San Antonio Medicine January 2024 by Traveling Blender

S A N A N TO N I O

Ezequiel "Zeke" Silva III 2024 BCMS PRESIDENT

LIFESTYLE MEDICINE

SAN ANTONIO

TABLE OF CONTENTS

THE OFFICIAL PUBLICATION OF THE BEXAR COUNTY MEDICAL SOCIETY

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LIFESTYLE MEDICINE Harnessing the Power of Lifestyle Medicine

By Monica Salas, MD, DipABLM ......................................................12

Dietary Weight Loss Supplements: What does the evidence say? By Edwin Davila, DO, MS, CISSN ................................................14

What Does it Mean to be Healthy? And How do We Get There? By Jennifer Seger, MD..................................................................16

Diet and Nutrition in Patients with Gastrointestinal Cancers By Hycienth Ahaneku, MD, PhD...................................................18

Prioritizing Physical and Mental Wellness: Recommendations for Women Physicians By Amita Kumar, MD ...................................................................20

Public Health and Our Planet’s Health is Intertwined By Sandra Zargoza and Kristy Y. Kosub, MD ...............................21

Discovering the Power of the DASH Diet By Ayomide Akinsooto .................................................................22

UTHSCSA Lifting: Fostering Fitness, Community and Philanthropy By Victoria (Tori) Vargas and Andrew Ta ................................................................................................................24 BCMS President’s Message .................................................................................................................................................8 BCMS Alliance Message ....................................................................................................................................................10 The Dream Continues By Carlos R. Orozco, MD .....................................................................................................26 Win with Wellness: Physicians Helping Physicians, Interview with Dr. Nora Vasquez, Interview conducted by Monica Jones, BCMS COO, and Trisha Doucette, Editor .................................................28 Out of the Darkness Suicide Walk ......................................................................................................................................30 Dr. Aureliano Urrutia, Surgeon from the Valley of Mexico By Anne Elise Urrutia .................................................................32 Book Review: Diet, Mitochondria and a Leaky Gut: Navigating Nutrition and Wellness By David Alex Schulz.....................34 BCMS 2024 Board of Directors..........................................................................................................................................36 BCMSA 2024 Board of Directors ......................................................................................................................................38 BCMS Management Staff...................................................................................................................................................39 BCMS Vendor Directory .....................................................................................................................................................40 Auto Review: 2024 Cars and Trucks to Watch By Stephen Schutz, MD ............................................................................44 Recommended Auto Dealers .............................................................................................................................................46 PUbLISHED by: traveling Blender, llC. 10036 Saxet Boerne, tX 78006

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SAN ANTONIO MEDICINE • January 2024

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JANUARY 2024

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VOLUME 77 NO.1

San Antonio Medicine is the official publication of Bexar County Medical Society (BCMS). All expressions of opinions and statements of supposed facts are published on the authority of the writer, and cannot be regarded as expressing the views of BCMS. Advertisements do not imply sponsorship of or endorsement by BCMS. EditoriAl CorrESpondEnCE: Bexar County Medical Society 4334 n loop 1604 W, Ste. 200 San Antonio, tX 78249 Email: editor@bcms.org MAGAZinE AddrESS CHAnGES: Call (210) 301-4391 or Email: membership@bcms.org SuBSCription rAtES: $30 per year or $4 per individual issue AdvErtiSinG CorrESpondEnCE: louis doucette, president traveling Blender, llC. A publication Management Firm 10036 Saxet, Boerne, tX 78006 www.travelingblender.com

For advertising rates and information Call (210) 410-0014 Email: louis@travelingblender.com SAN ANTONIO MEDICINE is published by SmithPrint, Inc. (Publisher) on behalf of the Bexar County Medical Society (BCMS). Reproduction in any manner in whole or part is prohibited without the express written consent of Bexar County Medical Society. Material contained herein does not necessarily reflect the opinion of BCMS, its members, or its staff. SAN ANTONIO MEDICINE the Publisher and BCMS reserves the right to edit all material for clarity and space and assumes no responsibility for accuracy, errors or omissions. San Antonio Medicine does not knowingly accept false or misleading advertisements or editorial nor does the Publisher or BCMS assume responsibility should such advertising or editorial appear. Articles and photos are welcome and may be submitted to our office to be used subject to the discretion and review of the Publisher and BCMS. All real estate advertising is subject to the Federal Fair Housing Act of 1968, which makes it illegal to advertise “any preference limitation or discrimination based on race, color, religion, sex, handicap, familial status or national orgin, or an intention to make such preference limitation or discrimination.

SmithPrint, Inc. is a family-owned and operated San Antonio-based printing and publishing company that has been in business since 1995. We are specialists in turn-key operations and offer our clients a wide variety of capabilities to ensure their projects are printed and delivered on schedule while consistently exceeding their quality expectations. We bring this work ethic and commitment to customers along with our personal service and attention to our clients’ printing and marketing needs to San Antonio Medicine magazine with each issue.

BCMS BOARD OF DIRECTORS ELECTED OFFICERS

Ezequiel “Zeke” Silva, iii, Md, President lyssa ochoa, Md, Vice President John Shepherd, Md, President-elect Jennifer r. rushton, Md, Treasurer lubna naeem, Md, Secretary John Joseph nava, Md, Immediate Past President

DIRECTORS

Woodson “Scott” Jones, Md, Member Sumeru “Sam” G. Mehta, Md, Member M. “Hamed” reza Mizani, Md, Member priti Mody-Bailey, Md, Member dan powell, Md, Member Ana rodriguez, Md, Member raul Santoscoy, do, Member lauren tarbox, Md, Member nancy vacca, Md, Member Col. Elisa d. o’Hern, Md, MC, FS, Military Representative Jayesh Shah, Md, tMA Board of Trustees Representative John pham, do, UIW Medical School Representative robert leverence, Md, UT Health Medical School Representative ramon S. Cancino, Md, Medical School Representative lori Kels, Md, Medical School Representative ronald rodriguez, Md, Medical School Representative victoria Kohler-Webb, BCMS Alliance Representative Carolina Arias, Md, Board of Ethics Representative Melody newsom, BCMS CEO/Executive Director George F. “rick” Evans, Jr., General Counsel

bCMS SENIOR STAFF

Melody newsom, CEO/Executive Director Monica Jones, Chief Operating Officer Yvonne nino, Controller Al ortiz, Chief Information Officer Brissa vela, Director of Membership and Special Events phil Hornbeak, Auto Program Director August trevino, Development Director Mary E. nava, Chief Governmental Affairs Officer Betty Fernandez, BCVI Director

PUbLICATIONS COMMITTEE

lokesh Bathla, Md, Member Elizabeth Clanton, Md, Member Erika Gabriela Gonzalez-reyes, Md, Member timothy C. Hlavinka, Md, Member John robert Holcomb, Md, Member Soma S. S. K. Jyothula, Md, Member Kristy Yvonne Kosub, Md, Member Jaime pankowsky, Md, Member George-thomas Martin pugh, Md, Member rajam S. ramamurthy, Md, Member Adam v. ratner, Md, Member Monica Jacqueline Salas, Md, Member Jennifer C. Seger, Md, Member John Joseph Seidenfeld, Md, Member Boulos toursarkissian, Md, Member Francis vu tran, Md, Member Faraz Yousefian, do, Member louis doucette, Consultant Brissa vela, Consultant Monica Jones, Staff Liaison trisha doucette, Editor Moses Alfaro, Student victoria Ayodele, Student tue Felix nguyen, Student niva Shrestha, Student Andrew ta, Student Alixandria Fiore pfeiffer, do, Resident Elizabeth Allen, Volunteer Adelita G. Cantu, phd, Volunteer rita Espinoza, drpH, Volunteer natalie reyna nyren, pA-C, Volunteer david Schulz, Volunteer 6

SAN ANTONIO MEDICINE • January 2024

PRESIDENT’S MESSAGE

We Can Accomplish So Much Together By Ezequiel "Zeke" Silva III, President, Bexar County Medical Society (BCMS)

As I step into the role of BCMS President, I am filled with a sense of honor and responsibility. Representing and advocating for our physicians and medical students in San Antonio and its surrounding counties is not just a duty; it's a privilege that I embrace wholeheartedly. My Background – A Commitment to Medical Advocacy I joined the South Texas Radiology Group (STRG) in 2002, a transition that followed my training at Massachusetts General Hospital. Being part of STRG, a practice that values and invests in advocacy, has been a fortunate step in my career. Alongside this, my role as an Adjunct Professor of Radiology at UT Health - Long School of Medicine and Vice-Chief of Staff at Methodist Texsan Hospital have provided an important vantage point to witness and contribute to the power of advocacy in medicine. My involvement extends beyond local boundaries. As a member of the TMA Council on Legislation and Chair of the AMA RVS Update Committee (RUC), I've gained insights into the challenges and opportunities at the state and national levels. This diverse experience positions me to lead BCMS with a broad perspective, understanding the nuances of local needs while keeping an eye on the broader horizon. This Year's Goals – Amplifying Our Collective Voice 1. Maximizing BCMS' Relevance: Our focus is to ensure that BCMS remains crucial and beneficial to our members. We want to be your go-to resource, offering support and guidance that is both practical and impactful. 2. Strengthening Community Ties: We aim to fortify our connections within the community, forging partnerships that extend our reach and influence. These relationships are vital for our collective success and the advancement of healthcare in our region. 3. Expanding Our Influence: Our voice needs to resonate not just locally, but also at the state and national levels. We'll strive to ensure that the concerns and achievements of San Antonio's medical community are heard and acknowledged far and wide. Your Role – The Essence of Our Success I cannot emphasize enough the importance of your involvement. As physicians, your time is a precious commodity, and your willingness to volunteer is the cornerstone of our success. BCMS is committed to maximizing your contributions through efficient meetings, consistent support and timely communication. 8

SAN ANTONIO MEDICINE • January 2024

BCMS – A Legacy of Service and Advocacy With a 170-year history, BCMS has been a steadfast advocate for our medical community. Our diversity is our strength, encompassing physicians across various specialties, career stages and practice models. This collective power enables us to form meaningful partnerships with civic leaders, healthcare systems and patient groups, among others. Our Local Focus – A Foundation for National Relevance Our primary responsibility lies in representing and advocating for our local physicians and medical students. However, our local achievements and challenges have the power to influence and shape state and national policies. For instance, our experiences with prior authorization have already made an impact at the state level, contributing to the passage of the Texas Gold Card Act. Looking Ahead – Your Vision, Our Mission As your new President, I am eager to understand your vision and challenges. Your insights are invaluable in shaping our path forward. Let us work together to make BCMS an even more powerful voice for our physicians and our community. In Closing – A Call to Association I firmly believe in the power of associations, echoing the words of President Theodore Roosevelt in 1908: “Every man owes part of his time to the business or industry to which he is engaged. No man has a moral right to withhold his support from an organization that is striving to improve conditions within his sphere.” Today, this statement is inclusive of every man and woman, reminding us of the importance of organizations like BCMS to our profession. Let's embark on this journey together, reinforcing our commitment to our local community while making our mark on the larger medical landscape. Your engagement, insights and contributions are what will drive us forward. Together, we can achieve remarkable things. Ezequiel "Zeke" Silva III, MD, is the 2024 President, Bexar County Medical Society. Dr. Silva is a radiologist with the South Texas Radiology Group and Vice-Chief of Staff at Methodist Hospital Texsan. He serves on the TMA Council on Legislation and is a TMA Delegate to the AMA. He Chairs the AMA RVS Update Committee (RUC).

Visit us at www.bcms.org

BCMS ALLIANCE

Message from the BCMS Alliance President By Victoria Kohler-Webb, BBA, MS

Since 1917, the Bexar County Medical Society Alliance (BCMSA) has supported physicians and their families throughout their journey down their medical life road. Unlike other groups, we all already have something wonderful in common — YOU! In an ever-overwhelming and increasingly busy world, that’s a great place to start for building fellowship and family friendships as well as expanding your social network. We strike a balance between purposeful, mission-driven community service and legislative advocacy, and fun membership-bonding events. BCMSA routinely serves community partners like Sleep in Heavenly Peace, Ronald McDonald House and the Children’s Bereavement Center. Together, we spearhead Alliance core initiatives like Texas Medical Association Foundation (TMAF) Hard Hats for Little Heads, bringing bike helmets and safety resources to local schools like Young Women’s Leadership Academy, and the TMAF BookShare, providing uplifting, healthy lifestyle books to the Children’s Hospital of San Antonio Child Life Department. BCMSA proudly adds their voice to First Tuesdays at the state capital to underscore BCMS efforts, advocate for the medical community, and achieve real results for Texas physicians and their patients. Whether you need family-friendly fun, such as the BIGZ Family Party & General Meeting, or some adult time at our frequent member mixer happy hours, BCMSA is there for you. BCMSA is blessed with a tradition of outstanding leadership and, believe me, there are some really big shoes to fill! Our wonderful board and I are excited to get to work and add to their legacy. Here’s to a happy, healthy and successful 2024 — we see it as another year full of opportunities for the Bexar County Medical Society Alliance to demonstrate that truly WE ARE THE FAMILY OF MEDICINE.

JOIN US!

Victoria Kohler-Webb, BBA, MS Marketing/Statistics is the 2024 Alliance President. She and Ben, an ENT/Head & Neck Surgeon, are proud Aggies and parents to Luke, 14, and four rescue dogs.

