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On this edition of the Best Docs Network featuring Forest Park Medical Center, Dr. Jorge Casas,
Dr. David Genecov, Dr. Garner Newton, Dr. Jeffrey Cattorini. And hi again everyone,
Jim Knox along with Kandace Krueger and welcome back to another edition of the Best Docs Network
featuring Forest Park Medical Center. Of course, Kandace, Forest Park Medical Center, one of
the top medical centers in the entire Dallas, Fort Worth area. Indeed it is and we'll start
off with our first best doctor who operates right here at Forest Park Medical Center,
its Dr. Glenn Ihde. Once we've diagnosed reflux and we're sure that we're dealing with that
entity then we can talk about treatment. And a lot of people think that we just skip straight
to medications but in fact most people initially recommend lifestyle changes. We tell people
maybe elevate the head of your bed to help gravity take effect with the symptoms that
may be occurring at night. Avoid eating late at night, eat smaller meals, avoid carbonated
beverages and avoid some of those trigger foods that may relax that lower esophageal
sphincter and increase the amount of reflux that can occur. If those don't work many people
will go to over the counter medications, they may see their primary care doctor or gastroenterologist
and they may prescribe acid reducing medications. As people get reflux more often they start
using medications that actually prevent the production of acid so the stomach content
is less acidic so when they do reflux it doesn't burn. If you've been on those medications
for more than 8 weeks or you have to take them every day to prevent symptoms or even
if you're having symptoms while you're taking those medications, then it's time to think
about surgery. Reflux disease is normally a problem with the anatomy at the junction
of the stomach and the esophagus and there's usually a hiatal hernia that can accompany
reflux disease in patients and when we go and correct that anatomical defect you can
basically help restore that normal anatomy to where patients do not have to take their
medications any longer. So the newer procedure, what we call a transoral fundoplication tends
to provide the treatment without the complications so if you're taking the medications for a
long period of time, if you're symptomatic on those medications then now might be the
time to think about turning towards a surgical procedure that can recreate the anatomy the
way it's supposed to work. It is a minimally invasive procedure that's done without incisions
and it's very helpful in treating the reflux symptoms and as well as decreasing the amount
of side effects that were seen previously with the other types of surgery. Before we
even start the surgery on the patient we actually review the plan. The 3D analysis that was
obtained from the CAT scan allows us to see the knee in real time and this allows us to
see the orientation, the alignment and actually the size of the implant that we'll use. So
I can actually look with 3D technology to see exactly what the implant looks like, the
alignment, the rotation. As we get into the surgery I can actually make adjustments in
surgery to balance the ligaments inside of the knee as well. So once we place these pins
into the bone we attach what we call arrays to the pins and this allows us to consistently
always know the position of the bones at all times. Once we register both the patients
anatomy and register the robot then the next step is to actually begin the surgery itself.
So I can slowly chisel away the bone that's necessary. When I look at the screen, the
green data tells me the extra bone that I must remove. What's critical is this robot
will not allow me to go outside of the plan that we've instituted in the very beginning
of surgery. The surgeon is actually still doing the surgery. The robot is just allowing
the surgeon to do it in a more precise manner because the robot will not let me deviate
from the plan at hand. Then the next step is to trial or place the implant to see if
it fits correctly and as you can see it's perfectly aligned, the rotation is perfect
and as a surgeon it's very exciting to see that we can do this reproducibly consistently
and do it successfully. This technology allows us to do surgery with the smallest incisions
possible. Our patients are recovering much quicker than the traditional approaches. Best
Docs Network featuring Forest Park Medical Center, welcome to the twenty first century
of cutting edge medicine, Forest Park Medical Center. I assess patients based on their nutritional
needs if they are at nutritional risk if I need to do any kind of intervention as far
as medical nutrition therapy which is prescribing certain diets. For example, if a patient has
diabetes then we would order a diabetic, heart healthy diet so that it would fit into their
meal pattern to help control their blood sugars while they're here at the hospital. Having
a culinary team in place definitely gives us an avenue to provide great, great meals.
