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VETERANS’ HEALTH Optimizing Combat Casualty Care – The Only American Burn Association-Verified Burn Center in South Texas Interview with Leopoldo "Lee" C. Cancio, MD, FACS, FCCM, Director of the U.S. Army Institute of Surgical Research Burn Center, conducted by Monica Jones, BCMS COO, and Trisha Doucette, Editor .......12

Benjamin Hall’s Story of Survival and Appreciation Interview conducted by Monica Jones, BCMS COO, and Trisha Doucette, Editor ..............................................................16

U.S. Army Institute of Surgical Research Burn Strong Initiative By Brent Sabatino, ADN, RN......................................................18

20 Years After Founding, Wounded Warrior Project® Still Serving By Rob Louis .............................................................................20

Paws for Purple Hearts By Dani Garroutte .....................................................................22

The Environmental Effects of War on Veterans: Chemicals and Extreme Temperature By Victoria Ayodele and Bryan Ubanwa.................................................................................................................24

Neonatologists in the Military By Rajam Ramamurthy, MD .............................................................................26

NOVEMBER 2023

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VOLUME 76 NO.11

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

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The Vietnam Army Grunt Museum “Serving Vietnam in Perpetuity” Interview with Michael Lynd Sr., conducted by Monica Jones, BCMS COO, and Trisha Doucette, Editor ..............30

Discovering Our Voices: The Veteran’s Writing Collective at Gemini Ink By Kristy Y. Kosub, MD, through an interview with Sarah Colby, MFA ....................................................................32 BCMS President’s Message .................................................................................................................................................8 BCMS Alliance Message ....................................................................................................................................................10 Medical Practice – Tax Credit By Bryan Boswell, Certified Financial Planner ......................................................................34 2023 Women Leaders in Medicine Awards ..............................................................................................................................36 BCMS Vendor Directory .....................................................................................................................................................40 Auto Review: Porsche Rennsport Reunion 7 By Stephen Schutz, MD...............................................................................44 Recommended Auto Dealers .............................................................................................................................................46 PUBlISHED BY: traveling Blender, llC. 10036 Saxet Boerne, tX 78006

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SAN ANTONIO MEDICINE • November 2023

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

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BCMS BOARD OF DIRECTORS

ElECTED OFFICERS John Joseph nava, Md, President Brian t. Boies, Md, Vice President Ezequiel “Zeke” Silva iii, Md, President-elect John Shepherd, Md, Secretary rajeev Suri, Md, Treasurer and Immediate Past President

DIRECTORS Woodson "Scott" Jones, Md, Member Sumeru “Sam” G. Mehta, Md, Member M. “Hamed” reza Mizani, Md, Member priti Mody-Bailey, Md, Member lubna naeem, Md, Member lyssa n. ochoa, Md, Member Jennifer r. rushton, Md, Member raul Santoscoy, do, Member lauren tarbox, Md, Member Jenny Case, Alliance Representative ramon S. Cancino, Md, Medical School Representative lori Kels, Md, Medical School Representative robert leverence, Md, Medical School Representative Keiko McManus, Md, Board of Ethics Chair John pham, do, Medical School Representative Cheryl pierce-Szender, Alliance Representative ronald rodriguez, Md, phd, Medical School Representative

Elisa d. o’Hern Col, MC, FS, Military Representative George F. “rick” Evans, Jr., General Counsel Jayesh B. Shah, Md, TMA Board of Trustees Melody newsom, CEO/Executive Director

BCMS SENIOR STAFF Melody newsom, CEO/Executive Director Monica Jones, Chief Operating Officer Yvonne nino, Controller Mary nava, Chief Government Affairs Officer Brissa vela, Membership Director phil Hornbeak, Auto Program Director August trevino, Development Director Betty Fernandez, BCVI Director Al ortiz, Chief Information Officer

PUBlICATIONS COMMITTEE norys Alexandra Castro-pena, Md, Co-chair John Joseph Seidenfeld, Md, Co-chair louis doucette, Consultant david Schulz, Community Member Elizabeth Clanton, Md, Member Kristy Yvonne Kosub, Md, Member neal Meritz, Md, Member Jaime pankowsky, Md, Member Alan preston, phd, Member rajam S. ramamurthy, Md, Member Adam v. ratner, Md, Member

SAN ANTONIO MEDICINE • November 2023

Faraz Yousefian, do, Member Moses Alfaro, Student Member victoria Ayodele, Student Member tue Felix nguyen, Student Member niva Shrestha, Student Member Bethanne Bradshaw, Student Member Andrew ta, Student Member Monica Jones, BCMS Coo, Staff Liason trisha doucette, Editor

PRESIDENT’S MESSAGE

Suicide Risk in Military Families - The Good News By John J. Nava, MD, 2023 BCMS President

This year, BCMS has a new ad hoc committee on Physician Wellness, formed initially in response to increasing suicide rates noted among physicians associated with the COVID-19 pandemic. As November is upon us, it is natural that our thoughts turn to our military veterans. A similar concern regarding effects of the pandemic on suicide risk for veterans was addressed in a recent annual report on National Veteran Suicide Prevention released by the Veterans Administration (VA) in September 2022. This report showed some data points that serve as anchors of hope. But before we review the data, let's go back a bit in time, and retrace how we got here. A few years ago, it was noted that veterans had a higher suicide rate than the general public, and it continues to be a little over 1.5 times greater. Attention to this general risk from self-harm began in 2012 with the National Strategy for Suicide Prevention developed by the U.S. Surgeon General and National Action Alliance for Suicide Prevention. In 2018, the VA introduced its 10-year National Strategy for Preventing Veteran Suicide, “which reflects a comprehensive public health approach to veteran suicide prevention. This combines community-based suicide prevention strategies and clinically based interventions. The National Strategy for Preventing Veteran Suicide provided the vision to begin coordinated implementation of public health approaches across universal, selective and indicated approaches to reach all veterans, including those without recent VA contact. These efforts are also fueled by the 2019 publication of the VA and Department of Defense (DoD) Clinical Practice Guidelines (CPG) for the Assessment and Management of Patients at Risk for Suicide. This provided the latest analysis of research on suicide prevention in clinical settings. Together, the National Strategy for Preventing Veteran Suicide and the latest CPG provided a road map that would be operationalized in the deployments of the Suicide Prevention 2.0 (SP 2.0) and Suicide Prevention Now (SP Now) initiatives.” (p. 6.) “Approved for full launch in 2019, SP 2.0 is a 6-year strategic plan with national reach focused on the implementation of clinical and community-based prevention, intervention and postvention services that reflect the National Strategy’s four pillars.” (p. 7.) “SP 2.0 outlines a practical strategy for implementing CPG evidence-based treatments — for example through dissemination of telemental health suicide 8

SAN ANTONIO MEDICINE • November 2023

prevention services across all VHA local health care systems, bringing treatments into the homes of veterans, a critical service particularly since the start of the COVID-19 pandemic.” (p. 7.) In 2021, the White House published Reducing Military and Veteran Suicide: Advancing a Comprehensive, Cross-sector, Evidence-informed Public Health Strategy. All of these efforts have culminated in the results revealed in the 2022 report. Here are some of the key findings: • “There were 343 fewer veterans who died from suicide in 2020 than in 2019, and 2020 had the lowest number of veterans suicides since 2006. • From 2001 through 2018, the number of veteran suicides increased on average by 47 deaths per year. From 2019 to 2020, there were consecutive reductions of 307 and 343 suicides, respectively, an unprecedented decrease since 2001. • From 2018 to 2020, adjusted rates for veterans fell by 9.7%. By comparison, the adjusted rate for non-veteran U.S. adults fell by 5.5%. • The age-adjusted suicide rate for women veterans in 2020 was the lowest since 2013, and the age-adjusted suicide rate for veteran men was the lowest since 2016. • From 2019 to 2020, among veteran men, the age-adjusted suicide rate fell by 0.7%, and among veteran women, the age-adjusted suicide rate fell by 14.1%. Among non-veteran U.S. men, the age-adjusted rate fell by 2.1%, and among non-veteran women, the age-adjusted rate fell by 8.4%. • Assessment of veteran suicide rates by race show decreases from 2019 to 2020 for all groups. • Despite the 24.6% decrease in the veteran population from 2001 to 2020, the number of veterans with VHA health care encounters in the year or prior year rose 55%, from 3.8 million to 5.9 million. • Despite onset of the COVID-19 pandemic in 2020, age and sexadjusted suicide rates among veterans fell 4.8% from 2019 to 2020, versus a 3.6% decline among non-veteran U.S. adults. The overall downward trends in veteran suicide in 2019 and 2020 are encouraging. They followed VA's launch of the 2018 National Strategy for Preventing Veteran Suicide (National Strategy).” (p. 7.) “While VA worked on the longer-term plan of SP 2.0 implemen-

PRESIDENT’S MESSAGE

tation, in collaboration with community partners, 2020 also saw the launch of the SP Now initiative, a bundled set of interventions, across five key domains, in alignment with a vision of the National Strategy. The SP Now plan aims to develop and deploy actions that available data suggests have the potential to be effectively implemented and to create meaningful results in a short amount of time. It is focused on these five critical areas: 1) Lethal mean safety; 2) Suicide prevention in at-risk medical populations; 3) Outreach and understanding of prior and non-VHA users; 4) Suicide prevention program enhancements; 5) Media campaigns.” (p. 7.) Part 4 of this report is titled Next Steps in VA’s Implementation of a Full Public Health Approach. It reinforces “three core tenets for suicide prevention …: 1) Suicide is preventable. 2) Suicide prevention requires a public health approach combining clinical and community-based approaches. 3) Everyone has a role to play in suicide prevention.” (p. 36.)

ects. The last few paragraphs are an invitation for the nation to become more fully engaged in veteran suicide prevention. In just a few years, many assets have been directed toward finding a solution to a problem that had been deferred for too long. Thoughtful study developed a large data set, which has now led to the development of best practices for suicide prevention, and this report shows how we can bend the curve to benefit our military veterans and active service members. The general public may benefit as well, as those best practices can inform community-wide efforts to achieve similar results in the non-veteran population.

Reference: U.S. Department of Veterans Affairs, Office of Mental Health and Suicide Prevention. 2022 National Veteran Suicide Prevention Annual Report. 2022. https://www.mentalhealth.va.gov/suicide_prevention/data.asp. John J. Nava, MD, is the 2023 President of the Bexar County Medical Society. He is interested in Primary Care, Clinical Research and Public Health.

What follows are highlights of community prevention efforts, grant programs, innovation efforts, research and demonstration projVisit us at www.bcms.org

BCMS ALLIANCE

The Transition from Uniform to Suit By Jenny Case, MSN, MBA, RN

The transition from the military world to civilian life can be exciting and freeing. At the same time, however, it can be a daunting and uncertain period as well. The change is not as easy as simply wearing a military uniform one day and a suit the next. So, what are the other challenges that veterans face when going into the civilian workforce, specifically medical professionals? When I transitioned from being an Army nurse to working in the civilian sector, I noticed some differences in the outlook on patient care. In the military, we were always mission driven. “Soldier first” was a phrase I took to heart. Deployments and military training would often remove you from patient care and take precedence over patient continuity but was ultimately preparing you for your primary job. And as a fellow veteran and local physician, Dr. Mark Bagg made the point that civilian medicine is more patient-focused and can lead to overall patient satisfaction. The mission-focused side of military medicine instills a deep level of esprit de corps into your practice. Dr. Shane Sweeney, who just recently ETSed from the Army, said that “besides deciding what to wear every day, the hardest part was leaving behind all my awesome colleagues.” This camaraderie is a part of the military that would be hard pressed to replicate in other areas of work. The second takeaway I learned from the change from military to civilian medicine was the difference in the business aspect of medicine. Dr. Mark Bagg thought back to his retirement from the Army and going into private practice, explaining, “After getting out I really had to take the time to build my practice and go out and meet other providers.” There is an inherent competition that you don’t necessarily see all the time in military medicine, which can take time to get accustomed to. He also noted the difference between “leading in the military vs managing personnel in a clinic setting.” Having spent my life as an Army Brat and then immediately going 10

SAN ANTONIO MEDICINE • November 2023

on Active Duty, I had never known anything besides military medicine. So, while I made the transition professionally to working as a civilian nurse, I also made the change to civilian medicine as a patient. While I now had the freedom to choose where I received my medical care, I had to navigate of world of co-pays, deductibles and in-network vs out-ofnetwork care. Dr. Christopher Case said the biggest change he noticed when leaving the military is navigating the administration and bureaucracy of civilian medicine, but sees it as a trade-off for getting more stability for his family. “It seems like I spend more of my day sometimes dealing with insurance companies rather than patient care … but I will take that over having to move every three years and leaving my family for months at a time,” he said. When discussing it with Dr. Raymond Bagg, he reflected that the military had prepared him to work well within a large system and allowed him to transition to a teaching hospital. The switch from military to civilian life is eased specifically by living here in Military City, USA. Dr. Shane Sweeney explained to me that finding a position here in San Antonio made the change to the civilian side a little easier, so he didn’t have to uproot his family. Most of the hospital systems and clinics in San Antonio are well acquainted with hiring veterans and onboarding them successfully. As an organization in Military City USA, the BCMS has a large mixture of active-duty families and veterans who have decided to settle down in San Antonio. Whether it is welcoming a new military family PCSing to the area or helping a transitioning family moving into the unfamiliar civilian workforce, we in the BCMS and the Alliance can use our experiences to help each other through these times of change for our families. Jenny Case, MSN, MBA, RN, is the 2023 Co-President of the BCMS Alliance.

