We all know Botox– or botulinum toxin – to be a beautifying procedure. However, a second purpose has come to light and people everywhere are finding relief for their chronic pain. Doctors have found that for a person suffering from chronic back pain, neck pain, facial pain, or even migraines, a visit to Botox specialist can provide quick and effective relief from pain that just doesn’t respond well to other treatments.

Dr. Edrick Lopez, a Harvard-trained intervention pain management specialist with Physician Partners of America’s (PPOA) McKinney, Texas location, takes a multidisciplinary approach to pain relief ranging from neck, back, and joint injections to Botox for migraine headaches and regenerative medicine.

How Does it Work?

Botox is used for multiple purposed and to many, is viewed as one of modern medicine’s most fascinating treatments. A protein produced by certain types of bacteria, botulinum toxin, in its natural form, is one of the most toxic substances known to man. The toxin itself works by blocking a neurotransmitter called acetylcholine, which forces muscles to relax; in large doses Botox causes parts of the body to shut down completely, but when administered in small doses by a trained professional, it relaxes muscles safely and locally to smooth out wrinkles and to target muscular sources of chronic pain. Decades of research and careful refinement of the toxin has allowed scientists to start using this substance for good, and today Botox is used safely in millions of procedures, both medical and cosmetic.

What Conditions Can Botox Treat?

Because it relaxes muscles, pain management doctors at PPOA’s clinics, along with Dr. Lopez, find that Botox is particularly effective at treating chronic pain that is muscular in origin. Botox can be especially helpful when treating conditions such as whiplash, TMJ, and lower back pain. In these cases, Botox forces the muscles to relax, allowing joints to return to their natural position without pain.

“Botox is a great alternative for patients who suffer from chronic migraines,” says Dr. Lopez. “It can significantly enhance the quality of life of these patients by reducing the intensity and the frequency of their migraine headaches.”

Botox is also FDA approved as a treatment for chronic migraines. Regular injections at specific sites around the head and neck can create long-term relief for patients who suffer migraines more than 15 days out of the year, and for patients who have tried and failed at least 2 different preventative medications.

Injections to treat chronic migraines are usually administered once every 12 weeks, and, as with other Botox-treated pain, patients usually start to feel positive effects within a few days.

“I love that we can offer this therapy that can so markedly help our patients with chronic migraines.” – Dr. Edrick Lopez

Contact us today to see if you might be a good candidate for Botox.

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Our employees are all patient care champions, but some go the extra mile and we want to give them the recognition they deserve. They embody the PPOA values known as S.I.T.E. – Safety, Integrity, Teamwork, Empathy – which informs our service to patients and the community through high quality health care.

Business development representative Caroline Bloom is in the business of making connections. She spends her days educating doctors and their staffs about the pain management alternatives offered by Physician Partners of America. This includes laser spine procedures, spinal cord stimulators and, soon, regnerative medicine.

She primarily markets the services of Dr. Alejandro Tapia in Boynton Beach and Wellington, Fla., and laser spine surgeon Dr. Brett Menmuir.

“There’s a lot of education involved in what I do,” she says. “I teach them the difference between interventional pain management – the procedures we do – versus medication management. Many doctors have had their chronic pain patients on opioids for years. We teach them that there are other options. It turns the lightbulb on.”

A native of Maplewood, New Jersey, she graduated from St. Thomas University in Miami with a B.A. in Business Management. She started out in the nascent telecommunications industry, selling the first “big brick” cell phones for Cellular One, now AT&T.

After taking time off for motherhood, she was drawn back into the workforce – and the healthcare world – when her husband became ill.

“When he got sick, I learned how to be an advocate for him, and in turn, patients in general,” she says.

She worked for pharmaceutical company Astra Zeneca as a marketing representative and for a large hospice provider before joining PPOA in November 2017. While most of her time is spent calling on providers and practice managers, those connections help her assist patients.  She recalls a particular case of a special needs man.

“His mom was talking to the staff of her son’s primary care doctor. The referral coordinator called me and I connected the patient with Dr. Tapia, who he had seen in the past,” Bloom recalls. “The son had Medicaid, which we don’t accept, but I helped him to get him special clearance for Dr. Tapia to treat him. Those are the most rewarding moments for me.”

Caroline Bloom’s supervisor, regional business development manager Susan Hoskins, admires Bloom’s willingness to go the extra mile.

“Caroline is an example of compassion and true caring concern for all patients. She will always take the time to listen and make sure patients have a great experience with PPOA,” says Hoskins. “Her tenacity and constant professional attitude and drive for success inspire me every day. Caroline looks at every opportunity as a bold challenge and adventure.”

