M A R C H | A P R I L 2 014
THE REAL HEALTH CARE REFORM
THE IMPORTANCE OF SELF-CARE DISEASE MANAGEMENT
ePATIENTFINDER: AN INVESTMENT IN OPPORTUNITY
PET THERAPY AT UNIVERSITY HEALTH SYSTEM
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CRAIG CORDOLA pg. 18
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NSIDETHISISSUE MARCH.APRIL 2014
FEATURE 10 » A mission moment
HEALTH & WELLNESS 26 » DocTalk
- S hots for seniors
PROFILE THE UROLOGY AND PROSTATE INSTITUTE
The gold standard: Dr. Naveen Kella and his team stay on the cutting edge of care and bring the latest and greatest technologies and procedures to South and Central Texas.
PROFILE CRAIG CORDOLA
The CEO of the Memorial HermannTexas Medical Center remains committed to quality of care and patient safety, focusing on positioning the center as a national standout.
Page 28 28
PROFILE WENO EXCHANGE LLC
By creating a secure medical information highway for patients and providers, the brainchild of CEO Tina Goodman effectively builds better solutions for health care communications.
MD 32 » Pain resolution 34 » Marketing knowhow 36 » An investment in opportunity
PATIENT 38 » A step ahead 40 » All the right stuff 42 » Unique experiences 44 » Service, service, service 46 » True caring NONPROFIT 48 » Double duty
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AUSTIN, DALLAS, LAREDO/RIO GRANDE VALLEY AND SAN ANTONIO COVERS: PHOTO OF DR. NAVEEN KELLA BY ALEXANDER ALEMAN HOUSTON COVER: PHOTO OF CRAIG CORDOLA BY JUSTIN CALHOUN
HEALTH & WELLNESS 52 » Above and beyond MD 54 » Part of your team PATIENT 56 » Get back into action 58 » Two brothers, one mission 60 » A higher level of caring
HEALTH & WELLNESS 66 » InforMD
- The gold standard - 'Tis the season to be sneezing - Are you aware of autism?
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Drs. Morton Kahlenberg and Dennis Rousseau and their team operate at the highest level and raise the bar for the surgical care of cancer patients in South Texas.
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HEALTH & WELLNESS 76 » Ask the experts
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SENIOR PROFILE THE NEW WELLMED AT CROCKETT PARK
SENIOR PROFILE JIM AND MONA KOONCE
This perfect patriotic couple continues to value God, family and country, as well as to give back to their community, after 62 years of marriage.
PATIENT 86 » Beyond the spine 88 » Not everyone needs surgery 90 » Fact or fiction 92 » Form and function
MD 96 » Undiagnosed heart
disease in women poses malpractice risk 98 » The real health care reform
FEATURE 100 » Bringing smiles
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PROFILE SURGICAL ONCOLOGY ASSOCIATES OF SOUTH TEXAS
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A MISSION MOMENT The Lupus Foundation of America, Lone Star Chapter: finding purpose in what we do By: ANGELICA GARZA
ON THE MORNING OF JAN. 11, 2014, the Lupus Foundation of America, Lone Star Chapter, held its first support group meeting of the New Year. Melissa was referred to the group by recommendation of her doctor. She relocated to San Antonio about five months ago, and much to her surprise, she was diagnosed with lupus just a short three months after her arrival. The native New Yorker has no family in the area and was looking for a way to cope with her 10
NSIDE TEXAS MD / MARCH.APRIL 2014
newfound disease. Every 30 seconds, someone is diagnosed with lupus, a serious and chronic autoimmune disease that causes inflammation and tissue damage to virtually every organ system in the body. It can affect many parts, including the skin, joints, blood and blood vessels, heart, lungs, kidneys and brain. Being new to a city is hard enough, and with the added diagnosis, Melissa needed a resource in the
community to help her navigate the winding road of lupus. So she attended her first support group meeting, which comes together every second Saturday of the month at the Broadway Bank Downtown Banking Center. Again to her surprise, she met fellow lupus patients who connected with her on a level that only lupus patients could or would understand. Lupus has many varying symptoms, so it affects each person differently. Among the most common symptoms are extreme fatigue and body aches. Lupus is unpredictable because it is a disease of flares (symptoms worsen and you feel ill) and remissions (symptoms improve and you feel better). Support group attendees range in the amount of time they have lived with lupus, so sharing individual stories amongst the group is typically the starting point of the exchange of information with those involved. During the exchange, the newly diagnosed Melissa sat and watched as others shared. Her eyes welled with tears and another attendee told her, “I can see the fear in your eyes, and I want you to know we have all been where you are now, and trust me, it gets better.” With those words, Melissa quickly regained her composure and began inquiring on how to become involved with the organization. One way to help raise awareness for this cruel disease is by participating in the Walk to End Lupus Now event taking place on March 22 at Brooks City-Base. Forming a team of walkers and fundraising toward a pledged goal helps grassroots efforts on awareness, education and advocacy, all of which are main staples of what the Lupus Foundation of America, Lone Star Chapter, aims to do. This year, thousands of walkers will participate in more than 70 Walk to End Lupus Now events in the United States, promoting lupus awareness, physical activity and healthy living in a family-friendly setting. They will walk to raise funds to save lives from lupus, a life-threatening autoimmune disease that damages any organ in the body and affects more than 1.5 million Americans today.
To register for a team in this year’s Walk to End Lupus Now, please visit www.sanantoniolupuswalk.kintera. org. And for more information or any event inquiries regarding the Lupus Foundation of America, please visit www.lupuslonestar.org or email Angelica Garza, field director for Lupus Foundation of America, South Central Texas, at firstname.lastname@example.org.
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TEXAS • SAN ANTONIO // PROFILE
DR. NAVEEN KELLA: THE SURGEON WITH THE MOST EXPERIENCE IN ROBOTIC PROSTATECTOMY IN CENTRAL AND SOUTH TEXAS
NSIDE TEXAS MD / MARCH.APRIL 2014
The Urology and Prostate Institute continues to bring the latest technology and procedures when it comes to treating diseases. By: CEDAR JOINER | Photography: ALEXANDER ALEMAN
ll men are at risk for prostate problems. One man in seven will get prostate cancer during his lifetime, and one man in 36 will die of this disease. Prostate cancer is considered the most common cancer in men and the second most common cause of cancer death. BPH is common in older men. By the age of 60, more than half of men will have BPH. By the age of 85, about 90 percent of men will have BPH, but only 30 percent of men will be bothered by their symptoms. Led by Dr. Naveen Kella, a fellowship-trained surgeon, the Urology and Prostate Institute, a division of Oncology San Antonio, opened on Sept. 1, 2012. Kella performed the first robotic prostatectomy in San Antonio more than 10 years ago, and he is one of the country’s most experienced surgeons performing the most advanced surgical treatment for prostate cancer. He has performed nearly 2,500 robotically assisted surgeries, and he is one of the top surgeons for the procedure nationwide. His patients seek him out from all across the United States, Canada, Mexico, Puerto Rico and beyond. According to Kella, “Robotic prostatectomy is becoming the gold
standard for treating prostate cancer.” Kella did his urology residency at Tufts New England Medical Center in Boston and was intrigued by a demonstration of non-robotic laparoscopic prostatectomy. “It was about that time that robotics first came out, and that was an even better way,” Kella says. He spent the next year at Baylor College of Medicine in Houston, where he helped start a robotics fellowship program. “It was probably the toughest year of my life,” Kella says. “I was in Houston; my wife was in Boston. I was living in a tiny apartment. But it was what I needed to do. It’s where I learned about prostate cancer and robotics’ role in curing it.” Born in Detroit and raised in Texas (“my dad said it was too cold in Detroit”), Kella is the son of parents who immigrated to the United States from India. He attended public school in Dallas and did his undergraduate work at Stanford University as an engineering major, with a track to biotechnology. However, he felt the pull of medicine and returned to Dallas for medical school at the University of Texas Southwestern Medical. A conversation with his future father-in-law (a urologist) convinced him to specialize in urology. MARCH.APRIL 2014 / NSIDE TEXAS MD
ROBOTS: FRIEND OR FOE? What makes a surgeon good at robotics? Kella’s answer is surprising: “Being good at video games definitely helps, and lots of practice. It’s a very fancy power tool, so like anything else, you have to practice a lot before you become good.” When he’s not in the operating room directing the precise movements of a four-armed mechanical
Known as “the prostate cancer doctor” in all of South Texas, Kella, the director of the Urology and Prostate Institute, has brought in two highly skilled urologists to help with the group’s expansion and plans to bring in a fourth and fifth urologist in 2014 as the demand for advanced care continues to be sought-after. According to Kella, “Our commitment to excellent care is not restricted to prostate cancer.” The institute sees general urology, including fe-
KELLA HAS PERFORMED NEARLY 2,500 ROBOTICALLY ASSISTED SURGERIES, AND HE IS ONE OF THE TOP SURGEONS FOR THE PROCEDURE NATIONWIDE. marvel, Kella is often on the basketball court. “I’m a wannabe NBA player,” Kella says. “I can make 10 threepointers in a row regularly, but since the NBA hasn’t called yet, basketball is just my preferred method of exercise.” But these days, Kella can be found spending as much time as he can with the two women he loves the most: his beautiful wife, Reema, and his 5-year-old daughter, Kajal. When asked about the most rewarding thing about his work, Kella says without hesitation, “seeing how patients are so grateful the cancer is addressed and that they are back to normal activities after surgery so quickly.”
NSIDE TEXAS MD / MARCH.APRIL 2014
males, and continues to be on the cutting edge when it comes to the latest procedures, while holding the greatest of care. It is not unusual to find Kella giving a physician lecture or a patient talk or coordinating a support group meeting, as his love for what he does and helping others is always his top priority. According to Dr. Michael Nazmy Jr., urology allows him to practice medicine in which he is able to diagnose and then treat patients with medication, but also to cure problems through surgery. “I chose urology because you have a range of patients, from young to old, from male to female, from healthy to sick, and a range of surgeries from minor to very major.”
Since joining the Urology and Prostate Institute in August 2013, Nazmy enjoys working with the physicians at the oncology clinic. “They are all highly trained professionals with excellent credentials and wonderful personalities, as well,” he says. “What I look forward to the most is the ability to truly coordinate cancer care between surgery, radiation oncology and medical oncology, which is an extremely unique opportunity to have in the world of medicine.” Nazmy completed his medical degree in 2006 at the University of Medicine and Dentistry of New Jersey – New Jersey Medical School, and he completed his general surgery internship and urology residency there, as well. He also completed a clinical and research fellowship in urologic oncology from the City of Hope National Medical Center in June 2013. Kella and his team continue to teach the importance of PSA testing. The higher a man’s PSA level, the more likely it is that he has prostate cancer. This is why the PSA test has been widely used to screen men for prostate cancer.
“OUR COMMITMENT TO EXCELLENT CARE IS NOT RESTRICTED TO PROSTATE CANCER.”
GILLIAN DEVLIN, MPAS, PA-C, ASSISTS DR. NAVEEN KELLA IN SURGERY, AS WELL AS EVALUATING AND TREATING HER PATIENTS. SHE RECEIVED HER MASTER’S DEGREE IN PHYSICIAN ASSISTANT STUDIES FROM TEXAS TECH HEALTH SCIENCE CENTER.
MARCH.APRIL 2014 / NSIDE TEXAS MD
DR. NAVEEN KELLA AND DR. MICHAEL NAZMY JR.
NSIDE TEXAS MD / MARCH.APRIL 2014
THE UROLIFT PROCEDURE RECEIVES FDA APPROVAL Dr. Naveen Kella is the first physician in Texas to perform the UroLift procedure, a new FDA-approved, minimally invasive procedure for BPH. The Urology and Prostate Institute is the only provider of this advanced technology in the city exclusively focused on urologic and prostate procedures. According to a 2013 U.S. Census Bureau international database, more than 500 million men worldwide will suffer from the condition known as BPH, which causes the prostate to enlarge. BPH is a non-cancerous growth of the prostate that causes bothersome urinary symptoms when it presses on the urethra. The most common symptoms associ-
DR. SAMMY VICK
ated with BPH are a frequent need to urinate, a weak or slow urinary stream, difficulty starting urination
THE TRUTH ABOUT PSA SCREENING By: DR. MICHAEL NAZMY
In 2012, the U.S. Preventive Service Task Force (USPSTF) issued a report rating PSA screening at a D grade, recommending that it not be used, as harms outweighed benefits. Unfortunately, this conclusion was based on inaccurate and poorly interpreted data. The PLCO and ERSPC trials on which the report was based each had significant shortcomings. The PLCO trial saw more than 50 percent of its control arm obtain PSA testing during the course of the study, and it is more accurately a trial of annual vs. biennial screening. The ERSPC trial saw data gathered from multiple European countries, all with different PSA thresholds for intervention, and the USPSTF applied European prostate cancer death rates to a U.S. population, which resulted in a considerably lower number needed to screen (NNS) than was actually true. A median follow-up of 11 years was also too short to determine true disease patterns in a malignancy with a slow natural course. Not one member of the USPSTF was an oncologist or urologist with clinical prostate cancer experience. PSA remains the most widely available, reproducible and inexpensive prostate-specific test available. Judicious use of screening by primary care physicians and interpretation by knowledgeable urologists remains the best method of prevention of morbidity and mortality from prostate cancer.
ABOUT DR. SAMMY VICK At 13 years old, Dr. Sammy Vick was diagnosed with juvenile diabetes. He recalls the fear and apprehension he felt about having to make key changes to his lifestyle at such an early age. But from that adolescent experience, he developed a desire to want to help others. “I spent a lot of time at the hospital as a kid,” he says. “My doctor was really good. He had a very caring demeanor, and I saw how he helped people. I wanted to be like him.” Today, Vick has fulfilled that dream, and he is a urology surgeon who performs all types of surgeries, including prostate cancer surgery, urology robotic surgery and living donor nephrectomy (kidney removal). “Different specialties require different personalities, and urology fit my personality,” he says. “I get to do internal medicine as well as surgery. I want my patients to be informed and educated about their diagnosis and treatment and what they can expect. It’s important that they understand what’s going on every step of the way.”
and the sense that you cannot completely empty your bladder. The UroLift system revolutionizes the approach to BPH treatment by not requiring any type of cutting, heating or removal of prostate tissue. The system simply lifts the enlarged prostate tissue out of the way so it not longer compresses the urethra. The procedure can be performed under local or general anesthesia. The Urology and Prostate Institute is pleased to offer this exciting new technology to patients who seek a less invasive alternative for the treatment of BPH, and it is here to detect, treat and cure urinary disorders with compassion and dedication, alleviating distress and
For more information regarding Urology and Prostate Institute, call 210-591-7171 or visit www.theupi.com.
MARCH.APRIL 2014 / NSIDE TEXAS MD
TEXAS • HOUSTON // PROFILE
NSIDE TEXAS MD / MARCH.APRIL 2014
A Born Leader AS THE CEO OF THE MEMORIAL HERMANN-TEXAS MEDICAL CENTER, CRAIG CORDOLA IS COMMITTED TO MAKING A DIFFERENCE. By: KELLY HAMILTON | Photography: JUSTIN CALHOUN
nce in a while, the stars align. Although the path before us is not a promised one and hard work and perseverance notwithstanding, life seems to take on a theme and keep us within boundaries of a similar vein. Acquaintances blossom into lifelong friendships with those of like minds, as obstacles give way to opportunity. Craig Cordola, CEO of Memorial Hermann-Texas Medical Center, began his career the day he was born. The native Houstonian came into the world with a palpable passion for life that still lives today. Spending an extensive period of his first months of life in the neonatal unit of Memorial Northwest Hospital, Cordola overcame the heart condition he was born with and grew into a healthy young man who relished all aspects of life from music to sports. Unbeknownst to him at the time, he met his future wife, Allison, in the sixth grade. Both were very active in school, and as the years passed, Cordola kept in touch with her, resulting in a first date during their senior year of high school. The budding romance carried them through college and into graduate school. The accomplishment of being the first person in his family to graduate from college is something Cordola is quite proud of. Upon completion of his psychology degree from the University of Texas at Austin, he and Allison moved back to Houston to begin graduate school. Married during the first
MARCH.APRIL 2014 / NSIDE TEXAS MD
semester of his graduate program in health care administration, Cordola simultaneously worked in health care sales to support his new family. As Cordola gleaned valuable experience from each professional endeavor, Cordola’s career in health care continued to grow as he worked as an internal consultant to a large physician group. Within this position, Cordola learned the value of respecting professionals who “grew up” in physician practices. “It did not matter that I had a degree and was furthering my studies. They had the experiential knowledge that was an invaluable resources from which to draw.” Cordola learned a substantial amount about process improvement, organizational design and fostering physician relationships during his time with the physician group. Seeking to grow his professional experience, Cordola accepted a position at Texas Children’s Hospital as the director of operations for outpatient physician practices. In leading the operations of the business, he led a project, in partnership with a grant from the United Way, to develop physician practices in underserved areas of Houston. Under the leadership of Dr. Robert Austin, Cordola assisted in starting the Cullen Health Center, a cooperative effort with Houston ISD, Baylor and Harris County Precinct I. Physically refurbishing the rented space in an old courthouse, Cordola worked alongside the other medical staff members to bring life to the community clinic. Five years, exceedingly positive results and thousands of patients later, the clinic model was replicated across the Houston area in other locations numerous times to serve those with no insurance and limited or no resources. In 2003, Cordola’s life came full circle, as he joined Children’s Memorial Hermann Hospital as their assistant vice president of operations. Working with Steven Weber, director of nursing, Cordola took a hospital that had a large neonatal unit and a lot of trauma, but limited sub-specialty services, and almost doubled the size of hospital beds while adding an impressive amount of sub-specialty depth. “Expanding the network across other Memorial Hermann facilities,” he says, “we took the standards of care and knowledge we’d acquired and transferred these accomplishments, translating into stronger standards of care across the board.” The culmination of Cordola’s efforts with Weber rendered Cordola’s 2006 promotion to CEO of Children’s Memorial Hermann Hospital.
NSIDE TEXAS MD / MARCH.APRIL 2014
Continued emphasis on physician recruitment and growth fostered Cordola’s professional relationship with the current president of the University of Texas Health Science Center at Houston and dean of the UT Health Medical School, Giuseppe Colasurdo. “We grew up together professionally," Colasurdo says. “He was of vital importance to my appointment as associate dean of UT Health Medical School furthering the goal to integrate UT physician services across our Memorial Hermann community facilities.” September 2010 brought Cordola to his current role as CEO of Memorial Hermann-Texas Medical Center. As such, his primary focus is on quality of care and patient safety. “I’m very proud of the results we’ve had and how we stand up nationally,” he says. “We’ve experienced a substantial amount of growth in physician recruitment with attraction attributed to the relationship between UT and the hospital system. Physician candidates know they can make a real dif-
“Approximately one-third of patients that end up in Memorial Hermann are transfers from smaller facilities – that’s because of the expertise and specialties that exist in a busy academic medical center. There’s a huge value in having an academic medical center like us in the Houston marketplace to provide the high-end sub-specialty issues care that you cannot find elsewhere. We work hand-in-hand with a vast network of community hospitals anchored by a tertiary medical center.” A crucial aspect to expediting patient care at Memorial Hermann-Texas Medical Center is the state’s only hospital-based air medical transport service. Founded in 1976 by Dr. James H. “Red” Duke, Memorial Hermann’s Life Flight lands on the John S. Dunn helistop atop Memorial Hermann-Texas Medical Center. This crucial service allows the the center to extend its reach of services to surrounding cities. Cordola knows all too well that the health care
"WE HAVE A STRONG FOCUS ON HOW TO DERIVE BETTER VALUE ON THE SERVICES WE PROVIDE." ference with us by having a dean and CEO who work real-time on issues. We have been fortunate to be able to recruit great faculty as a result of our strong partnership. People gravitate toward environments where they can grow and make a difference. We follow through on our commitments and honor our promises.” Cordola says his job is to help acquire the resources and implement the tools his physicians need to stay on the cutting edge. “It is my objective to position this hospital as an exceptional tertiary academic medical center that stands out nationally.” Cordola further explains that to some degree, the inclination is to take the hospital system’s academic orientation for granted, primarily because they have existed in the Houston marketplace for a long time and in the context of the largest medical center in the world.
field operates 24/7. Conceding that there will always be a relevant need for care, he says, “For us, it’s about continued growth to meet market demands, continued expertise on campus clinical areas and continuing to find ways to provide safer, better care. We have a strong focus on how to derive better value on the services we provide. It takes a never-ending, laserlike focus to ensure patients and families receive this level of care.” In the way in which patients are seen and how hospitals are reimbursed – an intricate ecosystem – complexity becomes the biggest obstacle in the health care industry. It is part of Cordola’s management and leadership purpose to repackage that complexity in a more efficient way. “We are working hard on a culture change so that our staff understands my expectations around quality
MARCH.APRIL 2014 / NSIDE TEXAS MD
service and patient safety and changing how we deliver that care. Nimbleness around change is crucial. It will always be around, so we have to get comfortable with the ability to make change. The world is changing around us, so we either have to adapt or grow extinct.” As evidenced through his professional advancement, leadership is clearly a skill that Cordola has finely honed through the years. “As a leader, you have to have vision, put the right structure in place and have the right people in place.” Humbly, he proclaims deep appreciation for the work his faculty and staff put in on a daily basis and views himself as just one of the 5,000-plus employees of the hospital who are there to make a difference. The CEO recalls looking back over the years and realizing that he has routinely found himself in positions of leadership. It is these life experiences, both inadvertent and deliberate, from which he has learned volumes. “You have to find people who impact you on both ends of the spectrum – the good part of leadership and the bad.” Cordola emphasizes the importance of relationships and life experiences and the learned value of hard work, integrity and understanding that how you treat people directly affects your productive output. One thing he has come to appreciate through his experience is that outcomes are based on the relationships we build rather than the number of transactions we make. These life lessons carry over into his marriage of 18 years and the parenting of he and Allison’s two children. Affectionately referring to his wife as the “SHEE-O,” Cordola has the utmost respect for his life partner. As a family, they attend Second Baptist Church in Houston and place their faith as the cornerstone of the family. As any cohesive family unit, they spend as much time as possible together, enjoying one another. “Our kids are active in sports, so as a family, we do a lot of outdoor runs and cycling outings together. Evenings and weekends are family time, and I try to be as present as possible for my family during our time together.” As evidenced through his professional accomplishments and aspirations, as well as his transparent family values, Memorial Hermann-Texas Medical Center is well placed to continue its position as an anchor for the hospital system with Craig Cordola at the helm.
For more information on Memorial-Hermann Texas Medical Center, visit www.memorialhermann.org/tmc.
NSIDE TEXAS MD / MARCH.APRIL 2014
"WE FOLLOW THROUGH ON OUR COMMITMENTS AND HONOR OUR PROMISES."
MARCH.APRIL 2014 / NSIDE TEXAS MD
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[ DOCTALK ] SHOTS FOR SENIORS What vaccinations do you need, and when do you need them?
WHY ARE VACCINES FOR AGING ADULTS SO IMPORTANT?
All preventative medicine is important, but vaccines for older adults are especially critical since our immune systems tend to weaken as we age. As a result, older people are at a higher risk for certain diseases, and when they do fall ill, they have a more severe reaction than younger people. Vaccines can prevent or decrease the severity of a contagious disease, which helps keep seniors from being needlessly hospitalized and minimizes complications.
WHO SHOULD GET VACCINATED?
Vaccines are recommended for anyone and everyone, with the exception of the pneumococcal vaccine, which is not recommended for people who have had their spleen removed. Luckily, that’s not a significant part of the population. Some people are allergic to certain preservatives commonly used in vaccines, but there are “allergy-free” versions of these vaccines. Talk to your doctor if you think you fall into this category.
WHICH VACCINES ARE RECOMMENDED FOR OLDER ADULTS?
