The CDC reported November 19, 2012 that the updated number of people infected with fungal meningitis has climbed to 490, and the number of related fatalities is now at 34.
Congressional hearings took place on November 14 and 15 to determine what went wrong at the New England Compound Center now at the center of the growing fungal meningitis outbreak.
According to data released by Medscape Medical News, physician employment by hospitals has increased since 2000. This increase is partly due to the protection that working for a large entity affords a physician. Many physicians feel that they can truly focus upon their specialized field by working in a hospital environment, as opposed to opening a private practice.
Working for a hospital relieves the physician of trying to keep up with complex private health care insurance and government regulations, investing in medical equipment and technology, marketing and HR issues. While owning a private practice gives a physician more independence and the physician is not constrained by the hospital’s policies or procedures, the private-practice physician must be concerned with all the business issues, which could be undertaken by a hospital employer.
It seems the current trend is leaning toward more physicians choosing to work for a hospital, with the private-practice physician becoming rare. But, as Uwe Reinhardt, Ph.D., a healthcare economist at Princeton University, told Medscape, “Don’t forget, there are cycles. Some years from now, there will be a whole new trend. Physicians working in hospitals will see what is profitable and what is not, and will jump out and establish practices in the profitable things.”
Meiselman, Denlea, Packman, Carton & Eberz P.C. offers legal advice to physicians on medical issues. If you need legal assistance or guidance on a matter regarding your practice, please call our office.
Ayalew Tefferi, M.D., with the Department of Hematology at Mayo Clinic in Rochester, Minn., discusses the results of a study of 1,000 patients who have primary myelofibrosis.
Key findings Researchers found that when patients with myelofibrosis present, their clinical features are not at a steady state and usually progress within the first few months of the diagnosis. It is best to wait a several months before providing a prognostic score.
Many patients with primary myelofibrosis can live a long life (exceeding 15 years) and patients who won’t live that long can be identified.
The most recent version of DIPSS-plus scoring system performed much better than prior versions, helping researchers to determine what proportion of patients with myelofibrosis are suitable for therapies. More than 50 percent of patients require observation alone.
A description of the study is included in the January 2012 issue of Mayo Clinic Proceedings.
ABSTRACT Objective To share our decades of experience with primary myelofibrosis and underscore the importance of outcomes research studies in designing clinical trials and interpreting their results.
Patients and methods One thousand consecutive patients with primary myelofibrosis seen at Mayo Clinic between Nov. 4, 1977, and Sept. 1, 2011, were considered.
The International Prognostic Scoring System (IPSS), dynamic IPSS (DIPSS), and DIPSS-plus were applied for risk stratification. Separate analyses were included for patients seen at time of referral (N=1000), at initial diagnosis (N=340), and within or after 1 year of diagnosis (N=660).
Results
To date, 592 deaths and 68 leukemic transformations have been documented. Parameters at initial diagnosis vs time of referral included:
Median age (66 vs 65 years)
Male sex (61% vs 62%)
Red cell transfusion need (24% vs 38%)
Hemoglobin level less than 10 g/dL (38% vs 54%)
Platelet count less than 100 × 109/L (18% vs 26%)
Leukocyte count more than 25 × 109/L (13% vs 16%)
Marked splenomegaly (21% vs 31%)
Constitutional symptoms (29% vs 34%)
Abnormal karyotype (31% vs 41%)
Mutational frequencies were 61% for JAK2V617F, 8% for MPLW515, and 4% for IDH1/2.
DIPSS-plus risk distributions at time of referral were 10% low, 15% intermediate-1, 37% intermediate-2, and 37% high. The corresponding median survivals were 17.5, 7.8, 3.6, and 1.8 years vs 20.0, 14.3, 5.3, and 1.7 years for patients younger than 60 years of age.
Compared with both DIPSS and IPSS, DIPSS-plus showed better discrimination among risk groups. Five-year leukemic transformation rates were 6% and 21% in low- and high-risk patients, respectively.
Conclusion The current document should serve as a valuable resource for patients and physicians and provides context for the design and interpretation of clinical trials.
At first glance, LASIK can seem like a confusing or complicated subject. As a result, many patients don’t explore their LASIK options, for fear of being misinformed or not understanding the procedure completely. Because we want all our patients to find out what laser vision correction can do for them, we thought we would take a moment to “de-mystify” LASIK and answer some of the most common questions we’re hearing. It’s time to set the record straight!
Here is our list of the Top 5 Patient Questions About LASIK:
What is LASIK in a nutshell? The goal of a LASIK procedure is simple: to improve vision and reduce a patient’s dependence on corrective lenses. The procedure uses special light energy to reshape the cornea, effectively combating the affects of nearsightedness, farsightedness and astigmatism.
Are all LASIK procedures the same? There are several types of LASIK procedures available today – each with their own unique benefits. Our practice is proud to offer what many are considering the gold standard in modern laser vision correction: iLASIK™. Using 3D eye mapping to create a fully-customized treatment plan, iLASIK is completely bladeless and relies on cutting-edge “cool laser” technology to safely reshape the cornea.
Is LASIK painful? While tolerance can sometimes vary, LASIK is generally regarded as a “relatively painless” procedure. Very often, the only sensation patients report is a slight pressure. Furthermore, we work to ensure patient comfort by administering numbing eye drops before the procedure.
Are most patients happy with their results? While each patient is different and can expect unique results, LASIK tends to be a highly successful procedure. In fact, “LASIK vision correction has the highest patient satisfaction rate of any elective surgery,” reports The Eye Surgery Education Council, “95.4%, according to a 10-year survey of scientific studies from around the world.”
How can I find out if LASIK is right for me? In general, LASIK patients tend to be in good health, free of eye conditions such as cataracts, over the age of 21. But, since there are other factors to consider in determining a good candidate for LASIK, we encourage anyone interested to schedule a consultation and find out what laser vision correction can do for them.
