San Antonio Medicine February 2022 by Traveling Blender

NON PROFIT ORG US POSTAGE

PAID

SAN ANTONIO, TX PERMIT 1001

MILITARY MEDICINE S A N A N TO N I O

SAN ANTONIO

TA B L E O F C O N T E N T S

THE OFFICIAL PUBLICATION OF THE BEXAR COUNTY MEDICAL SOCIETY

•

WWW.BCMS.ORG

•

$4.00

•

FEBRUARY 2022

MILITARY MEDICINE 5@

, 4 2 5

VOLUME 75 NO.2

San Antonio M edicine is the officialpublication of Bexar C ounty M edicalSociety (BC M S). Allexpr /essions 3 2of opi 5nions/ and 4stat 1em,ent 4s 0of5sup3 2 5 ! 4 posed fact . < 5s are published on the authority ofthe w riter,and cannotbe regarded as expressing the 5ew3s 2 5 ! . Adver 2 5 ti# 1 s /do2not 3 i/ vi of BC M S. sem2ent m ply @ 2 ,shi 6p @ 2 endor 1 . sem 6 @ 6 @ + . 0 sponsor ofor ent2by BC.M S.

# * 5 . 2 ( 5 ! . 2 5 # 2 1 / 2 3 / 5 0 @ @ @ 0 > ( < 8 ? 9 5::::@ ::::: >::::::::@ ::::: 8:::: 3::::?::::@ ::::: !:::::::::/ ::::: @ $ @ @ / 0 - ( 4 2 / 2 4 ( 5 % 05 2 5 . 0 4 @ @ @ 1 5 @ 7 - > 8 3 5 @ : @ / % 7 8:::; :::: @6 @ , 4 5 / 0 - ( 5 / " 5 5’ 4 0 . 0 3 + 5 EDITORIAL * 4 ( 3 CORRESPONDENCE: + 3 2 4 5 15 55 @ 8 : @ 0 > 4 @ # ; 9 > = @ @? 4 4 5 6 @ 2 ,C ount 6 @y # ; cal 5 ? 9 et 3y @ / 3 ; 3 6 @ 2 , Bexar M edi Soci @ @ @ ; < 4 @ ::::::::::@::::::::: >::::4::::::::: 6:::: @::::#::::< :::::::::@::::2 ::::, @ 4334 N Loop 1604 W ,Ste.200 @ 1 5 / 5 3 & 55 * ,. 4 5 4 &- - / 0)515 .! 2San 1 +/Ant 40oni 5’ o, /5TX " 78249 5 4 . & 5 5 5 ! % / 0 1 5 / 2 5 15 , 4 5 / . ( 5 1 Em / ai 5l:edi 4tor+@ bcm / s.or 4 g0 ’ 5 5 +5 <5 > - @ 8 3 ? @ 0 , 0 9 @ ; 8 7 @> = ; 4 @ 0 ? = 8ADDRESS ? < @ CHANGES: > < @ = ( < 5 @ ’ MAGAZINE @ @ @ ; = * ::::: @::::0::::> ::::: =::::8::::< ::::: >::::4:::::::::::::::::::::::::::::::::::::: @ 0 ; 4 4 @ & @ @ $ $ @ > @ - ; 7 4 @ - ? ? @ < 9 3 7 ) 3 , 1 5 4 . 0 ) 5 / " 5 & . + 51 5 # 2 5 4 0 3 4 5 / " 5 1 , 4 5 * 3 SUBSCRIPTION RATES: 5 5 5 4 . - 51 , 5 2 ) 1 3 1 % 1 4 $30.per 5 15 55 @ 1 5 < > = @ ? ( < = 6 @@::2 ::::: ,::::6::::@ :$ !@ / + year @ 2or;$4 per > indi < vi @duali?ssue = ? < ; 4 @ ? @ 0 . % & . 5 . 0 4 5 3 2 5 5 * 3 - 3 1 . 0 ’ 5 ADVERTISING * 4 ( 3 +CORRESPONDENCE: 3 2 4 Loui 5 15 55 @ / ( 9 ; = = ; 3 @ : @ @:::: 7::::)::::3 ::::: >::::4::::9 :$ >@ $= 6 s@D oucet 2 , te, 6 Pr @ esi 2 dent / 6 @ + . 0 / @ Traveling Blender,LLC . # 0 1 , 0 3 1 3 ) 5 #+ &< /> 2- @ 58 @:::: 3::4::?::1 ::@ ::: 4:: 0::0::,::. ::0 ::$ 2 5) A5Publ 5 ication M anagem entFirm @ % 1 % 0 4 5 - . 2 ) 5 3 2 5 1 , 45 5 * 3 - 3 10036 1 . 0Saxet ’ 5,Boer # "ne, 1 TX 4 78006 0 5 4 + / & 3 2 5 w w w .travelingblender.com ) 1 4 / . 1 , 53 + 5 , ’ ) 3 + 3 . 2 5 15 55 @ # > 3 = ; 8 3 > = @@::,::::::::: @::::::::;::::< ::::: <::::7::::9 :$ 65 @ & advert @ !es/and . +inform ation For isi6 ng@rat @ C al l ( 210) 4100014 3 1 5 ) @ 5 0 > 4 ’ : 5 @ 5 # ; - ? 9 @ ? = *@:::? ::::: <::::9::::> ::::: =:::: @::::::::::::: 6::::@::::2 ::::: ,::::6::::@ ::::: !::::/::::. ::::$ + @@ 2 0 6 @ ? 8 :

Em ail:louis@ travelingblender.com

4 " - 4 + 1 3 / 2 ) 5 / 2 5 * 3 - 3 1 . 0 ’ 5 * 4 ( 35 + 3 2 4 5 0 / & 5 . 5 / % 0 1 , 5 15 55 @ 0 3 < 7 9 8 7 ; = @@:: 1:::::::::@ ::::::::: ?::::4 ::::4 ::::: 9::::6::::@ ::::: &::::@:::::::::::::@::::! ::::: /::::@::::. ::::: <::::-::::5 :::::::::::::::::::::::::::$ @ @ 1 0 2 / @ ’ < ? 9 7 *::::? ::::: =::::8::::::::: 9::::@::::2 ::::: ?::::9::::9 ::::: ;::::"::::?::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: @ 1 0 2 / @ . 4 4 7 ; = ) ? @::::’ ::::: <::::?::::9 ::::: 7::::*::::? ::::: =::::8::::::::: 9::::@::::2::::? :::::9::::9::::; ::::: "::::?:::::::::::::::::::::::::::::::::::::::::::::::: @ 3 ? @ 0 3 ; 4 4 ? = " ? 9 @ ’ < > 8 ? ) 8 @ ; = * @

> - ? = @ + ; ) ? * @ 8 > @ 1 <:::?::::; :::::::::@::::7 ::::: =::::8::::> ::::: @::::2::::?::::: *& 7@

< > % @

> ( < @ 2 > = ? 5 @ % 7 8 3 @ / ::::: ?::::<::::7 ::::: ?::::9::::@ :::::::::@::::/::::: ;$ @

’ 3 5 9 7 ) 7 ; = 9 @ ’::: (::::<::::) ::::: 3::::;::::9 ::::: 7::::=::::" ::::: @::::,::::7::::: <::::?::::)::::8 :::::>::::<::::5 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::$ @& . ( 8 > @

7 ? %

@ &

& & @ + > <::: *::::@::::1::::: <::::>::::=::::) :::::>::::@::::1 ::::: 5::::@::::/ ::::: 8::::?::::::::: 3::::?::::= ::::: @::::/::::)::::: 3$ (@

? ) > - - ? = * ? * ::@ ::::: .::::(::::8 ::::: >::::@::::, ::::: ?::::;::::4 ::::: ?::::<::::9:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::$ @

PUBLISHED BY: Traveling Blender,LLC. 10036 Saxet Boerne,TX 78006 PUBLISHER LouisDoucette louis@travelingblender.com BUSINESS MANAGER: VickiSchroder vicki@travelingblender.com ADVERTISING SALES: AUSTIN: SandyW eatherford sandy@travelingblender.com

•

SAN ANTONIO: M adeleineJustice m adeleine@travelingblender.com GerryLair gerrylair@yahoo.com PROJECT COORDINATOR: Am andaCanty am anda@sm ithprint.net

Form oreinform ation on advertising in San Antonio M edicine, CallTraveling Blenderat 210.410.0014 in San Antonio and 512.385.4663 in Austin.

SAN ANTONIO MEDICINE • February 2022

4 . 0 5 * 4 ( 3 + . - 5 ! 1 %

SAN ANTONIO MEDICINE ispublished bySmithPrint,Inc.(Publisher) on behalfoftheBexarCountyMedicalSociety(BCMS).Reproduction in any m annerin whole orpartis prohibited withoutthe express written consentofBexarCountyMedicalSociety.Materialcontained herein doesnotnecessarilyreflecttheopinion ofBCMS,itsmembers, oritsstaff.SAN ANTONIO MEDICINEthePublisherand BCMSreserves the rightto editallmaterialforclarityand space and assumesno re,error ions.San?Ant edic= ine > % 9 )spons 7 ibi =lity?forac @cur 1acy5 @sor # om;iss7 @oni’o M ; doesnotknowinglyacceptfalseormisleading advertisementsoredihe Publ 7torial = nor " does 9 t@ 1 i>sher=orBCM * 9S as@sume 1 res 5pons @ ibi 1lity<shoul 7d ; = @ such advertising oreditorialappear.Articlesand photosarewelcome andmaybesubmittedtoourofficetobeusedsubjecttothediscretion and review ofthe Publisherand BCM S.Allrealestate advertising is subjecttotheFederalFairHousingActof1968,which makesitillegal 8 6 @ 2 , toadvertise“anypreferencelimitationordiscriminationbasedonrace, color,religion,sex,handicap,familialstatusornationalorgin,oranintention tomakesuch preferencelimitation ordiscrimination.

Sm ithPrint,Inc.isa fam ily owned and operated San Antonio based printing and publishing com pany thathasbeen in businesssince 1995. W e are specialistsin turn-keyoperationsand offerourclientsa wide varietyofcapabilitiesto ensure theirprojectsare printed and delivered on schedule while consistentlyexceeding theirqualityexpectations.W ebring thisworkethicand com m itm enttocustom ersalong with ourpersonalserviceand attention toourclients’printing and m arketing needstoSanAntonioM edicinem agazinewith each issue.

