Elite Tampa Bay April 2014

TAMPA BAY APRIL 2014

ELITE

®Effient and the Effient logo are registered trademarks of Eli Lilly and Company.Copyright © 2013 Daiichi Sankyo, Inc. and Lilly USA, LLC. All Rights Reserved.PG84132. PGHCPISI03Oct2011. Printed in USA. May 2013.

Effient® (prasugrel) is indicated to reduce the rate of thrombotic cardiovascular (CV) events (including stent thrombosis) in patients with acute coronary syndrome (ACS) who are to be managed with percutaneous coronary intervention (PCI) as follows: [1] patients with unstable angina (UA) or non–ST-elevation myocardial infarction (NSTEMI); [2] patients with ST-elevation myocardial infarction (STEMI) when managed with primary or delayed PCI. The loading dose (LD) of Effient is 60 mg and the maintenance dose (MD) is 10 mg once daily. Effient is available in 5-mg and 10-mg tablets.

IMPORTANT SAFETY INFORMATION

WARNING: BLEEDING RISKEffient® (prasugrel) can cause significant, sometimes fatal, bleeding.Do not use Effient in patients with active pathological bleeding or a history of transient ischemic attack or stroke.In patients ≥75 years of age, Effient is generally not recommended, because of the increased risk of fatal and intracranial bleeding and uncertain benefit, except in high-risk situations (patients with diabetes or a history of prior myocardial infarction [MI]) where its effect appears to be greater and its use may be considered.Do not start Effient in patients likely to undergo urgent coronary artery bypass graft surgery (CABG). When possible, discontinue Effient at least 7 days prior to any surgery.Additional risk factors for bleeding include: body weight <60 kg propensity to bleed concomitant use of medications that increase the risk of bleeding

(eg, warfarin, heparin, fibrinolytic therapy, chronic use of nonsteroidal anti-inflammatory drugs [NSAIDs])

Suspect bleeding in any patient who is hypotensive and has recently undergone coronary angiography, percutaneous coronary intervention (PCI), CABG, or other surgical procedures in the setting of Effient.If possible, manage bleeding without discontinuing Effient. Discontinuing Effient, particularly in the first few weeks after acute coronary syndrome, increases the risk of subsequent cardiovascular events.

CONTRAINDICATIONS Effient is contraindicated in patients with active pathological

bleeding, such as from a peptic ulcer or intracranial hemorrhage (ICH), or a history of transient ischemic attack (TIA) or stroke, and in patients with hypersensitivity to prasugrel or any component of the product

WARNINGS AND PRECAUTIONS Patients who experience a stroke or TIA while on Effient

generally should have therapy discontinued. Effient should also be discontinued for active bleeding and elective surgery

Premature discontinuation of Effient increases risk of stent thrombosis, MI, and death

Thrombotic thrombocytopenic purpura (TTP), a rare but serious condition that can be fatal, has been reported with Effient, sometimes after a brief exposure (<2 weeks), and requires urgent treatment, including plasmapheresis

Hypersensitivity, including angioedema, has been reported in patients receiving Effient, including patients with a history of hypersensitivity reaction to other thienopyridines

ADVERSE REACTIONS Bleeding, including life-threatening and fatal bleeding, is the

most commonly reported adverse reaction

Please see Brief Summary of Prescribing Information, including Boxed Warning regarding bleeding risk, on subsequent pages.

*American College of Cardiology Foundation. †American Heart Association. ‡Society for Cardiovascular Angiography and Interventions.

References: 1. Data on file: #EFF20130124a: DSI/Lilly. 2. O’Gara PT, Kushner FG, Ascheim DD, et al. Circulation. 2013;127:e362-e425. 3. O’Gara PT, Kushner FG, Ascheim DD, et al. J Am Coll Cardiol. 2013;61:e78-e140. 4. Jneid H, Anderson JL, Wright RS, et al. Circulation. 2012;126:875-910. 5. Jneid H, Anderson JL, Wright RS, et al. J Am Coll Cardiol. 2012;60:653-689. 6. Levine GN, Bates ER, Blankenship JC, et al. Circulation. 2011;124:e574-e651. 7. Levine GN, Bates ER, Blankenship JC, et al. J Am Coll Cardiol. 2011;58:e44-e122.

1

THE FIRST ROUND WAS TOUGH ENOUGH.

I’D RATHER NOT GO A SECOND ROUND.

For more information, call your Effient representative or visit EffientHCP.com today.

Proven market experienceEffient is included in the Guidelines for UA/NSTEMI and STEMI patients undergoing PCI

2013 ACCF*/AHA† STEMI Guideline2,3

2012 ACCF/AHA Guideline Update for UA/NSTEMI4,5

2011 ACCF/AHA/SCAI‡ Guideline for PCI6,7

183-35833 PB KJob Number: 16322Revision No: 2Date: 9/25/13

YMCPMS 368Trapped NS

®Effient and the Effient logo are registered trademarks of Eli Lilly and Company.Copyright © 2013 Daiichi Sankyo, Inc. and Lilly USA, LLC. All Rights Reserved.PG84132. PGHCPISI03Oct2011. Printed in USA. May 2013.

Effient® (prasugrel) is indicated to reduce the rate of thrombotic cardiovascular (CV) events (including stent thrombosis) in patients with acute coronary syndrome (ACS) who are to be managed with percutaneous coronary intervention (PCI) as follows: [1] patients with unstable angina (UA) or non–ST-elevation myocardial infarction (NSTEMI); [2] patients with ST-elevation myocardial infarction (STEMI) when managed with primary or delayed PCI. The loading dose (LD) of Effient is 60 mg and the maintenance dose (MD) is 10 mg once daily. Effient is available in 5-mg and 10-mg tablets.

IMPORTANT SAFETY INFORMATION

WARNING: BLEEDING RISKEffient® (prasugrel) can cause significant, sometimes fatal, bleeding.Do not use Effient in patients with active pathological bleeding or a history of transient ischemic attack or stroke.In patients ≥75 years of age, Effient is generally not recommended, because of the increased risk of fatal and intracranial bleeding and uncertain benefit, except in high-risk situations (patients with diabetes or a history of prior myocardial infarction [MI]) where its effect appears to be greater and its use may be considered.Do not start Effient in patients likely to undergo urgent coronary artery bypass graft surgery (CABG). When possible, discontinue Effient at least 7 days prior to any surgery.Additional risk factors for bleeding include: body weight <60 kg propensity to bleed concomitant use of medications that increase the risk of bleeding

(eg, warfarin, heparin, fibrinolytic therapy, chronic use of nonsteroidal anti-inflammatory drugs [NSAIDs])

Suspect bleeding in any patient who is hypotensive and has recently undergone coronary angiography, percutaneous coronary intervention (PCI), CABG, or other surgical procedures in the setting of Effient.If possible, manage bleeding without discontinuing Effient. Discontinuing Effient, particularly in the first few weeks after acute coronary syndrome, increases the risk of subsequent cardiovascular events.

CONTRAINDICATIONS Effient is contraindicated in patients with active pathological

bleeding, such as from a peptic ulcer or intracranial hemorrhage (ICH), or a history of transient ischemic attack (TIA) or stroke, and in patients with hypersensitivity to prasugrel or any component of the product

WARNINGS AND PRECAUTIONS Patients who experience a stroke or TIA while on Effient

generally should have therapy discontinued. Effient should also be discontinued for active bleeding and elective surgery

Premature discontinuation of Effient increases risk of stent thrombosis, MI, and death

Thrombotic thrombocytopenic purpura (TTP), a rare but serious condition that can be fatal, has been reported with Effient, sometimes after a brief exposure (<2 weeks), and requires urgent treatment, including plasmapheresis

Hypersensitivity, including angioedema, has been reported in patients receiving Effient, including patients with a history of hypersensitivity reaction to other thienopyridines

ADVERSE REACTIONS Bleeding, including life-threatening and fatal bleeding, is the

most commonly reported adverse reaction

Please see Brief Summary of Prescribing Information, including Boxed Warning regarding bleeding risk, on subsequent pages.

*American College of Cardiology Foundation. †American Heart Association. ‡Society for Cardiovascular Angiography and Interventions.

References: 1. Data on file: #EFF20130124a: DSI/Lilly. 2. O’Gara PT, Kushner FG, Ascheim DD, et al. Circulation. 2013;127:e362-e425. 3. O’Gara PT, Kushner FG, Ascheim DD, et al. J Am Coll Cardiol. 2013;61:e78-e140. 4. Jneid H, Anderson JL, Wright RS, et al. Circulation. 2012;126:875-910. 5. Jneid H, Anderson JL, Wright RS, et al. J Am Coll Cardiol. 2012;60:653-689. 6. Levine GN, Bates ER, Blankenship JC, et al. Circulation. 2011;124:e574-e651. 7. Levine GN, Bates ER, Blankenship JC, et al. J Am Coll Cardiol. 2011;58:e44-e122.