Considering LASIK? Learn More Today
To learn more about Laser Eye Surgery, contact us today. Together, we can find the best treatment options for you. Our offices are located in Winchester, serving Virginia, West Virginia and Maryland. Book your appointment at (540) 722-6200.
There are a few different types of spinal injections, categorized by what is being injected and where the injection takes place. This video explains epidural steroid injections, selective nerve root blocks, facet joint injections, radiofrequency neurotomies, and sacroiliac joint injections, along with why and how each type of injection is used.
In discussing common spinal injections, it's important to remember what we’re trying to achieve and then choose the appropriate tool for the job. So, to discuss the injections, we'll break them up into small categories.
Epidural steroid injections can be done in mainly two ways. First of all, what we're trying to achieve is to place the steroid into the epidural space. Epidural space in itself denotes space that is intimately located above the dura. Dura is the outermost layer covering the spinal cord and the nerves that exit the spinal cord. Most of the inflammation occurs in that area and that is the area that we can place the medications most safely. This can be approached in two ways. One is what’s called "interlaminar" - that means between these lamina. That can be approached from what's called paramedian - or just off the mid-line - approaching this way. Another approach is called the transforaminal - what that means is "across the foramen." Foramen being this opening through which the nerve exits. The approach is taken by going into space where the nerve usually doesn't appear and this is done under the guidance of x-ray or fluoroscopy.
Another type of injection is called selective nerve root block. Selective nerve root block is selectively choosing a specific nerve in order to determine whether that nerve is causing the pain. And in order to that, we approach under the guidance of fluoroscopy, to target a specific nerve then place a small amount of (usually) contrast to outline that we are really concentrating on this nerve root, then place a very small amount of anesthetic. Now, the small amount is important because we don't want that that anesthetic to spread anywhere else and affect our outcome. If the pain is relieved with this injection, then we know that was the cause of the pain or a pain generator.
Another injection is a facet joint injection. This can be approached in two ways. One is the injection into the joint itself and in order to do that we use fluoroscopy for guidance and we approach the joint itself, going into the joint, and then place the medication into the joint. And the reason to do that is (1) to determine if injecting anesthetic and corticosteroid will relieve the pain - and that is the diagnostic part of this - and (2) the corticosteroid reduces the inflammation.
Another way to approach facet mediated pain is by blocking the nerve that actually transmits that pain. And the reason we can do that is because, anatomically, it is consistently found in the same place. It is found traveling along this path. And what we can do, once again under fluoroscopic guidance, we approach the anatomical location of this branch placing a small amount of medication, blocking the transmission of that nerve temporarily. And that, once again, diagnostically tells us: if we block this nerve, does this relieve the pain? Now, it’s not as simple as that because there are two nerves that usually supply each facet joint, so in order to really effectively block one joint, we have to block two nerves and that way we know that joint is blocked and then we see if it truly alleviates the pain or not.
That leads me into another type of an injection, which truly is not an injection, but more of an intervention to treat facet joint pain - that is the medial branch rhizotomy. And in order to do that, what we do is we place a probe - that is just like a needle - along the path of this medial branch and then we use radiofrequency to concentrate at the tip of that probe to heat it up and then lice the little nerve that travels along the path, effectively eliminating the transmission of the pain. The effect of this doesn't happen right away; it takes several weeks to take effect, but it provides a longer-term relief for people suffering from facet mediated pain.
Another type of a spinal injection is used to treat and diagnose sacroiliac joint pain. So, once again under fluoroscopic guidance in order to ensure the safety as well as the precision, we go into the sacroiliac joint placing a small amount of contrast to outline where the medication is going to spread, then we use a small amount of anesthetic with corticosteroid. The anesthetic serves as the diagnostic portion - if the pain is eliminated, then we know that was the pain generator and we've effectively diagnosed sacroiliac joint pain. Then, corticosteroid reduces the inflammation that usually is the cause of the pain and that is the therapeutic portion of this.
There are many other interventions that we can use for the spine, but these are the more common ones.
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Grochmal Eye Center Adds Hi-Def Cirrus Laser Eye Surgery Technology
The Grochmal Eye Center is a Baltimore LASIK surgery practice, offering complete and comprehensive eyecare for the entire family. Dr. Jay C. Grochmal is announcing the addition of the Cirrus™ HD-OCT by Zeiss, which he says helps him visualize and analyze the status and health of the retina. In particular, the Cirrus™ technology allows him to assess the health of his patients’ eyes prior to performing a number of procedures, including traditional cataract surgery and refractive lens exchange.
The Grochmal Eye Center was founded in 1978, and continues to provide state-of-the-art eye care and laser eye surgery procedures, such as PRK and LASIK in Maryland under the leadership of Dr. Jay C. Grochmal. As part of their commitment to the cutting-edge of ophthalmic technology, Dr. Grochmal is announcing the latest addition to the practice: the Cirrus™ HD-OCT by Zeiss. He says the new technology will help him and his staff diagnose any changes in the macula caused by different diseases, such as macular degeneration, diabetic retinopathy, or glaucoma. He adds that early detection of these diseases will enable him to start treatment before permanent vision loss occurs.
Zeiss is one of the world’s leading medical technology companies. Founder Carl Zeiss was the first to commercialize the OCT technology, and the first to deliver the high definition 3D maps created by the Cirrus™ HD-OCT. Dr. Grochmal says the new technology not only helps him detect potentially damaging eye conditions, but also helps him improve the overall level of care he can offer his patients. The printouts from the OCT are very helpful, according to Dr. Grochmal, as they aid in educating his patients and help them gain a better understanding of the disease and procedure.
Whether he is performing refractive or cataract surgery, LASIK or PRK, Dr. Grochmal says he and his team tirelessly pursue the latest advancements in eye care and laser eye surgery to ensure their patients receive the best care available. “The advancements in ophthalmology in just the last ten years are astounding; staying on top of these developments is essential to our continued dedication to providing state-of-the art treatment. Our patients deserve only the best, and that is what we constantly strive to offer.”
