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THE CCTA FOR HEART IMAGING

By Arlene Mavko ● February 14, 内蒙古快3
内蒙古快3Scanning & Screening, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

The topic today is the cardiac computed tomography angiography, or CCTA. This procedure is a more recent option for heart imaging that some may compare to the traditional cardiac catheterization or heart cath. While both procedures take images of the heart and assist in detecting blockages, the two procedures are different.


The heart cath remains the “gold standard” for the detection and treatment of blockages in the coronary arteries. Because it is an invasive procedure that is performed internally , the heart cath generates very accurate images of the arteries and allows the physician to perform immediate intervention, such as stent placement, if a worrisome blockage is found. Sometimes the heart cath will show lesser blockages that the physician will note for ongoing monitoring. The heart cath is appropriate for high-risk patients and those who have known coronary artery disease (CAD) and are symptomatic. During the procedure, a catheter inserted into a vessel in the groin or arm goes up to the heart where imaging contrast in injected directly into the coronary arteries to produce detailed images of the coronary arteries.


The CCTA is a noninvasive procedure that takes images from outside the heart. Imaging contrast is injected via a small needle into a vein in the arm, and the contrast travels to the heart to produce images using CT technology. The CCTA images are less detailed than those generated from the heart cath but are detailed enough to enable physicians to make decisions with a high degree of accuracy. The CCTA allows physicians to measure calcium in the walls of the coronary arteries, which is useful information to estimate the risk level of the patient for a cardiac event and determine an appropriate proactive treatment plan. The CCTA also can create 3-D models of the heart, which helps physicians evaluate heart abnormalities that were present from birth and provides data that assist in procedures involving the heart’s electrical system.


The CCTA offers yet another choice in addition to the heart cath and the stress test to get valuable information about the heart. It remains a viable option in certain circumstances, such as when patients are not able to endure optimal stress testing, when a CCTA can help identify known or suspected structural heart defects, when newly diagnosed cardiomyopathy calls for an evaluation of the coronary arteries, and when the anatomy of the patient’s heart will assist in performing another heart procedure. The patient’s physician will determine the tests or procedures, if any, that are most appropriate for each patient.


At SIR, the CCTA is expertly performed by Dr. Gerald E. Grubbs, interventional radiologist who is fellowship-trained from the Miami Cardiac and Vascular Institute at Baptist Hospital of Miami and who specializes in diagnostic, cardiovascular and interventional radiology. For more information about the CCTA or other offerings at SIR, call 941-378-3231.



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DEGENERATIVE DISC DISEASE (DDD) AND THE ACHING BACK

By Arlene Mavko ● January 31, 内蒙古快3
内蒙古快3Pain Management, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

DDD is a condition of aging that affects the spinal discs located between the vertebrae of the spine. These discs provide a padding or cushioning between the vertebrae while also helping the spine to bend. They have been compared to a jelly doughnut, having a thicker outer layer and a softer gelatin-like interior.


Stress factors placed on the spine throughout life cause several types of changes within the vertebrae:

• Loss of fluid content within the discs results in thinning of the discs that makes then less effective in doing their job as the body’s shock absorbers.

• Structural changes, such as small tears, cracks, and fragmentation, occur in the outer layer of the discs. Such changes may lead to seepage of the gelatinous substance of the discs and subsequent bulging or rupturing.


For some, DDD presents little to no symptoms, while for others it produces severe and even debilitating symptoms. DDD generally occurs in the lumbar spine (lower back) or cervical spine (neck).

• Lumbar spine—When DDD exists in the lower back, pain and discomfort affect the buttocks and upper thighs, but numbness and tingling may travel to the legs and feet. 

• Cervical spine—In this area, DDD causes pain in the neck, shoulders, arms, and hands.


Those affected by DDD also may experience a variety of complications that affect the nerves:

• The body may develop bone spurs, tiny projections of bone that may press against the spinal cord or nerves and cause pain loss of nerve function. 

• Severe bulging of the disc, referred to as a herniated disc, may occur.

• The spinal canal may become narrow, a condition called spinal stenosis.


Individuals with DDD may try a number of treatment options including physical and/or occupational therapy, special exercises, water aerobics, braces and other support devices, medications, weight loss, interventional procedures, and surgery. 


Sarasota Interventional Radiology offers several injections that provide relief for pain from DDD. One is the facet joint injection, which involves injecting the joints next to the damaged disc with a local anesthetic and steroids to reduce inflammation and provide long-term pain relief. Fluoroscopy or CT is used to precisely guide placement of the needle into the facet joint. Skillfully administered by Gerald E. Grubbs, MD, SIR’s medical director, this procedure takes about 30 minutes and may be repeated up to three times a year. 


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CALCIUM CORONARY SCORING
Plaque Buildup in Your Heart's Vessels

By Arlene Mavko ● January 14, 内蒙古快3
内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Coronary artery disease is a condition caused by plaque buildup in the coronary arteries. Plaque deposits are primarily made up of cholesterol, fat, and calcium that accumulate over time and well before any signs and symptoms of coronary artery disease occur. Calcium coronary scoring (CACS) is a heart scan performed to measure the amount of calcified plaque in the heart’s blood vessels. It is used to help develop a treatment plan for those who have low to moderate risk of heart disease or for those whose risk of heart disease is unclear.


The American College of Cardiology and the American Heart Association do not recommend this test for the following individuals:


• Those whose known risk of heart disease is very low, as calcified plaque is likely not detected for this group

• Men under age 40 and women under age 50, as calcified plaque is likely not yet detected at these ages

• Those who already have known high risk, a diagnosis of coronary artery disease, or symptoms of coronary artery disease

• Those who have had an abnormal calcium scoring heart scan


Also called a coronary calcium scan, this test uses CT (computerized tomography) technology to take multiple pictures of the heart that enable the physician to determine if calcium in the heart’s vessels is a risk factor for a heart attack or other heart problems. Some exposure to radiation is involved, but the level of exposure is generally considered to be safe and is estimated to equal the amount of natural radiation an individual receives in a year. At Sarasota Interventional Radiology, the CT used for this test is state-of-the-art ultra-low dose technology that features the lowest radiation exposure possible.


The calcium scoring exam takes less than 10 minutes. Test results are given a score that reflects the total area of calcium deposits and the density of the calcium. The higher the score, the higher the risk of heart disease. A score of 100-300 indicates moderate plaque deposits, while a score above 300 indicates high to severe risk of cardiovascular disease and heart attack. Results are promptly reported to the patient’s physician who will develop a treatment plan, if needed, or schedule any appropriate additional tests.


Gerald E. Grubbs, MD, medical director of Sarasota Interventional Radiology, specializes in diagnostic, cardiovascular and interventional radiology. His background includes a fellowship in Cardiovascular and Interventional Radiology at the prominent and prestigious Miami Cardiac and Vascular Institute at Baptist Hospital of Miami. 


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OBSTACLES TO LUNG CANCER SCREENING EXAM

By Arlene Mavko ● November 24, 2019

内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Although the CT lung screening exam is slowly gaining momentum across the U.S., the level of participation by those eligible for this test is only about 10%. Recent published articles have presented some of the reasons that at-risk ex-smokers and current smokers do not participate in low-dose lung screening. The top obstacles are summarized here: 


Lack of education or awareness. If you are a regular reader of this blog, you probably have read about lung cancer screening and the studies that show its life-saving benefits. In March and July 2019, we provided the detailed results of two significant clinical trials that demonstrated decreased mortality attributed to early detection from the low-dose radiation CT lung screening exam. Check out these blogs below.


If you are new to this website, you may not be aware of this exam and its potential benefits. We encourage you to read the blogs posted on this website and then discuss this exam with your primary care physician. We also invite you to call us at 941-378-3231 for more information or to schedule your lung screening exam at Sarasota Interventional Radiology (SIR). 


Cost of exam. Medicare Part B covers an annual low-dose CT lung screening exam for individuals who meet specified criteria and have the test at a Medicare-approved facility, such as SIR. Private insurance companies are increasingly covering the cost of this exam, so it’s best to check directly with your insurance provider. At SIR, we can help you with that.


Risks of exam. Because exposure to radiation is always a concern, a low-dose radiation CT is the only recommended screening exam for lung cancer. SIR’s ultra-low dose CT technology features the lowest radiation exposure available for this exam. 


