Tarrant County Physician April 2016 by Ussery Printing

TARRANT COUNTY

PHYSICIAN

Vol. No. Vol. 8885No. 42

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Journal County Medical Society Journalofofthe theTarrant Tarrant County Medical Society I

| February April 2013 2016

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Tarrant County Medical Society Delegates to the TMA Bohn D. Allen, MD Susan Rudd Bailey, MD Val F. Borum, MD Stephen L. Brotherton, MD Anita V. Chaphekar Tilden L. Childs, III, MD Gary W. Floyd, MD Gregory M. Fuller, MD Larry E. Reaves, MD Erica W. Swegler, MD Jason V. Terk, MD David V. Turbeville, MD Jay Nandalal Yepuri, MD

Past President Past President Past President Past President Medical Student Vote Texas Inter-Specialty Society Texas Delegation to the AMA Texas Delegation to the AMA Texas Delegation to the AMA Texas Inter-Specialty Society Council on Legislation TMA Board of Councilors Texas Inter-Specialty Society

Husam H. Alkersam, MD Joane G. Baumer, MD Susan K. Blue, MD James S. Cox, MD David Donahue, MD David Dyslin, MD Michael G. Enger, MD Aslam M. Malik, MD R. Larry Marshall, MD Luis H. Martinez, MD G. Sealy Massingill, MD John A. Menchaca, MD Shirley A. Molenich, MD

Woody V. Kagelar, MD Stuart C. Pickell, MD Robert J. Rogers, MD Ponniah S. Sankar, MD Joseph H. Shelton, MD Mark M. Shelton, MD Linda M. Siy, MD Joe M. Todd, MD E. Thomas Wightman, Jr, MD Dan A. Willis, MD Michael E. Wimmer, MD James R. Winn, MD Hujefa Y. Vora, MD

Officers President, Gregory Phillips, MD President Elect, Ann E. Ranelle, DO Vice President, Linda Siy, MD Secretary/Treasurer, David Donahue, MD Past President, Robert J. Rogers, MD Trustees Chairman, G. Sealy Massingill, MD Larry Marshall, MD Tom Wightman, MD TMA Officers Gary Floyd, MD Board of Trustees Arlington Medical Society Ajay Sobti, MD, President Northeast Branch Medical Society Paul K. Kim, MD, President

Alternate Delegates to the TMA Ralph F. Baine, MD Darrin D’Agostino, DO Christopher S. Ewin, MD Josephine R. Fowler, MD Sreenivas Gudimetla, MD Eric Hill, MD Terance J. McCarthy, MD Gregory J. Phillips, MD Ann E. Ranelle, DO

Tarrant County Academy of Medicine 2015 Board of Directors President, Robert Bunata, MD Vice President: Craig Kneten, MD Jeff Beeson, DO Angela Bentle, MD Susan Blue, MD Theresa Crouch, MD Gary Floyd, MD Hujefa Vora, MD Publications Committee Hujefa Vora, MD, Chair publications@tcms.org C. Thomas Black, MD Susan Blue, MD Robert E. Bunata, MD Samuel T. Coleridge, DO Hugh Lamensdorf, MD R. Larry Marshall, MD Layna Chase, Alliance Mary Ann Shelton, Alliance Managing Editor Jonathan Blessing editor@tcms.org Advertising Director Karen Reynolds 817-266-3651 kreynolds@tcms.org Executive Vice President & CEO Brian T. Swift bswift@tcms.org

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Cover photo: by Todd Gontarek Website: www.facebook.com/ToddGontarekPhotography

2016 April Issue

TARRANT COUNTY

PHYSICIAN 14

Featured

President’s Paragraph “Serenity” by Greg Phillips, MD

Student Article “You know you’re a Third Year Medical Student when…” by Anita Chaphekar - OMS - III

BLUEPRINT FOR QUALITY - PART V FIELD TRAINING 101 - REBOOTED

by Neil Richmond, MD, Medical Director and Staff

LETTER FROM THE GOLD-HEADED CANE COMMITTEE

by Robert Sloane, MD

TMA PRESS RELEASE

BIRD WATCHING

by Jeffrey W. Heitkamp, MD

LETTER TO THE EDITOR by Robert Bunata, MD

The Tarrant County Physician (SSN 0199-5499) is published monthly by the Tarrant County Medical Society (TCMS), 555 Hemphill, Fort Worth, Texas 76104. Subscription price is $6.00 per year for members; $28.50 per year for non-members. Periodical Postage paid at Fort Worth, Texas 76101 and additional entries. All property rights on articles, including the right to reprint, are reserved to the artist or the Tarrant County Medical Society. Reproduction without prior å is strictly prohibited. POSTMASTER: Please send change of address to Tarrant County Physician 555 Hemphill Street, Fort Worth, TX 76104. The articles published in Tarrant County Physician represent the opinions of the authors, and do not necessarily reflect the official policy of the TCMS. Acceptance of advertising in Tarrant County Physician in no way constitutes approval or endorsement by the TCMS of products or services advertised. Printed by COCKRELL ENOVATION, Fort Worth, Texas.

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Departments & Columns

Alliance Update by Elizabeth McCurdy On the Blacklist “While the Editors Slept” by Tom Black, MD

Public Health Notes “Current State of HPV Vaccination” by Catherine Colquitt, MD

TCMS Family Members

Professional Cards

Classified Ads

Advertising Index

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PRESIDENT’S PARAGRAPH

SERENITY By greg phillips, md

hen my patients ask me, “Why?” I reply (with sincerity and sensitivity) “Because” - as that is the only answer to questions which start with the word “Why.” I also frequently have to remind them that eventually something medical will happen to them. The Serenity Prayer is generally attributed to Reinhold Niebuhr, an American philosopher born in Missouri who was Professor of Philosophy at the Union Theological Seminary for over thirty years. Referred to by some as the most influential American theologian of the 20th century, he was awarded the Presidential Medal of Freedom in 1964. I first became aware of this prayer on summer road trips with my family stopping at roadside stores (Walnut Bowls) along the interstates frequently framed needlepoint or engraved into wooden displays; however, I later learned that Niebuhr penned more than the familiar three lines: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference. Living one day at a time, enjoying one moment at a time, accepting hardship as a pathway to peace…” This concept of acceptance leading to serenity seems to have been around for a long time (per Wikipedia). 8th Century Buddhist scholar Shantideva: If there is a remedy when trouble strikes, what reason is there for dejection?

