Dennis M. Abbott, D.D.S.
The following is the final installment of a three-part series addressing oral health concerns that ideally should be addressed before, during, and after cancer treatment. This segment focuses on oral health care needs after cancer treatment.
To say a battle with cancer changes one’s life is perhaps one of the most profound understatements ever made! Few experiences leave their indelible mark on health, relationships, and spirituality as deeply as cancer. From the moment the diagnosis is verbalized by the physician, lives are changed forever…the life of the patient, the lives of family and friends, the lives of those not even yet born who will benefit from the lessons learned from the care given. There is little argument to be made - cancer changes lives!
People who have met cancer face-to-face understand that the disease expects much and adaptations in daily life must be made to meet those demands. So it is with the oral health of the survivors. Truly, there is still much to learn with regard to cancer survivorship in many areas of health care, and dentistry is no different. There are, however, tenets of care that must be followed for the cancer survivor. Some of these simply make life more pleasant; others are fundamental courses of care to which the patients must strictly adhere.
To the cancer survivor, I would say…because your experience with cancer has been a personal journey, there is no single adage that applies to all. There are, however, recommendations that are applicable to most. Always consult with your dentist or dental oncologist to customize a continuing care plan that is suited for your needs. Do not be afraid to begin a dialogue with your oral health care provider. Let him or her understand what is working for you, and what isn’t. Together, you and your dental oncologist can develop a regimen that is tailored to your needs and helps ensure your prolonged oral health as you live life as a survivor.
Dental Care Following Chemotherapy
Because many of the direct cytotoxic effects of chemotherapy subside after infusions have ended, much of the oral health care recommendations directed towards the post-chemotherapy patient focus on dealing with possible lingering side effects. Granted, the severity of enduring complications is usually contingent on the specific chemotherapeutic agents used, their dose, and the duration of treatment. Usually, however, the patient who has completed chemotherapy will notice a return to normal in the oral cavity. Dysgeusia (abnormal taste) and dysphagia (difficulty in swallowing) most often resolve without further intervention from the dentist. As white cells and platelets recover, mucositis is usually no longer an issue.
Xerostomia, or dry mouth, can continue to be a problem for many treated with chemotherapy alone, especially if medication for comorbidities continue after chemo has concluded. As long as the salivary flow is reduced, as determined by either a “feeling” of dry mouth or quantitative analysis by a dentist or dental oncologist, the xerostomic patient should commit to a professional dental cleaning and recall visit every three months. Dry mouth can lead to dental complications including rampant caries, periodontal disease, and oral infections. This condition should continue to be monitored and managed until normal salivary flow has returned and the patient has demonstrated a proficiency in home care that reduces the risk of extensive generalized decay.
During times of xerostomia, caries control is paramount. In some cases, it may be necessary to place the patient on microbial reduction therapy. The level of streptococci mutans can be reduced below a pathological level for three to six months by instructing the patient to use aqueous chlorhexidine gluconate 0.12% as an oral rinse: 1/2 oz. twice a day for two weeks. (This timeframe of bacterial load reduction has only been demonstrated in non-cancer patients. Patients battling cancer should continue using aqueous chlorhexidine gluconate on an ongoing basis and should be closely monitored if the oral rinse is reduce or discontinued as rapid recolonization has been documented in this population.) Similarly, the regular application of fluoride should be considered as long as patient remains at-risk for rampant caries.*
- Detailed instructions for fluoride application can be found in the second installment of this series.
Dental and Oral Health Care Following Head and Neck Radiation
Dental care following head and neck radiation is perhaps one of the most complicated areas of dental oncology as many of the side effects of radiotherapy linger for the remainder of the patient’s life. As is the case during treatment, it is imperative that the dental professional be thoroughly familiar with the dose of radiation the patient has received. An isodose map showing dosage according to anatomical structures must be considered prior to treatment planning for dental and oral health care following radiation. While most radiation therapy is now administered by intensity modulated radiation therapy (IMRT), some patients may have received treatment through a fixed beam of conventional radiation therapy or brachytherapy, which involves insertion of radioactive wires directly into the tumor. The dental professional must be familiar with not only the cumulative dose and the structures involved, but also with the radiation modality and the treatment schedule.
Perhaps one of the post-radiation risks most familiar to dental professionals is that of osteoradionecrosis (ORN). ORN is a late side effect of radiation where damage to the small blood vessels in the mandible, and more rarely the maxilla, impairs the bone’s ability to heal. Those who have received brachytherapy are particularly at-risk for developing this condition. Typically, ORN is not seen within the first year following treatment and the risk of ORN increases with time. Most often, bone necrosis of the jaw in the head and neck cancer survivor follows a traumatic event, such as an extraction or dental surgery; however, spontaneous exposure and necrosis of the bone - especially in the posterior mylohyoid ridge - has been reported. Although it can occur after lower doses, ORN usually occurs with doses greater than 60 Gy. All future oral health care treatment planning must consider radiation exposure to the bony structures of the face to minimize the risk for ORN.
Because of the risk of ORN, endodontic therapy should be considered as a viable treatment option for carious lesions with pulpal involvement. Root banking may be necessary when insufficient tooth structure remains supragingivally. For carious lesions, fluoridated glass ionomer is the restorative material of choice for the cancer survivor.
Exposure of the salivary glands to therapeutic radiation causes atrophy of the secretory cells resulting in xerostomia, the severity of which is related to the cumulative dose. Doses as low as 25 Gy can result in dry mouth. Although IMRT has reduced much of the widespread damage to the salivary glands seen in conventional radiation therapy, xerostomia continues to be the most widespread complication seen in head and neck radiation patients. The dental professional treating patients with a history of head and neck radiation should realize that long-term survivors who experienced conventional fixed beam radiation may present with more severe xerostomia that is a permanent side effect of their treatment.
Not only does ionizing radiation affect the function of the secretory cells in the glands, it also changes the composition of the saliva when some salivary function is retained. Serous glands are impaired much more readily than mucous glands. The result is a saliva that is much more viscous and acidic and lacks much of the protective qualities normally seen. Clinically, the patient may experience impaired remineralization capacity, taste alteration and difficulty swallowing, difficulties in mastication and speech, and decreased protection against microbes. These in addition to the increased propensity for dental caries makes xerostomia a side effect that cannot be ignored. Unfortunately for some head and neck cancer survivors, the damage of the salivary glands is permanent. These patients require close monitoring by the dental professional and should follow the guidelines for the post-chemotherapy patient as outlined above.
Fungal infections are more prevalent in this population, and the dentist or dental oncologist must be comfortable diagnosing and treating these conditions should they arise. When treating a Candida infection, both the patient and the denture should be treated, when applicable. Fluconazole 100 mg, twice a day, is an effective means of treating a yeast infection in the patient that can be used long term, if necessary. Nystatin suspension is not recommended due to its high sugar content. Alternatively, clotrimazole 10 mg troches, five times per day for two weeks, or mycostatin 200 mg oral pastilles, four times per day for two weeks, can be used. Dentures can be treated using bleach diluted in water (2 teaspoons per 1 cup water) for 30 minutes each day.
Beyond the teeth and oral mucosal tissues, many lingering side effects often plague the head and neck survivor. Permanent taste loss can occur at a dose of 60 Gy or higher. In lower doses, taste loss is often temporary although it may take several months to fully recover. Decreased salivary flow can cause taste alteration as can damage done by mucositis. Chemoreceptors on the tongue can take months to years to return to normal function if they have been affected by mucosal ulceration. Trismus can cause limited opening for three to six months following radiation therapy. Caused by contraction of the muscles of mastication and the TMJ capsule, trismus can occur with an unpredictable frequency and severity. Physical therapy (opening the mouth to maximum and closing 20 times, three times per day) can bring some relief and improve opening, but this condition must be considered when planning treatment and formulating an at-home oral hygiene regimen.
Long-term head and neck cancer survivors may also experience occlusion of the carotid arteries. Consideration must be given to this fact when using dental anesthetics with epinephrine. The dentist or dental oncologist should be familiar with signs and symptoms of a transient ischemic attack (TIA) or stroke and monitor these patients closely for signs of distress during dental procedures. Sometimes, head and neck survivors suffer degeneration of cervical vertebrae and may experience fatigue with minimal exertion. Fibrosis of the musculature in the radiation field may yield unusual results in head and neck examinations. Careful observation must be made during oral cancer screenings and head and neck examinations as “normal” may feel different to the dental professional examining the patient. For patients who have just completed treatment, radiation burns may still exist on the skin. Even long-term, a patient may complain of the tissue that was in the field of radiation as feeling “hot.”
The dental professional should be prepared to help the head and neck patient understand that many of these changes will affect the way he or she is accustomed to eating. The patient should avoid sharp or crunchy foods that can cause mucosal damage, hot and spicy foods, foods that are highly acidic, foods that are sticky or highly cariogenic, and drinks that contain alcohol. Patients should choose foods that are easy to chew and swallow, learn to take small bites and chew slowly, and sip liquids with meals. While many of these changes were necessary during treatment, most will need to continue these practices for several months following the completion of radiation therapy. When necessary, the dental professional should be ready to refer the patient to a registered dietician or professional nutrition therapist.
Other Post-Treatment Oral Health Care Considerations
Patients who have received bisphosphonate therapy via an intravenous route of administration are at risk for developing bisphosophonate-related osteonecrosis of the jaw (BRONJ). Medications used to treat metastatic disease in the bone include Zometa (zoledronic acid), Aredia (pamidronate), and Xgeva (denosumab). It is believed that the risk of developing BRONJ is directly related to the dose and duration of the bisphosphonate therapy. While the specific etiology of BRONJ is not fully understood, the dental professional treating patients with a history of bisphosphonate therapy should understand the risks associated with these medications and care for the patient in a manner similar to patients at risk for ORN. Since the half-life of some of these medications is in excess of ten years, a history of bisphosphonate therapy should be considered for all future oral health care planning in these patients.
Patients who are post-transplant, either for bone marrow or hematopoietic stem cells, are at high-risk for infection due to continued immunosuppression. In addition to bacterial and fungal infections, these patients are susceptible to viral infections including herpes simplex virus type 1, herpes varicella zoster virus, and cytomegalovirus. Moreover, these patients are at-risk for graft-versus-host disease (GVHD) and other autoimmune problems. GHVD and autoimmune issues can be very complicated. The dental professional seeing these patients should seek out continued education related to the specific care of autoimmune patients or refer to a dental oncologist experienced in their care.
Caring for patients before, during, or after their fight with cancer can be the most rewarding experience of a lifetime. More dental professionals are needed to commit to meeting the unique dental and oral health care needs of patients battling cancer. As the epidemiological forecasts continue to predict an increase in the number of new cancer cases as well as an increase in the population of survivors, now is the time for dental professionals to become part of a cancer care team. You can make a difference!
Dental Oncology Professionals of North Texas
News Feed: dentaloncology.tumblr.com/rss
Dennis M. Abbott, D.D.S. is the founder and CEO of Dental Oncology Professionals of North Texas, an oral medicine practice dedicated to meeting the unique dental and oral health needs of patients battling cancer. He holds a Bachelor of Arts in biology from Rice University in Houston, and is an honor graduate of Baylor College of Dentistry. After dental school, Dr. Abbott studied immunology, microbiology, and oral medicine at the School of Dental Medicine, State University of New York at Buffalo. In addition to private practice, he is a member of the dental oncology medical staff at Baylor Charles A. Sammons Cancer Center and Baylor University Medical Center in Dallas. Dr. Abbott also serves as a consultant to the national American Cancer Society in the development of oral monitoring guidelines for post-treatment cancer survivors.
Dr. Abbott has most recently conducted studies focusing on bisphosphonate-related osteonecrosis of the jaw and xerostomia in patients with cancer. He is the previous recipient of the Dentist Scientist Award and the National Research Service Award, both granted by the National Institutes of Health. Dr. Abbott has been a visiting faculty lecturer for the University at Buffalo School of Dental Medicine continuing education program and has lectured throughout the United States.


