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MD NSIDE MEDICAL MAGAZINE

SHANE MATT, DDS: AUSTIN’S ROCK ‘N’ ROLL DENTIST [PAGE 16]

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NSIDETHISISSUE NOVEMBER.DECEMBER 2013 30 Dallas

PATIENT 30 » Working her magic FITNESS 32 » 'Sur-thrive-al of the fittest'

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34 Houston

PROFILE DR. RICHARD FRANCIS

A true trailblazer in his field, this recognized leader in orthopedic surgery serves as the backbone of spine surgery at Spine Associates, combining his expertise in and passion for his craft to efficiently help his patients.

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PATIENT 38 » Beauty becomes you 40 » Different from the rest 4 1 » Minimally invasive revolution

Page 42

HEALTH & WELLNESS 42 » Clap two times for fitness! MD 44 » The equation for success

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16 Austin

PROFILE DR. SHANE MATT

Always staying ahead of the curve, Austin's "rock 'n' roll dentist" remains committed both to his profession and to making a holistic difference in the lives of those in need at Authentic Smiles Dental Studio.

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PROFILE DR. ROGELIO TREVIÑO

This primary care physician flies high for WellMed at its new Georgetown clinic, furthering the mission of emphasizing cutting-edge preventive care for our aging population in Williamson County.

PATIENT 22 » Raising the bar 24 » A voice for education 28 » 'Dr. Z in circle C'

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NSIDETHISISSUE (CONT'D) 46 Laredo 48

Rio Grande Valley

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Page 50 PATIENT 48 » Something to smile about HEALTH & WELLNESS 50 » InforMD

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56 San Antonio FEATURE 56 » Excellence in health care NONPROFIT 62 » Partners for prevention 64 » A dream of healing

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PROFILE MEDFIRST PRIMARY CARE

The team of compassionate physicians at the largest multispecialty group in South Texas provide passionate, quality care with the goal of helping their patients achieve optimal health and well-being.

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PROFILE MANUEL DIOTTE AND THE FERRARI KID

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PROFILE DR. SON NGUYEN

In true embodiment of the American Dream, this boardcertified family practice physician fulfills his father's dream and shares his amazing story of survival and success.

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PROFILE THE BONILLA FAMILY

With five children who have successfully followed in his footsteps, Dr. Jose Bonilla leads a family of dedicated physicians who continue their family legacy of values, hard work and dedication.

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PROFILE DR. CLINTON FALK

Through his dedicated efforts at CWF Periodontics and Implants, this periodontist provides his patients with the best in oral and overall health care every step of the way.

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PROFILE DR. KUMAR REDDY

This physician answers his calling to practice medicine and performs double duty to help patients by focusing on two multidisciplinary specialties: neurology and sleep medicine.

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PROFILE THE RIZZO MEN

Proudly continuing their ItalianAmerican legacy in San Antonio and sticking to their family values, Mark Rizzo and his sons, Nathan and Nicholas, serve as two out of three generations of proud Central Catholic High School alumni.

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- An ounce of prevention - A pain in the chest - Prize multi-tasker

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108 » Keeping breast cancer risks at forefront can lead to early detection and treatment

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NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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NSIDE Texas MD Magazine - November.December 2013

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NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013


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NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013


NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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AUSTIN // PROFILE

ON TOP of the

WORLD

MORE THAN JUST A DENTIST, DR. SHANE MATT OF AUTHENTIC SMILES DENTAL STUDIO SERVES NOT ONLY AS AUSTIN’S “ROCK ‘N’ ROLL DENTIST,” BUT ALSO AS A LIFECHANGING PHILANTHROPIST WHO REMAINS DEDICATED TO MAKING A DIFFERENCE FOR THOSE IN NEED. [SPECIAL TO NSIDE] Photography: [KELLY RUCKER]

G

rowing up in Central Louisiana, Shane Matt, DDS, was born into a family with 12 members who worked in dental offices. His mother was a dental hygienist, and his grandfather was a general dentist. Having an uncle who was a pediatric dentist added to the dental mix that obviously had a tremendous impact on paving his future. Yet Dr. Matt did not explore dentistry as his primary focus until he was in graduate school. Throughout his college years at the University of Louisiana at Lafayette (ULL), Dr. Matt thought he wanted to go to medical school or graduate school for marine biology or evolutionary ecology. “The idea of medical school came from working in a hospital pharmacy soon after high school, but I was constantly challenged by memories of Jacques Cousteau, who inspired many dreams for me when I was very young.” Excelling in all the graduate-level biology classes he took that would have led to a different career path, Dr. Matt became president of the ULL premed society, and he worked as a guide for scientific research on bird populations in the Atchafalaya Basin after Hurricane Andrew. “It took some time, but I realized that I wanted to work with people and I really liked working with my hands.” He applied and was accepted to the Louisiana State University School of Dentistry in New Orleans. Moving to Austin after graduating in 1999, Dr. Matt worked in a large practice with several den-

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tists in Round Rock, and then he worked for a smaller office in Cedar Park. In 2001, he opened a practice with another dentist in Westlake. “We had a great concept, but it didn’t quite fulfill my vision. By 2005, I realized that I needed to establish my business in the core of downtown.” This decision did not come to fruition overnight. It took three years and contracts on several locations before a deal was reached with AMLI in the 2nd Street District, and Authentic Smiles Dental Studio opened in October 2008. “The location is perfect for all the things I love,” Dr. Matt explains. “As a sponsor for KLRU and Austin City Limits, we enjoy many shows next-door at ACL Live. My favorite restaurants are within walking distance, and as a mountain biker, some of the best trails in Texas are one block from my front door.” Not only is 2nd Street a perfect location that Dr. Matt enjoys, but his patient population appreciates downtown Austin either before or after their appointment with him. His clients are a mix of every background imaginable. Seventy percent are single adults, and fewer than 3 percent are under 18 or over 70. Only 13 percent live downtown. Many of Dr. Matt’s patients travel from places such as London, Los Angeles and the Cayman Islands, as well as other Texas cities including Dallas, Houston and San Antonio. “I have a sincere passion for my profession and all of the specialties,” he says. “As a general dentist, it is possible to do any procedure and I do almost ev-

erything. Yet my favorite is aesthetic dentistry. I prefer to use the term ‘aesthetic’ rather than ‘cosmetic.’ One may be able to make a cosmetic change, but it may not be aesthetically pleasing. Aesthetically pleasing smiles appear healthy and convey a message of a positive self-esteem. I have seen many clients whose lives have changed after a smile makeover. Sometimes it is as simple as reshaping the teeth, whitening or bonding resin, or it may be a full smile of veneers, which I personally craft for each individual.” There are no temporaries, since each veneer is made onsite as each tooth is prepared. It is no wonder that Dr. Matt is an exceptional dentist with a faithful following throughout Texas and abroad. As far as dentistry goes, Dr. Matt rarely refers out procedures. He occasionally does so for root ca-


“I HAVE A SINCERE PASSION FOR MY PROFESSION and all of the specialties.”

nals, severely impacted wisdom tooth extractions and a few other invasive surgical procedures that he feels are better handled by a board-certified specialist. Dr. Randy Kunik is the only orthodontist downtown, and he works out of Authentic Smiles loft space on Mondays. Invisalign Austin is the only adult orthodontic practice in Austin. Dr. Matt adds, “I also make many referrals to physicians for sleep studies to assist in sleep apnea treatment, chiropractors and physical therapists to complement treatment of TMJ/bite dysfunction and to functional medicine physicians to guide those ready to make healthy lifestyle changes.” Dr. Matt has been able to achieve superb results due to his talent, his skills, his education and a series of continuing education courses. His first series after dental school were in aesthetics at the

Las Vegas Institute for Advanced Dental Studies. These were followed by courses in dental implants and advanced courses using the CEREC same-day crown system. For the past five years, he has been able to do a complete smile makeover in one day. The CEREC crown system eliminates multiple visits and allows for impressions and more anesthesia with CREC technology. The technology utilizes a 3-D infrared camera, CAD/CAM software and a milling unit to prepare the crown onsite while the patient waits. This allows Dr. Matt’s patients to return to normal activities within the day versus the standard process of a temporary crown and receiving a replacement three weeks later. Visits are seamless, and the patient receives 100 percent restorative strength with a natural-looking tooth within the hour.

“The most difficult of these cases are those with bite or TMJ dysfunctions that can cause aesthetic restorations to fail,” Dr. Matt says. “Recognizing the potential for these problems is essential and may involve the use of a night guard appliance or treatment of TMJ/bite dysfunctions prior to aesthetic restoration.” Authentic Smiles Dental Studio has a room specifically for treating TMJ and bite dysfunctions. These clients are referred out if surgery is the only option or for a second opinion if surgery is one of the options. As the foundation of Dr. Matt’s practice, neuromuscular dentistry considers the dynamic physiological relationships of both the hard and soft tissues to produce a harmonious relationship between the teeth, joints, muscles and nerves. Optimum results are achieved when the teeth, jaw NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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muscles and joints are in a balanced position. With computerized mandibular scanning and simultaneous electromyography, Dr. Matt can objectively correlate the jaw’s posture with muscle activity. “This is important because it ensures that the patient is pain-free and that we’ve stopped the forces that wear teeth down, cause gums to recede and can be destructive to the jaw joints.” Dr. Matt utilizes transcutaneous electric neural stimulation (TENS) treatments in the privacy of a separate treatment room. TENS relaxes the jaw muscles and eliminates accommodations to a bad bite. Typically, one hour of treatment relaxes and lengthens muscles and deprograms accommodative neuromuscular memory. Jaw tracking and electromyography (EMG) analysis is done to determine how much one is accommodating to a bad bite. Then, after TENS treatments, muscle function is measured with EMG to determine the most stable physiologic bite position. It is the bite position to which TMJ treatment, Pure Power Mouthguards and cosmetic reconstruction are designed.

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NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013

As the leading provider of OraVerse in the Austin area, Dr. Matt is ahead of the curve by providing his patients with the first and only product of its kind to rapidly reverse the effects of local dental anesthetic so they can feel, speak, smile and drink normally in approximately half the time. OraVerse is administered by Dr. Matt immediately following the anesthetized procedure, allowing for a return to normal sensation and function in about half the time. Being a well-respected dentist is paramount – but Dr. Matt has gone beyond that status. Actively involved with the Health Alliance for Austin Musicians (HAAM) even before its inception, Dr. Matt says, “Eventually, I had so many musician friends that it became evident for me to develop my business and marketing events around support for HAAM. Authentic Smiles was designed to function as a music venue for special events and art shows.” One such event is the annual Mouth by MouthWest parodying a local festival of a similar name and benefiting HAAM. Songwriters Rod Williams and Wendy Colonna and producer Mark Addison

came together to produce a holiday album in 2011 and 2012. These events raised money for struggling artists in the music community. Dr. Matt is pleased to announce that the third annual Mouth by Mouthwest concert series and fundraiser will take place on March 13 and 14 at Authentic Smiles Dental Studio from 4 or 5 p.m. to 10 p.m. nightly. The event will feature live music by celebrated Austin musicians (many of whom are also beloved Authentic Smiles patients), as well as several outof-town guests. All proceeds will benefit the HAAM in an effort to make comprehensive dental care for Austin-area musicians feasible. Austin is the Live Music Capital of the World, yet many professional working musicians are self-employed and rarely have access to health insurance. Without insurance, they can’t afford preventive health care, including primary medical care, basic dental services and mental health counseling. “I moved to Austin because I love music,” Dr. Matt says. “Being a proud supporter of HAAM since its inception, I help to raise awareness for HAAM and garner publicity for the Health Alliance for Austin


Musicians. Before I ever thought about moving downtown, songwriter David Baerwald began calling me the ‘rock ‘n’ roll dentist,’ as did Charlie Sexton and Savannah Welch of The Trishas. My friend and PR maven, Mary McKeown-Christie, heard that and ran with it. In doing so, she created a marketing edge for me in the Live Music Capitol of the World. “All of this was possible because Will Sexton became one of my dearest friends. He introduced me to dozens who introduced me to dozens, including a long-lost cousin. He broke the ground for me by combining my passion for music with my profession through live music shows at Authentic Smiles Dental Studio, which put my heart on top of the world in a place I truly love.” Dr. Matt is truly more than a dentist. He is a lifechanging philanthropist who engages daily to benefit the outcome of each life he encounters. Be it through his involvement with HAAM or their affiliates the SIMS Foundation (www.simsfoundation. org), the Seton Healthcare Family (www.seton.net), Estes Audiology Hearing Centers (www.hearlifeagain.com) or Prevent Blindness Texas (www.pre-

“I MOVED TO AUSTIN BECAUSE I LOVE MUSIC.”

ventblindness.org), Dr. Matt endeavors to make a holistic difference to those in need. Dr. Matt’s short- and long-term goals are basically the same. He is on the Access to Care Committee for the Capital Area Dental Foundation. Their objective is to organize dentists in the community to volunteer as a resource for people in need. “My goal is to have every dentist in the area participating in one of our programs,” he says. “As for Authentic Smiles, I would like to see this business as a brand known for a great reputation of honoring the work we do.”

Authentic Smiles Dental Studio is located at 211 San Antonio St. in Austin, Texas. For more information, call 512-330-9403 or visit www.authenticsmiles.com or http://haamjam.com/history. Note: While NSIDE Texas officially adheres to AP style, certain exceptions were made in the editing of this article. NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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AUSTIN // PROFILE

Members of the WellMed at Georgetown staff (from left): Associate Medical Assistant Jose De La Rosa, Dr. Rogelio Treviño, Patient Care Coordinator Christina Carlin, Receptionist Wynona Weber and Medical Assistant Maria Cervantes. Not pictured is Clinic Administrator Dena Bennight, LVN.

FLYING D

r. Rogelio Treviño grew up loving airplanes. In high school, he enrolled in an aeronautics magnet program at Dallas Skyline that offered the opportunity to learn all about them, including how to repair engines. “It was very nice because we would basically overhaul engines,” Treviño said. “We had a twin engine Apache, two Piper Cubs, a Cessna, a C-45 Expeditor that we used to have to prop start and a couple of helicopters, too.” These days, Treviño is still involved in repair, but it’s the human body instead of fabulous flying machines that holds his fascination. As the sole primary care physician at one of the newest clinics in the fast-growing WellMed family, WellMed at Georgetown, Treviño is quickly building a popular practice serving Williamson County seniors. Treviño has been practicing at the clinic just off

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NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013

As the sole primary care physician at one of the newest WellMed clinics, Dr. Rogelio Treviño brings cutting-edge preventive care to seniors in Williamson County. By: [DAN CALDERÓN] Interstate 35, almost within eyesight of the Round Rock Premium Outlet Malls, since 2009. In September, he joined WellMed Medical Group, which has physicians at more than 70 primary care clinics in Texas and Florida, to better focus on senior patients. “The focus on seniors is something we must have in health care, particularly in primary care,” Treviño said. “The older adult population is growing, and the diseases associated with older adults tend to be more complex. Older adults utilize medical services more as a group. For me, making senior care a priority is the right direction.” WellMed at Georgetown focuses on the care of Medicare-eligible patients, and the physician leaders at WellMed have high hopes for the fast-growing Williamson County clinic. “Although this is our third clinic in Williamson County, we waited to find the right fit before open-

HIGH ing a WellMed facility in Georgetown because we knew we had to make a great first impression here,” said Dr. Carlos Hernandez, president of WellMed Medical Group. “Dr. Treviño is committed to quality health care with an emphasis on preventing health problems before they occur. We’re proud to have him as the face of WellMed in Georgetown.” Treviño, 48, graduated from the University of Texas at Austin (where he was a member of the rugby team) with an undergraduate degree in psychology. Fluent in Spanish, Treviño earned his medical degree from the University of Monterrey in Mexico, completed an internship at Muguerza Hospital in Monterrey and completed another internship doing research on addiction in McAllen for the psychiatry department of the UT Health Science Center at San Antonio (UTHSC). Treviño completed his residency with the UTHSC Family Practice program in McAllen.


Treviño and his family moved to Georgetown, Texas, to set up his solo practice in 2009 shortly after he was accepted into, and completed, a prestigious geriatric fellowship program at George Washington University. He and his wife, Nadia, found a great location for a clinic right off of busy Interstate 35, a stone building they designed to be inviting to seniors with warm colors, non-slick faux-wood floors and no-glare lighting – exactly the kind of facility WellMed has been designing for its new clinics. The hilly terrain of Central Texas is a perfect fit for Treviño, an avid bicyclist who rides up to 120 miles weekly on his mountain bike. His rides are often conducted with a baby carriage in tow carrying his 2-and-a-half-year-old daughter, Nadia, named after her mother. “If it’s a smooth trail, she falls asleep, but when I go through the rough trail, she’s happy to be bumping along, laughing and screaming, ‘more, more!’” Georgetown marks a return to Texas for Treviño, who was born in Los Angeles, but moved to Dallas at the age of 6 with his family. Treviño has strong family ties in health care thanks to relatives in Mexico who are physicians, including one who works for the Pan American Health Organization. Today, Treviño’s younger brother is an orthodontist in Laredo, while his older brother is a petroleum engineer working for the Texas Railroad Commission. Always looking to stay on the cutting edge of

Dr. Rogelio Treviño confers with Patient Care Coordinator Christina Carlin at WellMed’s new clinic in Georgetown. Treviño created the clinic with warm colors, no-glare lighting and non-slip flooring to make it more inviting and comfortable for older patients.

“WE’RE PROUD TO HAVE DR. TREVIÑO AS THE FACE OF WELLMED IN GEORGETOWN.” the practice of good medicine, Treviño is currently in a fellowship program in integrated and complementary medicine offered through the Center for Integrative Medicine at the University of Arizona in Tucson. Treviño says his current fellowship jibes nicely with WellMed’s emphasis on preventive care. WellMed regularly gathers its 130-plus physicians, nurse practitioners and physician assistants in Texas and Florida for “learning sessions” to focus, in part, on more effective and efficient ways to treat patients. “The WellMed care model is an attractive model to work in as a physician,” Treviño said. “They really focus on prevention, and in my opinion, they are doing integrated and complementary medicine. Integration is key to having people be disease-free. You don’t want to wait for a disease to develop and Band-Aid it with a bunch of medicine. You want to keep disease from occurring, and WellMed does that by focusing on preventive care. They are doing the right thing. They are trying to create efficient medicine.”

To learn more about WellMed at Georgetown, call the clinic at 512-869-4800. To learn more about WellMed, visit www.wellmedhealthcare.com or call 1-888-781WELL (9355).

Dr. Rogelio Treviño, a graduate of the University of Texas at Austin, is currently in a fellowship program in integrated and complementary medicine offered through the Center for Integrative Medicine at the University of Arizona in Tucson. Before arriving in Georgetown in 2009, he completed a prestigious geriatric fellowship at George Washington University in the nation’s capitol. NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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AUSTIN // PATIENT

RAISING THE BAR Dr. Rocco C. Piazza: keeping Austin beautiful both inside and out By HEATHER DANIELS

A

t a very early age, Dr. Rocco C. Piazza knew he wanted to become a doctor. An innate desire to help others has always been a vital part of the Austin area native’s personality, driving him to a career in plastic surgery

22

so he could help people feel beautiful inside and out. The first step on this medical path was to get exposure to as many different medical specialties as possible. Long before he was Dr. Piazza, the young man volunteered his time during high school (he was a Lake Travis

NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013

High School Cavalier) at the family practice of Dr. Ira Levin. Toward the end of high school and in the summer before he headed off to college, Piazza started shadowing a plastic surgeon, Dr. Rick Parker, solidifying his goals of pursuing this specialty as a career. First, though, there was lots of schooling and training to be done and more study with practitioners. Piazza got his bachelor’s degree at Baylor University, and, he said, during his time there as an undergraduate, “I shadowed a general surgeon in Waco when I was in college and also completed the Michael E. DeBakey Summer Surgery Program in Cardiothoracic Surgery at Baylor College of Medicine.” Piazza was always several steps ahead of his peers during his training, and now he strives to maintain that edge for his patients in order to provide them with the most up-todate and best care possible. By the time he started medical school, Piazza knew he wanted to devote his career to plastic and reconstructive surgery. In this specialty, not only would he get to work with the science he found professionally fascinating, but he would also get to work closely with patients to improve their lives in profound ways – an aspect of the job he has found extremely personally fulfilling since these early days. Piazza received his medical degree with honors from the University of Texas Medical Branch at Galveston. During medical school, he became involved with the Division of Plastic Surgery, headed by Dr. Linda G. Phillips. He said this time was important in his growth as a medical professional, helping him cultivate not only an extensive knowledge base, but also an interest in research and innovation as a way to help patients. “I actively became involved in both clinical and basic science research under Dr. Lisa J. Gould in the Plastic Surgery Research Lab,” he said. He continued this work after medical school at the prestigious Michigan State University/Grand Rapids Medical Education and Research Center’s plastic surgery residency program. He was trained under 20 board-certified plastic surgeons, including worldrenowned breast surgeon, Dr. Dennis C. Hammond. This diverse training experience gave him wide exposure to many different surgical techniques in facial aesthetics, trauma reconstruc-

tion and breast and body contouring, and the latest advances in non-surgical facial rejuvenation. “It was this experience that has allowed me to visualize and subsequently develop the patient care environment to deliver exceptional care in plastic surgery in Austin,” he said. Piazza soon returned to his old Austin stomping grounds to bring his fresh knowledge and enthusiasm to patients in the area he loved. In fall 2010, he opened his private plastic surgery practice, the Center for Plastic Surgery and Advanced Skin Care. After a few years of thriving business, the practice celebrated its three-year anniversary in September with several promotions as a way of thanking current and future patients. Piazza said the practice’s emphasis on top-quality patient care and education has been a key to its success. “From the first encounter with our patients, we strive to provide the most up-to-date information about plastic surgery and how it applies to our Austin and Central Texas patients,” he said. “We believe it is essential to be the very approachable experts in plastic surgery in Austin. It is extremely important that my patients have all the information they need to make an informed decision, whether it is in reconstructive or cosmetic procedures.” Another component of Piazza’s success, he said, is connecting with patients on a personal level. Being actively involved with social media is of utmost importance in the practice’s philosophy. Piazza is very active on Facebook, Twitter and YouTube, and he has his own blog where he details procedures and provides the latest news on the forefront of plastic surgery and skincare. His blogs are extremely interesting and educational. Topics range from how to maintain a good skin regimen and procedure trends (arm lifts are all the rage) to the latest treatments for excessive sweating. “By being active with social media, my staff and I make ourselves available to our patients and feel that this has been really important when it comes to delivering a premium service in health care,” he said. “I also am continually raising the bar with regards to patient care at my practice. I am consistently reviewing our current practices, attending national educational conferences and bringing the latest techniques and treatments for


both surgical and non-surgical procedures to Austin.” Part of that constant review process means offering a wide range of procedures to address as many reconstructive and cosmetic needs as possible for patients. At the Center for Plastic Surgery and Advanced Skin Care, Piazza’s services include many of the most popular breast, face and body procedures. His surgical specialties include breast augmentation, lift, reduction and revision, as well as body contouring procedures such as tummy tuck surgery and liposuction. He also offers his patients a wide range of face options, both surgical and non-surgical. Facelift, eyelid surgery, brow lift and rhinoplasty are popular options, but Piazza said less invasive treatments have been gaining ground in recent years. He offers BOTOX Cosmetic, injectable fillers, laser treatments, facials, chemical peels and medical-grade skincare product lines to give his patients facial rejuvenation options that may better suit their lifestyles or budgets. “We are seeing a significant increase in BOTOX in both men and women for the treatment of frown lines, forehead lines, crow’s feet and for patients who are suffering from excessive sweating,” Piazza said. “When it comes to injections, I have seen patients desire a much more thorough experience. We have exceeded expectations by photo-mapping all of our BOTOX patients for best results. We are using DermaSculpt Microcannulas to deliver the best results when it comes to volume restoration, lip enhancement and the ultimate in full-correction (liquid facelift) for non-surgical rejuvenation.” Piazza said the medical spa part of his practice has been a huge draw for patients because there they can find some of the most innovative and effective options to fit into their schedules or budgets. The med spa recently started offering the HydraFa-

augmentation surgery as they move into their postcollege years. Women of all ages who are faced with a diagnosis of breast cancer and choose to undergo breast reconstruction also make up a significant portion of Piazza’s practice. He said he finds reconstructive work especially rewarding because it helps restore a strong self-image to a person who has usually been suffering for a long time. Skin cancer patients who have had lesions removed often seek him out for reconstruction, as well. Another common and reward-

patients as possible without ever compromising our mission: to provide personalized, comprehensive patient care in plastic surgery in Austin,” he said. Piazza aims to keep the office atmosphere very welcoming so that patients don’t hesitate to ask questions. “We strive to provide exceptional care by being polite, professional and punctual with predictable results,” he said. “We are partners in our patients’ overall health for life.” That’s a reflection of Piazza’s personal commitment to fitness and a healthy lifestyle, which he tries to emphasize for his patients.

PHOTO BY KARA TROMBETTA OF CLICK CHICK IMAGES

“I HAVE A VERY DIVERSE PATIENT POPULATION, AND I LOVE IT.” cial MD, a revolutionary new treatment for skin resurfacing with no downtime. While Piazza places a big emphasis on the importance of bringing in great new techniques and technologies, he also said he’s very careful to provide only the most effective procedures, no matter how trendy they are. This philosophy has drawn in male and female patients of all ages. While many plastic surgery practices cater mostly to older people who are trying to turn back the clock on their looks, Piazza aims to serve anyone – of any age – who feels he or she could benefit from an aesthetic treatment. He has cared for children with facial lacerations, teenagers who broke their noses playing sports, people with dog bites and a range of patients interested in laser hair removal. He said he sees a lot of women in their 20s who are interested in either breast reduction or

ing procedure Piazza performs is the mommy makeover, which combines tummy and breast surgeries to correct many of the changes that occur in a woman’s body during pregnancy. “I have a very diverse patient population, and I love it,” Piazza said. “This is one of the only surgical subspecialties where I have the opportunity to work with patients of all different ages, backgrounds, ethnicities and can help them address concerns from the head and neck all the way to the calves and ankles.” Piazza said the vision he has tried to cultivate at the Center for Plastic Surgery and Advanced Skin Care in Austin is a personalized, comprehensive plastic surgery experience in which the patient’s health and well-being are foremost in the treatment plan. “We always want to remain true to our short-term goal while providing exceptional care to as many

Piazza summed his philosophy up this way: “The most rewarding part of my practice is really listening to what my patients have to say and providing them with options for their specific desires in plastic surgery and skincare, followed through with surgical and non-surgical skills ... to help them achieve their personal goals while making a positive impact on their lives.”

