Wellington The Magazine-July 2016

Children’s Hospital At Palms West Offers Exceptional Pediatric Services Close By

Palms West Hospital knows that medical treatment affects children differently. They are not just small adults.

 Families in the western communities can take comfort in knowing that exceptional pediatric healthcare is located right in their own backyard. The Children’s Hospital at Palms West — the only dedicated pediatric hospital in the western communities — offers a full complement of healthcare services and is a hub of specialized pediatric services for a five-county area.

The Children’s Hospital at Palms West is essentially a hospital within a hospital. All hospital services offered for adults are also available for children. Palms West Hospital knows that medical treatment affects children differently than adults. Even if they suffer from the same illness or injury, children are not just small adults.

Growing children have different bodies than grownups. A routine procedure for an adult may have serious implications for a developing child. Not only do children require specialized pediatric care from practiced professionals who identify a young patient’s immediate medical needs, but also recognize the long-term effects of procedures and treatments on a child. In addition, caring for a child requires that “special touch” — to be able to communicate with the child at his or her level and inform the parent or family member regarding the child’s condition.

Palms West Hospital has specialized pediatric services in the emergency room, inpatient care, the intensive care unit, hematology/oncology, imaging and rehabilitation. The medical staff includes 128 pediatric specialists covering 22 sub-specialties, such as pediatric cardiology, pediatric endocrinology, pediatric neurosurgery and pediatric oncology. With this breadth and depth of specialists on staff, area families do not have to travel outside of the community for treatment. In fact, patients come from as far away as Coral Springs and Okeechobee to receive pediatric care at Palms West Hospital.

Palms West Hospital’s pediatric emergency room treats nearly 19,000 children annually, which accounts for 35 to 40 percent of the total ER volume per year. When a trip to the ER is needed, hospital staff members know how important it is to make children feel comfortable and put their fears to rest. That is why they offer a dedicated pediatric emergency room, where sick and injured kids receive emergency medical treatment in a separate, child-focused environment. This includes a bright, colorful area with murals, a movie theater, toys and games, staffed by board-certified physicians specializing in pediatric emergency care.

Pediatric services also include a child life specialist who helps children and families cope with the hospital environment, focusing on what a child needs emotionally in order to be treated medically. This often takes the form of diversionary activities, such as games, toys, books or even a new teddy bear.

The pediatric in-patient department features 22 all-private beds and 10 pediatric intensive care unit (PICU) beds. Patients in this area are cared for by pediatric intensivists, specialized in the care of critically ill young patients.

Palms West Hospital has a service-oriented philosophy that puts the needs of children and their families first. The Children’s Hospital at Palms West reflects a theme that is child-friendly, bright and cheerful, which keeps spirits up and tensions down. A very important part is the environment created for the children. Each pediatric room reflects an outer space theme, named for a planet, star or constellation, and is furnished with kid-friendly décor. Even in the hospital, a child’s room should be a safe haven. That’s why Palms West has separate treatment rooms where children can be transferred for any specialized treatment their condition may require. Afterward, they can return to the cozy familiarity of their own private rooms.

The Children’s Hospital at Palms West includes an interdisciplinary team comprised of dedicated pediatric professionals, such as physicians, nurses, respiratory therapists, pharmacists, social workers and clinical dietitians. All members of the healthcare team have been specially trained to care for children of all ages — from toddlers to adolescents.

A large focus in the pediatric unit is the playroom, where children can feel safe and comfortable while taking a needed break from their treatment schedule, as well as a teen room with computers and internet access. Just as in the ER, a full-time child life specialist provides therapeutic play and developmentally appropriate activities for patients, reduces the stress of hospitalization, and provides support to patients and their families.

The child life specialist also partners with outside charitable organizations that wish to provide cheer to the pediatric patients. These organizations provide junk food runs, Nerf fights and pizza parties, which allow kids to be kids while they are hospitalized. At holiday times, the calendar is filled with visits from generous local groups.

The Children’s Hospital at Palms West also has a dedicated unit for pediatric hematology/oncology patients. This program, started in 2006, is led by Medical Director Dr. Melissa Singer, the area’s only pediatric hematologist/oncologist. Since its inception, the program has grown tremendously. Many hematology/oncology patients are also treated on an outpatient basis, in a dedicated infusion area. Caring for children with cancer and blood diseases is complex and requires emotional sensitivity, something that the caregivers at Palms West truly understand.

