Best Practices - Second Quarter 2013

The Resource Guide to Your Medical Community

www.BestPracticesMD.com Second Quarter 2013

WOMEN IN MEDICINE

A look at the past with an eye toward the future

By Rod Evans

PLUS

Heart Healthy for Spring

Defend Against Skin Cancer

Obesity: Risks & Solutions

Hakeem Hosts Men Go Red

CONTENTS

Second Quarter 2013

PUBLISHER/CHAIRMAN Rick Clapp President Santiago Mendoza Jr.

EDITORIAL Editor Mary Alys Cherry Medical Director Victor Kumar-Misir, M.D. Contributing Writers Celyne Bueno-Hume Swet Chaudhari Mary Alys Cherry Rod Evans Betha Merit Greg Shockey Dianna Villarreal

ART Creative Director Brandon A. Rowan

Letter From the Medical Director 7 Four Horsemen of the Apocalypse - The Trojan Horse Wellness 8 Heart Healthy Ideas for Spring 10 Identifying and Fighting Cancer-Causing Obesity 11 Educating Parents on Childhood Obesity Prevention Local Focus 11 UTMB Starts Work on Victory Lakes Expansion 17 Hakeem Hosts Heart Benefit at West Mansion 19 Snapshots: Images from the Medical Community Cover Story 12 Women in Medicine Medicine 14 Dorothy Merritt, M.D. on EDTA Chelation 16 Choosing the Right Breast Enhancement Surgery 18 Accountable Care Organizations on the Rise 22 The Best Defense Against Skin Cancer 6 |www.BestPracticesMD.com | Second Quarter 2013

Graphic Specialist Victoria Ugalde Photography/Editing Brian Stewart

ADVERTISING Director of Advertising Patty Kane Account Executives Patty Bederka Natalie Epperly Ashley Karlen Santiago Mendoza Jr. Debbie Salisbury Amber Sample

PHONE: 281.474.5875 FAX: 281.474.1443 www.BestPracticesMD.com Best Practices Quarterly is trademarked and produced by Medical Best Practices Group, LLC. Best Practices Quarterly is not responsible for facts as presented by authors and advertisers. All rights reserved. Material may not be reproduced in part or whole by any means whatsoever without written permission from the publisher. Advertising rates are available upon request.

Best Practices Quarterly P.O. Box 1032 Seabrook, TX 77586 R.Clapp@Baygroupmedia.com

From the Medical Director

LETTER

Four Horsemen of the Apocalypse

THE TROJAN HORSE

By Victor Kumar-Misir, M.D.

T

“Timeo ‘DNA’ et dona ferentes”

hroughout human history, pandemic microbial plagues have periodically decimated mankind, and historically altered the geopolitical, socioeconomic landscape of the planet.

Inevitable bio-disasters – natural or terrorist, e.g., a highly contagious killer flu or a biologic weapon of mass destruction epidemic – will require mass screening of threatened populations to identify and isolate the infected, to prevent spread.

Infected non-English-speaking individuals in today’s multilingual communities may not get screened, and therefore would remain unrecognized and not isolated. As many may continue to work – as housekeepers, maids, drivers, gardeners, maintenance workers, etc.

– they would constitute a veritable microbial host ‘Trojan horse’ that would then disseminate the pandemic microbe widely, especially in the densely populated commercial and domestic institutions and thoroughfares that characterize most North American cities.

In bio-disasters, mass, multilingual medical screening would be crucial for identifying and isolating infected ‘Trojan horse’ microbial hosts, in order to prevent widespread microbial dissemination and socioeconomic disruption.

However, cost-saving and life-preserving trans-lingual, cross-cultural communication is not as simple as one would imagine and is fraught with unexpected dangers.

As an Emergency Room physician and Family Doctor, permit me to share with you a few of the experiences and lessons I have encountered over the past 40+ years, in attempting to meet this translingual and cross-cultural challenge.

Linguistic Equivalents: The use of dictionaries or computer translations is fraught with literal misinterpretation. In Quebec, “sick to your stomach (nausea)” is not the literal “mal a l’estomac” but “mal au coeur,” i.e. a weak heart. Nausea in battle was considered by the Normans, like Richard the Lionhearted, to indicate a lack of bravery, which was thought to emanate from the heart. This was assimilated in the post-1066 English Lexicon as ‘courage’ and ‘coward.’ In North Carolina, ‘nausea’ is “green in the gills,” and in Trinidad, it is “bad feeling,”

Conclusion: Trans-lingual communication is not a simple undertaking. In my experience, to be medically accurate in order to avoid serious clinical consequences, one must use my F A C T S methodology: Formal translation to be grammatically correct, Acculturated with vernacular linguistic equivalents, Contemporized in the original country, Tested in practice, and Subcultured for specific dialects.

CROSS-CULTURAL COMMUNICATION Gestures Can Be Misinterpreted In Bulgaria, tilting the head up and down means “No” (not “Yes,”) and sideways means “Yes” (not “No.”)

TRANSLINGUAL COMMUNICATION

“Hook ‘em horns,” the University of Texas rallying gesture, in Italy, means that one’s spouse is cheating. In Africa, it means levying a curse, but in Venezuela, it is a good luck sign. Showing the sole of your shoe is the ultimate Middle Eastern insult.

“What’s in a Name?” Names serve to identify individuals, but may also indicate origin. For example, names ending with: ‘-escu’ may be Romanian, ‘-deh’ Iranian, ‘-polous’ Greek, ‘-vic’ Serbian. Names beginning with: ‘Al-’ may be Arabic.

