food allergies.
In these cases, a patient allergic to any common food substance
(e.g. wheat, gluten, rice, corn, anchovy, to name a few) would
have minimal if any outer manifestations of an allergic reaction.
Instead, ingestion of these substances would activate their
immune system, causing a cascade of reactions that would lead
FLORIDA MD MAGAZINE - JUNE 2010
9
PHARMACY UPDATE
to inflammation of the digestive tract, especially the intestines.
This in turn would lead to poor nutritional acquisition and the
problems that arise from lack of the proper amounts of vitamins
and minerals.
Recently a test has been developed to identify foods as well
as factors that induce immune system activation. Called the
ALCAT Test, it is a simple blood test that can measure the body’s
response to up to 200 foods, 50 functional foods and herbs, 10
food additives, 20 molds and 10 environmental chemicals.
To perform the test, blood is drawn from the patient. Based
on the panel chosen by the patient, their blood is placed in
contact with the ‘challenged’ materials. Response is measured
by analyzing the change in the size and volume of white blood
cells (leukocytes). A histogram for each substance is recorded and
the substances tested against the patient’s blood are then placed
into four categories based on the results. Red-level foods are those
that generated the most response and should be avoided; orange
level foods caused moderate stimulation of the immune system.
Yellow foods are mildly irritating and should only be enjoyed in
moderation. Green level foods are acceptable to the patient and
can be freely consumed.
The ALCAT Test is considered by certain practitioners to be
a more complete test in that it tests the actual white blood cells’
response to a challenge substance. Traditional allergy tests (skin
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buying, seeking an associate
or practice valuation,
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that specializes only in
medical practices?
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10 FLORIDA MD MAGAZINE - JUNE 2010
testing or RAST) use the release of histamine from mast cells and
allergen-specific Immunoglobulin E (IgE) molecules to measure
an allergic response. While both are components of the immune
system, histamine release and the presence of IgE are more
indicative of the immediate mechanisms of immune response to
an allergen. The ALCAT Test not only measures histamine release
and IgE, but also several other factors that together compose an
immune system response to an allergen.
Immunoglobulin M (IgM) and immunoglobulin D (IgD)
work in concert together to alert the immune system to the
presence of antigens. IgM also helps to activate the complement
system, an immune pathway triggered by direct exposure to
antigens, and is a major component of rheumatoid factors
(autoantibodies). Immunoglobulin A (IgA) is present both in
serum and as a secretion released by cells. This ‘secretory’ IgA is
present in colostrum, intestinal secretions, tears and saliva and
provides localized immunity. Immunoglobulin G (IgG) is a major
component in the delayed immune response. Composing 85% of
the total immunoglobulins in adults, IgG has a great ability to
bind antigens and stimulate the removal of offending materials
from the body through phagocytosis. By measuring these various
factors, the ALCAT Test takes into account both immediate and
delayed immune response.
Patients who undergo food sensitivity testing receive a list of
red, yellow, orange and green- level foods so that they can customize
their diet to avoid any immune system triggers. Patients can also
add panels that include functional foods and medicinal herbs,
molds, food additives and environmental chemicals in order to
obtain a more comprehensive list of items to avoid. Test results
also include a booklet that explains to you your test results, a
customized 4-Dat Rotation Diet and a wallet-sized results card.
Pharmacy Specialists of Central Florida is pleased to
announce that they will start providing the ALCAT Test this
summer. Testing packages are available as both individual and
comprehensive panels, allowing for the patient to create their
own customized package. Since the ALCAT Tests only requires
a simple blood draw, patients 3 and younger can be tested.
Patients who are interested in finding out more about the
ALCAT Test are encouraged to go to www.alcat.com to read
more about this exciting new tool in personalized nutrition.
Jill Weinstein, R.Ph., is a clinical pharmacist at Pharmacy
Specialists of Central Florida. She provides one-onone consultations for patients interested in correcting
hormonal and nutritional deficiencies.
Melissa Page Crow is a Doctorate of Pharmacy Candidate
at the University of Florida. For more information about
the ALCAT Test, please contact Pharmacy Specialists of
Central Florida at 407.260.7002. Pharmacy Specialists
is located at 393 Maitland Avenue, Altamonte Springs,
Florida 32701. 
LIABILITY CONCERN: School & Sport Physicals
By Cliff Rapp, LHRM
Vice President, Risk Management
Physicians that conduct school and sport physicals, such as
pre-participation physical evaluations, need to be aware of the
inherent liability exposure, particularly in the absence of an
existing physician-patient relationship.
The most common types of conditions giving rise to malpractice
claims involving pre-participation physician examinations
are cardiovascular. Failing to discover a latent asymptomatic
cardiovascular condition is a prevalent allegation that in most
cases requires proof that the physician deviated from the standard
of care in terms of the pre-participation evaluation. Depending on
the legal venue, courts may hold that the mere performance of a
pre-participation physical exam serves to create a physician-patient
relationship with the same legal duties as that of an established,
private practice patient. Therefore, it is important to emphasize
the precise nature and limited scope of the physician-patient
relationship, delineated solely to the examination. Generally,
physicians that provide medical clearance for participating in
competitive sports are not legally liable per se for injury or death
caused by an undisclosed cardiovascular abnormality. Most courts
have recognized that the pre-participation screening standards of
athletes may follow current consensus guidelines in determining
cardiovascular fitness. Again, this will depend on the legal venue.
Cardiovascular screening is the primary, inherent liability
exposure associated with school and sports physicals. Congenital
aortic valve stenosis is the most likely condition to be detected
reliably during routine screening.(1) Primarily, differentiating
common heart murmurs from potentially lethal cardiovascular
conditions. Of course, other insidious and chronic underlying
medical conditions are also a consideration in terms of the liability
exposure inherent to these kinds of physical exams.
in doing so acknowledge the limited nature of the pre-participation
evaluation, the fact that no physician-patient relationship is created
or intended, and that the exam
does not replace an annual wellchild exam by the students primary
care physician.
Case Summary
Consider the case involving our
insured physician and ARNP who
were doing pre-participation sports physicals at an athletic facility
on behalf of the local high school. Both had performed school
physicals on a young male student whose father had died of an
MI at a young age. After being cleared two years in a row by our
insureds, the student died while participating in vigorous physical
training while on a treadmill at the school. A wrongful death
action was filed alleging that the student should not have been
cleared for sports activity without further evaluation in light of his
family history. Medical experts could not support a defense in light
of the fact that both of the student’s examination consent forms
noted the family history of MI. Medical clearance to participate
in the sports program should not have been granted. Our insureds
should have either pursued further diagnostic testing or referred
the student to his primary care physician.
Risk Management Guidelines
• Seek an indemnification and hold harmless agreement from the
school or facility requesting the pre-participation evaluation
High-risk Symptoms
• Determine if you are entitled to sovereign immunity by the
school or recreational entity
Subjects with a personal or family history of the following may
be at high-risk for cardiovascular conditions (and thus potential
claimants for failure and delay in diagnosis):
• Confirm that your existing professional liability coverage does
not exclude claims arising from school and sports physicals
• exertional chest pain/discomfort
• syncope/near syncopal episodes
• excessive, unexpected shortness of breath
• excessive, unexplained fatigue with exercise
• history of heart murmur
• elevated systemic blood pressure
• family history of cardiovascular disease
It is important that the parents or legal guardians not only
provide their consent for the student or child to be evaluated, but
• Require that parental consent to conduct the evaluation has
been provided and waives creation and expectation of a
physician-patient relationship
• Require that informed consent is obtained relating to the
purpose and scope of the evaluation
• Ensure that documentation of the evaluation is maintained
when evaluations are conducted externally to your practice
• Maintain a log identifying every subject evaluated
• Include a brachial BP measurement in the sitting position, precordial auscultation in both the supine and standing positions,
assessment of the femoral artery pulses, recognition of the
FLORIDA MD MAGAZINE - JUNE 2010
11
physical stigmata of Marfan syndrome,
BP >95th percentile, systolic murmur
equal to or greater than 3/6 intensity,
any diastolic murmur, any murmur that
intensifies with Valsalva.(1)
Meet the Physicians at
A d v A n c e d
s u r g e r y
&
M i n i M A l l y
g y n e c o l o g y
i n v A s i v e
s p e c i A l i s t s
• Retain a copy of any evaluation record
entailing a subject diagnosed with potentially compromising factors
• Communicate potential concerns or
medical conditions to the subject of
the exam, the subject’s parent or legal
guardian, and the subject’s primary care
physician
• Utilize a student medical history form,
executed by both the student and the
student’s parent or legal guardian
• Document any limitations with specificity
• Document any medical recommendations on the pre-participation form
• Advise the requesting party and the subject of the evaluation that such screening should be repeated every 2 years
(1) American Heart Association. Recommendations and
Considerations related to Preparticipation Screening for
Cardiovascular Abnormalities in Competitive Athletes:
2007 Update. AHA Journals
Cliff Rapp is a licensed healthcare risk
manager and Vice President for Risk
Management of First Professionals
Insurance Company, a leading professional liability insurer. Mr. Rapp
is widely published and a national
speaker on loss prevention and risk
management. Please call him at (800)
741-3742.
