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AUGUST | SEPTEMBER 2015

U Need 2 Put The Phone Down!

HI-FIVING THE FUTURE

IN ERIKA WE TRUST Dr. Gonzalez-Reyes Forges A Legacy of Leadership & Progress

The Orthopaedic Center of Corpus Christi uses robotic arm technology to give patients futuristic care and results

BY VANESSA TURNEY

BY REBECCA ESPARZA

Dr. Honrubia Is A Breath

ROBODOC Austin Drs. Fox and Manuel advance surgical outcomes with Stryker’s new robotic arm + 3-D imaging

ABOVE THE REST

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DISPLAY TILL SEPTEMBER 2015

THE HONRUBIA TECHNIQUE BRINGS A NEW STANDARD IN BALLOON SINUPLASTY LOCALLY AND ACROSS THE NATION BY JOEY GOMEZ

BY KIM ESTES


We are truly thankful for the memories we have...

“The word “Hospice” was fearful for me and my family. When Dad decided that he was tired of the chemo treatments, the hospital Case Manager recommended hospice. Donna from River City came and spoke with us and we agreed to try hospice so we can focus on enjoying the time we had left with Dad. We are truly thankful for the memories we have... hospice is no longer fearful, it is special to us and we will never forget them being there to show us the way.” -Susan C. “Hospice is the most rewarding job I have had as a nurse. It allows me to do what I had envisioned when I became a nurse; be there for the patient and the family. I get more one-on-one time with my patients and get to know them and their family, which makes my job very rewarding.” -Scott T. “My wife passed almost six months ago. River City Hospice still contacts me to see how I am doing. They even asked about Scruffy, my dog. People at hospice are true angels and I thank you for your help.” -David S.

For more information, please call 1-877-537-4837 River City Hospice provides loving care to patients and their families. We understand that a terminal illness presents many challenges including physical, emotional, spiritual and social. Our caring, experienced team of professionals and volunteers are prepared to meet these challenges.


Did you know? Hospice is a compassionate, patient-centered approach to medical care and support for people at the end of life and their families. It’s care focused on maintaining dignity, increasing quality of life, and providing comfort, including pain and symptom control. Hospice recognizes that every person’s experience will be different and the hospice team creates a plan of care according to the individual needs and wishes of each patient.

B e c a u s e E ve ry Mome nt Cou nt s Learn More at: w w w.rivercityhospice.com

Our Texas Locations: Alice - 361-664-4888

Corpus Christi - 361-882-5900

Austin - 512-292-4929

Hondo - 830-584-2030

Bandera - 830-796-7979

Jasper - 409-383-0788

Beaumont - 409-832-3311

Port Arthur - 409-982-2273

Boerne - 830-816-5578

San Antonio - 210-858-9138


A Spring 2015

HOSPITAL SAFETY SCORE SM


SOUTH TEXAS ALLERGY & ASTHMA MEDICAL PROFESSIONALS

ALLERGY & asthma RELIEF YOU CAN COUNT ON

WE SPECIALIZE IN THE TREATMENT OF: At STAAMP we take great pride in providing a comprehensive evaluation accompanied by selective and efficient testing. We believe that many allergic concerns can be helped greatly by proper education and lifestyle changes with careful use of medications. Our mission is to provide world-class care in a compassionate and friendly environment. We look forward to working with you!

• Allergies to pollens, molds, dust and pets • Allergies to foods, medications and insect stings • Asthma and other lung conditions • Chronic cough • Chronic sinus problems • Hives, swelling and skin rashes • Recurrent infections and immune deficiencies • Eosinophilic esophagitis

JOHN DICE, M.D. ERIKA GONZALEZ-REYES, M.D. MARK STAHL, D.O.

WWW.STAAMPALLERGY.COM

Hours: Mon-Thu 8am-5pm, Fri 8am -1pm & Sat 8am-12pm

10447 Highway 151, San Antonio, TX 78251 • Office 210-616-5385, Fax 210-647-1012


UT Medicine San Antonio Medical Arts & Research Center

Anesthesiology Audiology Cardiology Cardiothoracic Surgery Cosmetic Surgery Day Surgery Center Dermatology Endocrinology Executive Health Family Medicine Fertility Center Gastroenterology

Now Offering

General Surgery Geriatric Medicine H-E-B Pharmacy Hematology/Oncology Imaging Center Infectious Diseases Internal Medicine Lab Services Maternal/Fetal Medicine Men’s Health Nephrology Neurology

MYCHART

We accept most major health plans. For an appointment, call (210) 450-9000. www.UTMedicine.org

Neurosurgery Obstetrics & Gynecology Ophthalmology Optometry Orthopaedics Otolaryngology Pediatrics: General and all specialties Physical & Occupational Therapy Plastic & Reconstructive Surgery

Podiatry Psychiatry Pulmonary Medicine Radiology Rehabilitation Medicine Rheumatology Sports Medicine Travel Medicine Urology Vascular & Endovascular Surgery Women’s Health

8300 Floyd Curl Drive, San Antonio, TX 78229


• • • •

Most insurance plans accepted. Financing available.

Diabetic eye exams Macular degeneration Cornea transplants Eyelid surgery


EXPERT PRIMARY CARE.

Close to Home.

Lori Shirley-Wenzel, MD Internal Medicine Alamo Heights, Broadway (210) 824-5392

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Scott Horn, MD Family Medicine Alamo Heights, Sunset (210) 824-5201

Doris Ling, MD Family Medicine Castle Hills (210) 541-8689

Patricia Mackin, MD Family Medicine Castle Hills (210) 541-8689

Nishi Thakur, MD Internal Medicine Castle Hills (210) 541-8689

Angela Malarcher, MD Internal Medicine Downtown (210) 224-1771

Lovelesh Manocha, MD Internal Medicine Downtown (210) 224-1771

Heberto Garza, Jr. MD Internal Medicine 281N & Thousand Oaks (210) 824-5392

Paul Smith, Jr, MD Internal Medicine 281N & Thousand Oaks (210) 824-5392

Felicitas Gonzales, MD Family Medicine 281N & Thousand Oaks (210) 200-6744

Edward Lin, MD Family Medicine Northeast (210) 653-2693

Shashi Mittal, MD Family Medicine Northeast (210) 653-2693

Abe Rodriguez, MD Family Medicine Northeast (210) 653-2693

Marijan Gillard, MD Family Medicine Northwest (210) 453-1199

Julia Pursch MD Family Medicine Northwest (210) 453-1199

Blaine Carmichael, PA Family Medicine Schertz (210) 656-5600

Belmund Catague, MD Family Medicine Schertz (210) 656-5600

Victoria Chang, DO Internal Medicine Schertz (210) 656-5600

Kirsten Fikes, PA Internal Medicine Schertz (210) 656-5600

Jessica Barrientos, PA Internal Medicine Overlook (210) 497-2338

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

Ricardo Escamilla, MD Family Medicine Southeast (210) 333-0798

Erika Garza, MD Family Medicine Southeast (210) 333-0798

Daisy Ramirez-Estrada, MD Cesar Gerez-Martinez, MD Family Medicine Family Medicine Overlook Westover Hills (210) 497-2338 (210) 681-0126

Lubna Naeem, MD Internal Medicine Stone Oak (210) 490-3800

Luis Berrios, NP Internal Medicine Stone Oak (210) 496-2669

Steven Bauer, MD Internal Medicine Overlook (210) 497-2338

Sanjay Kumar, MD Internal Medicine Westover Hills (210) 681-0126

Cherry Maximo, MD Family Medicine Westover Hills (210) 681-0126

Inez King, NP Family Medicine Westover Hills (210) 681-0126 042815

For more information or to schedule an online appointment visit Med1st.com


From Grandkids to Grandparents, there’s no care like Angel’s Care.

Your leading providers in: • “Crown In a Day” CEREC® • Invisalign® • Implants • Sedation Dentistry • Cosmetic Dentistry

At Angel’s Care Dentistry on Wurzbach, our three premier San Antonio dentists use advanced dental technology with over 60 years of combined experience to give our patients exceptional service. We want you to walk in and out of practice with a smile on your face. If you want the best in family-oriented dentistry, Angel’s Care Dentistry at Wurzbach is the place for you. www.angelscare.com 11115 WURZBACH, SUITE 100 SAN ANTONIO, TX 78230

CALL TODAY!

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CCRH is the

only free-standing

Acute Rehabilitation Hospital in the Coastal Bend Area You have a choice We understand that YOU HAVE A CHOICE when it comes to your rehabilitative care. At Corpus Christi Rehabilitation Hospital (CCRH) we value teamwork and are connected at our core by the treatment needs of our patients. We are proud to be a freestanding acute rehabilitation hospital serving Corpus Christi, providing attentive and compassionate patient care to the community in which we serve.

Brain Injury • Amputations • Stroke • Neuro • Orthopedic CCRH is now part of the Ernest Health network of facilities. Eight of Ernest’s rehabilitation hospitals have consistently ranked in the top 10% of Inpatient Rehab Facilities in the United States by UDSMR®. Ernest Health strives for all their hospitals to receive this recognition. To learn more about CCRH and our services, visit our website at

CCRH.ernesthealth.com

5726 Esplanade Drive • Corpus Christi, TX 78414 • 361.906.3700


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{ COVER STORY }

contents 60 | Robots, Surgery and the 21st century, Oh my! The Orthopaedic Center of Corpus Christi paves the way for the future of surgical procedures with Stryker’s Mako.

66 | Balloon and Expand The South Texas Sinus Institute makes their mark with balloon sinuplasty and sets their sights on conquering Texas, and the nation, one procedure at a time.

Woman of Honor From Air Force Blues to stethoscopes and scrubs, Dr. Erika Gonzalez-Reyes brings new life to the community and ardently advances her field

70 12

TxMD

74 | Make Mine A Mako Austin Drs. Fox and Manuel employ and laud the latest in surgical technology from Stryker

AUG./SEPT. - 2015

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NSIDE TEXAS / TEXAS MD MAGAZINE AUGUST / SEPTEMBER 2015

Senior Care of Rio Grande CEO

Rio Grande’s Choice for In-Home Senior Care.

ELIOT GARZA ELIOT@TEXASMDMONTHLY.COM PUBLISHER

VANESSA TURNEY VANESSA@TEXASMDMONTHLY.COM

EDITOR-IN-CHIEF SINJIN HILASKI CREATIVE DIRECTOR FISHER CREATIVE DIRECTOR OF OPERATIONS KIMBERLY SCOTT DIRECTOR OF MARKETING AND SOCIAL MEDIA MARGAUX GONZALEZ HUCKABAY FASHION AND BEAUTY EDITOR TORI JOHNSON CONTRIBUTING WRITERS CRISTY HAYES DR. LISA MARTEN HOLLY COYLE ALBERT CAVAZOS KIM ESTES ANDY TIWARI JOEY GOMEZ DR. ERIKA GONZALEZREBECCA ESPARZA REYES SANDY CASTILLO JEFF WOOD STEWART BEASLEY BILL PACE LIA MEDRANO JENNIER BUERGERMEISTER DR. STEPHEN MAY STACY ALLRED DAVID ELLER JOHN HAWKINS NICHOLAS NILEST CONTRIBUTING PHOTOGRAPHERS JOEL MARTINEZ JOHN PATTON JOSHUA MICHAEL JOSHUA NOLDEN RUDY XIMENEZ JENNIFER HAMILTON

Meal preparation, housekeeping, companionship, grocery shopping. Managing behaviors, assisting with activities of daily living. Transportation prescription pick-up, doctor appointments, beauty care appointments.

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FOR ADVERTISING INFORMATION, PLEASE CALL (210) 373-2599 OR EMAIL ELIOT@TEXASMDMONTHLY.COM. FOR EDITIORIAL COMMENTS AND SUGGESTIONS, EMAIL VANESSA@TEXASMDMONTHLY.COM 22211 INTERSTATE HIGHWAY 10, SUITE 1206 SAN ANTONIO, TEXAS 78257 P: (210) 892-3011 Copyright ³ NSIDE Media Productions. All rights reserved. Reproduction without the expressed written permission of the publisher is prohibited. 2015 - AUG./SEPT. TxMD

Professional, Reliable & Caring. Available 24 Hours A Day, 7 Days A Week.

13

Hospice support services and respite services. REQUEST MORE INFORMATION

(956) 245-9796 www.seniorcarerg.com


contents

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FINANCE

INFORMED PATIENT

16 | Can You Afford To Retire?

44 | Oral Health = Overall Health

Albert Cavazos breaks down the numbers and gives insight into projecting how much you’ll need to retire comfortably.

Dr. Kevin Klenke, of Angel’s Care Dentistry, explains the oral systemic link and how good oral health directly impacts your overall well-being.

PROFILE

26 | Weltreisende Extraordinaire From Germany and Peru to Vietnam and France, Independence Hill resident Ehrenfried Wagner has traversed the globe, served our country and visited nearly every continent. MEDICAL BUSINESS

28 | More Than Medicine Hospitals can be cold, formal and uninviting. The Cardiology Specialists of Houston shatter that perception with their personal connection and a vested interest in patients’ complete recovery. LEGAL

32 | Thwart The Digital Criminals The advent of the digital age has ushered in a new class of criminal scouring the web for your medical records.

“Stem Me Up Scotty”

34

RESEARCH

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TxMD

ASK THE EXPERTS

46 | Do You Know Your Heart? Dr. Stephen May discusses heart rhythm disorders, symptoms, and the slew of treatment options offered by the Arrhythmia Associates of South Texas. ASK THE EXPERTS

48 | Minimally Invasive, Immensely Beneficial Dr. Seema Izfar divulges the latest advances in minimally invasive surgery and its impressive benefits for colon and rectal procedures. NEWS & VIEWS

58 | Why Do Hackers Want Your Medical Records? Today, criminals are willing to pay 20 times more for stolen medical records than they are for stolen credit card information

Celltex Therapeutics propels the state of regenerative medicine and stem cell therapy in the U.S.

AUG./SEPT. - 2015

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Join us for the

“Ride of Your Life”... come experience the fun!

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Come see why everyone is ZOOMing over!

(210) 782-9892 20450 Huebner Road San Antonio, Texas 78258

www.independencehill.com Lic #100102


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FINANCE / SAN ANTONIO

How Much Do You Need to Retire?

health insurance as you grow older. For instance, the average nursing home now costs more than $87,000 a year, and it’s likely to continue increasing. With these variables comes the realization that the responsibility for providing the bulk of your retirement income rests with you.

BY ALBERT CAVAZOS, CFA

C

AN YOU PICTURE YOUR RETIREMENT? If you can envision those future years, you’d probably see a life full of activity and decades of health, happiness and prosperity. The problem with this picture is that the pleasure and comfort of your later years depend, in large part, on the actions you take today.

Gaining An Edge: Personal Saving Is the Key The aging workforce, and the rising uncertainty of Social Security,

has increased the demand for retirement plans. Saving for retirement in a tax-efficient and low-cost investment program can accelerate your retirement savings. Also, investing in tax-efficient, non-retirement strategies involving real estate, stocks, and bonds can play a significant role in accumulating your nest egg.

CONTINUES ON PG. 20

TABLE 1 FACTORS

Today’s Planning Variables Americans used to count on a pension plus Social Security to get them through their “golden years,” but times have changed. Nowadays, Social Security represents a little more than 30 percent of the aggregate income of Americans age 65 and older. Social Security benefits are less significant, and the sums are diminishing and the age you can begin receiving benefits is higher. As you think about how much you’ll need for a comfortable retirement, you may be startled to learn the impact of inflation. At an average inflation rate of 3 percent, your cost of living would double every 24 years. Your annual income will need to increase each year during retirement in order to maintain your standard of living. You’ll also have to consider the likelihood of increased medical costs and

YEARS

INFLATION

GROWTH

MULTIPLIER

5

1.16

1.47

6.34

10

1.34

2.16

15.65

15

1.56

3.17

29.32

20

1.81

4.66

49.42

25

2.09

6.85

48.95

30

2.43

10.06

122.35

35

2.81

14.79

186.1

40

3.26

21.72

279.78

*Assumes 3% annual inflation and a 5% annual return.

TABLE 2 SOCIAL SECURITY INCOME ESTIMATE ** YEARS TO RETIREMENT Current

40

35

30

25

20

15

10

5

20,000

29,500

27,000

25,000

22,500

20,500

19,000

17,500

16,000

30,000

32,500

30,000

27,500

25,000

22,500

21,000

19,000

17,500

40,000

35,500

32,500

30,000

27,000

25,000

23,000

21,000

19,000

50,000

38,500

35,500

32,500

29,500

27,000

25,000

22,500

21,000

60,000

41,500

38,000

35,000

32,000

29,000

26,500

24,500

22,500

70,000

44,500

41,000

37,500

34,000

31,000

28,500

26,000

24,000

80,000

47,500

43,500

40,000

36,500

33,500

30,500

28,000

25,500

90,000

50,500

46,500

42,500

39,000

35,500

32,500

29,500

27,500

97,500+

53,000

48,500

44,500

40,500

37000,

34,000

31,000

28,500

*Assumes 3% annual inflation

FOR MORE INFORMATION CALL AC FINANCIAL 210.231.0456 OR VISIT WWW.MYACINVESTMENTS.COM. AC FINANCIAL IS LOCATED AT 242 W. SUNSET, SUITE 101 IN SAN ANTONIO, TX 78209.

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C A R D I O VA S C U L AR S P E C I A L I S T S O F T E X A S

MAKE YOUR HEART HAPPY. Visit one of our cardiology centers.

We believe in the sacred relationship between physician and patient that will last a lifetime. In keeping with that goal, we keep focus on delivering the personalized patient care that truly makes our practice a center of excellence.

