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MEDICINE

Inside this issue: Algonquin Ghosts & NCMS Events A Publication of the Nueces County Medical Society

January/February/March 2023

President

Ruben Pedraza, M.D. President-Elect

Allyson Larkin, M.D. Vice President Melissa Chiasson, M.D. Secretary

Nelly Garcia-Blow, DO Treasurer

Alma Rigonan, M.D. Treasurer-Elect

Crystal Garza,, M.D.

FIVE IMMEDIATE PAST PRESIDENTS

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Coastal Bend Medicine C O N T E N T S VOLUME 63 NUMBER 1

JANUARY/FEBRUARY/MARCH 2023

STANDOUT CASE #7 Page 11 FEATURED ARTICLES

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Algonquin Ghosts After the COVID Quarantine: Combating Lower Extremity Pain Using Movement is Life Multimedia Interventions and Home Exercise Programs

NCMS EVENTS

12 First Tuesdays at the Capitol 14 Installation Dinner 18 Monthly Mixers

COMMUNITY OUTREACH

22 Walk With A Doc 25 Medical Community News 25 IN MEMORIAM 26 ALLIANCE EDITORIAL 28 NCMS Physician Network

Sonia Mathew, M.D., 2022 Jack L. Cortese, M.D., 2021 Marita Rafael, M.D., 2020 Jacob Moore, M.D., 2019 Justin Hensley, M.D., 2018

BOARD OF CENSORS Lokesh Goyal, M.D. Llewellyn Lee, M.D. Maria Narcise, M.D. Susan Schulze, M.D. Steven Vela, M.D. William Wang, M.D.

TMA DELEGATES Fredrick McCurdy, M.D. Jacob Moore, M.D. Jack Cortese, M.D. Vijay Bindingnavele, M.D. Jerry D. Hunsaker, M.D. Mary Dahlen Peterson, M.D. Karl Serrao, M.D. Matt Bayazitoglu, M.D.

TMA ALTERNATE DELEGATES Pradip Dhar, M.D. Doug Pappas, M.D. David Wilson, M.D. David Vanderheiden, DO Rafael Coutin, M.D. Abeer Kaldas, M.D. Al Gest, DO

EXECUTIVE DIRECTOR Sandra Montemayor

EDITORIAL BOARD Eduardo Garcia, M.D., Editor Ernesto H. Guido, M.D. Mary D. Peterson, M.D. John Pettigrove, M.D. Erick Santos, M.D. P. S. Almond, M.D. Karl Serrao, M.D. Mark Geneser, M.D. Allyson Larkin, M.D. Lokesh Goyal, DO CORRESPONDENCE & SUBSCRIPTIONS TO

Cover Photo: Gitche Manitou face, is a piece created by John Pettigrove, M.D., a retired pulmonologist and NCMS Editorial Board member and regular contributor of Coastal Bend Medicine.

NUECES COUNTY MEDICAL SOCIETY MISSION STATEMENT Article II of the Constitution - Purposes of the Society The purposes of this Society are (1) to serve the people of Nueces County in matters of medical care, (2) to federate the profession licensed to practice medicine in the State of Texas, (3) to unite with other component societies to form the Texas Medical Association and through it with other State associations to form and maintain the American Medical Association, (4) to promote unity and cooperation among its members, (5) to secure the enactment of appropriate medical and health care legislation, (6) to extend medical knowledge and advance medical science, and (7) to strive for the prevention and cure of disease and the improvement of public health.

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DECEMBER -JANUARY

New members ALEKSANDER S. BORRESEN, MD PHYSICAL MEDICINE & REHABILITATION

KYIN HLAING, MD INTERNAL MEDICINE

5726 Esplanade Dr.

Corpus Christi, TX 78414

805 Morgan Ave Corpus Christi, TX 78404

TIMOTHY FAGEN, DO PATHOLOGY, FORENSIC

FAROOQ J. HUSAYN, MD PEDIATRIC

2610 Hospital Blvd. Corpus Christi, TX 78405

3533 S. Alameda Corpus Christi, tX 78411

ERNESTO FERNANDEZ, MD PEDIATRIC, CRITICAL CARE

HAITHAM JIFI-BAHLOOL, MD INTERNAL MEDICINE

3533 S. Alameda Corpus Christi, TX 78411

7326 S. Staples Corpus Christi, TX 78413

LUIS A. GONZALEZ, MD FAMILY MEDICINE

RAJESH KANNAN, MD PATHOLOGY FORENSIC

6182 Dunbarton Oak Dr., Ste B Corpus Christi, TX 78414

2610 Hospital Blvd. Corpus Christi, TX 78405

BLANCA GRAY, MD INTERNAL MEDICINE

CARISSA KIRK, DO ORTHOPEDIC TRAUMA

14646 Compass St., Ste 8 Corpus Christi, TX 78418

5917 CORSSTOWN EXPRESSWAY SH 286 Corpus Christi, TX 78417

JOHN A. HARTMAN, DO FAMILY MEDICINE

JOHN LEOTAUD, MD PEDIATRIC, CRITICAL CARE

5802 Saratoga Blvd, Ste 300 Corpus Christi, TX 78414

3533 S Alameda St Corpus Christi, TX 78411

NUECES COUNTY MEDICAL SOCIETY PHYSICIANS CARING FOR PATIENTS IN THE COASTAL BEND COMMUNITY FOR OVER 100 YEARS 4 Coastal Bend Medicine

