What Doctors Know - Vol 1 Issue 1

7/27/2019 What Doctors Know - Vol 1 Issue 1

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Vol.1, Issue 1 $ 4.99

Hearing NeverSounded So Good

Cool Sculpting-

Reduce FatWithout Surgery

TheEmotionalRoad toFamilyLife

NetMed AI:The Future is Here

Am I Too OldFor Lasik?

Your Child Can Make

A Difference


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Embarking onthe New Healthcare Journey

On Call with Dr. Porter

Steve Porter, MD

Publisher and Chairman

We would like to take this opportunity towelcome our new readers from the Barnes &Noble Nook to the inaugural edition of What

Doctors Know formerly Local Healthcare Today. Westarted approximately 2 years ago and currently reachabout 2 million residents of the greater Salt Lake Cityarea with a direct-mail healthcare magazine twice a year.We will now be available exclusively through Barnes& Noble starting on the electronic platform but comingshortly in print form to all of the Barnes & Noble storesthroughout the United States. We are pleased to have this

opportunity to inform you about health care in a way that has never been done before.

We promise to avoid the fluff and silliness so prevalent in healthcare journalism with the dumbing down ofinformation for the consumer to the point that medical information becomes pablum. I rarely read an article withoutfeeling that I'm being spoken down to and often that the author has no understanding of what they're trying toexplain. We think you are big boys and girls capable of understanding much more for which you are given credit.

Our mission is simple, its execution is not. Throughout history doctors have held healthcare informationclosely, parsing out to patients on a one by one basis, or worse still treating without explaining. Fearingthat an educated patient does not need a doctor. This could not be further from the truth. Educated patientsare the best patients and doctors who share information with patients do not give away their livelihood,but enhance their practice in a way that can only be understood once initiated. Patients do not make poordecisions because they have too much information, rather due to the lack of meaningful information.

Sometimes even just knowing what kind of doctor to start with for a specific problem is a good beginning.

I am reminded of a joke I heard while living in Vermont during my internship and residency inInternal Medicine and fellowship in Gastroenterology at Dartmouth Hitchcock Medical Center inNew Hampshire. It is a story about a traveling salesman in Vermont who stops to ask directions of anold farmer and the local, in the classic Vermont accent, replies you can't get there from here. Not thefunniest joke in the world but an apt description of how patients feel about current healthcare.

We make this promise to you. If you read our journal on a regular basis and give us feedback we willmake every effort to change to suit your needs. We beg your indulgence as we get started on this

journey. We realize we will make mistakes, but we also realize we will impact patient understanding ofhealthcare and this journal will serve as a useful tool that may very well save the life of you or someoneyou love. It may also save the life of someone you do not love but we cant be that discerning.

The words journey and journal share a common root both being derived from the Latin or really Italian word for daily.I promise you this journal, in its journey, will take things day by day and working together with our contributingauthors and our readers we will someday look back and realize that together it was possible to get there from here.


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HEADlines

WHAT DOCTORS KNOW And you should, too!

In The Trunk

Below The Belt

42 Welcome Relief-Revolutionary Advancesin the Treatment ofHemorrhoids

43 Why Does My FlatFoot Hurt So Much?

44 Are You A Candidate ForHip or Knee Replacement?

46 Get A Leg Up OnVaricose Veins

48 The Emotional RoadTo Family Life

50 Lap Band Surgery

51 More Than anInconvenience

52 Mindlessly Eating...Better

54 Colonoscopy: Out of PocketExpenses Eliminated

08 Can Allergy Shots Help?

12 Snoring & Sleepiness

14 Get Wise AboutWisdom Teeth

15 Cataract Surgery

16 Otoplasty forOutstanding Ears

18 The Power of a Smile

20 Get Your Vision Back-DumpThose Glasses or Contacts

22 Do You Suffer From TMJ ?

24 Is It More Than A Headache?

26 Am I Too Old For Lasik?29 Acid Reflux: The

Burning Issue

32 Is Your AsthmaWell Controlled?

34 Atrial Fibrillation: APersonalized Approach toDiagnosis and Treatment

35 Dont Let Your Thyroid Bea Lump in Your Throat

36 When Surgery is Neededto Correct Acid Reflux

38 Controlling Your RiskFor Vascular Disease

40 Don't Shrug Off

Shoulder Pain


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Mind, Body & Soul

56 Your Child Can Make a Difference

58 Pregnancy And Exercise

60 Are You at Risk for Shingles?

61 CoolSculpting-Reduce Fat Without Surgery

63 Just How Healthy Is That Healthy Glow?

64 Is It Sprained Or Is It Broken?

65 Making The Most Out of Your Body Fat

66 Sports Medicine--Getting You Back Into The Game

69 The Mommy Makeover

70 Are We Eating Ourselves to Death?

71 Diabetes or You? Whos in Control?

72 Childhood Obesity and Heart Disease: An Increasing Crisis

10 NetMed AI-The Future is Here

74 Hearing Never Sounded So Good

76 The Buzz Word-Minimally Invasive Surgery!

78 A Revolution in Cancer Treatment

80 Surgical Center vs. Hospitals

82 Time is Life- If You Have a Heart Attack, Minutes Count

Technology & Your Health

contents / FALL 2011

In Every Issue

01 On Call with Dr. Porter

04 House Calls62 Financial Health

68 In The News

on the CoverCongratulations to the

St. Joseph's girls' soccer

team who recently won

the Utah High School

State Championships.

Bottom to top:

Jane Porter, Tauna DeHaan,

Alex Shaw, Michelle Howe,

Katie Panushka

Photographer:Doug Reinhart, MD

74 Hearing Never Sounded So Good

56 Your Child Can Make a Difference

61 CoolSculpting-Reduce Fat Without Surgery

49 The Emotional Road to Family Life

10 NetMed AI-The Future is Here

26 Am I Too Old for Lasik


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House CallsYou have questions, we have answers.Q:

Iamstartingto

noticedarkspot

sinmy

vision.Isthisno

rmal,or

shouldIbeconc

erned?

-Andrea,CA

whatdoctorsknow.com

A:Whilemanydifferentsymptomscanbedescribed

asspots,themostcommonarewhatIcallfloaters.

Thesearetheoftenstringyorirregularspotsyouseesloshingback

andforthinyourvision,especiallyifyouarelookingatawhitewallora

bluesky,whereyourmindcan'tseeanythingelseinterestingtofocuson.Most

peoplewillhavethiskindoffloateriftheylookforthemandtheyaregenerally

harmless.However,anabruptchangeinyourfloaterscanbeacauseforconcern.If

younoticethatyouhaveobviousnewfloaters,especiallyiftheyareaccompaniedby

flashesoflightinyourperipheralvision,youshouldcallaneyedoctorimmediately.

Thiscanbeasignofchangesinthevitreousgelwhichfillsyoureyeandcan

evenputyouatriskofretinaldetachment.Thismaybehelpfulinidentifying

onepotentialemergency,butbeingsureofwhatishappeningin

yourvisionwillrequireavisittoyoureyedoctor. MichaelJ.

Bradley,MDatHoopesVision,SaltLakeCity,UT


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Disclaimer:The information contained in the magazine is intended to provide broad understanding and knowledge of healthcare topics. This information shouldnot be considered complete and should not be used in place of a visit, call, consultation or advice from your physician or other healthcare provider. Werecommend you consult your physician or healthcare professional before beginning or altering your personal exercise, diet or supplementation program.

whatdoctorsknow.com

Q:Itseemslikethesametimeeveryyear,Istartgettingsymptomsofacold

thatnever

seemtogoaway.HowdoIknow

ifitreallyisacoldorseasonalallergies?-Darryl,VAA:

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House Calls

Calling All Doctors. Our readers want to hear from you. What healthcareissues do you want to address? What do you want to tell patients all

over the country? Whats new in your practice, in your specialty?

Drop us a line and let us know about any healthcare topic you wantto address in What Doctors Know. Remember, we want to inform and

educate our readers. We know, an informed reader has the opportunity tolive longer and happier. You can be part of that healing process.

Our readers look forward to hearing from you.

Send story ideas to: [email protected]

Seasonal allergies are caused by pollen and sometimes mold spores

that achieve very high levels at specific times of the year. Pollen seasons

vary a lot depending on the geographic location. In much of the United

States tree pollens start the allergy season, then grass pollen, then in

the fall weeds, ragweed, and other regional plants contribute. Allergyseasons typically last for several weeks, often for several months. If

a person is allergic to these materials the allergy symptoms persist

for as long as the particles are in the air. Once the relevant particles

disappear, the nose returns to normal over a period of one to 3 weeks.

Symptoms of allergic rhinitis can be identical to the early symptoms

of a common cold. Seasonal allergies do not by themselves cause

fever. Allergic inflammation of the nose often is accompanied

by itching and burning of the eyes, excessive tearing, swelling

around the eyes, and dark discoloration beneath the eyes referred

to as allergic shiners. One clear hallmark of seasonal allergy is

that the allergy lasts much longer than the common cold.

