MD Monthly February Cover by MD Monthly

Preventing Brain Injuries

Dr. Michael Fuentes

3 Easy Ways To Stay Healthy

Metabolic Syndrome

Dr. Nilesh Patel

Pulmonary Associates of Corpus Christi

Fighting the Flu

Leading Experts In: Pulmonary Medicine, Critical Care MD Monthly 1 & Sleep Medicine 2018 - FEBRUARY

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 el 830.572.5000

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w e b PEGGYSONTHEGREEN.COM

contents February 2018 Production Digital Media Source Chief Executive Officer Eliot Garza Project Manager Jessie Moore Sales Representative Justin Zundt Digital Media Director Andrew Kovach Digital Media Coordinator Kristy Pierce 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 Jessica Cerda Jody Marmel Writers Jody Marnel Kiko Martinez Contributors Sue Carrington Alexa Cyr Dr. Michael Fuentes Dr. Steven Lin Dr. Erika Gonzalez - Reyes Dr. Kasi Howard Eric Kala CFP®, CIMA®, AEP®, CLU®, ChFC®, CRPS® Cher Murphy Dr. Nilesh Patel Janet Shapiro Sarah Washington Douglas R. York Art Young

Pulmonary Associates

Photographers Trinity Greer Paul Marshall

of Corpus Christi

38 The Pivot Point

Cesar Torres 6

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contents 46 Senior Health:

Chronic Wounds

Research:

Informed Patient:

Mindfulness & Substance Use

Virtual Reality: Does it Work for Physical Therapy?

16 Informed Patient:

Metabolic Syndrome

Informed Patient:

Preventing Brain Injuries

Healthy Living:

3 Easy Tips To Stay Healthy in 2018

Business:

Individual Income Tax

Childrens Health:

Practical Approachâ&#x20AC;&#x2122;s Newest Research Trials

44 Informed Patient:

Fighting The Flu 8

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INFORMED PATIENT | SAN ANTONIO

Mindfulness and Substance Use by Kasi Howard, PsyD

indfulness-based therapies have gained traction over the past three decades. First pioneered by Jon Kabat-Zinn in 1979, and later presented by Marsha Linehan

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as a key tenant in Dialectical Behavior Therapy (DBT), mindfulness practices continue to gain empirical support. Numerous studies have supported mindfulness-based therapy as an

effective treatment for anxiety, depression, PTSD, substance use and eating disorders, to name a few. Other benefits include improved immune system functioning, enhanced relationships, increased self-

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compassion, lower blood pressure, and greater focus. Mindfulness is defined by KabatZinn as “a way of paying attention: on purpose, in the present moment and non-judgmentally.” This includes being open to feelings and thoughts as they arise and just accepting them for what they are, without trying to change them or run away from them. Given that substance use disorders are inherently avoidant in nature, this ability to stay in the present moment is an integral part of recovery. Mindfulness exercises can be used to help individuals with substance use disorders see things as they are in the moment, rather than focusing on finding their next “fix” to escape the pain. Mindfulness also promotes the awareness of the constantly changing state of our minds, bodies and environment. Rather than fixating on the idea that “this feeling will not go away unless I get high,” individuals learn that

feelings really do pass if he or she can just ride them out. Think of a time when you were in deep emotional pain. Was it constant? Did it fluctuate? How long did it last? Helping someone to see that their current state is not everlasting can greatly reduce their need to escape by means of a temporary high.

self-acceptance that one can move on to address the issues that first led to the substance use disorder, thus creating a foundation for lasting recovery.

Dr. Howard is a clinical psychologist treating eating disorders, anxiety, depression, and marriage issues in the San Antonio area. For more info, visit www.kasihoward.com.

Individuals also work on acceptance of their urges. Those in recovery often get discouraged when they have urges to use, and they feel as if they have failed. Mindfulness techniques, such as urge surfing (which is a relapse prevention technique) teach acceptance of the urge without judgment. Urges are natural. They come and they go. One must simply be willing to ride them out without acting on them in order to truly understand this aspect of reality. These techniques, combined with other coping skills, provide a framework for recovery that creates self-awareness and mitigates shame by creating a sense of self-acceptance. It is in that 2018 - FEBRUARY

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HEALTHY LIVING | REGIONAL

Fitness Tips Every Teen - and their Parents -

Should Read

here are a lot of good reasons for teens to engage in regular exercise and to stay fit. The Centers for Disease Control and Prevention reports that students who are physically active tend to have better grades, that higher physical fitness levels are associated with improved cognitive performance, and that those who participate in physical activities have fewer disciplinary problems. Add to that the fact that these students will be laying the foundation for a healthy lifestyle and creating great habits, and exercise turns out to be an excellent deal all around. Yet many teens and their parents have questions about fitness that may be holding them back.

Strength & Performance Training, Inc. (SAPT), who is also the strength and conditioning coach for The Women’s National Basketball Association’s (WNBA) Washington Mystics. “Being fit and healthy is more than just exercising, so it’s a good idea to learn more about what you need to do to have all-around good health.” Here are five fitness tips every teen should read:

Eat brain food This is the good stuff, the unprocessed whole foods that include things such as salads, poultry, lean meats, eggs, healthy fats, etc. Unprocessed foods are packed with vitamins and nutrients that will keep you mentally sharp and physically fit.

“The benefits of being a fit teen are plentiful, but it’s important to also know how to help reduce injury risks and stay motivated over the long haul,” explains Coach Sarah Walls, personal trainer and owner of

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at worst, downright dangerous. Listen to your body, ask questions, and seek out expert advice when you need it! “The teen years are a great time to work on fitness and to lay the foundation for a healthy body and future,” added Coach Walls. “The more you know about what it takes, the less you are looking for an overnight fix. Getting fit, whether you are a teen or a senior citizen, takes time, patience, and dedication. But it’s worth it!”

Train to be successful Going to the gym to work on your “abs” and “beach muscles” is usually done with endless sit-ups and biceps curls, but you can get the same effect by training to be more athletic and faster, and by building the confidence to reach your goals. With this kind of work you make your entire body stronger and you train yourself for success. You can work with a personal trainer to put together a routine that meets these needs and with goals that are tailored specifically for you.

get a big bench press or increase your vertical jump by several inches. Both are worthy pursuits, but both also take time and dedication. Learn to love the small changes and watch how they lead to reaching big goals.

Strength & Performance Training, Inc. (SAPT) Located in Fairfax, Virginia, Strength & Performance Training, Inc. (SAPT) 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.

Go into “Do Not Disturb” mode A big part of mental fitness is the ability to step away from constant phone calls, texts, Instagram feeds, and the like. Your mind will keep you feeling better when you steer clear of those distractions more often. Take some time to go for a walk or spend time playing with your dog, as these kinds of things are good for your body and your mind.

Appreciate that nothing happens overnight When embarking on a fitness routine, it helps to celebrate the little victories that come with even the smallest daily improvements. Yes, you may want to

Sarah Walls has over 15 years experience in coaching and personal training. Owner of Strength & Performance Training, Inc. (SAPT), founded in 2007, she offers coaching to develop athletes, adult programs, team training, online coaching, and more. She is also the strength and conditioning coach for the WNBA’s Washington Mystics, and has over eight years of experience working as a National Collegiate Athletic Association (NCAA) Division 1 strength and conditioning coach and personal trainer. To learn more, visit the site: www.saptstrength. com.

Beware of the changes Fitness has changed a lot in 20 years, so be careful whose advice you take. There are plenty of well-meaning coaches and parents who dole out advice that is, at best, antiquated and,

Sources: Centers for Disease Control and Prevention. Health and academic achievement. https://www.cdc.gov/ healthyyouth/health_and_academics/ pdf/health-academic-achievement.pdf 2018 - FEBRUARY

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INFORMED PATIENT | REGIONAL

Metabolic Syndrome by Dr. Nilesh Patel

am Dr. Nilesh Patel and I’m part of Texas Bariatric Specialists. I’m a bariatric surgeon who was trained specifically in minimally invasive bariatric surgery in Pittsburg. I’ve been practicing in San Antonio for almost 15 years. One of the most important things to me, in my job, is helping to make dreams come true. That’s pretty simple when you’re talking about obesity. It’s being able to ride a rollercoaster, go to a quinceañera, or fitting into an old wedding gown. Those are the kinds of dreams we’re talking about, and bariatrics can make that happen. Metabolic syndrome is really a constellation of findings that we’ll find in a patient. It’s someone who is overweight, has high blood pressure, elevated blood sugars or insulin resistance and has a problem with cholesterol. When you have three or four of those components, you have metabolic syndrome. That’s how we put together this cluster of symptoms and signs to be able to find a patient’s risk profile.