About Dr. Grochmal
Dr. Jay Grochmal earned his medical degree from the University of Maryland. He then completed a rotating internship with the U. S. Public Health Hospital in Baltimore, MD. After becoming the Chief Resident at the Greater Baltimore Medical Center’s Department of Ophthalmology, he completed his residency and established the Grochmal Eye Center. Dr. Grochmal is currently on staff at some of the top hospitals in Baltimore, and continues to offer his expertise and skill to medical missionary trips around the globe.
The Grochmal Eye Center is located at 405 Frederick Rd., Ste. 102 in Baltimore, MD 21228, and can be reached at (410) 697-4090, or found online at www.grochmaleye.com or the Grochmal Eye Center Facebook page.
When pain persists after back surgery, the true cause of the patient's pain needs to be re-evaluated. It may be the case that the surgery was performed to address an issue that was not the true pain generator. It may also be damage from the surgical procedure itself that is causing pain. In a spinal fusion surgery, the mechanical changes to the spine may cause new pain to develop. All these things are considered to evaluate the cause of the post-surgical pain.
Failed back surgery syndrome is a term that is used to describe pain that starts or persists after spine surgery. The important thing to remember is that spine, in itself, serves a certain purpose; it solves a number of problems, but, as with any other tool, it has its own limitations. So, sequelae of the surgery can cause pain, but also at the same time, surgery cannot address all the pain generators. So in looking at it like this, we can actually turn our attention away from the aspect of the surgery and now refocus on the patient and look at the pain generators in that patient in the context of their life and in the context of their overall function. By looking at it like that, we can actually start treating the pain generators and really get to the source of the majority of the pain that's generated after the surgery.
So what we need to look at is the physiologic changes after the surgery. Those are:
Depending on the surgery, the mechanics of the spine will change. Now, if it's fusion surgery, then what happens is that two segments, for instance, that are being fused are no longer moving on their own. They are now moving in unison, which in effect creates a single segment. Because that single segment is no longer taking up the work of two segments, separately, it is now functioning as a single segment, which means - and this is for simplicity sake - we can say five segments doing 100% of work and that's 20% per segment, now we eliminate two or three segments, per se, and now 33% falls on each segment. Now you can imagine that with additional force going through that segment, there's going to be motion, more wear-and-tear, and more potential pain caused by that segment. And that's usually referred to as "adjacent segment disease." And that’s one of the post-surgical effects.
Another effect is the actual tissue damage that can happen after surgery. So, myofascial pains can happen after a separation of tissue. When that tissue comes back together, the connective tissue may cause fibrosis - and that can trap nerves - or in itself become tight and painful. That can be treated in a separate way.
Going back into the increased motion at separate segments, we have to remember that the motion actually happens across facet joints. Those joints are hinge-like joints - they are small joints - and those joints are just like any other joint in our body, which means it can get inflamed just like any other joint and that usually happens through overuse. Treating those joints usually resolves the pain that is associated with those joints and in that way, we can restore the function that was lost through the inflammation and alleviate the pain.
There are many other pain generators that need to be looked at and can certainly be treated with appropriate diagnosis and treatment.
Treatment of pain persisting after surgery should be approached in a systematic way. Diagnosing each pain generator and eliminating the pain generators can serve to restore function and eliminate pain and in order to do that, we can employ a number of different tools that are available to us. And those include a wide array of the tools. Now it can be manipulations, it could be physical therapy, at times injections, or at times if we need to things like spinal cord stimulation or implantable pumps that can supply a steady state of medication can be used to control the pain. By using all the tools that are available to us, we can really improve the patient's quality of life by doing two very important things: decreasing the pain and restoring function. That way, they can reintegrate back into life and not be limited by pain or by mobility.
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Forefront is a complimentary magazine from the Mayo Clinic Cancer Center, a National Cancer Institute-designated cancer center located in Arizona, Florida and Minnesota. The Cancer Center specializes in translational research and the effort to discover better ways to prevent, detect and treat cancer. It serves diverse patient populations across a broad geographic area and collaborates across the full spectrum of cancer research, from basic biology to treatment.
Email edition available Forefront articles highlight Mayo Clinic’s cancer research and its translation into clinical advances. Forefront is published in print and online annually, but beginning in summer 2012 a complimentary quarterly email edition will also be available. Subscribers to the email version receive:
A Supreme Court ruling in June 2011 ended state-law claims against generic drug manufacturers (link to previous article) because the drug manufacturers are obligated by federal law to provide drug labeling that is identical to the drug’s brand-name counterpart. However, there seems to be a way around this ruling, which is being used by some plaintiffs who have been harmed by taking generic brand drugs.
In a recent federal court case, Cooper v. Wyeth, plaintiffs claimed that the manufacturers of the generic drug, metoclopramide (an acid reflux medication), failed to update the warning label, in a timely manner, to match its brand-name drug, Reglan. As such, the claims against the manufacturer were recognized as valid arguments in federal court. This “failure-to-update” claim has been used in other federal court cases (Fisher v. Pelstring and Couick v. Wyeth) with positive results for plaintiffs.
It is federal law that generic drug labels match their brand-name equivalent. Failure to update the labels timely, and in accordance with the FDA-approved changes for the branded label, would give some legal recourse to consumers who may have had an adverse reaction to a generic-brand drug.
Whether the courts will continue to recognize “failure-to-update” claims remains to be seen, but for now, there seems to be a legal avenue for damages for those who have been harmed by taking a generic drug.
We were recently privileged to have New York Times bestselling author, and former Navy SEAL, Brandon Webb, speak at Eye Consultants of Texas in Grapevine. It was the idea of founder Phillips Kirk Labor, MD, to host this event, primarily for his staff and a group of local law enforcement officers, as well as special guests.
