HOUSTON
Healing Across America: The Rise of the Interstate Medical Licensure Compact
By Erin L. Muellenberg, J.D. Annalee Lee, J.D. Polsinelli, PC
Thegenesis of the Interstate Medical Licensure Compact (“Compact” or “IMLC”) started in 2013, when the Federation of State Medical Boards worked with its member state boards to study the feasibility of an interstate compact to support the medical license portability. The Compact has 42 member jurisdictions, including 40 states, the District of Columbia and the territory of Guam. IMLC legislation is pending in Massachusetts, New York, and North Carolina.
To participate in the Compact, physicians must meet specific qualification and training requirements. Once a physician applies, the State of Principal License reviews the application and conducts primary-source verification including criminal background check to determine eligibility. If all requirements are met, the State of Principal License issues a formal Letter of Qualification, which allows the physician to obtain license from multiple states. While the licensing process may be expedited through the Compact, the individual states retain the full authority in administering its duties of oversight.
Benefits Streamlining / Reduction of Administrative Burden. The Interstate Medical Licensure Compact Commission (“IMLCC”) noted that since operations, more than 100,000 licenses were secured in IMLCC
member states through April 2024. IMLCC’s recent release referred to a study that found nearly 30% of all new licenses issued to physicians in 2022 were done via the IMLCC. Further, IMLCC’s most recent twelve-month period study found that it took on average 43 days from application to Letter of Qualification issuance, then 20 days from qualification to license issuance. Because the Compact makes it easier and quicker for physicians to obtain and renew licenses, this expedited process reduces administrative burdens, including those for individual medical staffs.
Information Sharing/Disciplinary Information Reporting. All state boards participating in the Compact are required to share investigative and disciplinary information with each other.
According to the Compact Rules, any reported disciplinary action may be a basis for discipline by other member boards. Conversely, when a physician’s license in a state is “revoked, surrendered, suspended or relinquished,” all other state licenses of that physician is automatically suspended for 90 days to permit each member board to investigate the matter.
Therefore, a medical staff in a participating state could find out about an investigative/disciplinary action against a physician in any state where the physician has a license. This free flow of information may help identify quality concerns early on that could adversely affect patient care and help promote quality care.
Access to Care. The streamlined licensing procedure may also help enhance the portability of a medical license, which in turn may enhance access to and continuity of care. Further, the greater portability may increase the availability of out-of-state disaster-response providers who do not need emergency waiver, with greater availability to reach areas in urgent need of care. Therefore, individual medical staffs could promptly provide physicians emergency privileges to serve patient needs. Additionally, the Compact could facilitate the provision of telemedicine that can help reach rural areas.
Risks/Considerations Risk of Reliance on Information. All medical staffs in participating states must rely on the
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Oncology Research
Listen
to
Your Gut: Stomach Cancer Symptoms and Risk Factors You Need to Know
ThisBy John C. Hardaway M.D., Ph.D., FACS, Texas Oncology Surgical Specialists
time of year, when food-focused gatherings are in abundance, many people will experience common symptoms of overeating, such as heartburn, nausea, and abdominal discomfort. For most experiencing these symptoms, there isn’t a cause for concern as they can find relief with diet changes or occasional use of over-the-counter medications. However, for others, these can be the first signs of stomach cancer, also known as gastric cancer.
With such vague and mild early symptoms, stomach cancer is often challenging to diagnose until later stages when symptoms are more severe. Because there are no recommended
routine screening guidelines for those at average risk, it’s important to understand your risk of developing stomach cancer and the symptoms of this disease to help you have informed conversations with your doctor about your health.
What are the risk factors of stomach cancer?
Age, gender, and ethnicity can all affect your risk of stomach cancer. Approximately six out of 10 people diagnosed with stomach cancer are over 65, and the risk increases with age. While it’s most common in those over age 50, the rates of young adults with stomach cancer have been steadily increasing in the United States.
Stomach cancer affects more men than women, and people with a family history of the disease are also at a higher risk. Additionally, Hispanics, African Americans, Native Americans, and Asian/Pacific Islanders are more likely to develop stomach cancer. Other risk factors include:
• Bacterial infection: A specific bacteria called Helicobacter pylori, which commonly causes ulcers, has been linked to stomach cancer as a major cause of the disease. However, most people with this treatable bacterium don’t develop stomach cancer.
• Viral infection: The Epstein-Barr virus (EBV) is associated with some stomach cancers.
• Diet: Smoked foods, salted fish and meats, pickled vegetables, as well as eating few or no fruits, have been linked to an increased risk.
