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September 2017 Production Media Digital Source Publisher Eliot Garza Project Manager Jessie Moore Designer Meghan Goettl Cover Designer Michael Mancha Editor Morgan Grant Margaret Hager Writers Rudy Arispe Jody Joseph Marmel Contributing Writers Dr. Bob Basu Dr. William B. Miller Jr. Dr. Subhash Reddy Dr. Marc Taylor Sue Carrington Austin Hackney Mary Maloney Lori Morrison Christine Saks Don Winn

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Dr. Christopher J. Busken Dr. Busken delivers individualized special care to his patients at Heart Endovascular and Rhythm of Texas.

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Contributing Photographers Marc Arevalo Trinity Greer FOR ADVERTISING INFORMATION, PLEASE CALL 210.373.2599 OR EMAIL HELLO@MDMONTHLY.COM. FOR EDITORIAL COMMENTS AND SUGGESTIONS, EMAIL EDITOR@MDMONTHLY.COM.

Corporate Wellness: Mayor Nirenberg Staying fit and being a public servant

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HEALTHY LIVING/REGIONAL

You Can't Outrun Your Microbes: HOW EXERCISE AFFECTS YOUR GUT By: William B. Miller, Jr., M.D.

M

illions of Americans are serious about fitness since we have long been told of its benefits. It is well established that consistent exercise promotes long-term health by lowering blood pressure, improving glucose tolerance, and assisting in weight management. Most people who exercise report an additional positive; physical activity improves their mental outlook. Recent reports go even farther. Regular exercise may delay the onset of dementia for those who are prone.

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However, those are not the only systems that are affected. Modern research has documented many substantial changes that occur with exercise in our gut microbiome, which is being reshaped as a result of the metabolic changes that incur from regular moderate exercise. Exercise is associated with an increase in gut microbial diversity, which is associated with an improved metabolic profile and a strengthened immune system. This shift is believed to be the result of an increase in a particular bacterial strain, Bifidobacteria, that is essential

for optimum health and whose levels tend to decline with age. Exercise provides a valuable boost to that population in our gut.

Although the great majority of those who exercise do so in the moderate range, there are increasing numbers of recreational and elite performance athletes who engage in very high levels of physical exercise in order to enhance performance.

Extreme exercise is associated with a number of challenges, including a 10-20% in increase in heart size and an increased potential for cardiac

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arrhythmias. More recent evidence suggests that there is also a general immune deficiency associated with prolonged exertion. In fact, it is common for elite athletes at the peak of training fitness during preparation for major sporting events to be prone to respiratory illnesses and a range of gastrointestinal symptoms. For example, it has been documented that among ultra-marathoners, there is an increased risk of upper respiratory tract infection during periods of heavy training and the 1-to 2-week period after marathon-type race event.

Previously, it had been supposed that the depressed immune function coincident with strenuous exertion and heavy training was a by-product of dietary deficiencies in protein, carbohydrates or specific micronutrients. However, there is new evidence for a surprisingly different common denominator for this set of problems among endurance athletes is centered within the gut microbiome. Extreme

exercise is associated with gut related immune deficiency from increased permeability of the intestinal cells that line our gut. This disruption leads to the common symptoms of nausea, bloating, cramping, pain, diarrhea, and even bleeding. Under the chronic stress of exercise-induced muscle fatigue and dehydration, the intestinal cells cannot sufficiently counteract and detoxify the free radicals that are being produced by extreme exertion.

In these circumstances, some of the less desirable products of ongoing gut microbial metabolism can cross the gut lining barrier, a condition known as endotoxemia. As a result, extreme endurance training has been shown to be associated with a rise in inflammatory markers in the body and a breakdown of gut integrity.

These are known pathways towards chronic disease.

Fortunately, there is a way to counteract these negative effects. A number of studies have suggested a benefit from prebiotic and probiotic

supplements for serious recreational and elite athletes. For example, prebiotics, such as oligofructose enriched inulin, increase the number of the beneficial Bifidobacteria and Lactobacillus in the colon.

These bacteria protect against pathogens and antioxidants and also stimulate the immune system. A specific by-product of Bifidobacteria metabolism, butyrate, is an essential metabolite in our colon that helps maintain the energy supply of the body cells that line the colon and protects gut integrity. It is now known that increasing the proper microbes in your gut enhances these protective effects.

The good news for recreational and endurance athletes is that there are convenient means to prevent the most common non-muscular complications of strenuous exercise.

Certainly, the best advice for your optimum health is to exercise in moderation and support those efforts with a balanced and nutritious diet. But, if you insist on pushing towards even higher levels of athletic performance, part of your exercise regimen should include a daily supplement to boost your gut microbes, which are amongst your most important athletic partners.

Dr. Bill Miller has been a physician in academic and private practice for over 30 years. He is the author of The Microcosm Within: Evolution and Extinction in the Hologenome. He currently serves as a scientific advisor to Prebiotin. For more information, www.themicrocosmwithin.com.

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HEALTHY LIVING/SAN ANTONIO

a Parent’s Guide to Picky Eating By: Cristine D. Saks, MS, RD | CommuniCare

O

n a dinner outing with my 8-year-old nephew, the waiter asked if he would like a kid’s menu, and without batting an eye, he responded “I don’t need a kid’s menu. I’ll have the salmon.” As a dietitian who works with parents and small children, I know that so many parents would love to hear their children say these exact same words. Here are a few tips to help prevent your child from becoming a picky eater, or if your child is already a picky eater, to help them eat a greater variety of healthy foods.

she eats through her breast milk.

This further exposes and allows the baby to become familiar with different flavors. The American Academy of Pediatrics (AAP) recommends exclusively breastfeeding or offering maternal milk for approximately six months. Once complementary foods are introduced, the AAP recommends continuing to breastfeed for at least one year. A 2011 study by Shim et al found that following this recommendation decreased the likelihood of a child developing picky eating behaviors during their preschool years.

Mother’s Diet

Time and Method of Solid Food Introduction

Prevention starts before your baby is even born. During pregnancy, the baby can taste what their mother is eating through amniotic fluid. To let the baby experience different flavors, pregnant mothers should eat a variety of healthy foods. Once the baby is born, if the mother is breastfeeding, the baby can continue to taste what 12

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Shim et al also found that the timing of solid food introduction also played a role in the development of picky eaters. Avoid starting your baby on solid foods until around six months, unless otherwise indicated by your pediatrician. Before this time, they are not developmentally

or nutritionally ready for solid foods.

Once solid foods are introduced, give one new food at a time. If a child rejects a food, don’t give up. Children naturally reject the unknown as a way of protecting themselves from harm. It can take between 10 and 20 exposures to the same food for a child to finally accept it.

Divide Up the Responsibility Parents and children have different responsibilities in feeding.

Parents are responsible for the food purchased and prepared, as well as how it is presented. You can change the texture of the food and the seasonings. However, minimize the amount of salt you use on food so that your child can learn to enjoy the flavors of foods without added salt. You can also give your child their food on colorful plates and utensils.

Continue to be a good role model by eating a variety of healthy foods. I promise you, your child is watching.

Lastly, keep the eating environment

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calm and without distractions, such as TV, music, I-pads, and cell phones.

Stress and distractions can affect the amount of food your child eats and can cause your child to dislike foods associated with stress.

The child’s responsibilities, on the other hand, are to choose how much they eat and whether they eat at all. As difficult as it may be, do not force your child to continue eating if they have not finished their meal.

Let them set the pace for eating and allow them to touch and smell the food before they taste it.

and ‘picky/fussy’ eating in children: A review. Appetite, 50(2-3), 181-193.