1

THE FIRST ROUND WAS TOUGH ENOUGH.

I’D RATHER NOT GO A SECOND ROUND.

For more information, call your Effient representative or visit EffientHCP.com today.

Proven market experienceEffient is included in the Guidelines for UA/NSTEMI and STEMI patients undergoing PCI

2013 ACCF*/AHA† STEMI Guideline2,3

2012 ACCF/AHA Guideline Update for UA/NSTEMI4,5

2011 ACCF/AHA/SCAI‡ Guideline for PCI6,7

183-35833 PB KJob Number: 16322Revision No: 2Date: 9/25/13

YMCPMS 368Trapped NS

The bleeding rate is highest initially, as shown in Figure 1 (inset: Days 0 to 7) [see Warnings and Precautions (5.1)].Bleeding rates in patients with the risk factors of age ≥75 years and weight <60 kg are shown in Table 2.Table 2: Bleeding Rates for Non-CABG-Related Bleeding by Weight and Age (TRITON-TIMI 38)

Major/Minor FatalEffient

(%)Clopidogrel

(%)Effient

(%)Clopidogrel

(%)Weight <60 kg (N=308 Effient, N=356 clopidogrel) 10.1 6.5 0.0 0.3

Weight ≥60 kg (N=6373 Effient, N=6299 clopidogrel) 4.2 3.3 0.3 0.1

Age <75 years (N=5850 Effient, N=5822 clopidogrel) 3.8 2.9 0.2 0.1

Age ≥75 years (N=891 Effient, N=894 clopidogrel) 9.0 6.9 1.0 0.1

Bleeding Related to CABG - In TRITON-TIMI 38, 437 patients who received a thienopyridine underwent CABG during the course of the study. The rate of CABG-related TIMI Major or Minor bleeding was 14.1% for the Effient group and 4.5% in the clopidogrel group (Table 3). The higher risk for bleeding adverse reactions in patients treated with Effient persisted up to 7 days from the most recent dose of study drug.Table 3: CABG-Related Bleedinga (TRITON-TIMI 38)

Effient (%) (N=213)

Clopidogrel (%)(N=224)

TIMI Major or Minor bleeding 14.1 4.5TIMI Major bleeding 11.3 3.6

Fatal 0.9 0Reoperation 3.8 0.5Transfusion of ≥5 units 6.6 2.2Intracranial hemorrhage 0 0

TIMI Minor bleeding 2.8 0.9a Patients may be counted in more than one row.Bleeding Reported as Adverse Reactions - Hemorrhagic events reported as adverse reactions in TRITON-TIMI 38 were, for Effient and clopidogrel, respectively: epistaxis (6.2%, 3.3%), gastrointestinal hemorrhage (1.5%, 1.0%), hemoptysis (0.6%, 0.5%), subcutaneous hematoma (0.5%, 0.2%), post-procedural hemorrhage (0.5%, 0.2%), retroperitoneal hemorrhage (0.3%, 0.2%), pericardial effusion/hemorrhage/tamponade (0.3%, 0.2%), and retinal hemorrhage (0.0%, 0.1%).Malignancies: During TRITON-TIMI 38, newly diagnosed malignancies were reported in 1.6% and 1.2% of patients treated with prasugrel and clopidogrel, respectively. The sites contributing to the differences were primarily colon and lung. It is unclear if these observations are causally-related or are random occurrences.Other Adverse Events: In TRITON-TIMI 38, common and other important non-hemorrhagic adverse events were, for Effient and clopidogrel, respectively: severe thrombocytopenia (0.06%, 0.04%), anemia (2.2%, 2.0%), abnormal hepatic function (0.22%, 0.27%), allergic reactions (0.36%, 0.36%), and angioedema (0.06%, 0.04%). Table 4 summarizes the adverse events reported by at least 2.5% of patients.Table 4: Non-Hemorrhagic Treatment Emergent Adverse Events Reported by at Least 2.5% of Patients in Either Group

Effient (%) (N=6741)

Clopidogrel (%) (N=6716)

Hypertension 7.5 7.1Hypercholesterolemia/Hyperlipidemia 7.0 7.4Headache 5.5 5.3Back pain 5.0 4.5Dyspnea 4.9 4.5Nausea 4.6 4.3Dizziness 4.1 4.6Cough 3.9 4.1Hypotension 3.9 3.8Fatigue 3.7 4.8Non-cardiac chest pain 3.1 3.5Atrial fibrillation 2.9 3.1Bradycardia 2.9 2.4Leukopenia (<4 x 109 WBC/L) 2.8 3.5Rash 2.8 2.4Pyrexia 2.7 2.2Peripheral edema 2.7 3.0Pain in extremity 2.6 2.6Diarrhea 2.3 2.6

6.2 Postmarketing Experience: The following adverse reactions have been identified during post approval use of Effient. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.Blood and lymphatic system disorders — Thrombocytopenia, Thrombotic thrombocytopenic purpura (TTP) [see Warnings and Precautions (5.4) and Patient Counseling Information (17.3)]Immune system disorders — Hypersensitivity reactions including anaphylaxis [see Contraindications (4.3)]7 DRUG INTERACTIONS7.1 Warfarin: Coadministration of Effient and warfarin increases the risk of bleeding [see Warnings and Precautions (5.1) and Clinical Pharmacology (12.3)].7.2 Non-Steroidal Anti-Inflammatory Drugs: Coadministration of Effient and NSAIDs (used chronically) may increase the risk of bleeding [see Warnings and Precautions (5.1)].7.3 Other Concomitant Medications: Effient can be administered with drugs that are inducers or inhibitors of cytochrome P450 enzymes [see Clinical Pharmacology (12.3)].Effient can be administered with aspirin (75 mg to 325 mg per day), heparin, GPIIb/IIIa inhibitors, statins, digoxin, and drugs that elevate gastric pH, including proton pump inhibitors and H2 blockers [see Clinical Pharmacology (12.3)].8 USE IN SPECIFIC POPULATIONS8.1 Pregnancy: Pregnancy Category B - There are no adequate and well-controlled studies of Effient use in pregnant women. Reproductive and developmental toxicology studies in rats and rabbits at doses of up to 30 times the recommended therapeutic exposures in humans (based on plasma exposures to the major circulating human metabolite) revealed no evidence of fetal harm; however, animal studies are not always predictive of a human response. Effient should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus.In embryo fetal developmental toxicology studies, pregnant rats and rabbits received prasugrel at maternally toxic oral doses equivalent to more than 40 times the human exposure. A slight decrease in pup body weight was observed; but, there were no structural malformations in either species. In prenatal and postnatal rat studies, maternal treatment with prasugrel had no effect on the behavioral or reproductive development of the offspring at doses greater than 150 times the human exposure [see Nonclinical Toxicology (13.1)].8.3 Nursing Mothers: It is not known whether Effient is excreted in human milk; however, metabolites of Effient were found in rat milk. Because many drugs are excreted in human milk, prasugrel should be used during nursing only if the potential benefit to the mother justifies the potential risk to the nursing infant.8.4 Pediatric Use: Safety and effectiveness in pediatric patients have not been established [see Clinical Pharmacology (12.3)].8.5 Geriatric Use: In TRITON-TIMI 38, 38.5% of patients were ≥65 years of age and 13.2% were ≥75 years of age. The risk of bleeding increased with advancing age in both treatment groups, although the relative risk of bleeding (Effient compared with clopidogrel) was similar across age groups.Patients ≥75 years of age who received Effient had an increased risk of fatal bleeding events (1.0%) compared to patients who received clopidogrel (0.1%). In patients ≥75 years of age, symptomatic intracranial hemorrhage occurred in 7 patients (0.8%) who received Effient and in 3 patients (0.3%) who received clopidogrel. Because of the risk of bleeding, and because effectiveness is uncertain in patients ≥75 years of age [see Clinical Studies (14)], use of Effient is generally not recommended in these patients, except in high-risk situations (diabetes and past history of myocardial infarction) where its effect appears to be greater and its use may be considered [see Warnings and Precautions (5.1), Clinical Pharmacology (12.3), and Clinical Studies (14)].8.6 Low Body Weight: In TRITON-TIMI 38, 4.6% of patients treated with Effient had body weight <60 kg. Individuals with body weight <60 kg had an increased risk of bleeding and an increased exposure to the active metabolite of prasugrel [see Dosage and Administration (2), Warnings and Precautions (5.1), and Clinical Pharmacology (12.3)]. Consider lowering the maintenance dose to 5 mg in patients <60 kg. The effectiveness and safety of the 5 mg dose have not been prospectively studied.8.7 Renal Impairment: No dosage adjustment is necessary for patients with renal impairment. There is limited experience in patients with end-stage renal disease, but such patients are generally at higher risk of bleeding [see Warnings and Precautions (5.1) and Clinical Pharmacology (12.3)].8.8 Hepatic Impairment: No dosage adjustment is necessary in patients with mild to moderate hepatic impairment (Child-Pugh Class A and B). The pharmacokinetics and pharmacodynamics of prasugrel in