FEATURE ARTICLE

Algonquin Ghosts By John Pettigrove, MD My childhood was full of wonder and mystery. We grew up in north-east Oklahoma, in Indian country, where the federal government settled the last of the great native American Algonquin nations. My grandmother was of the Lenni Lenape, or “pure, original people,” later called the Delaware by the English colonists. The Iroquois were a confederation of tribes including the Seneca, the Cayuga, the Wyandotte and others. The structure of their old Ir-oquois confederation was an inspiration to the framers of our Con-stitution. The Iroquois recognized the Delaware to be the oldest of all the Algonquin tribes. I had friends among the Seneca-Cayuga, the Osage, and of course the Delaware. Like some of my stories, this one is fiction but based on true stories that happened while I was young. There is no history and no re-membrance. All is shame and the past is forgotten: Behold! The ceremonial drum no longer speaks. Many winters have passed since the thunder spirits have been called with reverent song. The thunders, who are the Manitoo that bring the rain which they have been given dominion over by the Creator, await the chants of the People. But the people no longer sing and dance to the traditional songs, and the sacred drums no longer pound to the pulse of the People. Behold! The Big Ceremonial House of the the Lenni Lenape, has burned and fallen. The timbers rot, the sacred poles long ago carried away. Now birds sing in the meadow where once the people danced. At dusk, the whitetail deer cautiously feed on the sweet grass where once the Sachem stood. Behold! The Sacred Drum is silent. Who speaks for the People now? There is no history. There is no remembrance. All is shame; the past forgotten. A few miles from my home flows Panther Creek, a tributary of the Caney River. Across the Panther there was a swing bridge that once serviced an old oil field pumphouse. Just beyond the swing bridge a faint trail cuts through the underbrush to an open pasture where the Delaware Ceremo-

nial Big House once stood. Perhaps two hundred paces from there, a rail trestle crosses the creek and the track winds its way cross country to the small town of Pawhuska, thirty or so miles distant.

“The Manitou” - John Pettigrove MD

That pump house thumps to a drum-like cadence as it drives the tie rods back and forth through the sweet grass. The creaking and singing of the tie rods gives the place a creepy feeling, especially at night. It was not enough that the big house was once there; the sounds of the pumping, the smell of the crude oil and the pungent odor of decaying timbers gave the place a sense of fearsome dread.

My grandfather came to the Indian Territory in Oklahoma from New Brunswick, Canada by way of Montana, where his father spent a life of desperation tending to a failing farm. My sister’s story is that my grandmother was part Delaware Indian. My grandmother’s death was a mystery; my dad was only four. My grandfather soon remarried and tended to his oil leases in Osage County, Oklahoma. All I knew about my father’s family were terrible stories of pain and regret. There were other stories in my home town of Bartlesville, Okla-homa. When I was a boy, Pistol Pete, the old gunfighter, was still living. He was nearly one hundred years old. Frank Eaton was his name. Frank held court outside the Burlingame Hotel barber shop in Bartlesville every Saturday. A flock of listeners held on his every word as he spoke of the old times and the men he killed. I was one of those little listeners. There were also stories of the Manitoo, the thunder spirits, the Gitche Manitou, (the Great Spirit) and Gush Ke Wau, (the Dark-ness). They were just stories. Few grownups took them seri-ously. Almost none spoke of spirits in public. Almost all of the red men had become Christians. One of my friends’ dad who was the Delaware tribal financial chairman was also a deacon in the Baptist Church. He later served two terms as the chief of the Delaware. The old ways were not to be remembered

Continued on Page 4 Coastal Bend Medicine 5

Algonquin Ghosts (cont’d from page 3) I had friends who were Delaware, Seneca, Cayuga, Cherokee, Wyandotte, and Osage. One day a Delaware friend along with several other boys and I visited my friend’s uncle who still prac-ticed the old beliefs. He told us many stories. When we asked my friend’s father about those stories, his dad took off his belt and started to whip the whole bunch if us. Those days were best forgotten! But there were still stories and those stories lived. The Manitoo spirits still lived silently in the hearts of many. The timber along Panther creek and the Caney River below my house was haunted by spirits. The legend was that when you saw the Manitoo you saw yourself. My friends and I often walked the railroad tracks in the Caney River bottoms to a small oxbow lake we liked to fish. My mom’s housekeeper had showed us that lake. We would catch catfish and crappie there and if she were along she would cook them up with fried potatoes on the shoreline. One day there was a report that two boys had been killed on the Santa Fe railroad tracks near Panther creek’s confluence with the Caney, River. The boys had been drinking and spot-lighting deer on the railroad right of way. Among the poaching crowd, spot lighting deer on train tracks was easy sport. The pungent smell of crude and decaying foliage masked a hunter’s scent from the game. And the rattle of the oilfield wheel house and its sliding tie rods masked almost all sound, even that of an approaching train. The boys passed out asleep on the tracks. As the night train from Tulsa came barreling up the track the engineer saw something. He blew his horn and the train braked but it was too late. The boys were brothers and local tough guys. My friend Ron-nie, their stepbrother, was usually brought along to skin the deer and catch a few fish for their lunch. Ronnie had been there the morning of the accident. He had been hiding in the brush while his brothers were drinking. Ronnie’s half-brother Jack was the worst; Jack was a bully and a brute. He called Ronnie “Rat Face” because of Ronnie’s long rat-like nose. Jack’s dad, Bad Sam, used to join Jack and beat Ronnie. They had broken that long nose more than once, so that it was twisted almost corkscrew-like. Ronnie was terrified of his step-dad Bad Sam, and often came to stay at my house when Bad Sam was drunk or in an especially foul mood. Ronnie’s mom had died years before. The circumstances of her death, just like those of my grandmother, were strange. Sherriff Lewis in-vestigated but nothing could be proven beyond a reasonable doubt. Bad Sam eventually got sent to the state penitentiary in McAlester for manslaughter after a barroom fight. My mom had been on that jury. Bad Sam got just three years, possibly because my mom did not want to send my friend’s dad to prison for longer. If she had only known. 6 Coastal Bend Medicine