And if there is no help for it, what use is there in being glum? A children’s rhyme from 1695: For every ailment under the sun There is a remedy or there is none. If there be one, try to find it. If there be none, never mind it. German philosopher Friedrich Schiller in 1801: Blessed is he who has learned to bear what he cannot change And to give up with dignity what he cannot save. The latest book by surgeon and New Yorker contributor Atul Gawande, Being Mortal, explores the difficulty that we in our society have in acknowledging end of life eventualities, etc. Even after many years as a physician, I am surprised at how hard it is for me to address the reality of a terminal condition with my patients - even those who I have known for many years and consider friends. I don’t know whether it is my not wanting to accept the diagnosis and prognosis or my hope that maybe my patient/friend will be the exception, but I do know that when I am able to deal with my fears and finally have “the talk” with the patient and family both of us experience a sense of relief and serenity. “I wish you hope when things are going bad, Kind words when times are sad, I wish you shelter from the raging wind, Cooling waters at the fever’s end.” -Eagles, “One of These Nights,” 1975 April 2016 I Tarrant County Physician I 7

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STUDENT ARTICLE

You know you’re a Third Year Medical Student when… by ANITA CHAPHEkAr, OMS - III I am six months into my third year of medical school. Recently, I have been thinking about how different my time has been as a third year medical student compared to my first two years. Here are just a few ways you know that you’re a third year medical student. 1. The most common question you are asked is “What specialty have you decided on?” Whether it is from patients, the physicians I am working with, or even family and friends, I have been asked this question on multiple occasions. At least for me, the answer to this question has changed many times but I really do appreciate being asked. I began asking my attending physicians and patients how they chose their specialty or career. It has been wonderful hearing their stories and seeing their passions shine through. 2. Your white coat replaces your purse or backpack. A Stethoscope, copies of Maxwell and Pocket Medicine, foldable clipboard, at least four pens, a little notebook, penlight, cell phone, car keys, and granola bars are just a few of the things I carry in my white coat. 3. You can explain the pathophysiology of a disease to a patient but not know the correct dose of the medication to prescribe. At the beginning of third year, coming fresh off taking Step 1, I was well versed in physiology, pharmacology, and the pathology of disease. My very first day in clinic one of the patients I saw was having pain with urination. The patient’s urinary analysis came back indicative of a urinary tract infection. After confidently presenting the patient to my attending physician with the plan of treating with an antibiotic he asked, “Now what dose and for how many days would you have the patient taking this antibiotic?” I immediately began to feel the blood rushing to my cheeks as my heart sank. I had no idea. Now that I am halfway through my third year of medical school, I am more familiar with dosages of various medications. However, it is funny to look back and think that I knew the mechanism by which bacteria infect the urinary tract but not the correct dose of antibiotic to prescribe the patient. 4. You’re hungry, exhausted, overwhelmed, and still so grateful after a long day in the OR, clinic, or patient’s bedside. Third year is demanding; you are thrown into clinics and hospitals leaving the classroom behind. My first night shift during my OBGYN rotation consisted of large amounts of caffeine and getting used to the labor

and delivery floor. I spent the majority of that first night coaching and encouraging a soon to be mother through her painful contractions. Throughout the night, I was able to get to know this woman and her family while realizing how this time was truly special for them. She delivered a beautiful baby just as my shift was ending. I felt like a zombie leaving the hospital the next morning, but I couldn’t help but think how amazing of a night it was. The experiences I have had on each rotation during my third year have been extremely rewarding. Patients are no longer part of exam questions but are actual people with complex problems relying on the medical team to provide the best care possible. Even though I may have long hours at the hospital and clinic, it has been an honor to be a part of patient care. 5. You take a step back and realize just how far you’ve come and yet how far you have to go. I can’t believe how much I’ve learned since starting medical school. I remember in college when I was shadowing in clinics but did not fully understand the patient’s medical concerns. Now as a third year, I am more comfortable obtaining a history, performing a physical exam, and deciding what tests or labs need to be ordered. I understand that I am only skimming the surface of a career in Medicine but I am excited for what is to come as a resident and beyond. As I continue my medical education and career, I will keep in mind what my attending told me on my very first day of third year (yes, after I didn’t know the correct dose of antibiotic to prescribe for a UTI): As a medical student, resident, and attending physician there is always something to be learned with every patient you treat. Anita Chaphekar is a third year medical student at TCOMUNTHSC. She received a Bachelor of Science in Biology at the University of Tulsa in 2013. Anita is interested in pursuing a career in pediatrics.

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ALLIANCE UPDATE

Alliance Update by Elizabeth McCurdy

The Medicine Ball Bollywood The Medicine Ball is the annual dinner and dance hosted by the Tarrant County Medical Society Alliance and Foundation. All funds raised go directly to community health projects. This year, the Medicine Ball took place on Saturday, February 20, at the Cendera Center which was transformed into the exotic and colorful world of India’s Bollywood. Guests came dressed in traditional Indian attire or black tie. Those wearing traditional attire could have their saris adjusted and wrapped by volunteers. Upon entering, over 350 guests were welcomed to craft cocktails and other spirits at a custommade walnut bar, designed and built by Cendera specifically for the Ball. A henna artist was available for decorating hands and arms with elaborate designs. My Time Photos set up to capture fun pictures of couples and groups. Raffle tickets were sold for some great prizes. The dinner buffet opened after the cocktail hour and offered delicious tastings of authentic Indian cuisine. During dinner, a pair of dancers took to the dance floor to perform. From top left, clockwise: Dr. Robert & Suzanne Wood; Tablescapes; Tricia Scniederjan, Orly Meyers, Linda Kennedy, Suzanne Wood, Layna Chase, and Lisa Queralt; Linda Kennedy, Layna Chase, TCMSA President Suzanne Wood, Tricia Schniederjan, Medicine Ball Chair Lisa Queralt, Orly Meyers; Cendera Center transformed into Bollywood

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Professor D was onstage to provide their incredible music to keep the dance floor full the remainder of the evening. A flash mob appeared half way through the evening for “Jai Ho.” This fun and beautiful evening was made possible by Medicine Ball Chair, Lisa Queralt, and her hard-working committee: Layna Chase, Jenny Reece Conrad, Linda Kennedy, Marilyn Kobs, Orly Meyers, Tricia Schniederjan, Mary Ann Shelton, Lori Urso, TCMSA President Suzanne Wood, and special event advisor Suma Bhandari.

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ALLIANCE UPDATE Tarrant County Alliance, Inc. 555 Hemphill | Fort Worth TX 76104 | (817) 732 2825

Upcoming Events April 27-30 ALLMED/ TMAA meeting in Dallas. Mary Helen Ware Star Awards and Recognition of 50 Year Members at Rivercrest Country Club. Friday, May 6, 11:30-1:30pm Book Club Annual Luncheon and Book Pick, May 5, 12-3, hosted by Marilyn Bloemendal and co-hosted by Billie Cochrum ______

SLATE OF ALLIANCE OFFICERS FOR 2016-2017 President Lori Urso President-Elect Layna Chase VP Community Health Barbara Garcia VP Membership Brooke O’Patry VP Membership Elect Orly Meyers VP Programs Amber Dyke VP Communications Elizabeth McCurdy VP Legislation Lisa Queralt Recording Secretary Tricia Schniederjan Treasurer Caryl Cochrum Representatives at Large Tammy Jensen and Ingrid Smith

The Medicine Ball Bollywood 2016 A special thank you to these sponsors:

Platinum Level: Gold Level:

