Dr. Maria Palafox - MD Monthly October Feature by MD Monthly

2018 - OCTOBER

MD Monthly

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

contents O ctober 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 Creative Services | Graphic Designers Aurora Balderas Vanessa Bolanos Editor Jody Marmel Writer Jody Marmel

Cover Feature

Dr. Palafox and Three of Her Patients Share Their Journey With Breast Cancer Breast Cancer Awareness Month: You Can Save Your Own Life

Contributors Dr. Michael Dechard Dr. Michael McKee Dr. Marianne Pinkston Dr. Jennifer Walden Eric Kala Norma Garcia Lachlan Malone Marie Piazza Joe Ullrich Holly Wayment Katerina Weissova Avid Wealth Partners CCRH Kennedy Dental Care FOR ADVERTISING INFORMATION, PLEASE CALL 210.373.2599 OR EMAIL HELLO@MDMONTHLY.COM FOR EDITORIAL COMMENTS AND SUGGESTIONS, EMAIL EDITOR@MDMONTHLY.COM

MDMonthly.com 6

MD Monthly

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

contents 10 | Breast Cancer

Awareness Change The Story on Cancer: One Card at a Time Special to MD Monthly

14 | Children's Health

Is Your Child’s Diet Hurting Their Teeth? Provided by Kennedy Dental Care

16 | Informed Patient

A Lumbar Epidural Steroid Injection Can Ease Chronic Pain By Dr. Michael S. McKee

18 | Women's Health

32 | Special Feature

MD Anderson Immunologist Jim Allison Awarded Nobel Prize Special to MD Monthly

36 | Social

Dr. Lyssa Ochoa Mixer Recap In Partnership With Earn-a-Bike

38 | Health & Wellness

Increasing Your Productivity By Having Better Blood Circulation By Katerina Weissova

What is a Tummy Tuck?

48 | Women's Health

By Dr. Michael Decherd

By Norma Garcia

20 | Special Feature

50 | Health & Wellness

By Holly Wayment

By Dr. Marianne Pinkston

New Procedure May Help Cure Chronic Pain

MD Monthly

Living for Today!

Up and at ‘Em: How Morning Workouts Could Fix Your Life

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

BREAST CANCER AWARENESS | SAN ANTONIO

The Cure Cancer Card is available online now!

Change The Story on Cancer ONE CARD AT A TIME - SPECIAL TO MD MONTHLY -

he SA Cancer Council is again teaming up with local businesses to fund cancer research at the Mays Cancer Center, UT Health San Antonio MD Anderson. For ten special days, October 12-21, shoppers who purchase a $50 Cure Cancer Card (previously called the Partners Shopping Card) will get a 20 percent discount at over 220 retail, restaurant and service locations. The entire $50 goes directly to the Mays Cancer Center for research to improve the diagnosis, prevention and treatment of cancer, and that money is used only in San Antonio. The many participating merchants include Julian Gold, The Container Store, Bjorn’s, Tory Burch, TUMI, Williams Sonoma, Cappy’s Restaurant, Auntie Anne’s, Satel’s, Sunset Ridge Home & Hardware, Hanley-Wood, and so many more. Hair salons and dog salons, jewelers, meat markets, sweet shops, fitness, bicycles and sportswear are also featured. For the full list of participating businesses, go to SACancerCouncil.org/ cure-cancer-card. How Do I Buy a Card? The Cure Cancer Card is available

MD Monthly

for purchase online now at SACancerCouncil.org and, in late September, at participating merchants. You may also purchase a card from anyone involved with the SA Cancer Council, a team of all volunteers who have been supporting cancer patients and cancer research for over 30 years. The card is valid during the designated October 12-21 period. “During this special time in October, shoppers in San Antonio, Boerne and Comfort can help change the story of cancer for today’s patients and for future generations,” said Liz Conklyn, chair of the Cure Cancer Card program. “Together, we can fund breakthrough research to better prevent, diagnose and treat cancer. With the help of such generous stores, restaurants, salons, etc., you can be part of the fight against cancer.” The SA Cancer Council’s shopping event has raised $2 million since 2006. To ensure that 100 percent of card sales go completely to cancer research, generous sponsors underwrite all of the program’s costs. “This is the same card program we

have sponsored in years past,” Conklyn stressed. “We changed the name to Cure Cancer Card because we wanted the name of the card to more clearly and quickly reflect its mission. Even if someone does no shopping at all, they have still given $50 towards changing how we treat and prevent cancer.” Over the past 30 years, the SA Cancer Council’s various fundraising and special events have generated approximately $4.7 million for research and patient assistance at the Mays Cancer Center. Council members also have the opportunity to volunteer through such activities as helping patients and assembling clinical trials kits to free nurses for patient care.

To learn more about the SA Cancer Council, visit SACancerCouncil.org/ E SACancerCouncil E UTHealthSA E MaysCancerCenter

For additional information, contact (210) 450-5571 or email: SACancerCouncil@uthscsa.edu.

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

INFORMED PATIENT | CORPUS CHRISTI

MD Monthly

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

CHILDREN'S HEALTH | CORPUS CHRISTI

IS YOUR CHILD’S DIET HURTING THEIR TEETH? Provided by Kennedy Dental Care

our child’s diet has a large effect on their oral health, and certain foods are healthier for teeth than others. Here’s how some foods hurt teeth, and some healthier alternatives for snacking. Types of Food That Harm Teeth Some common children’s snacks and drinks can cause a lot of damage to teeth and tooth enamel. Hard Candy Hard candy can get stuck in tooth crevices and stay around long after it’s been swallowed. This makes it difficult to remove from teeth, and gives cavitycausing bacteria more time to eat away enamel. Hard candy also sticks to wires and brackets, which increases the time that teeth are spent contacting sugar. Starchy Snacks Crackers, potato chips and other starchy foods can get stuck in the small areas of tooth surfaces. Without proper brushing, these foods provide sugar to bacteria that feed on it which ultimately leads to tooth decay. If your children eat starchy foods, have them floss and brush after their meal. They can also

MD Monthly

swish cool water to get rid of starchy food debris. Sugary Drinks Sugary beverages are one of the leading sources of sugar for children, and some can even be disguised as “healthy drinks” like nutritional water or sports drinks. Allowing children to sip on sugary beverages over long periods of time increases their exposure to sugar, and acid attacks that can erode their enamel. Try to limit or remove sports drinks, sodas, and high-sugar juices from their diets to aid in their oral health. Foods That Help Teeth The general rule of thumb for mouth healthy food is the more fiber and water content, the better! Fibrous Fruits and Vegetables Fibrous fruits and vegetables actually scrub teeth as they are being consumed, which helps remove bad mouth bacteria that lead to cavities and tooth decay. When eating fibrous fruits and vegetables, be sure to wash them thoroughly and leave the skin on

– which is a huge source of fiber. Good sources of fiber include apples, kiwi, berries, carrots and celery. Nuts Nuts contain calcium and vitamin D – both of which promote healthy teeth. They are a great salty snack that’s easy to pack and eat on the go. We suggest substituting them in place of starchy, salty snacks like chips and crackers. Water With every sip, water cleans teeth by ridding them of any leftover foods or acids. It also washes away bacteria and sugars that can eventually lead to cavities. Water has zero calories, and helps restore the pH balance in the mouth to fight unhealthy levels of acid. Dietary Choices Affect Teeth Visit our office for more useful dietary tips that can improve your children’s teeth. To learn more visit online www.paulkennedydds.com

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

INFORMED PATIENT | SAN ANTONIO

A LUMBAR EPIDURAL STEROID INJECTION CAN EASE

CHRONIC PAIN By Dr. Michael S. McKee

or many, neck and shoulder pain are a debilitating form of chronic pain, resulting in the inability to enjoy everyday activities of daily life. Some of the most typical causes of chronic pain include a pinched nerve, herniated disc, or poor posture; sometimes it’s the result of an accident.

procedure, your pain management physician will prepare a steroid mixed with a saline solution for injection into the epidural area. This area is home to the dural sac at the end of your spine. It’s filled with small blood vessels and fat and surrounded by cerebral spinal fluid and the spinal cord.