When Ronnie came out of the brush he found what was left of his step brothers. The deputies said that when they put Jack’s body into a bag to haul it away it looked like a light bulb smashed in a paper bag. There was not a bone left unbroken. The deputies wanted to take Ronnie home but Ronnie just wan-dered off and finally appeared at our house four days later. He stayed with us a week before went home to Bad Sam. Bad Sam was in a rage. His boys were dead and all Sam had left was a rat-faced little “Indian bastard--” the name he called Ronnie when he was drunk. When Ronnie later came back to our house we all stared at him. He was black and blue from the beating Bad Sam had given him. “Lord of Mercy boy, what happened to you?” Glenola my mom’s housekeeper exclaimed. Glenola was a mother and best friend to all the little kids in the neighborhood. “Somebody been whipping on you?” Ronnie just trembled. He would not eat. She kept asking him what happened but he would not speak about it. “Don’t you worry yourself. We are going to take care of you,” Glenola said. Bad Sam came around looking for Ronnie but Glenola shooed him off. She was not afraid of anyone, least of all a big Osage like Bad Sam. And Sam was big! Fully six feet eight without boots on. The fireman and the brakeman on that train were the first to break the story. They reported that there was something on the track. They said it was a big, really big, scary- like thing. The engineer throttled down and they braked but could not stop until they hit the boys. That was the story they gave to the reporter from the Tulsa World that day. The story was on the radio. Soon the papers were reporting that the engineer saw a weird large creature on the track and never saw the men. “If I had seen them boys they’d still be alive,” the engi-neer sobbed. “I can’t believe there was nothing else there.” Washington County, Oklahoma is way too sophisticated for an-yone to believe the outrageous tale of that train crew. But the old silent ones knew. Each man in that crew saw something different. The engineer was angry. He said it was a fierce, cruel monster. The brakeman said it brought on a feeling of peace and calm. The fireman felt terror and fear. He said it was a ghost spirit. The old silent ones knew. One day Ronnie broke down. “I killed them.” ‘You what?” my friends and I asked. “Killed ‘em both,” Ronnie said. “You are crazy,” we all said. Ronnie then told his story. “ It was cold with snowflakes in the air like when we built our log fort in the Osage. The wind was coming out of the west and spoiling our advantage. As we crossed the swing bridge across the river I was so scared. I held tightly to the bridge ca-bles and took one slow step at a time. The cable

was very cold and my fingers were freezing stuck to it. The bridge swung in the wind. “My brothers had already crossed the bridge and were up ahead. As the wind got stronger the bridge swung harder. I was slipping. I was afraid to take another step as I moved slow and cautious toward the other side.” The brothers had stolen a quart of Crown Royal from their dad. Bad Sam was a bootlegger and had a lot of whiskey around the house. “He won’t not miss it,” they snickered. But Ronnie knew different and knew Bad Sam would miss it. He counted the bottles every day. Jack said they could blame it on the “Rat” and looked at Ronnie and said “Don’t tell Paw Rat” and slapped Ronnie across the face. When Ronnie cried they snickered some more. The prospect that he would get whipped for something they did was so funny. Then they kept snickering as Jack beat Ronnie with his fists until Ronnie was bleeding. Ronnie began wanting Jack to die. Turning back down their trail toward that swing bridge, in the evening twilight Ronnie could see the two silhouetted brothers looking like ancient Osage warriors--one with roached hair and shaven side burns and the other with his hair pushed back in ducktails. But there was no paint and no rings adorned their ears; although they were walking on a sacred path they were not on a sacred mis-sion. As they crossed the meadow Jack looked toward the rot-ting ruin and his thin snicker of a smile said : “The dog eating Delaware Ceremonial House.” With that, they laughed heartily and broke out the Crown Royal and began passing it back and forth. Two whitetail deer had been in the meadow and they moved off flashing their tails as they trotted away. By then the brothers were too drunk to notice. Ronnie walked up the trail toward his brothers. They were tugging at the bottle. They stumbled toward that railroad tracks to set up for their shot. They be-gan tossing rocks off the right of way and then at each other. When they saw Ronnie one of them chunked a rock his way striking him on the cheek. Blood streamed down Ronnie’s face. He yelped in pain and tears came to him as his face stung and hurt. Ronnie turned back down the trail. His brothers shouted, “Catch up, Rat. If you get lost Paw’ll whip us, and he’ll whip you too if the Manitoo don’t get you!” Then the brothers chanted, “The Manitoo’s gonna get you! The Manitoo’s gonna get you!” They laughed and fought over the bottle. Soon it was turning very dark. It was the dark of the moon and the sky turned to blackness as clouds covered the stars. Ronnie sat in misery at the base of the right of way and then took refuge in the ruins of the old Big House crying and shiver-ing in the cold. His flashlight dimmed and the battery was fad-ing as the light flickered off and on. But he felt secure here. He was sure that his brothers for all their swagger were afraid of the place.