Radiology Associates Frost Bank Sewell Lexus of Fort Worth

Silver Level: Dr. Nikhil Bhayani, ID Doctors PA Charles Schwab Dialysis Associates Texas Oncology Dr. David and Angela Donahue Texas Health Resources Fort Worth, Texas Magazine Texas Health Huguley Kindred Healthcare Texas Health Southwest Dr. Tracy and Marilyn Kobs Hospital Cue Lipscomb at First United Mortgage UNT Health Science Center Dr. John and Lisa Queralt Winstead PC Dr. Robert and Suzanne Wood Congratulations to the Raffle Prize Winners: The Bombay Package, won by Bob Johns The Fort Worth Luxury Package, won by Time Cline The Tip Top Tailgating Package, won by Tricia Schniederjan Many thanks to our raffle donors: Fort Worth Luxury Group Dr. Arthur & Barbara Garcia Sewell Lexus of Fort Worth SPIRITS by Sedona

President: Suzanne Wood rcwoodjr@charter.net President Elect: Lori Urso lurso63@gmail.com Past President: Lisa Queralt lisapq@att.net 1st VP Community Health: Orly Meyers orlymeyers@gmail.com 2nd VP Membership: Tricia Schniederjan tschnied@gmail.com 3rd VP Programs: Jenny Conrad jenny@conradcreative.com 4th VP Communications: Elizabeth McCurdy emccurdy@sbcglobal.net 5th VP Legislation: Lisa Queralt lisapq@att.net Recording Secretary: Julie Diamond julie@diamondinternet.net Treasurer: Ellen Rogers ehrogers@flash.net Budget & Finance: Marilyn Kobs mkobs@charter.net Parliamentarian: Kathy Coleman k.coleman@tcu.edu Representatives-at-large: Katie Dyslin Olivia Prebus Membership Elect: Brooke O’Patry Interested in joining? Membership: $100.00/year Contact: Tricia Schneiderjan tschnied@gmail.com www.tcmsalliance.org Facebook: Tarrant County Medical Society Alliance April 2016 I Tarrant County Physician I 11

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Dr Heitkamp Tarrant County Physician magazine ad.indd 1

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1 in 6 persons

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On the Blacklist

by Tom Black, MD

WHILE THE EDITORS SLEPT: ACTUAL NEWS HEADLINES “Sheriff Offers $10,000 for Dog Fighting Tips” - Atlanta Journal-Constitution

Maybe he’s tired of his dogs losing. “Mexican Refugee Requests Skyrocket” Toronto Star

To celebrate Cinco de Mayo? “Pigeons Took Toll on Minnesota Bridge” Boston Globe

I’d heard they were trainable. “Clinton, Edwards Butt Heads” Portsmouth (N.H.) Herald News

Belongs in the Opinion section. “Dog Shooter Sought” Grand Rapids Press

Should have been in the Help Wanted section. “Local Man to Reproduce, Sell Texaco Fire Hats” - Grand Rapids Press

A humble man’s lifetime ambitions in a nutshell. “Man Arraigned in Death of Wife Thrown From Balcony” KCTV Web site (Kansas City)

What happened to ‘innocent until proven guilty’?

“Senate OKs Wider Kids’ Health Program” Associated Press

A kind way of referring to childhood obesity. “Meeting on I-471 Ramp Tonight” Enquirer (Cincinnati) Seems like a dangerous place to hold a rally. “Man Critical After Being Shot in the Head” - Indianapolis Star

I would be pretty upset as well. “Iran Replaces Revolutionary Guards’ Head” - Forbes.com

Who knew they had the medical expertise? “Stuck in Traffic? You’re Not Alone” Associated Press

Yogi couldn’t have said it any better. “Politically Connected Electrician Charged” - Philadelphia Inquirer

There’s a man who really gets into his work. “Schools Offer Free Water, Garbage to Attract Teachers” WRAL-TV Web site (Raleigh, N.C.)

Have they really no better incentives . . . ? April 2016 I Tarrant County Physician I 13

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BLUEPRINT FOR QUALITY, PART V

Field Training 101 - Rebooted Rayna Willis, EMT-P, Clinical Practice Coordinator Neal Richmond, MD, Medical Director Veer Vithalani, MD, Associate Medical Director Steve Davis, MD, Associate Medical Director Dwayne Howerton, RN, EMT-P, Chief of Staff New-hire orientation and training and on-going education and skills maintenance each present significant challenges for Emergency Medical Service (EMS) systems. While there are state and national certification or licensure requirements for out-ofhospital providers, these only serve to establish the minimum standard for knowledge and skills as a condition for initial employment. Similar to first-year residents fresh out of medical school, new EMS providers may have passed a set of exams but they routinely lack the practical knowledge, the skills, and/or the experience to function effectively as independent practitioners, whether from an operational or clinical perspective. The intern may lit-

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erally not know how to get to the radiology suite while the new EMT may not know how to make a radio notification to the emergency de-

partment trauma team waiting for their patient to arrive at the hospital. The new intern may not know how to integrate the knowledge gained by speaking with the radiologist into the patientâ&#x20AC;&#x2122;s plan of care while the new paramedic may not be able to assimilate information from the caregiver on-scene into a coherent differential diagnosis. Finally, while out-of-hospital providers with substantial prior clinical experience will need operational training to function effectively in a new system environment, they will, more importantly, also need evaluation of their knowledge and skills so as to ensure sound critical thinking and clinical decisionmaking.

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BLUEPRINT

In the belief then that effective initial assessment and training, coupled with meaningful ongoing evaluation and education, are the keys to developing a high quality EMS clinician, the Office of the Medical Director has been working closely with the leadership of MedStar and other system stakeholders to restructure the education and training process through our recently adopted Blueprint for Quality. The first weeks of a new employeeâ&#x20AC;&#x2122;s training are focused largely on orientation to the work environment: learning an electronic patient care reporting system, understanding local radio communication procedures, figuring out where supplies are kept on the ambulance, and gaining mastery of clinical protocols and procedures. While most of these elements are fairly straightforward to evaluate through testing and practical skills assessment, their integration into a coherent differential diagnosis and patient treatment plan, especially within the confines of available resources in the relatively austere out-of-hospital environment, pose much greater challenges for performance-based assessment. The field training officer (FTO) is key to the integrative assessment of the operational and clinical arenas. Much as a senior resident will have a significant impact on a new internâ&#x20AC;&#x2122;s knowledge and experience, an FTO will have a similar influence on the early career of an EMS provider. Therefore, the qualification, selection and training of FTOs are all critical components necessary to ensuring high quality instruction and assessment. An FTO cannot simply be an employee in good standing with a perfect attendance record and no disciplinary action. While those individual characteristics may provide a necessary foundation for good mentorship, they are not in and of them-

selves sufficient to ensuring sound clinical decision-making capabilities or the ability to synthesize and communicate them in an effective fash-

ion. A formalized train-the-trainer program has therefore been developed for the purpose of providing an objective method to select qualified FTOs. Similarly, an educational platform by which to instruct the FTO in the utilization of clinical scenarios and evaluation methods in field training has been created. The FTO candidates are now being mentored on scenario development, implementation, and evaluation, the primary focus being on the effective utilization of these tools within a competencybased training program. Once the FTO program was redesigned to better ensure appropriately trained and equipped clinical leaders and mentors, modification to the evaluation process was necessary, both to create a competency-based training program and to ensure a culture of critical thinking and evidencebased clinical decision-making. The new content focuses then on developing a range of more sophisticated