We feature anything from gourmet pizzas to ready made salads to order. Everything's prepared
fresh right in front of your eyes and we try to do that in a timely manner. Forest Park
Frisco café services incorporate patient and family members into our dining experience
so if there's something available down in the café that is not on our written menus
that a patient can select from, it's still an option that a patient can receive those
items from the café directly on to a tray up to a patient room. With Krista we you know
follow a pretty strict menu that we put out at the back but then there's also special
you know people with allergies or people that can only have certain things. We're a small
enough hospital that you know they really get a personal, a personal care touches for
the patient every day. She brings down the information to us and we take care of whatever
culinary needs they have. We have people from Frisco City Hall that come and frequent our
dining establishment quite often and they let us know how well we're doing. And I thought
it was pretty neat to have people walking down the street come into this facility, they're
not patients, they don't have any family members here at the hospital but they just want to
try us out because they've heard from other staff members that work with them of how good
the food is. Our menu is not typical hospital fare. It has a lot of I'd say Texas twists
to it. It's anything from fine dining up in the doctor's lounge to some of the caterings
that we do for the doctors. And then down here we try to do things a little more regional.
We use some of the local produce, try to make it more of a resort like setting. Food and
nutrition is a lot about lifestyle changes and lifestyle behaviors and those things don't
happen overnight so what little coaching that I do get to give patients here in the hospital
is mostly through a paper that they can take home with them and do some extra research
on it. We try to give contact information for the dietitian as well so if they have
questions postop there's always someone available or some kind of way to get the extra information
that they may need. Very, very strong congestion in my nose, could not breathe whatsoever.
Started about five years ago you know I started taking nasal sprays. Back then it was more
of a one or two day type of thing, maybe once a day to be able to catch some relief to breathe
and just as the years went by started getting you know progressively worse. Frequently individuals
come in with their biggest complaint being that they just cannot breathe through their
nose. Often they are addicted to some of the common over the counter nasal decongestant
sprays which is a bad thing. These patients often just, they use them several times throughout
the day and the problem with that is that you somewhat become addicted to them and the
sense that the more you use them, the more you need it. You can have a rebound congestion
in the nasal linings and passageways so it can cause a big problem with just persistent
nasal obstruction. Eventually you know it got to the point where I was having rebound
congestion from the nasal spray so which I didn't know about. My girlfriend had to warn
me you know, you've got to stop taking this stuff and I was like no, it's no big deal,
it's just nasal spray, it shouldn't be you know any harm to you. But you know after reading
the congestion and reading the back of it and seeing that it was dangerous and it does
cause rebound congestion, it says it right there on the label. So there's two different
types of nasal sprays, there's the over the counter ones which are typically the decongestant
nasal sprays. Those should only be used for short periods of time. The ones that can be
prescribed by a physician such as the nasal steroid sprays or antihistamine sprays can
be used on a daily basis indefinitely. The nasal sprays that are prescribed by the physician
are not addictive in the way that the over the counter ones are and do not cause that
rebound congestion and the problems that some of the over the counter decongestant sprays
do. People don't realize how precious being able to breathe is and you know with my job
I have to be able to sleep and before Dr. Wyll I wasn't able to sleep maybe three or
four hours a day and I was constantly up getting nasal spray trying to be able to catch some
relief to breathe but now you know basically life is full of sleep, I mean, it's great.
Ashley has a question for Dr. John Dulemba. What are the signs and symptoms of endometriosis?
There's several symptoms that women will experience with endometriosis and you don't have to have
all of those symptoms to have endometriosis or to suspect that you have endometriosis.
First is heavy and or irregular bleeding, painful periods, lower back pain with your
periods, painful intercourse, lower back pain, loose bowel movements and oftentimes a genetic
component to endometriosis so your mom, sisters, aunts, cousins might have had the same symptoms.
