Austin Medical Times - May 2018 by Rick Delarosa

May Issue 2018

Inside This Issue

Like Many Specialties, Vascular Surgery is Facing a Physician Shortage By Phillip Miller Merritt Hawkins

Steve Roach, MD, To Head Pediatric Neuroscience Care Program For Central Texas Children See pg.8

INDEX Financial Forecast............. pg.3 Legal Matters........................ pg.4 Mental Health...................... pg.5 Oncology Research......... pg.6 Healthy Heart....................... pg.7

Baylor Scott & White Medical Center Buda Celebrates Groundbreaking See pg. 10

hen the topic of physician shortages arises, much of the attention goes the dearth of primary care doctors – family physicians, general internists and pediatricians. There is a good reason for this. Demand for these types of doctors is extremely high while the supply is limited. In 2017, family medicine was Merritt Hawkins most requested type of search assignment for the 11th year in a row, while internal medicine has been either second or third for 10 consecutive years. According to Merritt Hawkins’ 2017 Survey of Final-Year Medical Resident, 55% of primary care doctors receive 100 or more recruiting offers during their training, underscoring the acute demand for these types of physicians. But it is a mistake to believe shortages are confined to primary care. The Association of American Medical Colleges (AAMC) projects there will be up to 104,900 too few doctors by 2030, including 43,100 too few primary care doctors but also including 61,800 too few specialists. Demand for specialists will be driven by patient demographics, as 10,000 baby boomers turn 65 every day, most of whom will need specialists to care for ailing organs, bones, nervous systems, and psyches. Advances in medical technology and consumer preference for the most cutting edge care also will fuel demand for specialists. Vascular surgery is just one of many specialties facing physician shortages that currently are flying under the

radar. There are only several thousand of these specialists in the United States who take care of the circulatory system, while there are some 100 million people

many other medical specialties. Merritt Hawkins conducts more searches for family physicians than for any other type of doctor, but that is in part a function of the fact that family physicians are comparatively numerous. Calculated by the number of searches Merritt Hawkins conducts relative to the total number of physicians in a given specialty, it could be argued that pulmonologists are in even greater demand than family physicians (see Merritt Hawkins’ 2017 Review of Physician Recruiting Incentives). Those who have tried to make an appointment with a specialist lately can corroborate this trend. According to Merritt Hawkins 2017 Survey of Physician Appointment Wait Times, the average time to schedule a new patient appointment with a dermatologist is 32 days, up from 29 days in 2014. In Philadelphia, the average wait time to see a derm is 78 days. Breakthroughs in diagnostic technology and the increased use of physician assistants and nurse practitioners can help address shortages in primary care, but are less likely

T he A s s o c i at io n of American Medical Colleges (AAMC) projects there will be up to 104,900 too few doctors by 2030, including 43,100 too few primary care doctors but also including 61,800 too few specialists. in the U.S. who are at risk for vascular disease, according to the Society for Vascular Surgery. More specialists will be needed to address vascular conditions from strokes to varicose veins, but the supply of vascular surgeons remains limited. An article in the Journal of Vascular Surgery indicates there will be an 11.6% deficit of vascular surgeons by 2030. The same point could be made for

see Vascular Surgery... page 14

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Financial Forecast Mistakes Young Investors Make By Dominic Cellitti Vice President and Financial Advisor Morgan Stanley

t is no secret that money issues continue to be one of the top causes of worry among young professionals, including medical professionals. In fact, a recent Morgan Stanley Investor Pulse Poll found that approximately one in five high net worth Millennials feel anxious when confronted with financial planning. Here are some common mistakes and subsequent tips to help you avoid feelings of apprehension when it comes to your financial situation. Mistake #1: “This doesn’t quite fit into my budget, but I have to have it.” In a world that echoes endless advertisements and 24-hour online shopping, it can be challenging to stick to your budget. Compound that with

