Mdmonthly January - Dr. Pradeep Mohan by MD Monthly

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

t e l 830.572.5000

w e b PEGGYSONTHEGREEN.COM

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contents January 2018 Production Digital Media Source Chief Executive Officer Eliot Garza Project Manager Jessie Moore Chief Media Director Andrew Kovach Assistant Project Manager Sarah Washington Publisher Eliot Garza Managing Editor Jessie Moore Assistant Managing Editor Sarah Washington Designer Aurora Balderas Cover Designer Michael Mancha Editors Margaret Hager Jessica Cerda Writers Rudy Arispe Jody Marnel

Dr. Steven Cyr Getting Your Life BACK with SA Spine

The Year of You with Dr. Pradeep Mohan

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Photographers Trinity Greer Paul Marshall 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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of Veda Medical

Contributors Shen Chao Dr. Michael Fuentes Eric Kala CFP®, CIMA®, AEP®, CLU®, ChFC®, CRPS® Mary Maloney Cher Murphy Karen Reed Dr. Jennifer Walden Douglas R. York

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contents

54 Healthy Living:

Six Winter Workout Tips To Keep You Motivated

12 Healthy Living:

8 Filling Midnight Snacks by Karen Reed

56 Healthy Living:

Prevention is Better Than Cure

Female Doctors Association of Corpus Christi

42 Business:

Time Weighted Return Understanding Your Rate of Return

46 Children’s Health:

Can an annual eye exam change your child’s life?

52 Business:

Ten Mistakes to Avoid When Filing for Divorce 8

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iNFORMED PATIENT

Special to MD Monthly submitted by Texas Center for Facial Plastic and Laser Surgery & Endormir Sleep and Sinus Institute

How do you know if you have NAO?

Nasal Airway Obstruction

hat if you constantly had difficulty breathing through your nose when exercising, or simply sitting on the couch? Imagine using nasal sprays and strips on a regular basis but still feeling as if you were walking around with a clothespin on your nose. What if nasal congestion, blockage or obstruction caused you to have trouble sleeping? This would significantly affect your life, right? For the more than 20 million Americans suffering from nasal airway obstruction (NAO), this is the norm – but it does no have to be. Dr. Jose Barrera, the Director of the Texas Center for Facial Plastic and Laser Surgery & Endormir Sleep and Sinus Institute, discusses signs of NAO and an innovative option that is now available to address a common cause of NAO – nasal valve collapse (NVC). Dr. Barrera, who was recently appointed a fellowship director with the American Academy of Facial Plastic and Reconstructive

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Surgery, and his patient Robert Demel, are among the first in the state to use an innovative device that ear, nose, and throat (ENT) physicians have deployed to help thousands of sufferers.

Collapsed valve What causes NAO? Nasal breathing normally delivers 70% of the airflow to our lungs, and every millimeter of nasal airway counts, as far as Dr. Barrera is concerned. A one milimeter reduction in the width of the airway costs a patient nearly 40% in airflow. “Even the slightest narrowing of the

nasal airway can lead to a significant reduction in airflow consistency,” said Dr. Barrera. “The most common conditions are septal deviation, turbinate hypertrophy, and NVC, which may be caused by previous rhinoplasty surgery,” he added.

Details of these conditions follow: • Septal deviation: The cartilage wall between the nostrils can bend and block the nasal passage. • Turbinate hypertrophy: Ridges of bone and tissue inside the nose can limit airflow when enlarged. • Nasal valve collapse: Weak or excessively flexible upper/lower cartilage in the outer nasal wall may cause it to collapse inward when a person inhales.

According to Dr. Barrera NVC may equal or even exceed septal deviation as the main cause of NAO.

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INFORMED PATIENT

Is NVC causing your NAO? Dr. Barrera typically sees NVC in many of his patients suffering from NAO (including the correction of a previous procedure in revision rhinoplasty patients), and he usually diagnoses it with the “Modified Cottle Maneuver.” Dr. Barrera explained that in order to diagnose NVC using the Modified Cottle Maneuver, a small cerumen loop or curette is used to gently support the lateral wall cartilage on each side of the nose while the patient breathes. This test is positive if the patient has significant improvement in breathing on inspiration. “If my patient’s symptoms improve during the Modified Cottle Maneuver, he/she may benefit from support for the lateral nasal wall,” said Barrera. “It is then time to decide appropriate treatment – usually an implant is indicated for supporting upper and lower lateral cartilage.” What are the best treatments for NVC? According to Dr. Barrera, NVC used to be significantly undertreated because conventional options typically require cartilage grafting from the nose, ear or ribs, carry risk of changing appearance, or do not address the underlying anatomical issue of a collapsed nasal wall. “I’m excited to now have this new option available called LATERA®, an absorbable nasal implant which

Absorbable Nasal Implant

supports lateral cartilage and may help patients breathe better through their nose, with significant quality-of-life improvements” said Dr. Barrera. He explained that LATERA is inserted through a small incision made inside a patient’s nose, where the implant material absorbs over a period of approximately 18 months and is replaced with the patient’s own collagen. One patient’s experience Robert Demel a musician, singer and allaround entertainer is about to record his second album. The 50-year-old country music artist recalls having had breathing issues ever since he was hit in the nose with a baseball several years ago. “I was regularly having trouble breathing through my nose, which is particularly frustrating to me as a singer,” said Demel. “I tried nasal sprays and strips, but they only provided temporary relief. That’s when I decided to schedule an appointment with Dr. Barrera.” According to Demel, he often felt fatigued and noticed that his breathing trouble interfered when he performed with his band. This finally prompted him to look into longer-term treatment options. Dr. Barrera diagnosed Robert with NAO due to NVC from previous rhinoplasty surgery, which did not support his cartilages. He told Robert

To learn more about Dr. Jose Barrera and LATERA please call 210-4685426 or visit www.drjosebarrera.com.

about LATERA, and how it was designed to help people breathe better by supporting the nasal airway, so that it stays more open while breathing through his nose. “I’m so glad Dr. Barrera recommended the LATERA nasal implant for my NVC,” said Demel. “The staff at his office was great, and he explained how the implants work, which made me feel comfortable with choosing it. I am sleeping and breathing better, my quality of life has improved dramatically, and there has been no cosmetic change which was a concern for me.” “I am proud to be one of the first practices in the state to offer patients this innovative treatment option. It is one of my preferred tools for patients with NVC who do not want a change in the cosmetic appearance of their nose.” - Dr. Jose Barrera

Risks involved with LATERA absorbable nasal implants may include mild bruising and inflammation, awareness of the implant, and mild pain or irritation.

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Healthy Living / Regional

Filling Midnight

Snacks

Under 100 Calories by Karen Reed Managing Editor at Positive Health Wellness

on’t you just hate waking up in the middle of the night hungry? You don’t want to spend the calories on something that will tide you over until your next meal, but you just can’t get back to sleep. Sometimes, you need to stay up for a few hours waiting for friends or because you have some coursework to do. The last thing you want is to snack throughout the night and end up gaining weight. After all, you don’t change your food choices throughout the next day to make up for the midnight snack. It’s time to find a midnight snack that will be good for your waistline. Here are eight extremely filling options that will only cost you up to 100 calories. Opt for Vegetables of Any Kind Vegetables are your friends when it

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comes to midnight snacks. Yes, you’ll hear this a lot about vegetables, but you want to choose them before any other snack. They are the best for your overall health, as well as your waistline. It doesn’t matter which vegetable you eat either. A cup of the majority of vegetables contains less than 100 calories. But are vegetables that filling? After all, they are side options when it comes to a meal. Well, yes, vegetables are filling. They’re full of fiber and water. The water will help to fill your stomach and trick you into thinking you’re full. It fills your stomach up without adding any extra calories. It’s the fiber that gives you the energy and the sustained feeling of being full. It takes time for the body to break down

the fiber in your digestive system. You can usually tide yourself over until your next meal with the help of one portion of vegetables. The next time you’re pulling an allnighter, stock up on some carrot sticks, chopped broccoli, and some cauliflower. You can also choose some peppers and cherry tomatoes. Mixing these together will help to curb some sweet cravings, make you feel satisfied, and add plenty of nutrients to your body. Baby carrots are certainly among the best options. There are just 35 calories in nine carrots. You won’t feel the need to consume anything else. Watch out if you’re going to add dip to your vegetables. This will take your calorie count up, so you’ll want to find out exactly how many calories are in your dip of choice. Hummus or salsa can be your best options.

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Opt Specifically for Radishes Technically, radishes are a vegetable, but they deserve a mention of their own. They are the perfect low-calorie midnight snack. Each radish is just one calorie. That means you can have 100 radishes that will equal just 100 calories. Chances are you’re not going to want 100 radishes. The slightly spicier taste will stop you from wanting to eat too many. You’ll also get plenty of fiber to help you feel fuller sooner than with other snacks in your kitchen cupboard.

recommended amount of calcium from a cheese string! Other types of cheese can be good (depending on the amount you eat), but there is a special benefit in cheese strings. You just can’t help but pull it to pieces. The child in you knows that you can pull it apart string by string to eat it. This helps you eat the cheese string much slower than you would a block of normal cheese, so you give your stomach a chance to tell your brain that you’re full. That way there’s less chance of consuming too many calories.