BCMS BOARD OF DIRECTORS

ELECTED OFFICERS RajeevSuri,M D,President BrentW.Sanderlin,DO,VicePresident Ezequiel“Zeke”SilvaIII,M D,Treasurer AliceGong,M D,Secretary John J.Nava,M D,President-elect Rodolfo“Rudy’M olina,M D,ImmediatePastPresident

DIRECTORS VincentFonseca,M D,M PH,Member W oodson "Scott"Jones,M D,Member LubnaNaeem ,M D,Member LyssaN.Ochoa,M D,Member JenniferR.Rushton,M D,Member RaulSantoscoy,DO,Member John Shepherd,M D,Member Am arSunkari,M D,Member LaurenTarbox,Member Col.Tim Switaj,M D,MilitaryRepresentative M anuelM .QuinonesJr.,M D,BoardofEthicsChair GeorgeF.“Rick”Evans,GeneralCounsel Jayesh B.Shah,M D,TMABoardofTrustees M elodyNewsom ,CEO/ExecutiveDirector TaylorFrantz,AllianceRepresentative Ram on S.Cancino,M D,MedicalSchoolRepresentative LoriKels,M D,MedicalSchoolRepresentative

SAN ANTONIO MEDICINE • February 2022

Ronald Rodriguez,M D,PhD, MedicalSchoolRepresentative CarlosAlbertoRosende,M D, MedicalSchoolRepresentative

BCM S SENIOR STAFF M elodyNewsom ,CEO/ExecutiveDirector M onicaJones,ChiefOperating Officer YvonneNino,Controller M aryNava,ChiefGovernm entAffairsOfficer BrissaVela,M em bership Director PhilHornbeak,AutoProgram Director AugustTrevino,Developm entDirector BettyFernandez,BCVIDirector AlOrtiz,ChiefInform ation Officer

PUBLICATIONS COM M ITTEE John Joseph Seidenfeld,M D,Chair KristyYvonneKosub,M D,Member LouisDoucette,Consultant Alan Preston,CommunityMember Rajam S.Ram am urthy,M D,Member Adam V.Ratner,M D,Member David Schulz,CommunityMember TaylorSullivan,DO,Member FarazYousefian,DO,Member NealM eritz,M D,Member Jaim ePankowsky,M D,Member W inonaGbedey,StudentMember CaraJ.Schachter,StudentMember NivaShrestha,StudentMember DanielleM oody,Editor

PRESIDENT’S MESSAGE

Military Medicine and COVID-19 By Rajeev Suri, MD, MBA, FACR, FSIR, FCIRSE, 2022 BCMS President

In the current era of COVID-19 and the SARS-CoV-2 variants that change almost every 3-4 months (most recent being Omicron B.1.1.529 and Delta B.1.617.2), scientific breakthroughs can often get lost in a deluge of the significant body of literature. One such article was the announcement from the Walter Reed Army Institute of Research about the creation of a vaccine that effectively fights all forms of COVID-19, including the new Omicron variant. In human trials so far, the vaccine known as Spike Ferritin Nanoparticle (SpFN) COVID-19 vaccine has shown effectiveness not only against COVID-19, but also against previous SARS viruses. In this ever-continuing battle against COVID-19, military medicine has delivered yet again by looking at the long game, from the original emergence of SARS to planning ahead for future variants. There are still two more human trial phases before a broader clinical rollout, but the future looks bright, as SpFN will soon join a list of approved vaccines and post-exposure treatment options. COVID-19 has fast-tracked innovation in the Military Health System (MHS) and many of these have already helped the civilian world. MHS has been a leader in virtual health — using secure, accessible and compliant technology. Lessons learned from MHS helped us maintain the continuity of care for our patients through telehealth services when our health care delivery systems were overwhelmed in the earlier part of the pandemic. Another role of MHS has been its active involvement with drug development and clinical trials — including the intramuscular long-acting antibody AZD7442 (Evusheld from AstraZeneca) to prevent COVID-19 among people who have been exposed to the disease (STORM CHASER Trial). In addition, over the last two years of the pandemic, military medical personnel have been deployed in large numbers to assist hospitals and health care facilities. This has become even more prominent now as civilian health care staff shortages mount and hospitalizations rise due to the Omicron variant, while hospitals are still battling the effects of the Delta variant. During the first surge in March 2020, the Army Corps of Engineers set up field hospitals in several cities to handle the overflow of coronavirus cases, and had hospital ships Comfort and Mercy available in New York and Los Angeles. Military medicine succeeds because of its culture of promoting innovations in treatment, in improving health care delivery and expanding access. As is evident from the recent pandemic, despite tremendous strides in public health, control of infectious diseases and preventive medicine during the past century, infectious diseases remain a substantial threat to populations and to the military. In 1893, Army Surgeon General George M. Sternberg established the Army Medical School, now the Walter Reed Army Institute of Research, which has since served as a center of the Army’s medical research efforts on infectious diseases like typhoid fever, yellow fever, malaria and dengue to name a few. It is befitting that the Walter Reed Army Institute of Research continues even now as the bastion for military medicine’s innovations against this newest pandemic. Rajeev Suri, MD, MBA, FACR, FSIR, FCIRSE is the 2022 President of the Bexar County Medical Society, Tenured Professor and Vice Chair of the Department Radiology at UT Health San Antonio, and Chief of Staff at University Hospital San Antonio. 8

SAN ANTONIO MEDICINE • February 2022

BCMS ALLIANCE

Military City By Jenny Case, MSN, MBA, RN

Military medicine has had a profound impact in shaping the person I grew to be. My dad, uncle and grandfather were all Army physicians and my mother was an Army medivac pilot. When I was young, the military allowed my family to live and explore Washington D.C., Germany and Hawaii all before calling San Antonio home. Everyone remembers where they were on September 11, 2001. I was in 7th grade on Fort Sam Houston. Over the next few months my father, an Army orthopedic surgeon, along with multiple friends’ parents were deployed overseas. Brook Army Medical Center (BAMC) was one of the Army’s major medical centers and began treating a growing number of Wounded Warriors that were being evacuated from overseas. Amputees and burn patients soon became more common in the San Antonio community as they were being treated for their injuries at Fort Sam Houston. With an increase in need for rehabilitation for these injured soldiers, my father was put in charge of opening the Center for the Intrepid, a state-of-the-art rehabilitation center for Wounded Warriors. A few years later when it came time for me to decide what I wanted to do with my life, I was drawn to what I grew up around, military medicine. I decided to continue on with our family’s tradition of service and joined ROTC at TCU with the goal of becoming an Army Nurse. My now husband finished his medical school in El Paso on an Army scholarship as I started on my first job as a medical-surgical nurse at Fort Bliss. While the military was training us to be experts in our respective medical fields, we were also expected to be soldiers and officers. The leadership that the military expects from all of their soldiers, to include nurses and physicians, is what sets up these professionals to flourish when they become civilians. With my husband starting his pediatric residency back at BAMC, I was able to transfer to San Antonio and began to work on the Wounded Warrior floor where my dad had spent a majority of his time. After five years in service, I left the Army and started graduate school and raising our daughters. When my husband was deployed for nine months with a Cavalry unit, it was inspiring to watch him pivot from his training as a pediatrician to taking on the role of Battalion Surgeon for almost a year − pushing his medical expertise and continuously learning while taking care of soldiers. I spent the first 32 years of my life in the military health care system, so entering civilian life for the first time was nerve-racking to say the least. Fortunately, San Antonio is known as Military City with good reason. As the backbone to the military medical effort over the last 20 years, the city has always embraced and thrived alongside its military community. This is the reason you would be hard-pressed to find a hospital in San Antonio without former military members on their staff. While I was sad to leave the military community, I am ecstatic to continue to work in Military City and enhance our medical community for the better. Jenny Case, MSN, MBA, RN is the President-elect of the BCMS Alliance.

SAN ANTONIO MEDICINE • February 2022

MILITARY MEDICINE

BAMC and San Antonio: GROWING TOGETHER IN SERVICE Courtesy of the U.S. Army

an Antonio’s military medicine heritage began in 1803 when 100 Spanish troops and their families converted the Alamo to a barracks and devoted the building’s second story to a military hospital — the first hospital in Texas. The U.S. Army first arrived in 1845 and the unit was accompanied by a surgeon who likely set up shop in a tent near the troops at the Alamo. The Confederacy also operated a hospital there, whereabouts uncertain. But it wasn’t until 1870 that the first stand-alone hospital facility used by the U.S. Army was established south of Commerce Street in a large private residence across from where the River Center stands today. San Antonio donated 92 acres north of Downtown in 1876, and the garrison set up a temporary clinic there, replaced by a permanent medical facility on Staff Post Road. This 12-bed clinic was the modest seed from which sprung the United States Army's premier 12

SAN ANTONIO MEDICINE • February 2022

medical institution, Brooke Army Medical Center (BAMC). BAMC is now the Department of Defense's largest facility and its only Level 1 Trauma Center, healing sustained injuries anywhere in the world. Its progress as a premier health care center is the story of America’s wartime involvements and the need to safeguard and heal our warriors. The Spanish-American War (1898), led to the expansion of Fort Sam Houston to become a Brigade Post, Cavalry Post and Light Artillery Post − the largest Army post in the country. Supporting the increased garrison, Station Hospital opened in 1908 with 84 beds. It was expanded to 152 beds two years later and a few years after, an isolation ward and a maternity ward were added to Station Hospital. 1908 also saw the opening of a Veterinary Hospital. The largest Army post, Fort Sam was a center for cavalry with more than 1,500 horses stationed.

MILITARY MEDICINE Photography by Jason W. Edwards

World War 1 saw the founding of the Army Veterinary Corps as an integral component of the Army Medical Department, continuing to distinguish itself within the veterinary profession. The First World War saw a 50,000 soldier-capacity base, called Camp Travis, requiring a Base Hospital with more than 4,000 beds. Spread over 61 buildings, 34 wards were joined by isolation wards, a laboratory, operating room, medical detachment barracks, nurses’ quarters, a chapel, kitchens and dining rooms to support nearly 1,000 staff. Armistice Day heralded the absorption of Camp Travis by Fort Sam Houston. By 1927, the Base Hospital was razed, clearing the way for the new Station Hospital, construction beginning in 1936 and completed the next year with a 418-bed capacity. The Station Hospital was upgraded to a General Hospital after the outbreak of WWII, and in 1942 renamed for Brigadier General Roger Brooke, commander of the Station Hospital from 1929-33. Brooke General Hospital expanded during the war by converting barracks to hospital wards, building a psychiatric ward in the Old Station Hospital area and eventually converting the 15th Field Artillery Barracks into Annex IV, increasing capacity to 7,800 beds. The war demonstrated the critical nature of centralizing medical facilities. After its cessation, the Medical Field Service School relocated to San Antonio and all the medical entities reorganized and designated BAMC. These changes ushered in the modern era of military medicine. “I would say it was that medical center of gravity to which we an-

chored ourselves throughout the end of World War II, Korea and Vietnam,” said BAMC’s former commander, Col. (Dr.) Evan Renz, now deputy to the commander for quality and safety. “So, you had three major historic wartime periods in our country that were linked to that base, that medical hub.” BAMC eventually sprawled into 59 buildings, most adapted to the purpose rather than designed for it. Ground was broken for a new Medical Center in 1987 and it was dedicated in 1996. Today it provides both inpatient and outpatient services to approximately 8,500 staff members, including active-duty military personnel from each of our uniformed services, Public Health personnel, federal civilians, contract employees and volunteers. The medical center provides safe, quality, evidence-based care for up to 483 military and civilian inpatients. As the sole verified Level I Trauma Center within the Department of Defense (DOD), BAMC simultaneously provides emergency services during 80,000 Emergency Department visits annually and serves as the premier medical readiness training platform for both the Army and the Air Force. BAMC providers also care for more than 4,000 patients each day during visits to its six separate outpatient clinics. Prominent on the hospital campus, and surrounded by four Fisher Houses, the four-story Center for the Intrepid (CFI) stands as a preeminent extremity injury rehabilitation center. 40 of the hospital’s beds are designated for the U.S. Army Institute for Surgical Research (USAISR) Burn Center. The verified Burn Center serves alongside the Level I Trauma Center to provide emergency services for residents from 22 separate counties in South Texas. BAMC facilities provide comprehensive care for nearly a quarter million military beneficiaries living throughout the area. The old building bore an inscription, “Dedicated not to Us, but solely to the Health of Mankind.” As a field leader in treatment of trauma, burn, PTSD and infectious diseases, the sign may be gone but the mission is ever-present. Visit us at www.bcms.org