VETERANS’ HEALTH

Optimizing Combat Casualty Care The Only American Burn Association-Verified Burn Center in South Texas Interview with Leopoldo "Lee" C. Cancio, MD, FACS, FCCM, Director of the U.S. Army Institute of Surgical Research Burn Center, conducted by Monica Jones, BCMS COO, and Trisha Doucette, Editor

he U.S. Army Institute of Surgical Research (USAISR), located at Joint Base San Antonio-Fort Sam Houston, Texas, is one of seven research institutes under the U.S. Army Medical Research and Development Command. As the Army’s premiere research organization focused exclusively on the combat wounded, the USAISR is home to the only Burn Center in the Department of Defense (DoD). The mission is a noble one, “Optimizing Combat Casualty Care.” The medical and comprehensive medical research performed at the USAISR is designed to address the treatment of combat trauma of today and on the future battlefield. This includes new technologies for providing far-forward personnel with tools to monitor, manage and care for combat casualties across multi-domain operations.

Benjamin Hall with Kelly Brown, a physical therapist at the U.S. Army Institute of Surgical Research Burn Center, who worked with Ben during his care while a patient at the Burn Center. 12

SAN ANTONIO MEDICINE • November 2023

The USAISR lineage is traced back to the U.S. Army Surgical Research Unit (SRU) at Halloran General Hospital, Staten Island, New York, that was tasked to evaluate the role of penicillin to treat war wounds and burns in 1943. At the end of WWII, the atomic detonation at Hiroshima in 1945 instantaneously generated 59,500 burn casualties. That massive number and a comparable number of burns at Nagasaki, alerted the Army to burn injury as a major problem in future conflicts. Consequently, the USAISR has been the driving force behind the most advanced combat casualty care since 1949. After WWII ended, Halloran General Hospital was eventually closed and the SRU was moved to Brooke General Hospital at Fort Sam Houston in 1947, and then to its current location in San Antonio, Texas in 1996. Dr. Lee Cancio, the Director of the USAISR Burn Center, stated that the USAISR’s comprehensive research programs address medical advances to stabilize and treat combat casualties, spanning the continuum of care from point of injury to return of duty/functional survival. Within the Large-Scale Combat Operations (LSCO) concept, routine, rapid patient evacuation cannot be guaranteed due to contested airspace and the potential for interdiction of evacuation platforms. During these intermittent and unpredictable periods, personnel must be prepared to sustain casualties in an austere environment for up to 72 hours with organic capabilities and limited resupply, known as Prolonged Field Care (PFC). The research directorate has three broad goals based on LSCO and PFC concepts that guide on-going efforts to ensure the USAISR Combat Casualty Care Research is relevant. These goals are: • Increase capabilities of forward medical personnel with smart diagnostics, decision support and robotic assist, as well as advanced drugs and other technologies, therefore reducing the burden of combat casualty care on operational units. • Maintain survivability of casualties during prolonged care and evacuation. • Prevent relatively minor, survivable wounds from becoming life, limb or eyesight threatening due to PFC conditions. “As a burn doctor, I had to translate what I learned here to what I learned in Iraq. If we look back over the history of progress and burn care that took place at this Burn Center and other places, you can chart, document and understand the interventions that were most effective at re-

VETERANS’ HEALTH

loss (now known as the Compensatory Reserve Measurement monitor or CRM) and to automate fluid treatments for burn patents (Burn Navigator). Today, the USAISR is the DoD’s lead laboratory supporting the development of products such as freeze-dried plasma and cold-stored, extended-life platelets that will make transfusions possible wherever medically needed on the battlefield. These products will also greatly benefit rural and remote civilian trauma care. The USAISR Burn Center was the second burn center established in the U.S. and is one of only 70 American Burn Association verified burn centers in the world, and six in Texas. It is the first and only DoD burn center, established in 1949, and the only military treatment facility co-located with a research laboratory. The USAISR Burn Center also serves as a regional burn center for 49 A Burn Center staff member (in Addidas shirt) traveled to his home country, Peru, to meet counties in South Texas, and treats both military and two Peruvian sailors who were transported by the Burn Flight Team from Hawaii for treatment after being burned on their ship during an exercise. civilian burn patients, which helps maintain clinical currency. There are currently 620 employees — 161 military ducing mortality. Effective fluid resuscitation, effective wound care, early / 194 civilian / 265 contract. surgery by competent surgeons, [and] effective pre-, intra- and post-opThe USAISR Burn Center maintains 40 beds (16 ICU / 24 Progreserative nursing care are the key things. Those things took place in a setting sive Care) for burn casualties and has cared for major burns from all milin the 1950s/60s in this Burn Center, which was a lot less fancy than our itary conflicts since WWII, including 1,000 patients from Iraq and technology today, yet those were the interventions that most significantly Afghanistan to date. Annually, the USAISR Burn Center admits apdropped post-burned mortality. The basic intervention saves the most proximately 625 burn patients, and 75 non-burn necrotizing problems lives. I tried to do this when I was deployed. However, when I was de- (soft tissue infections, desquamating skin diseases and soft tissue trauma ployed is probably different from what the combat medic or the medical from accidents). The team performs about 1,000 surgical operations a unit may experience on the battlefield of the future. If the battlefield of year — 800 for acute management of injuries, and 200 plastic/reconthe future involves large scale combat operation against a peer or near peer structive operations to correct the functional and disfiguring sequelae advocacy, we anticipate that we are going to lack air superiority and we of severe injury, to include scar-related contractures. Specialized treatwill not be able to evacuate patients in as timely a fashion as we did previ- ment modalities include high frequency ventilators, continuous renal ously in Iraq, Afghanistan and, even before that, Vietnam. Casualties will replacement therapy and extracorporeal membrane oxygenation. remain forward for a longer period of time and they will remain in the The USAISR Burn Center is also home of the Army Burn Flight theater of operation for a longer period of time. This will make the job for Team. The Team has conducted nearly 100 overseas missions since the deployed medical unit more difficult. That unit will need to have more 2003, and stands ready to deploy worldwide within 12 hours for both burn training and have to take care of patients for a longer period of time military and civilian patients in order for the patient to receive specialty than they did in the past. We received casualties from Iraq and Afghanistan burn care while in flight. within three to four days of injury on the battlefield, which is very fast The USAISR Burn Intensive Care Unit has the highest acuity critical considering all the stops along the way that they had to make from point care patients in the DoD whose injuries closely mimic combat casualof injury to the USAISR within 72 hours. [I] can’t stress enough — focus ties, and this serves as an excellent readiness training platform for stuneeds to be on fundamental skills,” explained Dr. Cancio. dent groups as well as deploying medical personnel who conduct In the early 2000s, the USAISR was the primary DoD laboratory clinical rotations for readiness training. Student groups include Special for the development and testing of advanced hemostatic dressings (eg, Forces Medics, Critical Care Flight Paramedics, Critical Care Nursing Combat Gauze), tourniquets (eg, Combat Application Tourniquet Students and GME programs, and clinical education also provides “CAT”) and other devices that are now carried by individual service training and outreach to community partners through training agreemembers, medics and civilian emergency personnel around the world. ments, community burn prevention events and provider training for In the mid-2000s, the USAISR developed new devices to detect blood non-burn center personnel to include Advanced Burn Life Support. continued on page 14 Visit us at www.bcms.org

VETERANS’ HEALTH continued from page 13

The primary mission of the USAISR Burn Center is Research and Development, driving advances in burn care by providing multidisciplinary, specialized therapy to the sickest patients in the DoD, and this research has become the standard for burn care throughout the world. As such, burn mortality has been cut in half since the 1940s. Dr. Cancio added, “In the past decades, our predecessors here improved post burn survival, doubling survival rates for the young adult population from the post-WWII era to present. Surviving has improved; [the] focus has turned to improving long-term outcomes, rehabilitation [and] psychosocial care of patients. [Our] newest efforts include funding by the National Institute on Disability, Independent Living and Rehabilitation — looking at long-term outcomes.”

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Their research has led to the development of life-saving, combat casualty care products provided to the soldiers in the theater of operations including: • Hemcon Dressing • Combat Application Tourniquet • Damage Control Resuscitation • Combat Gauze Dressing • Burn Navigator • Hemostasis Innovations • Hypothermia Prevention Kit • Intraosseous Infusion Systems • Resuscitation Innovations – Damage Control o Hemostatic (balanced) Resuscitation o Freeze-Dried Plasma (FDP) o Cold-Stored Platelets • Antibiotics by Medics • Burn Resuscitation Guidelines • Needle Thoracentesis • Ultrasound to Diagnose Pneumothorax • Individual/Vehicle First Aid Kit (IFAK/VFAK) • Extracorporeal Organ Support o Renal Replacement Therapy o Lung Support • Impedance Threshold Device for Cardiac Arrest and Hypovolemia • Device for Early Detection of Shock (CRM) • Battlefield Burn Prevention

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Current Research is focused on the following: • Extracorporeal Life Support (lung, kidney and combined) without blood thinners • Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) • Skin Substitutes • Reduce complications, improve facial wound outcomes and repair 14

SAN ANTONIO MEDICINE • November 2023

• • • • •

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Bone Regeneration Face and Burn Scar Mitigation Biofilm-impaired Wound Healing Repair of wounds that occur within the anterior segment of the eye Develop and test new treatments to preserve and restore vision after damage to optic nerve Produce combat-relevant models of blast-induced auditory injury and dysfunction Develop models to predict onset of sepsis Telemedicine and telemonitoring for prolonged field care Develop new ways to store platelets Develop of universal blood type and pathogen-reduced freeze-dried plasma Develop battlefield blood collection and transfusion models Provide new techniques, tools and knowledge to combat medics and prehospital providers to better treat wounded warriors at point of injury Analgesics that do not depress cardiovascular and respiratory function Develop models to determine how blast and hemorrhage interact in hemorrhage and TBI Reduce opioid use with novel analgesics and pain management devices

About Dr. Lee Cancio Dr. Cancio has worked at the USAISR Burn Center since graduating from surgery training in 1995. He had the privilege of working under the leadership of Col. Basil Pruitt, who was the Commander and Director of the Burn Center for 27 years, and later with Col. John Holcomb, who is renowned in the trauma community. Dr. Cancio led many of the improvements in combat casualty care that were implemented in Iraq and Afghanistan. Board-certified in Surgery and in Surgical Critical Care, Dr. Cancio is a Clinical Professor of Surgery at the University of Texas Health Science Center at San Antonio and the author/co-author of about 200 publications. During his active-duty career in the U.S. Army, Dr. Cancio deployed with the 82nd Airborne Division to Operation Just Cause, Panama, 1989-90 and to Operation Desert Storm, 1990-91. He served as the Deputy Commander for Clinical Services at the 86th Combat Support Hospital in Baghdad during Operation Iraqi Freedom in 2005, and again in 2008. In 2013 he deployed with a Forward Surgical Team to

VETERANS’ HEALTH

Benjamin Hall celebrates his 40th birthday at the U.S. Army Institute of Surgical Research Burn Center with his team of nurses and physical therapists.

Afghanistan during Operation Enduring Freedom. He retired in the rank of Colonel in 2014.

“My goal in life is to provide effective leadership of this Burn Center and to develop the next generation of burn professionals, particularly physicians/scientists. We ask a lot of those who work here across the board. Of my physicians, I ask that they develop themselves as scientists ... I also enjoy singing in the choir and scuba diving.”

such patients. Across the board, burns are a significant life event, for many burns could lead to adverse phycological outcomes, to include post-traumatic stress disorder, major depressive order, difficulty returning to work or community, or to activities of daily living. We know all about these challenges and we feel like we need to do our best to overcome these challenges. There are patients who successfully navigate these changes, and [are] able to grow and learn from their experience in a form or fashion. Even though their lives have been altered … they are able to experience what some people call post-traumatic growth. Our burn survivors are inspiring and we can learn from them in that regard.”