The Leura Gardens Festival is a registered charity, the objective of which is to provide funds for medical equipment and patient care at the Blue Mountains District Anzac Memorial Hospital.
Management of the Festival is in the hands of a voluntary committee currently chaired by Mr Brooke Broughton and supported during the Festival by around 400 volunteers from the local community.
The Festival was founded in 1965 when four gardens were opened in October and $900 was raised. Over the following 21 years the number of gardens participating increased and the Festival was extended to nine days, covering two weekends and the intervening weekdays. Additional attractions are now also offered to visitors, including art in the gardens and music in the gardens.
In the first 21 years of the Festival over $250,000 was raised and used to purchase hospital medical equipment and to improve hospital amenities. In the following 7 years between 1986 and 1993 a further $500,000 was raised. This money was spent to equip and furnish a high-dependency unit and two palliative care suites.
Between 1993 and 2001 the committee paid much of the cost of the new paediatric unit and paid for new endoscopic equipment, a state-of-the-art anaesthetic machine complete with monitoring units, a gastroscope and other invaluable equipment. Other purchases in these years included stress testing equipment, a ventilator for the high-dependency unit, a retinal camera and physiotherapy equipment, in all amounting to several hundred thousand dollars.
In 2002 the Festival purchased telemetric monitoring equipment, enabling patients to walk around the hospital having their vital signs monitored without being hooked up to cables.
In 2003 the Festival purchased a high-resolution screen monitor for the virtual critical care unit. This enables staff at Katoomba to consult with their colleagues at Nepean teaching hospital. The link immediately conveys high quality pictures, sounds and data allowing speed diagnosis and treatment.
In 2004 thirty electric beds were purchased, increasing the independence and comfort of patients by allowing adjustments by way of finger controls. The beds also save nurses' backs when lifting patients.
In 2005/6 money was spent on the refurbishment of the East Wing and a range of general equipment including portable vital signs monitors, wheelchairs, a labour ward bed and space lab monitors.
Between 2007 and 2009, a total of $247,000 was spent on a wide range of equipment, and towards the cost of the relocation of the Cardiac Rehabilitation and Chronic Airways departments of the hospital. Equipment purchased included resuscitation beds, a cardiotocograph, spacelab monitors, a labour ward bed, wheelchairs, and a paediatric cot.
In 2009 a donation of $6690 was also made to the Blue Mountains Cancer Help to fund advanced training for physiotherapy staff.
In 2010 the Festival committee approved a total expenditure of $110,000 on a range of items identified as priority items by the hospital. Principal items included four cardiac monitors, a video laryngoscope, a foetal monitor and two electric beds.
In 2011, a donation of nearly $96000 was made to the hospital for the purchase of medical equipment for physiotherapy, education, the east wing, the operating theatres and the A&E department. In addition, three local health-related charities each received $3000. They were, Blue Mountains Health Trust, Can Assist and Blue Mountains Cancer Help.
In excess of $100,000 was raised during Festival 2012, most of which assisted in the purchase of medical equipment for the Blue Mountains District Anzac Memorial Hospital. In keeping with Festival policy to assist other Blue Mountains Health related charities, donations were also made to The Blue Mountains Health Trust and Cancer Help.
In 2013, $112,000 was raised bringing the total funds raised by the Festival to the amazing figure of $2 million. Equipment purchased from festival funds included a humidicrib; special beds and a bed mover; significant upgrades to the cardiac and respiratory rehabilitation unit; and ECG equipment.
2014 – the Festival’s 50th anniversary year – was an amazing success, with around $150,000 made available to the hospital. This money is being put towards the upgrading and refurbishment of the East Wing and the establishment of an area for some new and much needed outpatient clinics. As a result of the 2014 success, donations were also made to Blue Mountains Cancer Help, Blue Mountains Health Trust and Can Assist.
As always, the success of the Festival is down to the garden owners and the hundreds of volunteers who freely give of their time and resources over the nine days of the Festival.


Digital marketing can be an effective way for healthcare providers in India to increase their patient base by reaching a wider audience and connecting with potential patients online. Here are some strategies that healthcare providers in India can use to increase their patient base through digital marketing:
- Search engine optimization (SEO): Optimizing website content to rank higher in search engine results for relevant keywords. This can help healthcare providers to be easily found by potential patients when they search for healthcare services and products online.
- Social media marketing: Utilizing platforms like Facebook, Instagram, and WhatsApp to connect with potential patients and promote healthcare services. By sharing educational content and engaging with patients on these platforms, healthcare providers can build trust and establish themselves as a reputable source of healthcare information.
- Content marketing: Creating valuable and informative content such as blog posts and videos to educate potential patients about healthcare services and products. By providing helpful information, healthcare providers can position themselves as experts in their field and increase the likelihood that potential patients will choose them for their healthcare needs.
- Email marketing: Sending targeted and personalized emails to potential patients to promote healthcare services and inform them about upcoming events or promotions. Email marketing can be an effective way to reach potential patients with specific messaging that is relevant to their healthcare needs.
- Pay-per-click (PPC) advertising: Utilizing platforms like Google AdWords to place ads on search engine results pages and other websites. This can help healthcare providers to reach potential patients who are actively searching for healthcare services and products.
- Influencer marketing: Partnering with healthcare influencers to promote your brand and services. Influencer marketing can help to build trust with potential patients by leveraging the credibility of the influencer.
It’s important to keep in mind that healthcare is a regulated industry in India, so it’s important to ensure that all marketing efforts comply with relevant laws and regulations, such as the Indian Medical Council Act and the Drugs and Cosmetics Act.
In addition, healthcare providers in India should measure and track the effectiveness of their digital marketing efforts through metrics such as website traffic, social media engagement, and conversion rates. This will allow them to make data-driven decisions and optimize their marketing efforts to increase the patient base effectively by using Webholik Media services.


John Michael Tate, DDS
John Michael Tate, DDS, a native of Southlake and Valedictorian of his Carroll High School class, earned his Doctor of Dental Surgery (DDS) with honors from Baylor College of Dentistry. After graduation, he established his practice serving Southlake, Grapevine and the surrounding Northeast Tarrant County communities, while serving as Assistant Professor of Restorative Dentistry at Baylor College of Dentistry. Dr. Tate has postgraduate training in complex restorative dentistry, orthodontics, cosmetic dentistry and dental implants. In addition to all phases of preventive and restorative dentistry, Dr. Tate offers both clear aligner orthodontics (Invisalign, Clear Correct) and traditional orthodontics.
While committed to providing the very best care for his patients, Dr. Tate continues his training through many avenues including C.A.R.D. (Center for Aesthetic Restorative Dentistry) where he is on the teaching faculty. He is a Fellow in the Academy of General Dentistry and a member of Omicron Kappa Upsilon Honorary Dental Society, the Odontological Honor Society, Dallas and Tarrant County Dental Societies,
American Orthodontic Society, and long time member of the Texas Dental Association and American Dental Association.
Dr. Tate is a fourth generation native to the Southlake-Grapevine area and proudly says he is practically kin to the dirt. He loves this community and the people. He is married with four grown children and four grandchildren. He and his wife Sue count it a blessing to have most of their family still living close to home. Their youngest and only daughter is still living in Oklahoma where her husband is finishing college. While Sue and Dr. Tate enjoy both their own family and church family, they also enjoy traveling and getting away from routine when the opportunity arises.
Dr. Tate is honored to have had his son, Dr. John Tyler Tate, join him in practice in 2011. He counts it a gift to have such an outstanding young man join him in what they both love to do (care for patients). Dr. Tate says of his son, “he has great hands and a caring heart and is a great asset to the Practice and to the community.”