Both seasonal allergy and the common cold can be complicated

by the appearance of bacterial sinusitis. When the sinus tissues

are inflamed by the viral infection or the entrances to the sinuses

are swollen shut by allergy, bacteria can get a foothold and then

lead to a complication that can become persistent and quite

troublesome. This complicates trying to distinguish the common

cold from allergy. One helpful feature is that if the nasal secretions

are colored 10 days after the beginning of what appeared to be a

common cold, it is very likely that a bacterial infection has set in.

When over-the-counter symptomatic medications or those prescribed

by primary physicians are not providing significant relief, consultation

with an Allergy & Immunology specialist can be very helpful.

The goals of therapy are relief from symptoms, restoring the

ability of air to go to the nose at night which then restores restful

sleep, and treatment of a sinus infection if it is present. The allergy

specialist can determine the presence or absence of allergy,

anticipate when new episodes of allergic reactions will occur,

and formulate plans to prevent this recurring set of problems.

Timothy J. Sullivan M.D., Atlanta, GA and Vicki J. Lyons M.D., Ogden, UT

You have questions,

we have answers.You may be concerned aboutany number of health issues--big or small. Perhaps they areabout you, a family memberor even a close friend and

you don't know who to ask.

ASK US!

Send us your questions or atopic and we will have one of

our knowledgeable doctors giveyou the answers...simplified.

We want to hearfrom YOU!

[email protected] us at, What DoctorsKnow,585 West 500 South,

Ste. 200, Bountiful, UT 84010


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Published byWhat Doctors Know, LLC

Publisher and ChairmanSteve Porter, MD

Editorial Advisory BoardVicki J. Lyons, MD, Chairman

Timothy J. Sullivan, MD

Editorial and Design DirectorBonnie Jean Myers

Senior DesignerSuki Xiao

Design AssociateCayden Chan

Executive Director, MarketingLarry Myers

Director of OperationsAllen Nunn

ProductionKai Xiao, Vice President

IT ManagerEric Lu

For more information on ad placementor contributing an article, please email

[email protected],or call (801) 299 -1122.

For information on subscriptions, pleasevisit www.whatdoctorsknow.com

Copyright 2011 by What Doctors Know, LLC. All rights reserved. Reproduction of this magazine,in whole, or in part is prohibited unless authorized by the publisher or its advertisers. The

Advertising space provided in What Doctors Knowis purchased and paid for by the advertisers.Products and services are not necessarily endorsed by What Doctors Know,LLC.

Corporate Office

What Doctors Know585 West 500 South, Ste. 200

Bountiful, UT 84010(801) 299-1122

Contributing Writers:Jeffrey Arrington, MDMark G. Ballif, MD

Spencer P. Barney, MDLe Grand P. Belnap, MD, FACS

Nadim Bikhazi, MDMichael J. Bradley, MD

Brigham and Women's Hospital

Dann C. Byck, MDCynthia Canga-Siao, MDC. Benjamin Dunkley, DO

Gregory W. Egbert, DDS, MSDAllen Francis, MD

Russell A. Foulk, MDBrian W. Fukushima, MDR. Chris Hammond, MD

Darrin F. Hansen, MDRobert A. Harris, MDJustin P. Hawes, MD

Phillip C. Hoopes Sr, MDPhillip C. Hoopes, MD

Eric C. Hu, MDJulia Johansson, MD

Phillips Kirk Labor, MDPeter G. Larcom, MDJodie Levitt, MD

Jeff Love, AdministratorVicki Lyons, MD

Nassir F. Marrouche, MDSteven L. Miller, MD, FACC

Richard L. Moss, MD

Jed P. Naisbitt, MDMark Newey, DDSRobert Orme, MDSteve Porter, MD

Christopher J. Price, DDS, MDJeffrey J. Rocco, MDDavid Schmidt, MD

Timothy J. Sullivan, MDScott K. Thompson, MDRoger C. Tidwell, CTFA

Brian Wansink, MDRobert M. Ward, MDJeff Weddle, RN, BSN

Blair Woolf


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Allergy season has either hit or is about to hit in yourarea of the country. Potent western weeds such assagebrush and western ragweed are pollinating as

most people are still heading outdoors for hiking, biking,hunting or other recreational activities. At the same time, allergyand asthma sufferers are grabbing boxes of tissues as well

as their rescue inhalers. Allergy sufferers are all too familiarwith pollen season, a time when they can be forced indoorswhile others are enjoying the beautiful weather and foliage.

Allergen Immunotherapy, also known as allergy shots,can help people who suffer from allergic rhinitis (nasalallergy), allergic conjunctivitis and allergic asthma causedby allergens such as pollen, mold and animal dander.

Patients who receive Immunotherapy are safely injected with smallbut increasing amounts of specific identified allergens over a periodof time. Immunotherapy has proven to prevent the developmentof new allergies, and in children, it can prevent the progression

of allergic disease from allergic rhinitis. It is also recommendedfor treatment of allergic asthma by the expert panel/2007National Heart, Lung and Blood Institute (NHLBI) guidelines.

How Does Immunotherapy Work?

Over the last century, much has changed in the standardizationof extracts and the number of evidence- based studies provingeffectiveness. Immunotherapy works like a vaccine. Yourbody responds to the injected amounts of a particular antigengiven in gradually increasing doses by developing immunityor tolerance to the allergens. As a result, allergy symptomsdecrease when a patient is exposed to that allergen in the future.

About the Author:Vicki Lyons, MD, is a board-certifiedand fellowship-trained Allergistand Immunologist. She has beenpracticing for years. For moreinformation, contact Dr. Lyons at(801)387-4850

There are generally twophases to Immunotherapy:

Build-up phase: This involvesreceiving injections withincreasing amounts of theallergens twice a week untilthe effective dose is reached.

Maintenance phase: Thisbegins once the effectivetheraputic dose is reached.

The effective maintenancedose has been studiedand has been found to beeffective in clinical trials.

Low-dose immunotherapy is noteffective. Clinical effectivenessrequires administration of adequatedoses. During the maintenance phase,Immunotherapy induces regulatoryT-cells that dampen the allergicresponse to allergens. The resultingimmune response in a treated patientresembles the response of a non-allergic individual to that antigen.The clinical and immunologicalbenefits of a successful course of

Immunotherapy persist for years after treatment is discontinued.

When Can Immunotherapy Be Helpful?

Immunotherapy is recommended for patients withallergic rhinitis, allergic conjunctivitis and allergic asthma.Beginning Immunotherapy early can prevent rather thanreduce the chronic inflammation caused by allergies, as

well as prevent further development of severe disease suchas asthma in a patient with allergic rhinitis. Also, startingAllergy Immunotherapy early appears to be the mosteffective treatment for asthma in children and young adults.Furthermore, in younger patients, Immunotherapy offers theadvantage of a treatment that may be successfully discontinuedafter three to five years, as opposed to management withmedication, which must be continued indefinitely.

In What Situations Can AllergyImmunotherapy Be Ineffective?

The benefits of Allergy Immunotherapy are dose-relatedmanypatients who have received poorly standardized extracts at low

or sub-therapeutic levels in the past may not have achieved relief.Inadequate doses of allergen in the vaccine can lead to treatment

CanAllergy

ShotsHelp?


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failure. Also, missing allergens not identified in the allergy vaccinecan lead to treatment failure. Board-certified, fellowship-trainedAllergists and Immunologists are trained to provide pollen andinhalant identification levels typically posted in local newspapersand television and are trained to provide the appropriate testingand treatment formulas for specific Allergen Immunotherapy.High levels of allergen in the environment secondary toinadequate indoor environmental control can also lead totreatment failure. Exposure to tobacco smoke or some occupationexposures can also offset the success of Immunotherapy.

What About Allergy Drops Under The Tongue?

The rationale for developing an oral treatment was aimed atreducing the inconvenience and discomfort of injections. Oraltreatments have been studied in a variety of forms includingcoated tablets, capsules and oral drops. European studies ofSublingual Immunotherapy (allergy drops under the tongue)appeared to be effective. However, several similar studiesrepeated in the United States in 2008 failed to achieve the sameresults. Instead, these recent studies reported no significantbenefit from oral treatments. Allergy drops under the tongue orswallowed are approved for use in Europe; however, questionsremain regarding the safety and effectiveness of SublingualImmunotherapy in the US. There are currently no FDA-approved sublingual allergy extracts in the US, and SublingualImmunotherapy is typically not covered by most insurance plans.

Is Allergy Immunotherapy Cost Effective?

Immunotherapy is less expensive than conventional over-the-counter medication or prescription therapy for the treatment ofallergic rhinitis and asthma when administered by fellowship-trained, board-certified Allergists and Immunologists. Thegreatest immunotherapy costs occur in the first year whenimmunotherapy is 33% less costly than medication. In yearstwo to five, immunotherapy is 75% less expensive thanmedication. These cost savings were confirmed recently in a 2006European study in patients with allergic rhinitis and asthma.

Who Should Prescribe Allergen IMMUNOTHERAPY?