COMPREHENSIVE CARDIOVASCULAR CARE

• Complete head to toe cardiac and vascular evaluation • Comprehensive cardiac testing • State-of-the-art facilities

• Advanced cardiac treatments • Coordinated medical management • Comprehensive patient education and self-care instruction

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• Chest pain

• Risk of heart attack

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• Palpitations or irregular heart beats

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• Hypertension • High cholesterol

• Peripheral artery disease • Pacemakers • Obesity

POST OAK CENTRE, N. 2200 PARK BEND DRIVE BLDG. 1, STE. 401, AUSTIN, TEXAS 78758 • F: 512.339.7838 7215 WYOMING SPRINGS, STE. 100, ROUND ROCK, TX 78681 • F: 512.615.9908

W W W. C S T H E A R T. C O M / P : 5 1 2 . 8 0 7 . 3 1 6 0 ( A U S T I N ) / P : 5 1 2 . 8 0 7 . 3 1 8 0 ( R O U N D R O C K )


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FINANCE / SAN ANTONIO

A Mission Statement for Your Family 8 Rules To Strengthen Family and Preserve Your Legacy BY STACY ALLRED, DIRECTOR OF THE WEALTH STRUCTURING GROUP AT MERRILL LYNCH

A

GROWING NUMBER OF FAMILIES ARE ADOPTING FAMILY MISSION STATEMENTS. Also known as a family constitution, or code of conduct, such a statement can be valuable in uniting a family around common goals and the actions needed to make them a reality. A mission statement can provide foundational concepts that help solidify future decisions. It can guide the way your family wants its money to be used, whether for education, entrepreneurship or philanthropy. Every family can benefit from a mission statement, regardless of wealth level. A shared purpose strengthens family bonds, and it provides guidance around major life decisions and goals. The statement can also teach younger members about making financially and socially responsible decisions.

Family statements can vary widely, but there are eight rules of thumb to keep in mind. 1. Involve everyone Ideally, the entire family should collaborate in developing the mission statement. Even children should participate so they have first-hand experience of being part of the discussion. 2. Define your key values Ask each family member: “What would you like this family to stand for? What are our aspirations?” Family values can range from characteristics like integrity, work ethic and making a difference to more personal considerations. Clarify the purpose of money in your family. Money can hinder growth and development, and being clear on its purpose can minimize this effect. 3. Think ahead Consider long-term goals. It’s hard to come up with a mission statement without envisioning

the future. Look at long-term goals. What kind of legacy do you want for your family? This will help firm your goals and time horizons for the family. A simple, yet powerful, exercise is to envision 25 years into the future, imagining that both you and your family have lived a life that you are proud of. What does that look like? What is your definition of success? 4. Keep it focused Work together to summarize the values and goals you’ve defined in a single sentence or paragraph. You want a statement general enough to be timeless, yet specific enough to apply to real-life issues. If you have more ground to cover, the statement can be supplemented with a list of supporting values or guidelines, such as resolving conflicts among heirs or distributing profits from a business. 5. Check your authenticity Don’t just craft a statement because it sounds good. It should be in your words and language, and it should be something you truly believe in. It can be aspirational, but should also reflect your current values and beliefs. 6. Keep it front and center Whether you frame your statement or post it on the

refrigerator, it’s important to have it on hand. This is a dynamic document; review it when weighing life-altering decisions, such as a job change or major financial investment. 7. Put it into action To realize the goals behind your mission statement, you’ll need to make it part of your regular planning and decision making. Use it to create a list of values that can help you adhere to the statement. For example, many families will have a list of bulleted value statements that follow their mission statement, to articulate their values in general and on the earning, spending, saving and sharing of money. With the help of a financial advisor you can then implement more detailed and specific guidance toward making decisions. It also helps to habitually ask yourself how your plans fit your values. 8. Revisit and revise annually Plan to gather annually as a family to discuss the mission and gauge family members’ success in achieving their goals. Mission statements may require updates as families CONTINUES ON PG. 21

FOR MORE INFORMATION, CONTACT MERRILL LYNCH FINANCIAL ADVISOR, TIFFANY MOCK BRIGGS, IN THE SAN ANTONIO LACANTERA OFFICE AT 210-278-3813 OR TIFFANY_MOCK@ML.COM.

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IS YOUR CHILD’S GROWTH & DEVELOPMENT ON TRACK?

CALL ! W.4492 N0.O 826

21

AT ND US A.ORG I F R O ONS RIGHT B . W W

W

Every child is different and learns at

his or her own pace. If you think your

child (0 - 3 years) is not on target, you can call the Brighton Center for more information about developmental

milestones and the services that we

offer to help get your child on track.

WHAT WE OFFER: •

Services that come to you! Brighton provides services wherever is most convenient for you and your child (family home, child care center, etc.)

Evaluation of your Child’s Development

Physical Therapy Services

eci early childhood intervention

Speech Therapy Services

Occupational Therapy Services

Case Management

Counseling

Referrals to other services in the community

• •

Services that can be billed to your insurance provider Access to other Brighton Center programs including, Parent Programs and Child Care Centers

Brighton Center provides therapy and other services for children ages 0 - 3 with disabilities who are displaying developmental delays. Through a team approach, children and their families are given the education, tools, strategies and services they to help them reach their maximum potential!

For more information regarding the Brighton Center’s services and their volunteer and donor opportunities, please call 210.826.4492 or visit www.brightonsa.org.


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FINANCE / SAN ANTONIO

Propel Yourself Into A Richer Future Invest in tomorrow with smart financial decisions today BY JOHN HAWKINS

T

HERE IS AN ADVANCED TAX STRATEGY GROUP THAT MEETS IN DIFFERENT PARTS OF THE U.S. SEVERAL TIMES A YEAR. The group is comprised of elite attorneys, CPAs and financial advisors. Over the last few years, they have developed two of the most valuable proprietary tax strategies that I have ever seen. I will briefly go over one of those strategies here in just a moment. But first, answer these questions: • When do you plan on retiring? • Do you have a plan in place? • Are you currently where you want to be according to that plan? • If things didn’t go according to plan and you or your family needed penalty free access to your money, could you easily obtain it? How would you like the opportunity to make an investment that is shielded from market losses and penalties, yet posts market gains on up to 10x the amount of your investment with tax-free access to your cash? It sounds too good to be true, right? Yep, we hear that all the time. It’s what everyone says right before they ask for more

information. That scenario is possible through our leveraged retirement strategy. It is designed to maximize and expedite retirement funding by leveraging financial institutions’ capital on top of your own for maximum gains and minimum risk The catch is qualifying; clients are required to have a minimum net worth or adequate cash flow. For example, an investor may place $100K annually into one of the investment vehicles, while an A+ Financial Institution contributes up to an additional $1 million annually on the investor’s behalf. Typically, these arrangements are setup for five years. So, an investor would be able to leverage $5 million of the financial institutions money with only $500K total

personal investment. What is Warren Buffet’s number one rule for investing? “Don’t lose money.” The funds are put to work inside the investment vehicle, which is indexed to the S&P. The vehicle carries a guaranteed minimum annual return, a “floor,” meaning that the vehicle will not lose value, even when the market declines. This floor is a key feature as to why this strategy works so well. Because of the compounding interests, and the built in floor, the vehicles are earning between 6 to 8.5 percent annually. Net. And that’s on the entire $5 million investment, not just the investor’s $500K. What does this mean? It means that a client in their 40s today, investing

$100K for just the next five years, may have tax-free income upwards of $1 million per year for 30 years at retirement age. It is no different than leveraging investors’ capital to buy and sell real estate, with the exception of market loss, a high risk that has been minimized with this strategy. The developer has been working with ultra-high net worth clients for over 30 years and teaching them the most tax-efficient ways of accumulating and passing down wealth. For corporate clients, this strategy can serve for key man, fund buy/ sell agreements, retain and attract key employees, and it can be used for a deferred compensation plan all in one.

CONTINUES FROM PG. 16

Let’s Crunch the Numbers and Estimate How Much You Need! While this is simplistic, try and follow the key concepts. Experts estimate you will need some 80 to 100 percent of your annual income each year in retirement. Find out how close you are to meeting this goal by completing the following exercise. 1. Estimate your future cost of living Multiply your current earnings

by the inflation factor from figure one, based on the number of years you have until retirement. Example: If you are currently making $100,000 and have 20 years until retirement, your formula is $100,000×1.81 = $181,000. 2. Determine the percentage of your current income you may need after retirement If 100 percent seems high, consider while you may be able to stop paying some expenses, like

FOR MORE INFORMATION CONTACT JOHN HAWKINS AT 888.940.7827

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mortgage payments, other expenses may increase, such as health and travel expenses. Multiply that percentage by the amount in step one. Example: $181,000 x .85 = $153,850. (85 percent of annual income)

If you are using figure two, take the number corresponding to your annual salary and years to retirement. Example: With $100,000 in earnings and 20 years to retirement, your estimated benefit would be $37,000.

3. Estimate your future Social Security and other pension retirement benefits The best source for Social Security benefit projections is the Social Security Retirement Estimator at www.ssa.gov/estimator. (If you cannot access the official calculator, you can get a rough estimate of your benefit from figure two.)

4. Calculate the net income you need to maintain your standard of living Subtract your Social Security benefits and other retirement benefits from the annual amount calculated in step two. This will give you an estimate of how much of your own savings you will have to CONTINUES ON PG. 25

CONTINUES FROM PG. 18

evolve. As time passes, make sure the mission statement remains authentic and continues to reflect the values of your evolving family. Consider asking your Financial Advisor the following questions about family mission statements: Does a family mission statement make sense for me?

Can you provide guidance on what financial considerations should go into a useful family mission statement? Can you help me organize a family meeting to get the conversation started? “Merrill Lynch” refers to any company in the Merrill Lynch & Co., Inc., group of companies, which are wholly owned by Bank of America Corporation.

“What would you like this family to stand for? What are our aspirations?”


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PHYSICIANS IN THE NEWS / HOUSTON

Health Is A Hands-On Art Dr. Evan Collins helps those who heal the soul BY CRISTY HAYES

D

R. EVAN D. COLLINS, chief of the Houston Methodist Hand & Upper Extremity Center at the Texas Medical Center, was recently named Chairman of the Houston Methodist Center for Performing Arts Medicine (CPAM). Collins, who previously served as vice-chairman of CPAM, now occupies an expansive

new space dedicated to the care of performing artists and patients suffering from common,

as well as complex, hand and upper extremity injuries and conditions. His work with athletes within the performing arts spans decades and includes the Houston Symphony and the Miró Quartet. Dr. Collins speaks regularly to university students and professional performing arts programs on the most common conditions affecting performing artists, and he is currently working on an innovative new research project focusing on these conditions. His findings are expected to translate into new protocols and preventive therapies for the general population at risk for repetitive stress injuries as well. Collins is boardcertified and fellowshiptrained in surgery of the hand, and he holds a certificate of added qualifications for surgery of the hand (CAQSH). He also obtained his MBA from Rice University, Jesse H. Jones Graduate School of Business and holds a faculty appointment at Weill Cornell Medical College. “Our center is unlike any other resource for performing artists. As athletes have sports medicine teams and centers to

support their high-demand occupation, we cater to this unique population of athletes. We understand the demands placed on every aspect of their body, and we take an integrated approach to not only addressing their injury but also ensuring their overall well-being,” said Collins proudly. “I am honored to receive this appointment, and I look forward to the growth of our center and what we’re able to offer these performing artists, who continue to nurture us through the arts they perform,” said Collins. A published author, his research findings are featured in international peer-reviewed orthopedic journals and surgical text books. His latest research article, “Radial Ridge Excision for Symptomatic Volar Tendon Subluxation Following deQuervain’s Release,” was featured in a recent issue of Techniques in Hand & Upper Extremity Surgery. Collins who is again this year recognized as an H Texas Top Doc, a Texas Monthly Super Doctor and one of Castle Connolly’s Best Doctors in America, is also part of the Houston Methodist Hospital healthcare team providing care to collegiate and professional athletes throughout Texas.

TO READ MORE ABOUT DR. COLLINS AND HIS LATEST TREATMENT OPTIONS FOR COMMON, AS WELL AS COMPLEX, INJURIES AND CONDITIONS AFFECTING THE HAND, WRIST, ELBOW AND SHOULDER GO TO WWW.DREVANCOLLINS.COM. OR CALL 877.72.MYDOC (877.726.9362) FOR A CONSULT.

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PHYSICIANS IN THE NEWS / HOUSTON

Heal The Burn Special To Texas MD

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RIVEN BY THE VISION OF PROPER DIAGNOSIS AND EFFECTIVE HEARTBURN TREATMENT, Dr. Elias Darido opened the Houston Heartburn Center. Dr. Darido has been in practice for nine years, and today he’s the founder of the Houston Heartburn and Reflux Center. Maintaining an impeccable safety record, he specializes in a wide range of advanced laparoscopic surgeries involving the gastroesophageal area. Dr. Darido is particularly focused on the upper part of the stomach known as the gastric fundus, and he employs a procedure called Nissen Fundoplication, which is used to wrap the fundus around the esophagus

to prevent acid reflux. Dr. Darido grew up in Lebanon. He attended the prestigious American University of Beirut. After graduating from medical school with honors, he moved to the United States. He trained in general surgery at Good Samaritan Hospital and The University of Cincinnati, two institutions renowned for their surgical tradition. Afterwards, he was accepted as the advanced laparoscopic and weight loss surgery fellow at the University of North Carolina, Chapel Hill. There he completed two additional years of subspecialty training under the world-renowned heartburn and reflux specialist Dr. Timothy Farrell.

FOR MORE INFORMATION OR TO CONTACT DR. DARIDO CALL 832.324.3100, AND YOU CAN VISIT WWW.HOUSTONHEARTBURN.COM OR WWW.HOUSTONSLEEVESURGEON.COM.

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The Houston Methodist Hand & Upper Extremity Center CONTINUES FROM PG. 21

use each year in retirement. Example: $153,850 - $37,000 = $116,850. 5. Estimate the total amount you will need to retire Multiply 19.3 by the annual amount you calculated in step four. This represents how much savings you would need to last 30 years at 3 percent inflation and earning a 6 percent annual return. Example: $116,850Ă—19.3 = $2,255,205. In this example, the goal is an estimated $2,255,205 for retirement. If you are concerned about your retirement accumulation goals, take heart. You have some powerful allies

on your side. First is the power of compounding, which takes advantage of time. Tax deferral is another ally. Use investment vehicles designed to put off paying taxes on your earnings until you are retired and potentially in a lower tax bracket. Meanwhile, your contributions may be pre-tax or tax deductible, helping reduce current tax bills. If you need professional help, don’t underestimate the benefit of working with a qualified financial advisor. An expert can help you implement an investment program and monitor your progress. Having someone keep you accountable in working towards your goals is invaluable. Do not delay planning for your retirement.

Evan D. Collins, MD, MBA dic surgeon who specializes in the hand and upper extremity. Formerly the Chief of the Hand Section and Director of the Hand Fellowship at Baylor College of Medicine, today he serves as Chief of The Houston Methodist Hand & Upper Extremity Center, an expansive new state of the art center at the Texas Medical Center. He is a member of the faculty of Weill Cornell Medical College and for the Houston Grand Opera, Houston Astros, Houston Texans, and the Houston Dynamo. Areas of Specialty include: • Repetitive stress injuries and conditions • Carpal Tunnel Syndrome • Fractures and dislocations • Dupuytren’s Disease • Trigger Finger • Arthritis • Minimally invasive endoscopic procedures • Fracture repair • Percutaneous Needle Aponeurotomy (PNA) • Ligament Reconstruction and Tendon Interposition (LRTI) • Joint reconstruction • Total joint replacement

  !   !     !   !   !     !                         "           ! myemma.com/nside

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• • • • • • • • • •

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

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The Houston Methodist Hand & Upper Extremity Center 6560 Fannin, Suite 410 (Scurlock Tower) Houston, Texas 77030 Phone 877.72 MYDOC (726.9362) Fax 713.790.2142

www.drevancollins.com


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PROFILE / SAN ANTONIO

Languages, Love And Life Vietnam veteran, world traveler and linguist extraordinaire, Independence Hill Retirement Community resident Ehrenfried Wagner is a globetrotting jack-of-all-trades BY JEFF WOOD | PHOTOGRAPHY BY JOSHUA MICHAEL

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HRENFRIED WAGNER IS A MAN WHO CAN SAY HE HAS BEEN ALL OVER THE WORLD, lived a thousand different lives and every word of it is true. As a member of the U.S. Army for 30 years, he has made roots on five different continents, speaks seven different languages, served our country in Vietnam, and retired in San Antonio as a husband and father. But to Wagner, the real story of his life is his wife, Joan Wagner. As he put it, “She’s 100 percent my life.” Wagner was born on August 9th, 1934 in Peru. Wagner’s parents

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came from Germany in 1925 to Peru, where his father worked as a hospital administrator. Wagner began his childhood in South America before finding his way to the United States. “We lived in Peru, Argentina and Brazil, and then we came up to the States in 1950,” recalls Wagner. It was at an early age that Wagner’s interests started leaning toward learning languages. “I’m conversational in seven different languages. I was born speaking German at home and Spanish in school. Then we went to Rio, and I had to learn Portuguese. Then we came to the U.S., and I had to

learn English, which my wife says I still don’t know how to speak,” laughs Wagner. Wagner had dual citizenship in Germany and Peru, and he got his green card. He was drafted by the Army in November of 1952. He received his American citizenship in Germany in 1955 while beginning his work in hospitals as an operating room tech for seven years and also learning Vietnamese in language school. When the Vietnam War came, Wagner served his country running the third largest Post Exchange (PX) near Saigon. “It was the Wal-Mart of the military,” jokes Wagner, “We’d sell everything. We did a million and a half dollars in business a month in 1968. We had a warehouse of about three million dollars worth of merchandise.” He was originally assigned to Vietnam as an interpreter because of his schooling in the Vietnamese language, but his job title quickly changed. “They had some problems with the Khaki Mafia at the time. Some of the military were getting caught in this contraband ring. The manager got picked up, and they didn’t have anyone to run the PX, so I volunteered for it,” details Wagner. After running trucks

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back and forth to Saigon for supplies and managing the PX for a year, Wagner continued his work in the military after Vietnam with an array of different job titles and in many different countries. But it was his job in classification assignment and personnel at Fort Sam Houston that lead him to meet his wife, Joan. “She was also in the Army as a certified, registered X-ray tech, and after basic training, she came to San Antonio where I was working in personnel. My job was picking people for their jobs, and I liked her, so I picked a job for her right next to my desk,” laughs Wagner, proudly adding that, “A year later, we got married.” From there, Ehrenfried, Joan and their daughter, Heidi Lynn, began their journey traveling and working overseas, where Wagner learned two more languages. “We lived in France and Germany twice. While we were there, I kind of picked up French and Italian. We also lived in the Panama Canal Zone for three years before it went back to Panama. The only two continents I haven’t been to are Antarctica and Australia,” recalls Wagner. The family’s favorite place to live after all of their travels was Kenya, on the continent of Africa. “I almost got out of the Army, as I had 20 years in the military, so we could retire there. We went there on

a safari, stayed on the coast of the Indian Ocean near Mombasa and it was heaven down there,” says Wagner. With his career in personnel and administration, Wagner had to become a jack-of-alltrades, covering hundreds of different jobs. “If you don’t know how to do something, you go learn it,” Wagner explains. “When I was in France, I was in charge of a U.S. military housing area with 880 units for military, civil service people and their dependents. I was the NCO for a DOD high school there. I was chief clerk for the post commander, and I was first sergeant of the garrison. In Germany, I was in charge of a medical illustration detachment with 13 German workers, handling all the medical conferences in Europe,” Wagner recounts. After 30 years of service in the military, Wagner retired as a sergeant major, but his work didn’t slow down. “My last 13 years in the army, I was an inspector general, and then I had 17 years of civil service at Fort Sam before I retired,” says Wagner. After all the careers, travel, and years of being in and out of this city, dating all the way back to 1959, Wagner and his wife were finally able to relax and settle into San Antonio. They chose to make their home and lives at

Independence Hill Retirement Community, where they enjoy living a much simpler life. “The people [at Independence Hill] are fabulous! They’re like family. Anything that we need, all we have to do is pick up the phone and ask. The housekeeping and maintenance is perfect. The food is out of this world…maybe too good,” Wagner jokes, patting his belly. The Wagners have resided in Independence Hill for six years now, and they keep busy visiting all the high-end spots San Antonio has to offer. “We go out to eat a lot. We know just

about every restaurant in town, and we like the restaurants in the hotels downtown. Independence Hill can pamper you. It isn’t hard to get use to this,” beams Wagner. Even though Ehrenfried Wagner has seen and done it all, he says the best part was getting to have those experiences with his best friend and wife, Joan. “After 55 years together, it could not be any better! I could not have done it without her. She’s the backbone of the family, and we have a lot of fun together. She’s indispensable,” shares Wagner warmly.

