MD Monthly February - San Antonio

February 2017

mdmonthly.com

Heart EDITION

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ONE DOCTOR

DOCTORS HOSPITAL

FINDS FULFILLMENT IN

AT RENAISSANCE PROMOTES A HEART

GERIATRIC CARE

Dr. Nelly Garcia Blow of CHRISTUS Spohn Hospital Corpus Christi found her passion in caring for elderly and vulnerable patients.

HEALTHY LIFE

Physicians at the Heart Institute at Renaissance foster longevity of life for all cardiac patients.

48 WHEN A NEWBORN MUST UNDERGO

OPEN HEART SURGERY A mother’s journey in having faith in God and medicine.

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INTERVENTIONAL

H.E.A.R.T. CLINIC BRINGS NEW INNOVATIONS & NEW FACES

TO SERVE THE SAN ANTONIO COMMUNITY. Dr. Salah El-Bash Becomes the Newest Member of the Heart Endovascular and Rhythm of Texas Team

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BOERNE, TEXAS

NOW OPEN

Lounge on the broad, breezy wraparound porch, cocktail in hand. Step into a lovingly restored 19th century dining room to savor contemporary interpretations of Southern heritage foods and classic American dishes. Sit down to a familiar, casual, satisfying menu influenced by seasonal bounty from “As a kid growing up in Jourdanton, I watched my Mother and Grandma make everything from scratch every day. My Father and Grandfather were the Kings of Barbeque. I cooked some, too, but I did a lot more watching, tasting, and learning.”

area farms and the affinity of beef and mesquite smoke that is the soul of the Hill Country.

CHEF MARK BOHANAN

KENDALL INN

128 WEST BLANCO ROAD BOERNE TX 78006

tel 830.572.5000

w e b PEGGYSONTHEGREEN.COM

Back to Normal S p i n e A s s o c i at e s

Comprehensive Spine Center Adult & Pediatric Orthopaedic Spine Specialists Spine Associates’ Comprehensive Spine Center creates a direct link between your primary care provider and the management of your spine injuries. Our Comprehensive Spine Center provides a full scope of spinal services including the evaluation, treatment of the cervical, thoracic and lumbar spine by a nationally recognized orthopedic spine specialist. Working together with referring physicians, our team ensures that each patient receives a personalized treatment plan specific to his or her circumstance and lifestyle. Spine Associates is equipped with the most state-of-the-art imaging and diagnostic technology which enables our spine specialists to effectively and accurately

THE SMARTER CHOICE FOR SPINE CARE Comprehensive Spine Care that follows you from diagnosis to treatment to recovery - and even follows you home AREAS OF EXPERTISE - Robotic Assisted Spine Surgery - Minimally Invasive Spine Surgery - Adult & Pediatric Scoliosis Correction - Reconstructive Spine Surgery - Physical Therapy - Interventional Pain Management

diagnose and treat you. We also offer a full range of leading-

STOP LIVING WITH PAIN

edge, non-surgical and surgical treatment options including

Call or email today and begin your personal treatment plan 800-9-SPINAL (800-977-4625) or info@myspineassociates.com

robotic assisted spine surgery and minimally invasive treatments to get you back to normal.

SPINE ASSOCIATES LOCATIONS: 9301 Southwest Freeway, Suite 600 | Houston, TX 77074 | 713-383-7100 3820 Pointe Parkway | Beaumont, TX 77706 | 409.767.8221 myspineassociates.com

Hospice is a journey and we’re here to hold your hand every step of the way.

Alice | Austin | Bandera | Boerne Corpus Christi | Hondo | San Antonio

River City Hospice has earned The Joint Commission’s Gold Seal of Approval

compassionate Wecareprovide for our patients and

those who love them most. Our experienced team of professionals are here to support you during the challenges that come with a terminal illness.

Because Every Moment Counts rivercityhospice.com | 1.877.537.4837

THE HUNT OF A LIFETIME If you are looking for the ultimate hunting experience, then look no further then DEA Ranch. The diverse selection of wildlife will create a lasting impression and make you the envy of your family and friends. For the discriminating whitetail, elk or exotic hunter, DEA Ranch is a paradise.

Skeet shooting, nature walks, bird watching or just relaxing under the 100-year-old oak trees, will make your trip a complete Texas retreat.

• Customized hunting packages for groups of all sizes.

• one-on-one guided, all day hunts that can include different types of game.

• Year-round hunting for axis, blackbucks, hogs, elk and several species of trophy rams.

• Introducing quail hunts and organic meat such as elk, axis and Kobe beef.

• Corporate dove hunts and spring turkey hunting.

• Wedding and party packages including skeet shooting and quail hunting.

We look forward to helping you plan the hunt of a lifetime or a oneof-a-kind event. Contact us today for additional information.

311 CR 351, Mathis, TX 78368 361.249.1157 www.dearanch.com

PRIMARY CARE.

Close to Home.

Lori Shirley-Wenzel, MD Internal Medicine Alamo Heights, Broadway (210) 824-5392

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

Scott Horn, MD Family Medicine Alamo Heights, Sunset (210) 824-5201

Doris Ling, MD Family Medicine Castle Hills (210) 541-8689

Patricia Mackin, MD Family Medicine Castle Hills (210) 541-8689

Angela Malarcher, MD Internal Medicine Downtown (210) 224-1771

Lovelesh Manocha, MD Internal Medicine Downtown (210) 224-1771

Heberto Garza, Jr. MD Internal Medicine 281N & Thousand Oaks (210) 824-5392

Paul Smith, Jr, MD Internal Medicine 281N & Thousand Oaks (210) 824-5392

Felicitas Gonzales, MD Family Medicine 281N & Thousand Oaks (210) 200-6744

Yetunde Sokunbi, MD Family Medicine 281N & Thousand Oaks (210) 200-6744

Edward Lin, MD Family Medicine Northeast (210) 653-2693

Shashi Mittal, MD Family Medicine Northeast (210) 653-2693

Abe Rodriguez, MD Family Medicine Northeast (210) 653-2693

Julia Pursch MD Family Medicine Northwest (210) 453-1199

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

Belmund Catague, MD Family Medicine Schertz (210) 656-5600

Victoria Chang, DO Internal Medicine Schertz (210) 656-5600

Kirsten Fikes, PA Internal Medicine Schertz (210) 656-5600

Ricardo Escamilla, MD Family Medicine Southeast (210) 333-0798

Salima Panjwani, PA Family Medicine Southeast (210) 333-0798

Lubna Naeem, MD Internal Medicine Stone Oak (210) 490-3800

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

Michelle Aliotta, MD Family Medicine Stone Oak (210) 496-2669

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

Daisy Ramirez-Estrada, MD Cesar Gerez-Martinez, MD Family Medicine Family Medicine Overlook Westover Hills (210) 497-2338 (210) 681-0126

Steven Bauer, MD Internal Medicine Overlook (210) 497-2338

Jessica Barrientos, PA Internal Medicine Overlook (210) 497-2338

Aaron King, MD Family Medicine Overlook (210) 497-2338

Sanjay Kumar, MD Internal Medicine Westover Hills (210) 681-0126

Cherry Maximo, MD Family Medicine Westover Hills (210) 681-0126

Inez King, NP Family Medicine Westover Hills (210) 681-0126 091315

For more information or to schedule an online appointment visit Med1st.com

LOSE WEIGHT, NOT HOPE GOOD-BYE DIABETES GOOD-BYE SLEEP APNEA HELLO WEIGHT LOSS

Benefits of Weight Loss Surgery •

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

•

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

•

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

•

Obstructive sleep apnea is cured in 86% of patients

•

Risk of death is decreased by 89%

•

Weight Loss Surgery (WLS) can enhance fertility and lead to successful full term pregnancies

•

Average weight loss is 50-70% of excess body weight

•

Improvement in arthritis with reduction in pain and increased mobility.

•

WLS is covered by 80% of insurances

•

Texas Bariatric Specialists accepts most major insurances including Medicare.

Nilesh A. Patel, MD, FACS

Subhash Reddy, MD

Leah A. Dill, D.O.

BypassDoc.com | 877.459.7065 San Antonio | Austin | Corpus Christi | San Angelo Kileen | New Braunfels | Del Rio | Laredo

Februar y 2017 Production Media Digital Source Designer Meghan Goettl Senior Writer Rudy Arsipe Project Manager Miranda Paredes Contributing Writers Dr. Constance Barone Dr. Irene Blaess Dr. Celeste Borchers Monica Brant Dr. John Douillard Josh Lopez Edmond Ortiz Dr. Maria Palafox Kelli Owen Quin Ashley Stevens

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HEART Welcomes The Fifth Member to Their Team With a diverse and skilled team of surgeons, Heart Endovascular Rhythm of Texas are dedicated to serving the San Antonio community.

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Fulfilling Life-long Dreams Through Geriatric Care

Dr. Nelly Garcia Blow’s independent and tenacious spirit led her to fulfill her dream. Today, she practices inpatient medicine and geriatrics at CHRISTUS Spahn Hospital Corpus Christi- Memorial.

Contributing Photographers Jason Roberts Paul Marshall Gerardo Garmendia Christian Moller Marc Arevalo

FOR ADVERTISING INFORMATION, PLEASE CALL 210.373.2599 OR EMAIL HELLO@MDMONTHLY.COM. FOR EDITORIAL COMMENTS AND SUGGESTIONS, EMAIL EDITOR@MDMONTHLY.COM.