student loans, a recent nursing school graduate or a doctor just finishing medical school may find themselves living paycheck to paycheck and holding debt. It is important to set up a plan to successfully pay off debt or student loans. To achieve financial success, you must first understand what it means to live within your means. The reality is, small expenditures have a way of adding up and before you know it, you have spent way more than you should have. Tip #1: Discipline is key. Budgeting is crucial to long-term financial success. To put an end to bad spending habits, begin tracking your spending. Decide what you need versus what you want. After you do this, you can create a realistic budget that allows you to live within your means while eliminating debt and putting money away in your savings. Mistake #2: “Life threw me a curveball, and I can’t pay for it.” Life can be complicated, and unexpected things are guaranteed to

happen. If you become ill, suffer an injury, lose your job or have another unexpected emergency, you may find yourself financially unprepared without savings in place. Tip #2: Create an emergency fund. It is important to have money set aside in an emergency savings fund for

life’s unexpected expenses. A good rule of thumb is to have at least two weeks’ pay. Mistake #3: “It’s too early to save for retirement.” Retirement seems like an eternity see Financial Forecast...page 13

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Legal Matters Texas Enacts Law On Health Care Facility Do-Not-Resuscitate Orders By Maily Hoang, JD Polsinelli, PC

n April 1, 2018, a new Texas law, S.B. 11, became effective governing in-facility Do-Not-Resuscitate (“DNR”) orders. As defined, a DNR order instructs a health care professional not to attempt cardiopulmonary resuscitation on a patient whose circulatory or respiratory function ceases. This article provides a brief overview of the new law, which, in short, makes it more onerous for physicians to issue valid DNR orders specifically in a health care facility or hospital. Valid DNR Orders To be valid, the patient’s attending physician must date and issue the DNR order in compliance with one of the following: 1. An advance directive. An

attending physician may issue a DNR order in compliance with any written and dated directive or oral directive of a competent patient. The oral directive must be witnessed by two competent adults, at least one of whom cannot be an employee of the attending physician or the facility. 2. The directions of a patient’s legal guardian or medical power of attorney (“POA”) agent. 3. A qualified treatment decision, if the patient does not have a directive and is incompetent. In this situation, the attending physician may issue a DNR order in compliance with a treatment decision made by the attending physician and one other person as follows, in order of priority: the patient’s (1) legal guardian or medical POA agent; (2) spouse; (3) reasonably available adult children; (4) parents; (5) nearest living relative; or, if none of the above, (6) another physician not involved in the patient’s treatment or who is a representative of an ethics or medical committee. 4. The decision of the attending physician, subject to certain

requirements. The new law still permits the attending physician to issue a DNR order in the physician’s reasonable medical judgment. However, for such an order under the new law, validity requires (1) the patient, when still competent, has not objected to a DNR order, and (2) the attending physician must decide that death is imminent regardless of CPR and the DNR order is medically appropriate. The terms “imminent” and “medically appropriate” have not yet been further defined. Notice Requirements If the DNR order is issued solely by the attending physician’s decision, and before the order is placed in the patient’s medical record, the physician must give notice of the order’s issuance

to the appropriate party. Also, notice must be given to certain individuals if such individual arrives at the hospital or facility and notifies the patient’s medical team. The latter notice requirement applies any time an in-facility DNR order is issued, but failure to provide such notice does not invalidate the order. Any good faith effort to provide notice should be contemporaneously recorded in the patient’s medical record. Revocation of DNR Order A physician must revoke a DNR order if the underlying directive is effectively revoked by the patient or, if the patient is incompetent, by the see Legal Matters...page 14

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Mental Health Alcohol – Special And Deadly By Jason Powers,MD,

lcohol is special, albeit arbitrarily. Alcohol is certainly not the most benign drug human beings abuse, but since it’s been around the longest, it has simply had more time to ingratiate itself into our psyche. After thousands of years, alcohol has managed to become enmeshed in our cultural DNA. It is a necessary component of many religious rituals. Indeed, even under Prohibition, Jewish people were given special permission to purchase and possess wine. Every Sunday, wine is consumed in many Churches across the country, and who could fault the Irish for drinking at wakes – funerals are painful! Birthdays, Anniversaries, New Year’s Eve, and St. Patrick’s Day are but a few other examples of alcohol’s prominence. Even on other lesser-known holidays, such as Arbor Day or Friday, alcohol is simply ubiquitous. Whether or not we drink the stuff, most of us at least recognize that alcohol is a sacred ingredient of holidays, celebrations, and even