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For a long time obesity was the disease. The fact of the matter is, you can be 300 pounds overweight and not have metabolic syndrome. High cholesterol and elevated blood sugars come together to cause metabolic syndrome. The thought process behind coming together to come up with metabolic syndrome emphasizes the fact that obesity is just one of the risk factors that leads to these life-threatening conditions. So, you can have metabolic syndrome without truly being obese. It’s scary because we shouldn’t be thinking this is a disease for only people who are overweight. Unfortunately, metabolic syndrome is deadly. You are two times more likely

to have a heart attack or a stroke, you’re seven times more likely to get diabetes, and you are much more likely to die prematurely. When you put those two risk factors together, you lose at least 10 to 15 years off your life expectancy in the metabolic syndrome risk factor alone. So, we have a complete gamut of ways we are able to help patients in regards to help control those conditions and help resolve metabolic syndrome with the aid of lifestyle changes. We can start with just a meal plan. We can supplement the meal plan with weight loss medications that are designed to get the weight off and resolve these conditions. We also offer weight loss surgery with multiple options that are very effective in being able to cure or put these conditions into remission.

For more information visit: www.bypassdoc.com or call us today at (210) 695-2757

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DIVORCE WHEN BOTH SPOUSES ARE PHYSICIANS 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. For more information visit: douglasyork.com.

he concept of divorce when both spouses are physicians is a fairly recent concern. In 1970 less than 10 percent of U.S. physicians were women, today more than 32 percent are women in addition making up almost half of the students in medical school currently in the U.S. Obviously, this means that a significant share of physician divorces

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these days will occur in situations in which both spouses are doctors. Two doctors divorcing will experience emotional upheaval just like any other divorcing couple, but in some cases the financial process of separating their assets may be a little easier. If both spouses are in the same practice and either started or joined the practice at the same time, the value of the practice needs to be determined by expert accountants and the asset then divided fairly according to the shares of the divorcing spouses relative to other partners in the practice. If one spouse, however, joined the practice or started the practice before the marriage, tracing of this fact becomes paramount because everything is considered

“community” until the spouse with separate property proves that it is indeed separate. If involvement in a practice prior to the marriage is not carefully documented and proven, the related income and property may be lost. What if they are in different practices, or one is working directly for a hospital or clinic or medical school, and the other is part of a private practice? According to a 2017 report on CNN Money based on a survey of 36,000 doctors, women doctors earn on average 74 cents for every dollar a male physician makes. Depending on where you live in the U.S., the pay gap can range from “only” 19% to a whopping 33%.

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A significant gap between the earnings of the male spouse over the years and the earnings of the female spouse can play a role in the division of community property and the allotment of temporary spousal support, just as in any other marriage in which earnings have been unequal. It may also be the case where one physician spouse didnâ&#x20AC;&#x2122;t put in the same number of hours per week as the other because, even though both were actively practicing, that spouse was handling the larger share of childcare, and that has to be taken into account in dividing up assets. Obviously, a lot of potential dissension and expensive financial analysis could be prevented if the two physicians signed a prenuptial agreement before they married, laying out how assets were to be divided in the case of a divorce. But it appears that, while male physicians may be comfortable taking this step - especially

Even when the two spouses have been part of the same medical practice, each should have his/her own legal representation when it comes to deciding how the value of the practice and other assets should be divided. An experienced attorney will also help each party properly document and protect any separate property he or she may have, apart from the joint practice. If each has his or her own representation, they are more likely to feel that their interests have been fairly and thoroughly represented at the end of the process. Choosing a less expensive attorney who is not competent and experienced in the tracing process could be extremely costly in the long run.

in the case of a second or third marriage - female physicians are much more reluctant to demand that a spouse-to-be sign a prenup, even in cases where her income is likely to be greater than his.

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 | CORPUS CHRISTI

HEADS UP ON PREVENTING

Brain Injuries by Dr. Michael Fuentes

ith the Winter Olympics on the horizon, many of us will be watching and celebrating these snowy, athletic feats worldwide. Unfortunately, a downside of this popular event includes the head injuries that have been known to come with it. American Snowboarder Jackie Hernandez slid unconscious against the snow after hitting her head during a snowboard cross event. British Halfpipe Skier Rowan Cheshire suffered a concussion during a training session - the first of three head injuries she received in the following 18 months. Czech Snowboarder Sarka Pancochova cracked her helmet during a fall at the slopestyle final, and, Snowboarder Trevor Jacob suffered 25 concussions by the time he was only 20 years old.

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While the majority of us don’t live the dare-devil lifestyles such as many of these athletes, we’re all at risk for head injuries. Brain injuries don’t discriminate and can occur anytime, anywhere…with anyone.

Brain injuries result from bumps, blows or jolts to the head. The symptoms of brain injuries can range from a brief change in mental state to an extended period of unconsciousness or amnesia. Regardless of the severity of the injury, all brain injuries are serious. Your brain is the consistency of

gelatin. It’s cushioned by fluid inside your skull. When you suffer a blow or 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. It 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 emotionally and behaviorally as well. In the United States, more than 5 million people live with disabilities caused by brain injuries. The most common cause of brain injuries is falling, which tends to happen more with children under the age of

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14 or with adults older than 65 years of age. Following falls, motor vehicle wrecks are the second-leading cause of brain injuries.

absorbing material like sand or mulch.

We’re all at risk for brain injuries, but with a little planning they can be prevented without epic – or Olympian – effort. Consider these precautions: • Always buckle up in a car – wear your seatbelt. Every time. • Make sure you buckle your child properly in a vehicle. Use the correct child safety seat, booster or seat belt based upon your child’s age and weight.

snowboarding, sledding, or any other activity where a head injury is more likely to occur.

• Shut your cell phone off while in the car. Don’t talk. Don’t text. Distracted driving causes wrecks.

• Help make living areas safer for older adults. Remove tripping hazards like throw rugs or clutter in hallways. Use non-slip mats in the bathroom and grab bars near the shower or toilet. Install handrails on all stairs. Improve lighting throughout the home.

• Wear a helmet, and, make sure children wear helmets with appropriate activities. This could include various sports like bike riding, skateboarding, skating, horseback riding, skiing,

• Help make living areas safer for smaller children by using window guards and installing safety gates around stairways. Keep doors that lead to stairs closed and locked. Set up outside play areas on shock-

• Never drive while under the influence of alcohol or drugs.

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

Corpus Christi Rehabilitation Hospital provides specialized rehabilitation services to patients recovering from or living with injuries, illnesses, or chronic medical conditions. The hospital has earned The Joint Commission’s Gold Seal of Approval for its Stroke Rehabilitation program. For more information, visit CCRH.ernesthealth.com. 5726 Esplanade Dr • Corpus Christi, Texas 78414 • (P) 361.906.3700 • (F) 361.906.3797

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HEALTHY LIVING | HOUSTON

3 Easy Tips to Stay Healthy

in 2018

by Alexa Cyr, Miss Houston’s Outstanding Teen 2018

fter stuffing yourself with holiday treats and all of that delicious eggnog it can be difficult to get back to a normal, healthy eating and workout routine. Feeling sluggish, having gained five pounds, and forgetting what it feels like to run on the treadmill can make that New Year’s resolution a seemingly insurmountable goal. However, if one follows these tips to stick to that New Year’s resolution, getting back into gear and staying consistent throughout the year will be much more manageable. It’s not easy going back to grilled chicken and broccoli after enjoying the guilty pleasures of holiday meals and treats, so, check out these three easy tips to help you stay healthy throughout 2018: Tip 1: Planning Your Meals The first tip is to be creative with

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healthy meals and to meal-prep. Using different spices, adding a variety of vegetables, and maybe getting inspiration from foreign cuisine can make the time spent cooking enjoyable. Websites like muscleandfitness.com have great, creative recipes for healthy meals! Also, don’t be afraid to try out new ingredients. A new, nutritious experiment could become a favorite. Meal-prepping is also a great way to ensure there won’t be any last minute fast food stops. Take one free morning per week and use that free time to plan and prepare your meals for the coming week. This suppresses the temptation to go out for a calorie-heavy meal, knowing that there is already something healthy waiting at home. Cooking food at home allows you to control every ingredient added, ensuring a more healthy outcome.

“Everything in moderation” is truly a motto to live by. Make sure not to have too much of one thing, because no matter what its health benefits are, no meal is effective in excess. Tip 2: Workout with a Purpose The next tip is to workout with a purpose in mind. World-renowned fitness expert and former Miss Fitness Olympia, Monica Brant, likes to encourage those who are seeking to improve their exercise routines by saying, “Make realistic goals that can be measured, dated, and attained!” She also suggests keeping a “journey journal” to show progress from beginning to end, as it is hard to see the daily changes. Ask yourself: What distinct changes would you like to see? How many pounds would you like to lose? Setting measurable goals means being specific.