Bloom is also known for assisting her fellow PPOA reps. She helps new hires learn the company sales database and the finer points of paperwork, sends group texts, and acts as a resource.

“Caroline always goes above and beyond to support her teammates,” Hoskins says. “She is always willing to help not only her Business Development teammates but has spent Saturdays coming into the clinic to help her operations team.”

While she enjoys caring for others, Caroline Bloom is about to take more time out for herself. Her son will graduate from Florida State University in 2020, and her daughter will enter the University of Florida as a freshman in a few weeks.  “It will be a house divided,” she says, joking about the schools’ infamous football rivalry. Still, she has no plans to slow down.

“When you love what you do,” she says, “It doesn’t feel like work.”

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Moving back home to New Jersey from Virginia right out of high school and ready to begin a career, Alexander took a chance and applied for some health care collection agencies.

“Without too much knowledge on the subject, someone took a chance on me and it all began there,” she says.

After working with her former company in New Jersey, she then relocated with the company, which is what brought her to Tampa, Fla. After a while, she decided to make a change and eventually found a position at Physician Partners of America.

Here at PPOA, Monique was recently promoted to ambulatory surgery center revenue cycle manager. In simple terms, she is responsible for and oversees teams for collections, coding, and cash postings. She believes in teamwork and communication, which is what ultimately helps her connect with people so well.

She excels at multi-tasking and meeting every challenge that arises. For her, connecting with people is one of the most important aspects of being a great leader.

Alexander’s niche in health care insurance is not a random choice. Her mother was diagnosed with breast cancer and while it was very difficult on Alexander, she knows she could definitely help with one aspect of it: insurance. She helped her mom get good medical insurance (which is not an easy task) while going through this hard time. Her mother eventually passed away but Alexander was glad she could do that for her mom and provide help in an almost helpless situation.

Alexander loves the PPOA atmosphere because it feels like home to her. “These people are like my family and we all support each other.”

While work is one of her passions, Alexander is also devoted to her 12-year-old daughter.

“She’s my world. Besides work, it’s her,” she says.”

For fun, Monique Alexander and her daughter go swimming and watch movies. They also hope to take some vacations soon.

We thank her for being such a great example of what a PPOA employee should be!

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If you have recently had an injury and find that you are having pain in one or more of your limbs, there is a chance you are at risk for CRPS.

CRPS usually affects the arms or legs after injury or incident. These two specific extremities are the typical areas that CRPS could impact. It most often occurs after an injury or incident like stroke, heart attack or surgical procedure.

“They way that I explain this to my patients is that when you touch the stove, you get a little shock that goes from your finger to your brain that tells you to stop, your about to burn your finger,” says Dr. Rodolfo Gari, “with CRPS, instead of telling you to stop, the pain goes into a loop from your finger to your spinal cord and becomes constant.”

Treatment is Crucial

As time goes on untreated, you will be at an increased risk of not putting CRPS into remission. Receiving treatment as soon as possible will give you better chances of treatment. Pay attention to your symptoms and do not ignore the signs of Complex Regional Pain Syndrome.

Symptoms of CRPS

As soon as you recognize CRPS symptoms, seeking help right away is essential for treatment and recovery. A specialist can help you manage the symptoms, relieve the pain and keep the condition from getting worse.

“With some patients,” says Dr. Gari, “even breathing or a slight touch to the skin can be so painful.”

The symptoms may include:

• Constant feeling of burning or throbbing in the affected limb, typically your leg, arm, foot or hand
• Swelling in the affected limb
• Your limb may change temperature from hot to cold and back
• The limb may be sensitive to old temperatures or being touched
• Your joints may swell or feel stiff
• Difficulty moving the affected limb
• Your skin tone may change, turning mottled or shades of red or blue
• Your skin may also have texture changes, becoming thinner, more tender or shiny
• The affected limb may have changes in nail and hair growth
• You may experience muscle spasms or atrophy

Keep in mind, symptoms can vary depending on the affected person, but the sensitivity and pain may occur first. The important thing is to seek help from a doctor as soon as possible.

Why Fast Treatment is Critical

If treatment is not given within a certain amount of time after the injury, changes in skin color may occur at a point when your condition has become irreversible.

There is a possibility of CRPS going away on its own if the pain and symptoms are not too severe and do not worsen. However, CRPS could possibly spread from the affected limb to another part of your body, such as another limb.

