MD MARCH.APRIL 2013
WORKING FOR A BETTER TOMORROW CATHY VALDEZ NO SHORTCUTS DR. HECTOR VILLASENOR
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BLAZING THE TRAIL WELLMED’S BEHAVIORAL HEALTH PILOT PROGRAM THE NEW VICTORY MEDICAL CENTER ELITE DR. MARIO BUSTAMANTE DR. JOEL B. NILSSON DR. JAMES D. WEISS NSIDE MD
O S I C E B C, F T STEVEN J. CYR, M.D., FAAOS ORTHOPAEDIC SPINE SURGEON
MINIMALLY INVASIVE SPINE CENTER EXCELLENCE IN NEUROLOGY AND NEUROSURGERY CENTER
HONGBO LIU, M.D.
NAVEEN RAMINENI, M.D.
PEDIATRIC & ADULT ORTHOPAEDIC SPINE SURGEON
PHYSICAL MEDICINE & REHABILITATION
MINIMALLY INVASIVE SPINE CENTER
ERIC R. RITCHIE, M.D.
JIM WEISS, M.D.
PEDIATRIC ORTHOPAEDIC SPINE SURGEON
ELOY CASTANEDA JR. MSN, FNPBC
PHYSICAL MEDICINE & REHABILITATION
CHILDREN’S ORTHOPAEDIC & SPINE CENTER
CHRONIC PAIN MANAGEMENT CENTER
SAQIB A. SIDDIQUI, M.D.
ORTHOPAEDIC REHABILITATIVE EXERCISE CENTER
CHRONIC PAIN MANAGEMENT CENTER
CHILDREN’S ORTHOPAEDIC & SPINE CENTER
SPECIALIZING IN ORTHOPAEDICS
ANDREW N BOWSER, M.D. F.A.C.S.
SHARON ROSS MSN, FNPBC
VASCULAR CARE SPECIALISTS
SPECIALIZING IN ORTHOPAEDICS
JOEL B. NILSSON, M.D. FAAOS
JOSEPH F. VINAS, M.D. F.A.C.S.
MARTIN YAMZON MSN, FNPBC
EXCELLENCE IN JOINT & EXTREMITY SURGERY CENTER
VASCULAR CARE SPECIALIST
SPECIALIZING IN ORTHOPAEDICS
ORTHOPAEDIC SPINE SURGEON
MINIMALLY INVASIVE SPINE CENTER
JOSEPH KLOTZ, D.C.
RICHARD E. DUEY, M.D. ORTHOPAEDIC SURGEON
DAMIAN X. GARZA PAC, MPAS
DOCTOR OF CHIROPRACTIC MEDICINE
EXCELLENCE IN JOINT & EXTREMITY SURGERY CENTER
Official Sponsors of
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N S I D E M T: D
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21 Spurs Lane, Suite 245
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ALAMO NEUROSURGICAL INSTITUTE
• Diagnosis and treatment of surgical disorders of the Brain and Spine • Board certified neurosurgeon by the American Board of Neurological Surgery • Conservative approach: Reserving surgery as the final option • Employing the least invasive procedures • Welcoming, personal, unrushed environment with knowledgeable, kind staff • Fellowship trained in Spine Surgery at one of America’s busiest trauma hospitals
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Did you know that there are
enefits that can help VA Boffset the cost of living in a
retirement community or assisted living?
• Full Service Apartments, Neighborhood of Homes and Assisted Living available • Restaurant style dining • Housekeeping, linen and laundry services • Extensive social calendar
Attend an informational session on the Veteran’s Aid & Assistance Benefit Program at Independence Hill.
Thursday, March 21st, 2013 2:00pm 20500 Huebner Road, San Antonio, Texas 78258 RSVP to 12
by March 19th Refreshments Served
• Social Clubs: Gardening, Wine, Bowling, Choir and more • Fitness center, water aerobics and exercise classes • Golf and social privileges at The Club at Sonterra • Emergency call system • Transportation to appointments, shopping, theater, airport and more... • Pets welcome www.independencehill.com Lic. #100102
nsidethisissue march / april 2013 profiles
Dr. Mario Bustamante
With more than 33 years of experience and specialties in orthopedic surgery, orthopedic foot and ankle surgery and sports medicine, this seasoned physician continues to go the extra mile for his patients.
Dr. Joel B. Nilsson
This orthopedic surgeon cares for a wide variety of patients at a Level I trauma center and always remembers to follow the golden rule and to love his neighbor as he would himself.
Dr. James D. Weiss
This internationally recognized physician, lecturer and practitioner brings his 25-plus years of experience and holistic approach to pain management to San Antonio.
alex garcia With his focus on building relationships and his lifelong love of health care, the CEO of Victory Medical Center San Antonio plans to do great things at the state-of-theart medical facility.
Behavioral Health at WellMed
WellMed Medical Group continues to advocate for the senior citizens of the Alamo City with its new behavioral health pilot program.
Through her work to grow and expand Project MEND, the organization's executive director continues to help low-income people with disabilities obtain the medical equipment and assistive technologies they need for rehabilitation and recovery.
Dr. Hector Villasenor
This cardiologist helps patients take the right steps to heart health and ultimately improve their quality of life at the Heart Institute of South Texas.
cover: Photographed by Alexander Aleman
also inthisissue march / april 2013
NSIDE MD Magazine - March/April 2013
ceo / nside media productions / Eliot Garza email@example.com
publisher / san antonio / tina rabe
publisher / corpus christi / adrian Garza firstname.lastname@example.org
publisher / austin / angela strickland email@example.com
executive editor Erin O’Brien
creative director Elisa Giordano
graphic designers Damaris Fike, Cristina Villa Hazar
account executive Isabel Pequeño
international marketing account sales Anabelle Rodriguez
executive assistant Ashley Gray
contributing writers Kelly Hamilton, Terry Hyland, Dr. Kristen Kenroy, Dr. Hongbo Lui, Jody Joseph Marmel, Linda Meeker, Dr. John Metersky, Ilona Palomba, Esmeralda "Mela" Perez, Ana Clarissa Rodriguez, Dr. David B. Troxel , Beth Zimbicki
contents 16 nside community - Royal gifts
18 nside nonprofit - Caring for America's national treasure - From one heart to another - A powerful life, even in death - Making it possible to live - A grand anniversary - A shining star in the Lone State
Alexander Aleman, Ron Aaron Eisenberg, Michael Giordano, Mark Humphries, Robin Jerstad, Jim Landers, Jason Roberts, Julie Yocham Katrina Torres
48 nside health & wellness
- Ask the experts
54 nside patient - A pain in the back
58 nside fitness - A healthy spring
62 nside md - REMS
www.getnside.com For advertising information, please call 210.373.2599 or email firstname.lastname@example.org. For editorial comments and suggestions, email email@example.com. 18402 U.S. Highway 281 N, Ste. 201 San Antonio, Texas 78259 Phone: 210.298.1761 Copyright © NSIDE Media Productions. All rights reserved. Reproduction without the expressed written permission of the publisher is prohibited.
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The 11th Annual Queen of the Vine campaign crowns the 2013 Queen of the Vine and celebrates a year of record-breaking fundraising for the Brighton Center at the Queen’s Ball. Photography: [Julie Yocham]
On Friday, Feb. 15, Brighton Center hosted the Queen’s Ball – the culmination event for the 11th Annual Queen of the Vine campaign. In the closest race to become Queen of the Vine in the event’s history, April Ancira came out ahead and was crowned the 2013 Queen of the Vine, raising more than $77,000! Close on her heels was Dr. Karen Hasty, who raised a little more than $76,000 and was crowned Princess of the Vine. The Duchess of the Vine was Gina Cruz, raising nearly $16,000. The Queen of the Vine is a fundraising campaign that benefits the Brighton Center, a nonprofit organization that provides direct services to children with disabilities and/ or developmental delays and their families. Collectively, the four candidates – Ancira, Cruz, Hasty and Adrienne Sudduth – raised more than $184,000, a record-breaking amount to be raised in one year from this campaign. The Queen’s Ball was held at the Kendall Plantation in Boerne, and it included a night filled with live culinary stations, specialty wines, beers and spirits, live music, dancing and a silent and live auction. As the new Queen of the Vine, Ancira will represent the Brighton Center for a year and act as their Fiesta royalty at their official Fiesta event, A Taste of the Northside. A Taste of the Northside, combined with the Queen of the Vine campaign, raised more than $530,000 in 2012 for the nonprofit and was also named “Best Fiesta Event” by WOAI for the second year in a row. All proceeds raised from both A Taste of the Northside and Queen of the Vine go directly to the Brighton Center and help cover the cost of providing therapy and education services to children with disabilities and delays right here in San Antonio and the surrounding counties. This year, the Fiesta event will be held on Wednesday, April 24, at The Club at Sonterra. To learn more about the Brighton Center, or to schedule an interview with the Queen of the Vine, please contact Katrina Campbell at 210826-4492 or firstname.lastname@example.org.
“ 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
Transplants for Children empowers families to
MASTER LIFELONG CHALLENGES of pediatric transplantation
We accomplish this through: n Peer to Peer Networks for children and their parents to create a sense of “normalcy” and acceptance, and to keep families together n Transition Program from pediatric to adult medical care that prepares transplant recipient youth to survive into adulthood n Patient Navigation & Direct Services to help families overcome the complex demands of transplant care cycles
n Advocacy & Parent Education to eliminate barriers to critical services and assist families to succeed long term
CALL TODAY 210.949.1212 OR DONATE AT www.transplantsforchildren.org 7550 W IH 10, Suite #104 San Antonio, TX 78229 18
Phone: 210.949.1212 Fax: 210.949.1217
Your donation changes a child’s life.