Opt for a little sea salt with your radishes. This can take away some of the spicy bites that radishes have. Compared to other salts, sea salt is a healthier option, without being too dehydrating. You’ll get plenty of other health benefits of radishes. One of these benefits comes with the spicy taste. The heat of the radishes will increase your body temperature, which helps to increase your metabolism rate. Grab a Cheese String Do you think that cheese is a no-go as a midnight snack? Well, you can eat some string cheese without spending more than 100 calories. Eating one cheese string is perfect– weighing in at just 85 calories! While getting those calories, you’re stocking up on plenty of protein. In fact, there are seven grams of protein in one cheese string. It takes the body time to break down protein and convert it into energy for the muscles. This means you feel fuller longer. Of course, there are other health benefits to the cheese string, such as the calcium. You’ll have healthier bones and teeth by opting for a cheese string instead of chocolate or chips. In fact, you get 20% of your daily

If you’re not fond of plain popcorn, add a few seasonings from your cupboard. Italian seasoning and cumin are among the top choices. Experiment with a few seasonings to create a delicious flavoring without all the calories that the butter, salt, and sugar have. Choose Greek or Natural Yogurt Yogurt can make an excellent snack, but you need to choose the right type. You want one that is either Greek or allnatural, and make sure there’s no added sugar. There will be some natural sugars in yogurt due to the dairy product used to create it. Greek yogurt is by far the best option. Avoid those with fruit flavorings, as they tend to have extra sugars and extra calories. Six ounces of plain, fatfree Greek yogurt has less than 100 calories.

Make a Bowl of Popcorn When you want to grab a handful of chips, vegetables and cheese strings aren’t exactly going to hit the spot. Rather than adding empty calories, why not opt for some popcorn? It’s best to make your own or get a plain bag, rather than buying the sweet, salty, or buttery options. Air-popped popcorn is quick to make and full of air! Three cups of it will give you less than 100 calories. You’ll also get plenty of fiber and protein in your snack, especially if you opt for whole grain kernels. Popcorn is the perfect option when you need something to satisfy you while watching a movie. Just make a promise to yourself (and stick to it) that you’ll only have the one helping of popcorn. It is very easy to consume more than you should because of mindless eating.

As with the cheese string, you’re not just benefiting from the low calorie count. Yogurts are extremely filling thanks to the protein. That six ounces of yogurt is made up of six grams of protein. The protein fuels the muscles and it breaks down slowly in the body. You can use a little yogurt as a dip for your vegetable sticks if you’d like! If you want some flavorings, make use of seasonings and herbs for something a little more savory. Make Some Oatmeal It’s time to pull out the oats and make some porridge out of them. To help keep the calories to a minimum, make them with water. If you want something extremely quick, you can choose a packet of instant plain oatmeal. You will get around 100 calories in a bowl, and the portion size is already worked out for

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Healthy Living / Regional

you. However, you can end up with fewer calories by pouring your own oats. Just make sure you measure them to avoid going over around 30g. Oats are packed with fiber. As with vegetables, the fiber will help to make the oats one of the most filling snacks. There’s a reason oats are used as a breakfast ingredient. Another benefit is that the oatmeal is hot. This can make it more satisfying and filling, especially in the middle of the winter when you have most of your project deadlines!

Turkey is an excellent option when you’re trying hard to get back to sleep. The tryptophan will help you fall right back asleep after your midnight snack. Try to get the real, white turkey slices. Avoid the processed options that are used for sandwiches and that are found in packets. While they are low in calories, they don’t have all the health benefits. They also aren’t as filling as real turkey slices. The best way to have turkey slices is to cook your turkey yourself and cut it up. Turkey slices on a covered plate will last a week or so in the fridge.

Oats on their own can taste a little bland. You’ll need to find another way to brighten up the taste. Opt for some nutmeg or cinnamon for zero extra calories but a lot of extra taste! Grab a Couple of Turkey Slices Turkey is the best poultry to eat when you want something filling. You know that feeling you get at Thanksgiving or Christmas after your turkey dinner? You fall into a sleepy state. It’s the turkey that’s doing this to you. Turkey is full of tryptophan, which is a sleep-inducing hormone. The tryptophan tells your body that you’re completely satisfied and that you couldn’t possibly eat another bite. At the same time, turkey is low in calories yet high in protein. When you eat the white part of the meat, you also avoid the fat, and be aware—the skin holds the majority of the fat! With the protein, you also get the macronutrient that tells your body it’s feeling full for hours to come. When you’re struggling to find a filling midnight snack, pull out a couple of slices of turkey. You’ll get more than enough to eat with just a couple of slices, which gives you around 100 calories.

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monounsaturated fats. They’re the same fats that you’ll get in olive oil! Healthy fats are like proteins and fiber. They take much longer than carbohydrates to break down in the body, therefore making you feel fuller longer. There are many other health benefits to eating olives, such as the antioxidants. There’s a reason the Mediterranean diet recommends olives on a regular basis. The antioxidants are excellent for cancer-fighting, anti-aging, and inflammation-fighting benefits. Grab a toothpick to eat your olives. Enjoy one at a time and savor the taste. You can enjoy both green and black olives for the health benefits. Just watch out for those that are stuffed!

Grab the Jar of Olives It’s time to pull out the olives from your cupboard. If you haven’t bought any olives yet, go get some, so you always have a jar ready for your midnight snacking. You get just 40 calories from 10 small olives. So if you want to eat the whole 100 calories, you can enjoy 25 olives. There is a high chance that you won’t need all 25 olives. Just 10 will be filling enough, especially if you consume them slowly. Due to the low calories, you can also enjoy some vegetables with your olives. Why are olives so filling? It’s all in the fat. Many people view fat as bad—and as the reason for gaining weight. Your body needs some fat to help support your metabolism, but it needs the right fats. The great news is that olives are full of healthy,

Snacking Isn’t Off Limits The great thing about eating healthily is that snacking isn’t completely off limits. You just need to make sure you eat the right types of snacks. You need to find snacks that are low in calories but high in nutrients. The above options are certainly ones that you can enjoy without worry. You can eat just one type of snacks if you’d like. This is the best way to keep your snacks to less than 100 calories. However, you can also mix them. You’ll need to know the exact amount of calories in all the servings when it comes to mixing and matching. It’s time to stock your cupboards up with the right ingredients. Get your vegetables, olives, and cheese strings right now. You will not regret having them when you want midnight snacks that are excellent for your waistline and health.

For more information visit https://www. positivehealthwellness.com

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Informed Patient / Austin

Special To MD Monthly submitted by Dr. Jennifer L. Walden, MD, FACS

IV Therapy H

ectic everyday life of the modern world rarely meets the requirements for leading a healthy lifestyle. Malnutrition, stress, lack of sleep, and constant overwork lead to the inability to maintain proper mineral and vitamin needs for correct cell functions. If these are some of the things you experience day to day, IV Hydration of Austin, brought to you by Dr. Jennifer Walden, can be the solution for you. Intravenous (IV) therapy can be used

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IV Therapy may be used to alleviate the following symptoms: • Acute strain or injury • Acute viral illness that has been treated • Allergic rhinitis • Aging • Asthma • Chronic fatigue • Chronic sinusitis • Detoxification (including heavy metals)

for preventative and curative purposes, such as treating a hangover, or simply

• Fibromyalgia • High blood pressure • High cholesterol • Malnutrition • Migraines • Muscle spasm • Upper respiratory infection that has been treated • Depression

infusing the body with vitamins and microelements. The procedure helps

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Informed Patient / Austin

to revitalize a patient’s body, reduce fatigue, boost the immune system, and improve sleep. IV therapies are aimed at achieving optimal health and performance, which are crucial factors in today’s fast-paced world. IV therapy has definite benefits and is extremely effective. The method is quick, efficient, and powerful. A large amount of saline fluid that carries antioxidants, amino acids, vitamins and other supplements is injected to the vein. This gets absorbed quickly and gets to work promptly because it is delivered straight to the blood stream. IV Hydration of Austin offers 10 different IV therapies, each tailored for a different purpose. Depending on one’s needs, Dr. Walden’s team will recommend the best IV therapy treatment and plan to achieve your goals. Every cell in our bodies needs water to function, but dehydration can sneak up on you. For example: You took a long hike without enough water; you worked harder than normal at the gym; you slept through your coast-to-coast flight and didn’t drink any water; you’ve had the flu and couldn’t keep anything down; your ski trip to the West dried you out; you drank a little too much alcohol last night. “John Myers, M.D. pioneered intravenous vitamin therapy (the Myers cocktail) more than 30 years ago. IV Hydration of Austin has taken this original concept and brought it forward with a variety of different options targeted to various purposes and needs. Even pre- and postoperative patients who are healing from their surgical procedures may benefit from the vitamins and mineral supplements that are offered. For more information, please call Dr. Walden’s office at (512) 328-4100 or visit online at drjenniferwalden.com/austin-ivhydration/.”

IV Therapies Cleanse Quickly rehydrate your body! “Mega Vitamin C” Boost your immunity! “Metabolism Boost” Start burning fat! “Royal Flush” Detox Cleanse your body! Hangover Aid Maximum Recover faster! Modified Myer’s Cocktail Fatigue

Disclaimer: You should consult your primary care physician before taking vitamins, minerals, nutritional supplements or herbal products. Our products are not intended to diagnose, treat, cure or prevent any disease. The statements in this article have not been evaluated by the FDA. Visit Dr. Jennifer Walden online at www.drjenniferwalden.com or call 512.328.4100 to learn more.

