Gruene House Med Spa - MD Monthly by MD Monthly

2018 - NOVEMBER

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

contents November 2018 Production Media Digital Source Chief Executive Officer Eliot Garza Publisher Jessie Moore Project Managers Evelyn Ekundare Miranda Paredes Assistant Project Manager Larissa Salazar Digital Marketing Coordinator Jaime Gage Digital Coordinator Dejanira Lamkin Creative Services | Graphic Designers Aurora Balderas Vanessa Bolanos Photographer Trinity Greer Editor Jody Marmel Writers Rudy Arispe Jody Marmel Kiko Martinez

Cover Feature

Dr. Michael McKee

Improving Patients Quality Of Life Cover Feature

Dr. Jay Hoelscher

Concierge Medicine Provides Personalized Patient Care at Alamo Heights Primary Care Physicians 6

MD Monthly

Contributors Dr. Michael Fuentes Dr. Jennifer Walden Lacey Batch Amelia Johnson Marie Piazza Avid Wealth Partners ENT Clinics of San Antonio FOR ADVERTISING INFORMATION, PLEASE CALL 210.373.2599 OR EMAIL HELLO@MDMONTHLY.COM FOR EDITORIAL COMMENTS AND SUGGESTIONS, EMAIL EDITOR@MDMONTHLY.COM

MDMonthly.com

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

contents

10 | Informed Patient High Cholesterol and Health Risks

By Dr. Michael Fuentes

14 | Senior Health Cover Feature

The Best At Beauty Enhancement Maira + Z. Shah M.D.

Eight Tips for Caring for Seniors and Elderly Parents By Amelia Johnson

18 | Informed Patient

What Does Alcohol Do to Your Teeth? By Lacey Batch

50 | Business

When Do You Need A Postnuptial Agreement? By Robert S. Hoffman Cover Feature

Altus Hospice Care

Our team. Your hospice.

56 | Business

Being Financially Savvy is A Family Business By Eric Kala CPWA®, CIMA®, CFP®, AEP®, CLU®, ChFC®, CRPS®

60 | Informed Patient

How To Deal With Earwax Buildup By ENT Clinics of SA Cover Feature

Dr. Paul Kennedy Improving The Oral Health of Children 8

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

INFORMED PATIENT | CORPUS CHRISTI

HIGH CHOLESTEROL AND HEALTH RISKS By Dr. Michael Fuentes

holesterol is a waxy, fat-like substance that is found in every cell of your body. Your body needs cholesterol to make hormones, Vitamin D, and substances to help you digest food. However, too much cholesterol can lead to a number of complications, including heart disease and stroke. When there is an excess of cholesterol in the body, it begins to form plaque that sticks to the artery walls. This plaque build-up can restrict blood flow and oxygen to the brain, which can cause a stroke. High cholesterol also increases your risk for heart disease due to the same plaque build-up. According to the Centers for Disease Control and Prevention, 95 million adults living in the United States have high cholesterol. Since there are usually no symptoms associated with high cholesterol, it’s important to understand the risk factors associated with it, how to manage it, and when you should get it checked. Major risk factors of high cholesterol include: • Unhealthy eating habits • Lack of exercise

MD Monthly

• Smoking • Excess alcohol consumption • Age • Weight • Heredity The desired total cholesterol level in someone’s body is below 200mg/ dL. This means that there are 200 milligrams of cholesterol per deciliter of blood. If your total cholesterol level is higher than 200 mg/dL, you may be at an increased risk for stroke or heart disease. Here are some ways to reduce your total cholesterol levels: • Exercise regularly throughout the week • Develop a healthy diet full of omega 3 and limit your saturated fats • Quit smoking • Maintain a healthy weight • Limit alcohol consumption Everyone should have their cholesterol levels checked periodically. The chances of developing high cholesterol only increase with age. So, the older you are, the more frequently you should have it checked. Gender also contributes to cholesterol levels. Be sure to ask your family doctor how often you should have your cholesterol

checked so he or she can offer specific recommendations based upon your medical history and lifestyle.

Board-certified in physical medicine & rehabilitation, Dr. Michael Fuentes is the Medical Director of Corpus Christi Rehabilitation Hospital. The hospital provides specialized rehabilitative care to patients recovering from disabilities caused by injuries, illnesses, or chronic medical conditions. For more information, visit CCRH.ernesthealth. com, call 361-906-3700 or visit the hospital at 5726 Esplanade Drive, Corpus Christi, Texas. Corpus Christi Rehabilitation Hospital provides specialized rehabilitation services to patients recovering from or living with injuries, illnesses, or chronic medical conditions. The hospital has earned The Joint Commission’s Gold Seal of Approval for its Stroke Rehabilitation program. For more information, visit CCRH.ernesthealth. com. 5726 Esplanade Dr • Corpus Christi, Texas 78414 • (P) 361.906.3700 • (F) 361.906.3797

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

INFORMED PATIENT | CORPUS CHRISTI

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

SENIOR HEALTH | REGIONAL

Tips for Caring for Seniors and Elderly Parents By Amelia Johnson

aring for seniors and elderly parents is something critical, as a lot of people want to give their parents the best quality of life as possible. Most parents spend the bulk of their active years working hard, and at an old age, they fall back on their children to help them stay strong while they push through. However, while a lot of people are willing to do everything to ensure a better life for their elderly parents and seniors, the current day living conditions makes it a little difficult. We live in a very busy world today, and the majority of people can not afford to quit their jobs or other sources of income and sit with the elderly all day. This often brings about the option of seeking help from a caregiver or taking them to memory care facilities . On the flip side, a lot of people would rather take care of their elderly ones at home and make senior living fun for them. Either way, the most important task is doing the right thing as you take care of them.

MD Monthly

Caring for seniors and elderly parents is quite challenging, but the following tips can help put you on the right track.

Have a Support System You don't have to do it all alone when you have people around you. Try to engage your friends and relatives to support you on this daunting task, even if it just means having a shoulder to lean on. You can also hire a professional service to do the job, so you don't have to stress yourself out. As much as friends and relatives might be willing to help, it is important that you don't get too comfortable with them and expect them to do a lot of the work. You don't want to put them under emotional stress. There are many elderly care agencies and home care services that can come to the rescue. They can help with basic chores such as shopping, laundry, cooking and even tag along to outings.

Understand How Much Care is Really Needed Every elderly person needs different measures of care and you need to find out how much care is actually necessary. It will help you if you take the time to think about the details and make a list of required help that this person needs and deserves. You can also consider what time of the day your help will be most needed and what you have to do. This will not only help you manage your time well, but it will also help you focus on other productive activities.

Use Public Welfare Benefits The public welfare benefits are there for your advantage. Learn how to make the best use of them; this includes healthcare services at low cost or even free, rather than spending expensively in private settings. This will also help you track their medical or health records. Taking care of the elderly is expensive enough and you need to cut down as much as you can, even

NOVEMBER - 2018

MDMONTHLY.COM

SENIOR HEALTH | REGIONAL

if it means taking advantage of public welfare benefits.

best. Whatever you do, ensure to give yourself some time to take breaks.

Be Realistic About The Care You're Able to Provide Without Harming Your Own Health While you are caring for others, ensure that your health is always in check. It takes a healthy person to care of someone who is weak. Don't try to stretch beyond your limits. This doesn't mean you shouldn't do the most for them, but this is also where your support systems come in. Your health is very important and should be prioritized too.