religious ceremonies. Of course, it feels pretty good as well. Alcohol is fully legal (only at 21 years of age) and alcohol drug dealers are still allowed to advertise on television, unlike nicotine drug dealers. Who could deny the ‘special-ness’ of booze? Alcohol is special - it’s the most commonly used mind-altering drug in the United States. But this popularity comes at a high price. Nearly 20 million Americans suffer with an alcohol abuse disorder. Millions more engage in high-risk drinking that very well could lead to alcoholism. Alcohol stands alone as the largest contributor to preventable causes of death in the U.S. - alcohol abuse disorders eliminate nearly 3 million years of potential life each year, or approximately 30 years of potential life lost for each death. Furthermore, alcohol costs us north of $185 billion annually in lost productivity, healthcare costs, and criminal justice costs. Alcohol is special, but it’s not unique. To be sure, alcohol is a mind-altering abusable drug like cocaine and heroin. Ethanol, the active

intoxicating ingredient is a central nervous system depressant drug. Like all drugs of abuse, alcohol mainly exerts its effects and causes dysfunction in the mesolimbic dopamine system (aka “the addiction center”). Additionally, the signs and symptoms of alcohol addiction…scratch that, alcoholism, are just as predictable and generally identical to every other drug of abuse. Amongst all the drugs of abuse, alcohol addiction generally takes the longest to develop. That is, people

can and do drink for decades before alcohol addiction sets in whereas crack or methamphetamine addiction has a very short gestation period. Alcohol is over-imbibed for so long in fact that it’s the only addiction which has a “high functioning” qualifier. I would bet dollars to donuts you’ve never heard anyone refer to himself or herself as a functional heroin addict. The only reason why people are see Mental Health...page 13

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Three Tips For Talking With Your Cancer Doctor By Michelle Ashworth, M.D., Texas Oncology– Round Rock

cancer diagnosis is a life-altering experience. Everyday errands and responsibilities become trivial compared to vital decisions concerning your health and cancer treatment. Many patients have no previous family exposure to cancer, so the idea of talking to a physician about an unknown topic can seem overwhelming. Three simple tips can help cancer patients communicate effectively with their cancer care providers. 1. Educate (Yourself and Family Members) Patient education and participation are essential to effective cancer care. Well-informed patients are better able to discuss their care and related issues with their doctor. Informed patients better understand medication compliance, potential treatment side effects, and when to call their cancer

May 2018

care team. Through education, we can help patients stay out of the hospital and emergency rooms. Cancer providers want patients to receive accurate information. Some providers conduct one-on-one patient care coordination visits to help patients better understand and retain more knowledge about treatment its side effects. At Texas Oncology, we develop a written treatment plan for all patients before they begin any new cancer treatment. The plan covers important patient issues including the type and stage of cancer, the purpose and goal of treatment, and information on drugs and any side effects. In the Internet age, patients have much more access to information and tend to conduct their own research more than previous generations. The Internet helps facilitate more informed and involved patients. Doctors want patients to ask questions, to know what treatment they’re getting, and to understand why. However, it’s important to use trusted and vetted websites. Ask your care team what resources they have or recommend. 2. Communicate (Early and Often)

Ideally, doctors should take the initiative to talk with their patients using conversational language that the patients can understand. It’s also helpful for the patient to have a friend or family member in the room to take notes or ask additional questions to help ensure that communication is clear. Before each appointment, patients can prepare by writing down any questions to make sure they cover any issues of concern. Cancer patients should speak with their doctor regularly. Ideally, that discussion should occur both very early and continue throughout the treatment process. Doctors want patients to let them know how they’re doing – including new symptoms, anything that has changed, even things that are embarrassing – because those discussions improve care. 3. Elaborate (About Values and Preferences) Know what’s important to you in receiving care. Evaluate your personal values and wishes and make those known to your doctor. It can be difficult for patients to express their values and wishes, but it can make all the difference in cancer outcomes. In addition to a written treatment plan, Texas Oncology also conducts a patient goals and values

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assessment prior to treatment. We ask patients what’s important, and that helps physicians better align treatment with patient wishes. Rather than just treating a cancer, doctors strive to customize care for patients based on what’s important to them. That’s why early and effective communication between a patient and the doctor is so critical. As cancers change, people and their goals and values can also change, so patients should continue to communicate with doctors throughout the treatment process. Through effective cancer education, communication with doctors, and elaboration on their treatment goals and values, cancer patients can significantly improve their chances for desired outcomes and personal satisfaction with their cancer care.