patients with severe hepatic disease have not been studied, but such patients are generally at higher risk of bleeding [see Warnings and Precautions (5.1) and Clinical Pharmacology (12.3)].8.9 Metabolic Status: In healthy subjects, patients with stable atherosclerosis, and patients with ACS receiving prasugrel, there was no relevant effect of genetic variation in CYP2B6, CYP2C9, CYP2C19, or CYP3A5 on the pharmacokinetics of prasugrel’s active metabolite or its inhibition of platelet aggregation.10 OVERDOSAGE10.1 Signs and Symptoms: Platelet inhibition by prasugrel is rapid and irreversible, lasting for the life of the platelet, and is unlikely to be increased in the event of an overdose. In rats, lethality was observed after administration of 2000 mg/kg. Symptoms of acute toxicity in dogs included emesis, increased serum alkaline phosphatase, and hepatocellular atrophy. Symptoms of acute toxicity in rats included mydriasis, irregular respiration, decreased locomotor activity, ptosis, staggering gait, and lacrimation.10.2 Recommendations about Specific Treatment: Platelet transfusion may restore clotting ability. The prasugrel active metabolite is not likely to be removed by dialysis.13 NONCLINICAL TOXICOLOGY13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility: Carcinogenesis - No compound-related tumors were observed in a 2-year rat study with prasugrel at oral doses up to 100 mg/kg/day (>100 times the recommended therapeutic exposures in humans (based on plasma exposures to the major circulating human metabolite). There was an increased incidence of tumors (hepatocellular adenomas) in mice exposed for 2 years to high doses (>250 times the human metabolite exposure).Mutagenesis - Prasugrel was not genotoxic in two in vitro tests (Ames bacterial gene mutation test, clastogenicity assay in Chinese hamster fibroblasts) and in one in vivo test (micronucleus test by intraperitoneal route in mice).Impairment of Fertility - Prasugrel had no effect on fertility of male and female rats at oral doses up to 300 mg/kg/day (80 times the human major metabolite exposure at daily dose of 10 mg prasugrel).17 PATIENT COUNSELING INFORMATIONSee Medication Guide17.1 Benefits and Risks

• Summarize the effectiveness features and potential side effects of Effient.

• Tell patients to take Effient exactly as prescribed.• Remind patients not to discontinue Effient without first discussing it

with the physician who prescribed Effient.• Recommend that patients read the Medication Guide.

17.2 Bleeding: Inform patients that they:• will bruise and bleed more easily.• will take longer than usual to stop bleeding.• should report any unanticipated, prolonged, or excessive bleeding, or

blood in their stool or urine.17.3 Other Signs and Symptoms Requiring Medical Attention

• Inform patients that TTP is a rare but serious condition that has been reported with Effient.

• Instruct patients to get prompt medical attention if they experience any of the following symptoms that cannot otherwise be explained: fever, weakness, extreme skin paleness, purple skin patches, yellowing of the skin or eyes, or neurological changes.

• Inform patients that they may have hypersensitivity reactions including rash, angioedema, anaphylaxis, or other manifestations. Patients who have had hypersensitivity reactions to other thienopyridines may have hypersensitivity reactions to Effient.

17.4 Invasive Procedures: Instruct patients to:• inform physicians and dentists that they are taking Effient before any

invasive procedure is scheduled.• tell the doctor performing the invasive procedure to talk to the

prescribing health care professional before stopping Effient.17.5 Concomitant Medications: Ask patients to list all prescription medications, over-the-counter medications, or dietary supplements they are taking or plan to take so the physician knows about other treatments that may affect bleeding risk (e.g., warfarin and NSAIDs).Literature Revised: December 21, 2012Effient® is a registered trademark of Eli Lilly and Company.Manufactured by Eli Lilly and Company, Indianapolis, IN 46285Marketed by Daiichi Sankyo, Inc. and Lilly USA, LLCCopyright © 2009, 2011, 2012 Daiichi Sankyo, Inc. and Eli Lilly and Company. All rights reserved. PG82128. PGHCPBS03Dec2012.PV 7802 AMP PRINTED IN USA

183-35833 Pg 4 (RH) KJob Number: 16322Revision No: 2Date: 9/25/13

Effient® (prasugrel) tablets Brief Summary of Prescribing InformationBRIEF SUMMARY: Please see Full Prescribing Information for additional information about Effient.

WARNING: BLEEDING RISKEffient can cause significant, sometimes fatal, bleeding [see Warnings and Precautions (5.1 and 5.2) and Adverse Reactions (6.1)].Do not use Effient in patients with active pathological bleeding or a history of transient ischemic attack or stroke [see Contraindications (4.1 and 4.2)].In patients ≥75 years of age, Effient is generally not recommended, because of the increased risk of fatal and intracranial bleeding and uncertain benefit, except in high-risk situations (patients with diabetes or a history of prior MI) where its effect appears to be greater and its use may be considered [see Use in Specific Populations (8.5)].Do not start Effient in patients likely to undergo urgent coronary artery bypass graft surgery (CABG). When possible, discontinue Effient at least 7 days prior to any surgery.Additional risk factors for bleeding include:

• body weight <60 kg• propensity to bleed• concomitant use of medications that increase the risk of

bleeding (e.g., warfarin, heparin, fibrinolytic therapy, chronic use of non-steroidal anti-inflammatory drugs [NSAIDs])

Suspect bleeding in any patient who is hypotensive and has recently undergone coronary angiography, percutaneous coronary intervention (PCI), CABG, or other surgical procedures in the setting of Effient.If possible, manage bleeding without discontinuing Effient. Discontinuing Effient, particularly in the first few weeks after acute coronary syndrome, increases the risk of subsequent cardiovascular events [see Warnings and Precautions (5.3)].

1 INDICATIONS AND USAGE1.1 Acute Coronary Syndrome: Effient® is indicated to reduce the rate of thrombotic cardiovascular (CV) events (including stent thrombosis) in patients with acute coronary syndrome (ACS) who are to be managed with percutaneous coronary intervention (PCI) as follows:

• Patients with unstable angina (UA) or non–ST-elevation myocardial infarction (NSTEMI).

• Patients with ST-elevation myocardial infarction (STEMI) when managed with primary or delayed PCI.

Effient has been shown to reduce the rate of a combined endpoint of cardiovascular death, nonfatal myocardial infarction (MI), or nonfatal stroke compared to clopidogrel. The difference between treatments was driven predominantly by MI, with no difference on strokes and little difference on CV death [see Clinical Studies (14)].It is generally recommended that antiplatelet therapy be administered promptly in the management of ACS because many cardiovascular events occur within hours of initial presentation. In the clinical trial that established the efficacy of Effient, Effient and the control drug were not administered to UA/NSTEMI patients until coronary anatomy was established. For the small fraction of patients that required urgent CABG after treatment with Effient, the risk of significant bleeding was substantial [see Warnings and Precautions (5.2)]. Because the large majority of patients are managed without CABG, however, treatment can be considered before determining coronary anatomy if need for CABG is considered unlikely. The advantages of earlier treatment with Effient must then be balanced against the increased rate of bleeding in patients who do need to undergo urgent CABG.2 DOSAGE AND ADMINISTRATIONInitiate Effient treatment as a single 60-mg oral loading dose and then continue at 10 mg orally once daily. Patients taking Effient should also take aspirin (75 mg to 325 mg) daily [see Drug Interactions (7) and Clinical Pharmacology (12.3)]. Effient may be administered with or without food [see Clinical Pharmacology (12.3) and Clinical Studies (14)].Dosing in Low Weight Patients: Compared to patients weighing ≥60 kg, patients weighing <60 kg have an increased exposure to the active metabolite of prasugrel and an increased risk of bleeding on a 10 mg once daily maintenance dose. Consider lowering the maintenance dose to 5 mg in patients <60 kg. The effectiveness and safety of the 5 mg dose have not been prospectively studied.4 CONTRAINDICATIONS4.1 Active Bleeding: Effient is contraindicated in patients with active pathological bleeding such as peptic ulcer or intracranial hemorrhage [see Warnings and Precautions (5.1) and Adverse Reactions (6.1)].4.2 Prior Transient Ischemic Attack or Stroke: Effient is contraindicated in patients with a history of prior transient ischemic attack (TIA) or stroke. In TRITON-TIMI 38 (TRial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet InhibitioN with Prasugrel),