A highly sought-after motivational speaker, Brandon focused his talk on the importance of attention to detail and striving for excellence. His New York Times bestselling book, The Red Circle, shares his personal story of dealing with adversity in a positive and constructive way, and passes on valuable leadership lessons he learned as a Navy SEAL. Everyone in attendance at our practice was incredibly inspired, just like all of Brandon’s audiences in his speaking engagements across the U.S.
In addition to inviting him to speak, Dr. Labor invited Brandon into the operating room to observe actual cataract procedures. Recently, Brandon wrote about his Eye Consultants of Texas visit and experiences in his blog.
Here is an excerpt from Brandon’s blog:
“The last part of September I had a chance to visit with Dr. Kirk Labor and his team at Eye Consultants of Texas. I was invited to sit in on a few Cataract procedures, and actually assisted in a minor way. I’ve been fortunate to tour plenty of U.S. companies when I was an active SEAL and after. Companies like Smith & Wesson, Nixon, ABC news, St. Martin’s Press, L-3, and many others. I can honestly say that Dr. Labor and his staff run an excellent facility and operation compared to these other organizations. They set the bar high, and are far ahead of the competition from my perspective. I’d highly recommend his facility to anyone regardless of your geographic location. For now, my own sniper eyes are good-to-go, if they start having problems I’ll have no problem flying to Texas. Excellence matters and I want only the best working on my eyes.”
In an email to Brandon, thanking him for coming, Dr. Labor said:
“The reports I have from those in attendance have been nothing but positive. I really think it helped my staff to hear about those attributes from someone other than me, and will serve the practice and my patients well going forward. I hope you enjoyed being here as much as we enjoyed having you. I know the girls in the operating room loved having you there (as did the patients; particularly the Vietnam veteran we operated on)!”
Baltimore, MD – According to the Administration on Aging (AOA), persons 65 and older represented nearly 13% of the U.S. population in 2009, and are expected to represent 19% by 2030. The Bureau of Labor Statistics finds that the number of older Americans in the workforce is growing as well. As the population and workforce ages, Baltimore eye surgeon Jay C. Grochmal, MD says his patients that are late stage baby-boomers are under extreme pressure to maintain a high level of performance in the workplace, and portraying a vivacious and youthful appearance is essential to continued success.
While helping patients improve their vision with procedures such as LASIK and cataract surgery is important to success in the workplace, Dr. Grochmal says the desire to help his patients enhance their aesthetic appearance has become an important part of his practice as well. He says this growing demand for increased confidence and a natural-looking enhancement is what led him to the decision to add cosmetic eyelid surgery to his list of procedures: “Our society places such a high value on appearance and equates a youthful look with the likelihood of business and social success. Baby boomers are still very active and productive and a refreshed look can eliminate unwarranted bias in career choices.”
As the number of cosmetic procedures performed in the U.S. continues to increase, Dr. Grochmal says the desire to look younger longer is obvious, adding that a tough economy and high unemployment rate further contribute to the stress his older patients must endure. Because he constantly strives to improve patient care while providing the latest and safest procedures, Dr. Grochmal says providing cosmetic treatments for his patients is a result of his original commitment to provide the most effective treatments available to meet any and all needs of his patients: “As the cliche goes now, 50 is the new 40 and 60 is the new 50, and so on. My patients want to look as young as they feel and be able to see well too. Ultimately, we believe providing cosmetic eyelid surgery will improve their chances of success in the workplace.”
About Jay C. Grochmal, MD
After earning his medical degree from the University of Maryland, Dr. Jay C. Grochmal completed his residency while achieving the rank of Chief Resident at the Greater Baltimore Medical Center’s Department of Ophthalmology. In addition to being on staff at some of the leading hospitals in the Baltimore area, Dr. Grochmal has traveled on a number of missions dedicated to improving eye care around the world.
Grochmal Eye Center is located in the Catonsville Professional Center at 405 Frederick Rd., Ste. 102, Baltimore, MD 21228, and can be reached at (410) 697-4090. Dr. Grochmal and his team can also be reached at grochmaleye.com or their Baltimore Eye Care Facebook page.
The first outbreak of cholera in over a century has been reported by the Cuban Ministry of Public Health. The risk to travellers is low, but they should be aware that Cholera can be spread via food being prepared by a person who is ill with the disease.
Travellers are advised to take care with food and water, and to ensure they eat seafood such as crabs and crayfish only when it has been cooked through and is thoroughly hot.
Source: ProMed Newsgroup Aug 2012
For further advice, contact the Globe Travel Health Centre on 01603 667323
As an ophthalmologist in Winchester, one of the top questions I’ll hear time and time again is, “Is LASIK right for me?” And, simply put, there’s no simple answer! Only a qualified medical professional can determine if LASIK’s right for you. There are, however, certain factors that good LASIK candidates share. Not sure where to look? To get you started, here are a few questions to ask yourself:
Are you in good health? Good candidates for LASIK are healthy and free of autoimmune disorders such as Lupus, HIV and muscular sclerosis.
Do you have any eye conditions? Certain eye conditions are not compatible with laser eye surgery. Often, these include cataracts, chronic corneal infections or keratoconus.
Are you the right age? In the US, LASIK is FDA approved for patients over the age of 18. On the other hand, if you’re worried you’re too old for a LASIK procedure, consider this: Reporting on a recent study on LASIK in older patients, WebMD explains that, “Patients in their 60s were just as likely to have good [LASIK] outcomes as those in their 40s and 50s.”
Is your dependence on glasses or contacts holding you back? For many patients, reducing their dependence on glasses and contact lenses is a major reason they’re exploring LASIK in the first place. A lot of folks find glasses and contacts to be uncomfortable, inconvenient and unattractive. And, while it can’t guarantee that you’ll never need to put on a pair of glasses again, LASIK will very often reduce a patient’s dependence on them.
Are you ready to learn more? Finally, a good LASIK candidate is an informed LASIK candidate. Be sure to understand the potential risks and benefits of the procedure, maintain realistic expectations, and most importantly, schedule a consultation with a qualified LASIK surgeon.