The Center for Plastic Surgery and Advanced Skin Care in Austin is located in the Seton Southwest Healthcare Complex at 7900 FM 1826, Health Plaza II, Ste. 206, in Austin, Texas. For more information, call 512-288-8200, or visit www.thepiazzacenter.com, www.facebook. com/piazzaplasticsurgery or http://blog.thepiazzacenter.com. NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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AUSTIN // PATIENT

A VOICE FOR EDUCATION

At Sullivan Physical Therapy, they are dedicated to helping patients achieve private goals, as well as educating both patients and the public about pelvic floor physical therapy. By HEATHER DANIELS

S

ullivan Physical Therapy is a pelvic floor and women’s health clinic that provides comprehensive care that encompasses strategies and interventions to promote and advance the health in women and men of all ages. Kimberlee Sullivan, P.T., DPT, WCS, BCB-PMD, and clinic owner, opened Sullivan Physical Therapy in October 2005. In the beginning, she was a solo practitioner with one other employee. “We recently have grown to seven physical therapists starting from one just eight years ago,” Sul-

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NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013

livan explains. “The clinic’s current goal is to offer Austin and Central Texas the best physical therapists with a variety of training to address the conditions that face women and men today, as well as continuing to be a voice for educating the public about pelvic floor dysfunction.” The body’s core houses most of the organs essential for biological functioning. The reproductive, digestive and urinary systems are all located in or near the pelvic region, which incorporates the abdomen, pelvic floor and lower back. In addition, the muscular, nervous and circulatory systems all play a

part in promoting or inhibiting the proper function and control of the essential organs. When there is dysfunction of the bladder, bowels or sexual organs, a person’s quality of life is greatly impacted. For some, it could mean constant trips to the bathroom or pain with urination, making it difficult to travel or sit through work meetings. For others, weakness and laxity of muscles causes embarrassing urinary or fecal incontinence. Pain with intercourse keeps some couples from experiencing the fullness of their relationship by inhibiting physical intimacy.


All of these scenarios are real, and they are what patients at Sullivan Physical Therapy have dealt with for a very long time before getting help. The latest statistic is that one in four women will experience vulvodynia, a pelvic pain condition that affects women’s outer genitals, at some time in their lives. These, like most of the conditions treated by the staff at Sullivan Physical Therapy, are chronic and very personal. As a result, some people may be reluctant to speak with their doctors about issues they are having because they feel awkward or embarrassed. “What is important to remember is that these issues involve basic human functioning, and our clinic’s goal is to help this population,” says Rachel Cortell, marketing specialist at Sullivan Physical Therapy. “In doing that, we try to create an environment that makes our patients feel comfortable and reassured that they are not alone and that various interventions can help to either correct their problem or help them to reach their goal of being painfree.” There is a real need for the services offered by Sullivan Physical Therapy, but not enough people are aware that there is help. And many physicians do not have a clear understanding of how pelvic floor physical therapy works. At Sullivan Physical Therapy, they hope to change that by treating and helping patients get the results they want and educating the community about these disorders and interventions. Patients need referral by a doctor in order to get treated, and the top referral sources at the practice are urologists, OBGYNs, family practitioners and gastroenterologists. “We treat a variety of conditions affecting the pelvic floor, and the diagnoses can be very complex,” Sullivan says. “Other diagnoses involve just a few visits before patients start experiencing a return to their normal quality of life.” Chronic pelvic pain is defined as any pelvic pain that lasts for more than six months. Both women and men are affected by pelvic pain. Symptoms can include urinary frequency and urgency, a sensation of not fully emptying the bladder, decreased urine flow, constipation, burning and pain in the pelvic area, pain during and/or following intercourse and pain in the low back and hips. The list of specific diagnoses that fall under chronic pelvic pain is quite extensive, but a physical therapist who specializes in women’s and men’s health can address the skeletal and muscular dysfunction. After an evaluation, a physical therapist treats tense muscles with internal and external trigger point or myofascial release, relieving the pressure on the nerves and reducing pain and inflammation. A low-impact exercise routine like walking or swimming for 30 minutes a day and stretching exercises are prescribed at the onset of treatment. “However,” Sullivan adds, “strengthening exercises are only initiated when the muscles have been sufficiently relaxed in order to prevent reoccurrence.” Scar tissue adhesions as a result of any abdominal surgery or trauma to the organs can affect both genders. In fact, scar tissue can limit range of motion and cause pain with activities. “A physical therapist who specializes in both women’s and men’s health can address scar tissue by myofascial manip-

“THIS SPECIALTY IS NOT WIDELY KNOWN BECAUSE OF ITS PERSONAL NATURE.” ulation,” Sullivan says. “This technique is the forceful passive movement of the fascial elements through its restrictive directions, beginning with its most superficial layers and progressing into deeper layers of connective tissue. The effects of connective tissue manipulation are decreasing painful scar tissue attachment, increasing local blood supply and also freeing tissue waste and thereby altering pH and releasing nerve impulses along quite specific paths. Once these channels of reflexes are released, the central nervous system becomes unblocked, resulting in decreased pain.” Another condition treated by Sullivan Physical Therapy is constipation. This is a common condition affecting approximately 30 percent of Americans. It is most prevalent in women and people over the age of 65. Studies have shown that constipation also increases the risk of colon cancer. Abdominal massage of the ascending, transverse and descending colon can be effective in regulating bowel movements through improvements in intestinal motility. The physical therapists at Sullivan Physical Therapy educate patients on pelvic floor anatomy and normal bowel functions. Patients referred for pelvic floor physical therapy usually have only a vague idea of what the treat-

ment entails. “When a patient first arrives for an appointment, oftentimes they are unaware of what ‘pelvic physical therapy’ involves and may have just been told to go to physical therapy by their doctor,” says Cody McNeely, P.T., DPT. “We explain the anatomy of the pelvic floor and how it can contribute to their condition. We explain how physical therapy treatment can address the impairments associated with their diagnosis. We also discuss what functional limitations their condition may be causing such as pain with sitting, lifting their child, with intercourse or household chores, to name a few examples. “By educating the patient on the proper body mechanics and postures for performing these tasks and by tailoring specific exercises to the patient’s limitations, we help them decrease tension in appropriate muscle groups and improve strength in appropriate muscle groups.” McNeely stresses the importance of patient compliance with the prescribed home exercise program. “The home exercise program is one of the most important tools a physical therapist uses. Instruction in appropriate strengthening exercises or stretches to address muscle impairments is vital, and in my opinion, patient compliance with the home exercise program is a large predictor in the success of physiNOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

25


cal therapy. If a patient is only being treated once or twice a week and not continuing with exercises at home, their progress will be limited.” Educating other health care professionals is one of Sullivan Physical Therapy’s goals. By offering a program where other health care professionals can observe the physical therapists during treatment, they are able to demonstrate what a typical treatment looks like. Educating visiting professionals and allowing them to see firsthand how the treatments are performed has proven successful for all parties concerned. “Those that have participated in the program have provided us with positive feedback,” says Angela Dobinsky, P.T., DPT, BCB-PMD, and lead therapist. “They feel that it is a great experience to increase their awareness to pelvic floor physical therapy. In addition, they feel this increased understanding is beneficial in improving the care they provide to their patients. The patients that allow for their treatment to be observed enjoy it because they are able to help increase awareness to a field that many are unfamiliar with, and that has helped them a great deal in managing or getting rid of their symptoms altogether.” Sullivan reflects on the path that led her into this field: “Growing up as a college football coach’s daughter, I was always around athletes who were working on a goal or who had been injured. When I was in physical therapy school at Creighton University in Nebraska, I had already decided I wanted to do sports therapy and follow in my father’s footsteps working with athletes. However, after one of my clinical affiliations in women’s health, this had all changed. “I was able to work with women and men in a different capacity. This specialty is not widely known because of its personal nature. No one discusses that they leak when they sneeze, have difficulty evacuating stool or have pain with intercourse. To be able to help patients achieve a private goal is priceless.”

For more information on Sullivan Physical Therapy, call 512-335-9300, or visit www. sullivanphysicaltherapy.com or www.facebook.com/pages/sullivan-physicaltherapy/191957411169.

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NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013


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AUSTIN // PATIENT

‘DR. Z IN CIRCLE C’

Dr. Greg Zygmont: providing optimal wellness and chiropractic care in the Capitol City By JODY JOSEPH MARMEL

D

r. Greg Zygmont was raised in the northern suburbs of Philadelphia with his six siblings. His parents strongly believed in taking all of their children to the chiropractor for their health and wellness needs. “We all used to joke around that our parents took us to the chiropractor to a fault. No drugs, no surgery; we just went to the chiropractor. To this day, rarely do any of us become ill or get injured. Developing a strong immune system at a young age surely must get some of the credit.” After attending Penn State, Zygmont started his chiropractic education in 1984 at Texas College of Chiropractic in Pasadena and transferred to Logan College of Chiropractic in St. Louis, Mo., where he graduated in 1988. Due to his early exposure to the world of chiropractic and the positive relationships developed, Zygmont knew he was going to become a chiropractor at an early age. On Zygmont’s first day of chiropractic college, one of the professors asked the class, “Who here has never been to a chiropractor?” Zygmont immediately thought to himself that surely everyone in the class had utilized chiropractic, but he was astounded to see that only about half of the class raised their hands. “It seems to me that if one is going to begin an education to start one’s career, you may want to expose yourself to that profession first. Unfortunately, since chiropractic began in America in 1895, there have been certain negative stereotypes that have attached themselves to it. In my practice, I actually

tor” for owners of different clinics all over the United States, Zygmont opened Zygmont Family Chiropractic in Circle C’s Escarpment Village in Southwest Austin in 2006. With the unwavering support of his wife, Lisa, Zygmont was able to attain his dream of owning and operating a successful practice. The clinic has very strong “word of mouth” referral marketing program, which shows the happiness and health of its existing patients. Zygmont explains that he treats patients who are children, teens, adults and elderly. There is an old chiropractic adage: “Anyone who has a spine needs chiropractic care.” Zygmont follows this philosophy. Typically, most patients believe that one goes to the chiropractor for neck or low back pain associated with bending or lifting something heavy or “driving to and from Dallas.” In reality, however, back pain often comes from emotional or dietary stress such as too much caffeine and refined sugar. “Now think of the average person: financial stress, stress from coworkers and bosses, too much caffeine and sweets and then they are doing some housework and that is the ‘straw that breaks the camel’s back.’” Zygmont is a strong advocate of what made chiropractic successful and utilized by millions: the chiropractic adjustment. “When a chiropractic adjustment is appropriate for the condition, there is no other substitute.” He treats his patients the same way he likes to be treated: with respect and minimal wait. The patients of Zygmont Family Chiropractic know they are in good hands with a well-respected chiropractor who gives them results. If you need chiroprac-

“ANYONE WHO HAS A SPINE NEEDS CHIROPRACTIC CARE.” go out of my way to do the opposite of this.” That same professor who posed the question to the class is famous for saying, “Take care of your patients and you will be successful.” Zygmont never forgot this, and it is surely one of the reasons his reputation as a caring and diligent chiropractor is so strong. After years of practicing as an “associate doc-

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NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013

tic, massage or acupuncture, for optimal results, visit “Dr. Z in Circle C.”

Zygmont Family Chiropractic is located at 5900 W. Slaughter Lane, Ste. 470, in Austin, Texas. For more information, call 512-288-5502 or visit www. zygmontfamilychiropractic.com.


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DALLAS // PATIENT

WORKING HER MAGIC Dr. Naila Malik takes a wholesome and unique approach to helping Dallasites stay healthy. BY JODY JOSEPH MARMEL

Dr. Naila Malik was born and raised in Pakistan, and Dallasites are grateful that she came such a long way to grace their city with her presence. Prior to settling in Dallas, though, Malik finished her residency training in family medicine at Grant Medical Center in Columbus, Ohio. From there, she finished an additional year of residency training in anesthesiology at Tampa General Hospital in Florida. Board certified in family medicine for 20 years, Malik has focused her practice on skincare and weight management for more than 10 years. “I have an unconventional and wholesome approach to treating

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NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013

skin problems, and I feel I can relate to my patients. This is probably what has led to a wide patient audience from all over Dallas-Fort Worth and believe it or not, from other states, as well.” She invented her own line of skincare products for most common skin needs to complement the office treatments. Naila MD Luxury Medical Skincare is based on an anti-inflammatory concept with additional ingredients for each specific skin condition. The products are free of parabens, sulfates, artificial fragrance and dyes and are made in the United States in recyclable containers. Her products are

working their magic, as Malik custom tailors a program for each patient and addresses their concerns and needs. “What I do in my office has always been very personal to me. My practice has evolved with my personal life and needs.” Having a family history of diabetes and obesity, in addition to finding it difficult to lose weight after her third child, ignited Malik’s extensive research. “I researched aging, hormones, metabolism and weight management and developed my own weight management program, which has worked so well for me and so many of my patients.”


BEAUTIFUL WOMAN IMAGE DANIEL_DASH/SHUTTERSTOCK.COM

Similarly, Malik’s own aging skin and adult onset acne led her to look into the best possible anti-aging skincare and alternative acne treatments. “I was frustrated with adult onset acne because commonly available acne treatments do not work very well for adult acne.” In 2008, Malik did a fellowship in antiaging and regenerative medicine, and it changed the way she approached aging, weight and skincare. As an active member of the American Academy of Anti-Aging and Regenerative Medicine, she learns a great deal from all of the conferences she attends. Regularly participating in webinars and conferences for aesthetic medicine keeps Malik at the forefront in this field. With an extensive menu of skincare treatments, Malik has an extremely unique approach. “It takes more than clinical training and anatomical knowledge to obtain the best aesthetic results with BOTOX and cosmetic dermal fillers. I find that innate aesthetic sense is essential to getting natural-looking results with these treatments.” The liquid facelift is achieved with a combination of BOTOX and dermal fillers and likewise requires clinical training, treatment experience and aesthetic sense for best results. “I do not like to introduce every new laser or treatment to my practice until I have researched it well. I am a huge believer in ‘less is more,’ and that is what my patients like about their cosmetic skincare treatments at our office.” Due to the services offered, the clinics have a wide range of patients: 70 percent are between the ages of 30 and 50, 10 percent are over 50 and 20 percent are less than 30 years of age, including a lot of teenagers for acne treatments. In the 30s age group, MicroPeel (medical microdermabrasion followed by their custom-compounded Retin A) is the most popular treatment. It takes approximately 10 minutes; has practically no downtime (two to three days of dry skin with mild peeling); and provides an excellent improvement in most signs of photoaging with a series of 3-4. The Dermalift NonSurgical Facelift is the treatment that is in high demand for patients in their 40s and older due to the duality of the procedure, which offers non-invasive skin tightening and improvement in skin texture, fine lines and tone. Another procedure that is getting recognition is the Madonna Lift. By using fractional CO2 laser resurfacing technology to replace traditional eyelid surgery, patients opt for the less invasive for obvious

reasons. Malik explains: “A recent study of fractional eyelifts involving more than 100 participants showed dramatic and consistent results with improvement in the appearance of dark under eye circles, wrinkles, tightening of the upper and lower eyelids and subtle elevation of droopy eyelids.” The procedure does not address bulging fat pads. The Madonna Lift is done with numbing crème and there are only two to three days of mild redness and swelling. Most people need between three and five sessions, two to three weeks apart, depending on the extent of aging and individual response. Malik continues forging ahead to help her patients in other areas of medical concern. The NailaMDFit program is administered in three phases: Phase 1 for metabolic correction and significant weight loss for some people, Phase 2 for slow and steady, healthy weight loss and Phase 3 for weight maintenance. “There are many hormones and neurotransmitters that affect metabolism. My program is aimed at correcting two major hormones (insulin and cortisol) and modulating numerous neurotransmitters to improve metabolism and control hunger through comprehensive and aggressive lifestyle modification. I do not recommend very low calorie or crash diets because of their detrimental effects.” Malik uses prescription appetite suppressants (the smallest dose for the shortest period), vitamin B lipotropic shots and HCG shots to complement the program if there are no contraindications after a thorough medical evaluation. “Most of our patients do very well with not only weight loss, but also in improving their blood pressure, cholesterol and blood sugar – and most importantly, we have a large number of patients who maintain their weight. I feel it is all about educating people and getting them motivated to take responsibility for their own health.” Let’s not forget the Dermalift Cellulite Reduction; Malik has her own treatment protocols for this. Dermalift Cellulite Reduction is a dual modality system that uses electrical stimulation of the muscles for tightening and a custom-compounded medicated gel, which is driven into the deeper layer of the

skin through electrophoresis. This breaks down trapped fat in the skin for smoother thighs, stomach, buttocks and so on. “The customized medicated lypolytic gel is what makes this treatment more effective than most other cellulite treatments. The program works best with a low glycemic index diet and regular aerobic and strength training exercises, which is the case with all cellulite treatments.” Currently, Malik has two offices. The primary office is in Dallas uptown, and the second office is located in Southlake. With her knowledge, skills and expertise, she has an established practice known for excellence in service, integrity and professionalism. Malik would like to see her skincare line become a well-known brand on a national scale. With her success rate, it looks like she will reach beyond Texas boundaries in the very near future.

For more information, visit Dr. Naila Malik at 3001 Knox St., Ste. 407, in Dallas, Texas; call 888-210-9693; go to www.nailamalikmdskin.com for office services; or visit www.nailamd.com for Naila MD Luxury Medical Skincare.

“I FEEL IT IS ALL ABOUT EDUCATING PEOPLE AND GETTING THEM MOTIVATED TO TAKE RESPONSIBILITY FOR THEIR OWN HEALTH.” NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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DALLAS // FITNESS

‘SUR-THRIVE-AL OF THE FITTEST’ Lex Ronin takes fitness to a new level at Ronin Fitness DFW. Growing up in Memphis, Tenn., Lex Ronin decided to move to Dallas years ago because he heard there was a strong music scene in this thriving Texas city. Being a guitar player at the time, his destination was a perfect one. “Somewhere between my old life and my second youth, I joined the Army, recorded a couple of records, lived in the wilderness, traveled Europe, drove an ambulance, studied martial arts and psychology and accidently became a bodybuilder,” Ronin explains. Before becoming a trainer, he was an EMT paramedic and trained as a SWAT tactical medic. Today, he is both a teacher and the owner of Ronin Fitness DFW. “Two years ago, I had the choice between the risk of starting a business or taking a job that offered mere security. In 2013, security is just an illusion. Calculated risk is good for the soul.” The first person who helped Ronin make the connection about lifestyle choices and the consequences of such was his Ninpo teacher, Ralph Severe of the Art of Combat School. He ventured on to Krav Maga and then to the world of fitness. Ronin started with serious methodical weight lifting and later on, he learned the complexities of competitive bodybuilding, which led to the more subtle aspects of running an independent business. Ronin is a certified personal trainer serving the residents of Richardson, Plano, Frisco and the surrounding areas of North Texas. Ronin Fitness offers personal training, nutrition counseling, bodybuilding, consulting, marathon training and group classes including yoga, meditation and self-defense. His philosophy is one-of-a kind. “In physical culture, there is nothing new under the sun. The same things that make or break the human form are the same things that did so a thousand years ago. What matters most is intent and application. If there is anything that might make me radically different than other trainers, it is that I begin with the end in mind. I definitely have an exit plan for my clients. The day I realized that I could progress as a bodybuilder without a coach was a great day for me, and I want to teach people how to have that level of independence.” Besides being a certified personal trainer, Ronin is also certified under Anmol Mehta for Kundalini yoga, pranayama and meditation. He is also an IAPC certified pre-contest conditioning coach. And now he is starting his journey to become a Westside Barbell power-lifting coach, which will take his game to a new level – one both he and his clients are looking forward to. The primary arts practiced at Ronin Fitness are Ninpo Taijutsu and Krav Maga. “Our main focus is Krav Maga because Krav is something that should not be trained and taught in the same manner as the traditional arts. Krav has been softened up in these past few years and it is sad to see; it is not a martial art, and it’s not ‘fun for the family,’ so to speak. It is a method of de-

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PHOTO BY TARA LOPEZ-FERENCE

BY HEATHER DANIELS


PHOTO BY TARA LOPEZ-FERENCE

stroying an attacker in the fastest and most lethal way possible. Currently, I am developing a training method that we feel to be superior to the ‘suburban commando’ that passes for Krav Maga these days. It is most certainly going to take people out of their comfort zone, but it will teach my clients Krav Maga as it was meant to be taught.” Ronin Fitness teaches Ninpo as a true martial art and as something you cultivate over a lifetime. “It is something that I always come back to; Ninpo has always spoken to something deep within me. There have been times in training where I know with total certainty that I am home.” Always making it a point to cross train as much as time allows, Ronin Fitness introduces different methods to refine techniques by seeing similar themes expressed in different ways. With clients ranging from 21 to those in their late 50s, Ronin Fitness customizes a fitness plan for everyone. “Like a lot of people, they often neglect their primary needs while moving forward and being a success in their respective fields. So they come to us for that last piece of the puzzle.” Heather Jennings has been a client for quite some time. “Lex Ronin is an inspiring and dedicated professional who commits the time and visions in

RONIN FITNESS HELPS TEXANS LIVE HEALTHIER LIVES BOTH PHYSICALLY AND MENTALLY. helping us succeed not only physically, but mentally. He assists the clients in realizing their true potential and their goals. I have never felt so fit, strong and confident. I’m fortunate to associate and train with this talented individual.” With endless testimonials from past and present clients, Ronin Fitness is helping Texans live healthier lives, as Jennings said, both physically and mentally. Accomplishments to date include seeing the first military and police recruits crush their PT test, seeing their first bikini/fitness competitor client get leaner than she has ever been and hearing success stories over the last few years from those who want to live life to its fullest by taking control of their

bodies and eating healthy. Ronin is continuing with the Krav Maga experiment, and he wants to branch out and establish a permanent school within the year. “As we speak, the foundations for a commercial Ronin Fitness DFW gym are being laid,” Ronin says. “It will be a dojo meditation space and minimalist iron gym under one roof. I am proud of all of my clients. The ones who stay the course get exactly what they came for and a whole lot more.”

For more information, visit www.roninfitnessdfw.com or call 214-702-8131. NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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HOUSTON // PROFILE

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NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013


IN

PERFECT HARMONY ROBOTIC RENAISSANCE MAN DR. RICHARD FRANCIS SERVES AS THE BACKBONE OF SPINAL SURGERY AT SPINE ASSOCIATES. BY: VANESSA MACIAS PHOTOGRAPHY: JUSTIN CALHOUN

W

hen was the last time you sat down and thought about the intricate workings of your back? How does it hold you upright? What are the mechanics behind your hips being the same distance from the floor? Why isn’t one shoulder considerably higher than the other? The back and spine are likely the unsung heroes of your body … until they belt out a little ditty in the key of pain-sharp. When your back is not working the way it is supposed to, pain is only one of the issues with which you have to deal. Doctors’ visits may become frequent. Rehabilitation may be unavoidable. Then there is the word that conjures irrational fear in most rational adults: surgery. Spinal surgery is serious business. Honestly, you only have one back. Even if it’s not perfect, it is still yours. There are no trade-ins or “take-backs,” so to speak. You have only one. So when faced with that scary surgical option, whom do you trust? It is important to seek an expert – someone who not only knows and treats spines, but also specializes in their care. This is exactly why many patients across the state and internationally are trusting their treasured, tortured backs to the care and guidance of Dr. Richard Francis, a rec-

ognized leader in orthopedic spine surgery, at Houston’s Spine Associates. Spine Associates specializes in treating spine deformities such as scoliosis, degenerative conditions, tumors, infections and metabolic diseases, especially in those who have had unsuccessful spine surgeries. Francis is a busy man, and with good reason. He is a trailblazer in his field, continuing to learn and implement innovative technology. Most recently, he has put into practice some previously unconventional aides in his operating room. Francis introduced robotics to his practice two years ago, and he says he and his practice are at the crest of moving forward because of the addition of these devices. “We can extend what we do and move along a trajectory that would have been more difficult a few years ago.” With his minions of robots at his side, he is helping pained-back patients off of their backs and back to being vertebrally vertical. “The Mazor Robotics Renaissance Guidance System is a quantum leap in robotics technology that is easy to use, very accurate and can reduce operating time,” Francis says about the cutting-edge robots, which are about the size of soda cans and significantly increase doctors’ precision. “For the complex cases that we do surgiNOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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cally, where we have to put implants into the spine, the level of accuracy that it gives is truly remarkable.” This precision these robots deliver offers peace of mind to patients with particularly difficult cases such as revision surgeries with heavy scarring, while reducing the risk of a subsequent revision surgery due to a misplaced implant. The harmony between the surgeon and the robot brings peace of mind to both sides of the table, reducing complications from factors such as concentration, fatigue, judgment errors during surgery and any patient anatomical variances involved. The improved vision significantly minimizes surprises during a procedure while opening the operating doors to candidates who may have posed a difficult obstacle. “We can do things that are difficult, things that are extraordinary – things that would normally push the envelope,” Francis adds. “We can achieve these things because the robot allows us to instrument the spine under very difficult circumstances. You can do it blindly. You can do it without even cutting the skin.” It makes surgery so easy that Francis can almost perform it with his eyes closed. Well, not literally, but the robots greatly enhance a surgeon’s vision during a procedure. According to Francis, surgeons typically compensate for the lack of line of sight during less invasive surgeries by navigating with X-rays taken prior to surgery. The robotic system enables doctors to see vertebrae in three planes, which saves the surgeon from probing the spine at different points to find the abnormality. This saves the patient from a longer and potentially more painful surgery. In some freehand surgery cases, doctors have to use additional X-rays during the procedure. Radiation levels are usually not documented when patients are exposed while in surgery, but it could amount to the equivalent of several radiation procedures. The robot guides the surgeon without the need to expose the patient to intra-operative X-rays, making this added radiation risk unnecessary. The ability to see where an implant is being placed without having to open up the site reduces scarring and thus, further lowers the complications and risks of further surgeries. An added benefit of the system is a significantly reduced operating time. Francis says the robot’s aid can decrease a patient’s stay on the operating table by 40 to 50 percent for larger cases, which improves the patient’s overall experience from diminishing complications to lessening recovery times. But while these robots are pretty amazing, there is no substitute for skill and finesse. Seeking a fully qualified surgeon like Francis is absolutely necessary. The surgeon is in full control of the operation when using a robot. The surgeon performs all of the instrumentation. The robot is just a guidance system to help the surgeon follow the “blueprints” mapped out using X-rays and CT scans prior to a surgery. These blueprints are then translated and implemented by the surgeon to achieve a highly accurate surgical performance with the results and minimized risks that both the surgeon and the patient desire. One X-factor for which the system cannot account is the love and the passion a surgeon has for his craft. Francis lights up when he speaks about cases in which the Mazor Robotics Renaissance Guidance System has assisted him in helping his patients. His vibrant personality shines through when he speaks about using new tools and continuing to not only learn, but also pioneer his craft. “It’s fun,” he says with a megawatt smile. “I work in a candy store every day.” There isn’t a robot in the world that can replicate the reassurance that enthusiasm creates in patients and their families.