patients with a history of TIA or ischemic stroke (>3 months prior to enrollment) had a higher rate of stroke on Effient (6.5%; of which 4.2% were thrombotic stroke and 2.3% were intracranial hemorrhage [ICH]) than on clopidogrel (1.2%; all thrombotic). In patients without such a history, the incidence of stroke was 0.9% (0.2% ICH) and 1.0% (0.3% ICH) with Effient and clopidogrel, respectively. Patients with a history of ischemic stroke within 3 months of screening and patients with a history of hemorrhagic stroke at any time were excluded from TRITON-TIMI 38. Patients who experience a stroke or TIA while on Effient generally should have therapy discontinued [see Adverse Reactions (6.1) and Clinical Studies (14)].4.3 Hypersensitivity: Effient is contraindicated in patients with hypersensitivity (e.g., anaphylaxis) to prasugrel or any component of the product [see Adverse Reactions (6.2)].5 WARNINGS AND PRECAUTIONS5.1 General Risk of Bleeding: Thienopyridines, including Effient, increase the risk of bleeding. With the dosing regimens used in TRITON-TIMI 38, TIMI (Thrombolysis in Myocardial Infarction) Major (clinically overt bleeding associated with a fall in hemoglobin ≥5 g/dL, or intracranial hemorrhage) and TIMI Minor (overt bleeding associated with a fall in hemoglobin of ≥3 g/dL but <5 g/dL) bleeding events were more common on Effient than on clopidogrel [see Adverse Reactions (6.1)]. The bleeding risk is highest initially, as shown in Figure 1 (events through 450 days; inset shows events through 7 days).Figure 1: Non-CABG-Related TIMI Major or Minor Bleeding Events.

Non-

CABG

-Rel

ated

TIM

I M

ajor

or M

inor

Ble

edin

g Ev

ents

(%)

2

3

4

5

1

018090 270 360 450

Clopidogrel

E�ent

Days from RandomizationNumber at risk:E�ent 6741 6042 5707 4813 4078 2747Clopidogrel 6716 6023 5764 4883 4138 2792

0

3

2

1

010 2 4 63 5 7

Suspect bleeding in any patient who is hypotensive and has recently undergone coronary angiography, PCI, CABG, or other surgical procedures even if the patient does not have overt signs of bleeding.Do not use Effient in patients with active bleeding, prior TIA or stroke [see Contraindications (4.1 and 4.2)].Other risk factors for bleeding are:

• Age ≥75 years. Because of the risk of bleeding (including fatal bleeding) and uncertain effectiveness in patients ≥75 years of age, use of Effient is generally not recommended in these patients, except in high-risk situations (patients with diabetes or history of myocardial infarction) where its effect appears to be greater and its use may be considered [see Adverse Reactions (6.1), Use in Specific Populations (8.5), Clinical Pharmacology (12.3), and Clinical Trials (14)].

• CABG or other surgical procedure [see Warnings and Precautions (5.2)].

• Body weight <60 kg. Consider a lower (5 mg) maintenance dose [see Dosage and Administration (2), Adverse Reactions (6.1), Use in Specific Populations (8.6)].

• Propensity to bleed (e.g., recent trauma, recent surgery, recent or recurrent gastrointestinal (GI) bleeding, active peptic ulcer disease, severe hepatic impairment, or moderate to severe renal impairment) [see Adverse Reactions (6.1) and Use in Specific Populations (8.7 and 8.8)].

• Medications that increase the risk of bleeding (e.g., oral anticoagulants, chronic use of non-steroidal anti-inflammatory drugs [NSAIDs], and fibrinolytic agents). Aspirin and heparin were commonly used in TRITON-TIMI 38 [see Drug Interactions (7), Clinical Studies (14)].

Thienopyridines inhibit platelet aggregation for the lifetime of the platelet (7-10 days), so withholding a dose will not be useful in managing a bleeding event or the risk of bleeding associated with an invasive procedure. Because the half-life of prasugrel’s active metabolite is short relative to the lifetime of the platelet, it may be possible to restore hemostasis by administering exogenous platelets; however, platelet transfusions within 6 hours of the loading dose or 4 hours of the maintenance dose may be less effective.5.2 Coronary Artery Bypass Graft Surgery-Related Bleeding: The risk of bleeding is increased in patients receiving Effient who undergo CABG. If possible, Effient should be discontinued at least 7 days prior to CABG.Of the 437 patients who underwent CABG during TRITON-TIMI 38, the rates of CABG-related TIMI Major or Minor bleeding were 14.1% in the Effient group and 4.5% in the clopidogrel group [see Adverse Reactions (6.1)]. The higher risk for bleeding events in patients treated with Effient persisted up to 7 days from the most recent dose of study drug. For patients receiving a thienopyridine within 3 days prior to CABG, the frequencies of TIMI Major or Minor bleeding were 26.7% (12 of 45

patients) in the Effient group, compared with 5.0% (3 of 60 patients) in the clopidogrel group. For patients who received their last dose of thienopyridine within 4 to 7 days prior to CABG, the frequencies decreased to 11.3% (9 of 80 patients) in the prasugrel group and 3.4% (3 of 89 patients) in the clopidogrel group.Do not start Effient in patients likely to undergo urgent CABG. CABG-related bleeding may be treated with transfusion of blood products, including packed red blood cells and platelets; however, platelet transfusions within 6 hours of the loading dose or 4 hours of the maintenance dose may be less effective.5.3 Discontinuation of Effient: Discontinue thienopyridines, including Effient, for active bleeding, elective surgery, stroke, or TIA. The optimal duration of thienopyridine therapy is unknown. In patients who are managed with PCI and stent placement, premature discontinuation of any antiplatelet medication, including thienopyridines, conveys an increased risk of stent thrombosis, myocardial infarction, and death. Patients who require premature discontinuation of a thienopyridine will be at increased risk for cardiac events. Lapses in therapy should be avoided, and if thienopyridines must be temporarily discontinued because of an adverse event(s), they should be restarted as soon as possible [see Contraindications (4.1 and 4.2) and Warnings and Precautions (5.1)]. 5.4 Thrombotic Thrombocytopenic Purpura: Thrombotic thrombocytopenic purpura (TTP) has been reported with the use of Effient. TTP can occur after a brief exposure (< 2 weeks). TTP is a serious condition that can be fatal and requires urgent treatment, including plasmapheresis (plasma exchange). TTP is characterized by thrombocytopenia, microangiopathic hemolytic anemia (schistocytes [fragment red blood cells] seen on peripheral smear), neurological findings, renal dysfunction, and fever [see Adverse Reactions (6.2)].5.5 Hypersensitivity Including Angioedema: Hypersensitivity including angioedema has been reported in patients receiving Effient, including patients with a history of hypersensitivity reaction to other thienopyridines [see Contraindications (4.3), Adverse Reactions (6.2)].6 ADVERSE REACTIONS6.1 Clinical Trials Experience: The following serious adverse reactions are also discussed elsewhere in the labeling:

• Bleeding [see Boxed Warning and Warnings and Precautions (5.1, 5.2)]

• Thrombotic thrombocytopenic purpura [see Warnings and Precautions (5.4)]

Safety in patients with ACS undergoing PCI was evaluated in a clopidogrel-controlled study, TRITON-TIMI 38, in which 6741 patients were treated with Effient (60-mg loading dose and 10 mg once daily) for a median of 14.5 months (5802 patients were treated for over 6 months; 4136 patients were treated for more than 1 year). The population treated with Effient was 27 to 96 years of age, 25% female, and 92% Caucasian. All patients in the TRITON-TIMI 38 study were to receive aspirin. The dose of clopidogrel in this study was a 300-mg loading dose and 75 mg once daily.Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials cannot be directly compared with the rates observed in other clinical trials of another drug and may not reflect the rates observed in practice.Drug Discontinuation: The rate of study drug discontinuation because of adverse reactions was 7.2% for Effient and 6.3% for clopidogrel. Bleeding was the most common adverse reaction leading to study drug discontinuation for both drugs (2.5% for Effient and 1.4% for clopidogrel).Bleeding: Bleeding Unrelated to CABG Surgery - In TRITON-TIMI 38, overall rates of TIMI Major or Minor bleeding adverse reactions unrelated to coronary artery bypass graft surgery (CABG) were significantly higher on Effient than on clopidogrel, as shown in Table 1.Table 1: Non-CABG-Related Bleedinga (TRITON-TIMI 38)

Effient (%) (N=6741)

Clopidogrel (%) (N=6716) p-value

TIMI Major or Minor bleeding 4.5 3.4 p=0.002

TIMI Major bleedingb 2.2 1.7 p=0.029 Life-threatening 1.3 0.8 p=0.015

Fatal 0.3 0.1Symptomatic intracranial hemorrhage (ICH) 0.3 0.3

Requiring inotropes 0.3 0.1Requiring surgical intervention 0.3 0.3

Requiring transfusion (≥4 units) 0.7 0.5

TIMI Minor bleedingb 2.4 1.9 p=0.022a Patients may be counted in more than one row.b See 5.1 for definition.Figure 1 demonstrates non-CABG related TIMI Major or Minor bleeding.