Results of a study presented by BMJ Global Health concluded that “radiation exposure and cancer risk from low dose CT screening for lung cancer, even if non-negligible, can be considered acceptable in light of the substantial mortality reduction associated with screening.” (http://www.bmj.com/content/356/bmj.j347 )


Fear and anxiety. Some individuals may worry about actually being diagnosed with cancer, and some are reluctant to appear for the exam because they don’t want to be labeled as smokers. These feelings may be alleviated by primary care physicians who can boost the confidence of their patients. 


Access to exam. While CT lung screening is widely available, access may be difficult due to transportation challenges and related costs that may be a burden for some individuals. Primary care physicians and local hospitals may have information about mobile locations or transportation assistance to lung screening sites.



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Prepare to Quit Smoking on November 21 and Schedule your CT Lung Screening Exam at Sarasota Interventional Radiology

By Arlene Mavko ● November 12, 2019

内蒙古快3Scanning & Screening, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

It’s that time of year again for the Great American Smokeout® sponsored by the American Cancer Society. Held on the third Thursday of November—this year it’s on November 21—this day serves to motivate smokers to kick the habit and become smoke-free. Clearly, quitting smoking is the best way to reduce your risks of developing serious health conditions. 







Among the diseases caused by smoking are:

• Lung Cancer

• Other Cancers—Liver, Colon, Bladder, Esophageal, Cervical, Oropharyngeal Cancer (soft palate, throat, tonsils, tongue)

• Heart Disease

• Chronic Obstructive Pulmonary Disease (COPD)

• Stroke

• Aortic Aneurysm

• Diabetes

• Cancer

• Erectile Dysfunction


One would conclude that these risks are serious enough to never pick up a cigarette or to quit smoking immediately. Even a single cigarette causes immediate effects—increase in heart rate and blood pressure, decrease in blood flow to capillaries, increase of carbon monoxide in the bloodstream and decrease of oxygen reaching the brain and other organs, and less effective clearing of the airways that enable breathing. So quitting now is the best plan to reduce your risks. 


If you are a current or previous smoker, you can benefit from getting a low-dose radiation CT lung screening exam. Those eligible for this exam are individuals between the ages of 55 and 77 who have a 30-pack year history of smoking. 


We strongly emphasize that CT lung screening is not a form of smoking cessation, and quitting smoking is one of the most important things you can do to prevent lung cancer and improve your overall health. We all know this! But we also know that quitting smoking is one of the most difficult things to do, as nicotine addiction is very powerful. We’ll be your cheerleader and encourage you to look at the many forms of smoking cessation, discuss various programs with your physician, and pick the one that will work for you—you can do it!


Although CT lung screening exam is slowly gaining momentum across the U.S., the level of participation by those eligible for this test is a mere 10%. So what does it take for those who can benefit from this exam to actually have it? Perhaps it’s patient and physician education, or maybe reducing fear of the results. In previous blogs on this website, we have lauded the merits of annual CT lung cancer screening, a quick and simple procedure that has proven to save lives. Several large studies have shown that screening reduced lung cancer deaths in both makes and females due to detection of early-stage cancers. Scroll through our previous blogs to read more about these studies and other information about lung cancer and CT lung screening. 


To schedule your low-dose CT lung screening exam, call SIR at 941-378-3231. No preparation is necessary. Medicare reimburses for this exam if you meet the criteria, and many private insurers also reimburse.


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A FOCUS ON WOMEN AND LUNG CANCER

By Arlene Mavko ● October 31, 2019

内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

November is Lung Cancer Awareness Month, and this article focuses primarily on women current and former smokers who are considered to be at high-risk for lung cancer.


In 2007, Harvard Health Publishing made the following statements about lung cancer in women1:


• Women seem to have a special vulnerability to lung cancer, whether they smoke or not. 

• Women who smoke are more likely to develop lung cancer than men the same age with an equivalent smoking history.

• Women may have even more to gain from screening than men, in part because they tend to develop lung cancer earlier in their smoking lives. Also, when women develop lung cancer, they're more likely than men to have adenocarcinomas, slow-growing tumors that rarely show symptoms in the early stages.


Current data (October 2019)2 from the American Cancer Society reveal that about 13 percent of all new cancers are lung cancers, and estimates for women are 111,710 new cases of lung cancer this year and 66,020 deaths. For women, the risk of getting lung cancer in her lifetime is 1 in 17. While most lung cancers are related to smoking, there are other causes of lung cancer, e.g., air pollution, exposure to radon gas, secondhand smoke, asbestos, and other carcinogens. Family history of lung cancer is also a risk factor.


With this information, it seems logical that women would benefit from CT lung screening, yet statistics for 2015 showed that only 6.3 percent of women in the 55-80 age bracket who were considered to be at risk for developing lung cancer from smoking had a CT lung screening exam. Actually, the women did a little better than the men who had a reported 5.6 percent participation rate for that same year.3  


More recently, from those eligible for CT lung screening (current and former smokers, both male and female, between 55 and 80 years of age who have a 30-pack year history), about 10 percent actually participated.4 While this statistic certainly indicates a rising trend, the rate still seems surprisingly low.


Here are a few suggestions for our women readers: 


Talk to your physician about lung cancer screening, discuss your smoking history and any other risk factors you may have, and determine if low-dose radiation lung cancer screening may be appropriate for you. If you meet the criteria for the exam and there are no medical reasons why you should not have it, it’s time to seriously consider scheduling your CT lung screening exam.


Each year many of you will have an annual mammogram. It is a great opportunity to also schedule an annual CT lung screening exam if you fall into the high-risk category for lung cancer. Keep in mind that these are two separate exams, and they are not done with the same equipment. When scheduling your mammogram, remember to use that opportunity to also schedule your CT lung screening exam.


If you are still a smoker, now is the time to quit. Today there are many methods to help individuals quit the habit—smoking cessation programs, medications, over-the-counter products, and quitting “cold turkey.” Speak to your physician about your options.


1 http://www.health.harvard.edu/newsletter_article  /Lung_cancer_screening_in_women  

2 http://www.cancer.org/cancer/lung-cancer/about/key-statistics.html  

3 http://progressreport.cancer.gov/detection/lung_cancer 

4 http://www.auntminnie.com/index.aspx?sec=sup&sub=cto&pag=dis&ItemID=126613 


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RICHARD'S STORY--FROM INTENSE PAIN TO TOTAL RELIEF

By Arlene Mavko ● October 18, 2019

内蒙古快3Pain Management, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice


A roofing contractor by trade, Richard was moving 125-pound loads of product when he exerted his lower back and felt excruciating pain. At 内蒙古快3, Richard was more comfortable on the floor than on any other surface as he writhed in pain and contemplated a trip to the ER. His wife came 内蒙古快3 from work and applied some ice to give a little relief, but the couple knew this injury was likely one that would not be resolved by ice alone. 


Having knowledge of Sarasota Interventional Radiology (SIR), they contacted the office and were told that Richard needed an MRI to diagnose the exact problem and then give Dr. Grubbs the opportunity to determine if interventional radiology would be able to help. After the MRI, Richard went to SIR where his severe pain prohibited him from sitting down in the waiting room. During the consultation with Dr. Grubbs, Richard was informed that the MRI showed a herniated disc that was at the point of rupturing, but Dr. Grubbs was confident that an epidural steroid injection (ESI) would provide relief for the intense pain from which Richard was suffering.


Richard describes the whole ESI experience as “relaxing.” He was prepped in the pre-procedure area where he also met the anesthesiologist to discuss how he would be sedated during the procedure. He was then taken into the CT procedure room where Dr. Grubbs used the CT technology to guide him to the exact area to administer the injection. In Richard’s words, this was a “precision process.” 


Thanks to conscious sedation, Richard felt nothing and remembers nothing about the 20-minute procedure. His next memory was waking up in the recovery area where he was well taken care of by the recovery nursing staff. Richard says he “felt like a new man” because he had total and immediate relief. When Dr. Grubbs arrived in the recovery area to check on Richard, he was already dressed and ready to go 内蒙古快3. But the post-procedure conversation proved to be very valuable because Richard was instructed to rest for a few days and then wear a back brace to allow the herniation to resolve naturally. After six months of wearing the back brace at all times, the healing took place as Dr. Grubbs said it would. Because Richard’s job involves physical labor, he has learned ways to protect himself from injury, including wearing the back brace at any time he might be putting some strain on his back. 


Richard explains that if he had not known about SIR he would have gone to a “back doctor” and likely would have had traditional surgery. By choosing interventional radiology, he was able to avoid surgery, so his recovery time was much shorter and easier. Since his experience, Richard has recommended SIR to three acquaintances who also had positive experiences and successful outcomes at SIR.


For more information about the epidural steroid injection and pain management at SIR, click here http://www./about-pain-management.



