Best Docs Network Forest Park Medical Center April 14 2013

On this edition of the Best Docs Network featuring Forest Park Medical Center, Dr. Michael Musacchio, Dr. Clayton Frenzel, Dr. Timothy Trone, Dr. John Dulemba. Hi again everyone, I’m Kandace Krueger along with Jim Knox and we’re back again with another edition of the Best Docs Network featuring Forest Park Medical Center. Of course Forest Park Medical Center is one of the best medical centers in all of the Dallas Fort Worth area. Yes indeed Kandace and some of the best doctors in the entire Dallas, Fort Worth area operate here out of beautiful Forest Park Medical Center, like our first doctor, Dr. John Dulemba. Many patients when they first hear the concept of robot, they go I want my doctors hands to be touching me. Well we haven’t been touching the patient for a long time. We’ve been doing laparoscopy and even doing other types of incisions our instruments are touching the tissue not our specific hands doing that. With the robot, I’m sitting at a console probably 10 feet away from the patient but the instruments and the camera that I’m looking for, it’s as if I’m immersed inside the abdomen. You don’t even think that you’re away from the patient. I feel like I’m inside. So it’s almost like an airline pilot doing flight simulator flying or jet pilots doing fighter simulation. You are in that abdomen and it’s 3 dimensional. Everything is magnified 10 times so whatever disease process you’re looking for it’s right there in front of you and you can treat it and deal with it in such a great manner. So when we get in we can cut out and see a significant more amount of endometriosis with the 3 dimensional aspect of the robot. The precision, we can scale our movements down, we can sit and relax versus standing up and being very uncomfortable. The instruments that we have have wrist actions where the standard laparoscopy is just a straight instrument. So there’s so many different tools for addressing what might be causing a woman’s pelvic pain. So when we get in there, a woman wants us as their expert to be as accurate and precise to find out what’s causing their pain. The robot is a wonderful tool to address those issues. So when patients have their hysterectomies or they’re having surgery for endometriosis or having fibroids removed or prolapse repair, when you do it robotically those patients will have somewhat less pain and will be able to function back at their normal functions than they would having other procedures done to them different ways. This is what’s called the Medtronic O Arm. It’s a combination of traditional fluoroscopy with also a 3 dimensional imaging component. Within 26 seconds it will take 755 high definition images. With the O Arm we can actually take shots of the spine in a 3 dimensional nature because the spine is a 3 dimensional structure and the value of that to a surgeon is that they can now see the spine in 3 dimensions and truly be able to determine with precise accuracy their placement of the hardware. The device also enables minimally invasive surgery by more precisely placing the screws he’s going to be able to allow the patient to have a quicker recovery time and hopefully have a better quality of life post surgery due to the more accurate placement of the hardware which the O Arm enables. We have the O Arm itself which collects the images, we have the viewing cart which the images are reconstructed on and then we also have the stealth navigation image guided surgery unit. After the images are recreated on the spinal navigation unit the surgeon is able to bring different surgical instruments into the field that will help him more effectively place the instrumentation into the patient’s back in a 3 dimensional nature. Because this device is used interoperatively the surgeon can use the image guided surgery unit to do the remainder of the case without additional radiation being delivered to the patient. The benefit of that is to the patient that they will potentially not need to be sent for a postoperative CT to check the final placement of their hardware since they’re able to do that real time in the operating room. Best Docs Network featuring Forest Park Medical Center, welcome to the twenty first century of cutting edge medicine, Forest Park Medical Center. We’re ground breaking for Forest Park Medical Center here in San Antonio. It’s a new 54 bed facility here in San Antonio. I think the outstanding piece of this is just the quality of care that we can bring to San Antonio. For the insured patient here it’s just going to be outstanding. The quality of care that Forest Park offers as you know this is the fifth facility that Forest Park will offer. We have a facility in Dallas and Frisco. We’re about to open in Southlake. You know I personally think that it’s the quality of care that sets Forest Park apart from our competitors here in San Antonio. The greatest thing about Forest Park really to be honest with you all is the people in this room and the people that we