Best Docs Network Houston January 12 2014


It’s a call that’s telling me
I’m here to serve. It’s a need to make a difference in the
world. 24 hours day or night these healing hands will make it
right. Looking in their eyes I know that I’m changing lives,
changing lives, changing lives for the better, for the better,
changing lives. Hello everyone, IÄôm Grace Sells and welcome
back for another edition of Best Docs Network, the show thatÄôs
featuring some of the best doctors in the Houston area that
are changing peopleÄôs lives. LetÄôs get todays show started
with vein specialist Dr. Peter Morgan. A few years back I
started having ulcers show up on my lower ankles so these ulcers
would take 2 to 8 months to get rid of. Once those would heal
over another one would pop up. We did an ultrasound and
discovered that he had severe chronic venous insufficiency
with very large varicose veins and swelling. His biggest issues
were that he had open non-healing wounds. He had a
very large one on the right side and he had a much smaller one on
the left side. He had been seen and treated by a variety of
people with a variety of methods over the years. None of them had
worked. He said well you know thaÄôs not really a problem.
We have surgeries that we can do on an outpatient basis. We can
get rid of that for you in no time. We very carefully mapped
out which veins were bad in his legs, the ones that are running
backwards and then made sure we understood where the blood was
running correctly and we ablated selectively the bad veins to
restore the venous circulation out of his legs back to normal.
And that improves the overall health of the leg and improves
healing and he actually healed up very nicely. The procedures
like I said didÄôt take any time at all. Come in in the
morning, go to work in the afternoon. Not a problem. There
was no pain after the surgeries. It all went well, went back to
work. No problems. You can have wounds that are unrelated to
venous insufficiency but most chronic non-healing wounds are
related to problems with your veins. But if you have a
non-healing wound that is almost certainly from venous
insufficiency and we can heal virtually all of those wounds
here with the procedures we do. Having the circulation back in
my lower legs allows me to work longer, it allows me to stay on
my feet longer, I donÄôt have the foot pain that I had prior.
The procedures helped dramatically. Stretching can
boost circulation and digestion and even ease back pain.
Remember when stretching, hold each position at least 25
seconds and to breathe deeply. Doctors on military post
couldÄôt tell me exactly what it was so I was being treated
for pneumonia and eventually I moved here to Houston and
thaÄôs when I met Dr. Varughese and she diagnosed it
as an enlarged heart. Steven Jones, wonderful man, developed
cardiomyopathy, weakness of the heart. Cardiomyopathies can
occur because of coronary artery disease, blockage of the vessels
that feed the heart, can happen from viral illness that can
attack the heart and many other metabolic derangements can cause
problems with the heart, the pumping of the heart. What he
had was a problem with the muscle and we were able to
change that by sending him to Texas Heart Institute at the
appropriate time in order to get a device that could help the
pumping mechanism of the heart. Last year I had a heart pump put
in and Äôve been living off of that right now for the last year
and a half. Left ventricular assist device and they come in
different types as weÄôve talked about with several
doctors at Texas Heart Institute including Dr. Fraser and Dr.
Delgado that weÄôve shown on the show before. But hereÄôs a
real live patient that we had from our practice that was able
to benefit from that technology. I thank Annie Varughese a lot,
sheÄôs been a trooper, sheÄôs been up front. She let me know
even though she told me some things that I didÄôt want to
hear but you know by her acting aggressively on this it has
saved me and I would say I devote a lot to her. Well it
used to be a bridge to transplant you know that it was
only a small amount of time that they had to wait but now they
can use that as their heart. Basically, I mean for a long
time and itÄôs just because theÄôve gotten smaller and
better and safer. A lot of people are on aspirin. Aspirin
is good to prevent heart attacks and strokes because it inhibits
the stickiness of the platelets in your blood. These platelets
clump together when they get real sticky and then they can
cause blood clots then you get a heart attack and stroke. Aspirin
stops that stickiness. Now we used to say that anyone at high
risk for a heart attack and stroke should be on aspirin to
prevent those problems but now we think we should only use it
for people who have had a heart attack or stroke. We found that
people who took aspirin to prevent those things yet had
never had one of those problems, a heart attack or stroke, those
patients still had just the same number of heart attacks and
strokes that had more bleeding from the aspirin because it can
be hard on your stomach and had more bruising because it can
cause the blood not to clot in your arms and legs and then
youÄôll get bruises all over the place. So if yoÄôve had a
heart attack and stroke you should take aspirin, 81
milligrams, thaÄôs a baby aspirin, doÄôt get brand name
just get generic stuff. If youÄôve had stomach problems
like ulcers and gastritis use an enteric coated aspirin. But it
is true in many cases an aspirin a day can keep the doctor away.