Your gift goes to where it is needed most Tax deductible
BRINGING OUR HEARTS WITH US IN BUSINESS
[ NSIDE NONPROFIT ]
Daniel Korzeniewski / Shutterstock.com
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Caring for America’s National Treasure Operation Comfort provides care and services for military men and women who were wounded while serving our nation in the Middle East. By: [Kelly Hamilton]
Operation Comfort (OC) is a 501(c)(3) nonprofit organization founded in 2004 by Janis Roznowski, an American Airlines flight attendant who was part of a team transporting soldiers to and from the Middle East. “I am honored to have had the experience of being in the presence of some of the bravest men and women I have ever met. We cannot do enough for them. I believe that our military men and women
are truly our nation’s national treasure. Now that they are wounded, the onus is on us to do what we can for them.” OC is specifically purposed to help those wounded in Iraq and Afghanistan and in recovery at San Antonio Military Medical Center (SAMMC). In 2004, Operation Comfort began remodeling waiting rooms at Brooke Army Medical Center because family members of wounded service members
were at the hospital for extended periods supporting their love one through burns, amputations, traumatic brain injuries and post-traumatic stress disorder therapies. In total, there have been 12 waiting rooms remodeled, as well as the Marine Corps Annex. Once the wounded troops come to the hospital, their finances change drastically. Often, the wife or mother has to quit her job in order to take care of
“I am honored to have been in the presence of some of the bravest men and women I have ever met.”
her loved one. OC offers services to assist families financially during rehabilitation, as well as when the wounded service member is transitioning out of the military and into civilian life. It is often several months before they receive their disability and VA pay, so OC helps them during their transition period. One method OC utilizes to generate funds for the families of wounded service members is through their online thrift store (www.bigvaluedepot.com/operationcomfort). People can post items they no longer want and donate 100 percent of the proceeds directly to OC. When a person buys the item, the funds go directly into OC’s account. By nature, service members are very competitive, and most of them participated in sports when they were in school. OC believes it’s important to put them back into the competitive arena by participating in an adaptive sports program, which consists of hand cycling, bike riding, sled hockey, swimming, softball and amputee surfing. For those more mechanically inclined, OC offers AutoMotivation, a program where the wounded troops have built a 1966 Cobra Kit car and restored
and modified a 1954 Dodge Power Wagon used by the Army as a weapons carrier. The National Auto Body Council (NABC) is raising the funds to purchase a building so OC will have a permanent location to house the AutoMotivation program. (To contribute, please go to www.autobodycouncil. org.) For the third year, Help for Heroes, a British nonprofit organization that helps wounded British troops, invited OC to join them for the Big Battlefield Bike Ride. “This is a great opportunity for our wounded troops to mix with the British wounded troops by riding 350 miles together,” Roznowski says. “They fought side-by-side, and now they can get to know each other in a different way and in a different atmosphere. It’s marvelous to see how well they get along.” This year’s ride will be from Paris to London, and the focus will be on the WWI battlefields. In 2011, OC riders were invited to take on the 350mile ride encompassing WWII battlefields starting at St. Mere Eglise, south of Utah Beach, to Omaha, Gold, Juno and Sword Beaches, all the way to Paris. Along the way, the riders lay poppy wreaths in honor of all who fought and died. OC’s wounded troops had the honor of retiring our flag on Omaha Beach. “It was very moving to the soldiers and marines who were on the trip and rode on hand cycles, trikes and road bikes.” It is only through the kindness and generosity of others that OC is able to make a difference in the lives of those who have given more for our country than we can ever dream.
HELP OTHERS BY DONATING YOUR USED MEDICAL EQUIPMENT
NEEDED EQUIPMENT DONATIONS: • Wheelchair • Canes / Quad Canes • Shower Chairs • Tub Transfer Benches • Bedside Commodes • Adult Diapers / Blue Pads • Tub / Shower Grab Bars • Rolling Walkers • Hospital Beds • Walkers with Seats • Trapeze Bars / Hoyer Lifts • Scooters
If you need medical equipment and can’t afford it... Project MEND can help! Call 210-223-6363 and talk with a Project MEND Case Worker
TO DROP OFF EQUIPMENT, CONTACT: Project MEND Warehouse 1201 Austin Street | San Antonio, TX 78208 P: 210.223.7283 | F: 210.223.6441 E: William.Sheeran@projectmend.org
For more information, visit www.operationcomfort. org or call 210-826-0500.
WWW. PR OJ EC T ME ND .O RG NSIDE MD
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From One Heart to Another
Dr. and Mrs. Jeff McKissick with their six children in Paraguay
With the help of MedSend, health care professionals who feel called to serve as missionaries transform communities in need by mixing faith and medicine in practical and powerful ways. By: [Ilona Palomba]
Helen Keller once said, “Life is either a daring adventure or nothing at all.” This is one of Dr. Jeff McKissick’s favorite quotes, perhaps because he, his wife and their six children have been living a life that is at least in some respects reminiscent of "The Swiss Family Robinson" – one that has required adaptation skills, a paring down of life’s things and deep faith. Since 2005, Jeff and Amy McKissisk, both 36, have lived in the small rural community of Colonia San Francisco, Department of Caazapa, Paraguay. As medical missionaries with Serving In Mission (SIM), they provide compassionate health care and the love of God to those who have limited access to preventative or curative health care and health education. This past September, Jeff, a family physician, moved his family to the smaller community of
Jataity, where he attends to people free of charge from his home five days a week. In addition to their work as health care professionals, the McKissicks plant churches; share their faith in Jesus Christ through evangelistic outreach activities, prayer, counseling with patients and biblical teaching; and raise their six children ranging in age from 2 to 12. Paraguay is described as “the heart of South America” by those who call it home. Close to half of the country’s population lives in rural areas, and many of them live below the poverty line. How is it that this boy from Belton, a town deep in the heart of Texas, and his wife, who hails from Hawaii, came to live among them? A 1995 medical evangelism training program in Guatemala changed their lives by showing them
how they could mix their faith in the Lord Jesus and health care in practical and powerful ways. But it was the assistance provided by MedSend that enabled them to fulfill their calling. “Without MedSend, I would still be in the States paying down our educational loans,” Jeff says. “MedSend enabled us to get right on to the mission field after residency and start the ministry God called us to, with a lot less ‘stuff’ and obligations tying us down to Texas.” Now in its 20th year, MedSend was started for exactly that purpose: to get Christian health care professionals to the mission field without delay. Two decades ago, U.S. missions leaders were becoming alarmed by a growing global shortage of health care missionaries. As health care education costs soared, many students borrowed heavily, and
Since 1992, MedSend has approved more than $15 million in grants for nearly 500 health care professionals.
Dr. jeff McKissick sutures a patient.
most of those who had planned to be missionaries were forced to delay their God-given call to stay in the United States and work off educational debt. Many never made it to the mission field at all. MedSend was founded to remove this obstacle by providing fulltime health care missionaries with grants that repay their educational loans on a monthly basis while they serve. Since 1992, MedSend has approved more than $15 million in grants for nearly 500 health care professionals, including physicians, nurses, dentists, physician assistants, veterinarians and others. Today, grant recipients serve in more than 75 countries and staff and run mission hospitals and rural clinics in Africa, Asia, Oceania and North and South America. Most are involved in training and mentoring Christian nationals as caregivers, a strategy that ensures cost-effective and sustainable ministry. And through extensive involvement in community health education programs, many grant recipients like the McKissicks are working to transform entire communities. Shortly after arriving in Haiti, Rachael Courter, R.N., gave someone an OTC medication. The next morning, she and her husband, James, a physical therapist and MedSend grant recipient, awoke to find hundreds of people outside their home waiting for medical care. With only their family’s medications and a stethoscope, the Courters began seeing patients on their front porch. Today, the clinic they founded that day has seen more than 15,000 patients and is becoming a permanent, self-sustaining ministry. As the first faith-based state and federally supported health center in New York, Beacon Christian Community Health Center serves medically underserved people on Staten Island. When Hurricane Sandy hit, the clinic Drs. David and Janet Kim founded as MedSend grant recipients added disaster relief to its services. “At times like this, the hurting need to see the love of Christ lived out in front of them,” Janet said. In Honduras, Mission Lazarus was co-founded by MedSend grant recipient Allison Brown, APRN, B.C., and serves those in need through two medical clinics, a child nutrition program, a family health program, early education centers, a children’s home and more. Mission Lazarus is now expanding into Haiti. MedSend physician Dr. Perry Jansen founded Partners in Hope (PIH), Malawi, which provides free HIV/AIDS care to more than 3,000 people each month, plus innovative HIV prevention, testing and counseling programs. PIH was cited by Malawi for its demonstrated impact on the HIV/ AIDS epidemic there. Hundreds of thousands of people with great physical and spiritual needs have been helped by highly qualified MedSend health care professionals like the McKissicks. Their blog is aptly entitled “Immeasurably More,” for God’s accomplishments through them have surpassed anything they could have imagined (from Ephesians 3:20). At MedSend, we are humbled to be part of a ministry that brings healing, good health, hope and God’s love to so many, and we are deeply grateful for the strong support we’ve received from the medical community in Texas.
For more information and to find out how you can make a donation, log on to our website at www.medsend.org or call 203-891-8223. NSIDE MD
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A Powerful Life, Even in Death My husband gave the gift of life, the gift of sight and multiple other blessings through organ donation. By: [Linda Meeker]
i am so proud to have known him, to have shared his life and to have been his wife.
Dennis and I met in August 2000. That melting we just imagined started the moment we met. I would have married him the next day, but we wanted all of our family to be there to celebrate the union, so we had to wait until Christmas. We married in front of family and friends in December 2000. One Friday in June 2009, Dennis was coming home, like he did every Friday. He called me excited to be almost home. He and I made plans to surprise our son. Dennis had purchased a used RV for our son and wanted to get the RV all set up for him. We had also made plans to take our dear friend out for a birthday dinner on Saturday night. Then “OK. See you in a few minutes. I love you, sweetie.” “OK. I love you, sweetie. See you soon. Bye.” Sometime after we spoke, his truck was sent off the highway at a 90-degree angle, went through a fence and stopped in a field. At 8:15 p.m., I called Dennis to say, “Don’t forget the ice, and hurry through that traffic. It must be awful since you are way late. Hurry up, sweetie; I want you here.” Dennis did not answer. At 8:20 p.m., I received a call from a social worker at the hospital where life flight had taken him. I was driving to Dennis seconds later. I held his hand all Friday night and all day Saturday while three nurses worked on him. They did not just take temps and vitals – they worked on him. They worked hard trying to put life back into him. He never regained consciousness after the accident. Early Saturday morning, a brain scan proved that, in fact, death had occurred. I knew what Dennis would want me to do. His kidneys were donated to two different people; someone received a new liver; his pancreas cells helped someone with diabetes; his beautiful eyes have given sight to two people; and his heart valves have given life. The list of blessings goes on and on. What a humble man. What a powerful life, even in his death. I am so proud to have known him, to have shared his life and to have been his wife.
Making it possible to live The Texas Organ Sharing Alliance and the Donate Life Texas Registry make it easier than ever to give the gift of life through organ donation. By: [Esmeralda “Mela” Perez]
18 people die each day due to a lack of donated organs.