clinical and cognitive skills through scenario templates, exposing the new clinician to case-based studies of varied patient acuity, including ones that may not specifically be encountered during realtime field training patient interactions. Correspondingly, standardized evaluations ensure a consistent training methodology as well as provide critical feedback to providers on their progression through the program. The evaluation process is also individualized to the new employeeâ&#x20AC;&#x2122;s on-going demonstration of competency, specifically focusing on areas of need and moving beyond areas of demonstrated ability. To sustain a continued culture of critical thinking and highlevel clinical decision-making, attention must also be given to continuing education and training that focuses beyond skill competency and recertification requirements. While knowledge and skill proficiency standards are established and evaluated annually, they represent only a minimum requirement, similar to what the new provider obtains with initial state certification. Clinical performance benchmarks for out-of-hospital care have therefore been designed, and dashboards constructed, for agency and individual performance tracking. Continuing education components have also being redesigned to incorporate a multi-faceted approach, including patient simulation, case-based lectures, on-line learning management systems and, in the future, cadaveric procedural labs. The demands of a high-performance EMS systems are great. Balancing the needs of operational efficiency and clinical proficiency is delicate. Ensuring and maintaining the competency and quality of EMS providers servicing our community is the highest priority for our Blueprint for Quality. April 2016 I Tarrant County Physician I 15

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PUBLIC HEALTH NOTES

CURRENT STATE of HPV VACCINATION by Catherine A. Colquitt, md

local health Authority and medical director Tarrant County public health

n the interest of safeguarding the health of our community, Tarrant County Public Health (TCPH) is actively involved in cancer prevention and surveillance. We positively affect the communityâ&#x20AC;&#x2122;s well-being through our immunization clinics, in our Breast Cancer and Cervical Cancer Prevention Clinic, in our two Adult Health Services Clinics (for sexually transmitted disease screening and treatment), and in our Preventive Medicine Clinic (for care of under-resourced HIV positive adults).

thousand new infections annually. Forty percent of infected persons acquire their HPV disease within two years of coitarche, and HPV vaccines (the quadrivalent vaccine was the first marketed in the U.S. starting in 2006) are most effective when given prior to coitarche. HPV infection can be transient and associated with a low-risk of associated future cancer secondary to infection with nononcogenic HPV types (though low-grade cellular abnormalities may persist mucosally indefinitely) or persistent and associated with a high-risk of future cancer development secondary to infection with highly oncogenic strains.

Between 1975 and 2010, the rate of cervical cancer in the United States decreased by 50 percent. This decline is attributed to increased screening, the advent of Human Papillomavirus (HPV) vaccines, and our exponentially expanding understanding of the relationship between mucosal cancers and certain types of HPV.

The Advisory Council on Immunization Practices (ACIP) currently recommends HPV vaccine series (three immunizations over six months) starting at age 11-12 years for boys and girls and through age 26 for women, age 21 for heterosexual men, and age 26 for men having sex with men.

Currently, there are more than 120 HPV types of which approximately 80 cause epithelial lesions (hand and foot warts) and 40 of which cause mucosal disease. Some of the mucosal diseaseassociated HPV types (especially HPV 16 and HPV 18) are highly oncogenic and are linked to cervical, vulvovaginal, anal, oropharyngeal, and penile cancer. Our country has a high prevalence of HPV infection, estimated at 14 million persons infected, with 79

Each year, approximately 26,900 cases of HPV-associated cancers occur in the US. Experts estimate that 21,000 of these cases are vaccine-preventable. To date, only HPV vaccines are proven to prevent cancer.

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Currently, the cervical cancer screening recommendations of the American College of Surgery, the United States Preventive Ser-

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PUBLIC HEALTH NOTES vices Task Force, and the American College of Obstetrics and Gynecology are in harmony regarding cervical cancer screening. They recommend a pap smear every three years for women ages 21-29 while counseling women ages 30-65 to undergo cotesting with pap smear and HPV screening every five years. Approximately 72% of cervical cancers are associated with HPV 16 or HPV 18, and these HPV types are included in all available vaccines. Among women, HPV causes cancers of cervix (55%), vulva and vagina (19%), oropharynx (11%), and anus (15%). In men, 78% of HPV-associated neoplasms are oropharyngeal, 14% are anal, and 8% are penile. The estimated cost of HPV-related disease in the US is $8 billion annually, and the consequences for affected individuals are at times truly catastrophic. Experts have long promoted the notion of an “adolescent platform” to allow us to help our adolescent patients optimally transition to adulthood with complete immunizations for vaccine-preventable infections and, in the case of the HPV vaccines, cancers. The concept of the adolescent platform also allows us to discuss health maintenance and risk reduction strategies in ageappropriate contexts with our patients and their parents. We can outfit our patients for their journeys into adulthood with a full complement of adolescent vaccine recommendations (Tdap, meningococcal, along with annual seasonal influenza vaccine) and we can

optimize their chances for future good health and freedom from vaccine-preventable cancer with the HPV series, recommended for boys and girls. Nationally, we vaccinate 45-54% of eligible girls with at least one HPV vaccine in the 3-vaccine series, but our success rate at vaccinating boys is much lower (8.3%). While rates for HPV vaccination are slowly climbing, several obstacles prevent us from achieving our goals. Some of us and many of our patients still regard HPV vaccination as “optional,” and we sometimes refrain from hearty endorsement of the HPV vaccines in younger adolescents out of reluctance to initiate an occasionally awkward conversation or to raise uncomfortable issues. However, the value of HPV protection by vaccination is incontrovertible. The HPV vaccines prevent 70% of cervical cancer and up to 70% of future abnormal cervical pap smears. We can encourage our patients and their families that the HPV series IS needed to offer our patients an incredible opportunity at cancer prevention. There is no increased risk of Guillain-Barre Syndrome, seizures, syncope, appendicitis, cerebrovascular accidents, venous thromboembolism, or anaphylaxis based on the data. There is also no data to suggest that administration of the vaccine increases sexual risk behaviors (compared with an unvaccinated cohort). Our message must be that the HPV vaccines prevent cancer, are safe, are most effective when given prior to coitarche, and are important for both boys and girls.

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LETTER FROM THE GHC LETTER FROM THE GOLD-HEADED CANE COMMITTEE The Tarrant County Medical Society has experienced continual growth in the 65 years since the Gold Headed Cane was first awarded. This has resulted in a massive ballot for the membership to review in voting for this prestigious annual award. Changes in medical practice patterns over time have resulted in less contact between society members and thus less general knowledge of particular physicians. Your Gold Headed Cane (GHC) Committee has considered these changes and has determined to respond with a change in the ballot procedure in selecting the 2016 recipient of the GHC award. This year there will be a ballot with 15-20 nominees. Your GHC Committee will select names for the ballot by accepting nominations from the TCMS membership and the GHC Committee members. A nomination form is printed in this issue of the Physician and can be returned by mail or fax prior to the deadline of May 20, 2016. Nomination forms are also accessible from the News Flash of April 1 and May 1, 2016. Names of eligible physicians can be accessed via the News Flash. Once the ballot is finalized, it will be mailed to the membership and also be available in the News Flash and the Physician. A ballot may be returned via mail, fax, or email. As usual, you may vote for three physicians (first, second, and third choice). It is the hope of your committee that this change in our selection process will encourage wide participation in the GHC award and continue the legacy of recognizing annually the Doctor’s Doctor of TCMS. Robert Sloane, MD Chair, GHC Committee