Victoria Kohler-Webb, President; Brittany Garcia, President-Elect; Jenny Case and Cheryl Pierce-Szender, 2023 Co-Presidents

SAN ANTONIO MEDICINE • January 2024

Victoria Kohler-Webb, President, and Brittany Garcia, President-Elect

Alliance Presidents enjoying the Fall Luncheon include Taylor Frantz, Danielle Henkes, Cheryl Pierce-Szender, Jenny Shepherd, Jenny Case, Nichole Eckmann, Victoria Kohler-Webb

LIFESTYLE MEDICINE

Harnessing the Power of Lifestyle Medicine By Monica Salas, MD, DipABLM

very January 1st, millions of people make health-related resolutions for the new year. While the intent is great, the problem is that we often think of “getting healthier” as a colossal, nebulous concept that seems insurmountable. We focus on diets, challenges and radical changes that burn us out quickly. What if we could shift the narrative to center on simply living healthily through making small, consistent, measured changes over time? That narrative can be found in the story of Lifestyle Medicine. Lifestyle Medicine is a medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions including, but not limited to, cardiovascular diseases, Type 2 diabetes and obesity. Lifestyle Medicine clinicians are trained to apply evidencebased, holistic, prescriptive lifestyle changes to prevent, treat and often reverse chronic conditions.1 This is accomplished through the purposeful application of the six pillars of Lifestyle Medicine. The Six Pillars Solution: Take Control of Your Health in the New Year Nutrition Worsening health metrics, despite significant technological and medical advances over the last century, point toward the possibility of the Standard American Diet (SAD) as a major cause of both decreased lifespan and healthspan in the U.S. A recent systematic review concluded that plant-based diets are associated with lower blood pressure and overall better cardiovascular and health outcomes, when compared to animal-based diets.2 Furthermore, the American College of Lifestyle Medicine (ACLM) published a consensus statement in 2022 that supports a whole-food, plant-based diet as a primary intervention in achieving remission in many adults with Type 2 Diabetes Mellitus.3 This expert consensus statement was endorsed by the American Association of Clinical Endocrinology and supported by the Academy of Nutrition and Dietetics. A general application of the nutrition pillar emphasizes increasing the consumption of whole, plant-based foods and minimizing the consumption of processed and animal-based foods. An easy approach when grocery shopping is to stick to the periphery of the store where more whole, natural foods are available, and avoid the center, refrigerated aisles. Another helpful rule of thumb is to try to keep your purchases to foods that have five ingredients or less. Making healthy changes can 12

SAN ANTONIO MEDICINE • January 2024

be the product of measured, incremental, sustainable changes over time, but it may feel overwhelming to even know where to start. I typically recommend that patients begin with setting a SMART (Specific, Measurable, Achievable, Realistic, Time-Bound) goal to help them stay focused and motivated. An example of a positive nutrition goal may look like, “I will add one cup of fruit to breakfast and a small orange as an afternoon snack at least five days this week.” Physical Activity Even those that exercise regularly move much less than we did in centuries past due to modern conveniences. According to the World Health Organization (WHO), more than 80 percent of adolescents and 27 percent of adults do not meet WHO’s recommended levels of physical activity.4 The U.S. Department of Health and Human Services’ Physical Activity Guidelines for Americans recommends 150 minutes of moderate intensity aerobic activity and two days of muscle strengthening activity per week for adults, on average.5 When approaching the physical activity pillar, it is important to remember that any amount of exercise is better than none. Working with a certified exercise professional is the safest and most reliable way to begin an exercise program. That said, while formal exercise is important, regular purposeful movement throughout the day has the greatest effect on an individual’s longevity. Restorative Sleep Insufficient or poor sleep can have a number of negative effects including mood dysregulation, sluggishness, poor concentration, decreased immunity, weight gain, insulin resistance and overall decreased performance and quality of life, linking it to a number of health concerns, both physical and mental. Sleep is often an untapped area of potential in a person’s well-being. Although some individuals truly do need medications to help with sleep, the vast majority can optimize their sleep by following a few simple guidelines from ACLM.7 This includes setting up your sleep environment for success by using the bed for sleep and sexual activity only, establishing a regular sleep schedule, minimizing bedroom noise and lights, and keeping pets out of the room. Actions taken during the day can have a huge impact as well, such as increasing daytime exposure to sunlight, staying physically active throughout the day, eliminating caffeine after noon, and avoiding late-night snacking and alcohol within

LIFESTYLE MEDICINE

three hours of bedtime. If sleep issues persist, utilizing meditation techniques or cognitive behavioral therapy for insomnia, in conjunction with consulting with your physician, may be helpful. Stress Management Stress is unavoidable, and at times, can be helpful. It can motivate us, promote exploration and growth, and in dangerous situations, save our lives. However, if it becomes excessive, chronic or overwhelming, it can be toxic. The key is to empower ourselves to know how to manage it in a healthy manner. Unfortunately, stress is often overtreated pharmaceutically without adequately exploring lifestyle changes as part of a therapeutic treatment plan. We can frequently find relief by changing our mindset about stress and considering, “Is there another way I can look at this situation?” Also, it is not helpful to focus on what we cannot change, but rather to focus on what is going well in life. Other helpful tips from ACLM7 to consider are trying different healthy ways to relax (exercise, meditation, yoga, dance, music, breathwork, massage), taking time for hobbies, keeping a gratitude journal, connecting with others, addressing our spiritual needs and making time to laugh. Social Connectedness Research has shown that the single greatest predictor of human happiness and vibrant longevity is having strong social connections. Due to factors from COVID-19, such as social distancing, overconsumption of social media and propagation of polarizing viewpoints, poor mental health became its own pandemic of sorts. In fact, due to the grave consequences of loneliness that we were exposed to during this time, the U.S. Surgeon General, Dr. Vivek Murthy, issued an advisory on loneliness last year, which offers solutions on connecting with others and community building.6 Achieving social connectedness can be challenging in a post-pandemic Zoom-world, but approaching it from a lens of helping others and improving your community, or looking for social activities that improve other areas of health can be helpful. ACLM tips for creating and improving social connections in your life include volunteering, joining a group with those who share similar interests (community, fitness or spiritual, for example), attending community events and celebrations, sharing new experiences, making time to spend with your loved ones, and being flexible and supportive about what others are doing in their lives.7 Avoidance of Risky Substances Consumption of toxic substances is at times an insidious endeavor whose risk is not always well understood. For some, it may look like drinking a couple of glasses of wine nightly to fall asleep or relax, while for others it may look like the occasional use of unprescribed sub-

stances to treat pain. Whatever the issue may be, it is important to understand that if toxic substances are used regularly and/or improperly, even when an addiction is not present, they can have a huge impact on a person’s health. When it comes to avoiding risky substances, this pillar can be tricky because, oftentimes, addiction is implicated. For those who truly have a substance abuse disorder, professional help with a team of addiction specialists that utilizes a combination of counseling, medication and support groups is important. That said, anyone who uses risky substances, even to a smaller degree, can benefit from measures such as setting SMART goals, having an accountability partner and attending counseling to address any underlying mental health issues. Remember — slips and relapses are normal and considered part of the process. Optimizing your health in the new year doesn’t have to be as overwhelming as it seems. Through goal-setting, persistence and asking for support from others (yes, it is okay to ask for help!), small, measured changes over time can have an enormous cumulative effect on both a person’s lifespan and healthspan. When setting your goals, think about your “why” to help you stay the course. Working side-by-side with a board-certified LM physician can help you to achieve a healthier you in 2024 through harnessing the power of Lifestyle Medicine. References 1. https://lifestylemedicine.org 2. Tomé-Carneiro J, Visioli F. Plant-Based Diets Reduce Blood Pressure: A Systematic Review of Recent Evidence. Curr Hypertens Rep. 2023 Jul;25(7):127-150. doi: 10.1007/s11906-023-01243-7. Epub 2023 May 13. PMID: 37178356; PMCID: PMC10224875 3. Rosenfeld RM, Kelly JH, Agarwal M, et al. Dietary Interventions to Treat Type 2 Diabetes in Adults with a Goal of Remission: An Expert Consensus Statement from the American College of Lifestyle Medicine. American Journal of Lifestyle Medicine. 2022;16(3):342-362. doi:10.1177/15598276221087624 4. https://www.who.int/teams/health-promotion/physicalactivity/global-status-report-on-physical-activity-2022 5. https://health.gov/our-work/nutrition-physical-activity/physicalactivity-guidelines/current-guidelines 6. https://www.hhs.gov/sites/default/files/surgeon-general-socialconnection-advisory.pdf 7. https://lifestylemedicine.org/wp-content/uploads/2023/06/Pillar-Booklet.pdf Monica J. Salas, MD, is a board-certified Family Medicine and Lifestyle Medicine Physician with over a decade of experience. She is co-owner and COO of Salveo Direct Care, a Direct Primary Care and Lifestyle Medicine practice in San Antonio and a member of the Bexar County Medical Society. Visit us at www.bcms.org

LIFESTYLE MEDICINE

Dietary Weight Loss Supplements: What does the evidence say? By Edwin Davila, DO, MS, CISSN

CDC

population data from 2022 showed 22 states have an adult obesity prevalence at or above 35 percent, compared to 19 states in 2021. This starkly contrasts with 10 years prior, when no state had an adult obesity prevalence at or above 35 percent. Furthermore, obesity in the United States is estimated to affect 100.1 million (41.9 percent) adults and 14.7 million (19.7 percent) children, accounting for approximately $147 billion in annual healthcare costs.1 Significant strides have been made in developing pharmacologic agents assisting in weight management. Data from the STEP and SURMOUNT trials have shown that Incretin agonists generate substantial weight reduction. Unfortunately, barriers such as significant costs, difficulty with prior authorization and medication shortages limit their use. As a result, many patients turn to dietary supplements advertised as weightloss-promoting agents in the hope of helping them reach their goals. It is estimated that approximately 15 percent of U.S. adults have used a "weight-loss" supplement at some point in their lives, leading to an annual spending of over $2.1 billion. The products' forms vary considerably from pills, liquids, powders, gummies, bars, etc. A quick Google search of weight loss supplements displays a plethora of strategic marketing campaigns with robust verbiage with examples like "increased thermogenesis," "advanced fat-burning potential" and "body recomposition agent," just to name a few. While the FDA regulates dietary supplements, the focus is on the ingredients they are composed of, confirming the component's safety and whether it is in line with the Dietary Supplement Health and Education Act (DSHEA).2 The FDA does not require a premarket review of the finished product, and leaves considerable leeway for manufacturers in combining and dosing ingredients. Many products utilize a "Proprietary Blend" format on their nutrition label, which further complicates transparency. This method combines several ingredients and provides the total combined dose as one number without indicating how much of a particular ingredient is being used. The question remains: what are these products' efficacy, and what trials can be referenced to back their claims? This question was addressed by the U.S. Government Accountability Office, which concluded that "little is known about whether weight loss supplements are effective, but some supplements have been associated with the potential for physical harm."3 A review of the top-selling weight loss supplements through several online retailers shows a standard collection of ingredients in 14

SAN ANTONIO MEDICINE • January 2024

variable disclosed, or sometimes undisclosed, dosages. The following are several of these ingredients and what the data tells us. Berberine Berberine is a bioactive alkaloid isolated from a variety of plants. Research models of varying designs have identified several possible effects, ranging from impacting the gut microbiota, improving insulin resistance, and decreasing adipocyte proliferation. Its popularity has increased substantially due to its being dubbed "nature's Ozempic®" by social media influencers. While the initial data is promising, trials indicating benefits have few participants and are short in duration. Currently, no evidence supports claims of reductions in weight to a degree anywhere near those of injectable GLP-1 and associated Incretins.6 Garcinia Cambogia The claimed ergogenic effect of this agent is due to the hydroxycitric acid (HCA) extracted from the fruit in which it is produced. HCA has been reported to inhibit ATP citrate lyase, an extramitochondrial enzyme that provides the two carbon units required in the initial steps of fatty acid and cholesterol biosynthesis. This inhibition would, in theory, decrease de novo lipogenesis and reduce body fat. In vitro rat studies showed suppression of food intake and reduction in weight. However, a review of numerous randomized placebo-controlled trials showed no significant weight loss compared to placebo, with several case reports identifying hepatotoxicity and the need for liver transplantation.4,5 Raspberry Ketones The associated fat-burning potential of raspberry ketones is based on a speculated sympathomimetic effect on adipocytes, which may increase fatty acid oxidation and suppress lipid accumulation similar to epinephrine. This has been based on rat models showing reduced adiposity when utilized. However, issues associating these findings with human application are observed when comparing the dose-to-weight ratio used in rats and the recommended dose advertised in supplements. While many brands recommend a daily dose of 100 – 200mg, animal models would indicate that human consumption would need at least five times that amount to possibly create a benefit.7 Beyond just the lack of peer-reviewed evidence to substantiate claims, concerns of safety need to be addressed. Some ingredients in weight-

