Mdmonthly November - Nurse Practitioners

Living With Parkinson's Disease

BY DR. MICHAEL FUENTES

Nurse Practioners

Saggy Baggy Eyes

BY DR. MARC TAYLOR

of the Coastal Bend

“It’s a job that I love going to every day.

It’s so rewarding” - Kristy Aleman

n Compresrseios FractuTEVEN

BY DR. S CYR

OSI CENTERS Spine Center

Interventional Pain Center Neurology & Neurosurgery Center Physical Therapy Center

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The Orthopaedic and Spine Institute is located in the heart of the South Texas Medical Center in San Antonio, Texas. We are a team of physicians, surgeons and practitioners

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Dustin Deemer, PA Family Medicine Alamo Heights (210) 824-5201

Rick Schilling, M.D. Family Medicine Boerne (830) 443-9029

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Lovelesh Stacey Manocha, M.D. Anderson, NP Internal Medicine Family Medicine Downtown/Skinner Thousand Oaks (210) 224-1771 (210) 200-6744

Felicitas Gonzales, M.D. Family Medicine Thousand Oaks (210) 200-6744

Jonathan Coppin, M.D. Family Medicine Northeast (210) 653-2693

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David Schneider, M.D. Family Medicine San Marcos (512) 754-6622

Jack Wallis, M.D. Family Medicine San Marcos/ Hunter Rd. (512) 754-7700

Crystal Botello, NP Family Medicine Southeast (210) 333-0798

Salima Panjwani, PA Family Medicine Zarzamora (830) 320-4955

Mariel Baez, M.D. Family Medicine Zarzamora (830) 320-4955

Jerry Britany Kindra Lerma, NP Kelley, NP Clark, NP Family Medicine Internal Medicine Internal Medicine Castle Hills Downtown/Skinner Downtown/Skinner (210) 541-8689 (210) 224-1771 (210) 224-1771

Paula Worley, NP Family Medicine San Marcos/ Hunter Rd. (512) 754-7700

Gregory Colon, M.D. Family Medicine San Marcos/ Hunter Rd. (512) 754-7700

Blaine Carmichael, PA Family Medicine Schertz (210) 656-5600

Belmund Catague, M.D. Family Medicine Schertz (210) 656-5600

Jim Bell, PA Family Medicine Schertz (210) 200-6744

Ricardo Escamilla, M.D. Family Medicine Southeast (210) 333-0798

Sandra Guerra, PA Family Medicine Southeast (210) 333-0798

Lubna Naeem, M.D. Internal Medicine Stone Oak (210) 490-3800

Michelle Aliotta, M.D. Family Medicine Stone Oak (210) 496-2669

Marita Rios, M.D. Family Medicine Stone Oak (210) 496-2669

Luis Berrios, NP Internal Medicine Stone Oak (210) 496-2669

Jeffrey Kozak, D.O. Sports Medicine Stone Oak (210) 496-2669

Eric Francis, M.D. Family Medicine New Braunfels (830) 387-5270

Ashley Bryce, NP Family Medicine New Braunfels (830) 387-5270

Erica Ormeno, NP Family Medicine Overlook (210) 497-2338

Daisy RamirezEstrada, M.D. Family Medicine Overlook (210) 497-2338

Sanjay Kumar, M.D. Internal Medicine Westover Hills (210) 681-0126

Laura Sinclair, NP Family Medicine Westover Hills (210) 681-0126

Kiranpreet Multani, D.O. Family Medicine Legacy Oaks (210) 538-2301

Alex Bunce, D.O. Family Medicine Westover Town Center (210) 634-2234

Steven Jessica Aaron Bauer, M.D. Barrientos, PA King, M.D. Internal Medicine Internal Medicine Family Medicine Overlook Overlook Overlook (210) 497-2338 (210) 497-2338 (210) 497-2338

Reinaldo Soto, NP Primary & Occupational Medicine Pleasanton (830) 569-1104

To find a doctor, call 844-8-MY-DOCS (844-869-3627) or visit Med1st.com to schedule online.

ST R RT OK IFI E E

CE

D

10 Early Symptoms of Parkinson’s Disease Parkinson’s disease is a chronic and progressive movement disorder. Some symptoms of the disease are easy to see, while others are hard to detect.

The National Parkinson Foundation offers these 10 early warning signs of Parkinson’s disease: 1. Tremor or shaking of a body part

7. Voice becomes softer or lower

2. Handwriting becomes smaller 3. Loss of smell

8. Serious look on your face even when you’re not in a bad mood

4. Trouble sleeping

9. Dizziness or fainting

5. Trouble moving or walking

10. Stooping or hunching over

6. Constipation

No one symptom necessarily means that you have the disease, as it may be caused by another condition. However, if you are experiencing symptoms, don’t hesitate to visit your physician.

To learn more about how Corpus Christi Rehabilitation Hospital helps patients with Parkinson’s disease, call 361-906-3700.

CCRH.ERNESTHEALTH.COM

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5726 Esplanade Drive • Corpus Christi, TX 78414 • ph: 361.906.3700

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November 2017 Production Digital Media Source Chief Executive Office r Eliot Garza Digital Media Director Theresa Marie Hong Project Manager Jessie Moore Publisher Eliot Garza Managing Editor Jessie Moore Designers Meghan Goettl Yvonne Valverde Aurora Balderas Cover Designer Michael Mancha Editor Margaret Hager Writers Rudy Arispe Jody Marmel Edmond Ortiz

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Tony Adeniran Owner/Head Coach of Black Stallion Boxing Plus

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Nurse Practitioners of the Coastal Bend “It’s a job I love going to everyday.” - Kristy Aleman

Contributors Dr. Steven Cyr Dr. Michael Fuentes Leticia Morales Joy Stephenson (JD) Dr. Marc Taylor Eric Kala CFP®, CIMA®, AEP®, CLU®, ChFC®, CRPS® Contributing Photographers Trinity Greer Paul Marshall Dan Hong FOR ADVERTISING INFORMATION, PLEASE CALL 210.373.2599 OR EMAIL HELLO@MDMONTHLY.COM. FOR EDITORIAL COMMENTS AND SUGGESTIONS, EMAIL EDITOR@MDMONTHLY.COM.

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Healthy Living

When Eating Proteins Becomes Deadly

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Physicians: Get Ready for the New Tax Year with these Hot Tips by Avid Wealth Partners Provided By: Eric Kala CFP®, CIMA®, AEP®, CLU®, ChFC®, CRPS®

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By: Joy Stephenson-Laws, Juris Doctor (JD) (Proactive Health Labs)

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Informed Patient

Living with Parkinson’s Disease By: Dr. Michael Fuentes

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Informed Patient

Physical Therapy vs.

Opioids in Treating Chronic Pain By: Leticia Morales

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Informed Patient

Saggy Baggy Eyes Dr. Marc Taylor provides information on what can be done for saggy baggy eyes 2017 - NOVEMBER MD Monthly

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PHYSICIANS GET READY FOR

THE NEW TAX YEAR WITH THESE HOT TIPS Provided By: Eric Kala CFP®, CIMA®, AEP®, CLU®, ChFC®, CRPS®

he end of the tax year looms, and while many of us don’t file our taxes until March, closing out the year is vital. Now is the time, as early as it may seem, to make sure that you are meeting your financial and tax planning goals for the year.

T

Here are some tips: 1. Pay attention to the news.

Attempts to repeal the Affordable Care Act have failed and it looks like those tax surcharges will remain in place for now.

Tax reform is unlikely to affect you for 2017, but it may well affect your tax bills and planning for 2018. Tax reform may affect your ability to claim

various deductions. Speak with your tax advisor regarding some of the options being considered, and what effect, if any, these deductions would have on any estimated taxes that you are paying.

2. At the end of the year, consider deferring income. This is a juggling act. If you can avoid a higher tax bracket, do so, but if it looks like you’ll come in well under this year, but might go over next year, then consider trying to bring in more money now.

3. Do an audit with a tax professional now. What is your projected tax bill?

If you have shareholders, are you on track to meet

your promises to them? If not, you might want to try to add more doctor days.

How are your bank and student loan repayments looking? How much income do you need to put back into the practice for equipment and facilities improvement?

4. Estimate the value of your practice as it will be at the end of the year.

This will allow you to plan better for the coming year, without rushing plans in January after getting your accountant’s report.

January is often a busy time for physicians as it is the height of the flu season.

5. Consider spending down profits–again, to

potentially reduce your tax bill. Now is a great time to see if you can spend any of your profit on equipment, facility maintenance, stocking up on supplies, etc. You may even be able to pre-pay some rent. If you are planning on attending a conference, buy tickets now rather than early next year when you have less of an idea of what you will be making.

6. Also, be wary of trust scams. Physicians are often targeted with complex trust opportunities that claim to save a ton of money on taxes, but may be more hassle than they are worth and at worst, may

2017 - NOVEMBER MD Monthly

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BUSINESS/SAN ANTONIO

be a legal liability. Never put money into a trust without consulting your financial team.

Avid Wealth Partners 17802 W Interstate 10, Ste. 114, San Antonio, TX 78257 210.446.5751 AvidWealthPartners.com

Following these tips will help you and your practice efficiently manage your tax liability and improve your overall financial planning.

Now is the time to talk to your tax accountant or legal advisor about your end of year taxes.

This publication is not intended as legal or tax advice, should not be used as a basis for legal or tax advice, and is not intended to be used and cannot be used to avoid any penalties that may be imposed on a taxpayer. Financial representatives do not give legal or tax advice. Taxpayers should seek advice based on their particular circumstances from an independent tax advisor.

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 Ilmari Kala is a representative for Northwestern Mutual Wealth Management Company®, Milwaukee, Wisconsin (NMWMC) (fiduciary and fee-based financial planning services), a subsidiary of Northwestern Mutual Life Insurance Company Milwaukee, Wisconsin (NM) (life and disability insurance, annuities

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MD Monthly

NOVEMBER - 2017

and life insurance with longterm care benefits) and federal savings bank. All NMWMC programs and services are offered only by representatives operating from agency offices of NMWMC. Eric Ilmari Kala is an insurance agent of NM and Northwestern Long Term Care Insurance Company, Milwaukee, Wisconsin (long-term care insurance), a subsidiary of NM, and a Registered Representative of Northwestern Mutual Investment Services, LLC (securities), a subsidy of NM, broker-dealer, registered investment adviser, and member FINRA and SIPC. 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 United States, which it awards to individuals who successfully complete CFP Board’s initial and ongoing certification requirements.