Your well-being is our priority.
Boheme Salon + Spa offers a variety of spa services customized to meet your individual needs. We proudly feature the use of two prestige spa product lines within all our spa service offerings, Aveda from the U.S. and Comfort Zone from Italy. To schedule, call us or request an appointment from our homepage.
|Elemental Nature℠ Customized Facial * †
|This 60-minute facial is ideal for anyone new to receiving facials or unsure of exactly what their skin needs for ideal balance. Let an expert discover your skin’s individual needs by beginning with a proper skin care consultation and analysis. This customized experience then focuses on balance of the mind, body and skin through proper cleansing, exfoliation, massage and masque techniques. Includes a customized aromatherapy sensory experience.
|True Radiance Skin Smoothing Facial †
|Enjoy the ultimate in skin smoothness and radiance. This facial combines the powerful benefits of mechanical skin resurfacing and a customized peel to give your skin an intense exfoliation experience. Can be customized for all types of skin.
|Self Renewal Facial Treatment * †
|90 minutes, includes foot, scalp and face massage. Experience a fully customized treatment, head to toe, that focuses on balance and renewal of the skin, mind and body. Balance the skin with a complete facial treatment, indulge the senses with the aroma of pure essential oils and relax the body with a full scalp and foot massage. Enjoy 90 minutes of pure wellness.
|Skin Rejuvenating Facial †
|Enjoy the best we have to offer in facial rejuvenation. This facial treatment is designed to reduce fine lines, smooth texture, plump and hydrate the tissue and allow for better penetration of skin care serums specifically taylored to the needs of your skin. This facial treatment incorporates nano-needle exfoliation and LED skin rejuvenation therapies.
|Lash Lift/Lash Lift & Tint
|Tired of straight lashes? Give them a lift by enhancing your natural lashes! Add tint to make them really stand out. Enjoy 6 to 8 weeks of lifted lashes that create a more energized and refreshed appearance to the eyes.
|Brow Lamination/Brow Lamination & Tint
|Enhance your brows into a more refined, fuller, smoother shape with our brow lamination. Add tint to emphasize and perfect your brows.
|Elemental Nature℠ Customized Massage * †
|This 60-minute treatment includes an individualized consultation, to determine what your body’s greatest needs are today, followed by a completely customized massage to meet those specific needs. Includes a customized aromatherapy sensory experience.
|Massage for the Expecting Mother
|A wonderful experience for the mother to be. Enjoy 60 minutes of massage tailored toward your specific needs, focusing on stress reduction, alleviation of pregnancy pains, and overall relaxation for the mother and baby. Techniques vary dependent on stage of pregnancy. A full consultation is included to customize the treatment and ensure safety.
|Self Renewal Body Massage * †
|90 minutes, includes foot and scalp massage. This 90-minute total body experience focuses on renewal of the entire mind and body. Beyond receiving a full body massage, customized for your individual needs, deep relaxation is achieved by bringing attention and awareness to the body’s universal stress points: the head and feet. This treatment concludes with 30 minutes of extra massage focused on releasing tension in the scalp and feet. Also includes a customized aromatherapy sensory experience.
|$45 (30 minute), $60 (45 minute)
Designed to assist in the rejuvenation and balance of the entire body, this foot reflexology experience can be added to any massage treatment or enjoyed as a service all on it’s own.
|Aveda Body Glow *
|This customized body treatment is designed to soften and purify the skin through a custom blended salt/sugar scrub exfoliation. Post exfoliation, the body is hydrated with a custom blended moisturizer, leaving the skin ultra soft and glowing.
|Hot Stone Massage
|This 60 or 90 minute massage is a unique experience of heated stones being used to provide the ultimate in relaxation and therapeutic benefits. The stones are used to massage deep into the muscles helping to dissolve stress and bring new energy to depleted areas. The stones are strategically placed on key areas of the body throughout the massage to promote calmness during the session.
* Aveda Signature Service
† Sales Pricing Available
|Arm / ½ Arm
|Leg / ½ Leg
Terms of Service
All waxing services performed at Boheme Salon + Spa include a full consultation to determine the specific type of waxing you are looking for along with the individual care and needs of your skin during the waxing process. To ensure a better waxing experience please be sure to allow for the proper length of hair to be present. Hair lengths, shorter than recommended my interfere with the result of the waxing service.
Ideal length of hair for facial waxing is generally 2 to 3 weeks of growth or 1/8 inch of growth.
Ideal length of hair for body waxing is generally 4 to 6 weeks of growth or 1/4 inch of growth.
Be sure to avoid the oral or topical use of all skin medications prior to waxing including but not limited to:
- glycolic acid concentration greater than 10%
For proper results with waxing, please disclose all skin medications and skin exfoliating ingredients you may be using currently or on a regular basis. If in doubt of the medication of ingredient please consult with the esthetician on staff prior to waxing or your doctor to ensure safe result. We reserve the right to turn away anyone for waxing services that we feel may not be an ideal candidate for the service.


Behavioral Assessment following SCI:
Cervical spinal cord injuries (SCI) are amongst the most severe spinal injuries affecting humans due to drastically impacting quality of life through the impairment of stereotyped movements and highly integrated sensorimotor functions, resulting in a high fatality rate. Other than physical therapy, which can only assist in gaining partial function, there is currently no treatment providing full recovery for cervical SCI. At the Horner Lab, rat models have been implemented to assess motor learning, control of fine movements, and track progression of recovery after cervical SCI through the forelimb reaching task (FRT). Additionally, the lab has been implementing the limb-use asymmetry test (LUAT), which assists in determining the limb-preference pre and post cervical SCI, as well as throughout the short and long-term recovery periods. Overall, the behavioral assessments of the rats demonstrate the degree of injury observed after a cervical SCI, allowing us to learn more about the natural progression and effects of the injury to implement therapeutic strategies that could improve quality of life.


Joshua Peters, M.A., R.P.
Life is a dynamic journey filled with both high and low moments. No doubt, when we are in the high moments we can often appreciate these experiences whole hardily; however, it can be much harder to cope with the negative feelings, thoughts, and behaviours that sometimes accompany our low moments. Instead, we can become absorbed in our negative emotions about ourselves and our relationships – and we may find ourselves increasingly anxious, depressed, and struggling to feel better. During these moments, you may feel even worse if you are experiencing feelings of loneliness or isolation. In seeking help from a therapist, you have taken an important and admirable first step towards learning more about yourself and your relationships. You do not have to work through these difficult times alone.
I offer you a warm welcome on your journey towards better mental health.
In my clinical practice, I work with individual and couple clients who are experiencing a diverse range of emotional, self, identity and relationship struggles. Specifically, I am interested in and have experience working with clients who are struggling with emotional distress related to anxiety, stress, anger, depression and grief. Processing difficult emotions can be challenging; however, with appropriate guidance in therapy, I can help you to get at the emotional roots of your distress as well as help you to become in touch with the concerns, goals and needs that underlie your experiences. I work with clients to address issues related to self (i.e., self-esteem, confidence) and identity (i.e., sexuality, sexual orientation, gender, relationship diversity). Moreover, I work with clients who have faced attachment trauma or traumatic experiences (i.e., childhood or present day emotional deprivation, or childhood or present-day emotional, physical or sexual abuse) that have altered their sense of self, others and the world around them.
In my individual work…
I will work collaboratively with you to identify the goals and concerns you would like to address in therapy. I provide all my clients with a non-judging, open, warm and supportive environment to ensure that you feel emotionally safe to explore your feelings, thoughts, behaviours and/or relationships. To ensure that I understand your experiences, I will conduct a comprehensive and scientifically validated assessment to gather information about how your thoughts, feelings, behaviours and interpersonal style might be contributing to your current challenges. As an integrative psychotherapist, I will also utilize supported treatment approaches (i.e., psychodynamic, cognitive behavioural, dialectical behavioural, mindfulness-based, narrative, emotionally-focused, family systems) to help you address your distressful thoughts, emotions, behaviour and relationship concerns. Incorporating these different treatment modalities allows me to work with you in different ways based on your unique needs.
In my couple and relationship work…
I will coach both of you to build stronger emotional communication skills as well as help your relationship manage conflicts and improve communication and negotiation skills concerning finances, parenting, and in-law difficulties. I can also support both partners in learning to become more physically intimate, help you work through any sexual issues that you are currently facing (i.e., arousal, desire, orgasm problems), and offer support for partners to work through relational hurts and betrayals (i.e., infidelities, absence of emotional support in time of need). Finally, I can also help navigate and support couples who decide to ‘open up’ their relationship by helping you construct a non-monogamous, open, or polyamorous relationship/network.
Professionally, I draw from a rich background of experience within the mental health field, including both clinical and research positions. I began my journey in the mental health field working with clients in crisis at the Distress Centre in Ottawa, Ontario. In this role I was directly responsible for the wellbeing of individuals who were experiencing distress and suicidal ideation. I have also conducted research in the area of couple relationships at the Couples Research Laboratory (University of Ottawa) aiding in research on LGBTQ couples and intimate partner violence. Lastly, over the past several years, I have gained experience at Saint Paul University’s Counseling Centre and CFIR’s Ottawa location. At these two settings, I worked with clients experiencing a wide range of issues, including diagnosable disorders, and other psychological issues, as well as couple clients from diverse backgrounds. These settings provided me with experience, skills, and the theoretical foundation to provide therapy to a diverse range of clients.
I am currently registered with the College of Psychotherapist of Ontario and have received a Master of Arts Degree in Counselling (Couples & Family Specialization) from the University of Ottawa (Saint Paul University). I am a Psychotherapist at CFIR, working on the supervision of Dr. Dino Zuccarini, C.Psych.
- Anger & Emotion Regulation
- Anxiety & Stress
- Couples Therapy
- Depression, Mood & Grief
- Eating, Weight & Body Image
- Interpersonal Relationships
- Self-Growth & Self-Esteem
- Sex Therapy
- Sexual Addiction
- Sexuality, Gender & Relationship Diversity
- Substance Use
- Trauma Psychology & PTSD
- Acceptance and Commitment Therapy (ACT)
- Attachment-Based/Mentalization Therapy
- Cognitive-Behavioural Therapy (CBT)
- Dialectical-Behavioural Therapy (DBT)
- Emotion(ally)-Focused Therapy (EFT, EFFT)
- Existential-Humanistic Therapy
- Integrative Therapy
- Mindfulness-Based Therapies (E.G., MBSR, MBCT)
- Relational Therapy
- Systemic Therapy