“ ” means “OK” in the United States. However, in France, it means “zero,” and therefore “you are worthless.” In Japan, it means “coins,” and indicates an offer of bribery. In Brazil, it refers to a private female orifice.

Words Can Be Misleading: “Oo” sounds like “No,” but means “Yes,” in Philippine Tagalog. “Nyet” sounds like “Yes,” but means “No,” in Russian. In Spanish, “Constipado” sounds like “constipation,” but means “nasal congestion,” and “Embarasada” sounds like “embarrassment,” but means “pregnancy.”

“ ” means “approval,” “great,” “good job,” or “hitch hiking” in the United States. In Nigeria, it is a rude gesture. In a bar in Japan it is the signal for “five drinks,” in Germany, “one drink,” yet pointing up with the index finger means you are ordering “two drinks.”

Informal interpreters’ disinformation: Bilingual bystanders, often relatives, are dangerous, because of unsubstantiated bilingual proficiency, breach of confidentiality and patient embarrassment.

Corridor consultations with non-medical staff, e.g. maintenance, can be more problematic because of misguided confidence. I once trusted a bilingual orderly, who, instead of translating my clinical instructions, was telling patients, in Chinese, that I wanted them to see a herbalist friend of his.

Formal interpreters’ misinformation: In 1983, at the Norman Bethune Hospital in China, a Western doctor told the large Chinese audience “In Canada, if a schoolteacher became pregnant out of wedlock, she would be fired.” Their best interpreter said “In Canada, if a schoolteacher became pregnant out of wedlock, she would be shot!”

 

Conclusion: “Be careful to use culturally-appropriate body language.”

The current trans-lingual, cross-cultural communication challenge is local and global, is real and important, and demands our professional response.

Victor Kumar-Misir, M.D., is an international physician, who has spent the past 40 years integrating trans-lingual, cross-cultural healthcare delivery with emerging information-management technologies, with input from physician executives of national academies of medicine in over 30 countries. He has been a media spokesman and key-note speaker in several countries, including the Society for Intercultural Education Training and Research (SIETAR). Fax: (281) 532-4329, email: jmlyon33@earthlink.net Second Quarter 2013 | www.BestPracticesMD.com|

7

By Betha Merit

HEART HEALTHY FOODS. You can do an internet search and come up with lots of information on the subject; perhaps too much information to digest.

T

here are lists for the top 25 foods for heart health, lists for a general heart healthy type of grocery list, and lists that make you question how accurate the information is on that web site. But you’ll be inspired. Inspired to learn more, adjust your diet towards more healthful choices, and pique your interest in trying new foods and recipes. As in all journeys, including the journey towards better heart health, you start it with one step and then just keep going.

Personalize your research to decide where you want to begin, and in what order you want to add new foods and subtract others.

A smart start is to add fiber through whole foods, fruits, and vegetables. One sage suggests five fruit and vegetable servings a day, another 10. Only you know what is realistic for your lifestyle, and what will truly motivate and be sustainable. There is much to be learned about cutting out processed foods, and that products labeled “low fat” or “diet” often have extra sugar, white flour, and additives that may counter balance their low fat advantage.

Here is a list of items that are in my kitchen and found on many heart healthy lists. Perhaps this rainbow of food options will jumpstart you towards a healthier heart plan:

8 |www.BestPracticesMD.com | Second Quarter 2013

•

Citrus fruits (oranges, clementines, lemons, limes, tangerines)

•

Kale (best of the leafy greens)

•

Cold-water fish (salmon, sardines, tuna are highest in omega-3 fatty acids)

•

Red wine (most sources limit daily to one glass for women, two for men)

•

Beans/Legumes (lentils, kidney, black, etc./rinse canned beans to cut down sodium content)

•

Nuts/Seeds (almonds, walnuts, pistachios, pumpkin seeds)

•

Pomegranate (whole fruit or juice)

•

Dark chocolate (at least 70% cocoa)

•

Tea (green or black)

•

Garlic (fresh, jar, and powdered all have benefit).

SPRING HEART HEALTHY MEAL The following recipe for kale and mango salad is colorful, tasty, and a great way to boost your fiber intake. Pair it with salmon (grilled or baked with garlic, dillweed, and lemon juice). Any fresh fish, Bay Area catch of the day, or your family’s favorite will also keep up the heart healthy theme if salmon is not your first choice. Grilled asparagus

with garlic and black pepper is a welcome side, and fresh blackberries, raspberries, and blueberries for dessert. If you must sweeten the berries, add a drizzle of honey.

Kale and Mango Salad Ingredients: •

• • • • • • •

6 cups fine to coarsely chopped kale, stems discarded (many stores sell rinsed, partially chopped kale in bags, with most stems removed) juice from 1 large lemon ¼ cup extra-virgin olive oil, plus a bit for drizzling sea salt 2 teaspoons honey freshly ground black pepper 1 ripe mango, diced small 4 tablespoons pumpkin seeds (pepitas)

Directions: In large mixing bowl, mix kale, half of lemon juice, drizzle of olive oil and sea salt.

Massage a few minutes with your hands until kale starts to soften and wilt. Set aside while you make dressing. In a small mixing bowl, whisk half of lemon with honey and lots of pepper. Whisk in ¼ cup of olive oil to your taste. Pour dressing over kale, add mango, and pumpkin seeds. Toss and serve.