MILITARY MEDICINE

World-Renowned Burn Care IN SAN ANTONIO By Timothy L. Switaj, MD, MBA, MHA, FACHE, FAAFP

id you know there is an internationally renowned burn center here in San Antonio? In the wake of World War II, the United States Army determined that burn injuries would be of great concern in future conflicts. The atomic detonation at Hiroshima instantly created 59,500 burn casualties with an equal number estimated at Nagasaki, while the Soviet detonation of an atomic bomb in 1949 raised the specter of nuclear war. At the time, the science and practice of burn care were rudimentary and mortality was high. The U.S. Army Institute of Surgical Research (ISR) had been established in 1947 to study wound infections. In 1949, the ISR’s focus turned to the treatment of burns, and it became the second dedicated burn center in the U.S. Today, the ISR’s mission is “Optimizing Combat Casualty Care” − to include the relentless pursuit of excellence in the care of burn patients. The ISR Burn Center is physically located at Brooke Army Medical Center (BAMC) in San Antonio, and consists of an outpatient clinic, progressive care unit (24 beds), intensive care unit (16 beds), two operating rooms and two rehabilitation gyms. It occupies 103,661 sq. ft., all tailored and dedicated to the care of burn patients. It is one of only 70 burn centers in the world (four in the state of Texas) that are verified by the American Burn Association. It serves as the regional burn center for civilians in South Texas, while also supporting U.S. military personnel, their families and U.S. veterans from around the world. Since the 1940s, through the advancement of the science in managing burn casualties, mortality from burns has been cut in half. On average, the ISR Burn Center annually admits 450 burn patients and 100

SAN ANTONIO MEDICINE • February 2022

patients with burn-like necrotizing infections or skin diseases, and performs 1,000 surgeries. The ISR Burn Center also fields the only U.S. Army Burn Flight Team to transport severe burn patients from anywhere in the world. Since 2003, the Burn Flight Team has conducted 100 overseas missions (mainly for the aeromedical evacuation of combat casualties from the recent wars in the Middle East). It stands ready to deploy worldwide within hours. The ISR Burn Center staff takes a multidisciplinary approach to the care of all patients through the entire spectrum of injury. All staff are fully dedicated to the Burn Center and specially trained to care for burn patients. This includes the physicians, nurses, technicians, physical and occupational therapists, nutritionists and many others. They specialize in novel treatment modalities such as high-frequency ventilation, continuous renal replacement therapy and extracorporeal

MILITARY MEDICINE

wars in Iraq, Afghanistan and Syria. The burn team has worked with a multitude of nations on burn care, training and disaster response. Most notable was a collaboration with the Soviet Union in the midst of the Cold War, following the 1989 Bashkirian pipeline explosion. The ISR Burn Center is a unique resource, as it is the only one of its kind in the U.S. military. It is fully dedicated to the care of burn casualties, to training in burn care and to advancing the science of burn care to decrease mortality and morbidity. The staff are fully committed to supporting not only the military, but also the civilian community of South Texas and beyond. We are blessed in San Antonio to have this exceptional resource readily available for all to access and use. membrane oxygenation. The staff of the Burn Center provide not only acute intervention and management for burn casualties, but also psychotherapy, rehabilitation, reconstructive surgery and long-term follow-up to mitigate the sequelae of injury. The patients of the ISR Burn Center have the highest acuity level of the Military Health System. As such, the ISR Burn Center is a significant training site for combat medics, nursing students, alliedhealth professionals, medical students and graduate physicians-in-training (interns, residents and fellows). Additionally, they offer training for civilian health care personnel in the South Texas region in emergency burn care, to include the Advanced Burn Life Support (ABLS) course. A full-time outreach coordinator, Brent Sabatino RN, supports these efforts. ISR Burn Center staff are incredibly proud of the work they do and of their role during major incidents in the U.S. and abroad. Some of the high-profile emergencies which they supported include the 1983 Beirut bombing, the failed Iran hostage rescue mission of 1980 and the 1994 disaster at Pope Air Force Base in North Carolina. They have taken care of combat casualties from every U.S. military action since the Korean War, including the Vietnam War, Operation Just Cause in Panama, Operation Desert Shield (the first Gulf war) and the recent

Acknowledgements: Many thanks to Dr. Leopoldo Cancio, Director of the Burn Center, for his review and edits to the manuscript and to Mr. Steven Galvan for the background information on the burn center and the photos. Points-of-contact for further information on the Burn Center at BAMC include: Mr. Steven Galvan at 210-739-4416 or steven.galvan2.civ@mail.mil and Dr. Anthony Basel at 410-924-8330 or anthony.p.basel.mil@mail.mil. Timothy L. Switaj, MD, MBA, MHA, FACHE, FAAFP is a board-certified Family Medicine Physician currently serving on Active Duty in the U.S. Army at the rank of Colonel. He is the Chief Medical Officer and Director of Clinical Operations for the newly established San Antonio Market under the Defense Health Agency. Dr. Switaj is the Military Representative on the Board of Directors of the Bexar County Medical Society.

Visit us at www.bcms.org

MILITARY MEDICINE

The World of Hyperbaric Medicine By Lt. Col. Jason Kelly, MD, Jayesh Shah, MD and Earl G. Wolf, Jr. MD

resident Kennedy dedicated the Aerospace Medical Health Center (AMHC) in San Antonio on December 21, 1963. Decompression illness (DCI) in military divers resulted in the use of hyperbaric pressure treatment protocols developed by the military in the early 1900s. However, it was not recognized as an etiology of DCI at altitude as aircrew returned to ground level. In the 1950s, high altitude conditions resulted in reconnaissance aircraft as well as altitude chamber research for space efforts that had deaths. A case of neurocirculatory collapse DCI was treated with hyperbaric oxygen therapy (HBO2) with success. This resulted in adding a large hyperbaric chamber to treat DCI cases at USAF School of Aerospace Medicine as part of AMHC. The dedication was President Kennedy’s last official duty before going to Dallas the next day. World research of HBO2 for clinical conditions blossomed in the late 1970s. Robert Marx at Wilford Hall Medical Center (WHMC) used HBO2 to treat osteoradionecrosis secondary to cancer radiation treatment with publications starting in 1983. Soft tissue and bone radiation injury treatments are now common. The USAF became the DoD Lead Agent for Clinical Hyperbaric Medicine in 1986. Partnership with WHMC, Brooke Army Medical Center (BAMC) and Audie Murphy Memorial Veterans Hospital (ALMMVH) resulted in central retina artery occlusion data in the 1990s. Due to the DoD Base Realignment and Closure (BRAC) of Brooks Air Force Base, the clinic was moved to the renamed Wilford Hall Ambulatory Surgical Center (WHASC) with a new rectangular multiplace and monoplace chambers in 2007. The Undersea and Hyperbaric Medicine (UHM) Clinic led the first DoD study for the potential use of HBO2 treatment for traumatic brain injury and post-traumatic stress disorder (PTSD) in 2009-2011. BRAC hit again as the WHASC facility was to be demolished once the new WHASC facility was completed. The USAF Surgeon General Green subsequently authorized a Military Construction Program connected to BAMC and approved by U.S. Army Surgeon General Schoomaker. The existing chambers were moved to the stateof-the-art facility at BAMC in 2017. The use of hyperbaric oxygen therapy lectures are rarely given in medical schools, so the information here may be new to many of our San Antonio providers. HBO2 is defined as an intervention in which 16

SAN ANTONIO MEDICINE • February 2022

President John F. Kennedy delivers an Address at the Dedication of the Aerospace Medical Health Center in San Antonio at Brooks Air Force Base on November 21, 1963. Photo courtesy: AmericanRhetoric.com.

an individual breathes near 100% oxygen intermittently while inside a hyperbaric chamber that is pressurized to greater than sea level pressure. It is used extensively to treat a variety of medical conditions amongst active-duty members, their families, military retirees and veterans. Approved indications most frequently encountered involve selected problem wounds, such as diabetic foot ulcers and wounds involving chronic refractory osteomyelitis, as well as delayed radiation injuries, such as osteoradionecrosis and radiation cystitis. HBO2 is also indicated as an adjunct treatment in more urgent conditions such as compromised surgical flaps and grafts, clostridial myonecrosis, acute traumatic ischemias, necrotizing soft tissue infections, iatrogenic arterial gas embolism, central retinal artery occlusion and idiopathic sudden sensorineural hearing loss. HBO2 is the primary treatment for DCI, which includes diving and altitude-related decompression sickness and arterial gas embolism. These conditions are experienced as a result of recreational and occupational hazards in both civilian and military populations, however, the nature of military operations can result in greater risk of occurrence. The BAMC UHM staff serves a dual purpose, treating routine outpatient and inpatient conditions, but also providing military operational

MILITARY MEDICINE

Most clinics that provide hyperbaric medicine services, including the BAMC UHM clinic, also provide advanced wound management. Wound care is more than just putting a dressing on a wound. It's also about looking into the patient’s general health, lifestyle and factors that might slow healing down. Wound care may consist of application of specialty dressings or ointments, negative pressure assisted wound closure, bio-engineered skin, debridement to remove infected tissue, compression therapy, transcutaneous oxygen studies and vascular studies. As the need for the wound care and hyperbaric service in San Antonio for veterans is so much, sometimes BAMC facilities are not able to accommodate all the veterans. This occurs with veterans who have Medicare/Tricare for Life as a military benefit or live outside mileage limits. Patients can be treated in civilian wound healing and hyperbaric facilities. Group physicians and providers take pride in treating our veterans who have provided a lifetime of service to our nation. Veteran patients who are referred to civilian wound and hyperbaric centers have diagnoses of diabetic wounds, sensory neural hearing loss, radiation cystitis and all other UHMS approved diagnoses. Lt. Col. Jason Kelly, MD is the Undersea and Hyperbaric Medicine Consultant to the USAF Surgeon General and the fellowship Program Director at Brooke Army Medical Center. He is certified in Family Medicine and Undersea and Hyperbaric Medicine.

support through the management of regional DCI cases and consultation on worldwide U.S. Air Force pressure-related injuries. In addition, the BAMC UHM clinic hosts fellowship training in UHM, one of only eleven programs nationwide. Over the decades, many of the fellowship graduates have settled in San Antonio, making it a robust community of hyperbaric medicine facilities in the country. The BAMC UHM clinic serves as one of two regional facilities that is capable of providing 24/7 emergency care, to include critical care services. As BAMC is one of San Antonio’s Level 1 Trauma centers, not only does the clinic serve DoD/Tricare beneficiaries and veterans, but it also treats some civilians who are admitted through the BAMC Trauma Service. The program is also frequently involved in research and other projects aimed at expanding the utilization of HBO2. Currently, the staff is collaborating with the Department of Veterans Affairs to expand the treatment of veterans with PTSD.