Get Extra Caregiving Help Get some extra help. While this might seem like the best idea ever, it isn't all that easy. You just need to have a clear and direct plan on how to go through the process the best way possible without burning out. Have a list of options and go for what suits you

Safety Against Scams Beware of scams, as it is quite common in elderly settings, considering how vulnerable they are. Most of these seniors and elderly parents are not quite familiar with technology in this modern age, so scamming them might come easily. This is where you need to be alert and protect them from any coming danger. This is especially important if they are far away from you and are more likely to pay for things by themselves. Check their credit cards often and monitor their bills to be sure they have been spending wisely.

Reduce Financial Pressure You might be under a lot of financial pressure, especially if your parents solely rely on you to take care of them. You can cut this down by having open

discussions with them about it and see how you can best manage the funds. They can advise you on what to do or suggest other options that might be helpful. You should also try to cut down on caregiving costs and go for a cheaper, yet effective option.

Keep Your Resources Alive Leaving your job to focus on caring for your parents might seem like the best option, but you need to think it through. If you go for that option, make sure you still have a source of income or enough resources to carry you through. You can also discuss this with your employee and request flexible working hours or take a short leave to get yourself together. Taking care of seniors and elderly parents can be daunting and expensive, but maximizing these tips will definitely make life easier for you.

2018 - NOVEMBER

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

INFORMED PATIENT | REGIONAL

WHAT DOES ALCOHOL DO TO YOUR TEETH? By Lacey Batch

lcohol is not healthy as it has both short and long-term effects on your health. This includes physiological, mental and emotional health. While a lot of people understand how it affects their organs, metabolism and circulatory system, very few people understand its effect on oral health. A 2009 study in Dental Care and Oral Disease in Alcohol Dependent Persons found that people who have an alcohol use disorder tend to have increased plaque levels on their teeth. This often leads to tooth extraction, which explains why many alcohol users have permanent tooth loss. Causes of Excess Alcohol A lot of alcoholics often look for the best teeth whitening to help reduce the effect of the alcohol on their teeth. However, it is beyond just the staining. Alcohol use involves even deeper issues. Excess Alcohol May Cause: Staining Staining is usually the first change noticed when you drink alcohol regularly. Most beverages are known to contain chromogens, a substance that adds color to the drink. These chromogens attach to

MD Monthly

the enamel of the tooth when you drink alcohol. As alcohol is acidic, your enamels are already weakened, thereby making the chromogens attach easily. You should also try to avoid mixing liquor with dark sodas due to the acidic reaction and also the risk of increased doses of sugars and chromogens. This worsens the staining.

Dryness Alcohol also dries the mouth, as it decreases the natural saliva that acts as the body's antibacterial cleanser. Lack of natural saliva in the mouth makes the mouth dry, and there is an increased risk of bacteria and infection in the mouth. The risk of oral infection could promote gum disease and eventually, a permanent tooth loss.

Dehydration Alcohol tampers with the absorption of water in the body, and this could cause dehydration and easy exposure to acid attack. It works by decreasing the body's production of antidiuretic hormones, and as a result, the body is unable to reabsorb water. Dehydration can also result from consistent vomiting due to excess alcohol intake. Dehydration causes dry and sticky mouth, sleepiness, increased fatigue, increased thirst, dizziness

or lightheadedness, headache, and decreased urination. Myths About Alcohol in Regards to Oral Health Myth 1: Beer Won't Stain Your Teeth Fact: Beer is acidic, which weakens your enamels and makes it easier for chromogens to attach to them. While you might have been advised to use a straw to reduce the risk, the truth is that the drink still touches your teeth. Myth 2: Adding Citrus Makes it Healthier for Your Teeth Fact: Adding citrus to your alcoholic drink worsens its effect on your teeth and does not in any way make it healthier. Citrus is acidic and adding this to alcohol, which is also acidic, can completely damage your teeth in the long run. Citrus is also sweet and ingesting a high amount of sugar will only lead to tooth decay. Myth 3. Frequent Consumption Cleanses and Avoids Cavities Fact: Frequent consumption will only worsen the state of your teeth and will not cleanse or help you avoid cavities. As the acid weakens your enamels, it allows more bacteria to attach to them. These bacteria will then eat up your enamel, thereby resulting in cavities, which can also lead to tooth decay.

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

FINDING PLEASURE IN PAIN RELIEF

Dr. Michael S.

McKee IMPROVES PATIENTSâ&#x20AC;&#x2122; QUALITY OF LIFE AT SPINE CARE OF SAN ANTONIO By Kiko Martinez

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

or Dr. Michael S. McKee, it’s a good day at the office when he’s able to find a treatment that prevents one of his patients from feeling pain.

Owner of Spine Care of San Antonio (20079 Stone Oak Parkway, Suite 1245) on the city’s far north central side, McKee, an interventional pain medicine specialist, has made it his life’s work to manage patient pain and discomfort through a number of conventional and advanced options. A graduate of the University of San Luis Potos in Mexico, McKee trained in New York City in general surgery, anesthesiology and interventional pain management. The latter became his calling, and he has been in practice in San Antonio for the last 14 years. “Helping someone manage their pain is an amazing thing,” said McKee, who is a member of the American Board of Pain Medicine and the American Board of Anesthesiology. “The best part of my job is when I make a plan with a patient and they start feeling better.” Dependable San Antonio Born in San Miguel de Allende in Guanajuato, Mexico, McKee, whose father is Irish American and mother is Mexican, spent most of his childhood south of the border, although he attended MacArthur High School in San Antonio for one year. After graduating high school in Mexico in the early 80’s, McKee moved back to San Antonio and enrolled at UTSA for a year before deciding to go back to Mexico to attend medical school. During his sixth year of medical school, McKee transferred to Cook County Hospital in Chicago, then went back to Mexico for his final year. McKee

found himself back in San Antonio doing research in the surgery department at the University of Texas Health Science Center and waiting to get into a hospital residency. After his training in New York City, where he met his wife and had three children, and working in hospitals there for more than a decade, McKee decided to move his family back to Texas in 2004 where he opened his current practice in Stone Oak. First Step to Healing So, what can you expect if you are suffering from chronic back pain and would like to see what services the Spine Care of San Antonio can do to offer relief? As much as McKee would love to be your doctor, the first step for new patients is an evaluation of their symptoms to see if they even need to be there. In some cases, McKee said he will tell people they should see a physical therapist before thinking about doing anything more invasive.

“First, I get their history and ask them when they hurt and why they hurt. Did they hurt themselves playing sports when they were young? Were they in a car accident?” McKee follows up a patient’s initial evaluation with diagnostic tests such as X-rays and MRIs. If McKee thinks a patient would benefit more from seeing a physical or massage therapist or chiropractor, he’ll send them on their way, but not before offering simple and sound advice. “I tell them, if you have back pain, stop lifting heavy things,” McKee said. “We all have to do what we do to pay our bills. If you work in the oil fields, you have to do it, but you should do it smartly. Don’t show off like you’re a 20 years old.”

2018 - NOVEMBER

MD Monthly

Inject to Protect If it was up to McKee, he would treat all of his patients in a non-invasive manner so they would leave his office with just a Bandaid. When patients need more than physical therapy, the next step McKee looks at is using injections to manage their pain. This might include steroid shots into the spine, neck and back.

