Central Florida’s dedicated providers are helping local residents enjoy a better quality of life through medical advancements addressing common issues.

As the husband-and-wife team behind Svelte Medical Weight Loss, Richard Bragg, MD, and Susie Bragg, RN, BSN, have not only made functional and anti-aging medicine a focus of their practice, but they also embrace those principles in their own lives. That means they are devoted to a comprehensive, holistic approach to health and well-being for both their patients and themselves.

“I’m committed to living at least to 125,” Susie says with a laugh. “I don’t know if that’s going to happen, but I’m trying.”

That ambitious goal aside, there are exciting developments in medicine, and women’s health in particular, that are allowing people to live longer and with a better quality of life. Central Florida is fortunate to be home to a number of groundbreaking practitioners and health care networks that are doing their part to push various fields forward and to make cutting-edge advancements accessible to the masses.

Orlando Family Magazine spoke to local specialists to learn more about several health concerns that women face and how they can be managed or treated to help them pursue the same activities and passions they always have.

Hormone optimization

Hormone imbalance—as the result of menopause for women, andropause for men, or other life factors—can lead to symptoms such as decreased sex drive, bladder issues, joint pain, headaches, weight gain, hot flashes, lack of focus and depression. It can also have an impact on hearth, brain, breast and bone health.

Since 2016, Svelte Medical Weight Loss has partnered with a national company called BioTE to improve hormone stability and regulation through bioidentical hormone optimization, or hormone pellet therapy. Not to be confused with hormone replacement therapy—which uses synthetic hormones with damaging side effects—the procedure is both safe and effective, and Svelte does extensive blood tests and information gathering ahead of time to ensure it is right for its patients.

“There are so many different delivery systems for synthetic hormones, including a weekly shot, creams and lotions, and even roll-ons that have testosterone in them,” Susie Bragg says. “But the synthetic is linked to higher risks for cancer. When people do bioidentical hormones, they are restoring the natural hormonal balance in the body, which prevents cancers. One of the other things we optimize is Vitamin D, which is cancer-protective and COVID-protective.

“Because of how dangerous hormone replacement therapy is, bioidentical hormone optimization is scrutinized by the FDA, and the DEA actually tracks all of the prescriptions. So there is tight, tight monitoring, and one of the things we do is monitor our patients for key risk factors. We do blood work frequently, we make sure our female patients are having routing mammograms and pap smears, and our male patients have to have PSA tests. … There are a lot of safeguards in place.”

The Braggs discovered bioidentical hormone optimization when Dr. Bragg was experiencing bouts of depression, was often irritable and lost interest in his hobbies as a result of andropause in his 40s. His wife says the use of pellet therapy for him saved their marriage, and she became a patient as well.

“I had menopause too, and when I started on the pellets, I immediately had this relief and sense of energy,” she says. “It was like reversing my aging, and I was so surprised. I used to minimize [the effects of] menopause—I thought it was just a part of getting older—but when you get the hormones back, you look good, you feel good, you’re strong, you sleep well. It’s just a game-changer.”

The procedure, which has been used since 1939, is a simple one in which hormone pellets are inserted underneath the skin, usually at the hip. The individualized dosing provides the patient’s blood with a steady hormone stream.

Men only need to undergo the procedure twice a year, while women may have it three or four times because they receive smaller pellets. The process takes just about 15 minutes for women and 25 for men.

“There are some restrictions post procedure,” Bragg says. “For instance, for the ladies they have to wear an airtight, waterproof dressing for three days, and they really shouldn’t get into a hot tub or a bathtub, but they can shower. We don’t want them doing any squats and we don’t want them running for a few days, and we go over all of this with them. 

“But I would say 99 out of 100 patients come back, and why do they keep coming back? Because they don’t mind putting up with a few days of limited restrictions. It’s worth it to them because of how great they feel.”

Urinary incontinence

A common condition described as the involuntary loss of urine, urinary incontinence is more widely seen in older adults but can actually affect people of all ages. According to David Ossin, MD, a urogynecologist at HCA Florida’s Oviedo Medical Center, risk factors for women include genetics, pregnancy, vaginal delivery during childbirth, obesity, a history of heavy lifting, comorbidities such as diabetes, and certain medications that can cause an increase in urine production.

“The prevalence does increase with age, and that’s why some people equate it to a symptom of an older woman rather than a younger woman,” Dr. Ossin says. “But it’s not just something seen with older women—younger women can be affected too if they have other risk factors for it.”

Dr. Ossin explains that there are two main mechanisms for urine leakage: the first is an overly active bladder that contracts and pushes the urine out, and the second is more of a storage issue related to weakness of the muscle that helps store the urine. The latter, known as stress urinary incontinence (SUI), often results in urine leakage as the result of normal actions like coughing, sneezing and laughing.

Treatment is based on the patient’s goals, he adds, and includes behavior modification such as monitoring fluid intake and avoiding bladder irritants like coffee, carbonated drinks, artificial sweeteners and alcohol. Pelvic floor physical therapy and medications are other options.

There are also surgical procedures for SUI, including a mid-urethral sling or urethral bulking. In the first, a synthetic mesh ribbon or sling is placed under the middle of the urethra to provide support. The procedure takes place in an operating room and requires up to six weeks of downtime during recovery.

Urethral bulking is performed in an outpatient setting and involves the injection of a bulking material such as polyacrylamide into the urethra that allows for greater pressure to be on the bladder before the patient starts leaking urine. Patients who are not typical candidates for surgery can undergo bulking, and Dr. Ossin has even performed it on a woman in her 90s.

“When we’re talking about the mid-urethral sling, which is the gold standard for stress urinary incontinence in the surgical realm, 90% of patients are satisfied with the results and 50% are completely dry,” he says. “Even doing urethral bulking, which can be done under local anesthesia with a very quick recovery—usually my patients are back to full activity in 24 hours—that procedure still has an 80% satisfaction rate and 40% are completely dry. The downside is that you have to do it again usually within four to six years.”

Dr. Ossin adds that about 10% of women will experience urinary incontinence, and while it can be a difficult subject to discuss with a doctor, he encourages them to do so.

“I think embarrassment is one component, but another component is that people think this is a normal process of aging and there’s not really anything that can be done for it,” he says. “I’ve had patients say, ‘I’ve been dealing with this for 20 years, but I thought it was part of the aging process and there wasn’t anything to do for it.’ [It’s important to know] that there are things you can do for it, and that it doesn’t have to be surgery—there are non-surgical modalities to manage or fix this issue.”

Postpartum health

In the face of alarming national statistics showing that Black mothers are being readmitted to the hospital following C-section deliveries at a significantly higher rate than white women—with postpartum high blood pressure as the leading cause—AdventHealth for Women recently launched the Fourth Trimester program to address the issue.

Based at AdventHealth for Women in Orlando and Celebration, the initiative utilizes a team of dedicated care coordinators who connect with every mother enrolled in the program. They ensure that follow-up appointments are scheduled and medications filled before they leave the hospital, and stay in contact for the 12 weeks after delivery to educate the women on managing high blood pressure, helping with insurance paperwork, providing baby supplies and answering any questions they have.

The mission is to reduce maternal morbidity rates and to empower Black women to prioritize their postpartum health.

“We cannot look away from the health disparities that currently exist in our country,” says Rizwana Fareeduddin, MD, the chief medical officer of AdventHealth for Women. “Black women are three to four times more likely to die during pregnancy or the year after. And of those deaths, 80% are preventable.”

Women’s Health & Wellness Resource Guide