“Avoid starting your baby on solid foods until around six months, unless otherwise indicated by your pediatrician.

Before this time, they are not developmentally or nutritionally ready for solid foods.”

Other Tips Once your child is old enough, let them help choose foods at the grocery store. They can also help prepare foods in the kitchen. There are many simple tasks that they can participate in, such as washing fruits and vegetables, tearing lettuce for salads, and mixing ingredients.

When children are involved in the preparation of meals, they are more likely to eat the meal.

It takes time, but if you are consistent with offering a variety of healthy foods every day, you might be the next one bragging about your child ordering off the adult menu.

References: American Academy of Pediatrics, www.aap.org Dovey, T., Staples, P., Gibson, E., & Halford, J. (2008). Food neophobia

Hayes, D. (n.d.). Coping With Picky Eating Phases. Retrieved from http://www.eatright.org/kids/article. aspx?id=6442459366 Hayes, D. (n.d.). Introducing Solid Foods. Retrieved from http:// www.eatright.org/kids/article. aspx?id=6442459352#authorinfo Hermann, M. (n.d.). Expanding Your Baby's Flavor Horizons. Retrieved from http://www.eatright.org/kids/ article.aspx?id=6442459331 Shim, J., Kim, J., & Mathai, R. (2011).

Associations of Infant Feeding Practices and Picky Eating Behaviors of Preschool Children. Journal of the American Dietetic Association, 111(9), 1363-1368.

For more information on CommuniCare Health Centers visit 4all4life.org or call San Antonio: (210) 233-7000 Hays County: (512) 268-8900 Boerne: (830) 249-1717

2017 - SEPTEMBER MD Monthly

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EMPOWERMENT:

TAKING A NEW APPROACH TO DEMENTIA PART 1: CONFRONTING THE CHALLENGES By: Sue Carrington

I

t’s a force to be reckoned with.

Alzheimer’s disease and related dementias (ADRD) are debilitating conditions that impair memory, interfere with thought processes, and limit day-to-day functioning. As the disease continues to surge—affecting more than five million Americans and as many as 16 million by 2050—the nation is seeking new ways to care for people with ADRD. One leading approach is focusing not on losses but on remaining potential.

“Fear about getting Alzheimer’s disease is pervasive,” says Kim Warchol, an occupational therapist and president and founder of Dementia Care Specialists, a nationwide dementia training and consulting company. “Why is the disease so scary? Because of the belief we continue to hold that if you’re diagnosed with dementia, you’re on your way down a long road of suffering.

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“Although this perspective is gradually changing, it’s still there in part because of the way we’ve traditionally cared for people with the disease. As soon as a person experiences memory challenges, we confine them to a world of losses— what they can’t do anymore. Over time, we begin to use labels like ‘wanderer,’ ‘rummager,’ or ‘feeder.’

Suffering is born out of this negativity.”

Facing the realities For healthcare stakeholders— providers, payers, and patients and their families—the challenges of ADRD are steep. Seniors with dementia are hospitalized three times more often than seniors without dementia and experience a greater reduction in quality of life. They may need intensive long-term services and support. Psychotropic medications

are often overused to control behavior issues. Many caregivers eventually burn out and leave their profession.

ADRD is also taking a huge financial toll. At an annual cost of more than $200 billion, it is the most expensive illness in America today.

According to Warchol, the devastating effects of the disease are made even more so by mistaken perception.

Flipping the perception The result can be such problems as depression, physical weakness, negative behavior expressions, more hospitalizations, and eventually, failure to thrive.

“Yet if we come from an empowered, person-centered point of

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view, focusing not exclusively on the disease, but on the person first and his or her remaining potential, we can significantly change the future for this individual and the downward spiral of events.”

Warchol notes that forwardthinking memory care providers are taking what she calls a “strengthbased approach” to ADRD, training staff to highlight residents’ cognitive abilities. For example, the strengthbased program was introduced two years ago to staff at Pathways Memory Care at Villa Toscana in Houston, Texas, one of seven memory care communities operated

by StoneGate Senior Living. Since then, staff members have received specialized training in tailoring care to individuals and helping residents with dementia do as much as they can on their own.

Following the developmental stages A key theory that’s helping change the perception of ADRD is retrogenesis, meaning “back to birth.” Warchol explains this as the concept that the brain of a person with Alzheimer’s disease deteriorates in the reverse order that the brain developed from birth. “Cognitive skills acquired last are the first to go, and the ones attained first are the last to leave.

“Functional cognitive capacity defined in the stages of dementia can be equated to capacity within developmental ages. Someone at the end of life with Alzheimer’s has the same cognitive abilities and functional capabilities as an infant. Yet we need to remember that regardless of their stage of cognitive development, children live a quality life. Even an infant has quality of life, because we celebrate who they are and what they

can do—and we accommodate for what they can’t do. We create many meaningful moments, not despair.

“That’s the way we need to see people with dementia. True, their brains are not fully functional, but that person is still there. If we as care partners can learn to adjust our perceptions and celebrate who that person is, those living with ADRD can have a quality life.”

About the Author: Sue Carrington is a seasoned and purpose-driven journalist, with a focus on healthcare innovation. She has pursued her love of words through a diverse array of callings – from book editor to radio news director, public relations manager to corporate writer and freelance writing entrepreneur.

Sue is a native of the Washington, DC, area.

2017 - SEPTEMBER MD Monthly

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Dr. Christopher J. Busken Delivering Individualized Special Care to His Patients at Heart Endovascular and Rhythm of Texas By: Jody Joseph Marmel

W

hen Dr. Busken was 13, his older sister died tragically.

Since he was in his early teens, this moment defined who he was to become later on in life. He explains, “I had to call 911 and give directions to the EMS crew about how to arrive at our house.” After he placed that call, Dr. Busken waited outside in the freezing cold, without a shirt or shoes, until the EMS team arrived so they wouldn’t miss his house which was located in a very small farm town in Mid-Missouri. “I remember looking up at the moon

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on that dark night and I decided at that moment in time that I was going to be a doctor. I didn’t want anyone else’s family to go through what our family did.”

He kept this promise and went to Southeast Missouri State University, then attended the University of Missouri for medical school, and graduated in 2006. For five years, Dr. Busken did his general surgery residency in Savannah, Georgia and he completed his vascular surgery fellowship at Baylor University Medical Center in Dallas in 2013. His first job was at UT Health Science Center San Antonio. He then returned to Savannah for his second job.

“Savannah is a beautiful city and if you haven’t visited it yet, it should be a must-do on your travel list.”

Returning to San Antonio in May of 2017, Dr. Busken joined Heart Endovascular and Heart Rhythm of Texas and is currently the only Vascular Surgeon on the team. Their practice is unique because they combine cardiology and vascular surgery, which at present no one else in the city is doing. Some of the services include open bypasses and minimally invasive vascular work. “I love what I do because I am really able to make a connection with our patients and their families on a one-on-one basis.” Dr. Busken also

PHOTOGRAPHY BY Marc Arevalo

loves the Alamo City because of the culture, diversity, the beautiful Hill Country and, of course, the food.

“I enjoy learning about the Hispanic culture and testing out my Spanish. I am from a part of Missouri where we didn’t have diversity. My hometown had a population of about 2,000 people. I always dreamed of being a part of a large city and every day here in San Antonio, I have a chance to learn something new about a culture and people.” Dr. Busken also co-owns a barbecue food truck in Austin–Gebby’s BBQ– that has three different locations and has won awards. (Visit http://gebbysbbq.com/ to find out about Gebby’s.) “I like to consider myself a foodie and I am forever trying out new places.”