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

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

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HEALTHY LIVING/REGIONAL

When Eating PrOtein

Becomes Deadly!

By: Joy Stephenson-Laws, Juris Doctor (JD) (Proactive Health Labs)

M

eegan Hefford was a 25-year-old bodybuilder competitor and mother of two. She seemed to be the perfect picture of health. As she prepared for an upcoming competition, Hefford visited the gym religiously and maintained a strict diet that included egg whites and protein supplements.

Hefford reportedly told her mother she had been feeling “weird” and tired. Her mother told her she should take it easy, but it was too late.

Hefford was found unconscious in her apartment and she was rushed to the hospital. She was declared brain dead and died two days later. The cause of death is believed to be due to urea cycle disorder.

So what is urea cycle disorder?

In a nutshell, it is a genetic disorder that makes it difficult for a person to metabolize the waste products of protein.

According to the National Urea Cycle Disorders Foundation (NUCDF), the disorder is “caused by a mutation that results in a deficiency of one of the six enzymes in the urea cycle.

These enzymes are responsible for removing ammonia from the blood stream. The urea cycle involves a series of biochemical steps in which nitrogen, a waste product of protein metabolism, is removed from the blood and converted to a compound called urea in the blood. Normally, the urea is transferred into the urine

and removed from the body. In urea cycle disorders, the nitrogen accumulates in the form of ammonia, a highly toxic substance, resulting in hyperammonemia (elevated blood ammonia).”

Hyperammonemia may cause brain damage, coma and death.

The severity of the diseases varies and, as a result, may go undiagnosed in some cases.

“Adults often go undiagnosed because they have mild urea cycle disorders which allow them to produce enough of the urea cycle enzymes to effectively remove ammonia until a stressor interferes 2017 - NOVEMBER MD Monthly

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HEALTHY LIVING/REGIONAL

with enzyme function, or causes massive amounts of ammonia to be produced. These adults may have subtle symptoms in their lifetime that go unrecognized or unheeded,” NUCDF reports.

In the unfortunate case of Hefford, the stressor of excessive protein intake through diet and supplements is likely what caused her death.

“Seemingly normal adults with undiagnosed urea cycle disorders may present at emergency rooms with staggering, confusion, combativeness and disorientation that is mistaken for alcohol or drug intoxication,” NUCDF says.

Along with excessive protein intake, other stressors of urea cycle disorder include the following: • Viruses • Excessive exercise or dieting • Surgery • Certain drugs including valproic acid (used to treat seizures and bipolar disorder), prednisone (a steroid) or other corticosteroids

incidence of these cases is unknown and underestimated. It is believed that up to 20% of Sudden Infant Death Syndrome (SIDS) cases may be attributed to an undiagnosed inborn error of metabolism such a urea cycle disorder,” NUCDF reports.

Newborns with severe mutations become “catastrophically ill” within 36-48 hours of birth.

How can we be proactive?

Although there is no cure, a liver transplant corrects the disorder in most cases. But getting a transplant for a vital organ is easier said than done.

Whole Genome Sequencing is an option. Discovering you have defective genes is not a bad thing. You can use this information to be proactive about hyperammonemia and take steps to avoid the consequences.

There are also some basic tests that may help diagnose urea cycle disorder. These include blood ammonia, plasma amino acids and urine organic acids. These laboratory tests measure substances that reflect how well the urea cycle is working.

How common is urea cycle disorder?

The estimated incidence, according to NUCDF, is about 1 in 10,000. NUCDF also reports the estimated incidence of urea cycle disorders is 1 in 8,500 births.

This makes it seem like this disorder is rare, but “[b]ecause many cases of urea cycle disorders remain undiagnosed and/or infants born with the disorders die without a definitive diagnosis, the exact

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MD Monthly

If you are a fitness competitor or making drastic changes to your diet, it is especially important to incorporate the above testing as well as get nutritional testing to know the levels of essential nutrients such as protein, vitamins and minerals in your body.

nucdf.org/ucd_treatment.htm.

In my opinion, the best way to be proactive about your health is to know what is going on with your body – no matter how good you look or feel.

An informed healthcare consumer is a healthy consumer. Always do appropriate research, and ask your doctor specific questions to make informed decisions about your health.

Never be afraid or intimidated to ask any questions you may have.

Enjoy your healthy life!

The pH professional health care team includes recognized experts from a variety of health care and related disciplines, including physicians, attorneys, nutritionists, nurses and certified fitness instructors. This team also includes the members of the pH Medical Advisory Board, which constantly monitors all pH programs, products and services. To learn more about the pH Medical Advisory Board, visit http://phlabs.com/Health-CareProfessionals.

Joy Stephenson-Laws is the founder of Proactive Health Labs (www.phlabs.org), a national nonprofit health information company that provides education and tools needed to achieve optimal health.

Her most recent book is Minerals: The Forgotten Nutrient: Your Secret Weapon for Getting and Staying Healthy, available through Amazon, iTunes and bookstores.

To learn more about treatment options for urea cycle disorder, including supplements for removal of ammonia from the bloodstream, visit http://www.

NOVEMBER - 2017

MDMONTHLY.COM

Nurse Practioners OF THE COASTAL BEND

Kristy Aleman

NURSE PRACTITIONER, ADDS EXTRA LEVEL OF CARE

M

By: Edmond Ortiz

ore and more Americans are seeing nurse practitioners.

Nurse practitioners are defined as advanced practice registered nurses trained to diagnose and treat acute and chronic conditions, and to promote health maintenance and disease prevention. It is a profession that is becoming increasingly critical as areas of the healthcare sector see shortages of physicians and other provider roles.

From two sides, Kristy Aleman has first-hand knowledge of the importance of a care provider who

offers an additional level of medical support. While going through college, the stepfather of her then-husband was diagnosed with lung cancer and underwent a lobectomy. The stepfather was thought to be in remission but began experiencing headaches. Soon afterwards, it was discovered that the lung cancer had metastasized to his brain. He died from resulting complications.

Recalling that part of her life, Aleman said she wishes there could have been another level of health care on which to lean. Perhaps then, she felt, the diagnosis of the metastasized

PHOTOGRAPHY BY Paul Marshall 2017 - NOVEMBER MD Monthly 17

cancer could have been made sooner.

“There is a shortage of primary care providers,” Aleman said, looking at the overall scheme of things.

She added that more physicians are going into specialty healthcare, leaving something to be desired in the providing of general preventative care. “There are usually precursors for major illnesses,” Aleman said. “Maybe if you see something in the initial examination, you can really help.”

Aleman has been motivated to be the best nurse practitioner that she possibly can be. The Port Lavaca, Texas native received her aassociate’s degree in nursing in 2004 – beginning her nursing career. She then earned a Master of Nursing degree from Texas A&M University-Corpus Christi in 2008, and a master’s degree in nursing as an acute care nurse practitioner from Texas Tech University in 2013. She has accumulated experience in emergency medicine, intensive care, medical surgery, and cardiac care and geriatric care.

Aleman currently works at Sun + Surf Medical Clinic in Corpus Christi.

“We (the nurse practitioners) have had years of training, and we’re providing didactic and clinical care.

It’s really the gateway to care,” she explained.

The aforementioned extra level of health care that a nurse practitioner is able to provide has been a proven lifesaver time and again. Aleman knows this all too well. This September, Aleman saw a patient who was seeking prescription refills at the clinic. While there, the woman asked Aleman to take a glance at a growth on her neck.

Aleman ordered an X-ray. When the results came back, something seemed off. “I still didn’t feel comfortable with the read,” she recalled.

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MD Monthly

Aleman ordered a CAT scan, which began to show not only more of the initial mass in the woman’s neck, but revealed other masses, too. A follow-up PET scan further showed the extent of the cancerous masses that had spread. Aleman next got a general surgeon involved.

Aleman said this demonstrates how vital it is to have a nurse practitioner to help offer support that may otherwise be lacking in some places. “We’re not trying to replace the primary care provider, we’re just trying to get the patient access to the care they need,” she added. Aleman has made an effort to extend the preventative care aspects of her job to more of the community, through entrepreneurial ventures.

In early 2015, Aleman opened Halcyon Med Spa and Wellness Center in Corpus Christi. Halcyon was a way for Aleman and her colleagues to provide state-of-the-art aesthetic care. At Halcyon, Aleman conveyed a message of strength and compassion to patients who want to feel beautiful both inside and out. “It’s not purely for aesthetics,” she added. Aleman has since sold Halcyon, and now is preparing to open a new medical spa in a smaller location in the area.

In 2016, Aleman launched Raw Bar, which offers the Corpus Christi community a range of tasty smoothies, juices, breakfast, and lunch options made with organic ingredients that are boosted by essential vitamins and nutrients. “It was about promoting healthy eating, healthy choices,” Aleman said. “It was about cutting out red meat, starches and sugars. Some sugars are good, but we don’t add sugar or artificial sweeteners.”Aleman practices what she preaches, maintaining an active lifestyle that involves being a marathon runner, Tough Mudder competitor, and a mother of two.

A second Raw Bar location recently opened up, and Aleman has shifted her entrepreneurial duties by franchising Raw Bar. She still handles the company’s marketing, visits the locations and approves menu items, ensuring that they stick to Raw Bar’s ideals. But Aleman plans to remain a nurse practitioner for the long haul. She sees a bright future for her career field.

According to a Forbes Magazine article in June, nurse practitioners are becoming more in demand than most types of physicians, as states have begun to allow patients to have direct access to these increasingly popular health professionals. Nurse practitioners ranked fourth among traditional health care providers recruited for jobs, according to the latest annual analysis of the U.S. healthcare industry from a review by Merritt Hawkins.

There are some regulatory barriers for those who wish to practice independently of a delegating physician. Texas state lawmakers in the last legislative session examined proposals that would have done away with prescriptive authority agreements—contracts between nurse practitioners and “delegating” doctors.

Supporters of the bills, which did not get far in the legislature this year, said a regulatory fix would incentivize nurse practitioners to stay in Texas, particularly in rural and low-income communities where they are the primary care providers.