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MEDICAL BUSINESS / HOUSTON

Tales Of The Heart Equal parts success and compassion define the Cardiology Specialists of Houston BY THE CRAVE GROUP

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MAGINE SUFFERING A HEART ATTACK AND NEVER LOSING CONSCIOUSNESS. This means you feel everything. From your chest tightening and feeling as though it will explode to sharp pains shooting through your body. You’re unable to move and can barely communicate what is happening to the 911 operator so that you can receive help. Luckily, you’re at work so your co-worker is able to finish the call for you as you lie on the floor because there is nothing else you can do. This was the case for Wayne Bell. He suffered a heart attack and was rushed to the emergency room where he was greeted by the physician who saved his life, and made this scary experience bearable and much more pleasant than he could have imagined. “It was a very scary experience,” Bell stated. Indeed it was. When Bell arrived to the hospital, the doctors had to run several tests to determine exactly what was wrong with him. They discovered after a series of tests that he had 100 percent blockage on the right side of his heart, something that they attributed to his genetics and to the fact that he is right heart dominant. The team from the Cardiology Specialists of Houston saved his life, and Bell is forever grateful. They went above and beyond to save his life, and they offered bedside manners that cannot be matched. “I remember when they were about to shock me and I started panicking, the doctor calmed me down and prayed for me right there,” Bell recalled. “There, also, weren’t any beds available in ICU, but they let me stay in the CATH lab and even allowed my family to come in.” From the beginning, Bell’s condition was serious and only heightened as time progressed. There was a moment in which he started bleeding profusely, and a hospital employee applied pressure to the wound for almost an hour. “Everyone was all around exceptional,” Bell stated. Despite suffering a major heart attack on Tuesday, Bell was cleared to go home on Saturday, and the Cardiology Specialists of Houston made

that happen for him. The treating physician on his case was Dr. Gerardo Kalife. With over 20 years of experience, Dr. Kalife teaches in the greater Houston area, and he practices medicine at various offices throughout the greater Houston area. Dr. Robert Card also practices at Cardiology Specialists of Houston with

an interest in interventional cardiology. He teaches at St. Lukes Hospital as a clinical instructor. Also included on the board is Dr. Carlos Jessurun. Dr. Jessurun works as an instructor at Baylor College of Medicine, and he has been recognized as a Fellow of the American College of Cardiology and a Muller Fellowship Award

FOR MORE INFORMATION ON THE CARDIOLOGY SPECIALISTS OF HOUSTON CALL 713.797.1620 OR VISIT WWW.CARDIOLOGY-HOUSTON.COM.

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Recipient. Last but not least, Dr. Juan Carlos Rozo of the Cardiology Specialists of Houston is board certified in internal medicine and specializes in echocardiography, nuclear cardiology and peripheral noninvasive imaging. The Cardiology Specialists of Houston have an office in Houston on Fannin in the Medical Center, an office in Crosby, TX and another one in Pasadena on Vista Road. This group of boardcertified specialists and interventionalists are affiliated with East Houston Regional Medical Center and Bayshore

Medical Center. Services include, but are not limited to, pacemaker implantation, coronary rotational atherectomy and transluminal extraction catheter.

“I remember when they were about to shock me and I started panicking, the doctor calmed me down and prayed for me right there”

COMFORT & CARE when it matters most

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www.cimahospice.com


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MEDICAL BUSINESS / SAN ANTONIO

S.O.S. = Saving Our Seniors WellMed Social Programs helps thousands of lowincome seniors access vital services and assistance BY LIA MEDRANO

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OR MANY OF THE FORTUNATE, finding $104 a month in their budget is just a matter of cutting back on premium cable, dining out or coffee breaks. But for many lowincome seniors, it can mean cutting back on something life sustaining, like prescription medications, healthy food, or even turning on the air conditioner in the middle of a blisteringly hot summer day. These “cutbacks” are all too familiar to Unidad Gonzalez, Supervisor of WellMed’s Social Programs department. Since 2006, Gonzalez and

her seven-person team have been devoted to helping patients secure extra help from federal, state and local community programs, such as qualifying them for the Medicare Savings Plan and Low-Income Subsidy prescription drug assistance. Their services are available at no cost to more than 100,000 Medicare patients in the WellMed network. The Social Programs department walks the patient through the application and submits it to the appropriate governing agency. This way, patients have one point of contact to help them get through the process. That WellMed Social Programs representative often becomes the advocate for these low-income seniors. “The Social Programs team was formed after our WellMed doctors discovered that many seniors were not taking their prescriptions because they simply couldn’t afford them,” Gonzalez explained. “These seniors were putting themselves in dangerous situations that often led them to become hospitalized. Our doctors needed a resource for their patients so they could continue taking their medication and stay out of the hospital.” The Social Programs department assists patients who qualify by walking

them through the rigorous application process for the Medicare Savings Program, an 18-page form that can be intimidating to anyone much less seniors who may not count English as their first language. The team also assists with re-certification, since the programs must be renewed every year and require reapplication. To meet the requirements, the patient must have Medicare Part A, hospital insurance, and meet certain income requirements. The program can save the patient money by qualifying them for reimbursement of their Medicare Part B premiums, which are automatically deducted from their Social Security checks. This equals around $105 each month, which can add up to more than $1,000 a year. “We hold their hand through the entire process, and we often intervene on their behalf if the state denies their claim,” Ms. Gonzalez said. Many seniors served by the Social Programs team have little or no savings, no pensions, and no other sources of income besides their monthly Social Security check. Patients love this service. “I’ve had patients start crying when they realize that someone is there to help them and that they

FOR MORE INFORMATION CALL WELLMED AT 210.615.WELL (9355) OR TOLL-FREE AT 1.888.781.WELL (9355). YOU CAN ALSO LEARN MORE ONLINE AT WWW.WELLMEDHEALTHCARE.COM.

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are going to get their money back. Some live on less than $800 a month. A lady once told me that now that she qualifies for the program, she can finally buy a blouse. She had gone years without buying new clothes for herself,” Gonzalez details. In 2014, the Social Programs team submitted applications for 2,428 low-income seniors, helping them receive a ¼ million dollars in Medicare reimbursements alone. Team members are qualified Area Agency on Aging statewide benefits counselors, and they can also help seniors tap

into other resources in their community. Team members are often at community events handing out pamphlets and answering questions about programs seniors may qualify for to help with rent, utilities, groceries and more. The Social Program team is a program open to eligible WellMed patients with Medicare. WellMed, a healthcare company serving more than 165,000 patients in Texas and Florida, specializes in senior healthcare. The Social Programs team currently is certified to assist patients in

WellMed’s Texas markets: San Antonio, Corpus Christi,

Dallas, El Paso, Austin and the Lower Rio Grande Valley.

Your Smile is our Top Priority

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“Excellence Through Compassion.”

DR. ANDREW WEBER, DMD, MS DR. KENT HAMILTON, DDS Board Certified Periodontists

Hours: M-F, 8am-5pm and Sat, 8am-1pm

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LEGAL / SAN ANTONIO

Medical Theft is Closer Than You Think Fraud evolves with the digital age, bringing a new class of criminal BY ANDY TIWARI

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EDICAL IDENTITY THEFT IS A BILLION-DOLLAR “INDUSTRY” THAT HITS A LOT CLOSER TO HOME THAN YOU THINK. It generally involves fraudulent use of personal information — name, social security number, insurance information — for the purposes of obtaining medical services or devices, insurance reimbursements or to get prescriptions illegally. But the motivation and method of exploitation of your information varies depending on the criminal, making it hard to concisely define.

In some cases, the perpetrator racks up large billing leaving the victim responsible for payment. In other cases, international criminals used patient data to obtain fraudulent reimbursements through fake medical offices. Overall, it’s increasingly common. A Kaiser Permanente study found there were nearly 1,000 large health data breaches between 2010 and 2013 that affected more than 29 million records, including those

of many Texans. Medical data is now fetching more on the criminal market than your credit card, but a surprising number of thefts were related to just obtaining medical care. Doctor’s offices have become wise to the issue and request identification for new patients as part of electronic medical records. But in other cases, it’s easy to see how it might happen. When is the last time your doctor asked for proof that your child was yours, or that you, the parent, were who you claimed to be? On a more basic level, if you go to the hospital and have insurance information, but don’t have your ID, the hospital is more focused on providing care; that’s their mission. If a confident criminal has your insurance information, but not

your ID, they might get past a busy gatekeeper and get free medical care. For many prescriptions, a pharmacy won’t ask for ID, and if it does, the criminal can try elsewhere, it’s a low-risk enterprise. This highlights the biggest potential problem for the average victim: false information in your medical file. Removal of inaccurate information is the preferable outcome because you don’t want permanent records inaccurately showing your child had broken bones or that you needed psychiatric care. But this will be up to the healthcare provider because there is no requirement that incorrect information in your file be deleted. Instead, HIPAA law allows for false information to be “marked” inaccurate because the industry fears inadvertently losing data that could be critical for care. Medical providers are required to notify patients about known breaches under the Health Information Technology for Economic and Clinical Health Act. But the crime can go unnoticed unless you closely watch the explanation of benefits you receive from your health insurer, or Medicare and Medicaid. If you notice errors, call your provider immediately and verify it’s not just a mistake. If you believe it might be theft, the process is similar to any other form of identity theft; you will need to file a police report and contact the social security administration. If it’s a federal benefit, such as Medicare or

Medicaid, you need to contact that office to alert them as well. If private insurance information is stolen, contact the Texas Department of Insurance and your insurer requesting that it “red flags” your account. Once your insurer does so, it should confirm services you receive in the future are in fact being obtained by you. Most insurers will not re-number a policy, though policy numbers are used in theft. In a worst-case scenario, cancel the policy and get a new one, but doing so may mean higher premiums and loss of grandfathered benefits. To prevent fraud, carefully monitor your records and safeguard your data. Of course, prevention is easier said than done if your insurance company or the government gets hacked. Routinely inspect documents that list your medical services or prescriptions, and double check dates closely. This is one of the easiest ways to spot possible theft. Healthcare providers should also implement identification verification procedures and train staff on spotting and avoiding potential theft. If you initiate the process of correcting your medical records, you may need some legal muscle to help argue for removal instead of “marked” files. An attorney may also help you fend off debt collectors until the issue is resolved.

K. ANDY TIWARI IS PRINCIPAL AND NAMED PARTNER OF TIWARI + BELL PLLC.

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EXPERIENCE MATTERS,

CREDENTIALS COUNT

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All of the Doctors at OMSH are diplomates of the American board of oral and maxillofacial surgeons. The surgeons at OMSH offer the full scope of oral surgery procedures as only oral surgeons are trained to do. SERVICES: • Bone Grafts

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RESEARCH / HOUSTON

A Miracle Stems From Cells Celltex Therapeutics initiates breakthroughs in regenerative medicine and stem cell therapy to improve the quality of life BY DAVID ELLER, CHAIRMAN AND CEO OF CELLTEX THERAPEUTICS

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LBERT EINSTEIN ONCE SAID, “To raise new questions, new possibilities, to regard old problems from a new angle, requires creative imagination and marks real advances in science.” At Celltex Therapeutics Corporation, we have raised the question of the healing power of mesenchymal stem cells (MSCs), we have imagined the possibilities they hold in improving the quality of life for millions, and we are using those possibilities to advance the field of adult stem cell therapy in the United States. Our belief in the medical possibilities of adult stem cells is what led Dr. Stanley Jones and I to establish a biotechnology company, Celltex Therapeutics, in Houston in 2011. The purpose of Celltex is to initiate breakthroughs in regenerative medicine through adult, autologous, or one’s own, stem cells and use those breakthroughs to improve the quality of life for individuals suffering from autoimmune and degenerative diseases, such as arthritis, Parkinson’s, multiple sclerosis (MS), Alzheimer’s and chronic pain. Celltex uses a proprietary technology to isolate, multiply, and store an individual’s MSCs

for use in stem cell therapy. Adult MSCs have the remarkable potential of migrating to different parts of the body, recognizing sites of injury and inflammation, and they are then able to transform into many different types of cells. The regenerative and anti-inflammatory abilities of MSCs make them therapeutically beneficial in degenerative and autoimmune conditions. Celltex has seen remarkable results from the clients we have worked with over the years, and one that really stands out is 23-year-old Sarah Hughes, who received stem cell therapy in 2014. Sarah was born with systemic juvenile idiopathic arthritis (JIA).

JIA is an autoimmune disease affecting approximately 30,000 children in the United States, and there is no known cure. The disease not only caused persistent joint inflammation and stiffness, it attacked the dura of Sarah’s spinal cord, the outermost layer of protective membrane surrounding the spine. Spinal cord leaks and inflammation to vital organs made it nearly impossible for her to sit up and eat on her own. “Before receiving my Celltex stem cells, I was on continuous tube feeds 24/7. I was on limited bed rest due to spinal leaks and overall weakness caused by my immune system,” says Sarah. “I was unable to be upright or really do anything considered normal.” After years of suffering and finding no relief from traditional treatments, Sarah and her family decided to contact Celltex and place their hope in stem cell therapy. Celltex obtains MSCs through an extraction from an individual’s abdominal fat in a 30-minute procedure that requires no recovery time. From that thumbsize sample, the individual’s MSCs are isolated, multiplied, and stored at -300 degrees Fahrenheit for future use. The fat extraction process only happens once, as Celltex will always have a master bank of an individual’s stem cells should he or she need them in three months or 30 years.

Our stem cell processing and banking methods ensure the genetic integrity and stability of an individual’s cells, which are multiplied in quantities never before possible, and they are then used for therapeutic applications. Individual’s can use their banked stem cells for regenerative and immune therapy through infusions or injections performed by a licensed physician. After having her MSCs extracted and banked by Celltex, Sarah traveled to Cancun, Mexico and received her own stem cells through an intravenous infusion performed by a highly qualified, licensed physician at Hospital Galenia. In just a short time following therapy, Sarah’s family and her doctors saw vast improvements in her body. “I am doing very well after my stem cell therapy,” says Sarah, detailing that, “Right after the infusion, I noticed increased hunger and energy. Around the second month, I was able to eat food for the most part without pain, and I was able to properly digest it. I have not had a spinal leak since December, and I’ve been able to swim in a pool and relax in a hot tub. By mid-January I was able to eat normal food during the day, and I am slowly CONTINUES ON PG. 38

FOR MORE INFORMATION CALL 713.590.1000 OR VISIT WWW.CELLTEXBANK.COM. CELLTEX THERAPEUTICS IS LOCATED AT 2401 FOUNTAIN VIEW DRIVE, SUITE 416 IN HOUSTON, TX 77057.

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Honrubia Technique™ for Balloon Sinuplasty Patient Comfort and Safety Come First

Stop the Pain Visit Us At AmericanSinus.com or SouthTexasSinusInstitute.com

The Honrubia Technique™ for Balloon Sinuplasty is a revolutionary, minimally invasive procedure for treating chronic sinusitis. The primary symptoms of chronic sinusitis are headaches, trouble sleeping, snoring, fatigue, facial pressure, ear discomfort, and post nasal drip. The Honrubia Technique™ addresses many of the primary symptoms of chronic sinusitis while maximizing the comfort and safety of the patient. It is recommended by our team of board certified ENT Physicians. This technique involves less pain than a traditional sinus surgery and therefore contributes to a quicker recovery. The Honrubia Technique™ for Balloon Sinuplasty is done under anesthesia. This ensures that patients have a more relaxing and positive experience than when the procedure is performed under a local anesthetic. It also allows us to address several other sinus related complaints. An anesthesia provider administers intravenous medications to keep patients lightly sedated and comfortable. Our American Sinus Institute team of specialists have performed thousands of procedures using the Honrubia Technique™ for Balloon Sinuplasty. Come see us at the American Sinus Institute. We Solve Sinus Problems.