All of the doctors featured here on Best Docs Network are all about changing people's lives,
like our next best doctor, it's orthopedic surgeon Dr. Steven Michelsen. I had pain in
my right knee and at that time I did what's called a procedure called microfracture surgery
which is a normal procedure where you infuse blood in order to create a cartilage like
feel in your knee and that was in my right knee. Then in 2010 I had a pain in my left
knee and at that time is when Dr. Michelsen told me about the new procedure called Carticel.
ACI is basically stands for, it's an acronym for Autologous which means it's from the same
patient, Chondrocyte Implantation and it's a procedure that's done for cartilage damage
in the knee. So essentially the surgery is a two stage procedure. The initial surgery
is where the knee is scoped and any other abnormalities within the knee are taken care
of. The second surgery is a more extensive surgery involving what we call an arthrotomy,
complete opening of the joint. The cells are implanted at that time and then the patient
goes through a little bit more extensive recovery. That recovery starts off slow, sometimes using
crutches and braces and not bearing weight on their leg to about eight weeks with or
without brace walking on it. But those cells take time to mature and that maturation occurs
over the course of about a year. In May of 2011 we went in and took out cells so we could
grow the cartilage and then we had the full surgery in December to sew in the grown cartilage
and go from there. Within three months I was back at the gym on a pretty regular basis
and then within six months I was doing even more strenuous exercise and now at ten months
later I'm actually jogging on a treadmill. It has been all but hold back the reins on
him, he's back up, he's running, he's jogging and saying that his knee feels better than
it has in a very long time. He's had an excellent outcome. It's funny you know when you first
have the surgery all you think is about that knee. You feel it in everything you do in
every walk of life right after the surgery. But then of course today I don't even think
about the knee now and that's probably the best endorsement of all. Dr. Michelsen is
a really good doctor. Thank you Dr. Michelsen for giving me my legs back so to speak. Welcome
to Forest Park Medical Center Southlake. It's coming to fruition, you can see it behind
me here. You know the best way to describe Forest Park Medical Center is imagine if you
had physicians that could actually lead and build healthcare the way that they wanted
it to be built. Lots of people build hospitals and design the systems in which we deliver
care but rarely are they physician led and physician driven the way that they are at
Forest Park Medical Center. So as a physician driven organization, a physician envisioned
organization we deliver healthcare differently and it's no more evident than looking at our
buildings. You know if you've not had a chance to walk through Dallas or walk through Frisco
and soon in just a couple of months be able to walk through Southlake, it's just different,
it feels different. The idea is to take the healing environment to a different level.
So we all know that really scientifically the environment that we heal in makes a difference
in how quickly we heal, how well we feel about the process and that level is taken to its
epitome in the Forest Park Medical Center facilities. And it's very not just visual
in the cosmetic appeal but from a LEED certification standpoint our buildings are LEED certified
which means that we're really leading the industry in healthcare in terms of not just
the look of the environment but the healthiness of the environment. So it is a cleaner environment
essentially and it's more environmentally sensitive. The whole idea that it is physician
lead, it's how physicians would want healthcare delivered if they really could control 100
percent of it and they never have been able to but here, here they do. The people make
all the difference. So the folks that are touching the patients are extremely customer
service oriented. Hiring the right people makes all the difference in the world. There's
going to be a couple of hundred people in the building and we hand select and pick the
best and brightest both technically and from a compassion standpoint. Really looking forward
to providing some leadership to the team that are innovative in bringing a different way
of delivering healthcare to Texas and of course now here to Southlake. For more information
on any of the doctors you've seen on today's show, just visit our website, it's bestdocsnetwork.com
and be sure to click on that Forest Park Medical Center tab. All right Kandace, now to another
outstanding doctor who operates right here out of Forest Park Medical Center, it's neurosurgeon,
Dr. Jeffrey Cattorini. Trigeminal Neuralgia is a disorder where patients have lancinating
pain in their face, typically in one of three distributions, either super orbital infra
orbital to the nasal region or nose region or below the mouth to the chin region. I went
to the neurologist for about three months and I wouldn't go the route of because I am
a single mom and ran my own business so I couldn't be in the drug induced coma and I
was asking really for a fix. I was like I don't want to bandaid the problem anymore,
I want this fixed. Laura's, case she had trigeminal neuralgia for almost 17 years and it initially
manifested itself in her early twenties and she underwent the medication route for multiple
years and became ineffective to the medications intolerant to them. Well at first I thought
it was just a toothache. It felt kind of like having your teeth drilled without novacaine
and then it moved into the whole side of my face. Basically neuralgia is nerve pain and
if you think that patient has nerve pain you treat it typically with seizure medications.