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When working out, spot reducing (losing fat in one area) is not possible, but a mixture of cardio and weight training specific areas of the body is the key to an overall lean and toned body. It may be hard to see results at first, but keeping track weekly, then seeing the difference between where you are now compared to six weeks ago could be shocking. With a dedicated routine, a dramatic change is possible in as little as three months. Tip 3: Self-Care Last and most certainly not least, take care of your body by drinking a lot of water and getting plenty of sleep. These two things are a lot easier said than done nowadays. A hectic work schedule and late nights at the office can mean that it is nearly impossible to get enough sleep, but according to everydayhealth.com, the average 26 to 60-year-old needs seven to nine hours of sleep per night. Getting enough sleep means you will be more

motivated to go to the gym even after or before a long day of work. Workouts are most definitely not as effective when one is sleep deprived, and forcing your body to do what it physically cannot do is unhealthy under any circumstance. If you are finding yourself feeling sluggish and you are getting appropriate amounts of sleep, you may simply be dehydrated. Dehydration not only causes one to feel tired, but it can lead to ailments such as headaches, nausea, dizziness, etc... Unfortunately, dehydration can also lead us to think that we’re hungry, when in fact, it may just be thirst. This sensation may cause one to overeat and gain weight. According to the Mayo Clinic, the recommended amount of fluids per day is 15.5 cups for men, and 11.5 cups for women (these recommendations cover fluids from water, other beverages, and food).

Year’s resolutions people made last year were to stay fit and healthy, and to lose weight, according to a Nielsen survey. As concepts, they’re excellent, but as goals, they’re amorphous and immeasurable, says muscleandfitness. com. Always remember, working out and eating healthy is a lifestyle! To see the results and change you want, it takes time, hard work, and commitment. Your body will thank you for it. And finally, remember that motto: “everything in moderation.”

The two most common New

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LOWER DOES NOT ALWAYS MEAN BETTER (OR SIMPLER): AN ANALYSIS OF THE INDIVIDUAL INCOME TAX CHANGES OF H.R. 1 Contributed by Eric Kala CFP®, CIMA®, AEP®, CLU®, ChFC®, CRPS® Avid Wealth Partners 17802 W Interstate 10, Ste. 114, San Antonio, TX 78257 | 210.446.5751 AvidWealthPartners.com OVERVIEW ne of the more significant changes in decades to the tax code occurred with the

passage of H.R.1 that affects how individuals are taxed. While touted as “tax simplification,” the end result is anything but that. An initial look at these tax changes reveals both challenges and opportunities for taxpayers. Generally, most of the provisions

focus on lowering marginal tax rates and taking away tax deductions and exclusions from income. Because of the Senate deficit rules, many of the individual income tax provisions go into effect in 2018 and sunset at the end of 2025. Here is a summary of the key changes impacting individual income taxes:

Tax Provision

2017 Tax Law

What’s Changing?

Child tax credit

$1,000 credit, which phases out for taxpayers with modified AGI above $110,if married filing jointly or $75,000 if single.

Credit increased to $2,000 and refundable up to $1,400; AGI phase out is increased to $400,000 if married filing jointly and $200,000 if single. $500 nonrefundable credit for non-child dependents (e.g. children caring for elderly parents)

529 education accounts

Favorable tax treatment for qualified higher education expenses related to post-secondary education.

Expands definition of qualified higher education expenses to include expenses for elementary and secondary schools. Elementary and secondary schools expenses are limited to $10,000.

Limitation on itemized deductions (Pease Limitation)

Certain itemized deductions (taxes paid, interest expense, and gifts to charity) are limited to taxpayers with an AGI greater than $313,800 if married filing jointly or $261,500 if single.

Eliminates the limitation on itemized deductions.

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Tax Provision

2017 Tax Law

Whatâ&#x20AC;&#x2122;s Changing?

Marginal tax rates

Ordinary income tax rates ranging from 10% to 39.6%.

Overall lowering of all marginal tax rates, with a top marginal tax rate of 37%.

Capital gains

Top capital gains rate on long-term capital gains and qualified dividends in 20% (before 3.8% net investment income tax).

No change.

Individual alternative minimum tax

Taxpayers with a higher AGI are required to calculate their tax with different adjustments, preferences, and exemptions. Taxpayers pay the higher of their regular tax or AMT.

AMT is retained but modified to include a higher exemption amount and a higher phaseout of the AMT exemption.

Standard deduction

$12,700 - married filing jointly $9,350 - head of household $6,350 - single

$24,000 - married filing jointly $18,000 - head of household $12,000 - single

Personal exemptions

$4,050 for each dependent (subject to phase outs for taxpayers with a higher adjusted gross income, AGI).

Eliminates personal exemptions.

Alimony payments

Payment of alimony is an above-the-line deduction; recipient includes in income.

No dedution for payer, recipient excludes from income.

State and local taxes (itemized deduction)

State local property taxes are deductible; a choice between income or sales tax is also deductible.

Total deduction for state and local taxes capped at $10,000; 2018 state and local property taxes can be prepaid but state and local income taxes cannot.

Mortgage and home equify interest (itemized deduction)

Mortgage interest deductible on loan balances up to $1 million. Interest on home equity indebtedness deductible up to $100,000

$1 million mortgage limitation stays in place for current homeowners, while the limmit is decreased to $750,000 for new home purchases. Eliminates the mortgage interest deduction for home equity indebtedness.

Medical expense deduction (itemized deduction)

Medical expenses deductible to the extent they exceed 10% of AGI (7.5% for taxpayers over the age of 65).

In 2017 and 2018, the threshold is lowered to 7.5% of AGI for all taxayers. The threshold reverts to 10% in 2019 for everyone.

Charitable contributions (itemized deduction)

Cash contributions to charity are limited to 50% of AGI. Taxpayers can deduct 80% of donations made to colleges in exchange for athletic seating rights.

Increases AGI limitation for cash contributions to 60%. Eliminates deduction related to athletic seating rights.

Miscellaneous itemized deductions

Miscellaneous itemized deductions (unreimbursed employee expenses, tax preparation fees, investment fees and expenses, etc.) are subject to a 2% floor.

Eliminates all miscellaneous itemized deductions.

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far fewer taxpayers, as the exemption amount and phase-out for the exemption amount were increased.

COMMENTARY Simplification? Not so much. Coming at a time when Americans need it to be easy, the new tax law may have the opposite effect and, in fact, not make taxes easier. And certainly, not always lower. Much of the focus on the new law is on the fact that marginal income tax rates for individual taxpayers are lower, at least initially, with brackets beginning at 10% and topping out at 37%. However, these rates sunset in 2025, and it is likely that individual taxpayers will pay more tax in the long run, particularly if the rates are not extended beyond that time. Deductions are a bit more complicated, and are a mixed bag depending on the taxpayers’ circumstances. Under either existing or new tax law, taxpayers choose between the standard deduction and itemized deductions. Increasing the standard deduction to $12,000 for single taxpayers and $24,000 for joint taxpayers, means that fewer taxpayers will itemize deductions starting in 2018.

Avid Wealth Partners is a marketing name for Eric Ilmari Kala in their capacity as a representative of Northwestern Mutual and is not a legal business name. Eric Ilmari Kala is a representative for Northwestern Mutual Wealth Management Company®, Milwaukee, 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 long-term care benefits) and federal savings bank. All NMWMC programs and services are offered only by representatives operating from agency offices of NMWMC. Eric

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CONCLUSION Now that tax reform has passed, the real work is just beginning. Advisors and taxpayers alike will need to evaluate what it means and how each individual can take advantage of any planning opportunities.

The changes will result in a tax increase or a tax reduction depending on each individual taxpayer’s circumstances. Generally, those who currently choose to itemize their deductions rather than taking the standard deduction are expected to see a tax increase (i.e., taxpayers from high-tax states or people who purchase homes and carry a large mortgage balance). Those who currently choose the standard deduction are expected to see a tax decrease. Although discussions involved it possibly being eliminated, the Alternative Minimum Tax for individuals was retained. Fortunately, it will apply to

This publication is not intended as legal or tax advice. This information was compiled by the advanced planning attorneys of The Northwestern Mutual Life Insurance Company. It is intended solely for the information and education, it must not be used as a basis for legal or tax advice, and is not intended to be used and cannot be used to avoid any penalties that may be imposed on a taxpayer. Northwestern Mutual and its Financial Representatives do not give legal or tax advice. Taxpayers should seek advice based on their particular circumstances from an independent tax advisor. Tax and other planning developments after the original date of publication may affect these discussions.

Ilmari Kala is an insurance agent of NM and Northwestern Long Term Care Insurance Company, Milwaukee, WI (long-term care insurance), a subsidiary of NM, and a Registered Representative of Northwestern Mutual Investment Services, LLC (securities), a subsidy of NM, broker-dealer, registered investment adviser, and member FINRA and SIPC. Certified Financial Planner Board of Standards Inc. owns the certification marks CFP®, CERTIFIED FINANCIAL PLANNER™ CFP® (with plaque design) and CFP® (with flame design) in the U.S., which it awards to individuals

who successfully complete CFP Board’s initial and ongoing certification requirements.