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INFORMED PATIENT / CORPUS CHRISTI

Is It a Cold or the Flu? By Dr. Michael Fuentes

h no, here it comes again — the cough, sore throat, stuffy nose. It is that time of year when the cold and flu become prevalent. But how can you tell the difference between them? A common cold and the flu are similar because they’re both respiratory illnesses. Even though different viruses cause them, they share many of the same symptoms. This makes it hard to know for sure which you may have unless you visit your doctor. Symptoms for both illnesses can include a cough, sore throat, runny or stuffy nose, fever, muscle or body aches, headaches, and fatigue. However, flu symptoms tend to be worse than cold symptoms, and people with colds are more likely to have runny or stuffy noses. A cold usually doesn’t result in

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serious health problems, but the flu can. While most folks can recover from the flu in less than a couple weeks, it can lead to respiratory complications such as bronchitis, pneumonia, and bacterial infections. In the worst cases, these complications can lead to hospitalization. While anyone can get severely sick from the flu, groups at higher risk for complications include adults older than 65, young children, pregnant women, people with chronic medical conditions, or individuals with compromised immune systems. According to the Centers for Disease Control and Prevention, the flu is typically seasonal, unlike a cold, which can be caught year-round. The United States experiences seasonal flu epidemics every year, with flu viruses being most common during the fall and winter months. Flu activity peaks between December and March.

Prevention is essential in avoiding the flu or a cold. With the flu, I always recommend a flu vaccination as your best form of defense — especially for those who are at higher risk for complications. Beyond that, many of the same techniques work in avoiding a cold or the flu. Some suggestions include: • Stay away from anyone who is sick, and stay away from others when you are sick. • Throughout the day, wash your hands thoroughly and often with hot water and soap. Use an alcoholbased sanitizer if hand-washing isn’t possible. • Don’t share utensils, cups, toothbrushes, towels or any other personal items. • Keep your hands away from your nose, eyes, and mouth. • Cough or sneeze into a tissue or the inside of your elbow.

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INFORMED PATIENT / CORPUS CHRISTI

• Limit what you touch when in public, such as stairway rails. Wash your hands soon after touching surfaces that could be contaminated. • Get plenty of sleep, eat right, and exercise regularly. If you still manage to catch a cold or the flu despite your best efforts, my recommendation would be to stay home, drink plenty of fluids, and rest up. For a cold, use over-the-counter medications such as antihistamines or decongestants to help relieve some of the symptoms. For the flu, your doctor may prescribe an antiviral drug to help shorten the duration of the illness and prevent complications. And with either a cold or the flu, always contact your physician if your symptoms persist or worsen. You know your body best. If it doesn’t feel right, get it checked out. It’s always better to be safe than sorry.

Board-certified in physical medicine and rehabilitation, Dr. Michael Fuentes is the Medical Director of Corpus Christi Rehabilitation Hospital. The hospital provides specialized rehabilitative care to patients recovering from disabilities

caused by injuries, illnesses, or chronic medical conditions. For more information, visit us online CCRH.ernesthealth.com, call 361-906-3700 or visit the hospital at 5726 Esplanade Drive, Corpus Christi, Texas.

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SECTION / CITY

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It’s Time to Get Your Life

BACK at SASpine

r. Steven Cyr is well known in the San Antonio community for surgical excellence and community service. Previously, as the founder of the Orthopaedic & Spine Institute, his practice was comprised of multiple practitioners addressing a full spectrum of medical issues. In an effort to deliver more precise and focused care for what he knows best, conditions affecting the spine, his practice is now dedicated to all things spine. His practice is evolving and has gone through a recent dramatic change in management and focus. The recently dubbed SASpine (which stands for Surgical Associates in Spine) is a full spectrum spine practice that focuses on conservative treatment of the spine, including proper diagnosis followed by physical therapy, pain management injections (if needed), medication management, and neurological evaluation and testing. When those measures fail, Dr. Cyr and his team are equipped to provide a detailed evaluation and determination of what surgery may be necessary to address, and hopefully resolve, the symptoms. Dr. Cyr was trained at the world famous Mayo Clinic, a top institution in many medical fields, including neurosurgery and orthopaedic surgery. His spine training was a combined fellowship in neurosurgery of the spine and orthopaedic surgery of the spine.

by Jody Joseph Marmel

Coupled with 14 years of honing his skills in the military as the Air Force’s Chief Spine Surgeon, consultant to the surgeon general, and his civilian practice, this training has resulted in the successful treatment of many thousands of patients, with amazing outcomes.

I can once again enjoy my family workouts in the gym without any restrictions. I feel as if I received a BRAND NEW BACK! Thank you Dr. Cyr!” Cristina Padilla

Dr. Cyr explains, “I was the only fellow in the country selected to train that year. It was a very competitive position to obtain and I feel very blessed to have trained there. That experience

with complex spine surgery, including trauma, deformity, tumors, and degenerative conditions of the cervical, thoracic, lumbar, and sacral spine was second to none.” His exposure to both the neurosurgical approach to spine care, which focuses on microscopic techniques and soft tissue preservation, coupled with the engineering knowledge and musculoskeletal expertise of orthopaedic surgery, provided Dr. Cyr with the ultimate training experience. A common question asked by patients is whom do I go to for my spine condition: a neurosurgeon or an orthopaedic surgeon? Fortunately, when it comes to spine surgery, you don’t have to choose. Dr. Cyr’s background and training come from both disciplines and at SASpine the quality of care, experience and training make him one of the nation’s most qualified spine surgeons, with a record of excellence and accomplishment in his field. In the beginning of Dr. Cyr’s career, his practice grew very quickly. As knowledge of his success spread, several physician colleagues approached him about joining his practice. Hoping to help several colleagues create a successful practice and to provide a comprehensive practice environment for patients, Dr. Cyr added orthopaedic surgeons followed by pediatric 2018 - JANUARY

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orthopaedics, pain management, other spine surgeons, a plastic surgeon, a dermatologist, and three family practice physicians. The idea was to create a practice similar to the university environment where most medical issues could be addressed under one roof.

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Dr. Cyr explains why the focus of the practice has since changed. “While this idea was a good one, implementing something that complex is challenging. It requires that the right people are in place to ensure its success. I realized after struggling to make it work with people who weren’t devoted to the

mission of the practice, this multispecialty approach was diverting the focus of the practice from what I know and do best, which is spine surgery.” After hiring a compliance officer and implementation specialist to restructure the practice, Dr. Cyr and the team decided that the best

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My quality of life — I was able to do some of my daily activities, but they were very limited. After the surgery it was almost immediate relief. I was able to stand and walk the second day. His staff made all the arrangements and I had all the equipment that I needed for a quick recovery.” Frank Flores

step was to re-center and pare the practice down exclusively to the spine. Thus, the name The Orthopaedic & Spine Institute became obsolete and confusing to patients. “We have always been known by our website address SASpine. The new management company that took over operations in December loved the name and the idea of focusing on the spine with practitioners trained to provide care for those patients.” The practice is now known as SASpine, which stands for Surgical Associates in Spine. SASpine is growing and branching out into other markets to meet the demands there

as well. SASpine is headquartered in San Antonio, Texas and a new office in Houston opened in early December of 2017. “My goals are to expand to markets that are desperately in need of quality spine care. There are many good spine surgeons in the world, but there are many, many patients to treat.” Dr. Cyr continues, “I know there are communities in desperate need of my approach to taking care of patients. I

plan to grow the practice by carefully adding other spine surgeons with similar training and a sincere desire to treat patients like family in an effort to relieve their pain and dysfunction.” SASpine has kept the logo, which is synonymous with Dr. Cyr’s practice. It is an artistic depiction of the spine in the center of a rotating globe because, as he says, “our world revolves around 2018 - JANUARY

MD Monthly

the spine as do our bodies.” The spine is the core of the human framework and it is the center of the structural support for our bodies. SASpine will continue to see a similar population of patients —those with neck and back pain. Dr. Cyr states, “We will continue to focus on providing treatment specific to each and every patient we see. The beauty of my orthopaedic and athletic background as well as my years of bodybuilding, is that my knowledge of the musculoskeletal system allows me to effectively and accurately identify the true source of pain. Many times, shoulder pain comes from the neck, but may also be from shoulder pathology. Hip pain commonly generates from the spine, but can also be a soft tissue or joint condition located within the hip. In order to implement the correct treatment, knowledge of all parts of the body is necessary, otherwise, an improper treatment plan may be carried out, leading to failed relief or worse, permanent damage.” Our bodies are highly complex. Conditions that affect our bodies vary. Therefore, it is important to evaluate everyone individually. “This approach requires a team of people devoted to identifying the issue(s) first and then enacting a specific treatment plan with the eventual hope of returning our patients to the level of functioning they once enjoyed.” For that reason, SASpine often relies heavily on mid-level providers who act as the front line to identify the issues plaguing the patients by performing the initial evaluations and ordering the proper diagnostic tests and conservative therapies to address a patient’s problem. Pain management physicians, physical therapists, and neurologist colleagues are also sought out to assist in this process and treat the problems from a non-surgical standpoint. Dr. Cyr continues, “Patients are not textbooks, so we provide a very specific