Many families throughout the 38year history of the Texas Organ Sharing Alliance (TOSA) have expressed their compassion by saving countless lives of many who were once strangers. Through organ donation and transplantation, many have formed a unique bond and created an extended family. It’s important to keep the issue in mind. There are more than 117,000 adults and children across the United States who face early death because of organ failure requiring a donated kidney, heart, lung, liver, pancreas and/or small intestine. In Texas, an estimated 11,400 individuals await a second chance at life. Many of these people will die waiting for a lifesaving transplant due to the lack of donated organs. Fact: Eighteen people die each day due to a lack of donated organs. Current surveys indicate confusion and lack of communication of wishes contribute to a critical organ shortage. Here are some of the most common reasons given: ● Families don’t know their loved one’s wishes. This could be prevented if more people would register their wishes to donate on the new Donate Life Texas Registry (www.donatelifetexas.org) and share their decision with family members. ● Families don’t want their loved ones to undergo the surgical procedure to procure organs. In fact, the process of donating one’s organs is very respectful and does not prevent one from having an open casket funeral.
● Some people believe their religion does not support donation. Currently, all faith-based groups support donation. Information about supporting donation by faith-based group can be found on the TOSA website: www. txorgansharing.org. How do you view giving back to your community? By providing financial support? By giving your time and talent? Or by making the decision to save up to eight lives through organ donation? Saving just one life may mean preserving a whole generation. Regardless if you choose one or all of the aforementioned methods of giving back, the legacy you leave will impact your community. Fact: Founded in 2006, the Donate Life Texas Registry allows Texans to legally designate themselves as organ, eye and tissue donors. To register, visit www. donatelifetexas.org. As the organization federally designated to serving Central and South Texas, TOSA is committed to conducting local donation-related activities. Through these coordinated activities related to public education about the benefits of donation, we increase donor awareness and the number of people registered on the Donate Life Texas Registry. Fact: To date, there are 3.2 million out of 25 million Texans registered on the Donate Life Texas Registry.
For more information, contact Esmeralda “Mela” Perez, TOSA manager of communications and community development, at email@example.com, 210-618-5052 or 866-685-0277.
Lemuel Bradshaw 1999 Heart Recipient
Friends for Life It’s true: There is power in numbers. Your time could save a life!
If you’re looking to help others – or yourself – receive the gift of life, there is no better way to make a difference than to get involved. You’ll love the partnership and strength of spirit to be part of people helping people by creating a donor-friendly community. Organ, eye and tissue donation is a choice, but it’s also a responsibility. Will you take action and do all in your power to help someone receive a second chance at life, health and happiness? Call today to learn more about becoming a friend for life: 1-866-865-0277. NSIDE MD
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A Grand Anniversary Jack and Jill of America, Inc., celebrates its 60th anniversary with a luncheon fashion show spotlighting the organization’s young members. Photography: [jason roberts]
On Jan. 20, 2013, the San Antonio chapter of Jack and Jill of America, Inc., celebrated its 60th anniversary at The Club at Sonterra in Stone Oak with a luncheon fashion show that spotlighted the children who were members of the organization. The president of this chapter is Dr. Linda Howelton. More than 250 guests were in attendance. Some of these guests included the organization’s South Central regional secretary, Fran Mayes, and South member-at-large, Diedra Fontaine. The afternoon’s festivities included a silent auction, booth vendors, a raffle with a multitude of items and a surprise visit from former San Antonio Spurs great, George Gervin, who helped raffle one of his own autographed basketballs. At the event, canned goods were for the San Antonio Food Bank. This 60th anniversary was funded by all of the San Antonio chapter members and organized by the foundation committee of the San Antonio chapter, chaired by Daphne M. Evans, who also served as mistress of ceremonies and culminated efforts that spanned more than a year-and-a-half of planning. Jack and Jill of America, Inc., was founded on Jan. 24, 1938, in Philadelphia, Penn. Today, the organization boasts more than 220 chapters nationwide, representing more than 30,000 family members. Each chapter plans annual programming activities guided under a national theme. Through community service projects, Jack and Jill of America, Inc., creates a medium of contact for children to stimulate their growth, positive development and leadership skills.
[ NSIDE nonprofit ]
A Shining Star
ÂŤ in the
Lone Star State Boys Town Texas continues to save children and heal families with a wide variety of programs more than 20 years after its inception. By: [Terry Hyland]
en-year-old Jacob was in the principal’s office – again. This time, it was for shoving a classmate to the ground. A few days earlier, it was for scrawling obscenities on his desk. Jacob was angry and acting out, and no one really knew why. At home, single mom Diana was desperate. She sought advice from several experts. But no one had an answer. Jacob remained defiant, anxious and depressed. Acting on advice from a friend, Diana scheduled an appointment with the Boys Town Texas Outpatient Behavioral Health Clinic. At his first counseling session, Jacob immediately connected with his Boys Town therapist. Now he and his family are receiving the kind of help that will bring lasting, positive changes to their lives.
When it comes to helping hurting children and families, Boys Town Texas is the shining star in the Lone Star State. Boys Town Texas has been serving children and families in the San Antonio area through a wide variety of programs since opening its doors in 1989. Boys Town Texas understands the needs of local children and families because it is a good neighbor in the community. Its professional staff knows children are suffering abuse and neglect, families are falling apart and parents are struggling with their kids. And they know the best way
to help kids and families find the life-changing results they need. As part of one of the country’s largest child and family service organizations, the site can offer services no one else has, mainly because of its unique integrated continuum of care. These include: In-Home Family Services, where trained family consultants work with families who are struggling to stay together or are in danger of having a child removed from the home. Consultants work right in the parents’ homes, helping them create a safe, nurturing home for children. Community Support Services, which connect children and parents with a wide variety of resources to learn how to help themselves through advice from our experts. Most resources focus on prevention rather than intervention.
Boys Town Texas understands the needs of local children and families because it is a good neighbor in the community. Outpatient Behavioral Health Services, which use Boys Town’s research-proven methods to provide specialized care for children with serious behavioral problems and counseling for their families. Foster Family Services, where foster parents who are trained and supported by Boys Town Texas open up their homes in the community to children who need a safe place to live. Children also receive foster care in five family-style homes at the 26-acre Boys Town Texas campus in San Antonio. When children can’t return to their homes, foster parents may choose to adopt them, providing a permanent, loving family. Boys Town Texas also provides parenting classes, and children and families can find help and advice through the Boys Town national hotline
(800-448-3000) and a number of online resources like parenting.org. Every year, these continuum services touch the lives of 81,000 people in Texas. When children and families need real help with real problems, Boys Town Texas is there.
If you would like to support our mission, please join us for the third annual Boys Town Texas Race for the Prevention of Child Abuse on Saturday, March 23, 2013, at Valero Energy Headquarters. The event begins at 8 a.m. To register online or to get more information, please visit www.boystown.org/texas, or contact Joyce Horner at 210-271-1010 or joyce. firstname.lastname@example.org. NSIDE MD
Breaking New Ground
Alex Garcia brings his expertise and love of health care to Victory Medical Center San Antonio, a state-of-the-art medical facility that provides a true VIP experience. By: [ana Clarissa Rodriguez] Photography: [alexander aleman]
“I found my calling for business a little differently than one would expect,” said Alex Garcia, CEO of Victory Medical Center San Antonio. “My father is a physician; my three older brothers are physicians, so naturally, I thought I was going to be a physician. Never in a million years did I think I would be the CEO of a state-of-the-art medical facility.”
Garcia was 7 years old when he and his family moved to San Antonio from Monterey, Mexico. The move was a bit of a culture shock, but thankfully, he had the support of his extended family to make the transition easier.
I know has gone through that school.” Garcia’s family has three generations of graduates from Central Catholic: his father, his uncles, his brothers and now his two sons, Marcelo Garcia (class of 2009) and Stefan Garcia (class of 2013). Garcia described himself as a regular high-school student. He played baseball for St. Luke’s Catholic Church, spent time with his family and worked a part-time job as a shoe salesman for Foley’s department store. “Growing up in San Antonio was a great experience,” he explained. “My parents were very involved in our lives, or as involved as they could possibly be spread between seven children. As the middle child, I strived for my parents' attention. My goal was to make them proud.” Garcia realized he had a knack for selling while working at Foley’s. “It came easily to me,” he said. “But I was still in the mindset of, ‘I’m going to college and I’m going to be a physician. That’s what I’m supposed to do.’” Garcia graduated from Central Catholic in 1978. He was accepted into St. Mary’s University School of Science, Engineering and Technology, where he studied biology as a pre-med student. His hopes were to follow in his father’s footsteps one day. “I was pre-med for my first three years at St. Mary’s,” he said. “The classes were tough, and I found myself studying more because the sciences did not come easily to me.” During his third year at St. Mary’s University, Garcia
“I make myself available to all of my employees with an open-door policy.” “My uncle, Raymond Garcia, was a monsignor, and my aunt, Sr. Rosalba Garcia, was a member of the Salesian Sisters,” Garcia said. “I had the privilege of attending Central Catholic High School. My father, Ruben Garcia, M.D., graduated from Central Catholic in 1941, and my brothers and I followed in his footsteps. Almost everyone
signed up to take a marketing class as one of his elective courses, and to his discovery, the material was clear and far less complicated. “I thought to myself, ‘This feels right,’” he said. “I immediately wanted to change my major.” Making the decision to change his major was the easy
Garcia ensures all who walk the halls at Victory Medical Center San Antonio are treated with kindness, respect and highquality care.