THE HARMONY BETWEEN THE SURGEON AND THE ROBOT BRINGS PEACE OF MIND TO BOTH SIDES OF THE TABLE.

For more information, visit Spine Associates online at www.spineassociatesofhouston.com. NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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HOUSTON // PATIENT

BEAUTY BECOMES YOU Building confidence: Dr. Eric Humble and Sugar Land Face & Body BY: ALLISON GROVER

Dr. Eric Humble is the founder and chief of staff at Sugar Land Face & Body PLLC, a spa-inspired full-service plastic surgery practice including his own operating room in the upscale suburb of Sugar Land, Texas. He is a board-certified plastic surgeon and a member of the American Society of Plastic Surgeons. Humble has been honored as one of Houston’s Top Docs three years in a row by H Texas  magazine. He has spoken numerous times at various medical industry conventions and meetings on

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the subject of plastic and reconstructive surgery and related topics therein, and he has made multiple appearances on television as an expert. He is licensed to practice medicine in the state of Texas, and he lives with his family in Sugar Land. Humble’s education and years of experience as a top-rated plastic surgeon have offered him firsthand experience on the impact that breast enhancement makes on a woman’s confidence level. Humble elaborates on this:


about their new clothing options after breast augmentation surgery. They feel clothes fit their bodies better after breast enhancement surgery. Swimwear, tops and dresses are more flattering. Low-cut clothing options are now available to them. Many women are excited about the opportunity to not have to wear a bra when wearing backless dresses. A good cosmetic surgeon will spend ample amount of time with you discussing your desired results. We help our patients find the best implant size for their body. It is important to listen to your patient to assess their desired results. You want to line up their expectations. It is helpful for the patient to express their desired results, as well, in order to accomplish their desired look. Some women not only need implants, but also need a breast lift, which can be determined at their initial appointment.  We have our patients try on a variety of different sized implants until they find the size they are most comfortable with. We also discuss implant options. There are many types of im-

“AN ATTRACTIVE, PROPORTIONED BODY IS IMPORTANT TO WOMEN.” An attractive, proportioned body is important to a woman. Many women feel insecure with their bodies after having children. Many women complain about their breast size and the deflated look after having children or as their age progresses. They are unhappy with the way their breast skin looks. It is very typical for women to lose size and firmness in their breasts after pregnancy.

Breast implants can be used to restore fullness, as well as give a more youthful appearance to the breast. Breast implants can also improve a woman’s breasts if they are different sizes by creating a more attractive and symmetrical breast line. Breast augmentation can help women to achieve a more shapely body, thus increasing their self-esteem and making them feel

more confident, socially and professionally. Breast implants can help women to achieve a more proportioned physique. Women with a pear-shaped figure can use breast augmentation to give a more balanced appearance. Increasing breast size can help balance out her hips or give a more feminine look to a boxy physique. Many of our patients are excited

plants these days. I assess the best implant choice based on the patient’s lifestyle and desired look. We discuss whether silicon or saline is the best option for the patient. We want them to feel comfortable and excited with their decision.

For more information or for a free consultation, contact Sugar Land Face & Body at 281-313-0555 or visit www. beautybecomesyou.com.

NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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HOUSTON // PATIENT

DIFFERENT FROM THE REST Gabriel Maislos, DPM, FACFAS, and his team at Houston Foot & Ankle Care are dedicated to providing patients with cutting-edge foot care in a friendly and comfortable environment. BY: JODY JOSEPH MARMEL

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he says. “I am sought out for nerve entrapment issues. I treat a lot of plantar fasciitis. In the office, we offer cutting-edge, state-of-the-art technology such as laser treatment fungal nails, EPAT (extracorporeal pulse activation treatment), treatment for heel pain, digital X-rays and physical therapy.” A few common treatments are detailed by Maislos. Plantar fasciitis is treated with orthotics, physi-

MAISLOS’ NO. 1 PRIORITY IS TO LISTEN AND FULLY UNDERSTAND THE PATIENT’S COMPLETE STORY. cal therapy, stretching exercises, ultrasound-guided steroid injections, night splints and non-steroidal anti-inflammatory drugs (NSAIDs) such as Motrin. If conservative treatments fail, surgery is recommended. Surgery options for nerve decompression, bunionectomy, hammertoes and plantar fasciitis are available, as well as a wide range of elective and non-elective surgeries. For neuromas, Maislos recommends orthotics, sclerosing injections, physical therapy, NSAIDs and surgery if conservative treatment (nerve decompression) fails. For bunions and hammertoes, treatment consists of NSAIDs, accommodative shoe gear and surgery if conservative treatment fails.

years old, his patient population is approximately 50 percent female and 50 percent male. For the convenience of all of his patients, Maislos offers a full line of orthopedic shoes. Dedicating an entire room in the office to shoes, offerings include diabetic shoes that have a deeper toe box and stretch easier to accommodate swelling and protect the neuropathic feet. They also carry the Aetrex line of men and women’s sport and dress shoes. At the practice, they are dedicated to making their patients comfortable and pain-free in a friendly and comfortable environment. Maislos wants to continue to grow his practice and “emphasize preventative medicine instead of reactive medicine.”

Basic foot care guidelines are: 1. Check feet periodically for open lesions, and if present, follow-up with your doctor. 2. Wear accommodative shoes. 3. Avoid high heels. 4. Wash daily.

Houston Foot & Ankle Care is located at 7777 Southwest Freeway, Ste. 506, in Houston, Texas. For more information, call 713-541-3199 or visit www.houstonfootankle.com.

FEMALE FEET IMAGE ARTEM FURMAN/SHUTTERSTOCK.COM

From the moment you enter the office of Dr. Gabriel Maislos, it is evident that the approach the team follows is “quite different from the rest.” Maislos’ No. 1 priority is to listen and fully understand the patient’s complete story. By carefully listening to various symptoms, the onset of pain or discomfort and what types of procedures the patient feels most comfortable with to alleviate discomfort, Maislos creates a customized plan that will help each of his patients to their complete satisfaction. Growing up in Houston with a father who is a cardiologist was an influential factor in his decision to pursue a career in the medical field. In fact, his father is a cardiologist at the hospital where Maislos works: Memorial Hermann Southwest. “My father, my brother who is an urologist and I work next to the same hospital. We often meet for lunch in the physician lounge.” These three fine physicians treat patients throughout Houston and extend their dedication, knowledge, experience and skills to those who need their help. Maislos was mentored by Dr. David Wolf, whom he considers the “grandfather of podiatry” in Houston. As he learned a great deal during this time, Maislos began to formulate his individualized approach to podiatry. “I am compassionate and highly trained in the latest technologies. Taking extreme pride in my work, I make sure to treat all of my patients as if they are family. Since I see a lot of referrals from past patients, this lets me know that I am doing a good job.” His academic credentials are par excellence. As an undergraduate, Maislos attended Tufts University and then went on to attend Dr. William M. Scholl College of Podiatric Medicine. He then returned to Houston and did a three-year surgical residency with the Houston Podiatric Foundation. Maislos is board certified in foot surgery, a fellow of the American College of Foot & Ankle Surgeons, board certified in extremity nerve surgery and a fellow of the Association of Extremity Nerve Surgeons. Specializing in nerve surgery such as tarsal tunnel release and neuromas, Maislos has a diverse practice. “I have a busy surgical practice that consists of both elective and non-elective procedures,”

Maislos is an advocate of “fitness and your feet.” Stretching, support and gradual increase in physical activity is imperative to avoid injury. Stretching prevents rupture of ligaments and helps prevent microtrauma and inflammation often seen with plantar fasciitis. Support (orthotics) helps place the foot in the correct position and support the arch, which is under constant pressure by the body’s weight. A rather fascinating procedure to lengthen the toe is based on the Ilizarov procedure, which was pioneered by a Russian doctor named Dr. Gavriil Ilizarov. The procedure was originally done to lengthen the leg in order to make people taller. “The same principle has been used in foot surgery to correct the condition, brachymetatarsia,” Maislos says. “This is a congenital deformity seen usually in both feet where the fourth metatarsal has stopped growing and is much shorter than the other metatarsals. The condition results in a fourth toe that appears floppy and often painful. The surgery consists of applying an external fixator and making a surgical fracture of the fourth metatarsal. As the fracture begins to heal, the bone is lengthened by the distractor and refracturing occurs. The process is repeated daily until the desired length is achieved.” As Maislos sees patients from 6 months old to 95


HOUSTON // PATIENT

For more information, contact the Katy Vein Center at 866-967-0367 or go to www. memorialandkatyveincenter. com.

MINIMALLY INVASIVE REVOLUTION

New advances in the treatment of varicose veins, a condition that affects approximately 60 million Americans BY: DR. CAMERON RUTTMAN to your heart. When valves go bad for different reasons, blood flows backwards due to the effects of gravity and builds up in your leg veins. The backwards flow of blood in your veins is known as reflux, and it places excess pressure on the vein walls. This causes veins to expand and become “varicose,� and the increased pressure is transferred to the skin. As this condition progresses, the increased pressure causes further enlargement of the varicose veins and fluid leaks out of the veins, resulting in swelling, permanent skin color changes and ulceration in advanced stages.

CONSERVATIVE MANAGEMENT

BACKGROUND ON VARICOSE VEINS

Varicose veins are blood vessels in your legs that have enlarged due to increased pressure that builds up while standing. Varicose veins are curved, bulging veins that are larger than spider veins. They cause heaviness, pain, aching, burning, leg swelling, restless legs and social embarrassment. Varicose veins occur for a number of reasons, including age, prior pregnancy, weight gain, hereditary factors and prolonged periods of standing. Often, the cause cannot be identified. They occur more frequently in women, but they are also common in men and seen in all age groups, from the 20s to the 80s. Approximately 60 million Americans are affected. This condition is easily diagnosed with a special type of ultrasound that is performed during your initial consultation. Normal veins in your legs are tubes that carry blood away from your feet toward your heart. Oneway valves are located inside your veins, and they should only allow blood to flow up out of your legs

Varicose veins may not require any treatment at all if they do not bother you or cause any symptoms of aching, swelling or skin changes. They are not dangerous, and they do not lead to blood clots or serious medical conditions. Conservative treatment includes lifestyle changes such as weight loss, exercise, elevation and compression stockings. These methods have proven successful in reducing the pressure that builds up in your veins, and they can improve your symptoms. Prescription-strength compression stockings aid in the treatment of varicose veins by helping squeeze the blood back out of your legs, preventing congestion. Ideally, compression stockings should be worn all day until you are able to elevate your legs at night. This may relieve discomfort, but patients frequently have difficulty wearing these tight-fitting stockings. Patients routinely complain of heat and difficulty placing the stockings.

decade with a remarkable transition from traditional open vein stripping to state-of-the-art, minimally invasive laser procedures. Laser procedures are performed on patients who have backwards flow or reflux in their saphenous vein, which runs under the skin along the inside of the calf and thigh. Because varicose veins can cause significant discomfort and eventual skin changes, most insurance companies consider this procedure medically necessary if you have attempted elevation, exercise and compression stockings sometime in the past. A laser attached to a small catheter (a thin, long, plastic tube) is used to close off diseased varicose veins without having to remove them. Numbing medicine is used to make a tiny nick in the skin to insert the laser catheter. Fluid is then injected around the leaking vein (where the laser catheter has been inserted) to protect the surrounding tissues and eliminate any discomfort during the laser treatment. The tiny incision is closed with a tape strip at the end of the treatment. This treatment does not typically cause scarring or significant discomfort. In most cases, patients are encouraged to resume normal activities the following day. These procedures are performed in an office setting and take about 30 to 45 minutes.

LASER VEIN TREATMENT FOR VARICOSE VEINS

Varicose vein treatment has been revolutionized in the last

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HOUSTON // HEALTH & WELLNESS

CLAP TWO TIMES FOR FITNESS! Fit with C.H.R.I.S.: helping people reach their fitness goals

Houstonians who are unable to achieve their fitness and health goals on their own often reach out to Chris White, founder of Fit with C.H.R.I.S. White was born and raised in Indianapolis, Ind. He graduated from Marian University and was the first All-American football player at his school playing the defensive end position. Throughout his college years, White was a personal trainer at Anytime Fitness. Not only was he a great trainer, but he became one of the top trainers in the state of Indiana. The rankings were based on customer retention, and his care for his clients became the lynchpin for his success. “I have been working out since high school because of football, but when I was in college, I sustained a neck

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injury that ended my 2007 season,” he says. “It took me two years to get back on the field, and that is when my passion for health and fitness grew.” In those two years, he decided to build himself up even “bigger and stronger.” His motivating factor was that he never wanted to experience another injury like the one he had in college. After several physical therapy sessions and working on several body strengthening exercises with his condition coaches, White developed a unique set of beliefs and workouts. “The feeling I had when I was able to return to playing football is what prompted my desire to help other people in similar situations,” he explains.

PHOTO BY ASHOK PATEL PHOTOGRAPHY

BY: JODY JOSEPH MARMEL


After White’s playing days ended, he decided to open a service to help people do just that. In January 2012, White started Fit with C.H.R.I.S. “I started with an idea, two dumbbells and a resistance band out of the trunk of my car. I traveled to several events around Houston in order to promote my brand. I landed my first clients in March of 2012.” His clientele increased steadily from that point, and White was able to open a 1,200-square-foot studio. Fit with C.H.R.I.S. offers “celebrity style” training services, which are workouts designed to fit the clients’ schedules. “Finding the time to exercise is a struggle for most,” White says. “We help you find the time and ensure the accountability usually reserved for celebrities. Most celebrities have the trainer come to their home or facility or they go to a private facility and train with their personal trainer. We offer the same thing, as well as the health and nutritional guidance to go along with the exercise regimen. Who wouldn’t want to train like a celebrity? They receive excellent treatment, and I felt it’s time for the working person to receive the same treatment.” White is the real deal. He and his professional training staff give the Lone Star State affordable “celebrity style” training. When it comes to their rate, they feel they are unmatched because it is not just about being the least expensive; it is about “giving the customer more ‘bang for their buck.’ We definitely have competitive prices averag-

ing about $30 a session and as low as $17 a session depending on the package you choose.” In addition to having low rates, Fit with C.H.R.I.S. adds value to their already affordable packages. Having a diverse client base including diabetic, arthritic, obese and very thin people, they also train clients who are in relatively good shape, but want that extra push to get into tip top shape. They train ages 6 to 65. Whether you want to build muscle or lose weight, the staff will design a program to help you achieve your goals. Fit with C.H.R.I.S. introduced its food line in August 2013. White wants to ensure people are not “giving back” their workouts by eating unhealthy foods. “You cannot outwork a bad diet no matter how hard you train, so it is pivotal to eat the cleanest foods.” Fit with C.H.R.I.S. Foods provides 100 percent natural and tasty meals for clients interested in the convenience of pre-cooked meals. The staff ensures that they teach clients how to focus more on portion control than on counting calories. “What you eat is 75 percent of the battle; the other 25 percent is exercise. Fit with C.H.R.I.S. Foods ensures clients take their eating habits as seriously as their exercise habits. Most people will pick the 90-day lifestyle package, which comes with 90 days of pre-cooked meals and a personal trainer to assist you in your exercise program. We offer several packages, but understand that 90 days is the minimum amount of time it will take to see real results.” Other services provided:

• Boot Camp C.H.R.I.S. • Self-defense classes for women • Childcare service for parents who need child supervision while they exercise The boot camps generally have 30 or more people attending, and parents with childcare needs are commonplace. “Boot Camp C.H.R.I.S. is an intense group workout designed for the strong-willed camper that is serious about their results.” The self-defense classes teach crime awareness, as well as escape tactics and fighting skills. Fit with C.H.R.I.S. offers private classes and corporate programs for companies interested in the safety of their employees. “We take the safety of women in our community seriously. We provide our clients with skills that can help them escape danger and perhaps save their lives.” Fit with C.H.R.I.S. is opening a second location in Katy, Texas. They are also opening the doors to entrepreneurs and future business owners. Those interested in opening their own Fit with C.H.R.I.S. location will soon have franchise opportunities.  “I am thinking big and plan of 1,000 locations in 10 years. It is just another challenge for me. I treat my company like my workouts: ‘Go hard or go home.’”

Fit with C.H.R.I.S. is located at 13003 Murphy Road, Ste. E-1, in Stafford, Texas. For more information, call 281410-5686 or visit www.fitwchris.com.

PERSONAL TRAINER AND CLIENT IMAGE OSTILL/SHUTTERSTOCK.COM

WHITE AND HIS PROFESSIONAL TRAINING STAFF GIVE THE LONE STAR STATE AFFORDABLE “CELEBRITY STYLE” TRAINING.

NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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HOUSTON // MD

The CRAVE Group: medical marketing at its best BY: HEATHER DANIELS

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Knowing what it takes to get new patients into a physician’s office, The CRAVE Group is making their mark in the medical field throughout the state of Texas. Shawn Broussard, founder, has been fortunate to work closely with physicians and the medical industry for the last 10 years. With this foundation, The CRAVE Group opened their doors in February 2011. This niche-based medical marketing agency is Houston’s only medical marketing agency that solely focuses on helping physicians and all medical industries promote themselves and their practices to current and prospective patients. Broussard has a reputation for being a strong

medical marketer in the state of Texas. His drive to help medical practices become successful through the use of marketing strategies has been extremely successful. His vast knowledge has helped multiple medical practices expand their business using TV, radio and print media in numerous markets across Texas. “At The CRAVE Group, we educate practices on how to promote and market their business,” Broussard says. “We work closely with marketing managers and office managers running their practices. We know what it takes to get new patients into the office. Being the only one of its kind, we are a passionate, hands-on medical

MAN IN OFFICE IMAGE OLIMPIK/SHUTTERSTOCK.COM

THE EQUATION FOR SUCCESS


marketing group covering all of Texas. We have learned that if you stick with an industry and perfect it, the results equal success.” Representing plastic surgeons, orthopedic surgeons, podiatrists, dermatologists, chiropractors, vascular surgeons and other specialists, they also represent surgical centers and hospitals. The main focus is filming testimonials and surgical procedures. “We find that filming patient testimonials is very important in today’s new patient search. Seeing the facial expressions on how happy the patients are about the doctor can make all the difference in the world.” Filming interviews with doctors about every single procedure they do at their practice has proven to be a vital marketing venue. In many instances, new patients are very intuitive and well educated; they want to see the procedure they have to go through. “In this day of social media, you can see just about everything online. We have found that this is very effective for patients and for our doctors. New patients want to see doctors that are kind and have a great bedside manner. That is exactly what we show them and we get results.” Even though marketing is not a novel idea, medical marketing is. The CRAVE Group is being recognized in Houston’s medical community as the “go to” company for all of their marketing needs. Broussard’s knowhow and his extensive experience in utilizing all media outlets and thinking outside the box have helped The CRAVE Group’s client base that is growing by the day. By creating a custom marketing plan for each client, the formula to success has been masterfully crafted and alterations are made for every client. A unique plan is brought to the table for all of those in the medical community, and Houstonians are very pleased with the results. Broussard explains, “a happy patient is a happy practice.” The CRAVE Group is helping educate all medical professionals on how they can make their business more profitable. The next step is establishing a statewide presence. “We want to cover all of Texas and plan on having offices in San Antonio, Austin, Dallas-Fort Worth and El Paso. We are the only medical marketing group in Texas, and expansion is a necessity.” The company’s philosophy is that “good marketing grows out of wellfocused strategic thinking.” Making sure the physicians reach their goals by placing patient education at the forefront is the perfect equation for success. The CRAVE Group has created a much-needed service, and their successful mission has been noticed beyond the Houston city limits. There is unlimited growth, and Broussard’s wisdom and marketing savvy are making The CRAVE Group a well-respected company throughout the Lone Star State.

For more information, visit www.cravemktg.com, www.texasmedmarketing.com or www.thetexasmedmarketer.com, or email shawn@cravemktg. com.

INNOVATON THROUGH

COLLABORATION OF EVIDENCE BASED

BUSINESS PRACTICES AM Healthcare Capital has spent years forming relationships with physician practices across Texas. These relationships provide our clients with access to best healthcare business resources in the lone star state. Headquartered in Houston, Texas with presence in San Antonio, Austin & Dallas, our network has over 15 years of roots embedded in the Texas medical community. We believe in innovation through collaboration and evidence based business practices.

CALL NOW FOR A FREE CONSULTATION

(713) 574-1149

www.amhealthcap.com NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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LAREDO // PATIENT

“WE BELIEVE IN TEACHING PEOPLE TO CARE FOR THEMSELVES.”

EDUCATE, EDUCATE, EDUCATE

CONTINUING THE NEAR 120-YEAR TRADITION OF THE SISTERS OF MERCY HEALING MINISTRY, MERCY CLINIC OFFERS PATIENTS COMPREHENSIVE MEDICAL SERVICES IN ORDER TO HELP THEM TAKE OWNERSHIP OF THEIR HEALTH. [SPECIAL TO NSIDE]

"Educate, educate, educate" is the mantra at Mercy Clinic, which strives to make each patient an advocate of his or her own health. Mercy continues the close to 120-year tradition of the Sisters of Mercy by offer-

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tient participation. Ninety-nine percent of those in our patient base have no medical insurance at all. Our average family of three earns $15,687, which is well below the federal poverty guideline of $19,090. Mercy is not a free clinic. All patients pay a co-pay based on their financial screening assessment.  We believe this helps the patients take ownership of their health. According to Sr. Maria Luisa Vera, president of MML, the clinic remains faithful to the Sisters of Mercy healing ministry. “We believe in teaching people to care for themselves,” she said. “We focus on the whole person by building one-on-one relationships and supporting their efforts to create healthier lifestyles for themselves and their family.” Mercy Clinic’s care is provided by mid-level nurse practitioners where patients are referred to specialty physicians as necessary. Our assessment, diagnostic and treatment plan includes group and one-on-one counseling, dermatology, podiatry, optometry and dental services provided by volunteer physicians and counselors. Our goal is to avoid or delay the complications of chronic illness for our patients.  Our treatment plan includes home assessments and visits by “promotoras” (community outreach workers) when needed. The Mercy Medication Assistance Program helps patients get free or reduced-cost medications.  Specifically, our services include the following:

ing comprehensive medical services to some of the neediest residents of Webb County while striving to improve the overall health of our community. Mercy Clinic, an entity of Mercy

NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013

Women’s wellness: including general health screenings, pap smears, breast cancer screenings and dysplasia General medicine: general checkups for uninsured men and women

with a focus on prevention through education and early detection Diabetes program: diagnosis and treatment of diabetics including education and early detection with an emphasis on nutrition and exercise classes Dental program: cleanings, fillings and extractions for adult clinic patients Case management: guiding patients through the health care system and assisting with referrals to other medical providers and social services Medication assistance program: helping clinic patients secure access to free or low-cost prescriptions Counseling: part of our integrated program that is available on a limited basis for patients who are referred to the counseling program due to diagnosis The classes in our Disease Management Program (DMP) are taught at the clinic, at underserved outreach areas and even at patients’ homes if need be by our well-trained and Texas state certified “promotoras” and our education coordinator. The diabetes classes are anchored in “Si, Yo Puedo Controlar Mi Diabetes!” developed by AgriLife Extension at the Texas A&M System and based on recommendations of the American Diabetes Association’s guidelines for diabetes self-management.  We currently partner with the University of Texas School of Public Health on outreach and education promoting general health and wellbeing. Classes include education on chronic illness, nutrition, exercise and cooking. Every program stresses the importance of physical activity, health eating (including portion control) and attending the assigned classes. All classes are open to the public in general.

Persons interested in seeking service at Mercy Clinic may call 718-6810 to inquire about qualifying for services. If you would like to volunteer or make a donation, please call Rosanne Palacios at 956-721-7408.

HOSPITAL RECEPTIONIST IMAGE RACORN/SHUTTERSTOCK.COM

Ministries of Laredo (MML), is a primary care clinic with a focus on prevention and control of chronic illness through education, outreach and pa-


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RIO GRANDE VALLEY // PATIENT

SOMETHING TO SMILE ABOUT Harlingen Family Dentistry offers high-quality dental treatment and care for the whole family at affordable prices.