– Dr. Lee Cancio. In 2022, The USAISR Burn Center team treated Benjamin Hall, the Fox News Foreign Correspondent who was seriously injured while on assignment in Ukraine. Two of his colleagues did not survive, but Hall’s final stop in his journey from point of injury to recovery was the USAISR Burn Center. Dr. Cancio acknowledged Hall’s determination, “We were grateful to take care of Mr. Hall. [That] he was a reporter covering a war zone was meaningful for us, and we wanted to help him. He went through a lot; a life-threatening, life-changing experience. He is very articulate about talking about his experience, and what all of our patients, to an extent, go through. Personally, [I] have not gone through a life-threatening or life-changing injury but I have interacted with many

Stay connected with the ISR Burn Center: www.usaisr.health.mil/ www.facebook.com/USAISR/ https://twitter.com/usa_isr Monica Jones is the Chief Operating Officer for the Bexar County Medical Society. She has been with the Society for two years. Trisha Doucette is the Editor of San Antonio Medicine magazine, Home Design & Decor magazine, Cordillera Ranch Living magazine and Rio magazine. Visit us at www.bcms.org

VETERANS’ HEALTH

Benjamin Hall’s Story of Survival and Appreciation

Interview conducted by Monica Jones, BCMS COO, and Trisha Doucette, Editor Interview facilitated by Brissa G. Vela, BBA, BCMS Membership and Event Director, and Steven Galvan, Doctor of Business Administration, USAISR Public Affairs Officer

n March 14, 2022, nearly three weeks into an assignment in Ukraine, a car carrying Fox News Foreign Correspondent Benjamin Hall and two of his colleagues was hit by Russian bombs just outside the city of Kyiv. Cameraman Pierre Zakrzewski, a longtime traveling companion of Hall’s who had accompanied him on many other assignments, and Sasha Kuvshynova, a Ukrainian journalist, did not survive. Through a monumental and coordinated effort to get him back to the U.S. for medical care, Mr. Hall survived. He sat down on Tuesday, September 26, 2023, to tell us his story. Hall was not new to conflict situations. In fact, he said he had been on much more dangerous assignments. But it was during this interview that his outlook revealed another side of war — a more compassionate approach to reporting. “I’ve been covering conflicts for about 15 years now. When I started in journalism, that’s the first thing I wanted to do. Frankly, I find conflict to be fascinating. I think that you see the worst on earth. You see the tragedy, the fear, the pain. You also see the best. You see courage and bravery. You see people helping each other. You see communities coming together, and it’s a really difficult thing to cover because you see the worst thing in one sense, and you also see the best, and it puts you at the forefront of what experience is. I think that’s what I wanted to do as a journalist ... I wanted to talk about real experience. I wanted to take what I saw and bring it back home.” Throughout Hall’s career, he has covered Middle Eastern conflicts in Syria, Libya, Afghanistan, Iraq and Somalia, to name a few. He has

been behind enemy lines, lived in caves with fighters, trudged through rivers in the middle of the night and boarded illegal weapons shipments. But when he joined Fox News in 2015, that expanded. He still covered conflict but was able to delve into world politics, natural disasters and families torn apart. “Nowadays, war in this big geopolitical pull. There’s military involved; there’s finance involved; the economies are involved … It’s all these different things, and there are people right in the middle. They often don’t appreciate that there are politicians sitting halfway around the world who might well be determining what will happen to their little community or country. It’s trying to understand these pushes and these pulls that I find so interesting,” said Hall. On assignment in Ukraine, Hall and his colleagues knew they were in a conflict area, where Russians were approximately 30 miles away, but they were not going straight to the frontlines. Hall explained, “At Fox, we have really set methods about where we go and the stories you pursue and how you move and the communications you have. We had a reading of where we were and did not expect it to be as close. Nowadays, with long-range artillery and drones, sometimes those weapons can reach you.” The first bomb landed about 30 feet in front of them. The second bomb landed by their car, and Hall blacked out. Hall tells of a vision he had where his daughter was urging him to get out of the car. “It brought me back. It gave me some sort of strength, and I opened my eyes and reached for the car door, took one step out, and the third bomb hit the car itself. That’s what threw me away and took the leg off ... Something saved me,” he shared. Hall estimates being there for about 40 minutes with no communications, alone, until he was discovered by the Ukraine special forces team. They drove him to Military Hospital #5, a small Ukrainian military field hospital only a few miles from the site where the attack had happened. While he doesn’t have much information from this time, Hall said five life-saving surgeries took place: “They took off what was Benjamin Hall at the U.S. Army Institute of Surgical Research Burn Center.

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left of my right leg, sewed up what was left of my left foot, worked on my burns, patched together my hand, did something to my eye.” The next day, he was moved to a larger Ukrainian hospital and transported to Poland the following day. A plan was already in the works. Hall explained that Jennifer Griffin, a correspondent at the Pentagon for Fox News, had reached out to Admiral John Kirby, but American policy stated that the U.S. military could not go into Ukraine. If they could get him to Poland, the U.S. military would take care of him — an uncommon occurrence for a civilian. It required the signature of Defense Secretary Lloyd Austin, who signed off while in flight from the U.S. to Europe. Hall traveled for 10 hours, without pain medication, on the Polish Prime Minister’s train. From there, the 82nd Airborne sent a Black Hawk helicopter to fly him to a base in Poland with a small U.S. contingent for a quick checkup, then on to Landstuhl Medical Center in Germany, where he underwent several more operations. “For 20 years, Landstuhl dealt with injured soldiers in Afghanistan and Iraq. They had seen people injured like I had been injured. There’s a real sense of comfort when you go in there and look around, and the doctors know exactly how to treat you. It’s a real sense of gratitude. I knew I was being treated in the right place,” he added. Then came the decision to move Hall to Walter Reed or the U.S. Army Institute of Surgical Research (USAISR) Burn Center, co-located with Brooke Army Medical Center. In the end, it was determined that the USAISR Burn Center had the better burn unit, and his burns had to be treated first. Hall remembers landing in San Antonio in the middle of the night, around 2 a.m., and Dr. Joseph Alderete, who ended up overseeing his case, came onboard, “…he [Dr. Alderete] looked at me, and he just said, ‘Don’t worry, we got you, we got you, we got you. You’re with us now; don’t worry, we got you.’ … I felt it at Landstuhl as well. I felt it when the helicopter landed in Poland. I felt it there on the runway. I was at the best place to be.” Hall spent six months in San Antonio, between the USAISR Burn Center and The Center for the Intrepid (CFI). He spent another four months at the Fisher House. He credits Dr. Alderete for overseeing his case, Dr. Casey Sabbag, who worked on his hands, Dr. Alicia Williams, who worked on his burns and CFI for his prosthetics. “They were absolutely amazing! They are life givers! They gave me back my life, and they sent me home to my family. … I will be eternally grateful.”

Hall praises the Polytrauma System of Care in San Antonio. “If I had not been in the [care of the] military, the other options would have been five or six different doctors in different hospitals. The burns guy is there, and the best prosthetics guy is there, and the eye person is there. It sounds almost impossible that you could do that with my kind of polytrauma injuries in different places, so to have this center where I was — first the Burn Center and then CFI, so coordinated, every single doctor talking to every other single doctor and the treatment moving forward at the same pace, knowing how to fit it in. That is absolutely amazing, and I think [is what] only military medicine can do … The military understands exactly the combined injuries. They know how quickly on the battlefield how to respond to these.” San Antonio is one of only five Polytrauma Rehabilitation Centers in the U.S. Hall’s memoir, "Saved: A War Reporter's Mission to Make It Home," was released on March 14, 2023, exactly one year after the bombing in Ukraine, topping the New York Times Best Seller list. Written while in the hospital, Hall called the writing therapeutic. He wanted the book to be about the people who helped him — the doctors, the serviceman who rescued him, the injured veterans who came to his room and told him he would be fine. And he wanted to continue to remember and honor Pierre and Sasha. Back at work, Hall finds his focus has taken a different direction. He has chosen to talk about hope and optimism. He is intrigued by leaders and those who risk their lives for us. “For the future [I want] to keep talking about wounded veterans. I was just at the Invictus Games. It’s amazing because these people are doing so well because of the support they have been given. And for the 500 that were there, there are still tens of thousands of people in America who are struggling, still finding it difficult ... I just hope that each of them gets the sort of care that I did. That had people around them because that helps. As so many people have mental problems and PTSD. So more than anything, I look forward and want to make sure there’s as much support for those people as possible. It’s not just the care you get in the hospital, it’s the care you continue to get for years to come. Being in the hospital is the easiest part because you are surrounded by people to help you, doing the right things. Then you go home and you sit there, you can’t go to work … The physical side is there but that mental support is so important. I just felt that’s what I was given.” Benjamin Hall was in San Antonio on October 12, 2023, attending the 2023 Heroes of Military Medicine Awards. Visit us at www.bcms.org

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U.S. Army Institute of Surgical Research Burn Strong Initiative By Brent Sabatino, ADN, RN

y mother is a veteran and was a Captain in the Army during the 1980s. She worked as a registered nurse in the worldrenowned U.S. Army Institute of Surgical Research Burn Center in the Burn Intensive Care Unit (BICU). I remember the stories she would tell me in my early childhood. She described her time there as one of the most rewarding times of her nursing career. I still see that same sparkle when I recount my stories to her. Yes, somehow, I ended up in the same world-renowned Burn Center as a BICU nurse myself. The Burn Center has been my home and has enabled my professional development as a registered nurse for the last 15 years. I must say, it has been the most fulfilling and inspirational position of my 22year nursing career. To clarify, I am not in the military, although my mother did run our household as though I was a soldier at times. The Burn Center is part of the U.S. Army Institute of Surgical Research (USAISR). We are the only burn center in the U.S. Department of Defense (DoD). The USAISR is a research organization whose mission is “Optimizing Combat Casualty Care.” Reflecting the importance of burns on the battlefield and in our civilian communities, the Burn Center supports the USAISR mission by conducting research and development that aims to constantly improve the care of patients with burns and similar conditions. The USAISR is a federal DoD facility, which primarily serves active duty servicemembers, their families and retirees. However, recognizing the importance of clinical practice to wartime readiness, the great majority of our patients in times of peace are civilians from the state of Texas. In 2018, I attended a national American Burn Association (ABA) conference in Chicago where I networked with many first responders, both firefighters and EMS. The persistent thought in my mind during my dialogue with these professionals was, “how can the Burn Center foster a relationship with our transporting EMS services and local community?” The Burn Strong Initiative was born at that ABA conference. I presented the Burn Strong Initiative to my leadership and received a wave of applause. The moment felt surreal for an ICU nurse because we live off the daily adrenaline rushes provided at the bedside, caring for patients in their greatest hour of need. We generally don’t gravitate towards the politics of administration. This idea settled well with me 18

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CPT. Eric McDade and Mr. Brent Sabatino with City Council District 6 Council Woman, Ms. Melissa Cabello Havrda, who hosted the November 1, 2022 Veterans Dance, where the U.S. Army Institute of Surgical Research Burn Center had a burn injury prevention booth.

though, because if I could bring it to fruition, Burn Strong could impact our future patients’ outcomes even though it wasn’t at the bedside. The Burn Strong Initiative encompasses three components: Education, Community Outreach and Burn Survivor Peer Support. With the help of our Director of the USAISR Burn Center, Leopoldo "Lee" C. Cancio, MD, FACS, FCCM, and the City of San Antonio Fire Department Medical Director, Dr. David Miramontes, we created a two-hour, Burn Strong Thermal Injury Pre-Hospital Quick Course, specific for first responders. Our first students would be from the San Antonio Fire Department. In 2019, over the course of the entire year, Mr. Reuben Salinas, our Burn Progressive Care Unit (BPCU) wound care specialist, and I taught a total of about 900 emergency first responders. As the program

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Mr. Brent Sabatino and Mr. Ruben Salinas with the attendees of the Burn Strong course from the San Antonio Fire Department’s first responders.

grew, we realized a separate course was needed for emergency department personnel because the first 24 hours of care that a burn patient receives are critical. According to the National Fire Prevention Association, “In 2021 local fire departments responded to an estimated 1.35 million fires in the United States. These fires caused 3,800 civilian fire deaths and 14,700 reported civilian fire injuries.”1 The course we developed familiarizes medical staff with interventions that need to be initiated prior to a transfer to a verified burn center. Since its inception, we have trained over 4,000 first responder and emergency medical staff, to include MDs, PAs, Nurse Practitioners, RNs and LVNs. These courses have both been approved for two continuing education credits for physicians and nurses. The second part of the Burn Strong Initiative is a focus on Community Outreach in the form of injury prevention. During times of peace, our patient population consists mostly of injured civilians and veterans, as opposed to battlefield military casualties. According to San Antonio Fire Department statistics, there were 14 house fire fatalities in 2021 and 15 fatalities in 2022. The city has reported 12 fatalities since January of this year.2 There is a need for education and training about burn prevention and fire safety. Our injury prevention activities include health and wellness fairs, safety fairs, senior center safety talks and other community outreach activities. The USAISR Burn Center wants to make sure San Antonio knows us as a resource to the city and surrounding areas. The last component of the Burn Strong Initiative is peer support. An important aspect of burn patient care occurs after they are discharged. The USAISR Burn Center partnered with Ms. Sue Dodson, the director of the Texas Burn Survivors Society (TBSS), a local nonprofit burn survivor organization, to create a burn survivor peer support group. This group meets the third Wednesday of each month at a centrally located school on the northside of San Antonio. The group is open to all burn survivors, to include their family and caregivers. The goal of the group is to get survivors out of their homes and around other survivors. There, they can talk to one another about their expe-

riences, struggles and challenges. The group strives to help survivors gain strength by sharing their lived experience in a safe place, and to facilitate reintegration in the form of social outings. Looking back, none of this could have been done without the support of the Burn Center leadership, the staff of the BICU and the Burn Progressive Care Unit, and all the Burn Center staff. It has been an adventure learning how to create and sustain an outreach program in a federal facility. That gleam in my mother’s eyes helps me get through the rough days. I hope that I have made you proud, momma. Our institution is here to help educate and support the communities that we serve, making our community BURN STRONG. Acknowledgements: The author wishes to acknowledge Dr. Lee Cancio for helpful suggestions on this manuscript, and Ms. Michae’l Gleason for the help provided with writing this manuscript and the data analysis. Thank you to my family for their support as well. Disclaimer: The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. References 1. https://www.nfpa.org/News-and-Research/Data-research-andtools/US-Fire-Problem/Fire-loss-in-the-United-States 2. https://sanantonioreport.org/san-antonio-fire-department-stressesneed-for-smoke-alarms-after-fatal-house-fires/ Mr. Brent Sabatino, RN, is a burn intensive care unit nurse, and outreach and injury prevention coordinator for the USAISR Burn Center at San Antonio Military Medical Center. He has been an intensive care unit nurse since 2002. Mr. Sabatino is a native to San Antonio since the 2nd grade, and girl dad to three beautiful daughters. "We get to do this job." Visit us at www.bcms.org