• Weight: Obesity and being overweight may increase the risk of certain types of stomach cancer.
• Smoking: Smokers face twice the risk of developing stomach cancer than nonsmokers.
• Environmental factors: Exposure to
radiation and work exposure in the rubber, coal, and metal industries leads to higher risk.
• Common variable immune deficiency: People with CVID have an increased risk.
• Stomach health issues: People with stomach lymphoma, previous stomach surgery, pernicious anemia, Menetrier disease, certain types of stomach polyps, intestinal metaplasia, chronic atrophic gastritis, and those with inherited cancer syndromes (BRCA-1, BRCA-2, familial adenomatous polyposis syndrome, hereditary diffuse gastric cancer, Li-Fraumeni syndrome, Lynch syndrome, and Peutz-Jeghers syndrome) have a higher risk.
Oncology ...page 14
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Mental Health
UTSW Study Explores Link Between High School IQ and Alcohol Use
A higher IQ during teen years increases the likelihood of moderate or heavy drinking later in life
Aperson’s
IQ during high school is predictive of alcohol consumption later in life, according to a study by UT Southwestern Medical Center researchers published in Alcohol and Alcoholism. Participants with higher IQ levels were significantly more likely to be moderate or heavy drinkers, as opposed to abstaining.
“We’re not saying that your IQ in high school controls your destiny,” said senior author E. Sherwood Brown, M.D., Ph.D., M.B.A., Distinguished Teaching Professor of Psychiatry and in the Peter O’Donnell Jr. Brain Institute at UT Southwestern. “But IQ levels could lead to intervening social factors that influence drinking, and it’s an important mechanism to explore. Higher IQ seemed to predict a greater likelihood of being a moderate or heavy drinker but not a binge drinker.”
Although Dr. Brown and UTSW colleagues have conducted numerous studies about alcohol use disorder, he said this is the first to examine predictors of drinking patterns.
Alcohol consumption is on the rise among adults, with excessive drinking linked to high blood pressure, cancer, stroke, and other diseases as people age. At the same time, Dr. Brown explained, some research comparing abstinence with moderate drinking has found a link between cognitive ability and future alcohol use.
“That led me to wonder, if alcohol influences cognition, could cognition affect alcohol consumption?” he said.
To find the answer, Dr. Brown and UTSW colleagues turned to data from the Wisconsin Longitudinal Study, a dataset composed of IQ and lifestyle information from more than 10,000 Wisconsin high school seniors beginning in 1957. The participants were born around 1939.
UTSW researchers used a random sample of 8,254 survey participants who answered questions about their drinking habits in 1992 and 2004, when they would have been about 53 and 65 years old. Moderate drinking was categorized as one to 29 drinks per month for women and one to 59 drinks for men, and heavy drinking as 30 drinks or more per month for women and 60 drinks or more for men. Those with higher IQs were less likely to binge drink, measured at five or more drinks in one session.
The researchers found that for every one-point increase in IQ, there was a corresponding 1.6% increase in the likelihood that respondents reported moderate or heavy alcohol use.
Income level partially influenced the relationship between IQ and drinking habits, potentially because higher IQ may lead to stressful jobs or more opportunities for social drinking among high earners.
“While it’s not possible to capture all the underlying mechanisms
that mediate the relationship between drinking and IQ, we know that income partially explains the pathway between the two,” said study co-author Jayme Palka, Ph.D., Assistant Professor of Psychiatry.
Men reported more bingedrinking episodes than women, supporting previous studies showing men are more likely to engage in hazardous drinking patterns than women.
Because the Wisconsin Longitudinal Study consisted of 99% white non-Hispanic participants, the research team emphasized the need for further research with a more diverse sample.
Healthy Heart Bah Humbug to High Blood Pressure
By Heather Butscher, LMSW Vice President, Health Strategies American Heart Association
Nomatter what holiday traditions you celebrate, you probably won’t find “think about blood pressure” on your to-do list, even after checking it twice. But that would be a nice idea for your heart’s sake.
High blood pressure is a leading risk factor for heart attack and stroke. Studies have shown that cardiovascular problems rise after Thanksgiving and peak in the new year.
People often put their health on the back burner this time of year, but they shouldn’t. The holiday season is a time for enjoyment. You want to enter the holidays healthy, and you want to leave the holiday season healthy.
With that goal in mind, here’s advice from the American Heart Association on keeping your blood pressure under control during the holidays.
Think before you feast
All of us enjoy a good party,
but if you have high blood pressure in particular, you have to be conscious about what you’re eating. So if you’re stepping out, consider having a healthy meal at home first so you’re less likely to overdo it.
