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CARE WHEN IT COUNTS Benevolent Hospice Keeps the Humanity in Caregiving


SOUTH TEXAS BONE & JOINT Pivotal Advancements in Patient Care & Technology

JUNE | JULY 2015








A Practice in Trust

Seeing Clearly in the Futre

Connection & Compassion Keeps Dr. Jaafar Committed to Creating Lifelong Care

Dr. Marten Ushers in Advancements in Eye Health



Joint Pain Just M e t i t s M at c h MAKO® total hip and partial knee replacement— customized just for you. MAKO joint replacement is the only truly patient-specific procedure planned from a 3-D model of your hip or knee, and performed using proven, highly accurate, surgeon-controlled robotic arm technology—optimizing joint movement and accelerating your return to an active lifestyle.

Now Available in South and Central Texas For more information visit TXJointReplacement.com or call 877.411.MAKO (6256) Individual results may vary. There are risks associated with any hip surgical procedure, including MAKO. Your

doctor can explain these risks and help determine if MAKO is right for you.

© MAKO Surgical Corp. 205559 r00 06/11


Years of Conquering Cancer

THE Answer for Cancer The Cancer Therapy & Research Center lives right here in San Antonio. For four decades our team of experts has pursued one mission – conquering cancer. CTRC has a world-class team of physicians focused on helping you and your loved ones find their answer for cancer. CTRC’s oncologists, surgeons, radiologists and many others work in collaboration to review each diagnosis and make decisions as a team - for every patient. If you or a loved one is facing cancer, let CTRC be the answer. Call (210) 450-1000 www.CTRC.net



bone bone & & joint joint ...and continues aa 40+ 40+ year year commitment commitment to to advanced, advanced, subspecialty subspecialtysurgical surgicalcare. care. We Weare arepleased pleasedtotofurther further

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Is Your Heart’s Health Worth a Few Minutes of Your Time?


outhwest General Hospital offers AngioScreenÂŽ mobile services for your employees, conveniently at your business. In a few minutes, this revolutionary health screening will provide your employees with insight about their heart rhythm, artery blockage, blood pressure and vascular fitness.


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42 | An Injection of Truth

28 | You’ll Never Walk Life Alone The MD Anderson Cancer Center’s William B. Baun reminds us that despite potential pitfalls we don’t do life alone

Dr. Belmund Catague talks with Texas MD on the facts and importance of immunizations


58 | Don’t Fall For the Pyramid’s Grandeur


46 | Examining Insect Allergies As summer advances, the risk of insect stings increase, but

Fact and fiction unveiled on the great American food pyramid

allergy experts offer respite from summer’s sting



36 | Alzheimer’s Dissected

16 | Collaborate and Expand Merging their experience and

Examining the pervasive mental illness and its cohort dementia

skill sets, four San Antonio-based


surgeons expand the South Texas TEXAS BUSINESS- MEDICAL

44 | Not So Soft Drinks

10 | Healthy Addition


Colorectal Center

Our favorite sweet treat is wreaking havoc on our pearly whites

26 | Sustaining Your Practice For The Future

Abacus Wellness Online consolidates online applications and makes healthcare more accessible

Tamra Swindoll’s tips for bolstering your practice to build a brighter future


32 | Are You Immune? Perennial symptoms could indicate a grander autoimmune disorder TEXAS BUSINESS- MEDICAL

38 | Foiling Cancer

Astute Diversification

Through gene testing and


preventative care, Dr. Miltenburg


beats back the malignant menace

A guide to navigating the increasingly complex and risky financial markets of today




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• Neck Pain • Low Back Pain • Compression Fractures • Kyphosis • Osteoporosis • Degenerative Disc Disease • Disc Bulges • Disc Protrusions • Herniated Disc • Nerve compression

Dr. Jones-Quaidoo is board-certified Orthopedic Spine Surgeon. He trained in fellowship with both Orthopedic and Neurosurgeons. He specializes in complex cervical and lumbar spinal disorders with neurologic deficits. His practice philosophy is to listen to each patient’s concerns and create an individualized plan of care to help you get back to functional living and a better quality of life. Dr. Jones-Quaidoo takes the time to help the patient understand the correlation between their symptoms and where their pain comes from. His treatment plan includes a program of conservative management of symptoms as well as surgical intervention. Each patient becomes like family and the team working with Dr. JonesQuaidoo is devoted to your care.

• Sciatica • Spondylolisthesis • Slipped back • Pars defect • Spinal Cord and Nerve Injuries


spinevuetx.com 7557 RAMBLER ROAD, SUITE 730, DALLAS, TX 75231


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Stocks, Bonds and Cash Equivalents There are key risks and reward characteristics of all major asset classes. Stocks: Well known for fluctuating frequently in value, stocks carry a high level of market risk—the risk that an investment’s value will decrease after it has been purchased— over the short term. However, keep in mind that stocks have historically earned higher returns than other asset classes, although past performance is no predictor of future results. Stocks also have a better track record of outpacing inflation, the rising prices of goods and services, than any other asset class and carry low inflation risk.

Asset Allocation Classic Innovation Remains In Style



N TODAY’S COMPLEX FINANCIAL MARKETS, you have a seemingly infinite array of investment vehicles from which to select. Each investment carries risk, so it’s important to choose wisely if you are selecting just one. Luckily, there are some simple rules that you can apply to help stay out of trouble. In fact, you can manage your investment risk and potentially increase your chances of meeting your investment goals by practicing “asset allocation.”

Asset allocation refers to the way you combine different investments in your portfolio. Generally speaking, there are two primary types of investments, stocks and bonds. Stocks provide ownership, and they’re normally purchased for growth and protection against inflation. Bonds are when you loan money for preservation of capital and a fixed income. So, you need to determine whether you want to be an owner or a loaner, and determine what mix of both asset classes is best suited for your particular goals. For most investors, the asset allocation in your portfolio is one of the most important investment decisions that will determine the long-term return and risk profile of your investments.

Risk/Return Level

Bonds: In general, these securities have less pronounced short-term price fluctuations than stocks and offer lower market risk. On the other hand, their overall inflation risk tends to be higher than that of stocks, as their long-term return potential is also lower. Bond returns may be influenced by movements in short-term












Cash equivalents




FOR MORE INFORMATION CALL 210.231.0456 OR VISIT WWW.MYACINVESTMENTS.COM. AC FINANCIAL IS LOCATED AT 242 W. SUNSET ROAD, SUITE 101 IN SAN ANTONIO, TX, 78209. Securities and advisory services offered through LPL Financial, a registered investment advisor. Member FINRA/SIPC.



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interest rates. When interest rates rise, bond prices are likely to fall. Cash equivalents: These assets are typically short-term, low-risk, low-return and highly liquid. Cash equivalents include U.S. government treasury bills, savings accounts and bank certificates of deposit.

DiversiďŹ cation: A Companion Strategy Before exploring how you can employ an asset allocation strategy to help meet your investment goals, you should first understand how diversification can help reduce risk and may help increase returns over time. When you diversify your investments among more than one asset class, you increase the chance that if one investment is falling, the return of another in your portfolio may be rising. Neither asset allocation or diversification guarantees against investment loss. Although the ideal asset allocation will vary from person to person, every investor may benefit from having at least a portion of their investable assets in stocks.

Studies show that most investors would benefit from adding stocks to conservative portfolios, and maintaining some exposure to stocks for life to help reduce inflation risk and provide the potential for growth.

A Simple Process, With Dramatic Potential Once you have a carefully crafted asset allocation, maintain it. Review it annually at least, and make alterations as your goals and other circumstances warrant. And rebalance the investment mix if the performance of one asset class throws it off kilter. Do this by adding new money to the asset class that is underrepresented in your portfolio, or shift money from the overrepresented class to the others. Regardless of the asset allocation strategy you choose and the investments you select, keep in mind that a well-crafted plan of action can help you weather all sorts of changing market conditions over the long term as you aim to meet your investment goals.






Add It Up


Abacus Wellness Online promotes healthcare and well-being


R. FRASER LESLIE BAKER has dedicated his time to a lifelong career in healthcare that embraced cancer research, clinical laboratory services and alternative healthcare. Abacus Wellness Online (AWO) is his “brainchild.” AWO is a collection of online applications intended to promote healthcare and well-being. Late in his scientific career, he began writing the LifeStyle Monitor, which is an on-demand application that provides nine wellness monitors — such as the SF-36 health assessment, a body composition calculator, a stress index, the ADLS, a nutrient calculator and other monitors. A threaded diary that can include chats with the user’s practitioner is included. An ailment monitor tracks the progression or regression of any ailment. For people with anger issues, an event log is also provided. A score is assigned to each entry. “Such scores are subjective, but they enable the graphical representation and rapid evaluation of the ailment’s impact, at least from the user’s perspective,” explains Dr. Baker. When the person using the Lifestyle Monitor is being seen by a practitioner using AWO’s complementary business tools, the practitioner can view the data held in their client’s LifeStyle Monitor. “This can enhance the delivery of alternative healthcare and the management of chronic issues,” says Dr. Baker. After Dr. Baker closed his clinical laboratory, he co-founded the Integrated Wellness Center of Houston (IWCH) with Dr. Mahesh Kanojia and served as its manager. “To help me in this task, I wrote software to handle its numerous routine tasks, such as managing appointments, invoicing for practitioners’ services, sales of

supplements from the apothecary and rental of space...As the delivery of alternative healthcare is predicated on the provision of educational material, such centers frequently host events,” shared Dr. Baker in detail. To manage events held at IWCH, Dr. Baker wrote an event calendar that over time became a comprehensive tool for the management of a wide variety of events. Unfortunately, the Integrated Wellness Center of Houston did not survive the untimely death of Dr. Kanojia. Over the next few years, Dr. Baker refined AWO’s business tools, enhanced its email messenger and added a newsletter editor. After supporting a dozen or so clients, Dr. Baker felt that AWO’s business tools were comprehensive and ultimately attractive to alternative healthcare practitioners. Dr. Baker was introduced to the home healthcare marketplace and began adding functions to his application to engage the home healthcare marketplace. “After all, wasn’t this an opportunity for my software as the elder marketplace was exponentially expanding? I was also captivated by the concept of introducing alternative healthcare to the non-medical homecare marketplace. While I concur that some alternative healthcare practices are mysterious, most of this realm is meritorious, particularly naturopathy and massage therapy that can enhance the well-being of seniors,” explains Dr. Baker. As AWO’s application was built

to serve alternative healthcare practices, Dr. Baker believed that the well-being of elderly folks would be enhanced if this application was available to non-medical homecare agencies. Motivated by this belief, the doctor added: A mobile application that plays well on smartphones to be used by care-givers that provides an Electronic Visit Verified (EVV) time clock, a task checklist with medication monitoring, a transportation log, caregiver’s schedules with map and directions, and wellness and incident report forms; A mobile application that plays well on a tablet to be used by marketers that registers new clients Lastly, a laptop or desktop application to be used by agency staff that provides time sheet monitoring with text and email alerts, a smart scheduler, client invoicing, performance reports and more. With these features in place, AWO’s applications provide the business tools to effectively manage both alternative medical practices and non-medical home healthcare agencies. And, consistent with Dr. Baker’s mission, AWO’s applications now contribute to the healthcare of a broad spectrum of clients by providing tools that help providers manage their businesses and communicate with their clients.

“After all, wasn’t this an opportunity for my software as the elder marketplace was exponentially expanding?”

FOR MORE INFORMATION ON AWO’S BUSINESS TOOLS VISIT WWW.AWOCARES.COM. You can also contact Fraser Baker, Ph.D, at flbaker@sbcglobal.net and by calling either 713.202.2503 or 713.466.7906.



JUNE/JULY - 2015




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




Evolutions in Care Dr. Burnett Advances Austin’s Chiropractic Care BY JODY JOSEPH MARMEL


ITH 16 YEARS OF EXPERIENCE AS A PRACTICING CHIROPRACTOR, Dr. Ron Burnett, Founder of Inner Sun Chiropractic in Austin, has one main goal, to change the face of chiropractic care. Born in New York City and raised on Long Island, Burnett attended Dowling College where he completed some of his undergraduate work. While studying, Burnett was also a member of the rowing team. A rowing injury eventually led Burnett to seek help from a chiropractor. At the time, Burnett did not know that his injury and the care he received would change his life, and it’d shape his decision to become a chiropractor. Burnett then decided to move to Atlanta where he continued undergraduate work and enrolled in the chiropractic program at Life University. Upon his graduation in 1998, and after visiting some friends in Austin, Burnett decided to move there and make it his home. Thus, Inner Sun Chiropractic was born. Inner Sun Chiropractic opened in 1999, and it’s unique in the fact that it is a 100 percent word-of-mouth referral practice. Starting in a tiny house and expanding to his current location on West 6th Street, Dr. Burnett has built a reputation serving his community as a world-renowned chiropractor. Dr. Burnett explained, “My goal is to create ways to better serve my patients, learn and teach different modalities and make the office as efficient as possible for the patient’s convenience.” Dr. Burnett treats so many different ailments that pinpointing a specific one is difficult. He does have a large clientele of pregnant women because his name comes

up as the preferred practitioner among professionals in the pregnancy community. From obstetricians, doulas and midwives to fertility specialists and other chiropractors, Dr. Burnett is the “go-to” doctor if there is pregnancy pain or to create a greater ease for delivery. He is also well-known for using the Webster’s Technique that aids breech babies in turning on their own with no trauma to the mother or baby, and it allows for a natural birth rather than a cesarean birth. With older kids and adults, Dr. Burnett treats sports injuries, growing pains, migraines, ear infections, allergies, sinus problems, scoliosis, arthritis, car accidents and a host of other ailments. Dr. Burnett also treats those who just want wellness care as they understand and receive the benefits of regular chiropractic care. They take less medication, have had fewer operations, are more clear-headed, and have a generally more balanced life than their non-chiropractic treated friends of the same age group. Dr. Burnett stated, “Love all, serve all. It really is that simple and true. Everyone that walks in the doors of Inner Sun Chiropractic is someone’s mother, daughter, son, father, brother, sister, aunt, uncle, cousin, grandparent, friend or colleague. They were referred to me by someone important to them, and they deserve to be served and treated with love, honor and respect.” In practice, it is truly all about the patient and their care. In the profession, Dr. Burnett is recognized as a teacher, counselor and mentor to some of the finest chiropractors in the country. His hope is “to continue to change the face of chiropractic care, bring more awareness to its benefits and rewards, and serve as many patients as I can.”

“The more people I can care for, the more that are getting better and hopefully using preventative care when it comes to their health and well-being,” shared Dr. Burnett. In keeping with his mission, “Love all, Serve all,” Dr. Burnett’s past humanitarian efforts are definitely noteworthy. Years ago, he took three different mission trips to Brazil. While there, he and his group set up tables in very poor areas where people would travel for days just to go see them. People filled up basketball stadiums and waited to be treated. Dr. Burnett and his team barely knew the language, had no money and stayed with a family that sponsored the chiropractors. They served patients all day long. “With the group I am affiliated with now, we are actually in the infancy stages of creating this again, and I’m very excited to see this come to fruition,” said Dr. Burnett excitedly. Dr. Burnett and his staff truly believe that educating their patients on the benefits of chiropractic care and overall wellness will benefit them in the long run. Healing, growth, wellness, and learning are all things in which Dr. Burnett hopes to shed some light on. Healing starts when someone asks for help, they put their ego aside and recognize that they can’t do it all by themselves. This can be very humbling and Dr. Burnett takes great care in regarding this as sacred. By listening to his patients’ concerns and seeing the overall picture, sometimes what is often unsaid, care can begin. Corrective care is not just a band-aid, it goes beyond the symptom to the heart of what is wrong. It works on overall balance




JUNE/JULY - 2015



to not only feel better, but to be better. Patients will often remark on how much their lives have improved overall. Dr. Burnett and his staff take great care to ensure that their patients understand what the problem is, how they will correct it, how long it will take and to answer any questions that they have. Once a patient has completed their foundational treatment plan, they are encouraged to be on wellness and maintenance care. Much like getting the oil changed in your car or getting your teeth cleaned, this helps patients learn how to better listen to their bodies and begin to prevent disease, rather than trying to cope with disease. Learning gives the patient knowledge on how to take care of themselves, the importance of balance, and how to listen to their bodies.