In 2004, Palms West Hospital developed the first pediatric residency program in the area, the only one north of Miami and south of Orlando. To this day, it is the only pediatric training program in the area. Many of the program graduates continue working in the local community.

Throughout the year, Palms West offers a number of family friendly community events focused on topics like summer safety, healthy habits or just good holiday fun. There are also teddy bear clinics, which allow children the opportunity to become familiar with a hospital environment, while they are healthy, so it is not such a scary environment should they require a trip to the ER.

The Children’s Hospital at Palms West’s reputation as a warm, inviting environment continues to draw physicians and families alike. This has helped with the program’s continued expansion and has led to its reputation of an exceptional healthcare hub for the specialized care of children.

To learn more about the Children’s Hospital at Palms West, call (561) 345-7009 or visit www.palmswesthospital.com.

Wellington The Magazine-July 2016

Palm Beach Urology Associates Raises The Bar In Robotic Surgery

Story and Photos by Julie Unger

Dr. Fred Muhletaler, a specialist in the da Vinci Surgical System, has joined the Wellington-based urology practice.

Although the basics of urology remain the same, technology has changed by leaps and bounds in the 31 years since Dr. Edward Becker began Palm Beach Urology Associates.

Originally a solo practice, Palm Beach Urology Associates has grown substantially, with several doctors on staff serving four locations. In 1990, Dr. Rafael Lopez joined the practice, followed by Dr. Damian Portela and Dr. Georgis Patsias.

“Several years ago, the robotic aspect of urology came into the picture, and at one point, Dr. Portela and I both got trained to do robotics,” said Becker, a longtime Wellington resident. “During that time, I realized that in order to really do robotics the way it needs to be done, it needs to be somebody who has a lot of experience and a lot of training.”

Their results were good, but it took Portela and Becker a long time in the operating room. They decided it was time to bring a robotics specialist into the practice, especially since there wasn’t, at the time, anyone in the county who was a fellowship-trained robotics surgeon, Becker explained.

One of the newest members on Becker’s team is Dr. Fred Muhletaler, of Palm Beach Advanced Robotics, who specializes in utilizing robotic surgery to treat urologic cancers such as bladder, prostate and kidney, and reconstructive procedures to reestablish function.

“I was very interested in the robotic technique since I first came into contact with it in 2001,” Muhletaler explained. “I was a medical student, and I decided to rotate at Henry Ford Hospital — and all of a sudden I saw a robot in the operating room. I just thought that was going to be the way major surgery in urology, and in general, was going to be done in the future.”

In 2006, Muhletaler joined the department as a clinical research fellow before completing his residency and spending two fellowship years working in urologic oncology.

The team he worked with truly was pioneering the field, and Muhletaler has had involvement with more than 1,200 robotic cases, of which approximately 900 were radical prostatectomies for prostate cancer, during his approximately 10 years at Henry Ford Hospital.

“My chairman in Detroit, his name is Dr. Mani Menon, is the guy who did the first radical prostatectomy in the United States,” Muhletaler said. “He is the guy who really pioneered robotics in the field. He’s my mentor, and he is regarded as the father of robotics in urology. He pushed the field forward. He pioneered and standardized surgical techniques in all of the commonly done surgeries done in urological cancer.”

Muhletaler joined the Palm Beach Urology Associates team in August 2015 after meeting them and learning about the need for minimally invasive robotic surgery in the area. He has primary privileges at four nearby hospitals with robotic systems — Palms West Hospital, Wellington Regional Medical Center, JFK Medical Center and Palm Beach Gardens Medical Center.

“We’re able to do major surgeries, specifically for urologic cancer, but also for reconstructive procedures, with hospital stays of one or two nights at the most, with very minimal pain and being very successful with controlling the cancer and reestablishing function within the urinary system,” Muhletaler said.

A common misconception, he explained, is that people think robotic surgery is programmed and the doctor just sits back and watches. That couldn’t be further from the truth.

The da Vinci Surgical System robot — the only one approved by the FDA —  acts as an extension of the doctor’s hands. Imagine taping skewers to your fingers and then trying to type — it isn’t an easy task, and is one which requires skill, precision, specialized training and hours upon hours of practice.