Immunotherapy should only be given under the supervisionof a specialized physician in a facility equipped with properstaff and equipment to identify and treat adverse reactionsto allergy injections. Ideally, Immunotherapy should begiven in the prescribing allergist/immunologist's office.

Given the complexity of the decision-making process as to

whether Allergen Immunotherapy is indicated and the knowledgethat is required to formulate a proper allergen extract (vaccine), itshould be undertaken only by a physician with specialty trainingin the field. Your board-certified Allergist and Immunologistis specially trained to provide evidence-based treatment forallergic rhinitis, allergic conjunctivitis and allergic asthma.

For more information, take a look at the followingwebsite: www.allergyandasthmarelief.org.

But most of all, find a board-certified allergist and immunologist,start allergy shots and start feeling great again!

Santiago Atitln:A Hospital in Need

A misty spray of cool lakewater moistened my face witheach rhythmic pound of the

skiffs hull against the waves.Green, cone-shaped volcanoessurrounded us, ascendingsteeply into a sky of undulatinggray clouds that threatenedrain. Estaremos por otro lado en como quince minutos, said ourboatman. We would be arriving at the indigenous Mayan town ofSantiago Atitln, on the other side of the lake, in minutes.

It was the summer of 00. We had embarked from the relativelyprosperous town of Panajachel, eager to learn what we would findat Santiago Atitln, a remote community nestled in the southernGuatemalan highlands across Lake Atitlan. Sadly, although the lakeand surrounding mountains were very beautiful, when we arrived atthe communitys small dock, it was obvious that this was not a placeof privilege. Poverty and disease had left their mark on the faces of thlocal Mayan population, a people that had managed to survive manyhardships, including the ravages of the recent Guatemalan Civil War.

I soon learned that one of the biggest problems for the people ofthis region was a chronic lack of adequate health care. Pulmonarydisease develops at an early age there, due to open cookingfires in the homes. Diarrheal illnesses, pregnancy complications,diabetes and intestinal parasitic infections are common.

Although a small hospital had been built in the 60s, it had longbeen abandoned. In 00, with much effort, a local group withinternational assistance began renovating the abandoned hospital.It reopened in 00, and began to provide -hour medical care forthe first time in over a decade. Then, almost unbelievably, only sixmonths later, rains from Tropical Storm Stan unleashed a devastatinglandslide that buried the new hospital and hundreds of people.When dug out, the hospital building was unsalvageable and the areawhere the slide occurred was declared unsafe and uninhabitable.

The people of Santiago Atitln are currently receiving medical serviceoffered by local providers and international volunteers in a building

that was once a hostel for backpackersbut the quarters are crampeand hardly ideal. In00, a safer hospitalsite was located, andwith more internationalassistance and manylocal volunteers,construction beganon a new hospital. Butfunding is badly neededin order to completethis worthy project.

Learn more about the Hospitalito Atitlanproject at www.hospitalitoatitlan.org, or contact

Erik Lyons at [email protected].

About the Author:Erik Lyons is aLanguage majorcurrently studying atSt. Petersburg StatePolytechnic Universityin Russia.


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The Physicians Office has Enteredthe Paperless Electronic AgeThe days of entering a physicians office and being handed

a clipboard please print legibly are officially gone. Instead,patients today can walk into a doctors office and be recognizedby the electronic device they carry. The device will allow the

office staff to greet them by name, instead of with a clipboard.

NetMed AI, a comprehensive medical office system, bringsfunction and the future together with a combination oftechnologies never before available until today. NetMed AIis an electronic marvel that melds the doctors diagnosis, withpatient history, medications, insurance, electronic notificationfor follow-up and more. While other systems bank a portionof this critical information on some form of EMR (electronicmedical record system) for the doctor, NetMed AI storesthe information on advanced cloud-based servers for thedoctor. While in the doctors office, the electronic devicetracks the patient progress tests ordered, completed, etc

You get more time with the doctor. You watch as thedoctor efficiently dictates diagnosis and other details.The examination is a marvel of technology and electronicinformation, evaluation and results. Your care is hightech, giving your doctor more time to focus on you.

Once again, no clipboard, no charts. Just the doctor dictatinginstructions, directions, medications, ordering labs, x-rays, andany need for follow-up. Once he has finished his dictations,things almost magically start happening. More than a decadein development, NetMed AI is nothing short of revolutionary.

Results. No WaitingPhone tag has been eliminated with NetMed AI. No needto call the doctors office and wait for the prompts. No needto leave a message to call back for the results and no moremissing the doctors call. Lab results and other importantinformation can be sent electronically via the patients choice

of communication text, e-mail, etc. Electronic notification isused to notify the patient for any follow-up need. For thosewho prefer phone notification with no waiting for a callback, they only need to call the office, identify themselves,and their information will be immediately available.

Red FlagsSo sophisticated is the system that NetMed AI even suggestspotential courses of action or red flags based on the doctorinput. When abnormalities come back from tests, NetMed AI willautomatically order additional testing to provide the physicianwith a broader scope of evaluation. More information for amore exacting diagnosis. When all the testing and evaluation is

completed, the system can also suggest follow-ups for patientsthat are on watch. Certain tests indicate borderline resultsand prompt the need for future follow-ups as a precaution.

NetMed AI is a voice recognition system providing instantaccess to medical records as well on the spot dictation andcoding. For the office staff, NetMed AI means accurate codingand billing. The streamlined, computerized system meansa virtually paperless system that allows for more efficiencyand less stress. For the nursing staff, ordering and sortingx-rays, labs and even paper charts are a thing of the past.

0 whatdoctorsknow.com

NetMed AIThe Future is Here


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NetMed AI is a major change for medical record transcriptionand the need for in office medical record storage.

Benefits to Doctor and Patient AlikeFor patients, NetMed AI means immediate access topersonal records and information online, 24-hours a day.

Armed with an encrypted key chain device with a built-in radio frequency, the patient can access personal recordsat any time once connected to the internet. Simply plugginginto a convenient USB port takes the patient to a securedpage with access to personal medical records. Medicalproblems will be highlighted with a link to more informationdirectly pertaining to the identified medical issue.

Doctors Not On NetMed AIIf your doctor isnt on the NetMed AI system, there is stillthe ability to cross check information and get a secondopinion. Simply go to the NetMed AI website, enter relevantinformation into the system and you will receive a comparative

diagnosis. If concerned or unhappy with information returnedon the NetMed AI site, you have the option of visiting aNetMed AI physician. After all, information is power.

For the first time, patients will have ownership andaccess to their medical information, giving them anaide to making critical health decisions. NetMed AI notonly revolutionizes the diagnosis path but it opens thecommunication process between patient and physician.

EASE OF INTEGRATION AND VIRTUALLYNO COST TO THE PHYSICIANNetMed AI may be one of the finest technological systems

of its kind, but it is user friendly and extremely seemless formost every physicians practice. No months of staff training, nostress incorporating the system is practically immediate. Theease of integration is almost as amazing as the system itself.

And cost. At the end of the day NetMed AI will have sentout prescription requests to the patients pharmacy ofchoice, it will have billed the patient insurance companiesas well as provided a summary of billing activity, includinghow much was billed, and how much was generated inaccounts receivable. The physician will have the choice topress a button to have NetMed AI buy those receivablesfor a small fee. That fee, is the cost of the system.

NetMed AI pays for itself.

For more information on the NetMed AI system,contact Larry Myers at [email protected]

Real-time Access toMedical Records

Voice RecognitionAvatar-based

Real-time BillingReal-time Coding

Real-time Dictation

PATIENT

PHYSICIAN

NetMedAINetMedAI

Total medical officemanagement system:

Bringing together medical

information and patient carewith the latest technologies

whatdoctorsknow.com

NetMedAI


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M

r. Ford is approaching 50 years of age, and he isconcerned about his health. Although he is overweight,he has always been in pretty good shape. However,

at his last few physical examinations, his physician repeatedlynoted high blood pressure. And though Mr. Ford successfullymaintains his accounting business, it has been brought to hisattention that his reports are frequently delayed. Coworkers havementioned that he does not seem as cheerful and outgoing asusual, and that he is becoming withdrawn. He is even beginningto forget the names of people that he knows at work and church.

Mr. Ford attributes these minor issues to stress atthe job and getting older. The Fords have a son in

Snoring & SleepinessMy husband snores.

Is his health at risk?Untreated sleep apnea can leadto hypertension (persistent highblood pressure), heart disease,stroke, impotence and otherconditions related to diabetes.

college and a young teenage daughter at home. They

wish to maintain optimal health and to live longenough to enjoy their future grandchildren.

Sleep has been a concern for the Fords, but more so for Mrs.Ford, as her sleep is often interrupted by her husbands loudsnoring. She also fears that her husband will stop breathingaltogether. Mr. Ford recently returned to his doctor, whodiagnosed him with hypertension (persistent high bloodpressure) . Mrs. Ford told the doctor about her husbandsloud snoring and poor breathing while he sleeps.

Mr. Ford admitted that he is often quite sleepy, and thathe sometimes nods off while watching television andeven when his wife is talking to him. Based on Mr. Fordssymptoms and exam, his physician suspected sleep apneaand was able to take appropriate steps for treatment.