The more active a patient is in their health care, the more they learn about themselves emotionally, spiritually and physically. This alone can shift so much for someone in how they view themselves, and the space they create for them to heal and move on. There are an infinite number of stressors, but prevention is the key. Whether you choose chiropractic alone or in combination with other types of care, consistency is paramount. You cannot expect to run a race and do it well without training. As we roll in to summer and autumn, most people want to increase their outdoor activities. Remember to stretch, take it slow, listen to your body and hydrate. We only have one body. How you treat it, inside and out, matters. One great preventative measure to

protect your lower back, and improve your overall posture and performance, is to improve hamstring flexibility and strength. The hamstrings are the muscles located on the back of your legs above the knee. To improve the function of the hamstrings, in a standing position, flex forward pivoting from the hips, keeping your back straight, until you feel the stretch in your hamstrings. Then, contracting the muscles in your glutes and hamstrings, come back to an upright position. Repeat this 20 times. This exercise is also known as “good mornings,” without the use of weights. Do this upon waking up or before exercise. This will teach your hamstrings how to stay supple and strong, and teach you good body mechanics.

Although Dr. Burnett practices alone, he is far from being alone. He is a member of Pinnacle, an educational group of about 400 chiropractors from all over the country. They meet six to 10 times a year in various places to speak to chiropractic students, fellow chiropractors and their staff about how to better serve patients. Chiropractors continue to learn how to hone their craft with love, honor, respect and other important aspects of chiropractic care. “We seek to further our profession, bring more respect and understanding to the field of chiropractic,” said Dr. Burnett, stressing, “but most of all, to give these students and chiropractors a platform to continue our education, and pass that knowledge, love and act of service on to our patients and their families.”

Your Smile is our Top Priority


SERVICES: • Complimentary exams

• Treatment of gum recession

• Dental implants • Smile reconstructions

• Treatment of periodontal gum diseases

• Emergency treatment and same day surgery

• Multiple sedation options • LANAP or laser gum surgery

• Cosmetic oral surgery

• 3D imaging

• Gummy smile makeovers

• Biopsy of mouth concerns

“Excellence Through Compassion.”

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

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

S A N A N T O N I O & N E W B R A U N F E L S / / 2 1 0 . 4 9 6 . 5 6 0 3 / / W W W. E X C E L L E N T P E R I O D O N T I S T. C O M




A Sweet Treatment Center Tackles Cancer BY THE CRAVE GROUP

Dr. Julia Oh and Sugarland Radiation Oncology beat back cancer and patients’ fear


PECIALIZING IN RADIATION ONCOLOGY, Dr. Julia L. Oh serves as the Medical Director at Sugarland Radiation Oncology. Dr. Oh attended Washington University in St. Louis, Missouri, graduating magna cum laude with a major in biochemistry. She attended medical school at the University of Illinois at Chicago and completed her residency in radiation oncology at the University of Chicago under worldrenowned pioneers Dr. Ralph Weichselbaum and Dr. Samuel Hellman. Upon completion of training, Dr. Oh was recruited to

The M.D. Anderson Cancer Center where she was an assistant professor specializing in breast cancer for six years before she entered private practice. She is certified by the Texas State Board of Medical Examiners and the American Board of Radiology and is a member of the American Society of Radiation Oncology (ASTRO). Dr. Oh has published numerous articles in peer-reviewed oncology journals, co-authored a book chapter on inflammatory breast cancer, and has been an invited speaker at ASTRO and other international meetings. The Sugar Land Cancer Center strives to provide the best care to its patients and works very closely with a multitude of other specialists. Here, patients will be educated on their cancer’s specific risk factors, treatment options and technology available to minimize any potential side effects of treatment. The Sugar Land Cancer Center is a state-ofthe-art center with the technology needed to treat patients with customized plans that are truly tailored to each individual. The Varian linear accelerator delivers 3-D conformal RT or intensitymodulated radiation therapy (IMRT). With IMRT, the degree of precision allows for very conformal beam shaping to preferentially treat tumors, while sparing nearby healthy tissues. The system is equipped with cone beam computed tomography and on-board imaging (CBCT/OBI), which allows the physician to make adjustments in real-time to ensure accuracy in target localization. The Sugar Land Cancer Center also offers volumetric arc therapy (VMAT or Rapid Arc), which is

the next generation of IMRT technology that allows for precise dose painting with a 360-degree rotation of the gantry. Patients with rapid arc can be treated in a single arc in less than two minutes. The Sugar Land Cancer Center also offers specialized technology for women diagnosed with early-stage breast cancer, including accelerated partial breast irradiation (APBI). APBI allows breast cancer patients to be treated in only one week instead of the more traditional six-week course. Finally, the Sugar Land Cancer Center is proud to be an American College of Radiology accredited center, which is an honor given to very few radiation oncology centers and testifies to the high level of quality control and patient safety. Being diagnosed with cancer can create fear and uncertainty for anyone, but former patients have consistently praised Dr. Oh and the staff for removing the fear by educating them with the information they needed to change their perspective from one of defense and fear to one of offense and courage, ready to beat their disease. Dr. Oh maintains a blog on the Sugarland Radiation Oncology website where she discusses a wide range of topics from new clinical studies, healthcare ethics and patients’ survival stories.




JUNE/JULY - 2015






Healthy Growth South Texas Colorectal Center Expands to Three Locations



OUR SAN ANTONIO-BASED COLORECTAL SURGEONS have merged their experience and skills to expand the South Texas Colorectal Center to three locations throughout San Antonio.

“We have a vision for unifying the colorectal community in San Antonio and the surrounding areas in order to provide system-wide, comprehensive, state-of-the-art gastrointestinal and colorectal care,” said James Prieto, M.D., F.A.C.S., F.A.S.C.R.S. “Our surgeons remain at the forefront of medicine, providing the latest and most advanced treatments available.” In a quest to provide high-quality, efficient colorectal healthcare that patients can afford, Dr. Prieto has been joined by surgeons J. Chris Connaughton, M.D., Mario Alcantara, M.D., and Seema Izfar, M.D. “We believe the expanded South Texas Colorectal Center will improve patients’ access to quality care,” Dr. Izfar said. “I believe that the new, expanded center will give patients better access to quality care at locations that are convenient to their homes.” Dr. Connaughton agreed, adding that, “This expansion will make expert care and surgery available to more patients. I look forward to seeing how things develop for

our patients. I foresee only good things happening.” The South Texas Colorectal Center now has locations in the heart of the Alamo City, Stone Oak and the Medical Center. While the colorectal surgeons with the center may be in different locations, they have one driving mission: to provide comprehensive, yet compassionate, care that puts people first. This group of South Texas surgeons believes that delivering progressive colorectal care today, right where patients live, is vital. Colorectal diseases and disorders are quite common and can range from milder types, such as abdominal gas, to serious conditions like colorectal cancer. Colorectal cancer is the third most common form of cancer in the United States. However, in addition to providing up-to-the-minute comprehensive care, Drs. Prieto, Izfar, and their center colleagues also seek to empower patients. “Educating patients and families regarding the prevention of diseases is extremely important,” Dr. Prieto said. “As the old saying goes, an ounce of prevention is worth a pound of cure.” Dr. Izfar agreed, explaining that, “The best thing that I can do as a physician is to impart knowledge and compassion. Patients need to understand the care that they are receiving, and they need to be able to trust that their physician has their best interest in mind.” “Ultimately,” Izfar added, “patients make their own medical decisions, and they should be well-enough informed to be able to make sound

decisions regarding their health.” The expanded South Texas Colorectal Center seeks to provide premiere healthcare, and promote healthy habits and lifestyles throughout San Antonio and the surrounding areas. Each of the three centers is strategically located so that no matter where patients live, they will have convenient access to surgical expertise and advanced procedures, including laparoscopic and robotic surgical techniques. However, surgery is not always the first-line treatment for a colorectal condition. “Colorectal problems many times can be treated with medication and lifestyle changes,” said Dr. Prieto, adding that it’s important for patients to be honest with their physicians about any symptoms that might foretell the onset of a colorectal problem. The colorectal surgeons at the center get referrals from a variety of medical providers, including gastroenterologists, medical and radiation oncologists, urologists, gynecologists and even plastic surgeons, among many others. But wherever the referral might come from, once a patient lands in the hands of Dr. Prieto and his colleagues at one of the three center locations for colorectal care, they can expect to be treated with respect. “In medicine, we physicians have the ability to help others,” Dr. Prieto said. “It is an honor and privilege that we find extremely rewarding. My guiding philosophy is to treat my patients as I would expect my family or myself to be treated.”

DRS. JAMES PRIETO, SEEMA IZFAR, J. CHRIS CONNAUGHTON, AND MARIO ALCANTARA are board-certified colorectal surgeons with South Texas Colorectal Center, a part of BHS Physicians Network.




JUNE/JULY - 2015




Close to Home.

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

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

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

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

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

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




How Patients Choose Their Doctor BY CRISTY HAYES


HE CHANGING HEALTHCARE LANDSCAPE presents both challenges and opportunities for healthcare providers. Understanding how consumers select healthcare facilities and individual physicians today can ease some of the pangs of the inevitable change.

While scientific studies over the years have tried to identify patient choice determinants in selecting healthcare providers, very few focus on today’s active consumer and rapidly changing selection tools. Changing trends are reported by consumer and healthcare reporting groups, such as the Harvard Business Review, Nielson, Forbes, the American Marketing Association, Medical Economics and others. Assessing the data can be daunting, but here are some of the highlights. Whether the search is for a pediatrician, primary care physician or specialist, the approach begins in much the same way. Beyond ensuring acceptance of health insurance, individuals continue to rely heavily on word of mouth referrals from friends, family or other respected sources. While social media and mobile technology have facilitated access and rapid reach to such referrals,

this important selection component remains virtually unchanged from past years and among the most trusted data available. Supporting data plays an important role in solidifying a patient’s ultimate selection. Supporting data may represent different types of information delivered from a number of different sources, though it consistently conveys the merit of a particular facility or physician. How much data each potential patient requires may vary based on age or health condition, but most require more than a referral and base their ultimate decision on a combination of factors, according to a recent report in the Journal of the American Medical Association. The search for supporting data today begins online and is often launched for both hospital and medical facilities as well as, and most importantly, the physicians in whom an individual will entrust their care or

Cristy Hayes has over 20 years of experience in marketing communications. Partnering with other thought leaders and technology innovators, she is able to provide organizations with valuable insight and comprehensive marketing support. For the past decade, she has specialized in physician marketing strategies working with renowned physicians throughout Houston. Cristy is also a medical writer/editor and provides research support to one of Houston’s leading medical research institutions.



that of a family member. Referred to as “e-patients,” many of today’s patients, and particularly those of tomorrow, will increasingly turn to online information and resources to make healthcare decisions. As reported in Forbes, Dr. Bertalan Meskó, medical futurist and author of “The Guide to the Future of Medicine: Technology and the Human Touch,” discusses how “healthcare is moving beyond the hospital and shifting toward patient self-knowledge and empowerment.” As Meskó puts it, “healthcare cannot really advance without physicians letting their patients help themselves.” Harnessing the vast visibility of the web, reviews and star ratings have also steadily climbed over the years to the top of the selection criteria list for consumers. This may serve as both referral and supporting data when positive reviews and top star rankings are visible on multiple sites. While general business directory sites allow consumers to leave reviews, some carry more weight than others in the selection process. Those specific to healthcare — HealthGrades, Vitals, UcompareHealthCare, RateMDs and ZocDoc — are deemed the most credible and trustworthy when selecting a healthcare provider or physician. Google reviews are also respectfully considered, as Google’s commitment to maintaining the integrity of its business pages and authenticity of reviews has become the gold standard. Editorial and advertorial content has not only remained a strong marketing support tool and influencing agent, it has today ignited a “content marketing” movement. According to a report by the Harvard Business Review, “content marketing and brand publishing has unfolded rapidly because it responds to consumer preference.” The article underscores a consumer’s preference to meaningful

content over an advertisement and the power in sharing knowledge to build brand loyalty. Inexpensive opportunities to disburse educational and other informative content online abound and are far less expensive than many traditional advertising tactics. Blogs, Q&As and expert articles give patients an opportunity to not only learn about a physician’s services, but they also see them as an educator and expert in their field. And then there is the obvious and often overlooked subliminal effect of repetitive marketing, branding and messaging. Often times, the tipping point in making a final decision is unclear, as consumer’s themselves may not recognize that certain words or images resonate more strongly than others. What speaks to individuals may vary. Is it the idea that a hospital system is leading medicine, advancing health or that it is giving life to possibility? Providers commit to and invest in a message, communicating it broadly through print, online, outdoor, television advertising, sponsorships and more. Each reinforces an earlier referral, review, editorial or other seemingly organic informational content. This is why it can often be difficult to measure the effectiveness of various marketing components in obtaining new patients. Ideally, multiple components are used, all supporting one another. Smaller budgets may find the greatest value in the multitude of online opportunities. Though, registering a new patient is just the beginning. Patient loyalty and second generation referrals depend on a number of factors. From personal rapport and confidence in physicians to courtesy and competency of administration and support staff, patient loyalty remains multifaceted.

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CALL ! W.4492 N0.O 826




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

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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

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Occupational Therapy Services

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Referrals to other services in the community

eci early childhood intervention

• •

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.




Continuum of Care C


IMA HOSPICE AND JORDAN HOME HEALTH are elated to be a part of an integrated healthcare system. We can provide more effective, efficient patient care. As a healthcare organization one of our visions is “Continuity of Care.” By providing this, we instill trust and confidence in the patients and communities we serve. The continuum of care between CIMA and Jordan has eliminated common obstacles by offering a clear guide to transitions for our day-to-day healthcare decisions. We can now be more efficient in identifying what is truly necessary for the patient physically and emotionally. We have cross-trained staff in each discipline, making these transitions easy, gentle and ethical. By providing this type of optimum healthcare, we can help several healthcare systems in many different ways. We can help cut down the percentage of readmission rates, increase utilization review for Medicare and provide stellar care. Our objective is to keep our patients safe and aging at home. We are your resource in the community. We are your comprehensive array of health services.

When the time comes Let’s face it, sometimes in life we just are not ready to face aging, death or dying. At this point in life those three things become white noise in our mind. We see it, believe it but somehow cannot seem to grasp it. We enjoy choices and opinions of our own. Being in control of your healthcare and what happens is

important. What if at some point in life you have to make the decision for home care services? Whether it be hospice or home health, what would you do? How would you feel? We become caged in our own emotional battle of dignity. “Have I lost control? Can I trust these providers? Who are these people? I have never met them!” Our mind becomes that of a wondering child lost in a forest. We have no idea how we got here and where to go. Ironically, this is the same feeling for the patient and caretaker. Hospice can be a very deceiving word, which can detour patients from choosing a necessary, but underutilized, service. With our streamlined transitions and cross-trained nurses, we offer a better approach to guide our patients in life’s journey. Aging in place, with dignity and security, is our number one priority. The unknown can be the hardest part in everyone’s journey in life. Our

company has a strong sense of pride in knowing we can provide the outcomes you deserve. In life we may just need progressive, preventative treatment, like home-healthcare. Wouldn’t it be nice to have all of this under one roof, with one person and one contact? If you’re a hospice patient and you’re being discharged from hospice to home health, this can be a very confusing transition. Having both continuity of care and cross-trained staff helps comfort patients, and it provides clinical knowledge of what the patient needs in their situation. Improving patient and family outcomes with care transitions in the healthcare industry is a goal we strive to excel in. This concept sometimes seems to be lost in the midst of day-to-day healthcare expectations. We take special

“With our streamlined transitions and cross-trained nurses, we offer a better approach to guide our patients in life’s journey” interest in this vision, that sets us aside from other companies. We believe in good health for the mind, body and soul. We are proud to offer a “Continuum of Care” between our hospice and home health services.




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Taking your Wellness to heart. Welcome to a new level of quality and care for patients with Medicare. Over 46,000 seniors in San Antonio and the surrounding areas trust WellMed with their healthcare. With 25 clinics from Floresville and Pleasanton to Seguin and New Braunfels, our group of local doctors work together to help make it easier for Medicare beneficiaries to live well. WellMed can bring more wellness to your life. WellMed is accepting patients with Medicare and select Medicare Advantage health plans. Call today to schedule a tour or get a schedule of events at your nearest WellMed location.