First Professionals Insurance Company is Florida’s Physicians Insurance
CompanySM and the endorsed carrier
for professional liability insurance by
22 county medical societies, 15 specialty societies, and two statewide associations in Florida. 
Frederick
Hoover,
MD
Georgine
Lamvu, M
D
Liza Colim
on, MD
Welcome to Advanced Minimally Invasive Surgery &
Gynecology Specialists! Our physicians and staff are
highly-skilled in the treatment of:
PELVIC PAIN | ENDOMETRIOSIS | BLEEDING DISORDERS
VULVODYNIA | URINARY INCONTINENCE | PELVIC ORGAN PROLAPSE
MINIMALLY INVASIVE SURGERY
Robotic surgery | Laparoscopy | Office procedures
If you suffer from any of the above ailments and require care, or you would like more
information on advanced treatments and research that may help to alleviate your
condition, please schedule an appointment to meet one of our physicians today.
Dr. Frederick Hoover received his medical degree from University of South Florida in
Tampa, Florida. Board certified in Obstetrics/ Gynecology, Dr. Hoover has more than 25
years of experience in the field of Gynecology and extensive minimally invasive surgery.
Dr. Georgine Lamvu received her medical degree from Duke University School of
Medicine and she is the Medical Director of Gynecology and Minimally Invasive Surgery
for Florida Hospital Orlando. She is internationally recognized for her work in pelvic
pain and serves on the Board for the International Pelvic Pain Society.
Dr. Liza Colimon received her medical degree from the University of Illinois College
of Medicine. She is board certified in Obstetrics and Gynecology and is currently
pursuing advanced training in gynecologic disorders, minimally invasive and robotic
surgery, and research methodology.
The office is located at Florida Hospital Orlando campus, inside the Florida Hospital
Cancer Institute building. To make an appointment, please call 407-303-2780.
2501 N Orange Ave. Ste. 286 | Orlando, FL 32804 | 407-303-2780
www.gynspecialistsorlando.com
12 FLORIDA MD MAGAZINE - JUNE 2010
USING NUTRACEUTICALS
Weight Gain and Unsuspected Gluten Sensitivity,
Sub-Clinical Gluten Enteropathy
The ‘Classical Presentation’ is the Exception, not the Rule
By David S. Klein, MD, FACA, FACPM
Introduction:
Obesity is now endemic. More than
a national disgrace, the fattening of
America may well be one of our greatest threats to our national security. In
North America, the general public
spends huge sums of money in futile
effort to lose weight, when simultaneously, we are wasting huge sums of
money ignoring what may be the treatable cause of weight gain in a large percentage of the population.
Gluten Enteropathy is a common cause of weight issues in populations that consume grain as a diet staple.
Celiac Disease (CD) is a digestive disease that damages the
small intestine and interferes with nutritional absorption, and it
can result in unexplained weight gain. Sufferers of CD cannot
tolerate gluten, a binding protein found in wheat, rye, and barley.
Most commonly, gluten is found in food products, but Gluten
may also be found in everyday products such as medicines, vitamins, and cosmetic products.
Sensitivity to Gluten is very common. Affecting as many as
30% of the general population, sensitivity to gluten is a ‘spectrum disorder.’ That is, it varies from Subclinical-mild in severity
to overwhelming-devastating. In its’ severest form, it is known
as Celiac Sprue, Celiac Disease (CD), non-tropical Sprue, and
less commonly as Gee-Herter Disease, Gee-Thaysen Disease or
Heubner-Herter Disease.
Celiac disease is both a disease of malabsorption, and an immunological condition. There may be a familial or genetic predisposition to CD, and it may be triggered after trauma, surgery,
pregnancy, childbirth, infection, or emotional stress.
Autoimmune in nature, CD sufferers will experience periods of
time where symptoms are minimal, stable and flair. Triggers are
usually dietary, as the protein family known generally as ‘Gluten’
will trigger complaints in most patients. Equally confusing is that
hormonal shifts, co-morbid disease states, infection and stress can
trigger symptoms, as well.
Clinical Presentation:
Misdiagnosed as ‘irritable bowel disease,’ CD is a lifelong complaint. Rare is the patient that presents to the office
complaining of the ‘classical presentation’ of dramatic weight
loss, diarrhea and cramping precipitated by pizza, spaghetti
and bread. More typically, patients present with peculiar,
episodic cramping, bloating and weight gain. Self-diagnosed
with ‘leaky gut,’ they often go through an embarrassing series
of self-treatment protocols, GI detoxifications and fad diets. A
minority of patients present with skin rash known as Dermatitis
Herpetiformis, as the principal symptom.
Other Signs and Symptoms Include: • unexplained iron-deficiency anemia
• fatigue, depression, anhedonia, anxiety
• arthritic bone or joint pain
• bone loss, osteopenia, or osteoporosis
• tingling numbness in the extremities
• seizures, depression, bipolar disorder
• dysmenorrhea
• canker sores in the mouth
• dermatitis Herpetiformis
The most common complaints are dyspepsia, bloating and abdominal uneasiness.
Associated disorders include:
• Diabetes
• Autoimmune thyroid disease, e.g. Hashimoto’s Thyroiditis,
Grave’s Disease
• Autoimmune liver disease
• Rheumatoid arthritis
• Autoimmune adrenal dysfunction; Addison’s Disease
• Sjögren’s syndrome
• Bipolar Disorder.
• Lupus
Diagnosis:
To most medical practitioners, blood work is the preferred approach to diagnosis, elimination diet is often the most practical
way to infer diagnosis. Elimination of gluten from the diet for a 2
week period is often all that is necessary to infer diagnosis.
The ‘gold standard’ in confirming diagnosis is the endoscopic
biopsy. When positive, diagnosis is firmly established. Unfortunately, biopsy for CD is fraught with false negatives.
Easiest of all is testing, serum anti-body determinations for
IgG, IgA, IgE and tTG IgA and tTG IgE are useful, but the derived information is sometimes confusing. Best drawn early in
the morning, these anti-body titers may demonstrate patterns
that suggest gluten sensitivity or frank Celiac Disease.
FLORIDA MD MAGAZINE - JUNE 2010
13
USING NUTRACEUTICALS
Nutraceutical Treatment of Celiac
Disease
The mainstay of treatment is as simple and as complicated as
avoiding Gluten in the diet. This means avoidance of most processed foods, and nearly all grains.
Gluten is widely used as a binder in medicines, supplements
and in many cosmetic products.
It takes a good bit of research to identify sources of Gluten in
the ingestible environment, and it takes but a single slip to cause
a patient to go into a gastrointestinal crisis.