In the quiet and the dark Ronnie thought about his despair and how he despised his step brothers and their paw. Ronnie’s thoughts turned to the Manitoo and the stories his mom had told him. The Thunderers and the Manitoo could be malevolent or they could be good. They could be guardians. They could be resolutely evil. You could call on the Manitoo for mercy or for revenge. His mom taught him that when you see the Manitou you see yourself. “Could a person call the Manitoo for revenge?” He thought. “Could I ask the Manitoo to protect me from my brothers?” He wanted the Manitoo to kill those who tormented him. He trembled. He cried. Hours passed. His obsession made him tremble. He started a little fire in the ruins of the Big House and settled back against an old timber. No sounds came from the tracks now. The brothers were stu-porous. They had started their own big fire, a bonfire of gran-diose proportions. It was a white man’s fire. The wind laid down, and in came the deadly stillness except for the drone of the pump house and the singing of the tie rods. Then the pump engine sputtered and the thump thump of the pump engine and the squealing of the tie rods died away and stopped. The dis-tant glow of the fire on the tracks conjured thoughts of the Manitoo. As Ronnie watched the glow of the fire on the tracks his little fire burned low and went out. He could hear the engine whistle and hear the train coming. At the same time the brothers were startled. They woke to the sound of the train. They were fro-zen in fear on the track. Ronnie said to us as he told the story, ”You remember that time when we were camping in the Osage? We built the log fort at Camp McClintock. Around the camp fire we told ghost stories. I told the story Chester’s uncle had told me about the Manitoo spirits. The one we all got whipped for.” And then he said “No one believes that stuff anymore. You are not sup-posed to talk about it. But that is what I saw: “This thing, a monster, stepped out on the track. It was red and black and dripping blood. As I watched it I was so angry and wanted to kill them and I did.” “ You mean, you killed them?” we all asked. “I thought If only I could call the Manitoo and have them kill my brothers. I saw the red face in the glow of the fire and all black around it. I thought, ‘kill them! Kill them!’ Then a faint rumble came and then the ground shook and the train approached and as the sound got louder I still watched the Manitoo on the tracks. The sound became still louder and the ground began to shake and I felt it tremble under my feet. Sparks from the fire scattered down the tracks and the grass burned. The train stopped a ways down and some men walked back up the tracks. I walked down to the bodies smashed and bruised and

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FEATURE ARTICLE

After the COVID Quarantine: Combating Lower Extremity Pain Using Movement is Life Multimedia Interventions and Home Exercise Programs By Myles Moore1, Guillermo Ramirez2, Kevin J Orellana3, Paul Treviño OPA-C4, Erick M Santos MD PhD5, Letitia Bradford MD, FAAOS, FACS6 Affiliations: Howard University College of Medicine1, University of Texas Rio Grande Valley School of Medicine2, Rio Health Medical Center3, Nth Dimensions4 Abstract: Osteoarthritis is a leading cause of immobility and disability due to lower extremity pain. Movement is Life (MIL) strives to combat musculoskeletal pain, mental downtrends, and overall health decline by encouraging early interventions. A previous study performed while the COVID-19 pandemic forced mandatory quarantine restrictions indicated no correlation between our multimedia education material (MEM) as well as home exercise programs (HEP) and lower extremity pain. The effects of the COVID-19 pandemic have lingered and have become a source of negative trends in overall American health by fostering a sedentary lifestyle both while ill and during quarantine. This study intends to build upon previous studies by evaluating data from short-term effects of this combined approach after the mandatory COVID-19 quarantine period compared to a study during the COVID-19 pandemic. Patients were recruited and surveyed at Rio Health Medical Center in South Texas and given MEM and HEP interventions. They were re-surveyed at 2 weeks and 4 weeks with additional questions. The questions included their well-being physically and emotionally since mandatory quarantine restrictions were lifted. Similar to previous studies before the COVID-19 pandemic, there were small-scale improvements in pain reporting at the 2-week follow-up and significant improvements in a majority of categories at the 4-week follow-up. However, additional data has suggested lingering lifestyle changes from quarantine may alter the effectiveness of these approaches. These findings indicate that although the quarantine period is over, many people have continued habits of a sedentary lifestyle learned during the quarantine. These habits further contribute to a negative effect on wellbeing. Introduction: Osteoarthritis (OA) and lower extremity pain are the leading causes of disability worldwide.1 Movement Is Life describes joint pain as a multifactorial cycle of pain, leading to limited mobility, inactivity, obesity, and more pressure on joints, therefore causing more joint pain.2-4 MIL strives to combat the cycle of joint pain by utilizing early interventions such as holistic multimedia educational materials. Studies previous to the COVID-19 pandemic have shown that a combination of MEM and home exercise program interventions lead to increased knowledge and meaningful improvement in patient wellbeing.3 However, the COVID-19 pandemic has had a negative effect on patients’ physical and emotional health and these same interventions did not have a correlation to improvements during this time period.7 There is a growing realization that the timescale associated with this crisis may permanently change the very foundations of society’s ‘normal’ day-to-day life.5 We hypothesized that the end of the pandemic would lead to an increase in reported physical health as well as emotional health, but to our surprise our data indicates that many people feel physically and emotionally the same or worse since the quarantine ended. These findings suggest that the COVID-19 quarantine will have lingering effects on people’s physical and mental health, and physicians should be aware of these changes as they navigate treatment options in the future. Methods: Patients with lower extremity pain including hip pain, knee pain, and ankle pain were recruited at Rio Health Medical Center. Exclusion criteria included age less than 18 years and history of prior lower-extremity surgery within the past year with the exception of diagnostic knee arthroscopy. Patients were given consent forms and a baseline survey (in English and/or Spanish) that included basic demographic information and a series of questions. The specific questions asked patients to rate their overall health, pain level, emotional wellbeing, social activity, eating habits, and desire to improve their health with variables on a scale from 1-10 (1 being poor, 10 being good). Patients were also asked to include their weekly physical activity, whether they had undergone or are currently doing physical therapy, and whether they would be willing to do 8 Coastal Bend Medicine

