Houston Medical Times

Serving Harris, Galveston, Brazoria, Fort Bend and Montgomery Counties

HOUSTON

April 2019

Volume 9 | Issue 4

Inside This Issue

Memorial Hermann Health System President & CEO, Chuck Stokes Announces Decision to Retire in 2019

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U.S. Army Veteran Patricia DarnauerLeads Harris Health System’s LBJ Hospital See pg. 10

INDEX Financial Forecast.............. pg.3 Legal Matters........................ pg.4 Oncology Research......... pg.5 Mental Health...................... pg.6 Healthy Heart....................... pg.8

Searching for the Other Half of Daniel”s Heart See pg. 15

emorial Hermann Health System’s President and CEO, Charles “Chuck” D. Stokes, announced his decision to retire at the end of 2019.

“I have been fortunate to serve Memorial Hermann for more than 10 years and have had the distinct pleasure to work alongside some of the most talented and hard-working professionals in health care,” Stokes said. “I am inspired every day by their unwavering compassion and dedication to each other, their patients and to this community. It’s with profound gratitude that I prepare to embark on this new phase of my life with my wife, Judy, during which we plan to travel and spend more time with family. I will also spend my retirement teaching and volunteering, with a focus on preparing and educating the next generation of healthcare leaders.”

The Memorial Hermann Health System Board has engaged a leading executive search firm to conduct a national search for Stokes’s successor, which is set to begin immediately. The Board will consider both internal and external candidates.

“Chuck is a well-loved visionary whose unique style of servant leadership, insightful perspectives and unrelenting focus on quality and high-reliability have been a guiding force for our

organization for m a ny y e a r s ,” said Memorial Hermann Board Chair Deborah M. Cannon. “We have always known it was Chuck’s intention to retire this year, and we a re i ncredibly appreciative that he decided to make Memorial Hermann the last stop in his long and storied career.”

Stokes first joined Memorial Hermann in 2008 as Chief Operating Officer and was promoted to President and CEO in 2017. During his tenure, he established a culture of excellence, transforming the system’s operational structure to ensure its long-term success in a new era of health care. His leadership has also been instrumental in helping Memorial Hermann achieve unprecedented

national accolades. Memorial Hermann Sugar Land Hospital became the first organization and hospital in the

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Financial Forecast Money Management for Patients with Cognitive Decline

By Joseph Radzwill Senior Vice President and Financial Advisor Morgan Stanley

recommendations you can make to your patients and their families.

First, make sure the individual has advanced directives in place. Two primary forms of advanced directives include a durable power of attorney and a living will. A living will can affirm a person’s choices for future medical ccording to the Alzheimer’s care decisions and wishes. Whether Association, every 65 seconds, for dementia-related health decisions someone in the United States or for other health care situations, develops the disease. By 2050, nearly having a living will is an important 14 million Americans will be living document to have in place. It can make with Alzheimer’s. One of the first stressful times less taxing. A durable warning signs of cognitive decline is power of attorney allows a loved losing the ability to manage finances. one or caretaker to make decisions, With confusion and forgetfulness, financial or otherwise, on behalf of individuals can lose cash, be unable the individual and therefore can pay to balance their bank account, and bills, ask account questions, and make forget to pay bills. As a healthcare investment decisions for their loved practitioner, you may have patients one when they are no longer able. who are suffering from this horrible Early in the stages of cognitive illness. The impact of this disease can decline, caretakers can help their loved reach beyond the individual and greatly one continue to have some freedom affect family and other loved ones. As and feeling of personal autonomy. By a financial advisor, I see the financial having a power of attorney in place, implications of cognitive decline. As the caretaker can co-sign on accounts and4:24 set PM up auto-billing, and even allow a healthcare professional, there1 are Hou_Med_times_ad_3_2019.pdf 3/14/19

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them to keep some cash in their wallet.

While still protecting their finances, a caretaker can help the individual retain a sense of independence, while still protecting them and helping to keep their finances secure.

As the cognitive decline continues, more significant steps in limiting their access to their finances may need to be taken. Some next actions include closing credit card accounts or removing cards from their possession, reviewing their credit report regularly, and setting up banking alerts if money is withdrawn from their accounts.

Caretakers should always be on the watch for scammers. Unfortunately, older adults with cognitive decline are all too often victims of financial exploitation, especially if they live alone. A caretaker needs to watch out for warning signs such as unusual banking or credit card activity, new

“friends” who show an excessive amount of affection, and any changes to their will, deed, or power of attorney.

Before it is too late, ensure your patients have conversations with their loved ones about their finances.