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I’ve been dealing with this for about 20 years. As time progressed I stopped doing the things I enjoyed. I like to play soccer, but I stopped playing soccer. All of this to avoid dealing with the root of the problem which was herniated discs. Since my treatment, I’ve gotten full mobility.” Jeffery Gagnon

treatment plan to each patient based on their diagnoses. This has provided SASpine with uncommon outcomes in spine treatment. Our reward is in the outcome. There is no feeling like the feeling you get when patients tell you, ‘You saved my life. You are my angel. You gave me and my family our lives back.’ That is why I do this. The long hours, the self- sacrifice, and the intensity are well worth it.” Dr. Cyr believes that medicine is a calling. “It’s a heavy responsibility that I carry with gratitude and humility, knowing that I have been entrusted to

care for the health of God’s children. I sincerely desire that every patient I treat will find the relief they seek and a pain-free life, which we all deserve. I see a lot of suffering and it is very important to me that I help eliminate as much of it as God allows me to. He gets the glory, but I am grateful that He is guiding and blessing me with this responsibility. The reward it brings to my life is in knowing that I am making a positive difference.” The mission of SASpine is to treat patients like family through a comprehensive and thorough approach that gives them the best possible chance of regaining their function and pain-free living. SASpine strives to Give People Their Lives Back. That slogan came about from repeatedly hearing those exact words from happy patients. What an amazing gift to “give someone’s life back to them.” Dr Cyr is a dedicated and sincere man. His patients uniformly praise his compassion, conscientiousness, and meticulousness. He truly puts all he has into helping patients because, as he says, “When I see the smiles of pain-free patients who I know suffered on a daily basis, my heart beams. It is truly an honor to have been able to be part of the healing for so many patients, from so many walks of life, who all had a debilitating problem that was consuming their lives and stealing their joy.” Many of Dr. Cyr’s patients are husbands and wives, or fathers and daughters. Some are physicians, military members, nurses, manual laborers, professional athletes, actors, and students. Dr. Cyr has performed surgery on friends he went to middle school and high school with, and on family members of close friends. They come from everywhere – although mostly from Texas, they come from all over the country seeking relief. Dr. Cyr says “It’s a distinct pleasure to be able to help them find that relief.” For Dr. Cyr and the team at SASpine, that it is

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time to get your life BACK, is what it is all about.

service in all forms continues to be an integral part of their lives.

Dr. Cyr and his family are also known for giving back to their community. “My family and I are heavily involved in charity work.” The Cyrs and their children help non-profit organizations focused on community service. Their daughter, recently crowned Miss Houston Teen in the Miss America Organization, has worked diligently to support San Antonio and Houston residents through her non-profit, PROject Christ by providing blessing bags of life’s necessities to the homeless and Hurricane Harvey victims. The Cyrs have chaired many galas for charities they believe in and they constantly devote time and resources to supporting charitable organizations. As if daily service to his patients wasn’t enough, Dr Cyr and his family ensure that

Looking ahead, Dr. Cyr would ultimately love to create his own fellowship to train surgeons in his approach to conditions that affect the spine and on how to effectively handle the pressures of the business and legal side of practicing medicine. “I have learned a lot in my 14 years as a spine surgeon. I’ve had many ups and downs in the business of spine surgery and there is a lot of learning that I have to convey. One day, I hope to guide aspiring young surgeons in delivering the gold standard of care while avoiding the pitfalls awaiting physicians on the business side of medicine. I want to be a continued example to others of sincerity, humility, service-mindedness, and devotion to excellence.”

www.saspine.com Facebook: SASpine San Antonio 8401 Datapoint Dr., Ste. 700 San Antonio, Texas 78229 (210) 487 - 7463 (48 - SPINE) Houston 9701 Richmond Avenue, Ste. 250 Houston, Texas 77042 (832) 919 - 7990

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MD Monthly

The Female Doctors Association of Corpus Christi

A Close Network of

Female Physicians

by Jody Joseph Marmel

he Female Doctors Association of Corpus Christi, FDACC, is a group of professional physicians who have several things in common. First and foremost, they are exemplary physicians in the Coastal Bend Region in Texas. Most of them are spouses and mothers. They are involved in hectic professional careers, and balancing both professional and personal lives.

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Dr. Jacqueline Phillips started The Female Doctors Association as a way to network with other women physicians in the area. She quickly gathered a core group of seven highly talented physicians whose idea was to meet, in spite of their hectic schedules, on a regular basis to socialize, share meals and discuss professional and personal anecdotes. Instrumental in coordinating for these physicians, Dr. Phillips recalls, “During our first night out in 2013, we had an instant bond.” As the group became better

on the Coastal Bend

known, other female physicians in the area joined. This friendly, welcoming, and nurturing circle of female doctors always kept the doors open and welcomed others to attend the meetings and become part of the FDACC. “We celebrate each other and lift each other up while sharing the stories of our lives, our marriages, our kids, and our medical school experiences, and when venting our problems we come up with solutions for each other. It is amazing to have these female friendships within our profession.

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simple, yet beautiful story.

out on the camaraderie.”

“It was not easy to agree on a time that would work for all of us because our profession is so demanding. We had to work around being on call, as well as finding a time that would suit our personal lives.”

At one of their meetings, the doctors began to discuss the need to have a name for their group. FDA – Female Doctors Association was born, and while it is not an “official” group, the FDA is a close network of female doctors on the Coastal Bend. “After word spread about the FDA, I was approached by other women in the field who wanted to be a part of the group.”

Looking ahead, Dr. Phillips would like to open up the group to females in the medical residency program. “This is sure to get them excited about other women in the medical field and about knowing they have a support system.”

The seven female doctors were having a wonderful night out, and their laughter could be heard by all. Before departing, they asked Dr. Phillips when their next meeting would be – and the rest is history. To think that this all started over dinner and a glass of wine makes their celebration of one another a

Dr. Phillips describes the group with immense positivity and she is certainly proud of what they have accomplished as a team. “It’s amazing to have these female friendships within our profession. Monthly meetings are well attended, however, being on call and doing late rounds causes many to miss

The FDACC began with the ‘original’ seven doctors and grew to 30 women over time. Physicians come out of this meeting refreshed and looking forward to the next one,” says Dr. Phillips.

Dr. Phillips elaborates on the ‘original’ seven female doctors that formed the FDA, “While I am the youngest in the group, they have helped me be a better person and they continue to encourage me. How can I be as thorough and detailed as they are? I aspire to be like all of these women, who are my role models. All of the female doctors who are part of the FDA have finesse, style, and are unbelievably awesome.”

Dr. Jacqueline Phillips

r. Jacqueline Phillips is the Associate Program Director for the Corpus Christi Medical Center Bay Area Internal Medicine Residency and is an Internal Medicine Physician at Amistad Community Health Center. She provides primary care to the underserved community of Corpus Christi and the surrounding areas. Dr. Phillips treats the primary disease states including, but not limited to, hypertension, diabetes, congestive heart failure, chronic kidney disease, thyroid disease, cirrhosis, and hepatitis. She is also in charge of the oversight of the Advanced Nurse Practitioners. Dr. Phillips attended Seton Hall University for a Bachelor of Science in Biochemistry. She was awarded a certificate for completing the University Honors Program. Lake Erie College of Osteopathic Medicine was her next stop and there she received her Doctor of Osteopathic Medicine Degree. She is Board Certified in Internal Medicine and attended Jersey Shore University Medical Center for her Residency in Internal Medicine. She is a member of the American Academy of HIV Medicine, the American College of Physicians, the American Osteopathic Association, the Continuing Education Advisory Committee for Texas A&M Health Science Center, the Nueces County Medical Society and the Young Business Professionals of Corpus Christi.

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Dr. Amber Kaldas

r. Amber Kaldas is the Medical Director of the U.S. Renal Care dialysis unit in Corpus Christi. She is a nephrologist and has been in private practice since July, 2013. With privileges in eight hospitals (three separate hospital systems) Dr. Kaldas makes daily rounds all over the Coastal Bend. She holds an office clinic twice a week to follow up with her hospital patients. Dr. Kaldas attended the Assiut University School of Medicine in Assiut, Egypt. She received her Medical Degree followed by a doctorate degree. Landing in California, Dr. Kaldas completed her Residency in Internal Medicine at Alameda County Medical Center/UCSF (The University of California, San Francisco) Highland Hospital in Oakland, California. She then went to Texas Tech University Health Sciences Center in Lubbock and received her Nephrology Fellowship. Dr. Kaldas is a member of the American College of Physicians, the American Society of Nephrology, the National Kidney Foundation and the Renal Physicians Association.

Dr. Shamim Badruddin-Mawji

r. Shamim Badruddin Mawji is a non-interventional cardiologist. Dr. Mawji is board certified in Internal Medicine, Cardiology, Echocardiology, and Nuclear Cardiology.