part. However, having the conversation with his father was what worried him the most. “I sat down with my dad and expressed to him the difficult time I was having with my current major. And to my surprise, he said, ‘Son, I will back you up and support you in whatever you want to do – you just have to be the best at it.’” Once Garcia earned his father’s blessing, he changed his major from pre-med to business in the second semester of his junior year. “It was truly God’s gift,” Garcia explained. “I ended up having to spend an extra six months at St. Mary’s in order to graduate, but it was worth it. When I switched majors, I stopped studying and my GPA went up. I graduated with a 3.8 GPA without opening a book for the last two years of college.” Garcia graduated from St. Mary’s University in 1983. At age 24, he embarked on his first out-of-college endeavor and opened a men’s clothing store, ACA JOE, in Northstar Mall. “With the help of my parents and God, I was able to run a successful ACA JOE retail store for seven years.” Garcia closed the doors of ACA JOE in 1993. “It was a great lesson to learn and one I have not forgotten,” he said. “Nothing can prepare you emotionally for having to close your own business. During my seven years at ACA JOE, I learned to be resourceful. I asked myself, ‘What are the barriers to my success, and how do I break them down?’ There is always a solution. Though you might not have the answer at the moment, surround yourself with the right people to help give you that answer.” Garcia later accepted a store manager position at Toys”R”Us in 1994. He worked in several locations throughout the city until the day an opportunity
presented itself. “I always had the continued itch for more,” he explained. “I was always looking for an opportunity for advancement. I told myself, ‘If this is what I went to school for, then I’m not satisfied just being a store manager.’ Soon enough, my older brother, Frank Garcia, M.D., an orthopedic surgeon, approached me and expressed an interest to expand his practice.” Garcia made a decision to leave his job at Toys”R”Us and work as a business development coordinator for his brother’s practice. His first big project was titled the Occupational Medicine Health Kit, designed to help employers access medical treatment for injured employees, allowing them quick access to top-notch physicians. “Frank needed me to handle the marketing, branding and communicating with employers,” Garcia said. “This is when I fell in love with health care. I had finally found a way to mix business with the health care industry. I am not a physician, but I am now in the business of health care alongside my father and brothers.” Garcia successfully helped his brother expand his practice with the Occupational Medicine Health Kit. He then decided to venture on a familiar journey: going back to school and earning his master’s degree. “It had been 10 years since I graduated from St. Mary’s University,” Garcia said. Yet I found myself walking the OLLU (Our Lady of the Lake University) campus, attending weekend classes as if I were in my early 20s again.” Two years later, Garcia earned a master’s degree in health care administration. “It came with a lot of sacrifice,” he said. “But it was well worth it.” Amid his
coursework, Garcia maintained a fulltime job and supported his family. He was able to see the “big picture” thanks to his father’s ambition during a similar situation. “My father was 49 when we moved to San Antonio in 1967,” Garcia said. “At age 49, moving to a new country with nine mouths to feed took a lot of confidence. I admire him for that.” Garcia considers himself a lucky man because his sons were able to see him walk the stage at his graduation. “To me, that was one of the proudest moments of my life,” he said. “The greatest feeling I experienced at OLLU was when I stood at the top of the stairs with my cap and gown, carrying my two sons.” Garcia established some incredible relationships during his time at the university. “These were people who believed in me,” he said. “I met a wonderful woman by the name of Linda Burton, who to this day I consider a dear friend and someone with tremendous vision whom I trusted to help me establish myself in the San Antonio health care community.” At the time, Burton was director of business development for Southwest General Hospital. “We were able to form a good working relationship,” Garcia said. “In a random turn of events, Linda asked me to apply for her position as director of business development at Southwest General Hospital. It was another true blessing. I worked there for eight years, and by the time I left, it was a very different hospital. “To make a difference in a hospital my father once worked in, who was an original physician partner, and where he did many of his surgical cases, meant a great deal to me.” Garcia left Southwest General Hospital in April
2003. He later accepted a regional director of business development position at CHRISTUS Santa Rosa Hospital. “Caroline Cox, VP of communications at CHRISTUS Santa Rosa, asked me to apply for the position,” he explained. “And once again, I found myself working in another hospital my father previously worked in. The nurses would approach me and say, ‘I was your father’s nurse in the OR back in the ‘70s.’ I really enjoyed my time there.” According to Garcia, a hospital is nothing more than brick and mortar; what matters most are the relationships you build with the physicians, patients and peers. “To date, I have maintained many of those same relationships with physicians that date back to my early days at Southwest General Hospital,” he explained. “They are no longer just physicians – they
are my friends. I understood this because of my father and three older brothers.” Garcia left CHRISTUS Santa Rosa Hospital in March 2011. “I believe when God closes one door, he opens another,” he said. Garcia was just beginning to settle into a new position at Kindred Hospital, and then one day, he received a phone call from a man named Robert Helms, owner and chairman of Victory Healthcare. Another physician had recommended Garcia to Helms. “We had a positive, energetic conversation,” Garcia said. “Mr. Helms told me about himself, his company (Victory Healthcare) and his vision for the future. We hung up, and two days later, Mr. Helms was here in San Antonio, meeting with me face-to-face.” Helms asked Garcia to travel to Houston and apply for the CEO position of Victory Medical Center San Antonio. “I interviewed with his entire senior
team for five hours,” he explained. “They were some of the brightest, most forward-thinking people I had ever met. After the interview process, I couldn’t help but think how much I would like to work for a company that had the same philosophies I did.” Garcia interviewed on a Monday and received an offer from Helms by the end of the week. “Thirty days post that date, I was the official CEO of Victory Medical Center San Antonio,” he exclaimed. “Words could not begin to describe how I felt. Here I am, sitting across from you introducing myself as the CEO of Victory Medical Center San Antonio – all because somebody believed in me, and I am forever grateful for that.” Garcia is CEO of two Victory Medical Center San Antonio locations: 4243 E. Southcross Blvd. and an up-and-coming location being built on Vance Jackson Road and Loop 1604 West. “The duties of a CEO never stop,” Garcia said. “We are in the process of building a new facility on the northwest side of San Antonio – an 82,000-squarefoot facility featuring six ORs, three special procedure rooms and 25 large private beds. I am now the orchestra leader.” Garcia has an incredible senior team of handpicked professionals working with him: Leroy Bernal, chief operating officer and chief financial officer; Sue Messer, R.N., MSN, M.A., chief clinical officer; and Yvonne Wheeler, director of marketing and PR. “My duties as CEO don’t end at 5 p.m.,” he said. “I am available to physicians, staff and patients 24/7.” From consistently greeting and meeting with physicians to rounding on staff, patients and family members, Garcia ensures all who walk the halls at Victory Medical Center San Antonio are treated with kindness, respect and a high quality of care. “I make myself available to all of my employees with an open-door policy,” Garcia explained. “It’s those employees and their patient care responsibilities who are my best ambassadors in providing the absolute highest quality of patient care.” Victory Medical Center San Antonio is a surgical hospital providing a variety of specialized services, including neuro spine surgery, orthopedic surgery, ortho spine, pain management, bariatric surgery, foot and ankle and otolaryngology. Garcia believes fostering relationships with his medical staff and patients is the key to being a successful CEO. “We offer the latest in minimally invasive procedures and exceptional quality outcomes,” Garcia said. “We are a premier healing environment filled with amenities to make your stay pleasant. From personalized, one-to-two staffing care to oversized patient suites, we have incorporated all of the details necessary to create a true VIP experience for you.” Garcia plans to do great things at Victory. He and his are anxious for the new facility to open in July 2013. “My advice to anyone would be to treat others with decency and be genuine to yourself,” Garcia said, “because a relationship you foster today can open up a new door to a future opportunity tomorrow.”
For more information, visit www.victory-healthcare. com. NSIDE MD
Going the Extra Mile
Seasoned physician Dr. Mario Bustamante uses his expertise of more than 33 years to provide the best quality of care to his patients.
By: [Ana Clarissa Rodriguez] Photography: [michael giordano]
With more than 33 years of experience, Dr. Mario Bustamante is a board-certified physician specializing in orthopedic surgery, orthopedic foot and ankle surgery and sports medicine. He was born and raised in Monterrey, Mexico, and he attended medical school and graduated first in his class at Universidad Autonoma de Nuevo Leon in San Nicolas de los Garza, a suburb of Monterrey. After graduating in 1980, Bustamante and his family decided to relocate to Austin, where he studied English at the University of Texas. He then moved to Houston to work for various hospitals in the Houston Medical Center, and he completed his first of three residencies at Baptist Memorial Health Care System in clinical and surgical pathology. Post-residency, Bustamante accepted a fellowship in anatomic and clinical pathology at the Mayo Clinic in Rochester, Minn. He said his experience at the Mayo Clinic was wonderful, but the Minnesota weather influenced his decision to move back to Texas. He accepted a teaching position at the University of Texas Health Science Center at San Antonio in the Department of Pathology. During this time, he conducted advanced research for breast cancer tumors. He traveled across the United States lecturing and sharing his expert knowledge of tumors. Bustamante expressed an inclination for orthopedics early in his medical career. As a medical student, he was fascinated with bones and the anatomy of the human body. He began working closely with the University of Texas Health Science Center Department of Orthopedics. He drew samples from every patient with a lump who came through the clinic for research. After spending two years as an attending professor, Bustamante decided to apply for a third residency in orthopedics at the University of Texas Health Science Center. At age 34, transitioning from doctor back to intern was difficult for Bustamante, but he managed to commit and make it work. He worked as a resident in the hospital for five years. Once he completed his residency, Bustamante joined the San Antonio Orthopedic Group (TSAOG), a long-time provider of quality orthopedic care in the San Antonio area since 1947. He stepped down from TSAOG in 1998 and launched his own practice in downtown San Antonio. Bustamante describes his method of practice as old-fashioned. He sees every patient face-to-face and is on call 24 hours a day. He is thrilled to be moving his practice and patients to the new Victory Medical Center on the northwest side of San Antonio. He said the administration staff and physicians at Victory Medical Center go out of their way to please patients, and no other facility in the city is as dedicated to exclusively providing the best medical care. His goal is to transfer his practice and to be exclusively dedicated to Victory Medical Center within the next few years. He feels honored to work with an elite team of physicians, and he is ready for the new facility to finally open.
For additional information regarding Mario Bustamante, M.D., or Victory Medical Center, call 210-368-7400 or visit www.victory-healthcare.com.
ADDITIONAL LOCATION OPENING SUMMER 2013 Victory Medical Center San Antonio Landmark
EXCELLENCE IS MORE THAN A WORD, IT’S OUR WAY.
Victory Medical Center San Antonio Southcross 4243 E. Southcross Blvd
Victory Medical Center San Antonio combines the expertise of specially trained physicians with the latest technology in a luxurious environment designed to promote comfort and healing. From personal attention to the latest in minimally invasive procedures and exceptional quality outcomes, Victory Medical Center San Antonio is setting a new standard in surgical care.
NEW LOCATION COMING SUMMER 2013:
Victory Medical Center San Antonio Landmark 5330 N Loop 1604 West @ Vance Jackson
· 6 oversized surgical suites · 3 special procedure rooms equipped with state-of-the-art equipment · 25 oversized, private patients suites: - Individually staffed and equipped to give a level of care equal to intensive care - Personalized care with a ratio of patients to nurses 2 to 1 and 1 to 1 when necessary - Each room is beautifully appointed with sweeping views of the area · Expansive waiting areas for family and loved ones with Wi-Fi access · Approximately 250 of San Antonio’s best nurses and medical professionals · Leading edge hospital services to be offered include: - Orthopedic surgery - Neurosurgery - Spine surgery (open and minimally invasive) - Pain management - Bariatric surgery - Foot and ankle surgery · Any many other disciplines
For additional information call Alex Garcia at 210.368.7400, Yvonne Wheeler at 210.368.7420 or visit www.victory-healthcare.com. NSIDE MD
Nilsson lives by two philosophies: the golden rule and loving your neighbor as you would yourself.
the spice of life
Dr. Joel B. Nilsson uses his broad experiences and his love of orthopedics to care for a wide variety of patients as a faculty member at a Level I trauma center.