TheTexas TexasMedical Medical Associationisisadvancing advancingthe theChoosing Choosing The ® campaign,Association Wisely an initiative to help physicians and ® Wisely campaign, an initiative to help physicians and patients talk about avoiding unnecessary care. patients talk about avoiding unnecessary care. Throughthe theChoosing ChoosingWisely Wiselycampaign, campaign,TMA TMAisishelping helping Through Texas physicians spur conversation around evidenceTexas physicians spur conversation around evidencebasedrecommendations recommendationscreated createdbybyyour yourmedical medicalspecialty specialty based societies. societies. Learnmore moreabout aboutthe theChoosing ChoosingWisely Wiselycampaign campaignand andhow howit it Learn can help you. Watch the Choosing Wisely CME webinars and can help you. Watch the Choosing Wisely CME webinars and earn3.75 3.75AMA AMAPRA PRACategory Category11Credits™ Credits™and and3.75 3.75ethics ethics earn credits.For Fora alimited limitedtime, time,the theChoosing ChoosingWisely WiselyCME CMEbundle bundle credits. is available free at www.texmed.org/ChoosingWiselyCME. is available free at www.texmed.org/ChoosingWiselyCME. Formore moreinformation informationabout aboutChoosing ChoosingWisely, Wisely,visit visit For www.texmed.org/ChoosingWisely/. www.texmed.org/ChoosingWisely/.

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Tarrant County Medical Society

2016 Gold Headed Cane Award Nomination Form Nominations must be returned by Friday May 20th, 2016 Name of Physician nominated__________________________________________ Criteria for selection: Describe the nomineeâ&#x20AC;&#x2122;s qualifications (check all that apply) The nominee must have been a member of ___Excellence in clinical practice The Tarrant County Medical Association for ___Participation in the community at least 20 years and must symbolize the ___Participation in organized pursuit of the highest standards of scientific medicine excellence and integrity. ___Integrity in all activity ___A doctorâ&#x20AC;&#x2122;s doctor You must provide specific detail and attach any supporting documentation; the Committee relies on your documentation. ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Nominating Physician Name:____________________________Phone__________ (Must be TCMS member) Please return form to TCMS-555 Hemphill Street, Fort Worth 76104 or fax (817) 732-3033

April 2016 I Tarrant County Physician I 19

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PRESS RELEASE

Texas Loses 10 Percent of its Public Health Preparedness Funding as State Faces Historic Zika Outbreak For Immediate Release: March 31, 2016 WASHINGTON, DC – As Texas faces deep pubic health funding cuts in the middle of their response to the Zika virus outbreak, the Big Cities Health Coalition (BCHC) is calling on Congress to pass the President’s $1.9 billion emergency funding request designed to prepare for and respond to the Zika virus. The Coalition membership consists of the 28 largest public health departments in the United States, including Dallas, Ft. Worth, Houston, and San Antonio. Because the U.S. Congress has refused to pass supplemental funding, the Centers for Disease Control and Prevention (CDC) recently announced that the State of Texas will lose $3.6 million, or almost 10 percent of their Public Health Emergency Preparedness (PHEP) funding. Texas has at least 27 confirmed cases of Zika (source: texaszika.org) and the main vector for the virus, the Aedes aegypti mosquito, is present in the state. The World Health Organization has concluded that Zika virus is highly likely to be a cause of microcephaly, Guillain-Barré syndrome and other neurological disorders. Microcephaly is a condition where a baby’s head is much smaller than expected because a baby’s brain has not developed properly during pregnancy. “Cities and states are racing against the clock to prepare for and contain the spread of the Zika virus, and these cuts will directly impact the response on the ground to Zika as well as the other emergencies they face such as mumps, measles, and foodborne illness outbreaks,” said Chrissie Juliano, MPP, Director of the BCHC. “It’s time for Congress to get real about the potential cost of their inaction and give those fighting this public health emergency the resources they need to avert the serious and costly impact of Zika virus infection.” “Our health department is working non-stop to address and prepare for a Zika outbreak,” said Vinny Taneja, MBBS, MPH, Health Director of Tarrant County Public Health. “PHEP is an integral piece of a community’s response plan. It is the capacitybuilding grant that has allowed us to respond to such emerging threats as the recent Ebola outbreak -- and now Zika. Without it, our capacity to respond to all hazards will be diminished.” PHEP funding is a critical source of funding for state, local, tribal, and territorial public health departments. Since 2002, the PHEP cooperative agreement has provided nearly $9 billion to public health departments across the nation to upgrade their ability to effectively respond to a range of public health threats, including infectious diseases, like Zika. However, this most recent cut means states are receiving 33% less than they received from PHEP a decade ago. Many of BCHC’s local health departments are engaged in educating the public and health care providers about Zika, conducting prevention activities through mosquito eradication, and screening travelers

Media Contact: Liz Voyles liz@brassrc.com, 202-297-9641 from countries where the outbreak has surfaced. Emerging infectious disease threats like Zika require ongoing vigilance, but the particular risks from this virus require immediate, additional investments. BCHC urges Congress to act quickly on the President’s requested $1.9 billion in emergency funding – $1.48 billion of which would be provided to the U.S. Department of Health and Human Services (HHS). This funding includes $828 million for Centers for Disease Control and Prevention (CDC) surveillance activities, and $200 million for vaccine research and diagnostic development and procurement. With this funding, state and local health departments would be able to immediately increase their virus readiness and response capacity, particularly in areas with ongoing Zika transmission; enhance laboratory, epidemiology and surveillance capacity in at-risk areas to reduce the opportunities for Zika transmission; and stand up their surge capacity through rapid response teams. Given continued cuts and overall limited investments in public health infrastructure, including vector surveillance and control, supplemental funding for emergent threats like Zika is necessary. But, it is just as important for Congress to sufficiently fund the core infectious disease (CID) program at CDC to help avert these situations in the future. CDC’s CID includes the vector-borne diseases program that provides resources to state and local health departments to detect, control, and prevent bacteria and viruses transmitted by mosquitoes. Although not a new virus, 2015 marked the first widespread transmission of the Zika virus in the Americas. The virus is spread primarily by mosquitoes and usually causes only mild illness or no symptoms, but it may be causing a steep increase in birth defects in infants born to mothers who were infected during pregnancy. In January 2016, the CDC warned women who are pregnant or trying to become pregnant to avoid travel to regions and countries with widespread Zika transmission or to prevent being bitten by mosquitoes there. The World Health Organization has recently declared a public health emergency of international concern due to the spike in microcephaly and Guillain-Barré syndrome in the Americas. The same mosquito also spreads dengue and chikungunya. The Big Cities Health Coalition (BCHC) is a forum for the leaders of America’s largest metropolitan health departments to exchange strategies and jointly address issues to promote and protect the health and safety of their residents. Collectively, BCHC member jurisdictions directly impact more than 54 million people, or one in six Americans. The Big Cities Health Coalition is an independent project of the National Association of City and County Health Officials. For more information, please visitwww.bigcitieshealth.org. ### April 2016 I Tarrant County Physician I 21