Jayesh Shah, MD, a wound care specialist certified in Internal Medicine and Undersea and Hyperbaric Medicine, is a member of the Board of Trustees of the Texas Medical Association and the Bexar County Medical Society. Earl G. Wolf, Jr. MD is board-certified in Aerospace Medicine and Undersea and Hyperbaric Medicine, both under the American Board of Preventive Medicine and has 43 years in UHM experience. The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force and Department of Defense or the U.S. Government.

Visit us at www.bcms.org

MILITARY MEDICINE

Lt. Col. Tim Maxwell’s Story THE IMPORTANCE OF TEAM SUPPORT ON THE ROAD TO RECOVERY From the CDC’s National Center for Injury Prevention and Control

hey train together. They fight together. So if wounded, why shouldn’t they go through recovery together? This was the question that Lt. Col. Tim Maxwell asked about his fellow marines being discharged from the hospital and left alone to recover from injuries of war.

“When you’re in the hospital, you are with other wounded warriors. But once you are out of the hospital, it’s tough,” explains Maxwell.

Approximately 5.3 million Americans are living with a TBI-related disability, and the consequences of severe TBI can affect all aspects of an individual’s life. This can include relationships with family and friends, as well as the ability to work or be employed, do household tasks, drive, and/or participate in other activities of daily living.

SAN ANTONIO MEDICINE • February 2022

He should know. While on his sixth combat deployment, Maxwell sustained a severe traumatic brain injury (TBI) during a mortar attack in Iraq. When he awoke a month later at the Bethesda Naval Medical Center, doctors didn’t think he would survive. The shrapnel that penetrated his skull inflicted severe damage to his brain, impairing his vision and leaving him unable to talk or walk. Unfortunately, Maxwell is not alone. Each year, TBIs contribute to a substantial number of deaths and cases of permanent disability. For individuals hospitalized after a TBI, almost half (43%) have a related disability one year after the injury. In fact, a TBI may lead to a wide range of short- or long-term issues affecting: attention and memory; coordination and balance; hearing; vision; perception and touch. A TBI may also lead to personality changes; aggressive behavior; poor impulse control; and mood disorders, such as depression and anxiety. Maxwell recalls his own feelings of isolation, depression, and anger, even after being back home with family. During his recovery, one of his doctors suggested he talk with other wounded service members. So while still in a wheel chair with a large visible scar on the left side of his shaved head, Maxwell set off to visit other wounded soldiers in the hospital. He later counseled Marines convalescing back at his old unit at Camp LeJeune, where he saw first-hand the difficulties young service members with serious injuries faced, living alone without any support. Maxwell fully understood the critical need for ongoing support during recovery from a life-changing injury. So he began a new mission: to find a place where Marines could stay together on their journey to recovery. He convinced his leadership of the need to have housing that would allow injured marines and sailors to recuperate in a supportive environment.

MILITARY MEDICINE

Almost one year after his devastating combat injury, Maxwell’s vision for a special home where service members could heal together was realized. Maxwell Hall, the first barracks for wounded warriors on the East Coast, was opened in 2005. The following year, the Marines opened a similar unit on the West Coast at Camp Pendleton. Maxwell’s accomplishments became a catalyst for reform of other wounded-warrior programs throughout the U.S. Department of Defense. Now retired from the Marines, Maxwell serves as president of SemperMax Support Fund, where he continues his mission to prevent feelings of isolation and disenfranchisement among wounded service members. The Centers for Disease Control and Prevention’s (CDC), National Center for Injury Prevention and Control salutes Maxwell for his service to the nation, his drive to help other wounded warriors while overcoming his own challenges of living with a TBI, and his success in helping others realize the importance of continuous support during the entire recovery process.

“My strength and mission in life is that I give people hope,” Maxwell said.

To learn more about CDC’s efforts to meet the challenge of severe TBI, go to: www.cdc.gov/TraumaticBrainInjury

Visit us at www.bcms.org

MILITARY MEDICINE

Eight Years of Impact: AN OVERVIEW OF THE MILITARY HEALTH INSTITUTE By Byron Hepburn, MD, USAF Major General Ret.

“Military Health is in our DNA.” This is the motto of the Military Health Institute (MHI) at UT Health San Antonio. The Institute was formed in 2014 to “strengthen the military health activities of UT Health San Antonio to improve the lives of our military service members, veterans, and their families.” This mission is accomplished by concentrating on four pillars: research, education, clinical advocacy and engagement. In each pillar, MHI facilitates collaboration with the Department of Defense (DoD) and the Veterans Administration (VA). 20

SAN ANTONIO MEDICINE • February 2022

Supporting research is our primary focus. As a facilitator, the Institute advises faculty and staff regarding DoD funding opportunities, the process of submitting research proposals and the importance of establishing collaborations with military partners. To encourage this activity, we have established a Faculty Associate Program, in which the program members serve as mentors to faculty who are new to DoD research. Our University’s DoD-focused research strengths include trauma, pain management, PTSD and Traumatic Brain Injury (TBI).

MILITARY MEDICINE In particular, we have supported notable innovations in research by our scientists to include Dr. Kumar Sharma, who is collaborating with Dr. Kevin Chung (Uniformed Services University of the Health Sciences), in evaluating the efficacy of a novel blood pathogen filter, Seraph. In addition, another UTHSA scientist, Dr. Susannah Nicholson, is collaborating with the U.S. Army Institute of Surgical Research (ISR) on microbiome research in trauma. MHI has also supported Dr. James Lechleiter in developing a therapeutic that has great promise for the treatment of TBI. As innovation in military health research broadens, we provide educational opportunities for our faculty, students and community, as evidenced in our sponsorship of the Military Health Interest Group (MHIG). The purpose of this group is to mentor students, who in their future roles as health care providers, will be caring for service members, veterans and their families. For instance, MHI recently supported the MHIG by hosting a wounded warrior panel discussion, highlighting military health care through veterans’ eyes. MHI is also honored to host the Distinguished Lecture Series designed to educate the community on diverse topics associated with military health. Senior leaders in military medicine are invited to UT Health San Antonio to provide insight into the extensive world of DoD research. Past speakers include Vice Admiral (Dr.) Raquel “Rocky” Bono, Director of the Defense Health Agency in 2015; Colonel (Dr.) Drew Morgan, U.S. Army Physician and NASA Astronaut; and Colonel (Dr.) Jeffery Tiede, Director of the Center for the Intrepid (CFI) and a leader in human performance research. Each speaker ignites impactful dialogue in military health research that leads to further collaboration and innovation. From the clinical perspective, MHI advocates for the continued enhancement of San Antonio’s integrated trauma system and its synergy between our two level-1 trauma centers, Brooke Army Medical Center (BAMC) and University Hospital. This military-civilian partnership is unique in the nation and facilitates the bi-directional flow of lessons learned in trauma care. One notable outcome has been the use of whole blood in trauma resuscitation, which was effectively used in recent military operations in Afghanistan and Iraq. MHI has also supported the Brothers in Arms program that serves as a blood donor pool of whole blood across San Antonio. This collaboration allows our military-civilian partners to effectively synergize their efforts during trauma-related events that impact South Texas. We are also actively engaged with multiple local and national partners to increase the positive impact of their military health activities. The Institute has strong relationships with partners like the City of San Antonio Military and Veterans Affairs Office, the San Antonio Chamber of Commerce Military Affairs Committee and the American Corporate Partners program. Additionally, over the past two years, we have actively supported the San Antonio response to the COVID-19 pandemic and

Left to Right: Brigadier General Clinton Murray, current Commander at BAMC, shakes hands with Byron Hepburn, MD, USAF Major General Ret.

have been honored to serve on the South Texas Regional Advisory Council (STRAC) Pandemic Medical Operations Working Group, and the Metro Health Community Response Coalition. Such partnerships provide a level of engagement that aids in achieving our ultimate goal: improving the health of the military affiliated community. The Military Health Institute is dedicated to its mission to improve the lives of service members, veterans and their families. We are expanding and strengthening a collaborative environment that produces positive impacts in research, education, clinical advocacy and engagement. Most significantly, this impact is made evident by the increase in the level of military health research efforts occurring at UT Health San Antonio and our growing interest in better serving the health care needs of the military affiliated community. In this issue, you will find many examples of DoD research and innovation being conducted at UT Health San Antonio. While not comprehensive, this collection will provide a great example of research in military medicine. For more information on MHI and how to collaborate with us in military health, please visit militaryhealthinstitute.org. Byron Hepburn, MD, USAF Major General Ret., is a UT Health San Antonio Associate Vice President and the inaugural Director of the Military Health Institute. He is a Clinical Professor in the Department of Family and Community Medicine and a member of the Bexar County Medical Society.

Visit us at www.bcms.org

MILITARY MEDICINE

Trauma Care

IN MILITARY MEDICINE By Susannah E. Nicholson, MD, MS, FACS

rauma is a leading cause of death both globally and in the United States. Approximately half of all trauma mortalities are a consequence of hemorrhage, and most of these patients die within six hours of injury. Trauma patients in hemorrhagic shock have shown improved survival with the implementation of the massive transfusion protocols (MTP). The United States military relied on whole blood (straight from the donor without extensive processing or separation into components of red blood cells, plasma and platelets) from 1917 through the Vietnam War. A resurgence of whole blood use, by necessity due to the dispersed military treatment facilities across Southwest Asia and the Middle East, prompted further study of safety and efficacy and began to infiltrate the civilian health care system in the United States. We sought to characterize MTP patients cared for at University Hospital by UT Health San Antonio surgeons, nurses and blood bankers in a study to better understand how Rh status of whole blood in our prehospital transfusion program might affect our trauma patient population. Our preliminary data, collected over the span of one and a half years (presented at the Military Health System Research Symposium in 2017), consisted of 63 patients who received massive transfusion on arrival at our American College of Surgeons Level I trauma center. Mortality was 76% (n = 48). This has been the case in most trauma centers in this country and this high mortality rate raised a concern that perhaps there was more we could do to improve survival in severely injured patients. Realizing that in our data set, most hemorrhage-related deaths after arrival had less than a 30-minute prehospital time (from time of injury to hospital arrival), prehospital transfusion appeared to be a potential strategy to decrease mortality in the MTP patient. As we developed a prehospital transfusion program, we decided on the use of whole blood for a variety of reasons. Whole blood is a superior resuscitation therapy compared with saline or albumin; whole blood administration is also an easier task than transfusion of multiple components. We decided on the use of low titer cold-stored O RhDpositive whole blood (LTO+WB).