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20 Years After Founding, Wounded Warrior Project Still Serving ®

By Rob Louis

hen Wounded Warrior Project® (WWP) started in 2003, the focus was on the immediate needs of wounded service members returning from Afghanistan and Iraq. They were injured and had no personal belongings, so a group of veterans and supporters collected comfort items and put them in backpacks to deliver to a military hospital. The response was beyond positive, and WWP would soon begin to take shape. Over two decades of service, WWP has invested more than $2 billion into serving wounded, ill and injured veterans and service members around this great nation. San Antonio is one of the first cities WWP looked to when opening offices as the organization grew. With nearby military bases, a large veteran population, and community leaders dedicated to supporting these men and women, Military City, USA, as San Antonio is sometimes called, created a perfect pairing. Army veteran Brian Neuman was the first WWP staff member in San Antonio. At first, his role had him visiting wounded service members at Brooke Army Medical Center at Fort Sam Houston. Brian knew the experience. WWP visited him after an explosion nearly killed him in Iraq. He lost an arm in that attack but gained a family in WWP. 20

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“I recognized everyone at Wounded Warrior Project lived the mission to honor and empower wounded warriors,” Brian said. “I wanted to be a part of what they were doing.” Along with those hospital visits, Brian has helped wounded veterans through their benefits process, has helped lead the connection program at WWP, and now helps veterans dealing with some of the more complex challenges. This year, WWP is recognizing 20 years of service to veterans, service members and their families. A lot has been accomplished since 2003, but there is still much more to do. A Growing Need While our nation is no longer in major conflicts in Afghanistan and Iraq, the needs of today’s generation of wounded veterans are not going away. In fact, it is growing. Many post-9/11 veterans live with the signature invisible wounds of those two wars: Post-traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI). The Department of Defense reports more than 460,000 diagnosed TBIs since 2000. TBIs range in severity from a mild concussion to a severe TBI that impacts daily lives.

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Estimates suggest more than 600,000 veterans live with symptoms of PTSD. WWP’s Annual Warrior Survey shows nearly four in five veterans registered with the organization report symptoms of PTSD. According to the Department of Veterans Affairs, those symptoms include: • Reliving the traumatic experience • Avoidance • Negative thoughts or feelings • Sleeplessness • Being on edge • Changes in behavior • Isolation Support Is a Phone Call Away Wounded Warrior Project helps with clinical treatment and nonclinical support to address PTSD. The lifesaving programs come at no charge to veterans and their families, and they have an impact. WWP Talk (www.woundedwarriorproject.org/programs/wwp-talk) is a nonclinical telephonic support service where a warrior or family member receives a call every week. They talk with a WWP Talk partner about different topics and address challenges. They are held accountable for goals they set at the onset of their involvement in WWP Talk. Project Odyssey® (www.woundedwarriorproject.org/programs/project-odyssey) combines adventure-based learning, direct support and camaraderie to help address the symptoms of PTSD. This program brings veterans together to face challenges and build support structures. WWP worked with four top academic medical centers to develop a program to treat PTSD and TBI. Warrior Care Network® (www.woundedwarriorproject.org/programs/warrior-care-network) provides two weeks of intensive clinical care. Veterans undergo a battery of evidence-based treatments, including cognitive processing, prolonged exposure, group therapy and more. Beyond verifiable results, warriors report improvements. Ninety-one percent tell WWP they can overcome barriers after care. Ninety-six percent say they are satisfied with their clinical treatment. While Warrior Care Network partner facilities are in Los Angeles, Chicago, Atlanta and Boston, veterans are treated from around the country, including in San Antonio. Not only are the treatment costs covered, but so are travel costs. It Starts with Connection One of the ways veterans are challenged in their transition from military to civilian life is by reconnecting with their community. In the organization's latest Annual Warrior Survey, two in three warriors served by Wounded Warrior Project reported feeling lonely. WWP helps by planning fun, engaging events to bring warriors together. In San Antonio, that can mean barbecue dinners, golf events, pickleball and other

gatherings. Bringing warriors together helps rekindle the camaraderie these men and women lost when they left the military. Beyond the fellowship, warriors also learn about the many ways WWP supports veterans. Word-of-mouth helps steer veterans to mental health support, career counseling to find the right civilian position, and physical health and wellness coaching to get back in shape. That connection also ensures veterans know they are not alone. Having fellow warriors to call or message in tough times or for advice is an important part of supporting this community. WWP launched peer support groups and warrior-led events to help extend its reach throughout Texas and the nation. These groups give veterans a chance to give back to fellow warriors by hosting monthly events in their community. It means more warriors are served, and more connections are made. From backpacks to beyond, WWP listens to the warrior population it serves. In doing so, WWP can evolve its programs and services to meet the changing needs of today’s generation of wounded warriors. WWP has been here for 20 years and will continue to serve. WWP is just getting started. If you are a post-9/11 veteran or know someone who is and wants to connect with Wounded Warrior Project, please call 888-997-2586 or visit www.woundedwarriorproject.org. Visit us at www.bcms.org

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Paws for Purple Hearts By Dani Garroutte

aws for Purple Hearts is an innovative therapeutic Service Dog training program that teaches Warriors with trauma-related conditions the skill of training Service Dogs for Veterans with war-related injuries. In July 2008, the first Canine-Assisted Warrior Therapy® program was established at the Palo Alto VA’s Men’s Trauma Recovery Program in Menlo Park, California, with 130 participants. Due to the program’s success, Paws for Purple Hearts expanded to Washington, DC. The program was invited to be part of the PTSD and Traumatic Brain Injury research and treatment mission at the new National Intrepid Center of Excellence in Bethesda, Maryland, in 2010. In 2013, Paws for Purple Hearts launched its first Team Training, where dogs that took part in Canine-Assisted Warrior Therapy® were matched and placed with an impaired Warrior. In 2021, Paws for Purple Hearts was accredited by Assistance Dog International. In 2022, we were one of three programs invited to voluntarily participate in the “Puppies Assisting Wounded Servicemembers” (PAWS) for Veterans Therapy Act to provide Warriors undergoing PTSD treatment with canine-assisted therapy. Today, Paws for Purple Hearts has six facilities across the United States and has directly improved over 10,000 lives. Paws for Purple Hearts serves the maximum number of Warriors

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through our three main programs — Social Therapy, Assistance Dog Placement and Canine-Assisted Warrior Therapy®. Social Therapy utilizes the unique skills of our Service Dogs-In-Training to bring comfort and joy to Warriors in a hospital or group setting, by using our dogs' innate empathy, calm demeanor and approachability to assist in the recovery process of injured Warriors. Paws for Purple Hearts pairs meticulously bred, lovingly raised and thoroughly trained Assistance Dogs with their ideal Warrior recipients using a scientifically rigorous matching methodology developed by the Bergin College of Canine Studies. Paws for Purple Hearts trains and places two types of Assistance Dogs. Facility Dogs can be found with their handler in a Veterans Administration Hospital, Military Hospital or similar institutions, visiting veterans to bring joy throughout the facility. They can also assist clinicians in improving the military patients' response to treatment, while Service Dogs are trained specifically for a Warrior needing mobility and/or psychiatric support. Our Assistance Dogs go through blanket training, regardless of placement, to learn over 110 commands making them more than capable of serving the most demanding category of the mobility-impaired Warrior, a quadriplegic-level patient. Our dogs are also trained to perform tasks that mitigate the symptoms of trauma-related conditions. A Paws for Purple Hearts Assistance Dog helps improve the emotional and psychological wellbeing of their Warrior, reducing the likelihood of the most tragic consequence of trauma, suicide. Finally, we have our signature program, Canine-Assisted Warrior Therapy®. This innovative therapeutic Service Dog training program teaches veterans and active-duty military personnel with Post-traumatic Stress Disorder and Traumatic Brain Injury the skill of training Service Dogs for veterans with combat-related injuries. Guided by our brilliant staff of highly experienced program instructors, in partnership with professional therapists, Warriors learn to reinforce commands and behaviors that are vital for a Service Dog-InTraining. Studies show that under stressful conditions, a dog's presence effectively reduces stress responses in healthy adults, adults with hypertension, and children with attachment disorders. Our program is voluntary and used as an adjunct to a wide range of PTSD treatments, including Cognitive Behavioral Therapy (CBT), Prolonged Expo-

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sure (PE), Cognitive Processing Therapy (CPT), and/or medications. All of our sites conduct Canine-Assisted Warrior Therapy® sessions with veterans undergoing treatment with their respective VA partners. During their two and a half years of training, each dog will impact 40 to 60 Warriors through their participation in this program. During Canine-Assisted Warrior Therapy®, Warriors work with the same dog weekly to promote bonding. This is a recurring theme as veterans relearn how to build personal connections, beginning with their dog. Each session starts with grooming to facilitate this bonding process. Following this, our program instructors teach veterans how to properly reinforce commands for a Service Dog-In-Training and simple dog training concepts. Following the whiteboard lecture and demo, Warriors practice what they have learned. Each session ends with a playgroup for our Warriors and dogs to decompress with one another and ensures that the training experience ends positively. By creating opportunities for positive, meaningful interactions between Warriors and our Service Dogs-In-Training, our participants report that they feel a sense of purpose in accomplishing a critical mission — training a life-long “Battle Buddy” for another comrade. Hence our motto, "Warriors Helping Warriors®." Paws for Purple Hearts has provided Canine-Assisted Warrior Therapy® to over 1,000 Warriors and placed over 40 dogs with Warriors and the professionals who serve them from all demographic and economic societal segments. Post-traumatic Stress Disorder and Traumatic Brain Injury are unresolved by most conventional treatments, but clinicians find Canine-Assisted Warrior Therapy® immensely helpful. For patients with Traumatic Brain Injury, working with our dogs can stimulate the regrowth of memory from learning and repeating commands as well as positively impact motor skills through repeatedly treating the dogs for a job well done.

For our Warriors struggling with symptoms of Post-traumatic Stress Disorder, Canine-Assisted Warrior Therapy® decreases emotional numbness, feelings of isolation, depression and dependence on pain medication while increasing the ability to display affection and feelings of belonging, and helps to develop better sleep patterns. Paws for Purple Hearts is built around the Warrior's deep synergetic love and devotion between our Warriors and their fellow canine fox-hole buddies. To learn more about our organization and the programs we offer, please visit our website at https://pawsforpurplehearts.org/. Dani Garroutte has been a staff member at Paws for Purple Hearts at the San Antonio, Texas location since April 2021. She oversees all regional marketing campaigns and social media channels, the Volunteer Program, and the Community Engagement and Fundraisers. She comes from a military background (is a veteran as well) and has lived all over the country, but has called Texas home since 2015.