While back, neck and shoulder pain may come and go, you have chronic pain if it’s persistent and lasts more than a couple of months. Most people with chronic pain have tried several different methods of pain management with little relief. If you struggle with ongoing lower back, neck, or shoulder pain due to the above conditions, you may be a candidate for lumbar epidural steroid injections. These injections are an excellent form of chronic back and neck pain relief.

After isolating the source of your back and neck pain, your doctor will clean and numb the area to receive the injection. He or she uses a live X-ray to guide the needle and inject the steroid and saline solution into the appropriate spot. Your doctor will then monitor you for approximately 15 minutes after the procedure to ensure that you don’t experience complications. The entire process takes between 15 and 30 minutes, and you could experience significant pain relief within one week.

WHAT TO EXPECT WITH A LUMBAR EPIDURAL STEROID INJECTION When you visit a doctor for chronic neck and shoulder pain, he or she should discuss each unique symptom to determine the source of the pain. If you’re a good candidate for the

RISKS ASSOCIATED WITH LUMBAR EPIDURAL STEROID INJECTIONS While risks are minimal, some do exist. Your physician should discuss each potential risk and side effect during your first visit to ensure that these injections are the best option for you. The

MD Monthly

following are the most common risks associated with this procedure: • Infection • Dural sac puncture • Bleeding • Nerve damage Less common side effects include: • Facial flushing • Anxiety • Headaches resolving within 24 hours • Fever • Temporary insomnia LEARN MORE ABOUT ALTERNATIVE PAIN MANAGEMENT Long-term neck and shoulder pain can have a significant impact on your quality of life. Fortunately, pain relief from lumbar epidural steroid injections can help you lead a more comfortable life, and relief can last up to one year before needing to repeat the procedure. If your current doctor doesn’t offer the lumbar epidural steroid injection, you may need to search for a pain relief clinic that primarily provides drug-free treatments.

For More Information Visit: www.spinecareofsanantonio.com Or call (210) 591 - 0396

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

WOMEN'S HEALTH | SAN ANTONIO

What is a Tummy Tuck? By Dr. Michael Decherd

tummy tuck, also called abdominoplasty, is a surgical procedure that is done to remove excess tissue and skin from the abdomen. There are different reasons why people want tummy tucks. Many women want the surgery because their stomach is no longer flat after having children or it starts to sag due to aging. Also, people who have lost a significant amount of weight have loose, hanging skin. Sometimes diet and exercise simply will not work. People tend to relate a flat stomach to youth, and they want to preserve that youthfulness as long as possible. When you stick to a regular diet and exercise program and you still can’t lose that little pooch on your tummy, it can be extremely frustrating. No matter how hard you try, you can’t seem to get rid of it. Many times this is because pregnancy has stretched out the fascia of the body wall. Exercise can’t fix this. This is the time to consider a tummy tuck. When certain people lose a lot of weight quickly, they can be left with excess skin that sags down from the belly. There are times when this is so severe that the extra skin

MD Monthly

actually has to be tucked into the clothing. Abdominoplasty is the only solution to removing the excess skin left over from the stomach after dramatic weight loss. Most fashionable clothing is tight or cinched around the waist and all bathing suits show off every curve of the body. This is another reason why people choose to have the procedure done. It helps with certain self-image issues some people have. Imagine finally being able to wear whatever you want without being self-conscious of how your body looks. Ideally, you will be able to wear a bathing suit or tight-fitting clothing without worrying about how your stomach looks in it. This is what an abdominoplasty offers. A tummy tuck is not performed to lose weight, although there will be a few pounds lost due to the removal of the tissue and skin. Rather, a tummy tuck is performed to reshape and define your body to regain that youthful, fit appearance. Each person’s individual results will vary, but all results are dramatic. We should be able to give you an idea of exactly how dramatic your

results will be. How is a Tummy Tuck Performed? Prior to surgery, we will perform some lab tests and ask you several questions regarding your health. This is to keep you safe during surgery. You will be given detailed instructions on things such as diet and anything special you need to do before surgery. Do not dismiss these instructions as they are critical to your outcome. A full abdominoplasty removes excess skin and fatty tissue usually from the pubic area to the belly button. Typically, a general anesthetic is administered so you will feel nothing. An incision is made just above the pubic line from hip to hip and the excess skin and fatty tissue from the lower abdomen is removed. The muscles in the abdomen are also repositioned and tightened so the stomach will achieve the overall taut and toned look. Some procedures include liposuction of the hips, waist, and upper abdomen to match the newly shaped tummy. The skin from the upper abdomen is then stretched down and attached at the incision. The belly button

OCTOBER - 2018

MDMONTHLY.COM

WOMEN'S HEALTH | SAN ANTONIO

stays in place and will be brought out through an incision made in the skin. The scar from the surgery usually extends along the pubic line from hip to hip. It is purposely placed in an area that will be easy to cover up with any normal underwear or bathing suit bottom. Recovery Period and Instructions After a Tummy Tuck After a tummy tuck, you should be prepared for a recovery period. With a desk job, we recommend planning on being away for ten days or so. If we did surgery on Thursday, shoot to go back Monday post-op day eleven. You will need someone who will be able to support you during your recovery period, especially the first few days. You will not get to your new baseline, though, for a few months. After your surgery is finished, there will be protective tape over the incisions

that will remain in place for a few weeks. The sutures that are below the skin will eventually dissolve and the discomfort and itching will subside. Drains will be placed and we will explain to you in detail how to take care of them. The only stitches that have to be removed are the ones that hold in the drains. You will have soreness for a few days after the surgery. We use an injection at the time of surgery called Exparel that greatly reduces pain. Pain medication is also prescribed to alleviate discomfort. When you are standing, you likely will not be able to stand up straight for a couple weeks. Some people find relief with a cane, or something to take some pressure off the lower back. We ask you not to raise your blood pressure for two weeks. We do not want something that was not bleeding to start. So, no heavy lifting, no exercise,

no constipation (which pain pills cause), and no sexual activity. Between weeks two and three, take it light. If you lift weights for example, lift a light weight, and knock yourself out on the repetitions. After three weeks, donâ&#x20AC;&#x2122;t do something to stress the incision, but basically you are free to workout while letting your body be your guide. At this point, the only things we do not want you to do is submerging in water, or doing something where you could get hurt. After the first night, you will be able to take a shower. Do not take a bath until all drains are removed and it is okayed by us. Typically this is a high-satisfaction surgery. It does require some recovery, but the results are usually well worth it!

For More Information Visit: www.drdecherd.com or call 210.348.3886

2018 - OCTOBER

MD Monthly

SPECIAL FEATURE | SAN ANTONIO

New Procedure May Help Cure Chronic Pain By Holly Wayment

hat seems like science fiction is now medical science, and it’s helping some San Antonians recover from chronic pain without the need for powerful opioid medications. Lucy (Luz) E. Rodriguez is a San Antonio mother and wife with a career devoted to helping San Antonio’s elderly. She walked into Dr. Stephen W. Dinger’s clinic suffering from severe, continual knee pain. Dr. Dinger is practicing cutting edge medicine in the Alamo City. She knew this and that is what led her to make an appointment with him. Her pain was so bad that she was unable to kneel, and Rodriguez needed to be able to kneel in order to work and help elderly people. Dr. Dinger performed regenerative medicine, taking Rodriguez’s own blood cells from her arm, spinning them in a device, and then reinjecting those cells into the damaged tissue to restore normal function. The process is relatively painless and takes minutes to complete.

MD Monthly

Rodriguez explains “Then, everything changed. I knelt down and thought, wow, I’m able to do it!,” I can do just about anything now. I can walk as long as I want. and I can dance.”

He says he likes the challenge of treating pain. “It’s a condition where most of the time, you are the last stop for patients,” Dr. Dinger explains. “For some people, it’s almost immediate improvement.”