LIFESTYLE MEDICINE loss supplements can interact with certain medications, such as anticoagulants, SSRIs and even chemotherapy drugs. Such interactions could have severe consequences, and individuals are encouraged to mention all supplements they are taking to their physicians as part of their medication history. The verification of product content also contributes to potential risk. Several lawsuits against popular brands have been launched due to evidence indicating their products contained controlled substances and untested pharmaceuticals that were not mentioned on the nutrition label. If someone is considering taking supplements, it helps to select a brand that participates in third-party certification of dietary supplement quality, such as NSF® (National Sanitation Foundation) and USP (U.S. Pharmacopeia). The meteoric rise of GLP-1 and associated Incretin agonists use for weight management driven by evidence-based data has unfortunately resulted in a concomitant rise in medication shortages. As a result, numerous clinics and online retailers have been selling compounded peptides manufactured by compounding pharmacies. Traditionally, the utilization of compounded medications is to develop a medication based on the needs of the individual patient whereas a factor of the original medication limits the ability for the patient to take it (for example, a pill needing to be a liquid suspension). Sections 503A and 503B of the Food, Drug, and Cosmetic Act sets conditions in which compounding pharmacies can manufacture medications that are placed on the FDA drug shortages list, of which Ozempic and Wegovy® were placed as of May 2023.8 Safety concerns arise due to compounding drugs NOT being FDA-approved as they DO NOT undergo FDA premarket reviews for safety, effectiveness or quality.10 This fact has caused confusion at the patient level, believing the compound medications they may be receiving are the same peptides that the STEP and SURMOUNT trials utilized. Adding to this, numerous online retailers use terms such as “Generic Ozempic” and “Generic Mounjaro®” to further try to establish a connection to these branded legitimate peptides. The FDA has stated that many of these compounds may be augmented with salts (for example, Semaglutide sodium, Semaglutide acetate), which have not been shown to be safe or effective, and advise patients to only obtain these peptides from state-licensed pharmacies or outsourcing facilities registered with the FDA.8 Several national organizations have provided position stances to try and bring clarity to this situation. The Obesity Medicine Association’s official position stance stated: “The OMA recommends that anti-obesity medications, and their formulations, undergo clinical trial testing for efficacy and safety via processes overseen by the FDA. The FDA does not approve compounded drugs and without their review, the FDA cannot assure that compounded drugs have the same safety, efficacy, and purity of FDA-approved medications that have gone through clinical trial testing.”9 Weight loss is a challenging goal for many, and the idea of a product that can accelerate that success is very enticing. It is crucial to open dialogue with our patients and ask them if they use products other than those prescribed to achieve their goals. This is not to demonize or

shame but to provide realistic expectations past those advertised by companies leaning on weak data to promote their claims. We can remind them that many factors impact weight loss, and lifelong success is achieved through Lifestyle Medicine, dietary management, exercise prescription and pharmacologic/surgical intervention if needed. Great resources to help gain further information on these topics include the Exercise Is Medicine initiative, which is a collaboration between the American Medical Association and American College of Sports Medicine, and the Obesity Medical Association, just to name a few. References: 1. HOP. (2023, February 23). Centers for Disease Control and Prevention. https://www.cdc.gov/nccdphp/dnpao/state-local-programs/fundingopp/2023/ hop.html#:~:text=Poor%20diet%20and%20low%20levels,in%20annual%20health %20care%20costs 2. Nutrition, C. F. F. S. a. A. (2023, March 6). Dietary supplements. U.S. Food and Drug Administration. https://www.fda.gov/food/dietary-supplements 3. Dietary Supplements for Weight Loss: Limited Federal Oversight Has Focused More on Marketing than on Safety. (n.d.). U.S. GAO. https://www.gao.gov/products/gao02-985t 4. Crescioli G, Lombardi N, Bettiol A, Marconi E, Risaliti F, Bertoni M, Menniti Ippolito F, Maggini V, Gallo E, Firenzuoli F, Vannacci A. Acute liver injury following Garcinia cambogia weight-loss supplementation: case series and literature review. Intern Emerg Med. 2018 Sep;13(6):857-872. doi: 10.1007/s11739-018-1880-4. Epub 2018 May 25. PMID: 29802521 5. Stacy L. Haber, Omar Awwad, April Phillips, Andrew E. Park, Tam Minh Pham, Garcinia cambogia for weight loss, American Journal of Health-System Pharmacy, Volume 75, Issue 2, 15 January 2018, Pages 17–22, https://doiorg.uiwtx.idm.oclc.org/10.2146/ajhp160915 6. Ilyas Z, Perna S, Al-Thawadi S, Alalwan TA, Riva A, Petrangolini G, Gasparri C, Infantino V, Peroni G, Rondanelli M. The effect of Berberine on weight loss in order to prevent obesity: A systematic review. Biomed Pharmacother. 2020 Jul;127:110137. doi: 10.1016/j.biopha.2020.110137. Epub 2020 Apr 27. PMID: 32353823 7. Cotten BM, Diamond SA, Banh T, Hsiao YH, Cole RM, Li J, Simons CT, Bruno RS, Belury MA, Vodovotz Y. Raspberry ketone fails to reduce adiposity beyond decreasing food intake in C57BL/6 mice fed a high-fat diet. Food Funct. 2017 Apr 19;8(4):1512-1518. doi: 10.1039/c6fo01831a. PMID: 28378858 8. Research, C. F. D. E. A. (2023, October 31). Medications containing semaglutide marketed for type 2 diabetes or weight loss. U.S. Food and Drug Administration. https://www.fda.gov/drugs/postmarket-drug-safety-informationpatients-and-providers/medications-containing-semaglutide-marketed-type-2-diabetes-or-weight-loss 9. Fitch A, Auriemma A, et al. Compounded peptides: An Obesity Medicine Association Position Stance, Obesity Pillars, Volume 6, June 2023:100061. ISSN 2667-3681. doi: 10.1016/j.obpill.2023.100061 10.Research, C. F. D. E. A. (2023a, March 24). Drug compounding and drug shortages. U.S. Food and Drug Administration. https://www.fda.gov/drugs/human-drug-compounding/drug-compounding-and-drug-shortages#:~:text=Compounded% 20drugs%20are%20not%20FDA,an%20FDA%2Dapproved%20drug%20product

Edwin Davila, DO, MS, CISSN, is a senior resident physician of Internal Medicine at the Texas Institute for Graduate Medical Education and Research. He is a CISSN holder with the International Society of Sports Nutrition, a Board of Director with the Texas American College of Sports Medicine, a member of the Bexar County Medical Society and Board member of the American Medical Society for Sports Medicine. Visit us at www.bcms.org

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What Does it Mean to be Healthy? And How do We Get There? By Jennifer Seger, MD

ccording to the World Health Organization, “Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” Often, we don’t think about our health until we are sick, or perhaps a family member or close friend is. Simply avoiding illness and disease does not make one healthy. It’s far more complex than that but unfortunately our current healthcare system tends to focus on treatment rather than prevention. What’s more, healthcare providers are notoriously guilty of neglecting their own care. Somewhere between medical school, residency and launching our careers, we’ve forgotten how important it is to take time for ourselves. Perhaps it’s time to take stock in your health portfolio, which means looking beyond just illness. In my wellness and weight loss practice, I like to refer patients to the Eight Elements of Health, which are: • Nutrition • Physical Activity • Stress Management • Sleep • Gut Microbiome • Hormones • Community/Connectedness • Purpose Nutrition Nutrition isn’t about being on a particular diet. It’s about optimizing the nutrient density of what we choose to eat and drink. All too often, we reach for what’s easy and convenient rather than putting a little more thought into our food choices. Nutrition has the power to prevent and even reverse disease yet we are eating more sugar, unhealthy sources of fat, inadequate protein and more highly refined, processed foods than ever before, and it is making us sick. We have the power to change this. Movement There is robust science about how sitting too much is killing us. Cutting out physical activity in schools was one of the most ill-advised moves that schools could have made. Physical activity decreases the risk of just about every chronic disease, yet many of us are not making it a priority. Think about it … if there was a medication that you could take that would decrease your risk of Alzheimer’s disease, diabetes, heart 16

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disease, high blood pressure, chronic pain … wouldn’t you take it? Then let’s get moving! Be sure to incorporate some cardio and strengthening, but don’t forget balance and stability. Sleep Getting a good night’s sleep goes a long way to improve health and overall quality of life. Studies show most adults need seven to eight hours of good, restful sleep for optimal health. A recent study even highlighted an increase in cardiovascular risk in patients who are chronically sleep deprived. So, unlike nutrition, quality, not just quantity, really matters. Stress Stress is not something we can simply dismiss or brush under the rug. Even if we seemingly have it “all under control,” chronic stress is doing a number on the inside. Fundamentally, stress can cause an increase in blood pressure, heart rate, cortisol and cravings, and it can decrease sleep and interfere with digestion, neurotransmitters and hormones. It’s more important than ever to take stock of our day-to-day stress levels, evaluate our current coping strategies, and assess whether we need to make some changes. Consider readjusting to put your mental energy where it truly makes a difference — in the areas of life in which you have some direct influence or control. For the rest, learn to let it go. Gut Microbiome They may be small but they are mighty and need not be underestimated. This is such an important topic, though admittedly not well understood by mainstream medicine. We hear about the harm of frequent, recurrent or long-term use of antibiotics but rarely do we hear about how incredibly important the gut microbiome is to our overall health and well-being. Gut bacteria have the power to influence our brains, metabolism, immune function and so much more. What we put in our bodies directly influences the balance of our gut microbiome. Think of it as a garden — the soil is what makes or breaks any garden. Tend to your garden to live your best life — it starts with more leafy greens, fruits and veggies, complex whole grains and fermented foods. Hormones What a controversial topic. To give or not? About 20 years ago, in

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response to data from the Nurse’s Health Study, women were told to stop their hormone replacement therapy due to concerns that it increased the risk of breast cancer. Upon some deeper reflection of this body of science, it appears that perhaps we jumped the gun. Clearly, hormones are not for everyone, but does that mean we shouldn’t be having individual discussions and considering the options on a caseby-case basis? Every woman (and man) deserves to live their best life, which includes weighing the pros and cons of HRT. Purpose We work, have family and friends. But what if we don’t like our work? Perhaps we have gone through some changes and our relationships have been challenged? Maybe it was the pandemic that forced us into isolation and we just haven’t quite made it back. Having something in life that truly gets us going, fires us up, and/or inspires us is fundamental to our overall health and wellbeing. It doesn’t have to be your paid job either. Pick a passion and decide to step up. It could also be how you contribute to your family, your community or your church, but just do something that matters TO YOU. No one is looking. No one is judging. This is you being you, and making a difference. Connectedness/Community According to the CDC, “Social connectedness can lead to longer life, better health, and improved well-being.” People living an isolated life tend to have more health problems. I’ve seen this firsthand in patients and family members. Humans were meant to go through life together — to lean on one another, to learn and grow together, and to share with one another. Don’t wait for landmark dates or catastrophic events to embrace this innate human tendency. There is no need to enlist of hundreds of friends or join several groups … simply having a few close friends/connections can be enough. It’s not about the number, but more about the depth of those connections that matters. Making these changes may sound overwhelming, but life is all about the journey. Cultivating a “life well lived” takes time and effort but is absolutely within each of our grasps if we just slow down and make it a priority. That’s why I’ve dedicated my practice to helping patients improve their health, decrease their disease risk, and live their best lives. Jennifer Seger, MD, is board certified in Family Medicine and Obesity Medicine and founder of the Dr. Jenny Wellness & Weight Management Program, where she guides patients toward their best possible quality of life through a comprehensive, evidencebased approach to wellness. Dr. Seger is a member of the Bexar County Medical Society.

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Diet and Nutrition in Patients with Gastrointestinal Cancers By Hycienth Ahaneku MD, PhD

he digestive system is responsible for processing food through ingestion and digestion as well as absorption. Adequate diet and nutrition are important for promoting growth, maintaining health and preventing disease. Emerging evidence highlights the interplay between the digestive and immune systems in maintaining the health and well-being of humans. The dual role of nutrition and diet, as well as the integrity of the gastrointestinal system, are of particular interest in patients with gastrointestinal (GI) cancers. “Gastrointestinal cancers” is a collective term used for cancers affecting the gastrointestinal tract, including the esophagus, stomach, liver, pancreas, small intestine, colon and rectum. GI cancers account for 26 percent of the global cancer incidence and 35 percent of all cancer-related deaths.1 In 2023, GI cancers were estimated to account for about 18 percent of new cancers in the United States, with colorectal cancers being the most common among the GI cancers.2 The vast majority of patients with gastrointestinal cancers experience malnutrition at some point in their cancer history. Upper GI cancers have the highest risk of developing malnutrition, with one study show18

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ing about 65 percent of patients developing moderate malnutrition and 22 percent developing severe malnutrition at some point in their cancer history. For patients with lower GI cancers, the risk is about 20 to 60 percent and 10 to 17 percent of developing moderate and severe malnutrition, respectively.3,4 The development of gastrointestinal cancers can compromise nutritional status via various mechanisms. These include reduced dietary intake, compromised digestive/absorption process, effect of cancer treatment (including surgery, systemic therapy and radiotherapy), and increased catabolic state because of cancer. Changes in dietary intake are usually due to poor appetite, physical obstruction of food, especially in patients with esophageal and gastric cancers, easy satiety and changes in taste perception. Additionally, physical debilitation, as well as depression and psychological stress from cancer, can affect appetite, and influence both quantity and quality of food intake. Cancer has been shown to induce a pro-inflammatory environment that drives an increased catabolic state, which, when combined with

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poor dietary intake, leads to increased weight loss, and loss of muscle and fat mass — a state often described as cancer cachexia. Cancer cachexia contributes to impaired function, decreased performance status, decreased tolerance to cancer treatment and poor overall survival. Three stages of cachexia have been described in the literature — precachexia, cachexia and refractory cachexia.5 The goal of nutritional interventions in GI cancer patients is to intervene at the pre-cachexia stage before the patient develops full-blown cachexia. In light of the above, the importance of a comprehensive and individualized nutrition plan for the GI cancer patient cannot be overstated. This process requires a multidisciplinary approach involving the oncologist, gastroenterologist, dietitian and even the social worker. This list is by no means exhaustive, as other specialists might be involved in the management of the patient along their cancer journey. Crafting a comprehensive and individualized nutrition plan starts with an initial assessment of the patient’s nutritional status. This initial assessment considers several factors, including current weight, recent weight loss, diet, exercise programs, symptom management, potential cancer treatment effects and any intercurrent comorbidities. Two commonly used nutritional assessment tools include the Malnutrition Screening Tool (MST) and the Patient Generated Subjective Global Assessment (PG-SGA).6,7 An initial nutritional assessment will inform dietary recommendations tailored towards the nutrition needs and preferences of the patient. For example, for upper GI cancer patients, the emphasis will be on small frequent meals addressing symptoms like dysphagia. For pancreatic cancer patients, the use of exogenous pancreatic enzymes with limitation to ingestion of sweets and sugars is emphasized. The overall goal of the nutrition plan is geared towards a well-balanced diet rich in essential nutrients. In maintaining essential nutrients, we should ensure monitoring and supplementing essential micronutrients, including vitamin B12, iron, folate and vitamin D. This includes managing potential drug-nutrient interactions. It will be of little benefit to the patient if they have access to a wellbalanced diet but are bedeviled by problems of fatigue or poor appetite, which can compromise overall food intake. Thus, the nutrition plan should necessarily include plans for the management of chemotherapyinduced side effects impacting nutrition (nausea, vomiting, diarrhea, anorexia), addressing symptoms like reflux and taste changes, and a program for enhancing physical activity within the patient's capabilities. Food intake can be further facilitated by empowering patients and caregivers with nutritional knowledge. Furthermore, there should be measures for addressing psychological and social aspects of nutrition, such as providing support groups and counseling services. Engaging the services of social workers, clinical psychologists and psychiatrists can be helpful in this regard.