For additional Medical Minutes from Dr. Honaker, logon to
bestdocsnetwork.com, click on Education and the Medical Minute
tab. For more information on any of the amazing doctors yoÄôve
seen today on our show, head to our website, itÄôs
bestdocsnetwork.com. LeÄôs go ahead and introduce you to our
next doctor, podiatrist Dr. Gabriel Maislos. A bunion
deformity is a deviation of the first metatarsal and the second
metatarsal so basically you know what people see of their big toe
is this. So the big toe is pointing this way and this bone
is going out this way. When iÄôs not matching up well you
get bone growth. And so bone starts to build up right here
and it also starts to build up top. I spend about 85% of my
time traveling so IÄôm in and out of the airports. As a
training manager I do a lot of facilitation so IÄôm on my feet
a lot walking and it got to the point where even flat shoes what
most people would think is comfortable shoes became
painful. Her surgery was an Austin Bunionectomy but it was a
little bit different because on the x-ray I discovered that she
had severely arthritic joint. She had fracture fragments. So
these fracture fragments never healed and because they were
constantly moving it was severe pain. It caused an enormous
amount of bone growth on the top and on the side. So I was really
excited to do her surgery because I knew it would provide
immediate relief. IÄôll be wearing a boot for at least
another 4 weeks and then Äôll come back for another
reassessment and then hÄôll determine then whether I can
take the boot off and then just start walking in normal shoes.
People always ask you know why do I have this problem and the
biggest component, genetics. So, if you look at your parenÄôs
feet or your grandparenÄôs feet, iÄôs basically telling
you that if you see a bunion forming that chances are your
feet are going to develop these structural deformities. And then
obviously for the females, iÄôs wearing the high heels.
You know, thereÄôs a price to pay for high fashion. You wear
the high heel it puts your foot in a position which predisposes
you to a bunion forming. I would love to be able to get back out
there and be pain free. A lot of times, I couldnÄôt wait for the
day to end because I would be in so much pain. So Äôm looking
forward to being able to be on my feet for longer period of
times pain free. The look on the patients face when they come in
and they see the results and theÄôre happy with the results
and they see that instead of having a crooked toe that iÄôs
actually straight and that the pain that they had before is
gone so thaÄôs the rewarding part to me. Jack from Tomball
has a question for Dr. Annie. How can airplane travel cause
clots and death? Long travel can cause venous flow to decrease so
therefore the flow in the legs can kind of pool and accumulate
and not come back up to the heart. When that happens after
patients are sitting for long periods on an airplane, a clot
can form because the blood becomes stagnant. To prevent
that we tell patients to walk the aisles of the plane,
exercise the legs even while sitting and try to stand up
intermittently throughout the flight. This will protect the
patient from having clot formation. What happens when the
clot forms is when the patient finally leaves the airplane and
gets to their destination, the clot can move and go up to the
lungs and cause sudden death from a pulmonary embolus. Very
critical to know about clot formation, very critical to
prevent it and easy to prevent by just moving, actually
sometimes wearing hose will help. And knowing the risk
factors of flying can prevent a problem when you get to your
destination. My teeth needed to all be extracted, they were
crumbling, they were breaking, I couldÄôt chew my food. HÄôs
a professional, an accountant and hÄôs certainly concerned
about finances and how to structure his budget and he was
the guy that his lower teeth were worse off than the uppers.