She attended medical school at Aga Khan University in Karachi, Pakistan and graduated with honors. Dr. Mawji then completed her Internal Medicine Residency at Baylor College of Medicine and was the Chief Medical Resident at Saint Lukeâ&#x20AC;&#x2122;s Hospital in Houston, Texas. She also completed her Cardiology Fellowship at Baylor College of Medicine with a special interest in Cardiovascular Imaging. Dr. Mawji is a partner at Coastal Cardiology Association and the Medical Director for the Echocardiography Advisory Committee at Del Mar College. She is a Fellow of the American College of Cardiology, Associate Member of the AMA, a member of the Texas Medical Association, and a member of the American College of Physicians. Dr. Mawji is married to Dr. Srikanth Damaraju. They have two children, Sarita, who attends Harvard University, and Aneel, who attends Rice University. Her interests include teaching, hiking, and traveling.

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Dr. Delia Quisenberry

r. Delia Quisenberry is Chief Hospitalist at Corpus Christi Hospitalists, PLLC. She received her Bachelor of Arts in Psychology at Western Kentucky University. Dr. Quisenberry then received her Medical Degree and completed her Residency in Internal Medicine/Pediatrics at University of Louisville School of Medicine in Louisville, Kentucky. Dr. Quisenberry is on the Board of Directors at Corpus Christi Medical Center. She is also on the Internal Medicine Program Evaluation Committee, as well as the Orthopedic Surgery Joint Replacement Certification Committee. She has a passion for Hospice Medicine and has been involved in hospice care since 2007. She is certified in the EssentiALZ Plus Dementia Care program through the Alzheimerâ&#x20AC;&#x2122;s Association. Dr. Delia Quisenberry has been married to Larry Quisenberry, PhD for 29 years. Their son Thomas is a medical doctor and their daughter Lauren is a fourth-year medical student.

Dr. Adriana Maria Pop-Moody

ince 2005, Dr. Adriana Maria Pop-Moody has been practicing at the Adriana Pop-Moody Clinic Pennsylvania in Corpus Christi. She is a Rheumatology Specialist. Her practice utilizes a fully integrated Electronic Medical Records, EMR, to maximize staff efficiency and deliver quality care leading to positive outcomes and a high level of patient satisfaction. Dr. Pop-Moody is also an Adjunct Clinical Professor at the University of North Texas Health Science Center at Fort Worth Texas College of Osteopathic Medicine. She attended the University of Timisoara Institute of Medicine in Timisoara, Romania for her Medical Degree and her Residency in Internal Medicine. Upon arriving to the United States, Dr. Pop-Moody attended Michigan State University for her Residency in Internal Medicine and then went to Sinai Hospital, Detroit Medical Center for her Fellowship in Rheumatology. She is a member of the American College of Physicians, the American Medical Association, the Nueces County Medical Society and the Texas Medical Association. 2018 - JANUARY

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Dr. Tara Hahn

ara Hahn M.D. received her Bachelor of Arts degree in History from Purdue University in Indiana. She then continued her studies at Indiana University School of Medicine and in 1995 was presented with her Doctor of Medicine degree. In 2001, Dr. Hahn completed the General Surgery Residency Program at the Indiana University School of Medicine. She then traveled to New York and in 2002 completed the Colon and Rectal Surgery Residency Program at the State University of New York at Buffalo General Hospital. Dr. Hahn has been a practicing physician at The Colon and Rectal Associates of South Texas in Corpus Christi for more than twelve years and is board certified in colon and rectal surgery. She enjoys the practice and the medical community on the Coastal Bend. Dr. Hahn is a member of the Texas Surgical Society, the Texas Medical Association, Nueces County Medical Society, and a fellow of The American Society of Colon and Rectal Surgeons. Dr. Hahn enjoys reading, kayaking, and cooking for family and friends.

Dr. Fariba Zarinetchi

r. Fariba Zarinetchi received her Bachelor of Science degree at the Massachusetts Institute of Technology and her medical degree at Tufts University School of Medicine in 1989. She then went to Georgetown University Medical Center for an internship and residency in internal medicine. She completed her fellowship in Renal Diseases and Hypertension at the University of Colorado Health Science Center. From September, 1996 to present, Dr. Zarinetchi has had a private practice, Kidney Specialists of South Texas Pennsylvania, in Corpus Christi. She has been an active member of several committees on the Coastal Bend. Dr. Zarinetchi is a clinical instructor for the Internal Medicine Residency Program at Corpus Christi Medical Center, the Medical Director of DaVita Corpus Christi Dialysis, and the President of the Dialysis Access Center in Corpus Christi. She is a member of the American College of Physicians, the American Society of Nephrology, the National Kidney Foundation and the Nueces County Medical Society.

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Veda MedSpa Veda Medical

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Special to MD Monthly

2018

The Year of YOU with

Dr. Pradeep Mohan by Rudy Arispe

n August, Alicia Lemley had a tummy tuck because of a large separation of abdominal muscle that caused an umbilical hernia. She also had stretching of the skin due to childbirth. However, before she had the abdominoplasty, she met with several other surgeons to discuss the operation, but never settled upon a physician until she consulted with Dr. Pradeep Mohan, a board certified, plastic and reconstructive surgeon. “I was impressed from the moment I met him,” said Lemley, a 33-year-old software company operations manager. “I had so many questions about the surgery, and he took the time to answer each one. He

never made me feel rushed. Not only is he caring, but so is his staff.” As for the tummy tuck, Lemley said she couldn’t be happier with the results. “I’m into fitness, but I wasn’t able to do core exercises because of the pain. I’m doing so much better. The surgery, the healing and the results were perfect,” said the mother of two. Recently, Dr. Mohan opened Veda Medical & MedSpa in Live Oak. The facility offers reconstructive treatments, non-surgical treatments and cosmetic treatments. One of the most requested procedures, he said, is the “mommy makeover.” “It’s a combination of a tummy

tuck, also known as an abdominoplasty, along with a breast lift,” he explained. “Oftentimes, after giving birth women experience a loss of volume and droopiness of the breasts. We also address scarring in the lower belly area which can happen after childbirth. We repair the muscles, which become separated, so that we are strengthening the core while removing excess skin and fat.” Dr. Mohan notes that women are often apprehensive about undergoing a tummy tuck or breast lift because of the fear of the vanity aspect often associated with both procedures. “The reasoning is that women only have these procedures just to look more voluptuous,” he said. “That’s not the case, however, we focus on giving 2018 - JANUARY

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Amazing!!!” Dr. Mohan has made this terrible experience so wonderful. The care and respect given to my son and our family is beyond compare. I’m so thankful.

patients back the shape and form they had before child birth or weight gain by lifting the breasts and giving them more volume, if they need it.” Veda Medical & MedSpa also offers non-surgical procedures to improve the head and neck, add volume to breasts and contour the body, or enhance facial features. “You will get the same great results that you would from surgery,” said Dr. Mohan.

Jessica M. 38

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FDA approved, vaginal rejuvenation laser procedure called Votiva. “It rejuvenates the outside and the inside of the vagina while improving musculature and hydration. In addition, it treats stress incontinence as well as pain and a myriad of other related medical problems. Votiva is FDA approved for sexual dysfunction. It has medical implications that can help women a great deal.” BodyTite, a minimally invasive, radio-frequency assisted lipolysis, is another popular procedure from Inmode that Dr. Mohan provides his patients. According to Inmode, BodyTite provides superior internal and external lipolysis, delivering body results previously only achieved through more extensive excisional surgical procedures. Powered by Radio-Frequency Assisted Lipolysis ( RFAL), BodyTite “provides unprecedented threedimensional contraction of the dermis, subdermal connective tissue matrix and deep fat. It works by delivering rapid and uniform heating of the entire soft tissue matrix. Built-in safeguards including real time measurements of skin temperature, impedance monitoring, power cut-off and audible feedback help ensure patient safety,” as stated on the website.

In addition to facial rejuvenation options, Veda Medical & MedSpa offers Fractora to help smooth skin and improve collagen formation. Touted as a non-invasive skin rejuvenation without surgery, according to the Inmode website, Fractora meets and exceeds the results of fractional CO2 without the associated downtime, prolonged redness, and pigmentation drawbacks. Dr. Mohan is excited about a new

Veda’s cosmetic procedures, Dr. Mohan believes, can help with a patient’s confidence. “It gives them a great deal of self-esteem, and their outlook is better,” he said. “All of my patients are happy with their outcomes, and they feel better about themselves.” In fact, helping others improve their self-confidence is the biggest driving force for what Dr. Mohan does as a plastic and reconstructive surgeon. “I became a plastic surgeon because of

The most positive experience I have ever had with a doctor!” I have never felt more comfortable with a doctor/patient relationship than my experience with Dr. Mohan and his staff. It is easy to tell when people actually care and when they don’t......these people really care about their patients. I’m so thankful they were there when I needed help so badly. Michael Richards

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Dr. Mohan changed my life!”

I’m a mother of three and with that came a three inch muscle gap and an umbilical hernia that made me live my life in unbelievable pain for nine years. In nine years I went to see different doctors and all of them would tell me that I would loose my belly button. One day a friend told me about Dr. Mohan and I quickly made an appointment. When I walked into his office and met his staff I quickly knew that he would be my doctor. I ended up with a tummy tuck and a hernia repair and I couldnt be more happy!

Ruby S. (She still has her belly button) 40

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the ability to improve people’s lives. I’m blessed to be able to do that, and it’s always wonderful to hear a patient say, ‘I used to never look in the mirror’ or ‘I stopped undressing in front of my husband, but now I do.’ ”

spot, he told me I had to have emergency surgery. I had it done that day,” she said, adding that the diagnosis was a methicillin-resistant staphylococcus aureus (MRSA) infection caused by staph bacteria.