Developing and implementing a nutrition plan is not a one-off event. This plan requires continual evaluation/revision to meet patients' changing needs in their cancer journey. Continuous monitoring and adaptation to patients’ needs, being proactive to prevent nutrition-related complications, and open and empathetic communication with patients and families, as well as continued engagement of all multidisciplinary team members, is imperative. In conclusion, diet plays a pivotal role in managing patients with gastrointestinal cancers. The metabolic and physical changes associated with cancer impair dietary intake, leading to weight loss, malnutrition and cachexia. Having a comprehensive and individualized diet and nutrition plan is imperative in patients with gastrointestinal cancers. This requires a multidisciplinary approach from the onset with continued evaluation/revision of the diet/nutrition plan to meet the evolving needs of the GI cancer patients. References: 1. Arnold M, Abnet CC, Neale RE, Vignat J, Giovannucci EL, McGlynn KA, Bray F. Global Burden of 5 Major Types of Gastrointestinal Cancer. Gastroenterology. 2020 Jul;159(1):335-349.e15. doi: 10.1053/j.gastro.2020.02.068. Epub 2020 Apr 2. PMID: 32247694; PMCID: PMC8630546 2. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023 Jan;73(1):17-48. doi: 10.3322/caac.21763. PMID: 36633525 3. Shaw, C. (2021). Management of diet in gastrointestinal cancer. Proceedings of the Nutrition Society, 80(1), 65-72. doi:10.1017/S0029665120007041 4. Burden, ST, Hill, J, Shaffer, JL et al. (2010) Nutritional status of preoperative colorectal cancer patients. J Hum Nutr Diet 23, 402–407 5. Fearon, K, Strasser, F, Anker, SD et al. (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12, 489–495 6. National Cancer Institute. Nutrition in Cancer Care (PDQ)— Health Professional Version: Nutrition Therapy. Updated November 3, 2022 7. Isenring E, Cross G, Daniels L, et al. Validity of the malnutrition screening tool as an effective predictor of nutritional risk in oncology outpatients receiving chemotherapy. Support Care Cancer. 2006;14(11):1152-6 Hycienth Ahaneku MD, PhD, is a medical oncologist/hematologist providing care for patients at Texas Oncology San Antonio Medical Center. Dr. Ahaneku is a member of the Bexar County Medical Society.

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Prioritizing Physical and Mental Wellness: Recommendations for Women Physicians By Amita Kumar, MD

he demanding nature of the medical profession can take a toll on the well-being of physicians, especially women who face unique challenges within the field. Juggling professional responsibilities with personal commitments often leads to neglecting selfcare and mental health. To address this pressing issue, it is crucial to provide recommendations tailored to the needs of women physicians. By implementing practices that promote physician and mental wellness, women in medicine can achieve a healthier work-life balance and enhance their overall well-being and quality of life. Embrace Self-Care Self-care is the foundation of well-being. As a woman physician, it is essential to prioritize self-care activities that promote physical and mental health. This may include allocating time for regular exercise, engaging in hobbies, practicing mindfulness and meditation, or simply indulging in activities that bring joy and relaxation. Remember, taking care of yourself is not selfish; it is a necessity. Build a Supportive Network Cultivating a strong support network is vital for women physicians. Surrounding yourself with colleagues, mentors, friends and family who understand the unique challenges of your profession can provide muchneeded emotional support. Participating in professional organizations or joining support groups specifically designed for women in medicine can offer a safe space to share experiences and find encouragement. Start here: http://www.bcms.org/committees.php. Establish Boundaries Setting boundaries is crucial for maintaining physical and mental wellness. As a physician, it is easy to become consumed by work, leading to burnout and exhaustion. Learn to say "no" when your plate is already full and delegate tasks when possible. Establish clear boundaries between work and personal life, allowing for adequate rest, relaxation and quality time with loved ones. Remember that self-care and work-life balance are not only essential for your well-being but also positively impact patient care. Seek Mental Health Support Recognize that seeking professional help for mental health concerns is a sign of strength, not weakness. Women physicians face numerous stressors, including long hours, high patient expectations and challenging work environments. It is crucial to prioritize mental health by seeking therapy 20

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or counseling when needed. Confidential sessions with a mental health professional can provide a safe space to explore emotions, cope with stress, and develop healthy strategies for managing work-related pressures. Foster Healthy Relationships Nurturing healthy relationships is crucial for maintaining well-being. Invest time and effort in building and sustaining relationships with friends, family and loved ones. Surrounding yourself with positive influences who provide support, encouragement and understanding greatly contributes to your overall happiness and resilience. Practice Mindfulness In the fast-paced world of medicine, mindfulness can serve as an anchor, helping you stay present and focused. Incorporate mindfulness techniques into your daily routine, such as deep breathing exercises, guided meditation or mindful eating. These practices can help reduce stress, improve concentration, and enhance overall well-being. Even just five minutes per day of mindful meditation can improve your outlook on a daily basis. Prioritize Sleep Sleep deprivation can significantly impact physical and mental health. As a woman physician, it is vital to prioritize quality sleep. Establish a regular sleep schedule, create a sleep-friendly environment, and practice relaxation techniques before bed to ensure restorative rest. Quality sleep will enhance your cognitive abilities, emotional resilience and overall performance as a healthcare professional. References: https://www.kevinmd.com/2022/01/prioritizing-physician-wellness-reducing-burnout-during-the-covid-19-pandemic-andbeyond.html https://www.physicianleaders.org/resources/wellness https://www.wolterskluwer.com/en/expert-insights/clinician-wellbeing-an-ongoing-conversation https://edhub.ama-assn.org/steps-forward/module/2702556 Dr. Amita Kumar is a Canadian native, and is board certified in Internal Medicine and practices primary care in San Antonio, Texas. Dr. Kumar has experience in both private practice and academics, and has most recently achieved her life coach and health coach certification through the Health Coach Institute. She is a member of the Bexar County Medical Society.

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Public Health and Our Planet’s Health is Intertwined By Sandra Zaragoza and Kristy Y. Kosub, MD

ne pillar of the Charles E. Cheever Jr. Center for Medical Humanities & Ethics at UT Health San Antonio (UTHSA) is the Community Service Learning (CSL) Program, directed by Melanie Stone, DrPH, MEd since its inception in 2008. Service learning is a structured community experience with mentored preparation and reflection. Students engage in projects in response to community-identified concerns, and learn about the context in which illness develops and their roles as citizens and professionals as they empower medically underserved communities in San Antonio, South Texas and globally. The Annual CSL Conference originated as an opportunity to learn from service experiences of students, faculty, staff and community partners. There is a focused theme relevant to service-learning with expert lecturers, skills-building workshops, opportunities to share best practices, and showcases of students’ poster presentations. The 17th Annual CSL Conference — “One Planet. One Health. We are all connected” is Saturday, February 3, from 8 a.m. to 2:30 p.m. Teddie M. Potter, PhD, RN, Clinical Professor and Director of Planetary Health, University of Minnesota School of Nursing, is the keynote speaker. The Mayor of San Antonio, Ron Nirenberg, will give a lunch plenary titled, “San Antonio’s 21st Century Challenge: Balancing Sustainability and Growth.” “Our students, like many future and practicing healthcare professionals, are concerned about the state of the planet and want a better understanding of how it connects to overall health,” said Dr. Stone. “We are excited to have esteemed speakers, including the Mayor and Dr. Potter, to lead these timely, solutions-oriented discussions.” Dr. Potter noted, “There are many ways humans are disrupting the Earth’s natural systems. Climate change, biodiversity loss, deforestation, and water, soil and air pollution are impacting agriculture, fishing and hunting, many forms of outdoor recreation and human health. These human-cause disruptions are reversing decades of public health gains and threatening survival of future generations.” Potter plans to discuss the planet’s challenges and opportunities to get it and our health back on track. “All is not lost. I’ll be speaking about planetary health, a solutions-oriented trans-disciplinary field and social

movement focused on analyzing and addressing the impacts of human destructions to earth’s natural systems,” Potter said. “I’ll share the global vision for solutions, particularly for the health sector. More than anything, I plan to share a word of hope because the actions that restore health of the planet are good for our health, too,” she added. The conference is free and open to the community. For agenda and registration details, visit www.texashumanities.org/CSLconference. Sandra Zaragoza, Senior Marketing and Communications Specialist, Health Confianza, Charles E. Cheever Jr. Center for Medical Humanities & Ethics. Kristy Y. Kosub, MD, Faculty Associate, Charles E. Cheever Jr. Center for Medical Humanities & Ethics, Member of the BCMS Publications Committee.

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Discovering the Power of the DASH Diet By Ayomide Akinsooto

n the quest to promote optimal health and well-being in recent years, the Dietary Approaches to Stop Hypertension (DASH) diet has emerged as a powerful and evidence-based eating plan that promotes heart health and manages blood pressure. This article aims to explore the key principles and components of the DASH diet, investigate its impact on various health parameters, and provide insights into its effectiveness as a dietary approach. The goal is to equip you with the knowledge and understanding necessary to embrace the DASH diet and experience its transformative effects on your overall well-being. Understanding the DASH Diet The DASH Diet is a well-researched and highly regarded eating plan that emphasizes the consumption of fruits, vegetables, whole grains,

lean proteins and low-fat dairy products while limiting the intake of saturated fats, cholesterol and sodium.1 By focusing on nutrient-dense foods, the DASH diet ensures an adequate intake of essential vitamins, minerals and dietary fiber.2 It encourages individuals to make longterm, sustainable dietary changes rather than resorting to short-term restrictive measures. Impact on Blood Pressure Control The primary benefit of the DASH diet is its positive impact on blood pressure control and cardiovascular health. Multiple studies have shown that adhering to the DASH diet leads to significant reductions in both systolic and diastolic blood pressure. For instance, a study published in the New England Journal of Medicine reported that individuals who followed the DASH diet experienced significant reductions in blood pressure.1 It also aids in preventing hypertension and reducing the risk of cardiovascular diseases, as demonstrated in research published in the Journal of the American College of Cardiology.3 Promoting Heart Health In addition to blood pressure control, the DASH diet offers comprehensive benefits for heart health. It emphasizes the use of whole grains, fruits, vegetables and lean proteins, which provide an array of essential nutrients that support cardiovascular function.2 The inclusion of high-fiber foods contributes to healthy cholesterol levels, while the reduction in sodium intake aids in managing fluid balance and reducing strain on the heart.4 Studies have indicated that adopting the DASH diet can lead to a significant decrease in the risk of heart disease, making it a valuable dietary strategy for overall heart health.5 Role in Weight Management Beyond its effects on blood pressure and heart health, the DASH diet has shown promise in supporting weight management. A study conducted at Duke University Medical Center found that participants who followed the DASH diet experienced weight loss and improvements in body composition compared to those following a standard American diet.7 Its emphasis on whole, unprocessed foods and portion control helps individuals achieve and maintain a healthy weight. The inclusion of nutrient-dense foods that are low in added sugars and unhealthy fats ensures a satisfying eating experience while limiting excessive calorie intake. Image: National Heart, Lung and Blood Institute2

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Image: University of Arkansas6

Nutritional Benefits and Disease Prevention The nutrient-rich nature of the DASH diet contributes to several additional health benefits and disease prevention. The diet's emphasis on fruits, vegetables and whole grains ensures an abundance of antioxidants, vitamins and minerals, which support overall health and reduce the risk of chronic diseases such as cancer, diabetes and obesity.2 Additionally, the DASH diet's low sodium content can be beneficial for individuals with kidney disease or those at risk of developing kidney stones.4 By incorporating these dietary components, the DASH diet offers a holistic approach to well-being and long-term health. Practicality and Long-Term Sustainability One of the strengths of the DASH diet lies in its practicality and long-term sustainability. Unlike many fad diets, the DASH diet does not involve drastic restrictions or exclusions. It promotes a balanced approach to eating that can easily be incorporated into daily life, making it more feasible for individuals to adopt as a lifelong eating pattern. Moreover, the DASH diet offers flexibility, allowing for individual preferences and cultural variations, which increases adherence and promotes better long-term outcomes.2 Conclusion With its focus on wholesome foods and balanced nutrition, the DASH diet emerges as a scientifically supported approach to improving heart health, blood pressure control, weight management and overall well-being. By adhering to its principles, individuals can unlock the potential for a healthier and more vibrant life. Whether you aim to regulate your blood pressure, maintain a healthy weight, or prevent chronic diseases, the DASH diet offers a sustainable and practical dietary framework. Embrace the power of the DASH diet and experience the transformative benefits it can bring to your health.