And so that was an area that he decided to focus on. I guess
this started in 2009 and this really happened in kind of in
two settings so that in 2009 we did the lower and in 2011 we did
the upper. The bottom is all done and Äôm in the midst of
having the prosthesis on the top done. And also with David his
concern regarding his budget. We were able to do this without
grafting. Previously in the upper jaw because of the
maxillary sinuses we would have to graft those areas in the
majority of cases that we were replacing a full jaw worth of
implants. But with the advent of cone beam CT we are able to look
at individuals from a 3 dimensional standpoint radio
graphically ahead of time so as to know where the bone is so
that we can position implants within that bone and avoid the
need for sinus grafting and subsequently lower his overall
cost significantly as well as increase the predictability. No
longer do I have to make sure that everything is in place
where iÄôs supposed to be in place. ItÄôs, I have, I have a
new chance at a brand new set of teeth and they doÄôt hurt.
IÄôs satisfying to see him come back smiling, see him
walking down the hallway standing upright with their chin
up, smiling and being much more confident so from a
psychological standpoint outside of the health benefits that you
see, the mental health benefits are significant. Äôm a CPA, I
meet with clients and high net worth clients. Appearance is
important to me, itÄôs certainly not of the utmost
importance, but iÄôs important to me and I donÄôt want to be
embarrassed by a crumbling smile. ItÄôs a wonderful,
wonderful solution. To request an appointment with any of the
amazing doctors youÄôve seen on our show today, head to our
website, bestdocsnetwork.com, go to the doctors profile page and
click on the Request an Appointment tab. And you can
even request an appointment with our next doctor, head and neck
surgeon Dr. C. T. Nguyen. The symptoms is I had headaches, a
lot of congestion and infections in the throat, a lot of mucous
in the back, ear aches, so much stuff going on. Jenice Martinez
is a patient who came to my office complaining of nasal
obstruction, facial pressure, constant headache. She has been
treated under multiple medications including
antibiotics, antihistamine, nasal spray without really,
without any good success. I went on but then I started getting
infections and I was on antibiotics for four months in a
row that they kept giving me. So I was like this is not good. So
when we examined Ms. Jenice Martinez we found that her
natural sinus drainage pathway is obstructed by chronic
inflammation, chronic infection so we offered her the option of
doing balloon sinuplasty. The best part was the breathing. I
could breathe again. The headaches little by little
started going away. Now when I sleep I would breathe real loud.
My husband would always say that and I donÄôt do that no more.
So when you have a chronic sinus disease that passage is
obstructed, iÄôs narrowed by chronic inflammation, chronic
infection. So what we do is we put a small balloon in the
passage and we open up, inflate the balloon and open up the
natural passage preserving the normal anatomy. And I donÄôt
sound like I have colds all the time. Before I was like I was
sick all the time. And now Äôm doing great. I can go out, do
everything and I feel good. One of the advantages is the quick
recovery. ThereÄôs really no down time to balloon sinuplasty.
The procedure can be done in the office under local anesthesia or
topical anesthesia with some nasal spray. TherÄôs not
really a recovery time for balloon patient. Can you know go
back to the daily activity the next day, and compared to
traditional surgery which recovery can last to a week.
Smartphones and on the go technology are on the rise
causing Americans to use headphones more than ever. But
did you know that wearing headphones for just an hour
could increase the bacteria in your ear by 700 times? I was
extremely overweight, I was tired all the time. I was a
mother of four, I couldÄôt play with my kids. I just felt
horrible. Debra is a younger person, she was morbidly obese,
but she was in a lower range from morbidly obese. She
didÄôt have a lot of other medical problems and she had her
surgery seventeen months ago, eighteen months ago. I had the
gastric sleeve done and I decided to have the sleeve done
because IÄôm a nurse and I had researched the lap band and also
the gastric bypass and neither one of those were really an
option for me in my lifestyle so thaÄôs what made me decide to
go for the sleeve. Since then sheÄôs lost all of her extra
body weight. ShÄôs actually in the normal range right now. I
think her body mass index is 23. The risk of other medical
problems merging that can lead to catastrophic events down the
line is lessened quite a bit, so sheÄôs in a much safer range.