210-615 WELL (9355)/888-781-WELL WellMedMedicalGroup.com

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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



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Bridging Cultures and Communities New center brings bilingual caregiver services to San Antonio’s south side BY RON AARON EISENBERG


S A FORMER MEMBER OF THE MILITARY, Andrew Villarreal thought he knew what it was like to face challenges and hardship. But nothing could prepare him for what he dealt with late in life. “The most difficult thing I have ever done was to be a caregiver for my late wife,” said Villarreal, a retired pastor. “I am not ashamed to say I cried and cried a lot, which I guess I needed to do as I worked through the issues I faced as a caregiver.” Villarreal was one of the featured speakers at the March 18th, grand opening of the newest Caregiver SOS Center on San Antonio’s south side. More than 200 seniors packed a lobby of the Elvira Cisneros Senior Community Center for the event, marking the arrival of the community’s first bilingual caregiver center. This is one of eight Caregiver SOS resource centers the WellMed Charitable Foundation operates in San Antonio, Corpus Christi and the Rio Grande Valley. WellMed also has San Antonio offices in Northern Hills, the López Senior OneStop Center, the Griffin Senior One-Stop Center and now the Elvira Cisneros Senior Center. WellMed Charitable Foundation Executive Director Carol Zernial welcomed the crowd and thanked those who are caregivers for the work they do. “We know being a caregiver is stressful and “The most often very difficult work,” Zernial said. “This difficult thing I Caregiver SOS Center is here for you and your loved ones. And,” she said half-jokingly, have ever done “it’s stocked with plenty of tissues because was to be a we know tears often come with telling your caregiver for my stories.” Zernial also proudly introduced Gloria late wife...I am Miranda, the new center’s program manager. not ashamed to “We stole her from the Rio Grande Valley,” said say I cried and Zernial with a grin. “We are fortunate to have her on our team, and I know she will do an cried a lot”

outstanding job helping you and other caregivers manage the stress and challenges you face.” Naturally, Miranda is excited and honored to manage the new Caregiver SOS Center. “I look forward to getting to know each and every one of you and your loved ones,” said Miranda, adding that, “We are here to help you be the best caregiver you can be.” The new president of San Antonio’s Catholic Charities, Antonio “Tony” Fernandez, shared his excitement for the new partnership his organization has formed with WellMed to bring added help and resources to the senior centers. Dr. Patricia Lane, lead physician at WellMed at Pleasanton, told the crowd how much she admires and respects caregivers. “We know how stressful caring for another can be,” Lane said. “And we want you to know we at WellMed are here to help you and your loved ones.” Retired pastor Andrew Villarreal shared how he has benefited from the caregiver services provided

by the WellMed Charitable Foundation. He thanked the Caregiver SOS Center “for helping to restore my sanity.” Caregiver SOS Centers are designed to be safe and confidential sanctuaries where caregivers and family members can talk with other caregivers, and find out about wellness activities, information, support, education and more. Caregivers tend to be isolated and very often succumb to the pressures of stress. The Caregiver SOS resource centers provide wellness, information, support and education for caregivers at no cost. Program managers, like Miranda, lead evidence-based classes in “Stress Busting” and arrange for special speakers on dealing with Alzheimer’s disease, dementia, chronic disease and more. Caregivers can also come to the centers for a respite. There is no charge for the services and help provided by the Caregiver SOS centers.




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SENIOR HEALTHCARE IS OUR PASSION AND OUR PURPOSE. WellMed is a medical group that specializes in senior care. We were created in 1990 by a doctor who is passionate about giving quality, affordable care to seniors. Today all of our doctors and staff members share that passion. We deliver a standard of health care that helps seniors live longer, healthier, happier lives. We treat you like family. • Our staff is friendly, helpful, and really cares about you. • You won’t be rushed. Our doctors see fewer patients each day so they have time to create a long-lasting relationship with you based on trust and respect. • We also help find alternatives to high risk medications, possibly resulting in lower out of pocket costs. We respect your time and financial well-being. • Medicare accepted – always. Social Programs and financial assistance programs available for those who qualify. • Fast appointment availability and low in-office wait time. • Health care guidance offered 24/7, and in some locations after-hours and walk-in appointments are available... just like the old days. • Multiple locations close to home. We help you live healthy. • We work to prevent illnesses before they start through proactive screenings. Our goal is to keep you healthy and out of the hospital. • We don’t stop at your appointment. We help keep you socially, physically, and mentally active. • You are an important part of your healthcare team: Team YOU. We’re in this together. • An independent study shows WellMed patients live longer.*

Call 855-795-1508 today. A WellMed representative can answer your questions Monday-Friday, 8 a.m.-5 p.m. C.S.T. Or visit WellMedHealthcare.com WellMed is a medical group with a network of primary care physicians and specialists. WellMed accepts Original Medicare and select Medicare Advantage health plans. Plans vary by county. *According to an 8-year study performed jointly with the American Academy of Family Physicians, WellMed patients in Texas ages 65 and older live longer than the general Texas population of adults in the same age group. The study was published in the January 2011 Journal of Ambulatory Care Management. AD_TX_WSSolJan14_CO091114

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Keeping Your Practice Alive Managing the Slippery Slope of Independent Practice BY MIKELA RAE BOWERS

shift as well. Stagnation is proving to be a guaranteed exit strategy for care-givers. While the concept of shifting care practices with the changing environment may seem intuitive, Tamra shares that “recent surveys of more than 5,000 physicians, conducted by a leading medical malpractice company, found that 56 percent of respondents believed they were unlikely to change practice models over the next five years.” This datum points to why market experts believe we are likely to see a significant decline in independent practice. Denying the need to change with the environment does not allow for a practice to thrive, and most likely, to not even survive. In getting clear around the tangible changes occurring in the medical environment, we see where an inability to adapt as an independent practice injures growth.

Legislative Changes


ITTING DOWN TO CHAT WITH TAMRA SWINDOLL IS AN ABSOLUTE JOY, regardless of the intention driving the conversation. The fact that she can transform your medical practice becomes the distinguishing bonus of the relationship established with such an innovator and industry pioneer. Beginning Catalyst Consulting in 1998, Tamra has become the nation’s leader in advocacy for medical practitioners. From start-up businesses to Fortune 100 companies, Tamra is sought out for her strategic, creative and practical solutions for not only surviving as an independent practice, but thriving as a business. Tamra has knowledge and passion around helping practitioners ride the waves of healthcare reform and shifts in patient consumption of care. We are all aware of the great impact legislation and patient satisfaction has on the broad picture of healthcare, but we are often blindsided by the ultimate impact these factors have on physicians’ abilities to maintain their livelihood as independent practitioners. As the consumption of medical care shifts, the methods in which care is offered must

Recent and ongoing healthcare reform, such as the Patient Protection and Affordable Care Act, brings much focus to the nature of care delivery. The result of what is found within this focus determines much in a practice’s financial health.

Technology Advancement Electronic health records have become mainstream and the ‘norm.’ Utilizing these innovative and efficient tools in one’s practice determines the overall efficiency and ability to deliver higherquality care, while maintaining a connection with the patient.

Shifting Care Consumption Shifting from the paternal relationship of assumed trust in one’s family doctor, we are now in a technological age where the patient is informed, albeit not always accurately, of their condition and their options in choosing a provider. Patients now approach their healthcare with a greater sense of power through their personal research, and more selectively choose their physicians based on available ratings, costanalysis and greater awareness of available options.

Income Flow How insurance companies pay providers for their services has become an even greater obstacle for a practice to keep the lights on in recent history. Due to the declination of fee-for-service reimbursement models, solely relying upon services offered that are covered by insurance can leave a practice at the mercy of perfection in paperwork and timing, in addition to their patient’s level of satisfaction in care. A physician once shared with Tamra that medical school trains a practitioner to “stay in the box” and maintain a comfort zone of consistency. This comfort zone of consistency allows physicians to perform for 18+ hours per day. However, this conditioned consistency in practice doesn’t allow for a physician to engage in and manage the business side of their practice. Tamra explains




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that, “positioning their practices is as critical as how physicians carry out their healing aspects. Those wanting to remain truly independent in their medical practice are having to seek new ways of doing so. Physicians are forced to look at their practice in more of a business sense than ever before.” Understanding that we need physicians to continue carrying out their healing practices independently, Tamra offers her problem-solving skills to establish or rejuvenate medical business strategies that work. Considering the constant evolution of the medical care environment and the need for physicians to be able to perform their craft, Tamra brings awareness to what is needed in each situation, including what no longer serves the practice. Her extensive experience and success in allowing physicians to continue their work, and even in elegantly wrapping up a successful practice for retirement, allows Tamra to bring in out-of-the-box strategies that not only work, but are what the population needs in care options. Some of the tools in Tamra’s toolbox are:

Focusing on Value-Based Care Value-based delivery methods, such as accountable care organizations (ACOs) and patientcentered medical homes, provide opportunities for higher-value care. This is a shift from quantity to quality, meeting the need for patient satisfaction and enduring treatment results.

Providing a Dynamic Patient Experience The greatest factor in an independent practitioner’s success is the connection between the physician and patient. Patient satisfaction often depends upon the patient’s experience more than the ultimate outcome of treatment. Regarding each patient as a customer and providing services and experiences around what the patient seeks must be paramount in the physician’s business approach.

Join Together While the overhead costs of independent physicians may be too great a burden to bear, this does not mean the only option is to become an employee of another. Joining forces

with other independent practitioners, to include holistic medicine, offers an opportunity to provide coordinated care. This strategy increases efficiency, lowers overhead, increases negotiating power for higher reimbursement and creates the dynamic experience the patient is looking for. Get Educated and Take the Lead Physicians have the opportunity to become more involved and set the stage for provider groups. Taking the lead may also look like physicians creating their own ACOs, patientcentered medical homes, and taking the initiative to reach out to hospitals and other potential partners, rather than the reverse.

Explore New Models and Ancillary Sources of Revenue A way to differentiate and create additional sources of revenue is to consider ancillary services. New and exciting advancements in medicine, such as DNA testing and pharmacogenomics, in addition to more common ancillary offerings — including med spa services, reference labs, allergy therapy, and diabetes and weight loss programs — allow physicians to incorporate a myriad of

complementary services into their existing practice for a more complete approach to caring for their patients and additional sources of income. Concierge, boutique, and micropractice models of medical care can be uniquely created and tailored to each practice’s needs and vision.

Automate As previously mentioned, technology is rapidly evolving and has become mandatory in delivering efficient care. Automated systems in both patient record keeping and aggregate reporting for insurance reimbursement take much of the burden from staff in maintaining perfect records. Electronic health records offer higher levels of organization than paper charts, and they allow for faster retrieval of lab and x-ray results. A patient’s medical history is now available at a physician’s fingertips and in many visual formats to facilitate more efficient information processing and sharing amongst caregivers. Tamra’s passion and highly specialized skill set facilitates the necessary transition independent practitioners must make in the evolving medical climate. While many practitioners may feel lost in navigating their way through such technical and rapidly changing business needs, Tamra offers her highly effective trouble-shooting and innovation to those ready to re-educate themselves and take control in creating the practice they envision. While change is necessary, and the only constant, staying open to new possibilities and asking for help when it’s needed will shift fear into excitement and a seemingly lost cause into a rebirth. 2015 - JUNE/JULY TxMD







T’S ALMOST 6:30 A.M., and I’m putting the finishing touches on my morning blog. I’ve been up since 3:45 a.m., for morning stillness has always been a time for my selfexploration and discovery. Raised in Baton Rouge, I have fond memories of drifting back to my mom’s home office at sunrise where she’d be working on her kindergarten class, and we’d sit in her rocker and watch the birds dance around the garden in first light. She fought cancer for 15 years, and her faith and belief in the goodness of life was amazing and blessed me with her positivism. My dad had an entrepreneurial spirit and worked hard to pay her healthcare bills, but by my junior year of high school, the family was bankrupt and my mother was dying. My dad also fought cancer at the end of his life, and now as a fourth stage prostate cancer survivor, I thrive because of the life lessons learned through their love of life. Odd jobs and a scholarship got me through LSU with a degree in economics and government, but like most in the 60s, I was headed to war. My dad had been a pilot in WWII and Korea, and after flunking my flight physical, I signed up to be an airborne ranger. Like all Vietnamera soldiers, I grew up fast, living through life lessons about dying and the preciousness of life. After my service, I worked in a church, but a car accident sent me to the hospital with a broken back. I spent six months in



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the hospital addicted to morphine, and six more months in a full body cast before I finally walked. But I’d gained a new vision for my life — to give back. Completing a master’s degree in exercise science, my scientific curiosity quickly grew my publications, and for several years, I worked on a doctorate. At the birth of

“It’s an amazing journey this walk we call life, and as my life experience has taught me, we don’t do life alone!”

my second child, I realized I was working too hard on me and was losing my family. My job search took me to Tenneco, a large conglomerate with 101,000 employees and a Houston headquarters. In the early 80s, the Tenneco program was part of the new breed of worksite programs moving into population wellness management. We published several of the early classic financial studies looking at healthcare cost, absenteeism and turnover, while I worked on a doctorate in human organizational systems. We gained recognition for our programming innovations from Fortune Magazine, the



Washington Business Group on Health and the Surgeon General, C. Everett Koop. Worksite wellness was growing exponentially as senior managers recognized the importance of health in human capital management, and in the late 90s, I entered the world of consulting and writing. Individuals from MD Anderson attended one of my book signings, which resulted in a job to build their employee wellness program. Our MD Anderson wellness team integrated into the employee health and well-being department with occupational health and EAP. The group grew its prevention efforts and worked to create an environment where the healthy

choice was the easy choice. In a 24/7 workspace, where almost 70 percent of employees were female, we added lactation rooms where new moms shared work-life solutions and transitioned back to work faster. Fighting cancer is hard work, and stress and burnout are major challenges, so 50 percent of our early wellness classes were on stress and resilience. Coupled with this, we added stress buster stations in employee hallways and the largest free employee fitness center in the Texas Medical Center. We quickly learned that it was not just about individual behavior change, but team positivism and support were critical, so we developed

mini-culture change techniques to strengthen departmental wellness efforts. But life has a way of happening, and eight years ago, my family history of prostate cancer finally caught up with me, and I was diagnosed with stage three disease. As I entered my mid-60s I realized my cancer journey needed me to focus on myself in a different way. I left my departmental management position and was given the title of Wellness Officer, where I could focus more on strategy, mentoring, research, committee work, and teaching in both the employee and cancer survivorship programs. I renewed old passions, and I’ve

published peer-reviewed articles with writing teams from the UT School of Public Health, the Center for Disease Control and had an article published in the Harvard Business Review. I wave the MD Anderson flag all over the world through my teaching, and last year, I taught in Chile and Argentina. My favorite work is teaching cancer survivor and caregiver groups about hope, gratitude, laughter yoga, the art of calm and other topics that are critical to a life after cancer. My daily blog is read by thousands and has connected me with patients and caregivers, so my cancer journey life coaching is growing. It’s an amazing journey this walk we call life, and as my life experience has taught me, “we don’t do life alone!”



Breaking Back Habits

Protect Our Kids From a Life of Pain



NFORTUNATELY, many adults experience neck, back and wrist pain while working on their computers. We often find ourselves pushing away from our devices to stretch, move or take a break in order to find relief. It doesn’t take long when working on our laptops, desktop computers or smart devices before we start to experience some levels of discomfort. Now, think about typical children and young people. How long do they work or play on their devices, and how good is their posture? Most children will play with digital technology for hours without even thinking about taking a break, and they will often be sitting in the most inappropriate positions on unsuitable furniture or the floor. Children don’t feel discomfort the way older people do. They believe they are invincible, and the idea that they may be at risk for musculoskeletal disorders (MSDs) will not enter their heads. To them, the absence of discomfort equals absence of risk. But there is growing evidence that this is a



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serious mistake. Most organizations have recognized that poor posture among office employees can lead to increased absenteeism, decreased performance and an increased risk of injury. MSDs can arise from prolonged static postures; the worse the posture, and the longer this

posture is held, the greater the risk of an MSD developing. As young people enter the labor force, we are seeing more and more 20-somethings with back, neck and wrist issues. They may have been playing and working with computers and smart devices for 10 years. They have formed bad habits and adopted poor postures. Now, consider that children aged three are using tablets and smart devices every day. How much damage will have been inflicted on their bodies when they enter the job market in

18 to 20 years’ time? Cardinus Risk Management surveyed more than 250 students in British primary and secondary schools. The survey found that more than 50 percent of 14-year-olds have back pain. Back pain! They are already in trouble. And because of social media, school work and gaming, our children spend way more time interacting with technology than adults do at work. Prolonged use and prolonged poor posture; we need to make some serious changes to help our children. Cardinus has developed training material and guides to help you educate your children and improve their posture. Our program helps children to recognize discomfort and understand that it is their body’s way of letting them know it is time to make a change, take a break or stretch. Bill Pace has worked in the US HR software market since 1995 and has specialized in ergonomics solutions for business for the last 12 years. He has worked with several Fortune 500 and 100 companies, including Honeywell, Travelers Insurance and USAA.