Skiing, inventive restaurants, tech companies, a certain green plant…Denver is known for a lot of things, but lately, it’s being recognized for its friendliness to visitors of the dog variety. Rover ranked Denver as the top dog-friendly city in America and SmartAsset listed it as number 3. Fido is welcome all over Denver. The city is full of dog-friendly amenities like hotels, parks, activities, and other destinations.
It makes sense, then, that Denver also has a wide range of high-quality veterinarian practices to help keep your four-legged friend healthy. Use this comprehensive list of Denver veterinarians to find the care your dog deserves.
Veterinary Practices in Denver 1:
Urban Vet Care is a full-service, accredited practice that was founded in 2003 and has since grown to a staff of over 35 including eight doctors. They offer personal, progressive and comprehensive animal care to dogs and cats in the Denver area.
Veterinary Practices in Denver 2:
Serving northeast Denver since 2011, Park Hill Veterinary Medical Center is accredited by the American Animal Hospital Association. They work with animals from birth to old age in preventive and emergency medicine, surgery, dental care, radiology, cardiology, and laser treatment.
Veterinary Practices in Denver 3:
Tender Touch Animal Hospital provides a full range of premium preventative care, diagnostic and treatment services, with a highly skilled staff that works with you to ensure your pets receive the best possible care.
Veterinary Practices in Denver 4:
The Center For Animal Wellness is a full-service animal hospital offering cutting-edge medical, surgical, and dental care. They also offer resources to help educate clients on health and wellness topics for their pets.
Veterinary Practices in Denver 5:
Dr. Christina Spears began Park Animal Hospital and Wellness Center in July 2012 to offer comprehensive veterinary medicine and surgery. They include a wide array of treatment options from traditional medications to alternative therapies such as herbal medicine and acupuncture.
Veterinary Practices in Denver 6:
Dr. Allison Jenkins and the staff at Highlands Animal Clinic work in a 120-year-old Victorian house in which they provide state-of-the-art veterinary care. Their treatments include in-house blood machines, digital radiography, dental radiography, high-tech anesthetic monitoring equipment, and heated cages for comfortable hospitalization.
Veterinary Practices in Denver 7:
Goldsmith Veterinary Clinic has been providing care for over 20 years. With five dedicated and caring veterinarians, their mission is to treat everyone’s pet as though they were their own.
Veterinary Practices in Denver 8:
This 24-hour veterinary hospital is part of a national chain that provides both primary and secondary care to pets. If a veterinarian needs help on a difficult case, VCA’s Advanced Veterinary Care Centers and board-certified specialists are always available to consult.
Veterinary Practices in Denver 9:
Vida Veterinary Care is open seven days a week providing complete veterinary care as well as emergency care services to Denver for over 50 years. They provide a range of veterinary services for dogs, cats and exotic pets, including general health care, surgery, endoscopic procedures, emergency care, and more.
Veterinary Practices in Denver 10:
Located near downtown Denver, VCA Firehouse Animal Hospital offers a complete range of general medical, dental and surgical services for dogs and cats as well as limited medical services for exotics and pocket pets.
Veterinary Practices in Denver 11:
Founded in 1947, Belcaro Animal Hospital is a full-service animal hospital that offers medical, surgical, and dental veterinary care with an in-house pharmacy, lab, and radiology facilities. They are open for appointments during the week and walk-in visits on Saturdays.
Veterinary Practices in Denver 12:
Evans East Animal Hospital is a full-service animal hospital for emergencies as well as general medical, surgical, and dental issues. In addition to first-rate medical care, the animal hospital has a comfortable, child-friendly, calm waiting room created to keep your animals calm before their appointments.
Veterinary Practices in Denver 13:
Accredited by the American Animal Hospital Accreditation, Overland Animal Hospital & Pet Resort offers a complete line of veterinary services as well as overnight boarding and daycare for dogs and cats. They also provide various grooming and wellness services.
Veterinary Practices in Denver 14:
For the last 40 years, Broadview Animal Clinic has provided quality, affordable veterinary care for our client’s pets in a friendly, professional environment. They pride themselves on their highly motivated, friendly staff and their high-tech facility.
Veterinary Practices in Denver 15:
A full-service accredited veterinary hospital, Stapleton Veterinary Hospital has been committed to providing high-quality, state-of-the-art medicine and compassionate care for pets since 2004. They offer a wide range of services including wellness and preventative care, vaccines, surgery, radiography, and dentistry.
Veterinary Practices in Denver 16:
Rising Sun Animal Care is a locally owned and operated veterinary practice that strives to exceed client’s expectations with high-quality personal care for their dogs and cats. They offer a wide range of traditional medicine and integrative treatment options, including veterinary acupuncture, laser, and veterinary orthopedic manipulation.
Veterinary Practices in Denver 17:
Gentle Touch Animal Hospital has been serving the community since 2000. They provide high-quality veterinary care in a warm, caring, fear-free environment. They strive to treat all of their clients and patients as if they are a part of their own families.
Veterinary Practices in Denver 18:
Washington Park Veterinary Clinic in Denver, CO is a full-service companion animal hospital. Their services and facilities are designed to assist in routine preventive care, early detection and treatment of disease, and complete medical and surgical care.
Veterinary Practices in Denver 19:
Pets on Broadway is a full-service animal facility that provides state-of-the-art medical treatment, board, and grooming. They combine traditional and alternative medicine to provide pets the best treatment according to their needs.


Be in Control When Battling Cancer
Knowing you may be in the fight of your life with cancer can prove unnerving for many people.
With that being the case, how will you stand up to this illness that can change your life in a moment once diagnosed?
For some individuals, they will rely on what advice their doctor puts forth for them.
For others, the option of natural cancer therapy is the way to go.
So, how much control will you have when battling cancer?
Exploring Your Options
As you look to take the battle to cancer, it is important to remember that you more times than not will have options.
In looking at those natural therapies, you want to keep learning as much as you can about such treatments.
While chemo and radiation may prove fruitful for some, others know both can damage good cells too. As a result, one is not only weakened, but could actually be reducing their chances of survival.
In taking a more natural approach to fighting cancer, you can do the following:
- Look at meditation – If you’ve never been one to meditate up to now, is it time you try it? Meditation can do wonders from both a physical and mental aspect. As you look to build up your immune system, you also want to have a positive attitude moving ahead. By meditating and doing other related therapies, you could be at more peace. Doing so could give you the upper-hand.
- Relieve the stress – Are you someone who seems to stress over the smallest of things? If the answer is yes, that is not going to help you in your battle with cancer. Do all you can to remove the stress sensors in your life. One of the more common ones is work. If you find that your job is stressing you out, see how you can lower the stress level. It may mean finding another job at the end of the day. Another stress issue can be finances. If money has you too stressed out, look to see how you can change that. It may very well correlate with your job situation. If you do not have enough money coming in to handle your bills etc. try to change that. No matter how you go about reducing stress, your body will appreciate it. As part of that appreciation, it will in all hopes lead to fewer sleepless nights.
- Positive attitude – Last, do you have a positive attitude? Unfortunately, too many people would have to say no to that question. With a positive attitude in-hand, you are able to stand taller against cancer. Look for the positive things in your life and not focus on the negative. As an example, do you have a child who has a wedding down the road? What about an anniversary you want to celebrate with your significant other in a few years? By having special times and dates to look forward to, you will be more inclined to keep fighting cancer.
In doing all you can to be in control, make sure you find the treatment program best suited to your needs.
At the end of the day, you have to decide what is best for you.