CRPS pain could worsen with signs of stress, so even if the condition has you feeling stressed, try to stay calm and simply get the help you need.

The medical team at Physician Partners of America can help you find the right treatment plan, and get your CRPS symptoms under control before they get worse.

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On June 21, some 300 inspirational military athletes will come together in Tampa, Fla. for the Department of Defense (DOD) Warrior Games, and PPOA will stand ready to assist them.

This Paralympics-style competition will run through June 30 in venues throughout the city. Its purpose is to allow disabled athletes to experience the healing power of sports while drawing inspiration from their fellow warriors and teammates.

It is free and open to the public.

Dr. Abraham Rivera, a veteran himself, is the Chief Medical Officer of Physician Partners of America and will welcome veterans from around the world to town. He and others from PPOA will volunteer their time during the games by offering consultations, x-rays and MRIs as needed.

“We are proud to offer our staff and facilities to these brave athletes during the games,” says Dr. Rivera. “They are truly an inspiration to us all.”

Established in 2010, the Warrior Games’ mission is to enhance the recovery and rehabilitation of wounded, ill and injured service members and veterans. They come from all military branches including the U.S. Army, Marine Corps, Navy, Air Force and Special Operations Command (SOCOM).

They have overcome a variety of challenges such as injuries to their upper or lower body and spinal cord. Some have suffered traumatic brain injuries, visual impairment, serious illnesses or post-traumatic stress disorder (PTSD). 

This is the first year the highly anticipated games will be held in Tampa. Teams have expanded, as this year’s Warrior Games will include five additional teams from U.S. allied nations: the Australian Defence Force, Canadian Armed Forces, the United Kingdom Armed Forces, the Danish Armed Forces and the Dutch Armed Forces.

Fourteen adaptive sports will be represented including archery, track, field, indoor rowing, powerlifting, road race cycling, time trial cycling, shooting, sitting volleyball, swimming and wheelchair basketball. For the first time, there will be competitions in golf, wheelchair rugby and wheelchair tennis.

The mission of USSOCOM’s warrior care program is to provide wounded, ill, and injured Special Operations Forces, veterans, and their families with advocacy after a life-altering trauma or illness to enhance their quality of life and strengthen SOF readiness.

The games will demonstrate the mass potential of wounded warriors through sports and show their incredible ability to prosper and overcome their challenges. For tickets, visit DODWarriorGames.com.

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Our employees are all patient care champions, but some go the extra mile and we want to give them the recognition they deserve. They embody the PPOA values known as S.I.T.E. – Safety, Integrity, Teamwork, Empathy – which informs our service to patients and the community through high quality health care.

Ken Stroud was once told he would have made a good pastor or funeral director for his ability to put people at ease. “I wasn’t interested in either,” he chuckles; instead, his caring personality serves patients well at PPOA’s Park Ambulatory Surgery Center in Plano, Texas.

As a certified radiology technologist, Stroud only sees patients for a few minutes before they get procedures, such as epidural steroid injections; but he makes a lasting impression, at turns lighthearted and compassionate. “I believe in treating everyone with the utmost respect and treating everyone the same, no matter who they are,” he says.

Gayle Schotte, clinical administrator at Park Ambultory Surgery Center, agrees. “Ken is very interactive with patients and shows great compassion,” she says. “He remembers names and faces and treats all of his patients with kindness and respect.”

His work involves taking live x-rays during procedures to help guide the physician to the treatment area. It requires a thorough knowledge of anatomy and a steady hand to ensure needles are positioned perfectly. In essence, he serves as the doctor’s x-ray vision.

Although Stroud says his line of work was chosen for him during aptitude tests in the United States Air Force, he comes by radiology with some background. He was raised in the small town of Kaufman, Texas, by his grandmother, who served as assistant to the town’s only dentist. “I would go in the darkroom and help her develop the x-rays,” he says.

After serving four years in the Air Force and earning a certification in Radiology Technology through Midwestern State University, moved to Albany, New York. Over the next 30 years, he worked at several hospitals and private practices, and crossed paths with one Dr. Abraham Rivera.

When his Texas roots called him back, Ken Stroud responded to an ad from Physician Partners of America. While Googling the company, he saw a familiar face on the screen: Dr. Rivera, who was now its chief medical officer.

Ken Stroud has worked at Park Ambulatory Surgery Center since 2014, and loves every aspect of his job.

A father of two adult children, Phillip, 28, and Rebecca, 25, he also enjoys playing the year-round golf that Texas weather offers, loves tournament bowling – he has bowled 11 perfect games – and playing tournament Texas Hold ‘Em poker.