Back in 1983, Dr. Juan D. Villarreal opened his doors to serve the community by providing quality dental care for adults and entire families. Growing up in Harlingen, Villarreal wanted to return to his hometown and establish the practice to serve the dental needs of his community, as well as the surrounding areas. “I wanted to come back, be a factor by creating a positive influence and do great things for my hometown,” Villarreal explains. “I was able to do this by establishing a practice in which my team provides dental education to improve the quality and health of all our lives and delivers high-quality dental care at an affordable price.” Since establishing the practice 30 years ago, Villarreal and his team have brought about a greater awareness in oral health. Harlingen Family Dentistry (HFD) strongly believes in helping, and this has contributed to their expansion into one of the larger practices that houses both general and specialty dentists. With an in-house laboratory for better, faster and high-quality service, this group of experienced dentists has all dental needs and services covered with accuracy, convenience and skilled craftsmanship. “Our office uses the latest modern technology available in the dental field to ensure that we provide patients with the highest quality of dental care.” Doctors and hygienists attend continuing

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education to keep current with the latest material and developments in dentistry. Assistants also attend continuing education to enhance their assisting in procedures, and the entire HFD staff is trained to be on the forefront of the dental field. Villarreal details the great service that the HFD group provides six days a week: “We understand that service is one of the most important reasons why patients stay with our practice. From the time they walk in until the time they leave, we maintain a high speed of service that does not affect the quality of dental care being delivered.” The practice also offers a variety of services inhouse. With periodontists, an orthodontist, oral surgeons and pedodontists on staff, most procedures can be performed at HFD. By establishing affordable pricing, HFD has ensured that patients have the necessary tools to care for their teeth without placing a financial burden on them. “We know the importance of good oral health, and so we do what we can to work with our patients so that they can receive the treatment recommended.” Additionally, the office offers a variety of solutions such as CareCredit (a dental credit card that has 0 percent interest promotional rates), and it accepts all major credit cards, as well. The HFD staff is actively involved in community service. The

PHOTOS COURTEST HARLINGEN FAMILY DENTISTRY

By: [JODY JOSEPH MARMEL]


PHOTOS COURTEST HARLINGEN FAMILY DENTISTRY

DR. JUAN D. VILLARREAL AND HIS TEAM HAVE BROUGHT ABOUT A GREATER AWARENESS IN ORAL HEALTH. Willy Dental Education Program has been active in the community and the schools since 2000. They have provided approximately 70,000 oral health care kits to area schools, churches and clubs, along with the educational component of this program. They also have adult education programs and a strong presence and alliance with the Cameron County Juvenile Justice Department, where they not only provide dental education, but volunteer weekly to teach “The Way To Happiness” (TWTH) program of moral values with the juveniles. Their community commitment is obvious, and the ways HFD gets involved are endless. They also volunteer at the Harlingen Outreach Center. “We offer to area high school students entering the health care field scholarships. Additionally, we have a major scholarship competition for the area high school JROTC students.” The students are asked to present the projects they have completed that apply the 21 precepts of moral values in TWTH, as well as their JROTC core values. Judges are military and community leaders. This competition has been offered for several years, and for the last three years, they have had retired military generals and POWs as judges. HFD also offers scholarships for dental/ hygiene students in the dental field through the Hispanic Dental Association. In addition to these remarkable community services, the dental services offered at HFD are vast. General dentistry is a given; the crown and bridge work

provides quality work in a one-day solution for new ceramic crowns, veneers, onlays and inlays with the CEREC dental restoration system. The CEREC system uses a variety of computer-assisted technologies to quickly take a 3-D scan of your teeth to determine the shape and size of your restoration. The dentist finalizes its design, and the crown is milled right in the office and is ready for placement. “It is fast and avoids the gooey impressions, temporary crowns and another visit to the dental office.” The latest cosmetic procedures are offered and are often preferred by their adult patients. “At times, this is used as an alternative to braces, as it eliminates the average two-year time period it takes to correct the alignment of teeth.” Some cosmetic services include teeth whitening techniques, both in-house and takehome, crowns and veneers, with permanent placement of crowns and veneers being completed in as little as two weeks. In orthodontics, HFD offers both traditional braces and Invisalign. Invisalign takes a modern approach to straightening teeth using custom-made aligners created for the patient. The aligners gradually shift teeth into the goal indicated and are changed every two weeks. Some of the benefits of Invisalign are that they are invisible, removable and comfortable. In addition to traditional hygiene services, HFD offers laser therapy for the care of all patients. This helps healthy or periodontally involved patients reduce the bacterial load that is responsible for periodontal dis-

ease. This allows for gingival tissue health to be at its best with proper cleanings and patient compliance. Due to the amount of patient demand for children’s services, HFD the Children’s Dental Clinic in August 2011, allowing for the privacy and nurturing environment that caters to children. It is located next to HFD, as is the Dental Specialty Clinic, which houses the orthodontist, periodontal and oral surgery departments. All of these services are conveniently located under one roof. Short-term goals are to establish Edinburg Family Dentistry in November 2013 and Raymondville Family Dentistry in 2014. “We also want to expand our services by hiring another orthodontist and a part-time periodontist,” Villarreal adds. “We will always continue to train our staff to provide the best dental care available.” Long-term goals at HFD include continuing their expansion into surrounding cities. “We want to be able to offer quality dental care, exceptional service and dental education. We will continue to strive to provide the most up-to-date dentistry available in a caring and nurturing environment in our surrounding communities.”

Harlingen Family Dentistry is located at 1214 Dixieland Road, No. 4, in Harlingen, Texas. For more information, call 956-428-5322 or visit www. harlingenfamilydentistry.com. NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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RIO GRANDE VALLEY

HEALTH & WELLNESS

DIABETES 101 The types, the diagnosis and the treatments

Q: WHAT IS THE DIFFERENCE

BETWEEN TYPE 1 AND TYPE 2 DIABETES? WHAT DOES "INSULIN DEPENDENT DIABETES" MEAN?

A: In Type 1 diabetes, an autoimmune process

destroys the pancreas and inhibits its ability to produce insulin, which results in hyperglycemia (high blood sugar). It often develops during childhood, but it can occur at any age. Because their pancreas has been damaged, most patients will eventually need insulin. Patients are frequently sensitive to insulin and require relatively low doses. With Type 2 diabetes, there is usually a degree of insulin resistance, often as a result of excessive weight. People with Type 2 diabetes usually have very high levels of insulin initially, as their pancreas tries to compensate for the hyperglycemia. At first,

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NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013

they may be able to use oral medications to overcome insulin resistance. Some patients, however, will progress to requiring insulin to control their blood sugar. Previously, “insulin dependent diabetes� referred to those with Type 1 diabetes, as patients with Type 1 diabetes almost always require insulin. However, that term is no longer preferred, as many patients with Type 2 diabetes use insulin, as well. Most of this column will refer to Type 2 diabetes mellitus.

tors. Testing for diabetes should also be considered in all adults over age 45. Diagnostic tests for diabetes mellitus include a glycohemoglobin (A1c), a fasting plasma glucose or an oral glucose tolerance test as described later. If the test is normal, it should be repeated at least every three years or more frequently depending on individual risk. Additionally, there are separate screening recommendations for the diagnosis of gestational diabetes in pregnant women.

Q: WHO SHOULD BE SCREENED

Q: HOW IS DIABETES FORMALLY

FOR TYPE 2 DIABETES?

DIAGNOSED?

A: Screening for Type 2 diabetes is recommended A: Traditionally, for non-pregnant adults who are overweight (BMI greater than 25 kg/m2) and have additional risk fac-

diabetes has been diagnosed based on either the fasting plasma glucose or after an oral glucose tolerance test. A fasting plasma glu-

DIET SPOON IMAGE ROBYN GTS/SHUTTERSTOCK.COM

By: [DR. MICHELLE CORDOBA KISSEE]


THERE ARE SEPARATE SCREENING RECOMMENDATIONS FOR THE DIAGNOSIS OF GESTATIONAL DIABETES IN PREGNANT WOMEN. Q: WHAT IS PREDIABETES? SHOULD IT BE TREATED?

A: Prediabetes refers to the conditions in which

Reference: American Diabetes Association. Standards of Medical Care in Diabetes – 2013. Diabetes Care. 2013 Jan;36 Suppl 1:S11-66.

GLUCOMETER AND PILLS IMAGE MAYAMAYA/SHUTTERSTOCK.COM

cose of more than 126 mg/dL is considered diagnostic of diabetes. In non-pregnant adults, the oral glucose tolerance tests consists of checking the plasma glucose following a 75 g oral glucose load, with a value of more than 200 mg/dL being consistent with diabetes. More recently, using a glycohemoglobin (A1c) value of more than 6.5 percent has also been accepted. A random plasma glucose of more than 200 mg/ dL can also be used to diagnose diabetes when accompanied by classic symptoms of hyperglycemia. Because of testing variability, the chosen test should be repeated for confirmation of the diagnosis.

patients have abnormal test results, but do not yet meet criteria for the diagnosis of diabetes. Two categories of prediabetes are impaired fasting glucose and impaired glucose tolerance. For fasting glucose, a glucose level of 100 mg/ dL to 125 mg/dL is considered impaired fasting glucose (IFG). If an oral glucose tolerance test is used, impaired glucose tolerance (IGT) is defined as a glucose level between 140 mg/dL and 199 mg/dL two hours after a 75 g oral glucose load. In addition to IFG and IGT, a glycohemoglobin (A1c) of 5.7 to 6.4 percent can be used to identify people with prediabetes, as well.

Patients who are diagnosed with prediabetes should undergo lifestyle interventions including weight loss and physical activity. Medications may be considered since several classes of medications (including metformin, Îą-glucosidase inhibitors, orlistat and thiazolidinediones) have been shown to decrease the incidence of overt diabetes. Of these options, metformin has a strong evidence base, as well as a demonstrated long-term safety profile. Patients with prediabetes should continue to be monitored for the development of frank Type 2 diabetes mellitus.

NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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USE IT OR LOSE IT Alzheimer’s disease: much more than simple forgetfulness [SPECIAL TO NSIDE]

More than five million Americans today are living with Alzheimer’s disease. By 2050, that number is expected to triple. The mortality rate from Alzheimer’s is increasing while many of the other major diseases are decreasing in mortality rates. November is National Alzheimer's Disease Awareness Month. Alzheimer’s is a disease that not only affects the diagnosed, but significantly impacts the health of caregivers, as well. Dr. Jose Igoa has been treating people with Alzheimer’s for more than 30 years. He believes it is a disease of the family. One person (with Alzheimer’s) is becoming less and less of a patient because of the breakdown in cognitive function and ability, while the caregiver becomes more and more of a patient as he or she deals with stress and/or depression. As the rates of diagnosis increase, more caregivers will feel the effects.

Q: WHY IS THE RATE OF

A: The main risk factor for Alzheimer’s is age.

So since people are living to an older age, we encounter more cases. We have been able to conquer many other diseases to a certain degree, which allows us to live to an older age, so the risk increases. There are other risk factors such as head trauma, family history and gender (females are diagnosed more, but they live longer).

Q: CAN ANYTHING BE DONE TO PREVENT, SLOW OR CURE ALZHEIMER’S?

A: There is no cure for Alzheimer’s disease, but

we can do things to help prevent or slow it. As far as prevention, a good rule of thumb is that what’s good for the heart is good for the brain. Eat a wellbalanced diet and exercise. Control risk factors like blood sugar levels and cholesterol triglycerides. One of the most important ways to help prevent Alzheimer’s is to use the brain. Use it or lose it. The more you use the brain, the more arborization of the dendrites and the more connection between the neurons. It helps delay the process or even prevent the causes of dementia. We do have medications to slow the progression

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of Alzheimer’s. We use at least two different mechanisms of action that seem to help each other out. So we usually give combinations of medications. In general, one would be a cholinesterase inhibitor, which slows the breaking down of key neurotransmitters that are related to memory. The other would be a receptor antagonist called NMDA (N-methyl-D-aspartate), which prevents too much calcium from getting into the brain cells. So these treatments together help slow the progression of the disease. Using this method of treatment is similar to using a parachute to slow a fall.

Q: MANY BELIEVE LOSING ONE’S MEMORY IS A NATURAL PART OF AGING. HOW DO WE KNOW IT’S ALZHEIMER’S AND NOT JUST FORGETFULNESS?

A: Alzheimer’s is much more than simple forgetfulness. It’s really a dysfunction in adaptability: It impairs the ability to function either socially or vocationally. There is a progression of memory loss. There is first the normal forgetfulness – the slowing down of the memory as we age. The next step is

called MCI, or mild cognitive impairment. People who suffer from this may complain subjectively about memory loss, but they are still able to function; however, 10 to 15 percent of these cases turn into Alzheimer’s or dementia that impairs their ability to function. The problem then is forming new memories. There’s no problem remembering what happened 20 years ago at “uncle John’s wedding.” They will remember every detail, but remembering what happened this morning, what they had for breakfast or to turn off the stove is a challenge. Remembering sequences becomes increasingly difficult – paying bills, balancing a checkbook, etc. It becomes even harder when there is a change in life. Routine is very important for people in this phase because things are safe – they are predictable. So changes in routines cause a crisis. We see people who are still able to go to work, but it’s important for them to take the same route – as long as there are no detours, these people can function very well. Coping with change is a huge challenge when dealing with Alzheimer’s or dementia.

PATIENT TOMOGRAM IMAGE SFAM_PHOTO/SHUTTERSTOCK.COM

ALZHEIMER’S DIAGNOSIS INCREASING SO RAPIDLY?


tive symptoms and blame them on “normal” aging, as well.

ONE OF THE MOST IMPORTANT WAYS TO HELP PREVENT ALZHEIMER’S IS TO USE THE BRAIN.

Q: WHAT IS THE EARLIEST

AGE YOU’VE SEEN OR HEARD OF SOMEONE DEVELOPING ALZHEIMER’S DISEASE?

A: There is a very, very small population of people

who can acquire Alzheimer’s disease in their 40s. This is related to genetics or a very dominant family history – the more genetic the component, the earlier the onset of the disease. In these cases, it is a 50/50 chance offspring will suffer from Alzheimer’s. This occurs in less than 8 percent of the population of diagnosed cases.

Q: EXPLAIN THE PHASES OF

ALZHEIMER’S DISEASE THAT ULTIMATELY LEAD TO MORTALITY.

WOMAN DOING A CROSSWORD PUZZLE IMAGE RACORN/SHUTTERSTOCK.COM

A: I would explain it as occurring in three phases.

The first phase of Alzheimer’s disease or dementia, as discussed, is the mental impairment of a person: recent memory loss and cognitive symptoms like disorientation. The middle phase is where psychiatric problems begin, including depression and sometimes psychotic problems, including paranoia, delusional beliefs and hallucinations. Then in that third stage is where we have the medical problems. Some people lose the ability to swallow, sometimes there’s pneumonia, they sometimes become bed-ridden and develop bedsores and they can contract sepsis. These phases do take a while. The average life span after being diagnosed is eight to 10 years. But it it’s dependent upon one’s health prior to diagnosis. If in general good health otherwise, the life expectancy is longer and vice versa.

Q: WHEN DO WE KNOW IT’S TIME TO SEE A SPECIALIST?

A: We see a few people come to us at the first sign

of recent memory loss, but that’s not usual. Most caregivers tend to be very tolerant of memory loss,

so they won’t seek help right away – they feel it’s a normal part of aging. When someone becomes agitated, restless or even combative, or if they can’t sleep or are incontinent, that’s when the red flag goes up and we see the majority of caregivers seeking treatment. Caregivers even dismiss cogni-

Jose Igoa, M.D., is a licensed psychiatrist in four different countries who currently serves as medical director of the Renaissance Behavioral Center. Igoa is also a distinguished fellow of the American Psychiatric Association, a member of the Royal College of Psychiatrists of England and a fellow of the Royal College of Physicians and Surgeons of Canada. For more information about Alzheimer’s or mental health, or to schedule an appointment, call the Renaissance Behavioral Center at 956-362-HELP or visit www.dhr-rgv.com. NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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COMMON COMBINATION COPD is a progressive disease of the airways (or windpipes) that is partially reversible and results in limitation to airflow. Traditionally, it was subdivided into two big groups: chronic bronchitis and emphysema. But in real life, most patients have a combination of the two and management is similar. November is COPD Awareness Month.

Q: HOW FREQUENT IS COPD?

COPD: The fourth-leading cause of death in the United States gives us another compelling reason to stop smoking. By: [DR. ADOLFO KAPLAN]

Q: HOW IS COPD DIAGNOSED? A: The most important test is a breathing test: either

spirometry or the most comprehensive pulmonary function test. Imaging studies such as a chest radiograph and occasionally a tomography scan are also helpful. The key aspect is to suspect the possibility of the disease and perform an inexpensive spirometry as the first step.

Q: WHAT ARE THE SYMPTOMS OF THE DISEASE?

estimates come from a 2002 CDC publication. Ten million American are formally reported to suffer from COPD. However, 24 million are estimated to suffer from the disease, accounting for the lack of diagnosis or “underdiagnosis” of this common disease. Importantly, 70 percent of affected subjects are younger than 65 years of age. And for the first time in 2000, more women died of COPD than men. A report using Social Security statistics stated that COPD is second only to heart disease as a cause of disability. It is also the fourth-leading cause of death in the United States, exceeded only by cancers, heart attacks and strokes. COPD is responsible for 125,000 annual deaths in the United States, 550,000 hospitalizations, 16 million health care office visits and $37 billion spent in direct and indirect health care costs.

Q: WHO IS AT RISK FOR COPD? A: By far, the major risk factor for the develop-

ment of COPD is tobacco smoke, which accounts for 80 to 90 percent of all cases. However, there are genetic diseases, long-term asthma (particularly when uncontrolled), the effect of lung growth, occupational exposures, outdoor and indoor pollution, infections and low socioeconomic status that can lead to the development of the disease.

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many ways of manifesting themselves. The most common symptoms by far are shortness of breath, cough and “abnormal” breath sounds one may or not hear coming from the chest. Chest pain, coughing up blood and other symptoms are rare and not a consequence of this disease. Importantly, COPD affects other organs and systems that must be treated if one wants to successfully improve the patient’s symptoms and well-being. Malnutrition, osteoporosis, muscle weakening, mood disorders (particularly depression and anxiety) and cardiac disorders are much more common in subjects with this disorder. Finally, because the risk factors are similar (tobacco exposure and indoor/outdoor pollutants), cancers are more frequent in patients with COPD – particularly lung cancer. One of the hottest topics in the field is the recent recommendation of the U.S. Preventive Task Force to screen selected patients with COPD for lung cancer with annual chest tomographies for three consecutive years. This strategy leads to a 20 percent decrease in dying from lung cancer, and it is at least five times more effective than mammograms to prevent deaths from breast cancer.

Q: IS COPD TREATABLE? A: Absolutely. Basically, there are pharmacological

(medications) and non-pharmacological therapies. There is now a large number of inhaled and oral medications proven to be effective to improve symptoms and decrease the rate of decline of lung function, the chances of suffering and exacerbation and even dying

INHALATION MASK IMAGE HOWARD KLAASTE/SHUTTERSTOCK.COM

A: The most up-to-date national A: As I always tell my patients, the lungs have so


from this disease. Among non-medications, there is a long list of options, beginning with pulmonary rehabilitation, devices to help respiration and surgeries (bullectomy and lung-volume reduction surgery). There are three particular therapies that are proven to decrease the chances of dying: Stop smoking if you do, use supplemental oxygen if you meet certain criteria and consider lung volume reduction surgery (in selected patients). In addition, there is a very active field of research that we hope will allow us to mimic what surgery does with devices we can place inside the windpipes without use of any knives. More medications coming into the market are now being tested to prove themselves effective in decreasing the chances of dying as a consequence of COPD.

Q: WHAT WOULD

YOU RECOMMEND TO SOMEONE WHO WANTS TO PREVENT DEVELOPING THE DISEASE?

A:

CIGARETTE BEING BROKEN BY MAN IMAGE FABIANA PONZI/SHUTTERSTOCK.COM

Do not smoke. Ever. If you smoke, stop today. And avoid second-hand smoke.

Dr. Adolfo Kaplan completed his medical education at National University of Tucumán in Argentina, and he went on to complete his residency and fellowship in pulmonary disease and critical care medicine at Beth Israel Medical Center in New York, N.Y. Kaplan’s interests include diagnosis and treatment of pulmonary and sleep disorders, polysomnograms, pulmonary function tests and pulmonary rehabilitation. For more information about COPD or other pulmonary disorders, or to find a physician who’s right for you, call Doctors Hospital at Renaissance at 956-DOCTORS or visit www.dhr-rgv. com. Note: Doctors Hospital at Renaissance proudly meets the federal definition of a “physician-owned hospital” (42 CFR §489.3). The physicians on our outstanding medical staff are not employees or agents of the hospital, but are independent contractors whose professional relationship is directly with the patient.

CANCERS ARE MORE FREQUENT IN PATIENTS WITH COPD – PARTICULARLY LUNG CANCER.

NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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SAN ANTONIO // FEATURE

EXCELLENCE IN HEALTH CARE San Antonio dermatologist Chad Hivnor, M.D., receives the prestigious Paul W. Myers Award from the U.S. Air Force Association. By: [LISA MUNTER]

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ON SEPT. 16,

2013, dermatologist Lt. Col. Chad Hivnor, M.D., of the 59th Medical Specialty Squadron at Joint Base San Antonio (JBSA) in Lackland, Texas, received the 2013 Paul W. Myers Award at the Air Force Association’s annual Air and Space Conference in Washington, D.C. The prestigious award is reserved for the Air Force medical corps officer who has made significant contributions in the health care of men and women serving in the U.S. Air Force. Hivnor’s superb work with lasers, which serve to improve skin texture and flexibility on burn wounds and amputee scars on wounded warriors, made him an easy choice to receive the honor. “By using a carbon dioxide laser, a number of wounded warriors were able to be treated for their burns and scars, to include leg amputations,” Hivnor says of his laser technique. “We were then able to increase the sweat and decrease hair, which causes frictional folliculitis, a skin condition caused by inflammation of hair follicles due to the prosthetics. We’re really helping the wounded warriors to assimilate back into society.” In addition to the award, Hivnor received a $1.1 million grant to study, in collaboration with Massachusetts General Hospital and Shriners Hospital in Boston, lasers’ effects on scars and functional improvement after scars and surgery. Hivnor will now be able to use his innovative knowledge and skills to treat the civilian population at HealthCrave Medical Centers in San Antonio, Texas, where he is the head of the aesthetics and skincare center. Besides lasers, Hivnor has also done extensive research in cosmetics, onychomycosis (toenail fungus), skin cancer and scars. Dr. Steven Cyr, director and founder of HealthCrave Medical Centers and the Orthopaedic & Spine Institute, is pleased to welcome yet another top physician into the practice. Hivnor was attracted to the fact that HealthCrave Medical Centers is a multidisciplinary wellness facility, meaning the center has 12 centers (all with different specialties) within its one office. Besides the aesthetics and skincare center, there are also centers for primary care, weight loss and nutrition, vascular care, age management, plastic surgery, massage therapy, sport psychology and migraine treatment. Hivnor and the other 13 specialists in the center (who range from board-certified physicians and surgeons to experts in personal training and nutrition), all work together and separately in order to care for their patients’ needs. Cyr’s vision is all about benefiting patients by providing complete health care for them and their entire family. Hivnor is a board-certified dermatologist who has distinguished himself in multiple areas of dermatology starting with training at the Ivy League University of Pennsylvania. He is extremely compassionate and truly dedicated to patient care. Hivnor got his start by being a distinguished graduate of the U.S. Air Force Academy and earning his medical degree from the University of Texas Health Science Center San Antonio. He received further training in general surgery at Wilford Hall Medical Center. After serving two years as a flight surgeon, Hivnor was chosen to receive training at the University of Pennsylvania, an institution that is often rated the best derma-


“WE’RE REALLY HELPING WOUNDED WARRIORS ASSIMILATE BACK INTO SOCIETY.” HAPPY COUPLE IMAGE EDYTA PAWLOWSKA/SHUTTERSTOCK.COM

tology program in the country. He received training in education and research, one of the most – if not the most – competitive fields in the country. He has served more than 14 years in the U.S. Air Force, with his most recent position as program director, which oversees the largest dermatology teaching program of residents in the country. Besides the Paul W. Myers Award, Hivnor has also received numerous awards including Air Combat Command Clinician (Physician) of the Year 2006 and the Excellence in Clinical or Academic Teaching designation. Hivnor is also an assistant professor in the Department of Dermatology Uniformed Services University of the Health Sciences.

To learn more about Dr. Chad Hivnor and HealthCrave Medical Centers, visit www.sahealthcrave.com or call 210-GETWELL.

Celebrate the Past 30 Years of the American Heart Association’s Life-Saving Mission in San Antonio. Join us April 5, 2014 at the Westin La Cantera Resort for

For sponsorship and event information, please call Danielle Gunter at 210-810-3108 or Danielle.Gunter@Heart.org THANK YOU TO OUR LEAD SPONSORS AND EXECUTIVE LEADERSHIP TEAM :

Doyle Beneby | David Handley | Eldon Roalson | Gay Nord | Greg Seiler | Jimmy Allen Joe McCart | Larry Baumgardner | Mac Williams | Marc Strode | Mark Bernard Mark Wittig | Michael Schaefer | Roberta Cloud | Sandy Morander | Skip Wood Ad designed by The Wood Agency

NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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ExpErt primary CarE.