Doctors at Hospital Renaissance: Healthy Heart, Healthy Life Physicians at the Heart Institute at Renaissance fosters longevity of life with an alternative for aortic valve replacement

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FEBRUARY - 2017

MDMonthly.com 22211 IH-10 W. #1206 | San Antonio, TX 78257

Cover Photo HEART – Jason Roberts Cover Photo Dr. Blow – Paul Marshall Cover Photo DHR – Gerardo Garmendia & Christian Moller

Stop the Pain Visit Us At AmericanSinus.com or SouthTexasSinusInstitute.com

Honrubia Technique™ for Balloon Sinuplasty

Patient Comfort and Safety Come First

The Honrubia Technique™ for Balloon Sinuplasty is a revolutionary, minimally invasive procedure for treating chronic sinusitis.

The primary symptoms of chronic sinusitis are headaches, trouble sleeping, snoring, fatigue, facial pressure, ear discomfort, and post nasal drip. The Honrubia Technique™ addresses many of the primary symptoms of chronic sinusitis while maximizing the comfort and safety of the patient. It is recommended by our team of board certified ENT Physicians. This technique involves less pain than a traditional sinus surgery and therefore contributes to a quicker recovery.

The Honrubia Technique™ for Balloon Sinuplasty is done under anesthesia. This ensures that patients have a more relaxing and positive experience than when the procedure is performed under a local anesthetic. It also allows us to address several other sinus related complaints. An anesthesia provider administers intravenous medications to keep patients lightly sedated and comfortable.

Our American Sinus Institute team of specialists have performed thousands of procedures using the Honrubia Technique™ for Balloon Sinuplasty. Come see us at the American Sinus Institute. We Solve Sinus Problems.

Vincent F. Honrubia, M.D., F.A.C.S., Director

6363 De Zavala Road, Suite 200 San Antonio, TX 78249 (210) 225-5666 • (210) BALLOON 1801 Binz Street, Suite 400 Houston, TX 77004 (713) 225-5666 • (713) BALLOON

2821 2821Michaelangelo MichaelangeloDrive, Drive,Suite Suite201 201 Edinburg, Edinburg,TX TX78539 78539 (956) (956)661.8200 661.8200• (855) • (855)99SINUS 99SINUS

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Healthy Living

Inspiring Women to Achieve Personal Goals The Body and Soul Retreat, hosted by Monica Brant, gives women the opportunity to jump start a physical and spiritual transformation.

20 Informed Patient

Dr. Constance Barone advocates for the minimally invasive Smart Graft technology, that is revolutionizing the ease of hair harvest.

Informed Patient

How To Combat Upper Respiratory Infections Know what steps to take to strengthen your immune system and fight off the common cold.

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Informed Patient

Vaccinations Are For Adults Too A vaccine can help strengthen the immune system and foster overall adult wellness.

MD Monthly

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! myemma.com/nside

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!

Style & Substance

Boxing In Style Box Beat owner, Luz Ortiz and family, model clothing courtesy of Neiman Marcus.

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Medical Business

Experimental Treatment to Reverse Fatal Liver Disease in Infants Doctors Hospital at Renaissance, is the first in South Texas to become an intermediate site for the use of a potentially livesaving treatment.

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Op/Ed

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New Technology in Single Hair Transplantation

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FEBRUARY - 2017

A Newborn Undergoes Open Heart Surgery A mother’s journey in having faith in God and medicine.

THE BUYANOV PROCESS Consultation MRI Stem Cell Therapy Results DrBuyanov.com | 210.899.5493 2425 Babcock Rd. Suite 108 San Antonio, TX 78229

Ser ving pat i ents t hrou gh Te l e h e a l t h Innova recovery is a telehealth treatment center for men and women ages 18 and older. Easily accessible from anywhere in the state, Innova is designed for clients who want exceptional treatment in a setting that is conducive to their lifestyle.

Therapy for Post Traumatic Stress Cognitive Behavioral Therapy (CBT) Exposure and Response Prevention (ERP) Family Therapy Dialectical Behavioral Therapy (DBT) Eye Movement Desensitization Reprocessing (EMDR) Meditation Therapy

innovarecoveryclinic.com | 210.254.3618

HEALTHY LIVING/SAN ANTONIO

The Body & Soul Retreat INSPIRES WOMEN TO ACHIEVE

Physical & Personal Goals

By Monica Brant

O

ften people, and especially women, forget to make time to take care of themselves. I wanted to create an inspirational weekend for women – away from all the hustle and bustle of everyday life. The Body & Soul Retreat is an opportunity to do just that.

This is not your average boot camp. Instead I prefer to refer to it as a retreat.

All women, no matter what age or skill level, are welcome. We leave no one behind. It’s not a

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competition, but instead, a fun opportunity to experience new things.

The Body & Soul Retreat is a dynamic compilation of all the things I love and practice myself. It is an opportunity to get to know one another and develop lasting relationships.

The retreat starts at the 40-acre ranch in Spring Branch (right outside of San Antonio) called Power Park Fitness, owned by one of my personal trainers and American Ninja Warrior competitor, David Yarter.

We will walk and jog the

outside, two-mile course, lovingly called the ‘Green Mile,’ that includes nearly 30 obstacles. Completing this course will challenge not only our bodies, but our minds as well. After a short break from the outside course we will conquer the American Ninja Warrior training facility inside.

Something unique about the Body & Soul Retreat is the opportunity to partake in a Women’s Gun Safety & Handling two-hour session. The 2nd Amendment of the United States Constitution stating

that the right of the people to keep and bear arms shall not be infringed, has caused quite a stir, and it is my opinion that women should take the initiative to learn the basics of gun safety. Together, we will practice safe gun handling and spend some time on a private shooting range, Garrison Arms, owned by Jeff and Holly Martin.

Through many years of competitive running I have developed a passion for sprinting, and I would love to share this passion through this retreat. As part

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MDMONTHLY.COM

HEALTHY LIVING/SAN ANTONIO

of the weekend, I will go over fundamentals and give us ladies a chance to show off our own skills. I have also invited my good friend and motivational speaker, Melissa Weathersby, to the retreat. She will conduct a nutritional body and soul connection session where we will both speak about the benefits of having a healthy body and soul. Over the years, it has become evident to me that we can’t gain strength in our bodies without spiritual growth.

Melissa uses biblical principles to teach women practical life skills in every area of life.

please see monicabrant. com/bodysoulretreat.

Military, Student & Group discounts are available. 12 and older are welcome to attend with a guardian.

Dr. Charles Bailey is an interventional cardiologist and endovascular specialist. He is board certified in Internal medicine, cardiovascular disease and interventional cardiology.

Sponsored by my good friends at: EggWhites International: eggwhitesint.com/likes/ monicabrant

Dr. Wassim Choucair is an Electrophysiologist and is board certified in internal medicine, cardiovascular disease, echocardiography and electrophysiology. He specializes in treating the electrical abnormalities of the heart that require pacemakers, defibrillators and the latest in ablative techniques to treat rhythm disturbances.

Play Again Now: playagainnow.com Paleo Zone Food Service: eatology.co

Dr. Feras El-Bash is an interventional cardiologist and endovascular specialist. He is board certified in internal medicine, cardiovascular disease, interventional cardiology, echocardiography, nuclear cardiology, and endovascular medicine.

My goal is that the attending women will leave the retreat with refreshed souls and full hearts, and that they will be motivated to tackle their next endeavors head on with some newlygained ammunition.

Our physicians treat cardiovascular disease, peripheral artery disease, rhythm disturbances, as well as the risk factors that cause these disorders, such as high blood pressure, high cholesterol and diabetes. They are skilled in performing procedures to identify and repair blocked arteries and treat electrical abnormalities using the latest tools and technology.

SAME DAY APPOINTMENT AVAILABLE

My next retreat will be February 4&5 and I will host another sometime in August. For more details

2017 - FEBRUARY MD Monthly

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1202 E. Sonterra Blvd., Building 6, Suite 604 San Antonio, TX 78258 | 210.844.2393

INFORMED PATIENT/NEW JERSEY

EIGHT SIMPLE STEPS TO RETRAIN YOUR BODY TO

I

DIGEST WHEAT AGAIN

By Dr. John Douillard

n a recent report, 70-80 percent of Americans were found to be experiencing some form of digestive distress, while one-third are obese, and more than 100 million adults are pre-diabetic and don’t know it. While many like to blame all of this on wheat, many food scientists do not agree.

While the standard American diet, which includes processed wheat, is likely responsible for these health concerns, there is also plenty of science that links a diet rich in whole grains, including whole wheat, to weight loss, better digestion, and lower blood sugar. The Mediterranean Diet is still revered as one of the healthiest diets on the planet, and is replete with whole grains and wheat.

The centenarians (folks over 100) who live in the Blue Zones (parts of the world where people live longer) eat a non-processed whole food diet 14

MD Monthly

which, once again, is rich in whole grains and wheat.

So, why are so many Americans having trouble digesting wheat?

That’s just it—they are not digesting it! Many who are gluten sensitive today digested wheat fine when they were young, but are currently having trouble. Somewhere along the line, our ability to digest foods that are a bit harder to digest, like wheat and dairy, has become compromised.