Our society needs to encourage inter-generational discussions about finances. Now, before any cognitive decline or while in the early stages, is the time to discuss their investment portfolio, cash flow, and debt situation.

Estate planning does not always mean bequeaths and wills. It needs to include end-of-life planning as well.

Having a loved one diagnosed with Alzheimer’s or other cognitive decline disease is stressful and emotionally taxing. By planning and preparing accordingly, caretakers can monitor and provide a more financially secure environment. 

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Legal Matters The OIG Approves Complimentary Follow-up Care Arrangements for Chronic Conditions Lauryn Anthony Pollard, J.D.

Polsinelli, PC

O

n March 6, 2019, the Department of Health & Human Services, Office of the Inspector General (“OIG”) published a new advisory opinion, No. 19-03 addressing a medical center’s proposed arrangement to provide free post-discharge support to patients currently with congestive heart failure and an expansion to include certain individuals with chronic obstructive pulmonary disease. The OIG considered the arrangement and decided it would not impose sanctions under the Civil Monetary Penalties law (“CMP”) or the federal Anti-Kickback Statute (“AKS”). However, the OIG did assert that the proposed arrangement would not fall within the “promotes access to care” exception to the CMP.

Proposed Arrangement The requestor, a nonprofit medical center that currently offers free, in home follow-up services to patients with congestive heart failure, wants to expand services to patients with chronic obstructive pulmonary disease. The goal of these services is to encourage compliance with discharge plans, improve patient health, and help reduce unnecessary hospital inpatient admissions and readmissions.

As a result, this would help decrease utilization of services and costs.

The requestor proposed limiting the program to patients who have a current or recent inpatient admission, have been identified by treating clinicians as at high risk for readmission, have scheduled follow-up care at the requestor’s facilities, and who live in a residence or assisted living facility within the hospital’s service area. Health insurance status or ability to pay would not be considered factors in eligibility for the program.

Patients in the program would receive

two visits per week for approximately 30 days from a community paramedic employed by the medical center.

OIG Analysis The OIG began by noting that the follow-up care services constitute a “significant benefit to patients” and would constitute remuneration for purposes of the federal fraud and abuse laws. While the OIG noted that the program would be limited to patients who had selected the requestor for follow-up care for their congestive heart failure or chronic obstructive pulmonary disease, the OIG determined that free services could still influence patients to seek out the requestor for other services covered under federal health care programs.

As a result, the arrangement would implicate the beneficiary inducement provision of the CMP. Next, the OIG determined that the proposed arrangement would not qualify for the CMP exception to “promotes access to care,” because the exception excludes from the definition of “remuneration” certain remuneration that improves a beneficiary’s ability to obtain healthcare items or services that pose a low risk of harm to patients and federal healthcare programs. While the OIG cited its own commentary that “some forms of remuneration that remove impediments to compliance with a treatment plan” and some types see Legal Matters...page 16

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Oncology Research The Rise in Colon Cancer Among Younger Adults: What You Should Know

By Branden Hsu, M.D., Texas Oncology– Katy

S

taying healthy is important at any age – and it could save your life. Case in point: Recent studies are shedding light on a concerning trend among those under the age of 50: a sharp rise in incidences of colon cancer.

People born around 1990 have more than twice the risk of a colon cancer diagnosis compared to those born around 1950, according to a study by the American Cancer Society.

What’s more, cases in younger adults tend to be diagnosed as late-stage colon cancer attributed to a delay in seeing a doctor to address symptoms. According to the ACS data, adults younger than 55 are 58 percent more likely to be diagnosed with the late-stage disease than older adults.

It’s never too late to develop

healthy habits. Make a plan to protect yourself and your family through awareness, education, and prevention.

• Tune in to what your body is telling you. Don’t let a lack of awareness determine your fate.

While colon cancer rates are increasing in younger adults, the signs and symptoms are consistent no matter your age. The most common signs of colorectal cancer include a change in bowel habits, rectal bleeding, the feeling that the bowel doesn’t empty all the way, unintentional weight loss, frequent bloating, gas, or cramps, and stools that are narrower than normal. If something seems concerning or you notice changes, reach out to your primary care physician.

• Don’t wait for tomorrow when you can develop healthy habits today. Take steps to lower your cancer risk today. Maintaining a healthy weight and avoiding weight gain in the midsection can lower your risk. Adding fiber to your diet by eating vegetables, fruit, and whole

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grains is a great place to start. Being overweight or obese was associated with a 53 percent and 54 percent higher risks of colon cancer for men and women, respectively. Increasing your level of physical activity can also help lower your risk.