The three I recommend to my senior patients are:
➊ The flu vaccine to protect against seasonal influenza ➋ The pneumococcal vaccine, which minimizes the severity of pneumococcal diseases that cause infections in the lungs ➌ The zoster vaccine, which protects against shingles The flu vaccine is the one that gets the most at-
NSIDE TEXAS MD / MARCH.APRIL 2014
tention, and for good reason. Nearly two-thirds of seasonal influenza-related hospitalizations occur in people 65 years and older. The flu vaccine contains different viral particles from a variety of different strains; however, the influenza virus can adapt and mutate, so you need to get vaccinated every year. I recommend getting a flu shot at the start of flu season after the first of September, but you can get vaccinated all the way until March. The pneumococcal vaccine doesn’t help prevent disease. Instead, it reduces the impact of bacteria called Streptococcus pneumoniae. Unlike the flu vaccine, you only have to get this vaccine once in your lifetime on or around your 65th birthday, or earlier if you have certain chronic lung conditions. The zoster vaccine is another “once-in-a-lifetime” vaccine that you should get around your 60th birthday, or even as early as your 50th birthday. The zoster vaccine protects against shingles, a nasty virus that technically is a reactivation of the same virus that causes chicken pox. If you had chicken pox as a child, chances are the virus has been lying dormant in your nerve cells. The older you are, the more severe the effects of shingles typically are – and boy, you know when you have shingles! It’s very painful, and the pain can be severe and long-term. The zoster vaccine can minimize the effects if you do develop shingles, and you are less likely to develop long-term complications.
ARE THERE ANY OTHER VACCINES THAT OLDER ADULTS SHOULD CONSIDER?
Older adults can consider getting a tetanus booster once every 10 years. There is a tetanus vaccine that is combined with vaccines for diphtheria and acellular pertussis (whooping cough). This “cock-
SYRINGE AND VIAL, BOCHIMSANG12/SHUTTERSTOCK.COM
By: DR. ALBERTO SANTOS III
tail” is recommended for older adults who have regular exposure to very young children. Whooping cough is resurging in Texas from adults passing the disease to babies who aren’t old enough to receive the vaccine. Adults can develop pertussis even if they were vaccinated as children. While it’s usually just a minor annoyance to those adults, it can be fatal to unvaccinated babies. If you belong to a family with very young children, please consider getting this vaccine.
WHAT ARE SOME OF THE SIDE EFFECTS OF THESE VACCINES?
The most common side effect is redness and soreness at the injection site. Other side effects can include headaches and fever. If you experience a severe reaction like hives, difficulty breathing or facial swelling, seek medical attention immediately. Another side effect is a large skin reaction from the pneumococcus vaccine. This occurs usually when someone who has already had the vaccine is given another one in a short amount of time. Sometimes, when senior patients are repeatedly hospitalized, they will receive the vaccine every time they are admitted, especially if they are admitted to two or more different hospitals. To prevent such a thing from happening, please keep a personal vaccination chart or record that can be accessed by you or by a loved one in case of hospitalization. And it’s not rude to ask your primary care physician to review your entire chart when you see him or her.
WHENEVER I GET THE FLU VACCINE, I GET THE –
Stop right there: I’ve heard this before! There are so many people who claim to have gotten the flu from the flu vaccine, but I’m here to bust that myth. It’s biologically impossible to get the flu from the vaccine, since the complete flu virus is not administered – just bits and pieces of the virus. Usually what happens is a person has already been exposed to the flu virus or some other type of illness when they get vaccinated. But the virus was there first, and it flares up. Also keep in mind that there are hundreds, if not thousands, of strains of flu virus that go around during seasonal flu. The flu vaccine aims to protect against most of those strains. If you’re thinking, ‘OK, doc, then why should I even bother?’ remember that the flu vaccine can help lessen the duration or symptoms of the flu, should you come down with it. This is very important for older adults since, again, they are affected more severely by the flu than younger people. As always, please schedule regular checkups with your primary care physician to keep up with needed vaccinations. A good relationship with your doctor is one of the key components to staying healthy and out of the hospital.
To learn more about the WellMed Medical Group, visit www.wellmedhealthcare.com or call 1-888-781-WELL (9355).
ABOUT DR. ALBERTO SANTOS III Dr. Alberto Santos III, boardcertified in family medicine, is the lead physician at WellMed at Springtown Way in San Marcos, Texas, and a provider in the WellMed Medical Group, which focuses on senior health care. He earned his medical degree from the University of North Texas Health and Science Center’s Texas College of Osteopathic Medicine in Fort Worth, Texas. He then completed his internship and family practice residency at Bay Area Medical Center in Corpus Christi, Texas. Santos is committed to changing the face of health care delivery for seniors by focusing on preventative medicine.
OLDER COUPLE, GOODLUZ/SHUTTERSTOCK.COM
NEARLY TWO-THIRDS OF SEASONAL INFLUENZARELATED HOSPITALIZATIONS OCCUR IN PEOPLE 65 YEARS AND OLDER.
MARCH.APRIL 2014 / NSIDE TEXAS MD
AUSTIN // PROFILE
NSIDE TEXAS MD / MARCH.APRIL 2014
Building Better Solutions Weno Exchange LLC works to improve health care communication by creating a secure medical information highway for patients and providers. By: JODY JOSEPH MARMEL | Photography: KELLY RUCKER
any of us have heard about various breaches in privacy and security lately. President Obama, during a debate over the Affordable Care Act, spoke of the importance of securely distributing sensitive patient medical records and other information across the Web. Adoption of electronic health records is a part of a plan to improve America’s health care system. While electronic records were already well on the way to becoming an integrated element of health care prior to the president’s orations, much work was yet to be done to develop a secure medical information highway. An effective medical information system builds itself from within, feeding on experience across the wide spectrum of medical-related services sharing private, personal data to an ever-growing number of component parts. Such a widely based digital information and communication system would have to meet the needs of all of its users from patients, their primary care providers and other physicians to hospitals and labs, the insurance industry, governmental over-
sight, pharmaceutical and medical suppliers and probably more. And while doing so, make it user-friendly, effective in all identified tasks for all of its various users, cost effective and sensitive data secured and partitioned. Tina Goodman, CEO of Weno Exchange LLC, was blessed with a vision to bring a better solution for health care communication to the table beginning in 2006. Valuable experience across a wide range of duties in the health care field, including nursing home administration and several sales-related positions across an assortment of health care providers, afforded Goodman a rather unique vantage point to observe the shortcomings in the current health care communication systems. Her solution was Weno Mail, a free HIPAA-compliant messaging system for the health care universe. After a successful casual private offering to several investors to garner support of her company’s vision of Weno Mail, Weno Healthcare Inc. was formed. Goodman says, “I found myself running an IT company without any IT experience.” With the legal assistance of Ken Saks and effective programming, Weno Mail be-
gan servicing the secure and private communication needs of five San Antonio HCA hospital case management departments, later to be expanded to more than 500 various health care-providing entities. In 2011, Goodman cofounded a separate e-prescribing switch organization to route electronic prescriptions from prescribers to pharmacies. As with many new technology startup companies, growing pains in a fast-evolving industry often create a volatile market. In 2009, Weno faced many challenges when they lost the HCA account to a competitor and saw the health care world respond to new federal requirements announced in 2008 and 2009. This required fresh and creative thinking on their part in order to re-establish themselves in the market. Weno’s clever patent pending e-prescription routing technology did the trick. In 2011, Goodman and Weno Healthcare Inc. shareholders cofounded a separate e-prescribing switch organization called Weno Exchange LLC. In 2013, Weno broke a virtual monopoly held by industry giant Surescripts when they began routing electronic prescriptions to pharmacies on behalf of 40,000 prescribers in the United States.
MARCH.APRIL 2014 / NSIDE TEXAS MD
An effective medical information system builds itself from within.
In January 2014, Weno Mail’s original organization, Weno Healthcare Inc., and the e-prescribing switch organization, Weno Exchange LLC, consolidated into a single entity: Weno Exchange LLC. The surviving entity is expecting to double their e-prescribing business as a result of recent contracts and plans to launch a new design of Weno Mail in March 2014. “Our current Weno Mail customers are currently patients and health care providers of all types and sizes,” Goodman says. “Patients are receiving their bills, surgery schedules, reminders and generally communicating with all their health care providers from one system. Providers are communicating with each other for care coordination and referrals. Weno Mail al-
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lows businesses complete control to establish public facing users or departmental mailboxes and hidden users and department mailboxes. Most businesses have both, so internal and external communication is protected. Weno Mail’s new design will be open to other businesses and people all over the world. Weno Mail’s short-term goals are to reach one million users by the end of 2014.” Other additions to the e-prescribing side of Weno Exchange planned in 2014 include BSURE, a new and exciting drug benefit coordination service. At the point of care, an electronic health record’s BSURE screen will inform the patient and prescriber what a patient can expect to pay if they paid cash or if they had all of their benefits automatically applied, such as from a health plan, and even those including a drug manufacturer’s coupon. This will prevent those surprises at the pharmacy sales counter and help fill rates and medication adherence. Also, health care plans embrace the fact that physicians and patients can see the actual cash cost of a drug instead of only seeing drugs as they relate to their formulary status. They expect this kind of awareness to have a very positive impact on reducing overall drug costs.
Goodman explains that Weno Exchange’s mission is “based on the Bible’s definition of the Golden Rule: to treat others like you would like to be treated. This goes for how we treat our employees, partners, customers, vendors and shareholders. So far, every employee is an owner or soon to be an owner. Our mission statement was put to the test by a Rackspace worldwide contest one year, as they put their own survey on the site for our users to express how they were treated. Weno landed as a top five finalist of the world for customer service. You can just image how this made us all feel when so many of our users took notice and appreciated what we did enough to bother expressing it in a popup survey!”
Weno Exchange LLC is located at 8127 Mesa Drive, B206-210, in Austin, Texas. For more information, call 877-890-3726 or contact Tina Goodman at tina@ wenoexchange.com. For Weno Mail, go to www.wenomail.com, and for e-prescribing information, go to www.wenoexchange.com.
AUSTIN // MD
The team of providers at the Center for Healing and Regenerative Medicine works to unlock the healing potential in patients and return them to full stability, balance and function. By: JODY JOSEPH MARMEL
IN AUGUST 2011, DR. DAVID HARRIS and his wife, Michele Harris, P.T., cofounded the Center for Healing and Regenerative Medicine (CHARM), a multidisciplinary medical practice utilizing state-of-the-art nonsurgical techniques and innovative therapeutic strategies to facilitate the body’s innate capacity to heal. Michele Harris explains that over a lifetime, a body incurs injuries, both large and small. “Many times, this accumulation of daily trauma leads to incomplete healing. All incomplete healing will lead to a cascade of imbalance and degeneration over time. Our role is to help unlock the healing potential in every patient who chooses to partner with us in their recovery.” However, she says, “Obstacles are simply opportunities when you have truth on your side.” With this positive outlook on life as a whole, it is easy to see why CHARM opened in Austin in order to meet the community’s need for a comprehensive center with a focus on regenerative medicine. The mission at CHARM is to provide comprehensive, integrated and progressive non-surgical therapeutic solutions to promote tissue regeneration, repair function and relieve pain in those with neuromuscular conditions or musculoskeletal injury. Drs. Harris and Eduardo Elizondo are both boardcertified in the specialty of physical medicine and rehabilitation, and Dr. Craig DuBois is a board-certified 32
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neurologist. Michelle Hall, PA-C, and Michele Harris are also on the CHARM team of providers. “Our experience using regenerative medicine techniques dates back to before 1996, and the procedures and options we have to offer have grown to help facilitate quality patient care,” Dr. David Harris explains. “Our main focus is regenerative medicine, which uses techniques such as prolotherapy, platelet-rich plasma (PRP) injections and stem cell strategies to facilitate the body to repair painful tendons, lax ligaments and degenerative joints that have become injured by trauma, sports or aging. Our professional team is dedicated to non-surgical connective tissue repair and therapeutic exercises to facilitate the healing process and return to full function.” CHARM has an integrated laboratory, fluoroscopy suite and mobile ultrasound machines to provide guidance of these advanced injection techniques. The physical therapy department incorporates stateof-the-art Neurac closed chain suspension therapy, microcurrent point stimulation, manual and motion release techniques, a Class 4 laser and comprehensive education and home exercise programming for long-term effective self-management. Historically, people have been told that a torn ligament or damaged tendon must be surgically repaired and that worn-out cartilage within a joint will even-
tually require replacement. “These connective tissues have a fairly poor blood supply and heal slowly and incompletely on their own. With proper stimulation, these tissues can be induced to repair back-to-normal strength and function, using four to six injections of natural growth factors over a period of a few months, proper nutrition and guided balancing and exercise techniques. Often, CHARM patients avoid unnecessary surgery and medications, eliminating the need for surgery or medication. This allows the patients to experience minimal downtime from exercise, work and activities of daily living.” “I am excited to rejoin Dr. Harris and Dr. DuBois in practice again as I join the CHARM team,” Elizondo says. “I am particularly excited about regenerative medicine. It is an exploding field in physical medicine and rehabilitation where we can make a positive impact on our patients’ functional activities. What makes CHARM different is the healing approach incorporating traditional treatment techniques, physical therapy and regenerative medicine.” DuBois explains the uniqueness of CHARM: “What sets CHARM apart is our ability to lend a multi-dimensional approach and discovery to complex problems as opposed to a single-focus approach. Our practitioners have complex backgrounds and experience to apply to each patient’s individual problems or issues. Our mission is to find out what you need and to give you the options of what we have to help you.” Virtually every joint in the body is a complex, but also familiar system that includes two bones coming together, cartilage in the space between, a capsule surrounding the joint, ligaments to provide support and directional control for stability and tendons operated by muscles to operate the motion of the joint. Since every joint is basically made of the same components, the treatment for most joints is basically the same. The connective tissue that forms the “bricks” for each component is also basically the same and the collagen “bricks” can easily be stimulated by prolotherapy techniques to be regenerated to fill the gaps of torn tissue, build cartilage and repair the connections. “Treatment for knee pain is generally as simple as
“BEING A PATIENT AT CHARM IS A UNIQUE EXPERIENCE.” treating a finger or thumb joint, or a shoulder, or an elbow or the back,” Dr. David Harris says. “The needle placement depends on a thorough understanding of the anatomy of the joint involved, and more solution is needed for larger joints, but basically, all joint, ligament and tendon pain is repairable using these techniques. Since all of these structures respond to the same strategies, a patient does not need to search
out a foot specialist, a hand specialist, a shoulder specialist or a spine specialist. What you need is a team of practitioners with a holistic approach to connective tissue repair. “Regenerative medicine reestablishes stability of the connective tissue. Add to regenerative medicine an appreciation and respect for the complex system of kinetic chains that make up human movement, and you find that CHARM can help return you to full stability, balance and function.” Prolotherapy uses natural solutions to stimulate the injured connective tissue to heal. This may include dextrose and other solutions that have been used since the 1930s and have proven over these decades to produce a profound healing response. In the last decade, the solution options have advanced dramatically and now include platelet-rich plasma (PRP), which is a concentrate of platelets from the patient’s own blood drawn at the time of treatment and processed using a centrifuge system to produce a “soup” of growth factors that can be injected at sites of injury to stimulate repair of the tissues. “Many published studies now clearly support the use of PRP to repair damaged tissue and heal the injury to avoid surgery with far less risk and cost. Stem cell concentrates may also be taken as a bone marrow aspirate from the hip bone (iliac crest) or from the fat (via liposuction) to provide even more stimulation to the damaged joint, to stimulate cartilage growth and repair.” CHARM practitioners have been using these strategies since 1996, and they have evolved as the solutions available have advanced. An advanced in-house laboratory processes the patient’s blood, fat and bone marrow at the time of service to produce PRP, adipose stroma and bone marrow aspirate concentrate (BMAC). Additionally, Dr. David Harris, in partnership with LifeSpan Medicine, is now offering Regenokine, a non-surgical program for joint pain, back pain and tendonitis. PRP can also be used for a variety of collagen weakness processes. Aging is associated with loss of collagen in the skin, leading to facial droop and sagging of a variety of other tissues. Specialized regenerative injection techniques are proving to restore more normal vitality and substance to these tissues, which can be used to enhance the face, the breasts, scar defects and the pelvic floor for periods of one to two years. The age range of patients at CHARM is from 7 to 102 years old. “They generally have some degree of functional impairment, pain, joint laxity, muscle weakness or altered neuromuscular control. They may have sports injuries, spine pain or general joint issues, including arthritis, tendon injury, ligament weakness or overuse conditions. Typical problems that are treated include headaches, TMJ dysfunction, shoulder rotator cuff injury, knee meniscus tears, hip arthritis, acute and chronic neck and back pain and traumatic injury of any region of the body.” With a major emphasis on regenerative medicine procedures, CHARM also performs interventional spine and pain management procedures such as epidural injections, radiofrequency neurotomy, facet blocks, sacroiliac blocks, electrodiagnostic evaluations, Botox injections for headaches, spasticity and aesthetics, facial collagen restoration, O-shots for
female urinary incontinence and Dyspareunia and Pshots for male performance and erectile dysfunction. “We want to continue to expand our knowledge and use of regenerative medicine techniques for even more connective tissue problems. We are currently developing and perfecting techniques for scalp hair growth, facial collagen restoration, erectile dysfunction, focal nerve damage and female urinary tract incontinence.” Carrie Zika, practice manager at CHARM, sums up the physician-patient relationship best: “Being a patient at CHARM is a unique experience. Every individual patient is treated exactly as that – an individual. No treatment plans are identical, as our practitioners look at you as a whole, not just as a knee or a spine. They take the time to understand not only your presenting pain or injury, but other variables that may be affecting your health and well-being. “Our goal is to reduce or eliminate your pain, improve your mobility and functionality and increase your outlook on your health and healing. We choose
to classify ourselves as pain resolution, not pain management; our success rates and outcomes solidify that classification.”
The Center for Healing and Regenerative Medicine is located at 7307 Creekbluff Drive in Austin, Texas. For more information, call 512-614-3300 or visit www.charmaustin.com. MARCH.APRIL 2014 / NSIDE TEXAS MD
AUSTIN // MD
MARKETING KNOWHOW MyMedLeads: converting inquiries into paying patients
IN 2010, MYMEDLEADS (MML) entered the medical scene “because there was a need for medical practices to track their marketing dollars,” explains Enrique Rangel, chief executive officer. “Our background was in SEO and digital marketing, and we needed to show our clients that we could prove ROI on the work that we did. Our first client was Personique in Austin, followed by a doctor in Hawaii. Both are still with us today, along with a much more detailed list of clients that we have brought on board along the way.” And the testimonials and rave reviews are part of the proof that MML is indeed a marketing force that is working quite well. The ROI is remarkable. MML brings together all of the tools necessary to streamline your medical office workflow, optimize your marketing investments and convert more leads into “paying patients.” Web-based and easy to set up, MML is a medical lead management system designed to simplify and automate each phase of the lead management process while tracking the effectiveness of your marketing channels. By removing the burden of tedious data entries and other repetitive tasks that slow down productivity, MML uses advanced integration and call tracking features. “MyMedLeads auto-captures lead information and enters new leads directly into the system. Our sophisticated 34
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data capture technology works with both Web forms and phone calls to auto-populate contact information. Leads can then be scheduled directly into your practice management software, radically reducing manual data entry and improving data input accuracy.” The bottom line is simple: to get more patients and to grow your medical practice by driving increased conversion. MML makes it easy to visualize your practice “sales funnel,” including how many leads you currently have, which stage each one is in and what steps you need to take to move them closer to becoming a patient. “Our easy-to-implement lead nurturing tools ensure that your name stays in front of prospective patients through consistent engagement and communication.” “We started MyMedLeads with cash-based doctors such as plastic surgeons and cosmetic surgeons, med spas and weight-loss clients,” Rangel says. “But this has fast expanded. We currently have family practices, urologists and many other specialty physicians. It was just a matter of time.” Rangel founded the company after working with lead generation for medical clients. Soon after, Greg Riley joined the team. “He handles operations; while I had many of the early ideas, Greg has come in to really refine them. He has the pulse of the client. He also has
to keep me under control so that I don’t keep adding features.” There is nothing better than having the dynamics of a wonderful working team, and Rangel and Riley seem to have that formula well patented. To date, MML has approximately 40 clients in Texas, but their client base expands from Hawaii to Long Island. “We have about 30 requests to go international; we want to focus on the United States for now.” Although medical practices do not see themselves as sales organizations, in very many ways, this is exactly what they are. A patient (the customer) is trying to buy a service (a cure or procedure) from a business (the practice). But along the way, the customer must find the business online, look up the feedback on the specific doctor and then make a decision whether they want to inquire or not. Once they do, they might call directly or fill out a form and wait for a call back. A real estate agent or an insurance agent would be calling back in seconds to earn your business. But medical practices can take hours or days because they usually do not have dedicated individuals for this. “We built a system that not only eliminates response time, but if the patient is not ready to schedule, we also automate email marketing and text message reminders. We then help get more reviews online.” Ninety-five percent of medical practices are burn-
DOCTOR SHOWING PROFIT, PESHKOVA/SHUTTERSTOCK.COM
By: HEATHER DANIELS
ing money in marketing because they do not have a process in place to manage the leads. “Our system captures the lead and then puts a stop watch on it to ensure that it was called quickly,” Rangel says. “If the caller wants more information, we automate email marketing and then remind the staff to follow-up two to three more times. This is Basic Sales 101, but without a system, you end up with medical staff scrambling. Just because a practice seems busy does not mean that they are maximizing marketing. “Let’s say a plastic surgeon makes 50 percent profit margin on breast augmentation, but his days are filled with Botox. He is busy, and so is his staff. But if a doctor spends $6,500 in social media, SEO, some print ads and radio with a deep focus on breast augmentation patients and converts four out of
MYMEDLEADS REMOVES THE BURDEN OF TEDIOUS DATA ENTRIES AND OTHER REPETITIVE TASKS THAT SLOW DOWN PRODUCTIVITY.
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nine using our MyMedLeads system (at $6,000 per procedure), he would need 27 leads in a month to produce $72,000 – not a bad return on investment at all.” Several physicians who have been using MML have noticed an improvement on their ROI within a month or even less. “We have now used this service for months and simply love it,” Dr. Grant Stevens says. “All leads are now at one easily accessed site. Follow-up calls are facilitated and recorded.” “We started using MyMedLeads in July with one of our two sales reps,” Dr. Ersek says. “I cannot express what a difference this has made. Our office was averaging about 90 monthly inquiries from the Web of which 10 to 12 would become scheduled consults. The first month, we scheduled 21, followed by 45 in August and 67 in September.” Typically, you will see return from MML in the first 30 days. The success of the tool depends on the adoption of the medical practice. “We have seen a high success rate when a physician is involved in the process and the staff learns and uses the tools,” Rangel explains. “There is a drastic difference in your bottom line.” The training at MML is very simple, and they have been able to condense it to six or seven three-minute training videos. But they also follow-up with a “go to meeting” training or “do face-to-face meetings if the client is in the Austin, San Antonio or Houston markets.” MML is a pay-as-you-go type of operation; it is $349 per month and you can cancel at any time. “We do not have to renew our doctors. We have great retention rates because we are offering a unique solution and few in the market have covered the entire sales cycle, plus helping generate more reviews online.” Due to the success of MML, Rangel explains, “We just expanded to a nonmedical version of the tool that works for all businesses. It is called MyLeadConverter, and it launched last year. Small businesses such as home contractors, pest control, painters, windows, real estate agents are using it currently with great success. This business remains mostly local. We are also now offering full marketing SEO services that can be traced with our tools.” While expansion is always a positive move, take note. If you want the paying patient/client, it is time to give MML a call. This is the marketing knowhow for your medical practice.
For more information, call 866-858-6785 or 512-657-5866, or visit www. mymedleads.com.