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The Environmental Effects of War on Veterans: Chemicals and Extreme Temperature By Victoria Ayodele and Bryan Ubanwa

he impact of war on mental health has been extensively investigated, with a particular emphasis on how it affects our veterans. Veterans often face a multitude of cognitive challenges, including depression, anxiety and post-traumatic stress. Despite the studies on mental health, the adverse effects of the environment on a soldier's physical health are frequently overlooked by the public. This essay aims to address this gap by discussing the significant impacts of chemical exposure and extreme temperature exposure. Furthermore, it will explore the long-term effects of these exposures and the various ways by which veterans can seek assistance and support. Chemicals The effects of war are often attributed to the physical and emotional harm caused by traumatic experiences, which later manifest as psychiatric conditions. However, environmental exposures, both deliberate and unintended, represent another important issue impacting soldiers. Pesticides and other chemicals have historically been utilized in warfare to deter opponents, inadvertently having long-term effects on human health and the environment in which they are used. The consequences of exposure to these chemicals are severe and encompass a wide range of diseases, such as cancer and cognitive dysfunction. A prominent illustration of the detrimental effects of environmental exposure occurred during the Gulf War in 1991, where the United States and its allies engaged Iraq. Over a span of around six months, 24

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this conflict unfolded across Saudi Arabia, Kuwait and parts of Iraq. Notably, soldiers from this combat began exhibiting non-specific symptoms, including fatigue, gastrointestinal issues, cognitive impairment and musculoskeletal pain, among others, years after their return. These symptoms, collectively referred to as Gulf War Syndrome, affected a substantial portion (about 25–32 percent) of the Gulf War veterans.1 Extensive studies ruled out biological causes and concluded that these symptoms were linked to the local environment at the time and drugs provided to the soldiers. Exposure to sarin/cyclosarin nerve gas, insecticides like organophosphate, and pyridostigmine bromide, a drug designed to prevent chemical exposure during combat, were all identified as significant contributors to these health issues.2 Another notable instance of chemical warfare is Agent Orange. During the Vietnam War (1961–1971), the U.S. government dispersed an herbicide known as Agent Orange throughout Vietnam. Tragically, in the aftermath of the war, some American service members and residents of Vietnam have demonstrated an increased risk of specific illnesses and health problems, including infertility, birth defects, diabetes, cancer and neurological impacts.3 Extreme Temperature Exposure: Heat Illness and Cold Injuries Apart from chemical exposure, prolonged exposure to extreme temperatures, whether cold or hot, can significantly impact the long-term

health of veterans. Cold injuries such as frostbite, hypothermia and immersion foot (also known as trench foot), are common ailments resulting from exposure to cold environments. Combat-experienced veterans facing cold injuries are at an elevated risk of developing neuropathy and skin cancer due to DNA alterations induced by frostbite.4 On the other hand, exposure to high temperatures can lead to heat-related illnesses such as heat exhaustion, heat stroke and sunburn. If not adequately addressed, heat exhaustion can escalate to heat stroke and, in severe cases, prove fatal. In addition, due to repeated sun exposure, veterans also have an increased risk of developing skin cancer when compared to civilians.5 What Can Be Done Going Forward The environmental effects of war place veterans at an increased risk experiencing a range of multisymptomatic illnesses. However, despite these potential outcomes, veterans can proactively maintain a healthy lifestyle by effectively managing any symptoms that may result from these occurrences in collaboration with their healthcare professionals and support systems. For those who have served in the military who were not dishonorably dismissed, the U.S. Department of Veteran Affairs provides valuable health benefits. Detailed qualifying requirements are outlined at www.va.gov/health-care/eligibility. Furthermore, compensation may be available to anyone who may have been harmed by environmental exposures during their service. It is imperative that veterans communicate openly with their providers about any prior environmental exposures, ensuring that these details are accurately documented in their medical history. This information can be considered when tailoring healthcare decisions for each patient. Fortunately, most of the diseases that veterans are more susceptible to due to environmental exposures, such diabetes, can be effectively managed with adequate medical care and treatment. Additionally, ongoing scientific research continues to investigate the long-term impacts of environmental exposure and develop new remedies for these conditions. For example, UCI researchers are currently exploring the effectiveness of Butyrate as a treatment for some symptoms of Gulf War Syndrome, offering hope for the improved care and outcomes for veterans.6 Soldiers bravely risk their lives to defend their nation, and unfortunately, this can lead to subsequent health challenges. Nevertheless, by implementing the strategies outlined above, healthcare providers, loved ones and veterans themselves can collaborate effectively to mitigate the impact of these health issues on their overall quality of life. By working in harmony, we can provide essential support, medical care and understanding to enhance the well-being of those who have served their country. References: 1. White, RF, Steele, L, O'Callaghan, JP, Sullivan, K, Binns, JH, Golomb, BA, . . . Melling, J. (2016). Recent research on Gulf War illness and other health problems in veterans of the 1991 Gulf War: Effects of toxicant exposures during deployment. Cortex, 449-475 2. Gulf War Veterans. (n.d.). Retrieved from VA: https://www.re-

search.va.gov/topics/gulfwar.cfm#research6 3. Schroeder, MO (2016, December 27). Agent Orange : How Veterans Can Deal With The Long-Term Health Effects. Retrieved from U.S. News: https://health.usnews.com/wellness/aging-well/articles/2016-12-27/agent-orange-how-veterans-can-deal-with-thelong-term-health-effects 4. Cold Injuries. (n.d.). Retrieved from VA: https://www.publichealth.va.gov/exposures/cold-injuries/index.asp 5. Heat Injuries. (n.d.). Retrieved from VA: https://www.publichealth.va.gov/exposures/heat-injuries/index.asp 6. UCI researchers awarded $2.5 million to test drugs that could relieve symptoms of Gulf War Illness. (2023, March 2). Retrieved from UCI Public Health : https://publichealth.uci.edu/2023 /03/02/uci-researchers-awarded-2-5-million-to-test-drug-thatcould-relieve-symptoms-of-gulf-war-illness/

Victoria Ayodele is a medical student at the Long School of Medicine, Class of 2026. Bryan Ubanwa is a medical student at the Long School of Medicine, Class of 2025.

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Transport team, from Taiwan to Hawaii. Courtesy of Dr. Antonio Hernandez (pictured standing with his hand on the incubator).

Neonatologists in the Military By Rajam Ramamurthy, MD

r. Brad Doles was watching American Idol on TV with his wife. It was 9:00 pm on the tiny island of Okinawa, at the U.S. military base. He was on call for transporting babies. The neonatologist in Okinawa called him to transport a newborn with a hypoplastic left heart from the Memorial Hospital in Guam to the Brady Children’s Hospital in San Diego, California. He was the physician on the team and the last one to arrive as the team of nurses, respiratory therapists and cockpit crew were assembled and ready to take off. They had done this several times; this was the first for him. The view from the cockpit was spectacular; the cabin was still, and the water level in the heart-lung machine showed the plane's vibration. Dr. Dole is the newest member of the group of neonatologists in San Antonio with the Pediatrix Medical Group. The group covers all the private neonatal intensive care units in San Antonio. He did 11 years of active duty and completed his pediatrics and neonatal medicine fellowship at the Wilford Hall Medical Center (WHMC) and Brooke Army Medical Center (BAMC). He spent three years in Okinawa and two years at Walter Reed Hospital in Bethesda to complete his military commitment. At present, there are 29 neonatologists in the Armed Services; 16 in the Air Force, 10 in the Army, and three in the Navy. The number of trainees in the neonatology fellowship is 10, three to four, and one, respectively, in each service. The training happens in three training programs. One, at BAMC in San Antonio, which was originally at WHMC, built in 1957 to care for service personnel returning from the Korean War. WHMC is named after Air Force physician Major General Wilford F. Hall. It grew to a 1,200-bed hospital with the largest 26

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NICU in the military, where cutting-edge research was conducted under the leadership of Dr. Robert DeLemos. In 2011, many services were moved to BAMC under the 2005 Base Realignment and Closure Act. Next, the Tripler Army Medical Center on the island of O’ahu, Hawaii, has been there since 1907 and is named after Civil War medic Brigadier General Charles Stuart Tripler. This 450-bed hospital is the largest military treatment facility in the Pacific Rim. Third, Walter Reed National Military Medical Center in Bethesda is the flagship of U.S. Army medicine, providing care and services to more than 1 million beneficiaries annually. It has a 25-bed Neonatal Intensive Care unit. The fellows’ clinical training occurs in a state-of-the-art Level IV unit at the University of New Mexico Children's Hospital (UNMH). The ECMO technology and newborns' transport on ECMO was perfected at the WHMC in the 1980s and ’90s. It was the only hospital with ECMO west of the Mississippi, said Dr. Richard Stribly, who I have worked with since 1988 when he joined the division of neonatology at UT Health. His career with the military started as a teenager, as it was for many of these physicians. His degree is in Bio-Medical Engineering. Later, he entered medicine and did his pediatric and neonatology training at WHMC when technological advances such as high-frequency oscillators and ECMO were rapidly developing under the guidance of Dr. Robert Delemos, a legend in neonatology, and Dr. Donald Null. When he was stationed at Clark Air Force Base in the Philippines, they had to divert a C5 Air Force plane bound for Operation Desert Storm to transport a baby. They were in the hold of the aircraft with the baby until they reached Sacramento, laughed Strib, as

VETERANS’ HEALTH

Above: Transporting baby Skylar at 6 to 7 weeks old from Okinawa to Hawaii. Courtesy of Dr. Antonio Hernandez (pictured far right). Left: Skylar at 7 years old.

his colleagues fondly called him. His most memorable moment was the evacuation of the entire NICU of Clark Air Force Base when Mt. Pinatubo erupted next to the Air Force Base. Drs. Stribly and Dole, two military physicians, one in private practice and another in academics, respectively, each with unique experiences. When you think of military medicine, images of injured men and women, stretchers and operating rooms in tents flash, but not a baby, and far less a tiny preterm baby. However, the field of neonatology and care of the newborn infant is well-established in military hospitals worldwide. I ventured to capture the experience of neonatal medicine physicians in San Antonio. I contacted Dr. Christine Aune, who connected me with the others. In a delightful interview, the physicians shared their stories. Dr. Aune is the Medical Director of the NICU at St. Luke's Hospital and the High-Risk Infant Development Clinic in San Antonio. Out of her 15 years in the Army, she spent 11 on active duty, including a few at Walter Reed Hospital and some research time at the NIH. She finally joined the Pediatrix Medical Group in San Antonio. She says she has transported babies on ECMO on land, air and everywhere except on a boat, with an infectious smile across her face. One of her most rapid transfers was evacuating from Driscoll Hospital in Texas during a hurricane. She was trained in using the jet ventilators. It is used when there are holes in the baby's lung with air leaks, where you exchange air within the lungs without expanding them. When Dr. Aune came to San Antonio, there were no jet ventilators in the hospitals. So, when she had a patient with multiple air leaks, she called her

mentor at Walter Reed, who hopped on an Army aircraft and brought the jet ventilator; the first time a baby in San Antonio received jet ventilation. Later, they introduced this to all the NICUs. Now, it is the first line modality used to breathe for babies. Technology is not the only contribution of the military. The ability to work as a team, advanced planning and repeated training are some of the cultures from the military that have helped in civilian practice as well. “There is no specialty like neonatology where you make an impact that lasts the most extended period in a patient's life,” muses Dr. John Isaac, Director of the Mission Trail Baptist Hospital in San Antonio. From 2001-2008, he was on active duty at Fort Hood in Washington as a pediatrician, covering the newborn ICU. He did a one-year fellowship in Maternal-Fetal Medicine but had to leave for India to care for his father. He came back and did a three-year fellowship at WHMC, after which, he was deployed from Fort Hood to the Middle East before returning to San Antonio. When he was on active duty, Okinawa was the longest distance they covered transporting an infant — an eighteen-and-a-half-hour flight with mid-air fueling. “It also made me think philosophically about the value of life; how much money the U.S. government would spend on saving one small life of a soldier's son or daughter,” said Dr. Isaac. The involvement of military physicians in providing healthcare in a small specialty like neonatology made me think about what military medicine meant for San Antonio and its impact on patient care, research and education. Dr. Maribel Morgan, when in college, was in ROTC, where she learned about the Health Professions Scholarship Program (HPSP) offered by the military. She served in the Air Force for 12 years — in active duty and the reserves. She joined the medical school when she was in the Air Force, which paid for her education, and did the Neonatal fellowship at the WHMC and completed it at BAMC. After two years in Bethesda, Dr. Morgan returned to San Antonio in 2014. She has been the Director of the NICU at Stone Oak Methodist Hospital for the past five years, and has vacillated between neonatology and pediatric intensive care, deciding what fellowship to pursue. She participated in transporting a newborn who was on ECMO from the children's hospital in Arizona to Stanford Medical Center in California. At that time, it was controversial to resuscitate babies born at 24 weeks. However, a group of physicians thoughtfully willing to push the envelope and be successful made a lasting impression on her. She made her career choice. Three of the neonatologists were driving as I was interviewing them online. I was thrilled to see Dr. Cody Henderson, whom I got to know well when he rotated through the UHS NICU. Still in his scrubs and a stubble on his face, I knew he was going home after a long day in the hospital. He recalls the time when they closed the military bases when he was serving in Panama. Dr. Henderson completed medical school and the fellowship training when he was in service, and has done thousands continued on page 28 Visit us at www.bcms.org

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ECMO transport from Arizona to Stanford Medical Center. Courtesy of Dr. Maribel Morgan.