an at-home exercise program. Participants were given links to the MIL brochure, a link to the MIL homepage, and athome exercises specific to their injury provided by Sports Medicine Patient Advisor. Participants then had follow-up surveys at 2 weeks and 4 weeks to compare with their initial responses. The follow-up surveys had three additional questions to inquire about the effects after the mandatory COVID-19 quarantine. These questions included physical health since mandatory quarantine restrictions were lifted, emotional health since mandatory quarantine restrictions were lifted, and employment status. The means of the survey responses were compared, and the p-values of all categories were calculated. Results: Fourteen patients with an average age of 37.7 were recruited and surveyed for the 2022 cohort. The baseline means included general health (5.72), physical activity limitations (4.05), difficulty with daily activities (4.89), difficulty with work (4.84), bodily pain level (4.58), overall activity level (4.84), emotional well-being (6.05), social activity limitations (6.26), eating habits (4.95), and motivation (8.74). There were mean improvements in all categories except emotional well-being within a two-week span; however, the improvements were not statistically significant. After the 4-week reported data, the results were compared to baseline data and there were significant improvements across the majority of categories including: physical activity limitations (mean 6.1538, p-value .0043), difficulty with daily activities (mean 7.25, p-value .0077), bodily pain level (mean 7, p-value .0177), overall activity level (mean 7, p-value .0480), emotional well-being (mean 8.33, p-value .0137), and eating habits (mean 10, p-value .0007). The remaining categories showed minimal improvement that was not statistically significant including: General Health (mean 5.83, p-value .7383), difficulty with work (mean 6.83, p-value .2189), social activity limitations (mean 7.25, p-value .6326) and motivation (mean 9.67, p-value .3243). Additionally, the data that asked about patients physical and emotional wellbeing since quarantine ended showed an average score of 5.0526 and 5.3157 respectively. Conclusion: This data indicates that many people now feel physically and emotionally the same or worse since the mandatory COVID quarantine ended, although there were small-scale improvements in pain reporting at the 2-week follow-up. At the 4-week follow up, six of ten categories showed significant improvements. Studies previous to the COVID-19 quarantine using an identical method were able to show a correlation of improvement for all categories; however, studies during the quarantine with these same methods were not able to show any significant improvement in any of the

categories. These findings suggest that the COVID-19 quarantine will have lingering effects on the patient’s physical and mental health, and physicians should be aware of these changes as they navigate treatment options of multimedia intervention and home exercise programs. n References: 1. Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage. 2013 Sep;21(9):1145-53. doi: 10.1016/j. joca.2013.03.018. PMID: 23973124; PMCID: PMC3753584. 2. SMSL Documentary - YouTube. Accessed June 28, 2020. https://www.youtube.com/watch?v=KGsJyJGYHsA 3. Yamout T, Ramirez G, Treviño P, Santos E MB. Multimedia Educational Materials and Home Exercise Program Improve Pain Level and Emotional Well-Being in Patients with Lower Extremity Pain. Published online 2019. 4. Lopez-Olivo MA, des Bordes JKA, Lin H, Rizvi T, Volk RJ, Suarez-Almazor ME. Comparison of multimedia and printed patient education tools for patients with osteoporosis: a 6-month randomized controlled trial. Osteoporos Int. 2020 May;31(5):857-866. doi: 10.1007/s00198-019-05210-4. Epub 2019 Dec 16. PMID: 31844906. 5. Fakhruddin BS, Blanchard K, Ragupathy D. Are we there yet? The transition from response to recovery for the COVID-19 pandemic. Prog Disaster Sci. 2020 Oct;7:100102. doi: 10.1016/j. pdisas.2020.100102. Epub 2020 May 12. PMID: 34171013; PMCID: PMC7214278. 6. The Sports Medicine Patient Advisor, 3rd Edition. (n.d.). Retrieved June 8, 2022, from http://www.sportsmedpress.com/ 7. Kevin J Orellana, Tarek Yamout, Impact of Movement is Life Multimedia Interventions for Musculoskeletal Health Amidst the COVID-19 Pandemic

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FEATURE ARTICLE

STANDOUT CASE #7 By Mark W. Geneser MD, FCCP

During our medical training and throughout our professional careers, we have all had the privilege to be involved with exceptional cases, which have contributed to our personal knowledge base and clinical acumen. Many times, the gist of a case can be distilled down to a single phrase, as with this case: “We were going to consult Psych next after we saw that he had self-inflicted cigarette burns all over his body.’ As one of two senior Pulmonary Fellows during my training at the Medical College of Wisconsin, I was responsible for handling all of the pulmonary consultations that were requested of our service. I was called to consult on a man in his late twenties with an abnormal CXR and skin lesions. He was an outdoorsman and avid hunter. History revealed that a few weeks prior, he had gone hunting and had explored and climbed onto a beaver dam. He presented to the Emergency Department with low-grade fever, dry cough, mild dysnea, and onset of small, painless, circular skin lesions, covering much of his body. CXR taken in the ED revealed bilateral patchy interstitial and alveolar infiltrates. He was admitted to the Internal Medicine service, who then consulted us. The Medical resident was unclear as to what they were dealing with, and confided in me, “We were going to consult Psych next after we saw that he had self-inflicted cigarette burns all over his body.” My examination of the patient revealed a male appearing his chronologic age, a good historian, with normal affect, and presenting in no distress, other than mild dysnea at rest. His skin lesions were nontender, circular with raised borders, measuring less than a centimeter in diameter, numerous, and present throughout his body, including his back. I asked him if he had burned himself with a cigarette multiple times. He looked at me incredulously and replied, “No.” We took skin biopsies for histological review and took the patient to the bronchoscopy suite, for Transbronchial Lung Biopsy (TBLBx) and Broncho-Alveolar Lavage (BAL). Pathological review of biopsies of both the skin and lung, as well as cultures of the BAL fluid, revealed Histoplasma capsulatum. Histoplasmosis is often times a mild flu-like illness that is self-limiting, over a couple of weeks. Primary pulmonary histoplasmosis, however, can be more debilitating and require treatment. Progressive disseminated histoplasmosis, as in this case, is more serious and is associated with skin lesions approximately 6% of the time. Histoplasma capsulatum is found in soil, often associated with decaying bat guano or bird droppings. This patient’s exposure was probably secondary to his climbing onto a beaver dam, which has been known to harbor and aerosolize histoplasma organisms, when physically disturbed. Of note, this very scenario, or a similar case, was presented as a Pulmonary Medicine Board Exam question, years ago! n