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CHILDRENS HEALTH | SAN ANTONIO

Pediatric Specific Technological Advances Targeted in Practical Approach’s Newest Research Trials by Sarah Washington

San Antonio, Texas -- Olutola Adetona, M.D., M.P.H., Head Pediatrician for Practical Approach Pediatrics and Pediatric Dentistry, announces a new clinical research project aimed at advancing pediatric care commencing in February, paving the way for pediatric research this year.

“T

he impacts of this clinical research are providing better and more specific treatments for the pediatric age group. There is only one vaccine for Respiratory Syncytial Virus, or RSV, occuring in infants and

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children for example, our studies would potentially address a new vaccine for this and other age specific care,” said Dr. Adetona. Within their newly developed research site at Practical Approach, specializing in Pediatrics, Pediatric Dentistry and Pediatric Urgent Care, Dr. Adetona will conduct drug/vaccine and equipment related studies, as well as other specific research to the pediatric audience tackling the issue of limited research for this demographic. “We have rooms that are specific for this research program. We’ve also had two compliance site visits by drug

and vaccine companies that we passed with flying colors.” Research is projected to start around late February or early March with vaccine studies slated at the beginning of the year. Although the exploration is centered around pediatrics, participants do not have to be children in order to participate; the target audience for the analyses are individuals from one-year-old to twenty. Participant requirements vary depending on the study and they are not required to be a Practical Approach patient to qualify and will be compensated for their time and travel.

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CHILDRENS HEALTH | SAN ANTONIO

Dr. Adetona eagerly anticipates the beginning of these clinical trials and stepping towards his goals for the clinical examination site including garnering more knowledge on the pediatric population, and having drugs and equipment specific to kids. Dr. Adetona graduated from the University of Ibadan Medical School in Nigeria in 1995. After his graduation, he continued to fulfil an internship with the Lagos University Teaching Hospital in Nigeria and later became a resident at the University of Texas Health Science Center at San Antonio, where he was a resident for two years. He became a resident at the Texas A&M Health Science Center in Corpus Christi, Texas and served as the Assistant Professor and Attending Emergency Room Physician at the Driscoll Childrenâ&#x20AC;&#x2122;s Hospital. He and his wife then went on to establish Practical Approach Pediatrics and Pediatric Dentistry.

For more information about the upcoming research trials, Practical Approach, or Dr. Adetona, please call (210) 697-3900, visit online at www. practicalapproachpediatrics.com and

follow on Facebook www.facebook. com/practicalapproach. Updates about the new clinical research site will be announced on their Facebook page, as well as www.mdmonthly.com.

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Pulmonary Associates

of Corpus Christi Jody Joseph Marmel

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r. Salim Surani founded Pulmonary Associates of Corpus Christi over ten years ago in the Coastal Bend. He began as a solo practitioner and then Dr. Alamgir Khan joined the group. As the years passed, the need for Pulmonary Specialists in the Coastal Bend region increased and Dr. Surani knew that the group had to expand to meet the community and patients’ needs in both the hospital and office setting. A few years ago, Pulmonary Associates of Corpus Christi started adding Pulmonary Specialists and as of 2018, the group has nine physicians on board to help the patients in both a critical care setting as well as follow up care of pulmonary medicine and sleep medicine. Dr. Surani explains, “Nationwide, there is an overall shortage of Pulmonary Specialists as it is an extremely demanding, challenging and stressful specialty. Many times, we are dealing with patients that are dying or are in the last stages of their life. We had to be empathic, passionate and considerate while providing the state of the art care to those patients. We knew that to get the best of the best, we have to provide extra incentives for our fellow Pulmonary Specialists so that they want to stay here in Corpus Christi as opposed to the bigger cities and that is exactly what we have done.” Pulmonary Associates of Corpus Christi provides excellent working conditions and they have a they help educate the residents in the area of Family Medicine, Internal Medicine, Emergency Medicine, Pulmonary & Critical Care Medicine. Dr. Surani mentioned that “In addition to helping graduate other specialty, we plan to graduate pulmonary and critical care trained physician from our training program. This will help to train our own physician in tis specialty to combat national shortage of Pulmonary & Critical Care physicians and therefore our success rate of keeping our physicians

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on the Coastal Bend region and this has been one of the most rewarding part of my career.” As the population ages, people tend to get sick and there is an increased need for Pulmonary Specialists throughout the area. The physicians of Pulmonary Associates of Corpus Christi cover the Intensive Care Units in several hospitals throughout the Coastal Bend and provide the services needed in the critical care setting. Dr. Surani states, “We have created a structure so that we all rotate between the hospitals to provide the care which is critical to the patients in the Corpus Christi hospitals as well as serving patients from Coastal Bend region in our office. This benefits our patients prevent physician burnout in our group.”

The mission of Pulmonary Specialists of Corpus Christi is to provide the best patient care in the most dignified manner and to date, they have met and exceeded their mission with excellent patient care by world class physicians. The long-term goals are to benefit the patients in the Coastal Bend. “We mentor and train all of our new and young physicians. This way, we know that we will be leaving our patients in good hands who can deliver an excellent patient care.” Dr. Surani continues, “Teaching goes hand in hand along with taking care of patients with critical illness. We believe in evidence based practice and patient care and this reflects routinely in our practice. We also have focused on sustenance plan, as if one of us gets older or retire, our practice does not miss a beat and the continuity of care is always there for our patients of the Coastal Bend Region.”

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Salim R Surani MD, MPH, MSc, FACP, FAASM, FCCP

r. Salim Surani serves as an Adjunct Clinical Professor of Medicine, Department of Pulmonary, and the Critical Care & Sleep Medicine Department at Texas A&M University. He also currently serves as the Program Director for the Pulmonary & Critical Care Fellowship Program in Corpus Christi. Dr. Surani completed his fellowship in Pulmonary Medicine from Baylor College of Medicine in Houston, Texas. He also has his Masters in Public Health & Epidemiology from Yale University and a Masters in Health Management from the University of Texas, Dallas. Dr. Surani also has served as secretary and board of trustee for THE CHEST Foundation. In addition to this, Dr. Surani was a grant reviewer for the government of Australia and Singapore

r. Sheila Zanoria attended Cebu Institute of Medicine in the Philippines for her Medical Degree and graduated Cum Laude. She then completed her Post Graduate Internship at the University of the Philippines-Philippine General Hospital. Dr. Zanoria secured an Internship in Internal Medicine and attained her Residency in Internal Medicine at the University of Connecticut. In 2016, she was awarded with a Fellowship in Pulmonary and Critical Care Medicine at the University of Connecticut. She is on the medical staff at Corpus Christi Medical Center, Bay Area Medical Center and Doctor’s Regional Medical Center. Dr. Zanoria practices at Pulmonary Associates of Corpus Christi. She is affiliated with several hospitals

as well as Ranis (the granting agency for the European Nation). Dr. Salim Surani is the Medical Director of Critical Care Services at Christus Spohn Hospital-Corpus Christi. He has authored more than 150 articles in the peer review journals, and has written several books and book chapters. He has also served as the reviewer for more than 20 peer review journals. Dr. Surani’s area of interests include, but are not limited to Critical Care, Asthma, COPD, Sleep Medicine, Quality Assurance Programs and Pulmonary Infections. Dr. Surani serves on the editorial board for several journals. He has also served as an invited speaker in regional, national and international scientific conferences. Dr. Surani has been on numerous committees of local, regional, national and international organizations and has received several community and teaching awards. He founded It’s Your Life Foundation, a community educational foundation.

Dr. Sheila Zanoria including Christus Spohn Shoreline Hospital, Post-Acute Medical-North and South Corpus Christi, and Care Regional Medical Center in Port Aransas. In addition to her busy medical career throughout the Coastal Bend, Dr. Zanoria is the Chair of the Clinical Competence Committee-Pulmonary Critical Care Fellowship at Bay Area Medical Center. She is a member of the Pulmonary Rehabilitation Assembly of the American Thoracic Society Web Committee. Dr. Zanoria is board certified in both Internal and Pulmonary Medicine. 2018 - FEBRUARY

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Dr. Alamgir Ahmad Khan

r. Alamgir Ahmad Khan received his MBBS at Khyber Medical College in Peshawar, Pakistan. In 1993, he completed an Internship (6 months in medicine and 6 months in general surgery) at the Postgraduate Medical Institute, Lady Reading Hospital Peshawar, Pakistan. Dr.Khan then completed his Postgraduate Training in General Surgery at the Postgraduate Medical Institute, Hayat Abad Medical Complex in Pakistan. He completed his Residency in Internal Medicine at Interfaith Medical Center in Brooklyn, N.Y. In 2004, Dr. Khan attained his Pulmonary Fellowship and in 2005, he achieved a Sleep Medicine Fellowship at Sleep Disorders Institute at St. Luke’s Roosevelt Hospital Center, N.Y. In 2006, Dr. Khan received his Critical Care Medicine Fellowship at Memorial Sloan Kettering

Cancer Center, N.Y. Dr. Khan is certified by the American Board of Internal Medicine-Critical Care Medicine, American Board of Sleep Medicine, American Board of Internal Medicine-Pulmonary Medicine and the American Board of Internal Medicine. Dr. Khan is the Program Director, Critical Care Medicine Fellowship at Bay Area Medical Center, University of North Texas, Corpus Christi. He is also the Chair of the Department of Pulmonary Medicine at Christus Spohn Hospital. Dr. Khan has been practicing Pulmonary, Critical Care and Sleep Medicine in Corpus Christi since 2006 and he finds helping the patients on the Coastal Bend a challenging, yet rewarding career.