The actual nerve is about the size of a wire to your headphones to your iPod. What he did
is cushioned the trigeminal nerve and then put me all back together again. Now my typical
day is I go to work, I have a full day of work because I have my energy back. I get
to come home and I go to dinner with my kids and we watch movies and we're up until 10:00
at night after homework and everything and it's a real day back again. Laura had a good
result from the surgery. We weaned her off the majority of her medications by three months
postoperatively. She had some incisional numbness around her incision site but she's much more
functional and much more happier than she was preoperatively. The pain is gone and it's
gone for good. He recognized that it was something that needed to be taken care of right away
and didn't make me go through a bunch of red tape and just took care of it. Did you know
that Forest Park Medical Center Dallas has the AccuVein vein finder. This allows the
phlebotomist to actually see the vein before drawing your blood eliminating multiple sticks.
Before I came to see Dr. Musacchio I was having a lot of pain in my right leg to the point
that I couldn't sometimes move, bend or even walk. Judy came to see me with a long history
of low back and leg pain. It was getting worse and creating more and more discomfort for
her. The pain would start in her back and go all the way down her leg. She did come
after having seen chiropractors and failing to improve with that and trying other methods
of treatment outside of surgery. It affected just my everyday life. I could not sleep,
I'd wake up in pain so I knew I had to do something. What we found was that Judy had
not only an instability in her spine, she also had developed a degenerative cyst. These
degenerative cysts can act much like a herniated disc that can pinch the nerve and in pinching
the nerve it causes significant amount of pain and discomfort to go down through the
back of the leg. He just really did make me feel comfortable, made me feel relaxed. I
knew that I was going to do the right thing by doing the surgery. The purpose of the surgery
was not only decompress the nerve by removing the cyst but also to stabilize the spine so
that the cyst didn't recur and to help alleviate her back and her leg pain. We did use a minimally
invasive approach with Judy and that involved doing a fusion and placing bone grafting and
screws in the spine but doing it in such a way that with a computer guided system that
creates somewhat of an interoperatively three dimensional image of the spine that allows
us to use a perkutaneous approach which is to say minimal muscle disruption and really
help the computer navigate the screws in the spine with very small incisions and very little
disruption to the normal tissue. The way I feel now compared to how I was feeling before
is like night and day. Before I was just in constant pain, now which I can move, I can
bend, I don't run but I could, exercise, it's just totally different, it's totally different.
There's absolutely and when I say this I mean absolutely no pain at all. I'm glad that I
saw Dr. Musacchio. Stephanie has a question for Dr. Pero. She'd like to know can someone
with severe allergies be helped with surgery? A lot of patients have severe allergy problems
and many of them also have chronic sinus infection problems and/or nasal obstruction. Sometimes
those patients can be helped with surgery. Typically like to make sure that we have their
allergies under as good a control as possible before deciding to proceed with surgery. In
other words, the allergies themselves might be contributing to swelling in the nose which
could be contributing to blockage of their breathing, could be blocking the openings
of the sinuses that leads to sinus infections. Our hope would be that we could treat the
allergies by themselves which would decrease the swelling enough to improve their airway
and decrease the severity and frequency of the infections. In some patients based on
their anatomy that's not possible and those patients are ones that would benefit from
surgical intervention. For more information on any of the outstanding Forest Park doctors
you see on today's show, head to the website, bestdocsnetwork.com and check them out. Right
now it's time to head to our next Forest Park Medical Center doctor, it's Dr. Richard Salter.