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REASEARCH / HOUSTON

Seven Pathways to Wellness Chemo Secrets from a Chemo-Induced Consumer Advocate Trifecta BY SANDY M. CASTILLO

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HAT I DO KNOW IS THAT WHENEVER SOMETHING IN LIFE COMES ALONG AND THROWS ME OFF OF MY PATH, somehow or another, I typically find out what really happened. When I receive the information, I am usually in a place ready to hear the truth, and it almost never surprises me. This has been true for the better part of my life in regards to friends, loved ones, and even clients and projects. I know in my heart that the truth somehow always manages to find its way to my knowledge, but the lesson is the art of understanding that even through life’s sometimes treacherous journey, the world is out there conspiring to give me what I truly need to stay on my path. So, it should come as no surprise that my life was saved by a diagnosis of breast cancer as I continued on a downward spiral stemming from a divorce. We had just moved to Switzerland, and we weren’t even there for a single year when on my birthday, my husband told me he wanted a

divorce. Spinning out of control, my life fell apart, and before I knew it, I was on a one-way flight to Houston with my dog, four suitcases, and without any type of closure on our 10-year relationship. Returning to my family in Houston after a 15 year learning excursion was surreal. My lifestyle changed in a blink of an eye, and it was my unwillingness to accept reality that forced me into an angry and resentful state of mind. What science is just now starting to comprehend is the fact that worldwide studies link cancer to unexpressed anger and extreme suppression of other feelings in patients over 40. The inescapable shock of life altering events has been shown to not only suppress the immune system, but it also affects a variety of other healthy processes. The California Breast Cancer Research Program found the survival rate of women in Dr. David Spiegel’s 1989 group therapy study who openly expressed their anger actually doubled their survival rate to 3.7 years, compared to women who

constrained their anger at 1.8 years. Throughout my journey as a health and fitness guru, I know that there are seven pathways to wellness that can work to alleviate unresolved anger, stress, weight gain and unease with life. Within each pathway are seven learning hurdles along the journey. Speaking about my life as an advocate trifecta, the journey continues to point toward living in happiness and sharing secrets only given or experienced during times when I wasn’t sure if that day would be my last. First and foremost is your attitude. The journey starts by being honest with yourself and everyone around you, and it ends with personal empowerment, by paying attention to life and how it’s affected by your thoughts. The second pathway is cocreating with your very own personal dream team within healthcare because they are the ones you trust for personalized treatment. Turning within to become your own science project can be a difficult task if you are like me and used to giving your time and power away. The third pathway is about using available resources to create a nutrient-dense, cancerfree, on-going health and wellness lifestyle for yourself. As an advocate and wellness coach, I find that clients who

have been diagnosed with cancer are the first ones to actually hear what I am saying, and they take it into deep consideration to move through life from a focused state of wellness from then on and forever. These are my favorite clients. Which leads to the next pathway, which is lifestyle. Moving into this heightened sense of awareness opens so many doors for patients that the cancer experience can become a blessing in disguise. From then on, they work to master their lives focusing on happiness, and they ultimately quit faking it because they’ve already found what they were looking for. The fifth pathway develops into consciously creating stealthy strategies for not only daily life, but for the future, because there can be one. The sixth blossoms into growing in gratitude, education, and guidance from within toward a more holistic world view. This in return draws true relationships filled with support and love. Spirituality encompasses all faiths, religions, and people as they grow in compassion for life and the lives of others. And finally as the patient continues to grow through the seven pathways of wellness, they find CONTINUES ON PG. 39

SANDY M. CASTILLO IS FOUNDER OF FLITTERCAKE, WHICH PROMOTES INNER PEACE AS A PURE CURE TO DISEASE AND CANCER. SHE IS A WELLNESS COACH, SPEAKER, AND CANCER ADVOCATE TRIFECTA LEADING CULTURAL MEDITATION TOURS THROUGHOUT THE CITY AND RETREATS ABROAD. FIND OUT MORE ABOUT SANDY AT WWW.SANDYMCASTILLO.ORG, OR CONTACT SANDY DIRECTLY AT 713.232.9796 OR SANDY@SANDYMCASTILLO.ORG.

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INFORMED PATIENT / SAN ANTONIO

What are floaters, and what can I do about them? BY LISA MARTÉN, MD

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LOATERS APPEAR AS SPECKS OR DARK SPOTS THAT FLOAT AROUND IN YOUR FIELD OF VISION. They are most apparent in bright lights or white backgrounds. They move away as you try to look at them, and they float in and out of your vision when your eye stops moving. As much as you try, you can’t make them go away. They are so annoying! Floaters are small, suspended protein fibers that form within the gel that occupies the back part of the eye. The vitreous gel fills about 80 percent of the eye and is firmly attached to the walls of the eye. Throughout life, the gel starts to shrink and liquefy. Eventually, it separates from the retina and forms strands and bubbles that cast tiny shadows on the retina. This is what you perceive as a “floater.” Floaters are a part of the natural aging process, but there are other, more serious causes of floaters. Infection, inflammation, hemorrhage, retinal tears or detachments can cause similar symptoms. It is important for you to have a dilated eye exam so these other causes can be ruled out. Floaters are usually not treated with drops or surgery. Once you realize there is nothing medically wrong, your brain will start to ignore floaters,

CONTINUES FROM PG. 34

gaining weight.” As it stands today, the U.S. Food and Drug Administration (FDA) has taken the position that an individual’s own stem cells are considered a drug if they have been expanded in large quantities. Therefore, an individual may not receive his or her own MSCs in the United States until clinical trials have been conducted. These trials can take years to complete, and Celltex has already begun that process in cooperation with highly qualified medical and scientific institutions. Following the conclusion of successful clinical trials, we will seek approval from the FDA to provide stem cells for use by physicians in the United States. In the interim, to meet the immediate needs of our clients, we took steps to comply with the regulations established by the FDA and the Federal Commission for the Protection against Sanitary Risk (COFEPRIS) — the equivalent of the FDA in Mexico — for exporting and importing MSCs. Celltex works with established, certified hospitals in Mexico where highly qualified, independently licensed physicians make it possible for Celltex’s clients to receive their own cells for therapeutic purposes. Currently, everything from

FOR MORE INFORMATION CALL 210.692.1388 OR VISIT WWW.SOUTHTEXASEYEINSTITUTE.COM. THE SOUTH TEXAS EYE INSTITUTE IS LOCATED AT 2424 BABCOCK RD, SUITE 101 IN SAN ANTONIO, TX 78229.

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PHOTO BY JOSHUA NOLDEN

Keep Calm and Float On

and with time and gravity they float down to the bottom of your eye. This process may take months to occur, and floaters still may interfere with your vision at times. A vitrectomy, a surgery to remove part of the vitreous from the eye, is usually performed to treat a number of retinal conditions. It is not performed routinely to remove floaters, even though it sometimes does, because the risks of the procedure outweigh the benefits. It is not guaranteed that the procedure will eliminate all floaters from the eye anyway. There are some new injectable medications that can help dissolve vitreous traction for some patients. Learning to live with floaters can be difficult, but it is important to realize they are nothing more than a natural aging change in the eye. Lisa Martén, M.D., is a boardcertified ophthalmologist at the South Texas Eye Institute.


the stem cell isolation process to expansion and banking is handled in Houston at Celltex’s FDA-compliant lab. When it is time for therapy, clients work with Celltex client service coordinators to schedule their therapy and travel in Mexico. After therapy, the individual returns home to let his or her body begin the process of healing itself. We make a point to inform clients that because stem cells come from their own body, they are classified as biologics, not as drugs, which means that one person’s response to stem cell therapy can vary from another person’s. “I have spent most of my life in hospitals, in critical condition,” says Sarah. “Since receiving my stem cells, I have not been hospitalized, so it is so nice to begin to feel ‘normal.’ I still have bad days, but my bad days are becoming less and less severe and less frequent. I am able to do so much more than I have ever imagined possible. Before the stem cells I was so sick and fragile; now I feel like an actual person.” It is Sarah’s story, and many others like hers, that fuel our passion to continue our work and research at Celltex. It’s time for the United States to reimagine the healing possibilities that lie within our own bodies and step to the forefront as a leader in stem cell therapy.

CONTINUES FROM PG. 36

a way to engage with the greater community for global change. This is where life crystalizes and takes on a completely different outlook and meaning as compared to life pre-cancer. One way is to utilize their voices to become educated patient advocates in legislative, research and patient settings, which is the trifecta of advocacy. Whichever way they develop and choose to express their journey, they are in fact helping shape the future of treatment. Just recently, professor James Holland, former Director of Cancer Research at Rosewell Park Cancer Institute and former president of both the American Society for Clinical Oncology and the American Association for Cancer Research (AACR), reported at the annual AACR meeting in 2015 that he has found the human breast cancer virus (HMTV) in 94 percent of women with Stage IV breast cancer. Personally, speaking to a list of those affected with breast cancer last night, one by one I continued to share the latest in research including the growing evidence that breast cancer may be a virus. As we all move along in life, disease may take many different forms and each person may find their own cure. And the seven pathways to wellness may prove to be the life-altering side effect needed to increase and sustain overall quality of life.

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“ 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


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INFORMED PATIENT / SAN ANTONIO

To Eat Or Not To Eat? Oral desensitization studies give hope to patient with peanut allergies BY DR. ERIKA GONZALEZ-REYES, BOARD-CERTIFIED ALLERGY, ASTHMA AND IMMUNOLOGY SPECIALIST

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HE PREVALENCE OF FOOD ALLERGIES CONTINUES TO INCREASE WORLDWIDE, AND OVER THE LAST 20 YEARS, the number of people that suffer from food allergies has increased by almost 20 percent. The biggest impact has been on the number of people with peanut allergies. This rate has doubled in recent years, and it currently affects about 2 percent of all young children in the United States. Unlike other life-threatening conditions, people with food allergies are completely healthy until they are exposed to their food allergen. Even the smallest exposure can lead to severe allergic reactions, and unfortunately, it is reported that approximately 1500 people a year die from food-induced anaphylaxis.

The field of allergy and immunology, like all of medicine, is advancing rapidly with the discovery of new mechanisms for diseases and new therapies to address these problems. Some of the most exciting areas of research involve food allergies. At the present time, the only strategy for people with food allergies is to avoid the foods that trigger dangerous reactions. For many reasons this method has always been difficult and unpleasant. Patients have to avoid a food they generally enjoy eating. It also requires laborious reading of food labels to ensure the offending food is not a minor ingredient. Many products even include confusing statements that it “might contain” the dangerous food or that the product was “manufactured in a factory that also produced” the concerning allergen. It requires informing family, friends, teachers, and coaches about the issue so that extra care can be taken by those around the patient. In addition to practicing avoidance, patients with food allergies are advised to carry injectable epinephrine at all times to treat an accidental reaction. Despite all these measures, accidental ingestion and dangerous reactions remain very common. One study found that one out of every 10 peanut-allergic children will

have an accidental ingestion and reaction each year, despite being aware of their sensitivity. Many of these lead to emergency room visits to treat the reaction. One of the most active areas of food allergy research involves attempts to desensitize patients to their known food allergy through what is known as oral desensitization. This process involves feeding small amounts of the offending food to the allergic patient carefully and slowly to build up a tolerance. Ideally this would result in a complete cure allowing the patient to eat as much of the food as they wished. In actuality, this therapy typically results in a temporary state of tolerance requiring the patient to regularly eat the food in question to maintain the state of tolerance. Any significant lapse in consuming the food and the dangerous allergy symptoms would likely return. While research into oral desensitization has involved many different foods most of the work has been done for peanuts. Unlike many other food allergies, a peanut allergy is rarely outgrown, leading to lifelong issues and fears. Peanut reactions also tend to be among the most severe and can often

FOR MORE INFORMATION CALL 210.616.5385 OR VISIT WWW.STAAMPALLERGY.COM. THE SOUTH TEXAS ALLERGY & ASTHMA MEDICAL PROFESSIONALS (STAAMP ALLERGY) ARE LOCATED AT 10447 HIGHWAY 151 IN SAN ANTONIO, TX 78251.

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be fatal. As a result, the goal of improving patients’ tolerance to peanuts is highly sought after. Some of the results to date have been quite promising. After a period of careful desensitization, patients who would normally experience significant allergy symptoms after eating only a single peanut were able to consume up to eight peanuts without a subsequent reaction. While this reduced sensitivity may not enable patients to eat any and all peanuts without limits, it had the major impact of reducing the fear associated with a peanut allergy. A small

ingestion was no longer likely to provoke significant symptoms requiring the use of injectable epinephrine or a trip to the ER. The quality of life for these people increased significantly. Despite the success many questions and concerns remain about the process. The optimal dose of peanut and length of therapy has not yet been established. It is still unknown if the benefits obtained are permanent or will wear off over time. In some instances, certain patients did not improve, and some patients even seemed to get worse. Other patients had significant reactions during

the desensitization which made oral desensitization impossible, and a small number of patients developed a different food allergy problem called eosinophilic esophagitis, which caused additional concerns. Unfortunately, it is not known how to best determine ahead of time which patients may respond better. It is hoped that these issues can be addressed and corrected in ongoing, and future, research

studies. A great deal of work on this topic is being conducted at major research centers around the world, and we are now closer than ever to finding a more viable treatment option. While oral desensitization may not be quite ready for use by the general public, it represents an exciting area of research that may finally give real hope to patients with severe food allergies in the very near future.

“It is reported that approximately 1500 people a year die from food-induced anaphylaxis”

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INFORMED PATIENT / AUSTIN

Dealing With Bullying Scott & White-Round Rock’s Dr. Bradley Berg sheds light on bullying stats and solutions SPECIAL TO TEXAS MD

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RADLEY BERG M.D., PH.D., pediatrician at Scott & White Clinic-Round Rock, offers tips on dealing with bullies as kids head back to school this fall. “Bullying is unwanted aggressive behavior that involves a real or perceived power imbalance,” explains Dr. Berg.  He explains that bullying is repeated or has the potential to be repeated, and it typically uses power examples, like strength, access to embarrassing information, status, or popularity to control or harm the victims.   There are three types of bullying: verbal, social and physical. Contrary to conception, bullying occurs not only during, but after school as well. It can commonly occur at the playground, on the bus, through social media, and even at clubs, after-school and athletic programs. Statistics on Bullying: The 2011 Youth Risk Behavior Surveillance System found that 20 percent of students in grades 9 through 12 experienced bullying, according to the Center for Disease Control and Prevention. The

2008-2009 School Crime Supplement, put out by the National Center for Education Statistics and Bureau of Justice Statistics, reported that 28 percent of students 6-12 experienced bullying. It also reports that only about a 1/3 of bullying cases were reported to an adult. Of those bullied, girls are more prone to suffer from psychological, social and verbal bullying, while boys are more likely to suffer from physical bullying. Ultimately, there’s not much difference between the prevalence of boys vs. girls experiencing bullying. 10 signs of bullying to watch out for: • Unexplained injuries • Sudden changes in behavior • Destruction to clothes, books or property • Complaints of headache, stomach aches, feeling sick or faking illness • Changes in eating habits, skipping meals or binge eating • Changes in sleep patterns or nightmares • Decreased academic performance • Sudden loss of friends or avoidance of social situations • Lower self-esteem and increase in self-destructive behaviors • Student skips school or comes up with reasons

to avoid school or extracurricular activities Risk factors for bullying may include: • Disabilities or special needs • Past history of abuse or neglect • Differences in development or appearance • Cultural or religious differences What to do about bullying: Zero tolerance policies are not shown to be very effective. Trying conflict resolution or mediation between the bully and the victim can do more damage than good. Interventions need to focus more on awareness and promoting openness to discuss bullying in public forms.  Therapeutic strategies like groups or clubs that foster empathy and compassion have been showing positive data.   Another alternative is to promote responsibility and safe places outside of the school where bullying can be discussed without fear of repercussions or retaliation. Dr. Berg suggests talking with school administrators about policies that are currently in place as well as any applicable state and federal laws that may apply.

FOR MORE INFORMATION CONTACT SCOTT & WHITE CLINIC-ROUND ROCK AT 512.509.0200 OR VISIT ROUNDROCK.SW.ORG

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INFORMED PATIENT / SAN ANTONIO

The Oral Systemic Link AM, A FATHER OF TWO, is your average American dad who loves to see his kids play sports and hang out with his friends. Sam’s wife had been relentlessly trying to persuade him to go to the dentist, and he finally scheduled an appointment. The dental visit seemed to be going well until the dentist shared his concern about the presence of peculiar symptoms related to diabetes. After a follow up with his regular care physician, Sam was shocked to learn that his dental visit actually helped

Link shows that our oral health greatly impacts our overall wellness. Genetics are not the only factors contributing to diabetes. So what is causing these diseases in dental patients? Poor lifestyle choices, such as eating an unhealthy diet along with lack of exercise, and infection of the gums around the teeth. We are fortunate to live in the information age where technology allows the dental and medical worlds to come together through the ease of sharing research studies

diagnose his early onset of diabetes. What surprised him the most was that his oral health could have such an impact on his overall health! Most people are not aware of the fact that your oral health is directly related to many major diseases, such as periodontal (gum) disease, diabetes, cardiovascular disease and Alzheimer’s. This connection is called the “Oral Systemic Link.” The Oral Systemic

and critical data. The Oral Systemic Link has recently been discovered as dentists and other medical doctors identify the correlation between studies of bacteria in the mouth and its effect on systemic diseases.

Dentist Dr. Kevin Klenke’s Mission To Educate San Antonio Residents BY KEVIN KLENKE, DDS

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Among these illnesses are cardiovascular disease, Alzheimer’s, pulmonary disease, irregular fetal development, diabetes, orthopedic implant failure and kidney disease. Dentists have found a number of different oral symptoms associated with these various illnesses. However, it is being proven that oral bacteria and periodontal disease are the most common contributing factors for these systemic diseases Periodontal disease, also known as gum disease, is a chronic bacterial infection affecting the gum and bone structure supporting the teeth. As periodontal disease progresses, the gum tissues and bone deteriorate, allowing bacteria to enter the blood stream, wreaking havoc throughout the body. Some of the most common causes of periodontal disease are not following recommended oral care, such as brushing and flossing twice daily, and not having bi-annual trips to the dentist. Studies completed by the American Academy of Periodontology indicate that almost a 1/3 of all diabetics have developed severe periodontal disease.

IF YOU WOULD LIKE MORE INFORMATION ON PERIODONTAL DISEASE’S SYMPTOMS, PREVENTION OR TREATMENT, VISIT WWW.ANGELSCARE.COM OR CALL 210.877.2273.

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If left untreated, this disease can disrupt diabetic control, leaving the patient at risk for serious health complications. The same studies show that mothers suffering from periodontal disease are actually eight times more at risk for pre-term birth, yet many of these individuals are unaware of this potentially life-threatening risk! Over 60 million Americans show symptoms of periodontal disease, including bleeding, swollen gums, loose teeth, gum recession, chronic bad breath,

recent bite changes and food accumulation in the gums. That adds up to about 19 percent of the American population who are running the risk of these diseases due to the Oral Systemic link. Since the Oral Systemic Link is such a new finding most Americans haven’t been informed. This is just one of the things we at Angel’s Care Dentistry are determined to change. Our mission is to educate the public about the potentially life-threatening link between oral and overall health. Our goal is to improve

awareness as most people don’t realize how easy it is to prevent periodontal disease and ultimately lower the risk of countless other illnesses. The easiest and best way to reduce the risk of periodontal disease is to practice good daily oral hygiene habits. This includes brushing your teeth twice a day for two minutes each time, including children old enough to brush on their own. The two minute “rule of thumb” ensures that plaque and debris from meals don’t get trapped and build up between your teeth and

gums. Floss daily to get the spots your toothbrush may miss, and finish by swishing mouthwash. Kids should start learning these habits early, giving them an advantage in both their oral and overall health. The dentist should be seen twice a year for routine cleanings for healthy gums, and if there are symptoms of periodontal disease, the patient should schedule an appointment for a periodontal evaluation to learn about the successful treatment options.