In spite of stress and long hours, Aleman enjoys the work immensely.

“It’s a job that I love going to every day. It’s so rewarding,” she said.

“There are family members who are so thankful that I’ve found what was wrong with their loved one. What I did was help them keep looking for the answers.”

NOVEMBER - 2017

MDMONTHLY.COM

Patrick Ayarzagoitia

Patrick Ayarzagoitia was born and raised in Robstown, Texas. He worked for local television news organizations before moving to San Antonio, then Houston, and eventually to Los Angeles. As a photojournalist, Patrick traveled extensively. While working for Telemundo, he was proud to have won an Emmy award for best news documentary.

A few years later, Patrick and his wife, Maria, a registered nurse (RN), moved back to San Antonio and she inspired Patrick to return to school to also become an RN. He began as a volunteer and went to San Antonio College for his twoyear nursing degree.

They moved to Corpus Christi to be closer to family and Patrick worked at CHRISTUS Spohn Shoreline and Memorial emergency rooms (ERs).

But, he wanted to do more and entered the Family Nurse Practitioner (FNP) program at Texas A&M

University–Corpus Christi (TAMUCC).

Patrick worked at CHRISTUS Spohn Memorial Medical Trauma Center in the ER while graduating with a master’s degree in 2011. He enrolled in the Doctor of Nursing Practice program at the University of Incarnate Word in San Antonio and graduated in 2013.

Patrick began to serve as clinical adjunct faculty in 2013 for TAMUCC. He discovered that teaching was a passion of his and he was hired as an assistant professor in the FNP program.

He is currently working as a FNP with Statcare Urgent Care clinic and with EmCare. Patrick founded Education for Advanced Practice which provides seminars, review courses and hands-on training for nurse practitioners and FNP students.

Patrick has been blessed with his beautiful wife of 25 years and together they have three wonderful children.

Rudolfo DeLeon

Rudolfo DeLeon has been working in the medical field since the age of 19. He served in the United States Navy for nine years as a hospital corpsman and respiratory technician and received an honorable discharge.

For an additional four years, Rudolfo worked as a respiratory therapist while working towards becoming a registered nurse (RN).

service, for two years.

As an RN, he worked in the Emergency Room at Spohn Memorial Medical Center for seven years. One of the highlights of Rudolfo’s career was working with Halo Flight, a nonprofit helicopter emergency medical

He and his wife Kim have six wonderful children whom they love dearly–Rudee III, Mario, Monica, Taylor, Olivia, and Erik.

He graduated from Texas A&M University–Corpus Christi (TAMUCC) and worked for all of the local emergency rooms until he opened his first clinic. Rudolfo is the owner of Sun Surf Medical Clinic on Padre Island, and Coastal Clinic in Portland, Texas.

2017 - NOVEMBER MD Monthly

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Gillian Cox

Gillian Cox grew up in Walpole, New Hampshire–the proud daughter of a local volunteer fire fighter and an Emergency Medical Technician (EMT).

At a young age, Gillian responded to emergencies with her parents and became enamored with their service to and compassion for those in need.

Gillian attended the University of New Hampshire and obtained her Bachelor Degree in Kinesiology Athletic Training. She then attended Delmar College to attain her Associates Degree in Nursing while working at the Spohn Shoreline Emergency Room as a Nurse Tech. She has gone farther and attained a Master’s Degree in Nursing at Texas A&M University–Corpus Christi (TAMUCC) in 2013.

Upon completion of the Family Nurse Practitioner (FNP) program, Gillian applied for jobs in the

emergency field and proudly serves as a nurse practitioner in several emergency rooms in the area.

Gillian has maintained her EMT and firefighter certifications since her teenage years. She serves as a volunteer firefighter with the Rockport Volunteer Fire Department. Gillian was one of the firefighters who evacuated during Hurricane Harvey and returned the following month, with helpers, to get the fire department and town back on their feet.

She spent the next month away from work while she served in the voluntary capacity of logistics coordinator for all fire department resources coming into Rockport.

Gillian is proud of her two amazing children and her husband, a local sheriff’s deputy.

Heather Kostoff

Heather Kostoff was born in Great Lakes, Illinois and because her father was in the Navy, the family traveled to different bases throughout the United States and abroad.

She graduated from Texas A&M University–Corpus Christi (TAMUCC) with a Bachelor of Science in Nursing (BSN) in 2003 and continued her studies there. Heather received her Master of Science (MSN) in 2006.

Immediately after graduation, she worked for a minor emergency room and taught for the university in the BSN program until she took a fulltime position in a pediatric practice.

After working in pediatrics for over a year, Heather went back to working with an internal medicine practice and she has been working in this specialty 20

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for almost ten years. She is currently practicing with Dr. Antonio Guzman.

During the past decade, Heather has continued to work as weekend coverage for minor emergency rooms and clinics to keep up with her pediatric and urgent care skills.

Heather is still working with TAMUCC as a graduate adjunct clinical faculty member, and in addition, she has been a preceptor for Nurse Practitioner students from many different universities.

Heather is married and has two wonderful children. In her spare time, she enjoys going to the various sporting events at St. John Paul II High School, as well as volunteering during these sporting events.

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Hugo Lopez

Since 1993, Hugo Lopez has been contributing to the Coastal Bend healthcare community. After completing a certificate program at Del Mar College as an Emergency Medical Technician (EMT), he earned an associate degree as a licensed EMS-Paramedic in 1995. In 2000, he became a registered nurse. Hugo assumed a prestigious position with HALO-Flight Air Ambulance in 2001, supporting the safe transport of sick and injured patients within the Coastal Bend and surrounding areas.

During this time, he also worked as a critical care nurse at CHRISTUS Spohn Hospital in the cardiovascular intensive care unit (ICU) where he used his experience in critical care and expertise in hemodynamics (the dynamics of blood flow), emergency care and trauma to teach fellow

nurses and nursing students. Hugo is a regular guest speaker at invitational programs reinforcing theories of critical care, counter-pulsation therapy and hemodynamics.

He completed the Masters of Science in Nursing-Family Nurse Practitioner (MSN-FNP) program at Texas A&M University–Corpus Christi (TAMUCC).

Hugo has been a FNP at The Doctors Center Urgent Care (Calallen) since 2014 and teaches at CHRISTUS Spohn Hospital, Del Mar College, TAMUCC, and at local conferences.

Most recently, Hugo was accepted into the Doctor of Nursing Practice program at TAMUCC. He is thankful for his wonderful wife Kara and his three beautiful children. Hugo is an avid movie enthusiast and enjoys spending time with his family and friends.

Martha Moon Martha Moon was born and raised in West Texas. She graduated from Texas A&M University–Corpus Christi (TAMUCC) and received her Bachelor of Science in Nursing (BSN) in 1992. Eventually, Martha wanted to go farther and she received her Masters of Science in Nursing (MSN) from The University of South Alabama, Mobile in 2003. Becoming a Family Nurse Practitioner (FNP) opened a few more doors for her.

In Houma, Louisiana, Martha practiced in both internal medicine and emergency medicine. Since 2005, she has lived in Corpus Christi and her focus has been in occupational medicine, urgent care, and emergency medicine. She has practiced occupational medicine since 2010.

Martha is the present owner of the Onsite Occupational/Wellness clinic at Kane Beef LLC. She recently teamed with Occucare International in Portland, Texas. Helping others for over 25 years in various medical specialties has been rewarding for her patients and for herself.

Martha has been married for 23 years to her husband Bill, and they have a daughter Emma, who is 16 years old. Martha enjoys snow skiing and playing tennis in her spare time. Martha is extremely grateful for the opportunity to help care for the work force of South Texas as she witnesses the enormous industrial growth unfolding in the surrounding area.

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Pradeep S. Mohan M.D.

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OP-ED/SAN ANTONIO

How a Naval Corpsman DROPPED ANCHOR ON A

Medical Career Special to MD Monthly

W

hen Josue Medina, MD was growing up in El Paso, he dreamed of going to college and of seeing the world beyond his Texas border town. “I knew since I was eight years old that I wanted to be a doctor, but my parents didn’t have the resources to pay for college. A career in the Navy helped me get there,” Dr. Medina, a partner in San Antonio’s Medical Vein Clinic, stated.

from the class “A” school, he had choice: become an X-ray tech or a pharmacy technician. Ironically, the man who now makes his living in radiology performing image-guided procedures, chose the latter. “With plans to become a doctor, I thought I needed to understand the ‘drug part’ of the equation,” Medina said.

His choice to focus on pharmacy while enlisted would also impact his life on a personal level. More on that, later . . .

Fresh out of high school he joined the Navy. His parents signed a waiver for him to enlist, as he was only 17. Following boot camp in Orlando, Dr. Medina trained to be a medic at the Hospital Corpsman School in San Diego. When he graduated

Stationed at hospitals in San Diego and Portsmouth, Virginia during his six years in the Navy, Dr. Medina didn’t ever get out of port. But what he learned from his service, he credits for getting him where he is today. “I wasn’t the best student in high school—I lacked discipline and maturity,” he

reflected. “The military helped me improve myself in those areas.”

When Dr. Medina received his honorable discharge from the Navy, he went to college–full speed ahead. The Navy College Fund and the GI Bill, along with a special Texas offering for former military personnel, made university studies a reality for him. At Texas A & M he majored in biochemistry, and following graduation, he attended medical school at Texas Tech School of Medicine in Lubbock. Medina’s radiology residency studies later took him to the University of Tennessee in Knoxville. “Tennessee and Texas have close ties with Davy Crockett and the Alamo, right?” Dr. Medina laughed.

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in early 2017, recruited by Medical Vein Clinic’s founder and business partner, John S. Hogg, MD. “I spent two years going around the United States, working with the top doctors and doing image-guided procedures to treat venous insufficiency,” Dr. Hogg said. “When I performed procedures alongside Dr. Medina, his skills, knowledge, ethics, and how he cared for his patients, were so impressive. I knew I wanted him to be a part of this clinic in San Antonio.”

Dr. Medina, now 41, appreciates his time in the military for many reasons. “It taught me to pay attention to everything I was doing, have goals in mind, and to work together with a team.” The values military veterans share, also make for great co-workers on the civilian side, Dr. Medina believes. He recruited other vets to senior positions at 24

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the clinic, including 20-year veteran David Velez, the practice’s manager, and Nate Galindo who serves as the clinic’s senior Physician Assistant.