Another suggestion is to scout before snacking at a family gathering. Do a little bit of groundwork and look around the room and see what’s on that buffet Aunt Sally prepared. A vegetable tray can be a good place to fill up on something healthy. But watch the dip and use just a bit.
When you sit down for the big meal, go ahead and eat your fill. You don’t want to walk away hungry, then overdo it on the desserts that are overabundant this time of year.
The sodium outside is frightful
Limiting sodium is challenging this time of year, and always important. Excess sodium in your bloodstream pulls water inside your blood vessels, increasing blood pressure. Table salt is one source, but most sodium in the typical American diet comes from processed foods. That means
watching out for anything that’s been canned, preserved or packaged. A lot of the hams that will be circulating are probably pretty high in sodium as well.
Federal dietary guidelines recommend that adults consume less than 2,300 milligrams of sodium a day. The American Heart Association suggests an ideal limit of 1,500 milligrams a day for most adults. Watch that cup of cheer
Drinking too much alcohol can raise your blood pressure. While federal dietary guidelines allow for moderate drinking (two drinks or less in a day for men, and one or less for women), it is suggested that you pay attention to what’s in your holiday cocktail as well. Be careful taking these medications
During cold season, people reach for over-the-counter medicines. But decongestants can raise blood pressure. Check the packaging for warnings or ask your doctor.
… but stay on these
The holidays can disrupt routines. If you take medicine to control high blood pressure, you might need extra reminders. Tracking apps can help, but it could also be something as simple as carrying a pill organizer and setting an alarm.
Have funukah
As much fun as the holidays bring, they also bring stress for people. Stress-related hormones have been see Healthy Heart...page 13
A Celebration of Strength and Survival
By Maureen Dyman
Kathy Mackie is a survivor. The Army Veteran, who was diagnosed with breast cancer in 2022, says she dug deep inside for the strength to battle through cancer treatment and has come out on the other side.
At 46, Luz Cervantes is also no stranger to a challenge. She is a Navy Veteran, a single mother and a survivor of breast cancer. Mackie and Cervantes both shared their stories of healing and strength at a Houston VA Breast Cancer Survivor Celebration this week.
“I remember the exact moment, that Dr (Mahdieh)Parizi at the VA told me I had breast cancer,” Mackie said. “She said that she couldn’t do her job if she wasn’t confident that there was hope, and she encouraged me to consider my diagnosis a bump in the road. I decided right then and there that I wanted to live and I was going to do whatever it took to get to the other side.”
Mackie, who missed a few mammograms during the pandemic, felt a lump in her breast and walked in to the VA’s Women’s Health Center because she felt something wasn’t right.
“I found a beautiful energy at the VA,” she said. “Once I was diagnosed they got me going quickly in treatment and were there for me every step of the way.”
Cervantes, who was diagnosed with breast cancer in 2021, said she has changed and grown since her diagnosis.
“One important thing that I have learned during this breast cancer journey is the power of yes,” she said. “I make a point to say yes when people ask me to go places and do things. Eat the piece of cake. Buy the pair of shoes. Life is too short to waste it.”
Cervantes says she has also learned that being by yourself doesn’t mean you are alone.
“I came to every appointment and surgery here at the VA by myself, but I found an amazing community
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of other Veterans and staff here and I have never felt alone,” she said. “We can all be there for each other.”
Mackie and Cervantes both credit their relationship with God and the power of prayer as key to their recovery. Mackie brought special prayer books to the cancer survivor celebration to share with other women Veterans currently in cancer treatment.
“Our Veterans have incredible strength, perseverance and the will to move forward” said Dr. Mahdieh
Irannejaparizi, breast cancer radiologist at the Houston VA. “Their diagnosis, treatment, surgeries and the moments of uncertainty caused by breast cancer are all big battles. I am so proud to see them stand strong against breast cancer, just like they did in their military service.”
Special thanks to all the staff, community partners and organizations involved in celebrating the Houston VA’s breast cancer survivors this year.
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Army Veteran Kathy Mackie (left) and Navy Veteran Luz Cervantes, both breast cancer survivors, shared their stories at the event.
A Young Neurologist Diagnosed with ALS is Inspiring a Call To Action
By Renee Yan
Eversince he was a boy, Michael Ibarra was fascinated by the human brain – its complexities, its secrets.
The concept of lucid dreaming, which is the ability to retain conscious awareness in dreams, piqued his interest and eventually cemented his chosen career path: neurologist, a doctor who specializes in diagnosing, treating, and managing disorders of the brain.