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BIRD WATCHING

BIRD WATCHING by Jeffrey W. Heitkamp, MD

Bird watching is a very relaxing and satisfying hobby. Few avocations give the chance to enjoy the outdoors, exercise, and challenge the mind and ears, and spend quality time with friends and family. One can plan a day of quiet observing new target species of birds in new places or familiar sites. A birding group in Ohio has a program to introduce bird-watching to kids. They call the program “No Child Left Inside” (no electronics or cell phones needed!). I became a “birder” in grade school. I sighted my first belted kingfisher in the woods on our family farm in southeastern North Dakota -- I was hooked. The 9,700 different species of birds in the world represent the pinnacle of creation. The first chapter of the book of Genesis mentions the word “bird” or “birds” six times. The study of this complex class of specialized animals offers insight to behavior, reproduction, coloration, migration and vocalizations. GETTING STARTED Several great birding festivals are held throughout the United States. These events feature daily guided field trips as well as lectures and social events. I have attended them in Harlingen, Texas, West Virginia, Arizona, Minnesota, Montana, and California. The Rio Grande birding festival in Harlingen, Texas, is held every November and is an excellent way to start birding. This event has guided trips to Padre Island, the King Ranch, the Rio Grande river, and many other sites. The Feather-Fest bird festival in Galveston is an excellent festival held every April. It is especially good for beginners and kids. Many song birds and shore birds return from Central America and Mexico in their northward migration and make “landfall” here every April. I would recommend a light backpack with the following items: Good binoculars, guide book, insect repellant, bottled water and toilet paper - not necessarily in that order of importance! Two very good field guides are the National

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Geographic Society Field Guide to Birds of North America and the Sibley Guide to Birds. When one goes to a new region of the country, prior study and developing a target list of bird species is helpful. It is also helpful to listen to songs and vocalizations of specific birds on a CD or bird app. Of course, like the field of medicine, you get to meet new friends and experts in specific areas (like shore birds or hummingbirds) -- a great learning opportunity. PAST EXPERIENCES: There is a special excitement in finding a new species (a Life Bird). I remember finding my first Louisiana Water Thrush on Goose Island at Rockport, Texas, one spring. I also spotted my first Wandering Tattler in a stream outside of Nome, Alaska. The Arctic tern migrates every year from the Alaskan tundra to winter in Antarctica waters and back! I saw my first one this spring in a Subway sandwich shop in Nome, Alaska. TEXAS

We are very blessed in Texas to have many diverse habitats to see specialty birds, birds occurring only in a specific region of the U.S. -- Big Bend National Park, Anahauc National Wildlife Refuge near Galveston, The Rio Grande valley, and Aransas National Wildlife Refuge -- for the whooping crane -- come to mind. Also, Big Bend National Park is very unique for certain species only found in that region in the United States. Those of any age who love the outdoors and natural science will find bird watching a rewarding and relaxing hobby. Don’t forget the toilet paper!

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LETTER TO THE EDITOR LETTER TO THE EDITOR from Robert Bunata, MD

I enjoyed our January issue’s update on committee activities. I would like to suggest that the publications committee to consider a regular, perhaps yearly, issue about committee activities and I’ll tell you why. When I started practice here in Fort Worth, I found a very welcoming and supportive community. Monthly society meetings were easy and convenient to attend and a good place to meet referring physicians. Periodic department meetings were a low key place to meet and discuss cases and issues with other doctors. Getting to know each other meant we were friends, not competitors and made us naturally less inclined to be carelessly critical (useful considering the stressful malpractice “crisis” at the time). In short, we had a second family, a network support group. Today I hear and read a lot about doctors being burned out and wondering what to do. As everyone knows, one thing that can help is a support system; friends that can share problems and decompress. That’s where the committee magazine issue might help. In addition to the great job our staff and members do to keep us informed of publicizing how to be involved, perhaps the Physician might reach someone at just the right time and just the right way to spark an interest to join in. As an example, if you have an interest in sports medicine, there’s a committee for you. You might find a life-long friend with whom to discuss difficult cases or help find a solution to a worrisome complication. You might also find a new source of referrals. You can check the January issue on line (www.tcms.org -> media), you can call the medical society and you can always write a letter-to-the-editor about this or any other topic. Robert Bunata, MD

Our TCMS Family Members

The Texas Medical Association is advancing the Choosing Wisely® campaign, an initiative to help physicians and patients talk about avoiding unnecessary care. Through the Choosing Wisely campaign, TMA is helping Texas physicians spur conversation around evidencebased recommendations created by your medical specialty societies. Learn more about the Choosing Wisely campaign and how it can help you. Watch the Choosing Wisely CME webinars and earn 3.75 AMA PRA Category 1 Credits™ and 3.75 ethics credits. For a limited time, the Choosing Wisely CME bundle is available free at www.texmed.org/ChoosingWiselyCME. For more information about Choosing Wisely, visit County Physician I 23 April 2016 I Tarrant www.texmed.org/ChoosingWisely/. 1577_TCMS.indd 23

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THE LAST WORD

The

Last Word by Hujefa Vora, MD

Chairman, Publications Committee

Why do you want to become a doctor? I remember working so hard through high school and college thinking about this question. It confronted me at every turn of my early career. My friends would ask me the question when I skipped the Friday night poker parties. I spent weekends and holidays reading instead of lazing about with my friends. When I started college interviews, the question struck again. In college, my fraternity brothers would throw the question out randomly in study hall and keg parties. By the time I made it to my first medical school interview, I had plenty of practice answering anyone that asked. How did you answer that question? I asked a few medical students just recently. Their idealism that bubbles up is infectious. I want to help people. I want to save lives. I want to work in a profession that gives my life meaning. Sure money is important, but that’s not what medicine is all about. Medicine is all about life. If you practice medicine well, you can really make a difference. That meaning that we are searching for as students is the same meaning we give our patients. In that ideal world, the patient, their family, they come to us for help. We offer a kind touch, a warm smile, the wisdom of Osler, and suddenly everything is right with the world. What about the ideal patient? The ideal patient loves their doctor. They come in with the most straight-forward of chief complaints. There is a weaving of the story. Everything comes together brilliantly, like something out of Harrison’s. We go through the differential diagnosis and order exactly the right test, purely for confirmation purposes of course, and then the treatment process

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begins. Pure medicine is an ideal that waltzes out of a textbook and into our hearts. We hold our flag high, the idealism and the truth. As physicians, this is our happy place, our dream, everything that we worked so hard to achieve. Residency changes that for most of us. The walls of Parkland grew into my soul. I once wrote that you can take the resident out of Parkland, but you can’t take Parkland out of the resident. It is something I said at our residency graduation. I meant it. I worked harder than I ever worked in medical school. There were moments when I couldn’t take another step, but I kept going. Part of me believes that as I wandered the halls of Parkland, I gave up parts of my very humanity. Patients became disease processes on some of those long call nights. The cliffs of my idealism began to get chipped away by fatigue and fear of failure. You see, the most difficult cross that residents bear is that idealism. They are not allowed to be wrong. Lives hang in the balance every time the pager goes off. When you are wrong, the chief would hold your feet to the fire at M&Ms. When you are wrong, people die, and lawyers make money. By the time I reached my goal of private practice, like many of us, I realized that the goal was an illusion. I coveted the doctor-patient relationship ideal, but soon saw that my rubric was flawed. There are too many other players to account for. My reality dictated something very different from that ideal. It becomes evident that those players include family, friends, and “others”. The two most important of the others who have inserted themselves into the doctor-patient relationship are the insurance companies and