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Healthy Heart Eighty Percent of Strokes May Be Preventable By Joel Rice, Executive Director American Heart Association Central Texas

ay is American Stroke Month and the American Heart Association wants you to be aware that up to eighty percent of strokes are completely preventable by avoiding or mitigating leading risk factors. Here are the top risk factors for having a stroke: HIGH BLOOD PRESSURE If you’ve been diagnosed with high blood pressure (or hypertension), it’s critical for you to know your numbers, keep them low, and follow the blood pressure management plan that you and your healthcare providers set out. High blood pressure is the single leading cause of stroke and the most significant controllable risk factor for stroke. Since nearly 1 out of 2 Americans may have high blood pressure, talk to your healthcare provider about your numbers and your risk.

SMOKING If you smoke cigarettes, take steps to stop. Recent studies confirm that cigarette smoking is another crucial risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system and pave the way for a stroke to occur. Smoking harms almost every tissue and organ in the body, including your heart and blood vessels. Smoking even harms the nonsmokers around you who are exposed to second-hand smoke. DIABETES Diabetes Mellitus is an independent risk factor for stroke. Many people with diabetes also have high blood pressure, high blood cholesterol and are overweight which increases their risk even more. While diabetes is treatable, the presence of the disease still increases your risk of stroke. If you have diabetes (Type 1 or 2), keep your blood sugar controlled and work with your healthcare providers on managing the disease.

your risk of stroke. Conversely, diets high in saturated fat, trans fat and cholesterol can raise blood cholesterol levels and foods high in sodium can DIET Did you know that what you increase blood pressure. What small eat can improve your heart and brain step can you take today to improve health? Studies show that a diet your diet? containing five or more servings of OBESITY If you’re obese or overweight, fruits and vegetables per day may lower there are steps you can take to get your

body mass into a healthy range. Losing as little as 5 to 10 pounds can make a significant difference in your risk for stroke and heart disease. Even if weight control has been a lifelong challenge, start by taking small steps today to see Healthy Heart...page 14

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Austin Medical Times

Steve Roach, MD, to Head Comprehensive Pediatric Neuroscience Care Program for Central Texas Children

cclaimed pediatric neurologist E. Steve Roach, M.D., is coming to Central Texas to advance research and learning around pediatric and adult brain and spine care. On May 1, Roach joins Dell Children’s Medical Center of Central Texas as section chief of pediatric neurosciences, and Dell Medical School at The University of Texas at Austin as associate chair for clinical integration and operations of its neurology department. Roach will work with the world-class Dell Children’s team, Dell Med adult and pediatric faculty and the local community of physicians to support and elevate care in Central Texas for the treatment of pediatric and adult neurological disorders such as epilepsy, spina bifida, movement disorders, autism, stroke and other issues such as headaches and brain tumors. “Under the leadership of Dr. Roach and Dell Medical school, Austin will attract additional physician-

scientists with deep roots in clinical services, academic pursuits, research and education,” said Christopher Born, president of Dell Children’s. “Dr. Roach and his team will accelerate access to the best neurologists in the country.” Roach will lead the development of neurological care at the medical school’s Mulva Clinic for the Neurosciences, where he will drive treatment and research efforts in autism, epilepsy and neuromuscular conditions, as well as other neurological diseases. “Dr. Roach’s leadership and expertise will positively impact the community at all levels – from patients to faculty, medical residents and students,” said David Paydarfar, M.D., professor and chair of neurology at Dell Medical School and interim director of the Mulva Clinic. “I am excited about helping to build the neurology programs in Austin,” Roach said. “The partnership between Seton, the Mulva Clinic,