With more than 18 years of experience in plastic and reconstructive surgery, Dr. Mohan is affiliated with Central Texas Medical Center, which is where he met retired Army Lt. Col. Virginia Riley. After undergoing a mastectomy, she later developed what she described as a “black spot” on her chest. Because the surgeon who performed the surgery was out of the country at the time, she went to see Dr. Mohan via a referral.

Over the past four years Riley has been a patient of Dr. Mohan who also performed breast reconstructive surgery on her and has treated the 73-year-old military retiree for other medical conditions as well.

“As soon as he saw that black

“He is extremely compassionate and truly listens to you,” she said.

For more information or to make an appointment, call (325) 665-9111 www.vedamedical.com Facebook.com/vedamedical

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Informed Patient / Corpus Christi

Winter Sports Snow Much Fun! by Dr. Michael Fuentes

ven though snow isn’t likely in the Corpus Christi area, many fans of winter sports will be traveling during upcoming months to participate in activities that include skiing, snowboarding, sledding, snowmobiling, and ice-skating. Winter sports and activities are a great way to remain active during the colder months. However, with winter activities comes some cautionary advice – especially for those who don’t regularly have access to cold-weather sports. Skiing and snowboarding are great forms of exercise. But ice and snow can create hazardous conditions that can lead to falls, and falls are the leading cause of brain injuries. Your brain has the consistency of gelatin. It is cushioned by fluid inside your skull. When you suffer a blow or a jolt to the head, it can forcibly slide your brain back and forth, which can stretch and damage the brain cells and create chemical changes. This can also lead to bleeding in or around the brain, which can cause symptoms such as drowsiness, confusion, blurry vision, headaches, nausea, dizziness,

or difficulty in concentrating and remembering things. Brain injuries can affect individuals, not only physically, but also emotionally and behaviorally. In the United States, more than five million people live with disabilities caused by brain injuries. Although with winter sports the danger of a head injury is real, don’t let it stop you from enjoying your activity. Just be cautious. There is no single tip about staying 100 percent safe, but there are many tips that can minimize the risks. With a little precaution and planning, you can keep yourself and your family free from injury during winter activities.

Dr. Michael Fuentes is the Medical Director of Corpus Christi Rehabilitation Hospital. The hospital provides specialized rehabilitative care to patients recovering from disabilities caused by injuries, illnesses, or chronic medical conditions. For more information, visit CCRH.ernesthealth. com, call 361-906-3700 or visit the hospital at 5726 Esplanade Drive, Corpus Christi, Texas.

Tips for Participating in Winter Sports: • Know your limitations, especially if you’re new to a sport or don’t participate in it regularly. Take a lesson from a trained professional if you’re just starting out. Also consider a refresher lesson if it has been a while since you’ve participated in that activity, or if you want to better your skills. • If you are skiing or snowboarding, go on the slope that is appropriate to your skill level. Novices should always go on beginner slopes. • Wear a helmet. Choose the right helmet for the right activity and make sure it fits properly. • Pay attention to the ground surfaces and conditions. Take note of any icy patches, drops, uneven terrain, and turns. • When outdoors, stay in wellmarked and maintained areas. Don’t go off established paths. • Wear proper equipment – especially proper shoes or boots –for the sport or activity in which you are participating. • Stay alert, and don’t wear headphones. • If skiing, snowboarding or sledding, try to stay in the middle of the trail and stay away from trees.

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BUSINESS

Time-Weighted Return (TWR)

UNDERSTANDING

YOUR RATE OF RETURN Provided By: Eric Kala CFP®, CIMA®, AEP®, CLU®, ChFC®, CRPS®

here are a couple of ways to measure performance for your investment portfolio. And you may have questions about the numbers you see. So we created this guide to make things a little clearer. The two ways we can measure the rate of return for your investment portfolio are using a time-weighted return or an internal rate of return. Sometimes the results we get from each method can be quite different. We’ll explain why in a little more detail, so you’ll have a better sense of how to interpret the returns you see. TIME-WEIGHTED RETURN (TWR) With a time-weighted return, we’re measuring the performance of your portfolio’s investment manager. Think

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of it as the growth rate of a single dollar invested in the account at the start of the period. A time-weighted return allows us to compare returns across managers and compare an investment portfolio’s return against an index or benchmark. Contributions to and withdrawals from your portfolio do not affect time-weighted return. INTERNAL RATE OF RETURN (IRR) An internal rate of return (also known as a cash-weighted or money-weighted return) measures the growth of your portfolio using a combination of manager decisions and your contributions and withdrawals. Think of it as your personal rate of return since it’s unique to your investing history. It’s a good tool to help you see if your portfolio is growing enough

to meet a future need or a specific investment goal. The timing and size of contributions to – or withdrawals from – your portfolio can significantly affect the internal rate of return, meaning greater weighting is given to those periods when more money is invested in the portfolio. COMPARING TIME-WEIGHTED RETURN AND INTERNAL RATE OF RETURN Now that you know the basics, let’s compare them. Time- weighted return and internal rate of return will be nearly the same if you don’t contribute to or withdraw from your account. But cashflows – especially large, material contributions or withdrawals – can result in big return differences.

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Cash-weighted return will be HIGHER than timeweighted return when:

Time-weighted return will be HIGHER than cashweighted return when:

Material contribution into the portfolio just before a period of positive portfolio performance

Material contribution into the portfolio just before a period of negative portfolio performance

Material withdrawal from the portfolio just before a period of negative portfolio performance

Material withdrawal from the portfolio just before a period of positive portfolio performance

If there are no material contributions or withdrawals from the portfolio, cash-weighted and time-weighted returns will be very similar, if not the same.

LET’S TAKE A LOOK AT AN EXAMPLE The example below shows the time-weighted and cash-weighted return for an account that began the year with $200,000 and ended the year with $560,000 to better illustrate what we’ve learned:

Example: Time-Weighted Return (TWR)

1/1/16

BEG VALUE

$200,000

7/1/16

CONTRIBUTION

$300,000

1.00%

12/31/16

END VALUE

$560,000

$510,000

1.59%

IRR

17.42%

$560,000

9.80%

TWR

12.67%

Period

Date

Cash Flow

Market Value

1/1/16

$200,000

6/30/16

$202,000

7/1/16

$300,000

12/31/16 $-

Example: Cash-Weighted Return (IRR) Return

Time-weighted example • The account began the year with $200,000 and increased in value about 1% after six months, ending June with a value of $202,000. • The account began July 1st with a balance of $502,000 following a contribution of $300,000 made at the beginning of the day. The account ended July 1 with a value of $510,000, gaining $8,000 or 1.59% for the day. • From July 2nd through December 31st, the account increased $50,000 in value, ending the year with $560,000 – a gain of 9.8%. • Combining all three period returns, we arrive at a time-weighted return of 12.67% for the year.

Cash-weighted example • The account began the year with $200,000 and a $300,000 contribution was made on July 1st. • The significant size of the contribution relative to account’s size, coupled with it occurring on July 1st, results in performance of the account during the second half of the year having more impact to the cash-weighted return. • Following the contribution, the account experienced positive performance, growing to $560,000 by year end. • As a result of the positive performance after the material contribution, we would expect the cashweighted return of 17.42% to be greater than the timeweighted return over the same time period.

The information is hypothetical and is provided for the informational purposes only. It is not intended to represent any specific return, yield or investment, nor is it indicative of future results. 2018 - JANUARY

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BUSINESS

In review, the 12.67% time-weighted return represents the return of the portfolio’s investment manager. The contribution made on July 1st had no affect on the calculated return. By comparison, the 17.42% return calculated using the cash-weighted method represents the overall growth of the portfolio, considering both the performance of the investment manager and the contribution made on July 1st. So now you can see that both methods are useful depending on the questions you want to answer. Time-weighted return answers the question, “How did the manager do?” And the internal rate of return answers the questions, “How did I do along with the manager?” and “Is my portfolio growing enough to meet my investment goals?” TALK TO YOUR ADVISOR Avid Wealth Partners is always here to help. Please talk to your advisor if you have questions about your portfolio’s performance or the returns displayed. Avid Wealth Partners 17802 W Interstate 10, Ste. 114 San Antonio, Texas 78257 210.446.5751 | AvidWealthPartners.com

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Avid Wealth Partners is a marketing name for Eric Ilmari Kala in his 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, WI (NMWMC) (fiduciary and fee-based financial planning services), a subsidiary of Northwestern Mutual Life Insurance Company Milwaukee, WI (NM) (life and disability insurance, annuities and life insurance with longterm care benefits) and federal savings bank. Eric Ilmari Kala is 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 U.S., which it awards to individuals who successfully complete CFP Board’s initial and ongoing certification requirements.

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Children’s Health

Can an Annual Eye Exam

Change Your Child’s Life? Yes, It Can by Mary Maloney

f you believe that school vision screenings adequately evaluate your child’s vision, please read on. “While school vision screenings are important, they do not take the place of a full eye exam, because they only detect distance vision issues,” says Optometrist Amanda Hoelscher of the Key-Whitman Eye Center in Dallas. During a comprehensive eye exam, optometrists such as Dr. Hoelscher evaluate more than distance vision. As she explains, “A school vision screening doesn’t touch on all of a student’s visual demands. Limiting vision tests to reading letters on an eye chart will not detect vision problems related to near vision, muscle imbalance, and other eye diseases and conditions.”