What are the immediateconsequences of sleep apnea?

When the upper airway meets resistance or completelycollapses, breathing ceases, oxygen drops and the brain isalerted that breathing needs to be restored. In a sense, peoplewith sleep apnea are unconsciously fighting for oxygen all nightand, as a result, quality of sleep is drastically affected. Although


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About the Author:R. Chris Hammond, MD, is board-certified in Neurology and SleepMedicine. He completed his residencyand fellowship training in 006 atNorthwestern University in Chicago.For more information, contact Dr.Hammond at (801)475-3200

What is sleep apnea?

Obstructive sleep apnea is a medical condition in whicha person temporarily stops breathing or has very shallowbreathing while asleep. This is caused by blocked orpartially blocked passages of the nasal or upper throatareas, which also leads to snoring. Each apnea may

last 0 to 0 seconds or greater and can occur multipletimes in the night. It can even sometimes occur onceevery minute or more in some people.

some people with sleep apnea may feel they sleep well, they donot recognize how disrupted their sleep really is and how thesedisruptions affect their lives and the lives of their loved ones.

What are common symptoms of sleep apnea?

The symptoms of obstructive sleep apnea go beyond snoring.

Commonly, many people with sleep apnea experience daytimesleepiness or fatigue. Unrecognized symptoms of sleep apneainclude mood problems such as irritability, depression andanxiety, and cognitive problems such as memory loss andpoor concentration. A person may be awakened at nightbecause of snoring (sometimes described as gasping arousals),shortness of breath, palpitations, heartburn or frequentneed to use the bathroom. Morning complaints can includedry or sore throat, headaches and unrefreshing sleep.

What are the long-term consequencesof untreated sleep apnea?

In addition to the symptoms described above, we now also

understand serious, medically related complications ofuntreated sleep apnea. Untreated sleep apnea can lead tohypertension (persistent high blood pressure), heart disease,stroke, impotence and conditions related to diabetes. Sleepapnea can also aggravate other medical conditions such as heartarrhythmias, pulmonary conditions, chronic pain syndromesand obesity. Snoring alone is one of the leading causes of divorce.

How is sleep apnea diagnosed?

After discussing your symptoms, your physician mayobtain a sleep study, also known as a polysomnograph.This test is performed overnight in a sleep lab and monitorsseveral parameters involved with sleep, including oxygen

levels, respiration, sleep stages, heart rhythm and others.Trained technicians record and later score the resultsbased on standardized criteria. The information is theninterpreted by a physician trained in sleep problems.

What treatments are available for sleep apnea?

Several options are available, depending on multiplefactors including the severity of sleep apnea found in theovernight study. One option is CPAP (continuous positiveairway pressure), a device that delivers pressurized airthrough a mask to keep the upper airway open and preventcollapse. Pressure levels are typically determined by asleep technician in a lab setting. Other options include

surgical reduction of involved tissues or a jaw advancement

device that is placed in the mouth while sleeping.Weight loss can also help some sleep apnea patients.

Mr. Ford was set up for an overnight sleep study, whichlater showed significant sleep apnea associated with majordrops in oxygen and disrupted sleep. He was effectivelytreated for his sleep apnea with CPAP. Since his treatment,Mr. Ford feels better during the day, his memory is less of aconcern, his job performance has improved and Mrs. Fordcan sleep more soundly. In addition, we know from medicalresearch that Mr. Fords general health is better off nowthat his sleep apnea has been recognized and treated.

A quick screen for sleep apnea:

1. Do you commonly snore?

2. Do you snore loudly enough to interruptyour sleep or others sleep?

3. Has anyone observed you stopbreathing while sleeping?

4. Do you awaken struggling tobreathe or with palpitations?

5. Do you awaken with a dry or sorethroat or with morning headaches?

6. Are you very sleepy or fatigued duringthe day, or do you have low energy?

If you answered yes to one or more of these questions,further evaluation may be warranted by your physician.


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About the Author:Christopher J. Price, DDS, MD, is a board-certified Oral and Maxillofacial Surgeon.He completed a six-year residency in oraland maxillofacial surgery at the Universityof Texas Southwestern Medical Center,specializing in all aspects of oral and facialsurgery. For more information, contactDr. Price at (801)446-4428

Why should I remove my wisdomteeth when they are not hurting?

Wisdom teeth are the thirdand final set of molarsto erupt in the mouth,

usually appearing in the teens orearly twenties. Sometimes these teetherupt normally and are healthy andproperly aligned, but more often, theyare misaligned and require removal.

Misaligned wisdom teeth present manypotential problems. A tooth is said to beimpacted when there is a lack of spacein the mouth and its normal growthand eruption is prevented by overlyinggum tissue, bone or another tooth.These teeth can position themselveshorizontally, or be angled towardor away from the second molars.

Poor alignment of wisdom teeth cancrowd or damage adjacent teeth, ormake them more vulnerable to decay byentrapping plaque and debris. This results

in pain, inflammation and infection of thesurrounding areas. More serious problemsmay occur if the lining surrounding theimpacted tooth becomes filled with fluidand enlarges to form a cyst or tumor.

Should the tooth come out if ithasnt caused any problems yet?

Not all problems related to third molarsare painful or visible. Your oral surgeonmay recommend that your wisdom teethbe extracted even before problems develop.This is done to prevent a more complicatedextraction that might have to be done later.As wisdom teeth grow, their roots become

longer, the teeth become more difficult toremove and complications become morelikely. In younger people, recovery andhealing time tend to be much shorter. Aswith any medical condition left untreated,the condition becomes more difficultand more complicated with time.

No one can predict when thirdmolar complications will occur, butwhen they do, the circumstancescan be much more painful and theteeth more difficult to treat.

What if my wisdomteeth have erupted?

Despite concern regarding impactedthird molars, a recent study sponsoredby the American Association of Oral andMaxillofacial Surgeons (AAOMS) and theOral and Maxillofacial Surgery Foundation(OMSF) finds that third molars that havebroken through the tissue and eruptedinto the mouth in a normal, uprightposition may be as prone to disease asthose third molars that remain impacted.

In general, earlier removal of wisdomteeth results in a less complicated healingprocess.The AAOMS/OMSF study strongly

recommends that wisdom teeth be removedby the time the patientis a young adult inorder to prevent futureproblems and to ensureoptimal healing. Theresearchers foundthat older patientsmay be at greater riskfor disease, includingperiodontitis, in thetissues surroundingthe third molars

and adjacent teeth. Periodontal infections,such as those observed in this study,may affect your general health.

Who should removemy wisdom teeth?

Theres some comfortand common

sensein going to the right doctor for theright medical need. And when it comes towisdom teeth, the wise decision is to consultan oral and maxillofacial surgeon. After all,it is surgery. Wisdom tooth extraction underthe trained expertise of an oral surgeoncan be a routine surgical procedure.

Why an oral andmaxillofacial surgeon?

Oral and maxillofacial surgeons arethe only recognized dental specialistswho, after completing dental school, aresurgically trained in an accredited hospital-based residency program for four to sixyears. Their training focuses on both thehard (bone) and soft (skin and muscle)tissues of the face, mouth and jaw. Theyalso have extensive training in anesthesia,giving them the training and abilityto provide patients with safe, effectiveoutpatient anesthesia. Their knowledge andsurgical expertise uniquely qualify themto diagnose and treat the functional andesthetic conditions in this anatomical area.

The scope of an oral and maxillofacialsurgery practice includes:

Outpatient anesthesia

Wisdom teeth removal Dentoalveolar surgery to manage

diseases of the teeth and theirsupporting soft and hard tissues

Placement of dental implants

Surgical correction of facialskeletal deformities

Facial trauma surgery

Temporomandibularjoint (TMJ) surgery

Surgical management of snoring

Treatment of pathologic conditions,such as tumors and abnormalgrowths in the head and neck

Facial reconstructive and

cosmetic surgery

Get Wise AboutWisdom TeethLearn when you should get them extracted


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whatdoctorsknow.com

Every year nearly a million cataractoperations are conducted, and usually withoverwhelming success, but a revolutionary

new procedure is yielding even better results.

Cataracts can be exacerbated by over exposure toultraviolet light, diabetes, or hypertension, but themost common cause is good, old-fashioned aging.

People begin to see the affects of clouding at aroundage 55. Some who suffer from cataracts notice aveiled glare as light is scattered by the cataractinto the eye. People suffering from this report:

difficulty reading difficulty seeing close objects difficulty seeing to drive, especially at night changing glasses prescriptions needing bifocals

Cataracts develop slowly, they are painless, and manypatients report not even noticing a decrease in thequality of their vision until they visit an eye doctor.

During traditional cataract surgery, the crystalline lens isremoved and a plastic implant replaces it. The new lensbecomes part of your eye and you cant see or feel it.

For people suffering from this clouding, the surgery is safe,quick and is like a miracle cure, restoring vision to people who

have lived much of their fifties and sixties in an ocular cloud.

Although the results for the traditional procedureare generally very good, the old way and thematerials associated with it, are not perfect.