5656 Bee Cave Rd. Suite E201 Austin, TX 78746 (located in the office of Dr. Jennifer Walden at Westlake Medical Center)
www.512skincare.com | By appointment only - 512.626.8883 | Terra Yeske
AN INVESTMENT IN OPPORTUNITY
Changing lives and saving lives: Tom Dorsett and his team help the patients who need it most and work to transform the face of clinical research with ePatientFinder. By: JODY JOSEPH MARMEL
TOM DORSETT, president and CEO of ePatientFinder (ePF), already had a wealth of experience and knowledge prior to starting ePatientFinder, including the successful acquisition of his last company, NuScribe. Drawing on his experiences, the company was founded in 2010. “We made an initial push and were met with multiple significant hurdles,” Dorsett explains. “We required the use of electronic health record systems by our referring physicians, as they facilitate an important part of the process. In 2010, the adoption rates were still hovering around 30 percent, and it was difficult to find the right partners to help us grow our network of referring physicians. So we pulled back and decided to 36
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wait until the market was ready.” By late 2012, the market felt right and ePF was relaunched, smashing through the hurdles that stood in the way before. The company unleashes the power of clinical research and brings it directly to the patients who need it most. Dorsett details the process: “To develop a new drug, you must first take it through three rigorous phases of clinical trials. To operate clinical trials successfully, you must have adequate patient enrollment. The reality is that most patients are completely unaware of the amazing medical opportunities that are available in clinical research.” Marketing for clinical trials has historically been handled by ineffective and costly mass media market-
ing. For that very reason, 86 percent of all clinical trials are delayed due to inadequate patient enrollment. Delays that last for months – and even years – keep drugs and treatments out of the hands of the patients who need them the most. Dorsett’s youngest daughter was born with a large port-wine stain birthmark on her leg. “My wife and I took her to a dermatologist that specializes in treating these types of skin anomalies. Having been in health care for a number of years, I was aware of the opportunities afforded to patients in the research domain through clinical trials, so I asked him what sort of opportunities were available. “He mentioned a couple, but largely shrugged the notion off, saying that it was very difficult to keep up with everything going on in clinical research. He was very correct; it is very difficult to keep up, given that there are over 17,000 clinical trials actively recruiting patients in the United States at any given time. Upon researching online, I became aware of numerous clinical trials of which the physician was clearly unaware.” Having an intimate understanding of the data available through electronic health record systems, Dorsett realized that there could be a much more effective method and platform to address this very significant issue. By keeping information about relevant clinical trials “top of mind” with physicians and helping automate the process by which they could help match their patients with life-changing treatments only available through clinical studies, ePF was born. “We launched the company, built the product and started assembling our referring physician network. The physicians we worked with were often the visionary type that really wanted to assist their patients in any way they could. They helped us realize that we had an opportunity to help patients with burdensome chronic diseases such as asthma, diabetes and heart disease to ease the horrible effects of their conditions. “We also learned that we could help patients where the standard of care is currently very low – diseases such as Alzheimer’s, Parkinson’s and multiple sclerosis. In this vein, we created a profile for the ideal clinical trial for our platform: those treating these types of diseases and offering some type of medical benefit for the patient.” In addition, when possible, Dorsett and his team strive to work with trials that offer “compassionate use.” This is when seriously ill patients who participate in trials are able to continue receiving the treatment even after the trial has concluded. The ePF platform connects their life-sciences clients with their network of referring physicians through matching algorithms within their platform. It ensures that cardiologists do not receive information about arthritis trials and such. Using their platform, the network physicians are able to identify patients from their own practice or hospital who are ideal candidates for the trials they have selected to refer to. This takes place through analytics they control, a three-tiered filtering process and a patient engagement component that helps inform and actively include the patients.
PHOTO BY TUSHAR JAIN
AUSTIN // MD
“In a time when patients and physicians are very apprehensive about the future of health care, our physicians have found that participation in the program helps strengthen their relationships with many of their patients. Participating patients often share that they feel that their physician is going the extra mile to really look out for them and keep abreast of every possible option for their treatment. The new reality is that it’s no longer impossible to keep up with what is going on in research. Any U.S. physician is invited to join our mission, and it costs them nothing to participate.” The lead investor and advisor to ePF is former congressman and House Energy & Commerce Committee chairman, Billy Tauzin. After serving 25 years in the U.S. House of Representatives, Tauzin became president and CEO of Pharmaceutical Research and Manufacturers of America (PhRMA), the largest trade association for the top global pharmaceutical companies. On his board sat the CEOs from the top 32 pharmaceuticals. “He had heard about us and wanted to get involved, especially since it was an experimental drug that helped him beat cancer after most of his doctors had given him less than a 1 percent chance of survival. He personally identified with our mission to help patients like him and ultimately believes that ePF will save many more folks like him. Chairman Tauzin’s strategic guidance and tactical execution assistance continue to spread our message and greatly accelerate our business.” Customers of ePF include life-sciences companies
WHEN POSSIBLE, DORSETT AND HIS TEAM STRIVE TO WORK WITH TRIALS THAT OFFER “COMPASSIONATE USE.” of all types, pharmaceutical companies of all sizes, medical device manufacturers and large contract research organizations (CROs), which conduct research on behalf of life-science companies. All of these organizations must conduct clinical trials before bringing their products to market. “We focus on those companies that are conducting trials that fit the ePF profile and offer medical benefits to patients.” Because the clinical trial recruiting issue is such a costly one, a number of companies have tried to solve it. Most have failed because their methods rely solely on clinical data to identify the patients and the reality is that the data isn’t rich enough to match up patients with the highly sophisticated inclusion and exclusion criteria that most trials demand. At ePF, they address this by having multiple layers of filtering. “We have also found through conversations with our clients and prospects alike that we are the only company engaging and solving the problem like we do,” Dorsett says. “Hearing this from actual clients is always exciting because it validates us as innovators.
It’s very difficult to produce an original concept or idea these days. I feel that we can go a long way with ePatientFinder. We strive to make the company one that is associated with the rich technical culture that is idyllic in Austin. We are proud to call Austin home and participate in a business scene that is not only a blast to be a part of, but respected as one of the top in the country.” The ePF platform can facilitate many more valuable processes that benefit patients. They have already experienced more growth this past year than they anticipated. Although the most significant, their goal is not only to help patients, but to also continue to build and strengthen a brand that physicians are proud to be associated with. As Dorsett concludes, “I personally look at ePF as an opportunity for myself and my cofounders, Greg Sweatt and Tushar Jain, to create a legacy of building something that has the ability to change lives and save lives – something that has the ability to transform the face of clinical research by connecting it with the patients that need it so badly and would have otherwise been unaware of the opportunity.”
The offices of ePatientFinder are located at 9433 Bee Caves Road, Ste. 140, in Austin, Texas. For more information, call 512-222-5525 or visit www.epatientfinder. com.
Surprisingly more than what you’d expect from a dental visit
4200 North Lamar, Suite 145 (next to Uchiko) Austin, Texas 512.459.5437 / www.drmoossy.com
AUSTIN // PATIENT
A STEP AHEAD
Dr. Dickson McGuire provides quality micro-endodontics with a main focus on patients’ comfort zones at Central Endodontic Specialists.
IT’S DIFFICULT FOR MOST OF US to go for a routine dental exam, but it is much more difficult to muster up the courage to go to an endodontist. Just hearing the specialist’s name makes our adrenaline levels rise. But leave it to Dr. Dickson McGuire to change all of those notions you once had while going to have a root canal. Somehow he turns those negative feelings into positive ones. The endodonist is not your enemy; in fact, McGuire is the type of dentist you wish could be your general dentist. This is one of the many talents he shares at Central Endodontic Specialists. In most cases, patients are referred for an endoevalutation to determine if they will need McGuire’s services or that of an oral surgeon. The referring dentist will want McGuire’s opinion on the restorability of the tooth and whether or not endodontics is a good option. As explained by McGuire, this has to do with the feasibility, the amount of coronal tooth structure and the bigger picture around the tooth. This is an important tooth for a bridge or partial denture’s retention. “If a person has a toothache and there is enough coronal tooth structure to work with, we will recommend conventional root canal therapy.” Many patients seen who are good candidates have developed a secondary infection. A lot of times, these infections involve one out of the three to four apices. The 3-D CBCT image used at Central Endodontic Specialists is very helpful for localizing the root apex that has infection. This is nearly impossible with conventional PA images. “This tool is invaluable for our treatment planning because it will show cracked roots, 38
NSIDE TEXAS MD / MARCH.APRIL 2014
missed canals, periapical pathology, separated instruments, periodontal bone loss and calcifications.” Studies indicate that root canals have received much scrutiny over the years due to the majority of the cases (greater than 95 percent) being performed by general dentists in the United States and other countries. Most, if not all, failing previous root canaled teeth have an untreated canal or a crack along the root surface. Both of these are easily detected prior to starting the case with the 3-D radiograph used by Central Endodontic Specialists. “If a tooth already has a root canal, buildup, post and crown, an apicoectomy is a great option,” McGuire says. “It’s quite easy and quick to perform. Patients enjoy the single visit, quick treatment time, minimal
“As a message to the reader, if you have a tooth that has had a root canal and crown, seek out an endodontist that is comfortable and enjoys re-treatment and surgery – typically ones that market themselves for endodontic microsurgery.” At Central Endodontic Specialists, micro-endodontics and microsurgery are a given. This means that every aspect of the examination and treatment is performed using the highest level of magnification possible. It is the practice of endodontics taken to the next level of magnification for each case. “Every phase of my treatment is done utilizing the microscope, including anesthesia, instrumentation, filling, restorative, incisions and suturing. There are specific and unique surgical skills that result in less
MCGUIRE ONLY USES THE BEST EQUIPMENT KNOWN TO ENDODONTICS. post-op discomfort and its incredibly high success rate over the long haul. Using the top-of-the-line PROErgo Zeiss Microscope, smooth surgical skills, small diamond-coated retro-tips and mineral trioxide aggregate as the root end fill yields greater than a 95 percent success rate over 10 years. The studies that demonstrate this use the aforementioned tools.
post-operative pain and esthetic results. I use micromirrors, instruments and surgical techniques that set us apart from typical endodontics.” There are several factors that give McGuire a cutting edge in his specialty. He only uses the best equipment known to endodontics. “The PRO-Ergo Zeiss microscope is the most expensive, ergonomic and best
DENTAL XRAY, VECTOR ILLUSTRATION/SHUTTERSTOCK.COM
By: JODY JOSEPH MARMEL
toy that I have. Since I have used all of the different dental microscopes that are on the market, this one is the best for my overall comfort and efficiency. “I can literally sit a couple of feet away from the patients, which automatically sets them at ease. My assistant has a set of occulars and can see exactly what we are doing. This is so crucial to our efficiency. We are both one step ahead towards completion of the procedures.” Most endodontists haven’t invested in the 3-D Carestream CBCT machine yet. It is quite expensive, and there is a high learning curve with interpreting them quickly. The machine quickly circles around the patient instead of the older sensors that endodontists had to wedge inside of patients’ mouths. It is a lot more thorough and comfortable for the patient. “I believe that my patients want and need to be comfortable, and I make sure of this. I always offer sedation because 90 percent of patients are afraid to be here. This is largely due to traumatic experiences in the past. I pride myself on the fact that I am a very patient and gentle endodontist. Patients have a great experience or I am not satisfied with my services. I am good at achieving comfort for myself and the patient. Focusing on both is crucial for excellent results.” The root canal is meant to be an excellent option for retaining your tooth for a very long time. McGuire is extremely thorough and highly efficient and trained
so that the procedure is painless and it lasts a long time. He gives a great deal of credit to his team. “We all work together so that our patients are comfortable and have a great experience. They are what makes the practice great.” Growing up in Colorado, McGuire finished high school in Springfield, Mo., because his father’s job took the family there, and he was an All-State basketball player. Doing his undergraduate work at UMKC and then getting accepted into their dental school after his sophomore year was an amazing feat. When McGuire graduated with a DDS, he was only 24. In 1999, he entered the Navy as a lieutenant and began the Advanced Education in General Dentistry (AEGD) program at the Navy Dental Center Southwest in San Diego. Graduating in 2000, he served as a dentist at the Marine Corps Air Ground Combat Training Facility for the next three years. “It was a busy time with a lot of teeth to clean and fix prior to the patients being ready for their extended exercises.” Shortly thereafter, in 2001, McGuire’s daughter was born. In 2002, he applied to endodontic residency programs and was accepted into Indiana University School of Dentistry – Graduate Endodontics Program. “There, I finally felt a sense of belonging and was inspired to learn the rich endodontic literature base, as well as taking advanced courses that would enhance my knowledge and skills as a clinician and scientist in endodontics.”
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In 2005, he graduated with a Certificate in Endodontics and a Master’s of Dental Science. The following year, in January 2006, McGuire opened Central Endodontic Specialists, and slowly, but gradually, the practice grew into the successful practice it is today. In his free time, McGuire enjoys mountain biking, running, walking, Olympic-style weightlifting and swimming in the natural springs in and around Austin. He also practices meditation and yoga and takes spiritual classes. His short-term goals include to dive in the Blue Hole in Belize and to cave dive in the Bahamas. “I also want to be an important part of my daughter’s life. She is a teenager now, and I want to enjoy the next five years with her while I can.” This multi-talented micro-endodontist wants to continue working as long as he can because he enjoys every minute of the work involved. And McGuire wants to continue being that “comfortable endodontist” for each patient who walks through his doors, making this dental process into a positive experience – now and always.
Central Endodontic Specialists is located at 901 West 38th St., Ste. 409, in Austin, Texas. For more information on Dickson McGuire, DDS, MSD, call 512-452-7668 or visit www.centralendospecialists.com.
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512.323.5376 512.323.5376 2900 West Anderson Lane 2900 West Anderson Lane Suite H, Austin, TX 78757 Suite H, Austin, TX 78757
AUSTIN // PATIENT
ALL THE RIGHT STUFF
With his patient-focused approach, Jeffrey Kahn, M.D., keeps the humanity within health care delivery alive at Austin Ear, Nose & Throat Clinic.
By: HEATHER DANIELS
NSIDE TEXAS MD / MARCH.APRIL 2014
DR. JEFFREY KAHN of Austin Ear, Nose & Throat (ENT) Clinic was born and raised in California, outside of Berkley. His father is a physician who still practices in Oakland today. “I used to tag along with him to the hospital when he rounded on the weekends,” Kahn says. “My dad has always enjoyed practicing medicine, and I am certain that to a degree, his positive experience influenced my decision to become a physician myself.” After Kahn completed his residency at Baylor in Houston in 2001, he felt very fortunate to have found a stellar place to practice in Austin – a city he describes as vibrant and creative. “My wife and I met on a blind date in Austin, and we were married here, as well, so we had many positive feelings about this town and were excited to settle here.” Since then, they have been blessed with three “awesome” children. Kahn’s prestigious and extremely well-rounded undergraduate and medical school education; his keen ability to practice his specialty of otolaryngology with excellence; and his desire to listen to his patients’ concerns with genuine interest are indeed the best combination in the medical field. And Kahn is making a return to this type of treatment to ensure that the doctorpatient relationship is solid. Attending Duke University, Kahn graduated with thesis honors in economics, magna cum laude, and was elected to Phi Beta Kappa. Going into Duke, he knew he wanted to be a doctor, but he still wanted to explore the more liberal arts side of the curriculum. “I immediately connected with the way economics explained our behavior in the face of choices,” he says. “Also, an economics major had the fewest requirements, which allowed me to complete the prerequisites for medical school and still have time to take drama, art, sculpture, literature courses and to camp out for many Duke basketball games.” To this day, his 7-year-old “sports-crazed” son has picked up the torch, and he and Kahn camp out on their couch and watch the games. “While he hasn’t yet painted his face blue-and-white, he is usually wearing full Duke gear.” Returning to California for medical school at the University of California, San Francisco, Kahn spent one year during medical school doing health policy work, splitting his time between the Pacific Center for Violence Prevention, the Pew Center for the Health Professions and a project on medical decisionmaking in breast care. The latter ultimately formed the basis for his elective thesis work. In medical school, he connected with his interest in doctor-patient communication – “how we communicate as doctors and how patients hear and respond to us. Between my first and second year of medical school, I developed a course on doctor-patient communication.” During his last year of medical school, Kahn completed a thesis on decision-making with regard to breast masses. “This project was primarily about how we present information to and elicit information from patients; how we can use data and studies to help guide our patients through the process of decision-making; and how we as doctors carry biases that sometimes cloud that process.” Kahn completed his general surgery internship and otolaryngology (ENT) residency at Baylor College of Medicine in Houston. He did several research projects focused on clinical care issues, including indications for imaging temporal bone fractures, and facial paralysis and facial nerve monitoring. He went to Boston for his research block, completing it at Harvard’s Massachusetts Eye and Ear Infirmary. It is obvious from Kahn’s educational endeavors and his philosophies that the patient always comes first, which is one of the many reasons he has an outstanding patient following and referral base. “During a visit to my office, the patient is the absolute focus,” Kahn explains. “I want to connect with patients to promote healing through understanding on every level – the entire process from understanding why you’ve come to see me, to forming a diagnosis, to discussing the options and then finally crafting a treatment plan based on your goals and values. Of course, I have all the advanced technological options that modern medicine can provide available to me, but it is the process of decision-making that makes the true difference in care.
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"I BELIEVE THAT ULTIMATELY, THE PATIENT HOLDS THE ANSWER TO THE COURSE OF CARE."
“I believe that ultimately, the patient holds the answer to the course of care. As an expert and consultant in the facts of medicine, it is my job to distill patients’ issues down to their essence so that they can make the right choice for themselves. The clarity of the interaction I have with patients forms the foundation for good health care choices. In general, in non-emergency situations where we have the benefit of time and patience, it is best to proceed from less to more invasive. My approach to each patient is thorough, open-minded, thoughtful and genuine.” Kahn details his daily practice at Austin ENT Clinic: “I’m a general otolaryngologist. I see both adults and children, and really enjoy seeing all ages. I’ve found that practicing in both spheres makes me a better doctor overall. I often borrow what I have observed and learned caring for one group and apply it to the other.” Austin ENT Clinic was established more than 30 years ago, and it is one of the largest ENT clinics in the nation. The practice now has 12 physicians, all of whom are board certified by the American Board of Otolaryngology. All doctors see pediatric and adult patients. Eleven of the doctors treat all aspects of general otolaryngology, and one physician treats only ear disease – otology and neurotology. There are physicians on staff who have completed fellowship training in neurotology, head and neck cancer, facial plastic surgery and otolaryngologic allergy.
Kahn is located in the clinic’s North Austin office near the Arboretum. With offices in North, Central and South Austin, Kyle, Bastrop and Lockhart, Austin ENT Clinic has Central Texas covered with quality care. They evaluate and treat patients with nasal breathing difficulty, chronic sinusitis, tonsillitis, ear infections, hearing loss, dizziness, allergies, snoring, sleep apnea, thyroid nodules, parotid and other head and neck masses, head and neck pain and voice problems. “We provide comprehensive care for sinus and nasal issues, including allergy testing and treatment. In office endoscopy, allergy testing and imaging are available. The treatments we provide include allergy shots, sublingual allergy drops, minimally invasive office procedures such as balloon sinuplasty and traditional operations under general anesthesia.” They also provide comprehensive ear, hearing and balance care. Patients with hearing loss can elect to meet directly with the hearing center staff for testing and hearing aid evaluation. The physicians frequently
AUSTIN EAR, NOSE & THROAT CLINIC South Austin office: 512-444-7944 Central Austin office: 512-454-0392 Kyle office: 512-268-5282
evaluate snoring and sleep apnea, and minimally invasive procedure options are available for appropriately selected patients. Patients suffering with voice problems, including professional singers, have often sought care at Austin ENT Clinic. In addition to his general otolaryngology practice, Kahn has been involved with the Travis County Medical Society, the Texas Medical Association and the Texas Association of Otolaryngology. He currently serves as president of the Texas Association of Otolaryngology, and on a search committee for the inaugural director of the Center for Health Communications at UT Austin. In the long run, Kahn wants to preserve his patientfocused process, which can be challenging in the face of external structural changes in the medical payment system. With increasing time and financial constraints, the field of health communication will play an everincreasing role. “I will continue to look for novel communication tools to integrate into my practice, sustaining the patient-focused experience and the humanity within health care delivery.”
Dr. Jeffrey Kahn practices in the North Austin office of Austin Ear, Nose & Throat Clinic. For more information, call the office at 512-346-5562 or visit the practice online at www.austinent.com. MARCH.APRIL 2014 / NSIDE TEXAS MD
AUSTIN // PATIENT
overall survival rate of those with esophageal cancer is less than 20 percent. These are scary numbers. Good news for women and bad news for men: There is an 8:1 predominance of men undergoing surgery for esophageal cancer compared to women. Why the difference? No one is quite sure at this point. There has been some interesting research into a protective mechanism based on estrogen production and estrogen receptors. There a few simple lifestyle modifications that can help you reduce the frequency of heartburn. Avoid foods and other products that actually cause you to reflux:
Understanding the gender differences in heartburn, GERD and esophageal cancer By: DR. PAUL F. BUCKLEY III
RECOGNIZING THE UNIQUE DIFFERENCES
in how any disease process affects and/or is perceived between men and women is part of being a good physician. When it comes to heartburn, many women have it a bit rougher than the guys out there. The good news is that when it comes to the most severe complication of heartburn (esophageal cancer), there is some good evidence that being a woman is protective. Heartburn is now of epidemic proportions in the United States and other developed countries, with 10 percent of the population suffering from gastroesophageal reflux disease (GERD), patients who have life-disrupting symptoms and/or damage to their esophagus, and another 40 percent taking weekly medications. For women, one of the most common times to experience heartburn is during pregnancy. The increase in progesterone tends to slow stomach emptying. Additionally, the growing uterus pushes up on the stomach and increases intra-abdominal pressure. This type of heartburn is treated with antacids such as Tums and Rolaids or more powerful medications such as Pepcid and Zantac. Fortunately, the heartburn usually goes away after pregnancy. But there is now good evidence that women experience heartburn and GERD differently than men. In epidemiologic studies, women tend to seek care for their symptoms more often and report a higher (worse) impact on their quality of life. In a recent
NSIDE TEXAS MD / MARCH.APRIL 2014
HEARTBURN IS NOW OF EPIDEMIC PROPORTIONS IN THE UNITED STATES AND OTHER DEVELOPED COUNTRIES.
study of 2,000 men and women who where undergoing surgery for GERD, researchers found that women were more likely to have a hiatal hernia (where the stomach pooches into the chest), and men were more likely to have a weak valve between their esophagus and stomach. The study also found that men seemed to have a pathologically more severe form of the disease when they did finally go seek medical care. And here is a finding that conforms to what others have observed: Men tend to delay their medical care (yes, we are stubborn). The problem is that this can have possibly deadly consequences, as we shall see. Esophageal cancer is the fastest-growing cancer in the Western world, and more than 70 percent of the newly diagnosed cancers are reflux related. The
Next, try these tips: 1. Control your portions. 2. Eat your last meal early (at least four hours prior to lying down). 3. Try to lose some weight if you are even five or 10 pounds overweight. If all else fails, talk to your doctor about medical treatments for GERD. Just be aware that medications only treat the symptoms of GERD – they do not stop reflux, which can still cause damage to your esophagus. If you have been on medications for more than five years or experience any of the following “alarm” symptoms, you should likely undergo an endoscopy (where a camera is used to look at your esophagus and stomach): 1. Difficulty swallowing (dysphagia) 2. Painful swallowing (odynophagia) 3. Gastrointestinal bleeding or chronic anemia 4. Unexplained weight loss 5. Chest pain that is not associated with the heart Finally, the surgical treatment of GERD has evolved over the years, and in every clinical trial, as well as pooled clinical trials, surgery has been as good as or better than medical therapy in controlling the symptoms of GERD and patients enjoy a better quality of life. The only caveat is that most of the trials looked at high-volume “anti-reflux” surgeons.
One of the most exciting developments in the treatment of GERD is the LINX anti-reflux system. This is the only FDA-approved device/procedure for the treatment of GERD. There are only a few surgeons in the state of Texas approved to place the device, and Paul F. Buckley III, M.D., at the Scott & White clinic in Round Rock is one of them. For more information, visit www.heartburn.sw.org or call 512-509-GERD.