“We always want to avoid surgery, so we start with pain injections,” McKee said. “The goal is to make a patient feel better for a long time, not just a couple of weeks.” Injections decrease pain by decreasing swelling, McKee said. At Spine Care of San Antonio, McKee offers a number of different injection treatments. These include bursa injections (local anesthetic and cortisone injections into the muscles and tendons in a joint); caudal epidural injections (cortisone injections in the tailbone to relieve back and leg pain); epidural steroid injections (cortisone injections to alleviate pain in the neck and mid and lower back); facet joint injections (cortisone injections into the spine, neck and thoracic or low back area); sacroiliac joint injections (local anesthetic and cortisone injections into the large sacroiliac joint, which is in the low back near the buttocks); and platelet rich plasma injections (injections of blood plasma that has been enriched with platelets, which helps stimulate and heal bone and soft tissue). Less-Invasive Options For patients who do not respond to therapy or injections, the next step is surgery, but not the type you might think.

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

“As technology advances, patients are demanding less invasive options,” McKee said. “Surgery used to be cutting into bone and adding screws. The future of medicine has changed that.” McKee said if a patient comes in with a hernia or tear, the first option for him is to see if he is able to shrink the disc through laser surgery. “Who wants to spend eight hours in surgery and come out with rods and screws in their back?” McKee said. “Medicine is always evolving. It wasn’t that long ago that doctors had to cut you open to take out your gallbladder. Now, they can do it with scopes.” There are also other non-surgical procedures McKee can explore at Spine Care of San Antonio, including the implantation of an intrathecal morphine pump – a device that delivers small doses of medications like morphine through a catheter into the spinal canal or a spinal cord stimulator, which is like a pacemaker for the spine.

“Some of these procedures are life changing,” McKee said.

Once McKee has exhausted all his options and patients are still in pain, he will refer them to an orthopedic spine surgeon.

who comes in with severe pain in her back and has to use a walker to get around. In some cases, McKee knows a patient like this would benefit from an injection that would only take five minutes to administer. Two weeks later, this same nice, old woman steps back into his office without her walker and gives McKee a hug and kiss and thanks him for stopping her pain. “To help someone like that gives you a lot of satisfaction,” McKee said. For McKee, serving the San Antonio community is not only about helping restore a patient’s health, it’s also about giving hope to those patients whose pain management plan is taking longer to solve than others. “Everybody’s pain perception is different,” McKee said. “It’s my job to help those people and give them the confidence they need to work through it, so we can find the answers they are looking for.”

A Satisfying Practice McKee loves giving his patients a better quality of life. He shares an example of his favorite patient: a nice, old woman

For More Information: Call (210)-591-0396 Visit http://spinecareofsanantonio.com

“Patients who were in pain one day, can go back to work and spend time with their family.” The newest medical technology is also allowing McKee to treat chronic pain through regenerative medicine – the injection of stems cells into damaged knees, shoulders and lumbar discs, which can restore cells and regenerate tissue.

2018 - NOVEMBER

MD Monthly

e s u o H e n e u r a G p S d Me MENTS T A E R T IS OF THIER AN OAS FOR A HEALSTYLE LIFE

h Marm

Josep y Jody

that we knew we had to open our own practice and that is when Gruene House Med Spa opened.”

r. Z. Shah is the owner and Medical Director of Gruene House Med Spa located in New Braunfels, Texas. His wife, Maira Shah is the Director of Marketing for the med spa and is also proactively involved with community outreach. Together, they have created a strong team that has been with them since the doors opened at the end of 2014. Dr. Shah says, “Our staff is totally invested in our practice because they are an integral part of the Med Spa. We are very fortunate to have them, and we make sure that they get rewarded for their work.” After speaking with Dr. Shah and Maira, it is very easy to understand why patients continue treatments and partake in programs that Gruene House Med Spa offers. As the visionary for the medspa Maira says, “We are very passionate about skincare, anti-aging, and educating our clients. That’s why we are a great fit for everyone.” Dr. Shah is board certified in internal

MD Monthly

medicine. He trained in upstate New York while still enlisted in the Air Force. Dr. Shah has since become a certified specialist in anti-aging medicine from the American Academy of Anti-Aging. From 2005 to 2009, Dr. Shah was on Active Duty in the Air Force and stationed in Texas. In 2006 and in 2008, he was deployed to Iraq and he did critical care medicine. To this day, Dr. Shah does post-acute medical care in New Braunfels. He is “people oriented” in every sense of the phrase and his calm and friendly demeanor coupled with his vast knowledge on wellness and anti-aging makes him a rare gem in the medical community. “After I was in the military, I started researching anti-aging. I noted the changes in how I felt physically, and having less energy was my chief complaint. I learned that my levels of hormones were low, and I began treatments with hormone therapy. I continued to eat healthy and exercise and within several months, I was feeling great. From my experience, I shared the information with others and our practice kept growing due to a grassroots campaign. We were growing so fast

Hormone management is based on natural science. Dr. Shah tests hormone levels via salivary testing and follows up with his patients every few months.

“We don’t sell compounds from our practice. We use local pharmacies that produces bio identical compounds.”

Dr. Shah explains, “Men and women are experiencing earlier life changes. A lot of this has to do with the environment and what is put in our food. Unless you grow your own fruits and vegetables, you are not really eating 100 percent organic food.” He adds, “I practice what I preach. It took me several months to get better and I tell my patients that. It is a lifestyle modification. This consists of weight management, exercise and what you

NOVEMBER - 2018

MDMONTHLY.COM

“I practice what I preach. It took me several months to get better and I tell my patients that. It is a lifestyle modification. This consists of weight management, exercise and what you eat. When they join our program, our patients learn how to exercise, how to take care of their skin, how to take care of their bodies and we individualize each person’s plan to fit their needs and wants.”

2018 - NOVEMBER

MD Monthly

eat. When they join our program, our patients learn how to exercise, how to take care of their skin, how to take care of their bodies and we individualize each person’s plan to fit their needs and wants.”

Gruene House Med Spa helps their patients improve or maintain their physical appearance as well as achieve an optimal quality of life. And, this is just a glimpse of what Gruene House Med Spa offers. The range of services offered include CoolSculpting-the number one noninvasive fat reduction in the world that targets and kills fat cells with no surgery and no down time, injectables such as Botox, Bellafill, and Juvederm, facials, chemical peels, acne treatment, laser hair reduction, and Kybella injections. They also offer a vaginal rejuvenation injection and a penile enhancement injection. Next stop is the IV Nutrition and O2 Bar. IV Nutrition delivers high doses of vitamins, minerals, and amino acids directly into your bloodstream. A healthy, well balanced diet along with oral supplements is always encouraged, but benefits are limited. “Through your body’s natural digestive process, only partial amounts are actually being absorbed and in turn, used throughout your body.” Dr. Shah elaborates on IV Therapy because it is getting rave reviews and the demand for this IV therapy is growing exponentially. “Nursing homes in New Braunfels as well as Wound Care Centers have been asking us about this treatment and it has become very effective in Wound Care Centers