REMOVE ALL PROCESSED FOODS The first step in re-booting digestive strength is removing all the processed foods. A processed food diet has been linked to a 141 percent increase in belly fat, high blood sugar and high cholesterol. In the same study, a diet of whole grains, including wheat, reduced the risk of these health concerns by 38 percent.

Fitness pioneer Jack LaLanne once told me the best way to eat is to never eat anything out of a package.

The reason why processed foods are processed in the first place is so they can sit on a shelf for extended periods of time. Whole foods, as we all know, go bad quickly and it is not always possible to eat freshly-cooked food. So, here are simple ingredient label navigation tips to avoid highly processed foods.

1. Avoid all added sugars or artificial sweeteners. Allow nothing over 6 grams of naturally-occurring sugar per serving.

2. Avoid refined, cooked oils.

(Anything baked with oils or fried, i.e., bread, baked goods, chips, etc.)

3. Avoid all chemicals. Don’t eat it if you don’t recognize the name in the ingredients.

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INFORMED PATIENT/NEW JERSEY

RE-BOOT LIVER AND GALLBLADDER FUNCTION In the 1960s, when the FDA put cholesterol on the nutrient concern list, food manufacturers started boiling, bleaching, deodorizing, and refining vegetable oils. They were used as preservatives to keep bread squishy and “fresh” for weeks. After almost 60 years of blindly consuming these indigestible oils, this remains the number one reason for the great American digestive breakdown. The processed oils congested both the liver and gallbladder, rendering the liver’s bile unable to break down both good and bad fats and insufficient to buffer stomach acids. Without adequate bile production to neutralize stomach acid, the stomach will not produce the needed acid to digest proteins like gluten and the casein in dairy. This has resulted in a huge spike in gallbladder surgeries and epidemic levels of obesity, high blood sugar and food intolerances.

It is natural to blame the hard-todigest foods, but removing them only addresses the symptoms and leaves the cause – weak digestion left untreated, only to haunt your health down the road.

BOOST BILE FLOW The first step in strengthening the stomach’s digestive acid is to make sure there is plenty of bile flow from the liver and gallbladder. To boost bile flow, enjoy these foods daily: 4. Eat one red beet and one apple day. They can be raw, cooked, juiced or blended.

5. Add 1 teaspoon of coconut oil and one teaspoon of high quality olive oil.

6. Eat more artichokes, celery and leafy greens.

7. Drink fennel and fenugreek tea with meals.

STRENGTHEN STOMACH FIRE Once the liver is making adequate bile and the bile ducts and gallbladder are less congested, then you can stimulate the stomach to make the stomach acid needed to break down hard-to-digest so-called “allergenic” foods. Instead of taking digestive enzymes or an HCL stomach acid pill, I prefer to stimulate the stomach to make its own acid, and the small intestine and pancreas to make their own digestive enzymes. This is best done with the following five spices: 8. Ginger, cumin, coriander, cardamom and fennel.

Studies suggest that when these five spices are used together, they act as a total upper digestive re-boot.

They can be taken as a supplement, in cooking or used to flavor food.

These five star spices: • • • • • •

Increase bile flow (no need for bile salts) Increase pancreatic enzyme activity (no need for digestive enzymes) Increase small intestine enzyme activity (no need for digestive enzyme supplements) Decrease gas and bloating (no need for HCL supplements) Increase fat and sugar metabolism Are powerful free

• • • • • • •

radial scavengers Support optimal weight Support microbiology health (especially ginger) Improve gut health Support a healthy growth rate of good bacteria (especially ginger) Decrease H. pylori from adhering to stomach Are digestive stimulants Quicken the transit time in the intestines – supporting better elimination

Following these eight simple steps of nutritional navigation, boosting bile flow and stomach strengthening, will set you on the right path to retrain your body to digest (and enjoy!) wheat again.

Dr. John Douillard, DC, CAP, is a globally-recognized leader in the fields of natural health, Ayurveda and sports medicine. Over the past 30 years, he’s helped over 100,000 patients repair their digestive systems and eat wheat and dairy again. He is the creator of LifeSpa.com, former NBA director of player development and nutrition advisor and author of the book, Eat Wheat: A Scientific and ClinicallyProven Approach to Safely Bringing Wheat and Dairy Back into Your Diet.

For more information, please visit, eatwheatbook.com and connect with Dr. Douillard on Twitter, @johndouillard.

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INFORMED PATIENT/SAN ANTONIO

We Have Heard Dentists

Tell Us to Floss

But Why?

By Irene Blaess, DDS

M

any people floss because we know plaque buildup can lead to tooth decay and gum disease.

The truth is the mouth is the window to the rest of the body.

Bacteria from the mouth has been linked to dementia, strokes, heart disease, increased risk of oral cancer, respiratory infections and even low birth weight in babies.

Gum bacteria can also systemically affect people with diabetes. In fact,

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it has been proven that if a diabetic patient, who has active periodontal disease, gets it treated, their average daily sugars will drop by an average of 20 points. Patients with heart disease must also do everything in their power to keep their mouth pristine. Current studies have shown that the more bacteria that gets built up in the mouth daily, the more bacteria present in the blood that can reach the heart.

Bleeding is not a sign to avoid an area, but is an area to be concerned about. If you have bleeding during flossing, most likely you have either gingivitis (swelling of the gums)

or periodontitis (gum disease that includes bone loss around the teeth) and should be seen by a dentist who can determine the type of treatment you need to heal the area. If someone has bleeding on any other part of one’s body, they would not ignore it.

Please know that ignoring bleeding gums can turn a small problem into a life threatening situation.

Daily flossing gets into places that brushing can’t reach and minimizes the bacteria present.

What is the right way to floss?

Proper flossing removes plaque and

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INFORMED PATIENT/SAN ANTONIO

food particles in places where a toothbrush cannot easily reach. Many people do not floss correctly. The two most common misunderstandings about flossing is you must reach under the gum line and behind your last tooth.

Most professionals will agree that after the last food consumed in the evening or after breakfast is the best time to floss. A common question is should one floss before or after brushing? The dental community as a whole is split on that question. I believe as long as you do it, that’s what counts.

Children need to clean between their teeth, too. Start as soon as your child has two teeth that touch.

Because cleaning between teeth demands more manual dexterity than very young children have, children usually are not able to do a thorough

job on their own until age 10 or 11.

Keep in mind that cleaning between your teeth should not be painful and could be an indication of gingivitis or periodontitis. If you floss too hard, you could damage the tissue between your teeth. If you’re too gentle, you might not get food out. It’s normal to feel some mild soreness when you first start, but don’t give up. If you continue daily brushing and cleaning between your teeth, that discomfort should ease within a week or two. If your pain persists, talk to a dentist.

There are several options for cleaning between teeth. You might choose to use dental floss or another product specifically made for this purpose like a dental pick, prethreaded flosser, tiny brushes that reach between the teeth, or water flosser. There are some benefits to each, but a good dental professional

will optimize the products that are best for your specific situation.

Why has there not been a huge study to prove the need to floss?

Studies are expensive and difficult to standardize. In my 20 years of practicing dentistry, I have never seen anything that saves people more money and increases the longevity of teeth better than daily flossing.

For more information on Northwoods Dental Spa visit northwoods-dental.com or call 210.495.7800. The Northwoods Dental Spa is located at 18160 Highway 281 North, Suite 104 in San Antonio, TX 78232.

For more information on De Zavala Dental visit dezavala-dental.com or call 210.691.1333. De Zavala Dental is located at 5999 De Zavala Road, Suite 122 in San Antonio, TX 78249.

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INFORMED PATIENT/SAN ANTONIO

IS HEEL PAIN

KEEPING YOU OFF

YOUR FEET?

By Dr. Celeste M. Borchers, DPM

O

ne in three Americans suffers from heel pain, which results in loss of work or a reduction in daily activities.

The degree of pain ranges from a slight inconsistent twinge, to a burning or stabbing pain that is constant while moving and while at rest. Millions of dollars are spent annually on over-the-counter shoe inserts, pain relief creams, and gimmick-based shoes to try to stem the pain and to remedy the problem of the pain. But, in most cases, a patient is in need of a licensed professional for treatment.

A patient will change their shoes, 18

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their habits, their lifestyle, their activity levels, and their profession just to find a small measure of relief.

The causes of the pain will vary, as will the treatment regimen that a podiatrist can prescribe. However, currently the most common treatment is an intramuscular cortisone injection with reduced athletic exertion for two to three weeks post injection.

An injection will temporarily relieve the inflammation and muscular strain, but it won’t address the root cause of the pain. An uneven gait, leg length discrepancy, pelvic alignment, incorrect posture,

pes plannus, or muscle atrophy can cause heel pain as the patient’s body attempts to compensate for the condition. Once the injection wears off, which can be anywhere from three days to three years, the pain will return since the root cause of the pain has not been addressed.

That’s all changing now. In my practice I’ve encountered higher patient satisfaction, lasting results and a lower recurrence of pain by implementing laser-based pain therapy and custom orthotics combination. Patients want a lasting solution, and an injection isn’t as effective for long-term relief in comparison to coordinated laser pain

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INFORMED PATIENT/SAN ANTONIO

therapy and the implementation of custom orthotics.