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PROSTATE CANCER DETECTION WITH THE
TRANSPERINEAL FUSION BIOPSY APPROACH

By Arlene Mavko ● September 30, 2019

内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Sarasota Interventional Radiology (SIR) has always been a leader in using innovative approaches that improve results while providing greater benefits to the patient. A recent example is the transperineal biopsy to detect prostate cancer, now used by SIR instead of the traditional transrectal biopsy.  


The traditional transrectal biopsy extracts tissue samples by means of an instrument that reaches the prostate through the rectal wall. This approach is generally well-regarded and considered to be highly effective, but newer technology now provides the opportunity for an even better approach. The latest transperineal technique allows for tissue samples to be retrieved by entry through the area of skin located between the rectum and the scrotum, an area called the perineum.


Advantages to the transperineal approach include:


Lower risk of infection. The transperineal biopsy is performed in the perineum, where there is an extremely low rate of infection, namely sepsis, as compared to the transrectal method. Because the transrectal approach is done in close proximity to the rectum, there is a slight risk of fecal bacteria straying into the bloodstream through the needle punctures. 


Less chance of bleeding. The colon is an area with a high concentration of blood vessels, and hemorrhoids or large blood vessels in the colorectal area may lead to increased bleeding. By contrast, the area of the transperineal biopsy has very few blood vessels and can be sterilized for the procedure.


Higher rate of detection of a tumor. Studies conducted in several countries have shown evidence of increased effectiveness in detecting a tumor when using the transperineal approach, particularly when the cancer is located in the front and lower front areas of the prostate. 


At SIR, the transperineal biopsy is also a fusion biopsy, meaning that detection of cancer in the prostate is enhanced by that patient having a pre-biopsy MRI, along with ultrasound-guided biopsy images done in real time. The fusion of the MRI and ultrasound images show the precise location, shape, and size of a suspicious tumor. 


Gerald E. Grubbs, MD and Medical Director of SIR, is a specialist in the transperineal fusion biopsy. “We perform the transperineal fusion biopsy under conscious sedation to alleviate any anxiety the patient may have. He is not aware of the proceedings and will not remember anything about the procedure.” Dr. Grubbs is at the forefront of merging these new technologies and techniques to get the most accurate diagnosis that can then be used to chart the best treatment program for the patient.


For more information on prostate cancer diagnosis at SIR, visit our website at http://www./prostate-cancer. 


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ABOUT PROSTATE CANCER

By Arlene Mavko ● September 16, 2019

内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Other than skin cancer, prostate cancer is the most common cancer among American men. Projections from the American Cancer Society for 2019 estimate that there will be about 174,650 new cases of prostate cancer and about 31,620 deaths from prostate cancer in this population.


Each September marks National Prostate Cancer Awareness Month, a time for health advocates, practitioners, and anyone interested in prostate health and prostate cancer to educate men about the causes, risk factors, diagnosis, early detection, and treatment of prostate cancer.


Here are some facts about the disease, as described by the Prostate Cancer Foundation in its 2019 comprehensive Prostate Cancer Patient Guide.


• Four factors that influence a man’s risk for developing prostate cancer are age, race, family history, and where you live.


• The risk of developing prostate cancer increases as men age, with the average age of diagnosis being 69.


• Men with relatives who have a history of prostate cancer are twice as likely to develop this cancer, so there is a hereditary risk factor in developing prostate cancer. Also, genetic mutations present in some families increase the risk for developing certain cancers. Specifically, the breast cancer mutations known as BRCA1 and BRCA2 can affect the risk of developing prostate cancer.


• Men of African descent are 76% more likely to develop prostate cancer and have more than twice the risk of dying from it.


• The highest risk for dying of prostate cancer is for men who live north of 40 degrees latitude. (Draw a mental line that goes across the U.S. from northern Philadelphia through Columbus, Ohio, and to Provo, Utah.) A possible explanation is that this territory is associated with less sunlight and reduced Vitamin D levels.


• Prostate cancer is 8 times more common in Western cultures than in Asia, possibly because of genetics, environmental factors, lifestyle, and screening protocols.


Screening for prostate cancer by means of the PSA test remains a topic of ongoing discussion and debate. PSA refers prostate-specific antigen, which is a protein produced by the prostate and released into the bloodstream in very small amounts. When PSA reaches a certain level in the blood, it is an indicator of cancer. The word “indicator” is important here because the PSA test is not a perfect test, and elevated PSA levels may stem from reasons other than prostate cancer, such as an infection in the prostate or a noncancerous condition known as BPH (benign prostatic hyperplasia).


Because many cases of prostate cancer are slow growing, they take many years for the cancer to be large enough to detect and spread. In cases where the PSA test discovers a very slow-growing tumor, there is no long-term threat to the patient. However, there is a concern about overtreatment for these patients, because the side effects of a prostate biopsy and of treating low-risk prostate cancers may be more disadvantageous than helpful. On the other hand, prostate cancer has one of the highest survival rates of any cancer and is 99% treatable when detected early. Also, some prostate cancers are more aggressive and should be treated more urgently.


Decision-making about PSA screening should be based on the four factors described in the above bullet points. Also, there is consensus among experts that PSA screening is not appropriate for men whose life expectancy is less than 10 years. Here is a timeframe, suggested by the Prostate Cancer Foundation, of when men should discuss PSA screening with their physician:


Age 40. If you have a family history of prostate cancer that has caused death of a family member, if you are African American, or if you have the BRCA1 or BRCA2 mutation.


Age 45. If you have no family history of prostate cancer and if you are not African American.


Age 55-69. Discuss PSA screening with your physician.


Age 70 or greater. Screening has not proven to save lives.


Sarasota Interventional Radiology (SIR) recognizes National Prostate Cancer Awareness Month and enthusiastically supports increased education and awareness of this disease. For information on the role SIR plays in the diagnosis and treatment of prostate cancer, visit our website at http://www./prostate-cancer. 


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INTERVENTIONAL PROCEDURES FOR PAIN MANAGEMENT

By Arlene Mavko ● August 22, 2019

内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

You have pain, and you need relief. You also have questions:


• What kind of pain do you have? 

• What is the cause of your pain? 

• How can you get relief? 


Pain is generally categorized as either acute or chronic, with the volume of pain issues and pain-related costs rising as the American population ages.


Acute pain is defined as sudden onset of pain that persists for a limited amount of time, such as pain from an injury or a burn as well as the pre- and post-operative timeframes.


Chronic pain is defined as pain that lasts more than 12 weeks and affects daily functioning and quality of life. Chronic pain includes many types of pain as well as many causes for the pain. Acute pain can develop into chronic pain, especially when the underlying physiological condition is not resolved. Common types of chronic pain include back pain, joint pain, nerve pain, and headaches.


The Centers for Disease Control and Prevention (CDC) reports that 50 million adults in the U.S. have chronic pain, and 19.6 million of them having high-impact chronic pain that interferes with their daily life. An estimated $560 to $635 billion is the annual cost of pain in our country, while the loss of human life has also been costly as a result of overdose deaths from prescription and synthetic opioids.


A report1 released in May 2019 by the federally-appointed Pain Management Best Practices Inter-Agency Task Force addressed the topic of acute and chronic pain management. It contained recommendations for the development of individualized patient-centered care in the diagnosis and treatment of acute and chronic pain with an integrative and collaborative approach to care when clinically indicated.


Whatever type of pain you have, your first stop will likely be your primary care physician with the expectation that this medical professional will provide you with a preliminary diagnosis and begin to place you on a pathway to reduce or resolve your pain by selecting one or more options from the five treatment approaches shown above. (See June 25, 2019, blog on this website for more information on these five approaches.)


The category of interventional proceduresis an excellent choice for non-opioid pain solutions, particularly chronic pain that emanates from the spine, joints, muscles, and nerves. The interventional radiologist specializes in minimally invasive, image-guided diagnosis and treatment of pain and many other medical conditions. With image guidance such as CT, ultrasound, and fluoroscopy, the interventional radiologist can deliver treatment to the precise location or source of the pain. 


At Sarasota Interventional Radiology (SIR), headed by leading interventional radiologist Gerald E. Grubbs, MD, you may be assured that you are in the right place for your interventional pain solution. Dr. Grubbs delivers effective non-opioid interventional treatments for patients suffering from acute or chronic pain. Prior to any treatment, he has a thorough consultation with each new patient to discuss symptoms, review medical history (including any diagnostic tests such as x-rays, CTs, or MRIs), perform a physical evaluation, and discuss pain management options. At SIR, you will find a highly experienced and trained team of medical professionals who have not only the ultimate integrity in providing medical services but also the compassionate care that makes your experience as comfortable as possible.