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

because high doses of Vitamin C increase collagen for wounds and thus helps tremendously in wound healing.” In turn, Chelation IV Therapy is in increasing demand at his med spa as well. “Pre and Post ambulatory surgical patients benefit from this too.” Metal toxicity can occur through contaminated soil, air, food, or water. “By using FDA approved chelating medication, we are able to remove any unwanted metals that might be present in your system to minimize negative health effects and maximize your overall well-being.” Mercury and lead can be found in your body from tattooing, certain skin creams, makeup and mascara, toys, toothpaste, hair dyes, to eating contaminated fish and more. All of the IV treatments at Gruene House Med Spa are overseen by Dr. Shah himself. He emphasizes, “Our IV’s are changing lives. We have seen what it is doing to people in research with Coronary Heart Disease, and other inflammatory disorders. We are witnessing the reversal of heart disease. I have been following what a few other physicians throughout the country have been doing with great results over the last two decades. These are doctors I respect and admire. Since the end results literally change lives, I am grateful that we provide these services so each one of our patients can have the best quality of life they deserve.” Maira tells us with excitement that Gruene House Med Spa has been growing not only in New Braunfels, but the number of patients that were coming in from San Antonio was increasing to the point where they decided to open Gruene House Med Spa in San Antonio. November 5th, 2018 is the opening day of the Med Spa in San Antonio located in the heart of the medical 2018 - NOVEMBER

MD Monthly

center on Fredericksburg Road. Maira says, “What has enabled us to grow so quickly is the way we deal with our patients and the services that we offer. The demand is there, and we are grateful that we can help our increasing patient base.” While the patient population varies, the majority of patients are between 30 and 50 years old with an established lifestyle. “They are happy where they are in life and their profession, but they don’t like the way that they look or feel,” explains Dr. Shah. “I am going to use myself as an example. Even though I eat healthy and work out every day, I had love handles due to my family genetics. CoolSculpting got rid of this. It’s amazing what a simple process can do for your overall sense of well- being.”

“It’s how you - the patient - feels about yourself and what bothers you. What I focus on is what you think and what you want to do to look and feel better. Since I have been working in internal medicine for over 15 years now, I have observed that not many physicians work like I do. I always want the people around me to be happy and I try to always change things around to ensure that each patient is very content with their consult and procedure. That matters a lot to me.”

MD Monthly

Dr. Shah is an artist in the medical field and he brings his natural artistic talents to Gruene House Med Spa on a daily basis. “I’m an artist with fillers and Botox. Each patient is a new canvas. I don’t want people to leave my practice until I am happy with my work and this has created strong relationships with my patients and friends.”

In regard to their personal life, Maira Shah elaborates, “We have been married for 20 years and we have two beautiful daughters. Persephone is 18 and Penelope is 14 years old. It’s definitely been challenging to juggle parenting and balancing work and home life. But, we have always known that nothing comes easy and both

NOVEMBER - 2018

MDMONTHLY.COM

our children have been very helpful and understanding. In fact, our oldest daughter cooks dinner for us on days we have to stay late at work and she is quite the chef.” Maira explains that one of the most popular services Gruene House Med Spa does is Botox and liquid facelifts-fillers. “Most of our clients love the fact that a board certified medical doctor is the injector and that usually puts them at ease. We also have free consultations to inform our clients about the pros and cons of the procedure, so they know exactly what to expect. And Dr. Shah gives them suggestions on what may or may not look good based on his experience and expertise.” Dr. Shah attends two to three CME courses a year in both the United States and worldwide to stay up to date with the latest findings in the field. At the

For more information call 830-312-4466 Visit gruenehousemedspa.com or facebook.com/gruenehousemed New Braunfels 1433 Hanz Drive New Braunfels, TX. 78130 Call 210-255-1400 San Antonio 4823 Fredericksburg Road San Antonio, TX. 78229

end of the day, the Gruene House Med Spa team has grown to be a family that helps their clients feel and look good. They provide information on good health habits, skin care and a pathway for a healthy way of living. Dr. Shah

concludes, “We need a way to change our lifestyle, not only aesthetically, but from within as well. And that is what Gruene House Med Spa provides. It’s all about feeling good and being happy with the way you look.”

2018 - NOVEMBER

MD Monthly

Kennedy

Dental Care

Pediatric Dentistry and Orthodontics

By Rudy Arispe

r. Paul Kennedy wants parents to know it’s never too early to take your child, or toddler, for that matter, for their first dental visit. It’s all part of his mission to take a bite out of dental disease and help prevent cavities.

oral health of children in South Texas, Dr. Paul can’t stress enough to parents how important it is to get their children to see a dentist early. “Dental disease is 95 to 98 percent preventable although we see so much of it,” he said. “We can show parents how to take care of their children’s teeth, how decay starts and how to prevent problems before they start.”

“I want to make a difference through prevention by getting the message across to Unfortunately, parents that they should however, by the time “Dental bring their children to many children come disease is 95 the dentist no later to Kennedy Dental to 98 percent than the age one,” Care, they already preventable said Dr. Paul, pediatric have significant tooth although we see dentist and owner of decay. “We see Kennedy Dental Care children at 18-monthsso much of it.” – Pediatric Dentistry old, who have 10 teeth, and Orthodontics, which and already four or five was founded by his father of those teeth have decay,” in 1969. Dr. Paul said. “We have to cap them or put medicine on their teeth to In fact, the American Academy of stop the decay or put temporary fillings, Pediatric Dentistry, Dr. Paul added, and then when they get older, we can recommends that a toddler should see do a filling or a crown. a dentist six months after the first tooth comes in or at one-year-old. Although Dr. Paul prefers not to crown a child’s teeth, sometimes it’s Because his goal is to improve the the only option. “A lot of times, you

MD Monthly

see kids with crowns, and you think ‘what dentist did that?’ It’s because the dentist is trying to fix an aggressive disease, and crowns are a good option so that the child keeps his baby tooth until it falls out.” With three offices throughout Corpus Christi, Kennedy Dental Care serves infants, children and teens with pediatric dentistry, as well as orthodontics for adults and children in surrounding cities of Portland, Alice, Port Aransas and Kingsville. “We provide comprehensive care, so every dentist gets to focus on what they like to do, and it’s allowed me to challenge myself and take on more difficult cases,” Dr. Paul said. In addition, Kennedy Dental Care’s pediatric dentists treat patients at Driscoll Children’s Hospital, CHRISTUS Spohn Hospital and Saratoga Surgical Center. “We do treatments on medically compromised patients and kids with severe dental problems who need full mouth treatment. It’s done while they’re asleep,” he said. “We also treat special needs children, including those with autism or Down syndrome,

NOVEMBER - 2018

MDMONTHLY.COM

“We provide comprehensive care, so every dentist gets to focus on what they like to do, and it’s allowed me to challenge myself and take on more difficult cases”

“We do treatments on medically compromised patients and kids with severe dental problems who need full mouth treatment. It’s done while they’re asleep.”

2018 - NOVEMBER

MD Monthly

and those who have heart transplants, kidney disease, blood disorders and cancer or who have had cancer treatments. That’s part of our specialty. We are trained to manage patients with complex medical conditions.” To practice pediatric dentistry or orthodontics, a dentist must complete an additional two years of specialized training after graduating from medical school and earning a DDS, Dr. Paul explained. “We learn everything about children’s dentistry. We work on children, but have faculty who oversee us,” he said. “We see difficult situations and routine situations. But, as a dentist, you’re practicing, and every year you learn more and more and get better at your skills.” Orthodontics is also a specialty that Kennedy Dental Care offers and it is a big part of the practice under the

MD Monthly

direction of Dr. Timothy Kuhlman, who sees patients at the Saratoga and Calallen locations. Kennedy Dental Care offers Invisalign in addition to traditional braces. “We are doing more Invisalign on teens, and there are some great advantages,” Dr. Paul said. “You can take them off, so that you can brush and floss your teeth. Invisalign is a clear aligner that snaps on your teeth. People often don’t know that you’re wearing braces.”