In the past, plastic lens implants were only monofocal,providing visual clarity at one distance, usually far

away, but seeing things up close, like reading a book,magazine or street sign, could still require glasses.

Now available in many doctor's offices is a miraculousadvancement in the way surgeons treat cataracts. It is calledmulti-focal intraocular cataract surgery. The surgery, about 15minutes in length, is even quicker, and safer than traditionalcataract surgery, and the best part is patients can see equallyas well, far away, at intermediate distances and close up.The new lens mimics the young eyes we used to have.

A doctor removes the cataract and then implants the multi-focalIntraocular Lens behind the iris where the cataract used to be.

Unlike the old procedure, which includes a 10 millimeter

incision in the eye, the new operation is done with a laserand the incision is a fraction of the size of the old one.

Using a procedure called phacoemulsification or phaco, thedoctor will make a microscopic incision in the eye, and inserta phaco probe to break up the cloudy lens and remove it.

The new method is quick healing, patients will not needstitches, and can be back on the golf course or at the bowlingalley within 24 hours. Patients have reported some minorhaloing, or rings around street and headlights whiledriving at night, but as the eyes begin to eventually adjustto the surgically implanted lenses, patients may see thishaloing diminish, or completely disappear, over time.

Patients do have to use eye drops for several weeks afterthe operation, but compared to the old procedures whichincluded stitches which remained in the eye for days or evenweeks, intraocular lenses are a marked improvement.

This is an out-patient procedure, conducted using only a localanesthetic, and clients are usually able to leave the doctor'soffice within an hour, and they will likely not need to returnto an optometrist for this problem for the rest of their lives.

The price is reasonable, and insurance companies usuallypay for the surgery, but patients may, in some cases, haveto dig into their own pocket books for the cost of thelenses, but that might be a small price to pay for the ability

to see the world the way it was meant to be viewed.

About the Author:Mark G. Ballif, MD, completed hisOphthalmology residency at The MedicalCollege of Wisconsin. He treats mostforms of eye disease, specializing in laservision correction and modern cataractsurgery. For more information, contactDr. Ballif at (801)476-0494

Cataract surgery is one of the mostcommon medical procedures conducted

in the US, and as Baby Boomers continueto age, they are flooding procedure

rooms and surgical centers in droves.

CataractSurgery


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whatdoctorsknow.com6

Big ears are not funny. In fact, the AmericanSociety of Plastic Surgeons reported that nearly40,000 teens in 2001 had Otoplasty surgeryto reduce the prominence of their ears.



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whatdoctorsknow.com 7

Children and teens withprominent ears are often teasedand ridiculed by their peers. Boys

grow tired of having to grow long hairto cover their ears while girls affected bythe problem are reluctant to even tucktheir hair behind their ears or wear apony tail in fear of being ridiculed.

Otoplasty gave these children morebalance to their facial features, but there

are many patients and parents whoare unaware that overly prominentears can be corrected by means ofa simple surgical procedure.

Otoplasty, or ear pinning, is a surgicalprocedure for individuals whose ears areabnormally large or overly prominent.The condition ranges from very mild, tothe complete absence of an ear (microtia)in severe cases. For the majority ofpatients with cupped, malformed, or eveninjured ears, dramatic improvement can

be achieved through otoplasty surgery.

The procedure takes between one andtwo hours, depending upon the specificcondition being addressed. It can bedone under local anesthesia in the officesetting, but for younger children oraccording to patient wishes, surgicalanesthesia can be used. In any case,hospitalization is not required, recovery isquick, and pain control is easily achievedwith mild analgesic medications.

Ear pinning can be performed at any agebut is best done when patients are at leastsix or seven years old and can be involvedand invested in the decision and surgicalprocess. Ive performed this operationon children as young as four, but I preferthem to be closer to six, when they aremore aware of their bodies and becomeexcited about the change to their ears.

Although I do see some adults seeking

improvement to their ears, the majority ofpatients are children. Concerned parents,most often prompted by their children,bring them in for evaluation during theirschool years. As with all elective surgery,to me its very important for the patientto be part of the decision making process.When the patient is excited about thechange to their ears, he or she is motivatedand able to smoothly navigate thesurgical process. As I see them back in myoffice following recovery with improvedconfidence and big smiles on their faces,

Im happy to know that Ive contributedto that happiness in some way.

As for numbers of people affected,studies cant isolate any race or genderfor the condition, but some data, as wellas empirical evidence, suggests thatgenetic inheritance is often involved.There also seems to be no genderpredilection. Available data suggests that53 percent of teens undergoing otoplastyprocedure are males. Approximately

33 percent of all

otoplasty proceduresare performed onboys and girls intheir teens. However,as mentioned above,I have had numerousadult cases. In fact,one patient wasin his 70s whenhe presented forsurgery. I knew

As I see them back in myoffice following recovery withimproved confidence and big

smiles on their faces, Im happyto know that Ive contributed tothat happiness in some way.

the procedure had been successfulwhen he cut his hair short enoughto expose his ears for the first timein years. Otoplasty brings a lot of joyto both the patient and the doctor.

As a fellowship trained Facial PlasticSurgeon and Otolaryngologist,I see many patients interestedin improving this aspect of theirfaces, and I find great satisfactionin assisting them in their desires

Before

After

Before

After

Otoplastyfor Outstanding Ears

Two of Dr. Thompsons otoplasty patients.Photos used with permission.

About the Author:Scott K. Thompson, MD, is boardcertified in both facial plastic andreconstructive surgery, as well asotolaryngology. For the past six years hehas joined a select group of surgeonsfrom Boston and Rochester, New Yorkwho travel to Ecuador and Guatemalatwice a year on a charitable journey to

correct congenital ear deformities on local children. For moreinformation, contact Dr. Thompson at (801)776-2220


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whatdoctorsknow.com

The Power of

a Smile

T

here are few things in life that are more powerful thanyour smile. A smile demonstrates your self-confidenceand reflects a positive attitude to those around you. The

symmetry of your upper and lower jaws affects the way you smileand may also impact the alignment of your teeth. Straight whiteteeth are most often a result of years of orthodontic treatmentand proper dental care. Many times, orthodontic treatmentalone is insufficient in correcting a dental malocclusion (poorbite), especially if it is a result of a skeletal growth discrepancy.

Christine, a 17-year-old patient, was referred to our officewith a complaint of an inability to chew because of her dentalmalocclusion. She had undergone three years of orthodontictreatment which had been unsuccessful in correctingher malocclusion. After careful clinical and radiographic

examinations, she was diagnosed with a facial growthdiscrepancy. Her mandible (lower jaw) had grown too farforward, whereas her maxilla (upper jaw) was too far back. Thiscondition had rendered her incapable of a normal masticatoryfunction. Christine was taken to the operating room, whereshe was given general anesthetic and both her maxilla andmandible were broken and moved into proper alignment. The

jaws were stabilized using titanium plates and screws andChristine went home the following morning. She returned toschool one week later and was able to chew with a perfect bite.

Current literature reveals that nearly 20% ofthe population have some form of facial growthdiscrepancy. The most common musculoskeletalfacial deformities include the following:1-Mandibular prognathism (lower jaw too far forward)

2-Mandibular retrognathia (lower jaw too far back)

3-Maxillary hyperplasia (upper jaw too far forward)

4-Maxillary retrognathia (upper jaw too far back)

5-Maxillary apertognathia (anterior openbite/only the back teeth touch)

6-Transverse maxillary deficiency(upper jaw too narrow)

7-Vertical maxillary excess (showsexcessive gum tissue)

Before

Before After

After

An Oral and Maxillofacial Surgeon is agraduate of an accredited dental school whohas completed an additional four or more yearsof training in an accredited, hospital-basedOral and Maxillofacial Surgery Residency

Program. Oral and Maxillofacial Surgeons carefor patients with wisdom teeth, facial pain, andmisaligned jaws. They place dental implants,care for patients with oral cancer, tumors andcysts of the jaws, treat facial trauma patients,and perform facial cosmetic surgery. Theiradvanced training in anesthesia allows themto provide quality care with maximum patientcomfort and safety in the office setting.

Dr Egbert's patients


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My jaw is too far back, I dont like my gummy smile,My chin looks too big, I cant close my teeth togetherare some of the complaints expressed at initial jaw surgeryevaluations. In order to address these complaints andachieve optimum results, it is important that patientswork closely with an orthodontist and a maxillofacial

surgeon. Generally, pre-surgical orthodontic treatmentlasts six to twelve months. This is followed by orthognathicsurgery and an additional four to six month post-operative orthodontic treatment to align the teeth.

Many types of asymmetry can be corrected with a singlejaw surgery. More complex growth discrepancies requiresurgery to both upper and lower jaws and chin or cheekimplants. The goal is to achieve not only a functionalocclusion but a balanced facial relationship as well.