The military has greatly enhanced his personal life as well. While a naval pharmacy technician in San Diego, he met fellow technician, Elvira. They dated for four years until he went back to Texas to college. Life went on. She married and had a daughter.

Dr. Medina got busy with his medical career. Twelve years later, they rediscovered each other on Facebook.

By that time she was single again.

The two of them reconnected offline and are now married. “I am so thankful for all the opportunities the military gave me,” Dr. Medina smiled.

For more information about Medical Vein Clinic, please call 210-622-8000 or visit www.medicalveinclinic.com.

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Altus Hospice: When the Curing Stops, the Caring Begins Because Every Minute Matters

By Rudy Arispe

I

n October 2016, Laura Hunt’s 52-year-old husband, Randall, was diagnosed with colon cancer, which then spread to his stomach. The diagnosis resulted in a referral from their oncologist to Altus Hospice.

“Altus offered us 24/7 nurse care via telephone, as well as daily nurse visits,” Hunt said. “They provided a thorough explanation of how the whole process would work.

They also provided all medications and equipment, and answered our questions and concerns. I wanted to move my husband to our home, and on a Sunday afternoon Altus helped with the smooth transition.”

Since 2007, Altus Hospice has offered compassionate care, and much more, to families whose loved ones are nearing the end of life.

November is Hospice and Palliative Care Month, which the National Hospice and Palliative Care Organization declares annually.

“This year’s theme is ‘It’s About How You Live,’ which Altus Hospice Care has thoroughly embraced,” explains Jessica Taylor, Vice President of Sales and Marketing.

“We believe it’s not about how long you have to live, rather about quality of life at the end of life,” she said. “Our focus is on the things we can do for our patients and their families. For us, we believe that when the curing stops, the caring begins. We know it’s the little things that mean a lot to patients and families.”

his family had one last picnic by the pond.”

For retired Air Force Colonel J.D. Tindall, Altus Hospice became an integral part of his family’s life when the agency began caring for his wife, who suffered from Alzheimer’s. “I took care of her at home as long as I could, but when her situation worsened I had to seek help,” he said. “Altus stepped right in without hesitancy.”

We believe it’s not about how long you have to live, rather about quality of life at the end of life, - Jessica Taylor One of the things that struck Tindall about working with Altus is the immediate rapport that he and their staff established. So much so, the colonel recalled, that he chose an Altus chaplain to give the sermon at Jane Tindall’s funeral after she passed away on October 23, 2016 at age 80.

“Every Altus hospice team member was very helpful and their level of expertise was apparent. The

benefits and support they provided were remarkable,” Tindall said. “Altus Hospice managed all of my wife’s care and met all of her medical needs at the end of her life.”

With locations throughout South Texas, Altus offers four levels of care, including routine home care, general inpatient care, inpatient respite care and continuous care. Services range from nurse visits, bereavement services, a social worker to assist with community resources, family relief help to prevent caregiver fatigue, and spiritual support services from a chaplain.

The Rev. Susana Beltran of Altus Hospice said that faith-based, spiritual support is essential for the dying and their families. “It completes the whole care of the client and their family,” she said, “and without spiritual support the patient is not at peace.”

Beltran, who has been a hospice chaplain for more than 17 years, and most recently with Altus, experienced the Altus philosophy and compassionate care plan firsthand prior to her mother’s death about six weeks ago.

“I truly got to see the Altus staff in action with my mom,” Beltran said. “The certified nursing assistants (CNAs) were wonderful.”

Taylor added that Altus staff truly listens to the concerns that families have, and this care is extended to helping fulfill final wishes. “We had a rancher under our care,” she said.

“More than anything, he wanted to ride around his land. It was a supreme effort to get him into the car due to his frail condition, but we did it and he and PHOTOGRAPHY BY Trinity Greer 2017 - NOVEMBER MD Monthly 27

“The basis of this initiative,” Taylor added, “is to provide a disease-specific approach to end-of-life dementia patients, set a higher standard of care, and provide a more advanced level of support to the family/caregivers. In addition to the interdisciplinary team members (IDT), team meetings will be attended by a physician who is also specialized in dementia care and credentialed through the Alzheimer portal.

“This approach will provide a higher degree of disease-focused care that for this increasing patient population is not being delivered by other hospice agencies in many of our service areas,” she said.

Beltran is also part of Altus’ dementia and Alzheimer-focused team known as DASH (Dementia & Alzheimer Specialty Hospice Team). Through extended training, DASH team members will become better qualified to adequately and appropriately meet the needs of these patients and their caregivers.

Incidentally, November is National Alzheimer’s Disease Awareness Month, which was designated by President Ronald Reagan in 1983. At the time, less than 2 million Americans had Alzheimer’s. Today, the number of people with the disease has increased to nearly 5.4 million, according to the Alzheimer’s Association.

Meanwhile, DASH team members that include a registered nurse, social worker, chaplain, aide and volunteer coordinator, are required to become credentialed through the Alzheimer Organization training portal and become Cares Dementia Specialists (CDS).

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Beyond the scope of patient and family care, this initiative will also provide opportunities to partner in facilities and in the community to provide education, including caregiver support, pre-bereavement support and Alzheimer’s support groups.

Facilitators for Alzheimer’s support groups are certified with additional training through the Alzheimer’s Association. Dementia-specific volunteer programs defined by the Alzheimer’s Organization will be implemented, including an Alzheimer’s Speakers Bureau staffed by volunteers and team members.

“One of the biggest misperceptions of hospice care,” Taylor said, “is that it is a last resort when ‘nothing else can be done.’

seven days or less, according to the National Hospice and Palliative Care Organization’s 2015 Facts and Figures.

“Until families see firsthand how big of a difference hospice care can make in keeping their loved one comfortable and enjoying the best quality of life possible, they don’t understand all the advantages we can provide,” Taylor said. “Unfortunately, most people associate hospice only with dying – instead of living more fully during the time that remains – and they avoid engaging with a hospice program as early as they should.

“Not getting their loved one enrolled in hospice care sooner is a consistent regret that Altus hears from families when evaluating their hospice experience,” she added. “Hospice focuses on caring, not curing. Hospice care is provided in the patient’s home but may also be provided wherever the patient lives, including assisted living, nursing homes and other long-term care facilities and, in some cases, free-standing hospice facilities and hospitals.”

For Laura Hunt, she is grateful that her husband spent his final days in the comfort of his own home. She is also appreciative for all the support that Altus provided. “To this day, they call to check up on me,” she said.

For more information, visit www. altushospicecare.com.

“Hospice care doesn’t mean that treatment stops,” she said. “It means the types of treatment and goals of care change to managing pain and symptoms while helping patients reach their goals by doing the things they enjoy and spending quality time with their families.”

Among more than 1.6 million Americans who received hospice services, 50.3 percent were on hospice care for 14 days or less while 35.5 percent received care only

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

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

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INFORMED PATIENT/CORPUS CHRISTI

LIVING WITH

Parkinson’s Disease By: Dr. Michael Fuentes

P

arkinson’s disease is a chronic and progressive movement disorder. One of the first steps to living with the disease is to understand it.

When an individual has Parkinson’s disease, vital nerve cells in the brain – called neurons – malfunction and die.

Some of these dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls the body’s movement and coordination. The amount of dopamine decreases as Parkinson’s disease progresses, which causes it to be difficult for an individual to control his or her body’s movements.

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In the United States, more than 1 million people live with Parkinson’s disease, with symptoms varying from person to person. Some symptoms of the disease are easy to see, while others are hard to detect. Symptoms often begin on one side of the body, but eventually will affect both sides as the disease progresses. Signs of Parkinson’s disease can include: • • • • • •

Tremors or shaking of a body part Slowness of movements Difficulty with walking or balance Muscle stiffness or rigidity Voice softening or slurring of words Loss of automatic movements such as eye blinking or smiling

• Handwriting becomes smaller • Stooping or hunching over While there is no known cause or cure for Parkinson’s disease, individuals can take an active role in their health care to help control symptoms and manage the disease.

Research has shown that a combined focus on medication management and intensive rehabilitation in an inpatient rehabilitation setting can dramatically improve function and quality of life in individuals with Parkinson’s disease.

An individual treated through an inpatient rehabilitation facility is

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offered the latest in rehabilitative technology and a multi-disciplinary approach that provides the expertise of numerous healthcare professionals including physicians, physical therapists, occupational therapists, speech pathologists, dietitians, pharmacists, case managers, nurses, and more. Members of the healthcare team work with the individual, family members, and his or her physician to develop a customized plan of care to meet needs and goals.

The treatments provided by the multidisciplinary team can address a number of issues, including: • Medication management • Muscle tone/tremor management

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• • • • • • • • • • • • • • • •

Balance Walking difficulty Speed of movements Fatigue and endurance Use of adaptive equipment Swallowing Deep brain stimulator monitoring Posture Impaired memory, problemsolving, and behavior Communication Self-care skills, such as feeding and dressing Bowel and bladder training Depression management Education on fall prevention and home safety Voice and speech impairments Range of motion, trunk mobility, rigidity reduction

Members of the healthcare team remain aware of each other, communicate regularly, and coordinate treatments and medications to allow for the best possible outcome.

If you would like to learn more about Parkinson’s disease treatments available at Corpus Christi Rehabilitation Hospital, call 361-906-3700.

Dr. Michael Fuentes is the Medical Director of Corpus Christi Rehabilitation Hospital. For more information, visit ccrh.ernesthealth. com, call 361-906-3700, or visit the hospital at 5726 Esplanade Drive, Corpus Christi, Texas 78414.

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Honoring our American Heroes Veterans Day Special with CommuniCare Health Centers

By Jody Marmel

In honor of Veterans Day, MD Monthly salutes CommuniCare Health Centers and these five outstanding physicians. With diverse backgrounds and a wealth of knowledge, experience and a commitment to excellence, each of these doctors has served our country in different capacities and they continue to do so by utilizing their superior skills to enhance our medical community.