“We also treat special needs children, including those with autism or Down syndrome, and those who have heart transplants, kidney disease, blood disorders and cancer or who have had cancer treatments. That’s part of our specialty. We are trained to manage patients with complex medical conditions.”

However, Dr. Kennedy explains that Invisalign is not for everyone. “They have made some changes with it that allows orthodontists to use it on more patients,” he said. “They now put an attachment on your teeth that acts as a bracket. You can twist and turn the tooth.”

molds to obtain an impression of a patient’s teeth. Today, it’s all about technology and 3D imaging. “We use a wand to build a 3D image of your teeth,” Dr. Paul said, “and then Invisalign can make a tray off that digital image.”

Gone are the day of making messy

Kennedy Dental Care will reach a

NOVEMBER - 2018

MDMONTHLY.COM

major milestone when it celebrates its 50th anniversary in 2019. When Dr. Paul’s father, Dr. Paul A. Kennedy Jr., opened his dental practice, he worked by himself. Later, he invited partners to join him, which led to the eventual expansion of three busy locations with the Saratoga office serving as the flagship office. “We have continued to grow and maintain the model of treating people like we would want to be treated as patients,” he said. “We’re also proud that some of our staff have been with us more than 30 years; others have been here more than 20 years.” Kennedy Dental Care has evolved over the past 50 years, of course, and that includes acquiring new technology and becoming a fully digital practice since 2008. That technology now allows Dr. Paul to use laser in his dental procedures, such as a frenectomy, a simple procedure that removes some of the frenum in the mouth. The frenum is the muscular attachment that connects the bottom of the tongue to the floor of the mouth. “Some babies are born with a more restricted frenum. If it’s severe or if there is a moderate restriction, it can affect feeding or speech,” Dr. Paul explained. “After lasering off that tissue in just a couple of minutes, that baby immediately does much better. It’s not often that we do a frenectomy, but it’s something we offer.” Business administrator Beverly Hayes, 60, started with Kennedy Dental Care helping at the front office when she was 25 and has known Dr. Paul since he was 10-years-old, when he would visit his father at work. “This is a great place to work,” she said. “We love taking care of kids, and we’re like one big, happy family. After 35 years, I still look forward to coming to work.”

“We learn everything about children’s dentistry. We work on children, but have faculty who oversee us.”

2018 - NOVEMBER

MD Monthly

Through the years, Hayes has seen how the dental practice has evolved from when she first began working here in 1983. “We didn’t have computers back then, and now technology is important to us,” she added. “We now have intraoral cameras and digital X-rays.”

“We have continued to grow and maintain the model of treating people like we would want to be treated as patients.”

Dr. Paul, meanwhile, is grateful to have been exposed to dentistry at an early age, long before he enrolled at the University of the Pacific School of Dentistry in San Francisco and then receiving a certificate in pediatric dentistry from the University of Texas Health Science Center in San Antonio.

MD Monthly

Working at his dad’s dental office gave him a head start in his pursuit of a DDS degree. “I learned how to do almost everything,” he said. “I took X-rays, sterilized instruments, poured study models and did measurements for orthodontics. We used to do stone models, so they needed to be trimmed and polished. I also did a lot of lab work, which helped tremendously in dental school, because we had to do a lot of our own lab work.” After graduation, Dr. Paul already had a job waiting for him in Corpus Christi. “It was easy to come back,” he said. “I had patients on day one.”

For more information about Kennedy Dental Care – Pediatric Dentistry and Orthodontics, visit www.paulkennedydds.com or call (361) 992-9500.

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

The A -

Altus Hospice Staff Proves There

By Kiko Martinez

t takes an entire team to provide the quality care and genuine compassion that Altus Hospice is known for in Texas. From as south as Laredo to as north as Round Rock, the Altus care team, which is comprised of “a diverse group of

MD Monthly

highly trained healthcare professionals” from nine locations across the state, is “tailored to meet the unique physical, emotional and spiritual needs of each patient.” “It is very important to have longterm, committed employees who always put patients first,” said Jessica

Taylor, Senior Vice President of Sales and Marketing at Altus Hospice. “Without a dedicated staff, we would be just another hospice agency.” According to the National Hospice and Palliative Care Organization’s annual overview of hospice care delivery in America, 1.43 million Medicare

NOVEMBER - 2018

MDMONTHLY.COM

-Team

is Life at The Heart of Hospice Care beneficiaries were enrolled in hospice care for at least one day in 2016. The average length of service for Medicare patients enrolled in hospice during that time was 71 days. With the dedication of the Altus staff, patients are given more than a place. They’re offered a “concept of

caring,” so they can spend their final days in peace and comfort and with dignity as they are surrounded by family and friends who love them. “At Altus, we focus on quality of life at the end of life,” Taylor added. “We believe that everyone deserves to live a full life even with a terminal illness.

A knowledgeable staff leads to patient and family satisfaction, and that is our number one goal.” Here is a look at some of the men and women who make Altus Hospice one of the nation’s leaders in hospice care.

2018 - NOVEMBER

MD Monthly

Focused on Living Director of Nursing Ashley Tauzin Papillion, RN, CHPN, began her career with Altus Hospice in North Houston shortly after relocating from Louisiana to Texas early this year. With experience in both the clinical and administrative side of hospice management, Papillion hoped to bring a sense of balance and hope to the agency. “People hear the word ‘hospice’ and they think of death and dying,” Papillion said. “At Altus, we will prepare the patient and family for the dying process and the death event, but our focus is on living. We want our patients to remain as functional as possible for as long as possible.” Currently, Papillion manages 10 RNs, one LVN, nine CNAs, one MSW, and two Chaplains. Along with her director and RN titles, she holds the title of Certified Hospice and Palliative Care Nurse (CHPN). “Holding this certification doesn’t mean I know more than any other hospice nurse, but it shows that I’ve taken the extra step of proving that I have a full understanding of all components of care that a hospice agency should offer their patients,” she said. At the end of the day, Papillion loves what she does and is proud of the work her and her nursing staff do on a daily basis for their patients. “Our clinical staff has a true sense of compassion for the patients and families that we care for, as well as for their fellow coworkers,” she said. “They love what they do, and it shows every day.” Helping Families ‘Grieve Well’ Kevin Jordan is a Bereavement Coordinator and Chaplain for Altus

MD Monthly

Ashley Tauzin Papillon, RN, CHPN Dir. Clinical Services Altus Hospice of North Houston

Clayton Berotte Case Manager Altus Hospice or Beaumont

Hospice in Austin, where he has worked since February 2017. As the Bereavement Coordinator, Jordan provides, oversees and manages grief support for the families and loved ones of deceased patients. This includes grief counseling and support groups, grief education and memorial services. Altus also provides services to hospitals, memory care and nursing care facilities and churches in the community.

peace as they either prepare for their own death or the impending death of their loved one.