That’s Baptist Care.

lori shirley-Wenzel, mD Internal Medicine Alamo Heights, Broadway (210) 824-5392

nishi thakur, mD Internal Medicine Castle Hills (210) 541-8689

Dustin Deemer, PA Family Medicine Alamo Heights, Sunset (210) 824-5201

Douglas Jenkins, mD Internal Medicine Downtown (210) 224-1771

scott Horn, mD Family Medicine Alamo Heights, Sunset (210) 824-5201

lovelesh manocha, mD Internal Medicine Downtown (210) 224-1771

Abe rodriguez, mD Family Medicine Northeast (210) 653-2693

Ambur Brown, mD Family Medicine Schertz (210) 656-5600

lubna naeem, mD Internal Medicine Stone Oak (210) 490-3800

Aaron King, mD Family Medicine Overlook (210) 497-2338

Blaine Carmichael, PA Family Medicine Castle Hills (210) 541-8689

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Doris ling, mD Family Medicine Castle Hills (210) 541-8689

Geri Poss, mD Family Medicine Downtown (210) 998-3156

edward lin, mD Family Medicine Northeast (210) 653-2693

Daisy ramirez-estrada, mD Family Medicine Northeast (210) 653-2693

James Doherty, Do Family Medicine Schertz (210) 656-5600

Cesar Gerez-martinez, mD Family Medicine Westover Hills (210) 681-0126

ricardo escamilla, mD Family Medicine Southeast (210) 333-0798

sanjay Kumar, mD Internal Medicine Westover Hills (210) 681-0126

erika Garza, mD Family Medicine Southeast (210) 333-0798

sveta singh, Do Family Medicine Westover Hills (210) 681-0126 05/2013

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SAN ANTONIO // NONPROFIT

DROWNING IS THE NO. 1 CAUSE OF ACCIDENTAL DEATH FOR CHILDREN UNDER 5.

PARTNERS FOR PREVENTION

Colin’s Hope has a vision of a world where children do not drown. Here’s how businesses and individuals can help achieve that vision. By: [ALISSA MAGRUM]

WHAT DO INTEL,

Hewlett-Packard, Dell, AMD, Build A Sign, McDonald’s, Exxon Mobil, Sam’s Club, Nitro Swimming, Peel Inc., Blackbaud, Headspring, State Farm, Backwoods, Reagan National Advertising, Schlitterbahn Waterpark, Lumen Media and Freebirds World Burrito have in common? The simple answer is that they are stellar businesses with a Texas presence, but if you ask me, the answer would be much more detailed and passionate. All of these businesses (and many others) believe in the vision of a world where children do not drown – so much so that they have generously given employee time and talent, as well as company resources and cash, to help achieve that vision. Specifically, to help Colin’s Hope realize that vision. It is a vision any person and any business can (and should) support. I am the executive director of Colin’s Hope, a Texas-based nonprofit whose mission is to raise water safety awareness to prevent children from drowning. Colin’s Hope was formed in 2008 after 4-yearold Texan, Colin Holst, drowned in a public pool with lifeguards on duty and family members present. His family quickly learned that drowning is the No. 1 cause of accidental death for children under 5 and a leading cause for ages 1 to 14. Yet, drowning is preventable. As I write this, I know that more than 68 Texas children have died this year after a fatal drowning (Texas DFPS), while

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countless others have survived a non-fatal drowning incident. According to the U.S. CPSC Pool Safely Campaign, Texas leads the nation again this year with the highest number of child drownings in pools and spas. These drownings are preventable. Our vision is of a world where children do not drown – but we need the help of every Texas business, community partner and parent to achieve that vision. Drowning does not have socio-economic or racial boundaries. Drowning does not pass over families who hold a college (or higher) degree. Drowning may actually choose you. Drowning may impact your family when you least expect it. Drowning may choose you after your children have completed swim lessons or after the water has filled up your backyard pool or even while on a vacation at a beautiful beach resort. Where there is water (backyard pools, community pools, kiddie pools, water parks, apartment pools, hotel pools, spas, lakes, rivers, bathtubs, toilets and even buckets), there are drownings. And they are preventable. Colin’s Hope is very proud of the deep and rich community partnerships we have. In fact, we thrive on working directly with our partners to develop a relationship that meets our needs, as well as their needs. These partnerships also give us the opportunity to raise the level of water safety awareness of these amazing partners as their employees learn simple water safety tips like constantly watching

kids around water, learning to swim, wearing life jackets, learning CPR and ensuring barriers around water. Truly a win-win. Here are a few examples of our win-win relationships with business and community partners. We invite you to work with Colin’s Hope. Together, we can create a high-yield win-win partnership with you. ■ Hewlett Packard, AMD, National Instruments, Build A Sign, Blackbaud, Dell and Intel all needed high-quality and fun team-building projects for their employees. Colin’s Hope needed volunteers to stuff and distribute 75,000 water safety packets. Result: Including the employee volunteers, 75,000 families received lifesaving water safety information while employee volunteers had a high-quality experience. ■ Nitro Swimming, Backwoods, Bicycle Sport Shop, Team Realty of Texas and State Farm wanted positive visibility in the community. Colin’s Hope needed sponsors for the Colin’s Hope Kids Triathlon. Result: Hundreds of families received water safety information, and 375 young athletes completed a triathlon and raised more than $40,000 to help prevent children from drowning. ■ Peel Inc. and Reagan National Advertising had unsold ad space in their community newsletters and highway billboards. Colin’s Hope needed multiple platforms to deliver their water safety awareness campaign. Result: Colin’s Hope delivered drowning prevention messages to thousands of families with children. ■ Headspring and Lumen Media wanted to allow their team members to use their technical skills on projects that would have a high impact on the community. Colin’s Hope wanted a Web-based way to engage parents and a method to recruit athlete ambassadors. Result: Colin’s Hope will soon have a Webbased interactive water safety quiz for parents and a new video to help recruit athlete ambassadors. Building, nurturing and growing partnerships is the smartest and most cost-effective way for Colin’s Hope to multiply efforts to prevent children from drowning. Rich partnerships allow us to use our strengths while leveraging the strength and skills of our partners and increasing reach and impact.

Alissa Magrum is the executive director of Colin’s Hope and mom to 8-year-old Ella. Please visit www. colinshope.org to learn more about Colin’s Hope. Contact us to begin developing a win-win partnership that will help save lives.


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SAN ANTONIO // NONPROFIT

A DREAM OF HEALING The heart of it all: Janis Roznowski and Operation Comfort honor and work to give something back to our nation’s wounded warriors. By: [EDEN MORRIS]

WALT DISNEY

said, “All our dreams can come true if we have the courage to pursue them.” You know an idea or dream is the right one when it scares you. That literally happened to Janis Roznowski, founder of Operation Comfort. “I was sleeping one night and shot out of bed from a dead sleep and said, ‘We’ll ride Vietnam!’” It seemed an impossible feat with too many obstacles. But what triumph is complete without adversity? First, a little background on this not-so-little brainchild of Roznowski’s. Operation Comfort was started by Roznowski, an American Airlines flight attendant who was part of a team transporting soldiers to and from the Middle East. The main objective of Operation Comfort is to show our wounded men and women that they are

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appreciated, valued and respected. The focus is to provide rehabilitative therapeutic programs for them while they are recovering at Brooke Army Medical Center in San Antonio. These programs are sled hockey, hand cycling, amputee surfing, Automotivation (a program where they can work on cars), woodworking, outings and a family financial assistance program that helps the families get over the financial burden they encounter while taking care of their loved one. “Having had the great experience of being in the presence of some of the bravest men and women I have ever met makes me realize that we can never do enough for them,” Roznowski says. “I believe that our military men and women are truly our nation’s na-

tional treasure. Now that they are wounded, we must do what we can for them.” And Roznowski is about to do something amazing. The homecoming of our wounded troops today is a vast difference from the reception our Vietnam veterans faced when they returned home. How do you honor those who vowed, “Never again will one generation of veterans abandon another”? How do you express gratitude to a group of combat veterans who changed how all of America treats her veterans? A large part of this is because our Vietnam veterans have taken a vow that the reception they received will not happen to the wounded troops coming home today. You don’t have to scratch the surface very far to find a Vietnam veteran doing what


THE MAIN OBJECTIVE OF OPERATION COMFORT IS TO SHOW OUR WOUNDED WARRIORS THAT THEY ARE APPRECIATED, VALUED AND RESPECTED. he can to take care of our wounded. Operation Comfort believes it is time to honor those who fought and died in Vietnam and to thank our Vietnam veterans for the difference they have made in the lives of those coming home today. For a couple of years, Roznowski had been thinking about a way for our current military veterans to give back to those who served in Vietnam. She realized that all of our soldiers and veterans are very interested and enthusiastic about our military history. So after months of stewing and formulating, the sleep-disrupting idea of “We’ll ride Vietnam” took shape. From March 28 through April 8, 2014, cyclists made up of the Operation Comfort Cycling Team, current military, veterans and civilians (spots are limited) will ride a distance of approximately 80 to 100 km per day with an H4H rating of “challenging.” “We’re going to the battlefield,” Roznowski says. “It’s not going to be easy. If you want a comfortable tour, call AAA. This is going to be a challenge.” One of the reasons this ride is so special is

what’s at the heart of it all. Working with Roznowski and Operation Comfort and within the individual’s community, each rider helps sponsor themselves and a Vietnam veteran to go back and visit the areas they served with the hope of providing an opportunity of healing. But that’s not all. Operation Comfort hopes to raise the funds to pay for their passports and shots and to put a little in their pocket for spending money. This is a gift from the heart to the Vietnam veterans with nothing expected in return. This is not only a ride for honor, but one of acknowledgment, respect and gratitude.

You may not be able to ride Vietnam, but you can help send others. You can give the gift of healing to our veterans. If you believe in these men and women and their cause and share a dream like that of Janis Roznowski and Operation Comfort, please go to www.operationcomfort.org and write “Paralympic” or “Vietnam” in the purpose box of the PayPal account. Checks may be sent in directly.

NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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SAN ANTONIO // PROFILE

‘COMPASSIONATE PEOPLE WITH COMPASSIONATE CARE’ 66

NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013


MEDFIRST PRIMARY CARE: THE LARGEST MULTI-SPECIALTY GROUP IN SOUTH TEXAS SERVES AS A TOP CHOICE FOR CUTTINGEDGE HEALTH CARE WITH MORE THAN 40 PRIMARY CARE AND SPECIALTY CLINIC LOCATIONS THROUGHOUT SAN ANTONIO.

By: [JODY JOSEPH MARMEL] Photography: [ALEXANDER ALEMAN]

H

aving a primary care physician you can trust near home or work is optimal. MedFirst Primary Care, which is affiliated BHS Physicians Network and Baptist Health System, is part of the largest multi-specialty group in South Texas. MedFirst has made it convenient for patients to find a physician regardless of where you live in the San Antonio area. With more than 40 primary care and specialty clinic locations, residents of San Antonio have the best choice in health care throughout the city. Physicians in the BHS network are committed to providing quality care to their patients, and the compassion they all share is evident by having a continuum of care available throughout city and making access more convenient for patients.

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A VIEW OF CITY COVERAGE Victoria Chang, D.O. INTERNAL MEDICINE

MedFirst Schertz

Dr. Victoria Chang Victoria Chang, D.O., is one of the primary care physicians at the MedFirst Schertz Primary Care Clinic. Born and raised in Southern California, she attended Harvard University, where she graduated cum laude with an undergraduate degree in biology. Chang continued her studies at the National Institutes of Health, where she performed two years of post-graduate research on the mechanisms of disease. At the conclusion of her research, she attended Nova Southeastern College of Osteopathic Medicine, where she earned her Doctor of Osteopathy. She completed her internship and residency training in internal medicine at Loma Linda University Medical Center in Southern California. Most recently, Chang completed her fellowship in neuromusculoskeletal medicine and osteopathic manipulation at Mercy Health Partners in Michigan. Her warm, outgoing and sympathetic demeanor comes natural to her. Chang truly cares about all of her patients. “I always want to make sure that I give the patients the right direction both in environmental health issues and all medically related issues,” she says. “I want to always ensure that the patient comes first while establishing myself as a leader in the community and utilizing all of my skills as an example for the community.” In her clinical years of medical school, Chang grew to appreciate internal medicine, which she is board certified in, for its ability to integrate whole person care with a broad scope of practice to best serve her patients. “Internal medicine provides comprehensive medical care for adults,” Chang explains. “Internal medicine physicians provide whole-person medical care and patient advocacy.” In addition to her comprehensive internal medicine services, Chang integrates osteopathic manipulative medicine into her practice to better provide for the wide range of common musculoskeletal issues that affect some patients. This remarkable woman and physician is proud to be affiliated with MedFirst Primary Care within the BHS Physicians Network. “Through this partnership,” she says, “I have the opportunity to serve the diverse population of South Texas and improve the lives of my patients by providing excellent medical care and encouraging healthy lifestyle.” Chang swam competitively at the NCAA Division I level for Harvard University and enjoys the practices of Yoga and Pilates in her free time. With her outstanding curriculum vitae and her vast medical knowledge, Chang is an exceptional primary care physician and a wonderful addition to MedFirst and the overall BHS Physicians Network.

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MedFirst Castle Hills

Dr. Nishi Thakur Nishi Thakur, M.D., has been practicing internal medicine at MedFirst for the past five years. Focusing on preventative medicine, she explains, “I believe in the saying, ‘an ounce of prevention is better than a pound of care.’” Growing up in India with an excellent educational background, she has had high ambitions since childhood. During her childhood days, her mother’s prolonged illness motivated her to choose a career in medicine. “Since I used to visit my mother in the hospital at a very young age, I had made up my mind to become a physician and serve the community, as well as my family,” Thakur says. “I have been affiliated with the BHS Physicians Network for approximately five years. The mission of Baptist Health System – ‘compassionate people with passionate care’ – describes their dedication and willingness to care for patients. During this time frame, I have seen the Baptist family grow and become leaders in multiple fields, which include the stroke prevention program, joint replacement programs, hospitalist programs, rehab and LTAC (long-term assisted care) programs led by our specialists.” Each BHS Physicians Network employee focuses on quality metrics with a major emphasis on colon cancer screenings, breast cancer screenings, cervical cancer screenings, smoking cessation, screenings for an overweight, obese and morbidly obese population and striving to achieve target BMI. The pneumonia and shingles vaccines are also part of the quality metrics utilized. “The mentioned conditions impose a financial burden to society, the family and the individual in terms of treatment if we are not able to prevent them,” Thakur says. “Since we are able to achieve the goals in preventing the conditions for which we are

Nishi Thakur, M.D. INTERNAL MEDICINE

“WE BELIEVE IN ‘HEALTH FOR ALL.’ ” fortunate to have the screening tests available, then we will be doing a better job in managing other conditions.” These other conditions include high blood pressure, high cholesterol, heart attacks, diabetes and heart failure. “Location is key to many of our patients in San Antonio. My patients love to know that they only have to

drive five minutes to see me and really like to know that we are here to take care of them. My goal is to try to take care of everybody by treating the conditions and keeping my patients out of the hospital. For those that need acute care, we minimize hospital stays when possible for the well-being of the patients.” Since human life expectancy has increased,

Thakur strongly believes that by using their resources wisely, physicians will, she hopes, be able to tackle these conditions in the same way most of the pandemics have been controlled in the past: through immunization and global awareness. Highlighting a better life and good living conditions, she adds, “We believe in ‘health for all.’” » NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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MedFirst Westover Hills

Dr. Cesar GerezMartinez

Cesar Gerez-Martinez, M.D. FAMILY MEDICINE

Cesar Gerez-Martinez, M.D., practices internal medicine at MedFirst Westover Hills covering the northwestern side of San Antonio. A medical background from his family strongly influenced him to follow in the same footsteps. “I love the medical field in all aspects, and family medicine gives me the option to be involved with the whole patient,” Gerez-Martinez says. “I have been able to treat all types of medical problems from general medicine, pediatrics and geriatrics. Being a part of a wellknown and highly respected organization, I am proud to practice at a MedFirst Primary Care clinic and to be a part of the BHS Physicians Network. It is an honor, and I do my best to give excellent patient care.” Always keeping up-to-date, Gerez-Martinez surrounds himself with medical journals, attends many conferences and believes that continuing medical education is the key to success. His kind and caring ways are appreciated by his patients. “Bedside manners are very important; I cannot emphasize this enough. At the end of the day, the patients don’t know how much you know, but they know how much you care.” Gerez-Martinez treats newborns to geriatric patients. The majority of his patients are in their 40s, but he sees anybody who needs medical care. He explains that he performs all kinds of procedures in the clinic from skin biopsies and laceration repairs to I&D and excisional biopsies. The majority of the time, he practices family medicine. “My goal is to stay and grow with the Baptist Health System and continue to care for my patients. This is what medicine is all about, and I follow the Baptist philosophies because they are my philosophies, as well.”

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MedFirst Overlook

Dr. Aaron King The MedFirst at Overlook clinic is located in the Stone Oak neighborhood of San Antonio, and it is graced with the presence of Aaron King, M.D. Having spent much of his youth traveling between San Francisco, Dallas and Houston, his family settled in Conroe, Texas, where he attended high school. After his sophomore year, King left home to attend the University of North Texas in a program called Texas Academy of Mathematics and Science, also known as TAMS. He studied there for two years and transferred to the University of Texas at Austin and graduated with a B.S. in microbiology. He completed his medical degree at Texas A&M University’s College of Medicine. While in medical school, King joined the Navy through their medical scholarship program. “After my medical school graduation, I moved to Florida to complete my family practice residency at Navy Hospital Pensacola,” he says. “After graduation, I was deployed to a small island in the Indian Ocean for a year, where I served as senior medical officer. After the tour, I moved to San Antonio and was an instructor for two years at the Interservice PA Program.” King left the military after this amazing career and started a diabetes clinic in North San Antonio, where he stayed for four years, followed by moving to MedFirst to resume his family practice duties for the last two years. In the setting of rising health care costs and busier lifestyles, the need for a solitary doctor to accurately diagnose and manage most medical diseases has never been greater. “Primary care has this unique charge and ability,” King says. “In addition, while a specialist may only be looking at the specific disease, primary care physicians have the ability to view the entire health situation for the patient. And knowing the patient personally helps to make sound judgments for cared based on the patient’s medical needs, desires and ethics.” King strongly believes that BHS Physicians Network allows doctors to

do their job well by empowering them with the infrastructure needed to run a busy clinic. “Since the mission of Baptist is aligned with the physicians, our common goal to deliver effective, affordable health care is possible.” Having a dichotomous patient base, approximately half of King’s patients are diabetics who travel from all over the city and have followed him from his prior diabetes clinic. The other half of his patient population consists of families who live near the clinic. MedFirst at Overlook provides full-

service family practice care while also providing cutting-edge diabetes and lipid management. They use advanced biomarkers for heart disease prevention and utilize the new advances in insulin pump and blood glucose monitoring technology. These services are usually only found in endocrinology offices. King strives to provide a smooth, comprehensive primary care office that is able to efficiently handle the vast majority of outpatient health care needs in a single visit. “The Baptist Health System gives

me a unique opportunity to be a part of a comprehensive health care network that is needed in San Antonio,” he says. “Having a full complement of tools at an advanced level and access to a specialty network makes providing quality health care a mission that we can attain together. My belief is that with the BHS Physicians Network, together, we are providing cuttingedge health care for the patients in consideration with their needs. We are not just looking at one problem; we are looking at the whole person.”

Aaron King, M.D. FAMILY MEDICINE

MUCH YOU KNOW, BUT THEY KNOW HOW MUCH YOU CARE.” NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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Skinner Clinic

Dr. Lovelesh Manocha Located in downtown San Antonio, the Skinner Clinic provides primary care through the BHS Physicians Network. Lovelesh Manocha, M.D., is a family practitioner who provides his services to a diverse group of people ranging from ages 18 to 97 years old. “As an internal medicine doctor, I strive to be caring, compassionate and always act on my patients’ best interests,” Manocha says. “I choose to follow my patients while they are in the hospital and make sure that I keep up with all the latest information as we move forward with EMR and all the current health care changes.” Coordinating care with other physicians and specialists is very important to Manocha, and in turn, his patients receive quality care. He details the multiple aspects of continuing the quality of care by thorough initial consults, follow-up consults, coordinating schedules with other physicians and ensuring that he educates the patients. “I believe in quality care and plan on working alongside of BHS to provide that care to our patients for a long time. The BHS Physicians Network has a strong commitment to the patients, as I do. I appreciate this, and they are always improving patient care through the network. In turn, I can provide the quality of care necessary and meet the needs of my patient base.” According to Julie Minnick, regional director for physician services with Baptist Health System, “Through attentive and compassionate care, our primary care providers’ main goal is to help patients maintain optimal health and well-being throughout their lives. San Antonio continues to grow, and there is a great need for us to continue to expand primary care access to patients. MedFirst Primary Care is committed to opening more neighborhood family practice clinics as part of our aggressive growth strategy over the next few years in order to serve the residents of this great city.” The newest location at 281 and Thousand Oaks, next to Baptist Emergency Hospital (16088 N. U.S. Highway 281 in San Antonio, Texas), is currently accepting new patients. They are adding new primary care providers to continue access and better capacity for their patients.

Lovelesh Manocha, M.D. INTERNAL MEDICINE

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To learn more about BHS Physicians Network, contact Julie Minnick at jaminnic@ baptisthealthsystem.com or visit www. bhsphysiciansnetwork.com.


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SAN ANTONIO // PROFILE

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MARK MAKING HIS

CANCER SURVIVOR MANUEL “MANNY” DIOTTE PUTS HIS BELIEF IN HARD WORK AND HEART WORK INTO ACTION WITH THE FERRARI KID, A LABOR OF LOVE DEDICATED TO GIVING SICK KIDS THE RIDE OF A LIFETIME. By: [JODY JOSEPH MARMEL] Photography: [ROBIN JERSTAD]

FERRARI LOGO IMAGE ESKA2005/SHUTTERSTOCK.COM

BORN IN GRANADA, Manuel (Manny) Diotte came to Amer-

ica when he was 5 years old. Shortly after his arrival, he was diagnosed with cancer at the age of 7. “Little did I know that I would have surgery every year of my life thereafter,” Diotte says. “Sometimes I would have surgery twice in the same year.” After 48 operations, three-and-a-half years in and out of hospitals and two years of chemotherapy and radiation treatment, Diotte beat some of “the toughest odds.” “Though my cancer is long gone, I still deal with the aftermath of treatments, chronic pain and recently underwent two total hip replacements on the same side,” Diotte says. “However, despite that, I am blessed every day to have the opportunity to do what I love and make a positive difference in my community and in the world.” Inspired by an experience he had in the late 1980s in California, he went to see a specialist to save his leg from amputation. Thankfully, he did. “When I walked out of the airport, there was this amazing red, shiny Ferrari,” he says. “I ran to it like it was mine. I asked the guy who owned it if I could take a picture next to it. He agreed; I never forgot that day, that feeling, that experience. Years later, I thought how cool it would be to give sick kids an amazing experience – a ride that they will never forget.” The Ferrari Kid was born a year ago on Diotte’s birthday. Being a compassionate and humanitarian man, Diotte faithfully asked his family, friends and clients to help him make a difference. He sent out his annual letter called “Begging for Change.” Diotte would ask them to write a check in any amount to a charity that

he thought needed help and was doing something great for humanity. “But last year, I decided to start my own charity; I wanted to support the needs of my community,” Diotte says. “Thanks to Roy Terracina, who gave us our first major gift, James and Mary Boyd, who faithfully give monthly, and volunteers such as Melinda Roberts of Transwestern, who I believe has never missed an event, it makes my work possible.” The Ferrari Kid picks the child up in a Ferrari and drives them around for about 30 minutes. They arrive at their very own VIP red carpet experience. “We have paparazzi that await their arrival, fans that ask for their autographs and more surprises that are top secret. Then they get to visit with me, and this is where the real magic happens. I remind them of the three things that I believe in: God heals, miracles happen and dreams really do come true. I want to fill their hope tank, and we have so much fun in the process. I get just as much from the experience as they do, and it’s amazing how many kids still stay in touch.” Taking the children on a first come, first serve basis is how The Ferrari Kid operates. As long as the child is between 8 and 18 years old (because they have to be able to fit in the front seat of the car), it does not matter what they are sick with. “If they are suffering in any way, I want to help.” Besides taking on this nonprofit business, Diotte is a professional speaker. Having the privilege of sharing the platform with some of the “greats,” he still feels like a kid on Christmas morning and sometimes can’t believe who he is in the green room with. “Life is truly beautiful,” he says. “I mean, I was just a kid with NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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Lola, our newest Ferrari kid, arrives in style.

a dream and a big mountain to climb called cancer. But if man can take molded bread and make penicillin, it’s amazing what an awesome God was able to do with me or with each and every one of us, for that matter.” Diotte is the author of the hit books, “Happiness

The Ferrari Kid has plans to take kids for chemotherapy and other treatments in the near future. Diotte’s philosophy is a wise one: “Cancer sucks, but the trip to the hospital doesn’t have to.” This amazing man has accomplished so much in so little time; he wants to share his story and take

“CANCER SUCKS, BUT THE TRIP TO THE HOSPITAL DOESN’T HAVE TO.” is a Pair of Shorts” and “Success is a Journey,” and a contributing author to the No. 1 New York Times Bestseller, “Chicken Soup for the Surviving Soul.” Also a professional coach working with small business owners and nonprofits that want to grow their business, Diotte is certainly making his mark. “My little hobby has turned into fulltime work. I love it, but we have a waiting list two to three months out. I don’t want any kid to wait that long.”

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The Ferrari Kid to other cities. “It doesn’t matter where you start or what you have; it is what you do about it. Whether you give your time, treasure or talent, there is a place at the table for all of us. I believe we were all born for greatness.” A list of all of the people he is thankful for in helping make The Ferrari Kid become a reality could very well be a book itself. Instead, Diotte expresses how grateful he is for his wife, Kristi, and their girls, Nicole

and Caroline. Always wanting to make the kids’ experience better, he works hard and keeps late hours because he believes in hard work and heart work. “My girls have sacrificed things they want by allowing me to get the things I need to make The Ferrari Kid work. Everybody gives me the credit, but the truth is my three girls are the real rock stars and my team makes me look great.” People often ask how they can help; currently, The Ferrari Kid needs funds to catch up. The best practice Diotte follows is “a little goes a long way.” With almost no overhead expenses, a couple of generous gifts will help The Ferrari Kid catch up and meet its monetary needs in order to help more kids. “We also need volunteers. If you have a camera, come take a few pictures and be part of the experience as paparazzi or ask a kid for an autograph. I promise you will come back because you will fall in love with these extraordinary kids. Believe me, if you show up, I can use your help and I would be forever grateful.” And so would the kids.

For more information, visit www.theferrarikid.org, or contact Manny Diotte at manny@theferrarikid.org or 210-887-7285.