touch have an opportunity to secure their own future and when you travel around the rest of the world and you see how healthcare exists you kind of have a future, a vision of what’s going to happen to us in the United States. There’s going to be a healthcare system for the vast majority of people and those who want something different need to have someplace else to go and we need to have physicians to treat those people who want to have someplace else to go and those physicians are in this room. And we have an opportunity to affect very positively on the healthcare for the future and the way we take care of patients. In addition we also have the opportunity to secure the future of ourselves, our practices and also that of our families. We all believe in excellence, we all believe in delivering the best healthcare at the best possible price in the best environment to our patients and we want to make sure that our families have a place, our friends have a place and our patients have a place that we think is as good as the place that we want to live in. Thank you very much for being here and we look forward to this hospital. Today’s Ask the Doctor comes from Eric. Eric has a question for Dr. James Davidson. The question? How soon after bariatric surgery can I expect to see my diabetes go away? People ask how fast is their diabetes going to be improved with either a bypass or a sleeve. The answer is it’s going to be improved faster with a bypass and they may if they don’t have real severe diabetes, they may leave the hospital throwing away their Metformin or their diabetic pills. With a sleeve it may take longer. It may take a few months to both have a little weight loss and have a cumulative effect of the metabolic changes from the sleeve to resolve their diabetes. So my recommendation is if somebody wants to resolve their diabetes as fast as possible you’re probably better off to have a bypass. While I was in Texarkana I had numerous tests because they had thought that it might be ovarian cancer and when I went in Dr. Oh looked at all my records from years past and he said from everything that he was seeing in my counts from my blood counts, it really didn’t look like I had cancer but he assured me that if it was cancer they would get it all in that one operation. If it wasn’t he told me he said we will go in and do a total hysterectomy, you will be going home the next day. When we say robotic surgery, the robot is just a very fancy, very expensive laparoscopic tool so it’s about a two million dollar machine that we use, the surgeons use to assist us with laparoscopic surgery so truly it’s laparoscopic surgery but it’s using a robotic system so the surgeon is still in complete control of the system. So when I went in for surgery, it was absolutely very easy in that they made it all so easy for me, they took care of me not feeling so anxiety ridden. I’ve personally been doing robotic surgery since 2008 and for me it’s been a game changer for my patients. And when I woke up the first thing they said to me was Mrs. Wright you do not have cancer. And at that point I was so ecstatic. In the past for a lot of patients with uterine and cervical cancer, those patients required very large incisions, many weeks to months of recovery time. Now a days with robotic surgery, they are able to get out of the hospital usually in less than 24 hours. By noon the next day I was packing my things, my belongings and headed back home to Texarkana. You would have never known that I had a major surgery. I was able to get up, sit down, get in and out of a car. I owe a lot of that to Dr. Oh’s knowledge, his expertise. I just can’t say how wonderful it was to experience such a painless operation that I had witnessed 30 years earlier with my mom and sister that was much different. Now let’s get to know our next best doctor, it’s ENT Dr. Timothy Trone. Sleep disorder breathing or commonly known as obstructive sleep apnea is a fairly common debilitating and sometimes life threatening condition that afflicts a fairly significant fraction of the U.S. population. The term apnea refers to the cessation or the slowing of breathing for 10 seconds or more and is frequently noticed by the bed partner as gasping or choking the patient. My wife would say, sometimes I think you’re dying, you know and I’d ask her why and she’d say because you’d be breathing real heavy and then all of a sudden you would just stop. As this airway space narrows and the most common reason is during sleep the individual loses muscle tone. When that patient loses muscle tone, the tongue falls back in the airway. The procedure that I commonly perform, and it was performed on Mr. New is what is referred to as the tongue and hyoid suspension. The tongue and hyoid suspension utilizes a device that inserts screws in the inner surface of the mandible. These screws have attached to it a very strong suture called prolene and that suture is placed around the hyoid bone. The hyoid bone is attached to the lower base of the tongue. This