References: 1. Appel, LJ, Moore, TJ, Obarzanek, E, Vollmer, WM, Svetkey, LP, Sacks, FM, ... & Karanja, NM. (1997). A clinical trial of the effects of dietary patterns on blood pressure. New England Journal of Medicine, 336(16), 1117-1124. https://doi.org/10.1056/NEJM19 9704173361601 2. National Heart, Lung, and Blood Institute. (n.d.). DASH Eating Plan. Retrieved June 9, 2023, from https://www.nhlbi.nih.gov/ health-topics/dash-eating-plan 3. Sacks, FM, Svetkey, LP, Vollmer, WM, Appel, LJ, Bray, GA, Harsha, D, ... & Karanja, NM. (2001). Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. New England Journal of Medicine, 344(1), 3-10. https://doi.org/10.1056/NEJM200101043440101 4. Azadbakht, L, Mirmiran, P, Esmaillzadeh, A, & Azizi, F. (2005). Beneficial effects of a Dietary Approaches to Stop Hypertension eating plan on features of the metabolic syndrome. Diabetes Care, 28(12), 2823-2831. https://doi.org/10.2337/diacare.28.12.2823 5. Salehi-Abargouei, A, Maghsoudi, Z, Shirani, F, & Azadbakht, L (2013). Effects of Dietary Approaches to Stop Hypertension (DASH)-style diet on fatal or nonfatal cardiovascular diseases--incidence: a systematic review and meta-analysis on observational prospective studies. Nutrition (Burbank, Los Angeles County, Calif.), 29(4), 611–618. https://doi.org/10.1016/j.nut. 2012.12.018 6. Lowering Your Blood Pressure with the DASH Eating Plan. University of Arkansas System Division of Agriculture, Cooperative Extension Service. Retrieved June 9, 2023, from https://www.uaex. uada.edu/counties/miller/news/fcs/meal-prep-healthy-eating/ Lowering-Your-Blood-Pressure-with-the-DASH-Eating-Plan.aspx 7. Carey, VJ, Bishop, L, Charleston, J, Conlin, P, Erlinger, T, Laranjo, N, ... & Kennedy, BM. (2008). Effects of a DASH-like diet containing lean beef on vascular health. Journal of Human Hypertension, 22(11), 785-792. https://doi.org/10.1038/jhh.2014.34 Ayomide Akinsooto is a medical student at the Long School of Medicine, Class of 2026.

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LIFESTYLE MEDICINE

UTHSCSA Lifting:

UTHSCSA Fall 2023 Lifting Competition participants.

Fostering Fitness, Community and Philanthropy By Victoria (Tori) Vargas and Andrew Ta

t The University of Texas Health Science Center at San Antonio (UTHSCSA), the student organization, UTHSCSA Lifting, brings together groups of people from all schools within the university, united by a shared interest in gym culture and weight lifting. Established by myself and a passionate group of medical students, UTHSCSA Lifting was born out of a shared love for the gym and a belief in the transformative power of physical fitness. The medical profession can be incredibly demanding with long hours and seemingly never-ending education, making the importance of maintaining a healthy lifestyle even more critical. Many of us have witnessed and experienced just how easy it is to disregard personal health to meet the demands of our work and studies. We saw this as an opportunity to create a supportive community focused on weightlifting and promoting overall well-being. UTHSCSA Lifting prides itself on being an inclusive organization that goes beyond the boundaries of academic disciplines. While its roots lie in the Long School of Medicine, the organization actively encourages participation from students in other schools within the Health Science Center. Whether students are studying nursing, dentistry, physical therapy or any other health-related field, UTHSCSA Lifting provides a common ground for individuals to come together, share experiences, and support each other on their fitness journeys. 24

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The Primary Goal: Making Lifting Accessible UTHSCSA Lifting is driven by a central mission: to ensure that weightlifting is not only accessible but also enjoyable for everyone. Recognizing that stepping into a gym can be overwhelming for newcomers, with its array of equipment and unfamiliar exercises coupled with an often-intimidating culture, our organization is dedicated to fostering an inclusive and supportive environment where individuals can learn, grow and achieve their fitness goals. Regular events, workshops and training sessions are organized to provide members with the knowledge and skills needed to feel confident in the gym. These workshops take place weekly where veteran lifters teach the complex movements involved with certain gym exercises, including the bench press, squat and deadlift. Recently, UTHSCSA Lifting proudly introduced the sport of powerlifting to our members and the wider campus community. The inaugural Fall 2023 Lifting Competition, hosted at the Gold’s Gym on campus, provided a platform for lifters of all levels to test their one-rep max in the three compound lifts following competition standards. This event drew participation from 40 competitors from varied schools at the UT Health Science Center, fueling healthy competition and facilitating connections among students pursuing different professions. UTHSCSA Lifting looks forward to making the powerlifting competition an annual tradition, and we are also considering the prospect of hosting additional competitions, including events like

LIFESTYLE MEDICINE Olympic weightlifting or a pull-up contest. These initiatives aim to create friendly competition among schools, motivating these busy students to continue prioritizing their health and fitness. Community Outreach Beyond the confines of the university, UTHSCSA Lifting expands its impact into the community through meaningful partnerships with local groups. One such collaboration is with Kinetic Kids, an organization dedicated to providing sports and recreation opportunities for children with special needs. Members of UTHSCSA Lifting actively participate in initiatives with Kinetic Kids, orchestrating events and activities designed to foster health and fitness among children facing physical and intellectual challenges. These activities are particularly meaningful, as they cater to children who are often unable to participate in conventional sports camps and activities due to their unique needs. Most recently, we started a project with Kinetic Kids focusing on the relationship between mental and physical health in children with special needs, specifically surrounding their AgilityFit CrossFit program. Our objective was to observe the impact on mental well-being following a targeted 6-week program that teaches basic resistance training and CrossFit movements. This project is especially important for the children in Kinetic Kids, many of whom grapple not only with their primary disabilities but also the accompanying emotional hurdles. In

our collaboration with Kinetic Kids, we hope to both teach these children how to be active as well as provide support and foster an environment where they can flourish in spite of their multifaceted struggles. This partnership reflects the organization's commitment to using their passion for lifting as a force for positive change in the community. UTHSCSA Lifting stands as a testament to the power of combining passion, community and philanthropy. As a student-led organization, it not only promotes physical fitness within the Health Science Center but also reaches out to the broader community, exemplifying the spirit of service that is integral to healthcare professionals. Through their dedication to making lifting inclusive and accessible, UTHSCSA Lifting is creating a culture of support, empowerment and health that extends far beyond the gym. Victoria (Tori) Vargas is a medical student at the Long School of Medicine, Class of 2026. Andrew Ta is medical student at the Long School of Medicine, Class of 2026. He is the 2023 Student-Faculty Collaborative Practice President overseeing the six student-run free clinics and is the 2023-2024 writing lead for Connective Tissue, the school's literature and arts journal. Andrew is also a member of the BCMS Publications Committee.

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SAN ANTONIO MEDICINE

The Dream Continues By Carlos R. Orozco, MD

Scenes from Los Quijotes of San Antonio's 2023 Oaxacan mission trip.

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his is a follow-up to an article that appeared in San Antonio Medicine magazine in May of 2023, which provided a 34-year history, from its formation to the current date, of the medical mission group of dreamers called Los Quijotes of San Antonio. From September 2-10, 2023, a group of about 70 volunteers, consisting of doctors, nurses, pharmacists, students and nonmedical helpers, at their own expense, went to the city of Oaxaca, Mexico to provide medical services for the less fortunate people and medically needy of that region. As on previous trips, testing, counseling, medical care and medications were provided. A concise summary of the data gathered was provided by volunteers from the University of the Incarnate Word, a school which aligned with the original Los Quijotes several years ago. Dr. Barbara Aranda, former provost and nurse, along with her husband, was instrumental in this addition. It needs to be pointed out that throughout these mission trips, we have been very fortunate to have always had the usual, tremendous cooperation from the local government officials and the medical community who have greatly facilitated our success as a mission. From the data gathered, approximately 2,000 prescriptions were filled with about a quarter being analgesic/anti-inflammatory medications, followed by 10 to 11 percent for gastrointestinal and ophthalmologic problems. The cost of approximately $13,000 for medications, testing and medical supplies was raised through contributions from various sources. The average number of dental patients seen by one dental hygienist and two dentists — one being Dr. Javier Garcia, a long-time Quijote — were 100 to 125 per day with 30 percent extractions, 60 percent cleaning and 60 percent fitting. This year we had two volunteer ophthalmologists — Dr. Ricardo Sepulveda from San Antonio and Dr. Juan Jose Cueto from Monterrey — who performed 30 cataract surgeries in three days, with 81 patients on the waiting list for next year. Through the coordinated efforts of many and the supervision of Rachel San Martin (with memory of her late husband, ophthalmologist and Quijote leader-founder, Dr. Roberto San Martin) 1,149 pairs of glasses were provided, of which 309 were donated by an optical company in Austin, Texas. Traveling to Oaxaca was not difficult, with direct flights from Dallas to a nice, well-run airport in Oaxaca. The lodging and flights were financed personally by each Quijote at a cost of $400 to $500 for roundtrip air, and the hotel cost was $80 per day for a single room and $40 per day for double occupancy. At the Marques Del Valle hotel, lodging is very cozy on the periphery

SAN ANTONIO MEDICINE

of a fabulous, bustling, colorful plaza with music and dancing, and an ornate gazebo at its center as is customary in Mexican towns. Many great restaurants are within walking distance, serving the renowned Oaxacan food. Interesting sites such as a world-class museums, markets and cathedrals are also within walking distance. Though we worked hard, there was ample time to walk to Santa Domingo de Guzman Cathedral, view art displayed along the cobble-stoned streets, and embark on guided travel tours to archeologic ruins and historical sites in the region such as Monte Alban, El Arbol de Tule, Mitla and Hierve de Agua. The food and drinks in Oaxaca are famous, with enchiladas alongside mole negro and mezcal, and the chance to sample tasty chapulines (grasshoppers), one of Oaxaca’s signature dishes. Oaxaca’s markets are fabulous, busy and colorful, and thrilling to explore. Yet it should be noted that despite Oaxaca’s vibrant city and culture, along with their treasured folk art traditions admired the world over, of Mexico’s 15 poorest municipalities where more than 98 percent of the population lives in poverty, eight of those municipalities are in the state of Oaxaca, according to a study by the National Council for the Evaluation of Social Development Policy (CONEVAL).1 Our decision to serve the people of Oaxaca since 1997 was based primarily on the recommendation by Dr. Hugo Castaneda who recognized the medical needs of the indigenous peoples of the area. The spirit, sentiments and memories of the people who went on this trip were expressed to me in several conversations. I will pass on just a few. Pharmacist, Jim Stultz, who made the decision to join the Quijotes medical mission trips in 1993, said, “Looking back now, it’s hard to fathom all the experiences and memories that came from that decision to join. From the first mission in Mexico City, Los Quijotes missions quickly became a passion for me. The shared efforts with the Los Quijotes team, the interaction with the local volunteers, and the opportunity to learn about Mexico, its culture and its people was something that drew me back year after year. I now find myself 30 years later with

memories of thousands of patients, hundreds of fellow Quijotes, more hardships and laughs and smiles and hugs and great meals than I can remember, and always looking forward to next year when we have another opportunity to serve.” Our devoted medical leader, a well-known and caring gynecologist in San Antonio, Leticia Vargas, points out three reasons how her service with Los Quijotes has personally benefited her: 1) It made her a better doctor by going back to the basics; 2) She has had the best dinners and open, judgement-free conversations with colleagues in different specialties about our challenges, fears and obstacles over the years; and 3) Involving the University of Incarnate Word professional schools has enabled us to pass the torch forward in stewardship, and it brings so much happiness to watch the excitement of the younger generations as they learn and offer service. Miguel Mendez, RN, ICU Director, quoted St. Francis of Assisi, “It is in giving that we receive.” He said this year and the past 25 years have given him the opportunity to serve the underserved as a nurse without compensation. In return, he has received much gratitude through kind words of thanks and hugs of appreciation. (If I may add, certainly God’s blessings). Miguel states that the organization builds positive relationships from both sides of the border. This year he was refueled physically and spiritually, enabling him to provide better patient-centered care here in San Antonio and beyond the walls of the hospital. I would especially like to recognize other fellow Quijotes, not mentioned above, without which the Quijotes would not have formed and grown. First is the biggest dreamer, the Don Quijote, Dr. Hugo Castaneda, who has retired. The second, and the most alive, energetic and superb ICU nurse that I refer to as the Dulcinea of the Quijotes, Yolanda Perez. And third is Dr. Diana Ballesteros, who is on the faculty of the Family Practice Program at Christus Health Center and has provided several residents to serve with us. Also, Dr. Ricardo Riojas, his wife, Beatriz, and family, who have served the Quijotes over the years. But most of all I want to thank my Lord and Savior, Jesus Christ, who showed us the dream 34 years ago at a prayer breakfast on a Thursday morning at the old downtown Santa Rosa Hospital. If you would like to help the Quijotes Medical Mission group, you can make a non-taxable donation on their website: www.quijotesofsanantonio.com Reference: https://www.coneval.org.mx/InformesPublicaciones/FolletosInstitucionales/Documents/Multidemensional-Measurement-of-povertyin-Mexico.pdf Carlos Raul Orozco, MD, is a Pulmonologist and a 5th grade math teacher. Proverbs 17:22 Visit us at www.bcms.org