1U.S. Department of Health and Human 内蒙古快3 (2019, May). Pain Management Best Practices Inter-Agency Task Force Report: Updates, Gaps, Inconsistencies, and Recommendations. Retrieved from U. S. Department of Health and Human 内蒙古快3 website: http://www.hhs.gov/ash/advisory-committees/pain/reports/index.html


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UPDATE ON EFFECTIVENESS OF LUNG CANCER SCREENING BY LOW-DOSE CT

By Arlene Mavko ● July 31, 2019

内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

On this website, we have featured several blogs about the effectiveness of lung cancer screening in reducing the number of deaths caused by lung cancer, and we have summarized the results of two significant clinical trials, one performed abroad and one here in the U.S.


The first study, known as the National Lung Screening Trial (NLST), was held in the U.S. The study, which began in 2002 and published its findings in 2011, compared the two most common means of detecting lung cancer—the standard chest x-ray and the low-dose radiation computed tomography (CT) exam. Over 53,000 participants were enrolled in the NLST and included current or former heavy smokers between the ages of 55 and 74. The participants, all of whom had a 30 pack-year history of smoking but showed no signs or symptoms of lung cancer. The participants were randomly assigned to undergo either the standard chest x-ray or the low-dose CT three times annually during the course of the study. While the study released a number of significant findings, its main conclusion was that the number of high-risk smokers who died from lung cancer within the first 6.5 years after CT lung screening was at least 20% lower than those who had screening lung by the standard x-ray. 


The second study was the NELSON lung cancer screening trial, conducted in Belgium and the Netherlands with almost 16,000 participants. Its results were released in early 2019, concluding that lung cancer screening played an important role in reducing lung cancer deaths for both males and females who are high-risk former and current smokers. A 26% reduction in mortality from lung cancer was reported for males at a 10-year follow-up, and a 39-61% reduction was reported for females at various years of follow-up.


In July 2019 an update of the NLST trial was released, confirming that lung cancer screening by low-dose CT contributed to a significant reduction in deaths even about 12 years after the initial screening exam for the study’s participants. Although the rate of occurrence of lung cancer was roughly the same for participants regardless of which type of screening they had, the death rate for those who had the CT was lower. 


We have not previously reported on a third, smaller study held in Germany for about 4000 smokers. This study compared mortality from lung cancer for those who had no screening exam at all with those who had CT lung screening. Results published in June 2019 found that CT lung screening lowered the risk of mortality for all participants by 26% but the rate of mortality was lower for women than for men. The study did not include any standard x-ray screening. 


“At Sarasota Interventional Radiology, we continue to encourage our physician peers to recommend lung cancer screening by low-dose CT to their patients with a smoking history,” states Gerald E. Grubbs, MD, SIR’s founder and medical director, “but smokers themselves may contact us directly, without referral from their physicians, to determine if their smoking history qualifies them as a candidate for this screening exam. The ultra low-dose CT technology at SIR is superior in early detection of small lung abnormalities and enables physicians to begin early treatment to save lives.”


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USE OF MRI FOR PROSTATE CANCER DIAGNOSIS

By Arlene Mavko ● July 26, 2019

内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

The transrectal ultrasound (TRUS) has long been the standard method used to perform an ultrasound- guided needle biopsy of the prostate to determine the presence or absence of cancer in men who have an elevated PSA or prostatic nodules evident from a digital rectal exam. Advancements in medical technology now offer an excellent alternative to the painful TRUS. This alternative is the diagnostic prostate MRI biopsy, technically known as the multiparametric MRI, or mpMRI. 


The MRI is a modality that performs better than the TRUS in detecting prostate cancer. This conclusion was reached in a study led by Nicholas Meermeir, MD, and his colleagues from the Oregon Health & Science Institute in Portland and published in the August 2019 edition of the American Journal of Roentgenology 1. 


Specific outcomes of the study include:

• MRI-guided biopsies detected positive prostate cancer in two-thirds of patients who had negative results on the TRUS.

• More than 70 percent of patients in the study received a new or upgraded diagnosis of prostate cancer, and 60 percent advanced to treatment for prostate cancer. 


Taking a closer look at what’s involved in these modalities, the TRUS-guided biopsy is generally performed with a local anesthetic that is injected into the rectum. An ultrasound probe and biopsy needle are then inserted into the rectum to evaluate the prostate. The biopsy needle is pushed into the prostate gland each time a sample is taken, usually up to 12 times to gather random core samples of prostate tissue. The key word here is “random” because the TRUS guides the biopsy needle to the prostate but not to the exact location of a suspicious tumor. Also, the TRUS is known to be very uncomfortable as each sample is taken and, despite the number of cores taken, can miss the actual site of a tumor. Other undesirable side effects may include bleeding, infection, and pain. 


The mpMRI, a pain-free procedure, is a special type of MRI scan that creates detailed images of the prostate that illustrate the size of the tumor and distinguish between cancerous and non-cancerous tumors. The images produced by the mpMRI are evaluated by an interventional radiologist who is trained to interpret them, determine the patient’s risk status, and guide management of the patient’s care and follow-up. If indicated, a targeted MRI/ultrasound fusion biopsy can be performed (rather than multiple random core biopsies) to evaluate a suspicious tumor. 


At Sarasota Interventional Radiology, interventional radiologist Gerald E. Grubbs, MD, is a highly skilled physician who performs real-time analysis of the mpMRI results and, when indicated, guides the patient through the next steps of the process to evaluate and treat a confirmed diagnosis of prostate cancer. Using the most current post-processing software, Dr. Grubbs has read and interpreted over 10,000 mpMRI exams. His experience and expertise draw physicians from all over the U.S. to rely on Dr. Grubbs for his important role in the diagnosis and treatment of prostate cancer.


1 AJR, August 2019, Vol. 213:2, pp. 371-376

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SPINAL INTERVENTIONS FOR RELIEF OF LOWER BACK PAIN

By Arlene Mavko ● July 2, 2019

内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Gerald E. Grubbs, MD, founder and medical director of Sarasota Interventional Radiology (SIR-Florida), uses his skills and training in interventional techniques and minimally invasive medicine to develop a comprehensive approach to pain management for his patients. “Here at SIR, we understand the importance of managing pain for patients who suffer from severe acute or chronic lower back pain,” states Dr. Grubbs, “and we want to enable the patient to progress with rehabilitation and resume a more normal life.”  


At SIR-Florida, several spinal interventions are performed to relieve common lower back pain: 

The lumbar epidural steroid injection (ESI) is effective in relieving low back pain and radiating leg pain. During this procedure, a steroid medication is injected into the epidural space between the L4 and L5 vertebra, using fluoroscopic guidance to pinpoint the precise location for the needle tip. The steroid medication, combined with an anesthetic to lessen pain, reduces swelling and inflammation caused by such spinal conditions as lumbar disc herniation, degenerative disc disease, and lumbar spinal stenosis. The ESI may provide immediate relief to some patients but frequently requires two or even three injections for maximum benefit. 


The selective nerve root block (SNRB) is used to diagnose a spinal nerve to determine if it is the specific source of radicular (radiating) pain that is causing the patient’s discomfort. Selection of which nerve to target for this procedure depends on the patient’s explanation of where the pain is occurring, along with testing that may be ordered by the physician. In this procedure, a local anesthetic and a steroid are injected along a specific nerve root. If the pain is alleviated, it can be concluded that the injected nerve root is the source of the pain. Initial relief can be attributed to the local anesthetic, which generally wears off within several hour, and duration of relief from the steroid varies from patient to patient. The injected steroid begins to take effect several days after the procedure and may last for several days or a few months, or even longer in some cases, if the injected nerve root is indeed the culprit. 


The facet block is an injection into the facet joints, which are located in the neck and spine between adjacent vertebra and give the neck and back flexibility. Because the facet joints are in almost constant motion, cartilage within them can degenerate or become irritated or inflamed, triggering pain in nearby nerve endings. The facet block injection is a diagnostic measure used to isolate and confirm the source of pain. The numbing anesthetic and anti-inflammatory steroid used in the injection deaden the pain and reduce the inflammation, thus providing relief where the facet joint is the source of the pain. As with the SNRB, the steroid takes effect in several days and provides relief for several days to months. 


“Our spinal interventions are minimally invasive and well-tolerated by the patient,” explains Dr. Grubbs, “and our board-certified anesthesiologists provide safe and appropriate conscious sedation, when needed, to give the patient maximum comfort during these procedures.”