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


5726 Esplanade Drive • Corpus Christi, TX 78414 • 361.906.3700




Running on Auto Could Your Nagging Symptoms be a Sign of an Autoimmune Condition? BY BETTY MURRAY


IFTEEN YEARS AGO, I started on a journey that no one in their right mind would choose to take. The journey was long and arduous, with roadblocks and detours along the way. The roadblocks appeared as things I thought at first were signs of “aging,” like extraordinary fatigue, restless and interrupted sleep, digestive pain, IBS and brain fog.

The detours came in well-meaning but useless labels of IBS, then colitis, chronic fatigue and fibromyalgia. Being labeled with these descriptive terms did not result in finding the cause of my ailing health, nor did it do anything to change the direction of my journey. My symptoms were not a sign of aging. They were signs that my body was turning on itself in “friendly fire” and in the process destroying my quality of life. To heal, I had to dig deep and become my health advocate, jumping feet first into a career change that ultimately became my life mission. If anyone asked you what genre of disease is the second most common cause of chronic illness in the U.S., what would your answer be? Chances are you would say diabetes or cardiovascular disease, and you would be wrong. The answer is autoimmune diseases. According to the American Autoimmune Related Disease Association, more than 50 million people in the U.S. have been diagnosed with one or more of the 100 to 120 identified autoimmune diseases. Many autoimmune diseases’ symptoms come on gradually, and

they’re usually shrugged off as injury or a passing illness, such as the flu, fatigue or “getting older.” Just like in my experience. While more and more people are being diagnosed with autoimmune illnesses, there is still a huge lack of understanding and awareness of these diseases among those who may be suffering and the medical community charged with diagnosing and treating them.

What is autoimmune disease? The word starts with “aut,” which comes from the ancient Greek word for “self.” “Immune” refers to the body’s immune system. So, autoimmune, or “self-immune-system,” diseases are those in which one’s immune system is attacking itself. The body’s mechanisms can no longer differentiate between foreign attackers and one’s own body. Normally, the immune system protects the body from infection and disease, but the immune response in autoimmune patients destroys normal and foreign tissue alike. Basically, it is a serious case of friendly fire. But why is the body attacking itself? Truthfully, we don’t know. There are theories that some bacterial or viral infections, exposure to environmental toxins or foods might trigger an autoimmune response in genetically susceptible people. The simple fact is that doctors and medical researchers have very few answers as to why the immune system starts a full-time attack. Interestingly enough, celiac disease offers clues for other autoimmune diseases. Pediatric gastroenterologist and founder of the

Harvard University Center for Celiac Research, Alessio Fasano explains that, “an immune reaction to a protein in wheat, rye, spelt, barley and tricale that results in destruction of the small intestine, is the only autoimmune disease where the cause is known. Complete removal of the protein called gluten from the diet halts the autoimmune activity, ultimately stopping the disease process.” Alessio Fasano believes all autoimmune conditions have three factors in common: a genetic susceptibility, food or toxin antigen exposure, and increased intestinal permeability. Recent evidence indicates that the process could be modulated and possibly reversed by interrupting one of the modifiable factors involved.

Underlying Causes of Autoimmune Disease It’s all in the genes. Your genes are the building blocks of your foundation. They dictate hair and skin color, height and body type and potentially your predisposition for disease. While we cannot change our genes, we can optimize their expression to reduce the likelihood of a genetic expression for diseases getting “turned on.” Epigenetics, such as one’s diet and lifestyle, are the modifiable factors that can either increase or decrease the genetic risk for disease. The gut is ground zero in autoimmunity. The intestines are the largest interface between the environment and us. The small intestine has the complex role of allowing nutrients inside the body while keeping bacteria, toxins and wastes outside. The intestinal lining and the immune system are dynamic structures that change based on what we eat, toxin exposures and stress. Incompetent intestinal lining increases intestinal permeability, commonly known as leaky gut. This can result in the absorption of incompletely digested foods and bacterial toxins that overstimulate the immune system through the bloodstream. The mind-body connection in healing is powerful and real. People do better if they have a sense that there is something they can do for themselves. Conventional treatment standards are to take drugs to suppress your illness symptoms, which only lead you to feel utterly powerless. It also makes your disease worse because it undermines the body’s natural healing process. Could your symptoms be signs of something more? Could one of the above or all be contributing to your loss of health? For me, my returning to school to study nutrition and become an advocate for my own health led to more than I could have even dreamed 15 years ago at my worst. Yes, my journey resulted in a remission of symptoms. I still have my diagnostic label, however, I no longer have the symptoms. I get to work every day alongside clients who have also been there and done that. My reward now is watching them heal and get their life back. The truth is you can too.




JUNE/JULY - 2015


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The Specter of Dementia Addressing The Pervasive Mental Menace BY KARIE SPELL, RN, BSN


VERYONE HAS, OR WILL, experience that moment of forgetfulness that causes you to stop and think, is this normal or should I be worried that something is medically wrong? As we age, there are cognitive and mental changes that occur which are completely normal. These changes are referred to as senility. Senility is very different from dementia or Alzheimer’s but may be used interchangeably, which is incorrect. Whereas senility is a normal part of aging, dementia and Alzheimer’s are not. Dementia is not a disease, but it’s a term used to define a group of symptoms that affect cognitive tasks like memory and reasoning, affecting daily tasks. Dementia can be caused by a variety of conditions, with Alzheimer’s being the most common. There is always a condition or disease that causes dementia. Sometimes it is difficult to determine what medical condition is responsible for these symptoms. Alzheimer’s is a progressive disease of the brain of which the cause is unknown, and at this time, there is not a cure. This devastating disease causes problems with memory, thinking and behavior. These problems affect the person’s ability to safely and adequately perform daily tasks. According to the World Health Organization, 5 million people live with Alzheimer’s disease, and every 67 seconds someone develops this devastating disease. Alzheimer’s is the sixth leading cause of death, and it’s devastating for the individual and their caregivers. In 2013, there was an estimated 15.5 million unpaid caregivers providing 17.7 billion hours of care. These caregivers were unpaid because they were the families and friends of those affected. One in three seniors dies with Alzheimer’s or another type of dementia. Even though the cause of Alzheimer’s is unknown, keeping the mind active, healthy and functioning is known to help. Increasing blood flow and rest is

Signs of Alzheimer’s

important in keeping the cognitive pathways clear and functioning. Physical exercise, consumption of caffeine in moderation, brain boosting exercises and sleep are ways to accomplish this. We must challenge our brain or it gets lazy, defaulting to efficient, non-engaged activity. This is much like being in a state of autopilot. We should try performing a new and challenging task daily. Driving a different route on your way home, using your non-dominant hand to brush your teeth, or doing a cycling class instead of your usual yoga are all simple things to increase your brain work out and contribute to its health. We must constantly change things up to keep our brain stimulated. The next thing for brain health is: we are what we eat. There is evidence that excess amounts of carbohydrates and grains may have a negative impact on our brain health. In his book “Grain Brain,” Dr. Perlmutter, a practicing neurologist, discovers fascinating and compelling evidence through his own patient population that supports this. This has changed his practice approach, as well as the approach of other physicians to incorporate a diet in which carbohydrates, grains, and other inflammatory foods are removed and controlled. These diet changes

have had positive and staggering improvements for patients struggling with these disorders. We must also have emotional and meaningful engagement on a daily basis. We, as humans, are social creatures. Interaction with others or pets is crucial to cognitive health and emotional wellness. We must engage in activities that are meaningful to us and create a state of happiness to keep our brains healthy. Reading books, having conversations, laughing, playing an instrument, doing puzzles, writing, painting, learning something new, these are just a few things that can create pleasure resulting in happiness and healthy brains. Be motivated to keep your brain and that of your loved ones healthy. Be informed and get involved. If you or someone you know is suffering from memory loss and you are unsure if this is normal or a medical problem make an appointment. If someone you know is struggling from a dementia, like Alzheimer’s, there are organizations available to help you. There are home health and home care providers that can offer skilled care or non-skilled care based on the needs of the patient.

Typical age-related changes

Poor judgment and decision making

Making a bad decision once in a while

Inability to manage a budget

Missing a monthly payment

Losing track of the date or the season

Forgetting which day it is and remembering later

Difficulty having a conversation

Sometimes forgetting which word to use

Misplacing things and being unable to retrace steps to find them

Losing things from time to time


KARIE SPELL HOLDS A BACHELOR OF SCIENCE DEGREE IN NURSING. SHE HAS SPENT THE LAST 15 YEARS OF HER NURSING CAREER AS THE ADMINISTRATOR OF SIGNATURE HEALTH SERVICES PROVIDING HOME HEALTH SERVICES TO THOUSANDS OF PATIENTS IN THE GREATER HOUSTON AREA. As a leader in home health care, Karie has developed and implemented programs with proven health and wellness outcomes. If you have any questions about the topics or are interested in additional information, please call her at 281.420.2704.



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Catching Cancer


Dr. Miltenburg employs gene testing and preventative care to thwart cancer


R. MILTENBURG IS A HIGHLY SOUGHT AFTER PHYSICIAN AND SURGEON SPECIALIZING IN THE TREATMENT OF BREAST CANCER and other breast diseases, with a focus on women. She is committed to providing compassionate care to her patients and dedicated to finding new, innovative methods of treatment, such as brachytherapy which shortens radiation treatment. Her research has been published in many medical journals, and her opinion has been featured in various articles. Considered an expert in her field, patients under Dr. Miltenburg’s care have a low reoccurrence rate. For the past several years, Dr. Miltenburg has taken her practice to new heights with breast cancer prevention. Through genetic testing of the BRCA gene, doctors can now determine which patients will get cancer based on their genetic history. “Genetic testing is becoming more and more common,” stated Dr. Miltenburg. “Looking at the history will allow us to see if the cancer came from someone in their

family or if they got it on their own.” The most common story of genetic testing is that of Angelina Jolie. She discovered she had the BRCA gene and was at high risk, so she had a mastectomy. This has become a very common practice in family members of former cancer patients. By taking the preventive measures, the chances of getting the disease decrease to almost zero. If someone discovers they have the BRCA gene, there are several methods of pre-treatment. For example, for a patient at risk for breast cancer, there is the option of a mastectomy, which is the most common. For patients who choose this option, Dr. Miltenburg and a plastic surgeon develop a plan together to remove the breast and then perform reconstructive surgery using fat from the tummy or implants, whichever the patient chooses. For patients with the BRCA gene, removal of the breasts and reconstruction is covered by insurance. The next option would be to take Tamoxifen for a span of five years, during which Dr. Miltenburg monitors the patient closely. This cuts the risk of breast cancer in half. The third option would be to do nothing and go for frequent check-ups in an effort to catch the cancer quickly. However, it is important to note that genetic testing does not just test for one specific cancer. If mutations other than BRCA genes are detected, Dr. Miltenburg refers the patient to a specialist so that they can receive the appropriate preventive care. “Genetic testing isn’t done on everyone,” Dr. Miltenburg explained. “We base it on the family history.” She chose to pursue this testing in an effort to assist those with a history

of cancer and prevent the onset. There is no minimum age or limit for the testing, but she does not allow younger patients at risk for breast cancer to get a mastectomy until later in life if possible. Because breast cancer and ovarian cancer are linked, she wants the patient to have a chance to start a family. Hailing from Canada, where she completed the majority of her studies, Dr. Miltenburg relocated to the U.S. and began a surgery fellowship at Baylor College of Medicine in Houston. Later she was invited to join the Baylor faculty as assistant professor of surgery. In 2002, she relocated to Temple, Texas, where she worked at Texas A&M as a professor of surgery and Chief of Breast Surgery at Scott and White. She stayed there for 10 years and handled 700 surgeries every year. During her time at Scott and White, Dr. Miltenburg played a key role in obtaining the National Accreditation Program for Breast Centers. In 2011, she relocated back to Houston where she became the Medical Director of Texas Women’s Comprehensive Breast Center. Dr. Miltenburg has been practicing medicine for more than 20 years and continues to excel in her practice. Dr. Miltenburg is certified by The Royal College of Physicians and Surgeons of Canada and The American College of Surgeons. Licensed by the state of Texas, she is also a member of several organizations including The American Medical Association and The American Society of Breast Surgeons.




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Could Your Sore Throat Be Caused by “Silent Reflux?” BY DR. F. PAUL “TRIPP” BUCKLEY III

THE TERMS HEARTBURN AND GASTROESOPHAGEAL REFLUX DISEASE GERD ARE WELL KNOWN. GERD affects 10 percent of the population daily, and more than 20 million Americans are on long-term stomach acid suppression medications. In fact, GERD is the third-most sought out healthcare related term on search engines like Google. However, GERD’s lesser known cousin is called laryngopharyngeal reflux (LPRD). This disease occurs when small amounts of stomach contents are able to “reflux” all the way up to the throat. Once there, even tiny amounts of acid activate digestive enzymes that can wreak havoc. Patients suffering from LPRD often complain of a sore throat, voice changes, chronic cough, bitter taste in the mouth and a fullness known as “globus.” Unfortunately, LPRD is notoriously difficult to diagnose and treat since many of these symptoms can be caused by other medical conditions, such as allergies and lung problems. We also know that most patients with

LPRD do not have classic symptoms of GERD, such as heartburn. LPRD is often treated and diagnosed the same way, by attempting to further suppress acid production. This is usually done with a class of drugs known as proton pump inhibitors (PPIs) and H2 blockers. If these are even marginally effective, then medical providers often label the patient as having LPRD. Unfortunately, this is very similar to patients suffering from GERD, and as a consequence, there are millions of patients taking medications for a disease they may not have, which may be marginally effective, potentially harmful or both. There are no less than three FDA warnings for PPIs. But this does not stop Larry the Cable Guy from recommending Prilosec every day. So, how should we diagnose and treat those suffering from LPRD and GERD? First, become a well-educated patient. That is not to say diagnose yourself. Rather, gain as much knowledge as possible, and find a doctor who is familiar with LPRD and its treatment in order to get a firm diagnosis. A pH test can diagnose both GERD and LPRD. Effectively treating LPRD and GERD requires a thorough understanding of what is causing the problem. To debunk a common myth, the cause is almost never an over-production of acid by the stomach. The common, underlying problem lies with an ineffective lower esophageal sphincter, the valve that allows passage of food and liquid into the stomach from the esophagus. When this valve becomes “leaky,” it can allow acid, bile, and other contents to “reflux” into the esophagus and throat. Symptoms can range from occasional heartburn to severe damage of the esophagus, throat, vocal cords and even ear problems. Left untreated, this disease can progress to esophageal cancer. While acid suppression, either with lifelong PPIs or H2 blockers, will relieve many LPRD and GERD symptoms, this may be inadequate or unacceptable for many patients. Between 30 and 40 percent of patients continue to have symptoms even with double-dose medications, and the number is even higher for those suffering from LPRD. Often, the side effects of the medications make this option prohibitive. Many patients do not want to be or cannot afford to be on lifelong medications. When acid suppression either doesn’t work or it “There are no isn’t desired by patients, we have to go less than three back to the root cause of the problem, FDA warnings the lower esophageal sphincter. There are several procedures designed to help for PPIs. But the sphincter do its intended job. At the this does not Heartburn & Acid Reflux Center at Scott stop Larry the & White Hospital-Round Rock, a part of Cable Guy from Baylor Scott & White Health, attending recommending physicians take a comprehensive, multiPrilosec every disciplinary approach to treating every patient with GERD and LPRD. day”




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Talking Vaccines

4-, and 6-months-old, as well as between 12- and 15-months-old. TXMD: Why are these vaccines

important for children?

Belmund Catague, M.D., MPH, chats with Texas MD about safeguarding children and preventing diseases with immunizations TXMD: What vaccines are commonly

given now and how are they typically administered?