I wondered why Dr. Busken chose to be a Vascular Surgeon

and he went back in time to explain that in medical school he had a wonderful mentor who helped him make that decision.

“Between my third and fourth years of medical school I was doing some extra work in the anatomy laboratory, working on a dissection. The vascular surgery fellow at the time, Colleen Johnson, walked in and asked me to do a case with her.” He elaborated that Colleen Johnson said, “Hey Busken, do you want to come do a case with me?”

He replied, “Absolutely!” He dropped everything he was doing and she took him through a carotid endarterectomy from start to finish.

“It was an incredible experience then and it remains one of my favorite cases to this day.”

A Vascular Surgeon specializes in

I love what I do because I am really able to make a connection with our patients and their families on a oneon-one basis.

- Dr. Busken the care of the arteries, veins, and the lymphatic system throughout the entire body, excluding the heart and brain. Vascular surgeons are rare in that they can do either traditional open surgery, or the newer minimally invasive endovascular techniques.

Dr. Busken performs angiograms, venograms, venous ablations, simple wound debridements, and catheter placements, to name some of the procedures he routinely does.

The most challenging procedure he performs is thoracoabdominal aneurysm repairs.

Typically patients who seek out Dr. Busken have leg pain, leg swelling, sores on their legs, problems walking, leg discoloration, varicose veins, or they need access placement for dialysis, or have had signs and symptoms of a stroke. The patient population seen by Dr. Busken is usually chronically ill and he rises to this challenge every day. He wants to make those who are suffering better as quickly as possible so they can attain a better quality of life. “I had a patient come in with a symptomatic abdominal aortic aneurysm, which is

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a lethal problem. With the help of my surgical team, we were able to go in and fix it in a minimally invasive manner, and the patient ended up leaving the hospital in two days.

She went home and is doing great.”

He emphasizes that the medical staff in San Antonio is incredibly dedicated and hardworking. “I feel blessed to interact with these people on a daily basis.”

What Dr. Busken does not say, I will say for him. He is a big part of the medical community in San Antonio and his devotion to his patients, practice, and staff is amazing. His work starts at 6:00 a.m. and usually ends late that night. His life is centered on his medical career, and most importantly, on the patients who need him the most. Dr. Busken spends time explaining procedures to his patients and helping them understand what they need to do to get to a better place. His demeanor and intelligence, as well as his keen sense of humor, make him the type of doctor who is respected and trusted, and can therefore be highly recommend to those who need his services.

Dr. Busken has health tips: Keep walking. Don’t smoke, and if you do smoke, quit. Take care of your blood pressure and diabetes. He states, “Listen to your primary care doctor.

Your primary care doctor is very smart and is in the best position to help you

Dr. Busken’s short term goal is to build his own practice. His long term goals include adding 15-20 more vascular surgeons and double that number of cardiologists. Having had the opportunity to talk with him, I am quite certain that he will reach all of his goals without delay.

make positive life changes.”

The Heart Endovascular and Heart Rhythm of Texas offers a whole approach to open and endovascular techniques to peripheral vascular disease, carotid disease, aneurisms, and wound care. Dr. Busken explains that this “whole approach” is what he has been looking for. “One of the challenges that I have faced in medicine is the incessant ‘turf battles’ that various specialties and competing groups routinely engage in. I believe it is petty and self-defeating. A multidisciplinary approach is the most effective in delivering outstanding outcomes to our patients. To that end, I wanted to find a practice where people work together to help the patients.

This group is superbly positioned to offer that to the patients of South Texas and Mexico.”

Delivering individualized special care to their patients is what this team is all about. Dr. Busken takes this a step further. “I always ask my patients what they like to do and what they want to do with their lives. When they come see me, they are typically very ill. I want to find out what they enjoy in life, and work to get them back to that. I want to help give someone another Christmas with their family, help them go on a vacation that they have always wanted or to see their grandchild graduate from school. Helping my patients attain their goals means the world to me.”

For More Information Visit www.heartdoc.care (210)-844-2393 North East Clinic 12602 Toepperwein Road #118 Live Oak, Texas 78233 Stone Oak Clinic 1202 E. Sonterra Blvd.

Building 6, #604 San Antonio, Texas 78258

2017 - SEPTEMBER MD Monthly

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OP-ED/SAN ANTONIO

HEART ENDOVASCULAR & RHYTHM OF TEXAS Begins First Commercial, FDA-Cleared,

IN-PATIENT USE OF DABRA TO TREAT Peripheral Artery Disease Special to MD Monthly

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an Antonio-based Heart Endovascular & Rhythm of Texas recently began performing a groundbreaking procedure with its new DABRA System to treat patients with Peripheral Artery Disease (PAD) and prevent them from undergoing diabetic amputations.

According to the City of San Antonio Metropolitan Health District, 14.2 percent of Bexar County adults have been diagnosed with (type 1 or type 2) diabetes, which is higher than the state and national average.

People with diabetes are often at risk of amputations.

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The Heart Endovascular & Rhythm of Texas is the first outpatient facility in Texas to commercially work with Ra Medical Systems, makers of cardiovascular and dermatology catheters and excimer lasers, to cross and treat arterial blockages via femoral artery access. It is also the first in the country to perform a procedure independent of the clinical trials for FDA clearance. This follows the California Heart & Vascular Clinic in El Centro, Calif., which participated in a FDA clinical study and treated the first post-FDA clearance patient, associated with the study, in June.

“There are very few devices that are available today that are effective for opening CTOs (chronic total occlusions),” said Dr. Charles Bailey, interventional cardiologist of Heart Endovascular & Rhythm of Texas. “If you can't get those vessels open, the only alternative is surgical, and unfortunately with surgical procedures, it runs the risk of infection. This laser and catheter is unlike any other device because of its design. The fact that you can open up a vessel that's been closed for a long time and not have to place a stent in it and not have to operate on a patient is phenomenal.”

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The device is a catheter and excimer laser system for the treatment of complex and diffuse arterial blockages in the lower vessels. The single-use catheter produces a lumen while minimizing trauma to the vasculature. It is a full catheter tip forward cutter, without the “dead-space” of fiber optic bundle catheters. The DABRA laser photochemically ablates arterial blockages, reducing calcium, thrombus and atheroma, minimizing downstream debris. The portable laser weighs about 100 pounds.

DABRA is covered by most private insurance carriers and Medicare.

“Patients who have had the procedure have matched DABRA’s clinical study results, highlighting the efficacy and safety of this treatment to date, with zero adverse events,” said Dean Irwin, CEO, Ra Medical Systems. “We are thrilled to bring the DABRA system to patients and doctors in San Antonio in the

treatment of Peripheral Artery Disease. With shorter procedure times, better patient outcomes and the procedure being less expensive, it’s a win-win-win for patients and their doctors and the healthcare system.”

Rhythm Endovascular & Heart Institute of Texas cath lab is working with Ra Medical Systems to be part of the next phase of clinical trials for coronary CTOs. DABRA (Destruction of Arteriosclerotic Blockages by laser Radiation Ablation) changes the paradigm of vascular treatments clinically and economically, continuing Ra Medical Systems’ decade-long successful track record of delivering better, safer, faster and less-expensive solutions to treat complex and chronic medical conditions. Compared to other treatments for arterial blockages, Ra Medical Systems’ DABRA has shorter procedure times, better

patient outcomes and is less expensive. Combined with its safety profile and versatility, these DABRA advantages may reduce the costs that are associated with treating Peripheral Artery Disease and ultimately lead to greater patient access to, and success with, interventional procedures.