Vast improvements have been made in the field of Oraland Maxillofacial Surgery in the last fifteen years. In the

past, the surgical procedures took four to five hours tocomplete, required a two to three day hospital stay andnecessitated that the jaws be wired shut for eight we eks.Now, the procedures are generally completed in less thantwo hours, are performed on an outpatient surgical basis,and no longer require the use of wire fixation. Patientsleave the hospital wearing rubber bands and generallyneed only ibuprofen for post-operative pain. They arethen maintained on a soft diet for six weeks to allow thehealing of the jaws. They return to school or work withina week, and to full physical activity after six weeks.

Post-surgical visits continue until the orthodontic treatment

is completed. Once the braces are removed, patients returnfor post-operative photographs and a final checkup.It is rewarding to hear comments such as Thank youfor giving me a beautiful smile and making me a moreconfident person. I cant wait to see my before and afterpictures!, You have changed my life!!, and Thank youfor the miracle you have blessed me with! I am so gratefulfor everything you have done for me!! It is extremelyfulfilling to be part of a life-changing experience forour patients. Patients can now chew well, smile withoutembarrassment and radiate a new sense of self-confidence.

About the Author:Gregory W. Egbert, DDS, MSD, isa Maxillofacial Surgeon practicingfor the last years, specializingin Orthognathic Surgery. He is anAssistant Clinical Professor of Surgeryand Division Chairman of Oral andMaxillofacial Surgery. For moreinformation, contact Dr. Egbert at(801)265-1500

Before

Before After

After

In the past, the surgical procedurestook four to five hours to complete,required a two- to three-day hospitalstay and necessitated that the jaws bewired shut for eight weeks. Now, theprocedures are generally completed inless than two hours ... and no longerrequire the use of wire fixation.

Photos used by permission


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Get Your Vision BackDump those glasses or contacts!

LASIK skills arent reserved for just those with aname. Yet, visitors who walk the halls of HoopesVision see walls with a number of pictures and

autographs of celebrities who have enjoyed the lastingbenefits of LASIK surgery. These mementos arent displayed

to intimidate or impress. They are mere reminders thatwhen vision is important, LASIK is often a great choice.

Vision is just as important for a mother with a growingfamily who spends her day chauffeuring, cooking, andchasing children as it is for the professional athlete or thestudent in the back row of a classroom. Perhaps thatswhy I have seen thousands dump their glasses or contactlenses and opt for LASIK eye surgery correction.

For over eighteen years I have been correcting refractive errors andduring this time, the advancements in procedures and equipmenthave been nothing short of miraculous. In the early days, therewere a few rare cases of night vision problems and in some cases,

patients required a touch up. Today, the procedure is done withpinpoint accuracy with state of the art laser technology with veryfew problems and complications. We now use 5th generation lasersthat produce better results with fewer problems than ever before.

Amazingly, the total procedure time is about 20 minutes withthe actual laser time taking less than 20 seconds on average;there is no pain just a little pressure. The patient is givennothing more than a sedative prior to the procedure to takethe edge off the nervousness. Total in-office time on theday of surgery is about two hours part of which is spentin a massage chair eating warm chocolate chip cookies.

What is LASIK Surgery?There are two types of laser vision corrections available forpatients today: PRK and LASIK. Photorefractive keratectomy(PRK) is a laser treatment of the cornea surface and wasfirst approved in 1995 and was the forerunner to laser

surgery procedures. The first PRK after FDA approvalwas performed at Dr. Hoopes laser center in Kansas City.Shortly afterwards, the FDA approved LASIK surgery.

PRK is performed with an excimer laser, which uses a coolultraviolet light beam to precisely remove microscopicamounts of tissue from the surface of the cornea in orderto reshape it. When you reshape the cornea in the rightway, it more precisely focuses light into the eye and ontothe retina, providing clearer vision than before.

Both nearsighted and farsighted people can benefit fromPRK. With nearsighted people, the goal is to flatten the too-steep cornea; with farsighted people, a steeper cornea isdesired. Also, excimer lasers can correct astigmatism, bysmoothing an irregular cornea into a more normal shape.

LASIK SurgeryEven though the surgery is relatively quick, LASIK isa very delicate procedure and it's important to haveit performed by a highly skilled surgeon with properequipment. You also should have someone accompany youto the surgery center and drive you home afterward.

Before your LASIK begins, numbing drops will be appliedto your eyes so you don't feel any discomfort during the


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About the Author:Phillip C. Hoopes, MD, is a pioneerin Lasik surgery. He has performedmore than ,000 Lasik and refractivesurgeries, and over 60,000 visioncorrection procedures. For moreinformation, contact Dr. Hoopes at(877)305-2745

procedure. The doctor will then have you lie down, makingsure your eye is positioned directly under the laser.

The first part of the surgery is to create the corneal flap.Traditionally this was done using a metal razor blade(microkeratome). For the past six years we have been using aprecise, safe laser (IntraLase) to do this. During the procedure

you won't actually see the creation of the flap, which is very thin.

This ultra-thin flap is then lifted and the second laser reshapesand sculpts the anterior corneal surface. The flap then isreplaced, irrigated, and smoothed.

The surgeon uses a computer toadjust the laser for your particularprescription. You will be asked tolook at a target light for a short timewhile he or she watches your eyethrough a microscope as the lasersends pulses of light to your cornea.

The laser light pulses painlesslyreshape the cornea and you willhear a steady clicking sound whilethe laser is operating. The newerlasers are equipped with trackersthat will follow any eye movementthat might occur. This assuresthat each laser spot is deliveredwhere it is intended with accuracyand produces better vision.

The higher your prescription,the more time the surgerywill take. Rest assured, the surgeon has full control of thelaser and can stop it at any time. We have 6 FDA-approvedlasers and our most frequently used laser, the AllegrettoWavelight, is 8 times faster than the older lasers whichresults in a much more comfortable experience.

After the procedure is finished, you will rest for a littlewhile. If you're having both eyes done the same day,the surgeon will begin working on your second eyeimmediately after treatment of the first eye is finished.

Once the surgery is complete, your surgeon may prescribemedication for any postoperative pain, but most people feel nomore than mild discomfort after LASIK. That's one advantage of

LASIK over PRK, which can cause some soreness for a few days.

Cataract SurgeryCataracts are the leading cause of treatable visual loss in adultsage 55 and older and the leading cause of blindness worldwide.By age 65, about half of the human population has signs of acataract, and by age 75, almost everyone has a cataract. However,cataracts are highly treatable, and through advances in bothcataract surgery and intraocular lenses (IOLs), more people areexperiencing full restoration of their vision than ever before.

A cataract is a clouding of the eye's natural lens, which liesbehind the iris and the pupil. The lens works much like a

camera lens, focusing light onto the retina at the backof the eye. The lens also adjusts the eye's focus, lettingus see things clearly both up close and far away.

The lens is mostly made of water and protein. Theprotein is arranged in a precise way that keepsthe lens clear and lets light pass through it.

As we age, some of the protein may clump together andstart to cloud a small area of the lens. This is a cataract,and over time, it may grow denser and cloud more of the

lens, making it harder to see.

Cataract surgery is very successfulin restoring vision. In fact, it isthe most frequently performedsurgery in the United States, withmore than 3 million Americansundergoing cataract surgery eachyear. During surgery, the surgeonwill remove your clouded lensand replace it with a clear, plasticintraocular lens (IOL). The surgeryused to take about an hour butnow only takes 10 minutes orless. Sutures are no longer usedand vision recovers quickly.

New IOLs are being developedall the time to make thesurgery less complicated forsurgeons and the lenses morehelpful to patients. Presbyopia-

correcting IOLs potentially

help you see at all distances, not just one. Another newtype of IOL blocks both ultraviolet and blue light rays,which research indicates may damage the retina.

The outcome of cataract surgery is usually excellent. Theoperation has low risk, the discomfort is minimal, andrecovery time is short. Sight improves quickly for most people.

Are you a candidate?If you have been wondering if you might be a good candidatefor LASIK eye surgery, talk to your opthomologist todetermine if you are a candidate for LASIK, PRK, or the newIOLs that give good vision close up and in the distance. Youcan also visit www.hoopesvision.com for more information.


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Do You

Suffer FromTMJ ?An estimated ten millionAmericans suffer from headaches,neck pain, earaches, tendernessof the jaw muscles, and/or

dull, aching facial pain theytoo often attribute to lifes littleaches and pains. However,their discomfort can actually becaused by temporomandibularjoint (TMJ) disorder.

T

hese aches and pains can have a variety ofcauses, but when they are TMJ related it usuallymeans the chewing muscles and jaw joints arent

working together correctly. The good news is that inmany cases TMJ disorders can be treated successfully.

THE TMJ ORIGIN

The structures making it possible to open and close the mouthare very specialized and work together when you chew, speakand swallow. These structures include the muscles, ligaments,bones and joints of the jaw. Five pairs of muscles allow youto open and close your mouth. They also control forward,backward, and side-to-side movements of the lower jaw.Among these structures are the temporomandibular joints.Each of these important joints has two sections, connected

by a disk, that allow the hinge and gliding actions neededto open the mouth widely. Any problem that prevents thiscomplex system of muscles, ligaments, bones, and joints fromworking together properly may result in a TMJ disorder.