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FULFILLING A

Dr. Son Nguyen, who graduated magna cum laude from West Texas State University, is a primary care physician at WellMed at Embassy Oaks.

FATHER’S DREAM

DR. SON NGUYEN: A STORY OF SURVIVAL AND ACCOMPLISHMENT By: [RON AARON EISENBERG] Photography: [RON AARON EISENBERG]

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hen you first meet 46-year-old Dr. Son Nguyen, it’s his smile and engaging personality that grab your attention. You might not be surprised to learn he graduated magna cum laude from West Texas State University, or that he earned his medical degree from the University of Texas Health Science Center in San Antonio (UTHSCSA). How all of that happened, however, is a story worthy of a best-selling novel or a Hollywood feature film. It involves a harrowing escape from a war-torn country, the kindness of a larger-than-life

Texan who built his fame on “free” 72-ounce steaks … and a poem. It was April 1975, and American forces were abandoning South Vietnam. For 7-year-old Son Nguyen, becoming a doctor was the least of his worries; surviving was all that mattered. Nguyen and his family were among thousands of South Vietnamese desperately trying to flee the country as North Vietnamese forces surged into Saigon. His father, who at one time had been left for dead in a North Vietnamese prison camp, knew he and his family were in deadly danger once the North


took control of Saigon. It was chaos on the tarmac as the Nguyen family – mom, dad and 10 children – raced toward a helicopter. The children were separated from their folks, but an older relative led them to one of the waiting helicopters. It whisked them away from Saigon. Their parents made it out safely, too. Later, refuge workers helped reunite the family and their journey to America began. The Nguyen family ultimately settled in the Texas Panhandle under the sponsorship of R. J. “Bob” Lee, founder of the Big Texan Steak Ranch in Amarillo. Talk about a cultural shift. The Nguyen family left a dangerous home where finding food could be a daily struggle to find a new home thanks to a man whose restaurant was famous (featured on the Food Channel and elsewhere) as home of the free 72-ounce steak – if you can finish it in an hour. The family settled into their new home. The kids learned English, attended local schools and adapted to life in America. Nguyen’s dad often told his children he dreamed of their success in America. His hope was that at least one of his children would

“SENIORS ARE SPECIAL. THEY HAVE SO MANY GREAT STORIES TO TELL. AND MANY NEED OUR HELP NOW MORE THAN EVER.” become a doctor and another a priest. Son seriously considered entering seminary school and becoming a priest, but he decided he could help more people as a physician. And so it was medicine for him. “For the Vietnamese, our heroes are rarely sports stars,” Nguyen says. “They are professors – educated people. My dad shared a poem with us as we were growing up. It urged us to study, and in doing so, the poem explained, ‘you will honor your parents, showing respect for them.’ The poem also stated, ‘everyone loves an intelligent person.’” Nguyen has kept that poem in focus all of his life. Nguyen earned his undergraduate degree magna cum laude from West Texas State University. It doesn’t get any better than that. And he went on to excel in medical school at UTHSCSA. Early on in his medical career, he practiced medicine at a clinic in Baytown, Texas. His love was medicine and helping people. His focus was rarely on the income side of the practice. He tells the story of how his clinic administrator told him one day, “Dr. Nguyen, if we hope to stay in business to help people in this community, we have to charge them for our services.” Nguyen acknowledges she was right, of course. But he is one of those doctors who’d rather give it away than charge those who cannot afford to pay.

In 2006, he joined CommuniCare in San Antonio as a senior physician. By 2010, he was medical director. It was a good fit for him because the health care provider is a nonprofit organization committed to providing quality care at a low cost for its patients. Over time, Nguyen realized he enjoyed working with seniors the most. “They are special,” he says. “They have so many great stories to tell. And many need our help now more than ever.” He joined WellMed Medical Management in 2013 so he could provide medical care to a growing number of seniors, which is WellMed’s specialty: delivering quality medical care to Medicare-eligible seniors. He says he came to embrace WellMed’s mission and vision, which states: “WellMed’s mission and vision is to change the face of health care delivery for seniors. By developing a measurable and results-driven health care delivery system for seniors, WellMed will help the sick become well and help patients understand and control their health in a lifelong effort at proactive wellness.” “The WellMed model is how I thought medicine should be practiced,” Nguyen says. “It’s patient centered, and that makes so much sense on so many levels. And as the Affordable Care Act (the new national health care law) comes into play, Wellmed is fast becoming recognized as a leader in this new

world of health care delivery. We were a medical home for our patients long before the term had any caché. Our commitment to wellness and prevention is now written into the law, but it’s something we do very well for our patients.” Nguyen is board certified in family practice, and he is a lifetime member of the Texas Medical Foundation. A highlight of his life is his dad living to see him graduate from medical school. “He passed away in 1994 – not long after I graduated,” Nguyen says. “I think he wanted to live long enough to see me graduate – to achieve one of his dreams for his children.” As for the poem his dad shared with his children, Nguyen’s dad presented a copy wrapped in a box to him on his graduation day. It is a cherished possession and a marvelous memory. Nguyen and his wife, Sandra Nieto, who is also a physician, have two children: a daughter, Tana, at UT Austin, and a son, Diego, at Health Careers High School. And a very special poem is a gift Nguyen will share with his children one day.

For more information on WellMed Medical Management, or to inquire about becoming one of Dr. Son Nguyen’s patients, call 210-615-WELL. NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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“THE APPLE DOESN’T FALL FAR FROM THE TREE,” INDEED. WITH FIVE SUCCESSFUL PHYSICIANS FOLLOWING IN THE FOOTSTEPS OF THEIR FAMILY PATRIARCH, DR. JOSE BONILLA, MEDICINE TRULY RUNS IN THE BLOOD OF THE BONILLA FAMILY.

t is not too often that almost an entire family pursues a medical career, but with a hardworking, devoted and influential father who was also an excellent physician, Dr. Jose Bonilla led the way for the next generation of Bonilla doctors. Without even knowing that his driving force left immeasurable imprints on his children’s plans for the future, he forged ahead with his plans before he and his wife started a family. Jose was born in Nuevo Laredo, Mexico, and he went to medical school in Monterrey, Mexico. After graduating, he obtained his residency in obstetrics/ gynecology at the Robert B. Green Hospital in San Antonio. Although the initial plan was to return to Mexico after his training, he fell in love with the city and decided to stay in San Antonio. He began his practice in 1966. While other physicians chose to practice in the more lucrative north side of San Antonio known as “The Hill,” Jose felt there was a need to help the people of downtown and the south side of San Antonio. He decided to practice downtown for his entire career. “It is common for people to walk up to my dad and tell him that he delivered the grandmother, mother and grandbaby,” says Jose’s son, Arturo. “I hear it all the time: ‘Your dad delivered me and all of my children.’” Jose’s devotion to his practice is surpassed only by his devotion to his wife and five children. “My wife, Laurentina, was the backbone of the family,” he explains. “She was the one that was in charge of driving the kids from place to place, helping them with homework, helping me manage my office, cooking at home and everything else you could think of.” Together, they raised five children: Dr. Juan Bonilla, a practicing pediatric otolaryngologist; Dr. Esther Laura Bonilla, a practicing den-

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PHOTO BY ALEXANDER ALEMAN

By: [JODY JOSEPH MARMEL] Photography: [ALEXANDER ALEMAN and SARAH BROOKE LYONS]


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Word High School. All five children spent their college years at St. Mary’s University in San Antonio. After college, each one followed a different path. Juan went to the University of Texas Health Science Center at San Antonio and continued with his residency in general surgery at the State University of New York – Buffalo. He then continued his otolaryngology/head and neck surgery residency in Buffalo and completed his fellowship in pediatric otolaryngology at Boston Children’s Hospital. Today, he is a specialist in pediatric sinus disease and pediatric airway anomalies. “After seeing my dad’s passion and love of his work, I was convinced that I wanted to go into medicine,” Juan says. “I chose pediatric head and neck surgery because I felt I could really make a difference in these kids’ lives.” Arturo studied at the University of Texas Health Science Center at Houston for his medical school years. His general surgery residency followed at

Methodist Hospitals in Dallas. He then went to Buffalo, N.Y., for his residency in otolaryngology/head and neck surgery, and he completed his fellowship in pediatric otolaryngology at Children’s Hospital of Pittsburgh under the direction of the world-renowned Dr. Charles Bluestone. Today, Arturo is the only exclusive pediatric ear reconstructive surgeon in the United States. He specializes in reconstruction of children born without ears. Children with ear deformities and severe hearing loss come from all over the world to see him. “One thing I admired about my dad was that as busy as he was, he never missed any of our school and sports functions,” he says. “He and my mom were very involved with all of my brothers’ and sisters’ lives. If he could do this, then so could I. “I chose pediatric ear reconstructive surgery because it was such a rare ear deformity and there were few doctors in the world that specialized in this field. When one of my patients said that he

DR. JOSE BONILLA’S DEVOTION TO HIS PRACTICE IS SURPASSED ONLY BY

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his devotion to his wife and five children. NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013

PHOTO BY SARAH BROOKE LYONS

tist; Dr. Arturo Bonilla, a practicing pediatric ear reconstructive surgeon; Dr. Jorge Bonilla, a practicing pediatric anesthesiologist; and Dr. Lorena Bonilla, a dental hygienist and attorney. Although he downplays his role, the medical patriarch attributes the success of his children to his wife. As busy as Jose was, his children say he was always there during their activities. “Our dad would get the call, run to the hospital to deliver a baby and was back watching us during all of our activities in no time at all,” his children say. “We don’t remember dad not being there because he was always there.” “My parents never pushed us into medicine,” Arturo emphasizes. “They always told us to do whatever we wanted to do, but to be the best at it. Their hard work, values and integrity were what made all of us want to be just like them. Our mom was always and continues to be the epicenter of the family.” The three sons attended Central Catholic High School, and the two daughters attended Incarnate


PHOTO BY SARAH BROOKE LYONS

could hear the birds chirping for the first time in his life, I knew I was hooked. Pediatric microtia surgery became my passion. These children who are born without ears and with severe hearing loss have a life transformation after the surgeries. There is nothing more gratifying than that.” Jorge attended the University of Texas Medical Branch at Galveston and continued his internal medicine transitional residency at the University of Pittsburgh. He continued his anesthesiology residency at the University of Texas Health Science Center at San Antonio. He then went to Denver Children’s Hospital for his fellowship in pediatric anesthesiology. “I chose medicine because medicine runs in our blood,” he says. “Everyone in my family was initially in the medical field, and I saw how my dad changed so many lives. I chose to specialize in pediatric anesthesiology because of the technical skills involved in dealing with pediatric airways. Presently, I perform all kinds of anesthesia with Star Anesthesia.” Esther Laura attended dental school at the University of Texas Health Science Center at San Antonio. “I chose a different path because I had a great interest in family dentistry,” she says. “I was fortunate to graduate through the dental program in San Antonio (which is considered the top dental school in the country). I have been in private practice for over 20 years in the downtown area and had my office located right across from my father’s office.” Lorena attended St. Mary’s University School of Law. “I chose a different path, as well,” she adds. “Although I received training as a dental hygienist and continue to practice with my sister, I wanted to go down a different path. We always hear the funny comments that with so many doctors in the family, we needed to have a lawyer, too. Although not for that reason, I decided to pursue a law degree, and I am very happy balancing everything in my life.” What makes the brothers stand out is that they are the only pediatric specialist brothers who work together in the operating room in the United States. Juan’s training at Boston Children’s Hospital gave him the skills to be a highly sought-after pediatric sinus surgeon. He has been in private practice for more than 25 years. Arturo initially joined Juan’s practice, but because of his pediatric ear specialty training from Children’s Hospital of Pittsburgh, he branched off into solo practice to exclusively specialize in pediatric ears. Since then, his practice has grown into the largest exclusive pediatric ear reconstructive practice in the United States. His practice specializes in the surgical reconstruction of children born without ears. Parents continue to bring their children from all over the world to have their ears built by Arturo. Throughout the year, Jorge provides pediatric anesthesia services for both of his brothers. The goals of all five Bonilla children are the same: to continue to dedicate their lives to their trade, while at the same time, balance the time with their spouses and children. “The apple doesn’t fall far from the tree” is an excellent saying that is applicable to the Bonilla family. The patients of all of these fine physicians are lucky, indeed; the Bonillas care about each and every one of their patients, just as their father did.

JUAN BONILLA, M.D.

Pediatric Ear, Nose & Throat Institute of South Texas 210-PEDI-ENT • www.pedient.com

Arturo Bonilla, M.D.

Founder & Director, Microtia-Congenital Ear Deformity Institute 210-477-EARS (3277) • www.microtia.net

Jorge Bonilla, M.D.

Northeast Anesthesia (Star Anesthesia) 210-375-7760 • www.staranesthesia.com

Esther Laura Bonilla, DDS

Jose, the patriarch, recently retired after having practiced for nearly 50 years and delivered tens of thousands of babies. He was so accustomed to being on the go all of his life that he forgot how to take things at a slower pace. He has since gotten used to the retirement world and spends all of his time with his wife and children. His activities include going to his daughter’s dental office to help with office activity, and he loves pruning in the garden, even when it is not his garden. The future of the medical world is in the hands of his children, and he feels a lot safer knowing that a plethora of patients will be well taken care of by his own DNA: his intelligent and highly skilled children.

Family Dentistry / 210-228-0084

Lorena Bonilla, J.D., RDH 210-228-0084

Note: While NSIDE officially adheres to AP style, certain exceptions were made in the editing of this article. NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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DR. CLINTON FALK

The Best in

ORAL CARE DR. CLINTON FALK PROVIDES TOP-QUALITY CARE FOR HIS PATIENTS EVERY STEP OF THE WAY AT CWF PERIODONTICS AND IMPLANTS. By: [JODY JOSEPH MARMEL] Photography: [SARAH BROOKE LYONS]

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was born and raised in Amarillo, Texas. His educational history is stellar; he was salutatorian upon graduating from Tascosa High School, and he received his bachelor’s degree in biology from West Texas A&M University. After just three years of undergraduate college, Falk began dental school at the University of Texas Health Science Center in San Antonio. Receiving his DDS in 2001 with summa cum laude honors, he continued his studies and specialty training in periodontics and implants at the University of Missouri in Kansas City. After completing his training, he moved to San Antonio in 2004 to begin his career in periodontics. Having an older brother in dental school while Falk was in college was one of the influential factors in his decision to pursue a career in dentistry. “However, while I was in my first year of dental school, I actually had a periodontal surgery performed on myself. I was treated with a connective tissue graft to correct some gum recession on one of my teeth. I watched the entire procedure, and from then on, I knew this was what I wanted to do every day.” CWF Periodontics and Implants provides their patients with state-of-the-art facilities while maintaining a very warm and inviting environment. Patients can enjoy coffee and Wi-Fi in the waiting room and TVs in each operatory. With a full-service dental surgical facility including a 3-D CT scan, Falk has ensured that the practice is a top-notch facility with a highly skilled dental team providing excellent care and wonderful results for all of his patients. Falk explains the practice’s mission and philosophy. “We provide our patients with the highest level of care and comfort every step of the way. While we always ensure that our top quality and care is given to all of our patients, we give them the best in oral and overall health care.” CWF Periodontics and Implants uses the most widely accepted research-based techniques, along with the most modern and safe equipment and supplies. Performing many therapeutic and cosmetic surgical procedures ranging from periodontal surgery to dental implants, most of the procedures offer both a therapeutic and a cosmetic benefit. Dental implants have become the most popular dental treatment in recent years. Falk places


“I ENJOY MY PROFESSION, AND HELPING PATIENTS EVERY DAY IS MY MISSION.”

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dental implants for individual tooth replacement to full-mouth tooth replacement. Patients can go to the office with a broken front tooth and leave with an implant and tooth the very same day. Falk also performs full-mouth dental implant procedures to restore and replace all teeth in just one day. “A patient does not have to wear dentures anymore and can have a beautiful smile in just one day.” Depending on the patient, all procedures can be done with sedation. Sedation dentistry has allowed Falk to perform all of these dental procedures on patients who have avoided the dentist due to anxiety or a previous “negative” experience. A vital component of the practice is treating periodontal disease both surgically and non-surgically. A third of the population suffers from periodontal disease, which is a chronic bacterial disease that has no cure, but can be controlled. Many patients are genetically susceptible, and diabetics also tend to be highly susceptible. Periodontal disease causes the loss of bone and tissue around the teeth until the tooth becomes loose. “Many procedures are available for these patients to treat the disease so these patients can keep their teeth for as long as possible, if not forever. Periodontal surgery can be performed to treat and clean the affected teeth; bone grafting can also be done to help regenerate lost bone around the teeth.” The treatment of periodontal disease has become even more important due to its relationship with overall health. “It has a very close link to diabetes, and research has also shown a close link to the heart and other body systems. It has been proven that untreated periodontal patents are at an increased risk for heart attack and stroke. A link has even been shown between periodontal disease and pregnant mothers giving birth to preterm low birth weight babies.” Good oral health is very important to a person’s overall health. Bone grafting is another procedure performed to help teeth that have lost bone to periodontal gum disease, preserve or grow bone in order for dental implants to be placed and to allow for dental implants to be placed for sinus elevation. Falk details this: “We all have two large sinus cavities in the cheek bones called the maxillary sinus. Many times, the sinus extends down to the roots of the upper back teeth. The sinus lift procedure is utilized to gently move the sinus floor up and allow bone graft to generate. This now allows dental implant placement without penetrating and affecting the sinuses.” Other procedures can correct gum re-

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“ Where smiles blossom ”

cession, and a significant cosmetic procedure offered is to treat what is called a gummy smile. A surgical procedure can be performed on the gingival tissue that removes the excess gum tissue and exposes more of the natural tooth upon smiling. Patients are always amazed on the aesthetic improvements from all of the aforementioned treatments offered by Falk. The majority of Falk’s patients are sent to him by referral from their general dentist. “The dentists I work closely with are exceptional dentists and treat all of their patients as family, and I want to continue and build on that relationship. Many of the dental procedures performed require a team effort with their dentist. We stay in constant communication and work synergistically every step of the way.” Prevention and keeping teeth healthy is one of Falk’s many goals. The more they can educate their patients on oral hygiene and regular dental visits, the healthier the patients will be in the long run. Education and prevention are key. “An untouched tooth will last a patient longer than a treated tooth.” Falk’s main goal is to treat a patient how he would like to be treated. “I want a doctor who sees me in a timely fashion – one who cares, listens and treats me with the best abilities. I make it a point to listen to their every issue and need and personally call each one of my surgical patients every night of the procedure to check on them. I enjoy my profession, and helping patients every day is my mission. Every patient I see is important not only to me, but to my entire staff.”

CWF Periodontics and Implants is located at 4466 Lockhill Selma Road, Ste. 102, in San Antonio, Texas. For more information, call 210-236-8672 or visit www. cwf-periodontics-and-implants.com.

pediatric dentistry Carlen Palmer Blume, DDS, PC Board Certified Pediatric Dentist Dr. Blume and staff aim to nurture and support your child’s oral health throughout the formative years. We provide contemporary, preventive dentistry in an intimate, fun environment.

8221 Fredericksburg Road, San Antonio, TX 78229 210.614.3334 www.BlumeDentistry.com Se habla Espanol Major insurance accepted, including Medicaid

NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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D

r. Kumar Reddy likes a challenge. And the complex creativity of his double medical specialties keeps his life interesting. “There is a definite overlap between neurology and sleep medicine,” Reddy said. “For example, sleep problems can be a precursor to neurological conditions. And both specialties are multidisciplinary. They are intellectually challenging, requiring both strong analytical skills combined with creative thinking. Working in these specialties to help patients is like putting together pieces of a puzzle. It’s a passion of mine.” And this passion has existed for as long as Reddy can remember. His father is a practicing cardiologist in San Antonio, and he grew up in the Alamo City within a community of physicians. “Going into medicine was a calling for me,” he said. “Growing up with a father who is a practicing physician showed me firsthand the lifestyle of a doctor, and I got to see how hard medicine is, but I also got to see the rewards that come with it. Going into medicine was natural to me, really. I never had any doubts.” Reddy was first drawn to a neurological practice because of the handson nature of the specialty. “Neurology is one of the few medical fields that still requires a physical exam,” he said. “I have to use my examination skills to find out what’s going on with patients.” When people are referred to a neurologist, he said, they are most often nervous or downright frightened. Being told something is wrong with their brain is daunting to most people. “I strive to have a compassionate, but honest discussion with each patient about what’s going on and what they can expect,” Reddy said. “Part of my job is to make patients more comfortable.” Reddy’s neurology practice is wide-ranging. He treats a variety of conditions, from seizures and headaches to multiple sclerosis, Parkinson’s and Alzheimer’s disease. “I love the diversity and daily challenge,” he said. A focus on neurology also led Reddy to devote time to a second complementary specialty: sleep medicine. People spend one-third of their lives in sleep, he said, so this is a field to which everyone relates. He treats

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“Going into medicine was a calling for me. I never had any doubts.”

DOUBLE DUTY Kumar Reddy, M.D., helps patients with practices in both neurology and sleep medicine.

realize how important proper sleep hygiene and habits are to good overall health. The natural importance of sleep to healthy, successful living appeals to his humanity and calling as a physician, but the variety of conditions he treats as a specialist in sleep medicine piques his creative problem-solving side. “It’s always interesting,” he said. “No two days are alike.” Reddy, a long-time San Antonio Spurs fan, cherishes the circumstances that allowed him to return to his hometown to practice medicine. His father’s cardiology practice is still thriving, so two generations of Reddys are helping South Texas patients regain their health. “Growing up here, it’s really nice to come back and practice in the only city I’ve ever wanted to live in,” he said. “My father is beyond happy. I am back here practicing, and the grandkids are here.” The study of medicine, and of his two medical specialties in particular, has taught Reddy more than just scientific healing methods. It has deepened his sense of humanity. “I’ve learned to appreciate different cultures and backgrounds,” he said. “I’ve come to realize that an individual perception does not equal the absolute truth, but only one faceted side of the entire piece.”

By: [PAMELA MOOMAN]

many types of sleep disorders, from insomnia (not as garden-variety as some might think) to narcolepsy and sleepwalking. He even investigates cases of bad dreams to determine if there are any underlying medical conditions causing them. Laughing, though, he said he does not plan to

NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013

take up dream interpretation anytime soon. Nonetheless, the field of sleep medicine has seen explosive growth in the last 15 years, he said, and he feels satisfaction as not only medical practitioners, but the media and gradually, the general public begin to

Dr. Kumar Reddy practices at River City Neurology (502 Madison Oak, Ste. 320, San Antonio, Texas 78258). For more information or to make an appointment, call his office at 210-6553800. To learn more about Reddy, go to www.bhsphysiciansnetwork.com. And more information on BHS Physicians Network, please contact Julie Minnick at jaminnic@baptisthealthsystem.com.


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LIVING LEGACY THE RIZZO MEN: THREE GENERATIONS OF PROUD CENTRAL CATHOLIC HIGH SCHOOL ALUMNI KEEP BOTH THEIR ENTREPRENEURIAL SPIRIT AND THEIR FAMILY VALUES ALIVE. By: [JODY JOSEPH MARMEL] Photography: [ROBIN JERSTAD]

M

ark L. Rizzo was born in San Antonio, and his Italian-American family provided him with rich traditions that have been carried through several generations. Sunday Italian meals at his grandparents’ house were one of those customs, and they all quickly learned that family was the greatest value behind God. His school years set the groundwork for his future endeavors in the Lone Star State. First attending Mount Sacred Heart grade school, Rizzo followed his father and brother and several cousins to Central Catholic High School (CCHS). Being a graduate of CCHS doesn’t sink in until years later, as explained by Rizzo. “If you would have asked me at the time, I would have said that it’s a good school, but it was very disciplined. We had to wear uniforms, had hair requirements and went to mass, while my public school friends had long hair and wore whatever they wanted to school. It was confining, but we did

it.” Rizzo was actively involved in sports, the student council and a plethora of schoolwork. Back then, it was just high school to him. “Now I can tell you that I was very fortunate that I had the opportunity to attend Central Catholic. I try to sum it up to people by saying it’s the difference between A&M and the University of Texas-Austin. Although I’m a Longhorn, the Aggies are steeped in tradition and bonding. They are Aggies for life, and I see several of my friends wearing their Aggie college rings. Central Catholic is just like that. When asked where I went to high school, there is a definite pride in saying, ‘Central Catholic.’” Rizzo continued his education with a bachelor’s degree in psychology from the University of Dallas and furthered his pursuits by getting an MBA from the Graduate School of Management at the University of Dallas. He began his working career with a company that sold computer systems to doctors’ offices. Shortly after, Rizzo married his high-school girlfriend, Joan, and they had four children. The two oldest are sons, Nathan and Nicholas, and the

younger ones are daughters, Leah and Ciara. In 1995, they founded RX Technology, a computer services firm in San Antonio that has grown to 50 employees and has expanded to cabling and physical security services throughout South Texas. Having the entrepreneurial spirit for quite some time, Rizzo and his wife had just had their fourth child and the company he was working for was going out of business. “I didn’t have the luxury of the months it takes to find a new job, so we took the plunge. Our success is rooted in a very simple example. A year prior to Rx Technology, I received a call from a guy that wanted to buy a used computer. He didn’t want to spend too much money, and no other company wanted to fool with it. I found him one and even delivered it to his house.” A couple of months into the struggling new Rx Technology, that same man called Rizzo and told him he needed 300 used computers for the company he was working for. He wanted to know if Rizzo could do that. And the success of Rx Technology NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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GOD, FAMILY AND OTHERS HAVE BEEN THE IDEALS OF OUR FAMILY FOR GENERATIONS. GOING TO CCHS ONLY STRENGTHENED THOSE VALUES.”

began and has continued since then. Rizzo tells that story to every new employee. Rizzo founded Meddoc Pro LLC in 2011; this is where he spends most of his time now. Meddoc Pro provides secure communication between health care professionals. With their first round of funding completed, they are now marketing the product in San Antonio and have distribution lined up throughout Texas. The oldest son, Nathan, who is also a graduate of CCHS, joined the company in 2009 after receiving his MBA. His father had one rule for the children: They had to work at least two years somewhere else before he would consider them as candidates. He wanted them to know what it was like to wonder if you would have a job tomorrow – to be able to empathize with being an employee. “After Nathan’s two years in Dallas, I actually recruited him,” Mark says. “He was doing so well in sales that I was afraid I was going to lose him, and who doesn’t want a top-notch salesman? At that point, it had nothing to do with him being my son; it had to do with his abilities.” Nathan has grown the business by 25 percent since he has been working at Rx Technology, and he is still making the company grow even more. Nathan’s CCHS story started when he moved back to San Antonio. “I was at Rx for only a week or so and stopped at a bar to grab a beer after work. I ran into a CCHS guy who was in the class ahead of me. We started to hang out; it was awesome to find a new group of friends after being away from San Antonio for so long. I was at his house, and he had the CCHS alumni magazine on his table. I looked and found Chris Martinez’s name from Central Electric and figured he would be able to give me insight into the industry. He has been a mentor ever since then. He took over his father’s business after 10 years. Only six more to go for me!” In 2012, Nicholas joined the company with a bachelor’s in finance. “He didn’t have any intention of coming to work here,” Mark explains. “He was studying for his CFA exams and had his sights on Wall Street as an analyst. I had a problem in 2012 with my business manager. I started looking to replace her, and Nico called me from Dallas and said that he would come down and help for a couple of years. It was the perfect call. I knew his talent, and most of all, I knew I could trust him.”