broke out with Chicken Pox. A kind and gentle physician, Dr. Powers is back at UT part-time while continuing to help small neonatal units in Mobile, Alabama. A flier in the student's cubby hole about the HPSP of the Air Force started Dr. Antonio Hernandez on the military medical path when he was in medical school at UT Health in San Antonio. He did the pediatric residency at Travis Air Force Base in California. Travis Medical Center is a major haven for returning wounded veterans and aeromedical transport. He returned to San Antonio to do a three-year neonatology fellowship. Following that, he was posted in Okinawa for three years and at Tripler Army Medical Center in Hawaii. The presence of threat from North Korea looms large when you are posted in these places and, to some extent, China as well, said Dr. Hernandez, whose two children were born in Okinawa. He vividly remembers a mother admitted with twins at 23 weeks. She delivered one baby, and her labor stopped. The second twin was delivered at 26 weeks in the Navy hospital. For public medical schools, the median total cost for state residents for four years is $164,380 ($41,095 annually). For private medical schools, the median cost for four years is $269,176 ($67,294 a year). The 15 most expensive U.S. medical schools have an average cost of about $70,000/year in tuition and fees. Applicants for the HPSP must have a minimum 3.2 undergraduate GPA and 500 MCAT with a minimum score of 124 on each MCAT subsection. The HPSP offers a substantial financial benefit and a pathway to a medical career. On a sunny Saturday morning, I was on for the delivery room calls, making rounds with the team of residents and students. The resident in charge received a call. I expected the team to move; we had a well-organized pattern set in motion to be mobilized when a delivery call came. Here, no one moved. The resident was mumbling something to the fellow, who looked puzzled and turned to me and said, “They have a delivery

and thousands of miles of transporting babies on ECMO as a trainee and later as the Director of ECMO transport. San Antonio is benefitting from those years of his experience. He is, at present, the Director of ECMO transport at the Santa Rosa Children’s Hospital in San Antonio. Dr. Michael Batista wanted to attend medical school when he finished college and was trying to find a way to pay for it. He joined the Army and got a scholarship. His father and uncle were Army men and good role models for him. Dr. Batista said he would never regret his 14 years in the Army as it gave him many things beyond medical education. After being at the cutting edge of neonatology with surfactants, oscillators and jet ventilators, he wanted to be in the academic atmosphere of San Antonio. He is the Medical Director of the Pediatrix Medical Group. It is interesting to note that many of these physicians have a solid family history of military service. Dr. George Powers’ father is a West Point graduate. Dr. Powers received a HPSP scholarship when he was in college. His residency training was at WHMC, where he was deployed to Germany. He served as a pediatrician for three years and one more year at Andrews Air Force Base in Maryland. When he came out, he worked as a hospitalist at UT for five years and then did a three-year fellowship in neonatology at UT. I was one of his mentors, and published a paper that focused for the first time on the developmental outcome of Hispanic premature babies who weighed less than 1.5 kg. One of the salient findings was that the developmental outcome of babies from less acculturated families was significantly better. From 2006, for 13 years, he worked for the Pediatrix Medical Group. He recalls a child who came from the Philippines with a complex syndrome that needed a tracheotomy, and was at Camp CAMP in San Antonio. The parents of this child did not take a vacation for two years, and were finally convinced by Dr. Powers Dr. Christine Aune with and his wife to take a vacation by offering to take care of the her daughter, Sophia. baby in their home. The day after the parents left, the child 28

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Wilford Hall NICU with Dr. Maribel Morgan discussing a quadruplet delivery with Drs. Rouse, Lefkowitz and Doles.

VETERANS’ HEALTH

A KC-135 transport from Clark Air Force Base to Travis Air Force Base. Note the baby Bird ventilator. Courtesy of Dr. Richard Stribly, pictured.

in the VA (Veterans Administration) Hospital.” We have never had a delivery in the VA hospital in the 30 years I was an attending physician. I instructed them to send the transport team to the VA, and I, with my team, dashed to the VA on the skywalk across Merton Minter Street below. We were directed to a patient examining room. There lay a tiny baby, well covered, with a cap on his head to keep him warm. The little infant resuscitation box was open with a small bag and mask ready. The

two nurses, a man and a woman, breathed a sigh of relief seeing us. We stabilized the infant and placed him in the transport incubator. As we wheeled across the VA waiting room, the faces of old and young patients broke into a smile, and murmurs of, “Oh! Cute, bless his heart,” filled the room. A newborn baby always evokes a feeling of oneness, even in the most emotionally hardened person. Neonatal care does figure in military medicine. In San Antonio, military physicians have contributed to every field of medicine in patient care, leadership and research. In the field of neonatology, this includes cutting-edge research in the ventilation of tiny lungs and transporting babies safely. The contributions of military physicians have had a significant impact on San Antonio, putting us on par with Dallas and Houston, and excelling in trauma and burn care. We salute these men and women. I would be remiss if I did not mention the names of these Neonatologists who worked in various hospitals in San Antonio and contributed greatly to caring for premature babies. Drs. Donald McCurnin at UT Health, Donald Null, Reese Clark, and Robert De Geronimo, who pioneered the research work with Dr. Delemos at WHMC. Rajam Ramamurthy, MD, is a Professor Emeritus in the Department of Pediatrics at UTH. She serves on the Publications Committee of BCMS and is a past president.

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The Vietnam Army Grunt Museum “Serving Vietnam Veterans in Perpetuity” Interview with Michael Lynd Sr., conducted by Monica Jones, BCMS COO, and Trisha Doucette, Editor

r. Michael Lynd Sr., principal of Lynd, a multi-family management company based in San Antonio for more than 43 years, had a vision that would serve Vietnam veterans in perpetuity. As an Infantry Officer in Vietnam during 1968 and 1969, he participated in Operation Fayette Canyon in Quang Nam Province as part of the 196th Light Infantry Brigade, American Division, and later became personally involved with America’s Veterans Foundation. Inspired by the efforts of his friends at Southwest Florida Military Museum & Library (SFMML) located in Cape Coral, Florida, Mr. Lynd recognized the importance of acknowledging and honoring those brave Army soldiers, the Grunts, who fought on the front line of the Vietnam War. In 2019, he committed to creating the Vietnam Army Grunt Museum – the Army Grunts Story. Housed in the Lynd headquarters on Loop 1604 in San Antonio, neighbor to the Bexar County Medical Society building, the Vietnam Army Grunt Museum Honors United States Army Grunt soldiers who fought on the ground in Vietnam, giving visitors some sense of what soldiers, in combat, experienced and the challenging environment of Vietnam. Mr. Lynd has personally acquired a substantial number of items on display. He encourages the soldiers of the Vietnam War and their families to contribute cherished items and testimonials from their experiences during their time of combat, to be housed and displayed permanently to benefit the thousands of future visitors as well as eternally honor those brave Army soldiers. The museum charges no admission and is staffed almost entirely by volunteers. “We would not be able to operate if not for generous individual donors, sponsorships and endowments that will ensure our vitality for future generations,” noted Mr. Lynd. For Mr. Lynd and his fellow veterans, the museum, along with the process of creating it, has helped him personally heal in the aftermath of his time in war. He shared, “It’s like a sanctuary — it releases builtup anxiety.” Many veterans come to remember and reconnect with old friends and honor friends who have now gone. “When groups come in, you can see the camaraderie and bonding that occurs in the military.” It is the museum’s goal to use cultural and historical documents, interactive displays and selected artifacts to expose the visitor to the realities and perspectives of that long war. Items include uniforms, field gear including a radio pack, rifles, personal testimonies and more. Mr Lynd specifically is proud of a display honoring wartime nurses, and has 30

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hosted a nurses veteran group in San Antonio, explaining, “Women volunteered to join … What those ladies had to endure and live with their entire lives … There’s a connection between the medics and the wounded soldiers they are treating. I was never seriously injured but it’s near and dear to my heart.” There are personal photos taken by soldiers on display — some showing rare opportunities for much-deserved Stand Down’s, which are two to three days off during the war — while most are poignant reminders of the grueling conditions and devastating outcomes of the war. The museum houses a collection of photographs donated by actor Mathew Modine taken during the filming of Full Metal Jacket. Mr. Modine’s collection lines the museum and lobby. While striking and appreciated, Mr. Lynd described Mr. Modine as the difference between Hollywood and reality — he gives from the heart. Mr. Modine chose the Vietnam Grunts Museum to house these very personal photos. When he comes to visit, Mr. Modine visits Brooke Army Military Center and fundraises for the cause. In a conversation with Mr. Lynd, he revealed his experiences returning from the war. “It was an unsettling time at home. Returning veterans were considered traitors because the war was so controversial. Times have changed — there is pride in military organizations now. The attitude upon our return kept vets silent but it still sticks with you. What I did, I did because I had to,” he shared, adding he was advised, “Don’t put ‘Vet’ on your resume.” He believes this treatment contributed to the mental health of veterans and resulted in the ways many eventually coped — through drink and drugs. Mr. Lynd has a passion and goal to make the museum accessible for our youth. He explains how important it is for young minds to learn and understand this part of history. “I am trying to reach a younger group and the easiest way to do that is through pictures,” he said, noting that ages 10 to 13 show the most interest and tend to compassionately absorb the information more than high schoolers. School groups often visit, and students from local Jr. ROTC groups assist with special events. Many special events and reunions are hosted at the museum to welcome veterans with lunches and the opportunity to view the exhibits. These have included “Quilts of Valor” presentations where the foundation gifts quilts to veterans, and events honoring Vietnam women veterans and Purple Heart recipients, to name a few.

VETERANS’ HEALTH The Museum has also delivered lunch and Christmas gifts to the residents at the Frank M. Tejeda Texas State Veterans Home in Floresville, and has contributed to other veteran organizations such as sponsorships to golf fundraising tournaments and Wreaths Across America, an organization that coordinates wreath-laying ceremonies at more than 3,700 locations across the U.S. and abroad. The Lynd Company apartment complexes house some of the honor walls for veterans.

Vietnam Army Grunts as defined by Encyclopedia.com:

“The main reason I put the museum together is to honor the almost 58,000 kids who fought in the Vietnam War, most of which passed away as young men. They never had a chance to live. I was 24 when I was in Vietnam and feel blessed — I wasn’t a teenager like most who served.” Ultimately, the Vietnam Army Grunts Museum is a place to remember, reflect and honor the soldiers of the Vietnam War whose courage and sacrifice must be realized and always be acknowledged. For his veteran visitors, Mr. Lynd said the first thing you do is give them a hug and welcome them home. Open Monday through Friday from 9 a.m to 5 p.m., and is free to the public. www.vietnamgrunts.org

“For the soldiers who served in the Vietnam War, the word grunt was not just a nickname but also a commentary on their status in the hierarchy of war. To be a grunt was to be in the infantry. It meant leaping out of helicopters into landing zones that were sometimes under enemy fire. It meant marching through elephant grass taller than a man and as sharp as a knife, or slogging across streams and rivers so deep and muddy that men sometimes disappeared beneath the surface or found themselves mired in mud so thick it sucked the boots off their feet. It meant suffering from heat, humidity, rain, and insects while straining under the burden of equipment, which could weigh as much as eighty pounds. It meant enduring endless marches up and down mountains, through jungles, and into villages, looking for an enemy who was hard to find and sometimes even harder to fight, all the while being on the lookout for booby traps and ambushes. Finally, it meant tolerating hours — and sometimes days — of boredom and frustration, punctuated by moments of terror when contact was made with the enemy. Being a grunt may have been the least enviable and most underrated task of the Vietnam War. Grunts usually served a twelve-month tour in Vietnam. When they were in the field, they carried everything they needed on their backs: their weapons, ammunition, food, water, and medicine. They could be on patrol for extended periods and were occasionally resupplied by helicopters as they searched for the enemy — either the Vietcong or units of the North Vietnamese Army. When their tours in Vietnam were over, many grunts were rotated back to the United States to either complete their service obligation or be discharged and become civilians again.” Courtesy of Lynd and the Vietnam Army Grunts Museum Visit us at www.bcms.org

VETERANS’ HEALTH

Discovering Our Voices: The Veteran’s Writing Collective at Gemini Ink By Kristy Y. Kosub, MD, through an interview with Sarah Colby, MFA

arah Colby is a professional writer and teacher at Gemini Ink, a writing arts program in San Antonio dedicated to teaching the craft of writing to children, youth and adults, and bringing their stories to life. Though she pursued a career as an art historian, she has been passionate about writing since childhood and had a previous career as an art historian. Sarah began to write more seriously when her husband was deployed to Iraq. She returned to school and took a poetry course. Her classmates were fascinated by her writing about her military experiences as a spouse, and she found that writing lessened her feelings of separation and distance from her husband. She also realized that no matter how forthcoming a spouse can be in talking about his or her personal military experiences, their partner cannot fully understand or feel it, and vice versa. Sarah relates that the person who is deployed can often be caught in a confounding space that doesn’t foster a healthful transition from war zone adrenaline back to family life. And that family members waiting at home can also feel disoriented and a lack of familiarity due to separation. Sarah dreamed of forming a creative writing group for active-duty military, veterans and their immediate family members to mitigate these feelings. In 2017, she proposed the idea to her director at Gemini Ink and created the Veterans Writing Collective (VWC). Sarah envisioned a safe space in which military members and their loved ones could engage in writing with others who are bound to similar life experiences. The primary goal is to teach the craft of writing and allow all to become more experienced writers in a supportive and nonjudgmental setting. Sarah also noted an important secondary outcome — veterans can experience a therapeutic benefit from writing and sharing stories that unburden them of past trauma and painful experiences. Sarah points to the stigma of therapy being a barrier to accessing mental health and wellbeing resources for many of these individuals. The first meeting of the collective included three individuals from San Antonio. Five years later, there are approximately 95 members who are at various stages of engagement in the writing workshops, ranging from those who attend monthly seminars to persons who attend once or twice yearly. Roughly two-thirds of members are active-duty, veterans and military retirees, and one-third are immediate family members including spouses and children. The VWC is free and open to anyone with direct military affiliation regardless of skill level and writing experience. Sarah’s objective is to “identify and foster promise in every story, essay, poem or drama, and in each writer.” 32