and Dell Medical School provides a terrific opportunity to develop innovative clinical and research programs that will improve health care in Central Texas and well beyond.” R o a c h currently serves as professor of neurology and pediatrics at Ohio State University College of Medicine and N e u r o l o g i s tin-Chief at Nationwide Children’s Hospital in Columbus, Ohio. Steve Roach, M.D. The 2017 U.S. News and World Report survey ranked Nationwide Children’s neurology and neurosurgery program among the Top 10 in the country. Roach has experience in a variety of clinical, academic and research roles. He has led multiple neurology programs and held various

academic appointments, including those at Wake Forest University Baptist Medical Center in North Carolina, The University of Texas Southwestern Medical Center, and Children’s Medical Center in Dallas.

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May 2018

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The Framework

Baylor Scott & White Medical Center – Buda Celebrates Groundbreaking Largest not-for-profit healthcare system in Texas begins construction on its first medical center in Hays County

aylor Scott & White Health leaders joined Buda city officials to celebrate the start of construction on a new medical center set to open in summer 2019. The new medical center, the first in Hays County under the Baylor Scott & White name, located at 5330 White Wing Trail, Buda, TX 78610 will help meet the healthcare needs for Buda area residents. “We are grateful for the opportunity to work alongside the

improve the patient experience and prevent unnecessary medical tests, while aiming to reduce the time a patient spends in the hospital or clinic. According to a recent U.S. Census Bureau report, Hays County is one of the fastest growing U.S. counties. Buda, a popular and growing Central Texas city in Hays County, created the need for expanded medical services. Due to the pace of growth, Hays County recently was designated a Health Professional Shortage Area by the U.S. Department of Health and Human Services.

THE STRENGTH TO HEAL and get back to what I love about family medicine Do you remember why you became a family physician? When you practice in the Army or Army Reserve, you can focus on caring for our Soldiers and their Families. You’ll practice in an environment without concerns about your patients’ ability to pay or overhead expenses. Moreover, you’ll see your efforts making a difference.

Health Leaders and City officials celebrate the start of new construction

To learn more about the Army or Army Reserve, call MAJ Tamela Mitchenor at 210-692-7376, or tamela.l.mitchenor.mil@mail.mil

May 2018

City of Buda and excited to support a mutual commitment to the health and wellness of this community,” said Jay Fox, president, Baylor Scott & White Austin/Round Rock region. “We’re enthusiastic about our mission to create a healthier Texas and look forward to offering residents a unique and integrated healthcare model.” Baylor Scott & White – Buda will include a full-service hospital, primary care and an integrated multispecialty medical clinic. The model of care offers greater care coordination through a single electronic medical record, allowing hospital and clinic medical team members to coordinate care. This integrated model helps

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“As our city continues to grow, it is imperative that our citizens have access to quality health care. We look forward to working with Baylor Scott & White as we take a major step forward in meeting the community’s health needs,” said Buda Mayor George Haehn. “I would also like to thank the Buda Economic Development Corporation for their determination and hard work in bringing a state-ofthe-art health facility to Buda.” Upon completion, the medical

see The Framework...page 14

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Tourniquets Save Lives After Shootings

or the first time ever, a new study led by Dell Med trauma researchers shows that tourniquets save lives when used to treat civilian trauma victims. Trauma researchers at Dell Medical School at The University of Texas are seeking out solutions to the public safety crisis of mass shootings. One possible answer is using tourniquets – an ages old practice which fell out of use during the 20th century and involves stanching blood flow in the arms or legs. The research, conducted by the Texas Tourniquet Study Group and published as an “article in press” by the Journal of the American College

of Surgeons, followed 1,026 patients and showed that bleeding victims who receive a tourniquet before arriving at the hospital have almost a six times greater chance of surviving compared to those who don’t receive one. The findings suggest bleeding control kits should be available in public spaces, similar to how defibrillators are used for cardiac arrest, according to researchers.