The HyperBlue 1530 Laser will gently and temporarily raise the tissue temperature surrounding the inflamed area for an increase of blood flow and oxygen to the affected area, which promotes muscle relaxation and pain relief. Once the muscle has been relaxed, the custom orthotic then provides the stable and balanced foundation for the patient for every step they take.

A custom orthotic insert is molded to the patient’s foot and matches the contours of their feet precisely and is designed for the way the patient moves. They are used to correct abnormal motion while walking, or to provide

greater cushioning to the patient’s footbed. The New York Times quoted David Schofield, president of the American Podiatric Medical Association, as saying, "A custom orthotic puts your foot in an ideal position at every stage of walking, running and pivoting. You'll be at your most strong and at your maximum efficiency."

By combining the HyperBlue 1530 Laser pain therapy and the use of a custom orthotic, a patient can avoid the injection pain and the possible adverse cortisone reaction that can occur, while continuing their life activities with little to no interruption from pain or discomfort. I have found my patients not only have a faster recovery from the heel pain they presented with, but they also have

been able to increase their levels of activity and have a greater range of motion in their ankle and arch after the laser and orthotics treatment.

As the Baby Boomer generation becomes more active and our patients find more hobbies and adventures to undertake, the landscape of podiatric medicine will change and evolve, as will our treatment plans for them.

Learning how to best treat a patient with compassion, lasting care and faster recovery time is the daily challenge we all face as medical professionals.

For More Information visit LoneStarPodiatrist.com.

2017 - FEBRUARY MD Monthly

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INFORMED PATIENT/SAN ANTONIO

Amazing SmartGraft

TECHNOLOGY FOR

Single Hair TRANSPLANTATION

By Constance M. Barone, MD, FACS

I

recently performed single follicle hair transplantation using the SmartGraft machine and let me tell you, this is a fantastic machine! I have been practicing Plastic Surgery for over 20 years and have performed hair transplantation over the years using strip-graft harvest and rotation flaps.

This machine revolutionizes ease of hair harvest and protection of the grafts—in short this is definitely not your daddy’s hair transplant technique!

This is a minimally invasive procedure and leaves no linear donor scar, using a new suction-assisted, minimum-penetration technique that is virtually painless. This suction technology allows the hair follicles to be gently suctioned into environmentally controlled holding canisters in a completely closed system, which prevents grafts from 20

MD Monthly

drying out. The lack of desiccation (extreme dryness), the reduced treatment times, and the reduced graft trauma all translate into better graft survival.

The handpiece is balanced and lightweight, and has a built-in illumination as well as being coupled to suction. The machine’s screen is touchscreen-controlled and user friendly, with information feedback, and allows for user presets. All of the disposables are low in cost, which translates to lower cost to the patient. The company technicians are excellent and readily available for procedures.

This technology places it above the technology of NeoGraft and the difficult, bulky robotic systems that are available.

For all of the above reasons, this system, with its well thoughtout technology, yields excellent results. Therefore, both men and women have a new solution for hair restoration which is minimally invasive, with fast recovery and amazing results!

Dr. Constance Barone does not have any financial association with SmartGraft Constance M. Barone, MD, FACS Past Chief of Plastic Surgery at the University of Texas San Antonio Board Certified Plastic Surgeon 9502 Huebner Road building 2 unit 202 San Antonio, Texas 78240 Telephone (210) 614-0400 baroneplasticsurgery.com constancebarone1@yahoo.com

FEBRUARY - 2017

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INFORMED PATIENT/AUSTIN

WHAT YOU NEED TO KNOW ABOUT Upper Respiratory Infections Special To MD Monthly

A

s we find ourselves in the middle of winter, many doctors are treating quite a few patients with upper respiratory infections. Some key symptoms to look out for include runny and stuffy nose, sore throat, headache, cough and fever.

Many types of medicines can help you fight off a respiratory infection. But sometimes the best medicine is not a prescription medication. Taking such medication when they are not needed can actually make the situation worse.

Your doctor will evaluate your 22

MD Monthly

symptoms and decide if you need a prescription medicine or not.

Respiratory infections causing the common cold, sore throat, sinus infection and bronchitis are generally caused by viruses. Viruses are not killed by antibiotics, which are medicines that only kill bacteria.

That’s why no cure for the common cold has yet been invented.

Sometimes a viral infection can lead to a bacterial infection. A virus can weaken your immune system or damage tissues. This makes it easier for bacteria to grow and

cause disease. It can be hard to tell if a viral infection is leading to a bacterial infection. The indicator used most often is time: the longer your symptoms persist, the more likely bacteria have become involved.

Viral respiratory infections usually get better within seven to 10 days.

If symptoms continue longer than that, or if you start to feel better but then get worse, you may have a bacterial infection. Your doctor might prescribe an antibiotic to help fight the infection. If so, you should take the medicine exactly as prescribed.

If you quit taking the medicine early,

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INFORMED PATIENT/AUSTIN

you may end up with an even more serious infection.

Even though antibiotics don’t help you recover from a viral respiratory infection, there are ways you can speed recovery and feel better: •

• •

If you smoke, stop. Stay away from other smokers. Smoking and cigarette smoke can make your symptoms worse.

If the air is dry, add humidity to a room with a humidifier.

An over-the-counter nasal spray can sometimes help with stuffy, congested nose symptoms, but don’t use over-the-counter nasal spray decongestants for more than three days. Prolonged

•

•

• • •

use can lead to “rebound” symptoms—a return of the original symptoms, possibly with greater severity.

Use over-the-counter antihistamines or decongestants or a combination of both. If you take medicines for other medical problems that you have, check with your doctor or pharmacist before taking cold remedies.

Take pain relievers. (Ibuprofen or acetaminophen may be helpful for aches and pains.)

Read and follow all medication label instructions.

Blow your nose gently.

Drink plenty of clear fluids.

• •

For facial discomfort, apply warm towels or facial packs.

Wash your hands frequently, especially if you are in close contact with others. This will help stop the spread of the virus. If you need to cough, do so into your sleeve or into a Kleenex or napkin and quickly dispose of these.

A respiratory infection is never fun. But now you know how to make smart decisions about your treatment.

You’re more likely to recover quickly and breathe easily once again For more information or health tips visit sw.org.

2017 - FEBRUARY MD Monthly

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INFORMED PATIENT/AUSTIN

HEALTHY SNACKS & RECIPES FOR

Superbowl

Sunday Special To MD Monthly

S

uper Bowl Sunday on Feb. 5 is a day when many of us chow down on our favorite snacks while we root for our favorite team. But don’t let Super Bowl destroy your New Year's resolutions you just made. Cheer for your favorite team while keeping on track with these tips from dietitian Karla Luna, RD, LD of Baylor Scott & White Medical Center– Round Rock.

•

•

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Keep food in another room instead of in front of the TV. Fill up a small snack plate and then sit down. You may just notice how many times you are getting up.

Plan for a halftime meal instead of serving a lot of snacks. Make healthy chili (see recipe below) and serve with onions and lowfat or fat-free sour cream. Have baked corn chips on the side,

MD Monthly

• • • • •

•

along with fruit and salad. A warm chili taco salad with lots of lettuce, tomatoes, and chili with salsa as dressing and a few crushed baked chips on top is a filling and healthy meal.

Serve a variety of cut-up fruit with yogurt as a dip.

Have a big vegetable tray with lowfat healthy dips (see recipe below).

As a fun serving option, consider shish kabob veggies and fruit.

Use hummus as a dip for vegetables or whole wheat pitas.

Wrap whole wheat tortillas, fatfree refried beans, lettuce, and tomato. Add a dab of guacamole dip. Skip the cheese or use low-fat or non-fat cheese.

Make turkey wraps: whole wheat tortillas lightly spread with fat-free or low-fat cream cheese, turkey, lettuce and tomato. Wrap them up,

•

• •

• •

cut into small spirals and serve.

Buy mini whole wheat bagels and make bagel pizzas using pizza sauce and low-fat mozzarella. Add chopped up vegetables and bake until cheese is melted.

Serve pretzels with mustard for dipping.

Munch on popcorn: Using a brown paper lunch bag, cover the bottom with kernels and use the popcorn setting on your microwave to pop it up. Limit the margarine and salt.

Buy baked chips instead of regular chips.

Be careful with what you drink.

Alcohol has a lot of calories, and can also lower your resolve for healthy eating. Sugared drinks can also add a lot of unwanted calories.

Instead, serve sparkling, flavored, calorie-free water or sugar-free tea or lemonade.

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INFORMED PATIENT/AUSTIN

Recipes from Executive Chef DyRell Dilorenzo, Baylor Scott & White Medical Center - Lakeway:

•

Low-Fat Chili Recipe

• • • • •

• •

• • • • • • • • • •

1 tbsp olive oil 1 pound lean ground turkey or chicken. If you are a traditional chili eater, you can use beef. Just be sure it is the leanest you can find.

Chili seasoning to taste.

(McCormick is a good one.)

1 jar salsa (any kind) 1 16 oz can tomatoes diced 1 16 oz can kidney beans 2 cups water Diced peppers of all colors, 2 cups Salt to taste Low-fat cheddar cheese (garnish) Minced onions (garnish) Corn chips

1. In a large pot, heat olive oil and brown the ground meat.

2. Add salsa and chili seasoning.

3. Over medium-high heat, stir for a minute or two cooking the salsa a little (It should bubble).

4. Add canned tomatoes, kidney beans, water, frozen corn and salt. Add more chili powder if desired. Heat on high until it comes to a boil. Then lower the heat to medium and simmer for about 20 minutes.

