Best Docs Network Houston June 23 2013

Best Docs Network Houston June 23 2013


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,
I’m Dr. Annie Varughese and welcome back with another edition of the Best Docs Network featuring
some of the best physicians in the Houston area that have helped change people’s lives.
We have a fabulous show for you today again and let’s learn more about our first doctor,
Dr. C. T. Nguyen. He’s an ENT surgeon helping people to breathe better. So many of our people
in Houston especially have allergies, have sinus problems. Let’s see how he has helped
many patients in his practice. Originally I was having a lot of sinus pressure, pretty
much all the time I had sinus pressure. And I had a lot of headaches, I would have sinus
infections pretty much back to back. I’d have several sinus infections a year. Amanda has
consulted multiple ready clinic, urgent care that does not really address her problem.
All they did was to refill her prescription of antibiotics, gave her some antihistamine
and tell her to go home. What they do is they treat her symptoms instead of treating the
cause of her problem. He basically just looked at my nose and kind of tried to figure out
what the problems were based on the symptoms and he noticed immediately that my turbinates
were really big. The inferior turbinate, it’s a normal structure in your nose that everybody
has. It has a role of filtering and humidifying the air that you breathe in. So it becomes
enlarged and enflamed when it is irritated by either allergies, infection or pollution
in the air. Considering her busy schedule we decided upon two prong approach treatment,
balloon sinuplasty in office to treat her sinus issue and inferior turbinate reduction
to relieve her nasal obstruction. I don’t really have any more sinus issues. I haven’t
had a sinus infection since the surgery and it’s been a few months now. The advantage
of balloon sinuplasty is that it can be done in office. There’s no general anesthesia,
the cost is less than doing it in the hospital and the recovery time is really quick, there’s
really no down time. The patient can go back to their daily activities quickly. It’s actually
kind of funny. There’s a lot of things that I didn’t realize were issues until after the
surgery. I know one time I was sitting in my bathroom and I was sitting there and there
was a candle about two feet away from me and I actually could smell it. That was something
that I have never done before and it kind of just hit me. I was like, I can actually
smell that candle. Welcome, today we’re 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, they’re 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 it’s 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, we’re 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. It’s been my great privilege to have trained a great
many of the operators who’ve gone on from the Texas Heart Institute into the community
and to other places in the country and brought forth the skills they’ve 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. You’re 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. You’ve been such a tremendous
force here in the Texas Heart Institute and in my life and I want to thank you. Thank
you. On a day to day basis I was experiencing chronic pain, chronic migraine all day, 24
7. I’d wake up with one, I’d go to bed with one and it would never go away. I tried everything
from acupuncture, a chiropractor, nerve blocks, spinal tap and there was no relief with anything.
When Jennifer first came in she was 17 years old, had been totally debilitated by her headaches.
Had been basically housebound, was homeschooled, hadn’t been able to do all the normal stuff
teenage girls do during high school just because of her chronic, daily pain. And so we talked,
decided she was a good candidate for the trial and then when we did the trial when she came
back several days later, she’d been almost essentially pain free from the time we put
the trial in to when she came in to take the trial out. The five years I experienced chronic
migraines I you know was completely limited, I couldn’t do anything. Stuck at home, dark
bedroom , cold room, the typical I’ve got a migraine, don’t talk to me irritability,
everything. We’ve been using stimulators for chronic back pain for 30 years or so and Dr.