Dr. Abhay P. Vakil

r. Abhay P. Vakil attended Smt. N.H.L. Municipal Medical College in Ahmedabad, India and received his Bachelor of Medicine and Surgery (M.B.B.S.) Degree in 2008. He then traveled to New York and completed his Residency in Internal Medicine at Jamaica Hospital Medical Center in 2012. In 2014, Dr. Vakil received his Fellowship in Pulmonary Medicine at Jamaica Hospital Medical Center. But, he didn’t stop there. In 2016, Dr. Vakil completed his Fellowship in Critical Care Medicine at

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the Mayo Clinic in Minnesota. Dr. Vakil is Board Certified in Internal Medicine and Pulmonary Medicine. He is a member of the American Thoracic Society and the American College of Chest Physicians. He has an impressive presence in peer reviewed book chapters as well as journals. Dr. Vakil’s remarkable history of both international and national presentations and lectures and his extensive involvement in medical research is outstanding.

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Dr. Chinthaka P. Bulathsinghala

r. Chinthaka P. Bulathsinghala received an M.B.B.S.-Faculty of Medicine, University of Colombo, Sri Lanka in January, 2002. In 2011, Dr. Bulathsinghala completed his Residency-Department of Internal Medicine at Danbury Hospital which is affiliated with Yale University School of Medicine in Danbury, Connecticut. He then secured his Fellowship in Pulmonary and Critical Care at the University of Connecticut in Farmington in 2014. Dr. Bulathsinghala is a Clinical Assistant Professor at the University of North Texas. He is on the Faculty of the Pulmonary/Critical Care Fellowship at Corpus Christi Medical Center-Bay Area and he is the Director of the Bronchoscopy Lab for the Pulmonary/ Critical Care Fellowship at Corpus

Christi Medical Center. Since July, 2014-Dr. Bulathsinghala has been a practicing Pulmonary and Critical Care Physician at Pulmonary Associates of Corpus Christi. He has also been a Teaching Attending (Pulmonary and Critical Care) for the Emergency Medicine Residency Program and Family Medicine Residency Program at Christus Spohn Memorial and Shoreline Hospital in Corpus Christi. He is Board Certified in Internal Medicine, Pulmonary Medicine, and Critical Care. Dr. Bulathsinghala has been involved in numerous publications and research. He is a member of the American College of Chest Physicians, the American Board of Internal Medicine, and the Connecticut Thoracic Society.

Rene Franco Jr. M.D.

ene Franco Jr. M.D. started his journey in the medical field at Texas A & M University-Corpus Christi. He received his Bachelor of Science Degree in Biology in 2003. In January, 2010, Dr. Franco attained his medical degree at the Medical University of The Americas in Nevis, West Indies. He then completed his Internal Medicine Residency Program at the University of Arizona, South Campus in 2014. In June of 2017, Dr. Franco successfully finished his Pulmonary Critical Care Fellowship at Baylor Scott & White. With a plethora of clinical experience and ongoing research experience, Dr. Franco has an exemplary history of volunteer work in several communities. He has also been involved in numerous presentations. In October of 2015, Dr. Franco attended the CHEST Annual Conference in Canada. He was a presenter of â&#x20AC;&#x2DC;The Diagnostic Value and Economic Impact of Fiberoptic Cytologic Brushing during Fiberoptic Bronchoscopyâ&#x20AC;&#x2122;. 2018 - FEBRUARY

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Dr. Humayun Anjum

r. Humayun Anjum was born and raised in Karachi, Pakistan. He received an M.B.B.S. (Bachelor of Medicine and Bachelor of Surgery) with honors at Dow Medical College in 2001. In 2002, Dr. Anjum completed his Internship in Medicine and Surgery at the Civil Hospital, Ziauddin Medical University Hospital and Mayo Hospital/ King Edward Medical College in Pakistan. He then finished his Residency in Internal Medicine at Columbia University New York in 2006. Dr. Anjum further completed his medical training in 2014. He attained his Fellowship in Pulmonary and Critical Care Medicine at RUSH University/John H Stroger, Jr. Hospital of Cook County in Chicago. Dr. Anjum is Board Certified in Internal Medicine, Pulmonary Medicine and Critical Care Medicine. He is an

r. Rivi De Silva received his Medical Degree at the University of Colombo in Sri Lanka. He then traveled to Long Branch, New Jersey and completed his Internal Medicine Residency at Monmouth Medical Center. From 2013 to 2014, Dr. De Silva was the Chief Resident (3rd year) of Internal Medicine. In 2017, he achieved a Fellowship in Pulmonary and Critical Care Medicine at the University of Connecticut. Dr. De Silva is Board Certified in Internal Medicine and Pulmonary Diseases. He is a member of the American Thoracic Society, the American College of Chest Physicians, Sri Lanka Medical Council, the American Medical Association and the Society of Critical Care Medicine.

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Attending Physician –Pulmonary, Critical Care and Sleep Medicine at Pulmonary Associates of Corpus Christi. With several academic appointments as well as professional appointments, Dr. Anjum stays active in various medical committees on the Coastal Bend. In 2016, he was awarded with the Healing Hero Award-a patient nominated award for compassion and dedication at Christus Spohn Hospital-Shoreline. He also received the Specialty Teaching Award at Texas A & M University/ Christus Spohn Hospital-Shoreline. Dr. Anjum defines the best part of his career as the connections and relationships he makes on a daily basis with patients and staff members. The most rewarding part of the profession is being able to live up to the patients’ trust and providing the best possible care.

Dr. Rivi De Silva From 2016 to 2017, Dr. De Silva was involved with two research projects at the University of Connecticut. He conducted the study titled “An analysis on Cardiac troponin testing in adult patients with sepsis admitted to a medical intensive care unit”. He also conducted the study “Measurement of exhaled nitric oxide (eNO) in patients admitted with COPD exacerbation”. This was a prospective study testing the exhaled nitric oxide in patients admitted with COPD exacerbation. Dr. De Silva has also been actively involved in various publications.

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Dr. Khalid Sherani

r. Khalid Sherani was born in Dublin, Ireland and he spent his teenage years growing up in Pakistan and England. He received his medical degree from St. Georges University School of Medicine in Grenada, West Indies. Dr. Sherani completed his Internal Medicine Residency at Jamaica Hospital Medical Center in New York and was the Chief Resident, Internal Medicine from 2013 to 2014. He then went on to attain a Pulmonary Medicine Fellowship at Jamaica Hospital Medical Center. From 2016 to 2017, he completed his Critical Care Fellowship at Memorial Sloan Kettering Cancer Center, New York. In 2015, Dr. Sherani received the American Thoracic Society award for

Innovations in Fellowship Education. From 2013 through 2016, he was a Clinical Instructor at St. Georges University at Jamaica Hospital Medical Center. Dr. Sherani is a member of the American College of Chest Physicians, the American Thoracic Society and the American College of Physicians. He explains why he is a proud team physician at Pulmonary Associate of Corpus Christi. â&#x20AC;&#x153;I enjoy being part of a multi-disciplinary team and taking care of the most critically ill patients. I strive to help patients understand their disease so they will take better care of themselves in order to have quality of life.â&#x20AC;?

Pulmonary Associates of Corpus Christi long term goals are to benefit the patients on the Coastal Bend. 2018 - FEBRUARY

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INFORMED PATIENT

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INFORMED PATIENT

The Pivot Point Customizes Plans for Medical Companies to Grow Outside Comfort Zone By Kiko Martinez

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n the sport of basketball, a pivot is a move where players stop dribbling, keep one foot in place on the court and reposition themselves by rotating on the stationary foot for a pass or shot without shifting the pivot foot from its original spot. In the business world, Cesar Torres, founder and CEO of The Pivot Point, a consulting firm specializing in empowering companies to grow in all facets of business. The Pivot Point wants business owners to also reposition themselves and take their organizations to the next level. “For small to medium-sized businesses, growth might always seem just out of reach,” Torres, 34, said.