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THE LAST WORD the government. They interfere not to the betterment of my patient, but all too often to their detriment. The difference speaks to the underlying motivation of the parties involved. Patients are interested in better health. Family and friends are sometimes motivated by this as well, but some are also motivated by ulterior issues that may be in direct conflict with this goal. Insurance companies…. Let’s face it. They are only motivated by one thing. Money. Sure, their bottom lines improve when patients are healthy and not sick, but when they do get sick, the insurance company is really only looking to minimize their potential liability. As for the government, their motivation now is primarily related to saving money as well. Presidential candidates, congressmen, and administrators may speak of loftier goals, but as most of us have come to know, those noble intentions are only a means to acquiring more votes. Our idealism as physicians has been crushed by the weight of our reality. How does all of this help my patients? How does pointing and clicking all day long really save lives? As for our ideal patient, they are gone too. Patients today are confused. There is a general mistrust that all patients now have for our healthcare delivery system. I believe that this mistrust stems from the interlopers that have placed themselves squarely and forcibly into the doctor-patient relationship. As an example, I consider my own experience as a patient. I have catastrophic coverage insurance, which means a high deductible plan. I pay over $6000 a year into that plan. I see my personal physician once a year and a

specialist every now and then. Because of that high deductible, all of these visits are also paid by me, not the insurance plan. My patients often ask me in the office what it is that they are paying for. In my own situation, I understand that I am paying into a plan in case of a catastrophe. Most of my patients are unable, however, to discern between the money they are paying the insurance company and the money a physician gets. When they do get an EOB, the numbers are jumbled messes that it takes an MBA to translate. The insurance company doesn’t really have a face. The only people that our patients can discuss this with, can vent their frustrations to, are our offices. Our ideal patient is now a confused consumer who doesn’t believe that they have gotten what it is they are paying for. Unfortunately, our patients misplace their mistrust by pointing their ire in the directions of their physicians, the only people they can talk to, rather than the faceless insurance company. Our patients deserve better. That is the ideal. They deserve the doctor-patient relationship without all of the confusion, the interlopers, the others interfering. I don’t know how to fix this broken system though. Along with many of you, my colleagues, I want so badly to go back to that ideal of medicine. I wish I could offer some solutions. For now, all I can do is hope and pray that we can get this ship right again. I want to become a doctor again. My name is Hujefa Vora, and this is this month’s Last Word.

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Testing only patients with elevated ALT’s may miss 50% of infection

Hepatitis C is a leading cause of liver cancer and liver transplants

Care and treatment can help prevent Hepatitis C-related disease and deaths

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VIRAT R. DAVE, MD SuSAn DEERIng, nP MEgHAn FREED, nP JOSH gEORgE, MD KuMAR guTTA, MD ARTHI KuMARAVEL, MD TERRI LOSACK, nP REnEE MIPHOuVIEng, nP DAn A. MORTOn, MD SuSAn g. MOSTER, DO SHARAD nAngIA, MD SYED SADIQ, MD JOSEPH SHELTOn, MD AMY STEVEnS, nP KAMAL A. SYED, MD FATEMA uDDIn, MD ELLA WALLACE, nP KEnnETH YAng, MD 900 W. Magnolia #100 Fort Worth, Texas 76104 Phone: (817) 870-7300 Fax: (817) 332-8372

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Fort Worth noelle g. Cloven, MD Asad Dean, MD Kenneth C. Hancock, MD Sanjay Philip Oommen, MD Chi Pham, MD Mark W. Redrow, MD Stephen L. Richey, MD Robert L. Ruxer, Jr., MD Reagan Street, MD, MMS 1001 12th Avenue, Ste. 200 Fort Worth, TX 76104 (817) 850-2000 Southwest Fort Worth Cristi Aitelli, DO David n. Barrera, DO 6500 Harris Parkway Fort Worth, TX 76132 (817) 263-2600 Arlington South Shrinivas Diggikar, MD Lixin Liao, MD, PhD Linda Verkruyse, MD, PhD 515 W. Mayfield Rd., Ste. 101 Arlington, TX 76014 (817) 664-4400

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Arlington north Charles J. Deur, MD Scott Fleischauer, MD Angela E. Seda, MD Reagan Street, MD, MMS

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Mansfield Shrinivas Diggikar, MD Lixin Liao, MD, PhD Sarju Waghela, DO 2800 East Broad, Suite 218 Mansfield, TX 76063 (817) 276-3300 Lake Worth Jessica Hals, DO 6302-A Jacksboro Hwy. Lake Worth, TX 76135 (817) 597-7900

Bedford Thomas C. Anderson, MD Vikas Aurora, MD Randall T. Davis, MD Sandeep S. gill, DO Henrick B. Illum, MD Lea K. Krekow, MD Mark J. Messing, MD Mrugesh P. Patel, MD Reagan M. Street, MD, MMS James M. Turner, MD 1609 Hospital Parkway Bedford, TX 76022 (817) 359-9000 north Richland Hills Sandeep S. gill, DO Henrick B. Illum, MD Mrugesh P. Patel, MD James M. Turner, MD 4351 Booth Calloway Rd., Ste. 208 North Richland Hills, TX 76180 (817) 284-4994 grapevine Thomas C. Anderson, MD Vikas Aurora, MD Randall T. Davis, MD Heidi A. Jordan, MD Lea K. Krekow, MD 1631 Lancaster, Ste. 150 Grapevine, TX 76051 (817) 251-9080 Weatherford David D’Spain, DO Jessica Hals, DO 911 Foster Lane Weatherford, TX 76086 (817) 597-7900 Cleburne Sandhya Bejjanki, MD 191 Walls Drive Cleburne, TX 76033 (817) 648-0120 granbury David D’Spain, DO Jessica Hals, DO 303 West Pearl Street Granbury, TX 76048 (817) 579-3700

AL April 2016 I Tarrant County Physician I 27

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DEREK A TAggARD, MD Diplomate, American Board of Neurological Surgery 1000 Houston St, 2nd Floor Fort Worth, TX 76102 (817) 336-0551 www.cndpa.com

NEURODIAGNOSTICS EMG/NCS

Michael H. Boothby, MD Richard P. Wilson, MD Bret D. Beavers, MD Diplomate American Board of Orthopedic Surgery, Fellow American Academy Orthopedic Surgery Arthroscopic Surgery • Sports Medicine

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Ade L. Adedokun, RPh, DO Diplomate of the American Board of PM&R Diplomate of the American Board of Electrodiagnostic Medicine Diplomate of the American Board of Pain Medicine Metroplex Medical Rehabilitation & Sports Medicine, P.A.