According to the National Institutes of Health , regenerative medicine is Tiger Woods may be the most highthe “process of creating profile regenerative medicine living, functional tissues patient, Dr. Dinger explains, to repair or replace but the procedure can “It’s your body’s tissue or organ help a wide array of own healing response function due to age, people with different right where you need it, disease, damage pain problems such or congenital as arthritis. “ Dr. Dinger says. “So, (inherited) if we can concentrate defects.” “It’s your body’s on your body’s healing own healing response response, who’s better to right where you “Regenerative to heal than you.?” medicine is where need it,” Dr. Dinger we are headed in says. “So, if we can medicine, “says Dr. concentrate on your body’s Dinger. “Now we’ve gone healing response, who’s better from trying to help support the situation to heal than you?” or disease to making it better and reversing the damage.” Regenerative medicine could be for anyone who has chronic arthritis,

OCTOBER - 2018

MDMONTHLY.COM

SPECIAL FEATURE | SAN ANTONIO

tendonitis, and back pain, and works best for people in their 30’s, 40’s and 50’s, or people such as Rodriguez. Born in the city of Juarez, Mexico, Rodriguez and her husband of 44 years, Roger, have danced through many cities as a military family. “I married a military guy and he took me around the world,” she says. The couple has two daughters: Veronica, 42 and Laura Beth, 36. Rodriguez worked in nursing homes and hospitals and felt like something was lacking for service to the elderly. “Nobody could give them what I thought they should have at the end of life.” So, she started her own in-house nursing home, where she could provide nurture, kindness and respect to the senior citizens around the clock. She even provided hair styling, make-up as needed for the women, and regular, home-cooked meals. “When you take care of the elderly, you forget about yourself,” she says. Her job also involved a lot of lifting, and that is why, many years later when she is about to retire, she had chronic injuries. “I worried that I would be sitting down for most of my older life.” Targeted cell therapy is currently not covered by insurance, but Dr. Dinger hopes that in a year or two that will change. “This has made all the difference for me, “ she says, while holding her husband’s hand. Dr. Dinger, who is a father of three children, a ten-year-old son Nathan, and twin twelve-year-old daughters MyKenna and Makalyn, completed his undergraduate degree at Syracuse and then medical school in New York. His

residency brought him to San Antonio. His mother, who worked in a medical clinic, and also underwent a larger abdominal surgery when he was a child, inspired him to become a doctor. He is an athlete and recently completed his first ironman triathlon. He has participated in sports ever since he can remember. Dr. Dinger is passionate about customer experience, and treating patients in a kind and compassionate environment. He also emphasizes that patients need not depend on opioids. “We are trying to change the narrative on pain management. Opioids are not a longterm treatment. We need to focus on the source; the root cause of the pain.” Rodriguez is getting ready to retire, where she and her husband will take their first retirement trip to visit a friend

in Illinois. She feels great, is excited about retirement, and does not need opioid medication. “I tell everyone about it! I can enjoy the things we want to do. It was a wonderful experience,” she says. “Dr. Dinger gives you the time and doesn’t rush. He is a doctor that cares for you and wants to make things better for you. He does not just give you medication because he wants you to live a normal life.”

Dr. Dinger is the founder of Advanced Pain Management and Rehab, with clinics in Stone Oak 1585 Sigma Rd. Ste 104, Schertz 5000 Schertz Pkwy Ste. 400, Boerne 110 East Bandera Rd., and Bulverde 32685 Hwy 281 N #100. To book an appointment, call 210-495-7246 or go to their website: backpainsa.com 2018 - OCTOBER

MD Monthly

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

Breast Cancer Awareness Month You Can Save Your Own Life

DR. PALAFOX AND THREE OF HER PATIENTS SHARE THEIR JOURNEY WITH BREAST CANCER By Jody Marmel

r. Maria Palafox is a general surgeon, but she focuses on breast cancer because of the patients. She explains, “The stakes are substantially higher for a patient when they get a breast cancer diagnosis and both the good and bad are more deeply felt for all parties concerned. I appreciate being able to help them with that, and my life is richer because of this.” Educating the community is one of Dr. Palafox’s goals. “I want to see that 99 percent of women are getting mammograms. Currently, only 70 percent of women nationwide are getting mammograms. I also want patients and physicians to routinely discuss their family’s cancer history.” Family history of certain cancers, like breast cancer, can indicate that a family has a genetic mutation and people can be tested for this. “If a patient knows they have one, they can change their genetic destiny with increased screening, medical treatments or in some cases surgery, depending on what the patient wants.”

MD Monthly

Dr. Palafox emphasizes that the one risk factor for breast cancer that we can control is our weight. A BMI over 30 makes us at higher risk to develop not only breast cancer, but other cancers as well. “This is completely in our control.”

the public school sector and decided I wanted to help others in a different way.”

Linda and her husband live in Jourdanton, which is south of Pleasanton, Texas. But when they were in West Texas, she “I remember Three of Dr. had a pain in her ribs on telling Dr. Palafox, Palafox’s patients her right side. Since she share their journey did press outs and swam “Don’t ever leave me with breast cancer alone and she never did. daily, she thought she and how Dr. Palafox bruised herself and went She has been by my side helped each one of on with life. “So much no matter what.“ them 24/7. While was going on in my life that each story is different, Linda Riley I put my pain on the back each patient felt they burner. We left West Texas and were in the best hands and came home. I went straight to the she will always be their guardian angel. bathroom and looked at my breasts. I saw an indention in my breast and I felt Linda Riley a lump; I just knew what it was.” Linda Riley left home at the age of 12 to train for the Olympics in swimming. She Linda immediately called her PCP says, “I have always been healthy and and he referred her to Dr. Palafox. very athletic and as a result, I always Within two days, she had her first maintained a healthy weight.” Fast appointment with Dr. Palafox and her forward, and Linda used her energy in husband was by her side throughout the her Homeschooling Business, Riley’s entire journey. School of Tutoring and her Swimming School. “I taught for over 30 years in She met with Dr. Palafox and knew

OCTOBER - 2018

MDMONTHLY.COM

she was in the best hands. The doctor did a sonogram and Linda’s biopsy was set up immediately. “I remember telling Dr. Palafox, “Don’t ever leave me alone and she never did. She has been by my side no matter what. “ In September of 2015, Linda was diagnosed with Breast Cancer -Stage 2. On November 11th, Linda was scheduled for a double mastectomy. “I wanted both my breasts removed to reduce chances of more cancer. I believe you have to take the initiative to learn and be knowledgeable. You have to make sure that you are heard.” After her surgery, Linda was scheduled for reconstructive surgery,

but there were so many twists and Linda describes Dr. Palafox as a lady turns before she could even of grace. “She is an angel and she get there. She ended is always there for you no “I have so up having a very matter what. She doesn’t many good things to difficult time healing time you because she say about her; I believe and went into a listens to you and hyperbaric chamber she actually hears I could write a book about for six months. her. Dr. Palafox saved my life, you. She hears what “I couldn’t have you have in your so I consider her my savior. chemotherapy heart. Dr. Palafox is She saved me physically and a strong woman and or reconstruction she continues to help me at this point. she is helping others Everything was on take the journey. Her mentally.” hold.” Linda finally drive and her need to Margo Jimenez healed, and Dr. Palafox keep making things better told her she did not need for her patients makes all the chemotherapy. At this point, Linda difference in the world.” decided she did not want to have reconstructive surgery. She explains, “I Linda got back into the water in am happy with me and I didn’t want any 2017 and went back to being the more surgeries.” mermaid she was prior to her diagnosis. 2018 - OCTOBER

MD Monthly

“Dr. Palafox prayed for the day that I would embrace my body. And I can honestly say I am there. If you have scars, then you are a survivor and I am a survivor.” Linda is not in remission; she is in Survival Ship. “That’s like a ship out in the ocean that has smooth days and then there are those stormy days that you have to ride it out. I stay strong and believe more smooth days are ahead. Just ride the water. Since I am a mermaid, I can do that with prayers and God’s grace. And with Dr. Palafox-my wonderful doctor and forever friend.”

“She is an angel and she is always there for you no matter what. She doesn’t time you because she listens to you and she actually hears you. She hears what you have in your heart. Dr. Palafox is a strong woman and she is helping others take the journey. Her drive and her need to keep making things better for her patients makes all the difference in the world.” Linda Riley

Margo Jimenez Margo Jimenez is from San Antonio and is currently working at a senior level at FedEx. She has one son and he is 28 years old. She has been married to her husband since 1999. One day back in 2010, Margo felt a lump on her left breast, so she scheduled a mammogram. The technician told her everything was fine and that she could leave. She went home and 15 minutes later, she received a call and they told her to come back because they wanted to take another look at the left side. She went back, and the Radiologist told Margo that he wanted her to get a biopsy. “My mother was just diagnosed with breast cancer two months ago and I had to know what was going on. So, I told the Radiologist that I knew he was not allowed to tell me, but did he think it was cancer? He told me that it looked like it might be.”

because we were in this together.”