Second Quarter 2013 | www.BestPracticesMD.com|

9

Identifying and Fighting Another Cancer-Causing Agent: Obesity

By Celyne Bueno-Hume, M.D.

T

he number of obese Americans is on the rise.

In 2009-2010, more than 78 million (35.7 percent) U.S. adults and about 12.5 million (16.9 percent) U.S. children and adolescents were obese, according to a 2012 study by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics. Many people understand obesity’s links to high blood pressure, high cholesterol, diabetes and heart disease. However, few are aware that obesity is also associated with increased risks of various cancers, including but not limited to:

• • • •

Breast cancer (after menopause) Endometrial cancer Esophageal cancer Colorectal cancer

Also according to the CDC, two of every three adults in the U.S. are overweight. While overweight and obese classifications are different, as defined by body mass index (BMI), being overweight can easily lead to obesity if body weight is not monitored and controlled. The excess body fat carried by people with obesity triggers the production of insulin and other hormones that can play a role in cancer growth. For non-smokers, being significantly overweight (having a BMI of 25-29.9) and maintaining a lifestyle of low physical activity can be among the most important risk factors for cancer.

The National Cancer Institute (NCI) conducted a projection study that looked at the future health and economic burden of obesity. If obesity trends continue, it is projected to lead to about 500,000 additional cases of cancer in the U.S. by 2030.

Identifying the Links Breast Cancer The relationship between breast cancer and obesity is greatly influenced by what stage in life a woman gains weight or becomes obese. Weight gain during adult life has been associated with an increased risk of breast cancer after menopause, likely due to increased levels of estrogen. The ovaries stop producing estrogen after menopause, making fat tissue the most important estrogen source. Because obese women have more fat tissue, their estrogen levels are higher, potentially increasing the growth rate of estrogen-responsive breast tumors.

Endometrial Cancer Cancer of the lining of the uterus has been consistently associated with obesity. Obese women have two to four times the risk of developing endometrial cancer than women of normal weight, and while the cause has not yet been determined, evidence points to diabetes, possibly also linked with low physical activity.

10 |www.BestPracticesMD.com | Second Quarter 2013

Esophageal Cancer People affected by obesity are nearly twice as likely to develop a type of esophageal cancer called esophageal adenocarcinoma. Key to explaining this disparity is gastroesophageal reflux disorder or Barrett esophagus, which is more common in obese people.

These conditions are associated with esophageal adenocarcinoma, and it’s believed that obesity further exacerbates esophageal inflammation.

Colorectal Cancer In men, an elevated body mass index is strongly associated with an increased risk of colorectal cancer.

Abdominal obesity, which can be measured by waist circumference, shows the strongest link to colon cancer, with the distribution of body fat as an important factor.

High levels of insulin or insulin-related growth factors are hypothesized as the link between obesity and colon cancer.

Making a Change: A Concerted Effort

In addition to the types of cancers listed above, obesity has also been linked to gallbladder, kidney, thyroid, pancreatic, liver, ovarian, stomach and uterine cancers.

This extensive list of cancers, along with other negative health implications caused by obesity, point to a clear need to correct the current trend, and everyone can play a role. Physicians must actively counsel patients who are obese or at risk of becoming obese. Patients bear the responsibility to maintain a physically active lifestyle and nutritionally balanced diet. Reducing the risk of cancer development requires a proactive approach in both patients and physicians.

To encourage people to engage in a healthier lifestyle, The University of Texas MD Anderson Cancer Center created the Healthy Bites Challenge. Maintaining a healthy diet can be difficult, which is why Healthy Bites asks participants to make small diet changes by completing one nutrition challenge each month.

To sign up or learn more, visit: www.mdanderson.org/healthybites.

Dr. Bueno-Hume is an assistant professor of general oncology at the MD Anderson Regional Care Center in the Bay Area. She received her medical degree from The University of Texas Medical Branch School of Medicine in Galveston. She is certified in medical oncology and hematology by the American Board of Internal Medicine.

Educating Parents on Childhood Obesity Prevention

By Dianna Villarreal, M.S., CHES

UTMB starts work on Victory Lakes expansion

By Mary Alys Cherry

B

olstered by its success in north Galveston County, the University of Texas Medical Branch has begun work on its $90 million building expansion project at Victory Lakes in League City that will include an emergency department and beds to accommodate patients requiring overnight stays.

The project will create 142,000 square feet of clinical space, allowing for the addition of 39 patient beds and inpatient stays of up to 72 hours in order to better serve its patients. In a related project, UTMB will build a central-plant facility to provide utilities to its 62-acre Victory Lakes campus.

“UTMB Health is committed to providing the best patient care possible in its mission to improve health for the people of Texas and around the world,” said Donna Sollenberger, executive vice president and CEO of UTMB’s Health System.

“We are excited that this expansion allows us the opportunity to provide more services and convenience to our patients who live in the rapidly growing Bay Area in a completely integrated system of care,” she said.

The project will require the temporary redirection of traffic in the area, UTMB officials said. However, throughout the project, access to the primary patient parking lot (at the front of facility) will be available from the I-45 northbound feeder road.

The clinical space project is valued at $82 million and is scheduled for

completion in February 2015. The contractor is McCarthy Building Cos. and the designer is HKS Inc. The centralplant facility is valued at $8 million and is scheduled for completion in August 2014.