Dell Medical School trauma surgeon Dr. Pedro Teixeira demonstrates how to use a tourniquet. Photo Courtesy: Dell Medical School at The University of Texas at Austin

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HHS Innovators in Aging Highlights New Ways of Caring By Jeff Carmack Texas Health and Human Services

f you know an innovative person, program, organization, community or technology that’s improving the lives of older adults, consider nominating them for the Innovators in Aging by Texas Health and Human Services. Innovators in Aging provides state-level recognition for innovations that affect older adults. By highlighting these innovators throughout the state, HHS hopes to inspire more communities to seek out better ways to serve older adults. “The goal of the HHS Innovators in Aging is to highlight individuals, programs, organizations, and communities serving older adults in unique and effective ways across the state,” said Will Armstrong, HHS marketing director.

The award categories highlight the three components of the Age Well Live Well campaign at HHS: be healthy, be connected, and be informed. The campaign helps prepare older Texans, their family members, caregivers and Texas communities for all aspects of aging. • The “Be Healthy” category recognizes outstanding innovations that create opportunities for improved physical and mental health for older adults. • The “Be Connected” award highlights innovators who have created original ways for older adults to stay engaged. • T h e “Be I n fo r m e d” award highlights innovators who h ave cre ate d opportunities for older adults to learn about the supports and services available in the field of

aging. “Due to the sheer size of the state, many communities and organizations may not be aware of innovative programs used by others to help older Texans,” Armstrong said. “The aim of this new awards program is two-fold: to share innovations, and to inspire Texans and their communities to better meet the needs of older adults. “Innovative technologies, programs, and organizations will be highlighted on the HHS website,” Armstrong said. “Those chosen will be given the opportunity to work with HHS to create tools and resources highlighting their innovations that detail how other organizations and communities can replicate program success.”

To be considered for the Innovators in Aging nominees must show a positive effect on older adults or the older adult industry in Texas. Some examples of innovations include (but are not limited to) new technologies that improve older adults’ quality of life, research on new methods to treat chronic conditions, community efforts to change the stigma of aging, and people who find creative ways to meet the needs of older adults. Nominations open May 7th and will be accepted through November. To apply or learn more about the Innovators in Aging, visit hhs. texas.gov/innovators-aging or email AgeWellLiveWell@hhsc.state.tx.us.

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Financial Forecast Continued from page 3 when you are beginning your medical career. However, one of the biggest misconceptions and mistakes that young professionals make is assuming they don’t need to start saving for retirement now. Tip #3: Start saving for retirement today. To avoid a “too little, too late” scenario, start saving as early as you can before other financial commitments begin, such as children or a mortgage. Also, consider the benefits of

compound interest. Even if it means putting away a small amount each month. Every little bit helps over time. Meanwhile, do your research to choose a retirement plan or approach that best suits you. There are several to choose from, such as your company’s 401(k), a traditional IRA or a Roth IRA. A financial advisor can point you in the right direction based on your needs.

invest in it as soon as possible.” Do not be persuaded by a colleague’s “hot tip” or a “sure thing” from a relative. Naturally, the stock market will ebb and flow. Don’t make any risky, emotional or knee-jerk decisions about your portfolio.

Mistake #4: “I heard about a hot stock right now and I’m going to

Tip #4: Find a Professional If your inner circle isn’t made up of a money management professional, then it’s best to not take their advice. Just like you wouldn’t take medical advice from a financial advisor, seek

staged an intervention just like you see on TV. I fell so far down the rabbit hole that had they remained silent, I would be dead. On many levels, I was a very “high-functioning” alcoholic. I was not only employed, I had a boutique private practice with quite a few A-list patients. But in terms of well-being, I was extremely low functioning. Like so many others with addiction, I suffered unspeakably agony. Approximately half of all alcoholics are “high-functioning”…but only on the outside. The hidden agony happens inside, where no one can see. Being out of integrity with oneself is bad enough without the pain of isolation, but addiction has no mercy. Addiction robs its host of volition and suffocates authentic inter- and intra-personal connections. Alcoholism is not a disease that cares about your socioeconomic position, either – it can and does affect anyone. Several high-profile “high-functioning” alcoholics who have publicly acknowledged having alcohol abuse disorders include Robert Downey, Jr., Betty Ford, and former President George W. Bush. As healthcare workers, we may not interact regularly with the likes of Downey, but we do see more alcoholism than most people, even if we don’t know what we are seeing. Healthcare professionals have a higher risk of developing alcoholism than the general population. The trouble is, like pilots, alcoholic healthcare workers put other people’s lives in grave danger. Surgeons have been known to operate even though they smell like booze and shake. Admittedly, it’s difficult to notice and intervene on people who have