“It’s something you really have to be doing every day,” Becker said.

The kidneys and prostate are deep organs that are difficult to get to and require larger incisions in traditional open surgery, Muhletaler explained. In robotics, by utilizing small holes in the abdomen, doctors are able to have the view of open surgery, with minimal cuts that cause less pain.

Typically, with a prostate removal, the patient will be in the hospital between three and five days with open surgery. With robotics, it is only one night. Patients are able to return to work within a few weeks rather than six to eight weeks.

“It makes a significant difference,” Muhletaler explained. “The surgical pain, that is a large part of the surgical recovery, is greatly improved.”

Having a great team is also important to excelling.

“Before Dr. Muhletaler got here, this practice already did very big surgical procedures; we just did them open,” Becker said. “In order to do big surgical procedures, you need a good assistant. Haydee Rodriguez, RN, joined our practice nine years ago, and she is the primary surgical assistant for this practice… Palm Beach Urology really is a comprehensive urologic practice. There’s really nothing that we don’t do, and in order to be able to do something like that, the surgical assistant is key.”

Rodriguez, Becker’s niece, is now Muhletaler’s surgical assistant in robotic surgery.

“It’s very interesting, the views that you get, and being able to reach everything without having to cut the patient open with a big incision. Just seeing the recovery is amazing,” she said. “It’s just really amazing, the technique, and seeing Dr. Muhletaler work with it — it’s amazing, the things he can do with it.”

Palm Beach Urology Associates has locations in Wellington (3347 State Road 7, Suite 101), Palm Springs (1620 S. Congress Ave., Suite 202), Boynton Beach (8198 Jog Road, Suite 209) and Belle Glade (1100 S. Main St.). For more information, call (561) 790-2111 or visit www.palmbeachurology.com.

Wellington The Magazine-July 2016

JFK Medical Center’s Neuroscience Institute Leads The Way In Treating Complex Disorders

The neuroscience team at JFK is committed to using the most advanced surgical and medical treatments.

The Neuroscience Institute at JFK Medical Center is a leader in treating brain, spine and nervous system disorders. Collaboration is key in caring for such complex issues, and JFK’s team of neurosurgeons, neurologists, neuro-interventional radiologists and specialty trained staff team up to provide the best care possible for patients.

The neuroscience team is committed to using the most advanced surgical and medical treatments, as well as the most cutting-edge technologies to treat all disorders of the nervous system, which are classified as:

• Vascular disorders such as stroke, transient ischemic attack (TIA), subarachnoid hemorrhage, subdural hemorrhage and hematoma;
• Infections such as meningitis, encephalitis and epidural abscess;
• Structural disorders, such as brain or spinal cord injuries, Bell’s palsy, brain or spinal cord tumors, peripheral neuropathy and Guillain-Barré syndrome;
• Functional disorders, such as headache, epilepsy, dizziness and neuralgia; and
• Degeneration, such as Parkinson’s disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS), Huntington’s disease and Alzheimer’s disease.

Physicians who treat nervous system disorders may have to spend a significant amount of time working with a patient before making a specific diagnosis. Often, this involves performing a number of tests to eliminate other conditions.

JFK Medical Center is designated as a Comprehensive Stroke Center and is known as one of the best-equipped hospitals in the state to treat any kind of stroke or stroke complication. The hospital receives a large number of transfers from surrounding primary stroke centers. The main goal for stroke patients is to stop the area of the brain where the stroke occurred from dying by restoring blood flow as quickly as possible.

Fast treatment is critical. Dr. Teresita Casanova, medical director of neuroscience and stroke, said the key to remember during a stroke is that “time is brain.” The chances of survival are best if a stroke is identified and treated immediately.

In 2015, JFK Medical Center treated more than 600 stroke patients, of which 87 percent had an ischemic stroke, which occurs as a result of an obstruction within a blood vessel supplying blood to the brain.

The remaining 13 percent had a hemorrhagic stroke, which is caused by a ruptured blood vessel, aneurysm or abnormal tangle of blood vessels (AVM).