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NCMS EVENTS First Tuesdays at the Capitol February

The NCMS and NCMS alliance had a great showing of support for the February and March First Tuesday at the Capitol, 2023. “The White Coat Invasion” Thank you to all of our physicians and Alliance members for helping to make our day of advocacy a big success. Thank you to TMA for the briefings each month at the TMA building.

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First Tuesdays at the Capitol March

Thank you to our State Representatives and Senators for taking the time to meet with NCMS Physicians and Alliance. In the months of February and March NCMS met with Senator Juan “Chuy” Hinojosa, Representative Abel Herrero, Representative Todd Hunter, Senator Morgan La Mantia, Senator Lois Kolkhorst’s staffers and Representative J.M. Lozano’s staffers. There were also bonus meetups with our new Nueces County Judge Connie Scott and our new Land Commissioner Dawn Buckingham. It was a great experience and all working to do what one can not do alone.

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NCMS EVENTS Installation Dinner The installation of the 2023 NCMS President, Dr. Ruben Pedraza, was held at the Art Museum of South Texas in the Singer Gallery. The ambiance of the event was mesmerizing with the Christmas tree forest in full display. A wonderful time was had by members and guests with over 150 attendees. TMA President, Dr. Gary Floyd administered the oath of office in the presence of Dr. Pedraza’s family. Thank you to our event sponsors: Presenting Sponsors, Corpus Christi Medical Center, Driscoll Health System, Texas Medical Liability Trust, Texas Medical Association Insurance Trust and WellMed; Table Sponsors, CHRISTUS Spohn Health System, Coastal Bend Eye Center, Humpal Physical Therapy and Premier Bio Waste Solutions; and a big Thank you to our Print Sponsor Grunwald Printing.

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Installation Dinner

Thank you to our Installation Dinner Sponsors! Presenting: Corpus Christi Medical Center, Driscoll Health System, TMLT, TMAIT & WellMed. Table Sponsors: CHRISTUS Spohn Health System, Coastal Bend Eye Center, Humpal Physical Therapy & Humpal Physical Therapy. We appreciate your support.

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NCMS EVENTS Installation Dinner

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NCMS FRIENDS OF MEDICINE

Platinum Sponsor

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Gold Sponsors

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Silver Sponsors reallygreatsite.com

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NCMS EVENTS

January Mixer The Nueces County Medical Society hosted its January Membership Mixer at the Nueces Brewing Company; the event was sponsored by our Friends of Medicine and was an opportunity for NCMS members to meet our sponsors. It was a great night of mingling and networking.

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January Mixer

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NCMS EVENTS

February Mixer Friend of Medicine, Driscoll Health Plan sponsored the NCMS Membership Mixer in February at Vietnam Restaurant. NCMS physicians learned of what the health plan offers it’s insureds and our community. It was a fun night of learning, laughter and networking .

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March Membership Meeting Friend of Medicine, McCracken Salazar Bhakta Group, Merrill Lynch, sponsored and presented the March Membership Meeting at Vietnam restaurant with 40 attendees. The presentation was services for the growth of a medical practice and protection of your business assets.

Dr. Vanessa Dr. Vanessa Gonzalez, was Gonzalez, was the winner of the the winner of door prize donated the by Dr.Dr. Menendez Menendez’ for International door prize for Women’s Day. International Women’s Day.

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COMMUNITY OUTREACH

NCMS WWAD 2023 is off to a great start., we’ve had three walks this year on the second Saturday of each month. WellMed has partnered with NCMS WWAD, we’re alternating months for our health topic and lead physicians. In January Dr. Allyson Larkin was our lead, February ‘s lead was Dr. Crystal Garza and in March our lead was Dr. Matt Bayazitoglu. NCMS and WellMed are helping our community to take a STEP toward better health by joining Walk with a Doc! It's a great way to get active, learn about health, connect with others, and spend time in nature.

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Algonquin Ghosts (cont’d from page 5) dead. I stared at their bodies. Fear and grief gripped me. I wanted to cry and celebrate. I felt pity and hate.”

saw the Manitoo and it felt my hate. I am still ashamed.” And then Ronnie just turned and walked.

The train crew could not agree on what they saw. It really shook them up. One swore a monster was there on the tracks. Another saw pain and fear and a smile with a soft forgiveness.

The Manitoo spirits vanished a long time ago. After the Big House burned there was a superstition that the meadow where it once stood was haunted. It was a widely held belief. I guess things can happen that no one can explain.

Ronnie spoke again, “The Manitoo had been on the tracks, I was so scared I ran and hid in the big house ruins. I hid there four days before I went home and then came here to your house. When I finally got home Paw had already heard what happened. He said I killed my bothers. I left him and never went back.”