• Smarten up about screenings.

Screening provides the opportunity to find and remove polyps before they develop into cancer, which typically takes around 10 to 15 years. Screening also allows cancer to be found early when it is easiest to treat. Speak with your physician about which test is best for you, as there are various tests used to screen for colorectal cancer. The ACS recommends patients start with a screening colonoscopy at the age of 45; however, a family history of colon cancer or polyps suggests beginning screening at least 10 years prior to the age of the youngest family member at the time of their colon cancer diagnosis.

• Ask questions and take the time to get familiar with your options. If you are diagnosed with colon cancer, the recommended treatment will vary according to stage, location of the cancer within the colon, and other factors. Tests will be performed to determine the

extent and characteristics of the cancer. The treatment of colon cancer typically consists of surgery and/or chemotherapy, and may involve a care team of physicians, a surgeon, a gastroenterologist, and other specialists.

A cancer diagnosis feels devastating at any age, and the rise in colon cancer among younger adults is a trend we should all be concerned about. As we continue to find new ways to diagnose and treat patients, I am encouraged by advancements and research that offers hope for generations to come.

Branden Hsu, M.D., is a medical oncologist at Texas Oncology– Katy, 1331 West Grand Parkway North, Suite 340, Katy, Texas. For more information, visit TexasOncology. com.

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Mental Health PTSD After a Sexual Trauma What You Need to Know About Post-Traumatic Stress Disorder After Sexual Assault or Abuse

By Mary Leigh Meyer

P

ost-traumatic stress disorder, or PTSD, is most well-known for its prevalence in the veteran population, but close to 50 percent of PTSD in the United States is due to physical or sexual violence. Furthermore, about 30 percent of all PTSD cases in the United States can be attributed to sexual violence alone. This statistic is alarming, especially considering that one in three women and one in six men experience some form of sexual violence in their lifetimes.

Sexual assault has many definitions, some legal and some medical, but the most widely accepted definition is sexual contact or behavior that occurs without explicit consent.

This definition includes actual and attempted rape, sexual touching and force or coercion of a person into unwanted sexual acts. Sexual assault can be a one-time traumatic event, or it can be a part of continuing abuse

stemming from domestic violence or human trafficking situations.

Feelings of trauma

The levels of trauma that result from sexual assaults are a little more difficult to define and conceptualize.

“Trauma is really self-defined,” said Nancy Downing, PhD, RN, SANE-A, CP-SANE associate professor in the Forensic Nursing Programat the Texas A&M College of Nursing. “What is traumatic to one person may not necessarily be traumatic to another person.”

While physical injuries may occur in sexual assault, they are typically minor injuries that heal quickly. Unfortunately, psychological injuries are more common and can have long-term negative impacts on survivors’ functioning and quality of life. Approximately 94 percent of women experienced symptoms of PTSD after an assault.

“It is normal to have a very strong reaction to a traumatic episode. And its normal to have disruption to your day-to-day activities, especially within the first few days,” Downing said. “You may have trouble concentrating, eating, sleeping, but you need to give yourself time and permission to let yourself feel that way.”

She emphasizes those are normal reactions to be expected, but if day-to-day life is still impacted after two weeks, then she suggests speaking to a local sexual assault resource center or health care provider for assistance, if they have not already done so. Health care providers cannot diagnose PTSD until four weeks after the trauma, so these natural reactions can be normal.

If they persist and if they continue to impact day-to-day function, then it is important to seek help, as early

intervention could potentially reduce the severity of symptoms.

Symptoms of PTSD The severity and type of symptoms can vary greatly among survivors of sexual assault and abuse, but there are a few common symptoms: • Depression • Anxiety • Flashbacks or hyper-reactivity to stimulus like sounds or colors that reminds them of the trauma • Intrusive symptoms like random thoughts which will drastically change their demeanor • Avoidance of thoughts or things that remind the person of the trauma • Hyper-sensitivity and easily triggered feelings • Detrimental impact on their ability see Mental Health...page 18

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Healthy Heart Move More Month

By Bonnie Houston Chief Administrative Officer, at National Oilwell Varco (NOV)

s part of Move More Month in April, the American Heart Association is helping companies boost efforts to help employees move more and eat healthy where they spend most of their time — at work.

Improved health needs to become a norm in the business space.

Finding fun ways to get active in the workplace such as team walks, corporate recess and working meetings help to reinvigorate the mind and elevate the heart.