The only FDA-approved treatment for ischemic stroke is a tissue plasminogen activator (tPA), which works by dissolving the clot and improving blood flow to the part of the brain that needs it. If administered within three hours, tPA can improve the chances of recovering from a stroke. Unfortunately, a significant number of those who experience a stroke do not get to the hospital in time for tPA treatment. This is why it is so important to identify a stroke immediately. Round-the-clock access to minimally invasive catheter procedures to treat a stroke, as well as neurosurgical availability to perform complex neurovascular procedures, are also available at JFK Medical Center.

Neuro-interventional radiologists specialize in the minimally invasive, endovascular approach of navigating microcatheters through the blood vessels under X-ray guidance. This procedure might be used in the case of a stroke, cerebral aneurysm, or brain and spine arteriovenous malformations (AVMs). Coiling is one type of procedure performed by neuro-interventional radiologists Dr. Abraham Obuchowski and Dr. Nana Amiridze. This procedure is used to treat aneurysms in the brain. A catheter is introduced into the femoral artery in the groin, passed up through the arteries of the body, inside the head, and into the aneurysm. The aneurysm is then packed off from the inside with wire coils, which are very pliable, soft platinum coils. Conditions that would have required open surgery in the past can now be considered for this type of minimally invasive treatment.

In some cases, it is too difficult to pass a catheter through the carotid artery to reach the aneurysm. If this is the case, alternative treatments such as surgery are performed by a neurosurgeon. Surgery could include a craniotomy and clipping of the aneurysm in which it is sealed off with a clip.

The neurosurgeons at JFK Medical Center are highly trained and skilled in the most modern treatment options. Their comprehensive capabilities, advanced surgical techniques and collaboration with experts in the field of neurosciences enable them to manage a wide array of conditions. Procedures can range from a straightforward insertion of a lumbar drain to the very complex removal of a malignant brain tumor. The most common procedures performed by a neurosurgeon are clot removal, aneurysm repair, tumor removal, brain bleed stoppage, shunt insertion/revision and endovascular procedures.

One of the most recent neurosurgery programs begun at JFK is the Endoscopic Skull Base Surgery Program. Skull base surgery, a procedure performed not within the brain, but at the skull base behind the nose, uses minimally invasive techniques that can replace open surgery in many cases. Neurosurgeons can remove tumors using the openings of the face instead of through incisions. Tiny endoscopes are used to navigate to the tumors.

Minimally invasive endoscopic skull base surgery is often an option for pituitary tumors, which are often inaccessible through open surgery. Diagnosing and treating anterior skull base conditions and tumors require the expertise of a multi-disciplinary team of specialists all working together. At JFK, this team of physicians includes Dr. John Cantando (neurosurgery), Dr. Alfredo Archilla (ENT) and Dr. Abraham Obuchowski (neuro-interventional radiology).

Also included within JFK’s Neuroscience Institute is spine surgery. JFK Medical Center has neurosurgical and orthopedic fellowship-trained spine specialists on staff. There are also pain management consultants, who work closely with physicians, nurses, physical therapists and occupational therapists to help determine an accurate diagnosis and develop a plan of care designed specifically for each patient to bring quicker recovery with less pain and complications.

With such an in-depth neuroscience program, it is important to have a dedicated neuroscience intensive care unit, as well as a specialized neuroscience inpatient unit. Staff members who work within these areas receive specialized training to care for patients with neurological disorders.

To learn more about the services offered at the Neuroscience Institute at JFK Medical Center, visit www.jfkmc.com or call (561) 548-4535.

Wellington The Magazine-July 2016

Chamber’s Medical & Wellness Committee Helps Make Wellington A Healthier Community

Top industry professionals are working with the Wellington Chamber of Commerce on this effort to help local residents.

The Wellington Chamber of Commerce has put together a Medical & Wellness Committee to represent the community’s vibrant medical, health and wellness industries.

Each of the committee’s professionals have committed to donate four hours each month to serve Wellington by providing outreach, consulting services, and health and wellness assistance through nutritional advice, mental health advice, stretching out a local sports team, pharmaceutical consulting, or providing wellness services to at-risk youth or local seniors.

Committee Chair Lisa Banionis has worked professionally in marketing, education and the health industry. As a certified health coach, she is able to follow her passion for health and wellness and provides health coaching to patients. She also uses her business and marketing expertise to provide guidance to Florida Interventional Pain Management and Palm Beach Anti-Aging & Regenerative Medicine as business and marketing director. She is also a member of the Women of the Wellington Chamber.