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ASK THE EXPERTS / SAN ANTONIO

How Well Do You Know Your Heart? Atrial Fibrillation Awareness SPECIAL TO TEXAS MD

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HE HEART IS AN ELEGANT PUMP, powered by a built-in electrical system. The process of a heartbeat begins as an electrical current spreads across the upper chambers, the atria, and then passes down through the ventricles,

the main pumping chambers in the bottom of the heart. The heart then contracts, pumping blood throughout your body. When this very intricate system breaks down or misfires, it can result in an abnormal heart rhythm called arrhythmia. Cardiac electrophysiologists are heart doctors with additional training who specialize in diagnosing these electrical problems and the heart rhythm disorders they cause. Dr. Stephen May, MD, FHRS, and his colleagues at The Arrhythmia Associates of South Texas are dedicated to delivering state-of-the-art, personalized care for patients suffering from heart rhythm disorders. There are various types of rhythm disorders causing the heart rate to become too slow, too fast or irregular, making the heart less efficient and people feel poorly. Atrial fibrillation is the most common, affecting more than 2.5 million Americans. “When a patient is in atrial fibrillation, the electrical activity in the atria becomes disorganized and chaotic, causing the heart to quiver instead of steadily contracting,” explained Dr. May. “The pulse becomes irregular, and heart function is reduced. Atrial fibrillation

increases a patient’s risk of stroke fivefold and is associated with higher rates of stroke. This disorder usually occurs in people over 65, but it can happen at any age, especially in patients with risk factors such as heart or lung disease.” The most common symptom of atrial fibrillation is palpitations, a sensation that the heart is flip-flopping, skipping or jumping around in the chest. Some patients feel short of breath and tire easily. “They may think they’re just slowing down due to age, but once we get them back in rhythm, they feel younger and more energized,” explained Dr. May. Some patients may be affected by their symptoms, but they are still at an increased risk for stroke. “Any patients with known heart rhythm problems, or symptoms that might suggest one, are encouraged to come for consultation,” added Dr. May. “We are happy to see patients without a referral, or we can work in collaboration with their other doctors and cardiologists.” An electrocardiogram, or EKG, can easily detect

FOR MORE INFORMATION ON BHS PHYSICIANS NETWORK CONTACT JULIE MINNICK, JAMINNIC@BAPTISTHEALTHSYSTEM.COM

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“30 Years Strong, Our Roots Run Deep”

atrial fibrillation for patients who have a heart that is out of rhythm at the time they are visiting their doctor. If symptoms are more intermittent, monitors can be worn for days or weeks at a time to try to catch the rhythm abnormality. Patients that are at a higher risk for atrial fibrillation, or those who have had an unexplained stroke, may be candidates for implantable monitors that can be injected under the skin to monitor heart rate and rhythm for up to three years. If undiagnosed, atrial fibrillation can greatly increase a patient’s risk of stroke, the heart muscle can fatigue and heart failure may develop. Also, when the heart rate varies too frequently or is too slow at times, a patient could lose consciousness causing additional associated trauma. A physician determines treatment for atrial fibrillation after a careful assessment, taking into account the patient’s risk of stroke and bleeding. Most patients can benefit from blood thinners. New blood thinners now available are easy to take and a great alternative to Warfarin, a commonly prescribed anti-coagulate, for many. For patients who experience symptoms when in atrial fibrillation, anti-arrhythmic

medications can be taken to help keep their heart in rhythm. The Arrhythmia Associates of South Texas are bringing new, groundbreaking procedures and techniques to San Antonio for treatment of atrial fibrillation and other heart rhythm disorders. The most effective treatment is atrial fibrillation ablation, a procedure where an electrophysiologist advances catheters through veins in the legs to the heart, modifying the heart tissue and making it more difficult for the heart to go into atrial fibrillation. “Ablation is much more effective than medications at keeping patients in a normal rhythm and is often a good option,” explained Dr. May. “Success rates and safety are now better than ever, thanks in part to better catheter technology and mapping systems.” Ablation without fluoroscopy eliminates the radiation risk associated with the usual ablation procedure, which traditionally requires the use of medical imaging that shows a continuous X-ray image on a monitor. Ablation without fluoroscopy is a more precise and safer procedure that uses realtime visualization of cardiac structures and catheters with CONTINUES ON PG. 55

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Regional Home Health Agency is family when it matters most.

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Learn more at www.rhhaonline.com Regional Home Health Agency 16 S. Johnson St. Alice, TX 78332 800-526-4873


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ASK THE EXPERTS / SAN ANTONIO

Minimally Invasive Surgery: A Medical Breakthrough

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URGERY CAN BE SCARY. Whether it’s minor or major, just the knowledge that you’ll be undergoing a medical procedure can be daunting to most people. Though as medicine advances, the risks are minimized and the rewards maximized. Bearing this in mind, Texas MD decided to sit down and talk with Seema Izfar, M.D., FACS, about the latest advances in minimally invasive surgery and its benefits in colon and rectal procedures.

TxMD: What is minimally invasive surgery? Dr. Izfar: Minimally invasive surgery is a technique that allows the surgeon to operate using specialized equipment through smaller incisions. This allows for less injury to the body compared to traditional, open surgery. Minimally invasive surgery can allow patients to recover more quickly and with less pain, and in some instances, it can even allow for a safer operation and better visibility inside the body. TxMD: How is minimally invasive surgery beneficial to the colon and rectal specialty? Dr. Izfar: Minimally invasive surgery can be successfully performed for a variety of colon and rectal conditions, including diverticulitis, ulcerative colitis, Crohn’s disease, colon polyps, rectal prolapse and more. It can also be used to remove the entire colon and rectum, or just a portion, or segment, of the colon. Over 100,000 new cases of colon cancer are diagnosed in the United States each year. Minimally invasive surgery can assist in the removal of tumors using a camera and long surgical instruments through only a few, tiny incisions instead of a single, large incision as is common with traditional, open surgery. TxMD: Is minimally invasive surgery safe?

Dr. Izfar: Every surgical procedure, whether minimally invasive or traditional, carries risk of complications, such as bleeding and infection. However, the smaller incisions associated with minimally invasive surgery mean less blood loss and post-operative pain for patients. Recovery time may also be significantly shorter and infection rates decrease. And the cosmetic results are much improved, this means less scarring! Certainly, as with any technique performed, the surgeon should select the technique that he or she feels more comfortable performing safely and that offers the best result for the patient. TxMD: What types of minimally invasive surgery techniques are most often used in the colon and rectal specialty? Dr. Izfar: Both laparoscopy and robotic surgery are minimally invasive techniques used in colon and rectal surgery. Laparoscopic surgery refers to a technique where the surgeon makes approximately three to five small incisions and uses a camera attached to a thin, tiny telescope, called a laparoscope, to observe a magnified view of the

FOR MORE INFORMATION ON THE BHS PHYSICIANS NETWORK, GO TO WWW.BHSPHYSICIANSNETWORK.COM OR EMAIL JULIE MINNICK AT JAMINNIC@BAPTISTHEALTHSYSTEM.COM.

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abdomen. One of the newer techniques available is the robotic da Vinci Surgery System. Baptist Health System was the first health system in South Texas to offer patients minimally invasive surgery using the da Vinci System. The da Vinci System uses a magnified, 3-D high-def vision system and tiny wristed instruments that can bend and rotate at a greater degree than the human wrist. The surgeon benefits from enhanced vision, precision, dexterity and control. The da Vinci System translates hand movements into smaller, more precise movements, maneuvering tiny instruments inside your body. A relatively new technique, transanal minimally invasive surgery (TAMIS) allows for safe removal of large pre-cancerous rectal polyps from inside the rectum without any incisions. TxMD: How do I know if minimally invasive surgery is an option for me? Dr. Izfar: Not everyone is a candidate for minimally invasive surgery. Only you and your surgeon can decide the best surgical technique for your condition. While prior surgeries, obesity, and your medical history do not

necessarily preclude minimally invasive surgery, all must be considered when making this decision. TxMD: What other treatments are available for colon and rectal conditions besides surgery? Dr. Izfar: Oftentimes, colorectal diseases can be treated and maintained with medicine alone. Surgery is indicated for diseases that are refractory to medical treatment, or for diseases that harbor risk or have a known risk for malignancy. Minimally invasive surgery is possible for just about all disease processes in colorectal surgery, but it must be selected on a patient by patient basis. Dr. Seema Izfar is a boardcertified colon and rectal surgeon with the South Texas Colorectal Center. She see patients at both 225 E. Sonterra, Suite 215 in San Antonio, TX 78258 and 311 Camden, Suite 501 in San Antonio, TX 78215. For more information you can call the Sonterra clinic at 210.314.7872 or the Camden clinic at 210.212.6202. For questions or to learn more, please call either clinic or go online to www. bhsphysiciansnetwork.com.

“Over 100,000 new cases of colon cancer are diagnosed in the United States each year� 2015 - AUG./SEPT. TxMD

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ASK THE EXPERTS / SAN ANTONIO

Know Your Body Control “The Change”

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OME THINGS IN LIFE ARE UNAVOIDABLE. You will age, albeit like a fine wine, you will change, and naturally, your priorities will shift accordingly. Both men and women will eventually undergo or encounter some physiological change due to aging, whether it be diminished eye sight or the end of the reproductive cycle. Acknowledging this, Texas MD consulted with Dr. Henry Garza on the inevitable bout with menopause all women will go through, and he shared the various signs, symptoms, and treatments women can undergo to alleviate discomfort associated with menopause.

TxMD: What is menopause? Dr. Garza: By definition, menopause is a normal part

of aging marking the end of a woman’s reproductive period. The ovaries no longer release an egg

every month and menstruation stops. The process is gradual and actually contains three stages: perimenopause, menopause and post-menopause. Each transition period is different for each woman. Perimenopause can begin several years before menopause as the ovaries gradually make less estrogen and lasts up until menopause, the point when the ovaries stop releasing eggs. Menopause begins when it’s been a year since a woman last had a period. And post-menopause is the subsequent years after menopause when most symptoms ease. TxMD: When do symptoms begin? Dr. Garza: In the last one to two years of perimenopause, the drop in estrogen quickens and symptoms may begin to surface, including hot flashes, irregular or skipped periods, insomnia, mood swings, fatigue, irritability, headaches, changes in libido and more. Not all women get these symptoms and severity can range from mild to severe. TxMD: How can you tell the difference between menopause and another condition? Dr. Garza: You or your doctor may suspect the approach of menopause based on your symptoms, but it also helps to keep track of your periods as they become more irregular. The average age of menopause is

51-years-old, but it may occur as early as your 30s or as late as your 60s. There are other conditions that may result in an absence of a menstrual period or irregular bleeding which may be easily confused with menopause, including weight loss or gain, stress, anxiety, depression, uterine fibroids, endometrial polyps or something else potentially serious. If you’re unsure, you should always make an appointment with your doctor. TxMD: Can menopausal symptoms be treated? Dr. Garza: It’s important to note that each woman’s experience is highly individual—no two women are the same. Symptoms may be minimal in some women while others may face a wide range of physical and psychological issues. Symptoms may also come and go throughout menopause. Lifestyle factors can help control symptoms including regular exercise, proper nutrition, adequate sleep and quitting smoking. Hormone therapy, bioidentical hormone therapy, and alternative/non-hormonal treatments are also available. TxMD: Are hormone and bioidentical hormone therapy safe? Dr. Garza: The use of hormones, estrogen and progesterone, and bioidentical

FOR MORE INFORMATION ABOUT THE PRACTICE OR TO MAKE AN APPOINTMENT CALL ACACIA OB/GYN AT 210.226.7827. FOR MORE INFORMATION ON THE BHS PHYSICIANS NETWORK GO TO WWW.BHSPHYSICIANSNETWORK.COM, OR EMAIL JULIE MINNICK AT JAMINNIC@BAPTISTHEALTHSYSTEM.COM.

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hormone therapy, medications containing hormones that have the same chemical formula as those made naturally in the body, to treat perimenopausal and menopausal symptoms is an individual decision in which patient and doctor should take into consideration risks, benefits and medical history. Regular monitoring and adjusting dosage can help find the right hormone level for your body. Oral contraceptives, birth control pills, are another form of hormone therapy often prescribed for women in perimenopause. TxMD: What other alternative treatments are available?

Dr. Garza: Alternative treatments for symptoms can be great, but they also their have limitations. The use of soy supplements and the herb black cohosh can have some benefit in treating hot flashes, but dosages can be unclear and each manufacturer may have different standards of purity and consistency. Certain anti-depressants have also been used to solely treat hot flashes. A healthy diet and regular exercise can be a tremendous aid in combating fatigue and boosting energy levels. If urinary incontinence is an issue, pelvic floor exercises can be helpful and over-the-counter lubrication

products can soothe sexual discomfort due to vaginal dryness. TxMD: Share something about menopause that may surprise most women. Dr. Garza: One of my most surprising observations has been that most women only experience very mild symptoms when nearing menopause. Therefore, they choose not to do any sort of supplementation or prescription treatment. It is still important to communicate with your provider any symptoms that seem unusual including intense pain, excessive vaginal bleeding or severe mood changes. Another surprise is that a

woman’s experience through menopause might exactly mirror that of her mother or grandmother’s. Communication with these women in your life, and of course, your provider, can be very reassuring. Dr. Henry Garza is a boardcertified obstetrician and gynecologist who practices at Acacia OB/GYN-Schertz, located in the Baptist Emergency Medical Office building at 16977 IH 35 North, Suite 210 in Schertz, TX 78154. Dr. Garza performs all surgical procedures and deliveries at Northeast Baptist Hospital in San Antonio.


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Primary Care Is Your First Line of Defense Special To Texas MD

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OU ALWAYS HEAR THE TERM PRIMARY CARE PROVIDER, but how much do you really know about your primary care provider and their services? Texas MD sat down with Erica Ormeno, APRN/FNP-BC, and we sought to better understand the primary care provider role, as well as their purpose and importance for patients. TxMD: What is a primary care provider? Erica Ormeno: A primary care provider can come in many forms, a family physician, internist, pediatrician, physician assistant or a nurse practitioner, all of whom serve on the front lines of your healthcare. They are the best place to start when you need any type of medical attention, advice or care. Your provider can help you navigate the healthcare system, ensuring that your issues or concerns do not fall through the cracks. They are responsible for making sure you get the right care, at the right time, in the right setting. Central to the concept of primary care is

always the patient and their well-being. TxMD: Why is it important to have a primary care provider? Erica Ormeno: It is important to build a relationship with a provider who knows and understands you and your health. Being cared for by someone who is aware of both your health issues and personal values is extremely important. It’s a valuable service that should not be overlooked. One in five sick people visit the ER for care that they could have received from a primary care provider, saving them time and money. Just as you would rely upon a loved one or family member, you should be able to rely on your primary care

Erica Ormeno is a board-certified nurse practitioner in family medicine, and she practices at MedFirst Primary Care Overlook, which is located at 26112 Overlook Pkwy, Suite. 1100 in San Antonio, TX 78260. Appointments can be scheduled online at www.Med1st.com or by calling 210.497.2338.

provider for comprehensive healthcare. TxMD: Do I need a primary care provider even if I’m healthy? Erica Ormeno: Choosing a primary care provider and scheduling regular visits helps you look out for your health and well-being today and for the future. Preventive care, like cancer screenings and chronic care for conditions like asthma, hypertension and diabetes, is a huge part of primary care. By developing a relationship with your provider and the practice you select, you become a part of a healthcare team. This team can help detect patterns and changes in your health, and they can recommend lifestyle choices to help you remain healthy. TxMD: How has the model for primary care changed or evolved over the years? Erica Ormeno: In the past, popular culture tended to relate medical care with that of a medical necessity. People usually sought medical attention only when they were very ill, or had exhausted every natural or home remedy. Today, our community has embraced and encouraged preventative care for overall wellness. The movement toward preventive care and annual wellness exams has

evolved with a cultural shift toward disease prevention in order to protect an individual’s health and well-being. The importance of prevention is now widely embraced, becoming the backbone of early disease detection resulting in improved outcomes. TxMD: How does our healthcare system support and encourage primary care? Erica Ormeno: The medical community as a whole promotes health and wellness as evidenced by health fairs, mobile health clinics, employee discounts and reimbursements for those seeking preventative care. Health insurance companies offer saving plans and flexible spending accounts specific for preventative health. Community organizations, such as churches, fitness clubs and schools, even offer simple screenings for blood pressure, weight and glucose assessments as primary prevention screenings. Primary care has evolved to view each patient as an individual, from a holistic perspective. The physician and patient enter a relationship of open communication built upon trust, compassion, and acceptance to tailor the right healthcare plan for you.

FOR MORE INFORMATION ON THE BHS PHYSICIANS NETWORK, GO TO WWW.BHSPHYSICIANSNETWORK.COM OR EMAIL JULIE MINNICK AT JAMINNIC@BAPTISTHEALTHSYSTEM.COM.

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Spine ASSociAteS

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AREAS OF EXPERTISE - Robotic Assisted Spine Surgery - Minimally Invasive Spine Surgery - Adult & Pediatric Scoliosis Correction - Reconstructive Spine Surgery - Physical Therapy - Interventional Pain Management Spine Associates’ Comprehensive Spine Center creates a direct link between your primary care provider and the management of your spine injuries. Our Comprehensive Spine Center provides a full scope of spinal services including the evaluation, treatment of the cervical, thoracic and lumbar spine by a nationally recognized orthopedic spine specialist. Working together with referring physicians, our team ensures that each patient receives a personalized treatment plan specific to his or her circumstance and lifestyle. Spine Associates is equipped with the most stateof-the-art imaging and diagnostic technology which enables our spine specialists to effectively and accurately diagnose and treat you. We also offer a full range of leading-edge, non-surgical and surgical treatment options including robotic assisted spine surgery and minimally invasive treatments to get you back to normal.