The recovery period the first couple of days of course are the
most difficult you know. You kind of ask yourself did I do
the right thing and what did I put myself through? But I think
after about three days, I really felt good and then the first
week I had lost ten, fifteen pounds. My face looked different
already and so I got really excited. I knew that I had made
the right choice and I just kept going with it and every time I
came back it was twenty, thirty, forty pounds gone. And so by the
time a year came I had lost eighty pounds, eighty plus. She
can exercise much easier, sheÄôs consistently exercising,
she sleeps better. TherÄôs a whole bunch of quality of life
that shÄôs gotten better. I think you should be more afraid
of the long term difficulties and problems that youÄôll have
more so than being afraid of the surgery. The health effects that
being overweight has on you, iÄôs just tremendous. ItÄôs a
tremendous strain on you, your family. Whereas with the surgery
you do it and within a week youÄôre already losing weight,
youÄôre feeling better, youÄôre recovered from your
surgery. And really thereÄôs nothing to lose by doing this
procedure except for weight and you gain your life back in
return so iÄôs absolutely amazing. Welcome, today wÄôre
here with Dr. David Fish who is the director of interventional
cardiology at the Texas Heart Institute. Dr. Fish thank you so
much for joining us today. My pleasure. So we know that you
have done so many wonderful things in your career. Today we
have just a few minutes to talk about one of your great
interests is transcatheter aortic valve replacement. Could
you tell the audience what is that? Well, for many patients
especially those reaching older age, often the aortic valve
which is the main outlet valve for the pumping chamber of the
heart becomes narrowed or stenotic because of degenerative
changes of the valve. Ordinarily this is a reason to do open
heart surgery to surgically replace the valve but in some
cases the risk for open heart surgery is very high for some
patients. So for selected patients who have this problem
and who are at high risk for surgical valve replacement, now
we have techniques available and instruments available by which
we can deliver a valve into the valve position through a
catheter. Wow, that sounds very amazing. For years there was
only surgical option for these patients. Is this happening in
multiple centers? Yes, theyÄôre widespread now in the United
States. There is as yet only a single commercial valve
available and the delivery systems are large and require a
lot of expertise and a great deal of teamwork in order to
deliver successfully. We know that the great thing about the
Texas Heart Institute is that iÄôs a huge team of
cardiologists and surgeons and support services so we know that
you are one of the great teachers here at Texas Heart
Institute. Tell me what you feel about educating these students
over the years. What has been your main feeling about this?
Well, wÄôre fortunate here to have had over the years very
highly qualified, very gifted students of medicine and doctors
who come for their post graduate training in cardiology here and
among these a number selected choose to go into interventional
cardiology. That is of course the branch of cardiology
involved with putting instruments in the body and
opening arteries and correcting structural defects in the heart.
IÄôs been my great privilege to have trained a great many of
the operators whoÄôve gone on from the Texas Heart Institute
into the community and to other places in the country and
brought forth the skills theÄôve learned over there. I
know that you have been my favorite teacher in all of my
career and I thank you in front of the world for being such a
fabulous teacher about cardiology and about life.
YouÄôre very kind. Thank you. We just have a few more moments,
what would you like to tell the public about the Texas Heart
Institute and perhaps getting their evaluations done here?
Well the Texas Heart Institute has a long tradition of
research, patient care and of course teaching. And in this
kind of environment I think patients get the best possible
care and most astute kind of understanding of their problems
and their specific needs. In addition of course with critical
mass achieved here with all of the different researchers and
the different clinical efforts and the different programs every
patient has a chance to get the very best of what cardiology has
to offer. Well we thank you so much. YouÄôve been such a
tremendous force here in the Texas Heart Institute and in my
life and I want to thank you. Thank you. To check out hundreds
of videos on all the doctors youÄôve seen on our show today,
head to our website, itÄôs bestdocsnetwork.com. Something
as simple as a smile can really brighten your day. LeÄôs
introduce you to cosmetic dentist and smile specialist Dr.