It will generate electricity, emergency power, and hot and chilled water. The contractor is Tellepsen Builders and the designer is AEI Affiliated Engineers Inc. The Specialty Care Center’s ambulatory surgery and complex diagnostic services will expand to provide 39 inpatient beds for up to 72-hour stays, 17 emergency/urgent care treatment rooms, four operating rooms, endoscopy rooms and 25,000 square feet of shell space for future development. In addition, the finished site will provide increased imaging capabilities including an X-ray fluoroscopy facility, ultrasound and CT unit.

The utilities project will build a 5,000 square-foot plant to provide added thermal utilities, normal and emergency electrical power, and redundancy for each system at Victory Lakes. The system will be capable of independently providing electricity, hot water and chilled water for up to 72 hours. The design will provide for three 400-ton chillers and 6 million BTU of hot water.

UTMB opened the $61 million Victory Lakes Specialty Care Center, 2240 Gulf Freeway South, in 2010. It houses several clinics and currently covers 110,000 square feet. The University of Texas System Board of Regents approved the expansion at its meeting Nov. 14, 2012.

A

ccording to the Centers for Disease Control and Prevention (CDC, 2002) close to 18% of American children ages 2 to 19 have been diagnosed as obese. While there are many contributing factors that can lead to childhood obesity, the most common reason is based on an imbalance of consuming too many calories and the inability to burn those extra calories. The result is excess energy stored in the body, thus causing increased body fat. This can lead to children developing more serious comorbidities later in life that could decrease their life expectancy.

While childhood overweight and obesity continues to be a growing concern for parents and communities, there is hope! There are many government and community initiatives to teach and motivate families to make healthier choices with regard to health and exercise. A couple of websites that provide quick references to help educate parents with information and support are www.LetsMove.gov and www.

ChooseMyPlate.gov.

One way parents can show their children the importance of exercise and nutrition is to be a healthy role model. Children learn by observation and participation, and when families involve their kids in healthy decision-making, over time, these choices may become routine. Parents can also become advocates for their children’s health by contacting their community leaders to discuss ways of bringing childhood obesity awareness programs and resources to their schools and neighborhoods.

The United States Department of Agriculture (USDA, 2011) provides some quick tips for parents to initiate healthy choices for their children, all of which include being a healthy role model and incorporating healthy nutrition and exercise in a fun and rewarding way. *Before beginning a nutrition or exercise program for your child, you are encouraged to speak to your child’s pediatrician or medical provider for medical concerns and safety guidelines.

Second Quarter 2013 | www.BestPracticesMD.com|

11

“Women need to learn to support each other, but men need to learn to support women as well.”

WOMEN IN MEDICINE

A look at the past with an eye toward the future

A

By Rod Evans s the woman in the white lab coat holding a clipboard surveys the doctor’s office waiting room, an elderly gentleman patiently thumbs through an issue of Field & Stream. Right next to him, an obviously exhausted mom tries to soothe her flu-ridden daughter, while a 20-something guy with bandages on his arm from a weekend mountain bike crash lazily fiddles with his smart phone.

Not too many years ago, the waiting room occupants would have identified the woman in the white lab coat as a nurse, but no one bats an eye when she calmly calls out the name of her next patient. It’s a scene that’s regularly played out in thousands of waiting rooms and hospitals across the country, with

12 |www.BestPracticesMD.com | Second Quarter 2013

female doctors doing what doctors do: caring for the sick.

Today, many of us think nothing of seeing “Dr.” in front of woman’s name, but you don’t have to venture very far into the past to find a period when women seeking to become physicians were confronted with a host of societal and institutional barriers that effectively limited their healthcare industry career options to positions as nurses or mid wives.

In 1849, when New York’s Geneva Medical College made Elizabeth Blackwell the first woman to receive a medical degree in the U.S., her hard earned accomplishment was met with a flurry of protests from the public and members of the medical profession who believed that women lacked the mental, emotional and physical capabilities to serve as doctors. No one epitomized this belief

better than Harvard professor Edward H. Clarke, who believed that women who sought advanced education would develop “monstrous brains and puny bodies (and) abnormally weak digestion” among other maladies.

Despite the overt attempts to prevent women from entering the medical professions, several medical colleges for women were established near the end of the 19th century. With around 7,000 women working as physicians, nearly five percent of American doctors were female by 1900.

Those numbers would rise and fall during the first half of the 20th century, the result of medical education reforms and the closing of many of the female medical colleges, along with a societal shift that placed more value on a woman’s domestic skills than her education and professional prowess.

But lasting change arrived in the 1970s.

According to the American Medical Association (AMA), the number of female physicians increased six-fold between 1975 and 2010, rising from 35,636 physicians in ’75 to 296,607 in 2010. By 2010, the AMA reported that women made up over 30 percent of all U.S. physicians. Women now make up over 45 percent of new medical school entrants. Today, more than 60 percent of female physicians are concentrated in six specialties: internal medicine, family medicine, obstetrics/gynecology, pediatrics, anesthesiology and psychiatry.

Certainly, considerable progress has been made in making educational and training opportunities available to women, but elements of gender bias still exist that make certain medical fields more difficult for women to enter, and ascending to hospital leadership roles remains and ongoing struggle.

Uniquely Qualified Bonnie Broaddus-Benkula, associate vice president for health system service lines and ambulatory for UTMB Galveston, began her career as a fitness industry entrepreneur, but switched to hospital administration due to personal reasons.

“I lost my mother to emphysema and after she got ill I was disenchanted with the care she was given,” Broaddus-Benkula says. “I was infuriated with how she was treated as

a non-person. Having been in business for myself, I knew how important customer service is and was appalled at what I saw.”