Margo did not know whether she should go back to work or if she should go to church, but she decided to go home, and she lit a candle. She called her gynecologist and said that she had to have a biopsy immediately. “I did not want to wait. He referred me to Dr. Palafox. I called, and she saw me the same day. My husband came with me

“An angel sent Dr. Palafox to me. Every beautiful word in the book is what Dr. Palafox is-the positive words that go above and beyond the call of duty.” Margo remembers how calming Dr. Palafox was at their first meeting. She was reviewing the Radiologist’s paperwork and said that she would do a needle biopsy right now. After the

MD Monthly

needle biopsy, Margo recalls that Dr. Palafox said, “Margo, here is the deal. I don’t want you worrying about this. When I get the results, I will call you immediately.” It was a Friday and Dr. Palafox kept her word and called Margo on Saturday. “She called me and told me to sit down. I knew then that I had cancer. I went to see her that Monday and I got a tattoo on my arm with a pink ribbon for Breast Cancer with the date

OCTOBER - 2018

MDMONTHLY.COM

The day Margo started radiation, her mother passed away. But, with the help of Dr. Palafox and her support system, she managed to endure the burning sensation and completed treatment. “Dr. Palafox was the one that pushed me to have the lumpectomy. She said let’s get this done and that it was going to be okay. We can do this. She was with me every step of the way. I honestly believe that Dr. Palafox saved my life. I can still call her and talk to her and just cry. On those days when I am really scared that my cancer is going to come back, I call Dr. Palafox. When we end the conversation, I feel so much better. It’s a healing process and Dr. Palafox goes the extra mile with me.” Margo explains that after she went through the lumpectomy, chemo, radiation and some reconstructive surgery, she came to the decision that she did not want her breasts. “Since we know this is aggressive, I didn’t want my breasts any longer. Why take the chance?” In November of 2012, Dr. Palafox performed a double mastectomy because Margo insisted that she had to be the surgeon.

Margo Jimenez

August 26, 2010. My son has a similar one with the same pink ribbon that says Mom. “ Margo was diagnosed with aggressive breast cancer Stage 3. She had a lumpectomy and 17 lymph nodes had to be removed as well. “I had a lot of pain in my arm from the removal of the lymph nodes. And then I had to go

for chemotherapy. I was drained and exhausted. Dr. Palafox told me to take some time off from the chemo because she wanted me to maintain my quality of life.” In spite of her desire to be at work every day, Margo took time off and stopped chemo for a while in 2011. In total, Margo went for chemotherapy for two years.

Margo explains that she would send anyone to see Dr. Palafox -even if they did not have breast cancer. The words Margo used to describe her were kind, loving, caring compassionate and an extremely intelligent woman. “I have so many good things to say about her; I believe I could write a book about her. Dr. Palafox saved my life, so I consider her my savior. She saved me physically and she continues to help me mentally.” She continues, “I want to help others and my message is don’t take your body for granted. Love your body, be in touch with your body and remember, it’s your life.” Margo is back at work and her co-workers always say

2018 - OCTOBER

MD Monthly

OCTOBER - 2018

MDMONTHLY.COM

that they can’t tell that she is dealing with cancer. She always has a smile for everyone, but it’s just a bit different on the inside. Her positivity and her love of life and appreciation for Dr. Palafox is obvious. Margo is a fighter and while she has some setbacks, she always springs back and is ready to take life on full steam ahead. Leticia Velazquez Leticia is a native to San Antonio and is married with five children, and 15 grandchildren. She has worked at HEB for 17 years. Leticia started working in the store and then she moved to the warehouse in production and selection in the floral department. “While there is a lot of heavy lifting, I loved this job,” she explains. But, she was diagnosed with Breast Cancer in 2016 and is currently on long term disability. “In 2015, I noticed that my diabetic levels were super high, so I went to see my PCP and had a series of tests. Included in those tests was a mammogram. I was called back immediately after I left. I went back, and they did another mammogram and ultrasound. Hours later, the doctor finally saw me and showed me my ultrasound. I had a mass in my right breast and my doctor did not like the way it looked. The next step was a biopsy, but not once did I suspect that I had cancer.” Leticia was told that she could no longer carry anything heavy and her career at HEB was on hold. She went back to her PCP for a follow up on her tests and her biopsy. “She told me she had a bit of bad news. And that is when I was diagnosed with cancer. I remember crying because HEB was my job and that is what I do. That was my life. My doctor told me that I need to worry about my cancer and my health. I don’t know why, but I did not think about the severity of my cancer.” Her husband was in the waiting

Leticia Velazquez

room and she told him the news. They both started crying. “I told him that I can understand if he wanted to leave me. I didn’t know what to do. He is my rock and said that through good and bad, we are going to fight this together.” The oncologist was next and from there she was referred to Dr. Palafox. Both doctors felt that a lumpectomy to remove the tumor was the best option for Leticia. Dr. Palafox removed

the tumor and several lymph nodes to make sure the cancer didn’t spread. At that point, Leticia remembers that everything was a success. She says, “I thought I was just going to get radiation and that would be the end of this journey, but I was wrong.” She saw Dr. Palafox and discovered that the cancer had spread to her lymph nodes and she had to undergo chemotherapy for six months. After 2018 - OCTOBER

MD Monthly

“Dr. Palafox is a wonderful doctor. Through the good and bad, she told me I can call her anytime. She also helped my husband. A side effect is constipation and my husband had no idea what to get me. Dr. Palafox met him at the store, so he could get me what I needed. She went that extra mile more than once and it was so kind of her to help us. I just don’t know what I would have done without her.” Leticia Velazquez

chemotherapy, she went through radiation treatments. “Chemotherapy was very rough for me. I never felt like I was dying; I just knew I had a hard, bumpy road ahead of me.” Within time, Leticia started to have swelling in her breast and the fluid was causing a lot of discomfort. Dr. Palafox told her to come to the office and she drained the fluid to give Leticia the comfort she needed. “That helped me a lot. Dr. Palafox always had the answers and solutions whenever I encountered a problem and she was always there for me. I found this to be amazing because I never knew a doctor could be this compassionate.” “Dr. Palafox is a wonderful doctor. Through the good and bad, she told me I can call her anytime. She also helped my husband. A side effect is constipation and my husband had no idea what to get me. Dr. Palafox met him at the store, so he could get me what I needed. She went that extra mile

MD Monthly

more than once and it was so kind of her to help us. I just don’t know what I would have done without her.”

“For now, I take each day as it comes, and I am grateful for all of the love and support that surrounds me.”

Leticia adds, “I often wonder if this lady ever sleeps. She is extremely loyal to her patients from the beginning and her loyalty and compassion have helped us through this journey. I am truly blessed to have her as my doctor. She was there 24/7 for us and by explaining everything to us, she helped us so much. We have never been touched with cancer in either of our families, so we went into this not knowing too much about what was in store for us. Since my husband speaks Spanish, he felt comfortable calling Dr. Palafox and asking for her guidance because Dr. Palafox is fluent in Spanish, so the communication was easier on him. I am so thankful for her and for everything she did for me and my family.”

Three Different Journeys Dr. Palafox says that while Linda, Margo and Lety have all had different journeys, they represent the spectrum of what breast cancer and being a survivor is all about. She stresses, “Don’t be afraid. Ignoring a lump is not going to change what is coming, but if you do something about it, you can save your own life.”

While Leticia’s journey is not over, and she still has her lymphedema, her remarkable spirit and love for her family has kept her going strong. She says,

She continues, “What I love most is being able to help people out. My role in a patient’s life is pretty minor. I put them on the path to healing, but they still have to walk it.” After hearing Linda, Margo and Leticia’s stories, they all agree that Dr. Palafox does not just put them on the path to healing, but she is there for them throughout the journey.