Optimized Ashwagandha Extract, 60 vegetarian capsules
This product includes an extract of Ashwagandha, more specifically Sensoril® Ashwagandha Extract, which is standardized to contain 32% oligosaccharides and 10% withanolide glycoside conjugates.
This product includes an extract of Ashwagandha (Withania somnifera), more specifically Sensoril® Ashwagandha Extract, which is standardized to contain 32% oligosaccharides and 10% withanolide glycoside conjugates. Ashwagandha has been used for centuries in Ayurvedic traditions and is known for promoting healthy energy levels, emotional balance, and memory health.
Stress Relief: During a 60-day clinical trial that included 130 adults with chronic stress, the use of Ashwagandha supplements showed significant improvements in stress-related parameters. The study showed that the higher the dosage, the greater the positive response. Additionally, it helped in balancing biological markers of stress and promoted a healthy balance of the stress-related hormones cortisol and DHEA.
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Clomid is one of the most popular drugs used in bodybuilding. What is the secret of popularity and how did the drug migrate from medicine to sports pharmacology? To answer these and other questions of interest to bodybuilders, it is necessary to analyze what kind of drug it is, how it is taken correctly. It is also worth comparing the effectiveness of the drug with Tamoxifen, since the drugs are similar in their action.
The use of Clomid in bodybuilding on a course of steroids
Clomid is characterized by a powerful antiestrogenic effect, therefore it is actively used by bodybuilders on a course of steroids. It blocks the receptors of the female sex hormone, prevents its action. This helps prevent gynecomastia.
According to experts, for professionals who take steroids frequently and in high doses, it is difficult to protect against the side effects associated with conversion to estrogen with Clomid. In this case, it is not effective enough. Experienced athletes are better off taking aromatase inhibitors that suppress estrogen production. This is the most effective way to counter the manifestation of side effects.
If we talk about fluid retention in the body, Clomid slightly interferes with this process. But its effectiveness in this direction is insufficient. The drug does not reduce the concentration of estrogen in the blood, but only blocks estrogen receptors. It is worth considering that with the issue of fluid retention in the body, it is worth contacting nutritionists more often, and not resorting to pharmacological agents. Keeps it can, for example, an excess of carbohydrates in the diet. The effect is further enhanced by the intake of anabolic steroids.
Clomid on the AAS course allows you to prevent such a side effect as gynecomastia, but it will not cope with water retention in the body.
See also about most reviews of Clomid
In bodybuilding after a course of steroids on PCT
The main use of Clomid in bodybuilding is for PCT. The fact is that after a course of anabolic steroids, the production of testosterone decreases. The degree of suppression is determined by the type of anabolics and their doses. After the end of the course, the process of synthesis of the male hormone begins to improve. But it is very slow – in some cases it can last up to a year. And the consequences of low testosterone manifest themselves from the negative side. Elevated levels of the catabolic hormone cortisol. Under its influence, fat mass is gained and muscle mass actively begins to break down.
With the help of pharmacological agents, it is possible to accelerate the process of restoring the synthesis of endogenous testosterone. For this purpose, PCT is being developed, which in most cases involves taking Clomid or Tamoxifen, as well as the peptide hormone – hCG (human chorionic gonadotropin). What is the action of Clomid? In stimulating the release of gonadotropins. They, in turn, contribute to the synthesis of endogenous testosterone.
PCT is carried out if the bridge between steroid courses is more than 8 weeks. Otherwise, it is not recommended. PCT is also not performed if testosterone is administered between AAS cycles, as is common in hardcore athletes. Clomid on PCT is used to accelerate the restoration of natural testosterone synthesis.
Efficacy of Clomid for testosterone recovery: scientific studies
There is scientific evidence for the fact that Clomid is effective in the process of producing the male hormone. Various studies have been carried out:
- men aged 18-55 years took Clomiphene citrate for 2 weeks. In most of the participants in the experiment, testosterone levels increased by about two times. But there were also cases when, after 2 weeks and a month, a sharp decrease was observed;
- 125 men diagnosed with low male hormone levels (less than 400 ng/dl) and reduced libido took Clomid for 3 months. As a result, the concentration of testosterone increased by about two times. At the same time, the cholesterol level did not change, undesirable effects did not appear in any participant in the experiment.
Long-term studies have also been conducted in men with low testosterone levels. Within a year, its average concentration rose from 228 ng/dl to 612 ng/dl. Over the next year, the figures were already 562 ng / dl. By the end of the 3rd year of the study, they had risen to 582 ng/dl. No side effects were observed. Clomid has also shown to be effective in increasing libido in men with hypogonadism and erectile dysfunction. According to scientific studies, Clomid effectively increases the level of endogenous testosterone – an average of 2 times, regardless of the duration of admission (2 weeks or several years).
What are the side effects in bodybuilders when taking Clomid
Clomid is mild. It is well tolerated and does not cause undesirable effects in female or male athletes, which has been confirmed by scientific studies. But some side effects are still possible. Women who treat infertility with the drug note the manifestation of one of these side effects: irritability, mood swings, depression, fluid retention in the body. Other side effects are also possible:
- chest discomfort;
The use of Clomid may be accompanied by vision problems – manifestations of clouding and blurring. In this case, you need to stop taking the drug. More often, after its cancellation, vision is restored. But there are cases where this did not happen. Possible reasons for this action are long-term use of the drug and exceeding the recommended dosages.
Studies conducted on pregnant rats have shown that as a result of taking Clomiphene citrate, multiple reproductive disorders in mothers and their offspring are possible.
There is a possibility that exposure to Clomid provokes a decrease in bone density.
Does Clomid cause cancer? There is no scientific evidence for such a relationship. Even with long-term use, no effect of Clomiphene citrate on the formation of cancer cells has been identified. It should be borne in mind that all studies were conducted on women in the treatment of infertility, and not on athletes who resort to the help of pharmacology.
Clomid is considered a relatively safe drug for bodybuilders. Its use can provoke visual impairment and a decrease in bone density. Even long-term use of an antiestrogen does not increase the likelihood of developing cancer.


InStep Foot Clinic
The Specialists in
Monday: 8.00am - 5.00pm
Tuesday: 9.00am - 4.00pm
Wednesday: 8.00am - 8.30pm
Thursday: 8.00am - 6.00pm
Friday: 8.00am - 2.00pm
Before You Have Nail Surgery
You are currently suffering pain and discomfort due to the problems with your toenail. It is of benefit to you to have part or the whole of that toenail removed. This will relieve the pain. A nail surgery procedure will remove permanently part of or the entire toenail.
What is Nail Surgery?
In order to remove any nail, you will need to have a local anaesthetic. This numbs the toe so that you will not feel pain. It is important to let the podiatrist know if you have had any previous reactions to local anaesthetics. Once the toenail is removed, a chemical called 80% Liquefied Phenol is applied. This destroys the growth part of the nail. After the procedure a sterile dressing is applied. We ask you to leave this dressing on for 48 hours. Y ou will be given a leaflet called After Y ou Have Had Nail Surgery which contains all the instructions we would like you to follow to care for your wound in the early days between appointments. It is important to look after your toe, which will mean applying dressings for a few weeks until the toe is healed.
Is There a Waiting List For Surgery?
No, there isn’ t. We treat this procedure as urgent and will arrange your appointment within a few days of recommendation.
Points to Consider
• The procedure is carried out at InStep Foot Clinic, in Wansford so there is no hospital stay.
• The nail surgery procedure takes about one hour.
• Bring open toe sandals or roomy slippers to go home in after your procedure because your toe(s) will have on bulky dressing.
• Whilst the toe is still numb take care not to injure it, e.g. by stubbing your toe or wearing a tight shoe.
• We would advise that you do not drive after the procedure due to the effects of the local anaesthetic . You may drive once the numbness has worn off completely.
• The local anaesthetic injection you will be given is not expected to have any unwanted side effects. The effects should wear off after a few hours. But, there are risks to having a local anaesthetic. Although extremely rare, there is a possibility that you may have an extreme reaction, known as anaph ylaxis . Your Podiatrist has been trained to deal with this.
• When you are considering the procedure, there may be other ways of dealing with this nail problem and you should ask your Podiatrist. If you have any queries or concerns about nail surgery, you should discuss these with your Podiatrist.
Do I need a letter from my GP?
No, you can refer yourself for Nail Surgery.
What Can Happen After Surgery?
You may experience mild discomfort after surgery, so we would advise that you take appropriate pain relief. Rarely, an infection may occur, in which case we would advise a prescription for antibiotics from your GP . There is also a very small possibility (less than 1%) that all or part of your nail may re-grow. If any part of the nail re-grows, we will repeat the surgery free of charge.
The healing time is variable according to how fast you heal. In any case this should not exceed six weeks. Following the Podiatrist’ s instructions closely, keeping the toe clean dry and dressed helps to speed your healing process and recovery.
How Much Does Nail Surgery Cost
The fee for our Nail Surgery Package is £500.00. This includes the following:
• Initial Assessment to ensure suitability
• Local Anaesthetic & Surgery
• One week post-op review appointment
• Three week post-op review appointment
• Six week post-op review appointment
• All dressing required for 6 weeks
Some Health Insurance companies cover Nail Surgery . Please check with your insurance company before proceeding with treatment.
N.B. Payment is entirely your responsibility.