5. Serve topped with cheddar cheese and minced onion.

2-3 finely chopped, seeded Anaheim (for mild vegetarian chili) or jalapeño (for hot vegetarian chili) peppers 1/2 teaspoon dried cumin 1/2 teaspoon oregano salt and pepper to taste 1-2 tbsp olive oil 2 cups vegetable broth (or water)

Brush olive oil on the eggplant slices. Grill eggplant until just tender, flipping once during cooking. This usually takes approximately 5 minutes per side. Remove eggplant from grill and cut into 1/2 inch squares.

Stir in the zucchini, eggplant, kidney beans and vegetable broth.

Add the tomato paste and stir until thoroughly mixed.

Return your easy vegetarian chili to a boil, reduce heat and cover. Simmer for approximately 45 minutes.

This vegetarian chili recipe can be served over rice or pasta for a more hearty meal. I also enjoy grating fresh parmesan cheese over the chili and adding raw onions just before serving this dish.

Low-Fat Veggie Dip

In large saucepan, heat one tablespoon olive oil. Add the onion and bell peppers and cook while stirring for three minutes or until the onion is soft. Add garlic to onions and peppers and cook for two minutes with stirring.

Add tomatoes, chiles, cumin, and oregano. Bring vegetarian chili just to the point of boiling then reduce heat and simmer for 15 minutes.

• • •

1 pint creamed cottage cheese — fat free 1 tbsp mayonnaise or Greek yogurt — fat free 1 tsp dry salad dressing mix or onion soup mix

Blend together until smooth. Serve chilled with your favorite fresh veggies.

For more information or health tips visit sw.org.

Vegetarian Chili • • • • • • • •

1 large red onion, chopped 2 red bell peppers, chopped 1 medium eggplant, peeled and cut into 3/4 inch slices 5 garlic cloves, chopped 1 medium zucchini, chopped 1 14 oz can kidney beans, drained 2 16 oz cans diced tomatoes 1 tbsp tomato paste

2017 - FEBRUARY MD Monthly

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INFORMED PATIENT/AUSTIN

Vaccines AREN’T JUST FOR KIDS Special To MD Monthly

T

hese days, we know at least one or two people trying to improve their health and wellness. They are exercising more, eating better, and making healthier lifestyle choices. But many adults are not aware that a key part of being healthy includes staying up-to-date on your vaccinations. Vaccines help protect you and those around you from diseases. That’s why vaccines are an important part of a wellrounded approach to adult wellness.

What Are Vaccines and How Do They Work?

Your immune system keeps you healthy and fights off infectious diseases. Antibodies are an important part of the immune system. They recognize and help destroy invaders, such as viruses or bacteria.

If you have antibodies for an infectious disease, it means your body can often defend itself against that disease or infection. You can produce antibodies to an infectious disease two ways: by being exposed to the disease itself or by getting a vaccine. A vaccine can trigger your immune system to make antibodies that help protect you.

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When you get vaccinated for certain diseases, you can help protect more than just yourself. Certain vaccinations are recommended to help prevent you from spreading the disease to others. All vaccines carry some risk for side effects, which you should discuss with your doctor before being vaccinated.

Adults may need vaccines for several reasons: •

• •

•

•

The protection provided by some childhood vaccines fades over time.

Some adults are not fully vaccinated.

New vaccines have been developed that were not around during the childhood of many adults.

Adults may be at greater risk for some infectious diseases as they get older.

Vaccines can help adults avoid spreading disease to others.

Some illnesses require yearly vaccinations for protection.

About 50,000 adults in the United States die each year from diseases that might have been prevented

by vaccines. In fact, adults are more likely than children to die of some diseases that vaccines can prevent. That’s why you should talk to a healthcare professional about helping to protect yourself with the appropriate vaccines.

In addition to exercising, eating right and getting enough sleep, adults need to make sure they are up-to-date on their vaccinations.

Vaccines aren’t just for children.

Getting vaccinated helps protect you from many diseases such as flu, pneumonia and whooping cough.

Getting vaccinated may also help you avoid spreading disease to those you love. Talk with your healthcare professional. Make sure your vaccines are up-to-date and complete. If you have children, make sure they are up-to-date on their recommended vaccines as well. Vaccines are a way to help maintain your own health and help protect the health of those around you.

For more information or health tips visit sw.org.

FEBRUARY - 2017

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HEART ENDOVASCULAR AND RHYTHM OF TEXAS

WELCOMES DR. SALAH EL-BASH

By Rudy Arispe

get that continuity of care and treat the diagnosis, such as a heart attack, and they get great satisfaction and years later you’re still managing their chronic conditions.”

After earning his undergraduate degree in biology from West Virginia University, Dr. El-Bash received his doctor of medicine degree from West Virginia University School of Medicine and then completed his residency at Marshall University Joan C. Edwards School of Medicine. He credits his interventional cardiology fellowship for preparing him for his career as a cardiologist.

For Dr. Salah El-Bash, practicing medicine is truly a family affair.

While completing an interventional cardiology fellowship at Marshall University Joan C. Edwards School of Medicine in West Virginia, he did so with his brother, Feras, at his side.

“We trained at the same institution and would always scrub together,” Dr. El-Bash said. “A goal of ours has always been to work together.”

The siblings have made that vision into reality. Recently, Dr. El-Bash became the newest cardiologist to

join the team of Heart Endovascular and Rhythm of Texas (HEART), where big brother, Dr. Feras El-Bash, has been caring for patients since 2016.

In addition to being an interventional cardiologist, Dr. Salah El-Bash is also an endovascular specialist at HEART. “I deal with the arteries, veins and peripheral vascular disease,” he said. “Most of the time I'm able to provide patients with a quicker recovery by doing invasive cardiac and peripheral procedures through the wrist and even the foot, if necessary. Traditionally, it has been through the groin to get to the arteries. Me and other interventional partners are able to take on complex blockages that patients have been told are not approachable, and we believe amputation should be an absolute last resort.”

He chose to specialize in cardiology because of the hands-on procedures that are required for which he believes he excels. It also allows him to incorporate the acute care setting and provide long-term treatment of patients. “You

“I’m now fully skilled to tackle any peripheral vascular disease,” he said.

“I got tremendous exposure to all the modern technology that is available today while doing my fellowship.”

I GOT TREMENDOUS EXPOSURE TO ALL OF THE MODERN TECHNOLOGY THAT IS AVAILABLE TODAY.

- DR. SALAH EL-BASH While Dr. El-Bash said his brother, Feras, whom he “looks up to” influenced him to focus on cardiology, it was their father, a urologist, who encouraged him to become a physician. “Growing up, I saw the bond he had with his patients and the respect he had for them,” he said.

“That’s what I can take away for my doctor-patient relationships.”

For more information visit heartdoc.care or call 210.844.2393.

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

MDMONTHLY.COM

MEET THE TEAM OF HEART ENDOVASCULAR AND RHYTHM OF TEXAS

Dr. Charles Bailey graduated from the University of North Carolina School of Medicine before going onto internal medicine in Phoenix. He taught for a year as chief resident before starting his cardiology fellowship in Wisconsin. Dr. Bailey then completed his fellowship in interventional cardiology in Pittsburgh. He started his career in New Braunfels, where he started the interventional cardiology program and helped establish the first Center for Peripheral Vascular Excellence.

Dr. Wassim K. Choucair received his MD from Columbia University College of Physicians and Surgeons. He completed his residency and fellowships in internal medicine, cardiology and electrophysiology from George Washington University, the National Institute of Health and Georgetown University Hospital. Dr Choucair's training and practice spanned cardiovascular and heart rhythm disorders. He focuses on heart and rhythm disorders, cardiac devices and ablation interventions. He is honored to serve and practice in South Texas for the 15th year from Corpus Christi to San Antonio. He is now at the South Texas Medical Center with his established Heart and Rhythm Institute and Coastal Heart Foundation. In addition, Dr. Choucair takes great pride in partnering with the Heart Endovascular and Rhythm of Texas (HEART).

Dr. Feras El-Bash earned his medical degree from West Virginia University School of Medicine. Afterward, he did an internal medicine residency as well as a general cardiology fellowship at Marshall University. He did his interventional cardiology fellowship at the University of Connecticut Hartford Hospital. He is board certified in internal medicine, general cardiology, interventional cardiology, endovascular medicine, as well as nuclear cardiology and echocardiography. Dr. Feras El-Bash decided to leave his previous practice in 2016 to help establish and cofound Heart Endovascular and Rhythm of Texas (HEART).

Dr. Miltiadis (Milton) Leon is board certified in cardiovascular disease and interventional cardiology. He completed his residency in internal medicine at the University of Connecticut School of Medicine in Farmington, Conn. Dr. Leon then followed with his cardiology fellowship at the University of TexasHouston Medical School and Texas Heart Institute in Houston and continued his sub-specialty fellowship in interventional cardiology at Massachusetts General Hospital/Harvard Medical School in Boston. He is the founder of Cardiology Associates of West Texas, a well established practice in San Angelo over the last 14 years. Dr. Leon is proud to be affiliated with HEART PA. 2017 - FEBRUARY MD Monthly

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OP-ED/SAN ANTONIO

WHEN IT COMES TO

Colon Cancer Awareness, GET YOUR REAR IN GEAR

By Maria Palafox, MD

T

he American Cancer Society has launched a new campaign called “80% by 2018” to fight colon cancer. The ACS wants 80 percent of people, age 50 and older, to have a colonoscopy by the year 2018.