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Experts agree: A large number of children fail reading tests and have trouble learning due to vision problems. According to the National Center for Children’s Vision and Eye Health at Prevent Blindness, “Vision problems affect more than one in 20 preschoolers and one-quarter of school-aged children.” The organization also warns that eye-related conditions can lead to developmental delays, learning issues and vision loss. Even more compelling, a study by the Mississippi Optometric Association revealed that 88% of third graders who failed a state-administered reading test needed some form of visual intervention.

“If every child entering first grade had a complete eye exam, and we had an opportunity to intervene early, just think of where that 88% might be. I believe we’d be looking at dramatically different statistics,” says Dr. Hoelscher. She also advises parents to schedule eye exams for their children as soon as a child has a grasp of the alphabet, and annually thereafter. “Some children end up doubling their efforts to learn how to read if they’re struggling to see clearly and keep words in focus. By diagnosing vision problems early, we can treat children so they have the best opportunity to learn and to excel academically.”

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Children’s Health

Three signs that your school-aged child may have vision problems While it may be difficult for parents to monitor their kids during the school day, they can look for clues of vision problems by reading books together at home. According to Dr. Hoelscher, common signs a child may have vision issues include: • Skipping lines when they are learning to read • Occasionally losing their place in a paragraph while trying to read • Complaining of blurry or double vision during a reading session Parents of very young children should also watch out for signs of vision problems, such as eye irritation, constant eye turning, light sensitivity, excessive tearing, and the appearance of a white pupil. Dr. Hoelscher encourages parents to act immediately if they have any concerns about their children’s eye

stabilized. The only way to ensure that your child kicks off each school year with optimum vision is to schedule an annual eye exam.

health, and stresses that “Pediatric ophthalmologists can assess vision even earlier than school age, without any input from children.” Vision can change frequently during the school years, so annual eye exams are necessary. A child at age six can present with very different vision than at age eight, and many students in high school are still dealing with vision that hasn’t

According to Dr. Hoelscher, “A child’s ability to learn shouldn’t be hampered by dramatic vision changes that could be detected during a comprehensive eye exam. By seeing your child annually, we have a much better ability to make recommendations for glasses, contact lenses or vision therapy – whatever that child requires to see better and to succeed in school.” Dr. Hoelscher loves treating family members of all ages at her North Dallas office – especially kids. To schedule a children’s annual eye exam with Dr. Hoelscher in North Dallas, or with an eye doctor at the Dallas or Mesquite full-service family eye care locations, contact Key-Whitman’s office at (972) 905-9128 or set up an appointment online http://www.keywhitman.com.

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Psychological Effects of

Crooked Teeth on a Person by Shen Chao

smile is one of the first things that anyone notices about a person. However, if someone has crooked teeth they can be very self-conscious about smiling. Though this aesthetic issue isn’t big, it can cause deep emotional and psychological issues for some people who have crooked teeth and imperfect smiles. Five Ways Crooked Teeth Affect Someone, Mentally and Socially Not many people associate crooked teeth as something that can affect an individual’s emotional and mental state, but here are some ways in which they do affect some people:

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They Don’t Smile Often: People with crooked teeth get very self-conscious about their smiles exposing their irregular teeth. Therefore, they try to hide their teeth and they rarely smile. They Isolate Themselves: Some people are so conscious of their crooked teeth that they stop socializing and stay at home instead, completely isolating themselves from others. Their self-esteem also takes a massive hit and they avoid participating in any group or public activities. They Avoid Public Speaking: There are instances where one might be required to

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speak in public, but having crooked teeth has stopped many people from doing so. They might miss wonderful opportunities just because they don’t speak in public. They Have Social Anxiety: People with teeth that are not straight can suffer from social anxiety. They constantly feel embarrassed about how their teeth look. This instills in them a fear of being ridiculed or teased about their teeth by their friends and colleagues. They Avoid Conversations: Some people even go so far as to avoid conversations with people around them, as they are self-conscious of their crooked teeth. Dental Treatments to Fix Crooked Teeth If you have crooked teeth, don’t let it affect you mentally and emotionally. There are some cosmetic dental procedures which can help you get rid of crooked teeth and give you a nice smile, with the pearly whites you always dreamed of having. Your dentist will make a thorough diagnosis and decide which of the following treatments would be the best for you. Invisible Braces: Invisible braces help in straightening the dentition in a short period of time. It may take about six months to two years to fix the crooked teeth using invisible braces, depending on the individual’s need. Porcelain Veneers: These are the longterm alternatives used to repair crooked teeth. Dental Bonding: This is a pain-free and quick procedure that corrects crooked dentition by applying a composite resin material to the front of the teeth. The bonding helps in re-contouring and aligning them properly, thus eliminating the crookedness.

Consider all the options you have and zero in on the ones you can afford and that are suitable. Some of the treatments require proper maintenance beyond brushing, flossing, regular dental cleanings, and routine dental checkups. Understand clearly what the procedure involves and gather all the information you can about the restorative techniques before undergoing the chosen procedure. Ask your dentist all the questions you have so that together you can pick the right option. Don’t let your crooked teeth be a matter of emotional and mental concern

anymore! Get them fixed and feel free to smile, because a smile is the most beautiful accesory you can wear!

Shen Chao is part of Dr. Joshua Hong’s Smile Clinic. While working for the Smile Clinic, Shen Chao has gained firsthand experience regarding the questions and concerns that dental patients have. He has been writing to help inform his readers about various dental topics and to help them improve their oral health. When he’s not working, you can find him on a hiking trail with his dog or having a Sunday cookout with friends. 2018 - JANUARY

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Business / houston

10 Mistakes to Avoid When a Physician Files For Divorce by Douglas R. York

ivorce inevitably entails a degree of drama and emotional upheaval. Physicians, no matter how rational and competent they may be in their medical careers, are not immune. But with careful thought and advance planning, a physician can get through a divorce with his or her practice and self-confidence reasonably intact, if he or she avoids the pitfalls listed here.

Do not consider a divorce without planning ahead. Consult an attorney to understand exactly what steps you need to take before you file. Most physicians, like most other people inexperienced in the nuances of divorce law, are not financial experts. That is not your primary business. An experienced attorney can alert you to

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exactly what you need to do to prepare for this major change in your life.

Do not ignore the critical need of getting the worth of your practice evaluated by a credentialed expert who has a track record in this highly specialized area. Obviously, in most cases, your medical practice will be your most valuable asset when it comes to the division of marital property. Medical real estate — the value of your office lease — may have to be assessed separately.

Don’t inform your spouse before you file for divorce. He or she may get the jump on you and file first. The person who files first gets to present his/her story to a judge and/or jury first — which is always a distinct advantage.

Don’t delay the divorce. Some physicians have postponed a divorce until after their stock in their practice has been fully vested or the practice has substantially increased in value — not intentionally, but just because divorce is hard and we are all inclined to procrastinate. They regretted not acting sooner. Every day that you are not divorced, you are essentially working for half price because the other half of your income will go to the spouse you are planning to leave.

Do not embark on the divorce process without informing your partners in your medical practice, because they could become involved in the process. They may want to restructure the practice to avoid undergoing an intrusive analysis of their own property and interest in the practice.

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Do NOT give expensive gifts to a third party before the divorce. Gifting third parties with valuable jewelry, cars, trips, etc... can be viewed as a “waste” of community property. Judges and juries may view such waste unfavorably and as a result, award a disproportionate amount of community property to your spouse as compensation.

This brings us to another important point: don’t assume that community property will always be divided 50/50. Judges are only required to divide community property in a fair and equitable way. It is not uncommon for property to be divided according to a 60/40 or even a 70/30 ratio. Much depends on the stories told and the impression both parties make on the judge.

Don’t fail to disclose all required information. Attempting to hide assets that are legitimately part

of community property is highly inadvisable, possibly illegal, and can lead to special attention from the IRS. Most people have heard of “offshore” accounts and think it is easy to hide assets, but effective legal counsel and forensic CPAs (who examine business records in civil cases) are likely to ferret it out in the end.

Don’t fail to properly document and protect separate property, such as inherited property, or the value of a practice that was started before the marriage began. The burden of proof is on you to prove that certain assets should not be included in community property. If you don’t prove it, you could lose it.

Do not hire an attorney to represent you who has never, or rarely, handled a physician’s divorce before. There are many specialized issues involved, and you don’t want to put your fate in the hands of an attorney

who is learning on the job at your expense! A physician divorce can entail so many unique complications that the whole process may seem overwhelming at times. You may worry that your practice, and thus your future livelihood, will not emerge intact. But divorce, even a complex divorce, does not have to be a nightmare if you think ahead and plan ahead with the help of proven experts.

This article was written by Douglas R. York, an attorney based in Houston with 17 years’ experience in marriage dissolution, including multi-jurisdictional divorces involving highly complex legal issues. This article offers legal information but not legal advice pertaining to specific, individual circumstances. No attorneyclient relationship is formed with readers.