Almost a quarter of U.S. companies’ medical costs per year are for 10 modifiable risk factors. Employees who get moderate physical activity and eat healthy can reduce obesity, blood pressure and bad cholesterol, which are

wear sneakers and jeans and take a lunch-hour walk as a team. This can demonstrate the importance of health in the organization and build comradery among employees.

Here are some ideas to add more movement into the work day from the American Heart Association’s Healthy for Good™ initiative: 1. Take a walk on your lunch break. Don’t focus on the step count or the minutes, just move more when your schedule allows.

2. Increase your activity in simple ways around the office. Take the stairs instead of the elevator, park farthest from the door in the parking lot, convert conference room meetings to walking meetings or get up and walk to someone’s desk over sending email.

3. Schedule exercise on your

risk factors for heart disease and stroke.

Studies also indicate employees can gain about two hours of life expectancy for each hour of regular exercise.

Besides improving employees’ health, fitness in the workplace can lower long-term unemployment, reduce absenteeism, health care costs, turnover and short-term disability, while increasing productivity. It can even help to improve employee job satisfaction and work performance.

Employers also gain from a healthy workplace and workforce. In fact, every dollar spent on a worksite wellness program nets employers $2.50 to $10 in benefits such as reduced absenteeism and medical costs.

Employers with on-site programs also net a 6 to 32 percent drop in short-term sick leave.

The key to workplace wellness is leadership buy-in and involvement.

Top-level executives can set the tone for companies with a kickoff event for Move More Month. And as part of the activities, invite employees to

calendar. Add exercise to your calendar and treat your scheduled time like an important meeting.

4. Find a partner. Having a partner to keep you accountable and motivated can be the key to keeping your healthy habits moving forward.

5. Take advantage of workplace wellness offerings. Ask your supervisor or human resources department what employee wellness resources and incentives are available.

I hope you will take advantage of these resources and build a culture of health in your workplaces. At National Oilwell Varco (NOV), we are prioritizing the health of our employees by implementing AHA’s Check. Change. Control. program, an evidence-based hypertension management program that utilizes blood pressure self-monitoring to empower participants to take ownership of their cardiovascular health. Join us in helping our employees enjoy longer, healthier lives. 

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U.S. Army Veteran Patricia Darnauer Leads Harris Health System’s LBJ Hospital

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atricia Darnauer is the new executive vice president and administrator of Harris Health System’s Lyndon B. Johnson Hospital, the first Level III trauma center designated in the state of Texas. LBJ Hospital is a major medical teaching partner of McGovern Medical School at The University of Texas Health Science Center at Houston and The University of Texas MD Anderson Cancer Center.

“It’s an incredible privilege to serve as the new administrator,” she says. “From the moment I walked through the doors, I was inspired by the welcoming spirit of staff and awed by their tremendous commitment to excellence in patient care.”

Darnauer has been with Harris Health nearly three years, most recently as senior vice president of System Operations. She assumed her new leadership role on Feb. 15.

Darnauer is a retired colonel in the U.S. Army Medical Service Corps.

Highlights from her 29-year military career include leading the integrated

military health system at Fort Hood, Texas, that served more than 102,000 enrolled patients through a 98-bed community hospital and network of 11 ambulatory clinics. Her time in the military took her to Hawaii, Kansas, New York, Louisiana and the Middle East.

“The military teaches you to grow and to be a leader, to accept responsibilities and to be flexible,” she told the Texas Medical Center Pulse as part of a profile on military veterans in healthcare. “All of those things translate into the civilian sector. If there was one thing that transferred over without a second thought it was that mission focus—taking care of your patient, taking care of that population.

Many of the patients at Harris Health, don’t have many advantages or options in their lives, so to know that we are an entire health system focused on bringing them the best care possible is really meaningful and important.”

Her immediate goals for LBJ Hospital are to promote a culture

of t r a n s p a r e n c y, e n g a g e m e n t , accou nt abilit y a nd respect that will create positive change. She stresses the importance to continue the hospital’s i m p rov i n g p at ie nt quality, safety and patient satisfaction measures.

“Patient safety must remain at the center of everything we do,” she says. “Patient safety provides the foundation for our mission to improve the health of those most in need in Harris County. My goal is to ensure LBJ Hospital is always ready to face the ever-changing landscape Patricia Darnauer of healthcare.”

Prior to joining LBJ Hospital, Darnauer oversaw several important Harris Health functions including planning, construction, facilities, clinical integration and transformation, supply chain management, food and nutrition, pharmacy operations and public safety.