“We are currently providing biweekly grief support to nurses in a cancer ward of a local hospital, and a weekly support group for families of patients in that same ward,” Jordan said. “All of our services are open to the community at large, and not just our patients and their families.” As a Chaplain, Jordan provides ongoing spiritual and emotional support for patients and their families and loved ones. Jordan said it is his goal to meet each person no matter where they are on their spiritual journey. He wants to help them discover a renewed sense of meaning and spiritual and emotional

“It is my conviction that everyone, regardless of whether or not they adhere to a specific religious or spiritual tradition, has spiritual needs,” he said. “My role is to support, facilitate and provide guidance as they work out what it means for them to ‘grieve well’ and reconstruct their life apart from the physical presence of their loved one.” Providing Spiritual Support Throughout his life, Deacon Amando Leal has always had the desire to help people. Leal, who is an ordained

NOVEMBER - 2018

MDMONTHLY.COM

direct liaison between a patient and their family and doctors. Each day, he sees different clients who are on his schedule and also collaborates plans of care with facility nurses, updates medications and addresses any changes in condition with the primary caretakers.

Anel Hernandez Volunteer Coordinator Altus Hospice of South Texas

Kevin Jordan Bereavement Coordinator & Chaplain Altus Hospice of Austin

Deacon in the Catholic Church, began his journey as a Bereavement Coordinator with Altus in Corpus Christi in February 2017.

with whose faith stays steadfast during their trying times.

As a Bereavement Coordinator, Leal plans, directs, organizes and coordinates all bereavement activities and supervises the implementation of individualized bereavement plans of care and counseling. He is able to provide spiritual comfort to patients and family members and offer resources that are appropriate for each family’s needs. “My desire to provide help for those in need of spiritual support is what brought me to hospice care,” Leal said. “Having this support available is essential to the well-being of our clients. I know God has provided this path for me and I’m thankful I listened to His calling.” Leal said the work the employees from Altus Hospice do is from the heart and not superficial. Oftentimes, he is inspired by the many families he visits

“It is fulfilling to know that faith in God is abundant,” he said. “Knowing this, I am enriched and can take this to others who aren’t as secure in their faith and provide a direction that will assist in the loss of their loved one.” Creating a Bond In Clayton Berotte’s experience, there is always a bond established between a nurse and their patient. Berotte has worked as a Case Manager for Altus’ Beaumont branch for seven years, but has been a hospice nurse since 2001. “The family and patient put their trust in you with the expectations that as the RN, you have their best interest in mind,” Berotte said. “Many patients and family members develop an attachment and will address you as ‘my nurse’ instead of one of Altus’ nurses. In a sense, you become part of the family.”

“The best part of what I do is feeling a sense of accomplishment that I have benefitted a family that look to me for answers and intervention at a time when the stress was overwhelming,” he said. “Hopefully, I have reassured them through my actions that everything will be okay because I have met their needs.” Berotte said that when clients choose Altus for hospice care, they are receiving 100 percent honesty, dedication, commitment, and professionalism. “The family will never be alone,” he said. “They have a resource that is available 24/7 and staff willing to go the extra mile to maintain a patient’s dignity.” Being a Good Listener As a Social Worker at Altus Hospice, Bukola Farinde’s role is a diverse one that could be categorized as a “helping profession.” Her main responsibility is to provide emotional support to patients and their families. “Death is not an easy situation to experience,” Farinde said. “I am here to guide them through the transition with dignity and respect.”

As a Case Manager, Berotte is a 2018 - NOVEMBER

MD Monthly

Deacon Amando Leal Chaplain/Bereavement Coordinator Altus Hospice of Corpus Christi

Graciela Martinez C.N.A. Nurse Aide Altus Hospice of San Antonio

Bukola Farinde Social Worker Altus Hospice of Houston

Along with emotional support, Farinde helps connect families to community resources, assist with funeral arrangements and utilize tools for the completion of advanced directives.

patients and their passing affected me personally.”

Before her role as Volunteer Coordinator, Hernandez was, herself, a volunteer for Altus. She worked indirect patient care in the Altus office and at special events and was immediately touched by families she met during memorial services, caregiver support groups, bereavement support groups and family nights.

“What I enjoy most about my job is hearing people’s stories,” she said. “Everyone is from a different background, and it’s always such an honor to hear patients speak about their past.” It’s tough, Farinde said, when a relationship she has fostered with a patient ends. “The most challenging part of my job is building rapport with patients and then watch them pass away,” she said. “I have had some memorable

MD Monthly

Farinde, however, hopes that the time she does get to spend with patients is meaningful. As a Social Worker, she truly listens to patients and families and tries to provide a safe space for them during their difficult time. “Hospice social workers add a special and unique touch to hospice care,” she said. “We aim to provide comfort and care to patients, which in some cases extends their lives.”

Making a Difference Anel Hernandez enjoys her job as Volunteer Coordinator for Altus, where she has worked for two years recruiting volunteers for direct and indirect patient care. This includes serving as companionship support, caregiver relief, a household helper or raising awareness about Altus’ work as part of the speaker’s bureau.

“I wanted to make a difference,” Hernandez said. “After a few months of volunteering, a job became available and I became a permanent part of the Altus team.” Hernandez said the best part of her job is when she is able to recruit volunteers for direct patient care because they want to do something lifeaffirming and provide companionship for someone in need. “It is heartwarming to know there are people out there like that,” she said. Earning Trust It was the opportunity to show love and

NOVEMBER - 2018

MDMONTHLY.COM

kindness to patients and their families that brought Certified Nursing Assistant Graciela Martinez to Altus four years ago. As a CNA, Martinez’s job consists of providing daily personal care to patients as a hospice aide. “What I enjoy most about my job at Altus is being able to build friendships with patients and their families,” Martinez said. “It feels as if I become a part of their family. This makes it easier for a patient to trust and be comfortable with my services.” Part of Martinez’s job is to make sure patients feel at ease with someone helping them in the shower. She remembers one patient who refused to be helped. Martinez said over time, she was able to gain his trust. “He told his niece that he would accept assistance with his personal

care, but only if I was the aide helping him,” she said. “That made me very happy because he felt that he could trust me to give him the care he needed.” For Martinez, it is important to give all patients quality time and do it with affection.

“I treat all my patients as if they were my father, mother or anyone in my family,” she said. “I always keep in mind that they need to be shown the maximum love, dignity, care and attention possible.”

When a cure isn’t possible, hospice offers a person- centered approach to treatment that includes expert medical care, comprehensive pain management, and emotional and spiritual support – most often provided in your home. Living life to the fullest, up to the final moment is what hospice care is all about. When you or someone you love has a serious illness, time is precious. Hospice can provide comfort and support to make the most of that precious time. Hospice care delivers expertise to improve quality of life and relief from pain and symptoms associated with a terminal diagnosis.