For more information visit www.mariapalafoxmdtx.com Or call 210-660-2529

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

Special to MD Monthly

MD Monthly

OCTOBER - 2018

MDMONTHLY.COM

SPECIAL FEATURE | REGIONAL

T cell discoveries led to game-changing treatment revolutionizing cancer care

im Allison, Ph.D., chair of Immunology and executive director of the Immunotherapy Platform at The University of Texas MD Anderson Cancer Center, today was awarded the 2018 Nobel Prize in Physiology or Medicine for launching an effective new way to attack cancer by treating the immune system rather than the tumor. Allison is the first MD Anderson scientist to receive the world’s most preeminent award for outstanding discoveries in the fields of life sciences and medicine. “By stimulating the ability of our immune system to attack tumor cells, this year’s Nobel Prize laureates have established an entirely new principle for cancer therapy,” the Nobel Assembly of Karolinska Institute in Stockholm noted in announcing the award to Allison and Tasuku Honjo, M.D., Ph.D., of Kyoto University in Japan. “I’m honored and humbled to receive this prestigious recognition,” Allison said. “A driving motivation for scientists is simply to push the frontiers of knowledge. I didn’t set out to study cancer, but to understand the biology of T cells – these incredible cells travel to our bodies and work to protect us.” Allison started his career at MD Anderson in 1977, arriving as one of the first employees of a new basic science research center located in Smithville, Texas. He was recruited back to MD Anderson in November 2012 to lead the Immunology Department and to establish an immunotherapy research platform for MD Anderson’s Moon Shots Program. “Jim Allison’s accomplishments

on behalf of patients cannot be overstated,” said MD Anderson President Peter WT Pisters, M.D. “His research has led to life-saving treatments for people who otherwise would have little hope. The significance of immunotherapy as a form of cancer treatment will be felt for generations to come.”

with drugs approved to treat certain types and stages of melanoma, lung, kidney, bladder, gastric, liver, cervical, colorectal, and head and neck cancers and Hodgkin’s lymphoma. Clinical trials are underway in many other cancer types.

“I never dreamed my research would take the direction it has,” Allison The prize recognizes Allison’s basic said. “It’s a great, emotional privilege science discoveries on the biology of to meet cancer patients who’ve been T cells, the adaptive immune system’s successfully treated with immune soldiers, and his invention of immune checkpoint blockade. They are living checkpoint blockade to treat cancer. proof of the power of basic science, of following our urge to Allison’s crucial learn and to understand insight was to block how things work.” “I’m honored and a protein on T cells humbled to receive that acts as a brake on “Science advances this prestigious their activation, freeing on the efforts of recognition,” Allison many,” Allison said. “A the T cells to attack said. “A driving cancer. He developed succession of graduate motivation for an antibody to block students, postdoctoral the checkpoint scientists is simply fellows and colleagues protein CTLA-4 to push the frontiers at MD Anderson, the and demonstrated University of California, of knowledge. I the success of Berkeley, and Memorial didn’t set out to the approach in Sloan Kettering Cancer study cancer, but experimental models. Center played important His work led to roles in this research.” to understand the development of biology of T cells the first immune Allison’s ongoing – these incredible checkpoint inhibitor leadership at MD cells travel to our drug. Ipilimumab was Anderson focuses on bodies and work to improving knowledge of approved for lateprotect us.” stage melanoma by how these drugs work the U.S. Food and to extend the benefits Drug Administration in of immunotherapy 2011. to more patients with more types of cancer. He continues his own research, His drug, known commercially as focusing on the details of immune Yervoy, became the first to extend response to cancer and identifying new the survival of patients with latetargets for potential treatment. stage melanoma. Follow-up studies show 20 percent of those treated He also leads the immunotherapy live for at least three years with platform for MD Anderson’s Moon many living for 10 years and beyond, Shots Program, which conducts unprecedented results. Subsequent immune monitoring by analyzing tumor research has extended this approach samples before, during and after to new immune regulatory targets, treatment, aiming to understand why most prominently PD-1 and PD-L1, these drugs work for some patients but 2018 - OCTOBER

MD Monthly

SPECIAL FEATURE | REGIONAL

not for others. The platform works with more than 100 immunotherapy clinical trials at MD Anderson addressing a variety of cancers. The platform also collaborates with pharmaceutical companies to help them develop new drugs and combinations to better treat cancer. “We need these drugs to work for more people,” Allison said. “One challenge is that the clinical success has outrun our scientific knowledge of how these drugs work and how they might best be combined with other therapies to improve treatment and reduce unwanted side effects. We need more basic science research to do that.” Allison has collaboratively worked with scientists around the globe to

MD Monthly

expand the field of immunotherapy. Some of his leadership positions include serving as a co-leader of the Stand Up To Cancer-Cancer Research Institute Cancer Immunology Dream Team and as a director of the Parker Institute for Cancer Immunotherapy (PICI). Allison also is deputy director of the David H Koch Center for Applied Research of Genitourinary Cancers at MD Anderson and holds the Vivian L. Smith Distinguished Chair in Immunology. Crucial funding for his research over the years has come from the National Institutes of Health, particularly the National Cancer Institute, the Cancer Prevention & Research Institute of Texas, Howard Hughes Medical Institute, the Cancer Research Institute, Prostate Cancer Foundation, Stand Up

to Cancer and PICI. Allison will be honored at Nobel ceremonies in Stockholm in December. The Nobel Prize in Physiology or Medicine has been awarded 108 times to 214 Nobel Laureates between 1901 and 2017.

For more information about Allison, his work and the Moon Shots Program, please visit mdanderson.org/nobelprize.

Press Release Provided by MD Anderson Cancer Center, for more information please visit https://www. mdanderson.org/newsroom/2018/10/ md-anderson-immunologist-jim-allisonawarded-nobel-prize.html

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

SOCIAL | SAN ANTONIO

Dr. Lyssa Ochoa Mixer Recap In Partnership With

D Monthly was honored to recognize Dr. Lyssa Ochoa as our September cover feature. Hosted at Blue Star Brewing Company in Southtown with over 50 attendees including Councilwoman Ana Sandoval in District 7! Dr. Ochoa sits on the board of a non-profit, Earn-a-Bike, where their mission is preventing obesity related diseases and inspiring healthy life habits. We partnered up with them for the evening, and raised nearly $500! Thank you to all who attended.

MD Monthly

OCTOBER - 2018

MDMONTHLY.COM

SOCIAL | SAN ANTONIO

2018 - OCTOBER

MD Monthly

HEALTH & WELLNESS | REGIONAL

INCREASING YOUR

PRODUCTIVITY By Having Better Blood Circulation By Katerina Weissova

aving good blood circulation is essential. In fact, it provides great and amazing benefits to the human mind and body. Your health, fitness, and wellness are largely affected by the quality of your blood circulation. And having a poor circulation system may cause deterioration to your overall health. Now, your day-to-day productivity is also affected by your blood circulation. If you feel that youâ&#x20AC;&#x2122;re down and too lazy to move, it could be that your blood is not properly circulating. So, if you are looking for ways to increase your productivity, you may want to check and improve the quality of your blood circulation. Ways to Improve Your Circulation Walking Walking is a great form of cardio. Not only does it elicit weight loss, it is also great for your heart and blood circulation. Apparently, when you walk, the muscles in your legs contract and

MD Monthly

relax. Accordingly, the veins and other blood vessels in your legs are squeezed which allows the flow of blood to be more effective, especially in areas where the circulation is stagnant. Moreover, you can execute your walking activities at any pace you want. Whether you like it brisk or not, it still promotes better circulation.

Yoga Aside from the weight loss promotion, yoga can provide a lot of benefits to the body and mind. And if you are aiming to improve your blood circulation, practicing yoga is one of the best ways to do it. Apparently, yoga positions and routines involve a lot of bending, stretching, and twisting. And these positions are very helpful in squeezing your veins and blood vessels. Also, you may want to start practicing inversion therapy as well. Strictly speaking, this is in some way and somehow part of yoga routines.

But, it largely focuses on inverting your body and improving your back. Accordingly, when your body is in an inverted position, your hips and heart are put above the head. And gravity will work its ways to elicit better blood circulation.

Eat Superfruits Fruits are nutritious and beneficial foods. But, you may want to choose helpful kinds of fruits if you want to improve your blood circulation. These are normally called superfruits because they can give you health benefits, and they could also provide several properties that help your mind and body. Superfruits like oranges and other citrus fruits are great choices as they are rich in vitamin C. This can boost your immune system and superfruits are natural blood thinners that will decrease the risk of having poor circulation. Other superfruits may include goji berries and watermelon.