1. CLA- Conjugated Linoleic Acid. When taken 1,000 mg two
or three times daily, CLA will act as a topical anti-inflammatory for the GI tract. Taking a week or two, symptomatic
relief can be dramatic
2. Castor Oil- This old standby is useful to settle an inflamed
GI tract. Taken ½ Tsp to ½ Tbs in apple sauce, once daily,
the irritable bowel symptoms often abate within a few days. It
should be taken for several weeks, consistently, then periodically as symptoms dictate.
3. DPP IV (gluten digestive enzyme)- One or two capsules taken
immediately before meals will provide some protection from
modest amounts of Gluten. Taking these digestive enzymes
mitigates but does not eliminate the damage from dietary gluten, but social circumstances sometimes dictate the need for
this intervention.
Dietary Supplementation
Celiac Disease results in an unpredictable but inevitable malabsorption of essential vitamins, minerals, amino acids, oils and
essential fatty acids. Many nutritional deficiency syndromes are
easily detectable through available nutritional test panels. Most
practitioners are unfamiliar with these panels making specific intervention impossible. General supplementation should include:
1.
2.
3.
4.
5.
Mineral chelate (organic mineral salts)
Essential Fatty Acids & Oils
Amino Acid/protein supplementation
Vitamin B Complex, Vitamin C, Vitamin E
Vitamin D-3 (dosage dictated by age and condition)
As we age, we become less and less efficient in absorbing nutrients through the gastrointestinal tract. With CD, this efficiency
deteriorates even more dramatically. In short, it takes a great deal
more than the ‘recommended daily allowance (RDA),’ to ensure
adequate levels of these important and inexpensive nutrients.
NOTE WELL:
The commonly available OTC multivitamin/mineral complexes are entirely inadequate.
Individuals with CD tend to have elevations in CRP, suggesting increased risk of cardio-vascular disease. Omega-3 fatty
acid (fish oil) administration is an interesting, new intervention for the treatment and prevention of coronary artery disease
(CAD). Certain omega-3 fatty acids have biochemical properties
that promote atherosclerotic plaque stability and thereby decrease
14 FLORIDA MD MAGAZINE - JUNE 2010
the incidence of cardiac ischemia and ischemic cardiac arrhythmias. An ever-increasing body of evidence supports the role for
omega-3 fatty acids, i.e. fish oil, in through a role as anti-arrhythmic agents, through anti-thrombotic effect, and through
atherosclerotic plaque stabilization, probably as a result of topical
anti-inflammatory action.
Dosage requirement is between 2 and 3 grams per day, in divided doses. Generally, the preferred cardiac ratio of 3:2 EPA/DHA,
but in inflammatory conditions such as CD, the EPA/DHA ratio
does a bit better at 6:1.
Patient should begin with 1 mg per day, increase over a week or
two to the desired daily dosage.
David S. Klein, MD has practiced pain medicine for
the past 27 years and is the author of over 50 published
articles and textbook chapters and has lectured
extensively. He is a member of the American Board of
Anesthesiology, American Board of Pain Medicine,
American Academy of Pain Management, American
Board of Minimally Invasive Medicine & Surgery, and
has Sub-Specialty Certification in Pain by the American
Board of Anesthesiologists. Dr. Klein is presently the
Medical Director of the Pain Center of Orlando, located
at 225 W. SR 434, Suite #205, Longwood, Florida
32750. Telephone 407-679-3337. FAX 407-678-7246.
www.suffernomore.com. www.stages-of-life.com 
Faculty Member Position for
Florida Hospital’s
Internal Medicine Residency Program
Florida Hospital in Orlando, Florida is seeking a
broadly skilled physician to serve as a core faculty
member for the Internal Medicine Residency
Program. The physician’s duties will include
clinical teaching in an outpatient and inpatient
setting as well as seeing private patients and
developing research projects in conjunction with
residents and other faculty. Junior and senior
internists as well as flexibly skilled sub-specialists will be considered. A strong emphasis will
be placed on clinical teaching skills. Competitive
salary and benefits.
Forward CV to [email protected] to
indicate interest or call 407-200-2538.
Marketing Your Practice
Controlling Your Own Destiny Part II:
Reaching Your Target
By Jennifer Thompson
So now that you’ve had a month between columns, you’ve got your marketing plan all ready to go, right? You’ve
taken the tips from last month’s article
and now you’re ready to dive in to the fun
part, develop your brand and reach your
new clients, right? If you answered yes, then keep reading.
If you answered no, then shame on you,
but I appreciate your honesty nonetheless. After you’ve developed your marketing
plan it’s time to determine which vehicles
will take you and your practice to where
it is you want to go. Depending on your
individual goals, you’ll want to use a mix
of the below elements to achieve the best
results from your efforts. Remember:
track everything you do and be sure that
you’re receiving a positive return on your
investment – if not, change your mix of
tactics or consult with someone specializes
in the field of medical marketing because,
odds are, they know what they’re doing
more than you when it comes to this stuff
– no offense. and foundations in the trade area. These
efforts will not only help create a positive,
warm and fuzzy feeling between patients
and your practice, but they will put you
(and your staff) in direct contact with
hundreds of the people you are trying to
win over in just a few short hours. There
is not much better bang for the buck.
Print
Imagine your potential client or referring partner picks up a local magazine.
They skim through and an ad catches
their eye. Will it be yours? Your printed
materials are what will set you apart from
your competitors and establish you as a
leader in your field while, if done correctly, providing you with targeted and
measurable results. That goes for everything you print from ads in magazines
to brochures, rack cards and direct mail
pieces. Your printed materials should be
professionally designed, include between
three and five key points and some sort
of call to action or special offer. This will
not only entice people to call you soon,
but it will also tell you if the print job did
what it was supposed to depending on
the number of offers you receive back.
Without further ado, here are some
of the most commonly used tactics to
increase patient count and brand identity
for medical practices just like yours.
Grassroots Marketing
One of the best ways to establish yourself
in your community is to participate in
your community. This would include
outreach efforts such as supporting local
youth or adult sports teams/leagues,
participating in community healththemed events and even donating time
to help your favorite local nonprofit
organization. Grassroots efforts employ
low-cost tactics and don’t always focus
on selling your mission, instead they
focus on building strong relationships
FLORIDA MD MAGAZINE - JUNE 2010
15
Marketing Your Practice
Direct Mail
Yes, this is print material as well, but it
deserves its own section because of how
effective it can be. Direct mail can be
expensive – but it works. A good mailing
list will make or break a direct mail piece,
so make sure that you have a quality list
to mail to first. Direct mail works for
current patients, potentials and referral
partners and generally the success rate is
when you receive a return of 2 percent.
Web Site Development
We’ve touched on what your Web site
should include in previous editions of
the column, but it’s important to note
here. Your Web site is often the first
impression many patients and referring
partners will experience so you want to
make sure you’re putting your best foot
forward. Include pertinent information
such as your biography, maps, hours,
insurance carriers you accept, directions
and even forms for first-time patients to
fill out to speed up the check-in process.
If you want to get fancy you may want
to include a patient education section,
bill pay, prescription refill and portals to
versions of your site in another language.
partners and that can be done in a number of ways, the most effective being actually
sending someone to their office. You can also run contests, host events and use direct
mail to help. Bottom line: the more you build this relationship, the better off your
practice will be.
Is that all? No, of course not. There are literally dozens more tactics that can be
used to reach your target market, all of which can be modified to include your internal
communications with current patients as well.
Your next step is to determine which tactics will work best for your practice and how
you can use them effectively to grow your brand.
By now you should be well on your to creating a new marketing identity for yourself.
If you’ve found that you just have a headache instead, take two aspirin and call me in
the morning (I’ve always wanted to say that).
Jennifer Thompson is a Central Florida small business owner and serves as
President of Insight Marketing Group, focusing on medical office marketing, community and public relations. In this capacity she is responsible for
developing and implementing the long-term strategic vision for the overall organization including publishing the company’s community-based
monthly news magazine and hosting the company’s weekly small business
networking group. She can be reached at 321-228-9686 or by email at
[email protected]. 
Are you happy
with your
2009 tax bill?