DR.CATAGUE: Vaccine administration is usually given by intramuscular or subcutaneous injection, but rotavirus is given by oral administration, and the influenza vaccine can be given through a nasal route. Some of the doses can vary, depending on the manufacturer of the specific immunization, but the vaccination schedule for infants to 6-year-olds is agreed upon by the American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP) and the Centers for Disease Control. Vaccinations for measles, mumps, rubella (MMR), diptheria, tetanus, polio, and Hepatitis A and B are common. Children are also usually administered rotavirus, rotatrix, rotateq and influenza vaccines, amongst a number of others. Some children with sickle cell or an immune deficiency may also need specific meningitis coverage. These patients would need the MCV at 2-,

this risk must be weighed against the risk of being infected with measles, which, during an outbreak, is 35 times higher in an unvaccinated individual than in a vaccinated person.

DR. CATAGUE: Immunizations are

one of the most effective directives we utilize as a society to prevent disease, morbidity, and ultimately, death. Vaccines effectively prevent disability. Most Americans now have never seen individuals in a wheelchair due to polio, or lost an infant due to meningitis. We receive some immunity from our mothers during the last trimester of pregnancy through the placenta, but we need vaccinations during the first months after birth in order to develop antibodies against deadly, preventable diseases. Before Hepatitis B became part of the routine immunization schedule, around eight children out of every 100,000, in 1990, were being infected with this disease, but by 2000, the rate had dropped to around one case per 100,000 children. This is just one example of how vaccines have reduced the rate of infection. TXMD: Are there side effects,

and if so, what are some common symptoms? DR. CATAGUE: Vaccines are safe.

Any adverse side effects are usually minor and may include a fever that subsides the next day, mild headache, or a local rash or soreness at the injection site. There are rare instances of systemic reaction, but

TXMD: What are dangers or

drawbacks of delaying these vaccines, or not giving them at all? DR. CATAGUE: There are

definitely dangers in not vaccinating, including paralysis, brain damage, hearing loss or death. As for delaying vaccines, a study published in the Journal Pediatrics noted the incidence of post-vaccination seizures, while still low, was 2.65 percent when administered between 12- and 15-months-old, and it increased to 6.53 percent if administered between 16- and 23-months-old. This is one studied consequence of delaying the vaccine schedule. In the 2014 measles outbreak in the United States, 69 percent of the cases were due to unvaccinated patients. Some parents believe there is enough herd immunity to keep their child safe even if not vaccinated, but with more and more parents refusing vaccines, large scale outbreaks, as seen in Disneyland this past year, can and do occur. TXMD: Is there any valid

medical link between vaccines and autism? DR. CATAGUE: Simply put, no.

BELMUND CATAGUE, M.D., MPH, is a family medicine physician with MedFirst Primary Care.

There is no medical link between




JUNE/JULY - 2015



vaccines and autism. The research conducted in 1998 that started this controversy has been disproved. Despite any celebrity discussion, internet speculation, and persistent concerns in the media, there is no reason to believe vaccines cause autism.

if the patient ever developed Guillain-Barre Syndrome, a neurologic disease which causes weakness in the extremities, within six weeks of administration, then this is also a contraindication. TXMD: What is something

TXMD: What can physicians tell

parents who want to delay or not give these vaccines?

surprising about vaccines, or something that many people may not know about vaccinations?

DR. CATAGUE: Parents may want

DR. CATAGUE: Despite the

to delay vaccines for various reasons. Some think they should delay them because they are afraid the MMR vaccine may cause pain, while others are afraid of overloading the immune system with multiple vaccinations at once, and some people may have religious objections. I would advise physicians to have an open dialogue, noting that an overwhelming amount of data shows that vaccines save lives. Address any questions and concerns with facts. Multiple agencies, including the World Health Organization, the Institute of Medicine, the AAFP and AAP, agree on our current vaccination schedule. There is no evidence that we should investigate further for a delayed vaccination schedule.

seeming trend of more parents refusing vaccines, according to a 2009 survey of parents, just over 93 percent with a child younger than 6-years-old had or would be vaccinating their children. We have to understand that those parents who refuse vaccines are a small minority, and we need to continue to vaccinate children. The states that allow for philosophical and religious exemptions have higher rates of vaccine-preventable diseases than states with religious exemptions only, which makes intuitive sense. The more chances people have to refuse vaccines, the higher the rate of preventable disease. Some parents are concerned about the ingredients, such as aluminum in the Hepatitis B vaccine. And while an infant may receive 1,125 micrograms of aluminum in this vaccine, by 6-months-old that child will have consumed approximately 6,700 micrograms in breast milk, 37,800 micrograms in infant formula, or 116,000 micrograms in soy-based formula. It is a matter of context based on facts, and we should keep that in mind since vaccines are one of the best ways to keep your child healthy.

TXMD: Do these vaccines pose a risk

to children with auto-immune diseases, and, if so, how? DR. CATAGUE: Vaccines are safe.

The only contraindications are with vaccines for MMR, varicella, and influenza for patients with severe, symptomatic HIV or who have known severe immunosuppression, due to chemotherapy for cancer treatment. Of course, if a patient did have an anaphylactic systemic reaction in the past to a vaccine, then this is also a contraindication. For the flu vaccine,



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pulp would cause our teeth to look dull and grayish in color. • Dentin is the middle layer, which is a calcified, hard substance with microscopic channels called dentinal tubules. When cavities reach this area, we often experience tooth aches. • Enamel is the outer layer of our teeth and the hardest substance of the body. The enamel doesn’t contain any nerve endings, which is why small cavities in this area are not felt.

The hard truth about soft drinks The detrimental effects of soda on tooth enamel BY DR. J.C. PEREZ IV DO YOU EVER WONDER WHY SOFT DRINKS ARE SO BAD FOR YOUR TEETH? I’m guessing probably not. It’s not usually the first thing you think about while enjoying your favorite beverage. The average person worries more about how many calories are in that drink, rather than what harm it could be causing their teeth. The fact is nobody really thinks about how good or bad they’re treating their teeth on a daily basis. Why is that? Are we taking our teeth for granted, or are we just oblivious to what is going on in our oral environment? In reality, it’s probably a little of both. The most common response I get when I diagnose somebody with cavities is, “I hardly eat any candies!” Well guess what! Along with candy, soft drinks contribute greatly to tooth decay, and the amount of cavities in children and adults have increased because of it. I like to think of soda as “liquid candy,” because that’s what it basically is. But before we can comprehend why sodas are so harmful to our teeth, we must first understand what teeth consist of. Teeth are made of four main components. Three of those components are important for our purpose here. • The pulp is the inner layer of our teeth which contains the nerve and blood supply. This is where the vitality of our teeth is located. Necrosis or death of our

So if enamel is the hardest substance of the body, why should we be so afraid of a little sugary liquid? To answer that question, we must know a little about the physiology of our enamel. At a microscopic level, enamel is very dynamic and goes through many changes. It is constantly put under stress, and it goes through cycles of mineralization and demineralization. Depending on the acidity of the oral environment, the chemical structure of enamel can be greatly affected. Enamel breaks down in acidic environments with a pH level less than 5.5. Anything higher than that value will allow the enamel to repair itself, given the right minerals available. So if our oral cavity is constantly in an acidic state less than 5.5, our enamel will continue to break down without ever having the opportunity to fix itself. What does this have to do with our soft drinks? Great question! The short answer, is that all soft drinks are extremely acidic. The pH values range between 2.5 to 4.3, depending on which one you choose. Drinking a soda with a meal would probably

take about 30 minutes. In those 30 minutes, and maybe even a little longer than that, your teeth are being exposed to an acidic environment and are breaking down. Your saliva acts as a buffer and eventually brings the oral environment back to levels above the critical value. That’s why saliva is so important, and people with chronic dry mouth have a higher incidence of cavities. Additionally, the sugar in soft drinks interacts with the living bacteria surrounding your teeth and creates lactic acid. The lactic acid demineralizes and softens the enamel, which allows bacteria to further invade the teeth. This process continues until the bacteria finally reach the dentin and cause a toothache. In more severe cases, bacteria reach the pulp and destroy the nerve and blood supply. Many of these cases lead to major infections, called an abscess, and may result in a root canal or even a tooth extraction. There is nothing soft about our soft drinks! What we are drinking can be extremely hard on our teeth. So the next time you think about reaching for your favorite beverage, maybe think about water instead! J.C. Perez is a doctor of dental surgery and has been a certified dental technician for 12 years. Dr. Perez works as a general dentist for the Community Action Corporation of South Texas and is an instructor at Kaplan College in Corpus Christi.




JUNE/JULY - 2015





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The Sting of Summer The facts about allergic reactions to insect stings



S WE ENTER THE SUMMER MONTHS IN TEXAS, residents will spend a significant portion of the season outdoors. Parks, beaches, campgrounds and river tubing are just some of the activities that make up our summertime fun. Although the summer season brings a respite from mountain cedar, oak and ragweed pollens, the warmer, sunny days bring an increased risk of insect stings. Almost everyone has experienced an insect sting in their lifetime. While mosquitoes are the most likely culprits, they do not

normally result in severe allergic reactions. Instead, insects such as bees, wasps, yellow jackets, hornets and fire ants are the major insects causing allergic reactions in Texas. Luckily, most people experience nothing more than a simple local reaction from most insect stings. This is the well-known redness, mild swelling and pain that can last a few days. More distressing is what is referred to as a large local reaction. In this case, the victim can have a very large area of swelling and pain that can encompass an entire arm or leg. This reaction tends to last longer, and in severe cases, it can last for a week or more. Many patients confuse these large reactions with a true allergic reaction and seek the opinion of an allergy specialist. Luckily, there is only a small risk of these reactions ever progressing to something more dangerous, but treatments do exist

that can help lessen the severity of these large local reactions. This is particularly important for people like gardeners, campers or hikers, who enjoy spending a great deal of time in the great outdoors. The real danger from an insect sting comes in the form of an anaphylactic reaction. An anaphylactic reaction is defined as a severe, widespread and life-threatening allergic reaction. These potentially life-threatening reactions involve severe skin reactions, such as diffuse swelling and hives, as well as abdominal cramping, difficulty breathing, dizziness or loss of consciousness. These reactions can lead to death and result in about 40 deaths each year in the United States. Fortunately, an extremely effective treatment exists that can protect patients with severe insect allergies and reduce the number of deaths close to zero. For people who have experienced symptoms after an insect sting, an allergy specialist can help you determine if you are at risk for anaphylaxis from the insect venom. Blood or skin testing to these specific insects will help determine if you are allergic. If you are diagnosed with an insect venom allergy, the first step in protecting yourself sounds simple: don’t get stung! Learning to recognize insect habitats, such as wasp and hornet nests or fire ant mounds, is very important. For local reactions, a cold compress applied to the stung area and the use of anti-histamines can often help lessen the reaction. Topical steroids applied to the area often

help reduce the severity of inflammation at the site. All patients with a true venom allergy should always carry an epinephrine auto-injector that can be administered if a sting occurs and anaphylactic symptoms are experienced. These devices can be life-saving, since anaphylaxis can progress from mild to fatal within minutes following a sting. But the best therapy for true insect venom allergies is allergy shots. Just like allergy shots for pollen, this therapy involves the administration of small amounts of insect venom by a shot in gradually increasing amounts. Over time, this can lead to a drastic reduction in the risk of future allergic reactions. In fact, allergy shots for insect stings are often considered one of the most effective therapies in the entire allergy field, as the result is a complete cure in about 98 percent of patients. Patients receive a weekly shot for several months and then a monthly shot for three to five years. Some patients with the most severe allergies elect to stay on lifelong shots for the best protection. Allergy specialists are experts in the evaluation and management of insect sting allergies. If you have experienced any type of severe reaction to an insect sting, see a board-certified allergist right away for life-saving options. Don’t let the sting of summer get in your way of enjoying the beautiful Texas outdoors.




JUNE/JULY - 2015




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Dr. Kiesz and Dr. Bailey are experts in Interventional Cardiology and Endovascular Interventions and are two of the few physicians here in San Antonio and the world with unrivaled experience, skill and outcomes. Dr. Kiesz is also the author of over a hundred publications and is an inventor and an entrepreneur. He has pioneered many new coronary and endovascular techniques and devices.

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Own Your Health Encouraging proactive patients with regular healthcare screenings Dr. Omar Gomez is the Market Medical Director for WellMed senior healthcare clinics in Hidalgo County. Dr. Gomez, board-certified in internal medicine, joined WellMed because of its disease-prevention program that keeps seniors generally healthier by helping them understand and control their health in a lifelong effort at wellness. One of the challenges he addresses successfully is keeping patients 65-yearsold and older healthy through regular healthcare screenings. Dr. Gomez sat down with Texas MD and answered some commonly asked questions about screenings. TXMD: Why are healthcare screenings

that I’m happy with their care.

so important? TXMD: How does the WellMed DR. GOMEZ: The important step in

seniors staying healthy is prevention. The best way to prevent disease and illness is to receive regular healthcare screenings. These screenings will help identify any problems so you can receive treatment as soon as possible. Healthier patients mean lower healthcare costs, and that is good for everybody. TXMD: How do you encourage

patients to get healthcare screenings?

model encourage patients to get screened for diseases?

TXMD: Why are some patients

resistant to screenings? DR. GOMEZ: People are afraid of

what screenings may find. They are afraid to face reality or think the test will be uncomfortable. I keep pressing them until they do it. After they get it the first time, they realize it’s not so bad. The most neglected screening is a colonoscopy, which is recommended every 10 years after 50-years-old. It is the most accurate and thorough test, but also the most costly. There is also obvious discomfort with the idea. Medicare alone only pays for a colonoscopy if it’s a medical necessity due to a patient’s history. WellMed patients with a Medicare Advantage Plan are encouraged to have a screening colonoscopy. Some women avoid breast cancer screenings. With self-exams and a mammography, it is rare for a patient to die if the disease is caught early. There is a much better chance for successful treatment.

DR. GOMEZ: When patients are incorporated into a whole healthcare delivery system, as they are with WellMed, that motivates them to keep coming to the office. They leave with a follow-up appointment. If they don’t keep their appointments, we send them a letter or we call. We check their medications with the pharmacy to make sure they are receiving their prescriptions.

TXMD: What other health

TXMD: What are the recommended

screenings should be done and how often?

DR. GOMEZ: I try my best to

motivate patients. The most important part is to get them to understand that their problems are truly their problems. I am here to help as an advocate, but I try to make them understand they have a responsibility for their wellness and disease prevention. Patients understand that it’s for their own benefit. They see that I’m really concerned about their health. And they want to make sure

cervical cancer. Men need a PSA test to screen for prostate cancer.

healthcare screenings for seniors? DR. GOMEZ: Regular visits to DR. GOMEZ: Healthcare screenings

are most important for 55-yearolds and older. You want to check cholesterol and blood pressure, hemoglobin for diabetes and get a colonoscopy to check for cancer. Women need screenings for breast cancer, thyroid, osteoporosis and

the doctor are key in determining how often screenings should be administered. While most average about once a year, some screenings are required more or less often depending on a patient’s health. Seniors should also get bloodwork once a year to check

for anemia, kidney, liver and thyroid problems. Once or twice a year, it’s important to screen for diabetes and cholesterol. Men should get a PSA screening for prostate cancer. Kidney and liver function is tested at least once a year as part of a physical exam. Some issues are dehydration or medicines that affect the kidneys or liver. A urine test is usually taken when there is a symptom. It can catch the beginning of a kidney problem before it winds up in dialysis. TXMD: What is next after

testing? DR. GOMEZ: We talk to patients by phone about their test results. In a visit, we discuss the labs and the need, if any, to add or increase medication. TXMD: What other health screening advice do you have for seniors? DR. GOMEZ: Depression is one of the primary screenings at WellMed. I am very open to treating depression. Many physical symptoms — fatigue, apathy, pain, forgetfulness — can be improved with antidepressants. Overall, people who are more comfortable with aging are most likely to make appointments to get screenings. A person in their 70s used to be an old person. Now, suddenly, that’s not old. In truth, aging is all about having good quality of life.