Schedule a LASIK Consultation Today
To learn more about laser eye surgery, don’t hesitate to contact us today. Together, we can find the best treatment options for you. Our offices are located in Winchester, serving Virginia, West Virginia and Maryland. Book your appointment at (540) 722-6200.
Generic drugs account for almost 80 percent of all prescribed medications in the United States and most states allow generic drugs to be dispensed in place of brand-name drugs. This is quite a large number of generic drugs being taken by quite a large number of the nation’s population. The possibility of people who take generic drugs and having reactions to the drugs is also large – unfortunately, this is what is happening across the country. People, who are taking generic drugs, are having severe complications from taking the drugs. Reactions to these generic drugs are very serious, with some consumers developing inflammatory bowel disease, gangrene, and even movement disorders.
What is even more distressing is that the manufacturers of these generic drugs are protected by a U.S. Supreme Court ruling. In a 5-4 decision, the Supreme Court ruled in June 2011 that makers of generic drugs cannot be sued for not including side-effect warnings on their labels, if the warnings are also not on the labels of their brand-name equivalent. This makes it difficult for consumers who may not know they are receiving a generic form of a drug, such as in a hospital, or may be required by their insurance plan to fill a prescription with a generic drug. If they develop a medical issue while taking a generic form of a prescription drug, they basically have no legal remedy.
The Supreme Court ruling is based on the Hatch-Waxman Act of 1984. This law allowed companies to skip the involved process required to approve new drugs, if they could prove that the generic drug was equivalent to its brand-name counterpart. However, Representative Henry A. Waxman, who co-wrote the Act, has stated that “Congress did not intend for consumers’ rights to be categorically eliminated simply because they purchased a generic rather than a brand-name drug.” Mr. Waxman is investigating a change in the ruling.
Consumers should protect themselves and do their own research before taking any drug – check with your doctor about generic versus brand-name prescriptions and find out about all the possible risks and side effects.
Tired of having to wear glasses or contact lenses? Thinking of LASIK but don’t want to hear the same old rhetoric? Attend the Eye Consultants of Texas 60-Minute LASIK Campaign Event, Tuesday, September 25, 2012 from 6:30 to 7:30 PM. It’s Free, it’s only one hour, and we’re hosting it at our beautiful Grapevine offices – convenient to Fort Worth and Dallas.
Led by one of our expert doctors, you’ll learn all about the LASIK procedure, costs, financing, generally what to expect, and if you’re a candidate for LASIK. Not only will we give you the straight story, you’ll have plenty of opportunities to ask questions.
In addition, just for showing up you can register to win 2 Cuervo Club Rangers seats, given away at the conclusion of the event.*
LASIK is an elective procedure, so it’s important to go into it with open eyes. Please join us September 25 for this informative 60-minute event. To reserve your space, call us in Grapevine at 877-516-4364. Must be 18 years or older to attend. *Determined by random drawing. No purchase necessary, must be present to win.
As we’ve mentioned here before, LASIK has become a household word to anyone relying on glasses or contact lenses for everyday things. There’s no shortage of info out there, and much of it can be confusing, or written like an owner’s manual. At Eye Consultants of Texas, we cover the bases in educating our Dallas/Fort Worth LASIK patients, and try to do this as simply as possible. With that in mind, this is the first in a series of blogs we’ll be posting to highlight the basics of LASIK, in hopes of putting LASIK medical-speak more into simple-speak.
First Things First. LASIK is a simple, painless procedure that can be performed quicker and safer than ever before, mostly thanks to technological advancements. LASIK is also surgery on your eyes, so you owe it to yourself to understand the benefits, risks, and everything else about it. And to choose a skilled doctor who’s on your side.
How Long Has LASIK Been Around? A question to this that often follows is, “how many LASIK procedures have been performed?” To answer this objectively, we’ll go to a reputable source. According to the American Academy of Ophthalmology (AAO), LASIK was first FDA-approved in 1998. Since then, the AAO estimates that nearly 10 million procedures have been performed in the U.S. (an average of 700,000 each year). Worldwide, this number is double by some estimates you might find.
Why Would Someone Get LASIK? People who have LASIK performed are usually those that have to rely on glasses or contact lenses for everyday activities. Sometimes they opt for LASIK so they can see better and look better, or simply because they’re tired of having to wear glasses all the time. Sometimes LASIK may be the best solution if corrective eyewear is no longer doing the trick. Whatever the reason, it’s important that your vision health and overall health checks out, that you’re fully informed, and that you’re over 18 years of age. In other words, you have to be a candidate for LASIK to have it done. If for any reason you’re not, there are other options your doctor can tell you about.
Look for more in our next Simplifying LASIK Basics blog coming soon. Meanwhile, if you’d like to know more about LASIK at Eye Consultants of Texas, please call our office in Grapevine at 877-516-4364, conveniently located to Dallas/Fort Worth.
This blog is a general overview of LASIK surgery for general informational purposes only, and in no way intended as actual medical advice. Always seek a medical or eye care professional for advisement based on your individual health and eye care needs.
The first outbreak of cholera in over a century has been reported by the Cuban Ministry of Public Health. The risk to travellers is low, but they should be aware that Cholera can be spread via food being prepared by a person who is ill with the disease.
Travellers are advised to take care with food and water, and to ensure they eat seafood such as crabs and crayfish only when it has been cooked through and is thoroughly hot.
Source: ProMed Newsgroup Aug 2012
For further advice, contact the Globe Travel Health Centre on 01603 667323
There are a few different types of spinal injections, categorized by what is being injected and where the injection takes place. This video explains epidural steroid injections, selective nerve root blocks, facet joint injections, radiofrequency neurotomies, and sacroiliac joint injections, along with why and how each type of injection is used.
In discussing common spinal injections, it's important to remember what we’re trying to achieve and then choose the appropriate tool for the job. So, to discuss the injections, we'll break them up into small categories.