Dr. Max Cohen of MaxHealth Chiropractic graduated from the Palmer College of Chiropractic in 2010, becoming a third-generation chiropractor. His drive for treating musculoskeletal conditions and sport-related injuries began in 2001 as a licensed massage therapist. Cohen regularly attends seminars to keep up to date on the latest information and technology. His model of care is centered beyond passive care alone. This results in better movement, improved function and faster pain relief.

Her work with MorseLife has afforded Judy Gelpey the opportunity to promote and raise awareness of senior services in Palm Beach County. She serves on the healthcare committees of the Boynton Beach Chamber of Commerce, the Wellington Chamber of Commerce, the Hispanic Chamber of Commerce and the Chamber of Commerce of the Palm Beaches. For the past 15 years, Gelpey has been the co-chair of the Professional Resource Network, a networking group of healthcare marketing professionals.

John Goodfellow of Healthcare Source LLC has more than 35 years of experience in diverse and complex mid-to-senior-level executive positions in large and nationally acclaimed real estate development firms. He founded and continues to manage multiple small business ventures. Goodfellow possesses an active Florida certified general contractor license as well as a real estate license and a nurse registry license. A licensed pilot, Goodfellow also serves on the chamber’s Business & Economic Development Committee.

Dr. Stephanie Lippman is a Florida licensed clinical psychologist and co-founder at the Psychological Wellness Center. She has extensive experience conducting psychotherapy and psychological evaluations with couples, families, adults, children and adolescents. Lippman has served as a parent educator and has facilitated therapy groups with all age ranges. She also serves as a consultant devising and implementing training programs for other mental health professionals, and has served as a media consultant for local media outlets, including WPTV and WFLX.

Dr. Lori Mazza of Family Vision Center graduated as valedictorian from Nova Southeastern University in 1995. Her education included a four-month rotation at the Bascom Palmer Eye Institute in Miami, where she was trained under some of the top ophthalmologists in the country. She then completed a one-year residency in ocular disease. She is an active member of the Palm Beach County Optometric Association, the Florida Optometric Association and the American Optometric Association.

In 2008, Johnny Meier and his wife Meroe founded My Community Pharmacy to provide superior patient care in their new hometown. The business is now located near Whole Foods Market on State Road 7, where it serves an increasing volume of patients. The immediate past president of the chamber, he has worked hard to raise money for the American Cancer Society’s Wellington Relay for Life and is also a member of the American Legion.

Tiffany Rodriguez of Coast to Coast Pharmacy started working for Frank and Herta Suess 14 years ago as a customer service manager at Prescriptions Plus. She has worked her way through the ranks and is the current general manager of several pharmacies. She has also been very active in the Wellington Chamber, where she is the current vice president of the chamber’s board of directors and a member of the Women of the Wellington Chamber.

Dr. Andrew Savin of Bethesda Health Physician Group graduated from Rush Medical College in 1988. He completed two years of general surgery residency at Michael Reese Hospital in Chicago, and subsequently became board-certified in internal medicine after completing three years of training at Rush Presbyterian Saint Luke’s University Hospital. Savin practiced in Illinois before he moved to Florida in 2015. He is currently building a primary care practice, which will open this summer in Wellington.

Joe Stein of Merrill Lynch is co-founder of the Vanderpool Stein Group. He coordinates the investment affairs for a select group of families, business owners and healthcare practitioners in Wellington. A graduate of Tufts University, he holds a Florida resident agent’s license in life insurance and variable annuities, and long term care life insurance. Stein’s business focuses on customized strategies, asset protection and planning with an emphasis on service. He also serves as a chamber ambassador.

For more information about the Wellington Chamber of Commerce or this committee, call (561) 792-6525 or e-mail info@wellington chamber.com.

Wellington The Magazine-July 2016

Bethesda Hospital West Offers Trusted Kidney Care

Image-guided radiofrequency ablation therapy delivers advanced targeting for many kidney tumors.

Since the mid-1990s, kidney cancer, also called renal cell carcinoma, has been on the rise. According to the American Cancer Society, newer imaging tests are detecting solid renal masses at an earlier stage, partly contributing to the increase in renal cancer diagnoses.