Every male and female should have a colonoscopy at age 50. If you have close family members who had colon cancer before the age of 50, then you should have yours 10 years before the age they were diagnosed.

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For instance, if your brother had colon cancer at 45, you should have your first colonoscopy at age 35.

Colonoscopies are not painful because you are put into twilight sleep for the procedure. The day before your colonoscopy, when you clean out your colon, can be unpleasant because you are going to the bathroom all day. But so what?

It’s only one day, and it sure beats having colon cancer.

The purpose of the colonoscopy is not only to look for colon cancer but also to look for polyps. A polyp looks like a round bump on the inside lining of the colon. We know colon cancer starts off as a polyp; we just don’t know which polyp might someday turn into cancer. So we remove all the polyps that we see during the colonoscopy.

This decreases your risk of cancer. If you have no polyps, you do not have to have another colonoscopy for another 10 years, depending on your personal risk for colon cancer.

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Colon cancer is more common as we age, like most cancers. It is the second most common cancer in Hispanic men and women. Although the overall incidence of colon cancer is decreasing, there has recently been a disturbing trend: the incidence of colorectal cancer is increasing in the 18-34 age group. This is the same group with increasing rates of obesity and diabetes.

These aren’t the causes of colorectal cancer, but they seem to be adding to the risk. Factors that protect against colorectal cancer include increased physical activity,

use of anti-inflammatory drugs, milk and calcium consumption, and screening for the detection and removal of polyps before they turn into cancer.

Although the “80% by 2018” campaign is a step in the right direction, it does not include this younger group of patients. So talk to your doctor about your risk factors if you are not yet 50. They will discuss obesity, diabetes, high red meat consumption and family history of colorectal cancer, as well as personal history of inflammatory bowel disease.

Blood in your stool or a significant, prolonged change in your bowel habits might be a sign of something more serious that just hemorrhoids or constipation. Pledge to be part of the 80% by 2018 and get your colonoscopy if you are 50 or older.

If you aren’t, encourage friends and family to take the pledge.

There is a 5K Run/Walk on Sunday, April 3 in honor of Colon Cancer Awareness Month at the Wheatley Heights Sports Complex. Check out getyourrearingear.com to sign up.

2017 - FEBRUARY MD Monthly

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Marc Arevalo Miranda Paredes Grizelda Garza Luz Ortiz – Box Beat, Owner Christian, Alexis & Mia Michelle Sofia Allen Box Beat & Club at Sonterra Courtesy of Neiman Marcus

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LUZ ORTIZ is a mother of three children – Christian, Alexis and Mia Michelle – and a realtor with San Antonio Portfolio Real Estate.

But many people are surprised to learn that she also is the owner of a boxing gym, Box Beat, which she opened in October 2016.

“People ask me, ‘Why a boxing gym?’ I just tell them, ‘It’s the best whole body workout ever.’ Always makes me push my limits. I feel strong, healthy and happy.”

Model: Christian Jeans Mossimo – $24.99 Target Red Sweater Merona – $24.99 Target White Shirt Burberry – $265 Neiman Marcus Sun Glasses Zenga – $385 Neiman Marcus Model: Alexis Clothing Model Owned

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MEDICAL BUSINESS/RIO GRANDE VALLEY

DOCTORS HOSPITAL AT RENAISSANCE FIRST IN SOUTH TEXAS TO USE EXPERIMENTAL TREATMENT TO REVERSE FATAL LIVER DISEASE IN INFANTS

By Kelli Owen Quinn

Dr. Dynio Honrubia, Dr. Jyothi Swarup, and Dr. Emil Milano, neonatologists at the Women’s Hospital at Renaissance.

D

octors Hospital at Renaissance Health System (DHR) was approved by the Food and Drug Administration in August 2016 to become an intermediate site for the use of Omegaven, a potentially lifesaving treatment made with fish oil. Omegaven can both prevent liver inflammation and liver failure in preterm infants and can also heal

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the damaged preterm liver after exposure to prolonged conventional intravenous fat. Dr. Dynio Honrubia, Neonatologist at the Women’s Hospital at Renaissance, and the Doctors Hospital at Renaissance Research Institute, are leading the study that provides preterm infants with this lifesaving nutritional source. Without the administration

of Omegaven in babies who suffer from parenteral inflammation and liver failure, progressive liver disease and liver failure can continue later on in life.

Omegaven is a fish-oil emulsion that is given intravenously to patients who require parenteral nutrition supplementation. This treatment is

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MEDICAL BUSINESS/RIO GRANDE VALLEY

encouraged when oral or enteral nutrition is impossible, insufficient or contraindicated, based on the status of the baby. This new treatment is currently approved for marketing in Germany and only in the United States for Investigational New Drug (IND) applications. DHR has acquired an IND with the intention to treat parenteral nutrition dependence and cholestatic liver disease in at least three newborn babies every year with the use of Omegaven.

DHR is one of the few institutions on the country that has been granted permission by the FDA to use the investigative new drug.

An application was submitted to

request the use of Omegaven in babies at the Women’s Hospital at Renaissance when Dr. Honrubia noticed the need in our area. The next closest available center that administers Omegaven is Texas Children’s Hospital in Houston, Texas.

“Basic science and clinical research have shown Omegaven to be safe and lifesaving when used to prevent or treat the liver inflammation and liver failure that affects extremely preterm newborns,” states Dr. Dynio Honrubia, Neonatologist at the Women’s Hospital at Renaissance.

“We are very thankful and extremely proud that the FDA, after reviewing

our neonatal outcomes and staff resources, has chosen Women’s Hospital at Renaissance to be the first private hospital in the United States to be able to independently prescribe Omegaven.”

With equipment designed for infants and a hospital staff that has professional training in newborn care, the neonatal intensive care unit (NICU) at The Women’s Hospital at Renaissance (WHR) was created for newborns that need specialized treatment. The WHR NICU has consistently ranked among the top 5% of neonatal intensive care units in the United States. For the majority of complications caused by prematurity, including mortality, chronic lung disease, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity—the WHR NICU ranks in the top 5% in the world.

About the Doctors Hospital at Renaissance Research Institute The Doctors Hospital at Renaissance Research Institute was created in 2014 with the goal of bringing the latest and most innovative therapies and treatment regimens to the Rio Grande Valley.

Through the Institute, our goal is to encourage greater participation in clinical trials among our community and underrepresented populations.

Incorporating biomedical research with the top quality healthcare already provided by Doctors Hospital at Renaissance Health System will catalyze future life-saving cures and innovations, developed right here in our community.

Dr. Dynio Honrubia treats a newborn in the Women’s Hospital at Renaissance Neonatal Intensive Care Unit.

Doctors Hospital at Renaissance continues to be the premier healthcare provider in South Texas.

For more information, please call (956) DOCTORS (362-8677) or visit our website at dhr-rgv.com.

2017 - FEBRUARY MD Monthly

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Dr. Nelly Garcia Blow FINDS JOY IN TREATING

Elderly and Vulnerable Patients

By Rudy Arispe

G

rowing up in Brownsville on a 10-acre farm with some 500 pigs and 1,000 chickens, it’s no surprise that Dr. Nelly Garcia Blow initially wanted to be a veterinarian.

As an adolescent, she knew she wanted to be a doctor. Although this should have been good news to her parents, they strongly discouraged her by the time she was ready to enroll in college with her sights set on a medical degree.

“My parents never even went to elementary school, though they were always big on education for us,” she said. “To them, an accomplishment would have been for their children to graduate from high school. I think it was their fear of not wanting me to fail which is why they discouraged me.”

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When Garcia Blow let her high school teachers and coaches know of her dream to become a physician, they became her biggest cheerleaders.

WE WERE UP AT THE CRACK OF DAWN CLEANING PIG PENS BEFORE SCHOOL.

- Nelly Garcia Blow

“My principal would bring in medical students to talk to the health career students to help us bring our dreams one step closer to becoming a reality,” she said.

Garcia Blow’s independent and tenacious spirit led her to fulfill her dream. Today, she practices inpatient medicine and geriatrics at

CHRISTUS Spohn Hospital Corpus Christi – Memorial. She completed her residency in family medicine and a fellowship in geriatrics within the health system. Specifically, she does consultative services for injured geriatric patients admitted to the Level II Trauma Center.

“This includes anyone 55 and older– and trauma isn’t all knife and gun cases. It also can be car or water sports accidents,” she said. “I also do all the medical management for geriatrics and end-of-life care, so I meet with a lot of families.”

Last year, Garcia Blow began treating behavioral health patients, which she enjoys.

“I had the opportunity to work with Care Integrated Behavioral Health alongside the psychiatry team that provides the management for PHOTOGRAPHS BY Paul Marshall

MDMONTHLY.COM

a patient’s mental health, and I manage their medical co-morbidities (which is the presence of two chronic diseases at the same time in a patient),” she said. “The goal of the program is to provide vulnerable populations with an integrated medicine service. It’s been great to help this vulnerable population manage their blood pressure or diabetes, or be of service to those who are depressed or suicidal.