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Workshops occur on the third Wednesday evening of each month. Collective members post their original writing to the Gemini Ink class website. Peers are taught to offer honest, positive and constructive feedback on the writing. During class time, the writer can share any points they wish others to address followed by discussion and critique among the entire group. Facilitators may also share constructive criticism and relevant activities such as writing exercises or specific instructions in evaluation of a piece. The reviews are very encouraging to beginning writers, and Sarah sees amazing growth. As a mentor, she sees herself as the conduit — finding ways to connect within this community of writers. In 2020, the COVID-19 pandemic derailed the in-person workshops. The VWC pivoted to online workshops, which now allow individuals from other cities, states and countries to join, furthering the diversity of the writing experience. Workshops have remained virtual with a hybrid version planned in the near future. Writers are not limited to composing stories about their military experiences. If they do write nonfiction pieces, the only rule is that it must be true. Writers can set their own goals and choice of writing style. Sarah sees all genres: prose (nonfiction, fiction), poetry, song writing and even screen writing. She notes, “It is not unusual for veterans not to speak of their wartime experiences to anyone. This may be their first time writing about it.” Sarah remembers one veteran from the Vietnam War saying that his nightmares stopped since he began writing, a testament to the therapeutic benefit of creative writing. She sees a great deal of reflection, vulnerability and resilience in the writing and reports that not everyone has battlefield trauma. The writers may want to write about other types of trauma, their sense of responsibility, death or failures. She reads stories of gratitude regarding military colleagues and memoirs left as a legacy for grandchildren. Several members have published their writing. Veterans, active-duty personnel and their family members can have chronic social and medical issues that physicians see in any of their adult patient populations. Many believe that the most prevalent issue in veterans is post-traumatic stress disorder. However, the most significant issue that Sarah sees in her writers is social isolation. “An absence of community evaporates on retirement or separation from the military. These individuals are no longer connected to a sub-culture [for their identity],” notes Sarah. She hopes that the VWC “lessens this isolation and continues a sense of connectivity to community.” She highlights that while writing itself can be a solitary experience, the VWC engages

VETERANS’ HEALTH

Samples of writing pieces from VWC members: “Why didn’t you guys tell me about the rabbit?” Whatever he had been expecting, it clearly wasn’t that. He started as if he had awoken from a nightmare. “How did you know?” I just smiled and shook my head. “You two were never as sneaky as you thought.” He contemplated his answer for a few long moments. “Luck didn’t want you to think he had turned into a crazy man,” he finally said. “He wanted you to feel safe.”

A Soldier came by, jumped in beside him Why join me where things are so grim? Don’t worry I’ve been here, I know how to get you out I know the route, I know the route Excerpt from "The Hole," a song by Army Veteran Deb Wesloh.

Brief excerpt from “Losing Luck,” a novel in progress by Amanda Cerreto, immediate family member.

the writers in a shared endeavor through storytelling. Loneliness and social isolation have recently been highlighted in public health discourse and the medical literature as underlying factors that contribute to increased risk of cardiovascular disease, dementia, depression and premature death. In particular, the COVID-19 pandemic accelerated recognition and study of loneliness as a signature public health concern. In May of this year, a new General Advisory Report was released by Dr. Vivek Murthy, the United States Surgeon General, calling attention to the public health crisis and epidemic of loneliness, isolation and lack of connection in our country. Dr. Murthy points to disconnection being a primary element for mental, physical and societal health. His report outlines a national strategic framework with recommendations for individuals, governments, workplaces, health systems and community organizations to increase and improve health. Studies of U.S. veterans have specifically identified loneliness as having an independent association with a broad range of physical and mental health measures. As her biography states, Sarah’s “war-time experiences have motivated her to be a voice for the mostly untold stories of families and loved ones during these years of protracted conflict.” Her mission is to champion the mitigation of social isolation for military members and their families by growing the VWC and inventing additional creative writing outlets that expand opportunities to hear the voices of those who devote their lives to the military so that we all have a safe and thriving world. She is indebted to Gemini Ink for having the VWC under its umbrella as a validated creative writing endeavor. If you have a patient or know of a military-affiliated individual who might benefit from joining the Veteran’s Writing Collective, further information can be found at: https://geminiink.org/events/veterans-writing-collective2020-07-15-2021-11-17/all/

References: https://www.hhs.gov/about/news/2023/05/03/new-surgeon-general-advisory-raises-alarm-about-devastating-impact-epidemic-loneliness-isolation-united-states.html Straus, E, et al. Behavioral epidemic of loneliness in older U.S. military veterans: results from the 2019-2020 national health and resilience in veterans study. The American Journal of Geriatric Psychiatry, March 2022;30(3):297-310 Wilson, G, et al. Loneliness and social isolation of military veterans: systematic narrative review. Occupational Medicine, December 2018;68(9). https://doi.org/10.1093/occmed/kqy160 Brody, JE. To counter loneliness, find ways to connect. The New York Times, 2018 Kristy Kosub, MD, is a retired Professor of Medicine at the Long School of Medicine, UT Heath San Antonio. She remains a Faculty Associate in the arts and humanities programs at the UTHSA Charles E. Cheever Jr Center for Medical Humanities & Ethics and is a member of the BCMS Publications Committee. Sarah Colby was born in northern New Mexico and raised in the Rocky Mountains. She is married to a retired Army Chaplain and is mother to a son in the Navy. Sarah has an MFA in Creative Writing from Sierra Nevada College and an exuberant interest in making the ordinary luminous. She is currently working on a manuscript of poems about her experiences as a military family member.

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Medical Practice – Tax Credit By Brian Boswell, CERTIFIED FINANCIAL PLANNER™

In the ever-evolving landscape of healthcare, medical practices face a multitude of challenges, from keeping up with advancements in treatment to managing overhead costs. One crucial aspect that often gets overlooked is the financial well-being of the practitioners and their staff. The Secure Act 2.0, an extension of the original Secure Act, introduces powerful tax credits that incentivize medical practices to initiate 401(k) retirement plans for their staff. In this article, we will delve into the benefits of implementing a 401(k) plan, with an example to illustrate the substantial tax credits that can be realized. The Secure Act 2.0: A Game-Changer for Medical Practices The Secure Act 2.0, signed into law in 2023, brings a host of tax incentives aimed at encouraging businesses, including medical practices, to establish retirement plans for their employees. These provisions build on the foundation set by the original Secure Act, which sought to increase access to retirement savings for workers. Why Should Medical Practices Embrace 401(k) Plans? • Attract and Retain Top Talent: In a competitive job market, offering a 401(k) plan can be a game-changer for medical practices looking to attract and retain high-caliber professionals. It demonstrates a commitment to employee well-being beyond their immediate compensation, enhancing job satisfaction and loyalty. • Tax Advantages for the Practice: The Secure Act 2.0 introduces sub34

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stantial tax credits for medical practices that initiate 401(k) plans. These credits can significantly offset the costs associated with establishing and maintaining a retirement plan. • Personalized Retirement Solutions: A 401(k) plan allows employees to tailor their retirement savings to meet their individual needs and goals. This empowers them to take charge of their financial futures, leading to a more satisfied and financially secure workforce. The Tax Benefits of Secure Act 2.0 Let's delve into a hypothetical example to illustrate the tangible tax credits a medical practice could realize by adopting a 401(k) plan under the new Secure Act 2.0. Hypothetical Medical Practice: • Number of Employees: 15 • Average Annual Compensation: $80,000 • Total Annual Compensation: $1,200,000 • Percentage of Income Contributed to 401(k) by Employees: 5% • Employer Match: 3% – This example is hypothetical in nature. You should not expect the same results when starting a 401(k) for you or your employees. Contributions may be more or less than what they appear here. You should consult with your tax planner or financial advisor to discuss the practical applications.

SAN ANTONIO MEDICINE

Tax Credits Under Secure Act 2.0: • Start-Up Credit: For the first three years, the practice can receive a tax credit of up to $5,000 per year to offset the costs associated with establishing the 401(k) plan. Total Start-Up Credit Over Three Years: $15,000. • Auto-Enrollment Credit: By implementing auto-enrollment for employees, the practice can receive an additional credit of up to $500 per year for three years. Total Auto-Enrollment Credit Over Three Years: $1,500. • Employer Matching Contribution Tax Credit: The new legislation also offers a tax credit for employer matching or profit-sharing contributions for the first five years of the plan. The credit is for businesses with up to 100 employees, but the credit is reduced by 2% per employee over 50 employees earning less than 100,000/year. The maximum credit is $1000 per year for each of those employees. – 100% of employer contributions for the first two years after the plan is created – 75% in year three – 50% in year four – 25% in year five. Total Small Employer Pension Plan Credit Over Three Years: $69,000. Total Tax Credits Over Five Years: $93,000

Conclusion The Secure Act 2.0 presents a great opportunity for medical practices to not only secure their employees' financial futures but also to realize significant tax benefits for the practice itself. By taking advantage of the available tax credits and offering a 401(k) plan, medical practices can attract and retain top talent while simultaneously bolstering their own financial well-being. In an industry that demands excellence in patient care, investing in the well-being of your workforce through a 401(k) plan is a strategic move that benefits both employees and the practice as a whole. Don't miss out on the tax advantages provided by Secure Act 2.0 — consider starting a 401(k) plan for your medical practice today. Your employees and your bottom line will thank you. Brian Boswell is a CERTIFIED FINANCIAL PLANNER™ professional with Oakwell Private Wealth Management. Oakwell Private Wealth Management is a gold sponsor in the Circle of Friends.

Visit us at www.bcms.org

WOMEN LEADERS IN MEDICINE

2023 Women Leaders in Medicine Awards By Bexar County Medical Society (BCMS)

Every year, the Bexar County Medical Society recognizes the great efforts of local female leaders who excel in the delivery of patient care through their hard work and dedication to the honored practice of medicine. The 2023 Annual Women Leaders in Medicine Event was held on September 21, 2023 at the UIW Skyroom. The event was attended by more than 430 medical community members in Bexar County.

Dr. Diana Burns-Banks Community Service Award Priti Mody-Bailey, MD Medical Group of the Year Award Health Texas logo

Practice Manager of the Year Award Michele Treviño Health Texas Medical Group

Unsung Hero Award Tina Turnipseed, CMPE Clinical Pathology Associates

Business Leader for Community Well Being Award Palmira Arellano Methodist Healthcare

One At Heart Award Carolina Arias Cuello, MD South Texas Renal Care Group

Michyla Bowerson, MD South Texas Radiology Group

Jaclyn LeVan, DO Pediatrix Medical Group

Laura Suttin, MD WellMed Medical Group

Teresa Duran, MD Clinical Pathology Associates

Jennifer Brody, MD North Central Baptist Hospital

SAN ANTONIO MEDICINE • November 2023

WOMEN LEADERS IN MEDICINE

Ana Carolina Garza, MD Texas IPS

Jessica Yao, MD Community First Health Plans

Teri Perryman, MD Little Spurs Pediatric Urgent Care

Melissa Ann Crawley, MD Texas Oncology

Wendy Whitford, MD M&S Radiology

Paola Forero-Medina, MD Gonzaba Medical Group

Lori Kels, MD UIW School of Medicine

Cielo Manriquez, MD CentroMed

Christine De La Garza, MD Seven Oaks Women’s Center

Grace Onuma, MD MacGregor Medical Center

Leah Jacobson, MD Personal Pediatrics by Leah Jacobson, MD

Amy Cobb, MD University Medicine Associates

Stephanie N. Pearson, MD South Texas Spinal Clinic

Kathleen A. Rutecki, MD South Texas Spinal Clinic

continued on page 38 Visit us at www.bcms.org

WOMEN LEADERS IN MEDICINE

2023 UT Health SA Colette M. Kohler Awards

BCMS also recognized the following UT Health SA Physicians. By Bexar County Medical Society (BCMS) and UT Health San Antonio

Carolina SolisHerrera, MD Associate Professor of Medicine, Chief of Endocrinology Division

Rashmi Katre, MD Associate Professor, Radiology; Section of Emergency Radiology, Department Champion for Quality, Safety and Peer Review

Izabela Tarasiewicz, MD Professor, Department of Neurosurgery

Naomi Sayre, Ph.D. Assistant Professor/Research Department of Neurosurgery

Paola Martinez, MD Assistant Professor/ Clinical Department of Neurosurgery

Elizabeth Thomas, DO Associate Professor, Glen Halff, MD Endowed Professorship in Transplantation Endowment Transplant Center

Amy Mumbower, MD Associate Professor, Radiology; Section of Cardiothoracic Radiology

Chidinma Aniemeke, MD Associate Professor/Clinical Family and Community Medicine

Ellen Shrouf, Ph.D. Behavior Health Consultant Primary Care Center

Ronda Lantz RN, MSN, FNP Family Nurse Practitioner UT Health Primary Care Center and Department of Family and Community Medicine

SAN ANTONIO MEDICINE • November 2023

WOMEN LEADERS IN MEDICINE

2023 Women Leaders in Medicine Awards Event

Visit us at www.bcms.org

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

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

BANKING

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

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”

ASSET WEALTH MANAGEMENT

Aspect Wealth Management (★★★ Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life. Michael Clark, President 210-268-1520 mclark@aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”

The Bank of San Antonio (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community. Brandi Vitier 210-807-5581 brandi.vitier@thebankofsa.com www.thebankofsa.com Amegy Bank of Texas (HH Silver Sponsor) We believe that any great relationship starts with five core values: Attention, Accountability, Appreciation, Adaptability and Attainability. We work hard and together with our clients to accomplish great things. Robert Lindley SVP | Private Banking Team Lead 210-343-4526 Robert.Lindley@amegybank.com Denise Smith Vice President | Private Banking 210-343-4502 Denise.C.Smith@amegybank.com Scott Gonzales Assistant Vice President | Private Banking 210-343-4494 Scott.Gonzales@amegybank.com www.amegybank.com “Community banking partnership” Synergy Federal Credit Union (HH Silver Sponsor) Looking for low loan rates for mortgages and vehicles? We've got them for you. We provide a full suite of digital and traditional financial products, designed to help Physicians get the banking services they need.