At the same time, however, there has been a marked decrease in death rates from kidney cancer. This welcome news is likely due to improvements in image-guidance technologies that empower radiofrequency ablation (RFA).

RFA is a minimally invasive procedure in which a very thin needle electrode is inserted directly into the tumor’s cancer cells. High-frequency electrical currents pass through the needle, creating heat that destroys cancer cells without harming surrounding healthy tissue.

Specific to a cancerous renal mass, image-guiding technology adds real-time, GPS-like guidance to help a trained radiologist or urologic surgeon place the needle directly into the kidney tumor’s cancer cells, while avoiding healthy tissue.

Bethesda Hospital West is the sole medical institution in Palm Beach County that offers patients one of the most advanced image-guidance technologies, called the Artis Q by Siemens Healthcare, as well as Florida’s only urologic surgeon who performs advanced image-guided RFA for renal cell cancers — Dr. Raymond J. Leveillee, director of the Bethesda Center for Advanced Robotics & Urologic Care.

The Artis Q is a ceiling-mounted X-ray imaging system, with a C-shaped arm that connects to the X-ray source. It is commonly used for interventional angiography or oncology procedures. During the procedure, the patient lies on the specially designed table, and the C-arm is moved to different settings based on the imaging needs.

The quantum leap in this technology relates to a flat-panel detector that rotates around a patient in a two-second sweep, resulting in more efficient, real-time, CT-like medical imaging. There is also greater imaging accuracy when compared to traditional X-ray devices. In addition, the semi-open C-shaped arm gives the radiologist or surgeon more room to work.

An advanced image-guided RFA procedure requires a general anesthesia so that the patient stays perfectly still. “From the patient’s perspective, this therapy is virtually painless,” Leveillee explained. “It’s almost an acupuncture-style approach to solid renal masses.”

With Leveillee’s 15 years of experience in image-guided RFA, he often finds the technique as effective as a partial nephrectomy, the gold standard for treating solid renal masses measuring less than 4 centimeters (about 1.5 inches).

“When it’s the right candidate, image-guided RFA accomplishes the same high level of cancer cure for small renal or kidney masses as cutting the tumor out, but there is a minimal amount of trauma to the patient, virtually no blood loss and maximal preservation of kidney function,” Leveillee said.

Leveillee cites two primary factors for image-guided radiofrequency ablation’s acceptance.

First, enhanced guided-imaging capabilities remove the guesswork as to where the needles should be inserted. With real-time, CT-like imaging, a radiologist or urologic surgeon can see on a monitor precisely where to insert the needles — whether performing a biopsy or targeting cancer cells. With the ability to better target only cancer cells, as much normal tissue as possible can be preserved without compromising the tumor treatment.

“The needles go exactly where I want them, instead of my guessing where they should go and then having to confirm placement with a CT scan,” Leveillee said. “With fewer required CT scans, I reduce the patient’s exposure to radiation.”

Second, a better understanding of candidates for this procedure has increased positive outcomes.

“The proper candidate is somebody with a solid, enhancing renal mass that’s less than four centimeters, which we also refer to as stage T1a,” Leveillee said. “In the past, this therapy, if offered at all, was reserved for elderly patients or those who were not surgical candidates. However, more radiologists and urologic surgeons, like myself, now believe that if the procedure works on someone 75 years old, it will work on someone 65 or 55. So I discuss this option with every qualified patient who comes in the door.”

Recovery from image-guided radiofrequency ablation is quick. “About 98 percent of patients return home the day of the procedure. Within three or four days, patients are off pain medications and back to driving or work,” Leveillee said.

As Bethesda Hospital West continues to stay ahead of the curve in image-guided radiofrequency ablation, Leveillee points to yet another benefit — experience.

“In the early days, there was a higher rate of complications, such as bleeding and obstruction of urine flow from the kidney or skin burns,” he noted. “Those things rarely happen now. We’re selective about choosing the right candidates for this procedure, and we know our limits. That all adds up to improved outcomes, few complications or risks, and high patient satisfaction.”

Bethesda Hospital West is located at 9655 Boynton Beach Blvd. in Boynton Beach. To learn more about the Center for Advanced Robotics & Urologic Care, visit www.bethesdaweb.com or call (561) 737-7733, ext. 84405.