According to the Centers for Disease Control and Prevention (CDC), approximately 8.5 million people in the United States have PAD, including 12-20% of individuals older than age 60 and people of Hispanic origin may have similar to slightly higher rates of PAD compared to non-Hispanic whites.

Risk factors for PAD include smoking, high blood pressure, atherosclerosis, diabetes, and high cholesterol.

Peripheral Artery Disease is the leading cause of limb amputations.

More than 200 million people worldwide, including approximately 8.5 million Americans, suffer from Peripheral Artery Disease, a lifethreatening condition in which the arteries that carry blood from the heart to the legs and arms narrow and become blocked. In the U.S. and Europe, Peripheral Artery Disease is responsible for approximately 240,000 amputations every year.

Nearly one-quarter of these patients die within 30 days and almost half within a year of their limb amputation.

For more information visit heartdoc.care or call 210.844.2393.

Heart and Endovascular Rhythm of Texas is located at 1202 East Sonterra Boulevard, Suite 604 in San Antonio, TX 78258.

2017 - SEPTEMBER MD Monthly

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INFORMED PATIENT/SAN ANTONIO

Floppy FIX THOSE

STRETCHED EARLOBES

By: Marc T. Taylor, M.D.

E

ven earlobes cannot escape the aging process. Plastic Surgeon Marc T. Taylor, MD. Finds that few patients visiting his practice are aware that earlobe reduction is even an option.

Dr. Taylor states, “Drooping earlobes change the whole face, especially when the piercing hole is almost at the bottom of the lobes. Patients are frequently surprised that there definitely is a pretty simple way of reducing earlobes surgically.”

“Earlobe-plasty” (earlobe reduction or earlobe repair), usually done in conjunction with a facelift, is now gaining popularity as a stand-alone procedure. With few exceptions “detached” lobes can be “attached,”

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MD Monthly

prominent lobes can be made smaller, and elongated lobes can be shortened – all with the intent of making the earlobes more proportionate to the size of the ear and shape of the face. “It’s a subtle but definite enhancement in appearance and can give a more youthful look to the face when dangling earlobes are corrected,” states Dr. Taylor.

Erase Years in Under an Hour Earlobe-plasty or reduction is an office procedure done under local anesthetic. It takes less than an hour and there are no bandages. The techniques used will depend upon your specific anatomy. If there is simply extra earlobe tissue, an incision is made along the bottom edge of the

earlobe. That soft tissue is removed and repaired. If the lobe is very wide or the hole is stretched a great deal, a different incision may be used. Dr. Taylor states, “I repaired a stretched out, torn, and hanging earlobe on one of my face life patients a few months ago during the procedure. She had torn the earlobe over 30 years ago and had no idea they could be repaired.

She was as happy with the earlobe repair as the results of the face lift!”

Re-piercing of the earlobe can be done approximately six weeks post-opt.

For more information visit www.marctaylormd.com or call (210) 305-5797. Marc Taylor Plastic Surgery is located on 3338 Oakwel Ct., Ste. 207, San Antonio, TX 78218

SEPTEMBER - 2017

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DR. LISA MARTÉN JOIN US IN HONORING DR. LISA MARTÉN, CEO 10th Anniversary & Celebrating San Antonio Business Journal, Women’s Leadership Award 210.692.1388 | www.SouthTexasEyeInstitute.com 2424 Babcock Road, Suite 101 | San Antonio, TX 78229

INFORMED PATIENT/SAN ANTONIO

Arthritis & Obesity By: Dr. Subhash Reddy

A

rthritis is one of the major causes of morbidity, or the rate of disease, in people struggling with obesity.

Osteoarthritis is a leading cause of joint disorders with symptoms of degeneration occurring in the hips, knees, back, neck and hands. With increasing obesity rates in the United States, which has doubled compared to the obesity rate in the 1980’s, the prevalence of arthritis is also increasing. Common symptoms of arthritis include joint pain, swelling, and stiffness leading to impaired mobility that affects the quality of many people’s lives. Most people with arthritis are managed primarily with medications.

The most commonly

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used medications include NSAIDS, which not only reduce inflammation, but long-term use is also associated to gastritis, peptic ulcers, and kidney disease. Moderate to severe cases of arthritis are managed with surgery such as a joint replacement.

The exact correlation between obesity and osteoarthritis is still unclear, but being overweight increases the load on the major joints like knees and hips, which increases the rate of normal wear/tear of cartilages at joints(1).

Obesity alone can cause three to six times one’s body weight to press down on the knees while walking (2). Data from

the National Health and Nutrition examination survey shows that obese women had nearly four times the risk of knee arthritis as compared to non-obese women; that risk is five times greater in obese men (6). The Framingham Study done

by Boston city hospital showed that people with obesity, but without arthritis in their thirties, had an increased risk of arthritis later in life(7). That risk is ten times higher for knee arthritis in obese individuals. Furthermore, it’s clear from multiple studies that weight and osteoarthritis are associated, and similarly, a reduction in weight has shown significant improvements in a

person with osteoarthritis symptoms. Framingham and Felson et al studies noted for a person of normal height, a weight reduction of 11 lbs reduced the risk of knee arthritis by 50%. For obese elderly men (body mass index >30) who drop their body mass index to 25-29.9 (overweight category), the risk of arthritis drops to 21.5%.

Similarly, in the same case for women, the risk of arthritis drops to 33%.

Science has determined that long-term weight loss can be only achieved by bariatric or metabolic surgery, which not only reduces weight but also significantly improves or resolves diabetes

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INFORMED PATIENT/SAN ANTONIO

mellitus, hypertension, hyperlipidemia, sleep apnea, and arthritis, along with extending one’s lifespan and overall quality of life. A study published by Finland in 2013 on patients after bariatric surgery showed that people who had gastric bypass had an average weight loss of 27.3 kg, and had improved physical functions including improving the stiffness in the knee from osteoarthritis. Another benefit of bariatric surgery in patients with end stage arthritis who are awaiting knee or joint replacements is having a decreased financial burden overall. The savings from an improved quality and quantity of life resulting from bariatric surgery include less money spent on doctor’s visits, prescriptions, surgeries, food and more.

Another variety of arthritis is rheumatoid arthritis, which is caused by inflammatory systemic factors in the blood of the affected individual. Bariatric surgery not only decreases the disease activity, it also decreases inflammation overall, which results in less usage of rheumatoid arthritis medications.

Brigham Hospital and Harvard Medical School concluded these findings in a 2015 study: Their findings determined after one year following bariatric surgery, patients with severe rheumatoid arthritis dropped to 6% from the baseline of

57% of patients, and after 5 years 74% were in remission. Current medical literature supports both nonoperative and operative bariatric weight loss surgery to improve arthritis symptoms such as knee pain and joint function, but to achieve long-term weight loss bariatric surgery is the only solution. Many of the mentioned studies use gastric bypass as the golden standard for improving arthritis.

Although long-term research on the sleeve gastrectomy and arthritis has not been published, it also dramatically decreases a person’s weight after the surgery, which can also lead to alleviation of arthritis and weight on the joints.

In summary, the benefit of weight loss regarding arthritis improvement is like a small car carrying too large of a load, leading to transmission and axle damage. The solution is to take the excess weight off the car to avoid replacing the axle or transmission.

Similarly, weight loss is the best factor in treatment of arthritis, especially in osteoarthritis.

For more information, visit texasbariatricspecialists.com or call 877.538.6909. The corporate headquarters for Texas Bariatric pecialists is located at 14603 Huebner, Building 2 in San Antonio, Texas 78230.