The Mission of the LAC+USC Emergency Ultrasound Program:
To offer Emergency Medicine Residents, Attendings, Mid-Level Providers and Nurses in the LAC+USC Department of Emergency Medicine (DEM) the highest level of education and training in the use of emergency bedside ultrasonography in order to provide optimal care for their patients. Ultrasound imaging enhances the emergency provider’s ability to evaluate, diagnose and treat emergency department patients. Because ultrasound imaging is often time-dependent in the acutely ill or injured patient, the emergency physician is in an ideal position to use this technology to advance patient care and safety. Focused ultrasound examinations provide immediate information and can answer specific questions about the patient’s physical condition. The American College of Physicians (ACEP) and the Society of Academic Emergency Medicine (SAEM) believe that ultrasound imaging is within the scope of practice of emergency physicians and endorses training in bedside emergency ultrasound within residency training
The Los Angeles County+USC Medical Center Emergency Medicine Residency puts a strong emphasis on ultrasound training throughout the four-year program. Residents receive ultrasound instruction through lectures and extensive hands-on training in bedside ultrasound. By the time of graduation, residents will have completed an extensive curriculum covering all basic and many advanced applications in emergency bedside ultrasound as outlined by published ACEP training guidelines. Completion of this curriculum will lead to a letter of successful emergency ultrasound training that can be used by graduates for credentialing at the hospitals of their future employment.
Annual LAC+USC Emergency Medicine Ultrasound Course:
The LAC+USC Emergency Medicine Residency Program hosts an Annual Emergency Ultrasound 2-day, 16-hour course each year in June. Morning lectures are complemented by extensive afternoon small group ultrasound workshops. The workshops utilize live models, as well as patients from the Medical Center with varying pathologies. Residents and staff are instructed in multiple approaches including trauma/extended FAST exam, hepatobiliary, OB/GYN, echocardiography, renal, abdominal aorta, vascular access, procedural and soft tissue/musculoskeletal ultrasound. The program is an annual event each June prior to the start of clinical practice for the incoming EM residency class.
Annual LAC+USC Advanced Emergency Medicine Ultrasound Course:
The LAC+USC Emergency Medicine Residency Program hosts an Annual Advanced Emergency Ultrasound Class each year in May. This is a 5-hour course that covers advanced application of bedside ultrasound. All four classes of the DEM residency participate in this seminar. The May 2011 course covered regional anesthesia using ultrasound guidance, central venous cannulation under ultrasound (including subclavian and axillary approaches) and detection/removal of foreign bodies with ultrasound.
PGY-2 Year Month Rotation in Emergency Ultrasound:
All PGY-2 Year Emergency Medicine Residents spend a month rotating on the emergency ultrasound service. During the month, residents work directly with the emergency ultrasound faculty on 14 proctored ultrasound shifts. This allows for intensive instruction and immediate feedback in multiple applications of emergency ultrasound. Residents complete over 150 scans over the month to work toward the ACEP credentialing guidelines. They also complete an online ultrasound training program, called SoundBytes (www.sound-bytes.tv), and then test their knowledge with an online test, developed by the ultrasound faculty with ACEP. Finally, they select an interesting ultrasound case and write this up for scholarly publication. This case write-up develops each resident’s skills in fully researching a topic and then writing scientifically for a peer reviewed journal. The PGY-2 ultrasound rotation guidelines are attached as a PDF file below.
Senior Year Electives in Emergency Ultrasound:
Senior Emergency Medicine Residents are offered 2-4 week elective blocks in emergency ultrasound. They can use this time to work on mastering advanced applications of bedside ultrasound or to concentrate on a research topic. Interested residents should contact the ultrasound program directors directly.
Emergency Ultrasound Curriculum:
The full emergency ultrasound curriculum is attached as a PDF file to this website. During the 4 years of the DEM residency, residents will become expert at the following emergency ultrasound applications through the experience of performing multiple directly supervised.
Trauma Ultrasound: Residents will learn the standard four view focused abdominal sonography for trauma (FAST) exam in order to optimally facilitate trauma care. This exam includes the right hepatorenal, left perisplenic, suprapubic/pelvic and cardiac views. The primary goal of the FAST exam is to detect free fluid within the abdomen, pelvis and pericardial sac. Residents will also learn how to perform the newly developed expanded FAST (e-FAST) exam for evaluation of the thoracic cavity. The primary goals of the e-Fast exam are to detect pneumothoraces and pleural cavity free fluid.
OB/GYN: Residents will learn transabdominal and transvaginal sonographic approaches for OB/GYN sonography. The primary goal of first trimester OB/GYN sonography is the detection of intrauterine pregnancy defined as yolk sac or more. Advanced goals of first trimester OB/GYN sonography include evaluation of the adnexae and detection of ectopic pregnancy.
Emergency Echocardiography: The primary goals of bedside echocardiography include the detection of pericardial effusions and gross determinations of left ventricular cardiac contractility. The use of emergency bedside cardiac ultrasound to better guide appropriate care during shock states and resuscitations will be emphasized. Advanced goals of bedside echocardiography include evaluation of the heart for signs of cardiac tamponade, with diastolic collapse of the right ventricle or atrium. Residents will also learn how to map out pericardial effusions using sonography to determine the optimal route for emergent pericardiocentesis. Additional advanced echo techniques will also be covered during the curriculum, including determination of right ventricle strain suggestive of pulmonary embolus. Finally, residents will learn to evaluate the inferior vena cava through the respiratory cycle to gain a rough gauge of patient volume status.
Abdominal Aortic Aneurysms: Training will be given in the examination of the entire abdominal aorta from diaphragm to the bifurcation of the iliac arteries. The primary goal of bedside aorta ultrasound is to recognize the presence of an abdominal aortic aneurysms defined as an aorta greater than 3 cm in diameter and iliac arteries greater than 1.5 cm in diameter.
Hepatobiliary: The primary goals of bedside gallbladder sonography are the evaluation for gallbladder stones and assessment of the sonographic Murphy’s sign. Advanced goals include detection of the secondary signs of cholecystitis such as gallbladder wall thickening and peri-cholecystic fluid.
Genitourinary: The primary goals of GU bedside ultrasound are the evaluation of obstruction and acute urinary retention. Both kidneys will be examined for hydronephrosis and the bladder assessed for size. Advanced goals include evaluation for kidney stones and other renal pathologies.
Vascular Ultrasound: The use of ultrasound to guide both peripheral and central venous vascular access will be emphasized. Residents will learn to use ultrasound to aid in placement of central lines in the internal jugular, subclavian and femoral veins in order to minimize the risk of these procedures to patients. Ultrasound guided peripheral venous access to the basilic and brachial veins of the arm will also be taught.
Thoracentesis, Paracentesis and Lumbar Puncture: Ultrasound will be used to first detect the presence of pleural effusions and ascites amenable to a drainage procedure. Residents will then learn ultrasound guided approaches to facilitate the procedures of thoracentesis and paracentesis in order to minimize risks to the patient. Ultrasound guided lumbar puncture will also be taught.
Foreign Body Detection: Ultrasound will be used to detect radiolucent foreign bodies that may be difficult to visualize with plain radiography. Ultrasound guided techniques to remove foreign bodies will also be covered in the curriculum.
Cellulitis and Abscess: Residents will learn to evaluate the soft tissues for fluid collections in order to allow for better diagnosis of abscess and differentiation from cellulitits. Residents will also learn to evaluate the tonsils for peritonsillar abscess requiring drainage.
Deep Venous Thrombosis: Residents will learn the limited DVT screening exam focusing on evaluation of the proximal common femoral vein, greater saphenous and superficial femoral veins down to the proximal popliteal vein and the level of trifurcation. Analysis of the compressibility of the vessel with direct pressure of the probe will be taught as a means to diagnose a deep venous thrombosis.
Musculoskeletal: Residents will learn how to use ultrasound to analyze joints for the presence of effusions. Ultrasound guided approaches to arthrocentesis will be taught. Residents will also learn how to use ultrasound to examine tendons and ligaments for disruption/rupture. Finally, residents will be taught how to use ultrasound to diagnose fractures.
Ocular Ultrasound: Residents will have the opportunity to learn ocular ultrasound with the primary goal of diagnosing posterior chamber and orbital pathology such as retinal detachment, vitreous hemorrhage, and disruptions of structures. Residents will also learn how to evaluate for increase in intracranial pressure by measuring the optic nerve sheath diameter.
Rapid Ultrasound in Shock (RUSH Exam): Residents will learn the RUSH exam, a protocol developed to non-invasively evaluate the patient in shock using bedside ultrasound. The protocol is made up of 3 main areas; assessment of the pump, the tank and the pipes. Evaluation of the pump focuses on cardiac echo evaluation to look for left ventricular contractility, pericardial effusion and right ventricular strain. Evaluation of the tank focuses on assessment of the inferior vena cava and jugular veins to determine the central venous pressure. Evaluation of the pipes focuses on assessment of the aorta for abdominal aortic aneurysm, the thoracic aorta for aneurysm or dissection and the femoral and popliteal veins for deep venous thrombosis.
Pediatric Applications: Residents will learn ultrasonography applied to children with a focus on abdominal pathology: appendicitis, pyloric stenosis, inguinal hernia and intussusception.
Other Advanced Applications: Residents will learn basic techniques of testicular ultrasound helpful in diagnosis of pathology in this organ. Ultrasound guided nerve blocks will also be taught to better treat painful conditions in the Emergency Department.
Continuing Emergency Ultrasound Education / EM Resident Credentialing Pathway:
Submission of Ultrasound Scans:
Residents will submit at least 175-200 ultrasound exams for analysis to the ultrasound directors. Optimally, the ultrasound exams should be divided 25 each among the primary indications for ultrasound (cardiac, ob/gyn, hepatobiliary. genito-urinary, trauma/extended fast, aorta, vascular access).The QA scan sheets can be found online at wisdem.net (see link below).
Emergency Ultrasound Credentialing:
In addition to the above requirements, residents are expected to attend the Thursday Grand Rounds ultrasound lectures unless other EM Residency requirements conflict. Successful completion of the above requirements will allow for residents to receive a certificate of accomplishment as outlined by the ACEP ultrasound training criteria on graduation from the LAC+USC Emergency Medicine Residency. Each resident will be able to use this certificate towards hospital credentialing in bedside emergency ultrasound at their future jobs.
Resident Opportunity for Ultrasound Teaching at National Emergency Medicine Conferences:
Senior residents will have the opportunity to act as instructors at 2 yearly national Emergency Medicine conferences, USC Essentials in the fall and the Resuscitation Conference in the spring. They will gain the important experience of teaching bedside emergency ultrasound to practicing Emergency Physicians from academics and the community.
USC-Keck School of Medicine 4th Year Emergency Ultrasound Rotation:
1-2 students a month will have the opportunity to rotate on the emergency ultrasound senior medical student elective. Students will work directly with the ultrasound faculty on multiple proctored shifts to learn many applications of bedside ultrasound. Applications are taken through the USC-Keck School of Medicine. The full USC-Keck School of Medicine senior medical student ultrasound rotation guidelines are attached below as a PDF document.
LAC+USC Emergency Ultrasound Fellowship:
The fellowship in Emergency Ultrasound at LAC+USC Medical Center began in July 2011 with the first fellow, Dina Seif MD, a graduate of the LAC+USC Emergency Medicine Residency. Fellows receive intensive advanced instruction in emergency ultrasound over the one-year program. The fellow has specialized scan shifts each month in which they perform multiple ultrasound scans in a number of applications, together with the ultrasound faculty. The collected videos then provide the basis for weekly Thursday ultrasound review sessions. Fellows have multiple opportunities for advanced work in many areas of ultrasound; teaching, research, learning how to coordinate local and national conferences, mastering the many facets of running an ultrasound program and achievement of the RDMS (registered diagnostic medical sonographer) degree. Applications for the fellowship should be submitted from Sept-Nov. Selected applicants should send a CV and letter of intent to the Fellowship Directors at E-mails below. See attached LAC+USC EUS Fellowship Curriculum as attached PDF document.