183-35833 Pg 3 (LH) KJob Number: 16322Revision No: 2Date: 9/25/13

The JW Marriott Panama Golf & Beach Resort sits in the heart of Cocle, Pan-

ama, in the luxury community of Bue-naventura. The premier hotel offers the ultimate in beach vacationing as well as high-end amenities and services aimed at pampering every guest.

The Panama resort features 109 rooms and nine suites on four floors along with four meeting rooms with 3,918 square feet of flexible space, a number of onsite restaurants and bars, full-service spa, 18-hole golf course, state-of-the-art fitness center and out-door pool and whirlpool.

Tamarindo features international cuisine with a focus on locally sourced ingredients and is open for break-fast, lunch and dinner. While Prime 19 focuses on serving juicy steaks for lunch and dinner in a relaxed atmosphere, Tai Kai offers Japanese plates in a casual

dinner setting. El Faro reaches out to guests in the pool and beach areas with lunch and dinner options.Solera Pool Bar features a swim-up wet bar serving the most thirst-quenching concoctions around, and Bar-a-lago provides a variety of top-shelf liquors and a wide assortment of wines.

The Panama resort will surround guests in opulence when they experience the luxurious Panama beach accommodations with Spanish colonial décor, hard-wood floors and soft, inviting hues. Rooms feature private balconies and gardens, and some have ocean views. Down duvets and Egyptian cotton linens on one king or two double beds ensure a sound night’s sleep, while marble bathrooms with soaking tubs, premium bath products, plush bathrobes and ter-ry slippers pamper all guests. High-speed Internet access, 42-inch LCD TVs, iPod docking stations, in-room coffeemakers and irons and ironing boards are among high-end luxuries travelers can expect from the JW Marriott.

AFRICA ASIA EUROPE LATIN AMERICA MIDDLE EAST NORTH AMERICA

&

DISCOVER Panama

April 2014 Elite Tampa Bay 9

INSIDE

36HEALTHYSMILES

EXECUTIVE PHYSICALS

32 SLIP AND FALLS

42 REAL ESTATE VALUES UP

28 HEALTHY DINING OUT

50

16

TAMPA BAY AIRFEST


WELCOMEDear Reader

We appreciate all of the kind words and positive feedback that we continue to receive on a daily basis from our readers, advertisers, and sponsors. Elite Tampa Bay is constantly evolving as a result of the feedback that you are giving us. All of the content in our magazine is a direct result of the comments that we receive. We pride ourselves on creating beautifully made magazines that provide you with content that you actually want to read.

In this month’s edition you will find articles on concierge medicine, the 20 “must know rules” of men’s suits, the importance of protecting yourself and your assets from uninsured motorists, and find sound investment advice from one of Tampa’s best financial planners. Summer is coming, so you will also find tips on how to lose weight and keep it off.

If you have driven through South Tampa in the last few months you have probably noticed all of the new construction. This growth signifies the strength of our economy and how much it has bounced back from the quagmire that it was in just a few years ago. I am proud to live in such a beautiful city and encourage you to let us know any of your success stories that you would like to see in upcoming editions of Elite Tampa Bay. We love hearing about other businesses that are thriving in our town and enjoy bringing you their stories.

As always we are grateful for your support,

AdamAdam LongakerPublisher

As always, we are excited to present this month’s edition of Elite Tampa Bay to you. 2014 has been an exciting year so far. We have now produced 10 editions

of Elite Tampa Bay, moved into larger office space to accommodate our growing staff, and have now donated over $85,000 in advertising space to locally based non-profit organizations.


Elite Tampa BayMarch 2014 Edition

PUBLISHERTHE CUSTOM PUBLISHING

COMPANY

CREATIVE DIRECTOR BRYAN CLAPPER

EDITORIAL DIRECTORKEVIN ANDERSON

CHIEF PHOTOGRAPHERDANIEL HAVERTY

ADVERTISING ASSOCIATESJOHN PEREA

JARED PIERCE

SALES SUPPORT STAFFLAURA LEIGH WALSH

CONTRIBUTING WRITERSTHOMAS E. PARNELL

PENN DICORAYMOND LOEFFLER

TRAVIS JONINSKITRAVIS HORN

JENNIFER BRYAN

SPECIAL THANKSUSF HEALTHEPICUREAN

GOLD AND DIAMOND SOURCECHILL LOUNGE

www.TheCustomPublishingCompany.com

Changing Lives One Smile at a Time!

Providing personalized care for your whole family

Dr. Ron O’Neal

Call today for your appointment!South Tampa | (813) 253-5303 | 3733 West Neptune | 33629St. Petersburg | (727) 527-7207 | 7401 Dr. M. L. King, Jr. St. N. | 33702

www.TampaBayFamilyDentist.com

14 Elite Tampa Bay April 2014

This month we are introducing a special section of Elite Tampa Bay that is called Kaptan’s Korner.

Eight months ago we agreed to foster an English Bulldog. Within hours of bringing him home we became what rescues call “foster failures,” families that offer to foster dogs and cannot bear to give them back. We renamed him Kaptan (pronounced Captain) and he has brought joy to our family every moment since the day we brought him home. As a tribute to Kaptan; Elite Tampa Bay now donates a full page ad to an animal based non-profit every month.

Kaptan has never met anyone that he doesn’t like; and his affable, clown like personality make us laugh on a daily basis. He is great at making new friends, which is why we chose PetNet as this month’s charity.

WHO THEY ARE:PetNet is a membership group for professionals ages 21-45 for the benefit of the Humane Society of Tampa Bay.

WHAT THEY DO:PetNet hosts Professional Networking Events in Tampa, Florida to raise capital for the Humane Society of Tampa Bay.

Members of PetNet help homeless animals at the Humane Society of Tampa Bay facility by attending PetNet events and paying membership dues.

The PetNet Board plans 6-8 quality professional networking events per year at upscale venues primarily around downtown Tampa.

Thank you,

The Elite Tampa Bay Family & The Kaptan

Kaptan

P.S. If you want to submit your favorite animal charity to be included in Kaptan’s Korner like us on Facebook and make your suggestions.

KAPTAN’S KORNER

Members of PetNet help homeless animals at the Humane Society of Tampa Bay facility by attending PetNet events and paying membership dues.

April 2014 Elite Tampa Bay 1716 Elite Tampa Bay April 2014

THE UNSPOKEN

RULES OFMen’s Suits


The Lawyer You Want on Your

SideBUSINESS LITIGATION• Non-Compete Agreements

• Partner Disputes• Shareholder Disputes

• Stock Appraisal Litigation• Trade Secret Litigation

3110 Alternate US 19 NorthPalm Harbor, FL 34683

(727) 772-1941 (Pinellas)

(813) 336-5228 (Hillsborough/Pasco)

www.RobertEckardLaw.comState & Federal Litigation Practice

&THE LAW OFFICE OF

ROBERT ECKARDA S S O C I A T E S , P . A .

“We reserve judgment for the courtroom.”

We pay referral fees in accordance with the rules regulatin the Florida Bar.

1. The width of the tie should match the width of the lapel.

2. In general, thin lapels are more modern. Wide lapels are more old-school, Mad Men style.

3. A pocket square adds an extra level of polish, but make sure it doesn’t match your tie in either pattern or fabric choice. Before you go totally conservative, remember that the pocket square is where you get the most freedom and the one place you get to add a little pizzazz to your suit.

4. When buying an off-the-rack suit, the number one thing to check is how the shoulders fit.

5. A collar gap between your jacket’s lapels and your shirt’s collar can signify an ill-fitting jacket.

6. Opt for a charcoal or gray suit over black, unless you’re attending a funeral. Dark gray is more versatile and goes with more colors.

7. Your belt should be fairly thin and the same color as your shoes.


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By offering a complete suite of real estate services, we ensure that we meet our client’s every need. From sales and rentals, mortgage, and new developments, we have experts in every field to skillfully guide you from beginning to end of your real estate journey.

Dianaty’s outstanding track record, unique brand promise, and exceptional agent support system, attracts the top talent, ensuring that our team of experts represent the very best in the industry.