Epidural steroid injections can be done in mainly two ways. First of all, what we're trying to achieve is to place the steroid into the epidural space. Epidural space in itself denotes space that is intimately located above the dura. Dura is the outermost layer covering the spinal cord and the nerves that exit the spinal cord. Most of the inflammation occurs in that area and that is the area that we can place the medications most safely. This can be approached in two ways. One is what’s called "interlaminar" - that means between these lamina. That can be approached from what's called paramedian - or just off the mid-line - approaching this way. Another approach is called the transforaminal - what that means is "across the foramen." Foramen being this opening through which the nerve exits. The approach is taken by going into space where the nerve usually doesn't appear and this is done under the guidance of x-ray or fluoroscopy.
Another type of injection is called selective nerve root block. Selective nerve root block is selectively choosing a specific nerve in order to determine whether that nerve is causing the pain. And in order to that, we approach under the guidance of fluoroscopy, to target a specific nerve then place a small amount of (usually) contrast to outline that we are really concentrating on this nerve root, then place a very small amount of anesthetic. Now, the small amount is important because we don't want that that anesthetic to spread anywhere else and affect our outcome. If the pain is relieved with this injection, then we know that was the cause of the pain or a pain generator.
Another injection is a facet joint injection. This can be approached in two ways. One is the injection into the joint itself and in order to do that we use fluoroscopy for guidance and we approach the joint itself, going into the joint, and then place the medication into the joint. And the reason to do that is (1) to determine if injecting anesthetic and corticosteroid will relieve the pain - and that is the diagnostic part of this - and (2) the corticosteroid reduces the inflammation.
Another way to approach facet mediated pain is by blocking the nerve that actually transmits that pain. And the reason we can do that is because, anatomically, it is consistently found in the same place. It is found traveling along this path. And what we can do, once again under fluoroscopic guidance, we approach the anatomical location of this branch placing a small amount of medication, blocking the transmission of that nerve temporarily. And that, once again, diagnostically tells us: if we block this nerve, does this relieve the pain? Now, it’s not as simple as that because there are two nerves that usually supply each facet joint, so in order to really effectively block one joint, we have to block two nerves and that way we know that joint is blocked and then we see if it truly alleviates the pain or not.
That leads me into another type of an injection, which truly is not an injection, but more of an intervention to treat facet joint pain - that is the medial branch rhizotomy. And in order to do that, what we do is we place a probe - that is just like a needle - along the path of this medial branch and then we use radiofrequency to concentrate at the tip of that probe to heat it up and then lice the little nerve that travels along the path, effectively eliminating the transmission of the pain. The effect of this doesn't happen right away; it takes several weeks to take effect, but it provides a longer-term relief for people suffering from facet mediated pain.
Another type of a spinal injection is used to treat and diagnose sacroiliac joint pain. So, once again under fluoroscopic guidance in order to ensure the safety as well as the precision, we go into the sacroiliac joint placing a small amount of contrast to outline where the medication is going to spread, then we use a small amount of anesthetic with corticosteroid. The anesthetic serves as the diagnostic portion - if the pain is eliminated, then we know that was the pain generator and we've effectively diagnosed sacroiliac joint pain. Then, corticosteroid reduces the inflammation that usually is the cause of the pain and that is the therapeutic portion of this.
There are many other interventions that we can use for the spine, but these are the more common ones.
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C. Daniel Smith, M.D. , chair of the Department of Surgery at Mayo Clinic in Florida, discusses minimally invasive surgical options for patients with gastroesophageal reflux disease (GERD). A novel device, a ring of tiny magnetic titanium beads that acts to keep stomach acid from leaking into the esophagus, is now offered at Mayo Clinic in Florida. Read more about the LINX Reflux Management System in the April 11, 2012, edition of MedCity News.
Mayo Clinic in Florida is one of the first health care institutions in the U.S. to offer a newly approved device to treat GERD. Mayo Clinic in Florida helped test the device in patients. The U.S. Food and Drug Administration (FDA) approved the device and treatment procedure on March 22, 2012, for patients with GERD who continue to have chronic reflux symptoms despite taking medication. Mayo Clinic in Florida was one of 14 centers nationally that participated in a clinical trial that led to the FDA’s approval of the device.
About GERD In patients with gastroesophageal reflux disease, liquid or food in the stomach flow back up into the esophagus due to the inability of a ring of muscle between the lower esophagus and the top of the stomach to close properly. If drugs aimed at neutralizing the acid in the stomach fails to prevent GERD, an operation designed to correct the mechanical defect is considered. Nearly 2 million patients of those patients could benefit from this treatment, which is much less complex than current surgical options, says Dr. Smith.
The results of the clinical study that led to approval of the device have not yet been published. “The data presented to the FDA, however, revealed striking results when compared to other GERD treatments that have been investigated over the past 20 years,” says Dr. Smith. “The system offers effective control of GERD with limited side effects and thus far an excellent safety record.”
The implanted device is a ring of tiny magnetic titanium beads that is wrapped around the junction between the stomach and esophagus, serving as a mechanical augmentation of the lower esophageal sphincter (the ring of muscle). The magnetic attraction between the beads is strong enough to keep the sphincter closed to refluxing acid, but weak enough so that food can pass through it into the stomach. The device can be implanted using minimally invasive surgery methods.
“I expect this device to be a game changer for the treatment of GERD in select patients who have failed management with drugs,” says Dr. Smith.
Kenneth R. DeVault, M.D. , chair of the Department of Internal Medicine at Mayo Clinic in Florida, also participated in the studies. “I have many patients who are searching for something more than medication for their reflux, but have been hesitant to undergo a traditional reflux surgery,” he says. “I think this procedure may well be a very attractive option for that group.”
Drs. Smith and DeVault were consultants to the company that developed the device and participated in the research study. Mayo Clinic licensed related technology to the company in exchange for equity.