powerful positions such as pilots or surgeons because they aren’t closely monitored and there is always a fear of repercussions. “What can I do?” you may ask. The answer is this: a lot. Most importantly, if you witness alcoholism and remain silent, you are essentially aiding and abetting the deadly disease of alcoholism. Just as alcoholics avoid seeking help because they fear the repercussions, people who witness alcohol abuse and do not speak up, may be killing with their silence. W h ile “ h ig h-f u nction i n g ” alcoholics may not be physically addicted to alcohol, abstaining for long periods of time without experiencing withdrawal symptoms, they are nonetheless psychologically dependent. This psychological piece often provides clues they’re headed for a crisis, such as blackouts, elaborate excuses for their drinking and behaviors, or frequent severe hangovers. Some signs are obvious, but many are subtle. For example, if you’re worried about someone’s drinking, ask yourself if he or she is willing to attend functions where alcohol is served but reluctant to go anywhere if there isn’t any, Alcoholism is characterized by a combination of hard to define subjective and objective criteria; and science cannot measure the point at which overuse or even abuse turns into alcohol addiction. How much, how often, and even how long you drink are not as important as what happens 1) when you drink, 2) after you drink, and 3) in your head. Thoughts and actions matter most. Alcoholism includes craving - a tenacious and powerful urge to drink; tolerance - the need to drink more in order to achieve the same desired effects

out someone who handles financial and money management to help you cultivate a portfolio you’re comfortable with. Dominic Cellitti Vice President and Financial Advisor for Morgan Stanley in Houston dominic.cellitti@morganstanley.com 713-968-3034

Mental Health

Continued from page 5 allowed to abuse alcohol instead of other drugs, even while maintaining respectable lives (often in marriages with a home and kids) is that alcohol is legal, sacred, and in a word: special. But its not unique – alcohol addiction is just as wretched as heroin addiction. So-called “high-functioning alcoholics” seem to maintain enough of a normal life semblance that their alcohol-related boo-boos are excused or overlooked. From my perspective, using “high functioning” to describe a chronic progressive and fatal illness is not only misleading, it’s negligent. The risks we take in accepting and permitting alcoholism to progress are too grave to ignore. As someone who sees more than a fair share of the bad stuff, early signs of alcoholism are more than cute red flags or signs of occasional excess - they are downright frightening. Alcoholism is a deadly disease. Period. On a larger scale, Einstein commented that humankind wouldn’t perish at the hands who do evil deeds, but by those who stay silent. High functioning alcoholics, like despots, can trudge along for a long time. Alcoholism is progressive, which means sooner or later something horrible happens. Eventually, alcohol abuse will cause one or major crises, such as a driving under the influence arrest, loss of employment, or divorce. Sooner or later, one or more persons cannot remain silent. The pain of watching a loved one suffer is horrible. At that point, the lucky one’s become people of interest…to the police, their partners, or their friends. The others, those who aren’t so fortunate, end up in jail or dead. I joined one of the lucky ones when, on June 8, 2003, my friends and family

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(get buzzed or wasted); loss of control inability to stop or limit drinking once its started and the inability to predict what happens once you start drinking; substantial impairment in life arenas (relationship, occupational, educational, physical, and leisure); and physical dependence - reflected by withdrawal symptoms when one-to-three days pass in between drinks (i.e., shakiness, irritability, nausea, sweating, and anxiety). Alcohol is not de facto bad. Like my wife who can take it or leave it, most people who drink aren’t alcoholics and never will be. However, many of us aren’t as fortunate - millions of Americans are at risk of losing themselves to booze. Early identification and intervention (instead of waiting until its too late) prevents the unnecessary pain and suffering of irreversible complications, such as brain damage, liver disease, legal problems, divorce, unemployment, and death. The beauty of expressing your concerns is that it shows them you care. Don’t stay silent if you even suspect someone is headed down the rabbit hole. You’re words are more powerful than you imagine.