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SIR’s ROLE IN THE MANAGEMENT OF CHRONIC PAIN

By Arlene Mavko ● June 25, 2019

内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Chronic pain is a common but very complex medical condition in our era. Defined as pain lasting longer than 12 weeks, chronic pain affects about one of every three American adults, not including cancer patients. An estimated 50 million American adults experience chronic daily pain, and almost 40% of this group has pain that is serious enough to affect their daily functioning and quality of life. As the population ages, the prevalence of chronic pain is expected to rise even more due to people living longer, many of whom will have some level of chronic arthritic and spinal pain.1


Individuals with chronic pain experience both the physical pain and its mental and emotional consequences. While they struggle to cope with pain and communicate to physicians the ways in which it is affecting their lives, physicians are challenged with finding comprehensive solutions. Given today’s opioid crisis, many patients are reluctant to accept treatment by this class of drugs due to fear of addiction or for being categorized as “drug seekers.” Both patients and physicians are caught between the opioid crisis and the crisis that is growing in our country.


A federal advisory committee, named the Pain Management Best Practices Inter-Agency Working Group, was established by the U.S. Department of Health and Human 内蒙古快3 in October 2017 to “propose updates to best practices and issue recommendations that address gaps or inconsistencies for managing chronic and acute pain."2 The committee’s work included participation from experts in the fields of pain management, pain advocacy, addiction, recovery, substance abuse disorders, mental health, and minority health, as well as input from patients, representatives of veterans service organizations, the addiction treatment community, and experts in overdose reversal.3


In its final report approved on May 9, 2019, the committee recommended implementing a multidisciplinary approach for the treatment of chronic pain, which includes one or more treatment modalities from the following treatment categories:4

  • Medications--opioid and/or non-opioid drugs, with the ultimate choice(s) based on the patient’s pain diagnosis, mechanisms of pain, related comorbidities, and risk-benefit analysis
  • Restorative therapies--physical therapy, therapeutic exercise, and other movement-based techniques
  • Interventional approaches--image-guided and minimally invasive procedures such as trigger point injections, thermal ablations (radiofrequency ablation and cryoablation), and neuromodulation (alteration of nerve activity a neuromodulation device that acts directly on the area of pain)
  • Behavioral approaches--methods to deal with psychological, cognitive, emotional, behavioral, and social aspects of pain
  • Complementary and integrative health--acupuncture, massage, movement therapies (yoga and tai chi), chiropractic, spirituality, etc.
  • Biopsychosocial model of care--biological, psychological, and social factors associated with pain

“Sarasota Interventional Radiology plays a vital role in offering interventional approaches that, in many cases, may reduce or eliminate the patient’s need for opioid medication,” states Gerald E. Grubbs, MD, leading interventional radiologist and SIR’s medical director. “Our procedures may stand alone as the patient’s treatment plan or may fit into a multidisciplinary program.”


Patients should discuss interventional and minimally invasive procedures with their primary care physician or other physicians involved in their care to help determine if such procedures will be beneficial. Upcoming articles on this website will feature a description of some of the interventional and minimally invasive procedures available at SIR. During consultation, Dr. Grubbs and SIR’s clinicians will discuss treatment goals—maximizing function and improving quality of life—along with the most appropriate treatment option(s) to the reduce the patient’s pain.


1, 2 http://www.hhs.gov/ash/advisory-committees/pain/index.html 


3, 4 http://www.medscape.com/viewarticle/914058?nlid=130117_5295&src=/wnl_dne_190607_mscpedit&uac=153271MX&impID=1987286&faf=1 _/p/index.html>

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OSTEOPOROSIS AFFECTS MEN TOO

By Arlene Mavko • 22 May, 2019
内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Osteoporosis is a condition that results in thinning of the bones, or low bone density, and is generally associated with postmenopausal women due to hormonal changes that result in low estrogen levels and subsequent bone loss. While women are four times more likely to develop osteoporosis than men, millions of men are also vulnerable to this condition, which can greatly impact their mobility and independence and even threaten their lives. According to the International Osteoporosis Foundation, one in five men over age 50 will have an osteoporosis-related fracture.


Throughout our lives, bone is ever-changing. More bone is made than lost during childhood, but the aging process reverses that situation, resulting in more bone being lost than made as we get older. The NIH Osteoporosis and Related Bone Diseases National Resource Center reports that bone mass is at its highest level in the third decade of life, loss of bone mass begins earlier for women than for men due to menopause, but by age 65-70 men are losing bone mass at about the same rate as women.


What causes osteoporosis in men? One of the risk factors for men is hormone-related, specifically low levels of the sex hormone testosterone. This is often referred to as the primary cause of osteoporosis in men.


Other causes of osteoporosis in men, and in women, are known as secondary causes:

  • Declining absorption of calcium, another age-related factor
  • Chronic diseases that impact bodily organs, such as autoimmune disorders, blood and bone marrow disorders, some cancers, digestive and gastrointestinal conditions, endocrine disorders, and neurological disorders
  • Long-term use of certain medications, e.g., steroids, anticonvulsants, certain cancer treatments, and antacids containing aluminum
  • Lifestyle factors such as smoking, excessive use of alcohol, poor diet, and lack of exercise

Although there may be some signs of osteoporosis, such as back pain or gradual loss of height with a hunched or stooped position, many Individuals remain unaware that they have this condition until a fracture occurs, so the term “silent disease” has often been used to describe osteoporosis. 


Back pain may occur from spinal compression fractures, but pain from broken or fractured bones may occur anywhere in the body. Fractures may be serious situations, particularly when the hip is involved and especially in the elderly. Men are frequently older than women when they have their first fracture, so they are more likely to suffer serious complications and even premature death. They may experience physical immobility and have feelings of isolation and depression, while some will require nursing 内蒙古快3 care.

 

Treatments for men with osteoporosis are very limited. They may include some FDA-approved medications, but they certainly will include eating foods high in calcium and vitamin D, eating fruits and vegetables, getting regular exercise, and changing lifestyle when necessary.


If you have osteoporosis and suffer from pain associated with spinal compression fractures, you may be a candidate for managing your pain without surgery. Vertebroplasty and Kyphoplasty are procedures that may be able to reduce your pain and restore quality of life. Contact Sarasota Interventional Radiology at 941-378-3231 and visit our website for more information at http://www.sivr.net/pain-management-and-back-procedures.html.   

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TREATMENT OF UTERINE FIBROIDS WITH UTERINE FIBROID EMBOLIZATION--ELIMINATING PAIN, ABNORMAL BLEEDING, AND OTHER SYMPTOMS


By Arlene Mavko • 15 Apr, 2019
内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Uterine fibroids, growths of tissue in the muscle cells of the uterus, are noncancerous and very rarely develop into cancer. While this is the good news about uterine fibroids, the bad news is that they are prone to a multitude of uncomfortable symptoms: pelvic pressure, chronic or acute pelvic pain, leg or back pain, abnormal menstrual bleeding, spotting or bleeding between periods, frequent urination, difficulty emptying the bladder, constipation, enlarged abdomen, pain during intercourse, and infertility or miscarriages.


Many women will have uterine fibroids during their lifetime, with most fibroids occurring before age 50. Many of these women do not know they have this condition because the fibroids present no problems due to their small size or quantity and/or their location within the uterus. In these cases, the women may become aware of the existence of the fibroids after pelvic examination by their physician.


For those women who do have symptoms, the effects may be severe enough to warrant further analysis. Prior to any treatment plan, the presence of uterine fibroids is confirmed by a diagnostic tool such as MRI, CT, or abdominal ultrasound. MRI is becoming the preferred imaging modality because it produces precise anatomical definition of the uterus and uterine arteries, thus enabling physicians to select the best treatment option for the patient. MRI is the standard for interventional radiologists because of its excellent contrast resolution, wide field of view, and multi-dimensional capability.


When medications are not effective or appropriate to relieve symptoms, physicians may turn to surgery or minimally invasive options. Traditional surgery may take the form of a hysterectomy or myomectomy, both of which are invasive and have longer recovery times and more postprocedural complications than minimally invasive options.

  • Hysterectomy is a major surgical procedure that removes the uterus, thus permanently eliminating all uterine fibroids. However, hysterectomy also ends the ability of the woman to have children.
  • Myomectomy retains the uterus but removes uterine fibroids from the walls of the uterus. Where there are many fibroids, myomectomy may not be a viable option, and recurrence of uterine fibroids is possible after this procedure.