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8. Double vents in the back are more modern and fashionable. This look is also more flattering for larger figures, and it gives you enough room to do that effortlessly casual “hand in pocket” thing.

9. For a more casual, trendy look, opt for a single-button peak-lapel jacket.

10. If you’re going for more formal business attire, opt for a double-button, notched lapel jacket.

11. You should be able to slip your hand between your chest and your buttoned jacket such that it feels snug, but with room to move.

22 Elite Tampa Bay April 2014 April 2014 Elite Tampa Bay 23

12. Always unbutton your suit before sitting down, or you risk ruining it.

13. The top button of a two-button (or the middle button of a three-button) should fall at or above the navel.

14. Always go with the classic windsor knot for your tie, but use the size of your head to determine whether you should go half or full windsor. BIG HEAD = FULL KNOT. SMALL HEAD = HALF KNOT. If you’re not sure how your head size compares, ask one of your male friends. They should be able to give you an objective opinion.

15. If you’re wearing a vest, always keep the bottom button unbuttoned.

16. Sleeve cuffs should be exposed about half an inch. For a harmonious look, try to match the visible cuff length to the amount of collar that is visible at the back of the neck.

17. When you get your suit home, you’ll need a seam ripper or a small, sharp pair of scissors. Unstitch the jacket’s pockets, remove the tack stitches from the jacket’s vents, and remove the little embroidered label from the jacket’s left sleeve. Do this very carefully to ensure you don’t actually rip the fabric or neighboring threads.

18. Make sure that your socks are long enough that there’s no exposed leg when sitting down.

19. Your tie should always be darker than your dress shirt.

20. Your tie should JUST reach the waistband of your trousers, or be slightly shorter.



Couldn’t really make suits stretch this long — what do you want to put here?


The year was 1975; I was a freshman in High school growing up in the suburbs in Westchester County just north of New York City. I was sitting out on our back porch drinking a Pepsi and eating a bag of chips and listening to the TV set. It was Friday, so my dad was watching his favorite investment show Wall Street Week with Louis Rukeyser. He would always have a yellow legal pad and two pencils sitting next to his favorite chair and when Louis spoke, my Dad would listen. Every stock that Louis covered and recommended would be written down by my father with lightning speed. His eyes and ears were fixated on every word that came out of Louis’s mouth. When I would walk into the TV room and sit next to my dad he would be sweating bullets and writing as Louis was commenting about IBM. I stupidly commented (with my mouth full of chips), “ Dad didn’t you just have Shelly (his broker who worked at Merrill Lynch) sell that stock two days ago?” My Dad whipped his head around gave me the biggest glare that said ‘shut the hell up’.

My Dad was mad because he bought IBM 3 weeks earlier and sold it for 3 points lower. On that Friday IBM closed 5 points above his purchase price. Where was his discipline? Where was his patience? The year is now 2014. I’m having a Diet Pepsi and a protein bar while sitting in my Dad’s house in Boca Raton and he’s watching CNBC. I’m thinking, if only my Dad would of kept IBM, or better yet if he would have reinvested all the dividends back into IBM. Where would he be today? The real question is where would he be where would be today if he’d had kept every stock he ever sold and again reinvest the dividends of all those stocks? At 86 years of age he’s still buying and selling. He’s still trying to guess the direction of where the market will go. It didn’t work then and it doesn’t work now. But I still love my Dad.

No one can determine the direction of the market. But as investors, we can buy quality dividend yielding growth stocks that have the potential for increasing their earnings. Increased earnings could translate into increased dividends; which means that over time, both our principal could go up and our income could go up. And yes those dividends can be reinvested to

buy additional shares or used to buy additional stocks. If and when the market does correct, and I believe that it always does; those dividends can help minimize the decline in your portfolio. As you’re waiting for your portfolio to recover, could still be receiving dividends.

Time is a major ally when investing in a dividend yielding growth portfolio of stocks. Imagine if you owned your own apartment complex right on the water in Long Boat Key. Within this building you had a multitude of high end 2 and 3 bedroom rental units. The property is 100% leased out 12 months out of the year. Over ten years not only does your property value go up but your annual rental checks go up. Does this happen to every unit in the building? No. But the building as a whole, yes. You will have flooding and hurricanes but time is your friend not timing.

Over the course of the next two decades more and more of us will be in our retirement years. The need and demand for dividend yielding growth stocks will only be increasing. Growth stocks

with rising dividends are one of the primary investment vehicles that can help keep up with inflation or the cost of living. This is especially true in a rising interest rate period. Again what other investment vehicle will give you the potential growth in principal as well as the potential for growth in income?

Remember, Steady Eddie wins the race. More importantly staying disciplined, buying dividend yielding stocks, with historically rising dividends, and utilizing the generated income from the dividends, will help you to build a properly diversified portfolio achieve your financial goals.

Disclaimer: Dividends are not guaranteed and are subject to change or elimination. Past performance is no guarantee of future results. Stocks offer long-term growth potential, but may fluctuate more and provide less current income than other investments. An investment in the stock market should be made with an understanding of the risks associate with common stocks, including market fluctuations.

When you invest you can buy and sell, follow trends and pray to God, or you can build a portfolio based upon high quality dividend yielding growth stocks. I

believe that sticking to a structured program is the key to building wealth.

By Bruce F. ShindelmanSenior Vice President, Investments

PIM Portfolio ManagerWells Fargo Advisors

THE GRACEFUL ART OFDIVIDEND GROWTH

INVESTING

Bruce Shindelman


At the Monsour Executive Wellness Center, Medical Director, Dr. H.J. Brownlee assesses the healthcare needs of top executives through annual executive phys-

icals. This proactive measure empowers Dr. Brownlee’s patients, many of whom are C-level executives, by ensuring their healthcare needs are assessed and addressed allowing them to focus on growing their business.

So what can employers do to ensure their workforce is performing at peak? First and foremost, take care of your leadership team. The trickledown effect is alive and well in corporate America and when the boss is out sick or under the weather, workplace dynamics shift resulting in decreased employee productivity.

Corporations offering annual executive physicals to members of their leadership team and wellness screenings to employees notice 20% fewer medical claims and 45% fewer short term disability days than organizations without such incentives. Added perks of such programs include improved workplace morale as employees feel as though their leadership team genuinely cares about their well-being. In addition, lessening employee’s healthcare concerns can result in improved mental health, decreased stress levels, improved focus and clarity increasing job performance.

According to the U.S. Department of Health and Human Services, for every 100 employees in this country:

• 27 have cardiovascular disease• 24 have high blood pressure• 50 or more have high cholesterol• 26 are overweight by 20% or more• 10 are heavy drinkers• 59 do not get adequate exercise• 44 suffer from stress

While statistics clearly demonstrate the need for American corporations to create health conscience workplaces, some business owners may be left wondering where to start. Options vary from hiring a specialist who is tasked with creating a health care plan specific to your company’s needs to performing an

independent assessment. For those who elect the latter, helpful tips can be found on the Centers for Disease Control and Prevention website at www.cdc.gov. The site even offers a cost calculator which helps employers estimate the cost of lifestyle factors and preventable diseases versus wellness program implementation costs.

QUICK TIPS:Employers may ask their staff members to complete an anonymous health assessment designed to generate data specific to the workforce’s healthcare needs. Employee feedback may indicate a high risk of diabetes, obesity or even cardiovascular disease. In response, an employer may elect to place an emphasis on exercise and provide pedometers to staff. Pedometer tracking incentives serve to promote camaraderie and team building all the while placing an emphasis on well being. The installment of motivational signage in stairwells serves to encourage employees to take the stairs rather than the elevator. Encouraging employees to make healthy eating choices also serves to address the risk factors above. Numerous vending companies now carry healthier food selections as opposed to soda and chips and often deliver machines to facilities at no cost. Another simple, yet effective method of encouraging healthy habits while demonstrating an employer’s commitment to employee well-being is declaring a “smoke free” facility.

The mission of the Monsour Executive Wellness Center is to take care of executive’s health care need, so that they can take care of business. We encourage our clients to pass the message of proactive healthcare along to their employees.

HOW WORKPLACE WELLNESS BENEFITS EMPLOYERS

Programs such as executive physicals and employer provided wellness screenings are becoming more and more common among corporations and for good reason. The Centers for Disease Control and Prevention recently reported (Oct. 2013) that personal and family health concerns cost U.S. employers $225 billion in productivity losses annually. That averages $1,685 in productivity losses per employee, per year. Couple these statistics with the fact that employees are retiring later in life; the

CDC reports 18% of US workers were over the age of 55 in 2008 and nearly 25% are expected to be 55 and older in 2018 driving home the importance of proactive health measures. Employee health promotion programs improve workplace health and have the potential to yield major savings for employers. An example being chronic illness which affects more than a third of working Americans and accounts for approximately 75% of the nation’s healthcare costs.