Arlington - north Joseph Austin, Jr., M.D., FCCP Jack g. gilbey, Jr., M.D., FCCP Luis F. guerra, M.D., FCCP David H. Plump, M.D., FCCP Tony H. Su, M.D., FCCP 911C Medical Center Drive Arlington, Texas 76012 (817) 461-0201 (Metro)

Samer Fahoum, M.D., FCCP Roger gleason, M.D., FCCP John T. Pender Jr., M.D., FCCP John W. Hollingsworth II, M.D., FCCP 1201 Fairmount Avenue Fort Worth, Texas 76104 (817) 335-5288 Fort Worth - Southwest Kevin g. Connelly, M.D., FCCP Huy X. Duong, D.O. 6100 Harris Parkway, Suite 285 Fort Worth, Texas 76132 (817) 263-5864

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north Richland Hills R. L. “Lin” Cash, Jr., M.D., FCCP David R. Herrmann, M.D., FCCP Madhuri Kamatham, M.D 4375 Booth Calloway, Suite 402 North Richland Hills, Texas 76180 (817) 284-4343 Pulmonary Evaluation and Treatment Asthma Evaluation and Treatment Bronchial Thermoplasty Bronchoscopy Critical Care/Intensive Care Medicine Interventional Bronchoscopy Medical Thoracoscopy Sleep Disorders Diagnosis and Treatment

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Professional Cards RADIATION ONCOLOGY

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Fort Worth Jerry L. Barker, Jr., MD Clinton Park, MD Kathleen L. Shide, MD 1450 8th Avenue Fort Worth, TX 76104 (817) 923-7393 Klabzuba Karen L. nielson, MD Stephen D. Sorgen, MD 1300 West Terrell Ave. Plaza Level Fort Worth, TX 76104 (817) 820-4700 Southwest Fort Worth Harold P. Freeman, Jr., MD 6500 Harris Parkway Fort Worth, TX 76132 (817) 263-2600 Bedford Ajay K. Dubey, MD Janice K. Tomberlin, MD 1609 Hospital Parkway Bedford, TX 76022 (817) 685-4700 Arlington Berchmans John, MD 515 W. Mayfield Rd., Ste. 101 Arlington, TX 76014 (817) 467-6092 Weatherford Thanh nguyen, MD 911 Foster Lane Weatherford, TX 76086 (817) 597-7900

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TRAVEL MEDICINE Travel Health Services Tarrant County Public Health/Travel Health Services Catherine Colquitt, MD Travel Shots / Yellow Cards 817-321-4707 Locations in Fort Worth, Southlake, Arlington

Sleep Disorders - Pulmonology 2801 S. Hulen St., Suite 600 Fort Worth, TX 76109 (817) 731-0230 AASM Accredited 731 E. Southlake Blvd, Ste 190 Southlake, TX 76092 (817) 731-0230 AASM Accredited Sleep Consultants, Inc. John R. Burk, MD Huy X. Duong, DO John T. Pender, Jr., MD Kerim F. Razack, MD Donald E. Watenpaugh, PhD, DABSM

UROLOGY Urological Surgery Center of Fort Worth State Licensed-Medicare Approved ASC Charles Bamberger, M.D. Diplomate American Board of Urology (817) 338-4636 www.drbamberger.com 416 South Henderson Fort Worth, Texas 76104

AASM Accredited Since 1985 Comprehensive Diagnosis, Treatment and Follow-up Care of Sleep Disorders 1521 Cooper Street Fort Worth, Texas 76104 (817) 332-7433 Fax (817) 336-2159 www.SleepConsultants.com Information@SleepConsultants. com

Cleburne Thanh nguyen, MD 191 Walls Drive Cleburne, TX 76033 (817) 648-0120 grapevine Ajay K. Dubey, MD Janice K. Tomberlin, MD 1631 Lancaster, Ste. 150 Grapevine, TX 76051 (817) 251-9080

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Classified Ads EXPLORE A NEW HORIZON PRI has great Locum Tenens Opportunities & Staffing services available throughout the DFW Area! Full- or part-time, during the day, evening week or weekend. Competitive Rates include malpractice insurance. Apply Online today at www.physicianresources. com or contact PRI ay 1-800-522-7707 or at pridallas@physicianresources.com. We look forward to working with you soon!

TARRANT COUNTY GREAT MEDICAL OFFICE New Space - 1,833/sf, Architecturally planned, 4 exam rooms, 1 procedure, abundant drive-up parking, excellent signage, below market rates, next to Family Practice Physician, convenient to Harris Methodist Southwest, 6100 OAKBEND TRAIL @ Bryant Irvin Rd For information: (817) 763-9000 Walter Owen or Everett Roberts.

MD/DO WANTED Urgent Care and Family Medical clinic is currently seeking MD/DO to join our team of physicians and Nurse Practitioner in Mansfield and Grand Prairie, Texas. Clinic hours M-F 9am - 8pm and Saturday 9am - 6pm. Flexible days, $5,000 sign-on bonus. Health benefits, FP outpatient only, no rounding. Must have current Texas medical license and be BC or BE. Contact - fax CV to (682) 5188919 or email ahowell@mansfieldurgentcare. com (no recruiters please).

NEW AND USED SURGICAL INSTRUMENTS Retirement requires getting rid of surgical instruments. Many dedicated surgeons travel the world, setting up clinics, teaching, operating and carrying instruments. Response is gratifying. Tools received are put to good use. I will pick up and mail any single or box of instruments to one of those dedicated doctors. Please call me if you have instruments you will never use (no drugs please). (817) 988-2025 Dr. Donald Matheson.

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Advertising Index Thank you for supporting our advertisers. 25

Arlington Assn or Neurosurgeons

Central Imaging of Arlington

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PHYSICIAN NEEDED

Physician needed 1-4 days per week for supervision of Mobile Modified Barium Swallow Studies Clinic visiting metroplex rehabilitation centers. GREAT OPPORTUNITY FOR RETIRED OR SEMI RETIRED PHYSICIANS. NO SPECIALIZED TRAINING NEEDED. Required basic computer skills. Professional liability insurance provided. Office is centrally located in Hurst, TX. Contact Pam Ragland at (817) 514-6271.

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12,23

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SOUTHWIND MOTOR HOME - $45,000 Southwind Motor Home - 2005, 36-foot, 29,000 miles. Chevy 8100 gas engine. Three slides, power steps, power jacks (levellers), and awning. Onan power plant microwave/convection oven - gas oven & 4 burner stove. Front and back AC & heating - ice maker, double refrigerator. TVs up front and in bedroom. One year extended warranty. Call Bruce Jacobson, MD (817) 437-6707

PHYSICIAN

FOR LEASE IN GRANBURY Beautiful office building; 10,000 sq. ft. Ideal for medical center. 4425 Hwy 377, E. Lease all or part. Near new Kroger an HEB. Contact: Burt Hollingsworth, (817) 293-8470

#2 POWER TABLES First chair is large, deluxe “Midmark,” $6,000 OBO; 2nd chair is smaller “Midmark,” $3,000 OBO Call (682) 444-2716

State Health Services 20

TMAIT

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Back Cover

BUILD TO SUIT MEDICAL SPACE 4,134 sf at 1812 Park Place located next to the new Baylor Surgical Hospital in the heart of the Medical District. Call Meredith or Jamie at 817-334-8100 for details.

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