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Eye Disease in the English Springer Spaniel
Dr. Cynthia A. Wheeler, DVM, MS, DACVO
Animal Eye Care of Michigan
5265 Alward Rd.
Laingsburg, MI 48848
A variety of ocular diseases have been reported in the English Springer Spaniel (ESS) over the past century. Some of these diseases are inherited and some are not. Some are diagnosed in the young puppy (congenital) and some in the middle aged to older dog. In 1990, the American College of Veterinary Ophthalmologists (ACVO) established a Genetics Committee to be charged with the task of reporting diseases considered heritable in purebred dogs. The result was the text, Ocular Disorders Presumed to be Inherited in Purebred Dogs. This has formed the basis of data collection for the Canine Eye Registration Foundation (CERF) in North America. Listed under the ESS are the following disorders: entropion, corneal dystrophy (lipid), persistent papillary membranes, cataract, glaucoma, retinal dysplasia (RD) and generalized progressive retinal atrophy (PRA). These disorders will be discussed with emphasis on important clinical signs, diagnosis and breeding recommendations.
Note: In Europe, various examination procedures exist for each country with harmonization coming through active work of the European College of Veterinary Ophthalmologists and Kennel Clubs as well as regional groups. In general, what I present here falls under the general consensus of all these schemes.
External diseases of the eye
Entropion is a conformational defect causing the eyelid margins to roll in causing irritation to the cornea. Both lower and upper lids may be affected. It may be difficult to determine if the condition is primary and inherited (having no other associated cause) or secondary (associated with infection or injury). The disorder is likely influenced by several genes defining the skull shape and orbit depth, the skin weight and how much is present around the eyes as well as the size and position of the eye. It is therefore difficult to determine the precise cause. Unless cause can be determined, breeding recommendations are not to breed affected animals.
Treatment consists of plastic surgery to restore the lid margins to their normal position.
Corneal dystrophy is a non-inflammatory corneal opacity present in one or more of the corenal layers. Usually bilateral white to gray areas are aseen in the cornea. Early middle-age is the most common age of onset. Very few dogs are visually impaired due to this type of corneal dystrophy. It is the clinical impression of this author that most corneal "dystrophy" seen in the ESS is related to the diet fed. Certain types of fats and fats in excess as well as certain grains may lead to elevated circulating lipids causing deposition in the central cornea as a calcium cholesterol grain. In these cases reducing dietary fat or reassessing the types of fats in the diet may cause the lesions to disappear over time. Some cases may be associated with hypothyroidism. The disorder likely has a genetic basis but this has not been defined. It is the breeder's option to decide whether or not to breed an affected dog.
Diseases of the Interal Structures of the Eye
Persistent papillary membranes (PPM) are remnants of a layer of vascular tissue that spanned the pupil area in the neonatal eye. These vessels are necessary for the normal development of the eye, particularly the lens and cornea. At birth they normally break up and disappear forming the opening we know of as the pupil. Strands of this membrane may be retained into adulthood. They may be found as loose strands near the pupil edge or form solid attachments across the pupil (iris to iris), from the iris to the lens or iris to cornea. In severe cases parts or all of the tissue sheet may be retained. These may result in vision impairment or blindness when severe. The disorder is visible in young puppies and is usually bilateral. In minor cases, with the normal growth and development of the anterior structures of the eye, the PPM's may "disappear" but most persist throughout life without change. Diagnosis is made on routine examination with ophthalmoscope and slit lamp. In cases of iris remnants attached only to iris the breeding choice is left to the owner. Where lens or cornea are involved, breeding is discouraged.
Cataract is defined as any opacity in the lens and/or its capsule. It may be present in one or both eyes, and may involve all or part of the lens. Minor opacities do not affect vision. In cases where cataracts are bilateral and complete the dog will be blind. Diagnosis is made after dilating the pupils with a mydriatic during eye examination with an ophthalmoscope or slitlamp. Complete cataract is typically visible even without dilating the pupil.
Cataracts may be primary, and generally considered hereditary, or secondary, as in the case of diabetic cataract. Cataract diagnosed in the young puppy is called congenital (present at birth) and may or may not be heritable. Non-hereditary causes of cataracts include trauma, nutritional deficiency, infection or metabolic disorders. Juvenile cataract is a "loose" term used for cataracts that occur in young adult dogs, while senile cataract is seen in older dogs (older than 8 years of age). In the ESS, juvenile cataracts are seen involving the posterior region of the lens and developing slowly with time. Though the changes do progress with times, most dogs seldom develop severe visual impairment requiring surgery to remove the cataract. The mode of inheritance for cataract in most breeds appears as a familial trait, but it has not been elucidated in the ESS.
Treatment for cataract is by surgery. Lens extraction and replacement with an artificial intraocular lens are performed by veterinary eye specialists all over the world.
Dogs with cataract should not be used for breeding purposes.
Glaucoma is a complex disease entity, the major clinical sign being an elevation of the intraocular pressure. This causes damage to the internal structures of the eye , pain and ultimately blindness. The disease can be differentiated in to primary and secondary types, of which primary glaucoma is recognized as an hereditary condition in the ESS. The age of onset of glaucoma in the breed ranges from 3-12 years, with a mean age of 6 years. Usually affected dogs show unilateral signs of glaucoma with the other eye becoming affected months to years later. Typical signs are a red, painful eye, dilated pupils that do not constrict, or do so slowly, with light stimulation, and a grayish or white discoloration to the cornea. Diagnosis is made by routine examination of the eye including the measurement of pressure in the eye (by tonometry) and evaluation of the iridocorneal angle (also called the filtration angle) in the anterior portion of the eye by gonioscopy.
Pectinate ligament dysplasia (PLD) is a defect of the iridocorneal angle of the eye. The space bridged by the pectinate ligaments- the iridocorneal angle- is important for the circulation of fluids out of the eye. This fluid flow maintains a normal intraocular pressure inside the eye. A recent study by Bjerkas et al, 2002, showed that the prevealence of PLD is 25.5% in the ESS breed. Another frequent defect seein in the breed and associated with PLD, is narrowing of the relative width of the ciliary cleft, another important structure in the same region of the eye. Studies of the iridocorneal angle can be done using a technique called gonioscopy. This was one with a large group of normal ESS dogs and narrow iridocorneal angles with or without concurrent PLD was shown. This study demonstrated a clear relationship between glaucoma and the narrowing of the angle as well as between glaucoma and the degree of PLD. Consequently, both factors may contribute additively as well as independently to the development of glaucoma in the breed. The defects may also serve as markers of abnormalities in the deeper parts of the outflow pathways of the eye which may predispose to glaucoma.
The exact mode of inheritance of primary glaucoma in the ESS has yet to be demonstrated but a polygenic mode is suspected. Affected dogs should not be bred.
Retinal dysplasia (RD) is a congenital defect in the development and layering of the retina resulting in folding and abnormal growth of cells especially in the outer retina. The defect can be primary, and most often due to hereditary factors, or secondary, due to local or systemic inflammatory or infectious processes that affect the retina during development and maturation. Studies indicate that RD in the ESS is inherited and suggest it is an autosomal recessive trait. RD is a congenital disorder developing around 48 days gestation. Affected puppies are born with the lesions already present. The defect may be focal, involving solitary folds in the central parts of the retina; multifocal, with several folded structures in the central and midperipheral area; geographic, in which a localized area in the retina is partially detached; or complete, in which most or all of the retina is abnormal and detached. The defect is most often bilateral but not always with similar degrees of involvement in the two eyes. The appearance of RD during examination with an ophthalmoscope is linear, triangular, curved or curvilinear foci of retinal folding that may be single or multiple, most prevalent in the central tapetal area, near the main retina vessels. In more severe cases scarring with pigmentation and thinning of the retina are seen as well as partial or total detachments.
Clinical signs depend on the severity of the defect. Complete RD causes blindness, while focal RD may not cause any obvious visual problems. Clinical signs of RD usually do not change with age, but there are exceptions. Multiple abnormal areas near each other may progress slowly to full detachment in time. Also, solitary minor changes will partially or completely "heal" with age to a state where they cannot be seen by the examiner. It is therefore important that puppies be examined at a young age (6-12 weeks) to identify this congenital disorder.
None of the forms of RD are desirable and affected dogs should not be used for breeding.
Progressive retinal atrophy (PRA) is a slowly progressive disease of the rod and cone visual cells of the retina. Dogs are born with normal vision but become visually impaired over the course of 2-5 years. Initially there is night vision loss which progresses slowly into day vision loss. For the ESS a great variation of onset and progression of clinical signs has been noted (between 2-13 years). There is some indication that PRA in the ESS is similar to PRA found in the English and American cocker spaniels (progressive rod-cone degeneration- prcd).
Retinal abnormalities in the eye may be observed at examination using and ophthalmoscope after pupils are dilated with a mydriatic. Initially there are color changes at the peripheral tapetal retina early in the disease, the changes in reflectivity of the tapetal retina indicating a generalized thinning of the retinal layers and finally a reduction and thinning of the retinal vasculature. Dogs affected with PRA frequently have secondary cataract that may make diagnosis difficult. In these cases, diagnosis with electroretinography (ERG) is recommended. Through an elaborate testing procedure a diagnosis may be made, often before clinical signs are apparent.
There is no effective treatment for PRA. Affected dogs become blind. The disease is transmitted as an autosomal recessive trait. Affected dogs should not be used for breeding. In Sweden, it is not recommended to breed carriers, such as the parents of an affected dog or offspring of an affected dog.
Rubin, LF: Inherited disease in pure-bred dogs. Baltimore; Williams & Wilkins, 1989.
American College of Veterinary Ophthalmologists: Ocular disorders presumed to be inherited in purebred dogs, 2000.
Bjerkas, E, et al: Pectinate ligament dysplasia and narrowing of the iridocorneal angle associated with glaucoma in the English Springer Spaniel. Veterinary Ophthalmogy, 2000, 5, 1, 49-54.
Whitely, HE and Young, S: The external limiting membrane in developing normal and dysplastic canine retina. Tissue and Cells , 1986, 18: 231-239.
Whitely, HE, et al: Intramembranous particle distribution and filipin binding in dysplastic canine retina. Curr. Eye Research, 1991, 10: `069-1074.
Dubielzig, RR et al: Microphthalmia, cataract, lens luxation and ciliary body dysplasia in a litter of Springer Spaniel pups. Trans Am Coll Vet Ophthalmol 15: 96, 1985.
Schmidt, GM, et al: Inheritance of retinal dysplasia in the English Springer Spaniel. J Am Vet Med Assoc 174: 1089, 1979.
Lavach JD, et al: Retinal dysplasia in the English Springer Spaniel. J Am Anim Hosp Assoc 14: 192, 1978.
O'Toole, D et al: Retinal dysplasia in the English Springer Spaniel: Light microscopy of the postnatal lesions. Vet Pathol 20: 298, 1983.
Barnett, KC: Canine retinopathies III. The other breeds. J Sm Anim Pract 6: 185, 1965.
Koch, S: Retinopathy in the English Springer Spaniel: An aberrant form of PRA? Proc Am Coll Vet Ophthalmol 28: 91, 1997.
Wheeler, CA: Inheritance of progressive retinal degeneration in the English Springer Spaniel. Proc Am Coll Vet Ophthalmol 39: 19, 1998.
Narfstrom, K and Ekesten, b: Disease of the canine ocular fundus. In Veterinary Ophthalmology, 3rd Edition, Geleatt, KN (ed), Lippincott, Williams & Wilkins, Philadelphia, PP 882-903, 1991.