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Hard to Swallow Texas MD gets to know this esophageal disorder with Angel J. Tamez, M.D. TXMD: What is achalasia, and how

common is this disorder? DR. TAMEZ: Achalasia is

essentially an inability to swallow solids and liquids. It is a disorder of the muscular layer of the lower

esophagus where it empties into the stomach, wherein these muscles fail to relax during swallowing. With this disorder there is also a lack of peristalsis, normal esophageal waves that help with swallowing, making it difficult to pass the food bolus into the stomach. TXMD: Who can

develop achalasia? Is there a specific age group or gender more prone to this disorder? DR. TAMEZ: This disease affects mostly adults, especially those in their 30s through their 50s, although I have seen it in younger patients. Unfortunately, little is known about the causes of achalasia. It is believed that anyone can develop it. However, it is a rare disorder, occurring only in one to two per 200,000 people. TXMD: What are the

usual or common symptoms of achalasia?

DR. TAMEZ: The main symptoms

of this disorder include a progressive difficulty swallowing that often leads to a choking sensation, regurgitation, spitting up of undigested food, heartburn, chest pain behind the breast bone and weight loss. TXMD: What is the treatment for achalasia?

when patients seek help late in the diagnosis, and their esophagus is at the point where it no longer works. Other challenging situations include patients who have already undergone other treatment modalities, such as Botox injections, that have failed. These patients tend to be placed at higher subsequent surgical risks.

DR. TAMEZ: The treatment is

often a multi-specialty approach, where patients are usually started on medications to help relax the esophagus. Often, however, medications alone are not enough, and endoscopic dilatation is then implemented. The gold standard therapy is a minimally invasive surgical approach where the defective muscular fibers around the esophagus are individually divided in order to allow complete relaxation of the esophagus and a resolution of the swallowing difficulties. This surgical procedure is called a Heller myotomy, and it has a success rate greater than 90 percent. TXMD: What is the general

prognosis and recovery for achalasia? DR. TAMEZ: When treated correctly by an experienced surgeon, patients tend to do very well, having more than 90 percent resolution. However, treatment becomes challenging

ANGEL J. TAMEZ, M.D., is a board-certified general surgeon who practices with the South Texas Surgical Group located at 311 Camden Street, Suite 301 in San Antonio, TX, 78215. For an appointment call 210.228.9605.

TXMD: Do patients come to you directly, or are they generally referred to you by other physicians? DR. TAMEZ: This is such a rare disorder that patients are typically referred to me. However, occasionally I will have a patient who shows up to the office with these symptoms. TXMD: What medical specialties typically refer for the treatment of achalasia? DR. TAMEZ: Typically, GI

specialists, primary care providers, and other surgeons in the community are the primary referral sources. TXMD: What are the health risks posed by achalasia? DR. TAMEZ: There are a number of health hazards posed by achalasia, including malnutrition, pneumonia risk of aspirating food, liquids, saliva and stomach contents.




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A Treatment for Two Texas MD talks with Donald Dilworth, M.D., FACS about resolving both hernia and reflux disease TXMD: What is a hernia? DONALD: The formal medical

definition of a hernia is “a condition in which part of an organ is displaced and protrudes through the wall of the cavity containing it.� But most lay people consider hernias as a break in the abdominal wall musculature. TXMD: Who can get a hernia, and is

it dangerous? DONALD: Anyone can get a hernia.

Some people are born with one. Others are born with a weakness that allows a hernia to form later in life. Most develop a hernia by having repeated or excessive strain put on a muscle wall. This can occur from lifting, exercise, pregnancy, weight gain, trauma or from having a prior incision. A hernia can be a serious medical condition and even lead to emergency surgery. Typically, this occurs when the intestines become trapped through the hole in the muscle and begin to swell, a condition known as incarceration. As the intestine swells, it becomes permanently trapped outside, and this can lead to ischemia or

death of the intestine, which is called strangulation. Both of these conditions are surgical emergencies and require an operation to treat them effectively.

TXMD: How are hernias and

gastroesophageal reflux related? DONALD: A hiatal hernia can cause,

or worsen, existing reflux disease because the muscle at the lower end of the esophagus, that prevents reflux, can weaken or become kinked by the stomach, causing it to malfunction. TXMD: Is surgery a viable option for

combined reflux disease and a hiatal hernia, and if so what cases?

TXMD: What is something DONALD: Some smaller hiatal

TXMD: What types of hernias can

people get? DONALD: The more usual types of

hernias people can get are inguinal or groin hernias, umbilical hernias, ventral or front-of-the-abdomen hernias, femoral hernias, incisional and hiatal hernias.

can be performed laparoscopically on most patients and have been considered the gold standard for 15 to 20 years. Recently, the use of robotic surgical platforms has improved the performance and speed at which the surgery can be accomplished, while still using the same four or five small incisions that laparoscopic surgery does. In rare cases, sometimes the need for a larger open surgical procedure is required.

hernias with minimal reflux can be treated with diet modifications and acid-reducing medications. Larger hernias, or ones related to progressively worsening reflux disease, should be treated surgically to improve symptoms, reduce cancer risk, and reduce risk of aspiration. TXMD: What type of surgery is

TXMD: What is a hiatal hernia?

needed, and how is it performed?

DONALD: A hiatal hernia is

DONALD: The surgical procedure

a special type of hernia of the diaphragm in the area where the esophagus normally passes through. With a hiatal hernia, this area stretches out and allows the stomach, and even other organs, to push above the diaphragm. This condition can be caused by coughing, vomiting, straining with constipation and lifting. This can lead to upper abdominal or lower chest pain, reflux, hoarseness, belching, difficulty swallowing food, and a hiatal hernia can even cause a person to throw up undigested food.

for repairing a hiatal hernia is to pull the stomach and the end of the esophagus through the hole, back into the abdomen, and then repair the weakness in the diaphragm. This repair can be done by placing sutures in the muscle to tighten it for smaller hernias, while in larger defects the muscle may need to be supported by mesh or biological material. The reflux is then treated by wrapping the upper stomach around the esophagus to form a collar that helps prevent stomach contents from refluxing. These procedures

DONALD D. DILWORTH, M.D., FACS, is a board-certified general surgeon practicing in San Antonio.

surprising that people may not know about reflux disease and hiatal hernia surgery? DONALD: People with new onset

adult asthma, reactive airway disease, or hoarseness should be checked for reflux disease and a hiatal hernia, which are leading causes of those problems. From a surgical perspective, the surgery is very well tolerated. Patients typically go home the day following surgery, and they can be back to work in one to two weeks and at regular activity in two weeks. All types of hernias, including hiatal hernias, and many other surgical conditions can be treated at STAT Surgical by Dr. Dilworth and his partners. The main office is located at 8715 Village Drive, Suite 608 in San Antonio, TX, 78217. Dr. Dilworth is also available to see patients in the Schertz and Stone Oak clinics. To make an appointment at any of the locations call 210.657.2100 or visit www.statsurgicalservices.com.




JUNE/JULY - 2015


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Speaking Freely


Corpus Christi Rehabilitation Hospital Helps Stroke Patients Communicate Better IMAGINE BEING ABLE TO EASILY READ THE LOCAL NEWSPAPER OR A POPULAR MAGAZINE, but then struggling to read a child’s book aloud. For a person with aphasia, this wouldn’t be unusual. Aphasia is a communication disorder that impairs a person’s ability to process language, but it doesn’t affect intelligence. Aphasia can weaken the ability to speak, understand others, read or write. The disorder results from damage to portions of the brain that are responsible for language. It affects about 1 million people in the United States, the majority because of strokes. “A person’s communication abilities depend on the type of aphasia and the level of severity,” says Leticia Morales, a speech-language pathologist at Corpus Christi Rehabilitation Hospital. “Symptoms can range from mild to severe. Some people with aphasia may have minor problems finding words to communicate complex messages, while other may have lost the ability to read or write. But regardless of the severity, most find it frustrating to not be able to communicate like they did before their stroke or brain injury.” The good news, however, is that aphasia symptoms often can be improved through a collaborative team approach with speech-language pathologists, family members and professionals such as doctors, nurses, neuropsychologists and other therapists.

“Most physical gains can be made in the first six months following a stroke,” Morales says. “But, aphasia has a life-long impact on stroke survivors. It’s important to have ongoing support that allows a person with aphasia to continue practicing communication strategies, explore resources, be encouraged, and to learn how to best navigate life as a stroke survivor.” Morales says the goal of aphasia treatment at Corpus Christi Rehabilitation Hospital is to impact patients’ quality of life by improving their confidence to communicate

in various situations, and to increase their willingness to try activities they once thought they could never participate in again. “I’ve seen great results first-hand,” Morales says. “I’ve watched stroke survivors paddle canoes, complete wood working projects, bike, and participate in archery, all things they thought they’d never do. It’s exciting to see stroke survivors making such accomplishments, but probably mine, and their, biggest satisfaction is in just being able to sit down together and communicate.”

“It affects about 1 million people in the United States, the majority because of strokes” Corpus Christi Rehabilitation Hospital is a 35-bed, free-standing facility providing intensive physical rehabilitation services to patients recovering from strokes, head and spinal cord injuries, and other impairments as a result of injury or illness.




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Don’t Be Fooled


Special interest and pseudoscience collude at the great food pyramid


OST OF YOU PROBABLY REMEMBER THE FOOD PYRAMID FROM GRADE SCHOOL. Did you know the pyramid design was retired in 2011 for a dinner plate? Have you given any thought as to why the food pyramid was created in the first place? Was it truly healthy? And how did the USDA arrive at choosing what Americans should eat? In 1968, Senator George McGovern was deeply moved by a television documentary on starvation in America. McGovern promptly went to work in Congress to abolish hunger in the United States, and he was named Chairman of the Senate Committee on Nutrition and Human Needs. Shortly after embarking on this journey to end hunger, McGovern became acquainted with low-fat guru, Nathan Pritikin. Almost immediately, the vision changed from starvation to saving Americans from heart disease, diabetes and obesity through the vehicle of a low-fat diet. With this goal in mind, a committee was formed by Congress and charged with developing nutritional guidelines for Americans to help mitigate chronic disease. The committee was made up of nutritional scientists who did their job nicely. The original recommendation that was returned to Congress “cracked

down ruthlessly on empty calories and health-depleting junk food. The new guide’s base was a safari through the produce department – five to nine servings of fresh fruits and vegetables each day. ʻProtein foodʼ like meat, eggs, nuts and beans came in at five to seven ounces daily: for dairy, two to three servings were advised,” according to Denise Minger’s work “Death by Food Pyramid.” That sounds reasonable, right? But it’s nothing like the food pyramid of old that we remember, the one with the foundation built on breads, pastas, cereals and rice. So what happened? Why the change if this is what the nutritional scientists discovered? When the committee brought its original findings and food pyramid before Congress they were told there was no way the USDA could tell Americans to eat this way. It was much too expensive. Ironically, this was during the early 1970s when welfare programs were gaining traction within the government. Not to mention various special interest groups, like the grain and rice industries, balked at it completely. The nutritional scientists were told to take it back and rework it, make it affordable to the average American. With a few tweaks by the scientist and the USDA — making sure all interested parties got their fair share — the birth of the food pyramid came to pass. Fast forward some 40-odd-years under the guidance of the USDA food pyramid, Americans face obesity, diabetes and heart disease in near-epidemic proportion. The

Stewart Beasley is a 20 year veteran of the Baytown Police Department where he is assigned to Crime Prevention and Training, and he’s 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 stewart.beasley@baytown.org.



JUNE/JULY - 2015

USDA revised the nutritional guidelines, albeit ever so slightly. In 2011, this changed the diagram from a pyramid to a dinner plate, in hopes to give Americans a better image on portion selection. However, it remains as much a political as a public health document. It gives way to the same bad science and special interests that its predecessor did. Rest assured neither the pyramid nor the plate has Americans’ weight and health in mind. There seems to be a slowmoving shift within some factions of the medical community, as well as the nutrition industry, from thinking that eating fat makes you fat and cholesterol is the devil, to carbohydrates and sugars are far more evil than fat. I believe this to be true and have had great personal success with aligning my diet with that theory. There is such an abundance of nutritional and health information at our fingertips these days that it is often hard to determine fact from fiction. Keep in mind that science is constantly changing. Things that were taught as fact 20 years ago may be obsolete today. If you are interested in learning more about the science behind nutrition, without feeling as if you are reading a textbook, I encourage reading: “Why We Get Fat and What to do About It” by Gary Taubes, “The Art and Science of Low Carbohydrate Living” by Jeff Volek and Stephen Phinney, and the aforementioned “Death by Food Pyramid” by Denise Minger. If you fail to educate yourself on the science of nutrition, you will be easily fooled by the pseudoscience of those with special interest. COURTESY PHOTO


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Doctor Is In


Dr. Jaafar’s Rural Roots and Foundation of Trust Revive The Doctor-Patient Relationship BY SINJIN HILASKI


PHONES RING AND PIERCE THE STEADY CHATTER IN THE CLINIC. Laughter lets loose and smiles break across the faces of doctors, physicians’ assistants and nurse practitioners, amplifying an already jovial atmosphere. It’s amazing that in the bustle of a busy clinic, the constant motion of curing and caring is conducted with flawless professionalism and genuine joy. Though after meeting Dr. Saleh Jaafar, the clinic and staff’s demeanor is no longer so peculiar. Both the clinic and staff are an accurate reflection of Dr. Jaafar, his mission, and overall outlook on the role of medical professionals and the ever-evolving doctorpatient relationship.

A child of Baalbeck, Lebanon, roughly 53 miles north of Beirut, Saleh Jaafar was born in 1965. And while it is typically difficult to recall early childhood memories, he still remembers his mother’s desire for him to enter the medical field. “My mom told me to be a doctor since I was 3-years-old,” says Jaafar with a smile, “And I honestly never thought about anything else.” It was undoubtedly this encouragement from his mother, coupled with his life in Baalbeck, that molded Saleh into the Dr. Jaafar Texans know and love today. Rather than look toward metro areas, like Beirut or Houston, his professional fervor is rooted in practicing rural medicine, likely stemming from his formative years in Baalbeck. Dr. Jaafar’s devotion to rural medicine is founded in his extensive experience and studies across three continents in both rural and metropolitan areas. This expansive experience has shown and confirmed to Dr. Jaafar that the rural communities of Texas, and the world at large, are in need of steadfast physicians who can adapt and truly earn the trust of the communities they serve. But this knowledge didn’t simply thrust itself upon the impassioned physician. It was the by-product of his schooling and residencies. Growing up, Dr. Jaafar attended an international boarding school in Lebanon. Luckily, his attendance at the boarding school largely insulated him from the Lebanese Civil War that began in the mid-70s. In 1983, Jaafar decided to leave Lebanon and moved to France to attend the American University of Paris. But after a few months, he was disenchanted with Paris and moved back to Lebanon to attend the American University of Beirut, where he would major in chemistry as a pre-med student.