TREATMENT FOR TMJ DISORDERS

Since the teeth, chewing muscles and temporomandibularjoints all can be involved in a TMJ disorder, treatments vary.Your oral surgeon will decide what type of treatment is neededfor your particular problem. Often, treatment will involve aseries of phases. This step-by-step plan is in your best interestbecause only minor corrective treatment may be needed.

SIGNS OF A TMJ DISORDERTMJ disorders have many signsand symptoms including:

Pain in or around the ear. Thispain often spreads to the face.

Tenderness of the jaw muscles.

Clicking/popping noises whenopening or closing the mouth.

Difficulty in opening the mouth.

Jaws that get stuck, lock, or go out.

Pain brought on by yawning, chewing,or opening the mouth widely.

Certain types of headaches or neck aches.

If pain and other symptoms persist, a more involvedtreatment, such as surgery, may be needed.

SURGERY (arthroplasty)

Arthroplasty refers to all types of open surgery forTMJ, including disk repositioning, discectomy, and jointreplacement. Arthroplasty can range from minimallyinvasive to complex surgery. Due to the general risksassociated with surgery, this treatment is used onlyafter other treatment options have been considered.

DISK REPOSITIONING

Disk repositioning is used when the protective cartilagedisk has slipped out of place inside the TMJ. This conditionoften creates the "popping" noise inside the joint. Althoughpopping in the joint is not always caused by TMJ problems,in some patients the joint can become damaged and thesupporting ligaments can become stretched and inflamed.Nerves surrounding the TMJ may also be pinched by a slippeddisk, causing considerable pain and even inflammation.

whatdoctorsknow.com


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About the Author:Mark Newey, DDS, started his privatepractice in 00. He belongs to a numberof organizations including, AmericanOral & Maxillofacial Society, AmericanSociety of Dental Anesthesiologist, andWeber District Dental Association. Formore information, contact Dr. Newey at(801)825-1116

the surrounding tissue. This tissue often contains nervesthat cause significant TMJ pain. Research has also shownthat many patients have improved function of the jaw(able to open and close), which continues to improve overthe next few months and even years following surgery.

ARTICULAR EMINANCE RECONTOURING

In some cases, the articular eminance (part of the "socket"portion of the TMJ) can be too deep or too steep. Thiscan result in excessive forces being placed on the condyle(the ball portion of the joint). The surgeon shortens andsmooths the articular eminance in to prevent these excessiveforces, and improve range of motion and lessen pain. Thisprocedure is sometimes done as part of a larger TMJ surgery,such as joint replacement. If a joint is badly damaged andcannot be repaired, it must be removed and replaced.

Disk repositioning requires an overnight visit andapproximately two hours in surgery. Under general anesthesia,the surgeon makes an incision, moves the displaced diskback to its original position and stitches it in place. Thesurrounding ligaments are also repaired, if needed.

Although this can be a very effective treatment, andpreserves more of the patient's original anatomy,sometimes the disks do not stay in their new position.If this happens, a discectomy (surgical removal of thedisk) may be required to remedy the problem.

DISCECTOMY

A discectomy is performed when the disk providing paddingand protection to the TMJ has deteriorated or become damaged.Disks constantly out of position or those which pop back andforth inside the joint are also good candidates for a discectomy.

A discectomy requires an overnight visit andapproximately two hours in surgery.

Under general anesthesia, the surgeon makes an incisionand removes the disc. Although typical recovery timeis two to three weeks, it may take several monthsfor scar tissue to completely fill the joint and preventthe bones from rubbing and grinding together.

Discectomies can also help reduce pain associated withTMJ disease. When the disk is removed, so are parts of

whatdoctorsknow.com


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Brain tumors are silent killers. This year alone,more than 200,000 Americans will be diagnosedwith some type of brain tumor. Sadly, thousandsmore could be walking around with a tumorand may not know either because they dontknow the warning signs, or there are none.

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Is It More Than A Headache?

E

arly detection of some tumorscan increase the chance ofsurvival, whereas other tumors

simply are not successfully treatableno matter when they are found. Themost common adult tumor, calledglioblastoma, is also the most malignant.

Most brain and spinal cord tumorshave no known risk factors and occurfor no apparent reason. There are noproven ways to prevent these tumors.Diagnosing the presence of a tumor canbe more difficult than other diseases asthere may be few or no warning signs.

There is no blood test or other

screening examination to detectbrain tumors; there are only signsthat should not be ignored.

Four years ago, a well-known localfootball player was referred to myoffice with a possible neck problempresenting as arm weakness. Aftera thorough examination, I found theproblem was a large malignant braintumor. I operated and took out as muchof the tumor as possible while trying tomaintain his motor skills. We scheduledradiation therapy to kill the rest of

the tumor, but the tumor had grownbeyond treatment. In barely three shortweeks from when we found the tumor,it consumed him and he passed away.

There is a misconception that seizuresare a strong indicator of a tumor. Aseizure may or may not be an indicationof a tumor. Sometimes a symptom maydeter the diagnosis. For example, thisseemingly healthy football player wasthought to simply have a neck injury.

Severe, unrelenting headaches that crop up

suddenly are probably the most commoninitial symptom. Typical "brain tumorheadaches" are described as severe in themorning, with gradual improvementduring the day. The headache may wakeyou from sleep and sometimes, afterwaking, you vomit and then feel better.These headaches may worsen withcoughing, exercise or with a change inposition such as bending or kneeling.Often the headache does not respond toover-the-counter headache remedies.

muscle control, lack of coordination,decreased sensation, weakness or paralysisand difficulty with walking. Head tilt,

drowsiness or personality changes canalso suggest the presence of a tumor.

Symptoms are most likely to developgradually. In some cases, the tumorcan grow extremely large before anysymptoms surface. Physicians havereported tumors the size of a grapefruitwithout any symptoms, and benigntumors can grow very large withoutwarning signs. The brain can adapt totumors because they grow slowly. Usually,family members start seeing symptomsafter the tumor has grown substantially.

Once a tumor is suspected, the first step intreatment is a CAT scan or MRI ordered by theprimary care physician or a nurse practitioner.If a tumor is found, the patient is sent to aneurosurgeon for evaluation. Not all tumorsneed to be treated. Some may be followedbecause they tend to grow very slowly.However, there is always a very small chancethey can change and become malignantover time. If there are changes in the MRIpicture, or symptoms worsen, the physicianmay order a biopsy or remove the tumor.

Often, when tumors are malignant,the first treatment is surgery. This isoften followed by radiation and/orchemotherapy. Some benign tumors, suchas those affecting auditory nerves, maybe treated with focused radiation as well.

There is a fine line between beingovercautious and ignoring symptoms.The very nature of a tumor tells us thatit is better to be cautious. Dont ignorethe symptoms and dont be embarrassedto rule out the possibilities with yourphysician. It could save your life.

There are a number ofoutward signs that raise thepossibility of a tumor: Headaches Nausea/vomiting

Seizures Weakness or numbness onone side of the body

Changes in vision,hearing or sensation

Difficulty with speech Lack of coordination A change in mood or personality Memory loss

Tumors can appear at any age evenin early childhood. Because childrenusually do not complain of headaches,

early warning signs of a tumor can bemissed. If a child is falling or showinga frequent loss of balance, this can bea warning sign. Clumsiness shouldnot be confused with loss of balance.

In addition to headaches, there aremore specific or focal symptoms thatcan be warnings. These symptoms cansometimes help identify the location ofthe tumor and even the best treatment.

Focal symptoms include changes instrength or weakness on the side of thebody opposite to the side that lodgesthe tumor. Braintumor symptoms areprogressive, unlikestroke symptoms.Symptoms includechanges in thinkingor memory, hearing

problems such as ringingor buzzing, hearingloss, speech difficulties,double vision, decreased

About the Author:Jodie Levitt, MD, graduated from theMedical College of Pennsylvania in and spent five years of residency at OhioState followed by two years as ChiefResident at UMD of New Jersey. Sheis board-certified in Neurosurgery. Formore information, contact Dr. Levitt at(801)363-2473


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Regardless of age, if youve relied on eyeglassesfor most of your life, LASIK can be very effective.Bear in mind, Lasik is primarily designed

to correct myopia (near-sightedness) or hyperopia(far-sightedness) and some degrees of astigmatism.Generally, youre a LASIK candidate as long as there isno presence of cataracts, glaucoma or other eye issues.

Presbyopia (the gradual need for reading glassesafter age 40) is a very common condition LASIK cancorrect. This involves a type of added treatment calledmonovision, which can apply to special cases. However,

the Premium Lens Implant or Premium Smart Lens,as I call them, is becoming a more common choice forcorrecting presbyopia because it not only corrects visionbut also can prevent future issues such as cataracts.

Premium Lens Implants have been prescribed forcataract patients, but younger patients electing to havethis procedure to correct vision will also prevent theoccurrence of cataracts later in life. There are a number ofbenefits a premium lens implant can offer including theimprovement of intermediate and distance vision, whilealso improving the ability to see (or read) up close.