SAN ANTONIO MEDICINE • February 2022

Preparation of Resources The Southwest Texas Regional Blood Resuscitation program was developed based on the recommendations of the Trauma, Hemostasis and Oxygenation Research (THOR) network: an international community of civilian and military stakeholders specializing in emergency medical services, trauma, anesthesia, blood banking and basic/translational science. The THOR network is dedicated to the development and implementation of best practices in resuscitation from hemorrhagic shock. The longstanding relationship between South Texas Blood and Tissue Center (STBTC), UT Health San Antonio, UT Health Military Health Institute, University Hospital, San Antonio Military Medical Center, Institute for Surgical Research and Southwest Texas Regional Advisory Council for Trauma (STRAC) provided basis for providing whole blood on helicopters and ground ambulances. Low-titer cold-stored O RhD-positive whole blood is a licensed blood product, so there were no issues related to Food and Drug Administration approval. This product has a 35-day shelf life and was created in consultation with military partners including the Institute for Surgical Research, the Army Blood Program and the Mayo clinic Low Titer O Whole Blood (LTOWB) team. The overall donor base was evaluated, and donor testing was performed to find a cadre of low antibody titers O+ donors. All processes and supplies used in collection, labeling and transporting of LTO+ WB were validated by the STBTC

MILITARY MEDICINE

in this whole blood collaborative. Further, a collection, delivery and rotation schedule were created to achieve best practice utilization of product resources. South Texas Blood and Tissue Center standardized to the same low-titer value as our military partners. Only male donors are used in the program because of the risk of transfusion-related acute lung injury from female donors. STBTC has tested more than 10,000 individual donors, 85% of whom met the low-titer qualification for inclusion in the program. Community involvement was a key element in initiating this program. It required cooperation and encouragement of community leaders, the medical community, as well as improved outreach to potential donors. A grant was awarded from the San Antonio Medical Foundation to decrease the cost of development of this new product line. To recruit the necessary additional donors, STBTC developed the “Brothers in Arms” branded program with specific “Brothers in Arms” messaging to enlist and prepare potential donors for inclusion in the program. Prehospital Transfusion Protocol The STRAC serves 22 counties, over 26,000 square miles. There are five helicopter agencies (over 12 helicopter bases) within this region that provide up to two units of whole blood to trauma patients prior to arrival to a Level I trauma facility. Over 20 ground EMS agencies carry one unit of whole blood. All personnel administering products received whole blood training by STRAC via creation of a transfusion

protocol. Careful monitoring for transfusion reactions and hypothermia has shown no transfusion reactions above normal and no other complications. After 14 days, the whole blood products that have not been utilized in the prehospital setting are exchanged from the helicopter and brought to the hospital to be used in trauma patients before expiration at 35 days. Waste of whole blood is less than 1% with this rotational scheme and is unique to Southwest Texas.. Emergency Department and Prehospital Transfusion In the four years since the inception of the program, between several rural/critical-access hospitals, EMS agencies and both the University and Brooke Army Medical trauma centers, nearly 4,000 injured patients have received nearly 8,000 units of whole blood. No other place on planet earth has such a comprehensive program with the experience gained in the civilian sector. Only the United States Military has more experience with whole blood. The importance of the collaboration of these multiple agencies has been paramount to the success of this program. Mortality, in preliminary study, is lower than the blood component era of resuscitation and those that die of their injuries live, on average, four more hours than the historical control. The program benefits children, women who are pregnant, non-trauma relate hemorrhage conditions (e.g., gastrointestinal bleeding), vascular and transplant surgery patients and has been used successfully throughout the COVID-19 pandemic. Further uses of whole blood are being investigated and the military-civilian collaboration has never been stronger or more meaningful in the modern era of injury care and management. Susannah E. Nicholson, MD, MS, FACS is the Director of Trauma Research at the University of Texas Health Science Center at San Antonio. She is a member of the Bexar County Medical Society. Contributing authors to this article include Brian Eastridge, MD; Ronald Stewart, MD; Donald Jenkins, MD; Micah Wright, PhD; Byron Hepburn, MD; James Bynum, PhD; Andre Cap, MD, PhD and Eric Epley. Special thanks to the UT Health San Antonio Department of Surgery, UT Health San Antonio Military Health Institute, United States Army Institute of Surgical Research and Southwest Texas Regional Advisory Council for Trauma.

Visit us at www.bcms.org

Future Plans

MILITARY MEDICINE

IN THE MILITARY AFTER BECOMING AN OSTEOPATHIC PHYSICIAN By Johnathon D. Harris, 2 LT, USAF

s a 31-year-old medical student, I am still trying to decide what I want to be when I grow up. Many of my younger colleagues currently in medical school have known that they wanted to be a physician their whole lives. They know what specialty they want, what hospital they would like to work in and have mapped out a plan to get there. As for me, the only thing I know is that I am going to get the opportunity to serve some of the most selfless, brave humans in the world in whichever specialty I am fortunate enough to join after school. Although I am unsure of my future specialty, I have always been sure about the military. My great grandfather was a fighter pilot in WWII, and my grandfather flew heavies in the Korean War. Not to be outdone, my father followed in their footsteps and spent a career as an F-16 pilot before retiring in 2019 as a Lieutenant General. Growing up as a military dependent, my family was seen by military doctors my whole life. I was born on an Air Force base and was taken care of by a new military physician every three years with each Permanent Change of Station (PCS). My family and I would get our yearly checkups and physicals from flight docs and were transferred to military specialists when things came up. Military providers took care of all of my family’s needs, both physically and emotionally. (Except for one flight doc when I was about eight years old, who told me that he found fingerprints when checking my nose and made me admit to both my mother and him that I had recently picked my nose.) No one in my family was in the field of medicine growing up, so becoming a physician never really crossed my mind until later in life. I started out as a mechanical engineer at Arizona State University, and then became an Air Force helicopter pilot. I spent the next eight years working with some of the best men and women that I have ever met. In my rescue squadron, I was able to be a part of a team that was literally the difference between life and death. But I came to realize that if I wanted to make a real difference, it wasn’t going to be at the controls of a helicopter. I needed to be in the back of the helicopter where the most important fight was taking place. What I look forward to most about the field of medicine is all the possibilities. There is an endless number of specialties and so much to learn. It is a constantly changing field that requires knowledge, skill and perseverance. An Army veteran and pulmonologist once told me,

“Questions are more important than answers. Answers change with time, but the questions will always be there.” I have a lot to learn about medicine, but I suspect that will never change. I just hope that one day, I will be able to fill the shoes of those physicians who took care of my family and me over the past 30 years. And although I do not know what type of physician I want to be when I finally grow up, I look forward to the day that I am back on the line where I belong, taking care of those who take care of this country. To all of those who have served in the military and their dependents: Thank you. Before commissioning in the USAF Medical Corps, Johnathon D. Harris, 2 LT, USAF was a Captain and Evaluator Pilot in the USAF with over 1,300 hours in the UH1N (Huey) assigned to the 36th Rescue Squadron and 1st Helicopter Squadron. He is married, has one daughter and is currently attending medical school at the University of the Incarnate Word School of Osteopathic Medicine.

Visit us at www.bcms.org

MILITARY MEDICINE

When Pigs Fly By Col. James H. Henderson II, MD, USAF MC, Ret.

s a young Air Force officer and Pulmonary/Critical Care attending physician stationed at Wilford Hall Medical Center in 1993, I had certain expectations and career aspirations. I had just returned from a one-year Sleep Medicine fellowship at Mayo Clinic Rochester and planned on expanding and improving the Sleep Lab there while starting a Sleep Medicine fellowship with my new partner, Major (Dr.) Larry Epstein. I hoped to do my part as faculty in an excellent Pulmonary/Critical Care Medicine (PCCM) fellowship and provide state-of-theart medical care to the patients in the Air Force’s best tertiary medical center. In retrospect, it’s interesting how, at that time, very little of the primary mission of Military Medical Service occupied my thought process. During the Grenada operation, I was a medical resident in the ICU and helped care for seriously injured soldiers returning on Aeromedical Evacuation (AE) flights. The Panama invasion only lasted one month entering 1990, and I was not involved. Later, for “Gulf War 1,” I was a PCCM fellow doing research and was not listed for deployment. It seemed my entire Air Force career was like any other civilian physician’s career, except for field exercises, wearing a uniform daily, doing physical training, etc. At least it was until that day. That unique day in 1993, we had a department meeting and discussed a new mission, a new concept: Critical Care Air Transport. Unbeknownst to me, the crazy guys I was working for had been testing a concept for some time — the idea of setting up the equivalent of a working ICU in the back of a transport plane or at a forward location

SAN ANTONIO MEDICINE • February 2022

in order to stabilize and fly severely wounded soldiers for several hours at a time between facilities. I was quite accustomed to the idea of medivac: short 20-to-60-minute helicopter transports of patients who would die quickly if not moved. This plan was to move patients who had been stabilized and might get better but were at high risk to decompensate and were at a location already operating at the limit of its capability. Instead of adding medical capability for the patient, we would find a way to transport the patients to more capability. Over the prior 10 years, several emergency missions like this had been spun up on short notice in extraordinary circumstances. For more than five years, Brigadier General (Dr.) P.K. Carlton had wanted to make this a core mission of the AF Medical Corps for fixed-wing transport and obtained approval for a proof-ofconcept project. Major (Dr.) Steve Derdak had been testing portable ventilators and other equipment on C-130 training missions to begin the process of airworthiness certification. Lieutenant Colonel (Dr.) Chris Farmer and others had developed concepts and procedures to be employed and refined. Honestly, I thought it was all crazy. We would now develop a plan to routinely move patients who were presently deemed too unstable to leave the ICU for a CT scan. In short, I did not believe it was wise. I expressed my sentiment that this would work “when pigs fly.” Little did I know how wrong I was. The basic concepts that were discussed that day were refined over the next several years. Critical Care Air Transport Teams (CCATT) were