PG. 61


Following his graduation, Jaafar was faced with a few options — to study medicine at the American University in Beirut or to leave and attend another medical school. Ever the adventurer, Dr. Jaafar opted to leave and attended medical school in the British West Indies. He then spent a year training in Kingston-upon-Thames, outside of London, in the United Kingdom, and he finished his last year of schooling in the U.S. Dr. Jaafar did rotations at East Tennessee State, in Johnson City, USC in Los Angeles, an internship at Texas Tech in El Paso, and he did his residency in internal medicine at UTSA, ultimately finishing in 1996. Following his schooling and travels, Dr. Jaafar took a position as the medical director of the emergency room in Hondo, Texas. “I gained a ton of experience in that ER,” recalls Jaafar warmly. And while the trials of the ER could prove overwhelming for some, Dr. Jaafar decided to open a satellite clinic in Castroville. Just a few years later, he took over the clinic in Bandera too. Since then Jaafar and his associates have opened additional clinics in Boerne, Stone Oak, Utopia and by this summer they’ll have a new clinic in the Medical Center, for a grand total of six locations. Though his success was not as simple as the humble doctor makes it sound. When Dr. Jaafar worked in the ER, he would frequently work for 72 hours “on” with only 24 hours off. “I still opened the clinic in those 24 hours,” beams Dr. Jaafar, adding, “That’s how I met everybody in Medina County.” Although Dr. Jaafar graduated in the top of his class, he was still drawn to practice medicine in the rural areas. Medina County’s need for more physicians compelled him to help the people. Prior to arriving, the emergency room was typically manned by doctors who volunteered their free time. But when Dr. Jaafar took over, he brought two other graduates with him to work and service the residents of Medina County. “We really brought a ton of character to that ER,” says Dr. Jaafar on he and his co-workers’ efforts in the mid-90s. Indeed, in 1997 the San Antonio Medical Gazette wrote an article profiling Drs. Mercado and Jaafar and the “insane” schedule the two committed themselves to. “We got that ER up to a class that no one had seen before,” shares Dr. Jaafar proudly. As an internist, it gave Dr. Jaafar ample experience that he has since taken and employed in all other clinics he has worked in. Because of this real-life education, Dr. Jaafar makes it a point to see anyone and everyone. “I’ll see adults, newborns, kids. I’ve done skin cancer surgeries that no internist will do just because of where I am,” explains Dr. Jaafar. This is because of the limited medical resources and access rural residents have. So while in Stone Oak, Dr. Jaafar may practice solely as an internist, but when in Bandera or another rural area, he must act as the jack-of-all-

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trades. “I’m the psychiatrist, a surgeon, a plastic surgeon, I mean everything,” jokes Dr. Jaafar. The demand to be a multi-faceted physician has blessed Dr. Jaafar with a keen awareness and knowledge of a myriad of health issues that patients, both rural and urban, may face. Indeed, he recalls a patient named Juanita who had a persistent rash on her leg. She was referred to a dermatologist who conducted a biopsy and decided that it was nothing more than a minor rash. Despite the diagnosis, Juanita continued to have problems with the persistent leg rash. Juanita was referred to Dr. Jaafar who, employing his experience in rural health, took a look and told her that it was squamous cell carcinoma — a cancer caused by an uncontrolled growth of abnormal squamous cells. She explained to Dr. Jaafar how she had already had a biopsy and that the rash wasn’t cancerous. Trusting his clinical suspicion, Dr. Jaafar implored Juanita to allow him to do a biopsy of his own. The initial test came back negative, and naturally, Juanita was ecstatic and shared with Dr. Jaafar. Though, ever-persistent, Dr. Jaafar asked once more to conduct his own biopsy and remove the cells. Despite three tests, two analysis by dermatologists and a biopsy of his own, Dr. Jaafar ultimately proved to be right in his inaugural diagnosis. Employing rural know-how and his persistent spirit, Dr. Jaafar acted on his acquired knowledge and saved Juanita from suffering. “She’s now my patient for the rest of her life, because I refused to believe the dermatologists and biopsies, and I trusted my clinical suspicion,” shares Dr. Jaafar. The foundation of trust and rapport Dr. Jaafar has with his patients extends into his practice and relationships with fellow partners. When he started his practice it was solely him, today he works alongside 23 healthcare professionals, all of whom have an equal voice in the policies of MedCare Associates. Unlike other medical groups or monolithic medical systems, Dr. Jaafar encourages his group to function as a true democracy. All partners are encouraged to propose new rules and policies for the group that are then discussed and voted on, and, if supported by a majority, implemented. “The youngest doctor in my group can come up with as many rules as I do,” explains Dr. Jaafar on his group’s democratic decision-making. This camaraderie amongst MedCare Associates exemplifies the beauty of successful synchronicity. Indeed, when interviewing potential new partners Dr. Jaafar is candid with them and explains that, “When you join our group, your patients will be your patients. You’re not just another resident who graduated, you’re a valued member of our team.” Rather than get bogged down in the bureaucracy of contractual agreements and non-compete clauses, Dr. Jaafar

cities, there are more ample resources and specialists, but in rural areas like Bandera “you’re it, you’re the guy, you’re their doctor.” It is this foundation of doctor-patient trust that has made Dr. Jaafar a household name in his rural clinics, and because of these relationships, his patients remain his patients for life. “Whether they’re in the hospital, rehab, in hospice, we’re still involved with their health,” shares Dr. Jaafar earnestly. This sense of responsibility stems from the longevity of Dr. Jaafar’s relationships. He details that he feels obligated to remain involved because, “I’ve seen them for 20 years, and now they’re dying, so how could I tell them ‘Well Dr. Smith is going to take care of you.’” And while they may not say it, Dr. Jaafar explains that that kills their spirit because the patients have connected and known their physician for so long that there is a level of trust and acknowledgment that he will do whatever it takes to keep his patients healthy.

Front Row (Seated) 1. Bryan Sims, NP 2. Justin Hill, PA 3. Rosslyn Blake, NP 4. Tammy Howerton, PA (No longer with company)

5. Sarah Wright, NP 6. Steffany Mock, PA 7. Richard Walton, PA 8. Heather Cobb, PA Back Row (Standing) 1. Jahnavi Bheemreddy, MD

2. 3. 4. 5. 6. 7.

Auston Myers, MD Kristine Beauchamp, MD Saleh Jaafar, MD Rodrigo Crespo, MD Divya Muthappa, MD Aria Dayani, MD

still conducts business the old-fashion way — with a handshake and his word. It is undoubtedly this manner of business that has attracted skilled physicians to work with MedCare Associates. Looking toward the future, Dr. Jaafar envisions expanding his six practices to incorporate more specialties to better serve his communities. “I would really like to have bigger clinics with more specialties to better help and service more of the communities,” shares Dr. Jaafar with a warm smile. For all of his success, Dr. Jaafar remains a humble, humorous and relaxing presence for all around him. Though he credits his success to hard work, he also acknowledges that the support of Laura, his wife of 25 years, and the joy of his three children, Jordan, Brandon and Sophie, are huge motivating factors in continuing his work. When he’s not caring and curing the communities, Dr. Jaafar enjoys spending time with his loving family, and he is an avid outdoors man, with a passion for hunting, fishing and ranching. It’s the necessity of varied skill sets that draws Dr. Jaafar to practicing rural health. “I’m able to help more people, they put their trust in me, and you cannot replace that trust ever,” explains Dr. Jaafar. In



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Our team of

physicians and the medical

professionals at

Covering every orthopaedic sub-specialty, South Texas Bone and Joint offers comprehensive care for the Coastal Bend

Corpus Christi Medical Center are equally committed to providing the highest quality patient care.”

South Texas Bone and Joint is the leading name in orthopaedic care for patients in Corpus Christi and the entire Coastal Bend. Practicing orthopaedic care for over 40 years, formally as Orthopaedic Associates of Corpus Christi, the doctors and entire medical staff are synonymous with total care for multi-specialty, musculoskeletal services.

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Comprised of nine doctors, South Texas Bone and Joint boasts surgeons and physicians with expertise in every orthopaedic sub-specialty. Additionally, the medical team includes three physician assistants and an orthopaedic nurse practitioner. Dr. Bernard M. Seger, fellowship-trained in arthroscopic surgery, specializes in arthroscopy of the knee and shoulder. His major areas of interest include cartilage abnormalities, ligament reconstructions and realignment procedures. Dr. Charles W. Breckenridge is board-certified and fellowship-trained in sports medicine and specializes in arthroscopic shoulder and knee surgery. Board-certified orthopaedic surgeon Dr. John P. Masciale’s fellowship is in adult spinal surgery. Also board-certified, Dr. John M. Borkowski is fellowshiptrained in minimally invasive adult reconstructive spine surgery using innovative technology. Dr. Dawn Grosser is board-certified and is a sub-specialty trained orthopaedic surgeon who completed a fellowship in foot and ankle surgery. A sub-specialty trained orthopaedic surgeon, Dr. Ryan Thomas is also board-certified and completed a fellowship in hand and upper extremity surgery.

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Board-certified Dr. Justin Klimisch completed an accredited fellowship in adult reconstruction and joint replacement surgery. Dr. Frank Luckay is a board-certified orthopaedic surgeon specializing in general orthopaedics. The newest associate at South Texas Bone and Joint is Dr. Michael W. Montgomery, who is fellowship-trained in primary care sports medicine. He also specializes in concussion management, sports-related injuries, fracture care and non-surgical orthopaedic management of other musculoskeletal injuries, including arthritis, overuse, sprains and strains. Dr. Klimisch serves as the Medical Director of the Disease Specific Care Certification Program for Joint Replacement, knee and hip, at Corpus Christi Medical Center, where he also serves as Chief of Surgery. “There is no other practice in our area representing every sub-specialty in orthopaedics,” says Klimisch. “This allows our patients easy access to second opinions, as well as consultations with other specialists, in one convenient location. Waiting times for patients are reduced, while time spent between physician and patient are increased. We are creating an environment that is centered more on patient care than waiting to see a physician.” Klimisch adds, South Texas Bone and Joint is proud to partner with Corpus Christi Medical Center, the first hospital in the region to earn The Joint Commission’s Gold Seal of Approval for Disease-Specific Care Certification for Total Hip and Total Knee Replacement Surgery. The certification designates Doctors Regional an Orthopaedic Center of Excellence and reflects the hospital’s commitment to providing safe and effective patient care. “Our team of physicians and the medical professionals at Corpus Christi Medical Center are equally committed to providing the highest quality patient care. As a result of our combined efforts, patients benefit from better outcomes after procedures,” Klimisch says. Patients travel from as far away as the Rio Grande Valley to see the doctors at South Texas Bone and Joint. Klimisch notes, patients don’t need to travel to San Antonio or Houston for innovative treatments with orthopaedic

specialists. Now patients receive the quality care they need closer to home. The staff at South Texas Bone and Joint makes use of the latest advanced technology to treat and diagnose their patients, allowing a more streamlined diagnosis and surgery process. With digital imaging, technicians are able to immediately view detailed images of a particular bone or joint, prior to an operation. “These pictures are available to doctors much sooner than traditional x-ray imaging,” notes Klimisch. “This allows the doctor to begin immediately creating a road map to the operation process.” South Texas Bone and Joint also offers convenient, same-day MRI imaging, thanks to its partnership with the Corpus Christi MRI Center. Open since 2003, Corpus Christi MRI Center is affiliated with Blue Star Radiology, the official radiologists for the Dallas Cowboys. The fellowshiptrained, board-certified radiology team includes: Dr. Michael B. Jones, Dr. David T. Larsen, Dr. Michael E. Patyrak and Dr. Matthew Strange. The facility features the most advanced imaging technology available, which ensures uncompromising whole-body imaging, while helping patients feel at ease during the actual procedure. As medicine advances, the providers at South Texas Bone and Joint continuously embrace innovative technologies for joint replacement, advanced robotics, arthroscopic procedures, reconstructive spine surgery, foot and ankle surgery, and hand and upper extremity surgery, making patient outcomes more effective. Klimisch adds, the doctors at the practice work closely with rehabilitation centers to offer premium post-surgery care as well. “After a surgery, we focus on rehabilitation, addressing physical pain, as well as nausea and emotional stress from injury and surgery. By working with the patient from consultation to recovery, we


make sure the patient is not only satisfied with their overall outcome, but is also not experiencing anything unusual after surgery,” he says. A long-term goal for the practice is the eventual addition of physical therapists, specially trained to deal with orthopaedic patients recovering from hip, knee or joint replacements, spinal surgery, as well as sports-related and occupational injuries. “We’re currently examining the possibility of offering physical therapy services in this office. It would make things more convenient for our patients and allow our doctors to work more closely with the

specialists assisting patients through the rehabilitation process,” Klimisch adds. But for now, Klimisch says, they are focusing on the newest addition to South Texas Bone and Joint: a priority care clinic. Once again leading the local medical community with innovative patient-centered care, the clinic offers the area’s first walk-in, no appointment required, musculoskeletal specific services. Comprehensive services through the clinic include: concussion evaluation, care for fractures, sprains, back pain, strains and overuse injuries. Overseen by Dr. Michael Montgomery, the clinic is a perfect option for patients

with non-life threatening injuries, saving money and avoiding increased wait times of a typical emergency room visit. The clinic hours are currently Monday through Friday, 8 a.m. to 5 p.m. “We’re proud to have one of the most advanced orthopaedic clinics in Texas,” says Klimisch. “South Texas Bone and Joint offers the latest in digital imaging, doctors with specialized training and access to state-of-theart surgical medical centers. We’re honored to take orthopaedic care to the next level for South Texas, and poised to stay one step ahead of advancements in the care and treatment of musculoskeletal specific conditions and injuries.”

PG. 67

No Easy Explanation for the Heart? There’s An App For That BY KIM ESTES PHOTOGRAPHY

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had aybe you have m , n a ci si y h p As a : this experience xam s” sits in the e e y E y rr lu “B t Patien as been up all h e sh e k li g room lookin veral has. After se e sh t, c fa night. In , posts on well g in in m t e rn hours of Inte ve edical sites ha m d n a h lt a e h meaning last 14 hours e th r fo e k a kept her aw out formation ab in l a n o rs e p with im experiencing is e sh s m to various symp me ow, she has co N . rt a e h r e h related to s. d for bad new to you prepare

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Fortunately, as the cardiologist diagnosing her condition, you also have a technological resource that frames Dr. Web’s broad approach. Ms. Blurry Eyes relaxes. And beginning with three taps on a new iPad application called Cardio-Visual, you teach her more about what her symptoms mean in 10 minutes than she could possibly learn in hours of scavenging the web. The Cardio-Visual iPad app offers professionally produced videos and graphic presentations explaining most cardiac and cardiac-related conditions, diagnostic and treatment procedures, and demonstrations of devices available to correct them. Also, physicians can draw on screen displays for highlighting information regarding the patient’s personal condition. The Cardio-Visual app, currently for iPads only, is available for $30 from the iTunes app store. The cost is recovered quickly, as it is priced less than Medicare’s reimbursement for one patient office visit. Medicare usually pays about $49 of a $70 physician evaluation, according to a 2014 article by Modern Healthcare. Dr. Manish Chauhan, with Cardiovascular Specialists of Texas (CST) in Austin, envisioned the Cardio-Visual iPad app, found a team of developers and launched it this past February. “The bottom line is the patient is getting the right information from the right source: the trusted physician vs. Dr. Web,” Chauhan says. Once downloaded onto an iPad, the tutorial begins in three easy taps. With the first tap, the icon opens the app. The physician sees a sidebar of heart issue related categories: cardiac, electrical procedure (EP), structural and vascular. The second tap on the appropriate category displays several related conditions, and the third tap on the patient’s PG. 70

diagnosed condition initiates the lesson. A menu bar at the bottom of the screen breaks down information further into sub-categories: condition, procedure, device and “draw-on.” Using videos and graphics, “condition” features an overview of the issue. “Procedure” describes any necessary procedures or testing required for a more complete assessment. “Device” reviews the treatment instrument used and provides a demonstration of how it works. And, to finish, a “draw-on” option allows the physician to highlight the location of the patient’s problem on a graphic illustration and further elaborate specific treatment details. Several of Dr. Chauhan’s Austin colleagues praise Cardio-Visual as the modern technological source of improved communication for

patient education, satisfaction and inclusion. Jayne King, Director of Heart and Vascular Care at St. David’s North Austin Medical Center (NAMC), notes that brochures and heart models were their teaching tools before the availability of Cardio-Visual. She adds, “Sometimes, the physician would draw a picture on a piece of paper.” “The app is a much better tool,” King says. “Patients can hear and see it. The other tools were stagnant. We live in a world where people expect technology to be available.” King reports they use the app daily Cardio Texas physician Dr. Edward Chafizadeh says he also uses Cardio-Visual daily. “Patients love the app. I love it too. I appreciate the clarity of the descriptions and explanations, and the fact that it has great visual graphics for patients. I feel it allows me to give excellent information to patients and their families,” Chafizadeh says. Dr. Mark J. Pirwitz, Seton Heart Institute President and CEO, has a similar observation adding, “Although each video clip is relatively brief, it provides enough information to assist patients in formulating appropriate questions about their care.” Cardio-Visual offers a library of 60 videos, each less than two minutes long. Sixteen different companies supplied the productions, most of which have subtle commercial references. Nevertheless, Dr. Chauhan

“The bottom line is the patient is getting the right information from the right source”

believes the selected videos are the best presentation available on featured subjects. “We are open about where the information is coming from, and we are fortunate that most companies gave us the copyright. They see the value of physicians presenting information that helps the patient. They know that the patient is more likely to understand the information if the doctor guides them than if they go to the company’s website. The idea is not to be commercial, but to create an educational tool,” Dr. Chauhan says. While patient and physician communication has been a longtime concern among healthcare providers, Dr. Chauhan notes it is now also a metric for linking payer reimbursement to hospitals and, soon, to all physicians.