The da vinci robot has been used extensively in gynecology since about 2008 and it allows
us to do major surgery on patients that used to would facilitate a large incision but now
we're able to do these through smaller, minimally basic incisions allowing the patient quicker
recovery and quicker return to normal activities. I work a full time job, I perform on the weekends.
I'm a jazz, blues singer. The recovery time seemed to me to be a little bit more because
of the weight issue but the robotic procedure kind of lessened that fear. Wanda was having
a lot of pressure down below and she stated that she felt like things were changing inside
of her. She knew she had the fibroids and she felt like they might be growing again.
We did a sonogram, it showed that her uterus and fibroids collectively were about the size
of a volleyball and definitely could be causing the pressure and abdominal pain that she was
experiencing. It's kind of like a muscle cramp in the uterus and unlike muscle cramps in
other muscles, these muscle cramps don't go away, they stay. He explained the process
to me and I said this is the person that's going to do the surgery. And I was, the procedure
was done and within less than 2 weeks, I did a performance. I was very pleased with the
outcome. We did her surgery in mid afternoon or so and I saw her that night and she said
I really could go home right now but I think I'll just stay. So we kept her overnight and
the next morning she felt great. She was ready to get out of there. I saw her back about
2 weeks later and she had already done her first performance. I think she said it was
10 days from the time she had her surgery to the time she was back on stage. I know
my doctor said, don't do anything, don't drive for at least 3 or 4 days but I felt good you
know. So you know I would recommend this to anyone who is thinking about having the procedure.
Mark is a 52 year old gentleman with severe arthritis of both of his hips. We usually
don't see arthritis in such young patients like Mark so he brought a special unique case
to our attention. The process started about four years ago and it was just slow deterioration
over those four years. The simple things started to become very difficult for you. So I knew
it was time that I do something. I'm still young and I'm still trying to stay active
and I knew that this was something I really needed. Mark is still working. His job is
very important to him and getting him back to his job as quickly as possible was a very
important concern of his. So by performing bilateral hip replacement, bot hip replacements
at the same time, we were able to get him back to work much quicker than if we did one
hip followed by the other. Mark had the anterior approach to total hip replacement. This is
a special procedure in which we go between the muscles units instead of cutting muscle.
Because we don't cut any muscle when we perform this procedure, the rehabilitation is much,
much quicker. At one month after total bilateral hip replacement surgery, my mobility and my
overall condition is probably I would say 10% better than it was prior to my surgery.
Mark is back to work, he is walking independently without a walker or a cane. If you didn't
know Mark had both hips replaced simultaneously, it's very hard to tell because he doesn't
even have a significant limp. Not only am I happy about the decision that I made to
get my hips replaced, I am excited about the prospects of actually being able to have a
more active summer. I'm looking forward to the summer for the first time in a couple
of years. I'm looking forward to getting back to doing a lot of things that I really enjoy
and I'm confident that in the next couple of months I'm going to be right where I want
to be. That will do it, that'll wrap up another edition of the Best Docs Network featuring
Forest Park Medical Center. Of course Forest Park Medical Center, the top medical center
in the entire Dallas, Fort Worth area. For more information on Forest Park Medical Center
or any of the doctors featured on today's show, just visit our website, bestdocsnetwork.com
and be sure to click on that Forest Park Medical Center tab. And if you have a question or
comment for us we'd love to hear from you, send us an email at info@bestdocsnetwork.com.
So long everyone, we'll see you next week.