Broaddus-Benkula went back to school at age 29, earning a degree in healthcare administration from the University of Texas Medical Branch at Galveston (UTMB).

She earned a second degree in long term administration and began specializing in senior care and believes women are uniquely qualified to be effective healthcare institution leaders.

“I can think of no other product that people purchase that’s more heavily influenced by women because they are usually the decision maker for healthcare

“Men tend to support and bring each other up, but women can be jealous of or intimidated by another woman’s success,” she says. “Women need to learn to support each other, but men need to learn to support women as well.”

Receiving equal pay with men continues to be a hurdle for many women in the healthcare industry. Researchers from the University of Michigan Health System and Duke University found that women could expect to earn $360,000 less over the course of their 30-year health profession career than men working the same hours with the same qualifications. The same study showed that among 800 physicians who received an early career research grant, women earned an average of $12,194 less than men a year.

The study suggests that part of the discrepancy could be attributed to the fact that women tend to gravitate toward less well paying specialties like pediatrics, obstetrics/gynecology and anesthesiology. But career path choices don’t fully explain the income gap, as the researchers found that gender bias exists on both a conscious and subconscious level and that women would be well served to be more forceful in negotiating their salaries to demand equal pay.

“Women have to have confidence that they can do the job well and companies have to implement major shifts in their culture to raise awareness to not allow any biases to creep into the decision making process. They should also develop solid career opportunities and paths for women to succeed,” adds Broaddus-Benkula.

Even as the number of female physicians increases, there are still areas of practice that remain male dominated. Michele Blackwell, M.D., a physician in private practice in Bay Area Houston with hospital privileges at the Clear Lake Regional Medical Center, says

“Women now make up over 45 percent of new medical school entrants.” in their family. I think it’s important that (healthcare) companies begin to learn that it’s important to have female leaders to help them become empathetic to the position of the patient,” she says.

Broaddus-Benkula, 55, believes the advances women have made in becoming physicians and health system leaders should be celebrated, but much work is still needed to help level the playing field. She cites statistics from the U.S. Bureau of Labor Statistics that show that only four percent of healthcare system CEOs are women and says the lack of female executives can be attributed to several factors, many of which women can control.

surgical positions are still primarily held by men and believes that women are often discouraged from pursuing such positions.

“As I did my clinical rotation, I noticed that women are dissuaded from entering certain fields,” Blackwell, 44, says. “I loved surgery, but there are very few women in general surgery and the women that were in surgery were not treated equally. I remember thinking, ‘I’d love to do this, but I don’t want to be like those women.’”

The Next Generation As women join the general workforce in greater numbers—labor statistics show women comprise 49 percent of the U.S. workforce—it’s become vital for female physicians and healthcare system leaders to serve as mentors and role models for the next generation. Blackwell, who has a 14-yearold daughter who has expressed interest in pursuing a medical career, says she gives the same advice to other young medical career hopefuls as she does her daughter.

“My daughter told me, ‘Not to make you feel bad, but I don’t want to do what you do.

You’re away so much.’ I tell her you can do what I do, but in a different environment.

You should choose what you want to do because you do spend a lot of time at work, and you need to find a good work-life balance,” Blackwell says.

Dr. Raquel Mena, 50, a pediatrician with the Texas Gulf Coast Medical Group, says she tells young women interested in a career as a physician to, “Study hard and do it because you want to; not because someone else wants you to be a doctor.”

Broaddus-Benkula, recipient of the 2012 ATHENA International Leadership Award of the Bay Area (the award recognizes the work of those who help to improve the quality of life of others), relishes the opportunity to mentor young women seeking medical careers.

“I tell them (young women) that gender does not define success and that they can emerge as a transformative leader by using their intuitive strengths as women to become the best leader they can be.”

Team Building The recent book by Facebook CEO Sheryl Sandberg titled “Lean In: Women, Work and the Will to Lead” has been met by criticism in some quarters largely because Sandberg takes women to task for not aiming high enough for positions on the organizational chart and for underestimating their abilities. It’s a theory that Broaddus-Benkula does not discount.

Second Quarter 2013 | www.BestPracticesMD.com|

13

“I have seen countless cases of patients experiencing improvements—some quite miraculous—because of EDTA chelation.” coaster of attacks at every level: personal attacks, attacks at the Texas Medical Board level for advertising, attacks by insurance companies who drop chelation docs for no reason and now even from the chief of all ‘quackbusters,’ who attacks all chelation docs who have a website. But I’ve stood firm in my beliefs, based on the science, not the emotion, and because of my dedication to offering my patients everything I possibly can to improve their health and the quality of their lives. I have seen countless cases of patients experiencing improvements—some quite miraculous— because of EDTA chelation. The treatment has obvious benefits, in my opinion. I do not do this instead of traditional therapy, but rather in addition to evidence-based therapies that we now have, including smoking cessation.

How will the TACT trial affect your practice and your patients?

Dorothy Merritt, M.D.

The trial has certainly been sending shockwaves through the medical community. Costing $32 million, it was the first large-scale scientific study designed to investigate the relationship between disodium EDTA chelation and the reduction of cardiovascular disease.

The study revealed that there were no significant complications with EDTA. Secondly, it determined that EDTA improved outcomes 39 percent in diabetics with previous heart attacks.