MILITARY MEDICINE

put together and performed local and regional transports of single patients in conjunction with AE crews in C-21 Lear and C-9 Nightingale aircraft. The first test deployment of CCATT (including now Lieutenant Colonel (Dr.) Steve Derdak) was to Operation Uphold Democracy to Haiti in 1994 after an earthquake disaster. Other mission refinements were made after these experiences. My offhanded comment came back to haunt me soon thereafter when we tested multiple patient transport by flying six sedated and intubated pigs in a C9 over West Texas and Oklahoma. Yes, pigs really did fly! CCATTs consist of three personnel: a critical care (trained) physician, a critical care nurse and a respiratory therapist. These teams are trained and provisioned to care for up to three ventilated or six non-ventilated critically ill patients for up to 72 hours before resupply. They may have CCATTs work alongside standard AE crews who transport hospitalized stable patients. This development allowed for downsizing of forward operating hospitals from 250-500 beds to 30-60 beds while providing Level 1 trauma services as injured and ill warriors could be transported away in 12-48 hours rather than 5-7 days as in earlier conflicts. CCATT facilitated rapid repatriation of our injured to the continental U.S. when the injuries would require multiple surgeries and prolonged recuperation. CCATT was accepted as a core mission of the USAF Medical Service and became an integral component of all military medical doctrine for all services. Teams have combined with other small mobile medic teams, such as Mobile Field Surgical Teams in both forward deployments and served with Army and Navy units. Teams have subsequently deployed to Kosovo, Bosnia, Turkey, Saudi Arabia, Afghanistan, Iraq, Djibouti and other locations as needed to support warfighters. Techniques developed for this mission were combined with other core tactics to strengthen every aspect of military medical transport on air, sea and land. And for me, from that doubtful moment in 1993, CCATT became the prime mission of my career. My life became immersed in this mission and military medicine and, over the next few years, every position I held was intimately aligned with it and the incredible doctors, nurses and respiratory therapists who performed the mission. I became a support instructor at the Primary CCATT course. I served as a CCATT team leader flying numerous stateside missions, rescue missions to El Salvador and Bolivia, and eventually deployed shortly after 9-11 to Uzbekistan, supporting Special Forces in Northern Afghanistan. Once back in the States, I became the CCATT tactical development team leader, then a Squadron Com-

mander of the largest collection of CCATTs on active duty. I continued to assist in teaching CCATT courses and participated in Allied Force education courses in several countries. Subsequently, I helped write the formal Air Force tactical and doctrinal instructions and directed the agency in charge of pre-deployment trauma and critical care training, to include CCATT and deployed hospitals. I retired from the USAF in 2011 after 26 years of service and remain proud of those who have carried on and expanded the mission. CCATTs support humanitarian missions such as hurricane and earthquake support and tsunami relief. They have supported foreign travel of several presidents and other senior leaders. They have transported patients on primary heart-lung bypass as well as VV-ECMO, and highly infectious patients in special isolation equipment. Most importantly, CCATTs continue to serve our warriors and their families across the globe, ensuring that the best of Critical Care is provided. They serve with honor and are a unique force multiplier for the Air Force Medical Service. In the end, I’m incredibly happy that pigs do fly. Col. James H. Henderson II, MD, USAF MC, Ret. is a Critical Care Intensivist and Family Medicine residency faculty member at CHRISTUS Santa Rosa Westover Hills Hospital while serving as President of Medical Staff at CHRISTUS Santa Rosa Hospitals, President of CSR Family Health Center and member of its Board of Directors. He serves as Adjunct Assistant Professor for the UTHSCSA Department of Family and Community Medicine and the UIW Department of Family Medicine. He is board-certified in Critical Care, Pulmonary Medicine, Internal Medicine and Sleep Medicine. Dr. Henderson is a member of the Bexar County Medical Society.

Visit us at www.bcms.org

MILITARY MEDICINE

Reflections on Military Medicine FROM A FOURTH- YEAR MEDICAL STUDENT By Christian B. Wells, 2 LT US Army

n December 8, 2021, I had the privilege of joining hundreds of medical students across the nation as we fervently awaited our residency match results from the Joint Services Graduate Medical Education Selection Board. For most medical students, this was just a typical busy day of rotations, interviews or lectures; however, for the few graduating military medical students, it was a day we will never forget— the day we learned where the military would be sending us for residency training. This day felt like the beginning of my career in military medicine, but now I cannot help but reflect on the journey I took to reach this point and my motivation to pursue military medicine. I was predisposed to a career in the military before I was even born. My parents met each other in the Army and my father went on to have a 32-year long career. He initially enlisted to escape poverty but quickly found himself in love with serving others. He always instilled in me the necessity of helping those around me and leaving the world a better place than I found it. He preached excellence in all aspects of our lives, from academic pursuits to our spiritual lives. It was no surprise to anyone that all three of his sons have served or are serving in the military. The values that he engrained in me ultimately lead me to decide that I wanted to give back to others as a physician. A major factor that led me to military medicine is the emphasis on leadership—a core attribute that is inherent to the military. I believe that the U.S. military is one of the greatest leadership organizations in

SAN ANTONIO MEDICINE • February 2022

the world and that residency in the military will not only train me to be an excellent clinician but will also develop me as a leader and wellrounded human being. The military medical mission is unique in that there is a focus on operational medicine and occupational medicine. This means that physicians can find themselves serving as commanders or advisors, all in the pursuit of taking care of servicemembers, their families and veterans. The military and medicine are both careers that place an emphasis on leadership, adaptability and service to others. Military medicine has provided me with the opportunity to live a fulfilled life. An authentic life is one lived in service of others while building relationships with those around you. The fundamental core of medicine is about humanity and our journey through both life and death; therefore, there is something deeply enriching about being able to serve those who dedicate their lives to the service of others. While on the precipice of starting residency, I cannot help but feel that military medicine has provided me with opportunities and a career that I never imagined I would possess. I hope to always acknowledge the sacrifice of the veterans who came before me and the servicemembers that dedicate their lives to service every day. Christian B. Wells, 2 LT US Army is a fourth-year medical student at the University of Texas Health Science Center San Antonio Long School of Medicine. He will be starting internal medicine residency at Brooke Army Medical Center in summer 2022.

SAN ANTONIO MEDICINE

The Challenges Women Faced to Break into Medicine By Jaime Pankowsky, MD, FACS

lthough for many centuries women were pressed into caring for the sick, they did so intuitively and instinctively. Because they were not admitted to existing medical schools, they could not belong to the guild of barbers and surgeons, and no self-respecting doctor would accept a woman as a pupil to learn his trade. So, most of them were usually well-meaning religious members of convents who were more concerned with the spiritual well-being of the patient and his or her deliverance to heaven or purgatory, rather than learning how to treat their condition. There were a few caregivers who were neither spiritual nor honest and were there only to take whatever worldly possessions the patients had before or after they expired. One Medieval exception was Hildegard von Bingen, who lived in what is now Germany in the XII century. Born in 1198, she was the youngest daughter of a wealthy, noble family and, as was customary at the time, was assigned to be given to the Church. Against her will, she had to enter a convent. She was not happy in the convent. Praying and serving meals was not enough for her. She developed what she described as “visions.” Through them, she wrote beautiful oratorios. Her abbess was not happy, but her bishop protected her because he thought her visions could be messages from God. After several years, her father died and she inherited part of his fortune. She had enough of charity and chastity and walked out of the convent to build her own convent by the River Rhine. There, she began to care for the women of the nearby villages, particularly during preg-

nancy and delivery. She wrote a book on women’s health. She described menstruation in a precise way and made observations during childbirth. Menstruation and its abnormalities would not be studied or published in scientific papers again until the XIX century. She ordered all drinking water to be boiled before consuming in the convent and in the village. Thus, she might have prevented many premature deaths. She cultivated many herbs that she used as medications, although some of her treatments were frankly, “batty.” She

also attributed some of the women’s problems to the Biblical original sin. Florence Nightingale Florence Nightingale was born in 1820 to a well-to-do English family with nobility contacts. She grew up developing a complex personality. She could be selfish and compassionate, dedicated and impatient. Florence learned to speak five languages and became familiar with the new science of statistics, helping her win arguments with the

FLORENCE NIGHTINGALE

continued on page 30 Visit us at www.bcms.org

SAN ANTONIO MEDICINE continued from page 29

Royal authorities. She tried to help the conditions of the poorer classes in London by organizing charity events. In 1836, she went to Germany to study in the only nursing school in existence in Europe at that time, but found it inadequate and unsatisfactory, leaving after a few months. Then in 1854 came the Crimean War, where England, France and Turkey fought against Russia. For England, the war brought only two good things: Lord Tennyson’s “The Charge of the Light Brigade” epic poem, and the professional maturity of Florence Nightingale. For the English army, it brought nothing but disasters, pain and death due to the incompetence of its generals. Their wounded were piled in a so-called hospital in Northern Turkey, where dirt, vermin and discharges were causing a 40% mortality rate among the wounded soldiers. Florence Nightingale prevailed over the British War Minister because of her contacts through her family with the Prime Minister, and she was allowed to go to Crimea to care for the wounded. She recruited 38 gentlewomen to go with her for that purpose. Upon arrival, they proceeded to change bandages, prepare food and visit with the patients. Her rounds at night with an oil lamp in hand made the soldiers call her “The Lady with the Lamp.” The sobriquet persisted for years to come. Unfortunately, the 40% mortality rate persisted. This prompted a visit from James Miranda Barry, the Assistant High Medical Inspector for the British Army. Mounted on a high horse, Florence was ordered to clean the place from dirt, excretions, and vermin and stop worrying about the bandages. At first, she resisted, but Miranda Barry was unyielding and unimpressed about her family connections. She obeyed and proceeded to vigorous cleaning, helping drop the mortality rate to 15%. Upon returning to England, she suffered a nervous breakdown and was confined to her

SAN ANTONIO MEDICINE • February 2022

bed, leaving on only a few occasions. Nevertheless, she was honored by Queen Victoria for her efforts. She founded the first school of nursing in the United Kingdom and was instrumental in the introduction of the Red Cross in that country. Today we associate the honorable nursing profession to her name and her powerful influence in English society for the benefit of patients. James Miranda Barry Yes, this is the same British officer who pressured Florence Nightingale to clean up the wards at the Scutari Hospital in the Crimean War. But in reality, he was born Margaret Ann Bulkley in 1785 in Cork, Southern Ireland. From an early age, she wanted to become a doctor but women were not admitted to medical schools at that time. Excuses for the prohibition were often off-the-wall and outlandish. Some examples follow: No decent girl should be exposed to a naked body, particularly of a male until her marriage, and then sometimes not even then. It was also said that a woman was prone to “fainting spells,” which was probably based on evidence given in romantic novels or theatrical melodramas. So, disguised as a boy, she went by the name of James Miranda Barry, and enrolled in the Medical School in Edinburgh. Graduating as a doctor, she joined the British Army and was posted in different parts of the Empire. Serving in South Africa, she performed the first Cesarean section in the continent where both mother and child survived. She became too friendly with the governor in Cape Town, and the gossip in London was suspicious of a homosexual liaison. The governor, Lord Somerset, was recalled to London and Dr. Barry was transferred to Jamaica, where she acquired a loyal manservant who never knew her real identity until her death. Dr. Barry was promoted to Assistant Chief Medical Officer of the British army with a rank of brigadier general. In that position, she confronted Florence Nightingale in Scutari

and ordered her to clean out the wards. Dr. Barry died in London at the age of 70. When being prepared for autopsy or burial, it was finally discovered that “he was a she.” Elizabeth Blackwell, First American Woman Doctor A small upper New York College, Geneva, had a medical school around 1854. New students were selected by the faculty and/or the administration for enrollment in the medical school. One year, the student body requested the right to select the new admissions themselves. As a concession, the faculty was allowed to select only one. The students thought it a joke and responded, selecting Elizabeth Blackwell, who had been rejected by all the medical schools she had applied to. She entered their freshman class. Geneva’s residents thought she must be “mad or bad” and shunned her from all social gatherings in the homes of faculty members and other town notables. Nevertheless, she graduated at the head of her class. After graduation, she went to England to refine her skills and knowledge. After a year or two she returned to New York City where, with another woman graduate, founded a clinic for the treatment of women and women’s medical problems. Incidentally, the medical school in Paris began accepting women in 1865, but few, if any, applied until years later. Yale and Harvard did not admit women to their medical schools until after World War II, which ended in 1945. It is estimated that today, 50% of physicians in the United Kingdom and in the United States are women. To the best of our knowledge, none of them suffer fainting spells and if they so wish, are able have the children they want. Jaime Pankowsky, MD, FACS is retired and a life member of the Bexar County Medical Society.