Hello and welcome to the blog for Grochmal Eye Center! We’ve created this resource to assist our patients who are considering vision correction. Our goal is to provide you with information about the latest technology and procedures in vision care. Our blog will also serve as a forum for patients to learn about their surgical options from our Baltimore, Maryland Ophthalmologist, Dr. Jay C. Grochmal.
Cataract Surgeon in Baltimore Discusses the Future of Advanced Procedures
Baltimore, MD — According to the latest statistics from the American Academy of Ophthalmology (AAO), cataracts affect nearly 22 million Americans age 40 and older. However, Dr. Jay C. Grochmal, a LASIK and cataract surgeon in Baltimore, says with the recent advancements in cataract surgery, patients do not have to let blurring vision hinder their daily life. Dr. Grochmal discusses the latest innovations in refractive-cataract surgery and how they can benefit patients looking to improve their vision.
At his Baltimore cataract surgery practice, Dr. Grochmal says the aging baby boomer population has brought an influx of patients needing vision correction for cataracts and other age-related conditions. Cataracts develop as people get older and are exhibited in a clouding and opaqueness of the natural lens inside one’s eye, causing vision to blur. The AAO report also shows that by age 80, more than half of all Americans will have visually significant cataracts. Dr. Grochmal says while cataracts can be a bothersome medical issue, the good news is that advancements in ophthalmology and surgical techniques have made clear vision an affordable and effective option through cataract surgery.
With procedures such as laser refractive cataract surgery on the horizon, Dr. Grochmal says treatment is now ultimately safer than ever before and more successful in helping patients achieve improved vision with less dependence on glasses. He says other innovations have helped create smaller incisions for lens extraction and replacement during cataract surgery, and through technology such as the Zeiss IOL Master, doctors can better measure the power of the intraocular lenses and offer more accurate visual results. “With the safety of cataract surgery improving, patients no longer have to wait for their vision to drastically deteriorate before undergoing cataract surgery. Also, the quality of newer IOL’s are allowing excellent vision after surgery,” says Dr. Grochmal.
Thanks to a diverse arsenal of lenses such as toric and multifocal IOL’s, Dr. Grochmal says patients can now enjoy the benefits of custom treatment for their individual eye condition and lifestyle needs. Whether patients wish to enhance their vision up close or far away or find a balance of clarity in both distance and near vision, he says there is a solution for every patient’s desires. Dr. Grochmal says cataract surgery recovery is now also much quicker and requires less trauma to the function of one’s eye. “With such small incisions now possible and the availability of toric IOL’s, post operative astigmatism can be minimized if not completely corrected,” he says.
Regardless of whether patients are looking for cataract surgery or another vision correction procedure such as LASIK in Baltimore, Dr. Grochmal says the advancements in ophthalmology are making significant strides towards helping people attain perfect, lasting eyesight. He adds that he is excited to see the further development of patient comfort and care and hopes patients continue to take advantage of the benefits that procedures like cataract surgery can offer.
About Jay C. Grochmal, MD
Dr. Jay C. Grochmal received his medical degree from the University of Maryland, after which he completed a rotating internship at the U.S. Public Health Hospital in Baltimore. He also completed a residency in the Department of Ophthalmology at the Greater Baltimore Medical Center, where he was Chief Resident. A member of the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery, Dr. Grochmal has participated in several medical mission trips to offer his experience and skills in vision correction to patients in Pakistan, Jamaica, and the Bahamas. He is currently on staff with the Greater Baltimore Medical Center and St. Agnes Hospital. He is the medical director at the Snowden River Surgery Center.
Located at 405 Frederick Rd, Suite 102 in Baltimore, MD, Dr. Grochmal’s practice can be reached at (410) 697-4090. He can also be contacted online via the website grochmaleye.com or facebook.com/grochmaleye.
Contact: Rosemont Media Aaron Hurst aaron@rosemontmedia.com (858) 200-0044 www.rosemontmedia.com
As any physician knows, handling Medicare and Medicaid payments can be a very complex and time consuming process. As a result, many physicians, through no fault of their own, occasionally overcharge Medicare and Medicaid. To recoup such overpayments, the Centers for Medicare & Medicaid Services (CMS) administers the Medicare Overpayment Notification Process. Until recently, where an alleged overpayment has not been promptly resolved and refunded, CMS would send physicians a series of three letters: an Initial Demand Letter, a Follow-up-Letter 30 days later, and then an Intent to Refer Letter. However, CMS recently determined that the second letter was unnecessary because a substantial number of physicians responded promptly to the Initial Demand Letter with a payment. In addition, a recoupment action occurs on average 41 days after the initial letter, and that action is accompanied with another notice regarding the overpayment.
Thus, it is important for physicians to respond to the Initial Demand Letter in order to avoid further complications such as a referral to a debt collector. In fact, if an overpayment is not resolved within 90 days of the Initial Demand Letter, CMS will provide a notice of intention to refer the debt for collection.
Conventional IVF Today’s conventional IVF is ‘stimulated’ – drugs are used to prompt the woman’s ovaries to produce several eggs, rather than just one. The eggs are mixed with her partner’s or a donor’s sperm to become fertilised. Women take a course of ovarian-suppression hormones to shut down their menstrual cycle to control ovulation. Then [...]
Claudia*, 35, already had a child after aggressive, conventional IVF, and wanted another. However, because she had blocked tubes, she needed IVF. She was exhausted after her conventional IVF and said “never again”! It had been very aggressive IVF, had cost her nearly £9000 and she had lots of unpleasant side effects. She had never [...]
TRACY’S STORY… My Husband Andrew and I met in July 2005. Andrew told me he had fertility problem as a result of being a Cystic Fibrosis carrier. He was born with Congenital Absence of the Vas Deferens (no tubes from the testicles to the outside world). As a result our only way of having our [...]
World AIDS Day is held each December 1st as an opportunity for people to unite in the fight against HIV/AIDS by increasing awareness, fighting prejudice and improving education. It is also an opportunity to show support for people living with HIV and to commemorate people who have died.