She earned a Bachelor of Science in Agricultural Economics-Business Management from Cornell University, a Master of Science in Healthcare

Administration from Baylor University and Master of Science in National Resource Strategy from the National Defense University in Washington, D.C. She’s a fellow in the American College of Healthcare Executives and also serves as a board member for NextOp Vets, a non-profit organization focused on providing job placement assistance, mentorship and support to veterans in the Houston area.

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Houston Medical Times

Laser-Targeted Removal of Prostate Tumors Works as Well Complete Removal of Prostate Laser Treatment, However, Preserves Erectile and Urinary Functions

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esearchers from The University of Texas Medical Branch at Galveston, led by prostate cancer treatment pioneer Dr. Eric Walser, have shown that selectively destroying cancerous prostate tissue is as effective as complete prostate removal or radiation therapy while preserving more sexual and urinary function than the other treatments. This study is currently available in Journal of Vascular and Interventional Radiology.

Prostate cancer the second most common form of cancer in men.

In fact, 1 in 9 men will be diagnosed during his lifetime. The American Cancer Society estimates 174,650 new cases and 31,620 deaths from prostate cancer in 2019.

With current screening techniques, prostate cancers are now often detected early enough so that with treatment, they stay within the prostate gland and don’t spread or

cause harm to the patient. However, aggressive treatments such as removing the prostate or radiation therapy can result in difficulty with urinary and sexual functions.

This outpatient procedure has very little recovery or pain and preserves erectile and urinary functions.

—Dr. Eric Walser

Walser, lead author, UTMB professor and chair of the department of radiology, helped to establish a less invasive method of targeting and removing only the cancerous prostate

tissue called focal laser ablation or FLA. This outpatient procedure has very little recovery or pain and preserves erectile and urinary functions.

“FLA offers men more peace of mind than active surveillance or ‘watchful waiting’, the traditional alternative to radical treatment,” said Walser. “ ”

In 120 men with low- to intermediate-risk prostate cancer treated with FLA, 17 percent needed additional cancer treatment after one year with no noticeable change in quality of life or urinary function.

In a small group of men who underwent a more aggressive FLA, only 6 percent had evidence of cancer one year later. However, these men all noticed a significant drop in sperm count.

“Other studies have shown that after completely removing the prostate, 15 to 30 percent of patients have a cancer recurrence within 5 to 10 years of surgery,” Walser said. “Although FLA doesn’t yet have such long-term data, this technique may ultimately provide similar cancer control while better preserving quality of life.”

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Stroke Survivor Finds His Artistic Stroke Again

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eith Washington had a few more brush strokes to go before finishing a painting for a friend. However, the 55-year-old couldn’t complete it because of a stroke.

Close in age to Hollywood TV star Luke Perry, 52, who died recently of a stroke, Washington considers himself “blessed” for a much different result from his medical emergency.

Washington, a self-taught artist, has made tremendous strides in his recovery since his stroke last summer. He’s even managed to put the finishing touches on the painting—a scenic landscape where a couple shared their first kiss 70 years ago. For a time, painting seemed out of the question for him.

He could barely talk or walk following his stroke. Through his medical treatment and rehabilitation care at Harris Health System’s Ben Taub Hospital, he regained his ability to talk and walk, and most importantly—use of his hands for painting.

“My body was attacked, but I didn’t let it affect my mind,” he says of his determination to recover. “I knew I would recover. I kept my mind strong

so I could pull through my physical defects.” I stayed focus on God’s promise that was no weapon formed against me shall prosper.

In July 2018, Washington went to a dentist for a tooth extraction, but could not get the procedure done because of extremely high blood pressure. He went to Harris Health’s Lyndon B. Johnson Hospital to get it checked out and was eventually sent home when it subsided. He later felt a “chill” that continued through the night.

Doctors say it was, in fact, his first sign of a stroke.

The next day, Washington felt ill. He and his wife Wanda went to Ben Taub Hospital, a nationally recognized stroke center, where other symptoms—twitchy eyes, tingling right arm and numbness of the right leg—further developed during his emergency center visit.

A team of stroke specialists and nurses quickly rushed him to treatment and kept him in the hospital for more than a week. Almost immediately, rehabilitation staff began helping him regain his old self.

Houston Area Surgeon Adopts New Procedure to Realign Local Woman’s Deformed Foot Bones

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pril Davis spent years ignoring serious pain in her feet in order to care for her two growing children.

She noticed the bones on the sides of

April 2019

her feet seemed to be growing sideways, resulting in bumps near her toe that grew larger over time. When the pain finally grew so severe that she struggled to sleep through the night, her husband convinced her to see a specialist. That is when she learned her condition impacts more than 23% of adults aged 18-65 and is called hallux valgus— or more commonly a bunion.