The old Algonquin traditions hold that the Manitoo are guardian spirits. The “Gitche Manitou” was brought to the Delaware by the Black Robe Jesuit priests and was to be loved and not to be feared. But Gush Ke Wau—he is the dark one--that is the stuff of horror.

The sheriff and his deputies walked the tracks and the trains that day were cancelled until the matter was cleared up. Sher-riff Lewis looked at the mess. “How many were there?” “Two I guess.” A deputy answered with uncertainty. “Then there is this kid here. He saw the whole thing too.” They looked around but Ronnie was gone. The headline the next day was “Train crew sees Indian Ghost Spirit.” Ronnie truly believed he had called the Manitoo that day. He had called on the spirit of his dead mother and all the spirits. He called for revenge without pity. He cried for days after-ward. His stepfather hated him so Ronnie left, never went back and was raised by his mom’s sister. Ronnie had heard me tell about the electric chair at the state penitentiary in McAlester. When I stayed with my grandparents in McAlester during the summer, if there was an execution the lights would dim all over town as it happened. Ronnie knew he himself deserved the electric chair for murder, but the sheriff never came for him. Who would believe a story like that any-way? Ronnie never recovered and rarely spoke about that night. He wanted both punishment and forgiveness for the evil he thought he caused. Years later I saw him on the street one day. “It was real. I

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Legend has it, and the Sacred Pole in the Ceremonial House of the Delaware people shows, a face blackened in death for the death spirit and red with fire for the life spirit. Ronnie lived his life believing he saw the Manitoo that day. It is what the men killed on the track thought they saw and it is what the train crew thought they saw. “When you see the Manitoo you see yourself.” Always remember that. “Sometimes it comes as quite a shock when you recognize yourself in someone, especially if you don’t particularly like that person. “When you meet anyone, remember it is a holy encounter. As you see them you will see yourself. As you treat them you will treat yourself. As you think of them you will think of yourself. “Never forget this, for in them you will find yourself or lose yourself. Whenever two Children of God meet, they are given another chance at salvation. “Having made this choice you will understand why you once be-lieved that when you met someone else, you thought they were someone else. And every holy encounter into which you enter fully will teach you this is not so.” In the face of the Gitche Manitou we see the red spirit of life and the black spirit of death: two entwined as one. n

on Medicaid, CHIP and

MEDICAL COMMUNITY NEWS

the Uninsured

Consultant, Committee on Medicaid, CHIP and

Congratulations to our NCMS Physician Members  Congratulations to our NCMS Physician Members  Congratulations to our NCMS Physician Members 

the Uninsured

Congratulations to our NCMS Physician Members

Dr. Sh

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rdy, MD Gerard MDGerard Voorhees, Fredrick McCurdy, Karl Serrao, MD Gerard Voorhees, Voorhees, MD Dr. ShahMD Islam Fredrick McCurdy,MD MD drickConsultant, McCurdy,TMA MD Committee Karl Serrao, Gerard Voorhees, MD MD TMA Karl Serrao, MD Consultant, Committee Member of the TMA Council on CHRISTUS Spohn mmittee Member ofPublic the Council Committee MemberDistinguished of the Council onConsultant, Medicaid, CHIP and the on Medicaid, CHIP MD and the Science and Health Physician Karl Serrao, nsultant, Committee ofon the Council Uninsured Uninsured Leader Award CHIP and on Consultant, Committee Medicaid, CHIP andConsultant, Committee on ScienceMember and Public Science and Public Consultant, Committee Medicaid, CHIP and on Medicaid, CHIP and on Medicaid, CHIP and on Science and Public ured the Uninsured Health Health on Medicaid, CHIP and the Uninsured the Uninsured the Uninsured Health the Uninsured

“In Memoriam” Tributes

Coastal Bend Medicine is group listing the names, specialties and vital dates of its “In Memoriam” NCMS Member physicians. Friends, colleagues, and loved ones are welcomed Dr. Shah Islam Dr. Shah Islam and encouraged to submit “tribute” articles that will run in the edition after each group listing. Dr. Shah Islam CHRISTUS Spohn Distinguished PhysiCHRISTUS Spohn Distinguished PhysiWe appreciate your heartfelt glimpses into the personal and professional lives of our beloved CHRISTUS Spohn Distinguished Physicianlook Leader Award cian Leader Award Coastal Bend doctors and forward to sharing the warm remembrances of the community cian Leader Award to whom they committed their medical stewardship.

Paul R. Hummell, M.D. October 29, 1926 – December 31, 2022

Thomas Dewitt Harvey, M.D. March 8, 1930 – December 30, 2022

If you have questions or tribute articles to submit, please email them to the Editorial Board: [email protected] or call the NCMS Office at (361) 884-5442.