“The impact Central Catholic has had on my life revolves mostly around the ‘brotherhood’ that is often talked about,” Nico says. “I fall into the ‘grateful after the fact’ camp, as there were times with some friction between the things I wanted to get away with and Central’s expectations of a high school student. But now, seven years removed, I am still very close with over a dozen of my classmates and I take great pride anytime I get to mention that I am a Button. I know that it’s because of the experiences and environment that Central provided for me.” Three generations of CCHS alumni and all are equally proud of their education and friendships that were developed at the school. “I’m not sure that Central was really an option for me,” Mark says. “The same is true for my sons. We may have let them think they had a choice about their high school, but they were going to Central. I knew that although a public school may have been easier, they were going to learn the discipline and integrity that would take them through life. Like myself, they have made lifelong friends and are proud of their Central heritage.” Rx Technology has become one of the leaders in South Texas for IT services. With three areas of concentration (IT services, cabling and physical security), the largest customer base is the school districts throughout South Texas. The clients are diverse, ranging from city governments, SAWS and CPS to small and mid-sized businesses, and the company helps them manage their computer networks and provides access control, alarm systems and camera systems. Mark sees Meddoc Pro growing rapidly, and by 2014, he projects that it will consume 100 percent of his time. Nathan wants to take Rx Technology to another level, and his father expects that he will take over the management of the company and run with it. As for Nico, he has time to decide his long-term goals. “Our Italian heritage in San Antonio is steeped in tradition,” Mark proudly says. “God, family and others have been the ideals of our family for generations. Going to Central only strengthened those values, and we strive to continue those in both our business and family life.”

For more information about the Rizzo men, call 210-828-6081. And to learn more about Central Catholic High School, please visit www.cchs-satx.org.

NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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treatment based on a referral from his initial emergency visit. As the main provider for his family, Martinez led a busy lifestyle, working 10 days on and four days off in the oil and gas industry. His diagnosis was life Martin Martinez is sitting with a woman changing, making his health named Lorena a top priority, and he hoped Hurtado, a patient it wasn’t too late to receive advocate at Cancer treatment. Treatment Centers of America in Tulsa. A family member who had been treated at Cancer Treatment Centers of America (CTCA) shared her experience with Martinez. When she spoke of the personalized approach, attentive care, innovative technology and faith-based services, Martinez was hopeful. That’s when he decided to contact CTCA, and within a short time, he and his wife traveled from San Angelo, Texas, for their first visit to the CTCA hospital in Tulsa, Okla. A week after that visit, Martinez began a routine of chemotherapy and was assessed by a team of seven medical profes-

SPREADING HOPE

One man’s story of how the comforting team of professionals at Cancer Treatment Centers of America provided him with spiritual, nutritional and medical guidance that returned him to health [SPECIAL TO NSIDE]

WHEN MARTIN

Martinez was diagnosed with Stage 4 colon cancer in June 2012, he immediately thought of its capability and his strong desire to live life. As a husband of 35 years, a father of two grown children and a grandfather of two, Martinez chose to fight, and he struggled through a grueling 16 months of treatment, relying on his team of positive medical professionals and hope. Colon cancer, formally known as colorectal cancer, is the second most common disease among Hispanic men and women. Contributors to colorectal cancer are a diet high in fat and carbohydrates,

as well as foregoing regular screening for cancerous polyps. A highly treatable disease when found in its early stages, the National Cancer Institute recommends routine colorectal cancer screenings for men and women starting at age 50. After struggling with mysterious and intense pain, the 58-year-old visited the emergency room, only to be stunned by this life-threatening diagnosis and recommendation for immediate next-day surgery. The surgeon removed a tumor the size of a baseball, but the cancer had already spread to his liver. Martinez was left with a seemingly insurmountable battle to fight, but he sought further

“AT CANCER TREATMENT CENTERS OF AMERICA, THEY GAVE ME REAL TREATMENT OPTIONS THAT GAVE ME AND MY FAMILY HOPE.” 94

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sionals, including George L. River, M.D., FACP. “At Cancer Treatment Centers of America, they gave me real treatment options that gave me and my family hope,” Martinez said. Since receiving treatment at CTCA, Martinez has benefited from a medical team he prefers to call “family” – a team that has provided spiritual, nutritional and medical guidance that returned him to health. The cancer found in his liver has shrunk to two smaller spots, and he now visits CTCA every six weeks for followup visits. For Martinez, waking up every day since June 2012 has been a blessing. As the recipient of quality care by a comforting team of medical professionals, he is thankful for his progress at CTCA and he is hopeful.

Note: No case is typical. You should not expect to experience these results. For more information, contact Christie Enochs, director of public affairs for the CTCA hospital in Tulsa, at christine.enochs@ctca-hope.com.


NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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‘OWNING THE BONE’ What’s better than fixing a broken bone? Preventing it. And surgeons are working to do just that by helping manage the osteoporosis epidemic.

For more information, please visit www. universityhealthsystem. com/orthopaedicservices.

By: [LENI KIRKMAN]

seeing them for the second fracture as their initial presentation into our system. If this type of program had been present elsewhere, they may have been plugged into the program and perhaps this fracture would have been prevented.” Exercise is one of the most important things patients can do to reduce their risk for a second break,

Today, only about 100 health care organizations are participating in the program, but Agarwal is hoping more of his colleagues pledge to own the bone. “The stakes are really high,” he says. “Nearly 25 percent of patients who suffer a hip fracture die within one year, and for many of them, this was not their first fracture due to osteoporosis. It’s time to

EXERCISE IS ONE OF THE MOST IMPORTANT THINGS PATIENTS CAN DO TO REDUCE THEIR RISK FOR A SECOND BREAK. The Division of Orthopaedic Trauma has established a fragility fracture clinic at its trauma clinic at University Hospital. Physician Assistant Chris DeLallo helps oversee the medical management of these patients. “We focus on the surgical management of the fracture and assess the patient with regards to underlying osteoporosis and assess their risk for a second fracture,” Agarwal says. “Oftentimes, we are

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and teaching them which exercises can make the biggest impact and how to do them correctly is one of the key prevention measures included in the Own the Bone program. It also includes nutrition, medication and lifestyle counseling, as well as bone mineral density testing. The Own the Bone Webbased registry enables participants to document their results and compare them with other participating hospitals across the country.

bring greater attention to this silent public health epidemic. “The American Orthopaedic Association, along with other national orthopaedic organizations, is stressing the importance of taking ownership of the entire patient’s bone health and not just fixing the fracture. University Health System has made that possible by allowing and supporting us to become part of this national Own the Bone program.”

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THERE ARE MORE

than two million fragility fractures a year in the United States. That’s more than the number of heart attacks, strokes and breast cancer diagnoses combined. Today, more than 40 million Americans have osteoporosis or low bone density, and given our aging population, the problem is expected to worsen in the coming years. In response to the growing crisis, University Hospital has joined a national Own the Bone initiative, and it is one of 44 U.S. hospitals to be recognized by the American Orthopaedic Association for outstanding success in teaching patients how to prevent future fractures. “Our goal is to not simply treat fragility fractures, but prevent them from recurring,” explains Dr. Animesh Agarwal, UT Medicine orthopaedic surgeon and professor in the UT Health Science Center San Antonio Department of Orthopaedics, Division of Orthopaedic Traumatology. “When a patient comes in with a fracture, we have a responsibility to teach them what they can do to reduce their chances of ending up back in my office or the hospital with another, potentially more serious break.”  Through the comprehensive program, patients at University Hospital are educated on vitamin D supplementation and the use of medications that can help minimize further bone loss that occurs in osteoporosis. “We as orthopaedic surgeons are not only managing the surgical aspects, but also bone health. That’s what we mean by ‘own the bone.’”


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SAN ANTONIO // PATIENT

EYEING FREEDOM Your prescription is too high for LASIK. What are your options? By: [DR. LISA MARTÉN]

YOU ARE

too nearsighted or farsighted. You want to have more freedom from glasses and contact lenses, but you are not a candidate for LASIK. When prescriptions are too high, the LASIK procedure can cause distortion and reduction in quality of vision. Can you be free of glasses? How?

What surgery can remove high nearsightedness? Implantable collamer lenses (ICLs) are available as an option to reduce or eliminate moderate to high nearsightedness. This is an intraocular procedure, but it is minimally invasive and done with topical anesthesia. The lens gives high-quality vision quickly after surgery. There is a preparatory procedure that must be done to allow the lens to be implanted safely in your eye. This lens takes up space in the eye, so eye pressure can sometimes get very high. This initial procedure creates an opening in the color part of the eye and allows fluid to escape in case the pressure rises. Refractive lens exchange surgery, similar to cataract surgery, can also be done to remove the lens and replace it with an intraocular lens. The lens can be selected to reduce or eliminate nearsightedness, but not astigmatism. Neither of these procedures eliminates astigmatism. Sometimes patients will undergo the initial procedure and then a LASIK touchup to eliminate the

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astigmatism. Other times, incisions can be created on the cornea to neutralize the astigmatism.

Can farsightedness be corrected the same way? Options are a bit more limited for farsighted patients. The ICL is not commonly implanted because their eyes are usually shorter and have less space to accept an extra lens in the eye. The refractive lens exchange can be used for both nearsighted and farsighted individuals. The first step is to have an evaluation with your doctor to discuss possible options for surgical correction. Along with your surgeon, you can choose a lens that will give you the best chance for good vision. Your doctor will also make sure you don’t have any eye conditions that may keep you from getting one of these procedures.

Lisa Martén, M.D., is a board-certified ophthalmologist. She can be reached at South Texas Eye Institute, located at 2424 Babcock Road, Ste. 101, in San Antonio, Texas. To learn more, call 210-692-1388 or visit www.southtexaseyeinstitute.com.

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SAN ANTONIO

HEALTH & WELLNESS

DOWN TO A SCIENCE Michael Wargovich, Ph.D., puts his interest in cancer-fighting foods into action by traveling the world in search of micronutrients.

EATING WELL

is a science for Dr. Michael Wargovich. But he’s not counting calories – he’s traveling the world in search of micronutrients. Wargovich holds the Cancer Center Council Distinguished Chair in Oncology at the Cancer Therapy & Research Center at the University of Texas Health Science Center at San Antonio, having joined the university in 2012, and he spends his days there getting to the bottom of what foods and ancient medicines can keep us healthy. It’s an exciting field that has taken him to several continents, not to mention through some adven-

healing process, when it is prolonged, it can damage the body’s tissues. Nature, however, provides a bounty of anti-inflammatory foods that people have been consuming in wide variety for centuries. Cultures across the world that have always had access to these spices, herbs and teas have enjoyed reduced risk for many cancers, compared to westernized countries. Wargovich obtained his Ph.D. from Texas Tech University with a focus on colon cancer, but he became interested in cancer-fighting foods when he was doing post-doctoral work at the Ontario

time research began to show that the human diet was changing for the worse, particularly in developing countries where communities were abandoning plant-based diets for more processed ones. The Mediterranean diet started getting attention for its healthful attributes, and evidence began to mount in favor of anti-inflammatory substances like aspirin in reducing the risk of some types of cancer. “But aspirin is not gentle enough for most people to take every day,” Wargovich said. “I’ve been on a 10-year-plus journey to find a gentler anti-inflam-

NATURE PROVIDES A BOUNTY OF ANTI-INFLAMMATORY FOODS THAT PEOPLE HAVE BEEN CONSUMING IN WIDE VARIETY FOR CENTURIES. tures in bringing back samples of seeds, bark and spices from remote parts of the globe. Some of his current work focuses on green tea and the neem, a plant native to India with anti-inflammatory properties in the bark. The neem tree has been called the “poor man’s toothbrush,” and it may help cancer patients fight the painful mouth sores that are the side effects of some chemotherapies, depending on the results of Wargovich’s study. More and more, scientific evidence suggests that chronic inflammation is associated with increased risk for cancer, heart disease, diabetes, obesity and other diseases. Although inflammation is part of the body’s natural defense system and

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Cancer Institute in Toronto. The institute’s cancer prevention work drew Wargovich’s attention, and he became fascinated by the idea that natural compounds found in daily diets could help prevent some cancers. “That was 1984 – about the time the word, ‘chemoprevention,’ was coined – so I became one of the first trained in chemoprevention,” Wargovich said. “I think even back then there was a realization that it wasn’t just the big things in the diet (fiber levels, fat etc.), but that micronutrients also play an important role in health.” Fast-forward about 15 years, and these developing ideas were gaining momentum at the same

matory (research includes green tea and neem). Hopefully it’s chocolate.” Outside the university, Wargovich is teaming up with a chef, Iverson Brownell, to produce recipes that are simple and packed with the healthy phytochemicals that give food its flavor. The company, CanSurvive Cuisine, is nascent, but the founders envision success as changing people’s eating patterns so that they incorporate more anti-inflammatory foods.

For more information, contact Elizabeth Allen, UT Health Science Center San Antonio, at 210-450-2020.

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ASK SAN ANTONIO

HEALTH & WELLNESS

“Expert advice from your trusted BHS Physicians Network.”

THE EXPERTS

An Ounce of Prevention

PROACTIVE HEALTH WITH THE FLU VACCINE, THE FIRST AND MOST IMPORTANT STEP IN PROTECTING AGAINST THE FLU By: [BLAINE P. CARMICHAEL]

Q: WHO SHOULD GET A FLU SHOT? ARE THERE PARTICULAR POPULATIONS THAT CAN BENEFIT FROM IT?

A:

The Centers for Disease Control (CDC) recommends a yearly flu vaccine for everyone 6 months of age and older as the first and most important step in protecting against this serious disease. While there are many different flu viruses, the flu vaccine is designed to protect against the three main flu strains that research indicates will cause the most illness during the flu season. Getting the flu vaccine as soon as it becomes available each year is always a good idea. The protection you get from the flu vaccination will last throughout the flu season.

Q: WHAT ARE THE BENEFITS OF GETTING A FLU SHOT?

A:

Getting a flu shot often protects you from coming down with the flu. And although the flu shot doesn’t always provide total protection, it is worth getting. This year’s annual flu shot will offer protection against H1N1 flu, the swine flu virus and two other influenza viruses that are expected to be in circulation this flu season. A new vaccine that protects against four strains of the virus will also be available, as will a high-dose flu vaccine for adults 65 and older.

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BHS PHYSICIANS NETWORK


medical setting where immediate evaluation and treatment can be given.

Q: WHAT IS SOMETHING SURPRISING ABOUT FLU VACCINATION THAT NOT EVERYONE KNOWS?

A:

Q: ARE THERE DANGERS OR COUNTER-INDICATIONS FROM FLU SHOTS?

A:

There is no such thing as a risk-free vaccine. However, the health risk of not being vaccinated is far greater than that of being vaccinated. Most side effects from vaccinations are very mild and limited to local reactions at the site.

Q: ARE THERE DIFFERENT TYPES OR STRENGTHS OF FLU SHOTS, OR IS THERE ONLY ONE GENERAL FORMULATION?

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A:

There are several flu vaccine options for the 2013-14 flu season. The traditional flu vaccines, which protect against three flu viruses, are called trivalent vaccines and are available. In addition, this season, flu vaccines that protect against four different flu viruses called quadrivalent vaccines are available. The trivalent flu vaccine protects against two influenza A viruses and one influenza B virus. The following trivalent flu vaccines are available: • Standard dose trivalent shots that are manufactured using virus grown in eggs. These are approved for people 6 months and older. There are different brands of this type of vaccine, and each is approved for different ages. However, there is a brand that is approved for children as young as 6 months old. • A standard dose of trivalent vaccine that contains virus grown in cell culture, which is approved for people 18 and older. • A standard dose trivalent vaccine that is egg-free and approved for people 18 through 49 years of age. • A high-dose trivalent shot approved for people 65 and older.

• A standard dose intradermal trivalent injection, which is injected into the skin instead of the muscle and uses a much smaller needle than the regular flu shot, is approved for people 18 through 64 years of age. The quadrivalent flu vaccine protects against two influenza A viruses and two influenza B viruses. The following quadrivalent flu vaccines are available: • A standard dose quadrivalent flu vaccine. • A standard dose quadrivalent flu vaccine, given as a nasal spray, approved for healthy people 2 through 49 years of age. The CDC does not recommend one flu vaccine over another. The most important thing is to get a flu vaccination every year.

Q: IS THERE A DIFFERENCE IN GETTING A FLU SHOT FROM A PHYSICIAN OR P.A. VERSUS GETTING ONE AT A SITE SUCH AS A PHARMACY OR GROCERY STORE?

A:

No, the vaccines are the same. Flu vaccines are offered in many locations, including doctors’ offices, clinics, health departments, pharmacies and college health centers, as well as by many employers and even in some schools. Even if you don’t have a regular doctor, P.A. or N.P., you can get a flu vaccine somewhere else, like a health department, pharmacy, urgent care clinic and often your school, college health center or work. The advantage of getting your flu vaccination in a physician’s office is that the staff has your medical records and they will take your vital signs to make sure your blood pressure and temperature are normal. Plus, should you have the very rare allergic reaction to the immunization, you are already in a

People infected with influenza will shed virus and may be able to infect others from one day before they start to feel sick until five to seven days after recovery. If you get sick, remember to stay home and keep sick children home until fever has been gone for 24 hours. If you become ill with flu-like symptoms, you should stay home and avoid contact with other people. Staying at home means you should not go outside the home except to seek medical care. Avoid normal activities including work, school, travel, shopping and social and public gatherings. Stay home for at least 24 hours after your fever subsides. While at home, get plenty of rest, drink clear liquids, cover your coughs and sneezes and watch for emergency warning signs that indicate you need medical attention. If you have severe illness or are at high risk for flu complications, see your primary care physician, physician assistant or nurse practitioner, who will determine whether flu testing or treatment is needed. The following symptoms require medicine care: In children, emergency warning signs that need urgent medical attention include: • Fast breathing or trouble breathing • Bluish or gray skin color • Not drinking enough fluids • Severe or persistent vomiting • Not waking up or not interacting • A child who is so irritable that he or she does not want to be held • Flu-like symptoms improve, but then return with fever and worse cough • Fever with a rash In adults, emergency warning signs that need urgent medical attention include: • Difficulty breathing or shortness of breath • Pain or pressure in the chest or abdomen • Sudden dizziness • Confusion • Severe or persistent vomiting • Flu-like symptoms improve, but then return with fever and cough

Blaine P. Carmichael, MPAS, PA-C, a member of the Baptist Health System Physicians Health Network, practices medicine with Dr. Victoria Chang at MedFirst Primary Care (17331 IH 35, Ste. 107, Schertz, Texas 78154). For more information or to make an appointment, call 210-656-5600. NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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ted to hospitals for chest pain who go on to rule out for myocardial infarction will have a gastrointestinal cause for their pain, a condition such as esophageal reflux, esophageal spasm, esophageal perforation, peptic ulcer disease, pancreatitis or gallbladder disease. Musculoskeletal causes may account for up to 30 percent of all causes of chest pain in patients admitted to the hospital who go on to rule out for myocardial infarction.

Q: ARE THERE DIFFERENT TYPES OF CHEST PAIN, AND IF SO, WHAT ARE THEY?

A:

A PAIN IN THE CHEST

DIAGNOSING AND TREATING CHEST PAIN, A CONDITION THAT SHOULD NEVER BE IGNORED By: [DR. RICHARD WILKS]

Q: HOW COMMON IS CHEST PAIN, AND IS IT AUTOMATICALLY LIFETHREATENING?

A:

Roughly six million individuals per year present to medical settings with chest pain. Fortunately, for 80 to 90 percent of these patients, the chest pain is not cardiac in origin. Approximately 40 percent of patients admit-

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An easy way for us to think about types of chest pain is to categorize them as either cardiac or noncardiac in etiology. Cardiac chest pain is then divided into ischemic vs. nonischemic causes. Ischemic chest pain includes angina and myocardial infarction. Ischemia refers to a restriction of oxygenated blood delivery to an organ or tissue. This most commonly occurs as a consequence of atherosclerosis/cholesterol plaque buildup within the arteries supplying blood to the working heart muscle. However, ischemia can also occur in the setting of trouble with the heart valves (such as with aortic stenosis), in the setting of thickened heart muscle (hypertrophic cardiomyopathy) and in the setting of spasm of the arteries to the heart (coronary vasospasm). When ischemia occurs with the heart, a person will experience angina if the restriction is short-lived; if the restriction in blood flow is persistent, the person will have a myocardial infarction, or a “heart attack,” and heart muscle will die. Angina is typically described as chest pressure, burning or heaviness that may radiate to the neck, jaw, shoulders or arms. It is often precipitated by exercise, cold weather or emotional stress. Its duration is usually two to 15 minutes. It may be associated with nausea, vomiting, diaphoresis (sweating) and weakness. Chest pain secondary to myocardial infarction is the same as angina, but more severe. It usually is sudden in onset and lasts 30 minutes or more. It, too, can be associated with nausea, vomiting, diaphoresis and weakness. Nonischemic cardiac chest pain refers to pain

not related to restriction of blood flow to the heart. Pericarditis, aortic dissection and mitral valve prolapse are included in this group. Pericarditis occurs when the sac the heart sits in, the pericardium, becomes inflamed, as might occur with a viral illness. Pain associated with this is sharp, aggravated by breathing and changes in position and highly variable in duration. Aortic dissection refers to a tear in the lining of the aorta, the main artery originating from the heart. This pain is sudden in onset and excruciating and ripping in nature, and it often radiates to the back. It often occurs in the setting of hypertension or underlying connective tissue disorder such as Marfan syndrome. Mitral valve prolapse is a congenital abnormality of the mitral valve of the heart and may be associated with chest pain that is sharp in quality and well-localized in the area of the left breast. It may be associated with fatigue, shortness of breath and palpitations. Noncardiac chest pain is divided into gastrointestinal, pulmonary, musculoskeletal, dermatological and psychological causes. Gastrointestinal causes of chest pain include esophageal reflux, peptic ulcer disease, gallbladder disease and inflammation of the pancreas. Esophageal reflux typically produces a burning pain in the upper abdomen and chest that may be aggravated by a large meal or by lying down after a meal. It is relieved by antacid. Gallbladder disease typically produces prolonged upper abdominal pain and/or right upper abdominal pain. This pain may radiate to the lower chest. It often follows a meal. Inflammation of the pancreas results in prolonged upper abdominal and lower chest pain. It may be related to alcohol, gallstones or medications. Pulmonary causes of chest pain include pleuritis and/or pneumonia, tracheobronchitis, pneumothorax and pulmonary embolism. Infection may result in pleuritis and/or pneumonia. Pain related to this is sharp, it worsens with a deep breath (pleuritic) and it is usually brief, localized to the involved area and associated with shortness of breath. Tracheobronchitis results from infection, as well, and causes a burning discomfort in the midline, often associated with coughing. A pneumothorax is the collapse of a lung. Pain related to this is sudden in onset, on one side of the chest and associated with pleuritic pain and shortness of breath. Pulmonary embolism (blood clot obstructing a pulmonary artery) often causes

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GRUNGE MAN HAVING CHEST PAIN IMAGE KAMIRA/SHUTTERSTOCK.COM

SOME CAUSES OF CHEST PAIN ARE LIFE-THREATENING. sudden onset chest pain and shortness of breath, and may be seen in the setting of prolonged inactivity such as might occur with a long plane trip. Musculoskeletal or chest wall causes of chest pain include costochondritis, cervical disc disease and rib fracture. Costochondritis refers to inflammation of the joint connecting the rib to the sternum. Pain related to this is often sudden in onset, intense and fleeting. It may be reproduced by pressure over the affected joint. Degenerative joint disease involving the cervical (neck) spine may cause sudden, fleeting chest pain that often can be reproduced by movement of the neck. Herpes zoster can present as acute chest pain. The pain is often burning in nature and associated with a well-demarcated rash. Panic disorder can cause chest tightness or aching, often associated with shortness of breath and lasting 30 minutes or more, unrelated to exertion or movement.

Q: DOES SOMEONE EXPERIENCING CHEST PAIN NEED TO SEE A DOCTOR?

A:

Chest pain should not be ignored. Some causes of chest pain are life-threatening. If you are uncomfortable and unsure of the cause of the discomfort, you should seek medical attention in a timely fashion.

Q: WHAT PROCEDURES DO PHYSICIANS TAKE WHEN A PATIENT PRESENTS WITH CHEST PAIN?