Most bunions are hereditary and occur when an unstable joint in the foot allows the bone to bend out of alignment. Of the 400,000 bunion correction surgeries

“It was a miracle,” he says of his recovery.

Soon after leaving the hospital, he completed the painting—using it as part of his rehab to strengthen his arms and hands.

“With a stroke, time lost is brain lost, and we have a commitment as an award-winning comprehensive stroke center to provide aggressive, proven stroke care,” says Dr. Joseph Kass, chief, Neurology, Ben Taub Hospital and professor, Neurology, Psychiatry and Medical Ethics, Baylor College of Keith Washington at his home doing finishing touches on his painting Medicine.

Wa s h i n g t o n’s on painting and is expanding his home recovery was remarkable and a true collaboration between him shed into an art studio.

He offers some advice for and his caregivers.

“They taught me what I needed anyone suspecting stroke symptoms.

“If you love yourself, get and what I had to do for recovery,” he says. “Having a staff that truly cares yourself checked out,” he says. “If you about my recovery makes all difference have some kind of symptom that is not in the world.”

Washington, who normal to you, go to the hospital. The credits various artists with helping him next 10 minutes of your life might not hone his artistic ability, is nearly fully be promised to you.”  recovered. He’s focusing more energy

performed each year in the U.S., most only address the cosmetic bump on the foot by shaving away large pieces of bone. In addition to a long and painful recovery, the traditional procedure does not work long term – more than 70% of patients say their bunion returns over time, requiring a second painful surgery.

Recently, Dr. Thomas Pignetti at Advanced Foot Care in The Woodlands started using a new procedure called Lapiplasty® 3D Bunion Correction™ that uses precision guides to allow surgeons to rotate the bone back into a normal position. Special titanium plates are then used to permanently secure the joint in place to keep the bones in line permanently. Patients are typically walking in a boot comfortably within days of surgery (versus 6-8 weeks for traditional surgery).

April opted for the Lapiplasty® Procedure on both feet—

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Dr. Thomas Pignetti

fearing a traditional correction would not provide a permanent fix. She was walking just two weeks after a correction on the right foot and only four days after surgery on the left. 

Houston Medical Times

Searching for the Other Half of Daniel’s Heart and Finding Our Miracle, Our Team

By Staci Geiger

I

sat in the chair in the conference room, hands clasped, lips pursed.

The tension that radiated from my head and shoulders was almost palpable among the three of us. My husband, Brian, my mom, and I had driven four hours in the early morning for a fetal echocardiogram at The Fetal Center at Children’s Memorial Hermann Hospital.

Jittery from too much caffeine and too little sleep, terrified at learning the truth, we were praying for a miracle.

Now, the truth was upon us.

Learning the Truth

Four days before this moment, we had received our unborn son’s diagnosis on Good Friday at our 20week ultrasound at our home hospital in Temple, Texas.

Imagine sitting in silence for 45 minutes while the sonographer is searching and searching and searching.

Little did I know, she was searching

for the other half of our son’s heart.

The words “hypoplastic left heart syndrome” were bombs that ripped our world apart.

After Daniel’s initial diagnosis, I spent the next four days doing the absolute worst possible thing — searching online. I read horror stories.

I read terrifying words like “terminal” and “comfort care.” Too many fears too unfathomable to name weighed heavily on my heart. In fact, I convinced myself that none of this was real. Maybe the baby was in a weird position during the ultrasound! Maybe they were wrong.

After our two-hour fetal echocardiogram at The Fetal Center, in which the cardiologist meticulously took picture after picture of our unborn son’s heart, any illusions that this was all some mistake went out the window, and I braced myself for the horrifying truth.

Then Dr. Vidhya Annavajjhala, a fetal cardiologist, walked in the conference room. Even though she

Call 713-600-9500 for a free assessment, 24/7.

is a very petite person, she exudes confidence and competence. From the moment I met her, I knew this was someone I could trust. She carefully explained our baby’s condition.

Daniel, our unborn son, had hypoplastic left heart syndrome (HLHS).

Finding an Answer to HLHS

Healthy hearts have four chambers — the right side pumps blood that needs oxygen to the lungs; the left side pumps blood with oxygen to the body. Daniel doesn’t have a left side. She explained the three step palliative process: Daniel would need the Norwood operation shortly after birth, then the Glenn at 4-6 months old, and finally the Fontan at around 3 years old. All of these operations replumb the heart so that blood flows directly to the lungs, bypassing the heart altogether. The newly oxygenated blood flows to the right side of the heart, which pumps it to the body.