Carlos E. Moreno, MD, MBA Dr. Carlos E. Moreno is an accomplished bilingual professional with over 27 years of experience in the fields of biomedical research development, academia and healthcare administration. Collective Impact work of communities is an area of great interest to him and he has acted as a liaison with state, county and city government elected officials as well as state representatives to address health disparities of communities. He received his doctorate degree in medicine and surgery from the medical school in the Dominican Republic and a Master of Business Administration degree from the University of Texas at San Antonio.

Dr. Moreno joined the Medical Brigade of the Texas State Guard/ Texas Military Forces in 2006 and served for 10 years. The Brigade is a public health augmentation force deployed in preparation for, responding to, and recovering from natural and man-caused disasters and mass-casualty events such as hurricanes and tornadoes. Dr. Moreno served as a Staff Officer in the Brigade’s First (Alamo) Company.

His expertise in clinical medicine, epidemiology, public health and administration and as a director of a rural community health center contributed greatly to the readiness and effectiveness of the Brigade.

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Uchenna Lizmay Umeh, MD Dr. Uchenna Lizmay Umeh is originally from Nigeria, the first of six children in a family from the “Igbo” tribe of Southeastern Nigeria. In 1991, She completed her medical school at Ahmadu Bello University Hospital, Kaduna state, Nigeria. She moved to the United States in 1994 to begin her Pediatric Residency program at Howard University Hospital in Washington, D.C. Soon after completing her residency in 1998, she moved with her then-young family to the Carolinas, where she started her own pediatric practice–Children First Medical Center–in Lancaster, South Carolina.

In 2012, she sold her practice and joined the United States Air Force, moving with her three sons to the state of Texas, where she was stationed at Joint Base San Antonio, Lackland as a Lieutenant Colonel, and medical director of the ambulatory pediatric clinic.

A proud disabled veteran, she served four years in the United State Air Force and joined the CommuniCare family in 2016, where she has happily found her niche as a staff pediatrician.

She loves dancing, poetry and kickboxing, but on any given day, you might find her on the River Walk, in her garden, or (most recently), at the John Peace Library at the University of Texas at San Antonio, studying for her Master of Business Administration degree.

PHOTOGRAPHY BY Trinity Greer 2017 - NOVEMBER MD Monthly 35

Ignacio A. Chaves, MD Dr. Ignacio A. Chaves served in the United States Air Force for 35 years as a General Surgeon. His duty assignments included: Vietnam, during the Vietnam War; Fort Leonard Wood in Missouri; The Azores in Portugal; Clark Air Force Base in the Philippines; Minot Air Force Base in North Dakota; Plattsburgh Air Force Base in New York–where he served as Hospital Commander, General Surgeon and Flight Surgeon; Incirlik Air Force Base in Turkey–where he served as their Hospital Commander and General Surgeon; and Randolph Air Force Base in Texas–where he was a Senior Medical Member of the United States Air Force Disability System. Dr. Chaves received military awards during his time of service including the Legion of Merit, Bronze Star, Meritorious Service, National Defense, and the Vietnam War Campaign awards. He retired honorably in the rank of Colonel.

After an esteemed military career, Dr. Chaves has enjoyed returning to patient care and using his skills to help improve the health of the San Antonio community. He joined CommuniCare Health Centers in 2007 where he has practiced as a General Practitioner. Due to his leadership background, he has served as lead clinician at various centers in the CommuniCare Health System. He is a servant of the community and strives to help with the medical needs of all the patients within in communities he serves.

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Jeffrey Henderson, MD Dr. Jeffrey Henderson earned his medical degree from the University of Texas Medical School in Houston with the assistance of the Health Professions Scholarship Program through the United States Army Reserve. As a physician, he continued his training toward board certification via a pediatric residency program with the San Antonio Uniformed Services Health Education Consortium. He was then assigned to the 168th Medical Battalion in Daegu, South Korea where he served both active duty service members and their families.

During his time in the service, Dr. Henderson was awarded numerous medals including the Meritorious Service Medal, Army Achievement Medal, Army Superior Unit Award, National Defense Service Medal, Global War on Terrorism Medal, and Korean Defense Service Medal.

After five years on active duty, he transitioned to a private practice pediatric clinic in Boerne, Texas, where he has continued to work, now as a member of CommuniCare.

Through training and practice, both in and out of uniform, Dr. Henderson credits the Army with being the positive and formative force in making him into the compassionate and dutiful pediatrician that he is today.

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Maria TiamsonBeato, MD Dr. Maria M. “Maggie� TiamsonBeato graduated from Santo Tomas Medical School in Manila, Philippines prior to completing her Residency in Pediatrics at Mount Sinai School of Medicine New York City, New York.

Upon completion of her residency, she had a short stint in private practice before she joined the United States Air Force Medical Corp. While in the Air Force she served as a Flight Surgeon, and practiced Family Medicine and Pediatrics, eventually retiring as a Colonel. After serving in the United State Air Force, she returned to private practice.

Dr. Beato is an active member of the Bexar County Medical Society, having served on the Board of Directors, as a Treasurer, then as Secretary. Additionally, she is a member of the San Antonio Pediatric Society, the Texas Medical Association, the American Academy of Pediatrics, the Association of Air Force Reserve Flight Surgeons, the Texas Medical Association, and the American Academy of Pediatrics. She is also a Clinical Associate Professor at The University of Texas Health Science Center of San Antonio.

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INFORMED PATIENT/CORPUS CHRISTI

PHYSICAL THERAPY VERSUS

OPIOIDS IN TREATING

Chronic Pain By: Leticia Morales

M

any of us have experienced the nuisance of a minor pain. If allergies cause a sinus headache, a decongestant can help. If you have an aching back from a weekend spent doing yard work, ibuprofen may do the trick.

But what about those who suffer from chronic pain that lasts longer than six months?

No one wants to live in pain, but we also have to be careful not to put our health at risk to be pain-free.

When used properly, certain drugs – such as opioids – can help relieve pain. But, they can be dangerous if misused or abused.

Americans have increasingly been prescribed opioids such as Vicodin, OxyContin, Opana, and methadone, and combination drugs such as Percocet to help relieve pain.

The use of these prescription drugs has quadrupled since 1999 although there hasn’t been an increase in the amount of pain Americans report. In 2012, health care providers wrote 259 million opioid prescriptions – enough for every adult in the United States to have a bottle of pills. According to data collected by the Centers for Disease Control and Prevention (CDC), as many as 1 in 4 people who receive prescription opioids long-term for non-cancer pain in a primary care center struggles with addiction.

When taken as directed, opioids can manage pain effectively for

a short amount of time. But with long-term use, there is a possibility it can lead to physical dependence or even an addiction disorder. Along with addiction, opioid risks include depression, overdose, and withdrawal symptoms when usage is stopped.

In response to a growing opioid epidemic, the CDC released opioid prescription guidelines last year recognizing that opioids are appropriate in certain cases such as cancer treatment, palliative care, endof-life care, and in certain acute care situations – if properly dosed. But for other pain management, the CDC recommends non-opioid alternatives such as physical therapy to cope with chronic pain.

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effective way to treat long-term pain. Physical therapists can provide evidence-based treatments that not only help treat the pain, but the underlying cause of the pain. They can play a valuable role in educating patients about alternative options and setting realistic expectations for recovery without opioids.

While it may feel counterintuitive, the more a person who has chronic pain moves, the better he or she will usually feel. One of the goals of physical therapy is to help patients suffering with chronic pain become stronger because they’re usually weak from lack of movement. A physical therapist will work with a patient – typically as part of a medical team -- to understand the pain and what’s causing it. This allows the therapist to determine how best to treat and manage it.

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Physical therapy can help decrease pain, increase mobility, and improve overall mood. There are a number of ways that a therapist can help a patient manage pain.

These can include low-impact aerobics, massage, stretching, use of modalities such as ultrasound and electrical stimulation, strengthening exercises, movement therapy, and other types of exercises, depending upon individual abilities.

Therapeutic treatments are designed to help a person increase muscle strength, endurance, joint stability, and flexibility. In addition, physical therapy aids in reducing inflammation, stiffness, and soreness.

It encourages the body to heal itself by boosting the production of the body’s natural pain-relieving chemicals.

Overall, when it comes to chronic pain, physical therapists can often help people move safely and functionally in ways that they haven’t been able to for a while. So in my opinion, it’s wise to consult with your physician to discuss your options for a non-opioid treatment before agreeing to an opioid prescription for chronic pain.

Leticia Morales is Director of Therapy Operations at Corpus Christi Rehabilitation Hospital. The hospital provides specialized rehabilitative care to patients recovering from disabilities caused by injuries, illnesses, or chronic medical conditions. It is certified nationally by The Joint Commission for Stroke Rehabilitation.

For more information, visit http://ccrh. ernesthealth.com/, call 361-906-3700, or visit the hospital at 5726 Esplanade Drive, Corpus Christi, Texas 78414.

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Dr. Francisco G. Cigarroa H

aving a conversation with Dr. Francisco Cigarroa is like experiencing a breath of fresh air. His personality combines a refined intellect, a wealth of experience and a commanding vision towards our future with a profound appreciation of our past, all of which he has fortunately shared with the medical community throughout Texas over the last two decades. Those who know him, quickly realize that Dr. Cigarroa firmly believes that everything is possible; in fact, the word impossible does not exist in his lexicon. Listening to his captivating conversation, made that word disappear within moments even from my own perspective as I appreciated Dr. Cigarroa’s unique persona and the calming effect he has in helping restore hope in the future.

He is truly a rare gem not only to his profession, but also to his family, friends and our community at large.

In interviewing Dr. Cigarroa, I questioned him about his formative years, curious to know more about how he became the person he is today. He recounted how early on he was greatly influenced by stories from his family history, starting with that of his great-grandmother, Rebecca Iriarte Gonzalez de la Vega and the decision she made when she was widowed, with five children to raise, in Mexico City during the Mexican Revolution of 1910. Uncertain as to how she would support her children in a time when women in Mexico City were not even allowed to voice their opinions, her mother-in-law advised her to put her children to work . . . one as a shoemaker, another as a 42

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Making Generations of Dreams Come True

By Jody Joseph Marmel

street vendor, and so forth. Mama Rebecca replied, “I’m sorry, but my husband had a professional career as an attorney. I am going to be the one to go to work to support my family so that my children can aspire to become professionals like their father.” (A Mexican Dream, Cigarroa, 2016). Having made this decision, Rebecca sold tamales, made chocolates, taught piano and art, and served as a seamstress.