Am I Too Old For Lasik?Lasik is good-but Premium

Lens Implants may be better


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Using cataract surgery as an example,a premium lens implant replacesthe natural lens, which becomescloudy. This is normal because oureyes age and by age 70, nearly allAmericans either develop a cataract

or have cataract surgery. After age40, words or images up close start tobecome blurry, even if youve neverneeded glasses. Suddenly, you needglasses to read -- which is normal.

We are finding a premium lensimplant is no longer just forretirement age, or the olderpopulation, even though theprocedure is relatively the same ascataract surgery -- minus the cataract.

With premium lens implants,the patients natural lens

is replaced with a lens

implant to correct the need for reading glasses,

while preserving the intermediate and distance

vision which diminishes because of cataracts.

The implant procedure is simple and takes only afew minutes. There is no discomfort and the patientcan usually see normally in just a few days.

Several intraocular lenses (IOLs) are classified as being"Premium" and include presbyopia-correcting and thosecorrecting astigmatism. Within the presbyopia-correcting groupthere are two main types: 1) Accommodating and 2) Multifocal.

Accommodating Lens

Accommodating Lenses are designed to adjust like thenatural eye to see at multiple distances. Once the lens isimplanted, it moves naturally with the eye, providing clearervision and improved depth of focus at all distances.

Crystalens is the first and only FDA approved accommodatingintraocular lens and most closely mimics the natural

action of the eyes lens. Crystalens is an implant thatuses the eye muscle to flex and accommodate in order tofocus on objects in the environment at all distances.

Multifocal Lenses

Multifocal lens implants correct both your distance visionand your presbyopia. For the vast majority of patients, havinga multifocal lens implant means that you will be able to seeat distance and up close without being dependent on glasses.Patients choosing to have a multifocal lens implant will find

they can drive, watch television, read and more withoutthe need for glasses. The two FDA approved multifocallenses, ReStor and Tecnis, are fundamentally designedto enhance near, intermediate and far distance vision.

The Toric IOL Lens

The FDA approved the first Toric IOL lens in 1998. A Toriclens is mainly for anyone with a significant amount ofastigmatism. This usually means the cornea is irregularlyshaped causing blurred vision. Astigmatism can behereditary or developed through the use of contact lens.

Overall, every premium lens is designed for a

patients specific needs and your doctor will helpyou make the right choice based on your eye careneeds. After a thorough evaluation, youre doctorwill help you decided if youre a candidate for LASIK,premium lenses or some other treatment option.

Remember, dont hesitate to ask your doctor questions.Having a voice in your healthcare is an importantstep in treatment as well establishing trust andassurance between you and your doctor. And finally,remember your lens implant will last a lifetime. Soyour implant decision is one for a lifetime as well.

About the Author:Phillips Kirk Labor, MD is a BoardCertified Ophthalmologist, Dr. Laboris internationally known for his work inrefractive surgery, with more than 0years of refractive and cataract expertise.His affiliations include the AmericanAcademy of Ophthalmology, AmericanSociety of Cataract and Refractive

Surgery, American College of Eye Surgeons, and Society ForExcellence in Eye Care. For more information, contact Dr.Labor at (817)410-2030


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B@/27B7=:/:/520%, Utah Stage 3(moderate) >2035% and Utah Stage 4(extensive) >35%. The ablation successrate for patients who are classifiedas Utah 1 is nearly 100%. The stagingsystem is also useful for determining apatients stroke risk and the effectivenessof commonly prescribed medications.

In practical terms,this means thatpatients can nowbe screened beforehaving an ablationprocedure todetermine whetherthey are appropriatecandidates. Thisreduces theunnecessaryrisks and costs


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1. Incompetent (overly relaxed) esophagealsphincter which no longer controls backflow.

2. A hiatal hernia (top of the stomachbulges over the diaphragm)

3. Overly filled stomach with delayedemptying (because the stomach doesnot empty while we sleep.)

The interaction of all of these factors is a fairly complexmechanical and physiologic interchange. For more in depthinformation about physiologic, dietary, and weight loss optionsfor GERD, please see the article in this issue by Dr. StevePorter on pages 29-31 titled "Acid Reflux: The Burning Issue".

Once GERD is identified, anumber of treatment optionscan be prescribed.

Surgical Options

Nissen fundoplication is an anti-reflux operationthat helps patients who have persistentsymptoms despite medical treatment.

The upper part of the stomach (gastric fundis) is wrappedaround the lower esophagus and is sutured to the stomach,

When Surgery is Neededto Correct Acid Refux

Aromantic evening in town, an excessively richmeal late in the evening, wine, and a couple ofpeppermints from the checkout counter sets the

stage for a night of discomfort, indigestion, and chokingon undigested food and sour acid regurgitated into themouth...You have just crossed over into the TwilightZone of gastroesophageal reflux disease (GERD).

GERD refers to the regurgitation of stomach

contents into mouth and airways.

Food and acid are typically prevented from reflux by

competent function of the lower esophageal sphincter, aring of muscle in the lower esophagus, which is assistedin its job by the diaphragm, maintaining a mechanicalbarrier at the top of the stomach and lower esophagusto prevent backflow of acid and symptoms of reflux.Heartburn, also called acid indigestion, is the mostcommon symptom of GERD. However, if left untreated,GERD can cause esophageal ulcers, esophageal bleeding,and narrowing of the esophagus (peptic stricture).

What causes GERD?

GERD results due to a failure of themechanical barriers to reflux:


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whatdoctorsknow.com

To determine your BMI, you simply multiply your weightin pounds by 703 and divide the result by the square ofyour height in inches. The AHA suggests a BMI below 25.

If your BMI is below 25, keep up the good

work. If your BMI is above 25, it should be a

wake up call for you to change your lifestyle,

change the way you eat and get active.

Along with the potential for added body fat, an inactivelifestyle is a risk factor for coronary heart disease. Regular,moderate-to-vigorous physical activity helps prevent heartand blood vessel disease. The more vigorous the activity,the greater your benefits. Even moderate intensity activitieshelp if done regularly and long term. Physical activitycan help control blood cholesterol, diabetes and obesity,as well as help lower blood pressure in some people.

Keep in mind that not only will physical activity helpin the weight category, it also reduces blood pressure,increases HDL and improves the body's sensitivity toinsulin, which helps control blood sugar. I advise 30

minutes of moderate exercise 5x/week. Patients shouldexercise to a perceived moderate level - meaningsweaty and breathless, not able to speak in a fullsentence without talking a breath -- but not gasping.

As a general rule, I advise a physical conditioning

program focusing on 4 targets: endurance

(cardio), strength, flexibility, and agility.

Smokers' risk of developing coronary heart disease is 2-4times that of nonsmokers. People who smoke a pack ofcigarettes a day have more than twice the risk of heartattack than people whove never smoked. Cigarettesmoking is a powerful independent risk factor forsudden cardiac death in patients with coronary heartdisease. Cigarette smoking also acts with other riskfactors to greatly increase the risk for coronary heartdisease. People who smoke cigars or pipes seem to havea higher risk of death from coronary heart disease (and

possibly stroke) but their risk isn't as great as cigarettesmokers. Exposure to other people's smoke increasesthe risk of heart disease, even for nonsmokers.

High blood pressure increases the heart's workload,causing the heart to thicken and become stiffer. Thisstiffening of the heart muscle is not normal, and causesthe heart to work improperly. It also increases your risk ofstroke, heart attack, kidney failure and congestive heartfailure. When high blood pressure exists with obesity,smoking, high blood cholesterol levels or diabetes, therisk of heart attack or stroke increases several times.

Finally, diabetes seriously increases your risk ofdeveloping cardiovascular disease. Even when glucoselevels are under control, diabetes increases the risk ofheart disease and stroke, but the risks are even greaterif blood sugar is not well controlled. At least 65% ofpeople with diabetes die of some form of heart or bloodvessel disease. If you have diabetes, it's extremelyimportant to work with your healthcare providerto manage it and control any other risk factors.

Of course, if there is any doubt about your riskfor heart disease, see your doctor for a check up.Youll find out how healthy you heart is and receive

lifestyle advice based on your check-up.

About the Author:Stephen L. Miller, MD, FACC,received his fellowship in cardiologyat the University of Wisconsin. He isthe founder of a leading cardiologycenter in Salt Lake City, UT. Formore information, contact Dr.Miller at (866)885-4278.


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0

Common Causes of Shoulder Pain Bursitis (inflammation of the

lubricating layers of the shoulder)

Rotator Cuff Tear (tearing of thetendons that support the shoulder)

Frozen Shoulder (a condition thatleads to stiffness of the joint)

Calcific Tendinitis (a condition ofcalcium deposits within a tendon)

Shoulder Instability (looseness of thejoint resulting in partial dislocation)

Shoulder Dislocation (an injuryfrom an obvious trauma causing a

separation of the ball and socket joint) Shoulder Separation (also

called an AC separation)

Labral Tear and SLAP lesion(tearing of the cartilage ringthat supports the shoulder)

Arthritis (destruction of thecartilage lining layers of the j

Documents

What Doctors Know - Vol 1 Issue 1