Search Engine Optimization
This is often referred to as SEO and if
you get your site professionally done, you
shouldn’t have to worry about keeping up
with maintenance moving forward. This
is the component of your site that will
improve your office’s ranking and page
location on search result pages like Google
and Yahoo. The higher you are, the more
views you’ll get and, odds are, the more
inbound phone calls and patients you’ll
see. This can be very confusing, but it’s
essential to complement your new stateof-the-art Web site.
What can I do
to significantly
reduce my tax
liability for 2010?
Did you
use all the
deductions
available?
Referral Development
Working to develop strong referral
relationships will go a long way in getting
patients into your specialty practice.
Like any relationship, the more one
participant trusts the other, the happier
you’ll both be. It’s important to come
up with a system to reach out, develop
and cultivate relationships to area referral
16 FLORIDA MD MAGAZINE - JUNE 2010
Retirement Solutions for
Successful Business Owners
and Professionals
Creative Concepts for Wealth Creation
and Preservation
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www.NPA412i.com
WEALTH MANAGEMENT
As the Markets Recover, Rebalancing and
Dollar Cost Averaging Can Help
Get Your Portfolio Back on Track
By Tyson Smith
The rapid decline of the markets in 2008 and early 2009
caused many investors to shift their portfolio allocations to favor
more conservative positions, including cash. Now, with the
markets up nearly 40% from their 12 year lows in March, many
investors are wondering how best to increase their exposure to
equities again. For those seeking a way back to a more balanced
or growth oriented asset allocation, portfolio rebalancing and
dollar cost averaging are time tested investment strategies that
can be especially valuable in today’s market environment.
What You Should Know:
1.Portfolio rebalancing is critical to long-term investment
success
Establish an ideal asset allocation (i.e. The mix of assets
across stocks, bonds and cash) is only the first important step
in creating and maintaining an effective investment portfolio.
Regularly revisiting your portfolio and rebalancing your assets to
your target allocation is important to keep your plan on track to
your goals, especially amid rapidly changing market conditions.
Done Properly, Rebalancing Involves:
*moving existing assets from high-performing investments into
lower performing investments with upside potential, or
*changing the way new assets are allocated to put more into
lower performing investments.
If you’re like many investors who shifted to more conservative
portfolio allocations over the past six months to the market
volatility, rebalancing back to your target asset allocation now
can help position your portfolio for the economic recovery
ahead.
2. Dollar cost averaging is a smart way to expand your exposure
to equities
Many investors know the best time to buy shares in stocks
or mutual funds is when they are cheap and expected to rise
in value. There are many investors who see both factors in play
today. However, the volatility were experiencing as the markets
recover has some investors understandably cautious.
Dollar cost averaging is the principle of investing the same
amount of money in a particular security at regular intervals over
an extended period of time. By doing so, you essentially force
yourself to purchase fewer shares when the security is performing
well and more shares when it is undervalued. This strategy can
be extremely effective in volatile market conditions as it helps
mitigate the effects of market fluctuation on average share price
while gradually increasing investors’ position in the security.
What You Should Do Now:
If you haven’t rebalanced your portfolio since shifting to a
more conservative posture in 2008 or early 2009, you should
consult your financial visor to revisit your investment allocation
and make sure you have the proper mix of assets to reach your
goals. And, if you want to increase your exposure to equities
as the economy recovers but remain concerned about your
daily volatility, you should work with your financial advisor to
determine if Dollar cost averaging makes sense for you.
Tyson Smith is Vice President and Senior Investment
Consultant at R. W. Baird & Company in the Orlando
office. He provides investment services to business owners,
professionals, and retirees. Tyson specializes in retirement
plans, personal wealth management, and financial
planning to help his clients prepare for and overcome the
many financial challenges on the path to their long-term
goals. His office is located at 200 South Orange Avenue,
Suite 1550, Orlando, FL 32801. He can be contacted
at (407) 481-8286, [email protected] or by going to
www.TysonSmithFinancialAdvisor.com. 
FLORIDA MD MAGAZINE - JUNE 2010
17
Executive Benefits for Professionals
2010 Tax Planning… Start Now!
By Stephen P. Toth, CLU, ChFC
When it comes to tax returns, most of us are in the same place
so this should be a very good time to review our 2010 tax planning. We have gathered our receipts, printed out our detailed
profit and loss statements and met with our tax advisors in the
hope that we won’t have any tax surprises. Of course, there are
those of us who will procrastinate and delay having our 2009
return prepared; and, in so doing, lose out on possibly discovering many additional tax saving ideas we could have been doing
for 2010.
Because we are so busy dealing with our businesses on a dayto-day basis, it is easy to not think about our tax liability until
it is too late. Hopefully, when you read this, it will prompt you
to question “what else could I do to significantly reduce my tax
burden?”
While everyone should ask their tax advisors or financial professionals about what else is out there that will have the greatest
impact on tax reduction, we usually don’t get the answers we seek.
Therefore, in an attempt to stimulate your next tax planning
meeting, here is a short list of ideas that you might investigate:
What type of qualified plan do you have? Is it an “employee”
benefit plan or is it an “employer” benefit plan? Most pension
plans favor employees but there are a growing number of plans
that (when designed properly) will shift the results to the employer’s favor. We consider any plan where the owners and key
professionals receive 80% or more of the contribution to be “employer” benefit plans. These might include age weighted or new
comparability profit sharing 401k plans, defined benefit plans,
carve out plans or cash balance plans. All of these plans will usually include a safe harbor 401k provision for greater flexibility. So
check these out for your practice.
Do you have concerns about your own post retirement healthcare? What if you could set up a fund now that is tax deductible,
tax deferred and creditor protected that would reimburse you and
your spouse for any post retirement medical expense not covered
by Medicare including long term care, nursing home and much
more. These reimbursements would be tax free and can be passed
on to your spouse or children if not needed. These plans have
become very popular in the last few years and are worth looking
into if you have your retirement planning in order.
My last idea is a little more complicated and deserves much
more space than available in this article; however, I will throw it
out and hopefully will have the opportunity to expand on this
idea in future issues.
As many industries have fallen into recession, still others
remain somewhat insulated and immune to the recessionary
market forces. Most successful business owners want to create
wealth, protect their wealth, minimize required sharing of their
largess with their hard working staffs and access their wealth with
minimum interference from Uncle Sam.
18 FLORIDA MD MAGAZINE - JUNE 2010
Today, a near perfect opportunity
exists for successful entrepreneurs to
accomplish the following objectives
with the blessings and support of the
U.S. Treasury/Internal Revenue Service. These are Captive Insurance Companies (CIC).
• Contribute vast amounts of Pre-Tax Dollars (under IRC
831(b), $1,200,000 per captive insurance company)
• Grow the money over flexible periods of time (no 59 ½, no
70 ½, no eventual IRD treatment) on a tax favored basis (Receive the highest risk adjusted after tax return without downside risk)
• Asset Protection Structure – Protected from the claims of
creditors personally and professionally
• No contributions for any employees
• Ability to access the money on a most favorable tax basis while
living and passing assets to loved ones without gift and estate
tax
• Tax Favored access to assets based on clients advisors
a. Dividend rates at 15%
b. Capital Gains rate at 15%
c. Tax free
There is so much more we can discuss but for now you need to
start making inquiries so your 2010 tax picture may have a much
brighter outcome.
Stephen P. Toth is President of National Pension Associates, LLC and a partner in National Financial Network,
Inc. Both firms are located in Longwood, Florida. He attended New Hampshire College and The American College and acquired the Chartered Life Underwriter (CLU)
and the Chartered Financial Consultant (ChFC) professional designations. Steve specializes in finding creative
solutions to assist successful business owners and professionals with their retirement, wealth accumulation and
estate preservation needs. With forty years of experience,
he works with top professionals around the country. A
frequent speaker, he last spoke at The World Money Show
held in Orlando in February; his topic was “Four Secrets
Successful Business Owners and Professionals Use to Reduce Taxes and Create Wealth”. He has been married to
his lovely wife, Karen, for nearly forty-three years and
has one child, Danielle, who has worked with Steve since
graduating with honors from the University of Florida.