Moreover, she opened her house as a boarding house for students who attended the Universidad Autonoma de Mexico (UNAM). As a result of this decision to earn enough money to insure that her children received a good education, they thrived and each one became extremely successful.

Her eldest son, Angel, became Deputy Attorney General and then a Supreme Court Justice in Mexico; Manuel founded the Department of Chemistry at UNAM; Salvador was an eminent surgeon; and her youngest, Francisco (Dr. Cigarroa’s Godfather) was a Professor of Law, Majority Senate Leader, Governor of Durango, Ambassador to Argentina and to Portugal, and the author of Mexico’s Penal Code. Josefina, Rebecca’s only daughter (Dr. Cigarroa’s grandmother), who was uprooted from Mexico

City after the Revolution of 1910, envisioned and helped establish the Cigarroa Clinic in Laredo, Texas where she worked every day of the rest of her life up until she was in her nineties. Dr. Cigarroa adds, “She loved every moment of serving the people of Laredo.”

Dr. Cigarroa explains, “Mama Rebecca’s decision profoundly affected the next generation and generations after that in our family.”

Her decision, he explained, was founded on the importance of education for her children’s future . . . a value that has inspired generations from their family to reach their potential in order to better their families and their communities.

He also provided many more details of this fascinating story.

“When Mama Rebecca made the decision to open her house to boarding students, who came along?

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Not only Dr. Joaquin, but his sons and daughters became exemplary physicians and leaders in South Texas and beyond.

My grandfather, Joaquin Gonzalez Cigarroa, Sr., an orphaned student looking for boarding so he could attend medical school at UNAM. His older brother, Leonides had just fled to the United States after Pancho Villa’s guerrillas were about to execute him. My grandfather gave them the family’s silver mines in Mapimí, Mexico in exchange for Leonides’ life.”

After receiving his medical degree at UNAM, Dr. Joaquin Gonzalez Cigarroa, Sr. married Mama Rebecca’s only daughter, Josefina. They eventually moved to San Antonio and later moved to Laredo. He established the Cigarroa Clinic along with his two sons, Leonides and Joaquin, who also became physicians, and his daughter, Rebecca who became a pharmacist.

“The pure generosity Mama Rebecca activated by helping a student who did not have economic resources to pursue his calling, had such worth that it today continues to yield exponential returns that cannot possibly be measured.”

Dr. Cigarroa’s grandfather (Dr. Joaquin Cigarroa, Sr.) started a weekly tradition, “El Dolar,” in their Laredo home as he reflected on Mama Rebecca’s generosity that had allowed him to pursue his dreams. Each grandchild would contribute a dollar from their allowance, matched by their parents, for their college fund. Dr. Cigarroa vividly remembers contributing every Sunday. “I understood this was a sacrosanct tradition and that my future education was of great importance. This decision of Abuelito’s led to his 24 grandchildren pursuing a higher education so that we now count dozens of degrees—including 20 medical degrees—that his grandchildren and great grandchildren have earned by following in his footsteps. And just as importantly, these traditions are now firmly established with a vision for the future.”

Growing up in Laredo on the Texas-Mexico border, as the son of a physician, his father, Dr. Joaquin Cigarroa, Jr. also provided him with a tremendous experience in understanding the challenges faced by a medically underserved region “resulting in significant health care disparities which are now looming public health issues not only for Texas, but for the entire country.”

Dr. Cigarroa emphasized, “In shadowing my father as he made house calls, and seeing his love of his practice, I received a firsthand view not only of the beauty of the art of medicine, which has run through four generations in my family, but also how this art profoundly touches all classes from the poorest to the wealthiest without regard to class status or homeland of origin.”

From 1955 through the present, Dr. Cigarroa’s parents have created a home in which the daily practice of confidence, love, respect, and lifelong learning are expressed. “I know that for me, this legacy has been at

the very core of every decision I have made and will ever make.”

By way of background, Dr. Cigarroa attended Yale University and graduated with a bachelor’s degree in biology. In 1983, he earned his medical degree from The University of Texas Southwestern Medical Center in Dallas. He then went on to complete General Surgery at Massachusetts General Hospital and his fellowships in Pediatric Surgery and Transplantation Surgery at John Hopkins University in Baltimore, Maryland. “I always thought I was going to be a cardiac surgeon and throughout medical school, I kept believing this. In my fourth year as a surgical resident, I knew that this was not the specialty for me when I discovered pediatric surgery.

Caring for children made me realize that I could wake up at the age of 75 or 80 and still get excited about what I could do for my patients and their families.” Dr. Cigarroa enjoys the continuity of care that exists in pediatrics and he is rewarded by helping his patients by giving them a better quality of life.

As Director of Pediatric Surgery at the University of Texas Health Science Center at San Antonio (UTHSCSA), he established a Pediatric Liver Transplant Program with his partner Dr. Glenn A. Halff, whom he greatly admires. Once he became President of the UTHSCSA, Dr. Cigarroa

“I know that for me, this legacy has been at the very core of every decision I have made and will ever make.”

- Dr. Francisco G. Cigarroa PHOTOGRAPHY BY Paul Marshall 2017 - NOVEMBER MD Monthly 43

continued to take surgical call every other weekend. When asked why he made the decisions he made in different time periods in his life, Dr. Cigarroa expressed, “In every fork in the road, when facing divergent paths, I made an intentional choice to go one way rather than another guided by the compass of my family legacy that informed me to have the confidence not just to pursue the tried and true, but also to explore intriguing paths fraught with risks, challenges, and wonder.”

One of Dr. Cigarroa’s favorite poems is “The Road Not Taken” written by Robert Frost: Two roads diverged in a yellow wood, And sorry I could not travel both And be one traveler, long I stood And looked down one as far as I could To where it bent in the undergrowth; Then took the other, as just as fair, And having perhaps the better claim, Because it was grassy and wanted wear; Though as for that the passing there Had worn them really about the same, And both that morning equally lay In leaves no step had trodden black.

Oh, I kept the first for another day!

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Yet knowing how way leads on to way, I doubted if I should ever come back.

I shall be telling this with a sigh Somewhere ages and ages hence: Two roads diverged in a wood, and I— I took the one less traveled by, And that has made all the difference.

An example of a decision Dr. Cigarroa made to try a road less traveled, occurred in the year 2000.

The UT Board of Regents was conducting a search for a new president of the UTHSCSA and his name was thrown into the hat, so to speak. At the time, he had no interest in becoming anything but a full-time surgeon. He did not care for long meetings and viewed them as an inefficient use of his time.

“But my father and brother drove to San Antonio and urged me to go through the process. My father said, ‘You do not want to be disrespectful to the Regents.’ I asked him what he thought my chances were of becoming president and he said about one in a million. I liked those odds because I really did not have an interest in entering administration.”

To Dr. Cigarroa’s astonishment, he beat the odds. “I can tell you

that it is a unique experience to be promoted to President of UTHSCSA five years out of surgical fellowship.

I asked Dr. Gerald Austen, Chairman of Surgery at Massachusetts General Hospital, whether I should pursue this opportunity and he said, ‘Yes, but do not forget surgery . . . .’ ” Heeding this advice, Dr. Cigarroa accepted the role with the stipulation that the Regents allow him to continue his surgical calls every other weekend.

Since Dr. Cigarroa had not been trained in administration but as a surgeon, he immediately surrounded himself with the best people he could find. “I told them that I had a vision, but not a prescriptive agenda.

I empowered my staff to show leadership, accept responsibility and to get things done. In turn, they became more open and involved with helping create a new strategic plan.”

The rest is history with UTHSCSA’s growth and collective accomplishments while Dr. Cigarroa was President highlighted below.

(Sansom, 2009) • The operating budget rose 90% to $668 million • Philanthropic gifts in the Cigarroa era totaled $353 million. This

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• included a $25 million gift from Joe and Teresa Lozano Long to benefit medical students interested in practicing medicine in South Texas • The research expenditures increased 150% to $210 million • National Institutes of Health grants more than doubled to $107 million • Annual Hispanic enrollment rose 30% and the total of annual Hispanic graduates rose 70% After nine successful years serving as president, Dr. Cigarroa decided to go back to Pediatric and Transplant Surgery. But an “untraveled road” presented itself yet again when the new Chairman of the Board of Regents, Scott Caven, called and told Dr. Cigarroa that he wanted to interview him for the open position of Chancellor of the UT System. He accepted a new road yet again, this time becoming Chancellor of the UT System.

“As President and Chancellor, I used the same techniques I used when I created a successful team of transplant surgeons, with my mantra being: Work together, share the decision-making, and strive for continual improvement. Hold yourself and the team accountable when things do not go as expected. Treat everyone with respect––and listen.”

Dr. Cigarroa accepted the Chancellorship with the same stipulation he requested at UTHSCSA, namely that he continue to take surgical call to perform transplants and save lives.

“I did not want to leave the patient’s bedside for administration . . . . It also provided me with important insights that made me a better leader by being on the front line of patient care together with my fellow faculty, students and staff.

In my wildest dreams growing up in Laredo, I never imagined I would become a surgeon, much less Chancellor of one of the greatest systems of higher education in the world. As the first Hispanic Chancellor in the history of the UT System,” Dr. Cigarroa stated, “I am

“My grandfather gave them the family’s silver mines in Mapimí, Mexico in exchange for Leonides’ life.”

- Dr. Francisco G. Cigarroa aware that I not only made history, but I helped shape it by positioning others to follow in my footsteps.”

The UT System has 14 institutions that are educating and training a new generation of students and doing worldclass research that is improving the quality of life in Texas and beyond. The visions and ideas that Dr. Cigarroa shared with his administration played a large part in the success of the UT System. “The UT System has much to celebrate.

Our institutions are strong and world class, following their own trajectories toward excellence.”