Uterine fibroid embolization (UFE), also known as uterine artery embolization, is a minimally invasive approach that is surprisingly unfamiliar to many women. In fact, only about 44% of women with uterine fibroids have heard about UFE, a procedure that treats all existing uterine fibroids. During this procedure, tiny FDA-approved particles are released through a catheter into the uterine arteries, cutting off blood supply to the fibroids, shrinking them, and providing significant or total relief from their painful symptoms.


UFE is performed at SIR-Florida by leading interventional radiologist, Dr. Gerald E. Grubbs, while the patient is administered conscious sedation by board-certified anesthesiologists. The procedure is minimally invasive, results in less pain, and has shorter recovery times than hysterectomy or myomectomy. It is important for women to fully evaluate and discuss treatment options for uterine fibroids with their physician.

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LUNG CANCER SCREENING FOR EARLY DETECTION

By Arlene Mavko • 21 Mar, 2019
内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Lung cancer screening is a frequent topic on this website because of our firm belief that early detection reduces lung cancer deaths. This belief is backed up by the conclusions of several large studies that were summarized in our November 6, 2018, article on lung cancer screening.

  • Screening reduced lung cancer mortality for both males and females—a reduction of 26% for males (at 10 years follow-up) and 39-61% for females (at various years of follow-up).
  • 50% of lung cancers detected during the trial were very-early stage 1A cancers, 69% were stage 1A or 1B, and only 10-12% were diagnosed with more advanced stage IV lung cancers.

You might think that such an exam is not necessary or does not apply to you because your primary care physician has not recommended such a test. We were surprised to recently learn that only about 18 percent of physicians talk to their patients who are current smokers about the lung cancer screening exam, while fewer than 11 percent talk to patients who are former smokers about this test. One reason given as to why this conversation between physician and patient does not occur more frequently is that physicians do not have enough information about patient eligibility for the exam. We will speculate here that physicians also may not have enough information about insurance coverage for the exam.


Eligibility and Insurance Coverage for Lung Cancer Screening

  • Eligibility criteria for a lung cancer screening exam are:
  • Between 55 and 77 years of age (Some plans approve ages 55-80.)
  • A 30 pack-year history of smoking (This is equivalent to smoking one pack per day for 30 years, two packs per day for 15 years, etc.)
  • Still smoking OR quit within the last 15 years
  • No current signs or symptoms of lung cancer.

The cost of an annual low-dose radiation CT lung cancer screening exam is covered by most insurance plans for those who meet the criteria listed above and who have the exam at an approved radiology facility such as Sarasota Interventional Radiology (SIR-Florida). Complete information about coverage by various plans: Medicare, employer-sponsored plan, state insurance marketplace plan, individual plan, and Medicaid, can be found on this chart from the American Lung Association.


Lung Cancer Screening at SIR-Florida


If you are a current or former smoker who is at high risk for lung cancer, we encourage you to schedule a CT lung cancer screening exam. At SIR-Florida in Sarasota, we use the ultra-low dose radiation CT scanning technology of the Hitachi SCENARIA to produce high quality cross-sectional images that detect many lung diseases and abnormalities, while using up to 90% less ionizing radiation than a conventional chest CT scan. SIR is the only facility in the tri-county area (Sarasota, Manatee, and Charlotte counties in Florida) that uses this particular technology.


In advance of the exam, we would like to give you some assurance that most screening exams are negative. However, in the event that your result may be positive for suspicious lung cancer, we can offer next steps, if necessary: lung biopsy and/or PET/CT scan in a comfortable outpatient setting. If these tests confirm the existence of lung cancer, we can work with your oncologist to perform several nonsurgical treatments alone or in conjunction with other treatments.


If you are reading this article, you obviously have some interest in this topic, perhaps because you or a loved one is a high-risk current or former smoker. Call SIR-Florida at 941-378-3231 to schedule an appointment for a lung cancer screening exam. No advance preparation is needed, and the exam is quick, convenient, and painless.

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UNDERSTANDING INFLAMMATION

By March 6, 2019 • 06 Mar, 2019
内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

In recent years, you’ve probably been hearing about “inflammation” as a major health concern. Sure, you’ve heard that word before and occasionally have experienced the type of inflammation that you see externally on your body, but many of us are unclear as to just what type of inflammation is so concerning to overall health.


Generally speaking, inflammation is the natural response of the body to defend itself against irritants, infection, wounds, or other damage to body tissue. This natural response includes the release of antibodies and proteins, as well as increased blood flow, to the affected area. Without this inflammatory response, healing would not take place.


Acute Inflammation


This is the type of inflammation to which we are most accustomed because we feel it, see it, or both. Acute inflammation, which generally lasts for hours or days, is caused by harmful bacteria or injury to tissue and has recognizable stages:

  • Pain that results from sensitive nerve endings
  • Redness from blood-filled capillaries
  • Immobility due to the inflammation
  • Swelling due to fluid build-up
  • Heat from the presence of blood that flows to the affected area

Examples of acute inflammation are physical trauma, intense exercise, a cut or scratch on the skin, sore throat, various infections (e.g., bacterial infections of the eye, ingrown toenail), bronchitis, appendicitis, dermatitis, tonsillitis, sinusitis, etc. Some types of acute inflammation include the discharge of pus, the build-up of dead white cells that have formed to combat the infection. Acute inflammation usually has a positive outcome but, if the cause of the inflammation is not eradicated, it can turn into chronic inflammation.


Chronic Inflammation


This type of inflammation continues over a longer period of time, from months to years, because the cause of the inflammation is not eliminated. Chronic inflammation is inflammation on the cellular level and frequently one or several body systems, e.g., an internal organ or digestive system. Symptoms may be more vague, but pain, discomfort, and stiffness are frequent signs.


Causes of chronic inflammation include:

  • Untreated acute inflammation
  • Long-term exposure to harmful chemicals, polluted air, or other irritants
  • Autoimmune disorder that continually attacks healthy tissue

Other contributing factors for chronic inflammation include smoking, alcohol, obesity, and chronic stress.3 Some diseases that are associated with chronic inflammation are asthma, tuberculosis, periodontitis, periodontitis, sinusitis, and inflammatory digestive diseases such as Crohn’s. More recently, chronic inflammation has been linked to a number of diseases and health conditions.


Chronic inflammation may be treated with non-steroidal anti-inflammatory medications, steroids, supplements such as fish oil and lipoic acid, and foods known to have anti-inflammatory properties.


Foods to eat to better manage chronic inflammation include:

  • Olive oil
  • Leafy greens (kale, spinach)
  • Tomatoes
  • Fatty fish (salmon, mackerel, sardines)
  • Nuts (walnuts, almonds)
  • Fresh fruits (blueberries, cherries)

Foods to avoid that may exacerbate inflammation include:

  • Red and processed meat
  • Fried foods
  • Refined carbohydrates

Also, research has shown that some spices (e.g., turmeric, cayenne, ginger, cinnamon, cloves) and herbs (e.g., rosemary, sage) show potential in reducing chronic inflammation, but the research continues as to the efficacy of these substances. Be sure to discuss all forms of treatment—including foods, spices, and herbs—with your physician.


Research and discussion among scientists and medical professionals are ongoing to identify additional ways in which to diagnose and manage chronic inflammation.

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FEBRUARY--LOVE AND HEARTS

By March 6, 2019 • 06 Mar, 2019
内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

February is all about love and hearts, not only celebrated on Valentine’s Day but also traditionally observed throughout the month as American Heart Month, a time to learn more about heart disease, understand if you are at risk, and take immediate steps to reduce that risk.


While smoking, high blood pressure, and high blood cholesterol are the three main risk factors for heart disease, other risk factors include obesity, diabetes, lack of exercise, and an unhealthy diet. There is an abundance of information available on how to reduce those risk factors, but briefly they are:

  • Stop smoking.
  • Lose weight.
  • Exercise regularly.
  • Eat heart-healthy food.

Your physician can be your first go-to person to help you with smoking cessation, a weight loss program, and diet and exercise recommendations suitable just for you.


Cardiovascular disease is the leading cause of death among adults over age 35, but heart disease affects the young and the old, so it’s wise to be heart-healthy throughout your life and to be aware of any family history of heart disease. There is no age to start living a heart-healthy life, because the time is start is now. If you’re concerned about your status in terms of heart health, here are several simple tests you may consider.


Calcium Scoring Detects Calcification in Coronary Arteries


SIR-Florida offers the Calcium Scoring test to determine if there is any calcification in your coronary arteries. Calcium is not normally present in the coronary arteries that supply oxygenated blood to the heart, so its presence may be an indicator of coronary artery disease. While this is a screening test, it is an excellent predictor of a cardiovascular event. Read more about Calcium Scoring here.