By: [Ana Clarissa Rodriguez] Photography: [michael giordano]
Dr. Joel B. Nilsson is a boardcertified orthopedic surgeon who previously specialized in hand and upper-extremity surgery. He grew up in Nyack, N.Y., and graduated with a bachelor’s degree in biology from Wheaton College in Wheaton, Ill. He furthered his education at Georgetown University in Washington, D.C., receiving a master’s degree in physiology. He then went on to study medicine at Georgetown University’s school of medicine. Upon graduating, Nilsson began working with the U.S. Army. He accepted a transitional internship in Hawaii, which is where he discovered his love for orthopedics. He spent one year oversees in South Korea working as an ER doctor, and then moved back to the United States to begin his orthopedic residency in El Paso, Texas, at the Texas Tech University Health Science Center/William Beaumont Army Medical Center combined program. He trained there for four years in the full range of orthopedic disciplines, including hip and knee replacement surgery. Post-El Paso, Nilsson moved back to Washington, D.C., to complete a one-year fellowship for hand specialty training at Walter Reed Medical Center and Curtis National Hand Center. He then moved to Tennessee to utilize his skills at Fort Campbell, Ky., where he spent a reward-
ing year-and-a-half performing general orthopedics for combat soldiers. In 2003, an opportunity presented itself for Nilsson and his family to move to San Antonio, where he worked for Wilford Hall Medical Center. He spent four years at Wilford Hall before transferring to Brooks Army Medical Center for an additional year. As a faculty member at a Level I trauma center, Nilsson cares for a wide variety of patients. He lives by two philosophies: the golden rule and loving your neighbor as you would yourself. Outside of the hospital, he enjoys spending time with his family. He recently purchased a 1977 Jeep CJ-5 and plans to restore it with the help of his two sons. Nilsson is currently working with Victory Medical Center San Antonio on Southcross. He is ecstatic about working at the new facility on the city’s northwest side. Nilsson describes Victory Medical Center as a boutique hospital due to its top-notch equipment and perioperative care. He hopes to see Victory Medical Center become the best hospital in town because of its quality health care and family atmosphere.
For additional information regarding Joel B. Nilsson, M.D., or Victory Medical Center, call 210368-7400 or visit www.victoryhealthcare.com.
UT Medicine San Antonio
UT M ED07292011227
Medical Arts & Research Center
UT Medicine offers the power of academic medicine from our School of Medicine faculty and the convenience of a private practice setting at the Medical Arts & Research Center in San Antonioâ€™s Medical Center. Anesthesiology Audiology Cardiology Cardiothoracic Surgery Cosmetic Surgery Day Surgery Center Dermatology Digestive Diseases Endocrinology Executive Health Family Medicine Fertility Center
Gastroenterology General Surgery Geriatric Medicine Heart Station Imaging Center Infectious Diseases Internal Medicine Lab Services Nephrology Neurology Neurosurgery Obstetrics & Gynecology
We accept most major health plans. For an appointment, call (210) 450-9000. www.UTMedicine.org
Hematology/Oncology Ophthalmology Optometry Orthopaedics Otolaryngology Pediatrics Physical / Occupational Therapy Plastic & Reconstructive Surgery Podiatry Psychiatry
Pulmonary Medicine Radiology Rehabilitation Medicine Rheumatology Sports Medicine Travel Medicine Urology Vascular & Endovascular Surgery Womenâ€™s Health
8300 Floyd Curl Drive San Antonio TX 78229
Health Science Center San Antonio NSIDE MD
Dr. James “Jim” D. Weiss is a board-certified physician in physical medicine and rehabilitation. He has extensive experience diagnosing and treating spinal and musculoskeletal disorders and working with patients to determine their best possible options for care. His unique non-surgical, holistic approach to pain management includes physical therapy, nutritional management, epidural steroid injections and facet injections. He is dedicated to outpatient management and alternative medicine. He believes a healthy lifestyle helps in recovery and prevention. Weiss received his medical degree from Chicago Medical School and completed his physical medicine and rehabilitation residency at the New York University Medical Center Rusk Institute of Rehabilitation Medicine.
Weiss is a strong believer in maximizing what you have.
A Holistic Approach to Healing Known internationally as a physician, lecturer and practitioner for more than 25 years, Dr. James D. Weiss brings his expertise to the Alamo City.
By: [Ana Clarissa Rodriguez] Photography: [Jim Landers]
He served as a clinical assistant professor in the Department of Physical Medicine at Mount Sinai and Baylor College of Medicine. He also hosted several radio and television shows promoting health and wellness in the NYC metro area. He previously served as an investigator for the National Cooperative Somatropin Surveillance, where he evaluated the effects of human growth hormone on aging. As an internationally recognized physician, lecturer and practitioner for more than 25 years, Weiss has incorporated integrative medicine within his practice, including brain, fitness, botanical medicine, bio-identical hormone replacement and mind/body medicine. After spending 17 years in Houston at Memorial Hermann Southwest Hospital, Weiss moved to San Antonio on Jan. 7, 2013, to join the medical staff of Victory Medical Center, where he will provide conventional/rehabilitation medicine and pain management and incorporate a conventional medical approach with Eastern methods and holistic well-being to his patients. Weiss will be working at the new Victory Medical Center facility on the city’s northwest side. He is thrilled to be a part of the Victory Medical Center team, and he strongly believes his experience with spine patients will have a positive impact on the hospital and patients. Weiss’ ultimate goal is to utilize his experience to benefit his patients in a global way at Victory Medical Center. He is a strong believer in maximizing what you have. He stays healthy with a pure mind and a regular exercise regime, and by following the Paleolithic diet.
For additional information regarding James D. Weiss, M.D., or Victory Medical Center, call 210-368-7400 or visit www.victory-healthcare.com.
Queen of the Vine, April Ancira Princess of the Vine, Dr. Karen Hasty
The Queen of the Vine campaign raised more than $184,000 this year and will go directly to helping the children with disabilities and their families that Brighton serves. Make sure and see your Queen of the Vine winners at the 2013 Taste of the Northside!
Queen Brighton Center
of the Vine T H E O F F I C I A L R O YA LT Y O F TA S T E O F T H E N O RT H S I D E
Celebrate Fiesta®with our ALL-INCLUSIVE pricing!
The Nort hside
A TASTE OF
P ROU DLY
9 Tastings from over 50 restaurants and mobile food trucks 9 Over 40 different wine & beer selections! 9 Live music from Blue Finger Disco, Melina Band & The Decibel Band! 9 Free Parking & Shuttle
Brighton Center Supporting Children with Delays or Disabilities
Voted Best Fiesta event 2 years running by News4 WOAI
Wednesday April 24, 2013
$55 in advance
5:30pm to 10:30pm
www.BrightonSA.org San Antonio H.E.B. locations until 4/22/2013
The Club At Sonterra 901 Sonterra Blvd-78258
$60 at the door
No on-site parking. For event and parking details visit us at www.BrightonSA.org
UPGRADE FOR A
AT TASTE OF THE NORTHSIDE
Call 210.826.4492 or visit our website to upgrade your event tickets. You can purchase VIP Tickets for $200. V.I.P.’s enjoy NSIDE MD access to our exclusive Goodtaste with Tanji V.I.P. Lounge with specialty wines and restaurants, 2 live bands and more!39
Pioneers Senior Health Care for
[Special to NSIDE] Photography: [Ron Aaron Eisenberg]
WellMed Medical Group addresses the mental health needs of area seniors by introducing a new behavioral health pilot program.
ioneer. It is a commanding word, conjuring thoughts of trailblazing, path finding and leading. It is also a recurring theme in the WellMed care model, which focuses on accommodating senior citizens’ wide spectrum of medical needs. In that spirit, WellMed is piloting a behavioral health program at some of its clinics in San Antonio and Austin, bringing mental health services to Medicare-eligible patients of the region’s leading primary health care provider for seniors. Behavioral health, or psychiatric, services are not commonly offered at family practice clinics. Yet the need for them is growing, particularly among the rapidly growing population of Baby Boomers. According to a 2012 report by the Institute of Medicine, between 5.6 million and eight million Americans age 65 and older have a mental health condition or substance abuse disorder – a figure the report’s authors describe as conservative. Depression and dementia-related symptoms are the most common. And the figure is only expected to rise, as the number of seniors in the United States alone will double by the year 2030. Recognizing the need to address the demand for behavioral health among their patient population, physician leaders at WellMed have created a behavioral health pilot program and tapped geriatric psychiatrist Dr. Sandra Vale to serve as WellMed chief of behavioral health. Vale, board certified by the American Board of Psychiatry and Neurology, is former director of psychiatry services for the Department of Aging and Disability Services at
the San Antonio State Supported Living Center (SASSLC). In San Antonio, Vale is joined by Amber Hoberg, a family psychiatric mental health nurse practitioner. Together, the team is creating, implementing and ultimately expanding mental health services throughout the 22 WellMed clinics in the greater San Antonio area. When Vale was approached by WellMed with an opportunity to help pioneer an integrated behavioral health care model incorporating the mental health needs unique to older people, it was a natural fit for the doctor, who has spent years volunteering and supporting organizations catering to the aging population. “This is exactly what I am about,” Vale says. “This is a care model which embraces seniors as a whole person. New patients go in for a physical checkup and also get a mental health exam.” Vale explains the unique mental health needs of seniors. “They are dealing with loss. Not just the loss of their friends or family members, but in a way, the loss of themselves, and the things they used to do, as they age. It is important to remember that while they’ve lost, they’ve also gained so much along the way. We create an environment for them to replace the negativity, be positive and age gracefully.” According to Vale, diseases such as diabetes and hypertension, which are highly prevalent among San Antonio’s aging population, can contribute to many mental health issues. “Diabetes affects nerves and arteries in the body and in the brain, which leads to a form of dementia called vascular dementia,” Vale explains.