Steve may be contacted at (407) 834-6262 or stoth@
npa4142i.com 
ORTHOPAEDIC UPDATE
Orthopaedic Oncologist at
Orlando Orthopaedic Center Employs
High-Tech Treatments and Prosthetics
to Preserve Bone and Mobility in
Patients Facing Amputation
By Jennifer Roth Miller, Staff Writer
Orthopaedic oncology is a very specialized field with relatively
few doctors. In Central Florida, Craig P. Jones M.D., who is
affiliated with Orlando Orthopaedic Center, is essentially the
only fellowship-trained orthopaedic surgeon of his kind in the
area. Performing expert, dramatic surgeries that utilize leadingedge prosthetics, the surgeon is able to minimize amputation in
many more cases than in the past. The ability to salvage function
has increased dramatically over the years due to the increased
technology of implants and treatments. Dr. Jones performs
leading-edge reconstructions after tumor removal to help patients
recover efficiently and regain mobility so they can return to their
lifestyle with less debilitation than amputation.
Dr. Jones and his team treat benign and malignant bone and
soft tissue tumors as well as metastic lesions. Dr. Jones says, “Twothirds of the surgeries I perform involve muscoskeletal tumor
treatment.” He also aids in the management of orthopaedic
problems in oncology patients such as fractures, trauma and
arthritis. Some conditions he treats are bone cysts, osteomyelitis,
osteosarcoma, Ewing’s sarcoma and chondrosarcoma. In each of
these cases, Dr. Jones says, “I am able to offer options that can
avoid amputation of a limb and aid the patient in returning to
their previous way of life with less loss of function.”
Orthopaedic patients are in the best of hands at Orlando
Orthopaedic Center. Craig P. Jones M.D. is among the 16
board certified physicians across nine specialties at Orlando
Orthopaedic Center that provide a full range of world-class,
leading-edge orthopaedic services. Dr. Jones earned his medical
degree from Baylor College of Medicine in Houston, completed
a general surgery internship at Baylor under M. DeBakey M.D.,
completed a one-year residency in orthopaedic pathology at
Sinai Hospital of Baltimore, a residency in orthopaedic surgery
at the University of Pittsburgh Hospitals and a fellowship
in orthopaedic oncology at the Hospital for Joint Diseases in
New York City and at Mount Sinai Hospital. Dr. Jones is board
certified in orthopaedic surgery.
Osteosarcoma is the most
common type of bone cancer
and it generally affects young
people under the age of 25.
While the bones of children,
teenagers and young adults
are still growing, osteosarcoma
Craig P. Jones, MD
can develop. The osteoblasts
or cells that build up bone by
making bone matrix sometimes cause osteosarcoma to develop.
Most of these tumors develop in the bones around the knee,
either in the distal femur (the lower part of the thigh bone) or
the proximal tibia (the upper part of the large lower leg bone).
The prior standard treatment was amputation of the affected
limb and the five-year survival rate was less than 20 percent.
Currently, modular replacements and advances in chemotherapy
and radiation have revolutionized treatment, allowing most
patients to be treated with limb-sparing surgery. Five-year
survival rates are now approaching 60-80 percent.
Treating osteosarcomas involves surgically removing the
tumor. Unfortunately, along with tumor removal, some bone
loss is inevitable. This makes the technology of prosthetics so
important. Dr. Jones is utilizing very high-tech Stryker metallic
prosthetics that allow patients the opportunity to preserve
mobility and independence after the dramatic surgeries that are
required to remove and treat these tumors.
The advanced replacement system Dr. Jones utilizes in his
surgeries replaces bone on a modular, as-needed basis in the
hip, femur, knee and tibia. These metallic prostheses also feature
break-through bearing technology. Procedural and product
innovations have been created to stand the test of time. Utilizing a
polyethylene bearing material, the pioneering prosthetics reduce
wear by 97 percent while being proven to preserve mechanical
strength in lab testing. The prosthetics are also resistant to
oxidation.
Continued on page 28
FLORIDA MD MAGAZINE - JUNE 2010
19
20 FLORIDA MD MAGAZINE - JUNE 2010
Choosing a Malpractice Insurance
Company That Will Vigorously Defend You
By Matt Gracey
Defending claims is really where “the
rubber meets the road” in malpractice insurance! Doctors and their administrators
often get hung up in looking just at premium quotes, marketing slogans, brokers’
service or personalities, or insurance-policy provisions that they might or might
not like. The real reason one purchases
malpractice insurance is to be assured of a
strong and affordable defense if a lawsuit
is threatened or filed against your practice.
Unfortunately, figuring out each insurer’s
true claims-defense track record has been
tricky at best. The good news is that in
recent years, the Florida Office of Insurance Regulation (OIR) has been gathering more and more data on claims defense
and now has enough data to make for a
credible examination and analysis.
In looking at claims-defense records,
the most useful measurement index is
the one gathered on the percentage of
cases each insurer has closed without any
indemnity payment to the plaintiffs. A
higher percentage indicates a stronger
claims-defense philosophy. The industry
average in 2008 was just under 50% of
filed cases closed without any payment
to the plaintiff. One popular insurer’s
numbers have fallen rather dramatically,
from 90% of their cases closed with no
indemnity payment to only 37% of them
in the three-year span from 2006 through
2008, despite their marketing folks talking about their strong defense. This example demonstrates why doctors and their
administrators need to “look behind the
curtain” at the independent OIR data to
analyze what kind of claims-defense they
are really buying.
A few notes are important, though.
Some insurers’ marketing will show the
percentage of their cases closed with no
indemnity payment. However, some of
that marketing will skew that percentage
by including closed “incident reports” as
well as actual cases filed, to make their defense data look better. Also, some newer
or less-popular insurers have so few closed claims that their
percentage closed is almost meaningless. The top insurer in
Florida, FPIC, handles so many cases against their large number of Florida insureds that trying to compare their above-average percentage with another insurer handling a fraction of
their numbers can be a bit distorting. Experience does count
in Florida courtrooms though, and you can see from the OIR
reports how many more cases an insurer like FPIC handles
than their counterparts. The OIR data also show the average
defense costs spent by each insurer, which is another indication of an insurer’s defense
philosophy.
If you would like a copy of the most recent OIR report or to discuss your particular
insurer’s record, do not hesitate to contact us. We are independent malpractice insurance
experts and will help you through this maze and look out for you.
Matt Gracey is a medical malpractice insurance specialist with Danna-Gracey,
Delray Beach, 800-966-2120; [email protected]. Danna-Gracey offices
are located in Delray Beach, Orlando/Tampa, Jacksonville, and Miami. 
Treating Central Florida for over 25 years
Major Services include:
• Allergy Injections
• Allergy Testing
• Asthma Therapies
• Flu Shots (during Flu season)
• Pulmonary Testing
• Food Challenge
• Drug Challenge
• Exercise Challenge
Helping Patients with:
• Asthma
• Chronic Cough
• Drug, Insect and Food Allergies
• Eczema
• Hay Fever
• Hives
• Immunodeficiency
• Sinus Conditions
• And More!
Our physicians hold faculty appointments
at the Florida State University School of
Medicine and the University of Central
Florida School of Medicine and are
members of Florida Hospital Kid’s Doc’s
Board Certified Allergy,
Asthma & Immunology
& Board Certified Pediatrics
Steven Rosenberg, MD
Carlos Jacinto, MD
Winter Park
407-678-4040
Altamonte Springs
407-331-6244
Dr. Phillips
407-370-3705
www.aaacfonline.com
FLORIDA MD MAGAZINE - JUNE 2010
21
Treatment of the Child with Allergies
By Steven Rosenberg, MD
Every year millions of Americans,
both children and adults, develop “coldlike” symptoms during the spring and
fall. Many of these individuals think that
these symptoms are secondary to a “head
cold,” but in reality, they are caused by
allergies, or exposure to allergens circulating in the air.