EndoPAT® Test for Arterial Function


SIR-Florida’s sister facility, RevitaLife Vitality Center of Sarasota (RVC), performs the Endopat® test to evaluate endothelial function, the medical term for arterial function. In the early stages of cardiovascular disease, plaque may develop in the arteries and lead to a condition known as atherosclerosis, or hardening of the arteries. When excess plaque is present, the endothelial cells, located in the blood vessels, cannot dilate sufficiently to regulate the flow of blood. Read more about EndoPAT®.


Blood Cholesterol Testing


High blood cholesterol levels have long been associated with heart disease and stroke. While total cholesterol may be an indicator of risk, the number and density of the LDL (bad) cholesterol particles has even greater significance. A simple blood test at RVC will provide you with valuable information about LDL, HDL (good) cholesterol, plaque formation, and cardiovascular disease. Read more about Blood Cholesterol Testing.


Cleveland Heart Specialty Test


Some heart attacks or strokes occur in individuals who have normal cholesterol levels. In these cases, inflammation may be present and may serve as a strong contributor to heart disease. Inflammation Testing, along with Blood Cholesterol Testing, provides a more complete assessment of your risk for cardiovascular disease.


Happy Valentine’s Day to all, and strive to be heart healthy!

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HAPPY NEW YEAR--IS IT YOUR TIME TO LOSE WEIGHT?

By Arlene Mavko • 07 Jan, 2019
内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

With the arrival of the New Year, many Americans have turned to weight loss as their main priority or New Year’s resolution. Diet and exercise have been drilled into the heads of Americans for quite some time, and many ponder what diet to follow and/or what exercise program to undertake.


This article is not to compare or recommend diets or regimens but rather to emphasize the fact that weight loss for those who are overweight or obese is important to overall health and longevity. At SIR-Florida, we encourage our patients to maintain a heathy weight to avoid the risk factors for a number of diseases and other complications that arise from being overweight or obese.


Overweight or Obese?


Is there a difference between being overweight and being obese? According to the CDC (Centers for Disease Control and Prevention), calculation of one’s body mass index (BMI) is the means by which this determination is made:


BMI Calculation  


Less than 18.5 Underweight

18.5-less than 25 Normal

25.0-less than 30 Overweight

30.0 or higher Obese


Obesity is further subdivided into three levels (classes):


BMI

Calculation                    Obesity Level

30-34                                  Class 1

35-39                                  Class 2

40 or higher                     Class 3 (extreme or severe)


Statistics continue to show the alarming rates of adult obesity in the U.S. Data for 2017 reveal that the state of Florida ranked 35th in the U.S. with an adult (age 18 and over) obesity rate of 28.4%. This rate has gone up from 18.4% in 2000 and 11.4% in 1990.


Risk Factor for Disease


While only a healthcare professional can truly evaluate an individual’s health status and areas of risk based on weight, it is generally recognized that obesity is associated with many health risks including:

  • High blood pressure—Extra weight leads to more pressure on the artery walls, which then increases blood pressure.
  • Dyslipidemia (high or low blood lipid levels)—Obesity is one of the common causes of dyslipidemia, especially when excessive weight is at the body’s mid-section.
  • Type 2 diabetes—Being overweight or obese increases the chances of developing type 2 diabetes.
  • Heart disease—Excessive weight is linked to a number of factors that increase the risk for cardiovascular disease, including high blood pressure, abnormal blood lipid levels, and type 2 diabetes.
  • Stroke—Excess body fat increases the chances of having a stroke due to inflammation, poor blood flow, and possible blockages.
  • Gallbladder disease—The risk for gallbladder disease is higher, and the treatment of gallbladder disease is more difficult, in those who are overweight or obese.
  • Osteoarthritis—Excess weight puts a lot of strain on joints and is the main preventable risk factor for osteoarthritis, and fat cells themselves have a negative impact on joints.
  • Sleep apnea or other breathing problems
  • Cancer—Obesity is responsible for about four percent of cancer cases across the globe. Some types of (endometrial, breast, colon, kidney, gallbladder, and liver) are more common in obese individuals.

In addition, obesity may lead to low quality of life, mental disorders such as anxiety and depression, body pain, and difficulty in performing basic physical actions.


Common Sense Steps to Lose Weight


If you’re in the overweight or obese category, what’s your first step? Martin Binks, PhD, Director of Behavioral Health at the Duke Diet & Fitness Center, suggests breaking down large weight loss goals into small steps:

  • Focus on losing 1-2 lbs. each week.
  • Add small amounts of exercise and increase your exercise routine a little each week.
  • Fill up on high-volume, low-calorie foods such as salads and soups.
  • Don’t deprive yourself but select a sustainable approach to weight loss that you can follow for the long term.

See your physician for guidance before starting any weight loss program, as your physician may have additional recommendations specific to your current health status and weight loss goals.


Also, RevitaLife Vitality Center of Sarasota (RVC)—our sister facility that specializes in wellness, anti-aging, aesthetics, functional and metabolic medicine—can perform a number of diagnostic tests to identify possible underlying causes for your weight issues and then determine if RVC’s customized and physician-supervised weight loss programs are right for you.

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CHOOSING THE BEST METHOD FOR PROSTATE CANCER DETECTION

By Arlene Mavko • 12 Dec, 2018
内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Your physician may inform you that you need an ultrasound-guided biopsy because (1) your PSA reading is elevated or rapidly rising, (2) a digital rectal exam indicates an enlargement or other abnormality in your prostate, or (3) prostate cancer is prevalent in your family. If the recommendation of a biopsy is made, you may wish to steer the conversation in another direction.


While transrectal ultrasound core biopsy of the prostate (TRUS) has been the “gold standard” for many years, a more recent alternative is the multiparametric MRI (mpMRI). A better understanding of each procedure will help to guide your discussion with your physician and, ultimately, your decision of which to choose.


TRUS Prostate Cancer Biopsy


TRUS is performed by a urologist or radiologist on an outpatient basis in a hospital or clinic setting. During the procedure, samples of tissue from the prostate are removed and sent to the pathology lab for analysis. TRUS involves insertion of a special biopsy needle through the wall of the rectum and into the prostate gland to capture the core samples. The greater number of core samples taken, the better the detection rate of early prostate cancer. Six to 14 core samples are generally taken during an initial biopsy. Even with this number of biopsies, it is possible to extract only healthy tissue and completely miss unhealthy, cancerous tissue.


Some patients who have had an initial TRUS that resulted in no detection of cancer may need a repeat biopsy if their PSA continues to rise and, in these cases, the number of cores taken may be as high as 60. The patient experiences slight to significant pain with each core sample taken, so pain management must be addressed by the physician to minimize the patient’s discomfort during the procedure. This may be in the form of a local anesthetic or sedative, a light general anesthetic, or a periprostatic nerve block. The anxiety of pain from the procedure is a common reason that many patients actually refuse TRUS.


Other factors to consider when contemplating TRUS include:

  • Risk of infection—Patients usually take antibiotics for a day or two prior to the procedure, and additional antibiotics may be injected just before the procedure.
  • Bowel cleansing—This is important to maximize clarity of the ultrasound and reduce risk of infection.
  • Blood thinning medications—These may need to be stopped for days prior to the procedure, so it is important to report all such medications and follow the advice of your physician regarding these medications before and after the procedure.

mpMRI for Tumor Detection


At SIR-Florida, Dr. Grubbs is an advocate of the mpMRI to detect the presence or absence of a tumor and, using the most current post-processing software, has read and interpreted over 10,000 of these exams. With this level of experience, it is understandable that physicians across the U.S. come to Dr. Grubbs for his expertise in diagnosing prostate cancer.


The mpMRI is advanced technology that does not require tissue samples to determine the presence or absence of prostate cancer. It shows the exact shape and location of an enlarged area or mass and also distinguishes between healthy and unhealthy tissue by using two or more special imaging sequences, thus the term multiparametric. This important information then leads to the determination of whether or not a biopsy is needed. The mpMRI is painless, but claustrophobic patients may need relaxation methods or medication for anxiety.


MR/US Fusion Biopsy


If a tumor is not detected, the mpMRI has established a baseline for future monitoring of the patient. If cancer is detected, Dr. Grubbs develops a roadmap for an MR/US fusion biopsy to pinpoint the suspicious lesion. The MR/US fusion biopsy is performed instead of the more invasive multiple core sample biopsies of the TRUS.