OCTOBER - 2018

MDMONTHLY.COM

HEALTH & WELLNESS | REGIONAL

Stand up at Your Desk If you are one of those people who work in a corporate setting, then you have probably experienced sitting the whole day. Apparently, sitting for hours can largely deteriorate your blood circulation. Not only does it result in stagnant flows, but it slows down your metabolic system as well.

may seem too simple, but this can prevent poor blood circulation. If you are fond of wearing skin-tight clothing and apparel, you have probably experienced the quick dropping of your energy. Apparently, tight clothes can significantly affect your blood circulation. It can actually hinder the blood from flowing properly.

As mentioned, inverting your body will allow the gravity to work on your blood circulation. It is important for you to note that gravity plays an important role in your blood flow. And when done properly, it can benefit you greatly.

So, the next time that you sit down for the whole day, try to move and do a few stretches on your legs. Schedule an hourly break where you can simply stand and stretch your legs. Also, you could choose to do your tasks while you are standing.

Hence, if you really want to improve your blood circulation and be much more productive, opt to wear comfortable clothing on a daily basis.

Use the Inversion Table In relation to the inversion therapy, the inversion table is the most recommendable equipment that you should use. This will allow you to execute the routines of the therapy properly. Also, the inversion table has all the tools and attachments that you will need in order for you to do the positions effectively.

You can also use the inversion table for other positions and routines that you may want to try. These positions may include the elevation of your legs which is highly effective in improving the circulation of your blood.

This can help you improve the circulation of your blood and promote weight loss.

Wear the Right Clothing Wearing comfortable clothing

Today, not too many people pay attention to the quality of their blood circulation. Poor circulation can affect the overall quality of life, including productivity and energy. So, if you think that you need to start improving your blood flows, you may want to apply these tips and see the difference that it can make!

2018 - OCTOBER

MD Monthly

CHILDREN'S HEALTH | REGIONAL

How to Find the Best Tutor for Your Child By Lachlan Malone

f your child is struggling with his studies, you need to seek the assistance of a tutor and help him to manage his studies in an effective manner. However, looking for the best private tutor would not be an easy thing to do as you expect. That’s because you will need to pay attention towards a variety of factors to select the best tutor and move forward with the offered service. It is perfectly fine for you to take your own time when looking for a private tutor. That’s because getting the assistance of a good tutor is an excellent step that you can take to ensure the future of your child. Hence, you need to pay special attention towards the below mentioned facts and go ahead with the service offered by the best home tutors. Check whether your tutor is verified or not As the first thing, you need to check

MD Monthly

whether the tutor that you are going to hire is verified or not. To do that, you need to get in touch with the tutor and ask for appropriate documents to prove the verification. If the tutor offers them to you promptly upon request, you will be able to proceed with peace of mind as you have discovered a verified tutor. In addition to the verification, you need to double check the credentials of the tutor as well. Moreover, you need to ask for recommendations. Then you will be able to make sure that you are about to provide the best possible experience to your child with the assistance of a qualified tutor. Check the tutor experience Obviously, you need to start looking for a tutor who has previous experience in teaching students. But it is better if the tutor has experience in teaching the same subject to the students who are in the same age as of your kid. That’s because some things in tutoring cannot

be learnt from theoretical knowledge. Instead, the tutors learn them from the practical experiences that they go through. In other words, the tutors enhance their tutoring capabilities along with time. Due to this reason, you need to make sure that you are getting the assistance of an experienced tutor, who has been able to polish his skill set in the past. An experienced tutor can quickly determine the level that your child is in. Then the lessons will be adjusted accordingly to suit your little one. This can deliver a more personalized and an efficient learning experience to the child as well. On the other hand, you will be able to make sure that your child is not going through any frustration when adjusting to the teaching methodology of the tutor. Instead, the tutor would adjust according to the needs of your child. Check the tutor communication skills The tutor that you hire to help

OCTOBER - 2018

MDMONTHLY.COM

CHILDREN'S HEALTH | REGIONAL

your child should be equipped with excellent communication skills. In fact, the tutor should maintain regular communications along with your child throughout the lessons. On the other hand, the tutor should also be in a position to make the lessons interactive with the best use of his communication capabilities. Then your child will not have to worry about anything and you will be able to make sure that he gets the best possible knowledge required. In addition, your child will never be bored with the lessons that he is being provided with. The best home tutors know how to keep the attention of the little ones throughout the lessons. This can provide an efficient learning experience to the kids. See the attitude of the tutor towards work You must also pay special attention towards the attitude and personality

of a tutor when hiring a one. That’s because you don’t want to provide a compromised education to your child at the end of the day. The tutor should be willing to provide the best possible learning experience to the little ones at all times. To do that, the tutor should have an attitude to work beyond the boundaries. In other words, the tutor wouldn’t think twice before going that extra mile to make sure that your kid has learned the lesson. Check for reviews Last but not least, you need to take your time to check the reviews that you can find under the private tutor Singapore that you are about to hire. When you are going through the reviews, you will be able to get a clear understanding about the experience that your child will be able to receive at the end of the day. Therefore, you can easily determine whether you are going to provide such an experience to your child or not.

If you can see a lot of negative reviews about a tutor, you are not encouraged to go forward with the service offered. That’s because you will not be able to provide a quality learning experience to your child for the amount you pay. Hence, you must stick to a private tutor Singapore, who has been able to maintain an excellent reputation throughout the past. Now you have a clear understanding on how to search for the best tutor for your child. With that in mind, you will be able to start looking for a tutor. If you are looking for a good place to get started with your research, you can simply take a look at Smile Tutor. It is a reliable home tuition agency based in Singapore and can provide an excellent assistance for you to locate the best tutor who can help your child with the struggles that he is going through.

2018 - OCTOBER

MD Monthly

BUSINESS | REGIONAL

Physicians: Prenuptial Agreements Are Not Just For The Extraordinarily Wealthy

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.

any couples planning to marry never consider getting a prenuptial agreement drafted and signed before the wedding day. Often, they feel that even suggesting the idea will offend the spouse-to-be, because it will seem to suggest that the partner proposing the idea already lacks faith that the marriage will last. Doesn’t it seem appallingly unromantic to propose an agreement establishing a financial arrangement in case of divorce on the very eve of one’s wedding?

Nevertheless, there are good reasons why physicians in particular, even if they are not extraordinarily wealthy, should consider a prenuptial agreement. In many cases, such an agreement can offer stability and protection to the other party in the marriage as well.

MD Monthly

Under what circumstances is a prenuptial agreement especially important to a physician? Perhaps the partner contemplating a “prenup” is youthful, but already has an inheritance to protect. Or, if he or she is more mature and marrying for the first time, she may already have established a substantial medical practice or an interest in such a practice that she wants to protect as separate property. On the other hand, perhaps the physician is marrying for the second or third time, already has a substantial practice, and is concerned about protecting the future of any children he may already have. Proposing a prenuptial agreement does not have to be an insult to the prospective spouse. We have advised our clients in the past as to the best way to handle this delicate task. It actually makes a lot of sense to establish the financial ground rules for your marriage instead of allowing the Texas Legislature to determine them for you. And why not establish those ground rules while the two of you are getting along well and want to set up an

equitable, fair arrangement that protects each party’s financial well-being? A properly drafted prenuptial agreement can also protect one spouse from being responsible for the other spouse’s debts and may also protect a nonphysician spouse from being affected by the consequences or expense of a medical malpractice case filed against the physician. Some partners with separate established careers may decide that, during the forthcoming marriage, they will not comingle their finances at all. Rather, each will maintain separate records and pay for his/her own expenses. Or they may keep most of their finances separate, but also have a joint account to which each will contribute to cover basic household expenses. Or they may comingle most of their finances but still maintain some property or income separately. Here’s a common situation in which a prenuptial agreement can be helpful: an older couple is marrying and one party is selling (in this case) her home and moving into her fiancé’s