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211 San Antonio St. Austin, TX 78701 512-330-9403
AUSTIN // PATIENT
SERVICE, SERVICE, SERVICE
John S. Hogg, M.D., and his team provide consistency and quality across the board at Austin Radiological Association, a leader in medical imaging for nearly 60 years. By: JODY JOSEPH MARMEL
NSIDE TEXAS MD / MARCH.APRIL 2014
GROWING UP in a small town in North East Texas, Dr. John S. Hogg graduated with a degree in accounting and finance from Baylor University. Although he passed the CPA exam, Hogg became interested in medicine and switched careers. Taking his premedical curriculum at SMU, he later obtained his medical degree from Baylor College of Medicine and performed his radiology residency at Emory University. As an accomplished runner, Hogg has competed in many marathons and qualified for and ran in the Boston Marathon. Hosting dozens of philanthropic and political benefits annually, he also chairs many fundraising galas around Austin. Recently, he hosted the U.S. vice president. In addition to the plethora of activities he is involved with, in recent years, he has received the following notable accolades: the University of Texas’ “Community Leadership” award, the City of West Lake Hills “Citizen of the Year” award, the Human Rights Campaign “Person of the Year” award and the “Out & About 500 All-Stars” list by the Austin AmericanStatesman. “I have always enjoyed problem solving, which is really the essence of radiology,” Hogg says when asked why he made a career change so early in the game. “We are here to analyze imaging and decipher findings in order to arrive at likely etiologies for a particular condition. I thoroughly enjoy being a consultant to the other physicians, which is both challenging and stimulating. These factors, combined with my love of gross human anatomy, organ systems/function and a 3-D spatial resolution, make for the perfect profession. “I was initially attracted to Austin Radiological Association not only for its location in the most beautiful spot in Texas, but the emphasis on quality above all else. Although I knew that the thorough imaging protocols and utilization of the very best equipment would be expensive and make the practice less financially attractive than other private practices, it would also attract the very best of compassionate and talented radiologists. And I am proud to say that my partners are all some of the most outstanding people you will ever meet, professionally and personally.” The Austin Radiological Association (ARA) has always prided itself on providing leading-edge equipment for patients. A prime example is their acquisition of the First Outpatient Radiology 3 Tesla Magnet in Central Texas MRI machine. This device has twice the magnetic strength, providing more intricate imaging detail. Additionally, ARA is replacing their 64-slice CT scanners with new low-dose radiation CT scanners. These new scanners produce equivalent or even high-
er imaging quality, yet reduce the patient radiation by up to 60 percent. Hogg asks, “Wouldn’t you rather have 60 percent less radiation on your CT scan?” With 90-plus board-certified radiologists, ARA is able to provide in-depth subspecialty readings with diversified expertise. ARA also established seamless imaging protocols at all hospitals and imaging centers to assure consistency and quality across the board. The practice’s investment in technology is not limited to medical imaging equipment; they also utilize connectivity through their picture archive computer system (PACS) and state-of-the-art voice recognition software. Images and reports can be quickly communicated between physicians and hospital communities, which ultimately has a positive impact on the community. And quality promotes success. ARA owns and operates 16 outpatient imaging centers, with the anticipation of opening more imaging centers in the next year, as well as expansion of existing facilities. They also provide professional interpretation services and imaging leadership for 19 Central Texas hospitals. “The latest in technology is always evident in radiology, which makes it fun. Much of what we imag-
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HOGG BELIEVES ARA HAS GROWN ORGANICALLY BECAUSE OF EXCELLENCE IN SERVICE TO BOTH THE PATIENT AND THE MEDICAL COMMUNITY. ined as science fiction years ago is now a reality. As technology takes leaps forward, imaging is right there at the forefront, finding new and better ways to detect problems or disease, ultimately helping patients. And of course, ARA will have those new tools to provide the best imaging.” Founded in 1954, ARA is approaching their 60th anniversary. There have been many advances in medical imaging over the years. ARA has done a great job evolving and remaining a leader in medical imaging. As the Central Texas market has grown, so has ARA. Hogg believes ARA has grown organically because of excellence in service to both the patient and the medical community. “As a body imager in radiology, my practice covers many areas in both the outpatient and hospital settings,” Hogg explains. “I particularly
enjoy working with the emergency room physicians, who are bravely on the front line of saving lives, often in difficult situations. I always strive to learn more about each physician’s field of expertise so that I can continue to be a valued consultant for them. “There are more than 4,000 physicians in our Central Texas market in which ARA has referral relationships. As the provider of medical services in so many hospitals, we additionally have relationships with the hospital-based physicians.” Much like the real estate slogan, “location, location, location,” ARA follows the rule of “service, service, service.” While the radiologist is busy working on the imaging analysis, the team focuses on listening for feedback from both patients and doctors. From the initial telephone call for the appointment to the
actual arrival and imaging of the patient, ARA wants to make sure that those experiences are efficient and pleasant, always putting their patients first. “The patient is our valued customer; the referring physician is our respected health care partner.” Giving back plays a fundamental role for both Hogg and ARA. Hogg is the board chair for Ticketbud, an online self-service ticketing company that never charges for cancer fundraising events. He also recently participated in and served as the co-chair of Dancing with the Stars Austin, which is an annual benefit event for the Austin Children’s Shelter. Likewise, ARA has always been committed to community involvement, and it provides millions of dollars in charitable medical care each year. Many of the radiologists are involved in various civic activities and fundraisers. ARA also financially funds and supports numerous medical care organizations and health initiatives.
For more information on the Austin Radiological Association, call 512-795-5100 (business office) or 512458-9098 (scheduling line), or visit www.ausrad.com. MARCH.APRIL 2014 / NSIDE TEXAS MD
AUSTIN // PATIENT
Vitalogy Skincare: your partner in health and well-being By: HEATHER DANIELS
IN 2007, DR. ERIC ADELMAN opened the doors to what was to be the first location for Vitalogy Skincare, a full-service dermatology practice, in Georgetown. Central Texas is well-known for sunny weather, and the increase in population in this region over the last decade, particularly among retired adults who have spent years without sunscreen, has proven to be a great starting point for Vitalogy Skincare. When asked about his vision of Vitalogy, Adelman says, “I wanted to provide a unique patient experience by developing an environment of true caring in an informal office setting with top-of-the-line treatments based in science and academia.” Recognizing the need for specialty medicine in smaller-town markets, Adelman chose to focus on bringing high-quality dermatological care to these areas. By providing individualized patient care, Vitalogy Skincare has earned the trust of patients who often refer friends, neighbors and other family members to the practice. In these close-knit communities, word-of-mouth marketing has helped establish quite a loyal following
NSIDE TEXAS MD / MARCH.APRIL 2014
of patients who look to Vitalogy Skincare as a partner in their health and well-being. Due to its success rate, offices can now be found in San Marcos, Burnet, Cedar Park, Bastrop and Marble Falls. The future is bright for Vitalogy Skincare. In January 2014, Vitalogy opened a new office in Southwest Austin. In addition to the aforementioned expansion, the Georgetown location will be relocating to a new building to offer better access and a better overall experience for the patients. All Vitalogy Skincare locations offer full-service medical dermatology care and cosmetic dermatology such as Botox and dermal fillers – Radiesse and Juvederm XC. Laser treatments, chemical peels and facials are offered at Vitalogy Skincare Medical Spas in San Marcos, Georgetown and Southwest Austin, with limited spa services in Cedar Park. Vitalogy Skincare team members explain that many people don’t think of seeing a dermatologist until they have some sort of skin-related pain or aggravation that is beyond the scope of care of their primary physician. Common conditions seen at Vitalogy Skincare are acne, eczema, warts, psoriasis, skin aging and rosacea. Vital-
cosmetic, the area in which they have the greatest impact is advocating the prevention, early detection and treatment of skin cancer.” The American Academy of Dermatology (AAD) reports that one in five individuals will be diagnosed with skin cancer in their lifetime. The AAD recommends that individuals have yearly full skin exams to check unusual and changing moles, spots or growths on the skin for possible basal cell carcinoma, squamous cell carcinoma or malignant melanoma. As a fellowship-trained Mohs skin cancer surgeon, Adelman is proactive in patient education for skin cancer prevention. “Preventative medicine has always made sense to me,” he explains. “When you find a skin cancer early, it has a very high cure rate, but when found late and has progressed, it can be much more difficult to treat.” Mohs micrographic surgery is a specialized tissuesparring procedure for the removal of skin cancers. The four-step procedure is extremely precise and offers a very high cure rate while being less invasive than other methods. This is particularly important in delicate areas such as the face, neck and ears.
AT VITALOGY SKINCARE, THEY GO ABOVE AND BEYOND WHAT IS EXPECTED FROM A DOCTOR’S OFFICE. ogy dermatologists and physician assistants also treat disorders of the hair and nails such as hair loss and fungal nail infections. As Dr. Christopher Jones, a board-certified dermatologist at the Georgetown and Cedar Park locations, explains, “While the providers at Vitalogy Skincare diagnose and treat all skin conditions, both medical and
The Vitalogy Skincare Mobile Mohs Laboratory van makes this procedure available to patients at multiple locations. Quality care and quality medical service combined make an excellent practice into a highly respected one throughout the communities. Vitalogy Skincare has certainly left their mark, and by the looks of it, they will continue doing so for a very long time.
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Based on these strong medical dermatology services, Vitalogy offers an equally strong range of cosmetic dermatology procedures and treatments. “It’s the age of aesthetic medicine and rejuvenation,” says Dr. Holly Singletary, a board-certified dermatologist at the newest Southwest Austin location. “Injectables such as fillers and botulinum toxin (Botox) and laser resurfacing have become the key to both preventing and correcting the signs of aging and restoring one’s natural beauty.” Skin aging, which can include wrinkles, loss of collagen, uneven skin tone and dark spots, is a common concern among patients. Botox, a purified protein derivative, is used to improve fine lines and wrinkles. It can effectively reverse and prevent many of the facial lines between the eyebrows, across the forehead and around the eyes. Radiesse and Juveaderm XC are dermal fillers injected in the skin to reverse the signs of the aging face such as sagging skin and laugh lines. Consultations are offered to patients to learn more and to customize a treatment based on their skin type and desired results. “As a licensed medical aesthetician interested in healthy, brilliant skin,” says DeeAnn Gesino at the Southwest Austin Medical Spa, “Vitalogy has given me the tools to help you achieve your healthiest complexion ever.” In exciting news in regards to one such procedure, the Scittion Laser BroadBand Light (BBL) offered at Vitalogy can actually change the gene expression associated with the aging process to more closely resemble young skin. “As a board-certified dermatologist, it is critical to have a clinically proven solution
for anti-aging,” Adelman explains. “To be able to offer my patients a safe, light-based treatment based on groundbreaking clinical evidence that supports antiaging and the reversal of skin damage is exciting.” At Vitalogy Skincare, “we go above and beyond what is expected from a doctor’s office. Our providers and staff not only offer the highest-quality clinical expertise and care available, but go the extra step to ensure that our patients’ experience is the absolute best that it can be. Each patient is a unique individual with his or her own specific needs. Through personalized customer service and a holistic approach to medical treatment, we treat the patient – not just his or her condition.” When you go to an appointment at Vitalogy, you will be greeted by friendly staff members who listen to your concerns and help you know you are genuinely cared for. Adelman has created a team of dermatologists who share his mindset on how to treat people. “Not only is the team qualified and skilled; they are just good to people,” Adelman says. “They know that the little things count. Be caring and nice to people – it’s not that hard at all.” In addition to the patient-focused practice, Vitalogy is intricately involved in each of the communities it serves. Patient appreciation and word-of-mouth marketing set Vitalogy apart from other practices and centers. Participating and sponsoring in local events, health fairs and festivals such as the Georgetown Red Poppy Festival, the Burnet Bluebonnet Festival and the Bastrop Veteran’s Day Car Show makess Vitalogy an engaging and integral part of each community.
When patients walk into Vitalogy Skincare, whether in Georgetown, San Marcos or any of the offices in between, what Vitalogy wants most is “for the patients to feel truly cared for, not just medically, but as a person. Our team is highly qualified, and their skill unparalleled. What sets Vitalogy Skincare apart from other practices and centers is the good nature of our people. They are simply good people who care about the well-being of others and know how to show it.”
The new Vitalogy Skincare location in Southwest Austin is in the Southwest Medical Center at 5625 Eiger Road, Ste. 105, in Austin, Texas. For more information, call 512-930-3909 or visit www.vitalogyskincare.com.
“IT’S THE AGE OF AESTHETIC MEDICINE AND REJUVENATION.”
AUSTIN // NONPROFIT
Authentic Smiles Dental Studio partners with Austin Social Affair for its first big bash of 2014, benefiting the Health Alliance for Austin Musicians.
SHANE MATT, DDS, was gracious enough to open the doors of Authentic Smiles Dental Studio and partner with Austin Social Affair for their first event of the New Year on Jan. 30, 2014. The business networking mixer benefit for the Health Alliance for Austin Musicians (HAAM) featured amazing talented musicians Amy LaVere, Will Sexton and Cheryl Murdock. While those who gathered had their ears entertained by the sounds of great music, they had their palates entertained with savory food from Garridoâ€™s and drinks from Dos Equis and Dripping Springs Vodka. The networking event brought together some great businesspeople who shared their acumen, as well as their business cards, while getting to know each other. The event was a perfect opportunity for Matt to blend his professional passions with his love of music and involvement in philanthropic endeavors. The Authentic Smiles Dental Studio is a medical office by day, but it was designed for special events such as music and art shows outside of business hours. The enjoyable networking event allowed attendants to witness the accurate display of the versatility of the downtown space in the core of the 2nd Street district.
NSIDE TEXAS MD / MARCH.APRIL 2014
Amy Levene and Will Sexton
Cameron Gibson, Akala Lemus, Alexis Legault and Maegen Lindsey Bobby Thomas, Amy Levere, Shane Matt, Will Sexton, Fae Esparza and Johnny Goudie
Beth Newill, Jennifer Collopy, Michael Flury and Michelle Garza
Amy Levene and Will Sexton
Bo Davis and Chris Alberts
Lauren Gammon, Kira Watkins, Cheryl Murdock, Stephanie Bergara and Michelle Poole
Rebecca Coats , Shane Matt and Kayla Hemmert
Ricky Joshi, Beth Newill and Drew Zerdecki
MARCH.APRIL 2014 / NSIDE TEXAS MD
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HOUSTON HEALTH & WELLNESS
Dr. Gary Flam: wellness extraordinaire and physician of the 21st century By: HEATHER DANIELS
BEING AN ANESTHESIOLOGIST is a fulltime job; quite often, the general public is not aware of the enormous responsibilities an anesthesiologist undertakes. Without a highly trained and skilled anesthesiologist, procedures do not go as smoothly as one would like to believe. Dr. Gary Flam is a stellar anesthesiologist who has a plethora of experience and skills. Having joined Houston Anesthesiology, P.A., in late 1991, Flam had just completed his residency. At that time, Houston Anesthesiology only staffed St. Luke’s Episcopal Hospital. He was the 12th partner on board. They were one of the largest groups in Texas at that time. In 1996, Houston Anesthesiology joined forces with two other large groups and several smaller groups in Houston to form Greater Houston Anesthesiology (GHA), one of the nation’s leading anesthesiology groups; its “multidivisional” model serves all four large hospital systems in the Greater Houston metropolitan area. “The main reason we did this was to position ourselves in the anesthesiology services market so that we could not be ignored and priced out of the market the way the payors had done to the small groups and solo providers. With our large size, we became a 52
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formidable player in the health care marketplace similar in magnitude to the hospitals we worked at. This helped us to develop economies of scale and cost savings for all of our back office operations, malpractice insurance, health care and retirement plans.” And GHA’s excellent quality of care is well-known throughout Houston. As a partner in GHA, Flam has served as a member of the Clinical Quality Committee since its inception. The committee has developed and implemented a system-wide quality of
ciencies,” Flam explains. “Last year, GHA joined forces with Welsh, Carson, Anderson & Stowe (WCAS) to form U.S. Anesthesia Partners (USAP), a national anesthesiology billing and services company (www.usap.com). This was the only way for our physician partners to remain business owners instead of becoming employees, and is the obvious explanation for our high levels of productivity and job satisfaction.” While there are still scattered anesthesiology groups and individuals throughout the United States, USAP aims to be the largest player in the arena. “We are aware of most new opportunities that arise.” At USAP, they partner with high-quality anesthesiology groups, “positioning them for continued growth and success within their markets.” USAP and its physician partners believe that today’s health care environment has created an opportunity for leading anesthesiology groups to expand within their markets and beyond. “Hospitals need anesthesiologists to take the lead in managing clinical workflows, improving communication and care and investing in IT to support this broader perioperative role,” explain several USAP members. “They need physician leadership. Excellent clinical care is no longer enough. The groups that succeed in a rapidly changing health care environment will be those who expand their services to meet their clients’ needs.” And this is exactly what USAP does. In fact, USAP’s mission reflects the high quality of care and services they have become well-known for. “We provide quality anesthesiology care for each patient. We partner with fellow physicians and facilities to deliver effective, efficient perioperative services. USAP is dedicated to creating measurable value for
“I WANT TO CONTINUE TO HELP PEOPLE DEVELOP HEALTHIER MINDS AND BODIES.” care program and ensured that all members follow these guidelines. As a large group, GHA offers a good combination of opportunity, flexibility, vacation and benefits for its members. “With Obama Care on the horizon, we decided to expand again to increase our significance and effi-
our physician partners, surgeons, facilities, payors, investors and the communities they serve.” Flam has been a fulltime anesthesiologist and partner in GHA/USAP for the last 25 years, and his wisdom goes beyond his expertise in anesthesia and maintaining the highest quality of care for patients. At
ABOVE AND BEYOND
For more information on Gary Flam, M.D., DABA, DABPNS, DAAMRO, CPT, SHAPE, look for him on LinkedIn or visit Dr. Flam’s Natural Supplements online at www. drflams.com.
the age of 40, he had three children, he had no time for exercise, he ate poorly and he weighed nearly 200 pounds. He had metabolic syndrome (hypertension, an increased abdominal girth and increased lipids). “I had witnessed the chronic disability and death of my father from inactivity, obesity and smoking. I looked at myself in the mirror disgusted and said, ‘this is it. I will change my life.’” He had already spent some years as medical counsel for large pharmaceutical and medical device litigation firms, and even more than ever, it became routine for Flam to exhaustively research a topic from all angles and to be the in-house expert in that field. “In my typical fashion, I explored and learned everything I could and became credentialed in nutrition, fitness and other related fields. I began to walk the walk and talk the talk. I am 5’10 and went from nearly 200 pounds to 170 pounds. I have been active, healthy and happy ever since.” Flam began to share his knowledge and expertise with many of his administrative, nursing, medical, surgical, pharmacy and other health care colleagues. “Most of them had the same or similar health issues, and I gradually became their fitness, nutrition and wellness expert and teacher.” From his vast related readings, Flam learned that polyphenols (plant compounds that have multiple phenol rings) are magic bullets of good health, the most potent antioxidants known to man and abundant in a whole-foods, plant-based diet. “For those – including me – who do not eat the USDA-recommended five to 10 servings of fruits and
vegetables per day, supplementation is essential. I quickly realized that to get an appropriate variety and amount of these polyphenols, one would have to take more than two handfuls of capsules each day and spend hundreds of dollars per month. So I set out to produce a combination that was more potent and easier to take at a much lower price.” Flam’s LLC was thus born to provide relevant and needed functional foods, supplements and advice about how to live a healthier, fuller life. The product is further described on and available through the Dr. Flam’s Natural Supplements website. One dose of his supplement provides the same polyphenols as consuming 125 bottles of red wine, 10 cups of green tea, 30 pomegranates, a third of a pound of yellow mustard, several milk thistle plants and half a cup of raw soybeans (don’t try this in one sitting). In July 2012, Flam’s only son of three children was diagnosed with advanced Hodgkin’s lymphoma. He is currently fighting this disease. “My son’s diagnosis and battle with cancer has been a horrible thing to face, but it also stimulated my tremendous investigation into the interplay of diet and exercise with cancer,” Flam says. “I was not surprised to find that the answer to the
question of whether diet, exercise and habits play a role in prevention and treatment of cancers is a resounding ‘yes’ on multiple levels. This strengthened my interest in polyphenols and all whole foods, which combat inflammation, cancers and all chronic disease, and my resolve to teach people and give them the tools they need to become and stay fit and well.” Through his website and his book, “100 Top Behaviors, Eating Habits, Supplements and Physical Activities for Optimal Health and Performance,” Flam is building the necessary awareness and answers for those who need guidance. He is also building a 250-acre wellness retreat in Hempstead, Texas, where motivated clients will be hosted for one to two nights. Several doctors – M.D.s, Ph.D.s and CAM practitioners – will teach them how to cook, exercise and relax to have a better, fuller life. “All of these experiences have made me the physician and teacher that I am today. I want to continue to help people develop healthier minds and bodies. It is a slow process – one person at a time, of learning, eliminating bad habits and developing new ones – that is required to reach optimal wellness. The final goal here is to enjoy participating in your grandchildren’s lives.”
OUR GOAL... is helping you achieve YOURS.
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PART OF YOUR TEAM Providing medical technology at all levels of affordability for more than two decades, Sunbelt Medical Corporation continues to offer quality services across the board under the leadership of Sunny Sharma. By: JODY JOSEPH MARMEL
SUNNY SHARMA’S JOURNEY to service the health care industry began when he received an undergraduate degree in mechanical engineering in India; he then went on to receive a Master of Science in Industrial Engineering from Mississippi State University and a Master of Business Administration from the University of Houston. With these academic accom54
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plishments, Sharma knew he had many educational achievements to prepare him for his career. In 1974, Sharma started his career as a management engineer at St. Joseph Hospital and later became the director of the department of management engineering for St. Luke’s Episcopal Hospital, Texas Children’s Hospital and Texas Heart Institute in Houston. With an entrepreneurial spirit, he co-founded and became vice president and chief financial officer of Medical Enterprises International Inc. of Houston, Texas. This was an independent service organization “to maintain and service all types of medical equipment.” The company was sold in 1987 to Medical Systems Support Inc., where Sharma became the director of clinical marketing systems. Sharma did not stop there; in 1989, he developed the concept for Sunbelt Medical Corporation (SMC) and founded the company as president and chief executive officer. “SMC offers equipment, consultation, acquisition, equipment to physicians’ offices, imaging centers and hospitals. In a highly competitive medical field, SMC has been successful in providing costeffective solutions to its customers without any sales and marketing personnel.” Sharma found the perfect career that not only fit his business acumen, but helped serve those in medical communities both in and beyond the Lone Star
State, as well. SMC has been the only company to furnish a 50-bed general hospital in West Africa with all-refurbished equipment and a 40-bed specialty hospital in the United States with all-new equipment on a “turnkey” basis. The unique, comprehensive program SMC offers of total equipment management for health care facilities, plus the aforementioned services, is indeed an accomplishment, and one the medical communities appreciate. “I saw an opportunity to provide high-quality preowned equipment and services at affordable prices to domestic and international health care providers,” Sharma says, “and thus, Sunbelt Medical Corp. was born.” And it is thriving to this day. Sharma explains that SMC follows the total equipment cycle, from inception to de-installation. “We completed a 50-bed hospital in West Africa where we wrote the specifications for all needed equipment based upon input from local health care personnel and provided everything for the hospital with 100 percent refurbished equipment, delivered, installed and opened the hospital.” Another turnkey project was to plan, acquire, deliver and install for a 40-bed specialty hospital in the United States with all brand-new items including furniture, computers and the setup of a bio medical department in-house. Both turnkey projects included all
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HOUSTON // MD
SMC DEVELOPS TRUST AND LONG-TERM RELATIONSHIPS WITH QUALITY SERVICE AND A “TAKING CARE OF THE CUSTOMER” PHILOSOPHY. medical equipment and health care furniture including the waiting room furniture. SMC also focuses on startup offices for doctors, standalone imaging centers and surgery centers. SMC’s philosophy is to become the vendor of your choice by providing the high-quality and cost-effective equipment and services that they have been providing for more than two decades now. Being able to offer a full menu of health care products is quite the accomplishment. MRI, CAT scans, X-rays, ultrasound machines, surgical and lab instruments and therapy and rehab equipment are some of the options SMC offers. “We can also provide de-installation and relocating services.” Additional products and services are loan and rental of equipment, disposal of old equipment, upholstery services for furniture, office and health care furniture both new and refurbished, home health care products such as oxygen concentrators, CPAP and BiPAP sleep equipment, wheelchairs, beds, walkers, shower chairs, scooters and so much more.