STOP LIVING WITH PAIN Call or email today and begin your personal treatment plan 800-9-SPINAL (800-977-4625) or info@myspineassociates.com

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SPINE ASSOCIATES LOCATIONS: 5420 W. Loop South, Suite 2500, Bellaire, TX 77401 a 713.383.7100 3820 Pointe Parkway, Beaumont, TX 77706 a 409.767.8221 myspineassociates.com


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MEDICAL BUSINESS / AUSTIN

Curing Headaches Around Round Rock Baylor Scott & White launches an interdisciplinary approach devoted to headache diagnosis and treatment SPECIAL TO TEXAS MD

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IGRAINES, TENSION HEADACHES, CLUSTER HEADACHES, any headache can be debilitating. Your head is throbbing. You might feel pain in your neck, back and shoulders. You are nauseous and sensitive to light, noise and smell. You may even have trouble with vision. It can be

difficult to do your job, go to school or enjoy daily life. More people complain about headaches than any other medical ailment, and about 45 million Americans complain of headaches each year. That equates to about one in every six Americans. Scott & White Clinic-Round Rock, a part of Baylor Scott & White Health, has opened a headache clinic for patients in the Austin-Round Rock area. “Having a headache clinic means we can focus exclusively on the diagnosis and treatment of adult headache disorders and adult patients with facial pain,” said Stephanie Vertrees, M.D., neurologist and director of the Headache Clinic at Scott & White-Round Rock. “We’re committed to the diagnosis and treatment of headaches while advancing knowledge through research, and moving scientific advances into clinical practice. This commitment continues to fuel our focus on providing team-oriented, personalized care for these patients.” A team approach is used to develop a personalized treatment plan to help patients manage headaches. During a patient’s initial visit, a physician will discuss the patient’s experience with

headaches, take medical and health history, conduct a physical and neurological exam, and discuss how headaches affect the patient’s life. The physician then will develop an individualized, comprehensive headache management plan. Services and treatments could include drug therapy, including acute and preventive, physical or occupational therapy, or neck and shoulder disorders, and lifestyle modifications to identify and avoid common triggers. The clinic also offers patients Botox injections, trigger point injections, and cranial peripheral nerve blocks to treat migraine and other headache disorders. Dr. Vertrees says that “some headache patients benefit from a referral to a clinical health/ pain psychologist. Many patients who have severe headaches experience a lot of stress, depression, and anxiety that can contribute to their condition.” The psychologist may recommend treatments such as biofeedback, mindfulness meditation, cognitive behavioral therapy and group therapy.

FOR MORE INFORMATION CALL 512.509.0200. THE SCOTT & WHITE-ROUND ROCK HEADACHE CLINIC IS LOCATED AT 425 UNIVERSITY BLVD. IN ROUND ROCK, TX 78665.

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CONTINUES FROM PG. 47

intracardiac ultrasound and 3-D mapping technologies. The physicians at Arrhythmia Associates are also trained to perform ablations utilizing Stereotaxis—a magnetic and robotic system offering enhanced catheter control and safety, as well as the ability to drive the catheter to places handheld catheters cannot reach. Another treatment, the Watchman left atrial appendage closure device, can also lower the risk of

stroke in those who cannot tolerate blood thinners or are at high risk for bleeding. For patients with severe cases of atrial fibrillation, new surgical and hybrid approaches involving collaboration between heart surgeons and electrophysiologists can provide a greater chance for regaining a normal heart rhythm. A pacemaker may also become a part of a treatment plan, particularly for patients who experience a slow heart rate associated with their atrial fibrillation. However, a pacemaker alone

cannot stop or cure this disorder. “Fortunately, recent advances are available to help us diagnose atrial fibrillation earlier and treat it more successfully than ever before.” September is atrial fibrillation awareness month. If you or a loved one is experiencing a rapid or irregular heartbeat, has had an unexplained stroke, has a family history, or any questions or concerns, the Arrhythmia Associates of South Texas can help with their personalized approach to patient care,

the latest technology and advancements, and ongoing education and research. Dr. Stephen May is board-certified in clinical cardiac electrophysiology and cardiovascular disease, nuclear cardiology, echocardiology and internal medicine. He practices at Arrhythmia Associates of South Texas, located at 8715 Village Drive, Suite 518 in San Antonio, TX 78217. To learn more visit www. arrhythmiasouthtexas. com or to schedule an appointment call 210.590.7712.

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SANDERSCLINIC.NET | 888-530-4494 | 4126 S.W. FREEWAY, STE. 1730 (RIVER OAKS MEDICAL TOWER) | HOUSTON, TX 77027


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MEDICAL BUSINESS / SAN ANTONIO

Healthy Devotion United Allergy Services partners with physicians to provide your patients the care they need SPECIAL TO TEXAS MD

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LLERGIC RHINITIS ACCOUNTS FOR MORE THAN 12 MILLION PHYSICIAN OFFICE VISITS PER YEAR, and it’s the second leading cause of missed school and work in the United States. Studies show the cost is upwards of $7 billion annually nationwide. Historically, a primary care physician would recommend nasal rinses, or they’d prescribe antihistamines and over-the-counter

medications to help mask the symptoms of seasonal and perennial allergies. In other cases, the physician would refer their patient to an allergist, despite the fact that primary care physicians are qualified to deliver this level of care for a large portion of their patient population. Allergists provide in-office subcutaneous immunotherapy, commonly referred to as allergy shots or IT. Immunotherapy raises a patient’s tolerance by safely increasing doses of allergens through a series of customized injections, rather than masking symptoms with over-thecounter and prescription allergy medications. These medications often have negative side effects including anxiety, confusion, sedation and blurred vision. The purpose of immunotherapy treatment is to desensitize the patient to the allergen that triggers their symptoms. The U.S. has seen a steady decline of available allergists. According to a 2007 report by the American College of Allergy, Asthma and Immunology, there are approximately 3,500 practicing nationwide, leaving potential demand at over 17,000 patients per practicing allergist.

Additionally, allergists are typically located in urban areas, leaving rural populations with limited access to care. With 300,000 primary care physicians in America, why aren’t appropriate patients able to find allergy relief from their primary care provider? Enter United Allergy Services (UAS). Healthcare service companies like UAS are committed to broadening access to care for allergy sufferers by helping family doctors, general practitioners, pediatricians, otolaryngologists, and pulmonologists to act as the first line of defense for allergy diagnosis and treatment. UAS empowers physicians and health systems to bring effective, convenient allergy testing and immunotherapy to the masses of underserved allergy sufferers. UAS simplifies allergy testing and treatment by providing an in-office allergy center, staffing and training, quality control and assurance, healthcare compliance support, revenue cycle assistance and technology services. This level of support allows physicians and their staff to deliver more personalized, quality

FOR MORE INFORMATION ON UNITED ALLERGY SERVICES CALL 210.265.3181 OR VISIT WWW.UNITEDALLERGYSERVICES.COM. UNITED ALLERGY SERVICES’ CORPORATE OFFICE IS LOCATED AT 100 NE, LOOP 410, SUITE 250 IN SAN ANTONIO, TX 78216.

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Texas’ Choice for In-Home Senior Care. Professional, Reliable & Caring. Available 24 Hours A Day, 7 Days A Week.

care through improved access to convenient and effective treatment. Increased accessibility to care and effective treatments that diminish symptoms over time means better outcomes for the millions of people that suffer from allergies. Of those patients receiving allergy care from a UAS partner: • 94 percent of patients reported improvement in allergic rhinitis scores. • 86 percent of the subjects reported improved Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores after

immunotherapy. • 79 percent of patients reported improvement in medication scores, i.e. diminished antihistamine, ophthalmic antihistamines and nasal steroid use, after immunotherapy. Empowering primary care physicians to offer immunotherapy testing and treatment to allergy patients results in high-quality, consistent, safe and effective allergy care. Ultimately, it means improved access to the only therapy proven to alter the natural history of allergic disease.

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(210) 269-9941

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Hill Country Senior Care


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NEWS & VIEWS

Don’t Give Up The Goods Why hackers want your medical records BY CHRISTOPHER HEGG

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ANY HACKERS CONSIDER YOUR MEDICAL RECORDS TO BE LOW-RISK, HIGH-VALUE TARGETS. They can be obtained fairly easily, are sought after on the underground cyber exchanges, and the chance of the hacker being exposed is minimal. Even though millions of medical records have been stolen in the United States recently, analysts are predicting a sharp increase in cyberattacks on hospitals and doctors’ offices. Hackers already know identity theft is the most lucrative of all cybercrimes. They also know the best way too effectively hijack

an identity is by having as much information on the victim as possible. Medical records are the best way to have a complete profile on someone. Personal information that can be mined from an individual’s

Criminals are willing to pay 20 times more for stolen medical records than they are for stolen credit card numbers. However, this is not the only reason hackers have turned to this specific

medical record can include name, address, birthdate, social security number, employment information, financial records and much more. Armed with this kind of information, the criminal can do everything from apply for loans to drain the equity out of a person’s home.

theft in such large and growing numbers. Medical systems in hospitals and clinics are often outdated and easier to break into. Security was never of primary concern to the original software designers to begin with, and the sophisticated techniques

FOR MORE INFORMATION CALL 800.955.2596 OR VISIT WWW.CORERECON.COM.

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hackers use today easily exploit the vulnerabilities of these medical databases. Because of these reasons, the time it takes to discover a breach of security is greatly increased. This gives hackers a comfortable window of opportunity to take what they want, and it gives the stolen merchandise a longer shelf life before the victimized parties are alerted. Thus, we now have a situation where the medical community is in a race to modernize these systems before more damage is done. However, the process is slow and tedious, and more cyber criminals are getting in on this kind of crime in record numbers. Identity theft is especially prevalent in Arizona, which had more victims per capita than any other state in 2010, with about 149 victims for every 100,000 residents. California, Florida, Texas and Nevada were also leading states for identity theft, according to Federal Trade Commission data. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules establish federal requirements for keeping health information secure. The HIPAA Breach Notification Rule requires

most doctors, hospitals, other healthcare providers, and health insurance companies to notify if a “breach� of unsecured information about a patient is seen by someone who is not supposed to see it. This federal law also requires healthcare providers and insurance companies to promptly notify the Secretary of the U.S. Department of Health and Human Services if there is any breach of unsecured protected health information, and notify the media and public if the breach affects more than 500 people. This requirement helps patients know if unsecured protected health information has been breached, and it helps keep providers accountable for the protection of their health information. Conducting an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information held by an organization is a requirement of HIPAA. Taking this first step proactively helps protect your practice from these malicious attackers and keeps the confidence of your patients.

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PHOTOS BY JOEL MARTINEZ


Stryker’s Mako leads the technological evolution of 21st century surgery 0

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BY REBECCA ESPARZA


or Dr. Miguel Berastain, Jr., a physician at the Orthopaedic Center of Corpus Christi, empathizing with his patients comes easy. Born with hip dysplasia and spending his entire life with only one kidney, Berastain has a unique perspective on patient care, leading him to try new technologies that result in better outcomes for his patients.


It will change how surgeons will do procedures someday... This is a gamechanger. Dr. Berastain, who is one of eight physicians at the Orthopaedic Center of Corpus Christi, is one of only a handful of orthopaedic surgeons in the city who perform partial knee and full hip replacements with a new, milliondollar robotic device. Stryker’s Mako robotic-arm is the only one of its kind in South Texas, and it is changing the way surgeons tackle orthopaedic surgery in the region. Board-certified in orthopaedic surgery, Dr. Berastain says, “I’ve seen firsthand what a difference using the robotic device has on overall patient outcomes. It allows my surgery to be more precise, and the computer-assisted technology allows for recreating anatomy with precision that is mind-boggling.” Stryker’s Mako robotic-arm interactive system features proprietary technology with a high-definition, patient-specific visualization system that allows surgeons to pre-plan and treat each patient uniquely, with remarkable precision. Surgical planning and special software maps the patient’s presurgical plan using data from a CT scan. The digital tracking

system constantly monitors and updates the patient’s anatomy during the surgery, enabling the surgeon to make real-time adjustments to adjust the positioning and placement of the implant. The robotic-arm guides the surgeon with visual, tactile, and auditory feedback through each planned and well-defined surgical movement. Tactile resistance is sensed through the robotic-arm and instruments enforce the boundaries of the patient-specific surgical plan. South Texas Surgical Hospital purchased the robotic device in the summer of 2014, and Dr. Berastain began utilizing the robot soon afterward. “As a surgeon, you’ve got to take a step back, be humble and realize a robot will be more precise than a human can be in the operating room,” Dr. Berastain acknowledges. Adding, “There is no comparing being able to make cuts within a one millimeter of accuracy. It’s

simply remarkable, and we are so lucky to have such highcaliber technology right here in our own backyard. Ordinarily, patients would have to travel to San Antonio or Houston for such advanced technology.” During the actual surgery, surgeons receive feedback from the robotic-arm about how implants are fitting. The most labor-intensive part of the surgery is done before anyone steps foot in the operating room. Although the actual overall surgery time is less using the robotic-arm, the time for the entire surgery is comparable to a conventional surgery because there is prep time to consider when setting up the computer. “Using 3-D models on computers, we are able to pinpoint where we’ll make incisions and where specific implants will be placed, with a one millimeter degree of

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accuracy,” he says. Dr. Berastain adds he notices a difference in how quickly patients recover from surgery using the robot. “They seem to get their range of motion back faster with the robot. The end goal is to make sure patients have no pain in any part of the area we perform the actual surgery.” Once a patient is cleared as a good candidate for partial knee or total hip replacement, Dr. Berastain reviews general risks for surgery

with the patient and studies CT scans so the robot can be calibrated properly. “It’s all about balance,” he says. “The robot allows us to give a better fit with these implants, which makes a happier patient overall, and that’s what it is ultimately all about: happy patients.” The 3-D models done before the robotic surgery is like recreating the human anatomy. Berastain explains, “That’s the beauty of it all. Before you were having problems

with your knee or hip, your body told you what worked. We want to recreate what used to work on your body at one time.” Another physician who began performing partial knee replacements with Stryker’s Mako robotic-arm last summer is Dr. Jeffrey Schlimmer, also with the Orthopaedic Center of Corpus Christi. Born in Indiana, but raised in Portland, Texas, Dr. Schlimmer initially believed he would grow up to be a pilot someday. Eventually, his father, an oral surgeon, influenced him to consider a career in medicine leading him to be a boardcertified orthopaedic surgeon. Dr. Schlimmer, who performs partial knee replacements, notes the instrumentation with conventional surgery is not as precise as using the robot. “Having the robot help is light years ahead of a regular surgery. You know exactly where your implants will go before you ever step into the operating room,” he says. Schlimmer also hinted about other areas of the body that will benefit from using the same robotic device someday. “There are certainly more applications for it in the future. From a technology standpoint, it’s the first thing I’ve been excited about in a long time. It will change how surgeons will do procedures someday. There


will be no going back. This is a game changer.” Dr. Schlimmer notes that although the robot is instrumental to providing a precise surgery, it still needs to be guided by a skilled surgeon. “The robot can’t do anything on its own. It is controlled by me and operates within a set of specific parameters, which we are responsible for inputting, including placement, balance and sizing. You can’t get this type of precision with conventional surgery,” he explains. Dr. Schlimmer takes a certain

amount of pride in being one of only a handful of surgeons in Corpus Christi who offer the robotic-arm surgery. This surgery is the perfect option for a patient who has had isolated pain in the knee and tried conservative therapies, like antiinflammatory drugs, with no result. “It makes me feel good to offer such a high-tech option for a partial knee replacement. I love helping people get back to the things they used to do before they had pain in their knee. Reducing people’s pain increases their overall quality of life, and I enjoy being a part of that entire process,”

beams Dr. Schlimmer. The Orthopaedic Center of Corpus Christi is located in Corpus Christi, Texas. The surgeons treat the entire musculoskeletal system and have expertise in sports medicine, total joint replacement, hand and upper extremity, arthroscopic surgery and spinal surgery. For more information on the doctors and their services, visit www.orthocentercc.com

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Bringing

Medical Innovation

to Sinus Problems

South Texas Sinus Institute and Vincent F. Honrubia, M.D., F.A.C.S, are expanding and becoming American Sinus Institute BY JOEY GOMEZ PHOTOGRAPHY BY JENNIFER HAMILTON


ASI is the only place you can go, where the whole facility is aimed toward one procedure. I don’t know of any other medical facility that does

For more information visit ASI’s San Antonio office at 6363 De Zavala Road, Suite 200 or call 210.225.5666. Find ASI online at AmericanSinus.com. You can also contact ASI’s Houston office at 1801 Binz Street, Suite 400 or call 713.225.5666. Find ASI online at AmericanSinus.com. You can also contact STSI Edinburg office at 2821 Michaelangelo Drive, Suite 201 or call 855.99.SINUS. Find STSI online at Southtexassinusinstitute.com.

Typical Chronic Sinusitis Symptoms

SOUTH TEXAS SINUS INSTITUTE, located in San Antonio, is expanding and becoming American Sinus Institute to provide patients with the latest balloon sinuplasty technology for treatment of chronic sinusitis. While the original Edinburg facility will continue to operate under the name South Texas Sinus Institute, future expansion will be under the American Sinus Institute brand name. Expansion plans include the opening of American Sinus Institute-Houston in September 2015 with additional locations in Dallas and Austin planned for early 2016. Further expansion is expected across Texas in 2017 and then other locations across the United States. South Texas Sinus Institute (STSI) was originally founded more than a decade ago in Edinburg, Texas. From Edinburg, STSI embarked on establishing themselves in San Antonio. Their

• Facial Pain and Pressure • Congestion or fullness • Difficulty breathing through the nose • Discharge of yellow or green muscus from the nose • Tooth pain • Loss of the sense of smell or taste • Headache • Fatigue • Ear Pressure and Pain • Bad breath

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success was immediate and their growth exponential. Over the past three years, physicians at the Edinburg and San Antonio medical facilities have completed the most balloon sinuplasty procedures in the state of Texas

Balloon Sinuplasty Innovation Sinusitis affects approximately 37 million people in the U.S. each year. This equates to roughly 17 percent of women and 10 percent of men each year. These sinus problems are estimated to impact 73 million days per year

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of restricted activities and result in 18 million physician office visits. Balloon sinuplasty is an effective solution for many of these individuals suffering from chronic sinusitis. Balloon sinuplasty is a non-invasive


procedure in which doctors utilize a balloon catheter to expand and clear sinus passageways. The procedure involves compressing tissue to create space versus traditional sinus surgery done with surgical instruments. Balloon sinuplasty is a superior approach to addressing many sinus problems that manifest in the sinus symptoms shown in the table below. Compared with traditional sinus surgery where removal of tissue can create bleeding and scarring, with balloon sinuplasty procedure, bleeding and scarring doesn’t occur since tissue is compressed and not eliminated, according to Founding Director Vincent F. Honrubia, M.D., F.A.C.S. The balloon procedure is considered state-of-the-art when it comes to relieving sinus problems, and Dr. Vincent Honrubia has taken it a step further. His “Honrubia Technique” utilizes the latest sinus balloon technology and supporting equipment, coupled with general anesthesia and a state of the art medical facility that allows for a more complete procedure and thus better patient results.