“Often times, that’s a population difficult to treat because they don’t follow up. But I consider it an honor to be able to say that when I was younger I wanted to be a doctor, and now I live that dream and take care of the very people who need care the most.”

Dr. Nestor H. Praderio, medical director of Care Integrated Behavioral Health, met Dr. Garcia Blow when she did her rotations at CHRISTUS Spohn. “Since coming here, she has shown great dedication and

leadership,” Praderio said. “Through the years, I continue to see her grow. She has a brilliant career in her future and will continue to shine as a member of the medical community in Corpus Christi.”

Dr. Garcia Blow spoke of a recent case in which a 91-year-old female fell in a parking lot and sustained multiple fractures. Garcia Blow was determined to do all she could to help her patient walk again.

“I always tell people, ‘My goal is to get you to where you were before the accident. If you were in a wheelchair, the likelihood of you walking again is not going to happen. But if you were walking around and going to the store or to church, let’s get you back to that.’ Now this 91-year-old patient has walked out of the rehab facility,” Dr. Garcia Blow said.

Chaplain Lynne Blackler of Memorial Hospital said Garcia Blow has a caring and calming presence about her. “She is very spiritual, which is intertwined with her caring for people,” the chaplain said. “She is also very attentive and is a great listener, whether she’s talking to a patient, staff or a family member.”

Dr. Garcia Blow’s love and concern for her geriatric patients started with her grandmother, who recently passed away at age 100, and who lived with Dr. Garcia Blow and her husband, Dr. Osbert Blow, medical director for CHRISTUS Spohn’s Trauma and Surgical Critical Care Services.

“In bad situations with geriatric trauma patients, I’ve been able to help the families have their loved ones live out their days the way

they wanted,” she said. “In her final days, my grandmother asked not to be taken to the hospital. She died at peace in our home.”

WE LOVED IT. BEING TAUGHT TO WORK HARD WAS ONE OF THE GREATEST GIFTS WE EVER GOT FROM OUR PARENTS.

- Nelly Garcia Blow

Karen Urban, immediate past chair of the board of directors for the CHRISTUS Spohn Health System, has known Garcia Blow for several years as a friend and physician.

“She is one of the finest physicians in our community,” Urban said. “Her practice exemplifies what we hold true as our mission—to extend to others the healing ministry of Jesus Christ.

Her patient care embodies that. She is kind, caring and compassionate.”

Garcia Blow credits her parents for instilling within her a strong work ethic, starting with those early days of working on the family farm; an ethic that, as a physician, she still practices today.

“We were up at the crack of dawn cleaning pig pens before school,” she recalled. “We loved it. Being taught to work hard was one of the greatest gifts we ever got from our parents.”

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A MOTHER FINDS COMFORT WHEN HER NEWBORN

MUST UNDERGO

Open Heart Surgery

By Ashley Stephens

T

he Stephens family dynamic changed on May 13, 2016.

We were beyond excited to welcome our second child.

Another boy! My husband and I arrived for a repeat C-section and had zero expectations for anything except meeting our healthy Pearson Lane. Moments after his introduction to the world, we were shocked to hear, “Your son has markers of Down Syndrome.” On an emotional roller coaster neither of us expected, we relied on our faith to help process the news. “It is confirmed. He does have trisomy 21, also referred to as Down Syndrome.” The weight of the words was heavy.

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Unfortunately, Down Syndrome is associated with other health issues. While examining Pearson in the neonatal intensive care unit, nurses discovered a heart murmur. A cardiologist would soon deliver more

news we weren’t prepared for. Our cardiologist, Dr. Pooja Kashyap, is the doctor who delivered that news. The second I met Dr. Kashyap, I knew she was brought into our lives for a reason.

“Pearson does have a ventricular septal defect and an atrial septal defect.” More heavy words. She immediately followed with an explanation of these defects and how they affect the heart and other organs. With normal development of a fetus, the wall between the two lower heart chambers closes before the fetus is born. Dr. Kashyap explained that Pearson’s heart would not close by itself, and that he would need open heart surgery. She offered

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peace and comfort and it was almost as if she had shifted the burden from our shoulders to hers. We left that meeting confident that this doctor would provide answers and healing for our baby.

Over the next month and a half Dr. Kashyap invested her heart and soul into monitoring Pearson’s health through what seemed like countless doctor’s appointments, multiple medications for his heart and lungs, a nutrition plan, specialist examinations, and test upon test from heart to gastrointestinal to thyroid. After thoroughly investigating all aspects of Pearson’s condition in this short time frame, in a case conference, Dr. Kashyap was able to present Pearson’s case to a team consisting of a pediatric cardiologist,

a radiologist, and a surgeon. Ideally, a surgeon would not want to operate on a heart until 4 months.

At 2 months old, on July 14, Pearson Lane went back to the operating room for tiny open heart surgery. A successful repair was completed by Dr. Kupferschmid. Our baby’s heart was mended thanks to his skill and Dr. Kashyap’s diligence in providing a well-prepared case study.

resources, yet she still had time to comfort us. She shared her love with us. Pearson is such an incredible blessing, and my husband and I feel far from worthy of the joy he brings to our family. There are no words to describe the debt of gratitude we feel for Dr. Kashyap. I pray that every family enduring such hardship will get to experience the kindness, warmth, and persistence of a doctor of her caliber.

Our story is unique because of our faith in God, an amazing support group, and a guardian angel, Dr. Kashyap. She exceeded the expectations of a doctor. In fact, she became family to us. Her passion and expertise made me feel like she was treating her own child. She spent hour after hour analyzing test after test and cross-checking all her

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AVOIDING Open Heart

SURGERY:

DOCTORS HOSPITAL AT RENAISSANCE OFFERS A LIFE-SAVING ALTERNATIVE FOR AORTIC VALVE REPLACEMENT Special to MD Monthly

C

ardiologists at Doctors Hospital at Renaissance are saving lives through a less invasive medical procedure known as transcatheter aortic valve replacement (TAVR).

Dr. Norman Ramirez, Dr. Carlos Morales and Dr. Benjamin Robalino of the Heart Institute at Renaissance perform this life-saving procedure for patients at high risk for open heart surgery. They have performed more than 50 TAVR procedures since launching the program in August 2016.

“It’s convenient for patients because they don’t have to have their chests cut open or leave the city for surgery,” Dr. Morales said. “They go home three days after having the procedure. We’re proud of the fact that we’re the only hospital in South Texas doing TAVR.” Dr. Norman Ramirez has performed 42 TAVR procedures in the last several months. “I’ve been practicing medicine for 30 years, so it’s exciting to learn new techniques,” he said. “TAVR can be a life-saving treatment for people at high risk for open heart surgery.”

Dr. Ramirez knows all about saving lives in the Rio Grande Valley, where he was raised. He implanted the first defibrillator in a patient there in 1989 and also performed the first TAVR procedure at Doctors Hospital at Renaissance. It was his father, a physician who treated many of the poor in his hometown of Roma and from Mexico, he said, who inspired him to practice medicine.

“He used to make house calls, and I would drive him,” Dr. Ramirez said.

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“He delivered hundreds of babies and now I take care of all their children.”

I’VE BEEN PRACTICING MEDICINE FOR 30 YEARS, SO IT’S EXCITING TO LEARN NEW TECHNIQUES.

- Dr. Norman Ramirez

Dr. Ramirez recalls leaving home for the first time at age 16 and landing at New York’s La Guardia airport to begin college at Yale University. “People say you can’t get a good high school education in the Rio Grande Valley, but I graduated from Yale magna cum laude and in the top of my class at Stanford University Medical School,” he said.

After completing his cardiology training at Duke University School of Medicine, he was on staff at the Mayo Clinic before deciding to return home to care for patients in his community.

“I missed home and my family,” Dr. Ramirez said, “and I realized I could do things in the Valley that weren’t going to get done otherwise. My training had been quite extensive, so I took my skills back home and started doing procedures that had never been done here before.”

According to the American Heart Association, the TAVR procedure is somewhat similar to a stent placed in an artery. It delivers a fully collapsible replacement valve to the valve site through a catheter. Once the new valve is expanded, it pushes the old valve leaflets out of the way and the tissue in the replacement valve takes over the job of regulating blood flow.

The TAVR procedure is

performed using one of two different approaches, allowing the cardiologist to choose which one provides the best and safest way to access the valve: Entering through the femoral artery (large artery in the groin), which does not require a surgical incision in the chest or using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest, or through the tip of the left ventricle.

Dr. Morales explained that candidates for TAVR are evaluated by two surgeons who determine whether a patient is too high risk for open heart surgery because of advanced age “or other vulnerabilities.”

Dr. Morales has been a cardiologist since 1983 and said he still wakes up excited every day to treat patients and teach internal medicine residents at the University of Texas Rio Grande Valley.

“Teaching is part of my job,” he said. “It’s necessary that we teach future generations of physicians and cardiologists.”

IT’S CONVENIENT FOR PATIENTS BECAUSE THEY DON’T HAVE TO HAVE THEIR CHESTS CUT OPEN OR LEAVE THE CITY FOR SURGERY.

- Dr. Carlos Morales

Dr. Benjamin Robalino specializes in cardiovascular disease, and is a member of the TAVR team at Doctors Hospital at Renaissance. After graduating from Cayetano Heredia University in Peru, Dr. Robalino has spent more than 25 years serving the

PHOTOGRAPHS BY Gerardo Garmendia & Christian Moller

MDMONTHLY.COM

needs of people suffering from heart disease and related ailments.