For more information: www.altushospicecare.com 888.873.1822

2018 - NOVEMBER

MD Monthly

ALAMO HEIGHTS PRIMARY CARE

Physicians Offer Concierge Medicine

for 24/7 Doctor Access

PRACTICE WILL EXPAND ITS WEIGHT-LOSS PROGRAM IN JANUARY, 2019

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

By Rudy Arispe

r. Jay Hoelscher always makes the time to help and provide excellent service to the smaller group of patients that he treats. The internal medicine doctor, who is in private practice at Alamo Heights Primary Care Physicians (PCP), offers a personal touch tailored to meet his patients’ urgent and time-pressed needs through the concept of concierge medicine. Tired of long phone wait times to make an appointment? Dissatisfied over being rushed through your visit? Alamo Heights PCP in the Quarry Market area offers a cure, or rather a solution. “Concierge medicine is a concept that’s gaining popularity in San Antonio, and it’s certainly popular in other cities,” Dr. Hoelscher said. “The basis behind it is that we recognize we like to spend more time dedicated to each patient instead of a rushed appointment.” “The idea of concierge medicine is that when you become a member of a smaller group of people who the doctor is focused on, it definitely increases your access to care,” he added, “so you can get an appointment the same day you call. We have the capacity to do that very easily. Instead of a doctor coming in and visiting with you for five minutes, we come in and take our time. We let the patient feel like he can get all of his issues addressed without feeling rushed.” And just like decades ago, when a family physician made house calls to a patient’s bedside, Dr. Hoelscher can visit a patient in his hospital room to ensure consistency of care. “Today, a lot of physician practices have become segmented where they are either doing all in-patient work like a hospitalist does or they are confined to only taking patients in a clinic,” he said. “But the problem is there’s always this

continuity or transition of care that is difficult or interrupted. So, patients feel like they’re not getting the care of their primary physician if they have to be admitted to a hospital.”

“However, through this concierge medicine program, I’m able to visit my patients in the hospital, especially because I have a smaller group of patients I’m focusing on,” Dr. Hoelscher continued. “I have a variety of hospitals I can go to. I even go to nursing homes. It provides that same sense of what medicine used to be when a doctor had the time to take care of you.”

Alamo Heights PCP’s exclusive membership program comes with other perks including 24/7 access to Dr. Hoelscher via text, email or cell phone, an exclusive concierge only office line to have direct contact with an assistant, coordinating with specialists and ancillary services to expedite your care, and no wait or minimal wait time to see the doctor because they know your time matters. This personalized membership approach eliminates the typical communication obstacles that exist within traditional practices. Dr. Hoelscher shares the recent example of a female patient who called Alamo Heights PCP, complaining about abdominal pain. He was able to see her within an hour of her call. “Instead of doing what most offices do and say, ‘We don’t have space available to see you today, so you’ll have to go to the ER,’ we were able to take the time to evaluate her just like we would in an acute care setting or emergency room because I had time to 2018 - NOVEMBER

MD Monthly

do that,” he said. “We called her the next day to make sure she was doing well. We saved her a lot of time without having to go to the emergency room.” Another major benefit of the concierge medicine program is being assigned a personal care coordinator to schedule your appointments, and follow up with pharmacies to fill prescriptions, among other services. “The way it is now for many medical practices is that you have an office or medical assistant helping thousands of patients who are part of their practice,” Dr. Hoelscher said, adding that the average practice has 2,500 patients. “You can imagine how the phone is constantly ringing. That office assistant isn’t dealing with one patient, but with many patients.”

Renee Hoelscher Director of Marketing

Charrie Andersen Medical Assistant

At Alamo Heights PCP, however, you have a direct line to a personal care coordinator and not an answering machine. “You’ll get someone right away who is dedicated to our concierge patients.” Although Dr. Hoelscher is the only one who sees and treats patients that are part of the concierge program, the office has a family nurse practitioner on staff. The nurse practitioner “helps take care of patients who choose not to be in the concierge model,” he said. In addition to the concierge medicine model, patients can connect with Dr. Hoelscher remotely if they prefer via smartphone, laptop or tablet through telemedicine. “Telemedicine is a growing and convenient service that we take pride in offering here,” Dr. Hoelscher said.

Miriam Jeannotte Medical Assistant

MD Monthly

Roxanne Vallecillo Schedule Coordinator

“For example, we can give lab results

NOVEMBER - 2018

MDMONTHLY.COM

through telemedicine instead of a patient coming to the office. For older patients, who might have trouble with transportation or mobility, speaking with them face-to-face by computer is a great option. I can see the patient, and he can talk to me just as if he was sitting in my exam room. Of course, there are times when it is necessary to come to the office.” Meanwhile, in other good news, Alamo Heights PCP will expand its weight-loss program to the public in addition to its current patients who are already under Dr. Hoelscher’s supervision. The weight-loss program focuses on the HCG (human chorionic gonadotropin) diet because of the success many of his patients have had. It is a diet low in calories accompanied by an injection of a small dose of the hormone HCG.

“Based on our experience with our patients, it’s been shown to help metabolize their fat stores as a source of energy while on a low-calorie diet,” Dr. Hoelscher said, “and it helps them metabolize fat stores in the intraabdominal area which is a difficult area to lose fat.” He added that the HCG diet “seems to help stimulate the hypothalamus area of the brain which controls weight to metabolize fat stores, so that patients get better body contouring.”

Additionally, Dr. Holescher said research shows an improved amount of muscle mass preservation while a person is losing weight compared to those who were on a weight-loss program and didn’t use HCG hormone. “There seems to be an interaction between the hypothalamus and the way the body is able to reduce fat percentage and still maintain weight loss,” he said. “This is a well outlined, easy-to- follow diet, and I think that’s why it works for so many people.”

Alamo Heights Primary Care Physicians is a concierge, internal medicine practice located at 250 E. Basse Road, Suite 208, in the Quarry Market. For more information, visit alamoheightsprimarycarephysicians.com or call (210) 909-1300. 2018 - NOVEMBER

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

BUSINESS | REGIONAL

PHYSICIANS, WHEN DO YOU NEED A

Postnuptial Agreement? This article was prepared by Robert S. Hoffman, board-certified family law attorney, who has been practicing for 31 years in Houston, and Jennie R. Smith, an attorney in the Law Office of Robert S. Hoffman, PLLC. More information can be found at www. rhoffmanlaw.com

hy would marital partners ever sit down and negotiate a postmarital agreement or marital property agreement unless they are literally on the verge of divorcing? And what if they already have a prenuptial agreement? Shouldn’t that be all they need?

There are actually a number of reasons why physicians in particular may find it advisable to establish a postmarital agreement, whether they already have a prenuptial agreement or not. Perhaps one or both partners are

MD Monthly

considering the possibility of divorce but are not ready to end the marriage. Working out an equitable division of property can sometimes even ease financial tensions and anxiety in the marriage and prevent divorce. The physician in the marriage may want to transfer property to his/her spouse to protect it from possible medical malpractice suits or from creditors. If the couple has been married for a number of years, their financial situation may have changed radically. A medical practice, or a partnership in a practice, may have become much more valuable over the years. What if a non-medical spouse has contributed substantially to building the practice by managing the office or the financial accounts and records? How will this partner benefit in the event of a divorce or death? The choices made in drafting a prenuptial agreement may

no longer be appropriate or relevant for current conditions.

Doctors often have passive investments in various medical facilities, which may include emergency medicine centers, imaging centers, surgical facilities, compounding pharmacies, etc. How are these interests to be allocated if they divorce? The doctor’s situation may be even more complex if both spouses are doctors in separate practices, or if they are partners in the same practice. Unwinding these complex relationships and allocating assets can be critical to both partners’ financial future.