According to the Alzheimer’s Association, vascular dementia “is a decline in thinking skills caused by conditions that block blood flow to the brain, depriving brain cells of vital oxygen and nutrients.” Conditions such as diabetes and hypertension can affect smaller blood vessels, which creates progressing damage. “Also, when a patient is diagnosed with a disease, there is a risk for depression. There could be underlying anxiety, depression and dementia, so there is a need for fullspectrum care.” The newly developed integrated behavioral health program is threefold, involving pharmacological, non-pharmacological and social work support. “Part of loss is isolation,” Vale says. WellMed personnel make weekly phone calls to patients to provide the critical support necessary to ward off the feelings of seclusion and loneliness. WellMed provides health care to nearly 100,000 patients, most of whom are Medicare-eligible seniors. WellMed is recognized as an industry leader in medical risk management, highly effective disease management and chronic care programs, health care delivery services and more. The behavioral health program is the newest specialty at WellMed, which also employs cardiologists, rheumatologists, hospitalists, podiatrists, pain management experts and dermatologists, along with a cadre of family medicine, internal medicine and geriatric physicians. Experts are located in WellMed clinics for the convenience of the patient, as well as primary care physicians, allowing patients to visit NSIDE MD
Dr. Sandra Vale, Chief of Behavioral Health, WellMed, & Nurse Practitioner Amber Hoberg
specialists under one roof and giving their family doctor easy access to the latest patient records and specialist recommendations. This broad and multifaceted approach to health care includes access to health coaches – nurses who work with the doctor, patient and even family members who may serve as caregivers to enact an effective health care plan for the patient. “WellMed commits to supporting the caregiver, as well,” Vale explains. “Caregiver burnout is a real phenomenon and falls under the radar in other organizations. WellMed works to be on the forefront for the caregivers in the community.” One facet of this is the creation of Caregiver SOS resource centers, which offer complimentary programs designed to support family caregivers in their care-giving roles, including one-on-one assistance, education, wellness activities and
“We create an environment for seniors to replace the negativity, be positive and age gracefully.” more. The WellMed Charitable Foundation, the nonprofit partner of WellMed Medical Group, developed the program to help family caregivers, whom they consider the backbone of long-term care in the United States. An unfortunate reality geriatric patients, physicians and family members have to face is the prevalence of elderly abuse, which Vale considers
“an underreported phenomenon that happens frequently.” In December 2012, the U.S. Department of Health and Human Services awarded a grant of nearly $1 million to the Texas Department of Family Protective Services Adult Protective Services division in partnership with the WellMed Charitable Foundation. The grant, which is part of the Elder Justice Act of 2010, creates a partnership with WellMed and serves to educate seniors and medical professionals on how to reduce the risk and identify victims of the crime. It will fund extra Adult Protective Services personnel to train more than 120 of WellMed’s medical professionals to create screening and intervention procedures. All of these components come together to create wide-ranging care to ensure all of the seniors’ needs are met. Vale quotes WellMed’s vision to “change the face of health care delivery for seniors by providing quality, proactive patient care with a focus on prevention.” “I feel like I am a part of that in the WellMed population,” she says. “I am excited to be a part of this new endeavor to bring the pioneer spirit WellMed has to behavioral health.”
For more information about WellMed, call 210-615WELL (9355) or visit www.wellmedmedicalgroup. com.
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Making Her Mark Executive Director Cathy Valdez moves Project MEND to the forefront of the Texas medical community. By: [Jody Joseph Marmel] Photography: [robin jerstad]
“If you believe in what you are doing, you will reach each goal because you make it happen.”
here are certain people we meet during our lifetime who leave an imprint on our hearts that is everlasting. Cathy Valdez is one of those people. Her intelligence, career history, humanitarian ways, beliefs and positive attitude are outstanding, to say the least. Having held the title of executive director of Project MEND (Medical Equipment Network for Those With Disabilities) for six years, Valdez says, “We know what we have to do. So far, whatever goals we have set for a given year have been met with success. If you believe in what you are doing, each goal will be reached because you make it happen.” Project MEND is a nonprofit 501(c) (3) agency dedicated to helping lowincome people with disabilities obtain medical equipment and financial assistance to help with the purchase
of assistive technologies that are medically necessary for rehabilitation and recovery. Project MEND has a unique mission that Valdez strongly supports and has enlightened the community, city, state and nation on their beliefs in a better tomorrow for those in need of their services. Providing lowincome people with disabilities with refurbished, donated medical equipment and assistive technologies that will enhance their quality of life is an amazing service that Project MEND started 20 years ago. Joining Project MEND in 2006, Valdez explains, “I knew that we needed to grow in capacity each year. For example, the first year I was there, we went from seeing 10 to 15 customers per month to seeing between 50 to 60 customers per month. And it just continued to grow from there each year.” By increasing the staff in the ware-
house and the case management staff, Valdez increased revenue each year by developing new relationships with funding sources that were never contacted before. These include Bexar County, University Health System and a number of new foundations. The Gordon Hartman Foundation has since become a great advocate for Project MEND. “Something good always happens to Project MEND,” Valdez says. “Whether it’s moving case management staff into a new accessible building or purchasing a HUBSCRUB machine to help our warehouse staff cut down on the time it takes to sanitize and disinfect a piece of medical equipment, every step we take is bringing us to the next level. “We want to become the answer for low-income people with disabilities that need medical equipment and don’t have the means to obtain it on their own. We want the public to be able to see or hear our name and immediately associate us as the place to go to donate used medical equipment or get needed medical equipment.” Citing Goodwill as an example of a known business to donate clothing, household goods and furniture to, Project MEND will become a brand name in the near future. I am certain that with Valdez behind the wheel, this goal is a destination that will be successfully reached. Being the only medical equipment reuse company in Texas for almost 20 years, they are a licensed salvage facility with the State Health Department for Texas and the state’s only subcontractor for medical equipment reuse. “One of our goals is to see Project MEND develop satellite offices around Texas so that reused medical equipment can be accessible throughout the state. Obviously, this takes a lot of planning and funding.” Constantly implementing activities that will help bring awareness about who they are and what they do in the community is necessary to help Project MEND build donors from every sector. From MENDays at the warehouse (brief, hour-long presentations for anyone who wants to learn about them and get a quick tour of the warehouse) to Warehouse Volunteer
Days (where the community is encouraged to sign up and volunteer at the warehouse to clean medical equipment, sort through parts, repair wheelchairs and other projects), Valdez ensures that the word is permeating throughout the city and South Texas. “We participate in as many health fairs and community events throughout the city in order to provide the public information about our services. We have an open house event twice a year. Our staff also makes many presentations to the staff at hospitals, assisted living facilities, durable medical equipment businesses, social service agencies, pharmacies, doctors’ offices, community centers, rehab clinics and many more agencies that also serve our clientele.” All of these activities will eventually help grow the individual and corporate donor base. Networking is also a highlighted activity by all members of the staff. Short-term goals for Project MEND are always in development. The board of directors is currently arranging a strategic planning session that will help identify their goals over the next five to 10 years. An immediate need is the renovation of the current warehouse facility or finding a larger facility in another location. “With a new or renovated warehouse, we could then look at bringing in a new tracking system.” Valdez shares that they are also currently looking at changing their logo. “Sustainability is always an area of focus for us, both for the short term and long term. Finding new revenue streams that can help us sustain the services we provide is a challenge, but very necessary for any nonprofit. Long-term, we would also like to be expanding throughout Texas.” Valdez has already made her mark in the humanitarian components of business, medical services and life. Expansion is giving and going that extra mile to make a remarkable difference. Valdez will go miles to make all the difference in the world.
For more information, contact Cathy Valdez, executive director, at 210-2232323 or cathy.valdez@projectmend. org. NSIDE MD
Dr. Hector Villasenor spends quality time with patients to help them along their path to wellness at the Heart Institute of South Texas. [Special to NSIDE] Photography: [Mark Humphries]
nce rated by Men’s Health Magazine as one of the fattest cities in America, San Antonio has now worked its way onto the list as one of the fittest cities. But cardiologist Dr. Hector Villasenor remains pretty busy in this Texas town, he says, because of the types of foods that have become part of the San Antonio culture. Villasenor of the Heart Institute of South Texas graduated from medical school at the University of Texas Health Science Center San Antonio in 1978. After a cardiology fellowship in Houston, he came back to San Antonio in 1984 to start his
The key to early intervention is smoking cessation, maintaining a healthy blood pressure and getting cholesterol and weight under control for the younger population before they begin to have health issues. Villasenor always recommends a low-fat, lowcholesterol diet, exercise and smoking cessation for all of his patients, and he spends time with them to find easy ways to do this. He also encourages patients to always take their medications, since some choose not to, even though their doctor says it is crucial. “It’s difficult here in San Antonio to change the
There are no shortcuts when it comes to heart health. practice, and he has stayed there ever since. There was something quite intriguing about cardiac procedures, Villasenor says, as he is passionate about helping others live long and healthy lives by encouraging them to take the right steps to heart health. The majority of patients who come to Villasenor typically have complaints of chest pain or angina, areas of discomfort in the chest where the heart is not getting enough oxygen. Many patients also have other risk factors that affect the cardiovascular system such as high blood pressure and diabetes. “There are many risk factors we try to modify and hopefully improve on a daily basis,” Villasenor said. While Villasenor only treats adult patients, he says some of his younger patients are being diagnosed with diabetes and have other risk factors such as smoking, both of which affect the heart, arteries and veins. “Smoking and having diabetes at a young age makes it difficult as they get older,” Villasenor said.
culture,” Villasenor said. “The diet and high incidence of diabetes create a problem for cardiologists. We strive to improve the quality of life.” Unfortunately, Villasenor says only a very low percentage of patients take what their doctors say seriously and revert to unhealthy living, even though they are already at risk. There are no shortcuts, Villasenor says, when it comes to heart health. Patients have to decide to change their lifestyle for life. “At the end of the day,” Villasenor said, “I know I have done the best for (my) patients, and that I have tried my best with every patient.”
For more information about Dr. Hector Villasenor’s practice, contact the Heart Institute of South Texas at 210-223-7500. For more information on BHS Physicians Network, go to www.bhsphysiciansnetwork. com or contact Julie Minnick at email@example.com. NSIDE MD
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the experts Dealing With GERD Knowing when and how to treat the disorder can alleviate the discomfort of heartburn symptoms. By: [Dr. John Metersky]
Photo by Mark Humphries
Almost everyone experiences GERD, gastro esophageal reflux disorder, at some point in his or her life. Most commonly known as heartburn, GERD is characterized by a burning sensation in the chest or throat. Heartburn can be triggered by a number of things, most commonly large portions, fatty foods and late-night meals. Easily treated with medications, heartburn itself is not usually a cause for serious concern. If it becomes a daily occurrence, however, or is accompanied by difficulty swallowing or chronic coughing, it may be a symptom of a greater problem such as a hiatal hernia and could require surgical treatment.
Q: What is GERD, and how is it typically treated?