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Alliance News Maria Alexander President Greetings to everyone!!! I am filled with excitement as a new year gets underway and I am greatly honored to serve you as President for the year 2023. Earlier this January we launched into the new year with a planning/welcome board member event at Akasha Yoga with a yoga/meditation session. We have planned a great number of events to participate in community outreach and enrichment programs for our members. Let me begin by thanking Liz Farek for the great leadership and service she contributed to our alliance as our President last year. She brought the significance of “branding” for our organization and her commitment to Alliance was 110%. Thanks again for going above and beyond even if it falls outside of your own job title. Our first general meeting program was an informative talk on health and fitness by Rebecca Hawn, a fitness instructor at Sports Fitness Solutions. Our Alliance member Kevin Koehler graciously hosted us in his beautiful home and he played some great piano pieces which provided a great ambiance for the event. Thanks to the hostesses Debbie Mitchell, Robin Jifi-Bahlool, Lauren Ewing, and Haley Cambron who provided us with a great healthy lunch of salads and protein balls. Staying active was the overall message she iterated as we move forward into a new year. In March, Benna Timberlake hosted our skincare protection program with our guest speaker Heather Leinart with Halcyon Spa. Why is sunscreen so important? This question was answered to our members by Heather. The benefits of sunscreen and the ways to protect your skin from sunburn, premature aging, and skin cancer were some of the topics she covered for us. Another great event in March was the First Tuesday at Capital, which is an advocacy program to protect the practice of medicine for Texas physicians. We had an amazing group of Alliance members who attended the Capitol event along with our Medical Society physicians. Clad in commemorative scarves honoring the 20th anniversary of First Tuesdays at the Capitol TMAA members stood tall with white coat physicians as State Representatives Ju-

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lie Johnson recognized their dedication to medicine on the floor of the Texas House of Representatives on March 7th. It was an amazing experience to watch Advocacy in action. Hope some of you can attend the next two events coming up on the first Tuesdays of April and May. National Doctor’s Day in the United States is celebrated on March 30th each year. It is a holiday honoring the physicians for the work they do for the patients, for the communities they work in, and for society as a whole. We are excited to show our support and honor them on their special day by revealing a thank you message on a billboard displayed on the crosstown expressway and also another digital billboard on SPID near Greenwood drive. We would like to thank the three major hospitals – HCA, Driscoll, and Spohn for their donations and support for the physicians in the community on this project. Our major fundraiser of the year is the Wine tasting event – Under the Texas Sky. Dr. Mathew Alexander is hosting our event at his beautiful ranch – Dancing Elk Alexander’s ranch in Mathis, Texas on March 31st. It will be a great evening of fun, food, and wine and the money collected will be used for our future community service projects. Under our past president Liz Farek, the entire wine committee has worked tirelessly to put together a great event for the medical community. A big thanks go to Pooja Bindingnavele, Lisa Bayazitoglu, Ruth Brown, and Kitty Hommer for all the hard work they’ve put in for this event. A nature walk at the Oso Preserve and Walk With A Doc are other events in the month of March that the alliance participated in, showing support and camaraderie. What a busy month we had in March!!! I appreciate our board and general members for all that you do for the alliance. Please invite new physicians and their spouses that you come in contact with and encourage them to become members. Members are the threads that make the fabric of the alliance. So please come for the meetings and let us support each other to have a wonderful year helping our team and the community. n

NCMS Alliance Events

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NCMS PHYSICIAN NETWORK Diabetes—Endocrinology—Clinical Lipidology

Pediatrics

Osvaldo A. Brusco, MD, FACE

Sonia Mathew, MD, FAAP ABC Pediatrics

www.bruscomd.com 5814 Esplanade Dr.

3533 S. Alameda St.

Corpus Christi, TX 78414

Sloan Building, Ste 303

Phone: 361-885-0448 Fax: 361-879-0982

Corpus Christi, TX 78411

Site for multicenter clinical trials In the specialty

361-853-3222 Accepting patients from birth to 18 years

With a Listing in the NCMS Physician Network, you can stay connected to your colleagues day in and day out. This feature is designed to help our members with referrals and consultations. The information is featured in all issues of the NCMS Coastal Bend Medicine and is accessible on the NCMS website, avaliable to all physician members and to the community.

ADVERTISING INDEX

Coastal Bend Medicine Nueces County Medical Society (NCMS) does not endorse or evaluate advertised products, services, or companies nor any of the claims made by advertisers. Claims made by any advertiser or by any company advertising in the Coastal Bend Medicine do not constitute legal or other professional advice. You should consult your professional advisor.

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TMLT - Inside Front Cover

TMAIT - Page 2 American Bank - Page 9 Humpal Physical Therapy - Page 11 PAM Specialty Hospital - Back Cover

The Nueces County Medical Society (NCMS) and the Texas Medical Association (TMA) recognize the following practices for their dedication to strengthening the voice of medicine in Texas. This strong unified voice enables us to have a significant impact on legislative, medical and socioeconomic issues that affect physicians and their patients. The following practices have eight or more physicians with 100 percent membership in NCMS and TMA.

Large Group Practices With 100-Percent Membership in Nueces County: ABC Pediatrics

Coastal Bend Women’s Center

Bay Area Kidney Disease Physicians

Coastal Children’s Clinic

Bay Area Residency Program

Gulf Shore Anesthesia Associates

Coastal Cardiology Associates

Kidney Specialists of South Texas

Cardiology Associates of Corpus Christi

Neonatology Consultants Of C.C.

CHRISTUS Spohn Residency Program

Radiology Associates

Driscoll Children’s Hospital Residency Program

South Texas Bone & Joint

Because groups vary in both needs and specialties, TMA tries to meet with the group on the front end. If the group qualifies, based on County Medical Society guidelines (which also varies by county) then we are able to discuss their specific needs, and come up with a list of ‘customized’ benefits for each group. Not all groups want the same things.

The three things that TMA offers to all 100 percent membership groups are: • TMA hosted annual meeting of TMA 100% membership group practices • Annual conference call with TMA advocacy team for 100% membership group practices • Group practice name listed on TMA webpage of 100% membership group practices Some helpful links are: http://www.texmed.org/Member_Benefits.aspx and http://www.texmed.org/100/ Call Sandra Montemayor, Executive Director at NCMS, today for more information: 361-884-5442 or email her at: [email protected] Coastal Bend Medicine 29

Coastal Bend

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