NOVEMBER - 2018

MDMONTHLY.COM

BUSINESS | REGIONAL

Physicians often establish elaborate trusts, family limited partnerships, or other complex estate-planning vehicles as part of an estate plan, but do not realize that these arrangements may have provisions that conflict or are incompatible with a partyâ&#x20AC;&#x2122;s divorce goals. Any physician contemplating the possibility of divorce at some point should definitely ask a family law attorney to review all of his or her estate planning. The physician may want to make sure that he or she has provided for children by a previous marriage or marriages in case of divorce or death. The important point here is that a postmarital or marital property agreement should provide a â&#x20AC;&#x153;globalâ&#x20AC;? analysis of all separate and community property and a rational guide to allocating all of these assets. This may require the assistance of other experts in estate planning,

accounting and financial valuation, real estate, tax, analysis of corporations and limited partnerships, etc. But the overarching reason for such an agreement is that it is far less expensive than fighting out the same issues in court.

This article offers general legal information not pertaining to specific, individual circumstances. No attorney-client relationship is formed with readers.

2018 - NOVEMBER

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

BUSINESS | REGIONAL

BEING FINANCIALLY SAVVY IS A

FAMILY BUSINESS

Provided By: Eric Kala CPWA®, CIMA®, CFP®, AEP®, CLU®, ChFC®, CRPS®

ike it or not, we’re all involved in running the “family business.” We worry that our parents might outlive their retirement savings. We’re comforted by the thought that family members would probably bail us out if we got into money trouble. We strive to help our children financially, and we’d like to bequeath them at least part of our nest egg. In short, our family is our asset, liability, and legacy. Now here’s the contention: It’s time to build this notion into the way we manage our money. Here are just some of the reasons why: Raising Children: If your children grow up to be financial deadbeats, you may likely rise to the rescue. Indeed, your children could turn

MD Monthly

out to be your greatest financial liability. Don’t want your adult children swimming in credit card debt, missing mortgage payments, and constantly asking you for money? Your best bet is to make sure these problems never arise by raising money-savvy children. That’s trickier than it seems. Children grow up spending their parent’s money, so there is a great possibility they will have a skewed financial outlook. After all, for children, all purchases are free, so why should they fret about the price tag or control their desires? Make your children feel like they’re spending their own money. Give them a candy allowance when they are younger and a clothing allowance when they are teenagers, and insist they live

within this budget. This way, instead of you constantly saying “no” to your children, they will learn to say “no” to themselves. Launching Adults: Once your children get into the work force, you want them to get into what we call the, “virtuous financial cycle” where they are steadily building wealth. This could lead to them being able to own their home rather than renting, buy their cars rather than leasing, fully fund their 401(k) plan and their individual retirement accounts each year, and never carry a credit card balance. The sooner your 20-something children get into this virtuous cycle, the easier it could be for them to meet their goals and less of a financial drain on you. To that end, encourage your

NOVEMBER - 2018

MDMONTHLY.COM

BUSINESS | REGIONAL

(NMWMC), Milwaukee, WI, a subsidiary of NM and federal savings bank. All NMWMC products and services are offered only by properly credentialed Representatives who operate from agency offices of NMWMC. Insurance Agent of NM and a Registered Representative of Northwestern Mutual Investment Services, LLC (NMIS) (securities), a subsidiary of NM, brokerdealer, registered investment adviser and member FINRA and SIPC.

children with your words and with your fine example. A few financial incentives may also help. Tell your adult children if they scrounge together a house payment, you will lock in some additional dollars, or offer to subsidize their 401k contribution at 50 cents on the dollar. This doesn’t mean you intend to fund their retirement instead of your own but getting them started as investors sure seems like a smart idea.

Wealth Management & Business Planning Advisor Avid Wealth Partners 17802 W Interstate 10, Ste. 114, San Antonio, TX 78257 210.446.5755 AvidWealthPartners.com Eric Kala uses Avid Wealth Partners as

a marketing name for doing business as representative of Northwestern Mutual. Avid Wealth Partners is not a registered investment adviser, broker-dealer, insurance agency or federal savings bank. Northwestern Mutual is the marketing name for The Northwestern Mutual Life Insurance Company, Milwaukee, WI (NM) and its subsidiaries. Eric Kala is a Representative of Northwestern Mutual Wealth Management Company®

Certified Financial Planner Board of Standards Inc. owns the certification marks CFP®, CERTIFIED FINANCIAL PLANNER™, CFP® (with plaque design) and CFP® (with flame design) in the U.S., which it awards to individuals who successfully complete CFP Board's initial and ongoing certification requirements. To contact Avid Wealth Partners, please call (210) 446-5755, or visit avidwealthpartners.com.

2018 - NOVEMBER

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

INFORMED PATIENT | SAN ANTONIO

HOW TO DEAL WITH EARWAX BUILDUP Provided by ENT Clinics of San Antonio

hile it might not seem like there is a purpose behind why your ear produces earwax, there most certainly is one. Even though a lot of people try to clean out their ears on their own, it’s important to remember that ears are self-cleaning. This means that the earwax will typically just come out on its own. Of course, there are times when earwax can become impacted or blocked, which can temporarily cause muffled hearing and discomfort. Why does impacted earwax happen? There are a few things that could be to blame, but one of the most common causes is at-home ear cleanings. While it might seem rather unhygienic, you don’t need to clean your ears, and should never place a cotton swab into the ear canal as you risk damaging or injuring your ear. One look at the package of cotton swabs and you’ll see that it states that you should

MD Monthly

never place it in your ear. Plus, these swabs can end up pushing earwax deeper into your ear, which can lead to pain and other problems. If you have a narrow ear canal or if you are older, you may be more prone to ear wax impactions. If this is the case, you may want to visit an ENT doctor rather regularly for proper earwax removal. You may also find that you are prone to earwax buildup if you constantly place things in your ears, such as headphones or a hearing aid. Fortunately, an otolaryngologist will often treat earwax impaction through prescription-strength ear drops that will successfully breakup the wax. Of course, if this treatment doesn’t work, then you may need to come in so we can safely and effectively wash out your ears and dislodge the earwax completely.

Remember, do not remove the earwax buildup yourself, as this could cause more issues in the long run. While there are kits that you can use at home to help irrigate and clean out the ears, if you aren’t noticing a change in your symptoms after three days, it’s a good idea to visit your otolaryngologist for care. There are several techniques for removing wax, from irrigating the ear to using a painless suctioning device. The earwax treatment we recommend for you will depend on several factors such as health and structure of your ear. If you are dealing with earwax impaction, then it’s time you turned to an otolaryngologist who can safely remove the buildup.

For more information visit www.entclinicsofsa.com

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

2018 - NOVEMBER

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM

LOSE WEIGHT, NOT HOPE.

Nilesh A. Patel, MD, FACS

Subhash Reddy, MD

Benefits of Weight Loss Surgery •

WLS may improve obesity related health conditions such as diabetes, heart disease, high blood pressure, and obstructive sleep apnea, among others.

• Diabetes cured in 80% of patients and resolved or improved in 90% of patients. •

Hypertension is cured in 62% of patients and resolved or improved in 78.5%

• Obstructive sleep apnea is cured in 86% of patients • Risk of death is decreased by 89% • Weight Loss Surgery (WLS) can enhance fertility and lead to successful full term pregnancies. • Average weight loss is 50-70% of excess body weight • Improvement in arthritis with reduction in pain and increased mobility. • WLS is covered by 80% of insurances •

Texas Bariatric Specialists accepts most major insurances including Medicare.

GOOD-BYE DIABETES

BypassDoc.com | 877.459.7065

GOOD-BYE SLEEP APNEA

HELLO WEIGHT LOSS 2018 - NOVEMBER

MD Monthly

NOVEMBER - 2018

MDMONTHLY.COM