SAN ANTONIO MEDICINE

Protect and Grow Your Money with Series I Savings Bonds By Brian T. Boswell, CFP®, QKA

ne of the ripple effects of the pandemic is that interest rates are currently lower than inflation, meaning traditional savings accounts might not be keeping up with inflation. Instead, the purchasing power of your savings can go down over time. With interest rates so low, savings products such as nominal Treasuries, certificates of deposit and money market accounts often earn a negative interest over time. Protecting your financial security as a busy physician is crucial and challenging. Series I savings bonds (I-bonds) are a low-risk product that can help you protect your savings from inflation and earn a more attractive rate than you would through traditional savings accounts. What are I-bonds? The U.S. Treasury introduced I-bonds in 1998 as a safe way for Americans to get a meaningful return on their savings directly from the government. Today, you can purchase electronic I-bonds with a Treasury Direct account or paper I-bonds with your IRS tax refund. I-bonds are typically used to finance education or supplement retirement income, but they are increasingly being utilized as an inflation hedge. The current annual interest rate for I-bonds is 7.12%, and if inflation continues to rise, the I-bond rate will go up accordingly. This builtin protection against inflation rates means the purchasing power of your savings is guaranteed to stay the same and may potentially even increase over time. While I-bonds are not a new savings product, many people either don’t know that I-

bonds exist or don’t act upon this knowledge. In fact, I-bonds only represent about 0.2% of the current total amount of U.S. government bonds. Learn more about I-bonds to decide if this excellent, lesser-known long-term savings solution is right for you. How do I-bonds work? You can purchase I-bonds at face value for a minimum of $25 and an annual maximum of $10,000 per person from the Treasury. For example, you could pay $100 for a $100 Ibond, and if you have four people in your household, you could purchase up to $40,000 total in I-bonds per year. You can also purchase multiple I-bonds in varying amounts up to the annual maximum purchase threshold if you want to cash your bonds at different times or for different reasons. An additional $5,000 of bonds can be purchased in paper form but only through the proceedings of your federal income tax refund check. The minimum term of ownership for an Ibond is one year, but the interest-earning period lasts up to 30 years or until you cash them, whichever comes first. If you cash your I-bond before five years, you forfeit three months’ worth of interest as an early withdrawal penalty. Any interest earned on your I-bonds is taxdeferred until the interest-earning period ends. If you cash and use your I-bond to pay for qualifying higher education expenses in the same calendar year, the interest is also exempt from federal taxes. Since you purchase I-bonds directly from the government and not through a financial institution or advisor, there are no fees or com-

missions. I-bonds are a great alternative to bank accounts, mutual funds and other bonds and savings solutions. *The information contained in this article represents the opinion of Oakwell Private Wealth Management and should not be construed as personalized or individualized investment advice. Brian T. Boswell, CFP®, QKA is a Sr. Private Wealth Advisor and Partner with Oakwell Private Wealth Management. Oakwell Private Wealth Management is a Gold Circle of Friends sponsor.

Visit us at www.bcms.org

PHYSICIANS PURCHASING DIRECTORY Support the BCMS by supporting the following sponsors. Please ask your practice manager to use the Physicians Purchasing Directory as a reference when services or products are needed. 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.”

ACCOUNTING SOFTWARE

Express Information Systems (HHH Gold Sponsor) With over 29 years’ experience, we understand that real-time visibility into your financial data is critical. Our browser-based healthcare accounting solutions provide accurate, multi-dimensional reporting that helps you accommodate further growth and drive your practice forward. Rana Camargo Senior Account Manager 210-771-7903 ranac@expressinfo.com www.expressinfo.com “Leaders in Healthcare Software & Consulting”

ATTORNEYS

Kreager Mitchell (HHH Gold Sponsor) At Kreager Mitchell, our healthcare practice works with physicians to offer the best representation possible in providing industry specific solutions. From business transactions to physician contracts, our team can help you in making the right decision for your practice. Michael L. Kreager 210-283-6227 mkreager@kreagermitchell.com Bruce M. Mitchell 210-283-6228 bmitchell@kreagermitchell.com www.kreagermitchell.com “Client-centered legal counsel with integrity and inspired solutions”

ASSETT WEALTH MANAGEMENT

Bertuzzi-Torres Wealth Management Group (HHH Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending and estate planning. Mike Bertuzzi First Vice President Senior Financial Advisor 210-278-3828 Michael_bertuzzi@ml.com Ruth Torres Financial Advisor 210-278-3828 Ruth.torres@ml.com http://fa.ml.com/bertuzzi-torres

BANKING

BankMD (HHH Gold Sponsor) Our Mission is your Success. We are the ONLY Physician-Focused Bank in the Country Moses Luevano, President 512-547-6065 mdl@bankmd.com Chris McCorkle Director of Healthcare Banking 210-253-0550 cm@bankmd.com www.BankMD.com “Specialized, Simple, Reliable”

Broadway Bank (HHH Gold Sponsor) Healthcare banking experts with a private banking team committed to supporting the medical community. Shawn P. Hughes, JD Senior Vice President, Private Banking 210-283-5759 shughes@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

SAN ANTONIO MEDICINE • February 2022

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 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!”

BUSINESS CONSULTING

Medical Financial Group (★★★ Gold Sponsor) Healthcare & Financial Professionals providing core solutions to Physicians from one proven source. CEO is Jesse Gonzales, CPA, MBA Controller & past CFO of (2) Fortune 500 companies, Past Board President of Communicare Health Systems. Jesse Gonzales, CEO CPA, MBA 210-846-9415 information@medicalfgtx.com Linda Noltemeier-Jones Director of Operations 210-557-9044 lindanj@medicalfgtx.com www.medicalfgtx.com “Let’s start with Free Evaluation and Consultation from our Team of Professionals”

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”

FINANCIAL ADVISORS

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

Bertuzzi-Torres Wealth Management Group ( Gold Sponsor) We specialize in simplifying your personal and professional life. We are dedicated wealth managers who offer diverse financial solutions for discerning healthcare professionals, including asset protection, lending & estate planning. Mike Bertuzzi First Vice President Senior Financial Advisor 210-278-3828 Michael_bertuzzi@ml.com Ruth Torres Financial Advisor 210-278-3828 Ruth.torres@ml.com http://fa.ml.com/bertuzzi-torres

“People Bank with People” “Your Practice, Our Promise” 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. Jeffrey Allison 210-268-1530 jallison@aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”

SWBC (HHH Gold Sponsor) SWBC for Personal and Practice: Physician programs for wealth management and homebuying. For You Practice: HR administration, payroll, employee benefits, insurance, and exit strategies. SWBC’s services supporting Physicians and the Medical Society. Michael Leos Community Relations Manager Cell: 201-279-2442 Office: 210-376-3318 mleos@swbc.com swbc.com

HEALTHCARE BANKING

First Citizens Bank (HHH Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking. Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick

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. Jeanne Bennett EVP | Private Banking Manager 210-343-4556 Jeanne.bennett@amegybank.com Karen Leckie Senior Vice President | Private Banking 210-343-4558 karen.leckie@amegybank.com Robert Lindley Senior Vice President | Private Banking 210-343-4526 robert.lindley@amegybank.com Denise C. Smith Vice President | Private Banking 210-343-4502 Denise.C.Smith@amegybank.com www.amegybank.com “Community banking partnership”

HEALTHCARE TECHNOLOGY SOLUTIONS SUPPLIER

Lauren Smith, Manager, Marketing & Communications 210-450-0026 SmithL9@uthscsa.edu Cancer.uthscsa.edu Appointments: 210-450-1000 UT Health San Antonio MD Anderson Cancer Center 7979 Wurzbach Road San Antonio, TX 78229

INFORMATION AND TECHNOLOGIES

INSURANCE Nitric Oxide innovations LLC, (★★★ Gold Sponsor) (NOi) develops nitric oxide-based therapeutics that prevent and treat human disease. Our patented nitric oxide delivery platform includes drug therapies for COVID 19, heart disease, Pulmonary hypertension and topical wound care. info@NitricOxideInnovations.com 512-773-9097 www.NitricOxideInnovations.com

HOSPITALS/ HEALTHCARE FACILITIES

UT Health San Antonio MD Anderson Cancer Center, (HHH Gold Sponsor) UT Health San Antonio MD Anderson Cancer Center, is the only NCI-designated Cancer Center in South Texas. Our physicians and scientists are dedicated to finding better ways to prevent, diagnose and treat cancer through lifechanging discoveries that lead to more treatment options. Laura Kouba Manager, Physician Relations 210-265-7662 NorrisKouba@uthscsa.edu

TMA Insurance Trust (HHHH 10K Platinum Sponsor) Created and endorsed by the Texas Medical Association (TMA), the TMA Insurance Trust helps physicians, their families and their employees get the insurance coverage they need. Wendell England 512-370-1746 wengland@tmait.org James Prescott 512-370-1776 jprescott@tmait.org www.tmait.org “We offer BCMS members a free insurance portfolio review.”