These findings show that EDTA chelation does get the kind of positive results that many of us were already aware of. It is safe, low-cost, and now ‘proven,’ even though the calcium EDTA version has been FDA approved for lead toxicity since 1955. I am going to continue to offer this safe treatment and hope that the attitudes of the medical community change as the research continues to show it is both cost effective and effective.

D

orothy Merritt, M.D. is a board certified internal medicine physician and has been a pioneer in the field of integrative medicine for over three decades. She believes in an approach to medicine that promotes wellness and natural healing by providing the body what it needs nutritionally, but also one that uses pharmaceuticals and invasive treatments, when necessary, to reverse damage already done.

Why are you such a believer in EDTA chelation treatment?

I was researching an amino acid called NAC, and ended up on a chelation website, ACAM.org. What I found both intrigued and alarmed me—pages and pages of scientific references, mostly to positive cardiovascular studies, and pages of court cases against doctors who used it to treat patients for vascular-related disease. It was my introduction to the politics of medicine.

Many medical doctors thought I was crazy when I began to incorporate EDTA into my medical practice, treating people with an amino acid that binds lead and other metals, along with some B vitamins—and is very safe despite all the fear mongering among people who don’t understand what the procedure really is.

I have experienced firsthand how people have attacked doctors who offer their patients chelation therapy. It’s been a roller

14 |www.BestPracticesMD.com | Second Quarter 2013

SOUTHWEST WELLNESS SOLUTIONS 668 FM 517 West, Dickinson, TX 77539 www.swwellness.com 800.360.3382 • 281.218.6700

Choosing the Right Breast Enhancement Surgery

A

ccording to the American Society of Plastic Surgeons, breast enhancement surgeries are still the most common procedures performed by plastic surgeons. In 2012, over 300,000 breast augmentations and over 90,000 breast lift surgeries were done.

Breast augmentation or breast lift?

If you are considering breast enhancement surgery to improve your appearance, you may be wondering which procedure is appropriate for you. Breast augmentation can give a woman with small or unevenly sized breasts a fuller, firmer, better-proportioned appearance, and can restore volume following breast feeding or weight loss. A breast lift most commonly

“Keep in mind that you’re also undergoing a major procedure; therefore it’s critical that you do your homework.” addresses sagging – also called ptosis -- and the presence of extra skin on the breasts.

A lift will improve the contour and shape of the breasts, but will not significantly alter the size or volume. Likewise, a breast augmentation alone will add volume, but will not significantly correct the issues of sagging or extra skin. Therefore, some women find that a combination of both procedures provides the new look they desire.

As you weigh your options, ask yourself this simple question: Do you like the volume of your breasts within your bra? If the answer is YES, then you are likely more concerned about sagging breasts and a breast lift is most likely the right procedure for you. Conversely, if the answer is NO, then more volume with what you are seeking and an augmentation is likely your best choice.

Finding a surgeon that listens.

Once you’ve researched your options, do your due diligence to find a plastic surgeon that will be the right fit for you. A good

16 |www.BestPracticesMD.com | Second Quarter 2013

plastic surgeon will take the time to listen to your needs and concerns, and will not only help you decide which procedure is right for you, but will discuss details such as implant size and type, expected outcomes, and even surgical risks. A good plastic surgeon will work with you to create natural results that look amazing and restore your confidence.

Breast augmentation will not only transform your body, but can give you a new, positive outlook. But keep in mind that you’re also undergoing a major procedure; therefore it’s critical that you do your homework.

Invest the time to learn about various breast enhancement options, then be bold in seeking out a surgeon that will partner with you to not only achieve your desired appearance, but also to protect your optimal health.

Do your homework on your surgeon.

A cosmetic surgeon is not always a plastic surgeon, so do your homework

when choosing a surgeon for your breast enhancement. Ask your surgeon about their type of training and board certifications.

Trust only a board-certified plastic surgeon for your breast enhancement surgery.

Certification by the American Board of Plastic Surgeon ensures that your surgeon has undergone rigorous training and examination process to provide you with the highest quality of care and the best results for your plastic surgery procedure.

Dr. Chaudhari is a board-certified plastic surgeon and was recently voted by the readers of the Journal Newspaper as the Best Plastic Surgeon in Pearland and Friendswood.

Men Go Red for Women Chairman Santiago Mendoza Jr. and committee members Dr. Patrick Briggs, Dr. Marcus Giacomuzzi, Dr. Michael Lyons and Matthew Emory, from left, prepare to greet the arriving crowd at the American Heart Association benefit at the West Mansion.

Clear Creek ISD Superintendent Greg Smith chats with Hakeem Olajuwon during American Heart Association benefit at the West Mansion.

Hakeem Hosts Heart Benefit at West Mansion

By Mary Alys Cherry

BAY AREA PHYSICIANS and community leaders got an up close look at the newly renovated West Mansion when Men Go Red for Women joined NBA legend Hakeem Olajuwon in hosting an exclusive event benefitting the American Heart Association. ocal healthcare leader and Men Go Red Chairman Santiago Mendoza Jr. and committee members Drs. Patrick Briggs, Ronald Castagno, Matthew Emory and Marcus Giacomuzzi joined the former Houston Rockets superstar in welcoming the crowd that came to advocate for the heart health of the women in their lives and see the beautiful “new” mansion that now houses Olajuwon’s new upscale DR34M collection of fine clothing and accessories.

And, before the evening was done, they had raised nearly $20,000 for the American Heart Association and Hakeem had graciously posed for what seemed like a thousand photos.