2017 - SEPTEMBER MD Monthly

29

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INFORMED PATIENT/SAN ANTONIO

ERECTILE DYSFUNCTION: Definition, Causes, Symptoms, Diagnosis, and Treatment By: Austin G. Hackney

What is Erectile Dysfunction?

Are There Any Other Symptoms?

While most common later in life, a man may experience problems with his erection at any age. It is normal to have difficulties sustaining an erection from time to time. Erectile dysfunction is defined as the inability to get an erection hard enough to have sex. It's sometimes also called impotence. While men do not tend to talk openly about the issue, it is widespread. Once diagnosed, there are effective treatments available for the condition.

While there may be underlying conditions behind it, the only symptom of erectile dysfunction itself, is the inability to sustain a hard penis. However, even if a full erection isn't achieved, a man suffering from erectile dysfunction will still experience sexual desire. He may also still be able to achieve orgasm and ejaculate semen.

What Causes Erectile Dysfunction?

Many factors can lead to erectile dysfunction. It may be associated with other health issues, such as depression, anxiety, high blood pressure, or diabetes. It can also follow a physical injury, either to the penis itself or the nervous system.

Problems with your erection may also be the side-effect of certain medicines. Excessive alcohol consumption and smoking are linked to erectile dysfunction, too.

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MD Monthly

How is Erectile Dysfunction Diagnosed?

If you are having persistent difficulty achieving and sustaining an erection, you should consult your doctor. An interview and a physical exam will be used to diagnose the condition. You may also be referred to a mental health professional to assess whether the condition is linked to depression, anxiety, or issues of low self-esteem.

How is Erectile Dysfunction Treated?

The most common and effective treatments for erectile dysfunction include counseling, lifestyle changes

(such as cutting down on alcohol or quitting smoking) and medicines.

In rare cases, surgery may be advised. However, this will only be recommended as a last resort if other interventions have failed.

How to Prevent Erectile Dysfunction Most cases of erectile dysfunction are the consequence of physical problems. While there is no certain way to avoid it, living a healthy, active lifestyle may help.

Quitting smoking, cutting down on alcohol, eating well, and exercising regularly are good ways to improve overall well-being and decrease the risks. Counseling, meditation, and a positive outlook may help you avoid the psycho-emotional causes of erectile dysfunction.

If you suffer from erectile dysfunction, you should understand that you are not alone. It is not an uncommon condition. With a proper diagnosis and the right treatment it is usually temporary and curable.

The best first step is to make an appointment to see your doctor.

SEPTEMBER - 2017

MDMONTHLY.COM

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INFORMED PATIENT/DALLAS

FROM PROTECTIVE EYEWEAR

TO EYE DROPS

6 TIPS FOR HEALTHY, COMFORTABLE

EYES AT WORK By: Mary Maloney

P

ainful, irritated eyes make life on the job miserable, but you don’t have to suffer anymore. Whether you work construction, drive a forklift or stare at a computer screen all day – taking simple, proactive steps to prevent eye injuries and discomfort can be life changing.

Key-Whitman Eye Center’s Plano eye doctor, Sadaf Razi, regularly treats patients with work-related eye discomfort and injuries. She recommends the following six simple steps to keep eyes healthy and comfortable in the workplace.

Tip No. 1: Prevent – don’t chase – symptoms related to digital eye strain and near work.

Common symptoms of workrelated eye strain include: • Eyes feeling tired mid-afternoon.

• General feelings of fatigue and wanting to take a nap.

• Eye redness and burning.

• Sandy, gritty sensation in the eyes.

Dr. Razi finds that, “People tend to get in the habit of working without taking frequent breaks, which fatigues the eye muscles and can cause eye strain. We see a lot of ocular surface disease, which is essentially dryness and irritation due to excessive computer work or 42

MD Monthly

reading without taking proper breaks.”

patient’s visual demands.”

She also finds many people anticipate when discomfort will set in.

“It’s important to get in the rhythm of taking short breaks and using artificial tears before symptoms of digital eye strain arise. These simple changes can work wonders,” Dr. Razi says.

Tip No. 3: Take steps to prevent damage and discomfort from allergens and the sun.

Tip No. 2: Only wear a prescription that is accurate for your visual demands.

If you’re someone who goes to the pharmacy and chooses a pair of readers simply because the number sounds right or because you think you can see well while wearing them, you may be doing yourself more harm than good.

Improper eyeglass prescriptions can actually exacerbate eye strain, which can lead to headaches and a slew of other problems. According to Dr. Razi, wearing a proper prescription – whether it’s for computer work or reading fine print – is essential.

As she explains, “A lot of people do need a prescription for their computer work – or computer glasses. During an eye exam, we consider whether the patient has any active eye diseases or conditions and what kind of computer or other work he or she will be doing, then we calculate a prescription that fits that

People who work in the great outdoors – construction, lawn care, pest control, fishing guide, golf pro, etc. – are at increased risk for eye damage and discomfort due to harmful UV rays and exposure to allergens and pollutants.

Dr. Razi often hears patients who work outdoors complain of eye irritation, including itching, redness, watery eyes, and a sandy, gritty, foreign body sensation in the eyes.

“Ultraviolet rays and pollutants can cause eye discomfort. So it’s very important for people to always protect their eyes (even when it's cloudy) by wearing sunglasses with UV protection and brimmed hats. I also recommend taking regular breaks and using lubricating eye drops to flush out debris and minimize eye irritation,” says Dr. Razi.

Tip No. 4: Wear protective eyewear to block projectiles and debris.

If you work outdoors or in a lab or manufacturing environment where projectiles (rocks, sticks, glass, metal, etc.) could potentially fly your way

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MDMONTHLY.COM

INFORMED PATIENT/DALLAS

or chemical splashes may occur, protective eyewear is a must.

As Dr. Razi explains, “You don’t want to risk losing an eye or compromising your vision, simply because you didn’t wear protective eyewear or assume, ‘It won’t happen to me.’ Depending on your work environment, wraparound sunglasses or goggles should be worn whenever your eyes are in harm’s way.”

Tip No. 5: Stay hydrated and keep eyes lubricated.

“Staying hydrated is very important for overall health, but it also helps balance the hydration level on the surface of the eye. So it’s important to keep lubricants like preservativefree artificial tears handy to flush out irritants or to use preemptively to avoid or reduce symptoms of computer related eye strain. Again, it’s vital to stay ahead of symptoms. So

if you typically experience symptoms two to three times a day, use eye drops preventively more often than that,” Dr. Razi says.

Tip No. 6: Visit the eye doctor annually and as soon as eye problems arise.

To best manage eye wellness in the workplace, Dr. Razi recommends seeing an eye doctor annually for an eye exam and at the first sign of eye irritation. Don’t tough it out and wait until symptoms become severe.

About the Author: Mary Maloney is a freelance writer and marketing consultant based in Dallas, Texas.

She specializes in writing strategic marketing content that drives revenue for clients in the legal, financial, healthcare, wellness, manufacturing, event marketing, retail and M&A spaces. Contact Mary on Twitter: @MKoskiMaloney or LinkedIn: https://www.linkedin.com/in/ marykoskimaloney727/

As she explains, “It’s important to get an annual eye exam because your eye doctor may find things hiding in background that you didn’t know were damaging your eyes. We can also recommend treatments to resolve anything chronic or recurring, like dry eye symptoms and address eye irritation and injuries that could worsen without treatment.”

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2017 - SEPTEMBER MD Monthly

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INFORMED PATIENT/HOUSTON

Q&A ON

Buttock Injections By: Dr. Bob Basu

W

ith a rise in the desire for vivacious curves, and the influence of celebrity figures, more women look to plastic surgery as a way to achieve their dream body. This often leads to botched procedures, or even worse, untimely deaths.