GERD is heartburn. It occurs when the stomach becomes distended and puts too much pressure on the lower esophageal sphincter (LES), the ring of muscle that prevents the stomach contents from coming back up into the esophagus. In the past, the only way to treat it was with antacids such as TUMS and milk of magnesia. The introduction a few years ago of H2 blockers such as Zantac, Pepcid and Tagamet completely changed the playing field, and these are now among the most common treatments for people with heartburn symptoms. With physicians taking the lead, we can help obese patients find their own road, find what works for them and begin to improve their lives, starting with a healthy attitude and mind, which is ultimately the source of a healthy body.
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nonsurgical Q: When treatments don’t
work, what are the surgical alternatives?
Surgery can be effective for those people for whom medication is not an option due to side effects or the fact that the drug simply isn’t managing the symptoms. In those cases, there is often a larger issue such as hiatal hernia going on. In those cases, we recommend a robotic-assisted laparoscopic nissen hiatal hernia repair with esophagogastric fundoplication.
does the surgical Q: How procedure work?
A hiatal hernia occurs when the upper part of the stomach has been sucked into the chest through a tear or weakness in the diaphragm. By performing a robotic-assisted laparoscopic procedure, we are able to pull the stomach back into the abdominal cavity outside of the chest, repair the defect in the diaphragm behind the stomach and wrap the upper stomach around the lower esophagus, thereby recreating that LES high-pressure zone, which prevents stomach contents from getting into the esophagus. The procedure is done under general anesthetic, takes approximately one-and-a-half hours and involves an overnight hospital stay.
is a good candidate Q: Who for this procedure?
Before undergoing this – or any – procedure, the patient will undergo a full workup to determine whether or not it will be beneficial. A good candidate for this type of surgery is one who has a significant hiatal hernia and also has good esophageal motility. If a patient has an esophagus that is badly scarred from reflux, or if the esophagus doesn’t propel well, that person is not a candidate for the procedure.
GERD is characterized by a burning sensation in the chest or throat. is the recovery Q: What period? Are there any lifestyle changes?
A: are the risks Q: What and benefits of the procedure?
This is a very effective procedure, but, as with any surgery, there are risks. The most common is dysphasia, which can occur when the stomach is wrapped too tightly. This causes difficulty swallowing and can be more painful than reflux. However, I have never had that happen. The benefit is that it actually corrects the anatomical problem causing the GERD, rather than just treating the symptoms, which is what medications do.
Within two weeks of the surgery, most people are back at work. However, it is approximately two to three months before they are back on a normal diet. A liquid diet is all that is consumed for the first week post-op, with solid foods being introduced very gradually. Those who are obese, who smoke or who suffer from a chronic cough are at a higher risk for recurrence of symptoms, and up to 50 percent of patients will need to go back on heartburn medication at some point. However, the symptoms will be milder and easily controlled.
John Metersky, M.D., is a board-certified general surgeon specializing in advanced laparoscopic and robotic surgery with St. Luke’s Surgical Care, located at 7940 Floyd Curl, Ste. 620, Tower II, San Antonio, Texas 78229. For more information, call 210-614-7300.
Catch problems early through prevention and take a proactive approach to your heart health with a CT coronary calcium scoring.
Photo by Mark Humphries
[special to nside]
Prevention is key to maintaining a healthy heart, and being proactive about oneâ€™s heart health is one way to catch problems early. Along with having regular blood pressure, glucose, cholesterol and weight screenings, Dr. Laura Jacobs recommends one procedure that is affordable and insightful for those at risk for heart disease.
Prevention is key to maintaining a healthy heart.
is a CT coronary Q: What calcium scoring?
This is done using a special type of X-ray called CT (computed tomography). A CT coronary calcium score will detect coronary plaque long before a stress test will because it catches the plaques in the heart and arteries when they are microscopic – potentially before they would be visible even in a cardiac catheterization, another common test. A stress test will only detect a significant stenosis (narrowing) that is already blocking the blood supply of that coronary artery. A CT calcium score test ranges in cost from $75 to $150 at various imaging centers, and involves no contrast dye or IV. The exposure to radiation is minimal.
are the advantages of Q: What this test?
Catching heart disease early with a CT coronary calcium score has a major advantage in that it would prompt the initiation of more aggressive lifestyle modification efforts, and the initiation of an aspirin and statin for secondary prevention purposes. A statin is a medication typically used to help lower cholesterol, but would be indicated in this situation even if cholesterol numbers were perfect. The statins stabilize plaque and keep it from growing or cracking, which would expose the cholesterol to the blood stream. Exposing cholesterol to the blood stream is what causes a clot, which results in the sudden occlusion of an artery that causes a heart attack.
What are some nutritional Q: secrets to heart health?
There are nutritional supplements that I often recommend to my patients. I call it my “cardiac cocktail” – it includes fish oil, vitamin D, coenzyme Q10 and magnesium.
Laura Jacobs, M.D., is board certified in cardiovascular disease. She can be reached at Heart Clinic of San Antonio, located at 502 Madison Oak, Ste. 250, San Antonio, Texas 78258. The phone number is 210-483-8883. NSIDE MD
New Year, New You Setting goals and sticking to them
By: [Beth Zimbicki]
It’s the beginning of a new year, and many people resolve to start a new fitness regimen to get into shape, lose weight and eat healthier. But by March, some people lose momentum. Here are some tips to help you stay on track to meet your goals and continue on a healthier journey for years to come.
are some of the Q : What ways we can set goals
for healthier lifestyles and stick to them?
It helps to develop a health vision before jumping into goal setting. Think of where you would like to be one year from now, in all areas of your life – physical health, emotional health, stress management, relationships, career, finances and creativity. Brainstorm ideas and tap into your motivation to make changes in those areas. Identification of your personal motivation to change is essential to staying consistent with making changes. For example, say you want to work on your physical health and improve your diet so you have more energy to keep up with the grandkids. Put a picture of the grandkids on the fridge or something like that to remind you frequently why you are making changes. Then review your health vision and identify which areas you feel ready to take action in during the next month. For the areas you are not ready to change in the next month, either go back and develop motivation in that area further or wait to set a goal in that area later in the year. For the areas you are ready to change in the next month, set a SMART goal, which is a specific, measurable, attainable, realistic and timely goal. For example, based on your health vision to improve your diet to have more energy to keep up with the grandkids, think about what area is realistic to
change in the next week, for the short term. Brainstorm ideas and pick the one or two small changes that you are confident you will be able to make in the next week. Turn that goal into a SMART goal and make it as specific as possible – for example, ”I will pack a lunch from home instead of eating out three days a week.” Then look at your calendar for the next week and pick the three days you will pack a lunch. Identify any possible barriers to meeting your goal, like going grocery shopping early in the week so that you’ll have what you need on hand to pack a lunch, waking up earlier or packing the lunch the night before. At the end of the week, review your goals to see what worked well and what you would change for the next week. It is important to keep revising your goals frequently and to review your health vision every three months to keep refining what you are working toward and to keep your motivation relevant. It is also important to record progress and set up rewards that relate to your goals, like a new healthy cookbook or a set of containers to take your lunch in. It is also helpful to have someone who is supportive of your goals and can help you be accountable – maybe a workout buddy, a family member or a health/wellness coach. Have a system of reminders in your daily life to support your goals such as a calendar, a phone or health-related apps or websites that help you identify your motivation and set goals, as well as maintain your motivation. One of my personal quotes that helps me when I am working on goal setting is, “Start by doing what is necessary, then do what is possible – and suddenly, you are doing the impossible” (Francis of Assisi).
can folks Q: How incorporate healthier
eating in their lifestyles?
Building on what has worked for you in the past is a great place to start. Think of a time in your life when you were eating healthier and what was working for you then. Most people have skills and strengths they can build upon and incorporate back into their lifestyles. If it was a time when you were cooking more at home, maybe start again by trying one new recipe a week, rather than setting an unrealistic goal of cooking at home every day. Simple changes can make a big difference. For example, people sometimes struggle with getting enough vegetables. Maybe start keeping salad mixes on hand, or trying a new vegetable to increase variety. A trip to a local farmer’s market can be a fun way to add more vegetables to your diet. Buying produce in season tends to taste better, and talking with the famers can give you ideas for how to prepare. If you are not very confident in the kitchen, maybe take a cooking class to improve your skills so you can incorporate healthier eating into your lifestyle. Get your kids in the kitchen, too, so they learn how to make foods at home and avoid fast food. When trying to eat healthier, start small, identify areas where you might be lacking and set goals that are realistic.
are some ways to Q: What incorporate healthier foods into daily eating?
Increasing vegetable intake is one of the keys to making your diet healthier. Start filling half of your plate with vegetables and thinking of vegetables first when planning meals or grabbing a snack. Increasing protein in your snacks and meals can help decrease hunger. Choose higher-protein snacks such as nuts, string cheese, cottage cheese, hardboiled eggs, peanut butter and trail mix. Make your breakfast count. Most people tend to skip breakfast or eat refined carbohydrates such as instant oatmeal, cereals, bagels and muffins, which can make you hungrier later in the day. Start with a protein source like eggs, cottage cheese or Greek yogurt when planning your breakfast. It is also important to increase Omega-3 intake in your diet such as such as salmon, tuna, trout, flax seeds and chia seeds.
Simple changes can Make a big difference. people are dieting, Q: Ifshould they be allowed a “cheat day”?
It depends on the person if that is helpful, but it can promote the mindset of being on a diet or off. If you choose to have that piece of birthday cake, choose it and enjoy it – don’t feel guilty about it. If you are making good choices for you and your health, tap into your motivation and make choices that inspire your motivation. It’s really your choice. Eating healthfully is not a diet – it’s a lifestyle change.
Beth Zimbicki, R.D., L.D., CDE, is a diabetes educator and registered dietitian at MedFirst. For more information or to book an appointment for nutritional counseling, call 497-2338. To learn more about the BHS Physicians Network, please contact Julie Minnick at firstname.lastname@example.org.
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A Pain in the Back What you need to know about low back pain By: [Dr. Hongbo Lui]
Low back pain (LBP) is a common complaint. Almost all of us will experience it at some point in our lives. LBP is one of the most common reasons prompting a physician visit. Fortunately, it is usually self-limited, and most of it responds well to several weeks of proper conservative treatment and selfcare.
Almost all of us will experience low back pain at some point in our lives.
What causes LBP?
The human backbone is a stack of bones called vertebrae. Together, they create a bony canal that surrounds and protects the spinal cord and nerves. Nerves enter and exit the spinal cord through spaces in your vertebrae. The vertebrae are held together by muscles, tendons, ligaments and disks. LBP can arise from problems with any of these components. While muscle strain and ligament sprain are the most common reasons for LBP, other common causes include bulging or ruptured disks, arthritis in the spine, scoliosis (abnormal curvature in an aging and arthritic spine) and osteoporosis. Rarely, LBP can be related to serious conditions like cancer or infection in the spine.