The MR/US fusion biopsy is a precision method that directs a minimum number of needles into the center of the visible tumor to retrieve the largest quantity of cells. The cancerous tissue samples are then further analyzed to determine the best course of treatment for the patient. High Intensity Focused Ultrasound (HIFU), a revolutionary treatment for prostate cancer, is a minimally invasive technique that will be discussed in a future article.

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LUNG CANCER SCREENING STUDIES SHOW DECREASED MORTALITY

By Arlene Mavko • 06 Nov, 2018
内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

NELSON and NLST Studies


With the aid of lung cancer screening, lung cancer deaths for both males and females who are high-risk former and current smokers are significantly reduced. Conclusions of a large study known as the NELSON lung cancer screening trial1 were announced at the 19th World Conference on Lung Cancer held in Toronto this year2:

  • Screening reduced lung cancer mortality for both males and females—a reduction of 26% for males (at 10 years follow-up) and 39-61% for females (at various years of follow-up).
  • 50% of lung cancers detected during the trial were very-early stage 1A cancers, 69% were stage 1A or 1B, and only 10-12% were diagnosed with more advanced stage IV lung cancers.

The NELSON study2 had a population of nearly 16,000 people and compared the results of the screened group to the non-screened control group. Each group had just under 8000 participants who were men and women between ages 50-74 with a smoking history of at least 10 cigarettes per day for 30 years or more or at least 15 cigarettes per day for at least 25 years. This smoking history estimated the lung cancer mortality risk of the participants.


The NELSON trial, conducted in Belgium and the Netherlands, is the second major trial of this type. The original landmark study was the National Lung Screening Trial (NLST), which was conducted in the United States and published in 2011. The NELSON trial showed an even larger reduction in deaths than did the NLST, with 157 lung cancer deaths in the screening group as compared to 250 in the control group.


Lung Cancer Screening at SIR


Sarasota Interventional Radiology offers lung cancer screening using ultra-low dose CT scanning technology. Compared to in conventional chest CT scans, SIR’s sophisticated technology uses up to 90 percent less radiation, produces more detailed pictures, and is better at finding small lung abnormalities.


“We strongly believe in the value of screening exams for early detection of disease,” stated Gerald E. Grubbs, MD, founder and medical director of Sarasota Interventional Radiology (SIR Florida), “and the studies described above confirm the strong correlation with screening and survival in high-risk patients.”


Medicare Part B covers low-dose CT lung cancer screening once per year for individuals who meet certain conditions. Other insurers may also cover lung cancer screening for persons age 50 and older, with some covering at age 45. It is advisable to check directly with your insurance provider to see if it will cover the procedure.


It is important to note that screening is not a substitute for smoking cessation. The Centers for Disease Control and Prevention (CDC) reported earlier this year that although smoking has declined from nearly 21% in 2005 to 15.5% in 2016, nearly 38 million American adults age 18 or higher still smoke. Data collected by the CDC also show that more people are quitting and many smokers are smoking less, but the toll on the overall health is still evident among the smoking population, with over 30 million Americans lining with a smoking-related disease.2


Each year on the third Thursday in November, the American Cancer Society sponsors the Great American Smokeout® as a motivational day for smokers to make a commitment to a tobacco-free life.3 Smokers will be assisted by health care providers, community organizations, and others who will engage is this campaign to challenge smokers to kick the habit. Mark your calendar for November 15 and plan ahead to execute your own plan to quit. Or better yet, don’t wait, quit smoking today!


Sources:


1Cancer Imaging. 2011; 11(1A): S79–S84. Published online 2011 Oct 3. doi: 10.1102/1470-7330.2011.9020.


2Harrison, Pam. (2018, September 28). Second Large Study Shows That Lung Cancer Screening Works. Retrieved from http://www.medscape.com/viewarticle/902673?nlid=125311_4503&src=/wnl_dne_181001_mscpedit&uac=153271MX&impID=1755833&faf=1/index.html>

3CDC Press Release. (2018, January 18). Smoking is down, but almost 38 million American adults still smoke. Retrieved from http://www.cdc.gov/media/releases/2018/p0118-smoking-rates-declining.html


4The Great American Smokeout®. Retrieved from http://www.cancer.org/healthy/stay-away-from-tobacco/great-american-smokeout.html

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VENICE HEALTH SOUTH HEALTH SEMINAR OFFERS OPTIONS TO CANCER SURVIVORS

By Debbie Flessner & Axiom Ledger • 22 Oct, 2018
内蒙古快3Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Dawn Moore is an Englewood-based Cancer Care Advocate who volunteers for several cancer support groups, one of which is the Jewish Family and Children’s 内蒙古快3 (JFCS) Cancer Support Group.


Within the Venice community, the JFCS offers various programs for cancer patients and survivors, as well as their caregivers and families. In Moore’s role within the organization, she tries to bring in speakers at least every other month to talk about issues that directly affect them.


Recently, Moore invited Dr. Gerald Grubbs, of Sarasota Interventional Radiology (SIR), to speak to a group at Venice Health Park about treatment options for both cancer patients and those with chronic pain issues.


“The JFCS offers free programs within their Cancer Resource Network,” she said. “For this speaker, I invited survivors from that group, as well as some of the other cancer support groups I’m involved in within the tri-county area.”


Moore reached out to Dr. Grubbs partially because of his ties to the Venice area (he previously worked at Venice Health Park), but mostly because of his use of groundbreaking technology and the latest diagnostic and therapeutic techniques.


An engaging speaker, Dr. Grubbs outlined to the group of about 16 some treatment options they may not have previously considered.


“There are several minimally invasive, non-surgical procedures that we offer for both cancer patients and those with chronic pain,” he said. “We use the most current technologies and methods available to best help our patients.”


According to their website, SIR’s Outpatient Imaging Center in Sarasota is equipped like an operating room, and their diagnostic and treatment area uses advanced CT and Fluoroscopy imaging to accurately and safely guide every procedure. In January of 2014, SIR became the first facility in the state of Florida to house the latest and most advanced CT, the Hitachi SCENARIA ultra-low dose, 128-slice CT.


This revolutionary CT scanner was designed with integrated dose reduction technologies that guarantee the lowest amount of radiation exposure possible. The SCENARIA provides a more comfortable experience for all patients, even the most radiation-sensitive patients—pediatric and geriatric.


Dr. Grubbs told the group that his patients who have chronic pain usually ask him for two things.


“The first is 24/7/365 extended relief, and the second is an option for temporary relief,” he said. “It’s miserable to be in pain all the time—people become clock watchers instead of enjoying their lives. Many of them are looking forward to the next time they can take their opioid for pain.”


One of the options that Dr. Grubbs presented to the group as a substitute for those opioids has actually been around for a long time, but is still not being used on a widespread basis.


The American Cancer Society has touted the effects of medical marijuana, for treating both post-chemotherapy nausea and neuropathy, the pain caused by damaged nerves, a common side effect of chemotherapy. On their website, they state that while medical marijuana has been shown to be safe in treating cancer, it has not been proven to help control or cure the disease.


“Studies have long shown that people who took marijuana extracts in clinical trials tended to need less pain medicine,” the site states. “More recently, scientists reported that THC and other cannabinoids such as CBD slow growth and/or cause death in certain types of cancer cells growing in lab dishes. Some animal studies also suggest certain cannabinoids may slow growth and reduce spread of some forms of cancer.”


Here in Florida, anyone considering using medical marijuana as a treatment must first be examined by a qualifying physician, who then assesses the patient’s need for the method. If the physician agrees that the patient’s condition would benefit from medical marijuana, the patient is then given an identification card that allows them to purchase product from a dispensary, or have it delivered to their 内蒙古快3, for a small fee.


Dr. Grubbs, who is on the list of local approved physicians, says that being able to provide both cutting edge treatments and access to medical marijuana to his patients is his ultimate goal.


“For me, it’s extremely rewarding to help my cancer and chronic pain patients,” he said. “Medical marijuana, in particular, is almost like a magic solution to diseases and disorders that we’ve struggled with for years. It has significantly reduced patients’ need for opioids.”


For more information about Dr. Grubbs and the treatment options at Sarasota Interventional Radiology, visit the website at http://www.sivr.net. To learn more about the Jewish Family and Children’s 内蒙古快3 cancer support programs, visit the website at

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IMPORTANT! All information presented in this website is intended for informational purposes only and not for the purpose of rendering medical advice. Statements made on this website have not been evaluated by the Food and Drug Administration. The information contained herein is not intended to diagnose, treat, cure or prevent any disease. View SIR's Notice of Privacy Practice
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