Guy Lewis. I had, the 4 front teeth were very crooked. Two
were going forward, two were going backward. I found I had to
wear braces for quite a few years and that just wasÄôt a
good alternative for me so I did some research. I doÄôt know if
thereÄôs cosmetic dentists up there, Äôm sure there are but
I just didnÄôt investigate it but I did investigate this one
and thought well this is as good as any. So I did some research,
checked into it and here we are. Well Ken had come from
Cleveland, Ohio. So he sent me a lot of pictures and stuff before
he came and I knew I could help him out. And so he came in one
night and got here late and we stayed and took care of him,
prepared his teeth, made him some temporaries that looked
fabulous, let him go home and then came in and we put them on
him. HeÄôs just been really happy with them and it made a
big improvement on his smile. I spoke with Christine quite a
bit, more of a consultation type of format because obviously I
kind of skipped a couple of steps in the process because I
live so far away, but very helpful. Christine kind of
explained the process, what was done, whaÄôs going to be done,
how it works, I mean getting the quotes and pricing and
everything so it was very consultive, very helpful. We did
prep veneers on him but it was not extensive. I mean just
because you have to prep the tooth doesnÄôt mean you have to
take it down. A lot of people think oh yoÄôre going to have
to take my tooth down to a little nub or something like
that. No, sometimes iÄôs just a matter of a little smoothing
that is very, very minimal. I was getting pretty
self-conscience of when I would laugh or smile of putting my
hand over my face because I would just you know thaÄôs
funny something like that and what I found itÄôs a, itÄôs
somewhat liberating to the point where I find myself not doing
that any more which is nice, I mean I actually when I smile for
a picture with my family, my kids I actually smile instead of
you know kind of half smile it. TheÄôre always making fun of
me for that, so. Very happy with the results, the staff is very
professional, they obviously know what theÄôre doing. The
results are fantastic, really are. It doesnÄôt have to be a
trip to the dungeon. It doesnÄôt have to be
uncomfortable. I would just say you know come in and experience
it, see for yourself. It really, it really can be very pleasant.
For additional Medical Minutes from Dr. Honaker, logon to
bestdocsnetwork.com, click on Education and the Medical Minute
tab. You know I just always felt like my body was out of
proportion. When I would try on clothes I just, it was never
when I looked into the mirror what I envisioned in my own
mind. So I guess thatÄôs what prompted me to start researching
and looking on line. I just, I never felt like my full
potential. Karen came in just wanting to have bigger breasts
because she had always felt that her breast size was out of
proportion to her hips. She had always wanted to be a little
bigger. She just felt she needed it to kind of balance out her
shape so she was, after discussing it with her, a really
good candidate for that. As soon as I met his staff and him, I
know he had that attention to detail just speaking to him.
Something about him set him apart from the others. He just
made me feel safe. I knew I could trust him and his work. So
thereÄôs a lot of factors that go into it. By taking the
measurements and using them carefully to that particular
patient and matching it to the size of the implant, we can give
them a good aesthetically pleasing size and shape that
looks good and matches their body. It was an outpatient
procedure so I came in that morning, the same day I was out
and back at home. It was a really good experience. It
really made a huge difference in her confidence and self esteem.
It may seem like a small thing to someone who didnÄôt know her
or just a casual observer but in her mind it made a world of
difference. It just really changed her personality. It kind
of brought her out of her shell, she just felt better in a
bathing suit and photographs, just being out socially so it
was a real blessing for her over all. Before my breast
augmentation I was wearing a size A and after the
augmentation I was a C. I had already decided I wanted a very
natural look and thatÄôs something thaÄôs very
important to me. That is what Dr. Altamira gave me, a very
natural look and Äôm very happy with the results. It is so
great to see these doctorÄôs really changing peoplÄôs
lives. ThatÄôs going to wrap up todayÄôs show of Best Docs
Network. And for more information, head to our
website, itÄôs bestdocsnetwork.com. And if you
have a question or a comment we love hearing from you, send us
an email at [email protected] IÄôll
see you next week.

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