He may not have turned out to be a preacher or a funeral director, but you might say he’s eclectic – an assessment that is especially true for the people who work with him and the patients who rely on him.

“Ken is a dedicated employee who wears many hats at Park ASC,” says Schotte, his supervisor. “His primary title may be certified radiation technician but his work ethic goes above and beyond. He’s always helpful to co-workers when needed. He’s a jack of all trades.”

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A drug-free, wearable migraine treatment controlled by a smartphone offers new hope for the 30 million sufferers in the United States. It was recently cleared by the U.S. Food and Drug Administration for use with acute migraine.

An Israeli company developed the device, called Nerivo Migra. Placed on the upper arm, it uses a technology called remote electroical neuromodulation (REN): weak electrical pulses disrupt pain signals to the brain.

It consists of electrodes attached to the arm, a patch containing a battery, and a chip that wirelessly connects to a smartphone via Bluetooth signal.

In a study of 252 migraine patients, two thirds experienced pain relief in about two hours, with effects lasting up to 48 hours.

Doctors at Physician Partners of America, always seeking cutting-edge treatments for pain conditions, are following this development with interest.

“This device has tremendous potential for treatment of acute migraine episodes,” says Dr. Aaron Miranda, PPOA pain management specialist in Carrollton, Texas. Migraine pain relief is among his specialties. “There are a growing number of treatments including new medications, nerve blocks and Botox, which give patients and providers many possible options which can be tailored to each individual.”

In addition to Botox injections as a migraine treatment, PPOA doctors use other modalities, such as anti-CGRP monthly injectable medications for migraine prevention, occipital nerve blocks, sphenopalatine ganglion blocks and radiofrequency ablation.

Another PPOA provider, Dr. Lesco Rogers in Winter Haven, Fla., has also developed a migraine headache treatment, ThermoNeuroMondulation (TNM). It uses a special headphone device to supply heating and cooling sensations to the head. TNM earned FDA approval for home use in March 2018.

Common medications also used to control migraine headaches include triptans, beta-blockers and tricyclic antidepressants. However, finding drug-free ways to treat pain is a goal of PPOA and many in the interventional pain management community.

Not only are prescribing laws changing in the face of the opioid crisis; long-term use of some medications can have side effects and can make migraine headaches worse over time.

“[T]here is a great unmet need for alternative acute migraine treatments that are both effective and well tolerated,” the study authors conclude. “Non‐invasive neuromodulation is safe, well tolerated, and may have fewer adverse effects than drugs.”

The Nerivo Migra migraine treatment should be available in the U.S. sometime in 2019, Pain News Network reports.

Read the results of the Nerivo Migra study in Headache: The Journal of Head and Face Pain.

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Dr. Neil Ellis changes lives every day as a pain management specialist with Physician Partners of America’s Tampa – Habana clinic. A serendipitous phone call created a diversion that is allowing him to change lives outside the pain management realm.

He was recently called upon to administer a new medication called Spinraza to a patient who lives with spinal muscular atrophy (SMA). A relatively rare and progressive genetic disease, SMA causes the body to contort and become unable to hold up the torso. Patients gradually lose motor function in the lower and sometimes upper torso.

“Spinraza helps with changing the way genetics are programming a specific type of protein sequence and helps these patients gain muscular strength back,” Dr. Ellis says. “While a patient who is unable to walk will not regain that ability, he or she will be able to operate a motorized wheelchair more effectively.”

The patient, Ben Carpenter, 24, of Orlando, understands Spinraza won’t reverse the progression of the disease he was born with, but he already feels a difference.

“It has improved my grip strength, I can hold my head up a lot more and I have more energy during the day,” says Carpenter, a mechanical engineer.

Spinraza is a new and extremely costly medication developed specifically for SMA. Not every physician is able to administer it successfully, as the contorted body and orthopedic hardware make the spine difficult to inject.

“A lot of the patients had extensive hardware placed often at very young age to help with trunk strength,” says Dr. Ellis. “There’s an element of bony overgrowth and ton of metal that has been present for a long part of their life, so accessing any of this can be quite tricky.”

The medication is delivered intrathecally; that is, injected into the fluid surrounding the spinal canal. Although Dr. Ellis had not treated a spinal muscular atrophy patient before, intrathecal drug delivery is a common procedure for interventional pain management specialists. He seized the opportunity to help.

So far, it has been successful. “Once you’ve done it, you can mimic the technique on future patients. Each patient is unique, of course, with unique anatomical challenges, but each has the same characteristics.”