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“But that’s typically because, business owners, are so buried in the forest that they can’t see outside of it.” With The Pivot Point, Torres, who is also a motivational speaker for the company, wants to clear the path for business owners to see that they can achieve anything they want. Currently, The Pivot Point works with over 700 businesses nationwide, including in the construction, real estate, fitness, and hospitality industries. Their most successful industry, however, has been the medical field where they currently work with hundreds of doctors. From pediatricians to cardiologists and dentists to chiropractors, Torres said he works with all specialties.

“Ultimately, we are looking to streamline what, doctors, are doing so they have more time with their patients.” “This allows them to have more flexibility in their day-to-day responsibilities,” Torres said. So, what does The Pivot Point offer? It all depends on what a business owner is looking for to help enhance his

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or company. The Pivot Point process is customized for each client.

“People that come to us want a plan customized according to what they are dealing with in their business.”

“We offer help in automation, leadership training, and everything in between. If, a company, is solely dealing with marketing issues, then we come in and see how we can enhance their overall marketing. Most consultant companies focus on when the phone rings, while we do that and make the phone ring!” So, how does The Pivot Point work? It starts with an initial online interview session to see exactly what the business’s immediate needs are

from top to bottom. During this strategy session, a business coach works with a business owner to create a customized blueprint for their company. For example, if a therapist has a need for more patients, The Pivot Point will help create a system that will lead to a patient influx. “We find inefficiencies in what they are doing and correct them,” Torres said. “In turn, that increases their revenue. All of this is designed to grow their business.”

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After a plan is in place, the business coach enrolls the business owner into The Pivot Point’s online training academy where they can work with each other in one-on-one mentorship sessions. During these sessions, business coaches are able to guide business owners in learning about the four key areas of business (AKA pivots): Preliminary, positioning, profiting and prospering. “We want to find people that are willing to invest in themselves,” Torres said. When it comes to doctors, Torres believes more of them are looking for multiple streams of income. He thinks the days where doctors simply bill insurance companies is not a model that

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works for them anymore. Instead, The Pivot Point helps doctors think outside of the box and try something new— for example, creating a customized nutrition program that will benefit their patients.

“We want help doctors who are already reaching the masses. We’re also looking to increase the lifetime value of a patient by doing something right for them.”

The Pivot Point board chair Charles Chang, who has been with Torres since they started the company this past summer, said he believes The Pivot Point has some “prolific opportunities” in the health and medical fields. He and Torres also work together on IDLife, a line of nutritional supplements. “Many small and medium-sized business owners don’t necessarily have that much business background,” Chang said. “What we like to do is teach more methodology and structure so business owners can be more efficient in how they approach their business, find different revenue streams and gain more discipline in the operation side, which will affect their bottom line.”

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For Chang, it all comes down to how much doctors rely on health insurance. He wants doctors to know that there are other ways to create additional revenue streams without the red tape of the insurance industry. The light bulb goes on very quickly, Chang said, when he pitches this idea to doctors. “A lot of them think it’s better because they don’t have to go through layers of federal and state bureaucracy with Medicare companies,” he said.

“As they look through this, [doctors] are starting to see that they can keep their patients but offer them other types of medical services that patients can appreciate.”

Torres said he wants companies to feel comfortable working with The Pivot Point, which is why he has included a 90-day “out clause” in their contract. If a company is not satisfied with their services, they can opt out after three months. “We’re not holding people’s feet to the fire or trying to make them do something they don’t want to do,” Torres said. “We don’t look at a client as just another face. We look at clients as family.”

Along with building personal relationships with their clients, The Pivot Point also wants clients to be able to build personal relationships with other business owners. To do this, the company helps facilitate training meetings with business owners from all walks of life. “We like to put doctors in the same room as lawyers and restaurant owners and construction owners so they can talk business,” Torres said. “Business is business. When a doctor is able to hear advice from a dentist and a dentist is able to hear advice from a construction company, they start to feel good about being a part of a community.”

In the end, Torres said The Pivot Point has their clients’ best interest at heart. By creating systems that allow companies to thrive, he hopes more business owners will realize their full potential. “We want to help companies position themselves correctly to reach the goals they are after,” Torres said. “We want to get people who are stuck unstuck, and help them pivot into greatness.”

For more information visit thepivotpoint.us or email mentor@thepivotpoint.us

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INFORMED PATIENT | SAN ANTONIO

Fighting the Flu by Dr. Erika Gonzalez-Reyes

tâ&#x20AC;&#x2122;s that time of year again and it appears that this yearâ&#x20AC;&#x2122;s flu season is off to a fast start! As the fall and winter seasons approach, we get closer to the time of year where colds and other respiratory illnesses are more common. Among these more problematic illnesses is the flu (influenza virus). The flu season varies year by year, but most often occurs between October and January. This year it appears that the flu season has hit a little harder and earlier

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than previous years, and currently, January 2018, the CDC reports more than 45,000 confirmed cases in the United States. This is more than six times the number of cases reported this time last year. In addition, every state in the United States has reported widespread flu activity with Texas ranking second for the most reported cases of influenza up to this point. The flu is a contagious respiratory illness caused by the Influenza virus. It affects the nose, throat and lungs

and causes symptoms such as fever, cough, sore throat, headache, runny or stuffy nose, and muscle aches. In most cases, the symptoms are mild, but it some instances it can cause severe illness and even death. The flu virus spreads through droplets made when those who are infected sneeze or cough. These droplets can be easily transferred to healthy people that are nearby. The period of contagiousness usually starts as early as one day before symptoms

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develop and up to seven days after becoming sick. Although severe complications from the flu are rare, the U.S. Centers for Disease Control has estimated 17,000 flu related deaths during the mildest season to more than 50,000 deaths during the most severe. During a regular flu season, the majority of these deaths occur in the elderly and those under two years of age. There are certain people at higher risk of contracting the flu and having more serious complications. This includes people older than 50 years, children less than two years of age, pregnant women and people with other medical conditions such as asthma, diabetes, heart disease or those who are immunocompromised. These individuals are at higher risk for flu complications such as pneumonia, hospitalizations, dehydration, and death.

The single most effective way to prevent the flu is to get a flu vaccine every season. Vaccination is recommended for everybody six months of age or older. A variety of influenza vaccines are available in both an injectable and nasalspray formulation. The vaccines contain the three to four most likely influenza viruses prevalent the year given and helps people develop antibodies against those viruses. The antibodies provide protection from flu infection within two weeks after vaccination. Yearly flu vaccination is often available as early as September and continues to be administered throughout the flu season. Health officials are urging people to get protected, especially if they’re going to be around young children and the elderly. It is not too late to get vaccinated.

If you do happen to get the flu you will most likely suffer mild illness and may not need antiviral drugs. It is highly recommended that you stay home and avoid contact with other people except to get medical care. If you are in the high risk group and begin to have flu symptoms, it is advised that you contact your health care provider as early as possible so that antiviral treatment can be started if it is deemed necessary. This is important because the benefit is greatest if treatment is started within two days after illness onset. • You should stay home for at least 24 hours after your fever is gone except to get medical care or other necessities. Ideally, staying home for seven days is the best way to ensure that you are not infecting others. Your fever should be gone without the use of a fever-reducing medicine, such as Tylenol. Stay away from others as much as possible to keep from spreading infection. If you must leave home, for example to get medical care, wear a facemask or cover coughs and sneezes with a tissue. Wash your hands often to keep from spreading flu to others.

• The flu vaccine does not guarantee that you won’t get the flu this year, but it can decrease your chances of having to go to the doctor because of flu illness by up to 65%. So, before the influenza virus begins to make an appearance, be sure you and your family are ready to effectively fight the flu by going to your health care provider to get vaccinated.

Dr. Erika Gonzalez-Reyes is a BoardCertified Allergy/Immunology Specialist and Board-Certified Pediatrician. She is Medical Director of South Texas Allergy & Asthma Medical Professionals (STAAMP) and of STAAMP Research. For more information please visit www.staampallergy.com or call (210) 616-5385. 2018 - FEBRUARY

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SENIOR HEALTH

Chronic Wounds: Healing the Problem PART 1: THE PHYSICIAN’S PERSPECTIVE by Sue Carrington

bout 6.5 million Americans suffer from chronic, non-healing wounds at an annual cost of $25 billion. Problem wounds are particularly prevalent among patients in post-acute care (PAC) facilities, many of whom have chronic conditions that compromise their immune systems and make healing difficult. “The most common wounds encountered in post-acute care are pressure sores, vascular ulcers, diabetic ulcers, and surgical site wounds”, says Shark Bird MD, chief medical officer for Vohra Wound Physicians, the nation’s largest wound care group serving PAC facilities. “Typically, these wounds are slow to heal because of an underlying disease that interferes with the healing process.”