Now, at age 32, he is an Assistant Professor of Neurology at UT Southwestern, and he has come face to face with one of the most complex and deadly medical mysteries in his field, ALS, or amyotrophic lateral sclerosis.
Ultimately, it leads to paralysis of the entire body.
Dr. Ibarra has helped many patients and their families cope with this most difficult of diagnoses, and he admits there is very little that can
prepare you for it.
This time, though, he was the patient.
“I got the official diagnosis on March 1, 2023, and it felt like the world was spiraling before me. I was extremely devastated,” Dr. Ibarra recalls. He was 30 years old – the average age of diagnosis is 55, according to the ALS Association.
Most patients succumb to respiratory failure three to five years after symptoms emerge, according to the National Institute of Neurological Disorders and Stroke (NINDS). However, research suggests that 10% of patients survive a decade or longer. Physicist Stephen Hawking survived more than 50 years after his ALS diagnosis.
The irony of a neurologist being stricken by ALS – a disease that essentially traps the brain inside an unresponsive body – is not lost on Dr. Ibarra. But instead of caving to despair,
he found a renewed sense of purpose.
In addition to devoting his attention to every patient he treats in the Clinical Center for Sleep and Breathing Disorders and teaching medical fellows at UTSW, he is now working on behalf of the 31,000 Americans affected by ALS by sharing his story, raising awareness, participating in clinical trials, and pushing for more research funding.
“He’s amazing,” says Jaya Trivedi, M.D., Professor of Neurology at UT Southwestern and one of Dr. Ibarra’s physicians. “Despite his ALS diagnosis, Michael continues to see patients, teach residents, and has made it his mission in life to be an advocate for
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this community.”
In the past year alone, he gave a Grand Rounds lecture to other physicians about his experience, spoke at a national ALS conference, and revived the 2014 Ice Bucket Challenge in time for its 10-year anniversary. Many of his colleagues immediately accepted the challenge and gathered on campus to be doused with icy cold water.
“He has an infectious enthusiasm and a smile that brightens everyone who spends time with him,” says Won Lee, M.D., Medical Director of the Clinical Center for Sleep and
Since his ALS diagnosis, Dr. Michael Ibarra has embraced his role as an advocate for awareness of the disease.
LifeGift and Houston Methodist Building a Collaborative for Improved Organ Donation and Transplantation
Identifying Performance Improvements and Innovative Strategies to Enhance the Recovery and Transplantation of Organs
By Steve Stasny
The National Academies of Sciences, Engineering and Medicine (NASEM) issued a call to action in February 2022, urging a comprehensive overhaul of the national organ donation program within five years. Recognizing the critical need for reform, LifeGift in collaboration with Houston Methodist, is coordinating efforts to improve our system with the creation of the Deceased Organ Donation Performance Improvement Collaborative. This initiative includes representation from all transplant centers in the LifeGift service area, as well as experts in organ procurement, transplantation, research and patient
engagement from around the United States.
The urgency of this effort is underscored by the challenges faced by patients with organ failure and their families, many of whom experience the heartbreak of losing loved ones while waiting for a suitable organ match. Unfortunately, although organ donation is increasing nationally, there is also an increasing number of donated organs that are not transplanted. In fact, 1 in 5 kidneys from deceased donors are not utilized. The situation is further complicated by the racial disparity gap in clinical transplantation where underserved communities, including minorities and rural populations, are more likely
to require an organ but less likely to receive one.
“The primary goal of this collaborative, which is generously sponsored by Sanofi, is to search peer-reviewed literature, identify key performance improvement priorities and implement innovative care strategies to enhance the recovery and transplantation of organs,” says Kevin Myer, MSHA, LifeGift president and CEO. “By focusing on meaningful data collection and expert analysis, the collaborative aims to find interventions to increase the number of successful organ transplants and improve outcomes for patients in need.”
“The Deceased Organ Donation Performance Improvement Collaborative is dedicated to enhancing both the quantity and quality of deceased donor organs for transplantation. This includes increasing organ donation and transplantation within diverse racial and ethnic communities,” shares Amy Waterman, PhD, FAST, professor and director of patient engagement at Houston Methodist J.C. Walter Jr. Transplant Center. “The collaborative, consisting of transplant and organ procurement providers, researchers and family
Got Houston Covered.
Conroe to
Equine Assisted-Services Program Finds New Home at Institute for Equine Sciences
Courtney Cares Program Serves Families in Need with Healing Through Horses
By Alex Cozzitorto
ATexasA&M program that provides equine-assisted services to the Bryan-College Station community and experiential learning for Texas A&M students, will continue to thrive from a new home base within the Texas A&M Institute for Equine Sciences within Texas A&M AgriLife Research.