Allergic disease has been documented
throughout recorded history. Archeologists have unearthed a report of an Egyptian Pharaoh who died from an allergic
(anaphylactic) reaction after being bitten
by an insect, most likely a honeybee in
ancient Egypt. In medieval Spain, the
philosopher/physician Maimonides was
asked to treat the son of the warrior Saladin who had Asthma. As a result, Maimonides wrote the first medical paper on
the evaluation and treatment of Asthma.
During the early part of the 20th century it was observed that farmers in upstate New York would develop cold like
symptoms when they would be working
with Hay. At that time physician began
to realize that certain individuals develop
symptoms including head and chest congestion after exposure to pollens, animal
danders, dust, and molds. These individuals were classified as being “allergic”.
In the early 1960’s the IgE antibody was
isolated and identified as the cause of allergic disease.
Allergic Rhinitis is known by many
other terms including Pollinosis, Hay Fever, and Rose Fever. It is thought that
the incidence of rhinitis in the general
population could range from 3-20%.
In children allergies to the environment
usually start after ages 2 years and will
usually peek during adolescence. In most
cases, individuals will develop clinical
symptoms of Allergic Rhinitis before the
age of 20 years. Allergies, unlike many
other illnesses, tend to be most severe
in late childhood and early adult life -times when individuals are expected to be
the most productive. Because of this, the
economic costs of allergies are quite high,
22 FLORIDA MD MAGAZINE - JUNE 2010
exceeding five billion dollars each year.
Rhinitis is the inflammation of the nasal membranes.
Individuals who have inflammation caused by allergies
are diagnosed as having Allergic Rhinitis. Individuals with
Seasonal Allergic Rhinitis experience symptoms when the
outdoor pollens are most elevated -- usually during spring and
fall. Other individuals will have their symptoms year around and
are known as having Perennial Allergic Rhinitis. In the Central
Florida Areas tree pollens such as Oak, Maple, and Elm cause
the most severe allergic disease. In the Northeast ragweed causes
the most severe symptoms. Perennial or year round allergies may
also be caused by exposure to animals, dust, including cockroach,
dust mites, as well as to mold exposure. Foods are an extremely
rare cause of nasal allergies. .
Symptoms of Allergic Rhinitis include sneezing at times paroxysmal in nature. Nasal irrigation and congestion can be a sign
of more severe or chronic nasal symptoms. Other symptoms include nasal pruritus or itching, rhinorrhea or nasal discharge,
and post nasal drip leading to throat irritation. Allergic Rhinitis may also cause headaches, eye irritation, and pharyngitis.
Comorbid conditions associated with Allergic Rhinitis will include Eustachian Tube
Dysfunction, which may lead to Chronic
Otitis Media. Chronic Sinusitis may also
be seen in individuals with Allergic Disease.
Other conditions may include tonsillar and
adenoidal hypertrophy, sleep apnea, chronic
headaches and especially Asthma. Children
suffering from allergic disease may perform
poorly in school secondary to their symptoms.
The diagnosis of children with allergic
disease includes taking a detailed clinical
history. In that allergic disease is inherited,
there is usually a family history of allergic
disease. Allergy testing is of paramount importance in the diagnosis. Skin testing done
including both epicutaneous and subcutaneous is still the “gold” standard to detect if
the child has allergies and to what allergen(s)
he/she is allergic. In offices not equipped for
skin testing, RAST testing may be substituted. IgE and Immunoglobulin levels are
also of benefit in the work-up of the allergic
child. Where sinus disease is suspected, obtaining a CT scan of the sinuses or the use of
Rhinoscopy may be of benefit. A nasal smear
for eosinophils may also be obtained. Tympanometry may be of benefit for the child
with suspected eustachian tube dysfunction.
Pulmonary Function studies, both pre and
post bronchodilator will be of use if Asthma
is suspected.
Treatment of the allergic child may be
multifactoral. Environmental control in
which the individual attempts to avoid exposure to those allergens, which may lead
to a flare-up of symptoms, is of paramount
importance. Such measures include avoiding
yard work and even staying indoors when
the outdoor pollens are high. Indoors, a thorough house cleaning, including steam cleaning of the carpeting and the furniture
may be of much benefit. Other preventative measures include
the removal of old pillows, which may be dust collectors, replacing the air-conditioning filter with a high efficiency filter, and
the purchase of an air-filtration device, especially for the child’s
bedroom. If the individual with allergies is allergic to animal
dander, the removal of the family pet from the family sleeping
quarters may also be beneficial.
Unfortunately, environmental control measures, alone, will
often not be sufficient to control the symptoms of an individual with allergies. In these individuals, pharmacologic measures
should also be utilized. The drug of choice for the treatment
FLORIDA MD MAGAZINE - JUNE 2010
23
of allergic rhinitis is the H1 histamine blocker or antihistamine.
First generation antihistamines used to be the mainstay in the
treatment of allergic rhinitis. Unfortunately these agents are lipophilic and can cross the blood brain barrier. This can result
in significant side effects which has included sleepiness, decrease
in cognitive functioning, and even paradoxical central nervous
excitation, First generation antihistamines will include agents
such as diphenhydramine, chlorpheniramine, hydroxyzine, and
brompheniramine.
Second generation antihistamines such as loratadine, desloratadine, fexofenadine, certirizine, and levocetirizine, are lipophobic and do not cross the blood brain barrier. Because of this,
these agents generally do not have the side effects commonly seen
with the first generation antihistamines and are now the drugs of
choice for the treatment of children with allergic disease. Many of
these agents are now available without a prescription. Antihistamines are generally most effective for treatment of nasal pruritus
and discharge as well as for the ocular symptoms often seen with
Allergic Rhinitis.
Topical nasal antihistamines such as azelastine and olopatadine are also affective for the treatment of Allergic Rhinitis. In
addition, these agents are mast cell stabilizers and may have antiinflammatory effects. Side effects, which may be seen with these
agents, includes a bitter taste and in some individuals sedation.
Unfortunately, antihistamines are of minimal benefit for the
individual with severe nasal congestion. For acute flare-ups of
nasal/sinus congestion, the use of a decongestant may be of benefit. However decongestants may cause significant side effects.
Chronic use of nasally administered decongestants may result in
tachyphylaxis and rebound congestion. Other adverse effects observed with the use of decongestants include elevation of blood
pressure, insomnia, chest palpitations, tachycardia and hyperactivity; because of this their use should be limited.
Nasal irrigation and aspiration with a bulb syringe may also
be of benefit, especially when copious nasal secretions bother the
child.
Nasal corticosteroids are thought to be the most effective
medication for the treatment of the individual with allergic nasal
symptoms. Their mechanism of action is the inhibition of the
inflammatory cascade seen in individuals with rhinitis. Unlike
antihistamines and decongestants, the nasal corticosteroids often
requires several days of therapy before appreciable relief is experienced by the patient. In addition, nasal corticosteroids may be
of benefit in the reduction of nasal/sinus polyps. Some studies
suggest that use of nasal corticosteroids speeds the response to
antibiotics in the treatment of acute rhinosinusitis. Preparations
currently available include mometasone, fluticasone, and ciclesonide.
Other medications, which may be of benefit for the treatment
of the child with nasal allergies, include agents such as the leukotrience receptor antagonists. One of these agents, montelukast
(Singulair) has been released for the treatment of Allergic Rhinitis. Some studies have shown these agents to be as effective as
antihistamines. Other agents include nasal cromolyn, anticholinergics such as Ipratropium bromide, which helps to reduce nasal
secretions, and topical eye drops for the individual with allergic
eye disease.
24 FLORIDA MD MAGAZINE - JUNE 2010
In the most severe cases, the individual may continue to experience symptoms despite aggressive therapy with the measures
listed above. These individuals may benefit from the use of allergy
injections or Immunotherapy. Immunotherapy is the administration of small doses of those allergens to which the patient is sensitive. By administration of such allergens, the allergic individual
will build up a blocking antibody and develop a tolerance resulting in a significant reduction in symptoms. Immunotherapy
may be of benefit to children age 5 and older who have proven
to be refractory to other modalities of therapy. It is thought that
allergen immunotherapy is the only benefit that can reduce the
severity of symptoms, alter the progression of the disease, and
induce long term remission.