A recent example of this type of tragedy is when Latesha Bynum of New York died after receiving a botched buttock injection procedure (http://www.fox26houston.com/ news/271275515-story).

Below, please find a Q&A with Dr. Basu, American Board of Plastic Surgery certified plastic surgeon based in Houston, on this topic for your use.

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Q: What should this woman have done differently from the start to avoid her situation entirely?

A: It’s important for individuals to follow their gut feeling and use their common sense. Considering this procedure was performed in an apartment complex is one of the biggest indicators that it was not being properly regulated. However, there are many “black market” clinics or unqualified practitioners that are able to disguise their inadequate training in a more medical setting.

That is why the most important step is to research a doctor prior to your consultation. The American Society of Plastic Surgeons launched a “Do Your Homework” campaign for this very reason. Some important questions to ask are: Is your doctor board certified in plastic surgery (not another

specialty) by the American Board of Plastic Surgery? Is your doctor a member of the American Society of Plastic Surgeons? Does your doctor operate out of an accredited surgery center and has privileges to nearby hospitals? As well as does your doctor have impressive “before and after” photos on their website?

Q: Is death an outcome people undergoing buttock injections with a licensed medical professional should have to worry about?

A: Every surgery and medical procedure has risks and must be taken seriously. Although the risk of death from elective cosmetic surgery is very low, it does exist.

When you go to a board-certified plastic surgeon, you have the peace of mind knowing that your

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INFORMED PATIENT/HOUSTON

surgeon is trained in their field to perform your procedure and will know how to handle unanticipated complications, proper medical clearances will be obtained prior to surgery, they are using properly licensed anesthesiologist or nurse anesthetist and the facility is safe and sterile. Ensuring all these factors are met is important for a successful cosmetic procedure.

Q: What are some warning signs or bad symptoms patients should watch for post procedure?

A: Some warning signs to look out for after any cosmetic procedure include: shortness of breath, chest pain, fever, leg pain and fainting. If you experience any of these warning signs or any unusual symptoms you

must notify your plastic surgeon immediately or go to your nearest ER. Q: How could a buttock injection cause brain issues? Is it something to do with lidocaine?

A: Lidocaine can be used as a numbing agent, and if used improperly can lead to serious complications. In this case, since the practitioner was operating illegally and would not have access to proper anesthesia or have the knowledge of how to administer such medications.

Q: What buttock enhancement procedures involve the least amount of risk? Which have a higher risk?

A: In my practice, we prefer the fat transfer procedure also known

as the Brazilian Butt Lift for buttock enhancement. This procedure uses your own fat from multiple areas of your body to transfer into the buttocks to increase the size and define your shape. Along with a larger back side, you get the benefit of full body sculpting from the liposuction which will enhance the shape of the buttocks. As with any cosmetic procedure, it is important to consult with a board-certified plastic surgeon to go over all your options.

Dr. Basu did not treat Latesha Bynum.

For more information visit basuplasticsurgery.com or call 713.799.2278. Basu Plastic Surgery is located in 6400 Fannin Street, Suite 2100, Houtson, TX 77030.

2017 - SEPTEMBER MD Monthly

45

Christopher J. Busken, M.D. Dr. Christopher J Busken, is a Vascular Surgery specialist in San Antonio, Texas. He attended and graduated from University Of Missouri School Of Medicine in 2006, having over 11 years of diverse experience, especially in Vascular Surgery.

He is affiliated with many hospitals including Methodist Hospital, Baptist Medical Center, Christus Santa Rosa Hospital, Southwest General Hospital. Dr. Christopher J Busken also cooperates with other doctors and physicians in medical groups including University Of Texas Health Science Center At San Antonio.

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MAYOR RON NIRENBERG

WANTS YOU TO GET PHYSICAL AND HE’S LEADING THE CHARGE By: Rudy Arispe

B

efore he was elected mayor and long before he was even a city councilman, Ron Nirenberg was known to throw his weight around and flex his muscles on occasion.

But it’s not what you might think.

The weight we’re referring to are stacks of 45-pound, iron plates at the gym, and that flexing of his biceps were part of poses to show off his hard-earned physique, when as a young graduate student at the University of Pennsylvania, our city’s mayor was a competitive body builder.

Today, at 39, physical fitness is just as much an important part of Nirenberg’s life as it was back then.

And as head of the Mayor’s Council on Fitness, it is his hope that San Antonio strive to be a Fit City. So he encourages you to get outdoors – if it’s not too unbearably hot – and hop on a bike, go for a walk, get in the water or get to the gym, all in the name of health and fitness.

“Staying active is just as important for your physical health as it is for your mental health,” Mayor Nirenberg said. “Maintaining that balance helps your mood, productivity along with many other health benefits.”

As for his involvement with the Mayor’s Council on Fitness, he’s “looking forward to working with (the council) to do some creative

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SEPTEMBER - 2017

PHOTOGRAPHY BY Trinity Greer

MDMONTHLY.COM

fitness programming that will benefit the community.”

In fact, developing fitness programs is a perfect fit for the physically fit mayor. In 2003, he was a personal trainer, who offered fitness and nutritional consulting, under the name Nirenberg Fitness Training. “I truly enjoyed it,” he said. “I had a very exclusive clientele.

I started it because I had this dream of owning my own gym one day and envisioned it as the ‘Cheers’ of gyms.”

Mayor Nirenberg recalls entering Trinity University as a freshman and weighing a mere 110 pounds, which is hard to believe because when he competed as a body builder, he hit the scales at 220 pounds. “I decided I had to do something about it,” the 5-foot-11, 190-pound mayor said of those string bean days. “I went to see somebody to teach me how to work out right and eat properly. I ended up doubling my weight naturally without steroids or anabolics. It took me many years, though.”

Since being elected in June, Mayor Nirenberg is committed to nurturing San Antonio’s diverse economy, promoting its leadership on an international stage and pursuing strategies that foster resilience and equity in all sectors of the city, according to the City of San Antonio website. Additionally, he is committed to building a city

STAYING ACTIVE IS JUST AS IMPORTANT FOR YOUR PHYSICAL HEALTH AS IT IS FOR YOUR MENTAL HEALTH. MAINTAINING THAT BALANCE HELPS YOUR MOOD, PRODUCTIVITY ALONG WITH MANY OTHER HEALTH BENEFITS.

-MAYOR RON NIRENBERG that works for all, adapts to rapid growth, and advances innovation and opportunity for local businesses while balancing sustainability goals.

Health and wellness through physical fitness can be added as well, and the mayor serves as an

example by hitting the gym and treadmill regularly. Despite his heavy workload – council meetings, briefs to be read, appointments, public appearances and so forth – he still finds the time to exercise.

“When I was GM of (Trinity University’s KRTU jazz radio station) and then councilman and now mayor, I’ve had to learn to be flexible with my workout regimen,” Mayor Nirenberg said. “But I still have the same focus on resistance training supplemented with cardio as I did when I was competing. Over the last 20 years, I’ve been able to keep up with the basic foundations of my routine, which is to train each body part intensely once per week with two or three days of cardio.”

As for his eating habits, Mayor Nirenberg said he eats fairly “clean” by consuming a high-protein diet and complex carbohydrates while avoiding processed foods and refined sugars. That’s not to say he turns down dessert when he’s in the mood for it, especially dark chocolate. “I practice moderation,” he said. “I don’t deprive myself.”

Although he cites Arnold Schwarzenegger as one of his favorite bodybuilders whom he admired as he got into weightlifting, it was a female bodybuilder who motivated Mayor Nirenberg to reach his fitness goals: power lifter and IFSA world’s strongest woman champion Jill Mills. “She was the inspiration for me,” he said.