It dawned on me: I have been praying for a miracle and here it is.

The miracle of modern medicine, the incredible gift of a good life for my son.

Meeting the Team

At this same appointment at The Fetal Center, we met pediatric heart surgeon Dr. Jorge Salazar. I had

Page 15

done my research and I knew that Dr. Salazar was incredibly qualified and experienced, but the first words out of his mouth took me aback. “I have seven children of my own, so I know what it means to love and cherish your children. I treat every single baby I operate on like my own, and I will do everything in my power to give Daniel the best results possible.”

From that moment, I knew this was the man I trusted with my son’s life. Dr. Salazar and Dr. Annavajjhala were the first people on Daniel’s team, a team that fights for Daniel’s life every step of his journey.

Little did I know how much our team would grow. see Searching for Daniel’s Heart ...page 18

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Houston Medical Times

Page 16

Stokes

Continued from page 1

FITNESS. CONFIDENCE.

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Houston area to receive the Malcolm Baldrige National Quality Award, the nation’s highest presidential honor for performance excellence.

Under Stokes’s guidance, Memorial Hermann has accelerated its efforts to make health care more convenient and affordable for all. As part of Stokes’s ambition to address skyrocketing healthcare costs across the country, Memorial Hermann joined an elite group of national healthcare institutions as a founding member of Civica Rx, a not-for-profit generic drug company working to curtail rising drug prices.

Additionally, Stokes has been an ardent proponent of advancing the health and wellness of Greater Houston, advocating for robust resources and stronger outreach to assist individuals, not only within Memorial Hermann facilities, but in the broader community as well. During his tenure as President and CEO, Memorial Hermann launched “Hometown Healing,” a coordinated volunteering initiative mobilizing the system’s workforce of more than 26,000 employees to give

back to their communities through various philanthropic efforts.

Stokes announced his retirement 10 months in advance of his planned departure date, which is at the end of the calendar year, to provide the Board with ample opportunity to conduct a thoughtful and thorough search. He will continue to serve as President and CEO until his successor is in place and will work with the executive team and Board to ensure a seamless transition.

“As a leading national healthcare provider, Memorial Hermann has accomplished remarkable successes, both financially and operationally, during Chuck’s tenure. We are also fortunate to have a strong executive team in place. We intend to identify a strong and capable candidate who will build upon the momentum this organization has achieved while maintaining our deep-rooted commitment to safely and compassionately care for those we serve,” Cannon said.

Legal Matters

Continued from page 4

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of post-discharge support can promote access to care, it concluded that the exception did not protect the services offered under the medical center’s program. However, the OIG determined it would not subject the proposed arrangement to administrative sanctions because the “benefits outweigh any risk of inappropriate patient steering.” The following factors were considered by the OIG in making their determination: • The benefits to the patients would outweigh the risk of patient steering that the law was designed to prevent as only patients who had already selected the requestor for follow-up care related to their congestive heart failure or chronic obstructive pulmonary disease would be eligible for program and patients could choose any provider for other services while enrolled in the program.

• The requestor certified that no employees or contractors would be compensated based on the number of patients enrolled in the program which removes any interference

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with clinical decision making.

• The program would be unlikely to lead to increased costs to federal healthcare programs, as the program services would not be reimbursed by federal healthcare programs.

• The requestor certified that it currently does not, and would not advertise or promote the program through their website marketing.

• The ‘scope and duration’ of the services provided through the program appeared to be “reasonably tailored” to accomplish the requestor’s goals of increasing patient compliance with discharge plans, improving patient health, and reducing inpatient admissions and readmissions.

While the OIG’s advisory opinion is favorable for the proposed arrangement, it is noteworthy that this advisory opinion appears to be the first time the OIG has expressly concluded that the “access to care” exception is not available to protect a particular arrangement.

Houston Medical Times

Page 17

MOTHER. SISTER. FRIEND. It’s time to stand together.

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April 2019

Page 18

Mental Health

Continued from page 6 to function day-to-day

Families and loved ones may notice increased irritability, feelings of anger, feelings of numbness or substance abuse. Their loved ones may start to get into fights or have more angry outbursts. People also might also become less social, afraid to leave their homes and miss work or school. It is important to listen when they want to talk and steer them to get help.

PTSD progression and risk factors

“Most people who develop PTSD will have a spontaneous recovery, but about 10 percent will keep getting worse,” Downing said. “We do not know why this happens, but hormonal or genetic differences between people and the presence of past trauma,

Urgent Care

Continued from page 1 patients are interested in virtual care visits, and 19 percent of patients have already done so.