Clear Creek ISD Superintendent Dr. Greg Smith was in the crowd, as were Clear Lake Area Chamber Past Chairmen Jim Sweeney and Michael Divine, attorneys John Gay and Becky Reitz, Bay Area Regional Medical Center CEO Dr. Michael Lyons and his wife, First Financial Benefits President Rick Gornto, Bay Area Houston Magazine

Chairman Rick Clapp, Top Star Marketing Consultant Pierr Castillo, Tisa and Dr. Mitch Foster and Wealth Advisor Margaret Sucre Vail.

Before long, the basketball Hall of Famer invited all back to the East Wing for a short program by Santiago on joining the Circle of Red. Many went on to make $1,000 donations to become members of the Circle of Red, including Hakeem, Santiago, Dr. Greg Smith, Rick Lammers and his wife, Jill Williams, Dr. Michael Lyons, John Boettcher, Dr. Patrick Briggs, Dr. Marcus Giacomuzzi, John Gay, Earl Armstrong, Mike Gallagher, Michael Rosenblatt and Matthew Emory.

Men Go Red for Women is a dynamic and committed group of men rallying their resources to fight heart disease, the No. 1 killer of both women and men. “We’re standing behind the women we care about – wives, mothers, daughters, sisters and friends – by inspiring communities to provide funds for research and lifesaving programs,” Santiago said.

NBA legend Hakeem Olajuwon visits with Clear Lake attorney John Gay as he arrives at the Heart Association benefit at the West Mansion.

Dr. Patrick Briggs and Dr. Marcus Giacomuzzi look over their host’s basketball memorabilia in the west wing of the West Mansion.

Second Quarter 2013 | www.BestPracticesMD.com|

17

Accountable Care Organizations the Focus of Upcoming Expo

T

he healthcare delivery landscape is changing as Accountable Care Organizations (ACOs) are quickly becoming commonplace. Texas is home to more than 20 ACOs with many located in Houston, including the nation’s first accredited ACO. While these new organizations are only one of many innovative healthcare delivery models currently being studied by the Centers for Medicare and Medicaid Services (CMS), they are the most prevalent and the most discussed. ACOs represent an important part of healthcare reform and embody CMS’ triple aim of improving the individual healthcare experience, improving the health of populations and reducing the overall cost of healthcare.

There are currently 259 Medicare ACOs caring for approximately 4 million beneficiaries. What is making this model so popular? Perhaps it is the belief that this interesting concept indeed has the potential to substantially improve the nation’s healthcare conundrum. Here is a brief description of how it works. Hospitals, physicians and other providers voluntarily join together to participate in an ACO with the goal of delivering high quality coordinated care which leads to improved outcomes and reduced costs. Patients are free to receive care anywhere they choose and all providers are paid under existing payment methods. If the ACO is successful in achieving these goals, they receive a portion of the savings that is realized. The logic behind this model is that it enlists those most involved in the delivery of care, and theoretically best equipped, to find implementable solutions to our current system’s shortfalls.

It is widely believed that our healthcare system is in need of improvement. Some specific areas that have been identified as needing improvement include electronic health records, transitional care coordination,

18 |www.BestPracticesMD.com | Second Quarter 2013

May 7, 2013 at the Hilton Houston Southwest

lack of physician involvement, elimination of redundant services, patient education, medication errors, and patient compliance with treatment regimes. ACOs seek to achieve the triple aim by addressing these areas with their own innovative strategies.

These strategies generally include the use of nurse case managers, increased use of information technology, patient education programs, wellness initiatives, increased involvement with the patient’s primary care physician, and improved coordination throughout the entire patient care continuum.

According to CMS, 2011 spending for Medicare beneficiaries with two or more chronic conditions was about $276 billion or about 93% of all Medicare spending. Certain chronic conditions are disproportionately costly. Among the most costly 10% of Medicare beneficiaries (those in the top decile of Medicare spending), over half had Congested Heart Failure (CHF), as compared to less than 15% of the total Medicare population. Other statistics show that one in five beneficiaries discharged from the hospital are readmitted within 30 days, and one in three are readmitted within 90 days. Since chronic conditions have some of the highest incidence of readmission and account for such a large portion of Medicare spending, this population has become the target for many of the initiatives of healthcare reform.

One problem is a lack of coordination between hospitals and the various healthcare providers who care for patients upon discharge. Collaboration, especially between acute and post-acute care providers, has been identified as essential to achieving the initiatives included in the Affordable Care Act and ACOs in particular. Collaboration has become the buzz word of healthcare reform.

Unfortunately, it is more often a topic of discussion than practice. Healthcare delivery and payment systems of the past few decades

have been responsible for developing a very disconnected care continuum. This urgent need for bringing the various care providers together was the inspiration for the creation of national series of healthcare collaboration forums called the Accountable Care Expos.

The first Expo was hosted in Houston in May of last year, followed by Expos in Dallas, Chicago, Las Vegas and Ft. Lauderdale.

On May 7 the Accountable Care Expo returns to the Houston area. Providers from Houston, the entire Texas area, and all over the Southern United States will come together to share ideas and experiences on achieving Accountable Care initiatives, technology, and care transition strategies.

The Expo provides a forum for providers and other stakeholders to connect with likeminded potential care partners. This Expo will be held at the Hilton Houston Southwest from 8:30 a.m. to 4:30 p.m. The practical format and low cost ($129) is helping to make the Expo to be recognized as one of the premiere collaboration events of the Accountable Care discussion.

The Expo will also feature an ACO workshop with a panel of national experts from various sectors of the market place.