Midco® Aquatic Center offers a variety of water exercise classes. Classes are held in the 50 Meter and Warm Water Pools. Join us for fun and exercise!\
Do you want to give a water fitness class a try?? We created a day just for you!
Mark your calendar for 9-11am, on Saturday, December 8. Join us for a sampling of water fitness classes offered at the Midco Aquatic® Center.
It’s fun, low-impact, and yet water fitness classes are suitable for every age and fitness level. Classes can be tailored to your fitness level from beginning exercisers through elite athletes.
We use a variety of equipment which may include: water dumbbells, noodles, aqua gloves, flippers, and kick boards.
Participants will need to have an active swim pass or pay daily admission rates.
Just Try It Day – Water Fitness Frenzy
|12/08/18||50 Meter Pool-Shallow||50 Meter Pool-Deep||Warm Water Pool|
|9:00||Hydroriders||Deep Water Aerobics||Water Yoga|
|9:30||Water Aerobics||Deep Water Tabata||Stay Strong: Functional Fitness|
|10:00||Hydroriders||Deep Water Aerobics||Water Yoga|
|10:30||Shallow Torrent Tabata with Hydroriders||Deep Water Aerobics||Stay Strong: Functional Fitness|
This mind-body workout incorporates movements based on elements of yoga, tai chi, and Pilates. This class is designed to use the water’s natural resistance to increase the body’s full range of motion while stabilizing the core muscles. This class is suitable for all levels of conditioning. Class will be held in the shallow end of the pool.
Do you enjoy water aerobics? Let us challenge you a step further and take this fitness class into the deep water of our 50 Meter Pool! This challenging class incorporates high-intensity, nonimpact strength, and cardiovascular movements that provide one of the best forms of exercise. Also great on the bones and joints! Participants must be comfortable in deep water.
The Hydrorider is a user-friendly water bike and is perfect for any participant or skill level. Training in water also allows training at a greater level of intensity due to the cooling effect and faster recovery rate. Work at your own pace and try a new cycling experience in the water. Water shoes required.
This is a no-impact, intense workout. Various moves done using the resistance of the water and other equipment such as noodles and dumbbells. The moves will incorporate cardio, core, and strength so you can leave knowing you received a total body workout.
Water aerobics is a low-impact exercise. The expected resistance of the water against your body helps tone your muscles and increase your strength. Water aerobics is easier on your bones and joints than running, but still provides the benefits of an aerobic workout. If you have arthritis, are rehabilitating an injury, or just enjoy pool fitness classes, water aerobics can help improve your health.
This 60-minute Warm Water Pool class is designed to assist you in improving your strength and cardiovascular health. This light-to moderate-intensity class format combines body resistance and water exercise equipment with light to moderate aerobic exercise. During the 60 minutes of instruction, class participants will strengthen their major muscle groups as well as improve range of motion of all muscles and joints. Improvement of flexibility, balance, and stamina can be expected. The movements and cardio activity are different for every class in order for your body to receive optimal benefit for your physical health!
This high-intensity fitness class will leave you breathless, taking cardio to a new level. Using water as your resistance and moving to the music that motivates will keep the water around you churning. All the strength and core work you could ask for combined with riding will have you giving your all. Water shoes are required.
This water exercise and relaxation program is created to both enjoy the water and use powerful progressions. Improving range of motion and mobility using a combination of deep breathing and slow broad movements of arms, legs, and torso. No class on Thanksgiving Day.
The lap lanes provide those individuals wishing to keep fit by swimming continuous laps. Add number of laps to = mile, etc. No registration is required. Participants will need to have an active swim pass or pay daily admission rates.
On the following dates and times the 50 Meter Pool will not be available for open swim due to a swim meet event.


Modern technology presents healthcare professionals with numerous opportunities. Patient diagnosis, treatment, and care can all benefit from mobile devices and wireless technologies that weren’t available ten years ago. Clinicians can perform their duties better, become more efficient and productive, and enjoy a better life balance with the knowledge that they’re enhancing the lives of their patients — and may even save more lives.
The healthcare industry as a whole recognises and embraces technology that empowers them like no other time in history. We see new innovations all the time, and the future looks bright. So why do some healthcare professionals resist technology that promises to make their lives (and the lives of their patients) so much easier? And why do healthcare IT professionals shy away from adopting devices and applications that make users happier?
Despite the resistance to change, handheld computers combined with wireless capabilities will continue to transform the way healthcare providers can treat and interact with patients. Desktop as a service in healthcare can help address the needs and concerns of healthcare professionals and IT administrators alike, leading to powerful innovations in patient care.
As long as IT has been part of professional environments, there has been friction between the people who guard the data and those who need to access it. When you consider the competing goals of IT administrators and their users, it’s easier to understand why the healthcare industry can be slow to adopt technological innovations.
The needs of the healthcare IT professionals who administer the technology (and guard data like mother bears protecting their cubs) are often at odds with the needs of their users: doctors, nurses, lab technicians, and other hands-on providers. Those tasked with worrying about privacy concerns and meeting HIPAA regulations are justifiably cautious when it comes to new technology, while those tasked with caring for patients are eager for new tools that improve their practice.
Here are just a handful of the competing needs and concerns that complicate decisions surrounding technology adoption in the healthcare industry:
While the issues surrounding mobile technology in the healthcare space are dogged by adversity, Dell recognised an opportunity and partnered with Citrix to deliver desktop as a service in healthcare. They recognised that healthcare IT professionals are driven by three core needs:
Dell’s Mobile Clinical Computing (MCC) is a desktop virtualisation and identity management system built from the ground-up for caregivers and IT administrators alike. A flexible enterprise-level solution, MCC was designed for the healthcare industry, with equal emphasis on data security and usability.
Dell’s MCC makes it possible to utilise desktop as a service in healthcare with ease and security, so hospitals and physicians can treat patients with confidence. Data is stored to heavily protected and monitored data centres, not mobile devices, making IT admins happy. And many more features are in place to ensure healthcare professionals won’t compromise patient privacy, violate HIPAA regulations, or fail to meet insurers documentation demands:
When clinicians are able to access applications and patient records from their in-pocket mobile device, they can stop searching and waiting for available computers, increasing day-to-day efficiency.
MCC delivers data security, IT productivity, and clinical efficiency, making this desktop as a service in healthcare solution an obvious choice for healthcare professionals who want to provide the best care possible. By partnering with Citrix, Dell has delivered an end-to-end desktop virtualisation solution where it was most needed: the healthcare industry. For more information on this and other enterprise solutions, visit our website today.Go Back


If you are not planning on showing or breeding your pet, it is recommended that he or she be surgically sterilized. Early spay or ovariohysterectomy (females) or neuter or orchiectomy (for males) surgery can prevent diseases such as pyometra (infection of the uterus), prostatitis, and cancer of the mammary glands or testes.
Spay surgery is performed under general anesthesia, which means that the pet is unconscious while the surgery is performed. Animals should be in good health prior to surgery. Generally, we recommend dogs and cats undergo surgery at about six months of age, preferably before the first heat period.
Spay and neuter surgeries are routine procedures and stress to the patient is generally low. This is an excellent opportunity to microchip your pet.
Most animals can go home right away and recovery time is typically short. Nonetheless, the incision should be monitored twice daily for any signs of infection: swelling, redness, and discharge. The incision site should be kept clean and dry.
Your pet’s activities should be limited for the first week or so following surgery. Dogs should only be walked on a leash and not allowed to run or roam. Following that first week, the animal can resume normal activity.
Benefits of Spay/Neuter
Beyond birth control, the benefits to pets far outweigh the inconvenience of this routine procedure. Spayed and neutered pets can be more affectionate and many undesirable behaviors are eliminated.
The benefits of spaying females include:
- No annoying heat cycles to attract males
- Less desire to roam
- Reduced risk of mammary gland tumors
- Eliminates risk of ovarian and uterine cancer
- Eradicates risk of pyometra, a life-threatening infection in the uterus that requires emergency surgery
The benefits of neutering males include:
- Decreased aggressive behavior
- Reduced or eliminated spraying and marking
- Less desire to roam (reduces risk of getting hit by a car or injuries from fights)
- Eliminates risk of testicular cancer
- Decreased risk of prostate disease
This routine surgical procedure is a small price to pay for the long and healthy life of your pet.
Prevent Pet Overpopulation
Sterilizing your pet helps prevent cat and dog overpopulation. There are far more cats and dogs in the United States than there are available homes. Stray and unwanted cats and dogs overrun our animal shelters.
Even if you were to find a home for your pet’s puppies or kittens, this translates to fewer homeless pets already waiting in shelters being adopted, putting them at risk for being destroyed. Further and sadly, there is no guarantee that the owners you find will sterilize, so your pet’s offspring may be at risk of being homeless or destroyed.
While sterilizing kittens and puppies is advised, adult pets can have spay or neuter procedures performed as well. Please contact us for more information.