SAN ANTONIO MEDICINE

Win with Wellness: Physicians Helping Physicians Interview with Dr. Nora Vasquez, conducted by Monica Jones, BCMS COO, and Trisha Doucette, Editor

he Bexar County Medical Society (BCMS) is dedicated to providing physician resources that will help its members find personal and professional balance, improve their general well-being and mitigate the effects of burnout. Through a Texas Medical Association Foundation grant awarded in 2021, BCMS launched an innovative wellness initiative through a partnership with Dr. Nora Vasquez, a triple-Certified Physician Coach and board-certified Internal Medicine Physician, that extends throughout the nation and complements the Society’s extensive list of resources. In a conversation with Dr. Vasquez, she cited overwhelming statistics reported by the American Foundation of Suicide Prevention. “We know that every year we lose 400 physicians to suicide. For men, that’s 1.4 times their non-physician counterparts and for women it’s 2.7 times their non-physician counterparts. That’s my why. I’ve lost colleagues to suicide, and it’s devastating for families and the community,” she shared, adding, “Twenty-eight percent of medical residents experience depression nationwide. We take healthy, young, vibrant, high achieving students and run them through medical education and training, and they start to have mental health problems, but we don’t talk about it.” Through a series of personal coaching, webinars, wellness panels and videos, Dr. Vasquez is able to bring clarity, awareness and action to transform lives for the better. Professional coaching is an evidencebased intervention, and in just six sessions, it can decrease burnout and increase their quality of life. Many of the participants in the leadership and wellness coaching program shared their reflections here: “I’ve regained my energy and enthusiasm, plus also developed a set of lifelong tools to maintain a healthy work-life balance.” “I’ve gained a sense of community and knowledge that I’m not alone.” “I’ve learned tools to better manage stress and prevent burnout.” “I’m enjoying work more than before — considering my work as something I get to do rather than have to do.” “I learned so many things about leadership and wellness. I have shared this with my colleagues, and this has helped with our communication and morale.” As a physician coach who understands what it is like to lose a patient and to deal with the challenges of modern medicine, as well as her personal experiences with burnout, Dr. Vasquez created a platform on 28

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which physicians can feel seen, heard, validated and supported. But she believes it doesn’t stop there, stating, “Medical institutions have a moral responsibility to take care of their people. Decades of research proves that when medical organizations support and invest in their clinical staff and leaders, this increases engagement, retention and improves the quality of patient care.” The COI, or cost of inaction, is devastating for patients and communities nationwide. In 2022, upwards of 100,000 physicians left medicine, amidst already documented staff shortages across the nation. Every year, $979 million in excess healthcare expenditures are attributed to primary care physician turnover alone. Medical professionals are facing more work distress than ever before. “It doesn’t have to be this way. Healthcare leaders at premier institutions are implementing leadership and wellness coaching programs, and they are experiencing the benefits of having that level of support. For every dollar invested in wellbeing, leadership development and coaching, these institutions see a $4 return on investment in improved health and productivity. It works,” said Dr. Vasquez. Dr. Vaquez concludes by explaining, “When we talk about wellness, we need to expand our definition of wellness. We are creating an institutional change. This is a positive and transformational movement in medicine. I believe that we must first be well to lead well. When our medical teams and leaders have the support they need to deliver the highest quality of patient care, we all win!” Dr. Vasquez will present her BCMS Leadership & Wellness coaching webinars on the third Tuesday of each month at 7 p.m. CST, with the exception of May, which will take place on May 14, 2024, at 7 p.m. CST. Dates are subject to change. For additional information, webinar topics and calendar changes, please visit www.bcms.org/phywellness. php and www.renewyourmindmd.com. Nora Vasquez, MD, is a Certified Physician Coach and boardcertified Internal Medicine Physician with over a decade of experience. She developed the Physician Wellness Webinar Series for BCMS physician members to empower physicians with evidence-based coaching strategies to mitigate burnout and enhance physician well-being. Dr. Vasquez is a member of the Bexar County Medical Society and Texas Medical Association. You can learn more about Dr. Nora Vasquez at www.renewyourmindmd.com.

BCMS EVENTS SUICIDE WALK

Walk with us to Prevent Suicide On October 28, 2023, BCMS Physician Wellness committee members participated in the American Foundation for Suicide Prevention and Out of the Darkness San Antonio Walk. BCMS had an “Ask a Doctor” table manned by our participating physicians. We successfully handed out the “Physician Burnout, Depression and Suicide” onepager as well as our “Wellness Resource document” to attendees. Thank you to our sponsors: BCMS Alliance and the Vein and Artery Surgical Consultants.

SAN ANTONIO MEDICINE • January 2024

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BCMS HISTORY

Dr. Aureliano Urrutia,

Dr. Aureliano Urrutia (1872-1975) was a pioneer surgeon in Bexar County’s early 20th century, and an important member of the Mexican and Mexican American communities in San Antonio. He was active in the mid-20th century civic life of San Antonio, working alongside other Mexican Revolution-era exiles to improve healthcare and employment, and to represent San Antonio’s Hispanic commu32

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nity. Having already had a stellar medical career in Mexico, he came to San Antonio in 1914 at a time when the successful study of infectious disease was allowing great strides in surgery. Born in Xochimilco, Federal District, to a family of modest means, as a teen Urrutia won the nation’s top pre-collegiate honor, which awarded him access to medical school and

service in the Mexican army. During his service, he studied at the O’Horán Hospital in Merida, Yucatán. In 1900, La Escuela Nacional de Medicina appointed Urrutia, age 28, as its youngest professor of surgery through a competitive process. His demonstration of his astute knowledge of anatomy, through direct study of the body using a human cadaver, was the first of several progressive ideas he con-

BCMS HISTORY

tributed to Mexico’s medical reputation, which was gaining visibility in the industry. Soon thereafter, he established a private practice in downtown Mexico City, where he achieved local fame for saving the life of a popular bullfighter, and founded a hospital, Sanatorio Urrutia, in Coyoacán, on 25 acres of pastoral grounds. In 1910, President Porfirio Díaz commissioned the well-known photographer Guillermo Kahlo, father of artist Frida Kahlo, to film several of Urrutia’s operations. By 1913 he became director of the two most important medical institutions in the land, La Escuela Nacional de Medicina and El Hospital General. That same summer, Urrutia also served for three months in Mexico’s executive cabinet as ministro del gobernación (similar to secretary of interior). In the heat of the Revolution, his resignation from that position triggered his political exile, whereby he and his family immigrated to San Antonio by way of Galveston. In San Antonio, in 1916, Urrutia opened a medical practice located near downtown on Broadway. He practiced surgery for his entire career at the Santa Rosa Hospital, where he formed a strong relationship with the Sisters of Charity of the Incarnate Word, who served as his nurse assistants. In 1926, he built Clínica Urrutia, on nearly a full square block of Houston Street between Laredo and Santa Rosa Streets, including offices, an outpatient surgical facility and Farmacia Urrutia. The practice included his sons Hector, a dentist; Carlos and Adolfo, physicians; his daughter, Refugio, a pharmacist; and daughters, Luz, Alicia and Maria Luisa who helped run the business. Urrutia’s eldest son, Aureliano Jr., was also a physician and served his career at the Robert B. Green Memorial Hospital. Urrutia provided healthcare largely to San Antonio’s West Side community, but also attracted patients from other U.S. cities, Mexico and beyond. He was an innovative physician who was known for his innate sense of patients’ needs as well as his adept

diagnostic capabilities. He succeeded in many cases that were previously labelled as incurable or inoperable, and became an early and internationally-renowned pioneer in areas including anatomy, exploratory, vascular and pediatric surgery, anesthesia and surgical instrumentation. In 1917, he performed a landmark surgery for the separation of 5-year-old conjoined twins. The twins were joined at the abdominal cavity and at the sternum, with two hearts in one pericardial membrane, and one large liver. Urrutia employed two anesthesiologists and an additional surgeon to assist. He used an exploratory phase to determine how the patients were anatomically and physiologically connected; a temporary closing to determine whether to move forward, consult with the parents, and make a plan; and a second phase to fashion a second heart sac from the first, and divide the liver. Although one of the patients did not survive longer than a few days, the surgery was considered groundbreaking, with the other twin surviving and living a long, productive life. His work was often reported in the press, such as a 1924 surgery to relieve spinal pressure on a patient, which reversed the man’s paralysis and restored the use of his legs. In 1948, he reportedly reconstructed a girl’s severely damaged esophagus. Urrutia had the honor of addressing the General Assembly of the Sixth Pan-American Medical Congress in Brazil in 1935, where he presented several surgeries on aneurisms of the carotid and iliac arteries, the 1917 separation, and foreign and tumorous bodies in the stomach. Shortly after, he was inducted as a Fellow to the American College of Surgeons. Urrutia also had a passion for art and nature. He built his home near Mahncke Park in bold Mexican style, accented in details of black and red, and decorated with ornate furniture and a sizable collection of art, sculpture, porcelain and Talavera ceramics. In 1921, he bought a 15-acre parcel at the then northern

edge of San Antonio, near Incarnate Word College, and created his beautiful 5-acre garden, Miraflores, along the San Antonio River. The garden reflected his deep connection to his homeland of central Mexico, and held a remarkable collection of sculpture, important native Mexican herbs, trees and other plants, Urrutia’s personal collection of antique Talavera Poblana, which decorated the garden’s gates and benches, a 3-story library tower and a quaint casita. Although it was a private garden, it was well-known for its Talavera arch on Broadway, now located in the San Antonio Museum of Art, and its public gatherings and private celebrations. Today, the site, owned by the City of San Antonio, is mostly in ruins, but its significance as a metaphor for Mexican history and culture has been documented, and there is some hope for a re-envisioning of the site as a public community garden of Mexican cultural heritage. Urrutia became a United States citizen in 1942, and retired from medical practice when he was 88 in 1960. At the time of his death, August 14, 1975, several of his friends in the downtown community remembered his popularity, his benevolent attitude towards the impoverished, and that he offered medical services regardless of the ability to pay. Dr. Aureliano Urrutia died at the age of 103, and was buried at San Antonio’s San Fernando Cemetery No. 2. Anne Elise Urrutia is a writer and explorer of family history, especially the life, work and legacy of her great grandfather, Dr. Aureliano Urrutia. She received a silver medal, Mimi Lozano Best History Book award, from the International Latino Book Awards in 2023 for her book Miraflores, San Antonio’s Mexican Garden of Memory (Trinity University Press, 2022). Ms. Urrutia received her English degree from Colorado College, blogs at www.quintaurrutia.com, and lives in San Antonio, Texas. Visit us at www.bcms.org

BOOK REVIEW

Diet, Mitochondria and a Leaky Gut: Navigating Nutrition and Wellness By David Alex Schulz

“Buckle up — I’m going to take you on a ride,” promises Robert Lustig, MD, MSL, in the introduction to Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine (2021, Harper Collins Publishers). He’s not kidding, bringing the reader “on a journey from the ultra-micro to the ultra-macro — from molecule to planet, and everything in between. We’re going to get both the subcellular and the thirty-thousand-foot view” to fully reckon the relationship between diet, health and illness. Why? In order “to answer these questions: why has our health status declined, our healthcare system devolved and our climate immolated?” The connective tissue between the three phenomena is the gut, says Lustig: the gastrointestinal tract, and the microcosm of its inhabitants; the relationship of a person’s diet to healthy mitochondria — the organelles found in the cells of living organisms responsible for producing adenosine triphosphate (ATP), which is the primary source of energy used by the cell. In clear, concise and compelling prose, Lustig’s 400-page narrative asks the reader to shift their intellectual curiosity into high gear — learning or relearning some basic biochemistry — yet simplifies the solution to our health and, as a result, our healthcare paradigm in six words: “Protect the liver; Feed the gut.” Protecting essential organs and providing vital bacteria their sustenance (“You’re not eating for one … but for a hundred trillion.”) begins by recognizing that food drives wellness and illness. The study of nutrition has been de-emphasized in medical education, leaving physicians poorly equipped to spot the patterns in patient maladies.

“Only 28 percent of medical schools have a formal nutrition curriculum, even fewer than in 1977,” when the new Dietary Guidelines called for more nutrition science in the medical classroom. “Now, medical students receive on average 19.6 contact hours of nutrition instruction, during their four-year medical school careers, about 0.27 percent of the time in class.”

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Nutrition’s fundamental role in illness was recognized over decades of Dr. Lustig’s patient-facing practice. A neuroendocrinologist, with basic and clinical training relative to hypothalamic (the area of the brain that controls hormones) development, anatomy and function, he worked at St. Jude Children’s Research Hospital in Memphis, TN. There, he was charged with the endocrine care of children whose hypothalami had been damaged by brain tumors, or subsequent surgery, radiation or chemotherapy. Many patients who survived became massively obese. Dr. Lustig theorized that hypothalamic damage led to the inability to sense the hormone leptin, which in turn, led to the starvation response. Since repairing the hypothalamus was not an option, he looked downstream, and noted that these patients had increased activity of the vagus nerve

BOOK REVIEW

(a manifestation of starvation), which increased insulin secretion. By administering the insulin suppressive agent octreotide, he was able to get them to lose weight; but more remarkably, they started to exercise spontaneously. He then demonstrated the same phenomenon in obese adults without CNS lesions. The universality of these findings enabled Dr. Lustig to weave these threads together into a novel unifying hypothesis regarding the etiology, prevention and treatment of the current obesity epidemic. “If you see a wasp,” asks Dr. Lustig, “do you simply kill the wasp; or do you destroy the wasp’s nest? For too long, our healthcare system is designed to kill the wasps one at a time; I think we need to go after the nest that spawns disease.” And that nest is the human gut with its bacterial partners, who outnumber the host’s cells by a factor of 10. Research links gut health to including autoimmune disorders, metabolic syndrome and even mental health conditions. How? Disruptions in gut microbiota and intestinal permeability can contribute to systemic inflammation and disease manifestation. "Leaky gut syndrome" is a condition where the lining of the intestines becomes more permeable, allowing substances like toxins, undigested food particles and bacteria to leak into the bloodstream. The intestines usually have tight junctions that control what passes through into the bloodstream, but in this condition, these junctions become loose or damaged. This increased permeability can lead to a range of symptoms and potential health issues. “Why have we seen so many novel disease outbreaks in recent decades? SARS, Swine Flu, MERS, Ebola, Zika, and of course, COVID, have wreaked havoc in the last twenty years. Why have they mutated so quickly, become resistant to antibiotics, and why are we so vulnerable?” The answer, according to Dr. Lustig, is that we are polluting our own bodies, because the foods we eat and research suggesting their healthfulness are both polluted. Our foods are polluted not only by additives, but “subtractives” — removing valuable dietary components. Finally, the shoddy science that has polluted the medical literature by its primary sponsors, Big Pharma and the Agricultural Industrial Complex. Without overburdening this review with technical matters, let me urge our readers’ awareness of Dr. Lustig’s work — for if they aren’t, it’s likely their patients will be. Still ranked #4 in Public Health Administration and #6 in Medical Diseases Books by Amazon over two years following release, Metabolical is only one of Lustig’s many works. One of which is a cookbook based on these principles that he made public during COVID-19, and the pdf can still be found at

https://robertlustig.com/wp-content/uploads/2020/07/FatChance-Cookbook_Eat-REAL-Download.pdf. The opportunity to interview the author came about, and I explained it might be a challenge to recommend a book asking readers to develop new paradigms while rejecting old ones. He assured me that physicians recognize the dynamic nature of their continued education.