According to Dr. Cigarroa, quality is a moving target. So, as Chancellor, he introduced a Framework for Higher Education that changed the environment in higher education.

the UT System • To invest in high-performance computing • To enhance philanthropic success • To enhance excellence and accountability across the PhD programs • To enhance the health of Texas • To expand educational and health opportunities in South Texas and to plant a larger UT flag One of the most exciting new developments during Dr. Cigarroa’s tenure as Chancellor was the establishment of the Dell Medical School at the University of Texas at Austin. “It is now the first medical school established at a major Tier One (American Association of Universities) public research institution in the last fifty years. It will transform healthcare in Central Texas. In fact, with the addition of a medical school, UT Austin has the potential to become the top public research university in the nation, which was one of my most important initiatives as Chancellor.”

Dr. Cigarroa and his team also moved boldly forward with Project South Texas, including their plans to create a new university and medical

The Framework for Advancing Excellence throughout the UT System was an effort to address a number of challenges in higher education and to position UT institutions among the best. The focal points are below and Dr. Cigarroa states, “I am pleased to report that 100 percent of the initiatives were implemented.”

• To enhance undergraduate student access and success • To focus on faculty, administration, and staff excellence • To enhance success in research • To emphasize productivity and efficiency across the operations of

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school in the Rio Grande Valley. It is an area where the population is rapidly growing, but where current opportunities for upward mobility are limited. “In the Rio Grande Valley, there is an increasing need for doctors and health professionals, teachers, and a myriad of other professions that will improve basic services, educate children, and grow the economy in that region of Texas.”

At the centerpiece of Dr. Cigarroa’s commitment and vision, the Regents, together with the Legislature, funded a new university and medical school that will span the entire Rio Grande Valley with a presence in each of the major metropolitan areas in the Valley.

The new university is called University of Texas Rio Grande Valley (UTRGV) and the first students matriculated in September of last year. “This university will be transformative to Texas and our nation.” Of note, prior to the establishment of UTRGV, the UT academic campuses in South Texas were not eligible for funds from the vast UT Oil and Gas Endowment otherwise known as Permanent University Funds because of constitutional restrictions. Dr. Cigarroa always felt that this was a huge inequity for the students, faculty and staff from South Texas. Imagine being a part of the University of Texas Family and being excluded from this endowment! Dr. Cigarroa and the UT Board of Regents finally figured a way to direct these precious funds to the Rio Grande Valley. They proved skeptics wrong and the impossible became the possible!

One of America’s premier architects, Daniel Burnham, once said, “Make no little plans. They have no magic to stir men’s blood and probably will not themselves be realized.” At the UT System, Dr. Cigarroa believes that “Make no little plans” could be the guiding principle.

He elaborates, “The stereotype of Texans is that we are given to exaggeration, but it is no exaggeration to say that the aspirations of the UT System are big and bold. Every day at our universities, we are implementing innovations that create a stronger

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learning environment, improve the undergraduate experience, contribute world-class research, render public service, and provide nationally acclaimed medical training and patient treatment. We are saving lives and shaping lives. We are transforming the world in which we live.”

It is self-evident that Dr. Cigarroa’s accomplishments are endless. He has helped the medical community, the healthcare system and the universities within the UT System through the decisions he made as Chancellor. By creating a strong team in each one of his extremely important positions, he established blueprints for growth and outstanding accomplishments that all of us will benefit from for years to come.

Back full circle, in 2015 Dr. Cigarroa returned to his lifetime love of surgery at UTHSCSA on a full-time basis, working again with Dr. Glenn A Halff. “It is a fantastic experience being involved in helping my patients and saving lives. It is also extremely rewarding being active in educating students and residents and being a part of the very system I led. Re-establishing the pediatric liver transplant program is also exceedingly rewarding and meaningful as these children no longer have to travel to Houston or Dallas to receive this life saving surgical procedure. No longer should any child or adult patient have to leave San Antonio to receive their medical care with such a strong and talented medical community and a first-rate medical school. I truly love the people here and we are all a part of the team. It is also impactful to be doing research on Hepatocellular Carcinoma affecting Hispanics in South Texas as a Clayton Research Scholar.”

generations as they also consider roads less traveled by in achieving their life’s calling. Striving for excellence is what Dr. Cigarroa does every day, while maintaining a healthy balance in life. His family and loved ones are a big part of that equation and just as his great-grandmother, grandparents and parents taught him to reach his highest potential, Dr. Cigarroa inspires the next generation in kind. No doubt, as a result the Cigarroa tradition will continue, and future generations will benefit from their individual and collective passions for excellence, thereby positively affecting the lives of countless others through the decisions they make.

Citations: 1. Barbara Gonzalez Cigarroa, A Mexican Dream and Other Compositions. 2016. TCU Press For more information on history of Cigarroa family see website for A Mexican Dream at amexican-dream. com 2. Will C. Sansom. The Crown Jewel. 2009. The University of Texas Health Science Center San Antonio For More InformationFrancisco G. Cigarroa, M.D. Division Head of Liver & Pediatric Transplantation Surgery Carlos and Malú Alvarez Distinguished University Chair Ashbel Smith Professorship in Surgery Clayton Research Scholar University of Texas Health San Antonio 7703 Floyd Curl Drive, MC 7858 San Antonio, TX 78229-3900 Phone: 210-567-5777 Email: cigarroa@uthscsa.edu

After having served in one of the top careers in education in Texas through which he raised the bar both in education and medicine, Dr. Cigarroa certainly should be very proud. Through his exemplary life he has personified how a family’s values and dreams, starting generations ago, continue to be instrumental for future

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WHAT CAN BE DONE FOR

Saggy, Baggy EYES? By: Dr. Marc Taylor

A

re you feeling energetic but your eyes say otherwise?

Your eyes are one of the first features that people notice about your face. Your eyes say a lot about how energetic or tired you feel. Eyelid surgery helps improve the appearance of baggy and sagging eyes which is commonly caused by the aging process and sun damage.

This surgery is termed “eye lift” or Blepharoplasty. At his office, Dr. Marc Taylor performs this surgery to remove excessive skin, eyelid wrinkles, and excessive fat from the upper and lower eyelids, using oral and local anesthesia, which numbs the area around your eyes. This avoids the problems associated with general anesthesia. An “eyelid lift” can result in a more youthful and rested look,

improved peripheral vision, and it can lessen the feeling of eyestrain.

Most patients are 35 years or older, but if droopy, baggy eyelids run in the family, you might decide to have eyelid surgery at a younger age.

Eyelid surgery can be done alone, or in conjunction with other procedures such as a face lift, laser treatments of the face, or volume replacement with natural fat or boxed fillers such as Juvederm.

Upper Eyelid Surgery The upper eyelid surgery is done by means of an incision in the eyelid crease, allowing for removal of the excess skin and fat. The resulting scar is usually difficult to detect.

Brow Suspension Many people do not realize that the “tired” appearance of their upper eyelids is frequently a result of both excessive upper eyelid skin and a significant drooping of the eyebrows.

Sagging eyebrows play a major role in the way the eyes “look,” and lifting the eyebrows helps to improve eyelid surgery results. The eyebrows can be lifted with a simple “suspension” technique done at the same time as the upper eyelid surgery, using the same incision used to remove the excessive skin.

Lower Eyelid Surgery Lower eyelid fullness, bagginess, and wrinkled skin are familiar characteristics that become more 2017 - NOVEMBER MD Monthly

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pronounced with age. The procedures to help correct these problems vary depending on their cause.

surgery is done from inside of the lower lid, thus there is no skin incision or visible scar.

Skin Wrinkles of the Lower Eyes

Thinning of the Skin and Facial Volume Loss

Wrinkles of the lower eyes are typically not caused by excessive skin alone, but rather by sun damage, and thinning of the skin caused by aging. Removing a lot of the lower eyelid skin is generally not effective.

Eyelid surgery and laser treatments of the skin help to smooth and remove lower eyelid wrinkles. Many individuals benefit greatly with a laser treatment of the wrinkles.

Skin Wrinkles with Fat Bags of the Lower Eyes When there are both lower lid wrinkles and excessive “fat bags,” the surgery to remove the fat plus a laser treatment for wrinkles are recommended and can be done at the same time. The bulging orbital fat is either removed or repositioned. The

Aging and sun damage are two prime causes of the loss of fullness of the facial regions and thickness of the skin of the lower eyelids. The loss of subcutaneous fat creates creases and folds around the eye, nose, and mouth regions.

A temporary treatment with “filler,” such as Juvederm, is an option. A more permanent and longer lasting option, offered by Dr. Taylor, is using one’s own natural fat to replace the volume loss. Your own fat, usually taken from the belly button area by mini liposuction, is concentrated, and the fat alone with stem cells is reinjected into the facial areas.

Medical studies have shown that over time the fat injections can also provide a rejuvenated appearance to

the facial skin.

What to expect Normally, there is minimal pain with eyelid surgery, and the majority of the swelling is gone in a few days.

Makeup can be worn to cover the discoloration within 5 to10 days. It is best to have limited activity for the first few days after surgery. Cool compresses and routine care of the suture lines are important. Most people can drive within 2 to 5 days after surgery, and most can return to work in 3 to 10 days, depending on their healing and type of work.

Normal exercise can be resumed in about two weeks.

Give us a call at 210-305-5797 or visit marctaylormd.com to learn more or to make an appointment to see Dr. Taylor.

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Tony Adeniran SCORES A KNOCKOUT WITH BLACK STALLION BOXING PLUS

By Rudy Arispe

A

fter graduating from college with a Bachelor of Business Administration (BBA) degree, Tony Adeniran found himself working the graveyard shift – literally – when he couldn’t find an entry-level job in his preferred field.

“I ended up digging graves and trimming grass around headstones,” he said. “It was the worst job I ever had, but I needed money to support myself.”

Looking back, Adeniran knows his six-month stint with a mortuary

company was all part of “paying his dues” until life opened the way for better things to come. In reality, though, he was already

I ended up digging graves and trimming grass around headstones, - Tony Adeniran

doing what he enjoyed most, which is grueling physical fitness, or, more specifically, boxing.

And as they say, life has its way of putting people in the right place at the right time, which is exactly what happened when a then 10-year-old Adeniran started going with a friend to his boxing classes. “My friend’s brother signed him up for boxing because he was getting bullied at school,” the Houston native said. “I used to go with him to the gym to hang out. One day, the coach told me to put on some gloves, and the rest is history.”