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Focusing on The Patient Progressive PAC facilities are launching patient-centered innovations for comprehensive wound care management. One such program is offered by StoneGate Senior Living, a leading provider of rehabilitation, skilled nursing, assisted living, and memory care services. To continually improve the quality of wound management and achieve optimum outcomes, StoneGate has partnered with Vohra, which provides physician-led wound check-ups at 25 StoneGate communities. “StoneGate creates an optimal healing environment for patients with chronic wounds,” Dr. Bird says. “Traditionally, PAC patients have been sent out to a wound care center or a hospital. We believe it makes more sense for patients to be seen in their

own setting. We come directly to the facility to provide the same services to the patient in the comfort of their own room. By doing this, we save time and make the patients happier.” Bedside wound care also produces cost savings—more than $19,000 per patient, according to a study from the Lewin Group. Factoring in Chronic Diseases The wound-healing process is most complex with patients who have chronic conditions. “Our bodies have a finite amount of resources to deploy in healing wounds,” Dr. Bird says. “Many chronic diseases use up these resources and impede the body’s natural ability to recover. Cardiovascular conditions are among the most damaging, often hindering the flow

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SENIOR HEALTH

of blood, oxygen, and nutrients to the wound site.” Another major condition that affects wound healing is diabetes. Up to 15 percent of the estimated 17 million Americans with diabetes suffer from chronic wounds. “High glucose levels can restrict blood vessels and stiffen the arteries, decreasing blood flow to the wound,” Dr. Bird explains. “A small foot blister can quickly become a chronic open sore. Without early intervention and effective treatment, the patient may be at risk of amputation.” “Successfully treating problem wounds requires assessing the entire patient, not just the wound. A holistic approach, considering all factors that can delay wound healing, is essential to effective wound care management.” Following Best Practices In addition to partnering with physicians who have expertise in successfully treating chronic wounds, StoneGate follows several other best practices: Engaging a multidisciplinary team—including clinical, rehabilitation, wellness, and nutrition specialists trained in chronic-wound management to monitor wound sites for signs of infection and manage the healing process from start to finish. • Abiding by clinical practice guidelines and standardized procedures to document wounds, track recovery, and achieve improved outcomes. • Performing physician-led debridement (removing any accumulated dead tissue) to improve blood flow and supply of nutrients to the wound. • Using preventive interventions, from ensuring adequate nutrition to turning and repositioning patients to

prevent pressure wounds. Providing advanced therapies to relieve pain, restore mobility, and prevent infection. • Educating patients and families to identify barriers to effective treatment, accelerate the healing process, and prevent future wounds.

“With constant vigilance and proper management, most wounds can heal,” Dr. Bird.

Facilitating Excellence About 45 StoneGate nurses have completed Vohra’s Wound Care Nurse Certification course, confirming their dedication to delivering quality wound management. Also, four StoneGate facilities—Medical Park West Rehabilitation & Skilled Care, Baybrooke Village Care and Rehab Center, Garnet Hill Rehabilitation & Skilled Care, and Emerald Hills Rehabilitation & Healthcare Center have been certified as Centers of Excellence through Vohra’s Center of Excellence

for Wound Management Program, and additional StoneGate communities have started the certification process. Key characteristics of the Center of Excellence designation include having a 24/7 Vohra wound-certified nurse, achieving a rehospitalization rate of less than one percent for chronic wounds, and conducting regular team meetings with a focus on quality and process improvement. “This distinction recognizes StoneGate’s leadership in delivering quality care,” Dr. Bird states. “The StoneGate team is clearly committed to meeting the complex challenges of chronic wound care management and collaborating dynamically to heal the wounds, improve patient outcomes, and enhance patient satisfaction.

About the Author: Sue Carrington is a seasoned and purpose-driven journalist, with a focus on healthcare innovation. She has pursued her love of words through a diverse array of callings – from book editor to radio news director, public relations manager to corporate writer and freelance writing entrepreneur. Sue is a native of the Washington, DC, area. 2018 - FEBRUARY

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OVERVIEW HOW YOU LIVE When our patients are faced with life limiting diagnosis we understand that every moment matters.

OUR VIEW POINT

Studies show that pain and symptom management is a particular concern for patients and caregivers facing a life-limiting illness. Altus staff members are experts in state of the art pain and symptom management. We can assist patients and caregivers in feeling comfortable with pain management options in the home setting or wherever they call home. If inhome caregivers require new caregiving

skills or medication management and administration, you can count on the Altus staff for training and guidance. Most all care for the hospice patientâ&#x20AC;&#x2122;s comfort can be provided at home or in alternative long term care environments. Recent technological advances allow for a wide variety of equipment that can be installed in the home, thus reducing the need for hospitalization, except in the most complicated cases. In instances where symptoms cannot be controlled at home, inpatient hospice is available and respite care is an option for caregiver fatigue and support.

t Altus Hospice we believe it is about how you live. Because, when you are faced with a life threatening illness we know that every moment matters. We believe that patient comfort and quality of life are as important as curing disease or prolonging life. When curative treatments no longer have the desired effects, we believe that hospice care is a preferable option as it offers patients an opportunity to stay at home and make personal decisions about how to spend the time that remains. Altus Hospice offers service, not only to people with a terminal illness, but also to families and caregivers that need grief and bereavement counseling. Altus Hospice is comprehensive and affordable end-of-life care for patients with life limiting illnesses. Our service includes medical care with an emphasis on pain management and symptom relief. Our team of professionals and volunteers also address the emotional, social and spiritual needs of the patient, their family and caregivers.

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EMOTIONAL SUPPORT At Altus Hospice, professional staff members include bereavement and spiritual counselors to help patients and family come to terms with terminal illness and end-of-life affairs. They assist patients in nishing important tasks, saying their final goodbyes, healing broken family relationships, distributing precious belongings, and completing a spiritual journey. “Unfinished business” can make dying harder and grieving more difficult for those le behind. At Altus we recognize that a person who comes to term with dying has a more peaceful

death, and that the family bene ts from a less complicated grieving process. This knowledge is o en a source of relief and comfort for many hospice patients and they are relieved that their family will

receive ongoing bereavement support.

ill patients in a variety of living situations and circumstances. The vast majority of hospice care is provided in the patient’s home, where they are surrounded by family, friends and familiar objects.

consultations at any time. There is absolutely no obligation or charge to the patient. Hospice Care is covered by Medicare, Medicaid and most private insurance carriers.

Hospice care provides financial relief to vulnerable patients facing terminal illness. Altus Hospice professionals are available for patient and family

For more information call 888-873-1822 or visit us at altushospicecare.com Facebook.com/altushospicecare

Hospice provides emotional and spiritual support not just to patients, but the entire caregiver unit.

FINANCIAL RELIEF

Financial worry can be a major burden for a patient facing a terminal illness. Most hospice patients are Medicare participants with ready access to a hospice benefit that minimizes out-ofpocket expenses in the last months of life. The Medicare hospice benefit covers prescribed, medications, medical equipment and supplies, visits by medical and nursing professionals, home health aides, short term inpatient care, and bereavement support for the family. The Medicare hospice benefit also eliminates the burden of paperwork, as families are not required to submit claims or pay bills. Additionally, life’s day-to-day chores can become overwhelming for family caregivers. Altus hospice professionals will support, assist, and teach at-home caregivers to provide care, administer medications, operate equipment, and seek additional community services. Hospice care is designed for terminally

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RESEARCH

VIRTUAL REALITY: Does it Work for Physical Therapy? by Art Young

ike clockwork, every year the big ball drops in Times Square at midnight on New Year’s Eve. With the same regularity, millions of people who have added a few (or more) pounds during the holiday season resolve to lose this excess weight by starting a regular diet and exercise program. As a result, health clubs are extremely popular places in the first quarter of every year. However, something happens after about three months. Boredom sets in, and the number of people working out decreases, dramatically. The health club industry, estimated to be a $27.6 billion business category in the United States, has taken notice of this annual trend, which is driven by boredom. It has started looking for ways to reduce the monotony and keep

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customers coming to the gym every day, year round. One strategy that is receiving a great deal of media attention is the use of virtual reality (VR) software to spice up workouts. According to a Wall Street Journal article entitled “Working up a Real Sweat with VR,” commercial health clubs have been dabbling in the use of technology to enhance exercise for some time. “Gyms have long sought to distract members from the monotony and rigor of exercise with digital entertainment, from small TV screens mounted on workout machines to movie theater-like spaces for large groups. But some fitness gurus and academics say virtual reality does a better job of keeping gym-goers engaged. “With headsets on, users only see the digital world. In Fruit Ninja VR,

users swing their arms to slice flying fruit and may need to squat or reach up to succeed. Users throw chairs and darts—or duck to avoid getting hit—in Drunken Bar Fight. And when a headset is synced to a resistance machine being developed by Black Box VR, users defend a base from attackers while playing the Idaho startup’s battle game VR Fitness Revolution.” If this technology can reduce the boredom of a traditional workout, it begs the question about a medical application. Can VR Reduce the Boredom and Enhance the Effectiveness of Physical Therapy For the past (number) of years, Jason Brewton has been the director of physical therapy (PT) at Texas Back