Repairs of all of these products can also be serviced by SMC. “In addition to selling new, used and refurbished medical equipment and health care furniture, we also service, provide maintenance, inspections and calibration of all of these items, as well.” Houston is SMC’s major market, but they work in several states throughout the country. They have developed relationships with various domestic and international service companies to provide after-sales services, as well. “Right now we have a presence in Africa, Southeast Asia, Latin America and South America,” Sharma explains. “We are currently in talks to expand our services into the European, Middle Eastern and Asian countries.” With no sales force, SMC develops trust and longterm relationships with quality service and a “taking care of the customer” philosophy. Generating more customers has been through word of mouth. Being a one-stop shop for all medical equipment and health care furniture allows physicians and clinics to be able to utilize one source for all of their needs rather than
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multiple vendors. And by looking at the success rate of SMC, the medical communities enjoy the one-stop shop for convenience and reliability. The refurbished business sector of SMC fills the need for “cost-conscious” institutions offering savings from 50 percent to as much as 80 percent of new equipment. “In the event that a company prefers new equipment, Sunbelt maintains the capacity to specify and acquire new, state-of-the-art medical equipment. Sunbelt is able to meet the demands of any client and offer any service and warranty needs along with any piece of equipment sold.” SMC builds trust by providing quality services across the board. With this, along with reasonable costs and the desire to be your long-term technology services vendor with the trust factor and reliability component a given, SMC is part of your team. “We will continue to serve and grow our customer base,” Sharma concludes. “We are looking ahead to develop a ‘hands-on repair’ training facility for local and international bio med engineers to serve Third World countries.” Sharma is constantly adding new concepts to the company with his innovative business approaches that have given SMC a name to be proud of.
Sunbelt Medical Corporation is located at 2040 Johanna Drive in Houston, Texas. For more information, call 713-956-9500 or visit www.sunbeltmedical.com.
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GET BACK INTO ACTION
Local physician Dr. Robert Levinthal works to educate patients about spinal fractures. SPECIAL TO NSIDE
NSIDE TEXAS MD / MARCH.APRIL 2014
HAVING ONE SPINAL FRACTURE SIGNIFICANTLY INCREASES YOUR CHANCES OF HAVING ANOTHER. of spinal fractures, especially those associated with other treatments such as prolonged bed rest and use of analgesics. If the patient experiences back pain that lasts for more than several days, a visit to Levinthal should be scheduled to identify the cause of the pain and a treatment plan.
Dr. Robert Levinthal’s practice is located at 1200 Binz, Ste. 1025, in Houston, Texas. For more information, call 713-533-0100 or visit www.parkplazaneurosurgery.com.
ANY SURGERY INVOLVING THE SPINE typically will make a person take a second look at the recommending physician. Nonetheless, spinal fractures are quite common and Dr. Robert Levinthal’s goal is to educate patients about their condition and offer treatment through a minimally invasive treatment option known as the kyphon balloon kyphoplasty. A vertebral compression fracture or spinal fracture occurs when a bone in the spine is fractured or collapses. As we grow older and are living longer, we face certain diagnoses such as osteoporosis and menopause, which can contribute to a break or collapsed bone in the spinal column. Other contributors can be cancer, chemotherapy, radiation therapy, hyperthyroidism and long-term use of corticosteroids. It is important for patients to acknowledge pain as a signal that something is wrong. Specifically, sudden onset of pain or a chronic, dull ache in your back can be an indication that a spinal fracture has occurred. A spinal fracture means that one of the vertebra has either cracked or collapsed. When a bone breaks, localized swelling can occur and pain is common. Specific to the spine, swelling and misalignment can irritate adjacent tissue and nerves. Damage to even one vertebra can alter the alignment of your spine, upsetting the distribution of the weight along the spinal column and setting the stage for another fracture. It’s important to note that having one spinal fracture significantly increases your chances of having another. Over time, multiple fractures can disrupt the alignment of your spine, causing it to tilt forward (dowager’s hump). The kyphon balloon kyphoplasty can reduce or eliminate your back pain from a spinal fracture and restore vertebral body height and alignment. Early detection and effective treatment (repairing the broken bone) may reduce the consequences
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TWO BROTHERS, ONE MISSION Drs. Mark and Chris Khorsandi aim to give patients their lives back by advancing the field of migraine surgery at the Migraine Relief Center.
WITH THEIR EXPERIENCE in nerve decompression surgery and the amount of relief patients experience post-op, Drs. Mark and Chris Khorsandi knew they had to use their knowledge and skills to help others get relief from migraine headaches. “We realized that migraine headaches are nothing more than pinched nerves in and around the head,” Mark says. “We knew there were recently published papers describing nerve decompression surgery for migraines and acknowledged that this was the next area of surgery we had to pursue.” Knowing how much pain migraine patients experience, both physicians realized they had to be part of this evolution. The “eureka” moment happened five years ago as the family was celebrating the Fourth of July holiday at their parents’ home. “After the traditional day, we sat down at the kitchen table and talked about our experiences,” Mark says. “The very question came up about what area of medicine is nerve pain not being addressed correctly. I vividly remember Chris saying, ‘migraine headaches.’ At that point, we brainstormed and knew we were onto something.” The brothers started gathering papers, and they concluded that they had to open a clinic. They went to Cleveland and talked with several other physicians. “It 58
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was difficult at first, and to a degree, it still is. A lot of neurologists do not understand the principles behind why the surgery works.” However, both physicians kept pursuing their vision of a migraine relief center. They were not sure what the results would be, but patient after patient kept getting better. To date, 90 percent of their patients get decreased headaches in both frequency and duration months even after the surgery is performed. While surgery is one of many options for migraine sufferers, it should not always be considered a last resort. According to both Khorsandi brothers, the ideal candidate is a chronic migraine sufferer with 15 or more headache days per month. Typically, these patients have tried one or more classes of preventative migraine drugs; they have had multiple tests, including imaging studies such as MRIs, CT scans and EEGs; and they have usually been treated by neurologists for an extended period of time.
The surgeries have one goal in mind: decreased frequency and duration of headaches. The surgeries are directed at the pinched nerve in the patient’s head, making sure the tissues surrounding it do not continue to press on it. The incision is very small, and using HD camera technology through a video camera to help localize the nerve and give it more room has indeed provided a whole new option for migraine headache patients. An added plus is that this is an outpatient procedure and patients can go home the same day. “Patients have very little downtime post-op. Most activities can be resumed within a couple of days.” Pioneering the M.I.S.O.N. and M.I.G.O.N.E. surgical techniques, the Migraine Relief Center has helped a vast group of patients over the last couple of years. The M.I.S.O.N. targets the tiny nerves in and around the forehead and serves as an effective method for alleviating enflamed and constricted nerves. “Minimally
MAN WITH MIGRAINE, KAMIRA/SHUTTERSTOCK.COM
By: JODY JOSEPH MARMEL
invasive” is the key phrase in both procedures; only small incisions are made with little or no scarring above the hairline. The M.I.G.O.N.E. specifically targets the occipital nerve in the back of the head, and it is an effective method for alleviating this often enlarged and constricted nerve. The Migraine Relief Center physicians draw on years of surgical experience, having operated on many compressed nerves throughout the body. Mark’s credentials are impressive: He received his doctorate from Nova Southeastern University in Florida, he completed his internship, residency and surgical training in Philadelphia and New York City and he centered on Peninsula Hospital Center in Queens, New York. His training involved some of the most prestigious hospitals and institutions, including Memorial Sloan-Kettering, Westchester Medical Center, Albert Einstein, Beth Israel and LIJ Consortium. After residency, Mark went on to a fellowship in hand and microvascular surgery with the world-famous Dr. Charles P. Melone, who is known for his amazing talents in hand surgery and sports-related hand injuries. Already known as one of Houston’s top hand surgeons, having performed thousands of endoscopic and minimally invasive nerve decompressions, Mark began treating migraineurs (people who suffer from migraine headaches) with nerve decompression surgery through minimally invasive techniques. Having been at the forefront of advancing the field of migraine surgery, Mark has attended workshops and training seminars with other surgeons from around the world, including Dr. Bahman Guyuron at Case Western Hospital, to help establish standards and techniques for this groundbreaking new type of surgery. He has utilized his knowledge in minimally invasive endoscopic nerve decompression to bring relief to numerous migraine sufferers from all over the country. In 2011, Mark presided over the founding of the Migraine Relief Center in Houston with the goal of offering tangible results and unsurpassed quality of care for migraine sufferers. He is one of only a few surgeons in Texas who are trained in migraine, hand and microsurgery, and he is known for his uncompromising eye for detail and unerring sense of compassion for his patients. He is a member of the ACOS and the AOA, and he sits on the advisory board of the Bluebonnet Chapter of the Scleroderma Foundation. The Migraine Relief Center’s success led both brothers to open a Las Vegas office in 2012 and a Beverly Hills office in summer 2013. Chris lives in Las Vegas and travels between the Las Vegas and Beverly Hills centers, although his primary practice is in Las Vegas. Both brothers are licensed in Nevada to practice medicine, and they perform cases together only in Nevada. Chris is a board-certified plastic surgeon who has trained in the most advanced techniques of plastic surgery, minimally invasive hand surgery and the emerging field of migraine relief surgery. He is a two-time recipient of the National Patients’ Choice Award for his skills and a recent recipient of the National Compassionate Doctor Award for his healing compassion. Combined, the brothers have more than 12 years of experience in private practice; Mark has been a physician for 14 years, and Chris has been a physician for 10 years. “Together, we have performed close to 5,000 surgeries in that period of time. Many of them
"WE MAKE SURE WE REACH OUR GOALS FOR ALL OF OUR PATIENTS." involved nerve decompressions, but also reconstructive surgery, cosmetic, hand and general surgery, to name a few. What sets us apart is that our migraine clinic just focuses on patients with chronic intractable migraine headaches.” There are other options for chronic migraines, but both physicians feel that the best non-surgical option is Botox. They also perform this procedure and have a holistic approach for those who want to try that option. It includes massage, herbals, acupuncture and other vitamins and oils added to your diet. Yet, homeopathic treatments are often expensive and provide short-term relief. Most of the aforementioned services are arranged through their office with providers they recommend. “Most migraine sufferers suffer in silence. You are not alone. We will not discount your pain; we understand what our patients are going through. Our goal is to give you your life back, and we make sure we reach our goals for all of our patients. We are caring, conscientious physicians who want to make a differ-
ence in the world one patient at a time. We are the ones you will meet and have the surgery performed by. Our experience with the number of cases we perform per year and our results give us an advantage over other practices.” The Khorsandi brothers will continue to advance the field of migraine surgery, create new techniques and educate patients on alternatives to medications. They want to strive to have migraine surgery become the standard in the treatment of chronic migraine headaches. And with their vigor and skills, the Migraine Relief Center is beginning to set the standards for the future for migraine sufferers. “This is the most rewarding experience in our lives – seeing the difference between a patient who had severe migraines and then after the surgery, seeing how much their lives have improved brings a sense of fulfillment and satisfaction that all those years of training and education paid off. We love what we do and want to continue this great work to help others get their lives back now and for their future.”
The Migraine Relief Center is located at 1355 West Gray in Houston, Texas. For more information, call 713-522-5111 or visit www.themigrainereliefcenter.com. Note: While NSIDE officially adheres to AP style, certain exceptions were made in the editing of this article. MARCH.APRIL 2014 / NSIDE TEXAS MD
HOUSTON // PATIENT
gical centers and physician practice startups. With a plethora of experience, knowhow and skills, Breeze was ready to act on her vision for an urgent care center after an experience she had with her son. “The point was driven home when I had to use a freestanding ER for my own son on a Saturday when his regular pediatrician was unavailable. I was astounded at the $800 bill that I received for a straightforward 10-minute service. It became very clear to me that non-life-threatening complaints could be handled in a much less costly setting, so that is what I set out to do.” The vision for Next Level Urgent Care was developed from the perception of an unmet need in community health care. Breeze had heard the complaints from friends and physician colleagues about the lack of reasonably priced high-quality after-hours medical services available in the area. And Breeze’s experience was the icing on the cake, so to speak. Next Level Urgent Care’s mission is simple: to provide high-quality, affordable health care for all. The following are some of the more important features of the “constitution” they developed when they first began: ➊ We provide a quick, convenient, cost-effective alternative to a regular doctor’s office visit. ➋ Our staff are selected for strong people skills and further developed with excellent training programs to be outstanding providers. ➌ Cross-training staff provides only two points of contact during the onsite experience (the tech and the provider).
➎ We maintain a strong “backup” network of specialists for consultation if necessary.
A HIGHER LEVEL OF CARING
With a focus on the patient experience, Next Level Urgent Care provides high-quality affordable care and service for all. By: HEATHER DANIELS
NEXT LEVEL URGENT CARE opened on July 1, 2013, at the Sugar Land clinic in Houston, soon to be followed by multiple other locations throughout the city. With a much-needed niche being fulfilled in the medical community, Dr. Juliet Breeze, CEO, founded the company with her business partner, Tom Gee. Breeze practiced medicine as a family practice phy60
NSIDE TEXAS MD / MARCH.APRIL 2014
sician for four years before leaving practice to go into practice management and development. During the 10 years prior to starting the urgent care business, she served as the CEO of Richmond Bone & Joint Clinic and as the president of Kingsland Surgery Center, as well as in project management of all aspects of design, construction and operations for several hospitals, sur-
➏ Our staff’s priority is to connect with our patients. Our focus is on our patients’ experience. ➐ Our goal is to make patients glad that they chose to see us. “There are several things that differentiate us from our competitors. The first is quality services and staff. At Next Level Urgent Care, we have been incredibly selective in our hiring. Our staff has been chosen for their communication skills and compassion, as well as their experience and clinical competence. Our centers have been designed around patient comfort. Patients should notice the difference in the way they are treated and the attention they receive right away.” The second important differentiator is pricing. “We accept most major insurances, including Medicare and Medicaid, and our co-pays are similar to what a patient pays in a primary care office. For our uninsured patients or patients with a high deductible, we offer a transparent pricing model that is posted in our clinic and on our website.”
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➍ We see our staff as our greatest asset and reward productivity and skills achievements.
The time-of-service discounted pricing has three tiers: Level 1 ($155), Level 2 ($180) and Level 3 ($200). The pricing at Next Level Urgent Care is generally less than one fifth the cost of the same service provided in an emergency setting. For example, an 8-year-old patient fell out of a tree and fractured both of his wrists. The patient was Xrayed and splinted, and a follow-up appointment was made with the orthopedist his primary doctor uses. His co-pay with his insurance plan was $50; however, if he had not had insurance, his total bill would have been $200 maximum. “The same treatment at an emergency room would have been between $1,200 and $1,500.” “The third important differentiator is our relationship with the medical community,” explain Breeze and Director of Marketing Rafik Sandford. “We have a large network of community primary care providers and specialists who are supportive of our endeavor. The area physicians have really welcomed the chance to send their patients to a quality clinic when they are unavailable. Since we do not provide treatment of chronic illnesses, the physicians who send their patients to us can be sure that they will return to them for follow-up and continued care.” Next Level Urgent Care welcomes community physicians to provide their preferences so they can build them into their treatment protocols for their patients. “We ask for their preferred ER, cardiologist, podiatrist, orthopedic, hospitalist and ophthalmologist. We also ask if they are accepting new patients so we can refer patients. We understand physicians have their
own professional networks they prefer to work in, and we try to help maintain continuity of care by respecting those preferences.” Due to all of the needs of the community, as well as the excellence in care, Next Level Urgent Care’s expansion has been quite rapid, to say the least. They opened five clinics in five months, and they have another four opening in early 2014. This makes nine clinics opened within a 10-month time frame with possible plans for more in 2015. The model is based on cost-sharing clinic management and supplies across a network of clinics. It makes a great deal of medical and business sense for all of those patients who need to be seen by Next Level Urgent Care, and it has been a comfort rolling into various parts of Houston that the facilities are open for operation seven days a week from 9 a.m. to 9 p.m. With an emphasis on short wait times, convenient locations, quality medical care at its best and comfortable and friendly environments, as well as a “walk-ins are welcome” policy, this higher level of medical care is being embraced by Houstonians. As long as an acute condition is not life-threatening, Next Level Urgent Care can provide first-line treatment. This includes both illnesses and injuries. They promptly refer cardiac chest pain, neurologic issues and heavy trauma to emergency rooms. They do not provide routine or wellness care, and they do not treat chronic conditions like diabetes and hypertension. “Our stance is: If we cannot treat you, we don’t charge you. If someone presents us with a condition that is beyond our scope of services, we will refer
1355 West Gray, Suite 102, Houston, TX 77019
"OUR STAFF’S PRIORITY IS TO CONNECT WITH OUR PATIENTS." them to the ER of their physician’s choice or the nearest ER. We will do everything in our capabilities to stabilize a patient if they are in an emergency situation and then call 911.” Next Level Urgent Care is most definitely an alternative option worthy of investigating for all Houstonians who need after-hours care, weekend care or in-between care for the overall well-being of their entire family. The short-term goal at Next Level Urgent Care is to complete the first phase of growth with the opening of the ninth center in May. And Next Level Urgent Care’s long-term goal is to become the No. 1 urgent care brand in Houston, known for excellence in quality of care and service. It appears that Next Level Urgent Care will meet both goals as their expansion continues throughout Houston.
For more information on Next Level Urgent Care, please call 281-201-0657, or visit www.nextlevelurgentcare.com or www.facebook.com/nextlevelsugarland.
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In our office we have a state of the art facility and outstanding professional staff. If you think your bladder is not working right, you think you have pelvic organ prolapse, you have pelvic pain, or sexual health concerns or general gynecological concerns like uterine fibroids or heavy menstrual cycles and want my medical opinion please call and make an appointment. I give you my word to provide you the highest quality, ethical medical care with a personal touch should you trust me and my staff in your health care decisions.
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DR. ROBERT LEVINTHAL
The mission of Park Plaza Medical Associates is to partner with you to develop a health care plan to fit your individual needs. You can trust our experienced physicians and staff to provide personalized care respecting you, your time and your health care decisions. With early morning and evening appointments available, we are here to meet the needs of our community.
DR. CHRISTOPHER JAYNE
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Dr. Levinthal is devoted to the goal of excellence in neurosurgical care with the judgment to perform necessary surgery, only if all appropriate non surgical treatment has been considered. He believes in the importance of physician/patient honest and transparent communication to establish optimal results. Dr. Levinthal has always evaluated new and exciting treatment options but he strongly believes in the importance of clinical experience in determining the correct surgical or nonsurgical option for each individual patient.
Suite 1025 www.parkplazaneurosurgery.com
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RIO GRANDE VALLEY
RIO GRANDE VALLEY HEALTH & WELLNESS
THE GOLD STANDARD Fifty may be the new 30 … but you still need to get a colonoscopy.
ABOUT DR. ALBERTO A. PENA Alberto A. Pena, M.D. FACS, FASCRS, is board certified in both general surgery and colon and rectal surgery. He has been distinguished as a fellow of the American College of Surgeons and as a fellow of the American Society of Colon and Rectal Surgeons. He has received specialized training, and he is adept in the treatment of colorectal cancer and other benign diseases of the colon, rectum and anus. He has fellowship training in laparoscopic surgery and transanal minimally invasive surgery. Pena is currently serving as chairman for the department of surgery at Doctors Hospital at Renaissance. He also serves on the board of managers for Border Health PAC.
NSIDE TEXAS MD / MARCH.APRIL 2014
AMONG CANCERS that affect both men and women, colorectal cancer is the second leading cause of cancer deaths in the United States. The risk of getting colorectal cancer increases with age. More than 90 percent of cases occur in people who are 50 or older. According to the American Cancer Society, nearly 150,000 Americans are diagnosed with colon cancer each year, and an estimated 50,000 die from it. But this doesn’t have to be the case. Colorectal cancer screening saves lives, but many people are not getting screened according to national guidelines. If you’re 50 or older, getting a screening test for colorectal cancer could save your life. When detected and treated early, the five-year survival rate is over 90 percent. Dr. Alberto Pena, a board-certified surgeon specializing in colon and rectal surgery, shares his insight on this important topic.
evaluate the colon to detect and prevent colorectal cancer. While testing stool for occult blood is common practice, colonoscopic examination of the colon remains the best modality to screen for colorectal cancer.
Q: IS A COLONOSCOPY THE ONLY SCREENING OPTION FOR COLORECTAL CANCER? IF NOT, HOW DO I KNOW WHICH TEST TO TAKE OR RECOMMEND TO A PATIENT? A: The gold standard for screening for colorectal cancer in the United States is the colonoscopy. Screening should begin at age 50 for every person living in the United States. Colonoscopy can be done before the age of 50 for diagnostic purposes and is routinely recommended for patients younger than 50 who have blood in their stool or change in their bowel habit or caliber. Other screening modalities exist such as virtual CT colonography and flexible sigmoidoscopy with barium enema. Most societies still recommend colonoscopy as the study of choice to
Q: IF SOMEONE DOES NOT GET SCREENED, HOW ELSE WILL THEY KNOW THEY HAVE COLORECTAL CANCER? A: Colorectal cancer usually presents late in the disease process. The most common presenting symptoms are blood in the stool, change in bowel habit or caliber and even abdominal pain or fullness. When a patient presents with these symptoms, it is fairly concerning. In other words, when someone presents with symptoms, they already have a cancer. The ideal situation would be to prevent the cancer. If a polyp is detected during a screening colonoscopy, it can often be removed or destroyed. This essentially prevents cancer of the colon years before it changes to cancer.
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SPECIAL TO NSIDE
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THE RISK OF GETTING COLORECTAL CANCER INCREASES WITH AGE.
Q: WHAT IS THE KEY TO PROPER MANAGEMENT OF COLORECTAL CANCER? A: The best treatment for colorectal cancer is prevention. It has been well established that the majority of colon cancer starts as a polyp. Because colonoscopy is an excellent modality to detect and remove polyps, it is also a preventative intervention for cancer. When people present with colon cancer, the most effective treatment is usually surgery. Some patients may benefit from chemotherapy depending on the extent of their disease. Rectal cancer is a bit more complex, and at times, radiation and chemotherapy also play a significant role in therapy. Q: KNOWING THAT EVERY CASE IS DIFFERENT, WHAT ARE THE TYPICAL STEPS FOR DIAGNOSIS AND TREATMENT IF CAUGHT EARLY? WHAT IF IT IS NOT FOUND UNTIL IT HAS PROGRESSED FURTHER? A: The majority of colorectal cancer is diagnosed by colonoscopy. When detected early, colorectal cancer can often be treated very effectively with surgical
management. If a patient presents with advanced disease, chemotherapy has a significant role in therapy. Current chemotherapeutic regimens have become quite sophisticated and offer significant therapeutic value in many cases. Q: ARE THERE NEW TREATMENTS FOR COLORECTAL CANCER? TO YOUR KNOWLEDGE, ARE THERE NEW STUDIES BEING DONE? A: The most current advances in surgical management for colorectal cancer have been the advent and maturation of minimally invasive surgery for colorectal cancer. Laparoscopic surgery and robotic surgery have proven to be safe and effective modalities to remove colorectal cancer with excellent outcomes. Single-site surgery and transanal minimally invasive surgery are also minimally invasive techniques, which are gaining popularity. Continuing research is being done with different chemotherapy regimens to provide tailored chemotherapy based on the specific patientâ€™s tumor biology.
Q: AS MUCH AS WE PROMOTE GETTING SCREENED, MANY PEOPLE OVER THE AGE OF 50 ARE STILL CHOOSING NOT TO ON ANY LEVEL. WHY IS THAT, IN YOUR OPINION? A: I suspect people avoid screening for several reasons. Most people believe if they have no symptoms, there should be no reason to go through the expense, time and discomfort of an invasive procedure. Also, many patients are afraid of what will be found and how it will be dealt with. Many patients have fear of the unknown. They are afraid of finding a cancer and having to wear a colostomy bag for life. Fortunately, if found early enough, many cancers can be treated without bags and we have actually seen a decrease in the number of operations that require a permanent bag.