ASI has emerged as an effective solution for sinusitis patients. By establishing centers that are solely dedicated to the balloon sinuplasty procedure, Honrubia believes ASI has emerged as a practice that not only emphasizes highly specialized care, but also offers a level of innovation unsurpassed among competitors. “We are the first ones we know of that have opened to fill a need, which is to only do that one procedure, balloon sinuplasty,” Honrubia said. “That’s our number one priority. ASI is the only place you can go, where the whole facility is aimed toward one procedure. I don’t know of any other medical facility that does.” Dr. Honrubia has trained a team of boardcertified ENT physicians in the Honrubia Technique for balloon sinuplasty; they know what questions to ask so that patients can move forward with a better quality of life, and they have the technical skill to achieve it. According to ASI CEO Jim Havelka, “We have done several thousand balloon sinuplasty procedures between our ASI San Antonio medical facility and our STSI medical facility in Edinburg. Based on that

volume, we are the largest medical provider of the balloon sinuplasty procedure in Texas.” Solving Sinus Problems For those patients who are visiting their regular doctor every three months for injections of steroids or steroid pills, there is now an option. Patients will no longer have to rely on steroid injections, which are typically reserved for serious inflammation issues rather than allergy cases, according to ASI Medical Director Dr. Vincent Honrubia. “We are a highly specialized facility providing long term relief of sinus problems. Many of our patients come to us after having been on many rounds of antibiotics, steroids and nasal spray over and over without ever solving the problem,” Honrubia said. “We have seen it many times from our patients, who have been treated by their primary doctor for years. These patients have never been told that there is an option that may provide longer term sinus relief. Additionally, for allergy sufferers, the balloon procedure can change the way your body reacts to the allergy by giving you more space in the sinuses,” Dr.


Honrubia said. We want to change the mentality of the patient when it comes to sinus problems. If they have a sinus problem, they can go to the sinus doctor without having to go to a family doctor,” he said. “They can come to the experts immediately.” Improving the Patient Experience During the initial consultation with the patient, the ASI physicians review the patient’s symptoms and learn more about the specific ailment. After doing a thorough examination and patient history, doctors create a specific treatment plan catered to the patient’s needs. Through the balloon sinuplasty procedure, patients can finally find relief from chronic sinusitis. “Our medical facilities are not an operating room, and we are not an outpatient surgery center. Rather, it’s a blend between an out-patient surgery center and a medical office. Our medical facilities are staffed with highly skilled physicians, RNs, CT technicians and medical support staff. Our medical facilities and professional staff are optimized for the balloon sinuplasty procedure. It’s very hard to compete with us because we have a more efficient and effective facility and balloon sinuplasty methodology,” said ASI CEO Jim Havelka. ASI aspires to become the leading

balloon sinuplasty facility in the country providing relief to the many individuals suffering from sinus problems. When someone thinks balloon sinuplasty, they will think of the American Sinus Institute. The combination of the Honrubia Technique for balloon sinuplasty, boardcertified ENT physicians, our partnership with market leader Johnson & JohnsonAcclarent and our state-of-the-art medical facilities to ensure patient results have led to our success,” says ASI CEO Jim Havelka. “I think what is reflective is that the market has responded very positively to our medical services because of the success we have had with our patients,” Havelka said. “We are able to show a demonstrated track record of improved sinus outcomes for patients who come to our facility. That’s the measure of success for our clients and our business.” ASI is a Leader in Contributing to Scientific Studies ASI has begun publishing its results; in September 2015, two papers will be presented at a national conference for the American Academy of Otolaryngology, a yearly meeting for ENT doctors. Additionally, through a study called OASIS, which is funded by Johnson & Johnson, ASI has become one of the few medical facilities collecting scientific data comparing balloon sinus procedures

with traditional sinus surgery. “We are part of a very select group of medical facilities that are participating in the Johnson & Johnson OASIS study. Not only are we providing a new and innovative technique, we are constantly learning from what we are doing, and trying to improve our procedures by examining the scientific data,” Honrubia said. “We evaluate the procedure data from pre- and post-balloon sinuplasty sinus symptoms, revision rates, complication rates and our patient satisfaction surveys. We have very sophisticated methods in place to monitor our progress of how we are doing with the patients.” ASI Going Forward Given the large number of patients looking for longer term relief from sinus problems, American Sinus Institute expects to continue its strong growth across Texas and then across the country. “At the end of the day, patients are our best referral source. This is based on the outcomes they realize by coming to our medical facility and our team of boardcertified ENT physicians,” according to ASI CEO Jim Havelka. “When our patients leave our office feeling better than when they arrived, this is the best marketing for our business.”

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Based on that volume, we are the largest medical provider of the balloon sinuplasty procedure in Texas

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I quickly realized he would not make it back for Evan’s delivery, and out of everything I’ve ever done, that is the hardest thing I’ve ever had to face”


AIR FORCE

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Dr. Erika Gonzalez-Reyes Chief of Allergy, Immunology, and Rheumatology at the Children’s Hospital of San Antonio

TRUE-BLUE Military veteran Dr. Erika Gonzalez-Reyes brings core values to the community she serves BY VANESSA TURNEY

PHOTOGRAPHY BY JOHN PATTON

THERE IS AN INSTANT EASE WHEN CONVERSING WITH DR. ERIKA GONZALEZREYES. The reason behind her disarming nature doesn’t make itself evident instantly. Rather, like a lingering perfume whose signature note suddenly becomes clear and triggers alarm bells once

the origin is detected, it hits you: she rings true. Authenticity and integrity steeped in deep. With simple and impactful statements such as “excellence in all you do” and “service before self,” her local community roots and military background reveal the foundation of her work ethic and personal character. That foundation is the

basis of her educational and professional accomplishments in highly regarded positions for such a young professional. She is both chief of allergy, immunology and rheumatology at the Children’s Hospital of San Antonio and a key associate at the South Texas Allergy and Asthma Medical Professionals (STAAMP). Like many in the community who made their way to San Antonio through their parent’s military service, Erika landed in central San Antonio at 6-years-old. After continuing her education at St. Mary’s University, she followed in her father’s military footsteps and accepted an Air Force scholarship to the University of Texas Medical Branch at Galveston. Her military career in medicine eventually planted Dr. Gonzalez-Reyes in Biloxi, Mississippi in 2002. Erika completed her pediatric residency at Keesler Medical Center in Biloxi, and that same year she met her future husband and fellow doctor, Joel Reyes, who is currently the Pediatric ICU Medical Director at San Antonio Military Medical Center. Biloxi, Mississippi was more than just the beginning of her medical career as chief of pediatric residents. Her professional and personal life was irrevocably altered when

For more information about the Children’s Hospital of San Antonio call 210.704.2011 or visit www.chofsa.org. You can also visit their location at 333 N. Santa Rosa St. in San Antonio, TX 78207.


Hurricane Katrina pummeled through the state in August of 2005. Erika recalls the experience as “a big turning point for all of us because essentially we lost everything. We had no hospital; there was no place to work...We were both in Washington D.C. for a conference watching everything unfold on television, and the next thing we know, we are watching Biloxi under water.” After Katrina, Dr. GonzalezReyes was reassigned to Virginia with most of her colleagues. Her role as chief of pediatric residents was extended at a navy hospital in Virginia, where she then applied for her fellowship at Wilford Hall Medical Center at Lackland Air Force Base in allergy and immunology in 2006. Her move to Wilford Hall and back to her San Antonio roots marked another milestone professionally and personally for Gonzalez-Reyes. Erika and Joel Reyes married in 2007, and she stayed on at Wilford Hall training fellows until her military commitment ended in 2011. Her new career as a provider at STAAMP allows her to treat both adults and pediatrics in her hometown of San Antonio, where much of the populace suffer from a variety of allergies. “My fulfillment in private practice is that the clinic allows me to see patients over the years, from infancy to elderly,” Dr. Gonzalez-Reyes says warmly. Working sideby-side at STAAMP with Dr. Gonzalez-Reyes are providers and colleagues Dr. John Dice

and Dr. Mark Stahl, who all treat a wide variety of conditions from seasonal allergies and asthma to food allergies and atopic dermatitis. When asked about her colleagues, and what makes their clinic unique, she shares that all three providers have worked together for 15 years, and all three of them are military veterans. She explains, “We were all trained at the same place, Wilford Hall. John Dice trained me, and I trained Mark Stahl. We bring a lot of what we learned in the military to the practice, and the level of integrity we extend to our patients is reflected in our service to them. We all have a true appreciation of the military, and it means a lot to our patients.” With the clinic in close proximity to Lackland Air Force Base and San Antonio encompassing such a large military presence, a large portion of her patients have an instant connection with the providers in the clinic, many of whom are veterans themselves. When Christus Santa Rosa and Baylor College of Medicine approached Dr. Gonzalez-Reyes about creating the first standalone children’s hospital in San Antonio in 2014, she jumped at the opportunity to stay at the forefront of a specialty she is passionate about. “The academic world appeals to me because we can do research and look at cutting-edge treatments that are coming out. For instance, there are new treatments which lower the sensitivity to food allergies in children, as currently there is no cure for food allergies. The only protocol is avoidance, so the research and new treatments

available are very exciting, and they can help to save lives,” shares Dr. Gonzalez-Reyes eagerly. Dr. Erika Gonzalez-Reyes currently resides as the chief of allergy, immunology and rheumatology at the Children’s Hospital of San Antonio Baylor College of Medicine and associate professor of clinical pediatrics. Her enthusiasm for food allergy research is reflected in her involvement with additional organizations, such as Food Allergy Research and Education (FARE), where she is the medical executive chair for the yearly walk bringing awareness to food allergies, and the San Antonio Food Allergy Support Team, where she sits as the medical advisor. Her involvement in private practice and pediatric specialty at the Children’s Hospital allows

The road is not always easy. It’s not always how you planned or expected it to be...All of your experiences will make you the person you become”

her to see a range of patients from adults to children, and the message she wishes to convey is clear: nobody should have to suffer from allergies. Dr. Gonzalez-Reyes explains that, “It may not be seen as a chronic condition, such as diabetes or high blood pressure, but one of the reasons we love our field of medicine, is that we can improve quality of life for patients very quickly.” She emphasizes, “If you have been suffering, you either did not receive the correct treatment or perhaps were not diagnosed properly.” With her professional trajectory permanently in full swing, one is positive Dr. Gonzalez-Reyes has faced hardships both in her professional and military careers. Not surprisingly, she does not give ubiquitous examples of late night residency hours, nor of military relocation challenges. Incredibly, she relates her most daunting challenge as a lesson learned when she was on the dependent side of the military and facing a pregnancy delivery alone. With her son Lucas born in 2010, and four months pregnant with her second son Evan in 2012, Joel Reyes was called for deployment to Afghanistan for six months. Dr. Gonzalez-Reyes remembers, “I quickly realized he would not make it back for Evan’s delivery, and out of everything I’ve ever done, that is the hardest thing I’ve ever had to face. I was on active duty for 10 years and didn’t realize until I was on


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the dependent side the extent of what the family sacrifices in deployment situations.” While Joel Reyes’ commander made a surprise revelation to him on Thanksgiving that he was being released home early from his deployment and would be there for the delivery, the experience, she says, “It made us stronger.

We find such unique ways to support one another.” Indeed, Dr. Gonzalez-Reyes recalls that, “One time he called me and I ran out of diapers for Lucas, I felt like such a bad mom, and the next thing I know, Joel called and said he had me covered and ordered me shipments of diapers,

wet wipes and formula from Amazon.” The unity she and her husband share in both their family and professional lives extends into their extracurriculars as well. Selfdescribed “foodies,” they are still adventurous at heart in their love of travel, and they stay committed to spending

time with their family and close circle of friends. With her family settled in the city she grew up in and her husband separating from the military in the coming months, Dr. GonzalezReyes has her sights set on improving the quality of life for her city’s patients in the coming years with positive initiatives. She states, “I would hope to establish both a fellowship program and food allergy clinic at the Children’s Hospital, in addition to expanding STAAMP’s diagnosis and treatment of allergies to more patients across the city.” Her belief in “paying it forward” pushes her to mentor other women interested in medicine so that they may have a positive impact in the communities they serve as well. She reminds those looking to further their dreams that, “The road is not always easy. It’s not always how you planned or expected it to be...All of your experiences will make you the person you become.” Her statement of those hopes for the community cause the proverbial alarm bells to ring again, detecting an absolute trust in her ability to make those hopes a reality, and while doing so, guiding others in the same core values that have served her and her

For more information about Dr. Erika Gonzalez-Reyes’ work with STAAMP call 210.616.5385, you can email her egreyes@staampallergy.com, or check out their website www.staampallergy.com. You can also visit their location at 10447 Highway 151 in San Antonio, TX 78251.


PHOTOS BY RUDY XIMENEZ

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Stryker’s Mako Makes Waves of Advancements Austin Drs. Fox and Manuel laud the latest in the surgical technology BY KIM ESTES

GOOD NEWS FOR PARENTS WORRIED THEIR CHILDREN PLAY TOO MANY VIDEO GAMES: two Austin orthopedic surgeons said this pastime taught them initial skills helpful to performing modern-day, robotic surgery. Dr. Josh Fox and Dr. Jake Manuel laughed, but spoke with a note of seriousness saying that it was the video games they played as children that helped them adjust to using a robotic-arm for replacing knee and hip joints while watching the process on a screen. The procedure is called Mako. Notwithstanding their brief tribute to gamers everywhere, the two gave much applause to the surgically advanced technique used for partial knee and total hip

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“For partial knee replacement, I would not do it any way other than MAKOplasty”- Dr. Fox of Austin Bone and Joint Clinic 76

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replacement. Mako, acquired by the Stryker Corporation in 2013, was developed by the MAKO Surgical Corporation using the Robotic-Arm Interactive Orthopedic System. It is a high-tech tool with a cool price tag of more than $1 million. Dr. Manuel and Dr. Fox said its real value is a more precise and accurate solution for patients suffering from knee or hip joint pain. Dr. Manuel, with Austin Sports Medicine, said, “It takes an inexact operation and makes it precise. The robot maps out the bone and tells us how to cut. Only the affected bone and cartilage is removed due to the precision of the robot. No other tissue is damaged.” Some doctors, however, are uncomfortable with the advanced surgical methodology. Dr. Manuel said he understands their apprehension, but he maintains it is a procedure that truly benefits patients. “It is hard to get used to, but there was a study at Massachusetts General Hospital – Harvard – to determine how ‘good’ doctors are at the conventional style of partial knee replacement. We are ‘good’ only 50 percent of the time. The robot taught me I was not as good as I thought I was. It makes our effort better,” Dr. Manuel explained. Most candidates for Mako have been diagnosed with osteoarthritis. It is the most common type of arthritis and found in about 27 million Americans age 25 and older, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. There are a few more specific conditions for which Mako is a treatment option. For partial knee

replacement, the patient may have rheumatoid arthritis or avascular necrosis. “In total hip replacement, trauma rheumatoid arthritis, avascular necrosis or hip dysplasia would be a less common diagnosis,” Dr. Manuel said. For total hip replacement, Dr. Fox said, Mako is a particularly good solution in posterior procedures. “For a direct anterior (frontal) approach to hips, I typically have live x-ray present in the operating room and get that second sense of security that implants are exactly where I want them. For a posterior approach, however, it is difficult or impossible to use the live x-ray in the same way. These are the cases in which I am using Mako because it allows for that verification of implant position and, hopefully, improved longevity.”

“For partial knee replacement, I would not do it any way other than with Mako,” said Dr. Fox, with Austin Bone & Joint Clinic. MAKOplasty.com reported that in initial outcomes of an ongoing study in partial knee replacement, the procedure resulted in more accurately placed implants and less pain for the first eight weeks after surgery compared with patients receiving manually placed implants. Dr. Fox cautioned, “Patients will have post-operative pain. We are still cutting bone. It will hurt, there will be swelling. I tell my patients that they are going to hate me for at least two weeks. But, in the end, they do well. We take out less bone with Mako,

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and that’s a big thing for partial knee replacement,” he said. Additionally, the same study found Mako patients had increased post-operative function compared to those who underwent the manual procedure, based on American Knee Society Scores three months post-op. Dr. Manuel and Dr. Fox described a Mako partial knee replacement procedure from diagnosis through treatment. “Degenerative changes are changes in the cartilage within the knee or any other joint,” Dr. Fox began. “Cartilage is a strong, smooth surface that caps the ends of bones. It is supposed to create a lowfriction surface that allows bones to glide past each other with ease, allowing motion. As this cartilage ages or is injured, it can crack or peel, much like paint on a wall. As it peels off, it exposes the bone beneath. This leaves bone rubbing on bone in a joint, which is arthritis. Bone is not smooth and thus there is increased friction, and this increased friction leads to inflammation and ultimately to pain.” The most helpful initial diagnostic tool in partial knee replacement is a standard x-ray. It gives an overall picture of the knee and where the cartilage is worn out or wearing thin.