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RESEARCH

Institute and he has helped thousands of patients regain their strength and flexibility. As an expert on PT, Brewton’s insights about the use of virtual reality in a medical setting are thought-provoking. “I think VR definitely has a significant place in the fitness sector,” he said. “The biggest advantage of VR is its ability to place people in a multitude of environmental settings and situations without the inconvenience and cost of physically going to those locations or logistically setting up a competitive group environment. This can reduce boredom and entice those who are less athletically inclined to explore the VR activities that they would not otherwise try.” He continues, “One of the largest barriers to traditional fitness (in a health club setting) is convenience. VR may alleviate some of these pitfalls of traditional gyms and exercise classes where there are limitations on time and location.” Do these benefits transfer to a medically based program of physical therapy? “The possible benefits of using VR in different physical therapy settings are currently being explored in research. The big question for orthopedic and neurological-based physical therapy applications is do VR based therapy activities translate to real-world improvements?” “Research has yet to provide a definitive answer to this question. To date, systematic reviews of VR research have found that existing research is limited by small sample size and poorly controlled study design. I expect that stronger studies with larger sample sizes and good controls will emerge in the future, which will provide a clearer picture of VR’s place in rehabilitation.” “Since physical therapy has an ‘athome’ component, a potential drawback for patients using VR in the clinic is

translating this into a home exercise program. The patient may not have access to VR at home and if they do, the consumer- based models are not likely advanced enough to encourage therapeutically beneficial movements.”

“In order for VR to translate to actual ‘real world’ movements, the VR system would require accurate, real-time input from the trunk and limbs of the patient. This means the VR system would need to be robust enough to track this data in an accurate manner and translate their positions into the VR world.” Virtual Reality and Dizziness in a PT Setting Some of the media reports note the potential for dizziness when the VR app is used longer than 30 minutes. Is this a concern for its use in a PT environment? “There is significant concern for the potential of VR sickness as a side effect when using VR as a treatment,” Brewton said. “VR sickness, in the form of dizziness or nausea, occurs when augmented visual input or stimuli from the VR device conflicts with the ‘real’ somatosensory system (musculoskeletal data) and vestibular (inner ear) input of positional data. When this input does not match up in the brain, it can result in VR sickness.” “This is similar to motion sickness experienced in a car. If this were to occur during rehabilitation, it could undermine the treatment itself and/or create an unsafe treatment environment.”

Overcoming the Monotony of Physical Therapy One of the reasons for using this interactive tool is to make a very boring exercise or workout regimen more interesting. Some have suggested that patients who are undergoing physical therapy also get bored with the process and often fail to finish their prescribed therapy. Could this VR enhanced therapy keep PT patients more engaged in their therapy? “The majority of the time when patients state that they failed to finish their prescribed therapy because they got bored, it is the fault of the therapist for not challenging or progressing activities in a meaningful way. The therapy must also be relevant to the patient. If I went to therapy and did the same activities over and over without change, I would get bored as well.” “VR has a certain ‘cool’ factor because it is a novel technology. This technology will likely appeal more to the younger generations than to less techno-savvy generations. Like any new technology, it has the potential to lose its novelty and become boring, just like a video game and movies that are played repeatedly or not updated constantly. Ultimately, it is the responsibility of the physical therapist to provide a safe, dynamic and challenging therapeutic environment.”

About the Author: Over the past 35 years, Art Young has interviewed some of the most interesting people in the world and used these conversations to develop a diverse catalog of compelling stories. He is a writer, blogger, podcaster, broadcaster and frequent speaker on subjects ranging from technology to healthcare to music to outdoor sports and too many other subjects to mention. If content is king, then Art Young must be his strongest emissary. 2018 - FEBRUARY

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7 Signs

That You are a Candidate for Alzheimer’s Based on Your Teeth! From Teeth to the Brain —The Logical Path to Alzheimer’s? Provided by Dr. Steven Lin

s a dentist, I have witnessed how the mouth can harbor the first sign of diseases all over the body. One big mistake we can make with dental problems is addressing them too late. When a tooth has a cavity, there is no option but to treat it with dental fillings, crowns, and root treatments. Dental diseases fit into the chronic disease category that is seeing an alarming rise in society. It is estimated that 100 million people across the world will battle Alzheimer’s disease by 2050. These numbers have jumped from 26 million just over ten years ago. While an impending Alzheimer’s epidemic may be attributed to the fact that we are living longer, research is suggesting

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that there may be other earlier signs of cognitive decline.

being the long-term tooth decay of the brain.

For example, the first cognitive signs of Alzheimer’s disease may be:

The teeth and bones provide some of the best signs of whether we are feeding ourselves the right things. To prevent the Alzheimer’s, there may be ways to spot the signs early, via nutritional deficiencies.

• Memory loss • Speech problems • Confusion and trouble understanding simple tasks The problem is that if we wait to recognize cognitive decline, the disease has already been present for many years. There is currently no cure for Alzheimer’s disease. Like dental problems, the challenge of neurodegenerative diseases is to identify the long-term causes of the problems. If we don’t feed ourselves the right things, our teeth decay. Alzheimer’s disease may be likened to

And your teeth could give those first clues. Here are seven dental signs that you may be at risk of Alzheimer’s:

Snoring and sleep disorders Your brain needs oxygen. Many people are often starving themselves of oxygen through breathing and sleep disorders. The term ‘apnea’ refers to a pause in breathing. People with

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sleep-disordered breathing experience repeated episodes of apneas during sleep. Obstructive sleep apnea (OSA), occurs in 3 in 10 men and 1 in 5 women, according to the Alzheimer’s Association. For the brain, recent studies have revealed that a sleep disorder can increase beta-amyloid deposits over a three-year period. This was true regardless of the presence of the APOE-e4 gene considered a risk factor for Alzheimer’s. Sleep disorders, like any chronic disease, progress over time and may contribute to neurodegenerative conditions. If you snore, mouth breathe or wake up with a dry mouth, you may have a sleep disorder.

Teeth grinding Worn or ‘flat’ front teeth, especially the eyeteeth, or canines, indicate jaw movements in the evening that may be related to ‘waking’ events. These may indicate oxygen deprivation during sleep and also may relate to magnesium deficiency. Both of these have been shown to relate to Alzheimer’s disease.

Tooth decay A dental cavity is a sign that your body is not adequately managing minerals for your teeth. One of the body’s primary means of distributing calcium is through vitamin D. Low vitamin D is linked to risk of tooth decay. The brain is also covered in vitamin D receptors and is dependent on vitamin D levels. Similar to tooth decay, vitamin D deficiency is linked to Alzheimer’s disease. Low blood levels of vitamin D make us more susceptible to tooth decay in early life, and Alzheimer’s disease in later life.

Lichen planus, mouth ulcers, and Sjögren’s syndrome These conditions are autoimmune problems that can be detected as fluffy white lesions on the cheek or tongue.

Other signs are red, ulcerated lesions or dry mouth. New research is suggesting that Alzheimer’s disease may coexist with autoimmune problems, which could be first spotted in the mouth.

Bleeding gums If your gums bleed when you brush, it’s a general sign of inflammation. Neuro-inflammation is one model of how the progression of Alzheimer’s disease occurs. Bleeding gums indicate a general level of inflammation in the body, which if not addressed, may contribute to inflammation-driven cognitive decline.

Gum disease Periodontal disease has a close association with insulin-resistant type II diabetes. However, dubbed type-III diabetes, blood sugar regulation is now thought to be connected to Alzheimer’s disease. Gum disease, type II diabetes, and neurodegeneration may all be related to insulin resistance and blood sugar.

Swollen tongue An enlarged, red tongue may be a sign of vitamin B12 deficiency. Vitamin B12 is crucial for neural growth and

development. Long-term vitamin B12 deficiency may be linked to Alzheimer’s disease. Dental and neural decline diseases share strikingly similar processes in the body. An oral-systemic strategy for early-onset Alzheimer’s prevention may include: • Vitamin D and vitamin B-rich diets • Removing refined sugar from your diet • Getting enough sunlight • Weight loss • Smoking cessation • Alcohol reduction • Chronic nasal congestion treatment • Sleep assessment • Exercise Your mouth is the gateway to your entire body and the food you eat shapes your smile, body, and brain.

Dr. Steven Lin, is a dentist, TEDx speaker and author of The Dental Diet— an exploration of how food has caused the orthodontic epidemic and the 40-day food program to reboot your entire body. 2018 - FEBRUARY

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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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