Known as Courtney Cares, the Courtney Grimshaw Equine Therapeutic Program was housed in the Texas A&M College of Veterinary Medicine and Biomedical Sciences before becoming a part of the Institute for Equine Sciences.
Since 2012, the program has served 155 families, including children and adults with physical and cognitive conditions, as well as veterans as a Professional Association of Therapeutic Horsemanship International premier
accredited center.
Touching lives through equineassisted services
Courtney Cares has involved 562 volunteers and instructed over 360 Texas A&M students in the art of equine therapeutic riding, equine behavior and handling, management, and best equine-assisted service practices.
The advantage of the Institute for Equine Sciences is to provide the capacity to connect the intellectual expertise across the Texas A&M University System with the support of AgriLife Research.
The goal of this initiative is to unlock the therapeutic potential of equine-assisted services, evidencebased interventions and best practices, and to become a respected leader in support of a growing industry.
“We hope to be a driving force
in the coordination of collaborative research, teaching and community services for Texas A&M, Brazos County and the Equine Assisted Service industry across the state of Texas and beyond,” said Craig Huffhines, director of the Institute for Equine Sciences.
The Courtney Cares story
Courtney Grimshaw ’85 was a dedicated horsewoman and successful businesswoman. She dreamt of creating an equine-assisted services center for children and purchased a farm near
Thorndale to fulfill that vision.
Tragically, Grimshaw lost her life in an accident in 2011. Her family engaged with Texas A&M to start a program in her name and provided the initial donor pledge to create Courtney Cares.
Courtney Cares operates in collaboration with R.O.C.K., Ride on Center for Kids, in Georgetown, as well as the Texas Aggie Corps of Cadets see Equine Program ...page 13
Courtney Cares operates in collaboration with R.O.C.K., Ride on Center for Kids, instructors to provide equine-assisted services to children and adults with physical and cognitive conditions at Freeman Arena in College Station.
Leap Distributors Acquires Leap Surgical and DUB Enterprises: Partnership Positions Company for Continued Growth
Leap Distributors has acquired Leap Surgical and DUB Enterprises, two privately owned and nationally recognized medical device firms. Effective immediately, the three companies will operate as one under the Leap Distributors umbrella, with headquarters in Dallas, additional offices in Houston and a national customer base.
“We’re thrilled to unite the strengths of DUB Enterprises and Leap Surgical into a single, powerful entity. This acquisition enables us to provide top-tier service and access to high-quality medical devices to hospitals and healthcare providers nationwide,” said Allen Mason, CEO of Leap Distributors and co-founder of Leap Surgical.
Allen Mason, CEO of Leap Distributors and co-founder of Leap Surgical.
Integrating the resources of Leap Surgical and DUB Enterprises will enable Leap Distributors to offer an expanded range of products, enhancing its ability to meet the needs of patients, surgeons, independent distributors and healthcare facilities. The company remains committed to delivering superior medical devices, while streamlining the distribution process through cutting-edge technology and a customer-first approach.
In addition, Mason said the acquisition provides significant benefits to employees, distributors and manufacturer partners – including access to a large, well-established network, streamlined contracting processes, an advanced IT infrastructure, and dedicated customer support to help navigate the complexities of medical device distribution.
“Our goal is to empower independent distributors with the resources and support needed to thrive in an increasingly competitive industry,” added Peyton Woodyard,
partner at Leap Distributors and co-founder of DUB Enterprises.
“In addition, it positions Leap Distributors for rapid growth and creates opportunities for additional distributors to join and benefit from a robust and like-minded network. It represents a major advancement in the medical device distribution landscape, equipping Leap Distributors to innovate, adapt and lead in a rapidly evolving industry.”
Leap Distributors is an independent, national medical device distribution company that provides high-quality medical devices to healthcare providers, surgeons and hospitals across the United States. Focused on streamlining operations and improving patient care, Leap Distributors is committed to enhancing the efficiency and effectiveness of medical device distribution. For more information, visit www.leapdistributors.com.
Dear Doctors and Staff,
Let us take the guesswork out of fracture referrals.
No more waiting for appointments!
We at the Orthopedic Care Center wish to offer your patients and staff easy scheduling of patients.
Our office has extended office hours on Fridays to accommodate patients with fractures.
On behalf of the Orthopedic Care Center
ORTHOPEDIC CARE CENTER
Lubor Jarolimek M.D.