For more information about this topic or to schedule an appointment, contact Doctors Hospital at Renaissance at 956-DOCTORS.
MARCH.APRIL 2014 / NSIDE TEXAS MD
‘TIS THE SEASON TO BE SNEEZING Understanding, preventing and treating nasal allergies SPECIAL TO NSIDE
Q: WHY DOES THE MCALLEN AREA CONTINUOUSLY RANK AS ONE OF THE WORST AREAS FOR ALLERGY SUFFERERS? A: South Texas is so prone to this distinction because it’s a very humid environment. The humidity allows the allergy season to start earlier here than in most other areas. Pollen production can start as early as January. Trees such as cedar, elm and juniper begin to release their pollen at this time because the conditions are perfect. Because of this “perfect” environment, there is a great amount of mold, as well. Not only do you have a good amount of pollen around for a long time, you also have heat and humidity that allow that mold to flourish here. So people get bombarded by these things when the winds pick up – which happens often in the Rio Grande Valley. All of this gets blown around, and people suffer severely. Q: DO ALLERGY SUFFERERS ACCLIMATE TO AN ENVIRONMENT THEY ARE EXPOSED TO AFTER A SIGNIFICANT PERIOD OF TIME? A: It’s a very interesting phenomenon. There are a number of reasons people may suffer differently from time to time. When we are young, there are certain things that we are allergic to that may recede as we
NSIDE TEXAS MD / MARCH.APRIL 2014
get older because our body develops a tolerance. Adversely, we can acquire new allergies as we get older and become exposed to more things. When you get to a new area, you may not be allergic, but you can be irritated by the new environmental pollens and such. So you may develop localized symptoms, but not a generalized reaction. You may become accustomed to these irritants and no longer be affected by them, or conversely, you could develop an allergy as time goes on. Q: HOW DOES SOMEONE KNOW THE DIFFERENCE BETWEEN BEING IRRITATED BY SOME ELEMENT AND ACTUALLY BEING ALLERGIC TO IT? A: It’s very difficult to know the difference initially. Things like perfume, air fresheners and even smoke in the air can irritate your nose and cause a local reaction. A true allergy is when every single time you are exposed to certain element, there is not only a local reaction, but a systemic reaction, as well. Q: MOST PEOPLE KNOW THE BASIC SIGNS AND SYMPTOMS FOR BEING ALLERGIC TO SOMETHING. WHAT ARE SOME ATYPICAL SYMPTOMS SOMEONE COULD DEVELOP? A: Those typical signs are very important. Itchy eyes, nose, throat or ears, watery eyes, sneezing, nasal congestion and swelling under the eyelids are all typical signs. Itching or rashes on your skin; an increased amount of snoring when sleeping; or waking up with a sore throat because of post-nasal drip or a completely stuffed nose could occur. If these things don’t get relieved, you could experience sinusitis or a nasal infection. Then you would feel facial pain or pressure or even fever. It’s progressed from just a local allergic reaction to a full-on infection. Q: WHAT KIND OF PREVENTATIVE THINGS CAN WE DO ALLEVIATE ALLERGY SUFFERING? A: The first thing is to address or control the things in your home that could be causing irritations or al-
ABOUT DR. CARLOS AYALA Dr. Carlos Ayala is double board certified in otolaryngology and facial plastic surgery, and he is board eligible in sleep medicine. He retired from the USAF and is now practicing ENT and facial plastic surgery in the Rio Grande Valley. He serves the needs of a tremendously underserved population and demonstrates his ongoing commitment to those most in need, as well as his ongoing pursuit to simplify the beauty in all of us. Ayala specializes in revision rhinoplasty, rhinology, balloon sinuplasty, blepharoplasty, otoplasty, facial plastic surgery and voice, allergy and sleep medicine.
lergic reactions. Make sure to decrease humidity; air conditioning helps, and a dehumidifier or even a HEPA filter can filter out allergens in your particular environment. Keep the windows closed if at all possible to decrease certain elements from coming in from outside. Keep pets and dust off of your bed – hair and dust are huge allergens for many. Now, when outside, you can still do things to help prevent irritation. Perform nasal sinus rinses such as saline rinses with a neti pot or some other rinse in order to wash out allergens that have possibly been in your nose all night. Try to stay out of high winds as much as possible and keep your windows rolled up. Another great way to help control allergies is to eat the local honey. It can act as a form of immunotherapy to certain allergens in your environment. Q: WHAT IS THE STANDARD PRACTICE OF CARE WHEN YOU SEE A NEW PATIENT WITH ALLERGIES? A: First I would need to understand how severe the allergic reaction is. If someone is experiencing problems breathing or swallowing or some severe reaction, that’s an emergency. I would send them to the ER, where they would typically get treated with Diphenhydramine. As far as a more common non-emergency case, I
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NASAL ALLERGIES affect roughly 20 percent of Americans. Between prescription costs, physician visits and missed days of work/school, the economic burden of allergic disease exceeds $3 billion annually. The prevalence of allergic conditions has increased significantly over the last two decades and continues to rise. Based on a study from the Asthma and Allergy Foundation of America in 2013, the McAllen, Texas, area ranks No. 6 on the 100 Worst U.S. Cities for People with Allergies list. The cities of the United States have been ranked according to how challenging they are to live in for people with allergies. Dr. Carlos Ayala, a Harvard-trained otolaryngologist practicing in the Rio Grande Valley, knows why we rank so high.
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would suggest the preventative recommendations previously addressed. Next, we may recommend an over-the-counter antihistamine. For others who prefer not to take pills, we prescribe a nasal steroid or antihistamine spray. For those who prefer not to take medication at all, I recommend the saline rinse. When you are outside and exposed to the elements, those irritants can stay in your nose for a long period of time unless you rinse it out. That process actually physically removes the irritant that’s in your nose causing the reaction. Next, we would need to diagnose the allergy cause through testing. There are a number of ways to do this. One way is through a blood test called the RAST (radioallergosorbent) test. This test basically determines if you have antibodies to certain allergies or antigens in your blood stream. I could determine what foods, trees, grass, weeds or pollen you are allergic to – and even what animals you are allergic to. This is an important test because if you have animals in your home or trees in front of your house, for instance, and we determine that you have these antibodies in your blood, you can then do something about it to alleviate your suffering. There is also skinprick testing, where we actually prick your skin with an antigen and see the reaction to it or the severity of the reaction to these different allergies. Once we’ve determined what is causing your allergic reactions through these tests, we move on to treatment or allergy immunotherapy. There are two ways to treat you. One is through injections, which are special cocktails tailor-made to treat you specifically. Or you can be treated with sublingual immunotherapy. You actually ingest small amounts of the allergen so that our body slowly develops a tolerance toward these allergies, leading you to no longer suffer from them as badly. You could possibly be cured from them all together.
NASAL ALLERGIES AFFECT ROUGHLY 20 PERCENT OF AMERICANS.
Q: WHEN WOULD SOMEONE NEED SURGERY TO DEAL WITH ALLERGIES? A: If someone has been going through treatment for allergies and continues to suffer from congestion, there could be other anatomical causes for nasal congestion such as a deviated septum. Your turbinates could be large or swollen. You may have had trauma to your nose as a child and didn’t realize it; the inside of your nose could be blocked or collapsing. You would need surgery if presented with these challenges. Some people’s sinuses may be completely closed and need to be washed out or irrigated to remove allergens inside the sinuses. That’s when we would use balloon sinuplasty, which uses a balloon and catheter to physically open up the sinus. It’s an in-office treatment that causes no downtime for a patient. Some people require sinus surgery in the operating room, usually because of nasal polyps. But our efforts focus on giving you care in the office and keeping you out of the operating room.
For more information about this topic or to schedule an appointment, contact Doctors Hospital at Renaissance at 956-DOCTORS. MARCH.APRIL 2014 / NSIDE TEXAS MD
ARE YOU AWARE OF AUTISM?
April is National Autism Awareness Month. Here’s what you need to know about the fastest-growing serious developmental disability in the United States. SPECIAL TO NSIDE
ABOUT DR. PRITI MANOHAR Priti Manohar, M.D., specializes in neurology and pediatric neurology. She is certified by the American Board of Pediatrics and has specialty certification with the American Board of Psychiatry and Neurology in neurology with special qualification in child neurology and sleep medicine.
AUTISM IS the fastest-growing serious developmental disability in the United States, affecting one in 88 children. Boys are nearly five times more likely than girls to have autism. There is no medical detection or cure for autism. The most obvious signs of autism and symptoms of autism tend to emerge between 12 and 18 months of age. Being aware of these signs is just the first step. Dr. Priti Manohar is a board certified in pediatrics and neurology with special qualification in child neurology and sleep medicine. As April is National Autism Awareness Month, Manohar explains what to look out for and what to do if you suspect your child has autism. Q: EXPLAIN WHAT AUTISM IS EXACTLY. A: Autism is a condition of the brain where someone has a deficiency in communicative skills, which could be verbal or non-verbal. This can be combined with cognitive impairments or
NSIDE TEXAS MD / MARCH.APRIL 2014
Q: WHAT WOULD A PARENT OR PHYSICIAN LOOK FOR IN DETERMINING IF A CHILD MAY BE AUTISTIC? A: In early toddlerhood (as early as 6 months), mothers and pediatricians can pick up a few subtle signs. There may be an absence of cooing or nonresponsiveness to their name, or they may not be aware of their surroundings or not cognizant of familiar faces – even the faces of their own mothers. Another common sign is speech delay. Many little ones go to the pediatrician because the parents realize they aren’t talking. Other signs are that the child may have behavioral issues like tantrums, sleep issues or aggression. Additionally, we may see sensory issues such as being sensitive to certain kinds of feels or touches. We can even see movement issues such as constant moving of the hands or the body. They can be late in walking, too. Q: IF SOMEONE SUSPECTS THEIR CHILD IS AUTISTIC, WHAT IS THE FIRST THING THEY SHOULD DO? WHO SHOULD THEY GO SEE MEDICALLY? A: Of course, your pediatrician is your first point of contact for your child’s health care needs. There are primary screenings that would need to be done – for instance, a hearing test. A child should have this done before moving forward if autism is suspected because of a lack of speech. Many times, deafness can be the cause of speech delay, and it is very treatable if caught
early. From there, they would refer to a neurologist or child psychologist if further testing were needed to determine autism. Q: TELL US ABOUT THE SPECTRUM OF AUTISM DISORDERS. A: Autism disorders can be very mild to very severe. The lower end of the spectrum to this point is considered Asperger syndrome. At the higher end of the spectrum, a patient may have no verbal language or even no non-verbal language – that is known as agnosia. At the lower end of the spectrum, there is usually no history of speech delay. The intelligence level is normal, but there are very subtle deficits in learning and social skills. They often have issues with attention, focusing or hyperactivity or other co-morbidities like depression or anxiety that would take them to their physician’s office. Back on the higher end of the spectrum, with serial autism, one may not be able to develop any words or very few words; they are not responsive to their names. They follow certain rituals and have the stereotypical movements we associate with autism like rocking and hand wringing. They could have epilepsy or seizures. A lot of times, they do not have any relevant speech, but will have irrelevant speech – although, if they can talk, it will be a memorized, parroting type of speech. Q: IS THAT ABILITY TO MIMIC WHY WE SEE SOME AUTISTIC PEOPLE WITH SPECIAL “SAVANT” SKILLS? A: We see certain children with special skills that may not be possible among the ordinary population. This occurs in about 10 percent of cases. But that’s because certain parts of the
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the stereotypical movements like rocking or hand wringing. A patient could have all three of these deficiencies or not depending on the level of severity of the autism.
brain develop, where other parts of the brain have issues like the hypothalamus and speech areas.
LITTLE GIRL WRITING, KOOSEN; YOUNG BOY, ANASTASIA SHILOVA/SHUTTERSTOCK.COM
Q: IF SOMEONE IS DIAGNOSED ANYWHERE ON THE SPECTRUM, WHAT TYPES OF TREATMENTS OR SPECIALISTS WILL BE REQUIRED? A: For a child with autism, there should be a multidisciplinary approach to treatment or care. The parent and the pediatrician are the anchors as to what help to get. A child’s school should be involved in the care regimen, as well. As far as specialists, care could come from a pediatric neurologist, a child psychiatrist or other behavioral specialists. A physical therapist may be necessary, too. Q: WHAT IS YOUR APPROACH TO CARE AS A PEDIATRIC NEUROLOGIST? A: First, it’s important to say that all cases are different. Most of my patients come for speech issues. So I would first make sure they have normal hearing and then do a screening and an overall assessment. I observe a child right when they enter a room and study every detail of their history – behavior, sleep issues, eating habits, problems at school, teacher feedback, etc. I put that information together, and I give a diagnosis. It’s important to know that there is no diagnos-
tic test to confirm diagnosis of autism – no MRI can help us diagnose the disorder. But EEGs are helpful in patients with autism because many times, there is something called autistic regression, where a child develops words and some speech, but then regresses. The common cause for that is epilepsy or epileptic aphasia. The EEG allows us to measure abnormalities in the temporal spikes and slowing of the brain waves. As far as treatment, I usually start aggressive speech therapy depending upon the child’s age. Educating the parents and letting them know what they need to do is very important, as well. I direct them to multiple resources to help them best care for their child (books, websites, etc.). Behavioral modification may be necessary, and getting the child involved in social or community programs, especially at school, is important. As stated earlier, involving the school is crucial. There may be special education needs for the child. Making sure the parents leave my office with hope is very important to me – I let them know it is not the end of the world. With proper treatment, we even sometimes see many signs and symptoms of autism go away.
For more information about this topic or to schedule an appointment, contact Doctors Hospital at Renaissance at 956-DOCTORS. 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.
BOYS ARE NEARLY FIVE TIMES MORE LIKELY THAN GIRLS TO HAVE AUTISM. MARCH.APRIL 2014 / NSIDE TEXAS MD
THE ALAMO, RICHARD A MCMILLIN/SHUTTERSTOCK.COM
SAN ANTONIO // PROFILE
THE HIGHEST LEVEL Surgical Oncology Associates of South Texas: compassionate cancer care from skilled surgeons By: PAMELA MOOMAN
RS. MORTON KAHLENBERG AND DENNIS ROUSSEAU, partners at Surgical Oncol-
ogy Associates of South Texas, practice daily the short phrase that serves as a sort of motto: “operating at the highest level.” The team at Surgical Oncology Associates is comprised of not only the two experienced cancer surgeons, but also highly trained and skilled nurses and key support staff who work together to prevent and treat cancer through sharing knowledge, offering personalized treatment plans to patients and performing surgery when necessary. This specialized team has a combined 30 years of providing specialized cancer care in both prevention and treatment. Surgical oncology, as Kahlenberg explained, is a specific surgi-
NSIDE TEXAS MD / MARCH.APRIL 2014
cal sub-specialty. However, it seems that many physicians may not be aware of the advantages surgical oncologists offer patients diagnosed with cancer or pre-cancerous conditions because of the large number of cancer patient referrals made to general surgeons rather than to surgical oncologists. Most notably, surgical oncologists are trained, certified surgeons, Kahlenberg said, who have undergone two to four years of additional training focused on the treatment – and prevention – of cancer through surgery. Kahlenberg founded Surgical Oncology Associates in order to raise the overall level of surgical care for cancer patients in South Texas. “As a result of having practiced in San Antonio for more than a decade, it was apparent to me that the overall quality of cancer care for our community was extremely strong, but
that a surgical practice dedicated solely to the prevention and treatment of cancer was lacking,” he said. “My goal for Surgical Oncology Associates was to be recognized as our community’s primary resource for surgical cancer care. I created our practice in 2008 with this goal in mind, and to this day, all that our practice offers is based on putting the patient first. This is the way I would want my family members to be cared for, and this is what we strive for in our practice. “The removal of many cancers requires sophisticated, complex surgical procedures. Dr. Rousseau and I, and our team, believe that patients benefit from having two or more specially trained cancer surgeons in the operating room. We are the only practice in South Texas that offers this level of care. When surgery is indicated for a patient, we provide state-of-the-art procedures.” Rousseau said surgical oncology allows him to put his lifelong fascination with science and its application in improving people’s lives by seeking out the most effective treatment of diseases – specifically cancer – into practical, direct use every day. “The training surgical oncologists receive not only teaches surgical expertise in cancer care, but also emphasizes the importance of multidisciplinary cancer care to achieve the optimal cancer outcome for each patient,” Rousseau said. “Every patient has unique aspects to his or her cancer. Being trained in surgical oncology gives me the knowledge and expertise to identify the unique aspects of each patient, participate in the treatment planning for the best outcomes and to perform the surgical portion of the cancer care with the best results.” Peter Suess is a pancreatic cancer survivor of more than four years. Kahlenberg performed his surgery. “Dr. Kahlenberg saved my life,” Suess said. “The panic that sets in after a cancer diagnosis is incredible. He really settled us down, explained what was happening and he had a plan of attack. He operated on me twice. His plan worked.” Kahlenberg and Rousseau first met in San Antonio while both were working as faculty at the University of Texas Health Science Center at San Antonio (UTHSCSA) in the division of surgical oncology. Both eventually left UTHSCSA – Rousseau to move to Florida Hospital Cancer Institute in Orlando to develop a
surgical oncology program there, and Kahlenberg to found Surgical Oncology Associates in San Antonio.
“Being an integral part of a team of cancer experts,” Rousseau said, “guiding a patient and his or her fam-
KAHLENBERG AND ROUSSEAU GREATLY VALUE THE OPPORTUNITY THEY HAVE TO WORK ONE-ON-ONE WITH PATIENTS. Rousseau said when Kahlenberg reached out to him to return to San Antonio to serve as a partner
ily through treatment while managing the stress and fear associated with a cancer diagnosis and achiev-
at Surgical Oncology Associates, the decision was not overly difficult. “The opportunity to work with Dr. Kahlenberg again to further develop an outstanding surgical oncology program for San Antonio – a city my family loves – was too good to refuse.” Both physicians also are active, integral catalysts for the development of optimal cancer care for the entire Baptist Health System, thus making Baptist the desired destination for cancer care in San Antonio and South Texas. Kahlenberg and Rousseau greatly value the opportunity they have to work one-on-one with patients, guiding them through cancer treatment and survivorship, always with their focus on finding a cure. Rousseau explained how rewarding this process is for him every day, and Kahlenberg emphasized that this is the most gratifying aspect of their specialty.
ing the best possible cancer outcome for each patient gives meaning and purpose to the long hours, late nights and time away from family.”
Morton Kahlenberg, M.D., FACS, and Dennis Rousseau, M.D., Ph.D., FACS, treat cancer patients at two different offices in San Antonio for Surgical Oncology Associates of South Texas. One office is at 520 Madison Oak, Ste. 346, and the other is at 8715 Village Drive, Ste. 620. To schedule a meeting with the surgical oncology team, call 210-946-1400. And for more information on the BHS Physicians Network, go to www.bhsphysiciansnetwork.com or email Julie Minnick at jaminnic@baptisthealthsystem. com. MARCH.APRIL 2014 / NSIDE TEXAS MD
SAN ANTONIO HEALTH & WELLNESS
“EXPERT ADVICE FROM YOUR TRUSTED BHS PHYSICIANS NETWORK.”
GET ARMED WITH THE FACTS What you need to know about heart attacks By: DR. SCOTT MOORE
Q: HOW COMMON ARE HEART ATTACKS? A: Heart disease is the top cause of death in the United States. Annually in the United States, 1.2 million heart attacks occur. That’s one every 34 seconds.
A: A heart attack occurs when plaque builds up in an artery (a blood vessel that carries blood to the heart) and eventually cracks open. A blood clot will then form around the rupture, blocking the artery, and thus cutting off blood flow to the heart. The area of the heart muscle not receiving blood flow will die. Scott Moore, M.D., is an interventional cardiologist who practices medicine with the Heart Clinic of San Antonio, located at 502 Madison Oak, Ste. 310, in San Antonio, Texas. For more information, call his office at 210-483-8883.
Q: WHAT ARE THE SYMPTOMS OF A HEART ATTACK? A: There are several classic symptoms that can point to a heart attack. They are:
BHS PHYSICIANS NETWORK 76
NSIDE TEXAS MD / MARCH.APRIL 2014
PHOTO OF DR. MOORE BY MARK HUMPHRIES
Q: WHAT EXACTLY IS A HEART ATTACK?
• Nausea • Lightheadedness • Sweating • Shortness of breath • Chest discomfort (tightness, squeezing, pain, the feeling of “an elephant sitting on the chest”) • Discomfort in arms, neck, jaw and/or the back Women, however, may have any or all of the following uncommon symptoms: • Shortness of breath • Discomfort in the lower chest and abdomen • Extreme fatigue • Dizziness
Q: HOW ARE HEART ATTACKS TREATED? A:
Most commonly these days, physicians treat patients having a heart attack with angioplasty. A stainless-steel stent is wrapped around an angioplasty balloon, which is then inserted into the blocked artery and expanded.
Q: WHAT ARE RISK FACTORS FOR HEART ATTACKS? A: Several risk factors account for about 90 percent of all heart attacks. They are: • Smoking • Diabetes • Hypertension • Hyperlipidemia • Family history Other less common – but still important – risk factors for heart attacks are:
HEART ATTACK, HIN255/SHUTTERSTOCK.COM
• Abdominal obesity • Lack of exercise • Inadequate consumption of fruits and vegetables • Inactivity • Stress, anger, depression
Q: HOW CAN PATIENTS REDUCE THEIR RISK FACTORS? A: First, the single easiest means of reducing the risk
of heart attack for both men and women is quitting smoking – not that quitting is easy. But this cause of heart disease is directly within people’s control. People can start a regular exercise plan in cooperation with their physician. They should eat a balanced diet, preferably based on the Mediterranean Diet, with lots of fruits, vegetables, grains and legumes as the base, with seafood and fish next, then poultry and dairy products and finally, red meat no more than a few times each month. They should also monitor cholesterol levels.
IN THE UNITED STATES, ONE HEART ATTACK OCCURS EVERY
34 SECONDS. MARCH.APRIL 2014 / NSIDE TEXAS MD
ASK THE EXPERTS
THE THICK AND THIN OF IT Discussing the facts about osteoporosis By: DR. SHASHI MITTAL
Osteoporosis is a skeletal disorder characterized by low bone mass, which is associated with reduced bone strength and increased risk of fractures. For the most part, osteoporosis is an asymptomatic disease until a fracture occurs. Vertebral fractures may be found incidentally on CXR or spine X-rays. Osteoporosis also may cause hip fractures and Colles fractures.
Q: WHAT ARE RISK FACTORS, AND WHICH POPULATIONS ARE MOST AT RISK? A: Risk factors for osteoporosis include: • Previous fractures • Long-term glucocorticoid therapy • Low body weight (less than 58 kg [127 pounds]) • Family history of hip fracture • Cigarette smoking • Excess alcohol intake Populations at risk include postmenopausal women, men over 60 and anyone with a fragility fracture (a
FOR THE MOST PART, OSTEOPOROSIS IS AN ASYMPTOMATIC DISEASE UNTIL A FRACTURE OCCURS.
fracture caused by a fall from standing height without evidence of trauma).
Q: WHAT MEDICAL CONDITIONS PREDISPOSE SOMEONE TO OSTEOPOROSIS? 78
NSIDE TEXAS MD / MARCH.APRIL 2014
Certain medical conditions increase people’s susceptibility to osteoporosis. These include hyperparathyroidism, hypogonadism, inflammatory bowel disease, celiac disease, liver and kidney disease, hyperthyroidism, alcoholism, rheumatoid arthritis and other inflammatory diseases and anorexia nervosa. Some medicine, such as phenytoin, glucocorticoids, cancer chemotherapy and immunosuppressants and low calcium and vitamin D intake, also predispose to osteoporosis.
Q: HOW IS OSTEOPOROSIS DETECTED OR DETERMINED?
Shashi Mittal, M.D., is board certified in family medicine and practices at MedFirst Primary Care Northeast clinic, which is located at 2130 NE Loop 410, Ste. 325, in San Antonio, Texas. To schedule an appointment with Mittal, visit www.med1st.com or call 210-653-2693.