“David, let me share with you a story. My first day of med school, our ‘white coat ceremony,’ one of the most venerable clinicians in the history of medicine said to the class, ‘50 percent of what we teach you is wrong. We just don't know which 50 percent.’ Metabolical addresses that 50 percent. I hope that in figuring out that which is wrong, Metabolical can help be a guide to a different way of thinking.” David Alex Schulz is certified in HIPAA privacy and security compliance, and a contributing writer to San Antonio Medicine magazine. Metabolical, as all the books we review, is available from the San Antonio Public Library. Visit us at www.bcms.org

BCMS BOARD OF DIRECTORS

2024 BCMS Board of Directors

Ezequiel “Zeke” Silva, III, MD 2024 BCMS President

Lyssa Ochoa, MD Vice President

John Shepherd, MD President-Elect

Jennifer R. Rushton, MD Treasurer

Lubna Naeem, MD Secretary

John Joseph Nava, MD Immediate Past President

Woodson “Scott” Jones, MD First Term 2024-2026

Sumeru “Sam” G. Mehta, MD First Term 2023-2025

M. “Hamed” Reza Mizani, MD First Term 2024-2026

Priti Mody-Bailey, MD First Term 2023-2025

Dan Powell, MD Appointed to fill Term 2024-2025

Ana Rodriguez, MD Appointed to fill Term 2024

Raul Santoscoy, DO First Term 2022-2024

Lauren Tarbox, MD First Term 2022-2024

Nancy Vacca, MD First Term 2024-2026

Col. Elisa D. O’Hern, MD, MC, FS Military Representative

SAN ANTONIO MEDICINE • January 2024

BCMS BOARD OF DIRECTORS

Jayesh Shah, MD TMA Board of Trustees Representative

John Pham, DO UIW Medical School Representative

Robert Leverence, MD UT Health Medical School Representative

Ramon S. Cancino, MD Medical School Representative

Lori Kels, MD Medical School Representative

Ronald Rodriguez, MD Medical School Representative

Victoria Kohler-Webb BCMS Alliance Representative

Carolina Arias, MD Board of Ethics Representative

Melody Newsom BCMS CEO/Executive Director

George F. “Rick” Evans, Jr. General Counsel

Welcome BCMS Committee Chairs and Co-chairs 2024 Board of Ethics Carolina Arias, MD, Chair Jayesh Shah, MD, Chair Delegation to TMA Jesse Moss, MD, Chair Jayesh Shah, MD, Chair Emergency Preparedness David Marks, MD, Chair Kirby Turner, MD, Chair International Committee Jim Humphreys, MD, Chair

Leadership Development David N. Henkes, MD Legislative & Socioeconomics Jennifer Rushton, MD, Chair Joint Academic Collaboration Woodson “Scott” Jones, MD Medical Student Collaboration Adam Ratner, MD Medical-Legal Liaison David Siegel, MD

Nominating/Constitution & Bylaws Rajeev Suri, MD, Chair John Nava, MD, Co-chair

Public Health & Patient Advocacy Diane Simpson, MD, Chair Leah Jacobson, MD, Co-chair

Physician Health and Rehabilitation Alejandro Gonzalez, MD, Co-chair Matthias H. Kapturczak. MD, Co-chair

Publications To be announced Women in Medicine Amita Kumar, MD, Chair

Physician Wellness John Nava, MD, Co-chair Nora Vasquez, MD, Co-chair

Thank you for your service and leadership as you represent the Bexar County Medical Society in 2024. Visit us at www.bcms.org

BCMS ALLIANCE OFFICERS

2024 BCMS Alliance Board of Directors

Victoria Kohler-Webb President

Brittany Garcia President-Elect

Julia Halvorsen Vice President, Community Outreach Team

Thais Reichert Vice President, Membership Team

Heather Davila Vice President, Communications

Taylor Frantz Vice President, Programs/Social

Carly Friedman Treasurer

Amy Samples Secretary

SAN ANTONIO MEDICINE • January 2024

BCMS STAFF

Meet the Bexar County Medical Society Management Staff ADMINISTRATION Melody Newsom CEO/Executive Director (210) 301-4363 melody.newsom@bcms.org

PHYSICIAN ADVOCACY AND LEGISLATIVE Mary E. Nava Chief Governmental Affairs Officer (210) 301-4395 mary.nava@bcms.org

Monica Jones Chief Operating Officer (210) 301-4373 monica.jones@bcms.org

BEXAR CREDENTIALS VERIFICATION, INC. Betty Fernandez Director of Operations (210) 582-6355 betty.fernandez@bexarcv.com

Sabrae Fuentes Admin/Communications Specialist (210) 301-4391 sabrae.fuentes@bcms.org FINANCE Yvonne Nino Controller (210) 582-6343 yvonne.nino@bcms.org COMPUTER SYSTEMS Al Ortiz Chief Information Officer (210) 301-4385 al.ortiz@bcms.org MEMBERSHIP Brissa Vela Director of Membership and Special Events (210) 301-4371 brissa.vela@bcms.org Francisco Alba Membership Database and Services Specialist (210) 301-4398 Francisco.Alba@bcms.org AUTO PROGRAM Phil Hornbeak Auto Program Director (210) 301-4367 phil.hornbeak@bcms.org

Kris King Director of Software Services (210) 301-4394 kking@bexarcv.com Cindy Barron Credentialing Specialist (210) 301-4370 cindy.barron@bexarcv.com Jennifer Oliphant Credentialing Specialist (210) 301-4370 jennifer.oliphant@bexarcv.com Victoria Perez Nerio Credentialing Specialist (210) 301-4370 vicky.nerio@bexarcv.com Sandra Cadena Credentialing Specialist (210) 301-4370 sandra.cadena@bexarcv.com Lori Marie Rose Administrative Assistant (210) 301-4370 lori.rose@bexarcv.com

CIRCLE OF FRIENDS August Trevino Development Director (210) 301-4366 august.trevino@bcms.org

Visit us at www.bcms.org

Shop Vendors Who Support BCMS BCMS Vendor Directory We encourage you to use our supporting vendors whenever you or your practice needs supplies or services. ACCOUNTING FIRMS

Sol Schwartz & Associates P.C. (HHH Gold Sponsor) Sol Schwartz & Associates is the premier accounting firm for San Antonio-area medical practices and specializes in helping physicians and their management teams maximize their financial effectiveness. Jim Rice, CPA 210-384-8000, ext. 112 jprice@ssacpa.com www.ssacpa.com “Dedicated to working with physicians and physician groups.”

ASSET WEALTH MANAGEMENT

Aspect Wealth Management (★★★ Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life. Michael Clark, President 210-268-1520 mclark@aspectwealth.com www.aspectwealth.com “Your wealth. . .All aspects”

BANKING

Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community. Thomas M. Duran SVP, Private Banking Team Lead 210-283-6640 TDuran@Broadway.Bank www.broadwaybank.com “We’re here for good.”

The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the

state who specialize in medical malpractice and all lines of insurance for the medical community. Brandi Vitier 210-807-5581 brandi.vitier@thebankofsa.com www.thebankofsa.com Amegy Bank of Texas (HH Silver Sponsor) We believe that any great relationship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability. We work hard and together with our clients to accomplish great things. Robert Lindley SVP | Private Banking Team Lead 210-343-4526 Robert.Lindley@amegybank.com Denise Smith Vice President | Private Banking 210-343-4502 Denise.C.Smith@amegybank.com Scott Gonzales Assistant Vice President | Private Banking 210-343-4494 Scott.Gonzales@amegybank.com www.amegybank.com “Community banking partnership” Synergy Federal Credit Union (HH Silver Sponsor) Looking for low loan rates for mortgages and vehicles? We've got them for you. We provide a full suite of digital and traditional financial products, designed to help Physicians get the banking services they need. Synergy FCU Member Services 210-750-8333 info@synergyfcu.org www.synergyfcu.org “Once a member, always a member. Join today!”

Managing Partner 210-503-0003 kevin@genicslabs.com Artyom Vardapetyan Managing Partner 210-503-0003 www.genicslabs.com “Accurate results in record time.” Livingston Med Lab (HH Silver Sponsor) High Complexity Clia/Cola accredited Laboratory providing White Glove Customer Service. We offer a Full Diagnostic Test Menu in the fields of Hematology, Chemistry, Endocrinology, Toxicology, Infectious Disease, & Genetics. Robert Castaneda (CEO) 210-316-1792 Robert@livingstonmedlab.com www.livingstonmedlab.com/home “Trusted Innovative, Accurate, and STAT Medical Diagnostics”

CREDENTIALS VERIFICATION ORGANIZATION

Bexar Credentials Verification, Inc. (HHHH 10K Platinum Sponsor) Bexar Credentials Verification Inc. provides primary source verification of credentials data that meets The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA) standards for health care entities. Betty Fernandez Director of Operations 210-582-6355 Betty.Fernandez@bexarcv.com www.BexarCV.com “Proudly serving the medical community since 1998”

CLINICAL DIAGNOSTICS FINANCIAL ADVISORS

Genics Laboratories (HHH Gold Sponsor) Genics Laboratories offers accurate, comprehensive and reliable results to our partners and patients. Genics Laboratories is committed to continuous research, ensuring our protocols are always at the peak of current technology. Yulia Leontieva Managing Partner, Physician Liaison 210-503-0003 yulia@genicslabs.com Kevin Setanyan

SAN ANTONIO MEDICINE • January 2024

Oakwell Private Wealth Management (HHH Gold Sponsor) Oakwell Private Wealth Management is an independent financial advisory firm with a proven track record of providing tailored financial planning and wealth management services to those within the medical community. Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor 512-649-8113 SERVICE@OAKWELLPWM.COM

www.oakwellpwm.com “More Than Just Your Advisor, We're Your Wealth Management Partner” Elizabeth Olney with Edward Jones (HH Silver Sponsor) We learn your individual needs so we can develop a strategy to help you achieve your financial goals. Join the nearly 7 million investors who know. Contact me to develop an investment strategy that makes sense for you. Elizabeth Olney Financial Advisor 210-858-5880 Elizabeth.olney@edwardjones.com www.edwardjones.com/elizabeth-olney "Making Sense of Investing"

FINANCIAL SERVICES

Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life. Michael Clark, President 210-268-1520 mclark@aspectwealth.com www.aspectwealth.com “Your wealth. . .All aspects”

GERIATRICS/PRIMARY CARE

Conviva Care Center (HHH Gold Sponsor) Conviva’s value-based care model allows physicians to deliver high quality, personalized care and achieve better outcomes, while feeling free to focus on health equity and patient outcomes. Kim Gary Senior Physician Recruiter 812-272-9838 KGary4@humana.com www.ConvivaCareers.com “Fuel Your Passion & Find Your Purpose”

HOSPITALS/ HEALTHCARE FACILITIES

UT Health San Antonio MD Anderson Cancer Center (HHH Gold Sponsor) UT Health provides our region with the most comprehensive care through expert, compassionate providers treating patients in more than 140 medical specialties at locations throughout San Antonio and the Hill Country. UT Health San Antonio Physicians Regina Delgado Business Development Manager 210-450-3713 delgador4@uthscsa.edu UT Health San Antonio MD Anderson Mays Cancer Center Laura Kouba Business Development Manager 210-265-7662 norriskouba@uthscsa.edu https://uthscsa.edu/ Appointments: 210-450-1000 UT Health San Antonio 7979 Wurzbach Road San Antonio, TX 78229

HOSPITALS/ HEALTHCARE SERVICES

210-558-2520 cynthia.marshall@insperity.com Dayton Parker Business Performance Advisor 210-558-2517 dayton.parker@insperity.com www.insperity.com “Insperity’s mission is to help businesses succeed so communities prosper”

INSURANCE

TMA Insurance Trust (HHHH 10K Platinum Sponsor) TMA Insurance Trust is a full-service insurance agency offering a full line of products – some with exclusive member discounts and staffed by professional advisors with years of experience. Call today for a complimentary insurance review. It will be our privilege to serve you. Wendell England Director of Member Benefits 512-370-1776 wendell.england@tmait.org 800-880-8181 www.tmait.org “We offer BCMS members a free insurance portfolio review.”