Reed decided one day to somebody with headaches to try putting a stimulator over the peripheral
nerves that supply the, around the scalp and the patient had really good relief and that’s
how it all kind of got started. Now to have a procedure that gives people either complete
relief or 80, 90 percent relief that was real dramatic and that was you know, just the stories
you get back from patients was what makes it worthwhile. I can, I can do anything. I
feel like I can experience anything, my pain isn’t holding me back. I’m you know going
to school, experiencing life to the fullest as where I wasn’t before. The neurostimulator
completely gave me my life back. My life is completely changed. I’ve done a 180 and I
feel that I can experience anything because I’m pain free. So many of us have problems
with our feet, we stand on them all day long, they hurt. We’re complaining of painful feet
and legs. Dr. Gabriel Maislos has answers for us with regard to foot problems. He’s
a podiatrist here in the Houston area and he has a special story for us today. Let’s
watch and see how this can benefit us. I came for treatment of my toenails most of all but
all my nails, all my toenails were bad, really bad. They were in bad shape and they were
discolorated like some white stuff on them. How to say they were disattached from the
nail bed in one place especially and it was kind of yellowish too. Inna came to my office
complaining of fungal toenails, very common thing especially you know you see it in summertime,
it’s very prevalent. It’s a fungal infection of the nails, the nails are discolored and
she wanted them treated. I keep my body in shape and I want to be healthy and I want
to have you know everything perfect so it’s one of the things when I found out that something
is wrong I couldn’t go for some time because I was busy, busy, busy but I talked to myself,
no I have to. It’s basically a YAG laser and it creates this intense heat and it kills
fungus, bacteria, virus and it kills it at the root of the nail. That’s where the nail
begins. From that point on we have a protocol in place that prevents recurrence because
most of the problems that have occurred in the past is even prior to the laser with the
oral medication, you would get rid of the fungal infection and then it would come back.
So you also have to do your part to make sure that you don’t get a recurrence because once
you’re susceptible to fungal infections you remain susceptible the rest of your life.
I figured out that I have good results because when I could see my nail grow or my nail growing,
the new nail will come pretty and it doesn’t have anything. Like no fungus nothing, no
discoloration. It was pretty and nice and healthy nail. The risk of a fungal infection
is not just of appearance and so you don’t want to wait on it. You want to make sure
you come in early because you don’t want to go to that severe category where you might
require multiple treatments. It’s better to treat it early on and not only that the nails
when they become fungal they become yellow, thickened, discolored, hypotrofic and you
can develop ingrown toenails. That’s a serious risk because you know that’s an infection
and that requires a surgical procedure. I got new nail bed, new nail and it was pretty
healthy. There are three kinds of skin cancer. There’s squamous cell carcinoma. That’s the
kind that occurs in scaly legions that grow in size, usually in the sun exposed areas.
There’s basal cell carcinoma. Those are grey and pearly with sort of heaped up, raised
borders usually again in sun exposed areas. The most important and most dangerous skin
cancer is melanoma. That’s what occurs in moles. We use the ABCD rule to decide if a
mole or skin lesion looks like it’s bad. A for Asymmetry. If the lesion doesn’t look
perfectly symmetric then that’s a bad sign. B for Border. An irregular border is a bad
sign, a regular border is a good sign. C is for Color. If a uniform color occurs in a
mole that’s good. If there’s multiple colors or irregular colors or a change in the color,
that’s a bad sign. Diameter. Six millimeters is the magic number. Anything bigger than
6 millimeters is bad and that’s about the size of an eraser. So take good care of your
skin, you only have one layer. 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 doctors you have seen on today’s show, go to our website bestdocsnetwork.com.