PHOTOGRAPHY BY Trinity Greer 2017 - NOVEMBER MD Monthly 53

Part of that history includes 25 amateur fights as a middleweight, starting at age 18 and later, in 2014, turning pro. Today, the 29-year-old Adeniran is a certified USA boxing coach and is the owner of Black Stallion

Boxing holds many parallels to life and to business, - Tony Adeniran Boxing Plus located at the Éilan Resort and Spa in the San Antonio Hill Country, where he uses his experience in the ring to help clients spar their way to their health and fitness goals.

“Boxing holds many parallels to

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life and to business,” Adeniran said in explaining his love for the sport, “and in fact, when you put on the gloves, you can create something out of nothing.”

Moreover, the young boxing pro-turned-business owner enjoys the range of clients he trains, from stay-at-home moms to corporate CEOs, and watching them develop the physical stamina and mental toughness they need to tackle life’s daily challenges, and then some.

Margaret Loftis, the 58-year-old owner of The Loftis Company, a construction company that does business within the oil and gas industry, has been training with Adeniran for two years, five days a week, and said she is in the best shape of her life.

“I’ve exceeded goals that I never could have imagined reaching,” Loftis said. “My confidence is better, I’m making better food choices, I’m sleeping better, and my reflexes are faster. For me, this training is a great investment in today and in the future.”

Black Stallion Boxing Plus

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also trains a large group of Bexar County employees, including Assistant County Manager Tina Smith-Dean, who said she is accomplishing her goals of getting stronger and improving her endurance. “I never thought I could hold a squat for three minutes, but I did,” she beamed.

Bexar County employees who work out at Black Stallion Boxing Plus have been losing weight and firming up, she notes. “Most importantly, our elected body, the Bexar County Commissioners Court, made the decision to build an Employee Fitness Center,” Smith-Dean said. “One of the

main reasons for their decision was the fact that our employees are participating and making improvements to their health.

Black Stallion Boxing Plus plays a big role in that.”

As much as he enjoys fighting in the ring, Adeniran also gets great satisfaction from teaching boxing. After getting to know his clients’ personalities and workout preferences, the boxing coach tailors fitness programs to transform them into champions.

said. “You have to fake out your opponent, know what they’re going to do before they do it, and set up traps.”

Looking back on that uncertain time in his life when Adeniran wondered when he would be able to put his college degree to use, it’s safe to say that his BBA now serves him well as the owner of a successful business.

For more information, visit www. blackstallionboxingplus.com or call (210) 777-PLUS.

“Many come in initially looking to get into shape. Then they realize all the mental components of boxing, and they’re hooked,” he

Get to Know

Tony Adeniran Hometown: Houston Education: Bachelor of Business Administration from Texas A&M University San Antonio First job: I was a paperboy delivering the Houston Chronicle.

His fitness regimen: Boxing plus strength training and conditioning, running and weights. On the rehab side, yoga, Pilates, floating, massage therapy and cupping.

Favorite boxing themed film: “The Hurricane” (1999) based on the life of middle-weight boxer Rubin “Hurricane” Carter, who was wrongfully accused of triple homicide and spent almost 20 years in jail before being acquitted. His book “The 16th Round” is also captivating and inspirational.

Something about me nobody knows: I’m a first-generation American. My parents came to the U.S. from Nigeria in 1980.

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Welcome to the SOUTH TEXAS BRAIN AND SPINE CENTER.

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INFORMED PATIENT/SAN ANTONIO

By: Steven J. Cyr, M.D., FAAOS

reaking a bone is not an uncommon occurrence.

When it comes to breaking a bone, there are many different ways in which that bone may break. Factors contributing to how a bone breaks include the energy of the force taken to break the bone, how that force comes into contact with the bone, and the properties of bone itself. For decades, Orthopaedic surgeons, bone and extremity experts, have categorized and determined appropriate treatment for the many types of broken bones. One common type of fracture involving the spine is called a compression fracture. It occurs when forces on the front of the spine break the vertebral

column, creating a wedge deformity of the bone.

In a healthy spine, a compression fracture is the product of a highenergy force that loads the spine suddenly. Compression fractures can happen in motor vehicle accidents or sporting events. The compression fracture occurs in the vertebral body.

The vertebral body is the front half of the spinal bone. A compression fracture of the vertebra turns the cylindrical vertebral body into a wedge as it collapses anteriorly.

The severity of the wedge can vary and have associated problems.

Oftentimes, the wedge is not severe enough to cause anything

more than soreness. One possible major problem resulting from a compression fracture is that some of the broken bone can push backward into the spinal canal. These bony fragments can crowd the contents of the spinal canal including the nerves and spinal cord. When this is the case, the patient may have nerve related symptoms such as burning, tingling, numbness, and/or weakness in the extremities. At the level of the spinal cord (above the L2 level), spinal cord injury may occur resulting in incomplete or complete paralysis.

The most common symptom of a compression fracture is tenderness in the area directly over and surrounding the fractured vertebra.

SECOND PHOTOGRAPH BY Trinity Greer 2017 - NOVEMBER MD Monthly 57

INFORMED PATIENT/SAN ANTONIO

Compression fractures can be most easily identified on X-Ray and CT scans. These findings, combined with specific symptoms, and a history of a sudden forceful load onto the spine (termed axial load) are often enough to identify the diagnosis of a compression fracture. An MRI or a whole body bone scan can help to identify the “age” of the compression fracture, in other words, if the fracture happened recently or is old. A CT or CAT scan can help determine the severity of the bony injury as it more accurately reveals the characteristics of the broken bone.

The most common type of compression fracture occurs as a result of aging. With age, the spinal vertebra can lose their strength from a process called osteoporosis. As the bone weakens, the vertebra becomes more prone to failing. The stress carried by the spine, combined with weakened bone, can result in a failure of the vertebral body and, therefore, a compression fracture. This occurs from mild trauma such as a fall from standing height, lifting an object, and even from the mere weight of one’s body. Demineralization can be treated with Vitamin D and Calcium supplements, prescription medications, as well as weightbearing exercise. Some individuals with compression fracture may look relatively normal while others may have a hunched back. This appearance does not commonly result from just one compression fracture. It is usually the result of several broken, wedged bones leading to collapse of the anterior vertebral bones and an exaggerated curve forward.

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in patients under the age of 60.

For both men and women with osteoporosis, approximately 25% will have a compression fracture.

Treatment consists of relieving the symptoms, which commonly means pain relief. This can be achieved by ice, pain medication, bracing, and sometimes surgery. If ice, rest, bracing, and medication are not enough, the two minimally invasive surgical options include Vertebroplasty and Kyphoplasty. The purpose of both procedures is to halt any further wedging of the vertebral body. Progressive wedging results in structural problems and abnormal posture, which may inhibit activities of daily living. Vertebroplasty is a procedure in which low viscosity bone cement is injected into the collapsed vertebra, stabilizing the failing vertebra.

Kyphoplasty is a similar procedure where the height of the vertebral body is restored, usually with a balloon, followed by injection of the bone cement. This procedure helps reverse the postural problem from a collapsed vertebra. However, it is only effective in a fracture that has not healed yet.

It also works best for low velocity injuries, not those resulting from high velocity injuries, such as motor vehicle collisions. A vertebroplasty is appropriate for less severe cases where the bone is broken but has not wedged dramatically.

see a Spinal specialist and pursue an appropriate and comprehensive evaluation and plan of treatment.

At The Orthopaedic & Spine Institute, our uniquely trained team of medical professionals and spine surgeon have experience in treating all symptoms and conditions of the spine, from the cervical spine to the coccyx (tailbone). If you suffer from neck or back pain, contact us to schedule a consultation.

Dr. Steven Cyr is one of the nation’s few Mayo Clinic trained spine surgeons. His training included both neurosurgical and orthopaedic surgical techniques of the spine.

The Mayo clinic is one of the world’s leading medical institution and has ranked number one for orthopedic and neurosurgical training programs in America for more than 20 years. Dr. Cyr is the President and Founder of The Orthopaedic and Spine Institute Medical Centers in the South Texas Medical Center located at 8401 Datapoint Drive, Suite 700, San Antonio, Texas 78229.

(210) 487-7463 or (844) 896-7846 www.saspine.com

In conclusion, a compression fracture may be present even without significant trauma.

Compression fractures may be the source of pain in patients with osteoporosis who have had no injury whatsoever. Therefore, particularly in patients with known osteoporosis, who are over 60 years old, have experienced a sudden, forceful load on the spine, it is prudent to

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Treating Chronic Pain through Physical Therapy Physical therapy is a safe and effective way to treat chronic pain and its underlying cause(s).

Physical therapy can help decrease pain, increase mobility, and improve overall mood.

Physical therapists may help patients manage pain through:

• Low-impact aerobics • Massage • Stretching • Modalities such as ultrasound and electrical stimulation • Strengthening exercises, movement therapy, and other types of exercises such as aquatic therapy , depending upon individual abilities.

Therapeutic treatments are designed to help increase muscle strength, endurance, joint stability, and flexibility.

In addition, physical therapy also aids in reducing inflammation, stiffness, and soreness.

It encourages the body to heal itself by boosting production of the body’s natural painrelieving chemicals.

To learn more about Corpus Christi Regional Rehabilitation Hospital’s physical therapy program, call 361-906-3700.

CCRH.ERNESTHEALTH.COM

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5726 Esplanade Drive • Corpus Christi, TX 78414 • ph: 361.906.3700

PRACTICAL APPROACH SERVICES

Pediatrics, Pediatric Dentistry & Pediatric Urgent Care

Pediatric Care You can find the best pediatrician San Antonio has to offer right here at Practical Approach. From day one, Practical Approach Pediatrics helps children lead healthy and happy lives through a comprehensive approach to healthcare.

Pediatric Dentistry From the first tooth to wisdom teeth, the pediatric dentists at Practical Approach are committed to providing beautiful and healthy smiles. When should your child have their first trip to the dentist? We provide all general pediatric dentist services.

9480 Huebner Road, Suite 400 | San Antonio, TX 78240 210.697.3900 | practicalapproachpediatrics.com

Pediatric Urgent Care San Antonio’s only Pediatric Medical and Pediatric Dental Urgent Care! Our practitioners at Practical Approach are fully trained to handle pediatric emergencies.

Your child’s safety is very important to us and we take great pride in ensuring the quality of our pediatric emergency services!

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