A: A diagnosis of osteoporosis is made either if there
is a fragility fracture or by measuring the bone mineral density using a DEXA scan. According to classification by the World Health Organization, a T-score of greater than or equal to -2.5 in either the vertebral or femoral bone on a DEXA scan is diagnostic of osteoporosis.
Q: WHAT ARE COMMON TREATMENTS FOR OSTEOPOROSIS? A:
Osteoporosis treatment and preventative measures can be approached from many fronts. They include lifestyle modification; quitting smoking; performing moderate weight-bearing exercises; and taking 1,000 to 1,200 mg of calcium and 600 to 800 IU of vitamin D daily. Other measures to take include avoiding medicine that predisposes to osteoporosis, if possible, and treating medical conditions that may predispose to osteoporosis. Pharmacological treatment includes bisphosphonates for oral use. Examples include Fosamax, Boniva and Actonel. Treatments administered by IV also are available and include Reclast and Boniva. Other treatment agents include parathyroid hormones and Prolia.
Q: WHAT SHOULD PHYSICIANS DO IF THEY SUSPECT A PATIENT HAS OSTEOPOROSIS? A:
Physicians should order a DEXA scan of the patient’s spine and femur to establish the diagnosis of osteoporosis. Other testing procedures include measuring kidney and liver functions, CBC and checking
vitamin D and calcium levels. If a patient’s initial medical history and physical condition point toward a secondary cause of osteoporosis such as celiac disease, hyperthyroidism or hyperparathyroidism, specific testing to rule out or confirm the presence of such disorders may be needed.
Q: TELL US SOMETHING SURPRISING THAT NOT MANY PEOPLE KNOW ABOUT OSTEOPOROSIS. A:
A bone mass density test should be repeated no sooner than two years after treatment for osteoporosis begins in order to determine whether the treatment has been effective. Whenever possible, the same machine used for the initial DEXA should be used for retesting because the precision error for this test is unique for individual machines and technicians. Then a comparison should be performed using bone mineral density in g/cm2 instead of using the T-score because changes in the reference database may cause spurious T-score changes.
For more information on BHS Physicians Network, please visit www.bhsphysiciansnetwork.com or contact Julie Minnick at jaminnic@baptisthealthsystem. com.
PHOTO OF DR. MITTAL BY MARK HUMPHRIES MALE SKELETON, SEBASTIAN KAULITZKI/SHUTTERSTOCK.COM
Q: WHAT EXACTLY IS OSTEOPOROSIS, AND WHAT ARE SOME OF THE WAYS IT CAN PRESENT?
SAN ANTONIO SENIOR PROFILE
AHEAD OF THE
NSIDE TEXAS MD / MARCH.APRIL 2014
Currently under construction near downtown San Antonio, the new WellMed at Crockett Park clinic is set to raise the quality of senior services and provide a fine home for physicians and patients in 2015. By: DAN CALDERĂ“N
this time next year, construction should be nearly complete on a new medical facility with a familiar name near downtown San Antonio: WellMed at Crockett Park. For now, however, the project is essentially a burgeoning hole in the ground in what was the parking lot of the primary care clinic specializing in senior health care at 1715 McCullough. The original WellMed at Crockett Park clinic, nestled in the Tobin Hill neighborhood, will remain open while a larger, more modern medical building is being erected. WellMed Medical Management is funding part of the approximately $6.2 million project being developed by Nipe Property Investments Ltd. This is only the third clinic to be built from the ground up for WellMed, which operates 25 senior-focused primary care clinics in the Greater San Antonio area. At 27,000 square feet, the two-story structure will be two-and-a-half times the size of the current clinic, offering space and new resources to support the special needs of WellMed’s growing patient population. It is scheduled for completion by summer 2015. The construction has direct ties to the clinic’s history. WellMed acquired the practice, along with seven other clinics, from Dr. Curtis Ryder in 2007. Ryder retired from practicing medicine to focus on his property development and management company. “We purchased the original space in 2000, expanding and renovating it to make it a fine home for physicians and patients,” said Ryder, president and CEO of Nipe Property Investments Ltd. “But the practice has grown so much since WellMed took over that they have outgrown the space. So I’m really thrilled with the opportunity to build a much larger facility to accommodate patients and physicians for WellMed.” The new building with state-of-the-art equipment will house not only a primary care clinic, but also specialty providers in cardiology, rheumatology, dermatology, podiatry, palliative care and possibly more. Today’s WellMed at Crockett Park, which occupies a space that was once home to a Paesanos restaurant, does not have any specialty providers in-house, although specialists visit the clinic regularly to treat patients.
“There is a fast-growing demand for primary care and specialist services in the downtown and near-downtown area, which makes this the right time to build a new WellMed at Crockett Park,” said Dr. Carlos Hernandez, president of WellMed Medical Group. “The staff at Crockett Park provides excellent service considering they are working in a space originally designed to be a restaurant. When we move into a larger, more modern clinic next year – a space designed with senior care in mind – our patients will experience the next level of quality health care delivery.” Under chilly, overcast skies, clinic staff and WellMed executives joined special guests, including U.S. Rep. Lloyd Doggett, for a groundbreaking ceremony in January. Doggett is a veteran lawmaker, whose congressional district spans from Austin to San Antonio includes the Tobin Hill neighborhood served by the WellMed clinic. He noted that lawmakers in Washington, D.C., are talking more and more about the concept of the medical home, a physician-led, team-based health care delivery model centered on primary care. WellMed is a pioneer in that concept through continuing development of the nationally recognized WellMed care model. According to Doggett, WellMed has much to offer in the ongoing debate over health care. “I’ve been meeting with the leadership of WellMed to talk about some of the changes happening in Washington with health care,” said Doggett, a member of the House Ways and Means Committee, which has jurisdiction over Social Security and Medicare. “They are significant changes, yet WellMed seems to be well ahead of the curve on dealing with them effectively. “The whole concept of WellMed is working not only with the senior, but with that senior’s family, with caregivers, and raising not only physical spirits, but raising a feeling of comfort. Despite some of the indignities of the aging process, there’s someone there for you and someone there who understands what you’re going through and what your family is going through. I’m really impressed with that.” The new WellMed at Crockett Park will be an inviting place for seniors, Hernandez says, featuring amenities the health care company first introduced at its Northwest 410 clinic, including extra-wide hallways, slip-resistant flooring and plenty of lighting designed to be friendly to senior eyes. And with the range of health care services on the second floor provided by WellMed’s multi-specialty partner Specialists for Health, the Crockett Park clinic MARCH.APRIL 2014 / NSIDE TEXAS MD
“When we move into our larger, more modern clinic, our patients will experience the next level of quality health care delivery.” can offer better access to health care for its patients. X-ray, lab services and a nuclear camera to help diagnose and assess the extent of coronary artery disease will be onsite. “Getting an appointment to see a specialist can be difficult for patients, with waiting lists to see certain sub-specialties spanning weeks or months,” Hernandez said. “Our patients with chronic conditions such as ischemic heart failure, diabetes and chronic emphysema will be better served because Specialists for Health providers work almost exclusively with patients in the WellMed network.” The multi-specialty services on the second floor also will bring about 30 new jobs into the Tobin Hill community, adding to the staff and eight primary care providers (five physicians and three nurse practitioners) who are already housed at WellMed at Crockett Park. The jobs and construction are all good news for the community, according to Marty Kushner, president
NSIDE TEXAS MD / MARCH.APRIL 2014
of the Tobin Hill Community Association. He says the gleaming new facility will only enhance Tobin Hill’s growing reputation as a revitalized neighborhood. “What this is going to do for the community is to provide so much better access to quality health care at affordable prices for seniors, and we have many of those who need financial help,” Kushner said. “They are taking a building that had served the community well and making a new, better facility to improve on those services.” WellMed at Crockett Park recently joined the Tobin Hill Community Association, and according to Kushner,
the organization is excited to partner with WellMed. “We’re looking forward to being here for the ribbon cutting of the new building next year.”
WellMed specializes in senior health care. For more information, visit www.wellmedhealthcare.com or call 210-615-WELL (9355). You may also follow them on Facebook at www.facebook.com/wellmed.
Taking your Wellness to heart. Welcome to a new level of quality and care for patients with Medicare. Over 46,000 seniors in San Antonio and the surrounding areas trust WellMed with their healthcare. With 25 clinics from Floresville and Pleasanton to Seguin and New Braunfels, our group of local doctors work together to help make it easier for Medicare beneficiaries to live well. WellMed can bring more wellness to your life. WellMed is accepting patients with Medicare and select Medicare Advantage health plans. Call today to schedule a tour or get a schedule of events at your nearest WellMed location.
210-615 WELL (9355)/888-781-WELL WellMedMedicalGroup.com MARCH.APRIL 2014 / NSIDE TEXAS MD 83
SAN ANTONIO // SENIOR PROFILE
A Lifetime of Adventure God, family and country: Meet Jim and Mona Koonce, a perfect partnership 62 years in the making. By: KELLY HAMILTON Photography: ROBIN JERSTAD
NSIDE TEXAS MD / MARCH.APRIL 2014
ONCE IN A WHILE, you meet someone you just click with. If you’re me, it’s usually someone with a life history you can’t make up. Recently, the honor was all mine to sit down with Jim and Mona Koonce, residents of Independence Village. The Koonces are not your ordinary couple, and by no means are they slowing down. Within their 62 years of marriage, they have experienced more than most: a childhood Arkansas romance, a topsecret government military career, an Air Force career, three children and a lifetime of wedded bliss. Jim and Mona are now living a more relaxed lifestyle than they lived the first few decades of their life together. Having moved into Independence Village 11-and-a-half years ago, the Koonces are enjoying the full-service, resort-style life, which has
allowed them to travel and enjoy their retirement after a lifetime of “blowing and going.” Hailing from the great state of Arkansas, Jim and Mona met at a dance when she was 12 and he was 14. From that point on, they wrote letters to one another; before he left for college, he expressed his desire to date her. Her family loved him. He proposed after they dated for a while, and then, in Mona’s words, “we were off and gone.” After they both graduated from college, they married and moved away to Sacramento, Calif. Jim was in ROTC during college, so the military life came naturally to him. In Sacramento for little over a year, they were transferred to Japan for Jim’s next Air Force assignment. At this point, they already had one small child; during their three years
in Japan, their second son was born. Educated as a chemical engineer, Jim held secret clearance with his government position. Thoroughly enjoying the foreign experience and the caliber of people to whom they were exposed, Jim and Mona both have a vast appreciation for the Japanese culture and elegance. Together, they decided to continue on in the military life, so Jim entered pilot training in the Air Force. After graduation, he was assigned as a flight instructor, with subsequent assignments as a fighter pilot. With Mona’s affinity for people, they were regularly in the receiving line welcoming new and graduating pilots. Even now they are still in touch with some of those pilots who have progressed up the ranks to generals and other high-level positions. Viewing their life together as an adventure, Jim and Mona both say, “We’ve just had a wonderful life full of adventure and new people.” Nothing about Mona reminds you of a wallflower. She exudes an educated humor full of warmth and love and feels fortunate that she was always able to work at home taking care of her three children and making a good life for her husband. She does recall a few brief periods of employment that she has held over the years. At one point in her husband’s career, he was flying often and she was lonely, so in true “Mona style,” she wrote the social column for a local newspaper. With a broad smile, Mona exclaims that she loved the work and it fit seamlessly in with her personality. While his wife shares the stories of their life together, Jim sits quietly next to her. Once she stops talking, he smiles and says, “When you are living the service life, you have to have a strong woman who will hold down the home. Mona is a true partner.” Prior to their move to San Antonio, Jim and Mona lived in Washington, D.C., where he worked for the remainder of his military career running the computer center for the Joint Chiefs of Staff at the Pentagon. Finally retiring from the Air Force, Jim accepted an information systems management position at USAA, where he remained for the next 15 years, retiring as a vice president. The intelligent and subdued man next to his wife says, “I never turned down a chance to go to school and learn.” Holding a degree in chemical engineering and three master’s degrees (an MBA and a double degree in computer science and statistics) certainly bolsters his statement. Every aspect of Jim and Mona’s life together exemplifies community involvement. As longtime residents of Sonterra, they still serve as ambassadors for The Club at Sonterra, where they welcome new members and enjoy events and social gatherings. At such a time, however, when life starts to slow down and retirement is on the horizon, a number of their friends were losing spouses and wanting to downsize, so Mona, in true
EVERY ASPECT OF JIM AND MONA’S LIFE TOGETHER EXEMPLIFIES COMMUNITY INVOLVEMENT. hostess fashion, would bring them over to Independence Village while it was being built to look at lots and floor plans. After a number of trips to the Village, Mona was finally swayed to downsize from the Sonterra home they loved to a beautiful home at Independence Village 11 years ago, where they are still as happy as the day they moved in. With such amenities as housekeeping, grounds and home maintenance, group games, fitness, outings, dinners and more, the lifestyle presented itself irresistible to Mona and her friends. When Jim and Mona are not serving as ambassadors for Sonterra, leading a Bible study class or traveling around the country, they are happy at home having local friends over for the evening. “God, family and country.” Jim and Mona are of a generation wherein faith, family and pride in your country are a given. “We are very patriotic.” They attribute this to growing up in a church environment with a different mentality about politics, patriotism and entitlements. “We are just happy Americans. There’s a different mentality nowadays.” As members of Concordia Lutheran, they have a strong faith that they have done ev-
erything in their power to instill a belief in God and country in their children and grandchildren. With all that the military and government service has provided to Jim and Mona, they feel blessed to be Americans and to live in a land where their family can worship freely, aspire and prosper. Toward the end of our time together, when asked the secret to their 62 years of marriage, Mona smiles and says, “He does what he says he is going to do.” With a twinkle in his eye, Jim says, “She’s tireless and keeps me moving.” Together, they agree that they have lived out a lifetime of adventure and are eagerly anticipating what will come next.
For more information about the Independence Village neighborhood of homes for active adults 55-plus, call 210-782-9892 or visit www. independencehill.com. Note: While NSIDE officially adheres to AP style, certain exceptions were made in the editing of this article. MARCH.APRIL 2014 / NSIDE TEXAS MD
SAN ANTONIO // PATIENT
BEYOND THE SPINE In addition to the spine, the Orthopaedic and Spine Institute also specializes in the hand, hip, knee and shoulder thanks to Drs. Joel B. Nilsson and Richard E. Duey.
THE ORTHOPAEDIC AND SPINE INSTITUTE (OSI) is greatly known for its amazing spine
surgeons such as Dr. Steven Cyr. However, OSI also specializes in the hand, hip, knee and shoulder. OSI has two phenomenal orthopedic surgeons, Drs. Joel B. Nilsson and Richard E. Duey, who have helped expand OSI beyond strictly specializing in the spine to also specializing in the hand, hip, knee and shoulder. Nilsson is a board-certified orthopedic surgeon who specializes in low-impact joint replacement, sports reconstructions, minimally invasive techniques and hand surgery. He graduated with a B.S. in Biology from Wheaton College in Wheaton, Ill. He earned an M.S. in Physiology from Georgetown University in Washington, D.C., and then went on to earn his M.D., also at Georgetown University’s school of medicine. Once he completed his academic studies, he began his 14-year career in the U.S. Army with a one-year transitional internship in Hawaii. This is where Nilsson’s love for orthopedic surgery began, leading him ultimately to orthopedic residency in El Paso, Texas,
tificate of added qualification in hand surgery. Nilsson is a fellowship-trained orthopedic hand surgeon, and he is a member of the American Society for Surgery of the Hand. Duey is an orthopedic surgeon who has also received extensive specialty training in the areas of sports medicine and shoulder surgery. Originally born in Springfield, Mo., he spent six years between the ages of 7 and 14 living in Africa, where his parents served as missionaries. This unique experience provided him with valuable insight into what it means to live a life of service to others. Upon his family’s return to the United States, Duey completed his high school education. After graduation, he returned to Africa aboard a hospital ship affiliated with Mercy Ships, an organization whose mission is to bring hope and healing to the world’s poor. He spent a total of five months serving as part of Mercy Ships prior to returning home. Duey completed his undergraduate studies at Southern Nazarene University in Bethany, Okla., where
OSI DESIRES TO PROVIDE THE HIGHEST LEVEL OF CARE TO EACH PATIENT USING NONSURGICAL TREATMENT. at the Texas Tech University Health Science Center/ William Beaumont Army Medical Center combined program. There, he trained in the full range of orthopedic disciplines, to include complex hip and knee replacement surgery. He is a fellow of the American Academy of Orthopedic Surgeons and a diplomate of the American Board of Orthopedic Surgery, and he has obtained the cer-
NSIDE TEXAS MD / MARCH.APRIL 2014
he graduated summa cum laude with a Bachelor of Science in Biology-Chemistry. From there, he attended medical school at the University of Oklahoma College of Medicine. Upon completing medical school, Duey was accepted into a five-year residency training program in orthopedic surgery at the University of Kansas in Wichita, Kan. There, he received outstanding training
in the various disciplines of orthopedic surgery, in particular orthopedic trauma surgery, joint replacement and minimally invasive arthroscopic surgery. After his residency, Duey elected to spend a year specializing in orthopedic sports medicine in Tennessee. During this time, he managed and treated a variety of sports-related injuries and other musculoskeletal conditions in patients both young and old. Because of his strong, personal interest in caring for and treating shoulder problems, Duey chose to invest in an additional year undergoing specialty training in shoulder surgery. This decision brought him to the great state of Texas and allowed him the unique opportunity to address complex shoulder conditions utilizing cuttingedge arthroscopic and open techniques. Duey is board eligible on the American Board of Orthopedic Surgery, and he is a member of the American Academy of Orthopedic Surgeons. He is also fellowship trained in shoulder surgery and fellowship trained in orthopedic sports medicine. OSI desires to provide the highest level of care to each patient using nonsurgical treatment and, when necessary, surgical intervention. Both Nilsson and Duey look forward to serving the people of San Antonio and the surrounding area.
For more information on the Orthopaedic and Spine Institute or to make an appointment, please call 210-48-(SPINE) (210-487-7463) or visit www.saspine. com.
KNEE PAIN, SEBASTIAN KAULITZKI/SHUTTERSTOCK.COM
By: ASHLEY HOLIFIELD
Did you know that there are
enefits that can help VA Boffset the cost of living in a
retirement community or assisted living?
an informational session by the Veteran’s Administration experts to find out what benefits are available to you.
Tuesday, April 29th, 2014 at 2:00pm 20500 Huebner Road San Antonio, Texas 78258
RSVP to by Sunday, April 27th Refreshments Served
www.independencehill.com Lic. #100102
• Full Service Apartments, Neighborhood of Homes and Assisted Living available • Restaurant style dining • Housekeeping, linen and laundry services • Extensive social calendar & clubs: Gardening, Wine Tasting, Bowling, Choir and more • Fitness center and exercise classes • Privileges at The Club at Sonterra • Emergency call system • Transportation to appointments, shopping, theater, airport and more... • Pets welcome
SAN ANTONIO // PATIENT
NOT EVERYONE NEEDS SURGERY
With the expertise of Dr. Joseph Klotz and a number of fellowship-trained, board-certified orthopedic surgeons, the Orthopaedic and Spine Institute provides effective non-surgical solutions. By: ASHLEY HOLIFIELD
AT THE ORTHOPAEDIC and Spine Institute (OSI), finding the best and most effective approach for each patient is our goal! We will do everything we can to fix your injury while avoiding surgery. One proven, effective approach for certain patients is spinal manipulation, which can realign the spine 88
NSIDE TEXAS MD / MARCH.APRIL 2014
and help lessen tissue damage while diminishing back and neck pain. Chiropractic spinal manipulation is safe and effective spine pain treatment. It reduces pain, decreases medication, rapidly advances physical therapy and requires very few passive forms of treatment such as bed rest.
Used primarily by Doctors of Chiropractic (DCs) for the last century, manipulation has been largely ignored by most in the health care community until recently. Now, with todayâ€™s growing emphasis on treatment and cost-effectiveness, manipulation is receiving more widespread attention. Joseph Klotz, D.C., is the director of the Center for Orthopedic and Rehabilitative Exercise at OSI. He assists patients with pre- and post- surgical wellness by working under the direction of fellowship-trained, board-certified orthopedic surgeons. His unparalleled healing abilities are reflective of his excellence in education and professional experience. He obtained his BSN from Hardin-Simmons University. He was president of his class at Texas Chiropractic College (TCC) from 2006 to 2009 and vice president of the Student Chiropractic Association of Louisiana in 2007. He was also a teacher assistant in gross anatomy and a member of Omega Psi National Honors Society while at TCC. Additionally, he is board certified in physiotherapy. Klotz has been working in rehabilitation since 2008, when he began working as a clinical representative for Airline Chiropractic & Rehabilitation. As a chiropractic intern at Moody Health Center in 2009, he diagnosed, planned and treated musculoskeletal disorders and provided patients with customized complimentary orthopedic rehabilitation while working with primary care physicians promote optimum patient health. As a result of his skill, he was placed in charge of rehabilitation and education for physical medicine treatment. Klotz was recruited by OSI in San Antonio from Dallas, where he headed rehabilitation at North Texas Orthopedic & Spine. He has been a particular asset to the clinic, bringing many innovative ideas learned through his training and experience. By combing his expertise in chiropractic medicine with the orthopedic principles instilled by the surgeons at OSI, Klotz brings a unique approach to pre- and post-operative rehabilitation. This unique blend of rehabilitative approaches allows patients the maximum opportunity to treat pain without surgery and to maximize recovery when surgery becomes necessary.
For more information on the Orthopaedic and Spine Institute or to make an appointment, please call 210-48-(SPINE) (210-487-7463) or visit www.saspine. com.
BACK PAIN, CLIPAREA CUSTOM MEDIA/SHUTTERSTOCK.COM
KLOTZ BRINGS A UNIQUE APPROACH TO PREAND POST-OPERATIVE REHABILITATION.
TransitionCare Health, Inc. “Delivering Quality, Targeted and Focused Care”
See the receptionist or call our office today to schedule (this is not a physical exam).
225 E. SONTERRA, STE.201, SAN ANTONIO, TX 78258 • (210) 499-0060
SAN ANTONIO // PATIENT
PATIENTS MUST HAVE REALISTIC EXPECTATIONS FOR THEIR RESULTS FROM THIS TYPE OF TREATMENT.
FACT OR FICTION Is fat freezing an effective nonsurgical treatment for fat reduction? By: DR. JAIME R. GARZA
AS WINTER WINDS DOWN,
people’s thoughts are turning to springtime and outdoor activities with swimsuits and shorts. At this time of year my patients typically start thinking about body contouring procedures to erase some of their “winter bulges.” The question I am asked most often:
NSIDE TEXAS MD / MARCH.APRIL 2014
“Is fat freezing an effective nonsurgical treatment for fat reduction, and is it as good as liposuction?” The quick answer is maybe, yes … and there are some caveats. Cryolipolysis (“fat freezing”) was approved for non-invasive fat reduction by the FDA in 2010. We know that fat cells
die before the skin does after frostbite injuries. Fat freezing was based on this premise. CoolSculpting is a marketed medical device that performs fat freezing and has been studied for its effect on fat reduction. There are two landmark studies that were performed and published by reputable board-certified plastic surgeons in national peer-reviewed aesthetic journals: “Clinical Efficacy of Noninvasive Cryolipolysis and Its Effects on Peripheral Nerves” (Aesthetic Plastic Surgery, July 2009, Vol. 33, Issue 4, pp 482-488) and “Broad Overview of a Clinical and Commercial Experience With CoolSculpting” (Aesthetic Surgery Journal, August 2013, Vol. 33, no. 6, 835-846). The studies found that CoolSculpting can be effective in reducing fat volume just beneath the skin (subcutaneous). During a CoolSculpting session, an attachment that resembles a molded cup is placed over the area to be treated such as the love handles the abdomen or other areas that are “fleshy.” Heavy-duty suction pulls the skin and fat into the cup, where it is chilled to a predetermined temperature. Some of the fat cells that are being treated are destroyed and the resulting breakdown products (oils) are disposed of through the liver. Patients who are not overweight, but have stubborn areas that are resistant to diet and exercise (love handles, lower abdomen) are the best candidates. Careful treatment planning must be performed, the cup from the machine must be properly applied to the area and multiple treatments are required. A session takes a little less than an hour per individual area, and there is no anesthesia required. Patients should be aware that each site (lower abdomen, flanks, etc.) might have several individual sites to treat. Thus, two to three hours may be required to treat, say, the lower abdomen. Results take from two
to four months to reveal themselves. In a non-overweight patient with stubborn fat areas, you can expect a 20 percent fat reduction after a number of treatments. There are very few adverse effects reported. The most common adverse effects are post-treatment pain and some decreased sensation of the skin that eventually returns to normal. The studies also show that there is little risk of skin injury, and there’s no change in blood levels of fats. The patient should understand that the number of necessary treatments varies according to the areas being treated, the amount of fat the patient has and the skill of the medical practitioner. As in any medical procedure, it is very important for the patient to understand that the machine itself is only one factor in obtaining good results. Most important are the skills of the physician, their knowledge of human anatomy and the limitations of the medical device. Patients must also have realistic expectations for their results from this type of treatment. As in all medical treatments, choose your doctor carefully, inquire about ABMS board certification and in what specialty (look for board-certified plastic surgeons or dermatologists) and spend your money wisely. With expert technique, multiple treatments and a non-obese patient, the results from CoolSculpting may be comparable to those of liposuction, according to these two studies.