Now it’s time to head to our next doctor, Dr. Stephen Rose. Dr. Rose has been a radiologist
here in the Houston area for many years. He has a special interest in the early detection
of breast cancer. Watch this segment as we see how Dr. Stephen Rose has helped many women
in the Houston area with regard to evaluating and treating breast cancer. After having met
with Dr. Rose, toured the facility and saw the importance of the work on the early detection
side I was compelled to do something more. It’s kind of like once you have knowledge
to do something then you have to move forward and make sure that others know about it as
well. There’s several things that we’re looking for the foundation to do. One is continue
to fund important research. There’s always going to be more things that we can learn
and do better. The number two thing is to be able to educate both other physicians and
the community, especially the community so that people begin to understand and participate
in the process of screening because the sad thing is in recent years screening mammography
especially in younger women has decreased and now I see women show up who haven’t had
their mammogram and they have more advanced tumors. I hate seeing that. We also want to
try to be able to raise enough money to do more indigent care as well for those who need
additional care. So those are the three main areas we’re targeting. What I love most is
the fact that we’re educating other radiologists to read these mammograms so that we can spread
the word quickly and also the amount of anxiety that the results of these tests provide. Very
few people really realize that almost all of the breast cancers are detected in the
community. They’re not detected at facilities like MD Anderson for the most part because
most people are referred with the diagnosis there. So the research foundation was based
on that idea that we could fund research in the community and do things that weren’t being
done elsewhere. Our work is so important. I feel that we can take a big bite out of
breast cancer incidences if we can move forward with this early detection. Women who are vigilant
about having their mammograms annually, using a 3D tomosynthesis procedure can certainly
help themselves and not just for women who are insured but we would like for every woman
to have this available to them. For addition health information, be sure to check out our
Healthy Living blog for the best tips, latest medical procedures and up to date news for
modern medicine at our website at bestdocsnetwork.com. Coronary artery stenting is a part of interventional
cardiology that I absolutely love. It’s been around for about 30 years now. Initially the
great giants of cardiology formed a cardiac stent which is just a metal mesh that we place
on a balloon catheter, place it into the coronary artery that’s obstructed, open it up, leave
the stent and remove the balloon and the catheter. Easy procedure, but years ago it was quite
difficult and catheters were larger, there were a lot of bleeding problems but now the
catheters are quite small, the procedure is fast, done quickly and without much discomfort
at all for the patient. If a patient presents with coronary artery blockage, they can go
to the cardiac catheterization laboratory, have the coronary angiogram procedure done
and then if there’s a blockage, we can place a stent right at the same time. Coronary stenting
has protected many patients from going to cardiovascular surgery, has improved lifestyle
and many patients have gone without symptoms for many years because of coronary stenting.
We thank the developers of coronary stenting and we look forward to a future of great developments
with regard to the coronary stent. This is such a fabulous event, it’s called Go Red
for Women and it’s putting together women from the community, physicians, hospitals,
everybody supporting women and heart disease and the awareness for women to protect and
support. Even children can benefit from this event so I think it’s so fabulous and that’s
why I wanted Best Docs Network to really talk about it. My speech today is going to be about
how I’m dealing with heart disease and how to have an optimistic and positive attitude
while going through something or anything difficult in your life. I keep laughing, I
keep smiling, try to stay positive about things. I could be stuck in the hospital but instead
I’m home with my family. The biggest way to prevent these problems is education. So the
main reason for this type of event is to educate and through that we raise funds and can get
the word out. Number one, it educates people on what has happened over the last several
years and it brings to the forefront with women in particular with Go Red for Women
to listen to your body and know your symptoms. The most important thing about cardiovascular
disease is it’s the number one killer of women in this country and 50 percent of women or
men with cardiovascular disease die suddenly without any symptoms, without any warning.
I just believe getting the word out to women especially, we always are tired and rundown
and raising kids and going here and there and we might just think oh we’re just tired,
my neck hurts for some reason and it’s no big deal but it can be a sign of a heart attack
or a stroke. Women you know and they’re as we know as men are different and they present
differently. Fortunately stroke type symptoms are about the same but again another large
focus for us is heart disease and they are completely different in the way they present
as a general rule than men. Cardiovascular disease and the awareness for women is such
a tremendous topic and that’s why Go Red for Women is such a marvelous cause and I just
want everybody to support it. For numerous years I’ve had varicose veins. I’m a registered
nurse and so I have been on my feet for twenty years and also heredity has played into that
and so just a lot of varicosities and some pain, aching if I’ve been standing on my feet
for a long period of time and then just unsightliness. Varicose veins are a symptom. They’re a sign
of an underlying disease or abnormality in the venous circulation. In your legs there
is no heart to pump the used blood back up so the pumps are your muscles and when the
veins become too large and one way check valves have failed now all the pumping doesn’t work
and the blood pools in the legs, it creates high pressure which results in bulging, enlarged
veins that we call varicose veins. My dermatologist recommended Dr. Morgan and he was very forthcoming
with information. It wasn’t a lot of extraneous things that I didn’t understand, it was very
to the point you know exactly what he could do for me and what the benefits, what the
side effects and it gave me an opportunity to just weigh the pros and cons of whether
I wanted to go forward. The treatment is to close all the veins that are running backwards.