Monoclonal anti-IgE or Xolair (Omalizumab) has recently
been introduced for the treatment of the individual with severe
Asthma. Its mechanism of action is the binding and inhibition of
IgE or allergic antibody. At this time Xolair has not been released
for children under the age of 12 years. However, some studies
have shown it to be effective for the treatment of individuals with
severe Allergic Rhinitis. It is hoped that in the future Xolair will
be useful for the individual with severe allergic nasal disease and
even with food allergy.
The Allergist/Immunologist is a physician who is a specialist
in the treatment of the patient, especially the child with allergic
disease. The allergic child who continues to experience symptoms,
despite the use of simple measures may benefit from a referral and
consultation by an Allergist. The Allergist is especially skilled in
skin testing and the use of allergy injections or Immunotherapy.
Allergies, especially allergic rhinitis, can result in a significant
amount of misery and loss of school and work time. But with
proper recognition and treatment, people who suffer from allergies can have their symptoms brought under excellent control.
Steven Rosenberg, MD has been practicing medicine in the
Central Florida area for over 20 years, specializing in the area
of Allergy, Asthma, and Immunology. He received the Doctor
of Medicine from the State University of New York, Downstate
Medical Center. Dr. Rosenberg completed a residency in
Pediatrics at the State University of New York at Buffalo
and a Fellowship in Allergy, Asthma, and Immunology at
the University of Pittsburgh. Dr. Rosenberg has held positions
as President of the Central Florida Pediatric Society, at the
Florida Allergy, Asthma, and Immunology Society, and on the
medical staff at Florida Hospital. In addition, Dr. Rosenberg
has held the position of Chairman, Department of Pediatrics
at Florida Hospital and is a member of many local and
national societies which include the American Academy of
Allergy & Immunology, the Florida Allergy and Immunology
Society, Florida Hospital Kid’s Docs and the Central
Florida Pediatric Society. He holds faculty appointments at
the University of Central Florida Medical School and the
Florida State University School of Medicine. For additional
information please contact him at 407.678.4040 or aaacf@
embarqmail.com. 
Four-Legged Employee Joins
Florida Hospital for Children
Facility Dog aids pediatric patients with the healing process
One of Florida Hospital for Children’s newest employees walks
on four legs and can drool at times but he is lighting up the faces
of patients in the hospital by providing unconditional love and
comfort. He is an assistance dog named Murray from Canine
Companions for Independence.
Murray, a two-year-old yellow Golden/Labrador Retriever mix,
works at the hospital as a Facility Dog, or an expertly trained dog
who can respond to more than 50 commands. Murray works
from 9 a.m. to 5 p.m. five days a week, wears an ID badge and
makes regular visits to patient rooms, but most importantly Murray helps pediatric patients feel comforted and cheerful while in
the hospital.
“Most hospitals don’t have a dog,” said 10 year-old patient
Mike Salamon. “Murray gets in bed and lays with me like my
dogs do at home. He keeps me company at the hospital and
makes me happy.”
Murray is a Facility Dog from Canine Companions for Independence (CCI) and works with Traci Woods, Florida Hospital
for Children’s family experience director. Unlike therapy dogs
who only visit the hospital for a short time, Murray is at Florida
Hospital for Children every day and the patients can get to know
Murray and spend extended periods of time with him.
“I wanted the patients to have something fun to look forward
to in the hospital besides procedures and tests and feeling sick,”
said Traci. “I think that dogs can help kids with the healing process by our patients’ spirits and letting them focus on something
else.”
Murray is truly a unique addition to Florida Hospital for Children. In fact, Murray is only one a few facility dogs across the
country who works in a children’s hospital. Florida Hospital for
Children made the decision to have a facility dog after a generous
donation from the Vivian and Barry Wood Trust was made the
hospital to help fund pet therapy programs.
Murray had to undergo a vigorous training program with CCI
for two years before he could be matched with a facilitator. Traci
also had to undergo two weeks of intense training to learn how to
work with and benefit from Murray’s skills. CCI assistance dogs
are provided free of charge, though costs to CCI exceed $45,000
to breed, raise, train and provide ongoing support. Charitable
contributions, grants, special events, and corporate support fund
the substantial costs involved with this process. 
FLORIDA MD MAGAZINE - JUNE 2010
25
Delivering a Personalized Birth Experience
Expectant mothers now have a choice in their delivery. Florida
Hospital Altamonte’s new hospital-based birth center provides
women with more birthing options within the safety of a hospital setting. Florida Hospital Altamonte’s Baby Place is the only
maternity unit to offer a birthing center within a hospital, which
allows women the opportunity to customize their birth experience, giving them more power and involvement in the birthing
process.
The incorporation of the birthing center experience was created
to offer women the opportunity to choose a birth plan that best
fits their individual needs, while still having immediate access to
advanced medical care. The hospital’s new birth coordinator will
work with each mom to answer questions, helping them create a
personalized birth experience that is best for mom and baby.
As a registered nurse, the personal birth coordinator will help
answer any questions from prenatal to postnatal care and delivery and pain relief options, so that moms know exactly what to
expect and can choose what is best for her and her baby.
In addition to traditional options, Florida Hospital Altamonte
specializes in alternative birthing methods for low-risk births,
including the use of birthing balls and squatting bars and offers
midwives and doula* services. Moms can choose from aromatherapy and personally selected music, as well as other relaxation
aids during labor and delivery. The hospital also offers new mobile fetal monitoring, enabling moms to walk around freely or
labor in a Jacuzzi tub, while continuing to monitor the baby’s
heartbeat.
The staff at Florida Hospital Altamonte’s Baby Place, strongly
believe in family-centered care and encourage their involvement
in the birth experience. Once the baby is born, moms can also
choose if they would like the baby to stay with them rather than
the infant nursery.
“We give moms the opportunity to partner with our doctors
and midwives to design the birth just the way they want it,” said
Jon Sweet, MD, Florida Hospital Altamonte obstetrician and
gynecologist. “More and more women desire a home birth, but
Florida Hospital can offer the comfort of the ‘home setting’ with
the safety of advanced hospital care. We pride ourselves on an
environment of knowledgeable, one-on-one care that emphasizes
each mother’s chosen experience.”
The Baby Place at Florida Hospital has been recently remodeled, with home-like décor and amenities, including wood floors,
lighting control, extra seating for family, upgraded linens and
toiletries, and a large screen television with free movies on demand and internet services, just to name a few.
For more information or for a personal tour, call 407-3035395 or visit www.FloridaHospitalBirthCenter.com. 
Personalized just for you
Free Amenities and Options:
Individual Birth Experience
• Concierge Services to fulfill any personal requests
• Customized Birth Plan to meet your needs
• Personal Birth Coordinator – available throughout
your pregnancy
• Midwife and Doula Services
Birthing Options
• Mobile fetal monitoring
• Foam wedges, bean bag rolls
• Squat bar, Kneeler, birthing balls
• Birthing Stool/Chair
Comfort and Relaxation Aids
• Jacuzzi tubs with pillow
• Music therapy
• Light control
• Aromatherapy
• Rice Heating pads
• Blanket warmer
• Hot/cold packs
• Massage aids
Home-like Atmosphere
• Personal Refrigerator
• Microwave
• IPOD docking station/CD Player
• Upgraded sheets/linens
• Meal for dad/significant other
• Large Screen TV with movies and internet
*Doula fees not included in hospital costs.
26 FLORIDA MD MAGAZINE - JUNE 2010
Wuesthoff Medical Center Melbourne Approved
To Provide Emergency and Elective Angioplasty
Cardiac Procedures
“New cardiac catheterization lab at Wuesthoff Melbourne to play a key role
in the treatment of heart patients”
Wuesthoff Medical Center Melbourne
has received approval from the state to
open a new cardiac catheterization lab to
provide emergency and elective angioplasty cardiac procedures.