Guardian (★★★ Gold Sponsor) Live Confidently. Every financial dream deserves a well-crafted plan. Ned Hodge 210-332-3757 ned@nedhodge.com www.nedhodge.com | www.Opesone.com “Take care of today then plan for tomorrow”

Humana (HHH Gold Sponsor) Humana is a leading health and well-being company focused on making it easy for people to achieve their best health with clinical excellence through coordinated care. Jon Buss: 512-338-6167 Jbuss1@humana.com Shamayne Kotfas: 512-338-6103 skotfas@humana.com www.humana.com

INSURANCE/MEDICAL MALPRACTICE

Texas Medical Liability Trust (HHHH 10K Platinum Sponsor) With more than 20,000 health care 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 health care 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 512-658-0262 Kirsten.Baze@medpro.com www.medpro.com

continued on page 34 Visit us at www.bcms.org

PHYSICIANS PURCHASING DIRECTORY ProAssurance (HH Silver Sponsor) ProAssurance professional liability insurance defends healthcare providers facing malpractice claims and provides fair treatment for our insureds. ProAssurance Group’s rating is AM Best A (Excellent). Mike Rosenthal Senior Vice President, Business Development 800-282-6242 MikeRosenthal@ProAssurance.com www.ProAssurance.com

INTERNET TELECOMMUNICATIONS

Unite Private Networks (HHH Gold Sponsor) Unite Private Networks (UPN) has offered fiber optic networks since 1998. Lit services or dark fiber – our expertise allows us to deliver customized solutions and a rewarding customer experience. Clayton Brown Regional Vice President of Sales – San Antonio 210-693-8025 clayton.brown@upnfiber.com Aron Sweet – Account Director 210-788-9515 aron.sweet@upnfiber.com Jim Dorman – Account Director 210-428-1206 jim.dorman@upnfiber.com Tammy Carosello – Account Director 210-868-0420 tammy.carosello@upnfiber.com www.uniteprivatenetworks.com “UPN is very proud of our 98% customer retention rate”

INVESTMENT ADVISORY REAL ESTATE

MEDICAL BILLING AND COLLECTIONS SERVICES

Medical Financial Group (★★★ Gold Sponsor) Healthcare and Financial Professionals providing core solutions to Physicians from one proven source. CEO is Jesse Gonzales, CPA, MBA Controller and past CFO of (2) Fortune 500 companies, Past Board President of Communicare Health Systems. Jesse Gonzales, CEO CPA, MBA 210-846-9415 information@medicalfgtx.com Linda Noltemeier-Jones Director of Operations 210-557-9044 lindanj@medicalfgtx.com www.medicalfgtx.com “Let’s start with Free Evaluation and Consultation from our Team of Professionals”

PCS Revenue Cycle Management (HHH Gold Sponsor) We are a HIPAA compliant fullservice medical billing company specializing in medical billing, credentialing, and consulting to physicians and mid-level providers in private practice. Deion Whorton Sr. CEO/Founder 210-937-4089 inquiries@pcsrcm.com www.pcsrcm.com “We help physician streamline and maximize their reimbursement by 30%.” Commercial & Medical Credit Services (HH Silver Sponsor) A bonded and fully insured San Antonio-based collection agency. Henry Miranda 210-340-9515 hcmiranda@sbcglobal.net www.cmcs-sa.com “Make us the solution for your account receivables.”

MEDICAL PAYMENT SYSTEMS/CARD PROCESSING

First Citizens Bank (★★★ Gold Sponsor) We’re a family bank — led for three generations by the same family-but first and foremost a relationship bank. We get to know you. We want to understand you and help you with your banking.

SAN ANTONIO MEDICINE • February 2022

continued from page 33

Stephanie Dick Commercial Banker 210-744-4396 stephanie.dick@firstcitizens.com Danette Castaneda Business Banking Specialist 512-797-5129 Danette.castaneda@firstcitizens.com https://commercial.firstcitizens.co m/tx/austin/stephanie-dick “People Bank with People” “Your Practice, Our Promise”

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.”

MOLECULAR DIAGNOSTICS LABORATORY

iGenomeDx ( Gold Sponsor) Most trusted molecular testing laboratory in San Antonio providing FAST, ACCURATE and COMPREHENSIVE precision diagnostics for Genetics and Infectious Diseases. Dr. Niti Vanee Co-founder & CEO 210-257-6973 nvanee@iGenomeDx.com Dr. Pramod Mishra Co-founder, COO & CSO 210-381-3829 pmishra@iGenomeDx.com www.iGenomeDx.com “My DNA My Medicine, Pharmacogenomics”

MORTGAGES

SWBC MORTGAGE - THE TOBER TEAM (HHH Gold Sponsor) SWBC for Personal and Practice: Physician programs for wealth management and homebuying. For You Practice: HR administration, payroll, employee benefits, insurance, and exit strategies.

SWBC’s services supporting Physicians and the Medical Society. Jon Tober Sr. Loan Officer Office: 210-317-7431 NMLS# 212945 Jon.tober@swbc.com https://www.swbcmortgage.com /jon-tober

PROFESSIONAL ORGANIZATIONS 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! President, Kevin Barber 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. Alan Winkler, President info4@samgma.org www.samgma.org

REAL ESTATE SERVICES COMMERCIAL

Alamo Capital Advisors LLC (★★★★ 10K Platinum Sponsor) 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 developments, acquisitions & sales, lease representation and financial restructuring (equity, debt, and partnership updates). Jon Wiegand Principal 210-241-2036 jw@alamocapitaladvisors.com www.alamocapitaladvisors.com CARR Realty (HH Silver Sponsor) CARR is a leading provider of commercial real estate for tenants and buyers. Our team of healthcare real estate experts assist with start-ups, renewals, , relocations, additional offices, pur-

chases and practice transitions. Brad Wilson Agent 201-573-6146 Brad.Wilson@carr.us Jeremy Burroughs Agent 405-410-8923 Jeremy.Burroughs@carr.us www.carr.us “Maximize Your Profitability Through Real Estate” Foresite Real Estate, Inc. (HH Silver Sponsor) Foresite is a full-service commercial real estate firm that assists with site selection, acquisitions, lease negotiations, landlord representation, and property management. Bill Coats 210-816-2734 bcoats@foresitecre.com https://foresitecre.com “Contact us today for a free evaluation of your current lease”

RETIREMENT PLANNING

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. Cindy M. Vidrine Director of Operations- Texas 210-918-8737 cvidrine@favoritestaffing.com “Favorite Healthcare Staffing offers preferred pricing for BCMS members.”

Visit us at www.bcms.org

AUTO REVIEW

SAN ANTONIO MEDICINE • February 2022

2022 Ford Bronco

AUTO REVIEW

By Stephen Schutz, MD

Being an automotive manufacturer is hard. Tremendously hard, actually. The idea of car creation is simple enough: design and engineer a vehicle that appeals to a broad section of the population, manufacture it with very few defects and then market it so that people line up to buy it. Despite the simplicity of that concept, launching a vehicle that checks all those boxes is unbelievably difficult. For one thing, delivering a vehicle takes three years from approval to ready-to-sell, and customer tastes can change significantly during that time. In addition, government regulations may evolve, your competition may beat you to the punch and the economy can tank.

side can be hosed out without damaging anything if you’re so inclined. Nevertheless, the Bronco has all of the tech anyone would ever want. Apple Carplay and Android Auto come standard, and the central touchscreen enables you to control any HVAC/audio/what-have-you functions that you need to access. And the cinematic rocks-turn-intoa-bucking-bronco CGI show that happens every time you start your Bronco is kind of cool. Otherwise, experiencing owning a Bronco is going to be mostly similar to if you’d bought a Wrangler: there will be some compromises, but overall, you’ll be driving an authentic American icon,

If you’re sensing that it takes brains, clairvoyance and luck to get it all right, you're correct—car companies with thousands of talented employees and super-smart executives rarely hit home runs. In fact, I can only think of three over the past 50 years: the 1970 Datsun 240Z, 1979 Mazda RX-7 and 1990 Lexus LS400. Now there’s another one, the 2022 Ford Bronco. Seemingly a love child of the original 1960s Ford Bronco and current Jeep Wrangler, the new Bronco is a true phenomenon, selling out before a single unit was made, commanding up to $20,000 over list price at some dealerships and giving new meaning to the term, “waiting list” (expect to wait about a year if you order one today). I recently drove one for a week, and I get why it’s such a big deal. For starters, it looks great. Closely mimicking the current Jeep Wrangler’s footprint, the new Bronco adds lots of retro 1960s Bronco styling elements such as an upright grille with big “BRONCO'' lettering in the center, a boxy profile and round headlights coupled with vertically rectangular taillights. In person, the design works. Actually, this is such a striking truck that I don’t think it’s an exaggeration to say that 80% of its appeal is due to its good looks alone. Like the Jeep Wrangler, the Bronco can be had in either two- or four-door variants. And as with the Jeep, most Bronco buyers will opt for the four-door models. Unless you go off-road where the Bronco is superb, driving Ford’s home run is remarkably unremarkable. Around town it’s fine, good even, but on the highway it’s just average. The Bronco tracks well and has no problem keeping up with traffic, but the blockiness of the design means that wind noise intrudes at speed, and the larger tires that confer that off-road ability add noise as well. Having said that, the Bronco is better (and quieter) on the open road than the Wrangler. The Bronco’s interior is mostly utilitarian, which should appeal to most buyers who are looking for an authentic type of cabin. Buttons and switches are mostly big and obviously durable, and the entire in-

which means that other drivers will notice you, mostly approvingly, and you’ll feel special. A base two-door Bronco costs just under $31,000, and it includes a four-cylinder engine with a six-speed manual transmission, but that’s not what you want. You actually want the four-door Bronco with the ecoboost 2.7L V6 and the 10-speed automatic transmission. Any regular reader will know that I’m a manual transmission enthusiast, but Ford doesn’t allow the manual with the V6, and the manual coupled with the 4-cylinder is just, I’m sorry to say it, lame. Options and option packages are plentiful in the Bronco, so if you’re insistent on keeping your Bronco under $50,000, I wish you luck. You don’t need the expensive off-road killer Sasquatch package (although I suspect many readers will want it) because the middle of the road Outer Banks or loaded Wildtrak packages are plenty good enough. As noted, most BCMS members interested in a Bronco will probably configure one that costs north of $60,000 and will wait for a year or so to get it. To get your best deal and minimize your wait, call BCMS’ Phil Hornbeak at 210-301-4367. The 2022 Ford Bronco is a rare automotive home run, and I congratulate Ford for conceiving and launching it. If you are fortunate enough to get one, good for you. And if you’re on the waiting list, hang on. This is a very good SUV. 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. Stephen Schutz, MD, is a board-certified gastroenterologist who lived in San Antonio in the 1990s when he was stationed here in the US Air Force. He has been writing auto reviews for San Antonio Medicine since 1995.

Visit us at www.bcms.org

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

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

Coby Allen 210-696-2232

Rick Cavender 210-681-3399

Charles Williams 210-912-5087

William Boyd 210-859-2719

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

Northside Ford 12300 San Pedro San Antonio, TX

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

14610 IH 10 West San Marcos, TX 78249

Matthew C. Fraser 830-606-3463

Marty Martinez 210-477-3472

Paul Hopkins 210-988-9644

Mark Hennigan 832-428-9507

Kahlig Auto Group

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

North Park Lexus 611 Lockhill Selma San Antonio, TX

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

North Park Lincoln 9207 San Pedro San Antonio, TX

Cameron Tang 210-561-4900

Tripp Bridges 210-308-8900

James Cole 210-816-6000

Sandy Small 210-341-8841

North Park Mazda 9333 San Pedro San Antonio, TX 78216

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

John Kahlig 210-253-3300

James Godkin 830-981-6000

Al Cavazos Jr. 210-366-9600

Douglas Cox 210-764-6945

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

Gary Holdgraf 210-862-9769

Justin Boone 210-635-5000

Kahlig Auto Group