Corporations offering annual executive physicals to members of their leadership team and wellness screenings to employees notice 20% fewer medical claims and 45% fewer short term disability days than organizations without such incentives.

The Meridian Clubon Pine CayTurks and CaiCos islands

Imagine a private island with aspectacular two-mile, white sand beach

and the only footprints are yours.Such a place really exists.

Just 13 beachfront units andseveral private rental homes.

No cars, no crowds, no hassles.It will win your heart.

For inFormation649.941.7011reservations@meridianclub.commeridianclub.com

Elegant cuisine and as much or as little as you want to do.

Daily Snorkeling TripsBone, Reef, Deep Sea Fishing

Off-Island ExcursionsNew Spa Services

TMC heart.indd 1 9/11/12 4:29 PM

Beautifully positioned on a two-mile stretch of talcum-powder beach - considered by many as the finest in the Caribbean - The Meridian Club is an environmentally-sensitive private island re-sort ideally suited for those seeking an unspoiled, upscale but unpretentious retreat. With no automobiles, televisions, radios or telephones, guests unwind and enjoy the island’s natural beau-ty. Soothing trade winds ensure comfortable temperatures and low humidity while surrounding waters teem with marine life. Underwater visibility often exceeds 100 feet and there are miles of coral gardens within a five minute boat ride. Ashore, Pine Cay remains a pristine natural haven with vast open space and seven freshwater ponds, a perfect habitat for the abundant local fauna and flora. Aside from the obvious – bask in the sun on a deserted beach – guests can enjoy a variety of activities such as snorkeling, kayaking, paddle boarding, biking, playing basketball or tennis, and the most popular … taking golf carts out to explore the island.

Culinary AdventuresMornings begin with freshly brewed coffee, fresh-baked pastries and breakfast on a private screened porch, with the option to join other guests at outdoor tables on the pool terrace. In the af-ternoon visitors have the option of a tasty buffet lunch, often off the grill, or a more adventurous picnic lunch (prepared upon re-quest.) The club offers only the freshest seafood - locally caught ocean fish, lobster and conch prepared in various styles. There are other options, such as steak, chops, rack of lamb, duck and Cornish hen, and the award-winning chef prepares vegetarian meals upon request. With an new pastry chef this season, the club is excited to continue the tradition of fine desserts, beauti-fully presented with coffee or cordials.

Spa OfferingsThe Sand Dollar Spa, staffed by a Balinese masseuse, offers spe-cialty spa techniques, including massage, hot stone treatment, manicures, pedicures, and facials. Balinese massage is a high-ly evolved, distinctive form employing a combination of gentle stretches, deep tissue kneading, acupressure and aromatherapy oils to stimulate the flow of blood, oxygen and “qi” (energy) around your body, bringing relaxation and a sense of wellness. An ancient technique, related to the Ayurveda, the Indian holis-tic medical system, this type of massage is known to help with a wide range of ailments, including migraine, muscle and joint pain, sleep disorder, anxiety and depression, as well as allergies and breathing problems such as asthma which often are wors-ened by stress. The use of oils is calming and sensual and leaves guests feeling tranquil and serene.

FishingWith great fishing only 20 minutes off shore and a boat ride that in itself is an memorable excursion, many who visit Pine Cay come for the fishing or include fishing in their visit to the island. From deep sea fishing to fishing in the flats, there is always some-thing interesting for any level fisherman. Some take their catch back to our chef and have it prepared for the next meal, while others enjoy “catch and release” for the sport of it. Whatever your pleasure, if you plan to fish during your Caribbean vacation, many say Pine Cay is the best option.

For more information, call The Meridian Club at 866.746.3229 or visit www.meridianclub.com.

A PRIVATE ISLAND HIDEAWAYTurks & Caicos

Some call it “Cast Away meets Wolfgang Puck” where “shoes are optional” (Hideaways Collection), while others call it “an authentic tropical getaway” (Andrew Harper) and bestow awards (Trip Advisor

Readers Choice), but regardless of how it’s defined, it’s clear The Meridian Club staff enjoy hosting guests on this private hidden gem.


Haiti is the poorest country in the Western Hemisphere. Poverty, starvation and death walk hand in hand with daily existence here and life as we know it does

not exist in the mountain villages. Mombin Crochu is one of those villages located mountainous zone located in the North-East department of Haiti. People here live usually from seasonal farming. There are almost no practicable roads aside from the footways. The common means of transportation consist generally of donkeys and horses. These help mostly women carry their goods from villages to villages for selling in keeping with a fixed market calendar. There is as well a small health center with beds that provides preliminary healthcare. Essential medications for treatment of the sick and injured are continually in short supply. Basic hospital materials like wound dressings, mattresses, gloves, and IV fluids are also lacking. Dental care is essentially non-existent. Brutal roads and heavy use force frequent repairs and maintenance work on the vehicles used to transport patients and supplies.

TAMPA DENTIST HELPS BRING

Smiles to Haiti


Village Partners International (VPI) is a local organization of committed volunteers who partner, village to village, to help others help themselves. Since its beginnings in 2007, it has helped develop community public health programs and educational programs in outlying areas of rural Haiti. VPI believes that empowering those in need with the tools to develop their own resources improves sustainability and viability of projects that ultimately heal, nourish, and empower those who have such great need.

For the past 5 years, Dr. Ron O’Neal and a team of medical volunteers from VPI spend one week in the village each year on a medial mission trip. In just one week, 300 dental and 41 surgical procedures were done, 142 patients were treated in the medical

clinics, 262 glasses were distributed, nurses and doctors were taught, future programs were discussed, the Mobile Clinic was staffed and sent out for a day, knowledge was shared, and much was learned. Without the help of VPI, many necessary services and doctors would not be available and the villagers would suffer greatly. Thanks to VPI, the hospital has dedicated doctors and staff committed to providing quality health care to the villagers. The staff not only provides professional medical care but is also involved at the community level in providing health education in the village and schools.

If you would like to learn more about how to help those most in need in Haiti, please visit www.villagepartnersinternational.org.

www.dianatyrealestate.com813.712.7403

4904 Lyford Cay Road, Tampa$1,025,000Outstanding opportunity to live in the gated community of Culbreath Isles. This stunning 4 bedroom, 3 and 1/2 bathroom traditional home sits on a corner lot with a side entry garage. The property has been recently renovated with a brand new roof. The interior provides all the luxury with an open floor plan, a gourmet kitchen with Viking appliances, a terrace private resort style pool and lushly landscaped gardens. This home also includes a wine cellar. This is a home you will never outgrow offering a tasteful blend of casual elegance and warm inviting décor! Truly one of a kind. Please call Anthony Dianaty for a private tour.

What do you need in a vacation? Comfort without fuss? Warmth mixed with refreshing trade winds? Natural beauty? Excellence in service performed at a relaxed pace with a certain charm? Then make some time for the Turks & Caicos Islands, where your pulse rate is sure to slow down.

Turks and Caicos is actually made up of over 40 islands and cays east south east of the Bahamas, spanning a distance of less than 100 miles from east to west and even fewer north to south. Just eight are inhabited, each reflecting distinct natural beauty, history and culture. Most visitors spend their time on Providenciales, the perfect place to unwind, but trips to the outer islands are highly recommended if you are looking to get a better impression of this small lively nation. Scheduled air flights and well organized excursions are readily available.

Providenciales’ Grace Bay Beach consistently receives accolades as the world’s best beach. It was named after Grace Hutchings, an early visitor in 1892, in honor of her beauty, style and of course grace. This pristine 12 mile beach seems to have that perfect combination of fine white powder sand, expansive vistas, constant breezes and yet no crowds. The sea colors will stay with you forever; shades of Tiffany blue, turquoise, cobalt and more; and the sunsets are not to be missed. Many of the country’s most luxurious resorts are here, making for easy movement between one world class refreshment experience to another. Of course there’s nothing like becoming a ‘local’ in your own luxury resort, and one that has received the World Travel Award for the Caribbean’s Leading Boutique Hotel from 2005 to 2010 is Point Grace, Luxury Resort & Spa. The resort is appropriately named as it sits on the ‘point’ half way along Grace Bay Beach where with it’s expanse of white sand and untamed beauty you feel like you are on your own desert island. The resort’s magnificent suites, restaurants and spa are all inspired by classic turn-of-the-century British Colonial architecture creating a West Indian setting untouched by time.