A minimally invasive procedure to restore blood flow to the heart, angioplasties
are performed by placing a thin, balloontipped catheter into blocked heart arteries,
the balloon is then expanded to compress
against the artery wall to restore blood
flow.
introducing
Carlos Alemany, MD
Hematology & Oncology
Special Interest:
“With heart disease being the number one cause of death in the US, it was
important for Wuesthoff Melbourne to
provide comprehensive coronary interventions. This new service will contribute
significantly to the immediate treatment
of heart care for our patients,” said Bill
Hines, Wuesthoff Medical Center Melbourne administrator.
According to Hines, Wuesthoff Melbourne has always had the capability to diagnose and stabilize heart attack patients,
but not to provide treatment for those patients needing angioplasty procedures.
Located next to the hospital emergency
department, the nearly 600-square foot
cath lab contains state-of-the-art cardiac
imaging technology available around the
clock, 365 days a year.
“We are extremely pleased to provide
this advanced level of cardiac care to our
community,” added Hines.
Additional cardiac services performed
at Wuesthoff Medical Center Melbourne
are EKG’s, cardiac stress tests (nuclear and
exercise), ECHO cardiograms, diagnostic
cardiac catheterization, peripheral diagnostics, peripheral interventions, and cardiac pacemakers.
t #SFBTUDBODFS
The physicians of
Cancer Institute of
Florida are pleased
to welcome Carlos
Alemany, MD to the
medical staff.
Profile:
t'FMMPXTIJQJOIFNBUPMPHZBOEPODPMPHZ
at The Cleveland Clinic Foundation,
Cleveland, Ohio
t*OUFSOBM.FEJDJOFSFTJEFODZ5IF$MFWFMBOE
Clinic Foundation, Cleveland, Ohio
t#PBSEDFSUJöFEJO)FNBUPMPHZ0ODPMPHZ
and Internal Medicine
t&YUFOTJWFFYQFSJFODFEJSFDUJOHQIBTF
1,2, and 3 clinical trials
t -ZNQIPNB
t .VMUJQMFNZFMPNB
t (FOJUPVSJOBSZDBODFST
To schedule and appointment,
please call 407-291-8012.
Altamonte Springs
894 E. Altamonte Drive
Altamonte Springs, FL 32701
407-834-5151
East Orlando
7975 Lake Underhill Road, Suite 130
Orlando, FL 32822
407-303-6772
Orlando
2501 N. Orange Avenue, Suite 689
Orlando, FL 32804
407-303-2024
Ocoee
10125 W. Colonial Avenue, Suite 116
Ocoee, FL 34761
407-291-8012
t"VUIPSBOEDPBVUIPSPGNFEJDBMKPVSOBM
BSUJDMFTPOCSFBTUDBODFSMVOHDBODFS
lymphoma, anemia and multiple myeloma
www.cancerinstituteofflorida.com
For more information on Wuesthoff
cardiac services, log onto www.wuesthoff.
org. 
FLORIDA MD MAGAZINE - JUNE 2010
27
ORTHOPAEDIC UPDATE – Continued from page 19
Orlando Orthopaedic Center gives patients the best available options that allow them
to heal as quickly as possible so they can get back to their lives, families and work. That
is why Orlando Orthopaedic Center was named the “Best Orthopaedic Practice” in
Central Florida by Florida Medical Business in 2004.
Orlando Orthopaedic Center was established 38 years ago and provides a full range of
world-class, leading-edge orthopaedic services through its five convenient offices located
in Central Florida. The center was formed on the principles of offering these high quality
services in a cost effective manner through a highly trained integrated staff. Many of the
doctors, like Dr. Jones, are considered leaders in breakthrough medicine and are the only
doctors offering certain new, technologically advanced procedures in the area.
Orlando Othopaedic Center is committed to keeping patients active. In the extreme
cases presenting to Dr. Jones, every effort is made to preserve bone and minimize loss of
welcome
mobility. New technologies in prosthetics
and treatments are not only allowing much
higher survival rates, but are drastically
increasing the quality of these patients’
lives after surgery. In all that Orlando
Orthopaedic Center offers, preserving and
regaining mobility is of highest concern
so patients’ can remain active and return
to their prior activities. This philosophy
paired with top-notch specialists offers
patients options in their treatments to
minimize affect on their lives. 
ADVERTISERS INDEX
Advance Minimally Invasive
Surgery & Gynocology. . . . . . . . . 12
Allergy Asthma Associates
of CFL. . . . . . . . . . . . . . . . . . . . 21
CHETAN K. PATEL, MD
Associates in Dermatology. . . . . . 3
Director of the Spine Center at Altamonte
Doctors Broker. . . . . . . . . . . . . . 10
Board Certified by the American Board of
Orthopaedic Surgeons
Dr. Carlos Alemany. . . . . . . . . . . 27
Global Faculty Member, Nicholson Center
for Surgical Advancement
Dr. David S. Klein. . . . . . . . . . . . 22
SPECIALIST IN MINIMALLY
INVASIVE BACK AND
NECK SURGERY
Chetan K. Patel, MD is dedicated to offering
comprehensive care for all spinal disorders
with the least invasive means, including
reconstructive surgery of the neck and back.
Now ACCEPTiNg NEw PATiENTs
661 East Altamonte Drive, Suite 222
Altamonte Springs, Florida 32701
(407) 303-5452
floridamdmagazine.com . . . . . Back
Cover
Florida Hospital
Altamonte. . . . . . . . . . . . . . . . . 28
Florida Hospital
Recruitment. . . . . . . . . . . . . . . . 14
KD Interactive . . . . . . . . . . . . . . 25
M D Anderson
Cancer Center. . Inside Front Cover
March of Dimes Mud Volleyball
Registration Form. . . . . . . . . Inside
Back Cover
National Financial Network. . . . . 16
Orlando
Orthopaedic Center . . . . . . . . . . 15
Pharmacy Specialists. . . . . . . . . 23
Tim Kelly Portraits . . . . . . . . . . . 20
201001318
28 FLORIDA MD MAGAZINE - JUNE 2010
March of Dimes Mud Volleyball!
Sign Me Up For Some Mud Slinging Fun! Event date: Sat. Aug 21st
Team Name: _________________________________________________________________________
Two divisions….Pick one for your team.
Recreational Division________
(We just want to have a good time)
Competitive Division________
(We play more regularly and compete on a higher level)
Team Captain Name: ____________________________ E-mail _______________________________
Number of Team Members: ______ We’ve raised enough to be a Club Mud Team! ($1500 raised)______
Company/Organization Name: __________________________________________________________
Address: ___________________________________________________________________________
Address 2: __________________________________________________________________________
City _________________________________________
State __________ Zip _______________
Phone _____________________________________ Fax __________________________________

My Team wants to go straight to Club Mud! We are sponsoring a team and paying the club mud fee for $1950!

My company is ready to get muddy, buddy! We are sponsoring a team for $450 ~ before August 1st.
($1500 additional funds raised by team/company gets team into Club Mud!)

My company is a little piggy who forgot to check the calendar. We are sponsoring a team, after August 1st, for $500.
PLEASE MAKE ALL CHECKS PAYABLE TO THE MARCH OF DIMES! OR YOU CAN USE YOUR PLASTIC!
Visa/Master Card (circle one)_____________________________________________________
American Express______________________________________________________________
Name as printed on card _____________________________Expiration Date ______________
Please return by fax to (407) 599 - 5870
Or mail to: March of Dimes / Mud Volleyball Challenge • 341 North Maitland Avenue, Suite 115 • Maitland, Florida 32751-4761
First come, first serve! Sign up now to save your team’s spot in the mud! Date: August 21, 2010 at Lee Vista Center at
8:00A.M. - ??? DON’T FORGET: Teams may only have 6-10 players and 2 female players on the court at all times!.
Rules will be piggly enforced!
Questions? Call our office at (407) 599-5077 or email us at [email protected]
A COPY OF OUR OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER
SERVICES BY CALLING 1-800-435-7352 TOLL-FREE WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT.
REGISTRATION NUMBER SC-00569
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