A:

Initially, the physician will conduct a thorough history and physical exam, as these remain the most important components in evaluating a patient with chest pain, despite the advances in medical technology. Information gleaned from the history and physical exam will help guide further testing. Initial tests will include an EKG (electrocardiogram) and blood tests looking for markers of damage to the heart muscle (“cardiac enzymes”). If there is evidence of heart muscle damage, more aggressive and invasive therapies such as cardiac catheterization may be required to help guide treatment and therapy. If a patient “rules out” for myocardial infarction, an exercise treadmill test may be considered to screen the individual for the possibility of underlying plaque buildup in the vessels to the heart (coronary artery disease). An echocardiogram (ultrasound study of the heart) may be performed if there is a suspicion of pericardial disease, valvular heart disease or cardiomyopathy. A chest X-ray is often performed, and it might reveal evidence of pneumonia or a pneumothorax. If there is concern for the presence of pulmonary embolism or aortic dissection, a CT scan will often be performed to assess for these problems. If there is concern for a gastrointesti-

nal cause for chest pain, a consultation with a GI specialist may be obtained for additional special testing.

Q: WHAT ARE RISK FACTORS THAT MAY INDICATE A MORE SERIOUS CAUSE OF CHEST PAIN?

A:

Risk factors such as hypercholesterolemia, hypertension, diabetes, tobacco abuse, family history of heart attacks, male gender

and increasing age all heighten the possibility that the chest pain with which the patient is presenting may be related to atherosclerosis and plaque buildup in the arteries to the heart (coronary artery disease).

Richard Wilks, M.D., FACC, is a boardcertified cardiologist. His office is located at the Heart and Vascular Institute Texas (1933 NE Loop 410, San Antonio, Texas 78217). For more information or to make an appointment, call 210-8046000.

NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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ASK

THE EXPERTS

PRIZE MULTI-TASKER

HOW ORAL BIRTH CONTROL CAN HELP WOMEN WITH MANY SIGNIFICANT HEALTH CONDITIONS

Q: CAN BIRTH CONTROL DO MORE THAN PREVENT UNWANTED PREGNANCIES?

A:

The truth is that while prescription oral birth control is highly effective at preventing pregnancy, the different formulas now available can help women with other significant health concerns, as well. For example, I regularly see patients suffering from acne who turn to prescription oral birth control to help clear their skin. Sometimes these patients are even referred by a dermatologist or a primary care physician who wants them to see an

OB/GYN specialist in order to get the entire picture of their health situation. Besides treating acne, oral birth control also can help regulate irregular menstrual cycles, relieve pre-menopausal symptoms and relieve heavy periods and debilitating crams associated with the menstrual cycle.

jections, patches, upper-arm implants and vaginal rings, as well as oral formulas.

Q: IS THERE MORE THAN ONE BIRTH CONTROL FORMULA?

A:

A:

As with many other medical fields, scientific research has led to many advances in birth control so that women today have many choices, both in formulas and in delivery. Three common formulas are seasonal birth control, which gives women a cycle every three months; the mini pill, which is progestin only; and the combination formula, which has both estrogen and progestin. For delivery, women can now choose from in-

SMOKING INCREASES THE RISK FACTORS ASSOCIATED WITH BIRTH CONTROL FOR ALL WOMEN, NO MATTER THEIR AGE. 106

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Q: WITH SO MANY CHOICES, HOW DO WOMEN KNOW WHICH BIRTH CONTROL FORMULA IS RIGHT FOR THEM? I always let women decide. But as with any medication, I always advise women to read all of the literature they have about all medicines they are taking, including birth control. Of course, I am here to guide women in their choice. First, I take a medical history to determine any risk factors such as a family history of stroke or heart disease, or other risk factors such as age, previous health conditions and whether or not a woman smokes, since smoking increases the risk factors associated with birth control for all women, no matter their age.

BIRTH CONTROL PILLS IMAGE BARBARA J. JOHNSON/SHUTTERSTOCK.COM

By: [CHARLA HUTCHENS]


And of course, some women do not want any type of birth control at all, but are still personally practicing birth control through natural family planning methods such as charting their ovulation cycles. So I make sure women have access to all of the information they need, and that they are fully informed so they can make the best possible choice for their birth control.

Q: DOES PRESCRIPTION BIRTH CONTROL HAVE ANY NEGATIVE SIDE EFFECTS OR RISK FACTORS?

WOMAN HOLDING BIRTH CONTROL PILLS IMAGE SYDA PRODUCTIONS/SHUTTERSTOCK.COM

A:

As with any medication, birth control in any formula and delivery method has some side effects. These include an average weight gain of three to five pounds; hair loss; mood swings; breast tenderness; and gastrointestinal upsets. Major risk factors include an elevated risk of blood clots, heart attacks and strokes. But that’s why we take a thorough medical history in order to determine which birth control formula, if any, is right for every woman. I always say they need to be told the good, the bad and the ugly, and then allowed to choose.

Charla Hutchins, WHNP-BC, is a board-certified women’s health nurse practitioner who practices with Drs. Jose Garcia and Susan Rivera at Acacia OB/GYN, located in the medical office building at 8715 Village Drive in San Antonio, Texas, next to Northeast Baptist Hospital. For more information about her practice or to make an appointment, call 210-226-7827 or go online to www.bhsphysiciansnetwork.com. For more information on the BHS Physicians Network, go to www. bhsphysiciansnetwork.com or email Julie Minnick at jaminnic@ baptisthealthsystem.com.

NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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SAN ANTONIO // MD

KEEPING BREAST CANCER RISKS AT FOREFRONT CAN LEAD TO EARLY DETECTION AND TREATMENT By: [DR. JACQUELINE ROSS]

THE GRIM REALITY

is that one in eight women will be diagnosed with breast cancer over a lifetime. Breast cancer is second only to lung cancer in causing cancer deaths among women, with 220,000 newly diagnosed cases and 40,000 deaths each year in the United States. Fortunately death rates from breast cancer have been declining since 1990s due to early detection, screening and increased awareness. Although the causes of breast cancer are not well known, some risk factors are understood. The majority of women with breast cancer have no direct family history of breast cancer. The chance of getting breast cancer increases with age. Two-thirds of women diagnosed with breast cancer are ages 50 and older. Most of the rest are ages 39 to 49, with a much lower number of younger women also diagnosed. Some other risk factors related to

tors cannot be controlled. The BRCA1 and BRCA2 gene mutations account for about 20 to 25 percent of hereditary breast cancers and about 5 to 10 percent of all breast cancers. Much has been done in regards to genetics research, specifically regarding identification of the BRCA genes because women with these genes have a high probability of contracting breast and ovarian cancer. A woman who has a sister, mother, or daughter who had breast cancer – especially if cancer was in both breasts, was pre-menopausal, or occurred in more than one first-degree relative – is two or three times more likely to develop breast cancer. Physicians should encourage individuals with this history to consider genetic counseling. Occasionally malpractice issues may arise related to breast cancer. In examining the last six years of closed claims data from The Doctors Company involving breast cancer claims,

ONE IN EIGHT WOMEN WILL BE DIAGNOSED WITH BREAST CANCER OVER A LIFETIME. breast cancer include being female, radiation exposure, never being pregnant, having your first child after the age of 35, beginning menopause after 55, postmenopausal hormone therapy, never having breast fed, obesity, drinking more than one alcoholic beverage a day, and having dense breast tissue which can mask the presence of a cancerous tumor. As with any risk factor, some of these can be controlled, but many cannot. For example, hereditary fac-

108

most cases involved a diagnosis-related failure (92%) and multiple specialties (radiologists, gynecologists, general surgeons, pathologists, family medicine & internal medicine). Thirty percent of the cases included a misinterpretation of diagnostic test, such a mammogram, according to an analysis of factors leading to claims. This contributing factor primarily involves the specialty of radiology. Research has shown that screening mammograms may miss

NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013

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NOV

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10-20% of breast cancers. A study in the New England Journal of Medicine compared traditional mammograms to digital mammograms. The digital mammogram is stored in a computer, can be manipulated better for visibility and clarity, has a lower average lower radiation dosage, but is more costly. The findings showed that digital mammograms were superior to traditional mammograms for three groups of women: those under 50 years old, those with dense breasts (a risk factor in breast cancer), and those who were premenopausal or who were in their first year of menopause. Physicians should discuss with these patients the option of ordering a digital mammogram. Patients may be confused about when to begin screening mammography because screening recommendations vary. The American Cancer Society and the Susan G. Komen Foundation recommend that women over 40 get annual mammograms, whereas the US Preventative Task Force recommends screening mammograms should begin at 50 and younger patients should discuss with their physicians when to initiate screening mammography. Mammograms are

more apt to be diagnostic as women age, because the breast becomes less dense with aging which increases the sensitivity of mammography. Another issue seen in almost 30% of the breast cancer claims was a delay in ordering diagnostic tests, like mammograms or breast biopsies. A general surgeon may have thought a breast lump was a cyst and recommended waiting rather than getting a biopsy when in fact the lump was a breast tumor. In one case, a family practice physician thought a 38-year-old patient had fibrocystic disease and did not need mammography or referral. The tests were delayed and her breast cancer progressed. Breast cancer can only be excluded by biopsy. Breast cancer remains a major concern for women and their families. Communication between providers and patients is vital. Physicians should work closely with their patients to obtain a comprehensive history because many risk factors for breast cancer are known. Screening continues to improve outcomes. Early diagnosis and treatment are essential to promote patient safety and reduce risks. (The guidelines suggested here are not rules, do not constitute legal

advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.)

ology Imaging Network Digital Mammographic Imaging Screening Trial. Radiology. July 2011; 260(1): 61-67.

Baum JK, Hanna LG, Acharyya S, et al. Use of BI-RADS 3–Probably Benign Category in the American College of Radi-

Note: This article was reprinted with the permission of Š2013 The Doctors Company.

Jacqueline Ross, Ph.D., R.N., CPAN, is a senior clinical analyst for the patient safety department at The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors. com/patientsafety.

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SAN ANTONIO // STYLE

IF THE SHOE FITS … Not sure what’s on Santa’s list this year? Don’t sweat it! New Balance San Antonio’s 12 shoes of the season offer something for you and everyone on your holiday list. By: [DAWN ROBINETTE]

WONDERING

what Santa’s bag has in store to keep your feet fit? When the elves need help filling orders for fitness shoes, they turn to Rob Kaufman and his team at New Balance San Antonio for the right shoe to match any fitness need. With more than 108 different styles of shoes to choose from, New Balance has the perfect shoe in the perfect size to make your fitness routine comfortable and successful, no matter your activity level.

❱❱ DON’T SWEAT IT The holiday season is all about enjoying yourself, celebrating the season in high party fashion and having a good time. Everyone makes New Year’s resolutions to start a fitness routine or to try something new, but why wait until 2014 when you can jump ahead and give yourself the gift of health now? Then you can enjoy the holidays even more (guilt free!), knowing you’re ahead of the game in establishing a healthier, fitter, more active lifestyle that will give you more energy through the holidays and beyond. With the right shoe for every activity and the right fit for every foot, New Balance San Antonio is the right place to kick off a fitness routine or enhance your current routine by wearing the right shoe to make the most of your workout.

ABOUT NEW BALANCE SAN ANTONIO

Founded in 2002, New Balance San Antonio has been the Alamo City’s premier athletic shoe source, offering a variety of footwear and attire that provide the perfect fit for healthy living. With three locations in the San Antonio area (The Strand, The Forum and Quarry Village), New Balance San Antonio is the go-to place for your athletic shoe needs because “when your feet feel good, your whole body feels good.” For more information, visit www.facebook.com/ newbalancesa or www. newbalancesa.com.

❱❱ SIZING THINGS UP Whether you walk, run, Zumba, hit the links or the gym or simply take a hike, New Balance San Antonio offers a range of styles of athletic shoes for all ages and activities, and in all sizes: Adult shoes are available from size 5 to size 20 in widths ranging from AAAA to 6E, and children’s sizes range from 10.5 to 6.5 and are offered in four widths (narrow, medium, wide and extra wide). The American College of Sports Medicine reports that 85 percent of people wear running shoes that don’t fit, while three different studies found that across all types of shoes, more than 75 percent of people wear the wrong size. But that’s not an issue at New Balance San Antonio. By measuring customers’ feet and recording their natural walking style on an in-store treadmill, New

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NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013

Balance San Antonio makes the shoe-fitting process personal. Each store is also outfitted with an iStep machine, a patented digital foot scanner that accurately captures the necessary elements and measurements needed for customized comfort and body alignment in less than 30 seconds. The iStep machine uses 3,744 gold-plated barometric sensors to identify arch type and measure foot pressure, as well as 1,300 infrared light-emitting diodes and receptors to precisely determine both the length and width of a customer’s feet. Customers can even take home their personal digital scan for future use and reference. The stores also use the Brannock Device, a measurement tool that gauges heel-to-toe length, heelto-ball length and foot width. These tools, along with the extensive training they each receive, give New Balance San Antonio store associates the skills they need to help fine-tune your total fit, looking at the foot from every angle to determine the best shoe for your needs. The members of the staff are also shoe enthusiasts – they know shoes and what you need to make your feet fit for your fitness routine. “The proper shoe fit is the first step to overall health,” explains Kaufman, owner of New Balance San Antonio. “When your feet feel good, your whole body feels good. The right fit in the right shoe to match your fitness activity puts you on the path to success with your workout routine. Your feet will feel good, making your workout feel good.”

❱❱ SANTA’S SELECTIONS Red, green, neon and stripes are on holiday parade this season. So why wait to find out if you’re on Santa’s nice or naughty list? Beat Santa to the punch and give yourself a gift or find the perfect gift for the active person on your gift list – even the person you know who wants to be active, but hasn’t taken a step in the right shoes yet. And don’t worry: If you’re not sure what’s right or you aren’t on the fitness path you want just yet, Kaufman and his team can work with you to find the shoes you or the lucky people on your gift list need to get started.


TWELVE SHOES TO MAKE YOUR SEASON MERRY:

1

TRAIL WALKING SHOES

As the No. 1 brand in walking shoes, New Balance’s commitment to best-in-class support and ultimate comfort is available in a variety of walking shoes. From shoes designed for premier fitness walkers to shoes designed with motion control and additional stability for those who need it, you’ll find what you need to get the most from your walking routine. Is there really a difference between walking and running shoes? Yes! Walking is much easier on the body than running – with the exception of stress on the feet. Walkers land at a harsher angle with less force than runners, and the foot also spends much more time on the ground than while running, so New Balance walking shoes have different angles and geometries in the mid-sole than running shoes.

2

RUNNING SHOES

Running shoes are designed to help your body get the most from your workout while keeping your feet in good condition. And of course, the right shoe for you depends on many things: your posture, your age, your physique, your level of activity, your general health, your goals with running, your training intensity … the factors go on and on. But no matter what, you need a good, stable shoe that’s designed to meet your specific needs in the right size for you. New Balance offers more widths in more shoes with more proprietary technologies than any other athletic shoe manufacturer.

867

• Santa’s pick: New Balance 1260v3, voted the 2013 Runner’s World Best update, is a solid shoe that doesn’t feel clunky for big runners. The 1260v3 provides cushy stability, with good foot flexibility. N2 technology provides exceptional heel cushioning, featherweight materials and moderate stability.

• Santa’s pick: New Balance 1765, for the premier fitness walker. Possessing a veritable all-star team of technological features, the 1765 gives serious walkers the comfort, support and cushioning they demand. The elite technologies that go into the 1765 include ABZORB for cushioning, Fantom Fit for ultra-light support and fit and N2 technology for responsive and durable cushioning that gets you closer to the ground. The 1765 offers a lightweight ride without sacrificing cushioning or stability, with extra support and pronation control.

1765

smooth, multi-directional movement, and its sole is designed for slower stops, meaning that as you work through your Zumba moves, your body won’t be jarred because your shoes will flow with you. It also offers multi-layered strapping for a secure fit, and rounded edges for support during side-to-side motion.

1260v3

3

ZUMBA SHOES

Who knew dancing could be such a workout? New Balance did, and it created a shoe to meet the demands Zumba places on your feet. • Santa’s pick: New Balance 867, an official Zumba shoe. Released this past summer, the 867 provides extreme lateral support to help prevent rolling ankles, but at 7.1 ounces, it’s still lightweight. Featuring new pivoting technology to facilitate better movement, the 867 is also versatile: It is also a cross-training shoe. What makes it so great for Zumba? It features a pivot point outsole for

4

GLOW-IN-THE-DARK SHOES

Not just for kids, New Balance now features glow-in-the-dark shoes for the safety-conscious runner who wants to be sure to stand out in the early darkness of fall and winter runs in the early morning light, or on workouts during the cooler darkness of summer nights. Featuring a lightabsorbing technology to add built-in visibility for runners at night, the shoes are activated by leaving them under strong lights for 10 minutes. Light is then absorbed, and when you head into the night to run, a florescent glow seeps from the fabric of the shoes. • Santa’s pick: Glow in the Dark 1400, a racing flat not only built for speed with an ultra-light design, but for stability with a responsive RevLite midsole for performance. Beyond that, the Glow in the Dark 1400 is New Balance’s most visible shoe, using three levels of visibility to make runs at any time of day safer. In low light, the shoe’s fluorescence creates visibility. In the dark, light sources reflect from the shoes, creating visibility. In darkness without a light source, the shoe, when charged, literally glows in the dark. This shoe allows runners to run bolder, brighter and safer. You’ve never seen a shoe like it.

FASHION ALONE OVER FUNCTION LEADS TO DYSFUNCTION

The American College of Sports Medicine reports that 85 percent of people wear running shoes that don’t fit, while three different studies found that across all types of shoes, more than 75 percent of people wear the wrong size. “You don’t have to choose fashion or function alone,” says Rob Kaufman, owner of New Balance San Antonio. “With today’s technology, there are many amazing styles to choose from for each foot type and for any occasion. The key is making an informed decision to enhance your workout while also avoiding injury.” NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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And get ready to glow in the perfect running gear: to match the shoes, the New Balance “Beacon” jacket, a glow-in-the-dark running jacket. Just like the shoes, the jacket is activated through light exposure, absorbing light to then glow while you’re on your run. Patterns down the sleeves and on the chest glow to add visibility. Additional hints of reflective material down the zipper and seams double your chances of being seen. Maybe Santa should add New Balance’s Beacon line to his own Christmas wish list. As a guy who works all night by the light of Rudolph’s nose, he certainly could use the safety of glow-in-the-dark gear!

commodate orthotics. And even better: The shoe weighs only 9.1 ounces, making it very lightweight for a golf shoe, yet it features a full-grain leather upper and a waterproof internal liner. NB Minimus 1002

7

TENNIS SHOES

While everyone tosses around the term, “tennis shoes,” true tennis shoes are designed for what you need on the court, not what you wear on the street. Tennis players need a much stiffer and laterally strong shoe for tennis. New Balance has Probank, a great lightweight stability technology that keeps optimal midsole positioning during lateral cutting movements – in other words, it keeps your midsole where you need it to be set after set. Probank allows New Balance tennis shoes to be some of the lightest in the category while still delivering superior side-to-side support.

NB 1400

6

5

GOLF SHOES

Golf shoes aren’t usually known for comfort, but New Balance is changing that, providing all of the comfort and technology that New Balance is

CROSS TRAINING SHOES

• Santa’s pick: New Balance 996, a lightweight performance tennis shoe that combines comfort

NB 996

Cross training is just that: a blend of workouts to keep your total body in shape. So New Balance cross trainers are a blend of a running/walking shoe with a court shoe, borrowing key traits from each to ensure that cross trainers can handle what they put their feet through. With both good cushioning and a heel-to-toe strike path, these shoes tend to be slightly more rigid with a good amount of lateral support. A key element to the shoes is side-toside stability, while still being soft enough for some walking and even running. • Santa’s pick: New Balance 813, featuring a unique four-way stretch upper that provides lowimpact support both over and under the feet and expands to accommodate the natural swelling of

with lateral stability. Using Probank technology, this shoe delivers some of the best side-to-side

NEW BALANCE SAN ANTONIO HAS MORE THAN 108 DIFFERENT STYLES OF SHOES TO CHOOSE FROM. known for, packaged in a golf shoe. Featuring an OrthoLite insole and RevLite, an innovative foam compound that provides the responsiveness and durability of heavier foams but in a lightweight ride, New Balance’s new golf shoes offer unsurpassed performance and cushion with the traction you need on the golf course. • Santa’s pick: Minimus 1002 Golf Shoe, featuring all of the aforementioned technology listed, paired with classic styling and a superior leather package. Give yourself or the golfers in your life the fit and comfort they need to really enjoy a day on the links. The 1002 features a RevLite midsole that’s 30 percent lighter than typical foam, as well as an OrthoLite insole that’s removable to ac-

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NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013

feet in motion. A comfortable shoe with good support and a surprising amount of cushioning, the 813 is ideal for the gym or a short jog. The shoe has a really good initial fit and feel – extra-soft foam that makes your feet feel at home from the first time you try them on.

NB 813

support while offering the lightest-weight shoe in the category. And by the way, Milos Raonic, one of the top players in the world, wears the 996.

8

LIFESTYLE SHOES

Even when you’re just out and about, you want to be wearing the right shoes that are comfortable, casual and fitting. And of course, New Balance has you covered with cool, handmade lifestyle options. • Santa’s pick: NB 574, a classic retro-style shoe featuring a suede and mesh upper for a premium look and an ENCAP midsole for added support.


NB 574

shoe was built to go through more than 24 hours on foot over very demanding terrain. This terrific shoe features a Vibram outsole with N2, a nitrogeninfused foam cushioning in the midsole, and it is engineered to keep runners comfortable while they test the limits.

NB 1210

9

• Santa’s pick: New Balance 1569, a best-in-category rugged boot. With debris-free construction to keep dirt and twigs out of your boots and GORETEX to keep your feet dry and cool, this very stable boot uses the same technology as New Balance’s top-of-the-line motion control walking shoes to give you a comfortable step no matter how rugged the terrain. Maybe Santa should use these for roof and chimney climbing!

11

SANDALS

When you’re ready to kick back, New Balance has you covered, too: sandals made just for New Balance. With great styles for leisure and more, the line includes Revitalign, featuring a doctor-recommended supportive foot bed. Revitalign footwear ensures foot and body wellness in a way that revo-

Revitalign RX

NB 1569

10

TRAIL SHOES

For runners who like to leave the asphalt and hit the trail, trail shoes are designed to use offroad. Featuring more rigid midsoles to disperse the shock of landing on stiff, sharp objects, trail shoes keep you comfortable when you’re pounding the dirt and rocks of nature’s running paths. • Santa’s pick: New Balance 1210, the best trail running shoe on the market today. Inspired by the middle-of-the-pack runners at the legendary Leadville 100-Mile Run, also known as the “Race Across the Sky” (100 miles of extreme Colorado Rockies terrain, from elevations of 9,200 to 12,600 feet), the

KIDS’ RUNNING SHOES

While you’re thinking about your feet, what about the little runners in your life? Featuring multiple widths and incorporating the same technology as New Balance’s adult shoes, these attractive takedown styles are sure to bring smiles to the children you know. • Santa’s pick: New Balance KJ890 – great for kids on the run! A perfect choice for young ones involved in track or cross country, the shoe features a synthetic/mesh upper providing lightweight comfort and support, as well as a solid rubber outsole that provides long-wearing durability. A goodlooking shoe on the inside and out, the KJ890 features a RevLite midsole and an almost seamless upper.

TRAIL WALKING SHOES

When you like to go off the beaten path and take your workout off-road, you need shoes that can handle the terrain while giving you support. Hiking shoes, or trail walking shoes, as New Balance calls them, are designed for very rough terrain and to stand up to the stress of hikers carrying large packs. These shoes are designed to protect your feet no matter what terrain you choose to explore, and they are exceptionally durable. Put them to the test the next time you decide to explore the great outdoors.

12

lutionizes the benefits of wearing sandals, and it is great for people with plantar fascia pain or bone spurs. • Santa’s pick: Revitalign RX sandals are designed to support your feet and promote alignment while looking great and feeling better. Designed and engineered by orthopedic and biomechanics expert, Dr. Geoffrey Gray, Revitalign works like a custom orthotic. The 360-degree heel cup promotes proper foot alignment, along with full anatomical arch support and a flexible forefoot that allows the motion of the foot to occur naturally. Available in many styles and colors for both men and women, the unique foot bed shape will keep you comfortable and supported all day long.

Wondering which of the 12 shoes is right for you or what will fit for your gift list? Don’t sweat it and give the ultimate gift: the opportunity for a custom fit at any New Balance San Antonio store. A gift card allows your gift recipients to have their shoe needs assessed by New Balance San Antonio’s fit specialists. And for gift cards of $100 or more, the card is presented with a New Balance Lightning Dry Shirt that keeps moisture and odor at bay. What better way to start your loved ones on the road to fitness?

NEW BALANCE SAN ANTONIO MAKES THE SHOE-FITTING PROCESS PERSONAL. NB KJ890


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NOVEMBER.DECEMBER 2013 / NSIDE TEXAS MD

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ONE NURSE FOR EACH PATIENT. FIRST CLASS CARE.

The need for medical care is a reality and necessity of modern life. With two locations to serve you, Victory Medical Center is distinguished from any other hospital you may have dealt with is an almost unheard of dedication to excellence on a patient-by-patient basis. Health of mind, body and spirit has received thoughtful consideration. The result? Plush, all-private, oversized patient suites. Gourmet food. A 1:1 nurse to patient ratio. A facility with a resort-like feel that relaxes and soothes. The Victory difference—creating the standard in surgical care. · Bariatric Surgery

· Gynecology

· Orthopedic Surgery

· Podiatry

· Ear, Nose, and Throat

· Hand Surgery

· Ortho Spine

· Sports Medicine

· Gastroenterology

· Joint Replacement

· Pain Management

· Urology

· General Surgery

· Neuro Spine Surgery

· Plastic Surgery

Landmark Location 5330 N. Loop 1604 West Southcross Location 4243 E. Southcross Blvd.

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NSIDE TEXAS MD / NOVEMBER.DECEMBER 2013

210.877.8000 210.368.7400

victory-healthcare.com/sanantoniolandmark victory-healthcare.com/sanantonio

Austin NSIDE TX MD Nov/Dec 2013  
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