Any vein that is not pumping up out of the leg is only hurting, it doesn’t help and so
by removing or closing those veins you restore the circulation out of the legs back to normal.
The procedure itself probably took 30 to 45 minutes. I was able to get up off the procedure
table right afterwards and walk. I did have improvement and cosmetically which is a wonderful
side benefit but I also have decreased swelling, decreased aching, really it’s very minimal.
She got a great result. Her swelling has gone away completely, her pain has gone away completely
and her varicose veins have gone away completely as well. I decided to come see Dr. Marvin
because I struggled with weight my entire life. Well, Amanda’s a fairly young patient.
She was in her mid 20’s when she had the surgery. She did meet the national institute health
criteria for weight loss which means that her body mass index was 41. She was morbidly
obese. She wasn’t manifesting too many other medical problems related to her weight yet
but again she’s on the young side so she had some lower extremity swelling and those kinds
of things, tipoffs that things aren’t quite right. I was very uncomfortable. I was like
one of the only heavy people in my group of friends. My husband is very lean and active
so it had a lot to do with our lifestyle and I wasn’t able to go to the pool and I didn’t
want to wear sleeveless shirts or when my friends went out to the club I didn’t want
to go to the club. So it had a lot to do with my age and I wasn’t able to live life. Amanda’s
lost from 240 pounds down to 128.5 pounds and that’s a very significant weight loss.
That’s great, that’s a very good outcome for a gastric sleeve. The recovery for me was
pretty simple. I took two weeks off of work. I could have gone back within 5 to 7 days.
I get emotional, it changed my life. Just wearing sleeveless shirts, being able to dress
like everybody else, being able to spend time with my husband and go to the pool, and just
be active. A lot of people started to talk to me again because I wasn’t friendly whenever
I was heavier. I was angry, I didn’t want to do anything, I was like a hermit. So my
response is I mean, they want to know how I did it and I’m very open about how I did
it. I was like you know I had this surgery. I couldn’t do it myself. I could not do it
without the surgery, could not have done it. My patients, since obesity is a systemic disease,
when we cure it for them they get better on so many fronts. It’s nice to see how they’re
doing afterwards. They really are changed people. The need for vaginal rejuvenation
isn’t always talked about, but it is a common problem. Dr. Imtiaz explains why. For a lot
of women once they’ve had children, they feel that sex is not the same as it used to be.
They don’t have control during intercourse, they don’t find pleasure during intercourse
and internal most patients would say that they feel loose. If a woman feels loose then
she has the option of having a vaginal rejuvenation done. It’s a procedure where I would reconstruct
the pelvic floor muscles and also tighten the vagina in order to give her better sensation
during intercourse. Appearance can also be a cause for surgical intervention. If a woman
is concerned about aesthetically the way she looks, that surgery can also be done. As a
vulva ages you may notice wrinkling or loose skin on the outside or some women even as
young women notice that the shape of the external genitalia is not pleasing. But age doesn’t
necessarily determine the need for vaginal rejuvenation as young women are sometimes
candidates as well. It’s not uncommon for me to see a patient who’s young, maybe even
in her late teens who has labia minora that are so elongated that she’s embarrassed to
wear a bathing suit and it changes their life when you can improve the appearance and give
the woman a confidence that she may be needing. Thanks to Dr. Imtiaz and her vaginal rejuvenation
procedure, her patients are living a fuller, more confident life. But vaginal rejuvenation
in its true sense is more for tightness and function but we can also change the way you
look. Well we hope this edition of the Best Docs Network has helped you to learn more
about disease affecting many organs in the body and how we can prevent, evaluate and
treat these diseases. We featured some of the best physicians in the Houston area that
have helped change people’s lives. For more information for any of the fine doctors that
you’ve seen on today’s show, head to our website at bestdocsnetwork.com. If you have a question
or comment for us, we’d love to hear from you, send us an email at [email protected]
See you next time.

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