2017 - SEPTEMBER MD Monthly

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Melissa Y. Macias, MD, PhD Neurosurgery Dr. Macias treats a spectrum of adult degernative spine and brain pathologies and conditions: • Complex Degenerative Spine Disease, Disc Herniations, Spinal Stenosis, Acquired Adult Scoliosis • Infections • Tumors • Stroke • Trauma Through compassionate and individualized care, Dr. Macias uses minimally destructive techniques, as well as stem cell technologies in her procedures. She also offers treatment of chronic pain and compressive peripheral nerve disorders.

A Healthy Spinal Axis is fundamental to an active and healthy lifestyle.

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LEARN MORE AT

MyHiddenScar.com LIT 11968 Rev. A

INFORMED PATIENT/REGIONAL

Is Dyslexia

THE ROOT OF YOUR CHILD'S Anxiety & Behavior

Problems?

By: Don Winn

T

he task of educating our youth has many challenges, but two are especially arresting: the number of children manifesting symptoms of anxiety and those demonstrating behavioral issues.

These are not simple problems to decipher or address, but this article will ask parents, teachers, and medical professionals to approach these issues with a sense of inquiry.

Much has been written in recent years about dyslexia, its spectrum of manifestations, and strategies for helping students cope. But one aspect that receives less attention is that the challenges of dyslexia predispose children to anxiety

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and behavioral changes. Dyslexic students can put so much effort and energy into avoiding reading, writing, spelling, sequencing, math, or any other affected skills, and they can mask their lack of function in those tasks so well that sometimes their most attention-getting symptoms can be poor behavior or anxiety.

Of course, not all children with anxiety or behavioral issues have dyslexia, but here are some symptoms to be noted and investigated: • •

Agitation about going to school or doing homework Fidgety, distracted, or disruptive behavior in class

• • •

• •

•

•

Noticeable weight gain or loss Changes in dress and grooming Oppositional or angry outbursts when asked to do school work or in the classroom setting Tearfulness and frustration Avoidance (often quite creative) of reading silently, reading aloud, writing, turning in assignments, answering questions in class, or even showing up for school Reports of unauthorized absences by the school administration Negative talk about self: "I'm stupid," "I can't do anything right," etc.

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• • • • • • •

Frequent stomachaches or headaches Insomnia Frequent nightmares Enuresis (bedwetting) Becoming withdrawn and uncommunicative Excessive focus on what the student deems unfair Extreme fatigue at the end of the school day

Over the years I’ve shared a lot about my own personal experience growing up with dyslexia in the 1960s, from my academic challenges to my feelings of shame and inadequacy. My anxiety and behavioral manifestations were definitely discernible to my teachers and parents. I was constantly agitated, fidgeted all the time, lost weight to the point of concern, and was frequently sick. Very frequently.

My stomach issues were my constant companion. After I was finally diagnosed with dyslexia, any help provided was limited, due to

the lack of understanding of the nature and dimensions of dyslexia.

I continued to struggle in school, and the repercussions of anxiety became the background music of my life. When I started junior high, my anxiety got worse. I was sick so much that the doctor told my dad that if I kept missing school, the State (Child Protective Services) could take me away—as though that would have helped!

No child is born with coping skills, or with the ability to effectively analyze, label, and communicate what they are experiencing. The subtext of my story is representative of that of so many others with dyslexia: • ''There is something wrong with me."

• "Nothing I have figured out to do has helped, so maybe nothing will."

• "I'm afraid I'll never be able to do what's expected of me."

• "I'm afraid that when people find out, I'll be humiliated."

In other words, shame. Shame is defined as the belief that our troubles are caused by being defective, and therefore, there's no way out or through a problem, and the resulting feelings of humiliation and isolation can be devastating.

Therefore, the basis of anxiety and acting out in the case of many dyslexic students stems from the young, inexperienced mind-drawing inaccurate conclusions about self, and a lack of ability to see the potential for growth or change. Without intervention and effective redirection, these beliefs about self are a setup for a lifetime of misery, dysfunction, and unrealized potential.

Turning a blind eye to a child's anxiety or the behaviors it can cause will not make them get better. Just like any other challenge in life, improvement only comes with identifying the problem and addressing it. Whether dyslexia is the cause of a child's struggles or not, anxiety and acting out are cries for help that require a response.

If you have observed these traits or tendencies in your child or student, don't wait: talk to your child's physician about next steps to get your child the help they need.

Don M. Winn is an award-winning author and dyslexia advocate. He has written numerous articles about dyslexia and helping struggling readers. His blog archives are available at www.donwinn.com

2017 - SEPTEMBER MD Monthly

55

BUSINESS/SAN ANTONIO

BALANCING YOUR BUSINESS & RETIREMENT GOALS: THE ADVANTAGE OF A HOLISTIC APPROACH TO BUSINESS TRANSITION Provided by Eric Kala CFP®, CIMA®, AEP®, CLU®, ChFC®, CRPS®

Special to MD Monthly

I

t’s a day most business owners both dream about and dread: selling their business and retiring. To get to this major milestone, you’ve put in long hours. You’ve sacrificed time with family and friends along the way.

Transitioning out of the business world and into the next exciting phase of your life should be the easy part, right? Not always.

When the deal closes, the biggest financial event of your life will happen in this one meeting. But will you be able to fulfill your dream of a satisfying, financially secure future when this happens? You will either have all the money from the sale (if your deal is all cash), a good chunk of it with more to come (hopefully), or a down payment on the value of the business, along with the promise of a stream of payments to come over time.

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Why wealth must be managed If you’re like many business owners, you’re probably in one of two camps about what comes next: (1) you’ll want to prepare in advance, learning as much as possible about how to manage the cash you’ll be receiving; or (2) you’ll deal with the issue when the cash actually comes.

Either way, the choices you make about your business proceeds will have a profound impact on your life in retirement. That’s why the phrase “take your time” is important before moving forward.

Your business may represent your largest asset and the foundation for the money you will need in retirement. These taxable assets, along with whatever you’ve set aside in your qualified retirement plan and/or Individual Retirement Account(s) will need to generate sufficient income to last 20 to 40

years once you stop working. How will you ensure that your money goes the distance?

For starters, you need to understand what it will ultimately take to create the lifestyle you want for retirement. After years of focusing on wealth accumulation and the day-to-day cash flow needs of running a business, the challenge is to think in terms of drawing down those assets to provide a reliable stream of income that can last as long as you need it to. That’s why business experts suggest developing a plan that coordinates your business transition and retirement goals.

Among other things, your goal is to determine a sustainable income that will help ensure financial security and the realization of your dreams for the future.

A comprehensive transition plan can also provide a timetable and

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strategies that may help you reduce the tax liability on the transferring of assets on the sale of your business.

The transition plan can help make sure your income needs are met in the future by taking advantage of opportunities, such as setting up a pension plan or another type of a retirement compensation agreement prior to the sale of the business – a move that may assist in reducing taxes. It may also highlight opportunities to pre-pay future expenses, thus possibly reducing the amount of after-tax income you may need in retirement. Examples include paid-up life insurance and a special trust to pay for uninsured medical expenses incurred after retirement.

protect your new cash.

Take stock of your financial situation

The thought of handling this by yourself may be intimidating. That’s why you may want to consider working with a financial professional – someone who can show you how to maximize the proceeds from the sale of your business, based on hypothetical investment returns and withdrawal rates; explain various investments, so you can choose those that align with your long-term goals and risk tolerance; help you structure an asset allocation strategy for your portfolio, monitor your portfolio’s performance over time and help you make adjustments as your goals and needs change; and identify and fill gaps in your financial and estate planning.