That is another reason the app is such good news for NAMC Heart and Vascular Care. King says, “In my opinion, it has taken patient education and satisfaction to another level. There is no mystery in what we are going to do when the patient is taken to a scary, cold, sterile procedure room. The patient’s fears are alleviated for the most part when they understand what and why they are having their procedure done.” King reports that patients say things like: “I was really scared. This does not seem so bad now that I have watched this.” “This answers all my questions.” “I feel informed on the procedure I am having.” For all the sophisticated medical tools at his disposal, Dr.

Chauhan says Cardio-Visual is the link he, himself, missed in patient education. He says, “I was asking patients to imagine things that many of them had never thought to imagine. Physicians want to educate their patients, but we have not had the right tools.” Dr. Robert Wozniak, a physician with Dr. Chauhan at CST, agrees. “How people learn now is so visual. I do not know of any better way to communicate like the app lets me communicate,” Wozniak says. “In the case of sleep apnea, once the patient sees the video, they understand what a lifethreatening issue it is.” Another communication barrier Cardio-Visual breaks through is language. “I have


patients that do not speak English. The app is particularly useful when I try to talk to them,” Dr. Wozniak says. “Patient’s families are appreciative too,” comments CST nurse practitioner, Neva Schmelzer. “They are often the recipient of information because the patient feels poorly and may not take in the information well.” “Health communication is really important to me,” Schmelzer says. “The app is a really good visual tool. There is a lot less confusion, and patients feel more secure and confident.” “Research shows that if you do not educate patients,” she says, “they are less likely to follow your advice. We know that you get better outcomes when the patient feels included.” And, because Cardio-Visual is available electronically, it can be accessed repeatedly at the convenience of both the patient and family for re-education and reminding. Dr. Chauhan’s colleagues are so pleased with the Cardio-Visual app that they are anticipating further developments. Dr. Chafizadeh says, “I think the average patient really has a thirst for knowledge about heart disease.” “I love the app,” he adds, “and look forward to continued add-ons for additional procedures, disease states and pharmacologic information on heart disease.” Dr. Pirwitz says, “Patients have been uniformly appreciative and responsive to the app. I believe the procedural videos are particularly helpful, and it would be beneficial to have additional diseasespecific videos with treatment options in the future.” Fortunately, Dr. Chauhan, who had dreams of being an engineer when he was young, has future ambitions for the Cardio-Visual app. He would like to make it a better communication platform, getting more timely information to doctors faster with more precise features on both procedures and medications. “We are looking at it no longer as just a tool, but I would like to add more content and get patient feedback,” Dr. Chauhan says. PG. 71




Benevolent Hospice helps patients and their families ease into life’s final stages When people hear the word “hospice,” most patients and their loved ones think of imminent death. But this is not the case, according to Xiomara Allen, co-founder of Benevolent Hospice. “If a patient is given six months to live, they are eligible for hospice services, which help them deal with the ending stages of life on an emotional, psychological, physical and spiritual level,” shares Xiomara.

Patients do not have to wait until their physicians diagnose them with “a few weeks to live.” This is a major misconception in healthcare, and founder James F. Thomas Jr. and co-founder Xiomara Allen are doing their best at re-educating the public throughout Texas. While hospice is synonymous with morbidity, Benevolent Hospice is trying to eliminate the word morbid from the entire process. With their compassion, strong beliefs, taking active roles in their communities via education and quality care, this team is on a mission. The idea and concept of Benevolent Hospice is to bring patient care to the forefront of hospice, while eliminating the bureaucratic systems that exist in corporate business practices. Benevolent’s co-founder explains, “We did not want to be a part of a system where profit is over patient care, instead of patient care

being over profit.” The Benevolent Hospice LLC mission is to provide an accessible, effective, and efficient hospice service that is beneficial and responsive to San Antonio and surrounding communities’ residents with terminal illnesses. “As a hospice provider service, we will provide a non-curative, peaceful, comfortable, dying experience for the individuals and his or her family,” says Xiomara. Benevolent Hospice opened in November of 2009 in San Antonio from the garage of their house that was converted into an office space. Benevolent’s founder and co-founder orchestrated the everyday matters of caring for patients and running an office out of their home location for approximately nine months before they relocated to a small office space located off of Grissom Road.



“We stayed in this location for numerous reasons,” recounts Xiomara. “Affordability was essential, and then three years later, we moved to our current location in Helotes, Texas.” The Benevolent of Houston branch opened in February of 2012, and their office is located in Stafford, Texas. Keeping affordability as a part of the business model was crucial in order to make Benevolent into the patient-centric model they have crafted and continue to follow to this day. The driving force behind the concept of Benevolent Hospice was the experience of James F. Thomas Jr. after losing both a close friend and a newborn son while on hospice care. Benevolent’s founder was in medical school when his friend was diagnosed with AIDS and went into hospice. “What I saw — parts of it I loved, and there were parts I could not stand...I volunteered for the San Antonio

AIDS Foundation and did whatever I could to be proactive and make some kind of impact. What I knew as a fact, the way hospice was treating patients had to be changed,” shares the Benevolent founder. While James was still in medical school, his son was born prematurely, and while he survived birth, he had an E.coli infection to the blood. Weeks later, he died, and it was a turning point for James. Instead of completing medical school, he went to the healthcare science administration program and wanted to make a difference in hospice care. He opened up five hospice centers for the company he was working for at the time. James felt he was making a positive impact, but as soon as the hospices were up and running, “they started doing exactly what I did not want. It was all about profit over patient.” He details, “I was getting more frustrated with the system because I really care about what I do, and I knew that I needed to be the one to make a difference.” The hospice care that James experienced for his friend and son was impersonal, and the workers were not very compassionate. As a current hospice executive, this was not an acceptable practice toward the patient and family that was present. By experiencing both sides, it was apparent that the original concept of hospice was lost, and this became the motivation for Benevolent Hospice. The Benevolent Hospice philosophy is to provide patients, and their families, relief from physical, spiritual and emotional pain at the end of life. “We believe in creating an environment permeated with compassion, unconditional acceptance and professional competence,” says Xiomara proudly. The cutting-edge of Benevolent Hospice is performing palliative care, and


truly performing palliative care. Benevolent’s co-founder adds, “A lot of hospice agencies within the community state and advertise they are palliative care, but they are not practicing palliative care.” Both of Benevolent Hospice’s companies are accredited through Joint Commission and are veteran- and family-owned. What does Joint Commission mean to those in the health field? It means an agency went through the most scrutiny in order to obtain their accreditation; Benevolent Hospice is accredited the same as a hospital. Benevolent Hospice uses a family-oriented approach that includes a team of doctors, nurses, social workers, counselors and trained volunteers. “Our team works together focusing on the patient’s needs — physical, psychological or spiritual. The goal is to help keep the patient as pain-free as possible with loved ones nearby.

Our team develops a care plan that meets each patient’s individual needs for pain management and symptom control,” says Xiomara, adding that the, “emphasis is on care of physical symptoms and other problems associated with terminal illness, rather than on cure of disease. Priority is given to the symptom control for the patients and the supportive care for both the patient and the family members.” There are four levels of care that patients are entitled to while on hospice services: • Routine Home Care • Respite Care • Continuous Home Care • General Inpatient Care “Our advice is to always research the hospice you are selecting. Not all hospices are the same. ‘Accreditation’ is very important. The difference between hospices are very easy to distinguish. If the hospice doesn’t have a gold seal ‘Joint

“I was getting more frustrated with the system...I knew that I needed to be the one to make a difference”


Commission’ accreditation, it is limited in the services available to your family,” explains Benevolent’s co-founder. Based on recent changes to the federal guidelines, the government is pushing hospices to become corporate. What does this mean? “Profit over patient care! It is not about ensuring your patients receive the highest quality of care possible. It is about reducing cost associated with providing services to your patients. It’s about ensuring they pass in six months. That is why it is extremely important you select a hospice which is accredited as a palliative care hospice. This will allow your family and loved ones the best opportunity to live a fulfilled life through these times,” states Benevolent’s co-founder. Benevolent Hospice’s founder and cofounder will continue to make their mission patient- and family-oriented as they continue to grow throughout the state. “Our patients’ journeys are our journeys too. We take great pride in ushering our patients and their loved ones on this path. Our greatest joy is augmenting our families,” shares Xiomara proudly. After speaking with both James and Xiomara, hearing their stories, and their genuine concern for all of their patients and their families, it is apparent that Benevolent Hospice truly cares about the entire journey from beginning to end. I noted on Xiomara’s email an apropos quote she uses and I want to share that with you. “I’ve learned people will forget what you said, people will forget what you did, but people will never forget how you made them feel,” said Maya Angelou. And under Xiomara and James’ guide, Benevolent Hospice is destined to make a lasting impact on their patients, families and the community at large.













It’s a quarter past 5 o’clock on a Friday afternoon. While the typical business day ended about 20 minutes ago, ophthalmologist Lisa Martén and her staff steadily work through the evening, retraining and re-hashing the protocols of normal procedures, and furthering their knowledge on the newest technological advancements in eye care.

N Naturally, success isn’t measured by blips of excellence, rather, it is achieved through consistent performance where brilliance is the norm and the only allowable trajectory is forward. For the better part of a decade, the South Texas Eye Institute, under the guide of Dr. Martén, has persistently proven their impassioned dedication to their patients and

toward improving themselves to offer only the best service at all times. Established in 1987, the South Texas Eye Institute was the initial eye care provider to offer Lasik — an acronym for laser-assisted in situ keratomileusis — procedures to Alamo City residents. Building on this foundation, Dr. Martén continues to usher in the wave of health-related technologies to better serve her patients. The first eyeglasses are believed to have been invented in 13th-century Italy, and the first contact lenses are purported to have been crafted from hand-blown glass toward the latter end of the 19th century. Needless to say, modern medicine has made exponential improvements in eye care in a relatively small amount of time. The rate of technological advancement is truly mind blowing. “Just since I started, we now have laser-assisted cataract surgery, and we have all this equipment that can detect eye disease way earlier than we could ever see before,” explains Dr. Martén. Citing


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these advances, Dr. Martén details that now ophthalmologists are able to detect glaucoma, corneal disease and a host of other afflictions much sooner than previously possible. This is partly because “cameras are reaching the very the edge of the retina now, where as before they couldn’t do that without distortion. They are also showing the different layers of tissue and have advanced software to evaluate the risk for disease.” The advances in ophthalmology can largely by seen in three areas explains Dr. Martén. The improvements in technology, medicine and surgery have propelled the way ophthalmologists, like Lisa Martén and her staff, are able to treat and assist patients. And, as one could surmise, the advances in one area necessitate and facilitate the progression of another. An example Dr. Martén gives is the lenses employed in cataract surgery. “We’re able to get it where people are able to see distances intermediate and up-close without having to wear glasses, where as before when you had cataract surgery in the ‘80s you barely were getting an implantable lens, and in the ‘70s they didn’t put lenses in your eyes,” details Dr. Martén. Indeed, it was in the late ‘70s into the ‘80s when implantable lenses made their large public debut, but it wasn’t until the ‘90s that corrective implantable lenses were advanced to have different properties to allow patients to see up-close. While this sort of procedure may sound expensive, it is important to consider that patients would likely end up purchasing glasses on a yearly basis, and when compared, this one-time surgery would serve all the purposes that glasses would cure and would only be needed once. This advancement is a marked improvement from treating a condition to, nearly, permanently resolving it.

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Though implantable corrective lenses are just one aspect of the advances made in ophthalmology. In the realm of medicine, glaucoma patients can belay their worries of the dreaded red-eye stigma. As most are aware, there used to be a stigma and suspicion surrounding glaucoma sufferers. The bloodshot eyes have proved a persistent, occasionally humorous, characterization of this affliction. Where glaucoma drops would previously cause redness of the eyes, leading to accusations of intoxication, today “there are a number of newer medications for patients to treat their glaucoma without having all of these side effects,” says Dr. Martén warmly. The arena of surgery has seen its fair share of advances as well. An ophthalmologist’s, much like any other profession’s, tools are of the utmost importance in order to achieve the desired end goal. And surgery, as the saying goes, is always a serious matter. Today’s microscopes themselves have advanced to incorporate an overlay of patients’ eyes in the ocular of the microscope. This means that while Dr. Martén is performing surgery, she is also viewing a digital overlay of a patient’s eye to better see where exactly to line up the lens. “Coupled with doing laser-assisted cataract surgery and a fancy lens, it’s amazing how patients are able to see afterward,” shares Dr. Martén with a smile. Alongside this, Dr. Martén tells that the FDA has recently approved an in-lay for the cornea that is intended to correct presbyopia, the natural deterioration of eye sight that necessitates reading glasses, and give patients reading vision. Every advance that Dr. Martén and the South Texas Eye Institute make is noted by her large patient base. Indeed, patients frequently remark on seeing new equipment in the office and will inquire about it, but Dr. Martén much more prefers to show them how the new technology can help them. There’s something about seeing your eyes captured on camera that is mesmerizing. Of course, any time one looks in the mirror they could catch a glimpse, but to truly see them enlarged and in detail is captivating and frequently aids in illustrating eye health discussions with patients. “They

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love to see their eyes on the screen...we have the cameras in the room where we can take pictures of the surface of the eye and the retinal cameras to show them the back part... basically, anything that’s wrong with their eye we can show it to them,” beams Dr. Martén proudly. Putting a picture to a real affliction carries much more impact for the patient and ultimately helps with compliance. With these cameras you’re able to mark and show improvement over time, and this “really brings it home for the patient, and they’re able to see what is actually going on with their eyes.” This kind of technology leads to patients being more excited about their exams, and being able to see and better understand what is happening with their health. With all of these advancements, one must wonder how has Lasik surgery improved over time. When visiting and conversing with Dr. Martén for the first time, it was impressive to note that she would occasionally have to excuse herself to perform a Lasik procedure. While some may think that it is a relatively long procedure, Lasik has always been a comparatively quick medical procedure. “Usually you’re in and out of the operating room in about 15-20 minutes, and the actual laser time is usually less than a minute,” says Dr. Martén with her signature warm grin. The actual advancements that have been made in Lasik are the speed of the laser itself, and the technology of the laser and how it treats the eye. Indeed, the laser that the South Texas Eye Institute uses now can make a cut in about 15 seconds, where as five years ago it may have taken a minute. “It takes much longer to actually set up than to actually do the procedure,” explains Dr. Martén jokingly. In truth, Dr. Martén shares that the hardest part is not necessarily the surgery but the pre- and post-op work required before administering Lasik for a patient. Keeping patient care at the forefront of her mind, Dr. Martén explains that the South Texas Eye Institute has an open-door policy for patients. So even five months after surgery, a patient can always call and they will always be seen. Dr. Martén is known to come in

outside of typical office hours on a Saturday or Sunday to see patients and examine their concerns. Sometimes it’s a simple consultation or addressing a common postop question, but if she’s even the slightest bit unsure Dr. Martén will ask to meet them. “I was always taught in residency, if you have a doubt see the patient,” states Dr. Martén reflecting on her Tulane education, the alma mater of both her dad and brother as well. Though technology, medicine and surgery have seen advancements, Dr. Martén feels that the biggest area where ophthalmology could advance is in awareness and prevention. By establishing a relationship with patients and expressing concern over health risks, Dr. Martén believes that many lifestyle-induced ailments could be thwarted early on. An example is the ever-present specter of diabetic retinopathy, or blindness by diabetes, in South Texas. The problematic diabetes rate among South Texas residents is no secret, and by earnestly discussing and addressing the risks associated with it,


a host of medical complications, eye related and not, could be avoided. Recently celebrating their seventh anniversary under Dr. Martén’s guide, the South Texas Eye Institute is geared for a future filled with success. Given the staff and Dr. Martén’s dedication to furthering themselves and offering only the best, it is no wonder that the San Antonio Rampage have consistently over the last seven years lauded the South Texas Eye Institute as their official eye care provider. Though the question is, what more can this successful, happily married, mother of two seek to do? And Dr. Marten’s answer is simple. “I just hope to continue to provide the best care to patients and eventually be able to offer more types of surgeries and specialties,” beams Dr. Martén. With the support of the staff, her loving husband, Jorge, and sons, Alejandro and Andres, Dr. Martén’s future is as clear as 20/20 vision. The South Texas Eye Institute will undoubtedly continue their near-three decades of success and satisfaction, and with Dr. Martén at the helm, the future of eye care in San Antonio will be propelled by equal parts technology, compassion and earnest dedication to patient health.


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