brings the hyoid bone closer to the mandible opening up the airway space. In addition, there is another suture that is passed within the tongue and that holds the upper base of the tongue. Now it’s just, you wake up, you’re refreshed because you have you know gotten sleep. I noticed after my surgery, I fish a lot, when I got on a boat the wind would go through my nose and would just be going down the back of my throat because now that passage is open. It was just a totally different feel than you know you've ever felt. There were lots of times when I would fish before, that I’d be like I’m just too tired to go and now it’s not like that. If I get a chance, I’m going even if it’s just for a little while. Wes, a local store owner had cancer and he credits Dr. Sharon Gregorcyk for saving his life. To find out more about Wes’s story and other life changing stories, logon to bestdocsnetwork.com. I’m joined now by one of the founders of Forest Park Medical Center and top bariatric surgeon, Dr. Wade Barker. Dr. Barker, thanks for being with us today. Oh, thank you. If you would start out by talking to us a little bit about what made you decide to practice medicine and specifically bariatrics. Medicine is actually kind of a story that started in high school. I really didn’t like school to start with. From first grade I missed school, didn’t want to go and never thought I would go another thirteen years after high school. But in high school the valedictorian was going to be a doctor and my pride was well if he can do that I can certainly do that and so it was really a pride thing that got me interested in medicine and fortunately I enjoyed the science and I enjoyed you know biology and chemistry and so it just was right down my alley. And what’s the most rewarding part of your job? Seeing the results for patients and really getting a thank you, you know and a lot of fields and in medicine in general that’s your job to take care of the patients and do things correctly and so people expect that. But in bariatric medicine they are so grateful that they always remember to say thank you and tell you, not just thank you but how you’ve changed their lives. And in a lot of times, save their lives. Realistically that is true in the short term and in the long term in many cases. You’ve obviously been an integral part of the development of Forest Park. How did you come to the vision of Forest Park Medical Centers? Well, it really started in the O.R. Dr. Toussaint and I worked together every day. We worked long hours and the hours were so long because towards the end of the day all the hospitals would start sending the nurses home at three o’clock and so we would go from two rooms down to one room and it slowed things down so we would do eight cases in the first half of the day and then only be able to do two cases or three cases in the second half of the day because it slowed down. It just didn’t make sense. This is what they did for a living, this is how they, this was their business and they were basically shutting us down so we thought we could do it better. And so it really started as efficiency and being able to do what was best for the patient you know. If you have a patient that comes in at ten in the morning for a one o’clock surgery and that gets put off till six, seven at night because they’ve shut the O.R. down, that’s not good for anybody and so it really started from a practical manner. What do you say to a patient to tell them how much better Forest Park is and why they should have their procedure done here? I think we do it better. I think we do it more efficiently and I think the patients have better comfort. Thank you Dr. Barker, we appreciate your time. Thank you, Kandace. And stay tuned as we meet another Forest Park physician that is changing people’s lives. Don’t forget for more information on any of the outstanding doctors that operate right here out of Forest Park Medical Center, head to the website bestdocsnetwork.com and click on the Forest Park Medical Center tab. And now let’s get to know our next best doctor, it’s bariatric and cosmetic surgeon, Dr. Clayton Frenzel. The Brazilian butt lift has become quite a popular procedure over the last few years. It addresses multiple procedures in one meaning that essentially a Brazilian butt lift is usually full body liposuction to get the fat and then you re-inject it into the buttock area to give the buttock a nice, round fuller appearance. The person that would be a candidate would be somebody that wants a fuller more rounded appearance to the buttock. Somebody that feels like their buttock is flat and doesn’t have a lot of shape to it. I wanted, actually I wanted my stomach to be flatter and then I wanted my butt to be bigger. Whenever I exercise to lose weight, the first thing that went was my legs and my butt. And then the last thing to go was my stomach. The procedure is done in one setting, usually takes about 2 to 3 hours to do and it also depends on how much fat the patient has. Obviously