This is a practical nuts and bolts session where those in attendance can ask the panelists questions regarding the regulatory, operational, clinical, technological, strategic, and legal aspects of Accountable Care Organizations. It is an opportunity for new and prospective ACOs, as well as other providers who would like to learn more about participating in this new healthcare delivery entity. This includes hospitals, physicians and post-acute care providers of all kinds.

Greg Shockey is the managing member for Accountable Care Expos,LLC. He has been involved in the healthcare industry in Houston, and nationally, for nearly 20 years as an accountant, consultant, and proprietor of various healthcare ventures.

S N A P S H O T S

Regis Philbin speaking at the CHRISTUS Foundation for HealthCare Spring Luncheon.

Fay Dudney, Vaness Hamilton, Ida Hernandez and Anika Glover, pictured from left to right, look over a scale model at UTMB Health’s Specialty Care Center.

NBA legend Hakeem Olajuwon with Best Practices Quarterly President Santiago Mendoza Jr. and the Women Go Red Luncheon Executive Committee.

Dr. Fukshansky, on the left, and Dr. Sparrow, in the zebra dress, hold the ceremonial scissors at the CLACC ribbon cutting for the Spine and Joint Pain Center at 250 Blossom, Suite 120,
Webster, TX.

LyondellBasell continued its support of the UH-Clear Lake Environmental Institute by presenting a $5,000 check for the WaterSmart Demonstration School Habitat Lab and the Texas Envirothon, an annual high school environmental competition. Participating in the presentation are Environmental Institute of Houston Habitat Curriculum Specialist Sheila Brown and Executive Director George Guillen; LyondellBasell Regional Public Relations Manager Gayden Cooper and Bayport Site Manager Walter Pinto; and Texas Envirothon Coordinator and Environmental Education Program Coordinator Wendy Reistle.

Bay Area Houston Magazine Vice President Patty Kane chats with Jeanette Walker, owner of the Cock and Bull British Pub at the Go Red for Women Luncheon.

Second Quarter 2013 | www.BestPracticesMD.com|

19

There are different types of brain injury. A traumatic brain injury (TBI) is an injury to the brain caused by an external force after birth. Common causes of a traumatic brain injury include gunshot wounds, motor vehicle crashes, assaults, or falling and striking your head. An acquired brain injury (ABI) includes all types of traumatic brain injuries and also brain injuries caused after birth by cerebral vascular accidents (commonly known as stroke), and loss of oxygen to the brain (hypoxic brain injury).

According to the CDC, TBI is the number one cause of death and lifelong disability in the United States. TBI is an important public health concern.

A

ccording to the Brain Injury Association of America, a “brain injury is not an event or an outcome. It is the start of a misdiagnosed, misunderstood, under-funded neurological disease. Individuals who sustain brain injuries must have timely access to expert trauma care, specialized rehabilitation, lifelong disease management and individualized services and supports in order to live healthy, independent and satisfying lives.”

In 2009, the Centers for Disease Control and Prevention (CDC) identified approximately 3.5 million medical encounters and deaths in which TBI was one of the diagnoses listed in health care providers’ medical records or vital statistics (Coronado et. al. 2012).

The breakdown of the data: • 1.1 million were identified in office-based physicians • 84,000 in outpatient departments • 2.1 million in emergency departments (EDs) • 300,000 in hospitalization records • 53,000 died (Coronado et. al. 2012 )

20 |www.BestPracticesMD.com | Second Quarter 2013

• • •

1.7 million people sustain a TBI annually in the U.S 52,000 people die 275,000 are hospitalized

Children aged 0-4 years and adolescents aged 15-19 years are most likely to sustain a TBI. Almost half a million emergency department(ED) visits for TBI are made annually by children aged 0-14 years.

Approximately 18% of all TBI related ED visits involved children aged 0-4 years.

In the last decade, ED visits related to TBI increased by 60%.

PrinsaBella Mia Foundation is devoted to helping children and their families with surviving a traumatic brain injury by raising awareness, education, and providing financial and spiritual support in the Houston/Galveston area.

To make a donation or learn more about PrinsaBella Mia Foundation, please visit their website at www.prinsabellamia.org or via email at info@prinsabellamia.org.

Knowing Your Body: The Best Defense Against Skin Cancer eeping track of the spots on your skin is a must for beating skin cancer. And luckily, more than half of skin cancers occur in areas of the body easily within view. According to experts at The University of Texas MD Anderson Cancer Center, one of the most important things you can do is get to know your skin.

The most common locations for melanomas—the deadliest form of skin cancer—in men are the chest and back. In women, the legs are the most common sites.

Pay special attention to these parts when examining your skin, but don’t forget to check less common areas as well.

The idea is to get familiar with your entire body. Learn where your birthmarks, moles and blemishes are, and what they

22 |www.BestPracticesMD.com | Second Quarter 2013

usually look and feel like. You should be familiar with what is normal for you.

Look for new growths, spots, bumps or patches. Also, pay attention to sores that don’t heal within a couple of months.

See your doctor right away if you notice any unusual skin changes. Skin cancer is the most common of all cancers, but it’s also the easiest to cure if found and treated early.

Use this Body Mole Map from the American Academy of Dermatology to record your skin spots, and if you notice anything unusual make an appointment with your dermatologist or call MD Anderson at 1-877-MDA-6789.

To learn about the physicians and services at the MD Anderson Regional Care Center in the Bay Area, visit www.MDAnderson.org/BayArea.