Most business owners do not have a tremendous amount of investment cash at their disposal while they’re growing a business. The sale of a business may change that significantly. With your future financial security at stake, you may find yourself suddenly overwhelmed with the choices of how best to streamline your finances and preserve and

Consider working with a business transition expert who has the resources to answer more than just the investment management aspect of your wealth. Retirement income distribution planning, estate planning, family gifting and legacy, charitable planning, and medical and long-term care planning are all areas

BUSINESS TRANSITION PLAN A business transition plan should be holistic in scope, helping you to answer crucial planning questions, such as: • What do you want to achieve with the proceeds from the sale?

• How much will you spend each year in retirement?

• What is the best way to invest the money?

• And, are there gaps in your insurance coverage or estate plan? that should be integrated into your overall plan. Together, they may pay major dividends in terms of financial security for you and your family for years to come.

Article prepared by Northwestern Mutual with the cooperation of Eric Kala. Avid Wealth Partners is the marketing name for The Northwestern Mutual Life Insurance Company, Milwaukee, WI (NM) (life and disability insurance, annuities) and its subsidiaries Avid Wealth Partners is the marketing name for The Northwestern Mutual Life Insurance Company, Milwaukee, WI (NM) (life and disability insurance, annuities) and its subsidiaries. Eric Kala is a Wealth Management Advisor with Northwestern Mutual, the marketing name for The Northwestern Mutual Life Insurance Company (NM), Milwaukee, Wisconsin, and its subsidiaries. Wealth Management Advisor is an agent of NM based in San Antonio, TX. To contact Eric Kala, please call (210) 446-5752, e-mail him at eric.kala@nm.com or visit his Web site at avidwealthpartners.com.

This information is not intended as legal or tax advice. Not all products mentioned in this article are offered through Northwestern Mutual.

2017 - SEPTEMBER MD Monthly

57

HOLISTIC HEALTH/REGIONAL

A Spiritual View of

ADDICTION By: Lori Morrison

A

s I write this article the ashes of two of my close family members sit in urns. My nephew Ryan died of an overdose of alcohol three years ago and my grandson Antonio died of a heroin overdose less than two years later. The silver lining in these two very sad stories is that my nephew Patrick has so far survived a profound meth addiction and gratefully is in recovery.

With the loss of these gentle and caring souls I have reflected deeply on their stories and contemplated enough to finally write this article.

I asked myself over and over these questions: What did they all have in common that addiction became so profoundly embedded into their psyche? What advice could I give to others who are struggling with this issue that we now face at epidemic proportions in our families. What made the difference for survival?

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So here is what I learned: 1. Empaths: All of these young men were empaths, meaning that they were extremely sensitive to the world around them from birth. Being an empath means that they easily absorb other people’s feelings, energy and stress. There is an estimate that one in five children are considered highly sensitive, yet there is no diagnosis for being an empath by psychologists, and instead most are piled into the“social anxiety�category.

Although there can be benefits to being highly sensitive, like having a heightened intuition and a brilliant mind, it also has its challenges in the young adult years, as they are overstimulated and overwhelmed, and therefore particularly vulnerable to depression and addiction. Alcohol and drugs are an easy fix to numb the sensitivity they feel.

2. Expectations: Many fall victim to families with excessive expectations. When I talk to addicted empaths, the major complaint is they feel like victims of constant criticism by peers and parents. Only when they can truly dismiss the judgement are they able to overcome the sensitivity and learn to love themselves and feel accepted for who they are, and not feel they must shift into a person that society and families want them to be. This was especially the case with my nephew Ryan who was a star quarterback on the football team. I recall his funeral with 600 people in attendance and wondered why he never reached out to even one person who was sitting there? His fear of being judged was greater than his ability to seek help. As human beings we must learn and accept that there are times of light and

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HOLISTIC HEALTH/REGIONAL

times of darkness and it is okay.

Another pitfall I see are parents overzealously removing obstacles throughout their child’s life, when in reality, life is about overcoming adversity, not avoiding it. This causes an even greater crevasse to fall into when things do not go well and a wider gap to recovery.

3. Stigma: There is a misconception that depression is caused by something in your life that goes wrong, but the truth is that sadness is normal. Depression is when everything is going right and you are still sad. Most who are depressed find it is too difficult to talk about because of stigma, but the only way out of it is to talk about it because it is a vast problem. Somewhere in the world, by the time you finish reading this article, twenty people will be dead because of a mental illness or addiction. Unfortunately our society simply puts a bandaid on this gushing wound of depression that so many suffer from. A child should be able to tell a parent that they are going through hell and have a parent say, “everything is going to be alright”, show acceptance, and get the proper services before it is too late. Being able to accept a weakness and acknowledge a problem is the first step in overcoming the ignorance about it. Asking an empath to “suck it up, what will people think”, is a recipe for disaster. Mental Illness and addiction can also care less what your socio-economic level is, in fact often the more affluent you are the more vulnerable you become. From wealthy investment bankers to a poverty stricken black teenager, the suffering is endless and knows no demographic boundaries.

I feel that mental health

practitioners need to take a in-depth look at early identification of children who are empaths. Six years ago I did not even know what the word meant until someone described me this way and I went to Wikipedia and looked it up. That moment opened pandora’s box to the characteristics of my personality and the understanding that I too walked in the world with a heightened sensitivity compared to others.

I honestly question many childhood “disorders” and my intuition tells me that many of the labels placed on children are a misguided attempt to diagnose sensitivity. What is even more troubling is thinking that the solution is medicating them into a state of calm to protect them from their natural self.

I believe that if we are able to find out early on that a child is an empath, we would be able to create a gentler process to help guide them through a chaotic world with their hypersensitivity. Acquiring creative and mindful tools could go a long way in helping them perceive the world in a more constructive way. Teaching them how to be grounded and less susceptible to judgement and blame could save many lives that are now falling victim to a society’s ignorance of their special needs.

Lori Morrison holds a degree in International Studies from the University of Washington, Seattle.

Her professional accomplishments are vast from international high net worth investment banking, CEO of a world class food and wine distributor, and a commercial real estate developer. Since 2012, she has vigorously studied the application of sacred sciences and alternative and holistic healing methods to heal the mind and

body. Morrison has traveled the world studying with indigenous shamans and integrative medicine practitioners using cutting edge neuroscience and quantum physics to heal illness. She now sits on the board of the Mental Health Coalition of Verde Valley headquartered in Sedona, Arizona and is Head of the Education and Community Awareness committee (www.mentalhealthcoalitionvv. org). Morrison currently has a very successful spiritual counseling practice in Sedona, where she inspires people towards personal shifts in consciousness. In addition, she is creator of the Tree of Life Course and Tree of Life sound resonance CD. To find out more, visit Morrison’s Website and connect with her on Facebook, LinkedIn, and Twitter.

Lori: The Disintegration of My Ordinary Reality is currently available via Kindle on Amazon and will be available in print in July 15, 2017 and in AUDIBLE June 15th.

Since 2012, Lori Morrison has vigorously studied the application of sacred sciences and alternative and holistic healing methods to heal the mind and body. Morrison has traveled the world studying with indigenous shamans and integrative medicine practitioners using cutting edge neuroscience and quantum physics to heal illness.

She now sits on the board of the Mental Health Coalition of Verde Valley headquartered in Sedona, Arizona and is Head of the Education and Community Awareness committee (www. mentalhealthcoalitionvv.org).

2017 - SEPTEMBER MD Monthly

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