If you were to ask him what he does, he may boil down the definition a bit.

“I do interventional cardiology, a sort of heart plumbing,” Dr. Robalino says. “We treat the narrowing of the heart and peripheral circulation.”

Dr. Robalino is affiliated with Doctors Hospital at Renaissance, which offers the premier cardiovascular program in the Rio Grande Valley through its Heart Institute at Renaissance. Physicians at the Heart Institute at Renaissance perform many specialized procedures not available at other regional medical facilities.

Dr. Robalino says he’s proud to be part of a group of cardiologists who have served the area for so long.

“Better service, more efficient service, less waiting time — that was basically the idea behind the formation of the Heart Institute at Renaissance,” Dr. Robalino says.

Efficiency and a focus on cardiology and vascular care counts in many ways in the Rio Grande Valley. Poor health around the Valley has been well noted in recent years.

The region’s rate of diabetes was recorded as being 20 percent higher than that of all of Texas in 2013.

In the same year, nearly one in three Valley residents was diagnosed as diabetic.

“This area has a disproportionate number of people with diabetes,”

Dr. Robalino says. “Plus, the population has an aggressive form of vascular disease.”

He explains that many Rio Grande Valley residents are being diagnosed with diabetes and/or vascular disease at an earlier age, with some ending up on dialysis.

Actually, there are two populations emerging in the Valley’s health care scene these days. One is the native/ local population, mostly Hispanics and Latinos who face cardiovascular diseases because of high blood pressure, obesity and diabetes.

PEOPLE ARE MUCH MORE INFORMED NOW THAN THEY WERE 20, 30, 40, 50 YEARS AGO.

- Dr. Ben jamin Robalino The other population is the group of “Winter Texans” — Northerners and Canadians who head to Texas for the winter. These mostly elderly people already are diagnosed with cardio or vascular disease.

While February is American Heart Month, physicians at the Heart Institute at Renaissance say it’s important for everyone to balance prevention and awareness to fight heart disease, or to reduce the risk, year-round

disease or stroke, that’s already a bad start to life.”

Dr. Robalino says prevention or coping can come in the form of exercise and proper diet. For example, 30 minutes of continuous walking, five times a week, is a good start for many people. He recommends limiting salt intake, regularly monitoring one’s blood pressure and cholesterol, and not smoking for better heart and vascular health.

“There’s no particular diet that’s better than another,” he says. “As for exercise, it’s the base for prevention as long as you don’t smoke.

Otherwise, you can’t control it.”

As for cholesterol, Dr. Robalino agrees with other physicians and research that it’s best to keep bad cholesterol low and keep good cholesterol at an adequate level.

“This is a lifelong commitment to the situation,” he says. “People need to understand (the disease) will never go away.”

The Heart Institute at Renaissance is affiliated with Doctors Hospital at Renaissance Health System. The institute has locations in Brownsville, Rio Grande City, Edinburg and McAllen. For more information, visit dhr-rgv.com.

“People are much more informed about cardiac disease now than they were 20, 30, 40, 50 years ago,” Robalino says. “Think back to, say, 1950-1955. Nobody then knew smoking could lead to cancer, cardiovascular disease or stroke. If people aren’t aware that smoking can lead to cancer, cardiovascular

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FROM HOMELESSNESS TO A FULFILLING CAREER: OWNER OF SAN ANTONIO SHADES AND SHUTTERS TELLS HIS STORY OF STRUGGLE AND TRIUMPH

By Josh Lopez

I

grew up in the poorest part of South Bronx, New York. It was Mom, Dad and my five siblings.

Growing up we experienced some very challenging times. My dad moved us to Austin when I was a teenager and it was there I saw him battle a drug addiction that later led to me being homeless.

At 15, I dropped out of high school and began making poor choices, desperate to find my place in this world. A couple years later I had a breaking point and decided that I wanted to do something with my life. I moved to Puerto Rico and went back to school. I worked three jobs to put myself through college.

Later, I graduated as valedictorian of my class. Somehow, all that pain that I went through as a young kid had turned into drive and motivation to work hard for my dreams.

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I landed my first record deal straight out of college and began touring Latin America, opening for acts like Ricky Martin, Manรก, and other great artists. I was 21 and living the dream. However, I still felt like something was missing.

My mom always taught me that life was about living with purpose and passing along the good will I had received as a gift to help others.

During this time in my life, everything centered on me, and it was clear I needed a purpose greater than that of just becoming famous and wealthy. It was in the next months that my life took an even greater turn, and I found purpose through my faith.

I decided to move back to Austin and pursue this purpose in my life.

During the next years I had the

opportunity to work with some pretty amazing artists and producers. I have traveled the world doing what I love.

Seven years later, I have had amazing opportunities as a recording artist and songwriter. I started my own business and proposed to my dream girl. It has been an amazing journey.

Today, we have three precious children, a thriving business, a healthy lifestyle and, above all, we live our lives with purpose and hope that we can inspire others to never give up. Our life is by no means perfect, but it is a blessed life.

To wake up every morning and do what you love, and help others in the process, is an absolute dream come true. We continue to dream big because we know that the big dreams that we had years ago are now reality. Anything is possible if you believe. I have found that some

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of our greatest moments have come from pain and facing adversity.

The decision to never give up has helped us see greater things along the journey and helped us enjoy the destination so much more.

Life is full of adversity; it is full of challenge and disappointments.

I could have been another young kid who turned criminal or drug addicted. If it had not been for grace and the continual motivation to never give up, I would have missed out on some pretty great moments in life.

I am so grateful today for dreams realized, but today I am even more for the challenges in life that helped shape those dreams. Am I chasing greater dreams now? Absolutely!

Am I facing greater challenges now? You bet. You don’t get one without the other. A year ago, I had the opportunity to do the Ironman Race, which is a triathlon that consists of completing a 2.4 mile open-water swim, a 112 mile bike ride and a 26.2 marathon run in one day. I trained for one year and met many obstacles along the way. After a lot of hard work, a great support system and many lessons learned along the way, I finished the race and became an Ironman. It was one of the greatest things that I have ever experienced in life: To defeat something that represented so much fear and impossibility and to conquer a dream that seemed so far out of reach.

It made me think about life and how life is a journey that has many obstacles, challenges and lessons.

When we choose to never give up and stay the course, we have so many great rewards as we cross the finish line. No matter how hard or how challenging life can be sometimes, don’t give up on your dreams and purpose in life.

Josh Lopez has a new music project titled “Don’t Give Up” and later this year will release his first book. For more information, visit joshlopez.org.

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What is the

“CANCER MOONSHOT” All About?

By Maria Palafox, MD

L

creation of an open access resource for sharing cancer data to private sector commitments to further research. All of this is happening in order to find a cure for cancer.

On my most recent review of the whitehouse.gov Fact Sheet for the Cancer Moonshot, there are 39 Task Force initiatives currently in the works to achieve the goal of curing cancer. They range from making clinical research trials more accessible to cancer patients to

We might say that these 39 initiatives will not necessarily touch the average person’s life because the efforts are going to help advance research and scientific discovery. On Sept. 7, the Washington Post reported that a Blue Ribbon Panel of the Cancer Moonshot Program delivered 10 ideas to Vice President Biden.

These 10 ideas are recommendations that can be accomplished quickly

ast year, President Obama appointed Vice President Joe Biden to head a government initiative to end cancer as we know it. The Cancer Moonshot program is committed to doubling the rate of progress towards a cure for cancer.

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and that can make an immediate difference for the average cancer patient undergoing treatment today.

One of the most important of the 10 ideas is the creation of a national network that will allow patients all over the country to have their tumors profiled. This gives researchers tons of information about different cancers that can tell us what treatments work, how different cancers spread, and what makes the cancer weaker, so that each patient can get a personalized treatment plan based on their specific cancer’s behavior.

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Another one of the 10 ideas is to create a clinical trial network that focuses on immune therapy; these drugs are wildly effective against certain cancers by using the body’s own immune system to fight the cancer. One of the 10 ideas calls for increased genetic testing to look for inherited cancer syndromes—think Angelina Jolie. Knowing that you have a gene that predisposes you to cancer can give you the opportunity

to change your genetic destiny, with increased testing or preventative treatments. The Blue Ribbon Panel also makes recommendations regarding the prevention of cancer and ideas on how to educate patients and the community on these recommendations.

Another part of the Cancer Moonshot initiative was contributed on Sept. 6 by the American Society

of Clinical Oncologists (ASCO). They made three recommendations, but one in particular is worthy of special mention because it affects the minority community.

Poor patients, older adults and minorities are underrepresented in clinical trials. One part of the reason for that is that, unlike Medicare and private insurance like Blue Cross and Blue Shield, Medicaid is not required by federal law to cover routine care costs that are billed to patients who are enrolled in clinical trials. So if you want to participate in a clinical study trial for breast cancer, but you have Medicaid, the routine blood tests required by the trial is not covered.

You would have to pay for it out of pocket, but who has the money to do that? So you drop out of the study, and poof, there goes the Latina representation in that breast cancer study trial.

The Cancer Moonshot is ambitious for sure, but there are things being done already that are improving the care of cancer patients.

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