Financial Forecast The Power of Compounding in Roth IRAs
WhyBy Grace S. Yung, CFP Midtown Financial Group, LLC
Young People Should Start
Saving in a Roth IRA Early
Starting a Roth IRA at a young age offers significant financial advantages, especially when it comes to harnessing the power of compounding and benefiting from tax-free growth. By contributing early, young individuals can set themselves up for a much more secure financial future.
The Power of Compounding
Compounding is one of the most powerful forces in investing, especially when contributions are made early. This concept refers to earning interest not just on your initial contributions,
made with after-tax income, meaning there’s no immediate tax deduction, the major benefit comes later. All future withdrawals, including both the contributions and the earnings, can be taken out tax-free as long as the account has been held for at least five years and the individual is over 59½. This differs from tax-deferred accounts like traditional IRAs and 401(k)s, where you receive an immediate tax deduction when making contributions. However, with these accounts, you’re taxed on all withdrawals (assuming all contributions were deductible / pre-tax) in retirement, potentially at a higher rate than when you made the initial contributions. With a Roth IRA, since the taxes are paid upfront, the young investor avoids future tax liabilities on the gains, which can be significant over several decades of growth. Why Start a Roth IRA Early?
but also on the interest that has been accumulated over time. The earlier someone starts investing, the more they can benefit from decades of compound growth.
For example, if a 15-year-old who has earned income from a summer job or part-time work contributes the maximum amount of $7,000 (the 2024 limit for Roth IRAs) annually, and the investments grow at a conservative 5.5% each year, they would have over $1.5 million, tax-free by the time they turn 65. This dramatic growth happens because each year’s earnings increase the account balance, leading to even more earnings in the following years.
Roth IRAs: Tax-Free Growth vs. Tax-Deferred Accounts
The primary advantage of a Roth IRA is that it allows for tax-free growth. While contributions are
Starting a Roth IRA early offers numerous long-term benefits:
• Tax-Free Withdrawals: By making after-tax contributions, young people avoid taxes on future withdrawals, including the growth, which can provide immense savings later in life.
• No Required Minimum Distributions: Unlike traditional IRAs, Roth IRAs do not require withdrawals at any age, allowing the funds to continue growing tax-free for as long as the account holder wishes.
• Flexibility in Withdrawals: While it’s generally advised to leave the contributions untouched to maximize growth, Roth IRAs offer the flexibility to withdraw contributions (but not earnings) at any time, tax- and penalty-free,
Healthy Heart
Continued from page 5
linked to increased risk for high blood pressure. Stress also can contribute to depression, which also has been associated with high blood pressure. It’s important to set limits and to remember to take time for yourself. But don’t respond by overeating or overindulging in alcohol. These actions easily compound the problem.
Continued from page 8
Breathing Disorders. “Dr. Ibarra has been a revelation for our sleep clinic team, as we serve patients with not only sleep disorders but neuromuscular respiratory conditions such as ALS. His story will inspire others.”
For a boy who wanted to study dreams, he admits there are nights when he drifts off and imagines a world without ALS. Or at least more effective therapies. But then he wakes up, heads off to work to help his patients and students, and continues his race against time.
“I had to tell myself, ‘Yes, I have ALS, and I can’t do anything about that. But I can still live my life,’” he says. “I’ve found support groups that have helped strengthen my mindset, and now I feel extremely motivated to make a difference.”
Twitches, tremors, and ‘a diagnosis of exclusion’
The first symptoms appeared six years ago. That’s when Dr. Ibarra noticed intermittent muscle twitches, or fasciculations, in his left shoulder. They were easy enough to dismiss at first, but then came the small tremors in his foot and hand, which gradually grew more uncontrollable.
His reflexes were hyperactive, too, and although ALS symptoms can present differently among individuals, Dr. Ibarra knew his aligned with the classic warning signs:
• Muscle twitches in the arm, leg, shoulder, or tongue
• Muscle cramps or tightness
• Muscle weakness in the arm, leg,
Equine Program
Continued from page 10
Parsons Mounted Cavalry and their horses.
From its inception until 2019, Courtney Cares was housed under the A&M System. Once Global One Health at the College of Veterinary
Exercise can help with stress, so
or neck
• Slurred or nasal speech
• Difficulty chewing or swallowing
He consulted a fellow neurologist in 2021 and took an electromyography (EMG) test to assess his nerve and muscle function.
“I was still confident that it would not be ALS, despite what my brain was telling me,” says Dr. Ibarra, who was in the middle of a sleep medicine fellowship at the University of Rochester Medical Center in New York at the time.
The results showed signs of chronic muscle damage in several body segments. It was not a definitive answer, but it was foreboding enough.