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Informed Patient / REGIONAL

Winter Workout Tips to Keep You Motivated

ith winter here, it means shorter daylight time and colder temperatures. For many people, it will also be a time of the year when their physical activity efforts dip. People often reduce the amount of time they spend being physically active during the winter, usually because it’s so cold outside. Add to that the lack of motivation that people have during the darker, colder months, and it’s a recipe for disaster. The good news is that there are things people can do to help stay motivated to keep moving all winter long. “Although we may want to behave like it sometimes, we are not bears and cannot get away with hibernating all winter,” explains Coach Sarah Walls,

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personal trainer and owner of SAPT Strength & Performance Training, Inc., who is also the strength and conditioning coach for the WNBA’s Washington Mystics. “We must continue being physically active during the winter. It’s the only way that we can continue being healthy, and to help avoid seasonal weight gain.” Many people tend to gain weight over the holiday and winter season. Not only have their physical activity efforts decreased, but their calorie consumption has usually risen. Rather than curl up on the couch with a blanket and the television remote, there are many good health benefits to staying active all season long. According to the Centers for Disease Control

and Prevention, physical activity can improve health, and can help people live longer. Being physically active also helps to lower risks of stroke, heart disease, type 2 diabetes, depression, and some types of cancer. Here are six winter workout tips to help keep you motivated:

Enlist a workout partner Who no-shows on their workout partner? Not many people, and if they do, a good partner won’t let them hear the end of it. If you’re worried about missing an appointment with yourself, get a workout partner and set up a schedule - it’s likely you will show up for many more sessions with a friend to hold you accountable.

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Stay focused on healthy eating It’s easy for one holiday to flow right into the next. There are parties with alcohol and calorie-dense foods, and it may seem never-ending. When you are having fun, it can have a dramatic effect on how you are feeling. The alcohol and unhealthy party foods will wreak havoc with your energy levels immediately, so one of the best ways to stay motivated to get your workouts in is to start with what you are or rather are not, eating. If you feel good, you’ll probably want to keep that going with a workout. If you don’t feel good because of all the unhealthy foods, it’s likely you’ll spiral out of control a bit when it comes to keeping up your exercise routine.

Try something new The winter is a great time to try out a new class. Gyms are always coming up with something new and different, and this might be just the right time to add in something you’ve never tried. Trying new activities will help you find ones that you love, and help keep things interesting.

Define and track small goals Whether it is learning to do a certain exercise, getting stronger, or improving your endurance, it’s a great idea to write down and track goals. Start with the biggest one and then break it down into weekly and daily tasks that will get you there. Hold yourself accountable, track where you are at with reaching the goal, and give yourself some non-food rewards when you reach milestones.

Have a fallback plan What is your plan B for when you walk out of your office at the end of the day and it is unforgivably cold and dark? Do you need to call a friend to remind you how much you love working out? Do you have a secondary workout to do in front of the TV at home? Having plan B is a good idea because you will

automatically revert to it, rather than coming up with an excuse.

Try a virtual coach A virtual coach will help you reaching your fitness goals all winter long, all from the comfort of your home or office. You won’t have to go out in the cold air, rather you can get the motivation and guidance you need in a setting that is comfortable for you, and during a time frame that works best for you. “There is nothing to gain from not adhering to a workout plan all winter long, except for weight,” added Coach Walls. “When you hold yourself accountable and actively look for ways to keep yourself motivated and pushing on, you will be more successful at it, and you will emerge next spring feeling amazing.”

Sarah Walls has more than 15 years experience in coaching and personal training. Owner of SAPT Strength & Performance Training, Inc, founded in 2007, she offers coaching to develop athletes, adult programs, team training, and has an online coaching

program. She is also the strength and conditioning coach for the WNBA’s Washington Mystics, and has more than eight years of experience working as an NCAA D1 strength and conditioning coach and personal trainer. To learn more, visit www.saptstrength.com.

SAPT Strength & Performance Training, Inc. Located in Fairfax, Virginia, SAPT Strength & Performance Training, Inc. is a high performance training club that specializes in helping to develop athletes of all ages. They offer athletic training programs for youth, college students, and amateurs. The company was founded in 2007 by Sarah Walls, a professional strength and conditioning coach and personal trainer with NCAA D1 experience, who is the strength and conditioning coach for the WNBA Washington Mystics team. To learn more, visit the site: www. saptstrength.com.

Sources: CDC Facts about physical activity: https://www.cdc.gov/physicalactivity/ data/facts.htm 2018 - JANUARY

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Healthy Living

is Better than the Cure

With musculoskeletal disorders becoming a common feature of working life, and with MSD prevalence increasing, Bill Pace with Cardinus and Donna De Falco with The Health Enhancement Company look at how prevention can be better than the cure. 56

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or employers, the future poses many ergonomics-related risks and that means that many more employers will be paying out on reactive medical and technological interventions to minimize those risks. That might mean redesigning spaces, bringing in new equipment or increasing healthcare costs.

they have handled computer mice and keyboards from an early age, played with mobile devices and touchscreen equipment since they came on to the market. That means by the time they came into the workforce they entered with pre-existing Musculoskeletal Disorders, MSD, conditions that will only become exacerbated by 8-hour long days at the workstation.

Millennials, who have been in the workplace for more than a decade now, have presented and continue to present a grave threat to the balance sheet. They are the first generation to enter the workforce having been on the screen since the age of five. Significantly,

Employees across all industries now spend long work hours (in addition to many hours at home) in front of a multitude of screens â&#x20AC;&#x201D; desktops, laptops and mobile devices of all kinds â&#x20AC;&#x201D; increasing the likelihood for neck and back pain.

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There have been a number of changes in the workplace too, that have had an impact, either good or bad, on the health outcomes of its employees. Weâ&#x20AC;&#x2122;re now used to open offices, hot-desking, home working, lounge and coffee-house type seating areas, designed to save space, foster collaboration and achieve greater equity among employees. However, these are all risk factors that could contribute to increased MSD prevalence. All of these changes make the future of employee health difficult to assess. However, we are aware that reported MSD cases is on the increase and that means more expense for the employer. One of the primary methods of reducing this risk is through assessing individual risks and putting in place methods to mitigate them. Traditionally, this has been done through paper-based or spreadsheetbased assessments that are often rolled out individually and managed centrally through a large database, often to the bewilderment of employee safety managers. Now, this can be done in a staggered way with automated software that eases the process for the employee safety manager. However, the question remains, how do you engage employees, and in particular millennial employees, with programs and services designed to prevent MSD risk? The effectiveness of prevention programs is a direct function of employeesâ&#x20AC;&#x2122; willingness to engage, which can be fostered by building trust, a perception of need and utility, the intrinsic appeal of the program and the ease of access to the program. User-friendly offerings, including online training and risk assessments, workplace design and on-site training

all contribute to decreasing the incidence and prevalence of MSD and minimise healthcare costs. Cardinus and the Health Enhancement Company worked with Adventist Health, a hospital system with 20 hospitals and 20,000 employees, to provide an engaging preventative ergonomics system to help manage their risk. By combining online ergonomics with systems implementation expertise, the resulting outcomes were improved, enabling the company to save time, healthcare costs and a reduction on injuries. This preventative approach reduced high risk individuals by half and saw engagement rates soar. Adventist Healthâ&#x20AC;&#x2122;s Workers

Compensation and Safety Department found an increase in carpal tunnel syndrome, CT, and related repetitive movement injuries among their officebased staff and faced increasing health costs. Every time a new case came to the department its employees were faced with investigating each case, while additional costs for paid disability leave rose, and the risk of losing insurance due to excessive claims increased. The response was to hire two ergonomists to head out to the field and start combating these injuries. However, demand was high and after a while became overbearing. Cardinus and the Health Enhancement Company were invited in to help manage the workload, through a mixture of online self2018 - JANUARY

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assessment and education and cultural change to foster a better relationship with health and find a reduction in incidents of MSDs. Like all big projects, engagement proved a problem in the beginning. Due to the relative inexpensive cost of the Cardinus system compared to the existing program, senior leadership were easily convinced of the need for the software. However, management at their office locations still needed to be brought in to the process so that roll-out was smooth and engagement high. The Workers Compensation and Safety Department visited office locations and met with managers to put them at ease over the new program. They also provided training and a new communications plan to win over any last pockets of resistance.

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And that’s not all. From a cost perspective they’ve seen big changes too:

38%

decrease in total cost of ergonomics injuries over 1 year

25%

decrease in total number of ergonomic injuries over 1 year

This combination of software, cultural change and internal communications resulted in big wins for the

Adventist Health team. Initially they rolled-out to 1,400 employees and saw an engagement rate of 75%. This has seen Adventist Health to experience a decrease in the number of reported CTrelated injuries each year. Ashley Clabeaux from the Workers Compensation and Safety Department told us “Now we’re experts [in workplace ergonomics]. We’ve gained the respect of employees who appreciate the program and now trust the workers compensation department.” Once prevention becomes part of the management culture it can profoundly change the employer’s and employee’s relationship with officebased health risk, making it positive, proactive and meaningful.

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LOSE WEIGHT, NOT HOPE.

Nilesh A. Patel, MD, FACS

Subhash Reddy, MD

Benefits of Weight Loss Surgery •

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

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

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

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

Texas Bariatric Specialists accepts most major insurances including Medicare.

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