OCTOBER - 2018

MDMONTHLY.COM

BUSINESS | REGIONAL

home. But, before she gives up her independent dwelling, she wants to make sure that she will not immediately be thrown out of her home if something happens to her spouse. She wants a prenuptial agreement that gives her some ownership interest in the home. Prenuptial agreements may cover one specific issue or settle one potential problem, like the one described above. They need not necessarily cover the entire array of the couple’s overall finances. The prenup may, for example, establish the fact that one particular piece of property or income from a certain property that precedes the marriage should be considered separate and not part of the “community” basket. It can be very expensive at some later date to try to prove that certain property is separate during the course of a divorce or upon death in a probate court. Having both parties

agree in a prenuptial agreement that the property is separate is much more efficient. There are two very important caveats, however, to remember about prenuptial agreements: for one thing, a prenuptial agreement only concerns money. It cannot prospectively settle matters related to children. It cannot, for instance, require that children born of the marriage be raised in a certain religion, or that one spouse will automatically gain custody of any children in the event of divorce. It might be possible to provide in a prenuptial agreement for a fund to which each party will contribute to cover the costs of college for prospective offspring, but that is still essentially a financial matter. The second caveat to remember is that it is very difficult to “break” a prenuptial agreement; that is, to change

the terms of the prenuptial agreement during a divorce. The grounds for invalidating a prenup are very limited. One would have to prove, for example, that one party did not voluntarily sign the agreement, or that the agreement is unconscionable and that there was not adequate financial disclosure or a waiver of same. If a couple does agree on a prenuptial agreement, it is best that both go into the process with eyes wide open and good legal counsel. A sound prenuptial agreement can offer benefits to both parties and start the marriage off on a solid financial footing.

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

2018 - OCTOBER

MD Monthly

WOMEN'S HEALTH | AUSTIN

How Bioidentical Hormone Replacement Can Change a Woman’s Life Provided by Dr. Jennifer Walden

hroughout a woman’s life, it may seem as though she is consistently at the mercy of her hormones. There may be no other time when this is more frustrating than during the years surrounding menopause. We used to hear only about menopause itself. However, research has shed a lot of light on the fact that women need personalized support during perimenopause too. With the promising research on bioidentical hormone therapy and how it is helping women transition through this stage of life, we have elected to offer this treatment option in our Austin office. Hormones: A Driving Force In Women’s Health Hormones aren’t just related to a woman’s sex life. There is much more to it than that. Without the balance between blood levels of testosterone,

MD Monthly

progesterone, and estrogen, a woman is likely to struggle with her weight. She may find that she has very little energy and that her mental focus diminishes severely. In light of the ongoing need for physical, cognitive, and sexual function, we can see an immensely good reason to get hormones back into optimal balance.

Pellet Therapy One possible method of replacing hormones is pellet therapy. BioTE pellets are easily inserted under local anesthetic, so you don’t feel a thing. After insertion, the upper buttock where pellets have been placed may be bruised and tender for a few days. This method of application, as opposed to oral or topical supplementation, achieves the consistency that is necessary for health benefits to develop over time.

Each patient receives a dose of appropriate hormones based on in-depth lab work. After initial insertion, pellet treatment is repeated about every four months, leading to benefits such as: • Improved physical and mental energy. • Stronger muscles. • Easier weight management. • Reduced perimenopause symptoms such as hot flashes and night sweats. • Increased sex drive and stamina. • Better sleep quality. • Improved mood. We enjoy seeing the general improvement in well-being that patients in our office experience after obtaining pellet therapy. We can help you regain the quality of life you deserve. Contact our Austin office at 512-3284100 to learn more about customized bioidentical hormone replacement.

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

BUSINESS | REGIONAL

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

t’s a day most business owners both dream about and dread: retirement. To get to this major milestone, you’ve put in long hours. Sacrificed time with family and friends along the way. Transitioning out of the business 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’ll 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. 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

MD Monthly

have a profound impact on your life in retirement. That’s why the watch word is, “take your time” 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 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, its 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 strategies that may help you reduce the tax liability on the transferring of assets on the sale of your business. It 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 other 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. Take stock of your financial situation 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

OCTOBER - 2018

MDMONTHLY.COM

BUSINESS | REGIONAL

preserve and protect your new cash. 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. Consider working with a business transition expert who has the resources to answer more than just the investment management aspect of your wealth.

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’s the best way to invest the money? • And, are there gaps in your insurance coverage or estate plan?

Retirement income distribution planning, estate planning, family gifting and legacy, charitable planning, and medical and long-term care planning are all areas 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 a marketing name for Eric Ilmari Kala in their capacity as a representative of Northwestern Mutual and is not a legal business name. 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) 446-5755, e-mail him at eric.kala@nm.com or visit avidwealthpartners.com. This information is not intended as legal or tax advice. Not all products mentioned in this article are offered through Northwestern Mutual.

2018 - OCTOBER

MD Monthly

WOMEN'S HEALTH | SAN ANTONIO

Today! Living for

By Norma Garcia

s a Breast Cancer fighter, you cherish every breath of life. I am back on chemo because this past Monday, I had a biopsy done for a mass I found on the side of my neck. It came back positive for Triple Negative Breast Cancer. I was in shock. Who wants to get the news that your cancer has reappeared and is a recurrence of the disease.? The good news is that itâ&#x20AC;&#x2122;s contained and that I found it early enough. Now, all I have is faith and hope that the Halaven, the chemo I am on, will do its work and shrink this tumor.

with chemotherapy, radiation therapy, and new treatments such as PARP inhibitors. We know that 1 in 8 will develop breast cancer. And men are not immune to this disease. The statistics from Breast Cancer.org show that in 2018, an estimated 266, 120 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S. along with 63,960 new cases of non invasive (in situ) breast cancer.

Norma Garcia Triple Negative Breast Cancer means it has tested negative for hormone epidermal growth factor receptors , estrogen receptors, and progesterone receptors. TNB accounts for about 20% of breast cancers diagnosed each year. TNB is a very aggressive type of breast cancer and it is more difficult to

MD Monthly

treat. Patients with this type of breast cancer cannot be placed on hormonal therapy , Herceptin or tamoxifen. There have been many advances in treatments and they are having better results and higher survivor rates than in past years. TNB cancer can be treated

As a Triple Negative Breast Cancer Survivor and Fighter, I advocate for insurance companies to pay for yearly mammogram tests for women as early as 20 years old. And I would also advocate for OB GYN physicians and Family Doctors to be allowed to order ultrasounds, and scans of the ovaries for women as early as 20 years old. These diseases are being found too

OCTOBER - 2018

MDMONTHLY.COM

WOMEN'S HEALTH | SAN ANTONIO

late in their progression. Unfortunately, many young ladies go to their family doctors or OB GYN and the disease is already in a more advanced stage. Cancer, at times, has no symptoms and you can be feeling great. And the blood work and the labs don’t detect any abnormality. This has happened in my case two times now. I choose to live for today! This fall, I will be celebrating my 50th birthday and I want to live 50 more years. Today is what’s important. At the end, the memories I make with family and friends is what is left. It’s not about the clutter in my closets, the furniture I own, the car I drive , or the house I live in. No one will care about those things. What is important is, have I told my son I love him today? Did I spend quality time with my granddaughters? Did I have coffee with a family member or friend? Did I inspire others to live a better quality of life? Did I reach out to help someone in need? And did I simply take time to breathe today and thank God I am alive? If you are a breast cancer survivor or fighter, and are in need of assistance and have no insurance , or in need of support or prayer, please know that there are so many local and national organizations that can help you. I am part of Overcomers, a nonprofit that assists breast cancer survivors. There is also Sandra’s Hope and Pink Warrior Angels. These organizations are run by volunteers; most are breast cancer survivors who don’t get paid. They just want to help other women. We know how difficult this journey can be both physically and mentally. You can also reach out to SA Susan G. Komen that is a national nonprofit organization. The following are some of the most important things that you can do for yourself when coping with breast

cancer or any other disease. Spiritual support As we rely on Science as part of our healing, it is very much connected to our spiritual strength. Look for a place where you can meditate, pray ,and worship. Or join a prayer group. Surround yourself with friends and family members that can lift you up and offer you an encouraging message when you need it. Be your best advocate Ask your medical team lots of questions, stay on top of your exams, and compare your lab notes. Don’t ever feel you are asking too many questions. Ask for a copy of your medical records and financial statements. Get second and third opinions Always! Take the time to seek other experts in the field. This is not undermining your current physician. This will only validate what he has recommended . Love yourself Start a healthy eating regimen and

regular exercise routine. There is no way around it. It wasn’t easy for me, but I have made many changes in my life. Create a support system Isolation doesn’t help anyone. Allow family, friends, and neighbors into your life and let them help you. Ask for financial help when needed Stress will not allow you to heal properly. Create a Go Fund Me account. Allow family members to do a fundraiser on your behalf. There are so many nonprofits that have funds you can apply for depending on your financial needs. If you need help with gas, groceries, mortgage payments or rent, utility bills, medical bills, copays and so much more, don’t be afraid to reach out. Ask your physician’s office, nurse navigator and other breast cancer survivors for the resources they have used. October is Breast Cancer Survivor Month, so please go out and get your yearly mammogram. Early detection is crucial. Stay positive and never lose faith. 2018 - OCTOBER