Memphis Health Center, Inc. will observe Word AIDS Day on Friday, November 30, 2012 with a Candle Light Memorial in our main conference room located at 360 E. H. Crump Blvd 10:45 am – 12:00 pm. This event will highlight HIV awareness, and the importance of testing. We will also feature a video & testimonials of individuals that have been impacted by this disease.
For more information, please contact Latonya Foster, Health Educator, at (901) 261-2007 or by email at lfoster@mphshc.org.
Most people have heard of glaucoma, but few know the whole story. In short, glaucoma is an eye condition where the optic nerve becomes damaged, usually as a result of increased pressure in the eye. This damaging of the optic nerve ultimately causes a gradual but serious loss of vision. Untreated, the disease often results in complete blindness.
Now that you have a basic understanding of glaucoma, let’s clear up a few of the most common myths surrounding this serious condition.
Here are the top 5 myths of glaucoma:
1. Myth: Glaucoma is rare. Fact: On the contrary, it has been estimated that over 2 million Americans are suffering from glaucoma. Even more disturbing is the fact that glaucoma remains a leading cause of blindness in the US. 2. Myth: Only patients with a family history can develop glaucoma. Fact: Although certain factors like age and heredity can increase your chances of developing glaucoma, the condition can affect anyone, anywhere and at any age. 3. Myth: Glaucoma cannot be treated. Fact: While there is currently no cure, there are a host of Glaucoma Treatments aimed at minimizing the risk of permanent vision loss. These treatments include medications, eye drops and surgery. 4. Myth: Only patients with glaucoma symptoms should get checked out. Fact: The majority of glaucoma patients do not experience any symptoms before the optic nerve actually becomes damaged. For this reason, regular glaucoma screenings are vitally important.
5. Myth: Glaucoma screenings are painful. Fact: Glaucoma screenings test different things—visual field, pressure in the eye, etc. Each of these tests are not only quick, but non-painful.
Get Checked! Schedule a Glaucoma Screening Today
To schedule a glaucoma screening or to learn about any of the ophthalmology services we offer, we encourage you to contact us today. Our offices are located in Winchester, serving Virginia, West Virginia and Maryland. Book your appointment at (540) 722-6200. We look forward to seeing you.
When pain persists after back surgery, the true cause of the patient's pain needs to be re-evaluated. It may be the case that the surgery was performed to address an issue that was not the true pain generator. It may also be damage from the surgical procedure itself that is causing pain. In a spinal fusion surgery, the mechanical changes to the spine may cause new pain to develop. All these things are considered to evaluate the cause of the post-surgical pain.
Failed back surgery syndrome is a term that is used to describe pain that starts or persists after spine surgery. The important thing to remember is that spine, in itself, serves a certain purpose; it solves a number of problems, but, as with any other tool, it has its own limitations. So, sequelae of the surgery can cause pain, but also at the same time, surgery cannot address all the pain generators. So in looking at it like this, we can actually turn our attention away from the aspect of the surgery and now refocus on the patient and look at the pain generators in that patient in the context of their life and in the context of their overall function. By looking at it like that, we can actually start treating the pain generators and really get to the source of the majority of the pain that's generated after the surgery.
So what we need to look at is the physiologic changes after the surgery. Those are:
Depending on the surgery, the mechanics of the spine will change. Now, if it's fusion surgery, then what happens is that two segments, for instance, that are being fused are no longer moving on their own. They are now moving in unison, which in effect creates a single segment. Because that single segment is no longer taking up the work of two segments, separately, it is now functioning as a single segment, which means - and this is for simplicity sake - we can say five segments doing 100% of work and that's 20% per segment, now we eliminate two or three segments, per se, and now 33% falls on each segment. Now you can imagine that with additional force going through that segment, there's going to be motion, more wear-and-tear, and more potential pain caused by that segment. And that's usually referred to as "adjacent segment disease." And that’s one of the post-surgical effects.
Another effect is the actual tissue damage that can happen after surgery. So, myofascial pains can happen after a separation of tissue. When that tissue comes back together, the connective tissue may cause fibrosis - and that can trap nerves - or in itself become tight and painful. That can be treated in a separate way.
Going back into the increased motion at separate segments, we have to remember that the motion actually happens across facet joints. Those joints are hinge-like joints - they are small joints - and those joints are just like any other joint in our body, which means it can get inflamed just like any other joint and that usually happens through overuse. Treating those joints usually resolves the pain that is associated with those joints and in that way, we can restore the function that was lost through the inflammation and alleviate the pain.
There are many other pain generators that need to be looked at and can certainly be treated with appropriate diagnosis and treatment.
Treatment of pain persisting after surgery should be approached in a systematic way. Diagnosing each pain generator and eliminating the pain generators can serve to restore function and eliminate pain and in order to do that, we can employ a number of different tools that are available to us. And those include a wide array of the tools. Now it can be manipulations, it could be physical therapy, at times injections, or at times if we need to things like spinal cord stimulation or implantable pumps that can supply a steady state of medication can be used to control the pain. By using all the tools that are available to us, we can really improve the patient's quality of life by doing two very important things: decreasing the pain and restoring function. That way, they can reintegrate back into life and not be limited by pain or by mobility.
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At first glance, LASIK can seem like a confusing or complicated subject. As a result, many patients don’t explore their LASIK options, for fear of being misinformed or not understanding the procedure completely. Because we want all our patients to find out what laser vision correction can do for them, we thought we would take a moment to “de-mystify” LASIK and answer some of the most common questions we’re hearing. It’s time to set the record straight!
As an 
Most people have heard of glaucoma, but few know the whole story. In short, glaucoma is an eye condition where the optic nerve becomes damaged, usually as a result of increased pressure in the eye. This damaging of the optic nerve ultimately causes a gradual but serious loss of vision. Untreated, the disease often results in complete blindness.