Jaime R. Garza, M.D., DDS, P.A., is a board-certified plastic surgeon whose practice is located at 21 Spurs Lane, Ste. 120, in San Antonio, Texas. For more information, call 210-616-0301 or visit www.garzaplasticsurgery.com.
EXPERT PRIMARY CARE.
Thatâ€™s Baptist Care.
Ami Kadakia, MD Internal Medicine Alamo Heights, Broadway (210) 824-5392
Nishi Thakur, MD Internal Medicine Castle Hills (210) 541-8689
Lori Shirley-Wenzel, MD Internal Medicine Alamo Heights, Broadway (210) 824-5392
Douglas Jenkins, MD Internal Medicine Downtown (210) 224-1771
Anna Velasco-Neaves, NP Family Medicine Northeast (210) 653-2693
Blaine Carmichael, PA 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
Dustin Deemer, PA Family Medicine Alamo Heights, Sunset (210) 824-5201
Scott Horn, MD Family Medicine Alamo Heights, Sunset (210) 824-5201
Doris Ling, MD Family Medicine Castle Hills (210) 541-8689
Patricia Mackin, MD Family Medicine Castle Hills (210) 541-8689
Lovelesh Manocha, MD Internal Medicine Downtown (210) 224-1771
Geri Poss, MD Family Medicine Downtown (210) 998-3156
Sveta Singh, DO Family Medicine 281 North & Thousand Oaks (210) 200-6744
Edward Lin, MD Family Medicine Northeast (210) 653-2693
Abe Rodriguez, MD Family Medicine Northeast (210) 653-2693
Victoria Chang, DO Internal Medicine Schertz (210) 656-5600
Ricardo Escamilla, MD Family Medicine Southeast (210) 333-0798
Erika Garza, MD Family Medicine Southeast (210) 333-0798
Inez King, NP Family Medicine Southeast (210) 333-0798
Kirsten Fikes, PA Internal Medicine Stone Oak (210) 490-3800
Sanjay Kumar, MD Internal Medicine Westover Hills (210) 681-0126
Cherry Maximo, MD Family Medicine Westover Hills (210) 681-0126
Bernadette Collazo, NP Daisy Ramirez-Estrada, MD Cesar Gerez-Martinez, MD Family Medicine Family Medicine Family Medicine Overlook Westover Hills Overlook (210) 497-2338 (210) 681-0126 (210) 497-2338
YOUR HEALTH IS IMPORTANT
We are committed to providing quality compassionate primary care to our patients including services such as physicals, sick visits and disease prevention.
PRIMARY CARE PROVIDERS
SAN ANTONIO // PATIENT
FORM AND FUNCTION Post-bariatric surgery body contouring with Dr. Peter Fisher By: LISA CALDWELL
Dr. Peter Fisher operates his practice in the San Antonio Medical Center. For more information about him and his procedures, please visit www.mybariatricplasticsurgery.com or call 210-853-2407.
FOR PEOPLE who have undergone bariatric surgery, life is on the upswing. Not only is their health improving, their quality of life has done a complete turnaround. However, those who have undergone this procedure are faced with a new issue as the pounds melt away: excess, saggy skin. Though exercise and support garments help, an increasingly popular option is post-bariatric body contouring surgery. These procedures help women and men who have made the commitment to improve their health feel great about their bodies, as well. According to the American Society for Metabolic & Bariatric Surgery, about 150,000 people undergo weight-loss surgery each year. San Antonio-based plastic surgeon Dr. Peter Fisher consults with post-bariatric patients each week to see if body contouring is ideal for them in their weight-loss journey. With more than 25 years of experience in plastic surgery, Fisher has devoted half of his career to post-bariatric body contouring. He loves helping patients reclaim their body and achieve the happiness and confidence that come with a better body image. As one of Fisher’s previous patients elaborates, “Post-bariatric body contouring surgery helped complete my weight-loss journey.” ARE YOU A CANDIDATE FOR BODY CONTOURING? Fisher consults with patients at various points of their weight-loss journey. “Some patients research early and visit with me while they’re still considering their initial bariatric surgery,” Fisher says. “Other patients inquire about body contouring following their weight loss.” The timing of the consultation is up to the patient. In either case, Fisher likes his patients to have reached their weight goal and to be stable at that weight for three months before proceeding with surgery. “If their weight is still fluctuating, then they most likely will not get the best result possible,” Fisher says. The national trends show more women than men opting for body contouring (a normal trend for bariatric surgery, as
PATIENT 1 - BEFORE
NSIDE TEXAS MD / MARCH.APRIL 2014
PATIENT 1 - AFTER
ABOUT 150,000 PEOPLE UNDERGO WEIGHT-LOSS SURGERY EACH YEAR. well), though Fisher’s techniques work well for both genders.
TREATABLE AREAS Fisher is unique in that he can often complete multiple procedures in the same surgery. “Combining two or more procedures reduces the patient’s hospitalization costs, postsurgery downtime and missed workdays,” he says. The first treatment for post-bariatric patients is generally a lower body lift, which lifts the skin around the entire abdomen and lower back, the upper outer thighs and the buttocks. Fisher usually couples this with an arm and/or breast lift instead of bringing patients into the operating room over and over again. Fisher has customized the lower body lift to eliminate some of the potential imperfections that can occur. One of the innovations Fisher has developed to prevent the typical boxy or square look that can result from this procedure is an autologous hip augmentation. Instead of discarding body tissue, he uses it to retain a natural, feminine look. This customization is what his patients rave about and what draws new patients to him each year. Some patients even return a few months later for additional surgery to complete leftover areas such as the inner thighs, the face and the neck. Ultimately, Fisher brings form and function to his practice. His patients receive the best in treatment and care, as well as the finesse that comes with an experienced physician.
PATIENT 2 - BEFORE
PATIENT 2 - AFTER
We wrote the book. Meet Dr. Charles Rockwood and his books. If youâ€™re an orthopaedic surgeon anywhere in the world, you no doubt have spent time with one or more of his editions. Due to their value in medical education, they have been updated and republished year after year - for more than 40 years. Dr. Rockwood is just one of the many experts and authors at UT Medicine Orthopaedics. UT Medicine is academic medicine. Itâ€™s a powerful combination with powerful doctors, like Dr. Rockwood. UT Medicine Orthopaedics treats all ages for all bone and joint conditions.
To refer your patient, call 210-450-9300 UTMOrtho.com Medical Arts & Research Center (MARC) 8300 Floyd Curl Drive - 3rd Floor San Antonio, TX 78229
Health Science Center San Antonio
NSIDE TEXAS MD / MARCH.APRIL 2014
Do you suffer from BACK, NECK, or EXTREMITY pain? We can help! [ MINIMAL INCISION, MAXIMUM BENEFIT ] Our clinic specializes in the entire spectrum of non-surgical and surgical care. Our surgeons and proceduralists are board certified and fellowship trained by the nation’s top institutions.
CALL TODAY FOR AN APPOINTMENT
We tailor your treatment to your specific diagnosis. Not all patients are the same. We go to exhaustive efforts to ensure the most accurate diagnoses through cutting edge techniques and procedures. Most clinics specialize in either minimally invasive procedures or open surgery. We can customize your surgery to your specific diagnosis and symptoms to maximize the success of your procedure.
All you have to lose ... is pain.
OUR CENTERS: • Minimally Invasive Spine Institute • Children’s Orthopaedic & Spine Center • Excellence In Joint & Extremity Surgery Center • Chronic Pain Management Center • Excellence In Neurology & Neurosurgery Center • Orthopaedic Rehabilitative Center • Vascular Center
STEVEN J. CYR, M.D., F.A.A.O.S.
Texas Center for Athletes
21 Spurs Lane, Suite 245
Andrew N. Bowser, M.D., F.A.C.S. Eloy Castaneda, Jr., MSN, FNP-BC Steven J. Cyr, M.D. , F.A.A.O.S. Richard E. Duey, M.D. John T. Friedland, M.D., F.A.A.O.S. Damian X. Garza, PA-C, MPAS Crystal Grosko, LMRT Joseph Klotz, D.C. Hongbo Liu, M.D. Jimmy Mali, M.D. Joel B. Nilsson, M.D., F.A.A.O.S. Rita Yvonee Paredes, MSN, APRN, FNP-BC Naveen Ramineni, M.D. Eric R. Ritchie, M.D., F.A.A.O.S. Sharon Ross, MSN, FNP-BC Joseph F. Vinas, M.D., F.A.C.S. Jim Weiss, M.D. Martin L. Yamzon, MSN, FNP-BC
San Antonio, Texas 78240
T: 210.48.SPINE (487.7463) | F: 210.487.7468 www.SAMedicalCenters.com | www.SASpine.com | www.sachildrensorthopaedics.com MARCH.APRIL 2014 / NSIDE TEXAS MD
UNDIAGNOSED HEART DISEASE IN WOMEN POSES MALPRACTICE RISK By: DARRELL RANUM AND DEBRA A. DAVIDSON
NSIDE TEXAS MD / MARCH.APRIL 2014
DIFFERENCES IN THE EARLY SYMPTOMS and signs of an impending heart attack in women may make diagnosis more difficult compared to men. In a study of closed medical malpractice claims involving undiagnosed heart disease in women, The Doctors Company found that in 61 percent of claims the patient died when her heart condition was not correctly diagnosed and 33 percent had heart muscle damage from myocardial infarction. Failure to diagnose heart disease in women is often thought of as a problem in the emergency department (ED). However, the study found that in 50 percent of these cases, it was a primary care physician (PCP) who allegedly failed to diagnose the patientâ€™s heart disease. Cardiologists (22 percent) and emergency medicine physicians (17 percent) were the second and third most commonly named specialties in these claims. In the following case, failure to diagnose acute myocardial infarction resulted in death: A 47-year-old obese woman presented to her PCP complaining of a burning sensation in her chest after eating. The pa-
WOMAN WITH CHEST PAIN, KAMIRA/SHUTTERSTOCK.COM
SAN ANTONIO // MD
IN 61 PERCENT OF CLAIMS, FEMALE PATIENTS DIE WHEN THEIR HEART CONDITION IS NOT CORRECTLY DIAGNOSED. tient reported a similar episode the prior day after eating lunch as well as increased heartburn over the last few weeks. A review of the medical record reflected elevated blood pressures over the past six months and an elevated cholesterol level of 237 (mg/dl). On the day of the exam, her blood pressure was 160/90. She smoked, drank alcohol socially, and was unaware of a family history of coronary artery disease. A heart exam revealed normal rate and rhythm. The physician noted that the patient appeared diaphoretic; however, she wasn’t in acute distress and was pain-free throughout the examination. An ECG revealed a left bundle branch block. Prior ECGs were not available for comparison. Suspecting reflux esophagitis (heartburn), the PCP advised the patient to take an antacid and to return if the symptoms continued. Two days later, the patient called her PCP’s office stating that her chest burning sensation continued. The nurse advised her to continue taking the antacid and scheduled an office appointment for the following day. The nurse advised the patient to go to the ED if she developed chest pain. That night, the woman awoke with chest pain, nausea, and vomiting. She was taken to the ED for emergent coronary angiography, but died shortly after arrival.
TO AVOID SUCH RISKS:
• Rule out myocardial infarction before arriving at a GI-related diagnosis such as gastric reflux as the cause of chest pain or discomfort. • Consider cardiac risk factors such as obesity, smoking, hypertension, and hyperlipidemia. • Offer patients same-day appointments when they complain of continued symptoms for which they were recently seen. If this is not possible, send them to the ED and document this in the medical record. • Develop a written chest pain protocol.
Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety. 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. Note: This article has been reprinted with the permission of ©2014 The Doctors Company. MARCH.APRIL 2014 / NSIDE TEXAS MD
SAN ANTONIO // MD
THE REAL HEALTH CARE REFORM
Self-care disease management: the key to creating a better health care future
By: KARIE SPELL
NSIDE TEXAS MD / MARCH.APRIL 2014
HEALTH CARE REFORM is a very hot topic around the nation, and everyone has an opinion about it. Health care reform has been an industry and political agenda item for decades, but it gained national attention with the famous or infamous (depending on your political affiliation) signing of Obama Care into law in March 2010. Health care does need a transformation, but the real change must start with self-care disease management. With the rising costs of health care and the growing number of patients with chronic disease, a call to action is of the essence to change this trend. The entire health care community â€“ the givers and the receivers of health care â€“ must actively participate together to create a better health care future. According to the American Association for Clinical Chemistry (AACC), in 2009, more than 133 million Americans were reported to have at least one chronic disease. This is a staggering statistic because it represents 45 percent of the population. Another 26 percent of the population has multiple chronic diseases. Chronic disease is the leading cause of death and disability in the United States. The financial burden of associated with these conditions results in $1.7 trillion a year. This represents 75 percent of all health care dollars spent. With chronic diseases increasing, the cost of care and death also increases. This trend must be changed to improve quality of life and reduce health care costs through management and prevention of chronic disease. An effective self-care disease management program is the answer. What is self-care disease management? It is a patient-centered program designed by clinical professionals and the patient with a chronic disease to learn and effectively selfmanage the condition with success. Home health is instrumental in providing disease management education programs. These programs use effective, best practice care strategies for adult patients with chronic disease. This self-care management model empowers the patient to understand their disease process(es), implement effective care strategies and demonstrate the learned information and interventions to ensure permanent desired health outcomes. The three key focus areas of these pro-
IT IS IMPORTANT TO UNDERSTAND THAT INFORMATION IS NOT EDUCATION. grams are education on disease pathophysiology, therapeutic interventions and self-management strategies. The education is performed by licensed home health nurses and therapists who consistently instruct the patient during the course of care. The effectiveness of the plan is dependent on active patient participation. Patient engagement is essential for patients to embrace and work toward desired outcomes while preventing disease complications, health decline and hospitalizations. Effective education starts with an effective teacher. The home health professional should not only be equipped with clinical expertise, but also be an effective teacher. Adults have different learning needs from children. In order for the information to be translated into education, these techniques must be understood and incorporated into the patient’s clinical care for desired outcomes to occur. First, the home health patient must be internally motivated and self-directed about the health topic or needed change. If the patient feels that the presented health information is being imposed on them, they will most likely resist it, which will result in no change. It is important to understand that information is not education. Education occurs when the given information is disseminated into meaningful pieces so the learner can take these pieces and effectively implement them. The effective implementation allows the learner then to turn this education into habits. These habits result in permanent changes. The adult also learns based on life experiences and knowledge they have acquired. The home health nurse has to “meet” the patient “where they are.” This means being able to understand the patient’s perception of the fear, obstacles and expectations in the achieving the desired goal. It is essential for the educator to gain the confidence of the learner. This allows effective collaboration on a self-management plan with valid expectations of the patient and clinical educators. This plan turns into new health habits and desired health outcomes. This is important because the adult learner is goaloriented, practical and motivated by relevancy. A successful care plan must address the patient’s goals and priorities for health; if it doesn’t, true success will not occur because the patient will be unable to relate to the relevance. Another added component the clinical educator must incorporate is the equality between themselves and the learner. Effective education cannot occur without respect. We are all equal parts of humanity. We, as nurses, have the privilege of understanding disease and disease management. This expertise lends to effective education of others, our patients, so they too can be experts in disease management. Once this occurs, patients are able perform self-care management and conquer chronic disease for good. The effective self-care management model is proven. Our patients know more about themselves than any clinician will ever know about them. This is why it is essential for all able patients to be educated and in control so they can self-care manage their chronic disease and effectively manage their health. This knowledge and control is what creates desired health results, which preserves and improves quality of life, lowers health care costs and conquers the detriment of chronic disease. Health care reform starts with you being informed and in control of your health and your future.
References: American Association for Clinical Chemistry: July 2009 Clinical Laboratory News: Rates of Chronic Disease Expected to Rise Sharply; July 2009: Vol. 35, No. 7 Basic Principles of Adult Learning which the QOTFC (2005) have applied to the role of clinical educator with students in clinical settings. (www.qotfc.edu.au/ resource/?page=65375)
“ Where smiles blossom ”
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
SAN ANTONIO // FEATURE
From left: Crystal Kalinec-Craig with Cooper, Malinda Red Cloud with Bonnie, Lauren Brown with Caleb and Beverly Oakes with Junior
Patients and their families receive compassion, comfort and happy memories from furry therapists and their owners through the Paws Up Pet Therapy program at University Health System. By: JULIE WILEY
IF YOU’RE EVER AT University Hospital, chances are you’ll see man’s best friend making rounds and brining smiles to the faces of patients. These fourlegged furry therapists and their owners are part of University Health System’s Paws Up Pet Therapy program. 100
NSIDE TEXAS MD / MARCH.APRIL 2014
The program was implemented more than 20 years ago, and it has made a big difference in the lives of patients. It is designed to bring compassion, comfort and happy memories to patients and their families during a stay at the hospital. The six trained and certified animal-assisted teams were recognized by the volunteer services department on Jan. 20. The teams received a nice hot lunch and certificates of appreciation. Research has shown that specially trained therapy pets not only offer comfort, but actually help in the healing process. Pet therapy is used in the hospital for both children and adults, and its proven benefits include: • Lowering blood pressure • Improving cardiovascular health • Releasing endorphins that provide a calming effect • Lessening depression and encouraging communication • Helping children focus better • Lowering stress and improving recovery time University Hospital is the lead Level I Trauma Center for a 22-county region of South/Central Texas, an
RESEARCH HAS SHOWN THAT SPECIALLY TRAINED THERAPY PETS ACTUALLY HELP IN THE HEALING PROCESS.
area that is geographically larger than 17 states in the United States. It is the first and only verified pediatric trauma center for San Antonio and South Texas.
The volunteer services department is planning to expand the pet therapy program to its clinics by adding more teams. To learn more about the pet therapy program at University Health System, visit www.universityhealthsystem.com/volunteer-services/a-wealthof-volunteer-opportunities/animal-therapy.
Events Calendar SUNDAY
VS TEXAS 2
VS CHARLOTTE 4:00PM
VS CHARLOTTE 7:30PM
VS GRAND RAPIDS VS LOS ANGELES
VS ORLANDO 7:30PM
MILEY CYRUS 7:00PM
NCAA D1 MEN’S BASKETBALL TOURNAMENT 2ND & 3RD ROUNDS
VS UTAH 6:00PM
NCAA D1 MEN’S BASKETBALL TOURNAMENT 2ND & 3RD ROUNDS
VS NEW ORLEANS
VS CHARLOTTE 4:00PM
VS LAKE ERIE 7:00PM
VS GOLDEN STATE
VS LAKE ERIE 7:00PM
VS TEXAS 7:00PM
VS LOS ANGELES VS ABBOTSFORD VS ABBOTSFORD
TICKETS AVAILABLE ONLINE AT
All acts, dates and times subject to change without notice.
Join the Fight for Air. FIGHT FOR AIR
FIGHT FOR AIR
San Antonio | April 26, 2014
Austin | April 26, 2014 Houston | May 31, 2014
WE WALK, RUN & CLIMB FOR
healthy lungs and clean air.
Lung disease is America’s number three killer, responsible for one in six deaths (that’s more than 400,000 deaths every year.) We need your participation to help make an impact in the fight against lung disease. Join a walk or run event near you today! When you join the American Lung Association in the fight for healthy lungs and healthy air, you help save lives today and keep America healthy tomorrow.
FightForAirClimb.org | FightForAirWalk.org 1-800-LUNG-USA
â€œEquipping, encouraging, and mobilizing Christian women to unite in their workplaces and neighborhoods to pray for their city and nationâ€?
ONE in the SPIRIT 17th Annual Celebration
Friday, September 19 7:00-9:30 PM Event Sponsor Displays open at 6:15 PM Featuring: Charles Flowers Senior Pastor, Faith Outreach International
! ! ! ! ! " â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘
â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘ â€˘
To be held at the beautiful downtown Marriott Riverwalk Hotel Limited number of Special WPI Room Rates for September 18-20. Call (210) 224-4555.
Over 30 years experience treating children and adults using natural and integrative therapies
Open to Men & Women â€“ â€œafter fiveâ€? or â€œbusiness attireâ€? $60 per person, or reserve a table for 10 at $600
Womenâ€™s Prayer Breakfast Saturday, September 20 at 9:00-11:30 AM: $25 per person
Featuring: Joan Courtney President & Founder Womenâ€™s Prayer International Make Your Reservations Early!
For the Gala or the Womenâ€™s Prayer Breakfast You may pay online at: www.womensprayer.org or mail checks payable to â€œWPIâ€? (along with a list of attendees for the event you are attending) to: 11103 San Pedro, Ste. 221, San Antonio, TX 78216
Limited Sponsorships Available!
For more information call: (210) 349-PRAY (7729) or email: email@example.com Ladies! Visit a WPI group or start one in your workplace or neighborhood. Contact us at the info above.
We are a bridge between the western traditional model and the integrative alternative approach
The Center for Complementary Medicine A Group of Independent Practitioners
7300 Blanco Road, Suite 503 San Antonio, Texas 78216 www.complemed.net
Treatment methods include:
Nutrition / Bio identical hormones / Acupuncture Chinese medicine / Energy body work Intravenous nutritional and chelation therapies Specialized diabetes management Cancer treatment support program / Heavy metal evaluation
Q U A L I T Y. E F F I C I E N C Y. C O M PA S S I O N . AT GASTROENTEROLOGY CONSULTANTS OF SAN ANTONIO, WE ARE DEDICATED TO PROVIDING QUALITY, COMPASSIONATE CARE FOR ALL GI CONDITIONS. Schedule an appointment with one of our 16 board certified gastroenterologists and experience the difference for yourself.
PROUDLY SERVING SOUTH TEXAS FOR OVER 35 YEARS
C A L L U S F O R A N A P P O I N T M E N T T O D AY ! MEDICAL CENTER 8214 WURZBACH ROAD
STONE OAK 855 PROTON ROAD
NORTHEAST 11485 TOEPPERWEIN ROAD, STE 2
LEON SPRINGS, TEXAS
TING 10 RA
LIVE MUSIC and FAMOUS PIZZA with a neighborhood atmosphere. Serving delicious fresh pizza, salads, beer, wine and more. Plus, Take-N-Bake ready-to-heat pizzas. Takeout and delivery available.
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sAn Antonio (210) 858-9138
www.rivercityhospice.com 路 firstname.lastname@example.org
FIRST CLASS CARE. WHERE SERVICE MEETS EXCELLENCE. The need for medical care is a reality and necessity of modern life. Victory Medical Center Landmark is distinguished from any other hospital you may have dealt with — 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. Soft hotel grade linens. Gourmet food. Attention to individualized care. A facility with VIP treatment for every patient. The Victory difference — creating the standard in surgical care. · Neuro Spine Surgery
· Joint Replacement
· Orthopedic Surgery
· General Surgery
· Pain Management
· Ortho Spine
· Plastic Surgery
· Bariatric surgery
· Ear, Nose, and Throat
· Hand Surgery
5330 N. Loop 1604 West
· Sports Medicine