Is my LBP preventable?
Although LBP is very common, you can avoid it by improving your physical condition and practicing a healthy lifestyle. • Moderate aerobic activities such as walking
and swimming will allow your back muscles to function better. Some specific corestrengthening exercises can help build muscle strength and flexibility in your back and abdomen. • Proper posture is important for preventing LBP. • Cessation of smoking will help prevent premature aging of the spine. • Maintaining a healthy weight will reduce stress on your lower back.
When should I see my doctor for LBP?
Most back pain gradually improves with home treatment and self-care. If the pain persists or becomes worse after the first 72 hours of self-care, you should see your doctor. You should contact a doctor in time if the following red flags are present:
• New bowel or bladder problems • Pain going down one or both legs • Weakness, numbness or tingling in one or both legs • Unexplained weight loss and night pain • Recent significant injury of your back • Fever and a tender, warm area accompanying LBP You also should see your doctor if you start having back pain for the first time after age 50, or if you have a history of cancer, osteoporosis, steroid use or drug or alcohol abuse.
Hongbo Lui, M.D., is a fellowship-trained pediatric and adult spine surgeon and a fellowship-trained pediatric orthopaedic surgeon with the Children’s Orthopaedic & Spine Institute and Orthopaedic & Spine Institute Medical Centers.
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a healthy spring
Make 2013 your healthiest year yet by adding a new exercise regimen to your weekly routine in a few simple steps. By: [Dr. Kristen Kenroy]
As we head into spring, itâ€™s time to review and remind yourself of your New Yearâ€™s resolution. Whether your goal is to achieve weight loss or just to maintain a healthy lifestyle, there are appropriate steps to follow when starting a new exercise regimen. With anything that involves your health, you should always consult with a health care professional before starting physical activity. If you have other medical conditions such as diabetes, you may have to monitor your blood sugar more closely. To be safe, take along a source of good carbohydrates
or fruit juice in case your blood sugar gets too low. Also, consult with your doctor if you take insulin, as the time or dose may have to be adjusted for your exercise program. If you have any other conditions such as heart disease or high blood pressure, be aware of cardiac symptoms such as chest pain, shortness of breath, dizziness and/or heart arrhythmia while exercising. These may be signs of cardiac arrest or another serious cardiovascular complication, and require immediate medical attention. Despite the slight risk of complication with ex-
Exercise can reduce both the risk of heart attack or stroke and the progression of diabetes. 58
ercise if you have underlying health problems, the physical benefits you can achieve with exercise are far greater. Aerobic exercise can reduce blood pressure, cholesterol and body weight/fat. It has also been shown to have an impact on insulin resistance. Therefore, exercise can ultimately reduce both the risk of heart attack or stroke and the progression of diabetes. So how much exercise is required to benefit your health? The most current recommendation for general cardiovascular exercise from the American College of Sports Medicine (ACSM) is at least 150 minutes of moderately intense exercise per week. Moderate intensity exercise is defined as exercise at an intensity that is great enough to cause you to break a sweat, but during which you can still carry on a conversation. Exercising 150 minutes seems like a lot, but this amount equates to 30 minutes of exercise, five days per week. This may not be feasible when first starting an exercise regimen, and it can be broken up into even smaller segments of exercise (10 to 15 minutes) per day. As this becomes easier, you can gradually increase the time, frequency and intensity of your exercise. Be careful not to do too much, too fast, too soon, as this may lead to injury. If your goal is weight loss, this can be achieved with an appropriate balance of diet and exercise. It is as simple as expending more energy than you take in. A general rule for healthy weight loss is an average of one or two pounds per week. The amount of exercise the ACSM recommends is 250 minutes of moderate intensity exercise per week in order to achieve significant weight loss. This equates to at least 60 minutes of exercise five days per week. However, one can still lose a modest amount weight with 150 to 250 minutes per week. The hardest part about starting any exercise regimen is building it into your daily routine. It takes, on average, nearly three weeks for a behavior to become a habit or normal part of your daily schedule. To help ensure success, make small, yet feasible goals for yourself and monitor your progress on a weekly, or at times daily, basis. Keep an exercise journal to log the time, intensity and frequency of your workouts so you can see even the smallest improvements you have made. You may also find it helpful to purchase a pedometer to keep track of your daily steps, and use this information as part of your goal development. Exercise is not the most exciting activity to fit into our busy schedules because it does make us work! However, including a variety of types of exercise (walking, cycling, swimming), having an exercise partner or even listening to music or watching your favorite TV show while doing it can make it more fun. Best of luck as you make 2013 your healthiest year yet!
For more information on physical therapy or to schedule an appointment at Promotion Physical Therapy, please call 210-479-3334 or visit www.promotionptsa.com.
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Doctors in the WellMed network focus on the health and wellbeing of Medicare Beneficiaries. We believe preventive care is the key to keeping patients healthy and out of the hospital. Through the WellMed Care Model, primary care physicians coordinate patient care with specialists, hospitalists, and other healthcare providers ensuring our patients receive the care they deserve.
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Opioid-related patient safety and liability By: [Dr. David B. Troxel]
6.4% Anesthetics 5.8% Steroids 4.1% Chemotherapy drugs 4.1% Sedatives/Hypnotics 3.5% Antidepressants 3.5% Hormones 2.9% NSAIDs 2.9% Anticonvulsants 2.3% Antipsychotics Narcotic analgesics were the most common class of medications identified in these claims. They include the following: • • • • • • • • • • • •
Adverse drug events have become a subject attracting considerable attention, both in medical literature and in the lay press. In a recent report,1 the National Center for Injury Prevention and Control found that the number of overdose deaths from prescription painkillers (including hydrocodone, oxycodone, oxymorphone, and methadone) is greater than deaths from heroin and cocaine combined (both misuse and abuse). Drug deaths outnumbered traffic fatalities in 2011. Hydrocodone is now both the most widely prescribed and the most commonly abused prescription drug in America.
Dilaudid (hydromorphone) (3 claims) Dilaudid and morphine (3 claims) Dilaudid and oxycodone (1 claim) Percocet† (oxycodone) (2 claims) Oxycodone (1 claim) Vicodin† (hydrocodone) (7 claims) Norco† (hydrocodone) (1 claim) Methadone and oxycodone (1 claim) Methadone (2 claims) Morphine (4 claims) Fentanyl (4 claims) Darvocet† (propoxyphene) (1 claim)
Total: 30 claims †
Narcotic analgesics that also contain acetaminophen.
An analysis of 2,646 claims closed by The Doctors Company in 2011 revealed that 5.8 percent contained medication-related errors. These claims involved all medical specialties. The medication-related errors identified in these claims include the following: The medication classes involved in these medication-related errors include the following:
The medication-related errors identified in these 30 narcotic analgesic claims include the following: When compared to medication-related errors in all claims, monitoring errors in narcotic analgesic claims are more common (34.5 percent versus 20.8 percent), as are drug administration errors (17.2 percent versus 9.8 percent) and ordering errors (10.3 percent versus 6.5 percent).
Opioid analgesics and REMS
17.5% Narcotic analgesics 13.5% Anti-infective drugs 12.3% Anticoagulants 10.5% Cardiovascular drugs
What in the world is REMS? Robotic Exploration of Mars Study? Restoration of Egyptian Museums Society? Regulatory Earthquake Management Systems? Restoration of Epicurean Mannerisms Society? NO. It’s Risk Evaluation and Mitigation Strategies. Over the past decade, adverse events related to the inappropriate prescribing, misuse, and abuse of long-acting opioids have reached epidemic proportions and have become a source of substantial patient morbidity and mortal-
The number of overdose deaths from prescription painkillers is greater than deaths from heroin and cocaine combined. ity—and a growing cause of prescriber liability. As a consequence, the U.S. Food and Drug Administration (FDA) has mandated a Risk Evaluation and Mitigation Strategies (REMS) program for prescribing extended-release and long-acting opioid analgesics. In July 2012, the FDA announced plans to implement this voluntary program on March 1, 2013. As part of its REMS program, the FDA is requiring opioid manufacturers to provide grants that will fund continuing medical education (CME) programs to advance prescriber understanding and safe use of pain medications. The programs will be designed by independent, accredited organizations that provide CME for health professionals, and they will comply with standards set by the Accreditation Council for Continuing Medical Education (ACCME)—not standards set by the drug manufacturers. The drugs subject to REMS include hydromorphone, morphine, oxycodone, oxymorphone, and tapentadol in oral dosage forms; fentanyl and buprenorphine used in transdermal delivery systems; and methadone tablets and solutions. The CME programs are three hours long and cover three basic components: prescriber training to assure safe use, patient counseling (including the use of patient-prescriber agreements) on safe use and risks, and a medication guide for each opioid that patients will receive from the pharmacist when it is dispensed. In our analysis of the 30 medication-related errors involving narcotic analgesics, we identified the following opioids that are subject to the REMS program: hydromorphone (seven claims), morphine (seven claims), oxycodone (five claims), fentanyl (four claims), and methadone (three claims). Hydrocodone (eight claims) is not included in the REMS program. Thus, not only are medication-related errors involving long-acting opioids a patient safety concern; they are also a cause of significant professional liability for physicians and other prescribers. The Doctors Company has informed its 74,000 members about the patient safety and medical professional liability issues associated with opioid prescribing and encourages all physicians who prescribe long-acting opioids to complete this REMS CME program.
MED Logistics & Billing
“Your Practice Management and Billing Specialist” Medical Billing & Coding ● Workflow Management ● Compliance Management ● Audit Management ● Practice Management Consulting ●
CLOE SILL 218 Quinlan Street, Suite 554, Kerrville, TX 78028 830.928.9110 ● Fax: 866.941.6732 firstname.lastname@example.org
The incidence of medication-related errors in The Doctors Company’s 2011 medical professional liability claims is 5.8 percent, and long-acting narcotic analgesics account for 17.5 percent of the medications identified in these claims. We encourage all physicians who prescribe long-acting opioids to complete the REMS CME program for extended-release and long-acting opioid analgesics. Watch for future announcements about how you can advance safe use of pain medications while you earn complimentary CME credits.
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Centers for Disease Control and Prevention. Prescription painkiller overdoses in the U.S. Vital Signs. Pub-
lished November 2011. www.cdc.gov/vitalsigns/PainkillerOverdoses.
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 originally appeared in The Doctor’s Advocate, Fourth Quarter 2012. It was reviewed and edited according to the company’s policy and style.
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Willâ€™s Hope 4th Annual Luau May 10, 2013 6:30 p.m. - 10:00 p.m. San Antonio Country Club
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