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“If there is not clear evidence of the extent of the damage based on x-ray alone, then an MRI will give a detailed picture of the quality of cartilage throughout the knee,” Dr. Fox said. Once the diagnosis is settled, for patients headed to surgery, a computed tomography, or CT, scan is scheduled for use in pre-operative planning. From the CT, the RIO creates a 3-D model that allows the surgeon to plan placement and alignment of the patient’s knee implants prior to surgery. Dr. Manuel said, “With the 3-D model, you get more depth rather than just an upand-down view.” In surgery, doctors guide the robotic arm while preparing the bone for the implant. “To resurface the knee, you essentially remove this layer [of cartilage] along with a small amount of the supporting bone, and replace it with a combination of metal and plastic to recreate the low-friction environment that is usually present within a joint,” Dr. Fox said. Real-time response from Mako ensures bone removal stays within “the safety zone” of the surgical plan, providing auditory, visual and tactile feedback, which stops the roboticarm if necessary before bone can be removed outside the planned area. Dr. Fox said, “The robot will not allow you to push through to areas that are out of the plan, thus eliminating some potential bone loss. There is a haptic field that is setup in the process and, if the instrument leaves this field, the robot shuts down that instrument and

will not allow the surgeon to proceed.” Visually, there is a monitor on which physicians can watch changes they are making to the bone. “You can also look directly at the surgical site and compare the real knee to the virtual knee to verify that they match,” Dr. Fox said. Alarms beep if something out of the ordinary occurs, such as too much motion or too much pressure. “Additionally,” Dr. Fox said, “as the surgeon is getting started and registering the knee into the computer to match the pre-op CT scan, there are different sounds and tones as data points are collected to let him or her know if the points are good or not.” Finally, through real-time capabilities the physician can see exactly where the tip of the instrument is at all times when in the surgical field. “It shows what bone has and has not been removed as compared to the surgical plan,” Dr. Fox said. “You can change the plan based on what you see at the time of surgery,” added Dr. Manuel. Once bone preparation is complete, implants are placed in the knee. The procedure takes about 90 minutes. The patient can be completely asleep with general anesthesia, or sedated and treated with either spinal or epidural anesthesia. Post-operatively, in most cases the patient is up and beginning therapy the day of surgery. “If it’s not the same day,” Dr. Fox said, “then it would be the next morning.” The time can vary before patients return to work. “I usually tell patients that they can return when they are physically able to do what they need to do for their jobs and their pain allows


them to do so. For some people this is a week or less, and for some it can be longer,” Dr. Fox said. Mako reports a failure rate nine times lower than manual surgery. Dr. Fox said, “In the right patient, the success rate for Mako is very high. It is a very effective tool for reducing or eliminating pain when it is applied to the right patient.” People experiencing knee pain that has failed to respond to non-surgical treatment or medication are advised to talk to their doctor. For those interested in learning more

about Mako, visit www.aboutstryker. com. According to the corporation’s website, Mako is available in 15 Texas hospitals including Christus St. Michael Health System, Texarkana; Forest Park Medical Center, Medical City Dallas Hospital and Pine Creek Medical Center, Dallas; Good Shepherd Medical Center, Longview; Houston Orthopedic and Spine Hospital, Bellaire; Kell West Regional Hospital, Wichita Falls; Las Palmas Medical Center and Sierra Medical Center, El Paso; Medical Center

of McKinney and Methodist McKinney Hospital, McKinney; Memorial Hermann Memorial City, Houston; Memorial Hermann The Woodlands Hospital, The Woodlands; South Texas Surgical Hospital, Corpus Christi; St. David’s Medical Center, Austin and Tomball Regional Medical Center, Tomball. Aboutstryker.com also lists physicians who perform the procedure.

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convenience could be life saving. Patients can be screened, without having to go to the hospital, for the number two cancer killer, colon cancer, and if a polyp is found, it often can be removed on the spot, preventing cancer from developing. Dr. Piesman is also among a handful of physicians in San Antonio who is highly trained in detecting another killer, pancreatic cancer, while it is still curable. “We are able to find things a lot faster, find pancreatic cancer faster,” says Dr. Piesman, who is an

the community and becoming part of it.” Part of that growth may also be due to the location. “Patients say it is very convenient because we are close to I-35, plus very comfortable and clean,” says Arnold’s partner, Michael Piesman, M.D. That

expert in endoscopic ultrasound procedures. “Pancreatic cancer is only curable when found early. It’s almost like x-ray vision. We could never see outside the intestines before.” Personally, Dr. Piesman believes in work-life balance. “I preach

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exercise and balanced living. I practice that too,” Piesman says. David Pryor Jones, D.O., another partner practicing in the northeast office, says his 14 years in the military, including a six month deployment in Iraq, helps him be a better doctor. “I think it lets you understand people. You carry bags, work hard, learn the people aspect,” he says. “We tailor our care to the patients’ needs, as opposed to simply testing for testing purposes.” Dr. Jones says he believes humor and spirituality is important in medicine. “You may not be able to change the disease process, but how you deal with it does matter.” One disease process he is passionate about is irritable bowel syndrome. “Because so many people are under diagnosed,” Jones says. “There are options out there: medications, dietary strategies, acupuncture and yoga.” Drs. Jones and Arnold worked together in the military, so the two have a long-standing rapport and friendship. Dr. Arnold says his work life today feels a lot like the army days. “I was raised to respect other people. My mother raised me well: to be polite and respectful, emphasizing personal integrity. I treat people the way I want to

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be treated,” says Dr. Arnold. Part of that personal integrity includes heading up a new research effort in the clinic that could potentially help find a cure for fatty liver disease, a common problem in San Antonio. “We’re doing innovative research for new drugs for several different liver diseases. We are studying Crohns and ulcerative colitis also,” Dr. Arnold explains. “Ultimately, we will have a drug development unit as we explore therapeutic options for diseases that don’t have a cure right now. The research could be ground breaking. We are looking at

medications to treat fatty liver cirrhosis, or advanced liver disease, in the next year. It is common here in San Antonio because of the large population of diabetes and obesity.” Communication is essential in that research and in treating patients. His partner, Oscar G. Ramirez, M.D., who is from Guatemala City, Guatemala, is bilingual. “Many patients that don’t speak English, they have a barrier of communication. They don’t feel understood,” he explains. To someone who understands the cultural differences, they feel more

comfortable expressing what they feel.” “I am passionate about endoscopy. We love to do something that is going to help a patient get better right away,” beams Dr. Ramirez. Dr. Ramirez says he loves coming in to work every day because of the employees, patients and the environment. “Even though we come from different training, we all care for the patients. In the end, we are all striving for good patient care. We communicate well,” he says. “Doctor Arnold and Doctor Jones are leaders and

have great ideas,” he says. “The staff is caring and professional. The common denominator: everyone wants to improve. They have a way of making patients feel at ease.” That’s exactly how patient Donna English felt after she came into the clinic to be screened for colon cancer. “I just think it is wonderful to see the doctor, and get the surgery done here. It’s one happy family to me now,” she says, smiling, in the recovery room after her colonoscopy. “One of the doctors here saved my life.”

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MIND MATTERS

Mindfulness Can Change Your Brain

What does your brain have to do with anything? Everything. BY JENNIFER BUERGERMEISTER

F

OR TWO DECADES, I have been a practitioner of meditation and yoga. I couldn’t be more elated at what’s new and trending in the neuroscience community, where mindfulness is making mainstream headlines all over the world. I guess we are what we think after all, and it seems the fountain of youth resides in long-term meditative practices. Our brains can and do change. All the time! It was once thought that a brain develops and that’s it. What you have at maturity is all you have, and killing your brain cells over the years creates permanent damage. We now know that simply isn’t true. The brain has what is called plasticity, and with the right tools and guidance, we can all change our brains for the better at the neurological level. It just takes, like anything, a

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good amount of practice. Life expectancy has dramatically risen around the world. Though the brain starts to decrease in volume and weight from our mid-20s onward, by understanding the pathologies associated with brain aging we can identify factors in cerebral health that can have incremental effects across our lifespan. The direction of research has moved from identification of risk factors to positive approaches aimed at enhancing cerebral health. Currently, meditation is one of the most researched, and almost every major study is showing that changes in gray matter occur; increases where it counts and decreases in gray matter where it’s needed. There are three major studies that initiated the suggestion that meditation may slow, stall or even reverse age-related brain degeneration: Cortical thickness in two predetermined brain areas (Lazar et all, 2005) Whole brain as well as voxel-wise integrity in gray matter (Pagnoni and Cekic, 2007) Fractional anisotropy, and indicator of white matter fiber integrity, in 20 pre-defined fiber tracts (Luders et al., 2011) The research results suggest that there is less age-related gray matter decline in meditators than in control groups, both globally and locally. It was also suggested that stress levels, the modulation of potentially harmful effects

of immune response genes expression, down-regulation of neurogenesis, activation of pro-inflammatory processes, and the production of reactive oxygen species may come into play, supporting that meditation is brainprotective and associated with a reduced age-related tissue decline. The Harvard study with Susan Lazar and her colleagues indicated in a nutshell that EEG and MRI tested groups practicing 20 minutes of meditation per day showed a decrease in gray matter in the amygdala, associated with stress, and they had an increase in gray matter in the prefrontal cortex, where we develop empathy and self-awareness. Mindfulness-based stress reduction (MBSR) is one of the most widely used mindfulness training programs. It has been reported to produce continual positive effects on psychological well-being and to ameliorate symptoms of a number of disorders in eight weeks. Positive changes occurred in the left hippocampus, posterior cingulate cortex, temporoparietal junction, and the cerebellum in the MBSR group compared with the controls. Protocols set up for some neuroimaging studies to

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TEXASMDMONTHLY.COM


study mindfulness included a body scan, mindful yoga, and sitting meditation for eight weekly group meetings lasting two and a half hours, plus one full day at six and a half hours. Mindfulness was defined as awareness of presentmoment experiences with a compassionate, non-judgmental stance. They were also given a five facet mindfulness questionnaire. Changes in the ROI analysis showed concentrations of gray matter in the left hippocampus in the MBSR group, confirming that structural changes in the

region are detectable within eight weeks following the participation in the MBSR mindfulness-training program. The study demonstrated longitudinal changes in the brain’s gray matter concentration contributing to the regulation of emotion and improved function in regulating emotional responses. Decreases in these areas, most interestingly, are associated with posttraumatic stress disorder and depression. The hippocampus is a well-known region for its ability to remodel synapses and generate new neurons. Volume

loss here also seems reversible! The increase in the cerebellum in the integration of sensory perception, coordination and motor control also plays a crucial role in the regulation of emotion and cognition. Emotions and cognition play an important role in healthy psychological functioning. Regions within the brain stem were also found to increase in just eight weeks where regulation of various neurotransmitters such as norepinephrine and serotonin occur. Serotonin plays a

significant part in mood regulation. Resilience is accomplished by our ability to regulate our emotions and go with the flow of things. If a little meditation a day, only 20 minutes of our 24 hours, can play a significant role in how we feel, and how we relate to our surroundings and each other, wouldn’t it be worth it? Who doesn’t want to have health and wellness? It sure doesn’t seem to hurt to try! Be well and meditate! Mindfulness can change your life because it will change your brain.

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NEWS & VIEWS / CORPUS CHRISTI

What did you just say? U Need 2 Put The Phone Down! BY NICHOLAS NILEST

I

F YOU’RE LIKE ME, often times while driving I have to ask the passengers in my vehicle to repeat what they just said to me because I’m doing a lot of things at once. While this may seem harmless, albeit annoying to my passengers, think about the consequences of my actions if I was driving. Distracted driving is a growing, and dangerous, recurring event in the United States. All distractions — texting, talking

on a cell phone, putting on make-up — endanger the driver, passengers and any bystanders. In 2012, more than 420,000 people were injured in motor vehicle crashes that involved a distracted driver, with more than 3,300 people being killed. While there are various distractions in a car, texting is by far the most alarming because it requires visual, manual and cognitive attention from the driver. What’s frightening is that at any given daylight moment across America, about 660,000 drivers are using cell phones or electronic devices while driving. This figure has held steady since 2010. On average, sending or receiving a text takes a driver’s eyes from the road for 4.6 seconds, which is the equivalent of driving the length of an entire football field blind if the driver is maintaining a speed of 55 miles per hour. As a doctor of physical therapy, and the CEO at Corpus Christi Rehabilitation Hospital, I’ve seen the effects of distracted driving first-hand, including severe orthopedic injuries and brain traumas. I’ve watched a young man in his 20s spend weeks struggling to learn to walk again. I’ve seen a father that had to re-learn to eat. The list

goes on. While I’m more than glad that we’ve been able to help in the long-term recovery of these types of patients, quite honestly, it frustrates me. These injuries are so easy to prevent, yet they’re still happening. Our youngest and most inexperienced drivers are most at risk, with 16 percent of all distracted driving crashes involving drivers under the age of 20. But, they’re not alone. During the day, hundreds of thousands of drivers are using cell phones. Many of these drivers still don’t understand how dangerous distracted driving is. Others know the risks, but they make the mistake of thinking the statistics don’t apply to them and they can defy the odds. And, still others lead busy, stressful lives and feel they need to use their cell phones in their cars to accomplish their tasks. But, it’s time to stop this epidemic. Let’s all make a simple pledge to turn the cell phone off when you turn the ignition on. Let’s be responsible drivers. Let’s pay attention to the road. Let’s save lives together. Nicholas Nilest is the CEO of the Corpus Christi Rehabilitation Hospital.

FOR MORE INFORMATION CALL 361.906.3700 OR VISIT WWW.CCRH.ERNESTHEALTH.COM. THE CORPUS CHRISTI REHABILITATION HOSPITAL IS LOCATED AT 5726 ESPLANADE DRIVE IN CORPUS CHRISTI, TX 78414.

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NEWS & VIEWS / HOUSTON

Measuring Success Ignore the scale, fitness goals are defined more than one way BY STEWART BEASLEY

I

T’S INTERESTING TO ME HOW PEOPLE MEASURE SUCCESS IN RELATION TO THEIR FITNESS GOALS. Most of the time, progress in one’s training is measured by the sometimes loved, but more often hated, weight scale. For the large majority of people if the scale is down, all is right in the world, but if it’s up, the world moves slightly off its axis. Frustrating, I know. Perhaps you should consider a new way to evaluate your progress. Before we head down the path of discovering a much more effective manner in which to quantify your success than the scale, let’s first identify all things that define “training,” and moreover encompass and define your fitness progress. • Nutrition: Stop thinking about your food as a diet. It is nutrition that fuels your successful performance in the gym and general health as well. Regardless of your goal, gaining weight or losing weight, your eating habits are your training. A poor day of performing at the table equates to a poor day of training. Eighty percent of your success is nutrition. You can’t outwork poor nutrition. • Rest and Recovery: We are

all busy: work, spouse, kids, school and so on. It all takes its toll. The body, more specifically the central nervous system, cannot differentiate between external or internal stressors. The only thing it knows is that it is getting beat up daily. The body will only use the energy you provide it to meet your fitness goals when it is not struggling to survive. What does that mean? It means you have to take a day off once in a while from physical training when life is kicking your butt. A good day of nutrition and rest is much better for you than a half-assed day in the gym. • Training Program: Most people continue to look for the magic program. You know, that one that gets you on the cover of the latest fitness magazine by only training 15 minutes a day, three

days a week. Let me explain what that looks like — Failure! There are no magic programs or formulas. Being healthy, strong, and lean are by-products of solid training principles and good old-fashioned hard work. Earlier, I mentioned considering a new way to evaluate your progress if you have simply been using the scale as your quantifier. I must warn you, this unit of measurement is not for everyone. Those who use the gym as a social setting instead of a battlefield need not apply. And those who shirk challenges should probably stick to infomercial tactics. However, if you are willing to work, truly challenge yourself, and want something to look forward to going into the gym, then try a new measuring stick. Your progress toward your health and fitness goals is determined by one thing—how hard you work. Most people go to the gym with very little direction on what they plan to accomplish on any given day. They execute a couple of movements, exercises for specific body parts, some cardio, and they’re out the door. Every workout is different because that is what you think you are supposed to do. I hate to break it to you, but variety is overrated. Choose eight to 10 good, compound, meaning more than one muscle group at a time is working, exercises and test yourself to see how strong you are.

Try movements like pushups, chin-ups, squats of some sort, bench press, rows, overhead press, situps, dips, etc. Yes I realize those exercises are very hard. That is the point. But most gyms have bands or a counterweighted machine to help you if you are unable to use full body weight. Establish a baseline of strength for yourself, and write it down. Then simply start working at those movements each week to improve your repetitions or increase your weight. I frequently see people not challenging themselves. Use as much weight as you can, with good form, and get the number of repetitions you are after. Don’t just stop at 10 if you could have really gotten 15. Choose movements that are hard. Embrace the exercises you suck at, and get better at them. It becomes a fun challenge to see if you can do more today than you did last week. What you will soon see is your body responding in a manner in which it never has. You will become stronger, harder, and if your nutrition is in line with your hard work, the scale will start moving as well. The way your body looks and feels is a direct result of what you put in it, and what you force it to do. When you get tired of looking like everyone else, start working harder than everyone else.

Stewart Beasley is a 20 year veteran of the Baytown Police Department where he is assigned to Crime Prevention and Training and is frequently sought after to speak on his topics of expertise in a variety of community settings. Stewart has been a personal trainer and nutritional adviser since 1991. His current training resume includes competitive, high school and collegiate athletes as well as active duty police officers and members of the Baytown SWAT team. He is a published author and also devotes his time to writing a monthly article for the PD website focusing on fitness, health and nutrition. For more information you can contact Stewart at stewart.beasley@baytown.org.

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ROBOTICS: THE NEWEST ADVANCEMENT IN SPINE SURGERY Michael A. Leonard, M.D.

Board-Certified Neurosurgeon

TECHNOLOGY IS MAKING GREAT SURGEONS EVEN BETTER Dr. Michael A. Leonard is now performing state-of-the-art robotic spine surgery using Mazor Robotics’ RenaissanceTM spine surgery system. This technology provides Dr. Leonard the additional ability to perform surgery with extreme accuracy and precision, which decreases neurological risk. For you, this means reduced exposure to radiation, less pain, faster recovery, and even quicker return to your normal daily activities. With Mazor Robotics technology at his fingertips, Dr. Leonard is raising the standard of care at Alamo Neurosurgical Institute. San Antonio Location: 414 W. Sunset, Suite 205 San Antonio, Texas 78209 Phone: (210) 564-8300

New Braunfels Location: 598 North Union Street, Suite 250 New Braunfels, Texas 78130 Phone: (830) 832-0706 www.ani-online.com


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THE HUNT OF A LIFETIME If you are looking for the ultimate hunting experience, then look no further then DEA Ranch. The diverse selection of wildlife will create a lasting impression and make you the envy of your family and friends. For the discriminating whitetail, elk or exotic hunter, DEA Ranch is a paradise. Skeet shooting, nature walks, bird watching or just relaxing under the 100-year-old oak trees, will make your trip a complete Texas retreat. • Customized hunting packages for groups of all sizes. • one-on-one guided, all day hunts that can include different types of game. • Year-round hunting for axis, blackbucks, hogs, elk and several species of trophy rams. • Introducing quail hunts and organic meat such as elk, axis and Kobe beef. • Corporate dove hunts and spring turkey hunting. • Wedding and party packages including skeet shooting and quail hunting.

We look forward to helping you plan the hunt of a lifetime or a oneof-a-kind event. Contact us today for additional information. 311 CR 351, Mathis, TX 78368 361.249.1157 www.dearanch.com


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