MD Monthly

HEALTH & WELLNESS | SAN ANTONIO

Up and at ‘Em:

HOW MORNING WORKOUTS COULD FIX YOUR LIFE By Dr. Marianne Pinkston Wellness 4 Life

hen you think about it, everyone starts their day with a little bit of exercise. You have to do at least one sit-up to get out of bed, right? For most people, this is where the morning fitness routine ends, but it doesn’t have to be that way. Though it may not sound as tempting as hitting the snooze button for the fourth or fifth time, a morning workout can have tremendous positive impacts on your mood, energy levels, and, of course, overall health and physical fitness.

coffee is the only way to get their morning started. Though caffeine is a great and extremely effective way to get going each day, it is also addictive and dehydrating, and since many people prefer to take their coffee with cream and sugar, it can be bad for your nutrition as well. These attributes, in addition to the crash that many coffee drinkers experience after their caffeine buzz wears off, proves that a daily cup of joe is not the best option in terms of overall health and fitness or all-day motivation.

If you’re someone who already exercises regularly, moving your workout to the beginning of the day could take your fitness to the next level, and free up some time in the afternoon or evening. If you’re more of the sedentary type, trying out a morning workout routine could be your ticket to incorporating fitness into your life and developing more healthy habits.

A morning workout, on the other hand, can give you just as much energy as a cup of coffee, without any of the unpleasant side-effects. Working out has been shown to boost energy levels and focus, so a morning workout will make you sharper and more productive over the course of your entire day. These elevated energy levels also help to kickstart your metabolism, thereby regulating your weight. Working out in the morning could be your ticket to a healthy body and a productive day.

Benefits of Morning Workouts For many people, a steaming cup of

MD Monthly

Additionally, working out gives you a boost of endorphins, the “feel-good” chemicals released by the brain. The post-workout “high” that many fitness buffs describe is the result of these endorphins flooding the system after a period of exertion. If you exercise in the morning, endorphins could help boost your mood over the course of the day and make you feel better in the long run. Regular exercise has been shown to improve overall mood and have a positive impact on mental health conditions like depression, anxiety, and ADHD, so a morning workout is healthy not only for your body, but for your brain as well. In conjunction with the moodboosting properties of regular exercise, working out in the morning can give you a sense of accomplishment that makes the rest of the day easier to tackle. Knowing that you have already completed something challenging first thing in the morning helps everyday difficulties seem more manageable:

OCTOBER - 2018

MDMONTHLY.COM

HEALTH & WELLNESS | SAN ANTONIO

that deadline, test, or presentation that you’ve been sweating might not seem like such a big challenge when you’ve been sweating for real. Beyond that, accomplishing your workout in the morning means that you don’t have to worry about working out for the rest of the day. Especially if you’re someone who dreads exercise, getting it out of the way in the morning is a great way to free up your focus for other tasks.

starting any workout routine, whether you do it in the morning or not, is to find a fitness program that you enjoy. Getting up to work out is much easier when you are actually excited about doing your exercise. If your fitness routine has you dreading going to the gym, it will be much more tempting to get an extra half hour of sleep instead, so pick a workout that is within your skill-level and is something that is fun for you.

How to Start Your Morning Workout Habit Working out in the morning sounds great in theory, but in reality when your alarm is going off at 5:30 a.m. it can be hard to motivate yourself to get up and do a challenging workout. Luckily, there are a few ways you can find the momentum to get out of bed and start your day with some exercise.

Another great way to motivate yourself to work out in the morning is to set a short-term challenge. Telling yourself “I will go to the gym every morning for three weeks” sounds a lot more manageable than “I will go to the gym every morning.” By the time this short-term period is over, your body will be used to getting up and working out, and you may find that it has become an essential part of your day. However, if at the end of this period, you still find

The first and most important part of

getting up to work out more challenging than it’s worth, it may be time to find a workout schedule that is compatible with your internal clock. Either way, you will have completed something that makes you feel accomplished and is good for your overall health. If you can incorporate working out into your daily morning routine and can find a workout that gets you excited about going to the gym, you will quickly notice the benefits of morning exercise – not only in physical gains, but also in mood, mental energy, and acuity. Working out in the morning helps ensure that you will start your day strong and gives you the energy to tackle whatever else may come your way!

For more information visit: www.wellness4life.com

2018 - OCTOBER

MD Monthly

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

MD NEWS | REGIONAL

GENEUS HEALTH GRANTED RARE GROUNDBREAKING GENETIC PATENT By Joe Ullrich

eneus Health announced this week that after years of intensive review, they’ve completed the final process and have been issued a patent by the U.S. Patent Office, with an unprecedented twenty-two claims being accepted. Geneus Health is the only company solely focused on genetic addiction risk assessment and management. Company officials believe that with over 110 million Americans born with a genetic predisposition to addictive behaviors, this approval is the first step in curbing the national drug epidemic and saving people’s lives from drug overdoses. GARS™ is the product of over 30 years of intense research and extensive analysis of the genetic link to addiction, performed by preeminent scientist Dr. Kenneth Blum. Dr. Blum had this to say upon receiving his rare patent: "Following our seminal findings, published in JAMA in 1990, of the first gene variant to associate with severe alcoholism, thousands of studies have confirmed this discovery and identified many other DNA variants that

MD Monthly

were subsequently used to develop the now commercial Genetic Addiction Risk Score (GARS™) test for risk of Reward Deficiency Syndrome (RDS). GARS™ was the first genetic testing patent awarded since 2014 when the Supreme Court invalidated Myriad's breast cancer gene test. Our USPO GARS™ patent was issued on 9/11/18 - very exciting." From a simple cheek swab, the genetic test analyzes the genotypes and alleles most closely associated with addiction and other RDS behaviors. With striking precision, the GARS™ test reveals a comprehensive report identifying an individual’s potential risk and severity of alcohol and/or drug addiction as well as other RDS behaviors. Justin Jones, CEO of Geneus Health, said the consumer response to GARS™ has been overwhelmingly positive. “People have told us they wished they’d had this information earlier so that they could make better and healthier lifestyle decisions including issues around drug and alcohol misuse. Others say the GARS™ test results allow them to make better decisions with their healthcare

provider. Parents have especially responded well, saying the information from the GARS™ test provides them with valuable information to help them create an environment more suited for a child with a high-risk score.” Dr. Blum and Geneus Health are confident that the Genetic Addiction Risk Score (GARS™) has the unique ability to help curb our nation’s drug epidemic by preventing addiction and providing substantial therapies for a long and healthy recovery.

ABOUT GENEUS HEALTH Geneus Health, LLC is a genetic testing center located in San Antonio, TX. Our mission is to provide the powerful science and technology to improve addiction medicine and management for people everywhere. To learn more about Geneus Health, please visit us at http://www. GeneusHealth.com or call 844-800-2334. To purchase the GARS™ test, contact Geneus Health’s distribution partner at KnowNowDNA.com or call 307-274-4700.

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

INFORMED PATIENT | CORPUS CHRISTI

MD Monthly

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

EVENTS | CORPUS CHRISTI

MD Monthly

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

OCTOBER - 2018

MDMONTHLY.COM

2018 - OCTOBER

MD Monthly

OCTOBER - 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 - OCTOBER

MD Monthly

OCTOBER - 2018

MDMONTHLY.COM