“That EMG test was heartbreaking,” he says. “It was a huge shift in my life.”
Diagnosing ALS is a process of elimination, so that initial assessment led to a barrage of more tests and procedures. Doctors ordered MRI and CT scans of his brain and spinal cord. Dr. Ibarra also underwent a lumbar puncture, so specialists could extract a sample of cerebrospinal fluid to analyze it for infections, cancer cells, and other abnormalities that might provide an alternative explanation.
“ALS is a diagnosis of exclusion. Its symptoms can masquerade as other conditions, such as multiple sclerosis, cancer lesions in your neck or back, or nutritional deficiencies,” he explains. “There was a paradoxical disappointment I felt with each test. You generally never want a test to come back positive for anything, but every time I got a negative result, it brought me that much closer to an ALS diagnosis.”
Medicine and Biomedical Sciences was introduced, the program relocated to VMBS until this fall where the program found its new home under the Institute for Equine Sciences.
The program added an experiential learning opportunity for Texas A&M students when it became a part of VMBS. Through the Biomedical Sciences 380 course – Introduction to
try finding time to take walks, do yoga – or to just sit and relax. Be mindful as you enter the holiday season. And if you’re looking for more information on high blood pressure, navigating the holidays, or healthy living in general, turn to the American Heart Association’s website (Heart. org) for resources on a wide variety of heart-healthy topics.
When final confirmation came, preparing for the worst did not make the blow any easier to bear.
“Suddenly, I had to change all my plans for the future,” says Dr. Ibarra. “There was still a lot of uncertainty with how this would progress.”
He accepted a faculty position at UT Southwestern and relocated to Dallas, moving closer to family. In his new role, he quickly found a community.
“It has been really inspiring to watch how Michael has dealt so courageously with this illness,” says Elan Louis, M.D., M.S., Chair of Neurology at UT Southwestern. “He is an example to all of us in the department, and we are all here to support him.”
A glimpse into life with ALS ALS gradually robs people of their ability to walk, speak, eat, and breathe on their own, and as that happens, the need for supportive care grows more pronounced. Doctors primarily focus on treating symptoms because it’s a disease without a cure and options are limited. Care plans typically entail prescribing medications for fatigue or muscle cramps, using mechanical ventilation or respiratory equipment for breathing problems, recommending physical and occupational therapy, and helping patients adjust to life with wheelchairs, leg splints, or other adaptive devices.
More than a year after his diagnosis, Dr. Ibarra now wears leg braces to help with stability and sometimes relies on voice-to-text commands to write. Tasks that were once easy take longer now, he explains. Despite living near his work, he rises two hours earlier to ensure he can arrive at the Sleep and Breathing
Equine-Assisted Activities and Therapy – students learn about the therapeutic horsemanship industry while they serve the community and demonstrate the Texas A&M core values of respect, excellence, leadership, loyalty, integrity and selfless service.
“We are extremely appreciative of the support this program has received from the Chancellor and
Disorders Clinic by 8 a.m.
Being proactive and taking a holistic approach is key to living with ALS, Dr. Trivedi says. It’s the foundational principle of the ALS and Muscular Dystrophy Multidisciplinary Clinic at UT Southwestern. In addition to providing medical care, a centralized team helps people tackle the practical and emotional hurdles of their illness: applying for disability, arranging home health care, finding support groups, and communicating with insurance providers – a necessity as estimated annual costs of medical care can range from $16,000 to $200,000, according to a 2018 report from the Annual Journal of Managed Care.
“We have a physical therapist, occupational therapist, orthotist, social worker, counselor, speech therapist, respiratory therapist, neuropalliative care specialist, equipment specialist, and nutritionist. All of them work together in our multidisciplinary clinic to provide care to our ALS patients,” Dr. Trivedi says.
ALS doesn’t just wash away your physical strength, Dr. Ibarra adds, it can corrode your sense of self. Young patients, in particular, may find it a minefield to navigate socially.
“It can be very isolating. There is this loss of identity as who you are becomes entangled with what this disease is,” says Dr. Ibarra. “It’s driven me to ask myself, ‘What has my experience revealed? How can I challenge myself to be a better physician?’”
“I’m going to continue to fight, and I’m going to make the world a better place.”
Texas A&M System, and the College of Veterinary Medicine and Biomedical Sciences over the past 12 years,” said Nancy Krenek, DPT, Texas A&M adjunct clinical assistant professor and executive director of Courtney Cares. “We are excited for this next chapter of the program as we begin to work alongside Craig and his team at the Institute.”