INSURANCE/MEDICAL MALPRACTICE Equality Health (HHH Gold Sponsor) Equality Health deploys a wholeperson care model that helps independent practices adopt and deliver value-based care for diverse communities. Our model offers technology, care coordination, and hands-on support to optimize practice performance for Medicaid patients in Texas. Cristian Leos Network Development Manager 210-608-4205 cleos@equalityhealth.com www.equalityhealth.com Reimagining the New Frontier of Value-Based Care. Visit www.equalityhealth.com

HR HUMAN RESOURCES Insperity (★★Silver Sponsor) Insperity, a trusted advisor to America’s best businesses since 1986, provides an array of human resource services and technology designed to help you minimize risk and maximize profitability in your business. Cynthia Marshall Business Performance Advisor

Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) With more than 20,000 healthcare professionals in its care, Texas Medical Liability Trust (TMLT) provides malpractice insurance and related products to physicians. Our purpose is to make a positive impact on the quality of healthcare for patients by educating, protecting, and defending physicians. Patty Spann 512-425-5932 patty-spann@tmlt.org www.tmlt.org Recommended partner of the Bexar County Medical Society

The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community.

Katy Brooks, CIC 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.” MedPro Group (HH Silver Sponsor) Rated A++ by A.M. Best, MedPro Group has been offering customized insurance, claims and risk solutions to the healthcare community since 1899. Visit MedPro to learn more. Kirsten Baze, RPLU, ARM AVP Market Manager, SW Division 512-658-0262 Fax: 844-293-6355 Kirsten.Baze@medpro.com www.medpro.com

INVESTMENT ADVISORY REAL ESTATE

Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Alamo Capital Advisors is focused on Sourcing, Capitalizing, and Executing investment and development opportunities for our investment partners and providing thoughtful solutions to our advisory clients. Current projects include new development acquisitions and sales, lease representation and financial (RE)-structuring for existing investments. Jon Wiegand, Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com

MEDICAL SUPPLIES AND EQUIPMENT Henry Schein Medical (HH Silver Sponsor) From alcohol pads and bandages to EKGs and ultrasounds, we are the largest worldwide distributor of medical supplies, equipment, vaccines and pharmaceuticals serving office-based practitioners in 20 countries. Recognized as one of the world’s most ethical companies by Ethisphere. Tom Rosol 210-413-8079 tom.rosol@henryschein.com www.henryschein.com “BCMS members receive GPO discounts of 15 to 50 percent.”

PHYSICIAL SUPPORT SERVICES

Provider's Choice Scribe Services (★★★ Gold Sponsor) Our accurate and complete documentation helps our customers focus on what’s most important, their patients. Let us take on the task of documenting your patient encounters, it’s what we do. Yoceline Aguilar COO yaguilar@pcscribes.com 915-691-9178 Luis Chapa MD/CEO 210-796-4547 lchapa@pcscribes.com https://www.providerschoicess.co m/ “An Unparalleled Scribe Experience”

PRACTICE MANAGEMENT

Equality Health (★★★ Gold Sponsor) Equality Health deploys a wholeperson care model that helps independent practices adopt and deliver value-based care for diverse communities. Our model offers technology, care coordination, and hands-on support to optimize practice performance for Medicaid patients in Texas. Cristian Leos Network Development Manager 210-608-4205 cleos@equalityhealth.com www.equalityhealth.com Reimagining the New Frontier of Value-Based Care. Visit www.equalityhealth.com

PROFESSIONAL ORGANIZATIONS Healthcare Leaders of San Antonio (HH Silver Sponsor) We are dedicated to nurturing business connections and professional relationships, exchanging knowledge to enhance leadership, and creating career opportunities for healthcare and other industry leaders in a supportive community. David Neathery President 210-797-8412 healthcareleaderssa@gmail.com continued on page 42

Visit us at www.bcms.org

BCMS Vendor Directory Gary Meyn, LFACHE Vice President 210-912-0120 gmeyn@vestedbb.com https://healthcareleaderssa.com/ “Come, Learn, Connect!” The Health Cell (HH Silver Sponsor) “Our Focus is People” Our mission is to support the people who propel the healthcare and bioscience industry in San Antonio. Industry, academia, military, nonprofit, R&D, healthcare delivery, professional services and more! Kevin Barber President 210-308-7907 (Direct) kbarber@bdo.com Valerie Rogler Program Coordinator 210-904-5404 Valerie@thehealthcell.org www.thehealthcell.org “Where San Antonio’s Healthcare Leaders Meet” San Antonio Medical Group Management Association (SAMGMA) (HH Silver Sponsor) SAMGMA is a professional nonprofit association with a mission to provide educational programs and networking opportunities to medical practice managers and support charitable fundraising. Lindsey Herman Nolan, MHR, CMPE President info4@samgma.org www.samgma.org

REAL ESTATE SERVICES COMMERCIAL

Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) Alamo Capital Advisors is focused on Sourcing, Capitalizing, and Executing investment and development opportunities for our investment partners and providing thoughtful solutions to our advisory clients. Current projects include new development acquisitions and sales, lease representation and financial (RE)-structuring for existing investments. Jon Wiegand Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com

RETIREMENT PLANNING

Oakwell Private Wealth Management (★★★ Gold Sponsor) Oakwell Private Wealth Management is an independent financial advisory firm with a proven track record of providing tailored financial planning and wealth management services to those within the medical community. Brian T. Boswell, CFP®, QKA Senior Private Wealth Advisor 512-649-8113 SERVICE@OAKWELLPWM.COM www.oakwellpwm.com “More Than Just Your Advisor, We're Your Wealth Management Partner”

STAFFING SERVICES

Favorite Healthcare Staffing (HHHH 10K Platinum Sponsor) Serving the Texas healthcare community since 1981, Favorite Healthcare Staffing is proud to be the exclusive provider of staffing services for the BCMS. In addition to traditional staffing solutions, Favorite offers a comprehensive range of staffing services to help members improve cost control, increase efficiency and protect their revenue cycle. Mike DeQuattro Director of Operations - Texas & New Mexico 210-918-8737 Mike.DeQuattro@ favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”

SAN ANTONIO MEDICINE • January 2024

continued from page 41

TRANSCRIPTION SERVICES

Provider's Choice Scribe Services (★★★ Gold Sponsor) Our accurate and complete documentation helps our customers focus on what’s most important, their patients. Let us take on the task of documenting your patient encounters, it’s what we do. Yoceline Aguilar COO yaguilar@pcscribes.com 915-691-9178 Luis Chapa MD/CEO 210-796-4547 lchapa@pcscribes.com www.providerschoicess.com/ “An Unparalleled Scribe Experience”

Visit us at www.bcms.org

AUTO REVIEW

BMW i5

Acura ZDX

2024 Cars & Trucks to Watch By Stephen Schutz, MD

Toyota Land Cruiser

Volkswagen ID. Buzz

Tesla Cybertruck

Lucid Gravity

Ford Mustang

Hyundai Santa Fe

SAN ANTONIO MEDICINE • January 2024

AUTO REVIEW

It’s time for my every-now-and-then rundown of new cars and trucks that I think will be of interest to BCMS members. As has been the case for the past 10 years or so, battery electric vehicles (BEVs) are increasingly “the future,” but the internal combustion engine isn’t going away, mostly because the current BEV state-of-the-art isn’t where it needs to be yet. Once a BEV can go 400 miles on a charge regardless of the ambient temperature, and fully charge in 10 minutes or less, electric vehicles will be mainstream. They’ll get there, probably soon, but they’re not there yet. Anyway, here’s my list of 2024 vehicles that you should pay attention to. Acura ZDX: Ten years ago the weird Gen 1 ZDX was dropped by Acura with almost no one noticing. Soon Honda’s luxury arm will launch the ZDX Gen 2, a conventional looking SUV with an all-electric powertrain (think BEV MDX). Will it succeed? It can’t do worse than the previous ZDX. Cadillac Celestiq: Featuring either an ultra-modern or ugly exterior design depending on your point of view, the upcoming BEV Cadillac flagship promises a beautiful interior and premium buying experience that’s meant to rival Bentley. Even base models will offer 300mi range, 600HP, a full-glass roof with variable opacity, and GM’s best Super Cruise autonomous driving system. It’ll be expensive though, with an expected starting price of around $340,000.

same impact on the Toyota Rav4/Honda CRV market as the Palisade did on the Toyota Highlander/Honda Pilot market. Toyota Land Cruiser: I’ve said since 2008 (along with many others) that the last generation Land Cruiser was too big, and Toyota listened. The 2024 LC is on the same platform as the 4Runner, and it looks like a winner with a tough-guy design and serious off-road ability. The legend continues. Volvo EX30: A cool compact BEV from Volvo with an enticing $35,000 starting price that will appeal to young singles and couples who want to help the environmental cause. BMW i5: Basically a BEV version of the venerable 5-series, the i5 gets you lots of BMW goodness in an all-electric package. Families will probably prefer the BEV iX SUV, but many others will appreciate an electric car that’s designed to drive like a BMW. Lucid Gravity: Finally a Lucid SUV! The Saudi-funded BEV company started life with the Air, a luxury BEV sedan that cost around $120,000. Good looking car, but it didn’t sell. Enter the Gravity, a luxury SUV with 440 miles of range, 7-seats, and a starting price of under $100,000. Lucid and Saudi Arabia hope you like it. Lexus GX: The new mid-size Lexus SUV gets a major update with a much better looking exterior and 346HP turbo V6 powertrain. The last version had a V8 but looked completely bland. Thank you, Lexus for replacing it with an SUV with better emissions and more personality.

BMW M5 wagon: BMW must have hated watching the Mercedes E63S and Audi RS6 “hyper wagons” get showered with kudos from the automotive press because they’ve responded with a station wagon version of their delicious M5 sedan. A 600HP turbocharged V8 AWD soccer mom-mobile? Yes please!

Volkswagen ID. Buzz: Volkswagen has been teasing us with “coming soon” modern VW Microbuses since forever. Finally, we’re going to get one with the BEV ID. Buzz. It’s all electric and looks sensational. I hope it sells.

Ford Mustang: Yes it’s, “just a refresh,” but I’m going to play this up because this is likely the last ICE pony car ever now that the Chevrolet Camaro and Dodge Challenger are dead. The base engine is a 330HP turbo-4, the GT’s V8 has 450, and a 500HP Coyote V8 powers the Dark Horse track version. And the manual lives on! For driving enthusiasts, the Mustang is as good as it gets.

Porsche 911: The 992.2 gen 911 launches soon, and the good news is that Porsche wants it to be more available. While the fact that supply chain problems have been mostly fixed means that it will be, and Porsche has decided to bump the pricing significantly. Bummer. It’s still the car that successful BCMS members want, so deal with it, I guess.

Tesla Cybertruck: I’ve read about the clever bed that can haul or store almost anything and the impressive specs, but I can’t get past the cartoon-ish design that says to me (and probably most Texans), “Tesla’s not serious about pickup trucks.”

As always, call Phil Hornbeak, the Auto Program Manager at BCMS (210-301-4367) for your best deal on any new car or truck brand. Phil can also connect you to preferred financing and lease rates.

Hyundai Santa Fe: Hyundai’s Rav4 competitor has always been a just OK wannabe until now. Wow, Hyundai surprised everyone with a new Santa Fe that brings the action with a Land Cruiser/Land Rover Defender vibe and extra off-road chops. Expect this SUV to have the

Stephen Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the U.S. Air Force. He has been writing auto reviews for San Antonio Medicine magazine since 1995. Visit us at www.bcms.org

Kahlig Auto Group

11911 IH 10 West San Antonio, TX 78230

Audi Dominion 21105 West IH 10 San Antonio, TX 78257

Northside Chevrolet 9400 San Pedro Ave. San Antonio, TX 78216

Coby Allen 210-696-2232

Anthony Garcia 210-681-3399

Domingo Saenz 210-341-3311

Chuck Nash Chevrolet Buick GMC 3209 North Interstate 35 San Marcos, TX

Bluebonnet Chrysler Dodge Ram 547 S. Seguin Ave. New Braunfels, TX 78130

William Boyd 210-859-2719

Matthew C. Fraser 830-606-3463 Kahlig Auto Group

Northside Ford 12300 San Pedro San Antonio, TX

Northside Honda 9100 San Pedro Ave. San Antonio, TX 78216

14610 IH 10 West San Antonio, TX 78249

Land Rover San Antonio 13660 IH 10 West San Antonio, TX

North Park Lexus 611 Lockhill Selma San Antonio, TX

Marty Martinez 210-477-3472

Jaime Anteola 210-744-6198

Tim Rivers 832-428-9507

Cameron Tang 210-561-4900

Jose Contreras 320-308-8900

Kahlig Auto Group

North Park Lexus at Dominion 25131 IH 10 W Dominion San Antonio, TX

North Park Lincoln 9207 San Pedro San Antonio, TX

Mercedes Benz of Boerne 31445 IH 10 West Boerne, TX

Mercedes Benz of San Antonio 9600 San Pedro San Antonio, TX

9455 IH 10 West San Antonio, TX 78230

James Cole 210-816-6000

Sandy Small 210-341-8841

James Godkin 830-981-6000

Chris Martinez 210-366-9600

Kahlig Auto Group

North Park Subaru 9807 San Pedro San Antonio, TX 78216

North Park Subaru at Dominion 21415 IH 10 West San Antonio, TX 78257

Cavender Toyota 5730 NW Loop 410 San Antonio, TX

North Park Toyota 10703 Southwest Loop 410 San Antonio, TX 78211

Raymond Rangel 210-308-0200

Phil Larson 877-356-0476

Spencer Herrera 210-581-0474

Justin Boone 210-635-5000

Kahlig Auto Group

As of November 1, 2023, our loan rate will be

5.5% for 60 months with approved credit.

Call Phil Hornbeak 210-301-4367 or email phil@bcms.org

Jordan Trevino 210-764-6945