The islands are a divers feast with close to shore wall drops of up to 8,000 feet. Humpback whales pass by during Spring whaling season. Nature can be found in many forms from turtles to osprey eagles. Fitness lovers will find quality gyms, classes and water-sports with expert tuition. Kite-boarding, triathlons, 5/10K runs, sea-swims are all pursuits to join in. Tennis, golf and horse-back riding are all catered for, again with experts on hand. Fishing from bone fishing to deep sea fishing is world class. There is plenty to do if you are looking to be active.

World class chefs seek to impress you with their signature dishes creating a cosmopolitan fare, but C a r i b b e a n and native-style dishes abound with the fresh catch of the day and the country’s own Conch. Dining is everything from a simple to luxurious experience. You’ll find a huge selection of wines and drinks on offer too. Point Grace’s elegant gourmet restaurant, Grace’s Cottage, has specialized in pairing fine wines with inspired cuisine for many years now. Come, take time to enjoy cuisine at it’s best, in the best possible settings.

Your body and soul have already entered a new dimension, where you feel energized but utterly peaceful. The Point Grace Thalasso Spa is all you need to further the restoration process. Treatments are European in style; Thalassotherapy using the islands natural resources and Thalgo products. The setting is truly West Indian; white washed exquisite cottages just set back from the natural beach dunes with inspiring sea views and breezes.

Turks and Caicos is very accessible with many international flights. It’s just over an hour from Miami and two and a half hours from New York amongst many routes. Your first vision of the islands from the plane will be awe inspiring. You’ll finally know you are on vacation. Getting through the soon to be expanded small airport terminal is fine but a discrete courteous fast track VIP Flyers service is available; Turks and Caicos will give you the luxury you desire at every step.

Those that live in the islands keep their history and culture close to their hearts, but they also move with the times and going-green, ecotourism and government-reform are all hot topics. There is certainly a pride in the islands that we do things our way, we don’t just follow others, and that gives the islands a spirit all to their own. If you chose to visit Turks and Caicos you’d very likely become one of our many return visitors, so we hope to see you very soon.

Luxury getaway on the world’s best beach


Most of you are probably trying to figure out what the letters U.M. stand for. That’s ok, you are not alone. In fact you are in the great majority of Americans.

The subject of this article is car insurance. Wait, don’t stop reading. It may not sound interesting, and arguably it’s not, but it is very important for you and your family.

By Thomas Parnell

do not have attachable assets. That means that even if you get a judgment against them, you will never collect any money. Therefore, most attorneys will not sue an uninsured driver, unless you pay by the hour, which can be expensive and virtually futile.

So, it is up to you to protect yourself and your family from tragedy. You may be thinking that you pay enough for car insurance and you can’t afford it. The truth is, you can’t afford not to carry it. If it’s the cost that has prevented you from carrying U.M., then pay attention. It’s probably the cheapest type of coverage on your policy. On a standard one-car policy with an annual cost of $1000.00, the uninsured motorist premium is around $28. This is far and away the least expensive of all available coverages.

That means that for $28.00 dollars per year, you would have $10,000.00 of uninsured motorist coverage. Think of the protection this would give you for such a nominal price. As you increase the coverage, the premium goes up accordingly, but remains the cheapest of all the coverages.

Did you know that you could decline most all coverages, by simply telling your agent verbally. That is not true for U.M. If you reject uninsured motorist coverage, it must be done in writing. Florida Statute 627.727 requires a signed written rejection. The heading of the form must be in 12- point bold type and shall state: “You are electing not to purchase certain valuable coverage which protects you and your family ... when you sign this form. Please read carefully”. The legislature recognizes how important this coverage is to its citizens. They wanted to make certain that an individual was properly informed of the value of this coverage and knowingly declined it.

Please, when you get home, take out your insurance policy. Look at the front page where it lists your coverages’ and premium costs. See if you have U.M. If you don’t, then call your agent and demand it. Protect yourself and your family from potential tragedy. Educate your family and friends. Someone you know or love is going to be involved in an automobile accident. Remember, friends don’t let friends drive without U.M.

GOT U.M.?U.M. stands for Uninsured Motorist. This is a type of car insurance that is available in Florida. Have you heard of it? Do you even know what type of coverage you have on your own automobile? Most people don’t. I wish I had a dollar for every time a client has told me that they have “full coverage”. Rarely, does it turn out to be true. Usually, it’s those people that have the minimum insurance required by law.

Under Florida law, if you own an automobile, you must have certain basic coverage. This mandatory coverage includes, P.I.P. (Personal Injury Protection, a.k.a. No Fault) and Property Damage Liability. That is it. If you have these two coverages, you can lawfully drive in this state. P.I.P will pay 80% of your medical expenses up to your policy limit, which is typically $10,000. Property damage liability will pay for the other driver’s car damage if ‘’you” caused the accident.

Now, imagine you are driving to the beach with your family and

you are involved in a collision. You and your family are all hurt and it was not your fault. Now imagine that the other driver only had the minimum mandatory coverage or no coverage at all. Who is going to pay your excess medical bills? What about your pain and suffering? What if one of your children will need expensive · surgery? Even if the other driver did have bodily injury liability coverage, it is typically only $10,000.00. How long do you think that will last with hospital bills and surgical costs? What if you can’t work while you recover? The answer to all these questions is “U.M.”. If you carry uninsured motorist coverage, you are insuring yourself and your family from the real possibility of substantial losses due to an uninsured or underinsured driver.

I have interviewed thousands of people who have been severely injured by uninsured drivers. If they didn’t carry U.M., then there was nothing I could do for them. You may be thinking, why don’t you sue the other driver? Well, of course you can. However, this is analogous to a dog chasing his tail in a circle. Most people


1. SNACK, BUT SMARTLYGrazing between meals used to be on the weight-loss hit list. But nutritionists now know that it’s better to satisfy a craving with healthy grub than ignore it and risk a junk-food binge later. The best picks are filling, protein-packed snacks, such as one stick of string cheese, a tablespoon of peanut butter on a piece of fruit, or a medium-size bowl of edamame.

2. TURN OFF THE TVDining while viewing can make you take in 40 percent more calories than usual, reports a new study. And texting, driving, or any other distracting activity during a meal can also result in your eating too much. Instead, make each meal something you put on a plate and sit down to, even if you’re eating solo.

3. STEP ON THE SCALE DAILYIf your regular weight increases several days in a row, it’s a red flag letting you know you need to cut back a little or beef up your workouts slightly.

4. SCULPT THREE TIMES A WEEKDoing 5 minutes each of push-ups, lunges, and squats (in 30-second intervals) will help build and maintain muscle mass. The more muscle you have, the higher your metabolism will be, so you’ll torch more calories as you go about your day.

By Ray Loeffler

withoutpain

LOSINGWEIGHT

Losing pounds doesn’t have to be torture (we’re looking at you, cayenne-pepper

cleanse). Adopt at least three of these behaviors — they’re simple to integrate into your day-to-day routine, and all are enthusiastically backed by nutritionists — and you’ll be thinner and healthier in days. Plus, the weight will stay off.


5. REACH FOR YOUR CELLNext time your mind gets stuck on a certain food, call a friend and redirect your brain by asking how her day’s going. Research shows that cravings only last about 5 minutes, so by the time you hang up, the urge to devour junk will have subsided.

6. EAT A BIG, BALANCED BREAKFASTAn a.m. meal made up mostly of carbs and protein with some fat keeps blood-sugar levels steady and hunger pangs away so you’re not susceptible to pigging out come lunch, studies show. Opt for something satisfying for your stomach and taste buds — like egg whites and turkey bacon with whole-wheat toast.

7. WATCH THE BOOZEOne innocent-looking margarita or cosmopolitan can rack up hundreds of calories that do nothing to quench your appetite. Treat yourself just on the weekends and cut back somewhere else or stick to a glass of wine, light beer, or vodka and soda — three drinks that each have about 100 calories per serving.

8. HAVE FRUIT TWICE A DAYFruit has no fat and is mostly water, so it’ll fill you up while leaving less room on your plate (and in your stomach) for high-cal fare. Don’t freak about fruit’s carb count — we’re talking the good kind of carbohydrates that contain lots of healthy fiber.

9. STAY ASLEEP LONGERGetting to bed just 30 minutes earlier and waking up 30 minutes later than you normally do can help you make better food choices, researchers report. Also, when you’re well-rested, you’re less prone to snacking out of fatigue or stress.

10. VISUALIZE YOURSELF THINWhen you feel your willpower breaking, conjure up a mental picture of yourself when you looked and felt slim. The visual motivation keeps you focused on your goal weight and reminds you that it is attainable, since you’ve achieved it before.

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After Shen Yun performing arts shows on APR 22-23, Shen Yun’s symphony orches-tra will return to Sarasota for one concert

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Elite Tampa Bay April 2014