“We live in a technology-driven age where people want easy access to services and they are open to seeing a provider via video. With virtual urgent care, a patient can get help for minor illnesses from the comfort of their own home,” said Roberta Schwartz, executive vice president, Houston Methodist Hospital, and chief innovation officer for the Houston Methodist Center for

Searching for Daniel’s Heart Continued from page 15

Daniel, the Heart Warrior, is Born

Daniel is now 8 months old.

We have been home three months and I am still in awe. All the resources, all the people, all the years and years of research, everything had to perfectly come together for Daniel to live.

Our heart warrior was born on July 14, 2018 at 34 weeks gestation.

Being premature is serious all by itself, and much more so for a baby born with half a heart. I was so terrified during his birth. There were so many unknowns, so many questions with answers only God knows.

While I was giving birth, at least 20 people were in the room from several different teams.

There was the critical care April 2019

Houston Medical Times especially during childhood, tends to make people more likely to develop PTSD than others.”

The focus of Downing’s current research is to identify who might be at greater risk for PTSD development following sexual assault and potential interventions sexual assault nurse examiners (SANEs) can integrate into their care to prevent or reduce symptoms of PTSD. The American Psychological Association reports that woman are twice as likely to develop PTSD, experience a longer duration of posttraumatic symptoms and display more sensitivity to stimuli that reminds them of the trauma.

Men and women who have experienced long term sexual abuse, like domestic violence or human trafficking, are also at high risk for PTSD.

“Most women that endure domestic partner violence often also endure sexual assault at some point,” said Nora Montalvo-Liendo, RN, PhD, FAAN, an assistant professor at the Texas A&M College of Nursing, who specializes in interpersonal and sexual violence among minority populations.

“Studies have shown women of color are more likely to experience abuse. These women frequently speak about PTSD symptoms like feelings of numbness, poor sleep patterns and hyper-arousal in regards to their environment,” said Montalvo-Liendo.

“One of the biggest challenges for some women with PTSD symptomology is the ability to show maternal warmth to their children. It is important for people who experience sexual trauma to get the help they need, so it does not impact those around them.”

Innovation.

Virtual urgent care is available in the new MyMethodist app, which includes access to medical records through MyChart, physician communications, test results, bill payment, prescription refills, and wayfinding maps for Houston Methodist facilities across the greater Houston area.

Fewer than 35 percent of U.S. hospitals offer their own apps to improve patient access, according to a recent survey by Healthcare Information and Management Systems Society.

Anyone with access to the IOS

or Android app stores can download the MyMethodist mobile app. Urgent care video visits allow patients to have a face-to-face conversation to address certain medical issues without the need for scheduling an in-person appointment, unless otherwise directed by the medical provider.

Conditions that may be appropriate for virtual urgent care video visits include cold/flu symptoms, pink eye, skin infections/rash, allergies, cough/ fever/headache and upper respiratory infections. 

OBGYN, several residents and fellows and medical students, the neonatal intensive care unit (NICU) team, transport nurses and labor and delivery nurses. Many women might have felt exposed or nervous around all of those people, but for me, it was incredible. I felt so blessed to know about Daniel’s condition ahead of time so that everyone was mobilized and ready to fight from his very first breath.

Beginning the Journey Home

When he was 6 days old, he had pulmonary banding surgery. I’ll never forget pediatric heart surgeon Dr. Ali Dodge-Khatami, one of Daniel’s surgeons, explaining that he would be placing little bands around Daniel’s tiny pulmonary arteries, blood vessels the size of a string, in order to give Daniel more time to grow and mature before the big surgery, the Norwood.

I felt humbled and awestruck realizing that this man faced life-anddeath decisions every single day. All at

once it hit me that tomorrow Daniel would be one of those decisions.

Before Daniel turned 5 months old, he had had five surgeries. Of his first 162 days of life, only 52 of them were spent at home. Dozens of wonderful, selfless nurses worked tirelessly to give Daniel amazing care.

After spending 110 days inpatient with Daniel, I feel like I know the pediatric intensive care unit (PICU) attending physicians, physician assistants, fellows, residents, cardiologists and respiratory therapists better than many of my friends. When I am sitting at home with all three of my children, watching Daniel roll over, chew on his fingers and laugh at his brother and sister, I think fondly of each of them.

This team of people, this incredible, well-oiled machine with so many moving parts, is our miracle. 

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Houston Medical Times

Page 19

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April 2019

Houston Medical Times

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