we’re using the fat to put back into the buttocks, so if somebody’s very slender sometimes it can be a problem to get enough fat. I wanted it removed from my upper back, my lower back and my stomach. It doesn’t feel like there’s anything like how implants are. It doesn’t feel like there’s any implants or anything, it’s just, I mean it feels real. Her results were very good. She got a nice appearance from the liposuction. We injected about 450 cc’s or somewhere around there of fat in each buttock which gave the buttocks a very nice, round appearance. So I’ve had a lot of people notice. Actually last night whenever I went shopping to get some shorts for the summer this girl was like, oh I wish that my butt looked like that in those jeans, you have a really high butt, that’s good. I sit down with them in a very personal consultation and discuss the potential results I think I can get on that particular patient based on how much fat I think I can harvest from various areas of the body. And then I usually find one of my patients that has a body shape very close to what they are and show them pre-op and post-op pictures. Dr. Frenzel made me feel really comfortable as one of his patients. I’ve had other surgeries, I mean if I could turn back time I would actually go to him because I just like the environment and I like the way that they care about you and It’s just an overall good experience. Today’s ask the doctor comes from Jessica. She has a question for Dr. Brian Barnett. How does a fertility specialist work in conjunction with OB/GYNs? We work with them on a regular basis. In fact our two biggest referrals are previous patients and the local OB/GYN’s. So it’s very common that when women try and start a family, they commonly go to their OB/GYN first and they often initiate some of the workup and if those patients are not able to conceive through their local OB/GYN, choose basic treatments or require more advanced treatments they then refer those patients over to us. But at Dallas IVF we’re a full service infertility practice, we don’t deliver babies anymore. Our goal is to get these couples pregnant in a timely manner and then they return to their local OB/GYN’s to initiate their prenatal care. I was at my fitness center and I was playing basketball and I was reaching out to get the ball and somebody’s forehead actually slammed into the bridge of my nose and broke my nose immediately. I immediately knew I broke it because I heard a pop. Often patients come in and maybe either seen previous doctors or oftentimes had previous surgery where its been inadequate in assessing those outside parts of the nose so when we see the patients we obviously take a very careful history from them and do a careful examination. And if we determine that they have a problem in which the outside portion of the nose is contributing to their obstruction that’s typically when we recommend functional rhinoplasty . I noticed that I was having breathing problems. Throughout the day I would notice that I’m struggling to breathe and especially at nighttime while I’d be sleeping I would wake up in the middle of the night sometimes and just gasp for breath and I have never in my entire life had problems like that. The surgery is highly individualized based on the patient’s individual problems. It can last anywhere from an hour and a half to four or five hours sometimes depending on the complexity of the problem and the patient’s individual history. Have they had previous surgery? What types of collapse are they having? How much cartilage do they have left over in their nose and do we need to reconstruct that possibly with even cartilage from elsewhere in the body? After the surgery I woke up and I had the splints, I had the bandages on the nose so I was not able to actually breathe directly after the surgery. The recovery period I think was around 2 to 3 days for me. Although there is some discomfort associated with the surgery, most patients by a week or two after surgery are very glad they’ve had it done. Not only are they breathing better, but they’re pleased with the outside appearance of the nose. A week after the surgery he removed the splints and the bandages on the bridge of my nose. That’s when I took my first breath and I immediately knew that something has changed because I was breathing out of both nostrils which I’ve never done before in my entire life. It was a life altering experience. I remember I was at his office and I was just so happy and I think I gave Dr. Pero a hug. For more information on any of the outstanding doctors that operate right here out of beautiful Forest Park Medical Center, head to the website bestdocsnetwork.com and click on the Forest Park Medical Center tab. Right now it’s time to head to our next best doctor out of Forest Park Medical Center, it’s Dr. Michael Musacchio. I had been having a lot of pain mostly in my left shoulder and in my left back area for about a year. More and more it was where I couldn’t lift my left arm and then I just started