May 2018

Austin Medical Times

Page 14

Vascular Surgery

Continued from page 1 to reduce the need for specialists. Healthcare delivery systems that emphasize prevention and population health may inhibit the utilization of specialty care at some points in a

patient’s life, but ultimately our body parts wear out and require specialists to heal or to maintain. We can’t manage our way out of that fact. The nation is going to need more

specialists. We should reduce the caps on residency programs and begin training them now.

Published by Texas Healthcare Media Group Inc. Editor Sharon Pennington Director of Media Sales Richard W DeLaRosa

Legal Matters

Senior Designer Jamie Farquhar-Rizzo

Continued from page 4 patient’s legal guardian or medical POA agent. Criminal Liability Under the new law, a Class A Misdemeanor is committed if a person intentionally conceals, cancels, effectuates, or falsifies another person’s DNR order, or if the person intentionally conceals or withholds personal knowledge of another person’s revocation of a DNR in violation of

the law. Also, a physician is subject to professional discipline for issuing or failing to effectuate a DNR order in violation of the law. If the attending physician does not wish to issue or comply with a DNR order, certain procedures must be followed that might ultimately lead to transferring the patient, but such procedures do not permit the physician to issue a DNR order that would

otherwise be invalid. Texas Health and Human Services Commission has been tasked with implementing rules to accompany this new law as soon as possible, so providers should be alert for regulatory updates in the near future. 

Distribution Brad Jander Accounting Liz Thachar Writers Jorge Augusto Borin Scutti, PhD Denise Hernandez MS,RD,LD Office: 512-203-3987

Healthy Heart

Continued from page 7 manage your weight and lower risks.

all days.

PHYSICAL ACTIVITY If you’re physically inactive, starting moving more. Physical inactivity can increase your risk of stroke, heart disease, becoming overweight, developing high blood pressure, high blood cholesterol and diabetes, heart disease and stroke. Go on a brisk walk, take the stairs, and do whatever you can to make your life more active. Try to get a total of at least 30 minutes of activity on most or

Additional risk factors for stroke include having high cholesterol, carotid artery disease, peripheral artery disease, atrial fibrillation (AFib) or other heart diseases. AFib in particular can increase stroke risks fivefold. If you have a heart disease, talk to your healthcare provider about managing your condition to avoid a stroke.

control, such as age, genetics, even gender plays a role. But whether your risks are related to changeable factors or are primarily outside of your control, you can benefit your heart and your brain with healthy lifestyle choices. Visit www.heart.org today to get started.

There are also factors we cannot

The Framework

Continued from page 10 center will add 150 jobs within four years. “We’re pleased and excited that Baylor Scott & White is building a medical center in our area,” said Buda City Manager Kenneth Williams. “Providing our region adequate healthcare with a full range of medical resources is a goal established by the City of Buda as we continue maintaining greatness as a municipality.” 

For Advertising advertising@medicaltimesnews. com Editor editor@medicaltimesnews.com

Austin Medical Times is Published by Texas Healthcare Media Group, Inc. All content in this publication is copyrighted by Texas Healthcare Media Group, and should not be reproduced in part or at whole without written consent from the Editor. Austin Medical Times reserves the right to edit all submissions and assumes no responsibility for solicited or unsolicited manuscripts. All submissions sent to Austin Medical Times are considered property and are to distribute for publication and copyright purposes. Austin Medical Times is published every month P.O. Box 57430

A rendering of new Medical Center

May 2018

Web Development Lorenzo Morales

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Webster, TX 77598-7430

Austin Medical Times

Page 15

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PrimeLending and 70 Rainey are not affiliated. All loans subject to credit approval. Rates and fees subject to change. ©2018 PrimeLending, a PlainsCapital Company. (NMLS: 13649) Equal Housing Lender. PrimeLending is a wholly owned subsidiary of a state-chartered bank and is an exempt lender in TX. V010918

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May 2018

Austin Medical Times

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