IMLC
Continued from page 1
State of Principal License to correctly and thoroughly review, verify, and determine a physician’s eligibility. Therefore, individual medical staffs are prone to risk of reliance on false or incomplete information. Accordingly, such reliance may result in approval of membership/privileges for a physician who fall short of the medical staff’s standards, which in turn may result in patient safety issues, declining reputation, as well as organizational liabilities.
State Laws. Individual physicians should be mindful of differing standards and requirements of each
Oncology
Continued from page 3
If you think you might be at increased risk, it’s important to speak with your physician to determine if you should test for any of the factors above or begin routine screenings for stomach cancer. What symptoms are associated with stomach cancer?
Most stomach cancer patients won’t experience symptoms until it’s in later stages of development. However, some people may experience symptoms before it reaches advanced stages, which can include:
LifeGift
Continued from page 9
members of deceased donors, works together to identify key improvement priorities, evaluate new innovations and share best practices.”
The collaborative’s strategy involves developing a robust research
Financial Forecast
Continued from page 12
which can be helpful in emergencies.
• Building Good Financial Habits: For young people, contributing to a Roth IRA instills the discipline of saving and investing for the future. This financial head start
state to ensure compliance with state statues, rules, and regulations that can change. Some areas of laws to be mindful of include record retention, patient-provider relationship, abortion, informed consent, minor consent, unprofessional conduct, reporting requirements, prescribing practices, scope of practice, and telemedicine.
Further, as insurers may have territorial restrictions and procedural differences, medical staffs and physicians should review and verify professional liability coverage afforded in each state.
Conclusion
Individual medical staffs should use extra caution and appropriate review processes when making a membership/privileging decision
• Indigestion or heartburn
• Vomiting
• Nausea
• Pain or discomfort in the abdomen
• Diarrhea or constipation
• Bloating of the stomach after meals
• Loss of appetite
If you experience any of these symptoms for more than two weeks, you should speak to your primary doctor or a gastroenterologist. Furthermore, if you experience signs of late-stage stomach cancer, such as chronic weakness and fatigue, vomiting blood or blood in the stool, and/or unexplained weight loss, you should speak to your physician as soon as possible.
infrastructure, conducting studies on key NASEM priorities, analyzing and publishing research findings and presenting those findings at national conferences to boost the visibility and quality of research on deceased organ donation. The ultimate aim is to increase the number of donors, improve the utilization of organs and enhance the quality of care
can be transformative, especially as retirement needs increase with time.
Conclusion
Opening a Roth IRA as early as possible provides young people with a tremendous advantage in building wealth. By taking full advantage of compound growth and the tax-free nature of Roth IRAs, young investors can create a solid financial foundation for their future. The earlier they start, the more they will benefit, and
on a physician licensed via the IMLCC process, as they must rely on primary-source verification of the State of Principal License. To avoid granting membership/privileges to ineligible physicians, medical staffs should engage in complete and thorough review process with clear eligibility criteria. For example, such process may include primary-source verification of malpractice claims, current/prior affiliations, and peer references from peers in the same specialty. As we have seen a steady increase in the number of licenses issued via the IMLCC process, these types of measures by medical staffs would be valuable for patient safety and quality care.
Trust your gut
While stomach cancer was once a leading cause of cancer-related deaths in the United States, the disease has become less common. This year, an expected 2,210 Texans will be diagnosed with stomach cancer, and 910 will die from the disease.
November is Stomach Cancer Awareness Month, and as we enter a season of food-focused events, it’s important to understand your family’s history of cancer and speak with your physician if you notice persistent signs or symptoms. Remember, early detection of stomach cancer is key, so listen to your gut.
provided to transplant patients with added attention to health equity. By leveraging research tools and fostering collaboration among stakeholders, LifeGift and Houston Methodist seek to make significant advancements in donation and transplantation while bringing new hope and life to individuals awaiting organ transplants.
consistent contributions—even small ones—can grow into a substantial nest egg by the time they retire. If you are a parent, grand parent, or aunt / uncle, it would be a good idea to encourage the youngsters in your family to start saving early. Additionally, it would be beneficial to connect with a CERTIFIED FINANCIAL PLANNER practitioner so she or he can work with you and your loved ones on investment strategies customized to their needs.
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Dementia CME for Primary Care Providers
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Earn free online Continuing Medical Education (CME) credits developed by the Texas Department of State Health Services and physician experts on Alzheimer’s disease and related dementias. These courses will keep you up to date on the latest validated assessment and screening tools, help you direct patients to community resources, and reinforce your role in helping patients and their families manage symptoms throughout the disease process.
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