feeling some numbness and tingling in my arm. Denise came to see us because she was having severe pain starting in her neck and traveling all the way down her left arm with some numbness and tingling and actually weakness and had been going on for quite some time and she actually sought us out for minimally invasive options and options beyond the more traditional spine surgeries. I went for about 8 weeks of physical therapy and the pain kept getting worse. I did go see Dr. Musacchio, I did a lot of research on him about his outcomes and the minimally invasive technique that he did and so after a lot of research he was my top choice to go to for this procedure. We did get an MRI and her MRI showed that she indeed had herniated a disk and was pinching a nerve in her neck and that was causing this pain and disfunction in her arm and was very troublesome for her. A good surgical option that we offered her was a posterior cervical foraminotomy from a minimally invasive approach. And what that means is from the back of the neck we could go in with a very small incision and a small set of tubes to preserve the muscles and to limit the amount of tissue disruption to actually get to the spine and unpinch the nerve by removing disk tissue and small bone spurs that were pinching the nerve. I love to ride horses and that is one of my biggest passions and it had become to where it was interfering with my ability to hold the reins. I think Dr. Musacchio was a little surprised that I put him on track for having the procedure, when the recovery was and when I could get back on the horse. Immediately after the procedure I did have feelings back in my hand. Each day it gets better and stronger. And with Denise she was back riding her horses within a couple of months and that’s the most important thing and really satisfying for both the patient and myself that we can see a patient get better that quickly with such an easy process. I feel great, Dr. Musacchio has been great. I go back for a follow up every couple of months and each time it doesn’t change. He is just as engaged in the treatment as what he was on the first time that I did see him. Best Docs Network featuring Forest Park Medical Center, welcome to the twenty first century of cutting edge medicine, Forest Park Medical Center. The prevalence of skin cancer is increasing especially since we live in Texas and a southern state. Just the amount of sunlight exposure is greater than say if you lived up North and those who are susceptible can get skin cancers. The most common ones are generally less aggressive. They’re called basal cell cancers. We have some more aggressive sub types such as squamous cell and then the deadly killer which is melanoma. Fortunately that’s more rare. Back in 08 I had a little spot that was biopsied and came back positive as basal cell carcinoma. When I met Dr. Ha he said that he would have to do a skin graft using a piece of tissue from my ear. That surgical procedure worked out really well, scary at first, but it turned out really well. This year in May there was another spot on my nose. In Dottie’s case she had a skin cancer on the tip of her nose which is a very challenging location because there’s not an easy way to just bring the edges of the defect together without creating a lot of distortion, so, you’re left with some of the other options. Well skin graft on her was not a great option because of the depth of it, it was going to heal with a divot something that would have been very noticeable. So really we’re left with a more complex option of doing a nasolabial flap or borrowing tissue from the cheek, leaving it tethered to the cheek and then attaching it to the nose. Dottie had that procedure done and that trunk was left there for four weeks. She was a great patient, she hung in there. We went to that second stage, we divided it. I did some dermabrasion to kind of sand and smooth the edges of the scars and she’s only a few months out and it’s very hard to even tell that she had anything done. Dr. Ha is just amazing. He’s like an angel. He makes you feel comfortable. He held my hand and he said don’t worry Dottie, you’ll look great and I just had to trust in him. When I think about everything that I’ve been through, I’m very happy, very happy. I still recognize my nose and I think it looks great. Healthy nose, yes, cancer free, yes. I’m very pleased. Well that’ll do it, that’ll wrap up another edition of the Best Docs Network featuring Forest Park Medical Center. Of course Forest Park Medical Center is one of the top medical centers in all of the Dallas, Fort Worth area. Exactly right and for more information on Forest Park Medical Center and all the outstanding doctors that operate right here out of Forest Park Medical Center, head to the website bestdocsnetwork.com and click on the Forest Park Medical Center tab. Or if you have a question or comment for us we’d sure love to hear from you, send us an email at info@bestdocsnetwork.com. So long everyone, we will see you next week.