Carpenter received four high “loading” doses of Spinraza every two weeks for about three months. He is about to get the first of quarterly “maintenance” doses that he will need for the rest of his life.

Spinraza Treatment in Tampa

“I never thought they’d find a treatment in my lifetime,” says Carpenter. “I am so grateful to Dr. Ellis and the team at Habana. They’ve been fantastic to work with.”

Spinraza is most successful in young children. The therapeutic expectations for adult SMA patients represents a huge range of results, but the result can be greater muscle strength or a slowing of the condition’s progression.

“They may be able to use their arms and can operate a power chair, or hold up their head better,” says Dr. Ellis. “If you can give them enough strength so they can navigate their way through their environment, they can have a more normal life.”

“I never thought they’d find a treatment in my lifetime,” says Carpenter. “I am so grateful to Dr. Ellis and the team at Habana. They’ve been fantastic to work with.”

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Does your back and neck hurt while you are at work or sitting for long periods of time? You might be sitting in the wrong chair. The best office chair for back pain is based on preference and varies from person to person, however, there are features you should consider when looking for some pain relief at work.

Lumbar support office chairs

We all know the position you get into when you sit for too long and your back begins to round. Because your lumbar spine (lower back) curves inward, if lower back support is not given, your lumbar spine can become strained. A good chair should offer lumbar support, if you want even more structure, adjustable lumber support is a way to personalize your chair and get your positioning exactly how you want it.

Adjustable armrests

Armrests are very underrated but offer neck and shoulder strain reduction. Your elbows should rest lightly on the armrests and bend at about a 90-degree angle when using a keyboard and mouse. With adjustable armrests, you can ensure they are at the correct height for you and not adding more strain.

Deep seat

This feature is probably the most overlooked one when purchasing a new office chair for back pain. With a deep seat, you should be able to sit with your back against the backrest while leaving 2 to 4 inches between the back of the knees and the seat of the chair. This will help with posture and relieving strain off the back and neck.

Adjustable height office chairs

We are all different heights. Because of this, no one chair fits all. The best office chair for back pain will give you the support needed. It should allow you to scoot all the way to the back of the seat with your feet flat on the floor, thighs horizontal and arms even with the height of the desk. The average height of the chair for most people ranges from 16 to 21 inches off the ground.

While all of these are very important to remember when buying a new office chair, remember it will not cure your pain. If you are already having chronic neck or back pain and are seeking relief, contact Physician Partners of America to schedule a consultation and let us help you.

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Physician Partners of America (PPOA) as an organization is sensitive to the current backlash to the opioid crisis and the new prescribing laws that have resulted. We recognize a growing movement of law abiding chronic pain patients who rely on long-term “maintenance” doses of opioid pain medication.

In particular, we would like to address a sign that was placed in the window of one of our practices on May 14, implying that we will cease prescribing opioid medication to patients as of May 31, 2019.

Patients are and will continue to be titrated down according to CDC guidelines; however, there is no cut-off date.

This sign was brought to our attention through social media. It was in no way authorized or approved by management, and its message is untrue. It resulted from an employee’s misinterpretation of our goal to reduce opioid dependence.

At its foundation, PPOA uses interventional pain management modalities to treat pain at its source instead of masking it with medication. Our physicians come to our organization with a variety of backgrounds and use many modalities to treat chronic pain. They are medical pioneers like Dr. Phillip Kravetz, researchers like Dr. Neil Ellis and Dr. Michael Lupi, and inventors like Dr. Lesco Rogers.

Treatments may include Stimwave, trigger point injections, nerve blocks, minimally invasive spine procedures with and without laser assistance, Botox injections for migraines, neuromodulation and regenerative medicine. Physicians may also utilize a variety of medications – including topical, oral and intrathecal – to reduce pain.

We use pharmacogenomics to determine the safest dosage and medication type based on each patient’s genome, and intraoperative neuromonitoring

We have championed remedies to the opioid crisis in public forums, in the media, in televised town halls and at medical conventions. PPOA physicians strictly follow the prescribing laws of the states in which they operate.

We recognize the opioid crisis backlash. As an organization, we sympathize with the plight of people who rely on, but who do not intentionally abuse, prescription opioid medications to manage their chronic pain. We aim to show them what we consider a better, safer way to reduce or eliminate pain.

We will continue to engage in serious, thoughtful discussions toward finding a middle ground that balances patient concerns, federal guidelines and state laws.

We thank the public for input on this sensitive topic and invite you to learn more about who we are and what we do on our website.

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