SAN ANTONIO MEDICINE • November 2023

Synergy FCU Member Services 210-750-8333 info@synergyfcu.org www.synergyfcu.org “Once a member, always a member. Join today!”

CLINICAL DIAGNOSTICS

Genics Laboratories (HHH Gold Sponsor) Genics Laboratories offers accurate, comprehensive and reliable results to our partners and patients. Genics Laboratories is committed to continuous research, ensuring our protocols are always at the peak of current technology. Yulia Leontieva Managing Partner, Physician Liaison 210-503-0003 yulia@genicslabs.com Kevin Setanyan Managing Partner 210-503-0003 kevin@genicslabs.com Artyom Vardapetyan Managing Partner 210-503-0003 www.genicslabs.com “Accurate results in record time.” Livingston Med Lab (HH Silver Sponsor) High Complexity Clia/Cola accredited Laboratory providing White Glove Customer Service. We offer a Full Diagnostic Test Menu in the fields of Hematology, Chemistry, Endocrinology, Toxicology, Infectious Disease, & Genetics. Robert Castaneda (CEO) 210-316-1792 Robert@livingstonmedlab.com www.livingstonmedlab.com/home “Trusted Innovative, Accurate, and STAT Medical Diagnostics”

CREDENTIALS VERIFICATION ORGANIZATION

Bexar Credentials Verification, Inc. (HHHH 10K Platinum Sponsor) Bexar Credentials Verification Inc. provides primary source verification of credentials data that meets The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA) standards for health care entities.

Betty Fernandez Director of Operations 210-582-6355 Betty.Fernandez@bexarcv.com www.BexarCV.com “Proudly serving the medical community since 1998”

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

Aspect Wealth Management (HHH Gold Sponsor) We believe wealth is more than money, which is why we improve and simplify the lives of our clients, granting them greater satisfaction, confidence and freedom to achieve more in life. Michael Clark, President 210-268-1520 mclark@aspectwealth.com www.aspectwealth.com “Get what you deserve … maximize your Social Security benefit!”

GERIATRICS/PRIMARY CARE

Luis Chapa MD/CEO 210-796-4547 lchapa@pcscribes.com www.providerschoicess.com/ “An Unparalleled Scribe Experience”

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

HOSPITALS/ HEALTHCARE FACILITIES

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

INSURANCE

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

INSURANCE/MEDICAL MALPRACTICE

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

HOSPITALS/ HEALTHCARE SERVICES

Provider's Choice Scribe Services (HHH Gold Sponsor) Our accurate and complete documentation helps our customers focus on what’s most important, their patients. Let us take on the task of documenting your patient encounters, it’s what we do. Yoceline Aguilar COO yaguilar@pcscribes.com 915-691-9178

The Bank of San Antonio Insurance Group, Inc. (HHH Gold Sponsor) We specialize in insurance and banking products for physician groups and individual physicians. Our local insurance professionals are some of the few agents in the state who specialize in medical malpractice and all lines of insurance for the medical community. Katy Brooks, CIC 210-807-5593 katy.brooks@bosainsurance.com www.thebankofsa.com “Serving the medical community.”

MedPro Group (HH Silver Sponsor) Rated A++ by A.M. Best, MedPro Group has been offering customized insurance, claims and risk solutions to the healthcare community since 1899. Visit MedPro to learn more. Kirsten Baze, RPLU, ARM AVP Market Manager, SW Division 512-658-0262 Fax: 844-293-6355 Kirsten.Baze@medpro.com www.medpro.com

INVESTMENT ADVISORY REAL ESTATE

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

MEDICAL BILLING AND COLLECTIONS SERVICES

Wave Online (★★★ Gold Sponsor) Our team of professionals will act as your extended AR office enhancing your revenue through our proprietary metrics and claim management systems. In addition, you keep 100% control of your RCM. Contact us today for a no cost evaluation. Saranraj (Raj) Venkatesh Vice President – RCM | Sales and Client Relations 726-228-1097 saranraj@wavemt.com https://rcmwave.com/ “Innovation towards Solutions” 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 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.”

PRACTICE MANAGEMENT

Wave Online (★★★ Gold Sponsor) Professional Analysis focusing on Low Collections, High Denials Rates. Our Business Intelligence tools will identify Cash Pockets and Cash Leakages. With a 360degree view on your practices’ financials, we can tune your AR for best performance. Contact us today for a no cost evaluation. Saranraj (Raj) Venkatesh Vice President – RCM | Sales and Client Relations 726-228-1097 saranraj@wavemt.com https://rcmwave.com/ “Innovation towards Solutions”

PROFESSIONAL ORGANIZATIONS Healthcare Leaders of San Antonio (HH Silver Sponsor) We are dedicated to nurturing business connections and professional relationships, exchanging knowledge to enhance leadership, and creating career opportunities for healthcare and other industry leaders in a supportive community. David Neathery President 210-797-8412 healthcareleaderssa@gmail.com Gary Meyn, LFACHE Vice President 210-912-0120 gmeyn@vestedbb.com https://healthcareleaderssa.com/ “Come, Learn, Connect!”

continued on page 42

Visit us at www.bcms.org

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

REAL ESTATE SERVICES COMMERCIAL

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

RETIREMENT PLANNING

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

STAFFING SERVICES

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

SAN ANTONIO MEDICINE • November 2023

continued from page 41

TRANSCRIPTION SERVICES

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

Visit us at www.bcms.org

AUTO REVIEW

Porsche Rennsport Reunion 7 By Stephen Schutz, MD

Joe Buzzetta and Dr. Stephen Schutz

SAN ANTONIO MEDICINE • November 2023

AUTO REVIEW

Next month I’ll get back to reviewing cars, but this month I’m taking a break from that in order to discuss the amazing Porsche Rennsport Reunion 7 (RR7), as well as a 1978 Porsche 911 reimagined by RR7 participant Joe Buzzetta. RR7, hosted at the WeatherTech Raceway Laguna Seca in Monterey, California, was an awe-inspiring celebration of Porsche's racing history. This incredible four-day event, which took place during the last weekend in September, brought together racing aficionados from all over the world for an experience of unparalleled Porsche splendor. I’ll try to hold back on the superlatives now, but I’ve never seen so many spectacular old and new racing cars from one manufacturer in one place. And all of those old cars — the very best from Porsche’s past, by the way — were driven hard on the track despite their sky-high valuations. Porsche hosts a Rennsport Reunion every four years or so, and this year’s iteration was especially meaningful because 2023 is the 75th anniversary of the company’s founding as well as the 60th birthday of the 911. It was also the biggest RR ever, with over 300 race cars registered and more than 91,000 attendees. The heart of Rennsport Reunion 7 was undoubtedly the meticulously restored Porsche racing cars, which ranged from 356s, 550 Spyders and 911s to Le Mans prototype 917s, 936s and 956s to current year 911 racers and prototype 963s. And more. I’ve seen many of these very special cars on display in museums and collections around the world, but I’ve never seen them driven at speed on a track. The roar of flat-four, flat-six and flat-twelve cylinder engines was intoxicating, as was the scent of hot brakes and burning rubber. The smell of gasoline and un-catalytic-converted exhaust in particular got to me because I grew up in the 1970s, and that’s what I associate with cars from back then. As we move inexorably to an all-electric future, I think those smells are what I’ll miss the most. RR7 also paid homage to some of Porsche's most celebrated racing drivers, including Hurley Haywood, Derek Bell, Dick Barbour and many others. These racing icons and other dignitaries, who wandered around freely through the paddock, added depth and authenticity to the event. (Readers may be interested to note that Dick Barbour, who famously finished 2nd in the 1979 running of the LeMans 24hr race with Paul Newman, was a recent guest on my podcast, “Cars on Call.”) In addition to the racing cars, the event featured a Porsche Corral, where owners proudly showcased their cars. I spent two hours wandering through the Corral and was pleased to see a wide array of colors, including many “paint to sample” (PTS) examples, represented. My personal 2021 911 is a PTS Oslo Blue car, and I saw two other Oslo Blue cars, which made me happy. One notable participant of Rennsport Reunion 7 was Joe Buzzetta, a well-known Porsche collector and high school friend of mine. Joe’s father, Joe Sr, was a Porsche factory racing driver in the 1960s, and his

collection includes many cars that highlight Porsche's racing success from that era. Joe and other members of the Buzzetta family represented their recently deceased father very well with a number of his cars that they drove enthusiastically during the weekend ( Joe Buzzetta was also a recent guest on “Cars on Call”). Porsche restomods headlined by Singer (1990s 911s made to look like beautiful 1960s cars) and Rod Emory (1950s 356s made to look like even cooler 1950s cars) have been emerging as desirable alternatives to restored-to-original Porsches for many years. I am pleased to report that Joe Buzzetta has joined the fray with reimagined mid-1970s/early-1980s Porsche 911s that the general public can buy. His most recent creation, which I have driven, is a 1978 911 SC, which has been re-done as a 1974 911 RSR homage for the street. It has an all-new engine (in this case a 260HP 3.2 liter air-cooled flatsix), transmission, suspension, interior and, OMG thank you, A/C and normal seats. It was conceived as a 911 that you might take on a long road trip, but with none of the hassles that an original car might cause. I hate old cars with rattles and noises, and the Buzzetta 911 has none of that. It’s an analogue 911 with all of its personality and soul preserved, but with none of the negatives of owning an original older car. I’m a believer and have already started looking for a donor car to turn into a Buzzetta Porsche. It will be a wonderful addition to my garage. Porsche Rennsport Reunion 7 was an amazing car experience! If you’re a Porsche fan, go to the next one, you won’t be disappointed. And hopefully by then reimagined Buzzetta Porsche 911s will be a “thing.” 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 U.S. Air Force. He has been writing auto reviews for San Antonio Medicine magazine since 1995. Visit us at www.bcms.org

Kahlig Auto Group

11911 IH 10 West San Antonio, TX 78230

Audi Dominion 21105 West IH 10 San Antonio, TX 78257

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

Coby Allen 210-696-2232

Anthony Garcia 210-681-3399

Domingo Saenz 210-341-3311

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

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

William Boyd 210-859-2719

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

Northside Ford 12300 San Pedro San Antonio, TX

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

14610 IH 10 West San Antonio, TX 78249

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

North Park Lexus 611 Lockhill Selma San Antonio, TX

Marty Martinez 210-477-3472

Jaime Anteola 210-744-6198

Tim Rivers 832-428-9507

Cameron Tang 210-561-4900

Jose Contreras 320-308-8900

Kahlig Auto Group

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

North Park Lincoln 9207 San Pedro San Antonio, TX

Mercedes Benz of Boerne 31445 IH 10 West Boerne, TX

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

9455 IH 10 West San Antonio, TX 78230

James Cole 210-816-6000

Sandy Small 210-341-8841

James Godkin 830-981-6000

Chris Martinez 210-366-9600

Kahlig Auto Group

North Park Subaru 9807 San Pedro San Antonio, TX 78216

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

Cavender Toyota 5730 NW Loop 410 San Antonio, TX

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

Raymond Rangel 210-308-0200

Phil Larson 877-356-0476

Spencer Herrera 210-581-0474

Justin Boone 210-635-5000

Kahlig Auto Group

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

5.0% for 60 months with approved credit.

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

Jordan Trevino 210-764-6945